Objective To explore the efficacy of low tidal volume ventilation strategy in children with acute hypoxia respiratory failure (AHRF).Methods A total of 79 hospitalized children with AHRF from Aug 2006 to Jul 2011 in PICU of Kunming Children's Hospital were enrolled in this study.The observation group in-cluded 55 children who received low tidal volume ventilation strategy (6-8 ml /kg),while the other 24 children (control group)were given traditional mechanical ventilation (10-12 ml /kg).Oxygenation situations such as PaO2 ,PaCO2 ,PaO2 /FiO2 ,oxygen index and blood gas pH value,organ function,mechanical ventilation complica-tions,hospitalization days and expenses in PICU and the mortality were observed.Results (1)PaO2 ,PaO2 /FiO2 and oxygen index in the observation group were better than those in control group after 24 h mechanical ventilation [(68.51 ±7.53)mmHg(1 mmHg =0.133 kPa)vs.(61.64 ±9.28)mmHg,(162.9 ±21.84)mmHg vs.(152.1 ± 19.03)mmHg,and 18.85 ±4.1 vs.26.53 ±5.2,respectively],and there were significant differences between two groups (P ﹤0.05);and there were also significant differences between two groups in the results after 48 h and 72 h mechanical ventilation.(2)The PaCO2 was (47.48 ±10.52)mmHg after 24 h in observation group,while the PaCO2 in control group was (30.17 ±6.59)mmHg,and it suggested excessive ventilation.(3)Mechanical venti-lation time (7.6 ±3.1)d and hospitalization days (12.8 ±3.6)d were shorter in observation group(P ﹤0.01). Barotrauma (7.3%)and mortality (20.0%)in observation group was significantly lower than those in control group (29.2%,41.6%;P ﹤0.01).The number of damaged organs in observation group was lower than that in control group (P ﹤0.05).Conclusion Low tidal volume ventilation with appropriate positive end expiratory pressure could improve oxygenation,prevent alveolar collapse,reduce complications and mortality for children with AHRF,it should be applied for the treatment of children with AHRF.

Background Studies showed that macophenolic acid (MPA)down-regulates and inhibits the expression and secretion of tissue growth factor and inflammatory factor,and further impacts the proliferation and inflammation process.Pterygium is an inflammatory and proliferative lesion.Whether MPA has an inhibitory effect on pterygium is unclear.Objective This study was to investigate the antifibrotic effects of macophenolic acid on pterygium fibroblasts(PFBs) in vitro and discuss its mechanism.Methods Pterygium tissue was obtained from pterygium patient during the surgery.PFBs were cultured using explants and identified with vimentin immunohistochemisty.0,0.125,0.250,0.500,1.000 μmol/L MPA were added into the culture medium,respectively,and the cells were cultured in the medium without MPA as the control group.MTT colorimetry was used to find the optimization effective concentration of MPA and evaluate their inhibitory effect on PFBs,and BrdU fluorescence staining was used to assess the growth statue of PFBs.Expressions of nuclear factor-κB(NF-κB),p65 and inhibitor of NF-κB-α(IκB-α) in the cells were detected by Western blot.Results The cells was spindle in shape 3 days after cultured and showed the vortex and radial arrangement with the positive response to vimentin.With the increase of MPA,the proliferative value of PFBs (A560)showed gradually decline,with a significant difference among the five groups (F =42.874,P＜0.01).In addition,the proliferative value of PFBs (A560) significantly lowed as the prolong of MPA active time(F=26.038,P＜0.01).BrdU fluorescence staining showed a significant decrease of DNA synthesis of PFBs with the elevation of MPA dose among the five groups(F=175.279,P＜0.05),and the A560of PFBs DNA synthesis in different concentrations of MPA groups was lower than that of the control group (all at P＜0.05).No apoptotic and necrotic cell was found after MPA action by DAPI staining.The expression level of p65 in the PFBs was 0.886±0.072 and 1.542±0.124 in the MPA group and the control group,indicating a declined value in the MPA group(P＜0.05).However,the expression value of IκB-α in the cytoplasm PFBs was significantly higher in the MPA group compared with the control group(2.141 ±0.305 vs.1.559±0.267) (P＜0.05).Conclusions MPA has an inhibitory effect on the growth of PFBs,which probably is related to the arresting of NF-κB pathway.

To study the protective effect and the mechanism of asiatic acid (AA) from Potentilla chinensis on alcohol hepatic injury in rats. Male Wistar rats were randomly divided into six groups: the normal control group, the AA control group (8 mg · kg(-1) AA), the model group (5.0-9.0 g · kg(-1) alcohol) and high, medium and low-dose AA-treated groups (alcohol + 8, 4, 2 mg · kg(-1) AA). Each group was orally administered with the corresponding drugs once a day for 24 weeks. Approximately 1. 5 hours after the final administration, all rats were killed, and their blood samples and hepatic tissues were collected. The AST and ALT in rat serum and the contents of MPO, TNF-α, IL-1β, SOD, GSH-Px, GSH-Rd and MDA in hepatic tissues were detected. The expressions of NF-κB, TLR4, CD14, MyD88, TRIF and protein expression in hepatic tissues were measured by western blot. The pathological changes in liver tissues were observed by histological examination. The results showed that compared with the model group, the AA-treated groups showed significant decreases in serum ALT, AST and MDA and increases in the activities of SOD, GSH-Px, GSH-Rd and MPO. Moreover, AA markedly inhibited the expressions of TNF-α, IL-1β, TLR4, CD14, MyD88 and NF-κB. The histological examination showed alleviated hepatic issue ijury to varying degrees. In short, asiatic acid (AA) from P. chinensis could protect alcohol-induced hepatic injury in rats. Its mechanism may be related to the inhibition of NF-κB inactivation and the reduction of inflammatory response.
Animals ; Liver ; drug effects ; pathology ; Liver Diseases, Alcoholic ; prevention & control ; Male ; NF-kappa B ; physiology ; Pentacyclic Triterpenes ; pharmacology ; Potentilla ; chemistry ; Protective Agents ; pharmacology ; Rats ; Rats, Wistar ; Toll-Like Receptor 4 ; antagonists & inhibitors

Objective To explore the effect of low tidal volume ventilation on the treatment of children with acute respiratory distress syndrome (ARDS).Methods Forty-four hospitalized children with ARDS from Jan 2008 to Dec 2011 at Kunming Children's Hospital were enrolled in this study.The observation group included 24 patients who received the treatment of low tidal volume ventilation (6 ～ 8 ml/kg),while the other 20 patients were in the control group who were given traditional volume ventilation (10 ～ 12 ml/kg).Oxygenation situations and blood gas analysis at 24,48,72 h after ventilation、mechanical ventilation complications,and the mortality in the first 28 days were observed.Results The ratios of PaO2/FiO2 were 104 ±23.6 in observation group and 112 ±34.7 in control group (P ＞0.05).However,after 24,48 and 72 h of ventilation,the ratios of PaO2/FiO2 showed statistical significance (t ≥2.01,P ＜0.05 ; t ≥2.74,P ＜ 0.01).Barotrauma in observation group was significantly lower than that in control group (x2 =6.97,P ＜ 0.01).The mortality (16.7％) of the observation group was significantly lower than that (50％) of the control group (x2 =5.58,P ＜ 0.05).Conclusions Low tidal volume ventilation can reduce complications and improve oxygenation of ARDS patients,and reduce the mortality in ARDS children.The improved rescue technology should be applied for the treatment of children with ARDS.

Objective To observe the changes in serum vancomycin trough concentration,and explore its optimal dosage in critical patients.Methods A retrospective study was conducted.Data of 66 patients who used vancomycin during July 2010 to May 2012 in surgical intensive care unit (SICU) of the First Affiliated Hospital of Sun Yat-Sen University were collected and analyzed.According to the endogenous creatinine clearance rate (CCr),the patients were divided into two groups:CCr normal group (≥ 70 mL/min) and CCr lowered group (＜70 mL/min).The distribution of vancomycin serum trough concentration between two groups,relationship between vancomycin serum trough concentrations and CCr,and the influence of vancomycin serum trough concentrations on the prognosis was analyzed.The difference between actual dosage and the recommended dosage in guideline was compared between two groups.Results 119 times of vancomycin serum trough concentration in 66 patients were enrolled,and it was found that only 20.17％ (24/119) reached the target concentration (15-20 mg/L),45.38％ (54/119)＜ 15 mg/L and 34.45％ (41/1 19) ＞20 mg/L.Vancomycin serum trough concentration in CCr normal group (55 cases) was (13.11 ± 6.84) mg/L,among them 65.5％ (36/55) attained lower trough concentrations (＜ 15 mg/L).In the subgroup with 15-20 mg/L trough serum concentrations,vancomycin doses were significantly lower than that of recommendation (g/d:1.95 ± 0.61 vs.2.73 ± 0.32,F=1.739,P=0.001).Vancomycin serum trough concentration in CCr lowered group (64 cases) was (20.49 ± 8.12) mg/L,with 51.5％ (33/64) of them showed higher trough concentrations (＞20 rag/L).In the subgroup with 15-20 mg/L vancomycin trough serum concentration,vancomycin doses were higher than that of recommendation (g/d:1.08 ±0.49 vs.0.78 ±0.19,F=11.294,P=0.062).There was no significant difference in 28-day mortality between patients with targeting trough serum concentrations and those without [22.2％ (4/18) vs.18.8％ (9/48),x2=0.009,P=0.924].Serum creatinine [odds ratio (OR)=1.001,95％ confidence interval (95％CI):0.990-1.012,P=0.000],vancomycin doses (OR=0.600,95％CI:0.251-1.434,P=0.003),age (OR=0.985,95％CI:0.955-1.015,P=0.015) and body mass index (OR=1.013,95％CI:0.967-1.062,P=0.022) were found to be correlated to serum trough concentrations by multiple linear regression analysis.Conclusions The rate of vancomycin serum trough concentrations reaching the standard is low in critical patients,so constant monitoring is necessary.Creatinine,vancomycin dosage,age and body mass index show a relatively significant influence on the serum trough concentrations,and they should be taken into consideration in dosage to be given.

ObjectiveTo evaluate the effectiveness of transcatheter Amplatzer device closure on patent ductus arteriosus(PDA),and to give some evidences for the clinical application.MethodsAll studies in the world regard to the controlled trials(CT) about transcatheter Amplatzer device closure and cardiac surgery on PDA were searched and made synthetic evaluation by means of Meta-analysis.RevMan 4.2.2 software was used for statistical analysis.Cases relative risk(RR)and its 95% confidence interval(CI)of procedure failure,the incidence of complication and residual shunt were calculated.ResultsTotally 5 studies including 349 cases were analyzed.Operation failure of Amplatzer device occlusion was higher than cardiac surgery [5 CT,349 cases,3.0% vs 0,RR=4.29,95%CI(0.77,23.95)](P=0.10).Incidence of complication of Amplatzer device occlusion was lower than cardiac surgery[5 CT,343 cases,3.1% vs 38.0%,RR=0.11,95%CI(0.05,0.23)](P

Humans ; Intestinal Obstruction/complications* ; Ileus/etiology* ; Abdominal Injuries/complications*

BACKGROUNDEarly detection and accurate staging are crucial for planning treatment and improving survival rate of hilar cholangiocarcinomas. This study investigated the diagnostic value of a three dimensional, spoiled gradient echo, T1-weighted magnetic resonance (MR) imaging sequence (3D volumetric interpolated breath-hold examination, 3D-VIBE) in the preoperative evaluation of hilar cholangiocarcinoma.

METHODSThirty-one patients with surgically and histologically confirmed hilar cholangiocarcinomas underwent preoperative MR imaging examination. Unenhanced two-dimensional T1- and T2-weighted images, 2D MR cholangiopancreatographs (MRCP), gadolinium enhanced 3D-VIBE images in the early arterial, late arterial and portal venous phases followed by 2D T1-weighted images in the equilibrium phase were acquired. Images from 3D-VIBE, 2D T1-weighted enhanced sequences and 2D MRCP were interpreted by two abdominal radiologists through consensus reading in blind manner, focussing on the assessment of the morphological type, the longitudinal extent of tumor infiltration in the bile ducts and the involvement of neighbouring blood vessels. The accuracy of 3D-VIBE and 2D T1-weighted enhanced sequences in assessing the tumor resectability was compared.

RESULTSAll the 31 tumors were directly displayed and accurately classified on 3D-VIBE images whereas 8 periductal infiltrating tumors (8/31, 25.8%) were not depicted on 2D T1-weighted enhanced images. Using the Bismuth Corlette classification, 3D-VIBE was closer to MRCP in delineating the intraductal extent of tumor infiltration than 2D T1-weighted enhanced (28/31, 90.3%; 10/31, 32.3%; chi2 = 22.0, P < 0.05). Involvement of the hepatic artery, the portal venous trunk and their branches was shown more frequently on 3D VIBE than 2D T1-weighted enhanced images. The positive predictive value and accuracy of 3D-VIBE (84.2%; 90.3%) for assessing tumor resectability were higher than those of 2D T1-weighted enhanced images (64.0%; 71.0%, all P < 0.05).

CONCLUSIONGadolinium enhanced 3D-VIBE is better than 2D T1-weighted enhanced sequence in the preoperative assessment of the morphologicalal type, the intraductal infiltrating extent and the tumor resectability of hilar cholangiocarcinomas.

Adult ; Aged ; Bile Duct Neoplasms ; pathology ; Bile Ducts, Intrahepatic ; pathology ; Cholangiocarcinoma ; pathology ; Female ; Humans ; Imaging, Three-Dimensional ; methods ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Neoplasm Staging ; Preoperative Care ; Reproducibility of Results

OBJECTIVETo observe the effects of polydatin on learning and memory and cyclin-dependent kinase 5 (Cdk5) kinase activity in the hippocampus of rats with chronic alcoholism.

METHODSForty rats were randomly divided into 4 groups: control group, chronic alcoholism group, low and high polydatin group. The rat chronic alcoholism model was established by ethanol 3.0 g/(kg · d) (intragastric administration). The abstinence scoring was used to evaluate the rats withdrawal symptoms; cognitive function was measured by Morris water maze experiment; Cdk5 protein expression in the hippocampus was detected by immunofluorescence; Cdk5 kinase activity in the hippocampus was detected by liquid scintillation counting method.

RESULTSThe abstinence score, escape latency, Cdk5 kinase activity in chronic alcoholism group rats were significantly higher than those of control group (P < 0.05). The abstinence score, escape latency in high polydatin group rats were significantly lower than those of chronic alcoholism group (P < 0.05); Cdk5 kinase activity in high and low polydatin group rats was significantly lower than that of chronic alcoholism group( P < 0.05); immunofluorescence showed that the Cdk5 positive cells of chronic alcoholism group were significantly increased compared with control group (P < 0.05), and the Cdk5 positive cells of polydatin groups were significantly decreased compared with chronic alcoholism group ( P < 0.05).

CONCLUSIONPolydatin-reduced the chronic alcoholism damage may interrelate with regulation of Cdk5 kinase activity.

Alcoholism ; physiopathology ; Animals ; Cyclin-Dependent Kinase 5 ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Glucosides ; pharmacology ; Hippocampus ; drug effects ; enzymology ; Learning ; drug effects ; Memory ; drug effects ; Rats ; Stilbenes ; pharmacology

This study was conducted to investigate the paclitaxel loaded by hydrazone bonds in poly(ethylene glycol)-poly(caprolactone) micelles (mPEG-PCL-PTX) on proliferation and apoptosis of human lung cancer A549 cells and its possible mechanisms of anti-tumor activity. The cell proliferation was measured with MTT assay. Flow cytometry were used to analyze the cell cycle. The cell apoptosis was analyzed using Hoechst/P staining. The expression levels of apoptotic genes expression in the mitochondrial apoptosis pathway were detected by RT-PCR and Western blotting, respectively. The mPEG-PCL-PTX could inhibit the proliferation of A549 cells and promote the apoptosis. The Bax, caspase-3 protein expression were increased while Bcl-2 protein expression was decreased in A549 cells. Results showed that the polymer containing hydrazone bond is non-toxic in vitro, the mPEG-PCL-PTX micelles can inhibit the proliferation and induce the apoptosis of A549 cells. Key words: paclitaxel; micelle; A549 cell; proliferation; cell cycle; apoptosis
Apoptosis ; Caspase 3 ; metabolism ; Cell Line, Tumor ; drug effects ; Cell Proliferation ; Humans ; Lung Neoplasms ; metabolism ; pathology ; Micelles ; Paclitaxel ; pharmacology ; Polyesters ; Polyethylene Glycols ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; bcl-2-Associated X Protein ; metabolism