Objective We generated an experimental canine model of heterogeneous emphysema.The dogs subsequently underwent unilateral bronchoscopic lung volume reduction(BLVR).Observing the postoperative condition of ventilation/perfusion,blood gas analysis,respiratory dynamics,hemodynamic measurement,HRCT and radiologic outcomes,compared with the preoperative level,the correlative mechanism and the effects of BLVR were analyzed.Methods There were 15 healthy dogs that were treated samely with localized papain instillations under bronchoscopic guidance to generate heterogeneous emphysema.The right dorsal lobe was selected as the target area.All dogs were divided into 3 groups randomly.Group A was control group;Group B and Group C received BLVR 6 weeks later while group A was raised as the same way.Group B underwent endobronchial valve insertion(EVI);Group C underwent bronchial blocking with albumin gel.Measurements were made in each animal at 3 time points:prior to papain exposure(base-line),after establishment of emphysema(6 weeks later),6 weeks after BLVR.Data included blood gas analysis(PaO2,PaCO2),respiratory dynamics(respiratory peak pressure,lung compliance),hemodynamic measurement(pulmonary artery pressure,pulmonary capillary vessel wedge pressure),nuclear ventilation/perfusion scan(CTS,CTS/PIX).Dogs were euthanized at 6-week time point followed by autopsy.The data was statistically managed and compared.Results After development of emphysema,all dogs exhibitted aggravation in PaO2,PaCO2,PAP and lung compliance(P0.05).Through ventilation/perfusion scan,CTS/PIX of the target areas reduced(P

OBJECTIVE:To compare the anesthetic effect and safety of dexmedetomidine hydrochloride and propofol in pain-less colonoscopy. METHODS:80 patients who underwent painless colonoscopy was retrospectively analyzed and divided into group A and group B. Group A was given loading dose of 1 mg/kg propofol within 30 s and maintained with 6 mg/(kg·h);group B was given loading dose of 0.3 μg/kg Dexmedetomidine hydrochloride injection by micropump for slow pumping 5 min and maintained with 0.2-0.3 μg/(kg·h). Mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO2)and respiratory rate(RR)be-fore examination (T0),before microscopic examination (T1),1 min (T2) and 10 min(T3) after microscopic examination,1 min (T4)and 5 min(T5)after colonoscopy withdrawal,onset time of anesthesia,entry time,examination time and discharge time,pa-tients with adjunctive use of fentanyl and incidence of adverse reactions in 2 groups were observed. RESULTS:MAP in group A at T1 was significantly lower than T0,HR in 2 groups at T1-T3 was significantly lower than T0,the differences were statistically signifi-cant(P<0.05),however,there were no significant differences in the SpO2 and RR between 2 groups(P>0.05). Onset time of an-esthesia,patients with adjunctive use of fentanyl and incidence of adverse reactions in group B were significantly lower than group B,the differences were statistically significant(P<0.05). CONCLUSIONS:Both dexmedetomidine hydrochloride and propofol has good anesthetic effect in painless colonoscopy,but dexmedetomidine has better safety.

Objective To investigate the effect of penehyclidine (PHCD) on Toll-like receptor 4 (TLR4)mRNA and Toll-like receptor 2 (TLR2) mRNA expression in the lung tissue in rats with acute lung injury induced by lipopolysaccharide (LPS) .Methods Sixty healthy SD rats of both sexes weighing 200-220 g were randomly divided into 5 groups ( n = 12 each) :control group (group C) , LPS group and P1-3 groups. Acute lung injury was induced by intraperitoneal (IP) LPS 8 mg/kg in LPS and P1-3 groups. PHCD 0.3, 1.0 and 3.0 mg/kg were given IP after LPS administration in P1-3 groups. The animals were anesthetized at 6 h after IP LPS. Blood samples were collected for determination of serum TNF-α and IL-6 concentrations ( by ELISA) and then sacrificed, the lungs were immediately removed for determination of TLR4 mRNA and TLR2 mRNA expression (by RT-PCR), and microscopic examination. Results LPS significantly increased TLR4 mRNA and TLR2 mRNA expression in the lung tissue and serum TNF-α and IL-6 concentrations. PHCD 1.0 or 3.0 mg/kg significantly inhibited LPS-induced increase in TLR4 mRNA and TLR2 mRNA expression in the lung tissue and serum TNF-α and ILr6 concentrations.The lung histopathologic damage was significantly ameliorated in P2 and P3 groups as compared with group LPS.Conclusion PHCD can protect the lungs against LPS-induced acute lung injury through inhibiting TLR4 mRNA and TLR2 mRNA expression in the lung tissue and reducing the inflammatory response.

Objective To investigate the influence of pulmonary microembolism of early stage on hemodynamics, respiratory function and blood coagulation in dogs. Methods Eight mongrel dogs (6 male, 2 female) weighing 15.5-16.5 kg were anesthetized with intravenous atropine 0.02 mg?kg-1 , propofol 2-3 mg?kg-1 and pancuronium 0.4 mg?kg-1 . The animals were intubated and mechanically ventilated with 100% O2. The ventilatory settings were as follows : VT 12 ml? kg-1 , RR 15 bpm and I: E = 1:2. Anesthesia was maintained with intravenous infusion of propofol at 200-300 ?g ? kg-1? min-1 and intermittent iv boluses of pancuronium. A 7.5 F Swan-Ganz catheter was placed via femoral vein for hemodynamic monitoring and injection of microemboli. 50 ml of blood was removed from artery and mixed with methylene blue. The clot was cut into small pieces 1-2 mm in diameter. After being washed with normal saline, 100 microemboli in normal saline 10 ml were rapidly injected into pulmonary artery via Swan-Ganz catheter. BP, HR, pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure(PAWP), arterial blood gases, airway pressure, lung compliance, D-dimer, tissue plasminogen activator (t-PA), protein C and S were measured and recorded before (T0 ) , immediately after (T, ) and 30 min (T2) , 60 min (T3 ) , 120 min (T4) after embolization. Two hours after embolization, chest was opened and lung tissue was obtained for microscopic examination. Results Both systolic and diastolic PAP, PAWP and pulmonary vascular resistance (PVR) were significantly increased immediately after embolization (T1 ), and then decreased to the baseline level (T0) at Ih after embolization (T3) . There were no significant changes in respiratory function. D-dimer was increased at 30 min after embolizatiion (T2 ) and decreased to the baseline level at T4 . Microscopic examination showed that the lung exhibited hemorrhage and consolidation with microemboli in arterioles. Conclusion Pulmonary microembolism induces pulmonary hypertension and change in D-dimer level in the early stage but respiratory function is not affected. It causes injury to the lung parenchyma.

Objective To observe different effects of cyclic and continuous nutrition infusion on serum nutritional indicators, peripheral white blood cell counts (WBC), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ ) score in patients with mechanical ventilated respiratory failure (MVRF).Methods A cross-over and self-controlled trial was conducted in 48 patients with MVRF treated in a medical intensive care unit during December 2006 to June 2009, and continuous nutrition (group A) and cyclic nutrition (group B) were infused respectively for patients of the two groups.Serum levels of albumin (ALB), pre-albumin (PA), transferrin (TR), PaO2, PaCO2, WBC and APACHE Ⅲ score were measured for the patients with 24-hour continuous nutrition (group A) and 16-hour cyclic nutrition (group B)infusion.Effects of the two nutritional therapies were compared.Results After nutrition infusion, serum levels of ALB, PA and TR were (34±3)g/L, (196±28)mg/L and (2.1±0.3 ) g/L in group A, and (35 ±4) g/L, (198 ±25) mg/L and (2.0 ±0.4) g/L in group B, respectively; and PaO2 and PaCO2levels were (92 ± 12) mm Hg ( 1 mm Hg =0.133 kPa) and (42 ± 10) mm Hg in group A, and (91 ±9)mm Hg and (42 ± 10) mm Hg in group B, respectively.WBC and APACHE Ⅲ score were ( 11.8 ± 1.7) ×109/L and 38 ±7 in group A, and ( 12.6 ± 1.2) × 109/L and 40 ±6 in group B, respectively.Significant difference in serum levels of PA and TR was found between the two groups (PPA =0.019 and PTR =0.013),while there was no significant difference in other indictors between the two groups.Conclusions 24-hour continuous nutrition infusion for patients with MVRF can obviously improve their serum levels of PA and TR,but has no effect on serum level of ALB, PaO2, WBC and APACHE Ⅲ score in critical ill patients, as compared to those with 16-hour cyclic nutrition infusion.

Adult ; Ear Ossicles ; injuries ; Humans ; Joint Dislocations ; Male ; Wounds and Injuries

ObjectiveTo investigate the effect of cholinesterase inhibitor on endotoxin-induced brain injury in rabbits.Methods Twenty-one healthy male rabbits were randomly assigned into three groups ( n ＝ 7each):group sham operation (group S),lipopolysaccharide (LPS) group and cholinesterase inhibitor (tacrine hydrochloride,THA) group.LPS 200 μg/kg was intracerebroventricularly injected in LPS group,LPS 200μg/kgand tacrine hydrochloride 150 μg/kg were injected in THA group,while same volume of normal saline was injected in S group.Then blood and tissue samples were collected in different groups after 4 hours.Nuclear factor-kappa B (NF-κB) p65 activity of brain tissues was determined by using Western blot analysis.Tumor necrosis factor-alpha (TNF-α) levels in plasma,cerebrospinal fluid and brain tissues were measured using enzyme linked immunosorbent assay.The brain tissue's myeloperoxidase (MPO) activity and the ratio of wet to dry weight (W/D) were also analyzed.ResultsAs compared with S group,TNF-α level in plasma,cerebrospinal fluid and brain tissues,NF-κB p65 level,MPO activity and W/D ratio increased in LPS and THA groups (P < 0.05).When compared with LPS group,TNF-α level in plasma,cerebrospinal fluid and brain tissues,NF-κB p65 level,MPO activity and W/D ratio decreased in THA group ( P < 0.05 ).ConclusionCholinesterase inhibitor can attenuate the endotoxin-induced brain injury through inhibiting local inflammatory responses.

Objective To investigate the influencing factors of chronic brucellosis.Methods Nested case control method was used to study newly diagnosed patients (n =600) with brucellosis in a cohort study in 2012.Data of general characterstics,clinical presentation,treatment and prognosis of those patients were collected.These patients were followed up for one year,and the chronic patients as the case group (n =248) and the healed patients as a control group (n =260).By means of Logistic multivariate analysis,factors turned brucellosis into chronic were screened.Result The chronic brucellosis-related factors were:gender,veterinary or epidemic prevention staff,muscle and joint pain,fatigue symptoms,and substandard treatment (x2 =5.163,16.445,14.977,17.154,8.813,all P ＜ 0.05).Conclusion Gender (female),veterinary or epidemic prevention staff,muscle and joint pain,fatigue symptoms,and substandard treatment are probably the chronic brucellosis-related factors

10.3969/j.issn.2095-4344.2013.23.026

Objective To investigate the effect of batroxobin combined with tranexamic acid on the perioperative bleeding and blood coagulation in the patients undergoing adolescent idiopathic scoliosis.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 15-26 yr,weighing 41-56 kg,scheduled for elective adolescent idiopathic scoliosis,were randomly divided into 4 groups (n =20 each):normal saline group (group A),batroxobin group (group B),tranexamic acid group (group C) and batroxobin combined with tranexamic acid group (group D).0.9 ％ normal saline was infused after admission to the operating room in group A.Batroxobin 0.02 U/kg was infused at 20 min before skin incision,an increment of 0.02 U/kg was given every 2 h until the end of operation and the maximal dose was less than 1 U in group B.Tranexamic acid 20 mg/kg was injected immediately before skin incision,followed by infusion at 10 mg· kg-1 · h-1 until the end of operation in group C.In group D,batroxobin and tranexamic acid were given as the method described in B and C groups.The intraoperative blood loss,volume of autologous and allogeneic blood transfused,transfusion of fresh frozen plasma (FFP),and volume of drainage within 24 h after operation were recorded.Blood routine,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fbi),thrombin time (TT),activated clotting time (ACT),clot rate (CR) and platelet function (PF) were measured.Deep vein thrombosis was detected at 1 week after operation.Results Compared with group A,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly reduced,and Plt and Fib were significantly increased at T2,3 in groups B,C and D,and PF was increased at T2 in group C,Hct,Plt,Fib and PF were increased and PT was prolonged at T2,3 in group D (P ＜ 0.05).Compared with group B,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly decreased and Hct,Plt,Fib and PF were increased at T2,3 in group D,and the volume of postoperative drainage was increased and Plt increased at T2,3 was in group C (P ＜ 0.05).Compared with group C,the intraoperative blood loss,volume of allogeneic blood transfused,volume of autologous blood transfused,volume of postoperative drainage and transfusion of FFP were significantly decreased and Hct,Plt,Fib and PF were significantly increased at T2,3 in group D (P ＜ 0.05).No patients developed blood coagulation disorder and deep vein thrombosis.Conclusion Batroxobin combined with tranexamic acid can significantly reduce the intraoperative blood loss and volume of allogeneic blood transfused and improve the blood coagulation,and the efficacy is superior to that of either alone for the patients undergoing adolescent idiopathic scoliosis.