Objective　To explore the effect of dexamethasone (Dex) given with the intention of prevention or treatment on endotoxin shock in rabbits and its relationship with tumor necrosis factor (TNF). Methods　Fifty-three health rabbits were divided into 4 groups, including normal control (n=13), endoxin shock group (n=16), preventive Dex group (n=12) and therapeutic Dex group (n=12). Except normal control was given with saline, the other 3 groups were administered with lipopolysaccharide (LPS) infusion, and the preventive Dex group was treated with Dex (5 mg/kg body weight) 30 min before LPS infusion and the therapeutic Dex group 20 min after LPS infusion. Mean arterial blood pressure (MABP), survival rate, TNF level in circulatory blood and other parameters were detected. Results　In preventive and therapeutic Dex groups, MABP was increased and survival rate was reduced compared with the animals from endoxin shock group (P<0.05, P<0.01), and TNF activity in the circulating blood was significantly suppressed (P<0.01). In addition, dexamethasone administration could alleviate the elevation of plasma glucagon, glucose, lactic acid, and β-glucironidase (P<0.05, P<0.01) in shocked animals. It was also found that administration of dexamethasone in vitro prevented the release of TNF by Kupffer cells. Conclusion　These results indicate that the preventive and therapeutic effect of dexamethasone on endotoxin shock, which may relate to its direct inhibition of the release of TNF induced by LPS.

Objective To investigate the causes of complications induced by peripherally inserted central catheters(PICC)in cancer patients and summarize pertinent nursing measures.Method The clinical data of 26 tumor patients with PICC were analyzed retrospectively .Result The complications occurred in 8 patients with a rate of 30.8%, among which unsuccessful catheteration occurred in 1 case,oozing of blood at the mouth of catheter in 1 case,phlebitis in 1 case,dislocation in 1 case,skin allergy-like reactions in 2 cases and catheter emersion in 1 case,catheter breaking in 1 case and dislocation in 2 cases.Conclusion The skilled operation,preventive maintenance of catheters and health education to the patients are the important measures for prevention and reduction of the complications.

AIM: This study aimed at elucidated the possibility that prevent tissue from secondary injury by regulating polymorphonuclear neutrophil (PMN) apoptosis in vitro . METHODS:Neutrophils, isolated from peripheral blood, were incubated with sodium arsenite (Ars), tumor necrosis factor (TNF-?), interleukin-6 (IL-6), burned serum and traumatic serum, respectively. Apoptosis rate, expression of CD11b, respiratory burst and concentration of Ca 2+ were then measured. RESULTS:The elevation of PMN apoptosis rate was Ars concentration dependent, but activated PMN became insensitive to Ars. IL-6 delayed PMN apoptosis (compared with control at 24 h, P

Objective　The effects of nitric oxide(NO) on the endotoxin-induced tissue damage,especially intestinal injury and bacterial translocation are still poorly known, although its involvement in vasodilatation and hypotenion in shock is much clear. So, the intestinal damage and bacterial translocation were observed in this study in endotoxemic rats after treatment with Nω-nitro-L-arginine(LNNA),the special inhibitor of NO synthase(NOS),and L-arginine,the substrate of NOS.Methods　The endotoxemia was conducted with administration of lipopolysaccharide(O111B4,10mg/kg,i.p.),animals were treated with LNNA(4mg/kg,i.p.)or L-arg(40mg/kg,i.p.).Intestinal molondialdehyde(MDA) content and Diamine oxidase(DAO) activity were determined,and mesenteric lymph nodes were cultured.Results　The results showed that endotoxin decreased intestinal DAO acitivity but increased MDA content and incidence of bacterial translocation to mesenteric lymph nodes.These effects of endotoxin were aggregated by inhibition of NO production with LNNA, but attenuated by L-arg.Conclusion　We concluded that inhibition of NO formation might enhance endotoxin-induced intestinal damage and bacterial translocation,which suggested that NO might play a protective role in this endotoxemia model.

Objective To study the bio-safety of a multifunctional dressing based on isobutyl-chitosan,a derivative of chitosan.Methods To investigate the local irritation of the multifunctional dressing by skin,subcutaneous and eye application,determine its sensitization by patch test and observe its systemic acute toxicity by abdominal injection.Results The isobutyl-chitosan multifunctional dressing had no irritation,sensitization and systemic acute toxicity.Conclusion The isobutyl-chitosan multifunctional dressing has a good bio-safety as a wound dressing.

OBJECTIVE: To investigate the effect of bactericidal/permeability-increasing protein(BPI) on the outcome of sepsis in mice and its possible mechanism. METHODS: Sepsis was induced by injection of 2x10(6) colony-formed unit E. coli J5 via the tail vein. BPI of 5 mg/kg or equal volume of normal saline(NS) were injected intravenously at the same time. Endotoxin and TNFalpha levels in serum were assayed using a chromogenic limulus amebocyte lysate test and ELISA respectively. RESULTS: Seventy-two hour survival rate of septic mice was significantly higher in the BPI group (15/18) than in the NS group(8/18, P<0.01). Serum endotoxin levels in the BPI group (1.3+/-0.3 and 0.7+/-0.4 &mgr;g/L) were significantly lower than those in the NS group (3.9+/-0.8 and 2.5+/-0.9 &mgr; g/L, P<0.01) 0.5 and 1 hour following injection of bacteria respectively. The peak levels of serum tumor necrosis factor-alpha(TNFalpha)in the BPI group (1.9+/-0.6 &mgr;g/L) were also markedly lower than those in the NS group (3.8+/-0.8 &mgr;g/L, P<0.01) 1.5 hours following bacterial injection. But there was no significant difference in blood bacterial count between the BPI and NS groups 0.5, 1.5 and 3.0 hours after injection of bacteria. CONCLUSIONS: BPI has a marked protective effect on E. coli sepsis, which might be related to its action against bacterial endotoxin and its inhibition of TNFalpha production in sepsis.

Objective To understand the relationship between MTHFR 677C/T polymorphism and general status of pregnant women and offspring congenital heart disease (CHD).Methods A case-control study was conducted among the biological mothers of 100 infants with CHD and 100 healthy controls to collect the information about their demographic characteristics,general status during pregnancy and awareness of eugenics.Their MTHFR 677C/T polymorphism and serum homocysteine (HCY),folic acid,vitamin B12 levels were detected.Results The differences in MTHFR genotype and allele frequency between the two groups were not statistical significant (x2=1.08,P=0.582;x2=0.53,P=0.468),but the difference in serum HCY between two groups were statistical significant (t=-8.14,P=0.000).Univariate analysis showed that 14 factors had statistical significances (P＜0.05).Multivariate logistic regression analysis indicated that mother's educational level(OR=3.386,95％ CI:1.279-8.961),annual household income (OR =8.699,95％ CI:2.177-34.765),chronic disease prevalence (OR=0.343,95％ CI:0.134-0.881),awareness of eugenics (OR=0.906,95％ CI:0.836-0.981),serum HCY level(OR=1.734,95％CI:1.458-1.986) and abnormal reproductive history(OR=3.710,95％ CI:1.217-11.308) were correlated with offspring CHD.Conclusion There was no correlation between MTHFR 677C/T polymorphism of pregnant women and offspring CHD,but low educational level,low annual household income,abnormal reproductive history,low awareness of eugenics and high serum HCY levels of pregnant women might increase the risk of offspring CHD.

OBJECTIVETo study the clinical and histopathologic features of post-transplant kidney biopsy tissues from pediatric C-III donors.

METHODSThe clinical and pathologic features of 20 cases (22 case-times) of renal transplant biopsies from pediatric cadaveric donors were analyzed by light microscopy and immunohistochemistry according to the Banff system of working classification of renal allograft pathology. Biopsies were compared to those from adult C-III donors and adult cadaveric donors.

RESULTSSixteen cases (72.7%) showed renal allograft drug toxicity damage by Tacrolimus, seven cases (31.8%) showed degeneration and necrosis of renal tubular epithelial cells, four cases (18.2%) showed T cell-mediated acute rejection and six cases (27.3%) showed renal interstitial inflammation. There were two cases (9.1%) of renal dysplasia and one case (4.5%) of renal infarction. There was insufficient evidence for diagnosis of renal allograft nephropathy. Compared to post-transplant kidney from adult C-III donors, the proportion of drug toxicity damage was higher (P<0.05). Compared to post-transplant kidney from adult cadavers, the proportions of drug toxicity damage, degeneration and necrosis of renal tubular epithelial cells were higher (P<0.05) while the proportion of acute rejection was lower (P<0.05).

CONCLUSIONSThe pathologic changes in the post-transplant kidneys from pediatric donors are different from those from adult donors. Optimal long-term outcome can be accomplished by effective treatment based on timely or procedural biopsy.

Adult ; Age Factors ; Biopsy ; Cadaver ; Child ; Graft Rejection ; pathology ; Humans ; Immunohistochemistry ; Immunosuppressive Agents ; adverse effects ; Infarction ; pathology ; Kidney ; blood supply ; drug effects ; pathology ; Kidney Transplantation ; Kidney Tubules ; drug effects ; pathology ; Necrosis ; Tacrolimus ; adverse effects ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo discuss the diagnosis of and conservative management for lower uterine segment pregnancy with placenta increta complicating first trimester abortion.

METHODSFour patients with previous caesarean section and severe hemorrhage in induced abortion in the first trimester were studied. Uterine artery embolization (UAE) was used to control bleeding and preserve the uterus.

RESULTSUAE controlled heavy uterine bleeding satisfactorily. One of the four patients asked for a hysterectomy after UAE, and her pathology report confirmed "lower uterine segment pregnancy with placenta increta".

CONCLUSIONPrevious caesarean section is a risk factor for lower uterine segment pregnancy with placenta increta. UAE is one of the best conservative management methods for heavy hemorrhage, especially for women who desire future fertility.

Abortion, Induced ; adverse effects ; Adult ; Embolization, Therapeutic ; Female ; Humans ; Placenta Accreta ; diagnosis ; therapy ; Pregnancy ; Pregnancy Trimester, First ; Uterine Hemorrhage ; etiology ; therapy ; Uterus ; pathology

OBJECTIVE: To systematically review safety and tolerance of enteral nutrition (EN) in a prone position, as well as the risks of increased gastric residual volume (GRV), vomiting, aspiration, and ventilator-associated pneumonia, and determine the ways to improve EN tolerance in patients with acute respiratory distress syndrome (ARDS). METHODS: Databases including PubMed, Embase and Wanfang Medical data of the English and Chinese literatures were retrieved up from January 1979 to January 2022 to collet the randomized controlled trial (RCT), non-RCT, and observational studies, concerning safety and tolerance of EN in a prone position with ARDS. All trials must have a minimum of two patient groups, one of which must be prone to ARDS and receive EN. Data searching extracting and quality evaluation were assessed by two reviewers independently. RevMan 5.4 software was used for analysis. RESULTS: A total of 9 studies were included, including 2 RCTs, 2 non-RCTs, 4 prospective observational studies, and 1 retrospective observational study. The starting and increasing rate of EN were typically well tolerated in the prone position compared to the supine position in patients with ARDS, there was no significant increase in GRV (mL: 95 vs. 110), and the incidence of vomiting was not noticeably higher (0%-35% vs. 33%-57%). The incidence of ventilator-associated pneumonia with EN was not significantly higher in the prone position than in the supine position in patients with ARDS (6%-35% vs. 15%-24%). Aspiration occurred at a similar rate in patients in the nasogastric tube and post-pyloric feeding groups with EN in patients with ARDS in the prone position (22% vs. 20%). EN tolerability with nasogastric and nasojejunal tubes was similar in prone positions, with no significant difference in EN intolerance incidences (15% vs. 22%). Head elevation (30 degree angle-45 degree angle) improved EN tolerance in the prone position in patients with ARDS, thereby increasing the early EN dose [odds ratio (OR) = 0.48, 95% confidence interval (95%CI) was 0.22-1.08, P = 0.08]. Additionally, prophylactic application of gastrointestinal motility drugs, such as erythromycin, at the start of EN in a prone position significantly improved patients' EN tolerance (OR = 1.14, 95%CI was 0.63-2.05, P = 0.67). CONCLUSIONS The use of gastric tube for EN in prone position and similar feeding speed to the supine position in patients with ARDS is safe and well tolerated. The initiation and dosing of EN should not be delayed in the prone position. EN tolerance may be increased by elevating the head of the bed during enteral feeding in a prone position, and gastrointestinal motility medications should be promptly administered with EN initiation in patients with ARDS.
Humans ; Pneumonia, Ventilator-Associated/etiology* ; Enteral Nutrition ; Prone Position ; Respiration, Artificial/adverse effects* ; Respiratory Distress Syndrome/etiology* ; Randomized Controlled Trials as Topic ; Observational Studies as Topic