lsartan could reduce the release of p-selectin.Conclusions Valsartan could relieve myocardial ischemia reperfusion injury of rat, which may be through reducing p-seleetin of plasma.

Objective To explore the diagnostic approach and the idea of timely treatment for the spontaneous rupture of the esophagus (SRE) for improvement of the level of clinical diagnosis and treatment.Methods The relative clinical data and operation method of 16 cases SRE (4 cases of midpiece SREs and 12 cases of lower SRE) collected from February 1999 to June 2011 were analyzed retrospectively.There were one place breach in 16 cases of SRE with a broken length of 1.5 ～5 cm (2.6 ± 1.1 )cm,including 11 cases broken into the left breast,2 into right chest,and 3 no chest broken into.The main symptoms included intense thoracoabdominal pain,fever,difficulty in breathing,and shock.Ten cases of hydropneumothorax and 5 cases of subcutaneous emphysema were found with physical examination.Results Eleven cases were repaired within 24 hours and 5 cases were repaired after 24 hours.The esophaguses of 16 cases were sutured disconnectedly by absorbable suture line,to which omentum majus were sutured and fixed.Improved resisting backflow operation was carried out for 16 cases which got through the perioperative period smoothly and no deaths.There was no esophageal narrow in follow-up visit,otherwise,there were 2 refluxes that relieved significantly through conservative treatment.Conclusions It is the key to treat SRE that early diagnosis and exploration operation through cutting thorax after definite diagnosis,closing broken hole in order to rebuild the alimentary canal on which omentum majus was covered and fixed for the purpose of insuring continuity of digestive tract.

Objective: To investigate the expressions of CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells in peripheral blood of patients with acute coronary syndrome (ACS) and their significance. Methods: A case-control study was conducted. Ninety-four patients receiving coronary angiography (CAG) admitted to Tianjin Chest Hospital from March 5th to April 27th in 2018 were enrolled. They were divided into non-coronary heart disease (CHD) group (n = 12), unstable angina pectoris (UAP) group (n = 27), acute non-ST elevation myocardial infarction (NSTEMI) group (n = 27) and acute ST elevation myocardial infarction (STEMI) group (n = 28) according to the patients' symptoms, electrocardiogram, troponin test and angiographic results. General data, blood routine parameters, and biochemical indicators were collected. The ratios of CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells were determined by flow cytometry. Multivariate Logistic regression was used to evaluate whether CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells were associated with STEMI. Results: Ninety-four patients were included initially. After excluding the patients who died during the intervention, 93 patients were enrolled in the data analysis finally, with 12 patients in the non-CHD group, 27 patients in the UAP group, and the same as the NSTEMI group and the STEMI group. Compared with the non-CHD group, white blood cell count (WBC) was decreased (×10⁹/L: 6.03±1.30 vs. 6.60±1.30, P > 0.05), and lymphocyte ratio was increased (0.273±0.059 vs. 0.269±0.070, P > 0.05) in patients of the UAP group; however, in the NSTEMI group and STEMI group, WBC was increased (×10⁹/L: 8.29±2.28, 9.86±2.76 vs. 6.60±1.30, both P < 0.05), and lymphocyte ratio was decreased (0.236±0.076, 0.173±0.094 vs. 0.269±0.070, P > 0.05 and P < 0.05), especially in the STEMI group [WBC (×10⁹/L): 9.86±2.76 vs. 6.60±1.30, lymphocyte ratio: 0.173±0.094 vs. 0.269±0.070, both P < 0.05]. There was no significant difference in biochemical indicators among all of the groups. Flow cytometry results showed that the ratios of CD4⁺CD45RO⁺T cells in the UAP group and NSTEMI group were higher than those in the non-CHD group (0.323±0.074, 0.319±0.078 vs. 0.314±0.058, both P > 0.05); however, the ratio of CD4⁺CD45RO⁺T cells in the STEMI group showed a decreased tendency (0.270±0.057 vs. 0.314±0.058, P > 0.05), and it was significantly lower than that in the UAP group and the NSTEMI group (0.270±0.057 vs. 0.323±0.074, 0.319±0.078, both P < 0.05). There was no significant difference in the ratio of CD4⁺CD45RA⁺T cells among all of the groups. Multivariate Logistic regression analysis showed that CD4⁺CD45RA⁺T cells ratio was not significantly correlated with the occurrence of STEMI [odds ratio (OR) = 0.976, 95% confidence interval (95%CI) was 0.907-1.050, P = 0.518], but CD4⁺CD45RO⁺T cells ratio was significantly correlated with the occurrence of STEMI (OR = 0.888, 95%CI was 0.821-0.961, P = 0.003). Conclusions There was no significant difference in the ratio of CD4⁺CD45RA⁺T cells among UAP, NSTEMI and STEMI patients, and CD4⁺CD45RO⁺T cells ratio in the STEMI group was significantly lower than that in the UAP group and NSTEMI group. CD4⁺CD45RO⁺T cells ratio may be risk factor of STEMI.

Objective To investigate the effect of the modified surgery for spontaneous rupture of esophagus (SRE) so as to improve treatmeut level.Methods Clinical data and surgical methods of 16 SRE patients including four patients with mid-esophagus ruptures and 12 with lower esophagus ruptures treated between February 1999 and June 2011 were analyzed retrospectively.All patients had only one laceration with the gap length of 1.5-5 cm (median 2.5 cm).Eleven patients had rupture into the left breast,two had rupture into the right chest,with no rupture into the chest in three patients.Ten patients suffered from hydropneumothorax and five from subcutaneous emphysema.Thc esophageal mucosas rathcr than muscular layers of all patients were sutured disconnectedly with absorbable thread.Omentum majus were embedded and fixed to muscular layer on the edge of esophagus rupture site.Fundus ventriculi were suspended and fixed to the dome of diaphragm.In the meantime,diaphragmatic hiatus were reconstructed above the esophagus rupture site for lower esophagus ruptures.Results The time from SRE attack to operation ranged from one hour to three days.Eleven patients were repaired within 24 hours of SRE onset and five patients were repaired after 24 hours of SRE onset.All patients got through the perioperative period smoothly and survived the operation with cure rate of 100％.The median hospital stay was 18.5 days.No esophageal narrow or canceration were found during follow-up (range,1-10 years),but two patients suffered from reflux which were relieved significantly after conservative treatment.Conclusion For treatment of SRE,interrupted suture for esophageal mucosal layers,omentum majus embedding instead of esophageal muscular layer suture and simultaneous anti-reflux operations can significantly reduce incidence of complications like esophageal fistula,stenosis and reflux and improve the cure rate.

OBJECTIVETo evaluate the biomechanical effects of intracellular changes on the voltage-gated sodium channels (VGSCs) on trigeminal ganglion neuron (TRGN).

METHODSTRGN cells were acutely isolated from the neonatal SD rats. The voltage-dependent currents of the VGSCs on these neurons were elicited and analyzed by whole-cell patch-clamp recordings and the intracellular anisotonicity stimuli was established by adjusting the content of pipette solution. The effects of hypo-(260 mOsm) and hypertonic (350 mOsm) osmolarity on the activation and inactivation kinetics of VGSCs on TRGN were evaluated, compared with the normal intracellular environment.

RESULTSThe results demonstrated that intracellular hypotonic stimuli could influence both the activation and inactivation characteristics of VGSCs currents, including the membrane potential at half inactivation (V0.5) of the G-V and inactivation curves had obvious statistics significance (P<0.05) between hypotonicity (260mOsm) and isotonicity (306mOsm). However, only inactivation properties changed under intracellular hypertonic effects, including inactivation rate and k value.

CONCLUSIONIt suggests that the kinetics of VGSCs on TRGN can be modulated both by intracellular hypo- and hypertonic with different characteristics.

Animals ; Cells, Cultured ; Membrane Potentials ; Neurons ; Osmolar Concentration ; Patch-Clamp Techniques ; Rats ; Rats, Sprague-Dawley ; Sodium Channels ; Trigeminal Ganglion

Objective: To investigate the level of the core knowledge and related factors of cancer prevention and treatment among residents in the upper gastrointestinal cancer screening areas of Sichuan Province in 2018. Methods: From April to May 2018, a total of 1 386 residents from Chaotian District of Guangyuan, Enyang District of Bazhong, Nanjiang County of Bazhong, Cangxi County of Guangyuan, Shehong County of Suining, Yilong County of Nanchong, Xichong County of Nanchong and Xuanhan County of Dazhou were recruited in this study. A questionnaire survey was conducted to collect basic demographic characteristics and the knowledge of cancer prevention and treatment. The level of the core knowledge of cancer prevention and treatment of different population was analyzed. A multivariate linear regression model was performed to analyze the related factors. Results: In total, 80.9% (1 120) of all subjects was 25-64 years old and 48.0% (665) were male. The total number of questions answered by the subjects was 18 018, of which 12 147 were known, and the overall awareness rate among the respondents was 67.42%. The female respondents, respondentsaged 65 years old and over, with junior college education or above, and worked in government institutions had a good performance of the core knowledge (P<0.05), about 70.11% (6 571/9 373), 69.23% (387/559), 76.05% (6 327/8 320), and 77.09% (5 602/7 267) respectively. The results of multivariate linear regression showed that the older the age [β=0.871 (95%CI: 0.623-1.119)], the higher the educational level [β=0.741 (95%CI: 0.540-0.943)], the more questions respondents could know; compared with the workers in government organization and institution, workers in enterprise [β=-2.913 (95%CI:-3.499--2.327)], farming workers [β=-0.635 (95%CI:-1.175--0.095)] and other occupation people [β=-1.126 (95%CI:-1.663--0.589)] could know fewer questions. Conclusion In 2018, the level of the core knowledge of cancer prevention and treatment among residents in upper gastrointestinal cancer screening areas of Sichuan Province was relatively high. Age, education level and occupation were relevant factors.

Objective:To study the efficacy of norepinephrine in the treatment of neonates with septic shock.Methods:A prospective observation study of neonates with septic shock, who received norepinephrine in the neonatal intensive care unit of Guangdong Women and Children's Hospital from January 2019 to November 2020. All infants had functional echocardiography for hemodynamic monitoring before norepinephrine treatment and 1 hour thereafter blood pressure, heart rate, arterial blood gas analyses were recorded at the same time. The intravenous fluid volume and urine volume from the diagnosis of shock to the commencement of norepinephrine therapy (T0) and 24 hours thereafter (T1) were recorded, and the hemodynamic parameters, vasoactive drugs and clinical outcomes were analyzed.Results:A total of 66 newborns were enrolled, including 27 cases of mild shock, 33 cases of moderate shock and 6 cases of severe shock. 48 were male infants, 38 cases were premature infants. The gestational age was (35.2±4.1) weeks and the birth weight was (2 476±909) g. The median time of shock diagnosis was 2 days after birth, and the median shock score was 4 points. The median time from the diagnosis of shock to the start of norepinephrine treatment was 7.5 hours. Compared with that before norepinephrine treatment, stroke volume, stroke volume index, cardiac output, cardiac index, left ventricular ejection fraction, shortening fraction, systolic blood pressure, diastolic blood pressure, mean arterial pressure, blood pH and BE at 1 hour after treatment were increased, heart rate and blood lactic acid were decreased, the differences were statistically significant ( P<0.05). Urine volume was increased 24 hours after treatment ( P<0.05), and fluid overload decreased ( P<0.05). The maximum dopamine dose, the down-regulation time and duration of vasoactive drugs were positively correlated with the time to start norepinephrine therapy ( r=0.325、 r=0.383、 r=0.319, P<0.05). Among the 66 infants, 58 infants with shock had been corrected and 14 infants died within 28 days. Conclusions:Norepinephrine is effective and feasible in the treatment of neonatal septic shock and can significantly improve hemodynamic parameters.

Objective:To study the clinical value of neonatal shock score (NSS) and septic shock score (SSS) in the evaluation of mortality and serious complications of neonatal refractory septic shock.Method:From January 2019 to November 2020, clinical data of neonates with septic shock admitted to Neonatal Department of our hospital were retrospectively reviewed. According to the final outcomes, neonates were assigned into good prognosis group (neonates survived without serious complications) and poor prognosis group (neonates were dead within 28 days after birth and/or had serious complications). The NSS and SSS were calculated according to the worst value of each index during the septic shock course. SSS included computed septic shock score (cSSS) and bedside septic shock score (bSSS). The receiver operating characteristic (ROC) curve was used to analyze the efficacy of each scoring system evaluating the risk of poor prognosis due to septic shock. The correlation of each scoring system with the duration of vasoactive drugs was analyzed using Spearman rank correlation analysis.Result:A total of 72 neonates were enrolled, including 45 in good prognosis group and 27 in poor prognosis group. The vasoactive drug score, serum lactate level, NSS and cSSS in poor prognosis group were significantly higher than good prognosis group ( P<0.05).And bSSS score showed no significant differences between the two groups ( P>0.05). The area under the ROC curve (AUC) of NSS and cSSS predicting the adverse prognosis of neonates with septic shock were 0.644 (95% CI 0.510~0.777, P<0.05) and 0.765 (95% CI 0.654~0.877, P<0.05). The best cut-off values for NSS and cSSS predicting poor prognosis were 4.0 and 80.5, respectively. The positive predictive value (PPV) (81.3% vs. 47.5%) and negative predictive value (NPV) (75.0% vs. 70.6%) of cSSS were higher than NSS. Spearman rank correlation analysis showed that cSSS was positively correlated with the duration of vasoactive drugs( r=0.487, P<0.01). Conclusion:Both shock scoring systems have an evaluation value for the prognosis of neonatal septic shock. The evaluation value of cSSS is better than NSS, and can be used as a main tool for the evaluation of neonatal refractory septic shock.

Objective:To study the predictive value of vasoactive-inotropic score (VIS), fluid overload (FO) and lactate level for the outcome of preterm infants with refractory septic shock.Methods:Preterm infants diagnosed with refractory septic shock and required hydrocortisone treatment in our Department from January 2016 to December 2021 were analyzed retrospectively. Preterm infants were assigned into three gestational age groups (<28 weeks, 28-31 weeks, 32-36 weeks). According to the outcome of the disease, the children were further divided into good prognosis group and poor prognosis group. The relationship between the maximum VIS, FO and the mean lactic acid before hydrocortisone and the outcome of refractory septic shock was analyzed by receiver operating characteristic (ROC) curve, the cut-off point of ROC curve was calculated to obtain the predictive efficacy of the three indicators for the outcome of refractory septic shock in preterm infants.Results:A total of 50 preterm infants with refractory septic shock and received hydrocortisone treatment were enrolled, including 20 in the good prognosis group and 30 in the poor prognosis group. There were no significant differences in the maximum VIS, FO and mean lactic acid before hydrocortisone treatment between the two groups of gestational age of <32 weeks ( P> 0.05). The maximum VIS, FO and mean lactic acid of gestational age of 32-36 weeks in the poor prognosis group were higher than those in the good prognosis group, VIS: 56.1±15.7 vs. 37.1±12.9, FO (%): 108.2 (78.6,137.7) vs. 55.5 (10.3, 100.7), and mean lactic acid (mmol/L): 8.3 (4.6, 12.0) vs. 4.8 (-0.8, 10.5), all P<0.05. The area under the ROC curve of the mean lactic acid was the largest, the cut-off value was 4.1 mmol/L, and the Youden index was 1.732. Conclusions:VIS, FO and lactate level are difficult to be used for determining the outcome of refractory septic shock in preterm infants of <32 weeks. While the mean lactic acid has the best predictive performance in preterm infants of 32-36 weeks.

Objective:To study the predictive value of vasoactive-inotropic score (VIS), shock score and lactate level for the outcome of term infants with septic shock.Methods:From January 2019 to October 2020, clinical data of term infants with septic shock admitted to our department were reviewed. According to their clinical outcome, the infants were assigned into the survival group and the deceased group and the differences of the two groups were compared. Logistic regression was used to determine the risk factors of mortality in term infants with septic shock. Receiver operating characteristic curve was used to compare the predictive efficacy of VIS, shock score and lactate level for the outcome of septic shock.Results:Significant differences existed between the survival group and the deceased group in the following: maximum VIS, maximum shock score, maximum lactate level, the mean value of VIS during the second 24 h, the mean value of lactate during the first and second 24 h ( P < 0.05). Meanwhile, maximum VIS ( OR = 1.038, 95% CI 1.014~1.063), maximum shock score ( OR = 2.372, 95% CI 1.126~4.999) and the mean value of lactate during the first 24h ( OR = 2.983, 95% CI 1.132~7.862) were correlated with mortality in the infants ( P < 0.05). The area under the curve of maximum VIS was the most prominent, with 58.5 as cut-off. Conclusions:Among the three indicators, VIS has the best predictive value for mortality outcome in term infants with septic shock, followed by shock score and lactate level.