Objective To investigate the pathogenesis of brain-type hemodialysis disequilibrium syndrome(DDS) in dogs with acute renal failure. Methods Seventy-two hours after bilateral ureteral ligation,12 uremic dogs were hemodialyzed for 2 hours,yeilding decreases in plasma urea from (66. 76?13.70) mmol/L to (17. 85?5. 84)mmol/L( P

Anemia, Refractory ; Humans ; Male ; Middle Aged ; Thrombocytosis

Glioma ; pathology ; Humans ; Neoplastic Stem Cells ; pathology

Objective To discuss significance of continuous monitoring of jugular venous oxygen saturation(S_(jv)O_2)in the course of mild hypothermia treatment(MHT)for severe traumatic brain injury (sTBI).Methods Intracranial pressure(ICP),S_(jv)O_2 and brain tissue pressure(P_(bt)O_2)were contin- uously monitored in 36 cases with sTBI for analyzing the correlation between S_(jv)O_2 and P_(bt)O_2.Results (1)There was negative linear correlation between P_(bt)O_2 and ICP(r=-0.978,P＜0.05),negative lin- ear correlation between S_(jv)O_2 and ICP(r=-0.947,P＜0.05)and positive linear correlation between P_(bt)O_2 and S_(jv)O_2(r=0.965,P＜0.05)within 24 hours and at 36 hours and 48 hours after injury.(2) The cases with decreased S_(jv)O_2 value had a worse outcome than those with normal S_(jv)O_2.meanwhile,the cases with abnormal increase of S_(jv)O_2 value had worse prognosis.Prognnsis was improved significantly with increase of S_(jv)O_2 in certain range(P＜0.05).Conclusion Continuous monitoring of S_(jv)O_2 can reflect the condition of hemicerebral oxygen metabolism and guide treatment and predicting outcome.

BACKGROUNDThe dialysis disequilibrium syndrome is characterized by neurologic deterioration and cerebral edema which occurs after hemodialysis. The purpose of this study was to investigate the pathogenesis of acute cerebral and pulmonary edema induced by hemodialysis.

METHODSWe evaluated the effects of hemodialysis on the biochemical and hemodynamic parameters of the plasma and cerebrospinal fluid, including the intracranial pressure, dry/wet ratio, and pulmonary edema index, and we also examined the pathological changes of the brain and lung tissue in dogs suffering from uremia.

RESULTSSeventy-two hours after bilateral ureteral ligation, 10 uremic dogs were hemodialyzed for 2 hours, yielding a 73.6% and 60.1% decrease in the plasma urea and creatinine, respectively, a decrease in the plasma osmolality from (359 +/- 18) mOsm/kg H(2)O to (304 +/- 6) mOsm/kg H(2)O (P < 0.01), a decrease in the dry/wet ratio of the lung and brain tissue, and an increase in the hemodynamic parameters (right atrial pressure, right ventricular pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure), intracranial pressure, total pulmonary resistance index, and pulmonary edema index. Moreover, the pathological examination revealed lung and brain edema in the dialyzed dogs. This group was compared to 3 control groups: 6 uremic dogs which were sham dialyzed without dialysate so that no fall in the plasma urea occurred, and 12 uremic and 12 nonuremic animals that were not dialyzed. However, the parameters mentioned above were not significantly changed among these 3 control groups.

CONCLUSIONSThe acute brain and lung edema in our model appeared to be primarily due to a large osmotic gradient between the plasma and the brain and lung. This is the "urea reverse effect" which promoted the osmotically-induced lung and brain swelling.

Acute Disease ; Animals ; Brain ; pathology ; Brain Edema ; etiology ; Dogs ; Intracranial Pressure ; Lung ; pathology ; Pulmonary Edema ; etiology ; Radiography, Thoracic ; Renal Dialysis ; adverse effects ; Urea ; metabolism

Objective To evaluate the significance of CT assessment for extraarticular anatomy in treatment of displaced intraarticular calcaneal fractures.Methods(1)Measurement of normal calcaneum 40 pieces of adult calcaneum specimen were measured,items of measurement included height of culmination of posterior facet and tuberosity,width of posterior edge of sustentaculum and tuberosity.(2)CT measurement of calcaneum.Transverse(axial)and coronal CT scanning were obtained from 20 feet with displaced intraarticular calcaneal and 20 normal feet as control.Following items were measured in CT scanning:the height of culmination of posterior facet and tuberosity,the coronal talocalcaneal angle,in coronal scanning,the width of posterior edge of sustentaculum and tuberosity,the axial calcaneocuboid angle,in axial scanning.Results(1)Measurement of height of calcaneum height of culmination of posterior facet and tuberosity of calcaneal specimen were(43.07?2.85)mm and(44.69?3.67)mm respectively,and these two items from CT scanning of normal feet were(42.84?1.66)mm,(43.40? 3.01)nun,and from CT scanning of feet with calcaneal fractures were(34.76?3.24)mm,(40.41? 3.69)mm.There was a statistically significant different between these two items for normal calcaneal specimen and for CT scanning of feet with ealcaneal fractures(P

Objective To compare the survival rate of two kinds of neurovenofasciocutaneous flaps and investigate the venous reverse flow of flaps.MethodsTen New Zealand White rabbits were randomly allocated into 2 groups of 10 flaps(group A: the lesser saphenous sural pedicled fasciocutanous flaps,blood supply provided with perforator arteries;group B: the lesser saphenous sural pedicled fasciocutanous flaps,blood supply provided with axial type artery).The survival rate of flaps in two groups was observed.Pedicles of flaps were harvested and examined histologically.ResultsThe survival rate of flaps in group A was significantly lower than that in group B[(15.2?16.7)% vs(94.1?6.4)%,P

Objective To analyze the results of the Objective Structured Clinical Examination(OSCE) of medical interns in Department of Gynecology and Obstetrics,and to assess the role of OSCE in clinical teaching and practice. MethodsAtolal of 104 medical interns of five-year education program in 2002 and seven-year education program in 2003 in School of Medicine had taken part in OSCE of gynecology and obstetrics.The OSCE consisted of six stations: gynecologic examination,obstetric examination,oral test,interrogation of standardized-patients(SP),drawing partogram,and non-stress test(NST) explanation.After gathering the data of each station,the software of SPSS 11.0 was used to make statistical analysis. Results The median scores were as follows: 92.0 for gynecologic examination,91.0 for obstetric examination,83.5 for oral test,80.0 for interrogation of SP,80.0 for drawing partogram,and 70.0 for NST explanation.There was no significant impact of familiarity to OSCE on the results of the test.The results showed that medical interns did good job in basic performance,but lack of clinical practice skills in some complicated practice of gynecology and obstetrics.Conclusion The grading system and stations setup of OSCE in Department of Gynecology and Obstetrics in Shanghai Sixth People's Hospital show objectivity and equity.The OSCE can be widely applied in the after-department examination and even graduation examination.

BACKGROUND: Severe acute pancreatitis (SAP) can result in intestinal mucosal barrier (IMB) dysfunction. This study was undertaken to demonstrate the effect of IGF-I on the intestinal mucosal barrier in rats with SAP and its possible mechanisms. METHODS: Seventy-two male Wistar rats were randomly divided into three groups: a sham operation (SO group,n=24), a SAP group not treated with IGF-I (SAP group,n=24), and a SAP group treated with IGF-I (IGF-I group,n=24). SAP was induced in the rats by injecting 5.0％ sodium taurocholate into the biliary-pancreatic duct. The SO rats were given an infusion of normal saline instead. The rats in the IGF-I group underwent the SAP procedure and were given a subcutaneous injection of IGF-I at 30 minutes before the operation and at 3 hours after the operation. Eight rats in each group were sacrificed at 6, 12 and 24 hours after operation. Apoptosis of mucosal cells in the small intestine was determined by TUNEL. The levels of endotoxin and DAO and serum amylase were also measured. Pathologic changes in the small intestine were monitored. Changes of bax and bcl-2 mRNA expression in the small intestine were determined by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The levels of serum amylase were lower in the IGF-I group than in the SAP group at all three time points (P<0.05). The levels of endotoxin in the IGF-I group were higher than those in the SAP group at 6 hours, but lower in the IGF-I group than in the SAP group at 12 and 24 hours (P<0.05). The levels of diamine oxidase were higher in the IGF-I group at 6 hours but lower than those in the SAP group at 12 and 24 hours. The pathological score of the small intestine was lower in the IGF-I group than in the SAP group, and the difference was statistically significant at 12 and 24 hours. The pathologic changes observed under electron microscopy were better in the IGF-I group than those in the SAP group. The apoptosis index of intestinal epithelial cells was significantly decreased in the IGF-I group compared with the SAP group. Compared with the SO group, the mRNA expression levels of bax were increased at each time point in the SAP group, and were significantly decreased in the IGF-I group as compared with the SAP group at each time point (P<0.05). The expression levels of bcl-2 were weak and not different between the SO group and the SAP group (P>0.05). They were significantly increased in the IGF-I group versus the SO and SAP groups (P<0.05). The ratio of bax and bcl-2 mRNA expression levels at each time point in the SAP group were significantly higher than those in the SO group, but they were obviously decreased in the IGF-I group. CONCLUSIONS: Exogenous IGF-I seems to protect mucosal cells in the small intestine against SAP-induced apoptosis and could alleviate SAP-induced injury of the intestinal mucosa. The underlying mechanisms include enhanced mRNA expression of bcl-2 and inhibition of bax mRNA expression.

AIMTo investigate the extent of systemic absorption and uptake of meptazinol (MEP) hydrochloride in cerebrospinal fluid (CSF) after intranasal administration on rats and compare with oral administration.

METHODSCSF samples were collected by a serial sampling method. The concentration of MEP in the biological samples was measured by HPLC with fluorescence detector.

RESULTSRapid and significant levels of MEP in plasma and CSF can be achieved after nasal administration whereas the oral administration resulted in considerably lower drug concentrations. AUC in plasma and CSF from the nasal route are 7.375 and 15.6 folds compared with those of the oral route, respectively.

CONCLUSIONIntranasal MEP is able to show quick absorption and improve the bioavailability, which could be a promising alternative to oral administration.

Administration, Intranasal ; Administration, Oral ; Analgesics, Opioid ; administration & dosage ; blood ; cerebrospinal fluid ; pharmacokinetics ; Animals ; Area Under Curve ; Biological Availability ; Chromatography, High Pressure Liquid ; methods ; Male ; Meptazinol ; administration & dosage ; blood ; cerebrospinal fluid ; pharmacokinetics ; Rats ; Rats, Sprague-Dawley