ObjectiveTo investigate the effect of porcine large intestine-processed Dahuang （Radix et Rhizoma Rhei） on defecation in constipation model mice and the possible mechanism. MethodsFifty Kunming mice were randomized to blank group （n=10） and model group （n=40）. Loperamide suspension at the dose of 8 mg/（kg·d） was given by gavage for four consecutive days to establish a model of constipation. The 24 successfully modeled mice were randomly divided into model group， processed Dahuang group， lactulose group， raw Dahuang group， with six mice in each group. Moreover， six randomly selected mice were chosen as control group. Since the fifth day， 8 mg/（kg·d） of loperamide suspension by gavage was given to the model group， processed Dahuang group， raw Dahuang group， and lactulose group； two hours later， the processed and raw Dahuang groups were administered with 0.6 g/（kg·d） of processed and raw Dahuang suspension， respectively， while the lactulose group was given 0.6 g/（kg·d） of latulose suspension， and the blank group and the model group were given 0.2 ml/10 g of distilled water by gavage， all for four days. The general condition， body weight after the last gavage， number of fecal particles within six hours， fecal wet weight， fecal water content ratio， intestinal propulsion rate and colonic histology changes by HE staining of each group were detected. ResultsThe body weight of the mice in the raw Dahuang group was significantly lighter than that in the other groups （P＜0.05 or P＜0.01）. The number of fecal particles， fecal wet weight and intestinal propulsion rate of mice significantly decreased in the model group than in the blank group （P＜0.05 or P＜0.01）. Compared to those in the model group， the number of fecal particles and fecal wet weight in the processed Dahuang group， lactulose group and raw Dahuang group significantly increased， and the fecal water content ratio in the raw Dahuang group increased as well （P＜0.05 or P＜0.01）. Compared to those in the processed Dahuang group， the number of fecal particles and fecal wet weight in the raw Dahuang group decreased， while the fecal water content ratio increased （P＜0.05 or P＜0.01）， and the fecal water content ratio in the lactulose group increased significantly （P＜0.05）. The intestinal propulsion rate in the processed Dahuang group was higher than that in the model group， lactulose group and raw Dahuang group （P＜0.05 or P＜0.01）. Histopathological analysis showed that the colonic crypts and goblet cells in the blank group were normal and clear， and the colonic muscular layer was thicker. The colonic crypts of the mice in the model group were damaged， with reduced goblet cells to varying degrees and changed colonic muscularis. In the lactulose group and raw Dahuang group， part of the crypts were broken， and the goblet cells were damaged to varying degrees， while in the processed Dahuang group， still the colonic tissue structure of the mice was relatively clear， and the colonic crypts and goblet cells were relatively normal， with thickened muscular layer of the colon. ConclusionPorcine large intestine-processed Dahuang could improve defecation in constipation model mice， and reduce the drastic purgation function of raw Dahuang， for which the mechanism may be related to the protection of colon histopathological damage.

Objective:To identify the risk factors for and outcomes of preoperative hepatic dysfunction (HD) in patients who underwent surgery for the treatment of acute DeBakey type I aortic dissection (ADIAD).Methods:A retrospective study including 810 consecutive patients between January 2014 and December 2019 in Nanjing Drum Tower Hospital was performed with emergency surgical repair. All patients were divided into non-HD and HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery and their clinical parameters and clinical outcomes were collected and compared. To determine independent predictors of preoperative HD, multivariate logistic regression analyses were performed using variables with P<0.5 in the univariate analyses. Kaplan-Meier survival analyses were conducted to analyze the association between preoperative HD and postoperative long-term survival. Results:The mean age of the patients was (52.4±12.5) years. 215 patients (26.5%) were identified as the preoperative HD group. In univariate analysis, significant difference was found with respect to the postoperative complications (98.6% vs. 94.5%, P=0.011) and 30-day mortality (20.0% vs. 8.4%, P<0.001) between the two groups. Multivariate logistic analysis showed that elevated serum troponin T levels upon admission( OR=1.921, P<0.001) and preoperative cardiac tamponade ( OR=2.158, P=0.002) were independent risk factors for preoperative HD. The long-term mortality rate was not significantly affected by preoperative HD. Conclusion:Early HD before surgery was commonly observed in patients with ADIAD and was associated with increased postoperative complications and 30-Day mortality. Elevated serum troponin T levels upon admission and preoperative cardiac tamponade were identified as risk factors for preoperative HD.

Objective:To summarize acute type A aortic dissection(ATAAD) is relatively uncommon in dialysis patients, and repair outcomes are not fully understood.Methods:Between January 2014 and March 2020, 20 patients with ATAAD required dialysis for preoperative end-stage renal disease(ESRD) were treated by our group. There were 11 male and 9 female patients at mean age of(47.8±11.3) years. The mean duration of dialysis therapy in the total 20 patients before the onset of ATAAD was(4.5±3.9 )years, with 90%(18 cases) of these patients undergoing hemodialysis(rather than peritoneal dialysis). 17 patients were treated emergency surgically, surgical operation were performed under deep hypothermic circulatory arrest and perfused the cerebral selective cerebral perfusion, 5 cases with ascending aorta + arch fenestrated stent, 5 cases with ascending aorta+ hemi-arch replacement(2 cases with stent elephant trunk), 4 cases with ascending aorta+ arch replacement+ stent elephant trunk(1 case with coronary artery bypass grafting for left anterior descending coronary artery), 2 cases with aortic valvuloplasty + ascending aorta+ hemi-arch replacement, 1 case with Bentall+ arch fenestrated stent.Results:2 patients were died from aortic ruptured before operation, 1 patient treated medically was alive three months after admission. Cross-clamp, cardiopulmonary bypass, and circulatory arrest times of all the surgical patients were(233.8±84.4) min, (155.5±63.6)min and(28.2±10.8)min, respectively. The following complications occurred postoperative: 3 cases died in the hospital, 1 case of tracheotomy, 2 cases of cerebral infarction, 1 case of cerebral hemorrhage, 1 case of transient paraplegia, and 1 case of surgical site infection. After a mean follow-up of(11.6±14.5) months(rang, 3-61 months). the overall survival rate at 1 year and 5 years was 53% and 27% respectively.Conclusion:Dialysis patients with ATAAD should be operated on urgently and medical treatment carries high risks of aortic rupture, although in-hospital mortality is acceptable, long-term mortality is poor.

Objective:To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods:From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit), all adult patients hospitalized for 7 days before open-heart surgery were included. They were randomly divided into pulmonary rehabilitation group(198 cases) and control group(234 cases). To compare and analyze the clinical effects, the main observations were observed including overall outcome indicators(such as early extubation rate, ICU stay, hospitalization costs, advanced oxygen therapy support after extubation) and lung outcome related indicators(such as the occurrence of pulmonary complications, chest drainage, secondary intubation, tracheotomy, lung infection and chest tube drainage).Results:There was no statistical difference between groups in basic conditions and surgical conditions. The lung rehabilitation group significantly increased the rate of early extubation, reduced the number of advanced oxygen therapy after weaning, shortened the length of ICU stay, saved hospitalization cost, significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function( P<0.05). Conclusion:During cardiac perioperation, pulmonary rehabilitation significantly can increase the rate of early extubation , shorten the length of mechanical ventilation, reduce the occurrence of secondary tracheal intubation and pulmonary complications. And it can also effectively promote the recovery of lung function and the overall recovery.

Objective:To investigate the protective effects of Elabela(ELA) on the renal injury of db/db mice and its possible mechanism.Methods:Sixteen eight-week-old male db/db mice were intraperitoneally injected with ELA(5 mg·kg -1·day -1) or equivalent normal saline( n=8) for 8 weeks. Eight age-matched male db/m mice received equivalent normal saline injection as normal control. At the end of the experiment, blood and urine samples were obtained for HbA 1C and urinary albumin/creatinine(ACR) measurements. Immunohistochemistry was used to observe the expression of ELA. Histopathological changes in kidney tissue were observed by HE staining and Masson staining. The levels of collagen type Ⅳ(Col-Ⅳ) and transforming growth factor-β1(TGF-β1) as well as Yes-associated protein(YAP) phosphorylation in kidney tissue were examined by western blot. Results:Immunohistochemistry results showed that ELA expression was decreased in the renal tissue of db/db mice as compared with that of db/m mice( P<0.05). After ELA treatment, ACR and blood pressure were markedly decreased in db/db mice( P<0.05), but without significant changes in the body weight and HbA 1C. Renal tubular epithelial cells edema, basement membrane thickening, and increased collagen fiber in db/db were improved by ELA administration. Compared with db/m mice, the levels of TGF-β1 and Col-Ⅳ expression, as well as YAP phosphorylation were significantly increased in renal tissue of db/db mice(0.98±0.08 vs 0.68±0.10, 1.10±0.14 vs 0.51±0.08, 3.38±0.72 vs 0.81±0.13, all P<0.05), which were down-regulated after ELA administration(0.80±0.06, 0.51±0.05, 2.21±0.22, all P<0.05). Conclusion:ELA may improve the renal injury of db/db mice by regulating the signaling pathway of YAP, thereby delaying the development of diabetic nephropathy.

Objective    To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods    We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results    The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%，P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion    The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.

Objective To understand the characteristics of hydatidiform mole (HM) in recent years in Guangdong area. Methods We analyzed statistically the clinical pathological characteristics of 432 cases with HM in Guangdong area from 2000 to 2016 and compared them with the characteristics of cases before 2000. Results Of the total,the rate of partial hydatidiform mole(PHM)reached 75.9％ and it was higher than that of complete hydatidiform mole. The incidence of PHM was higher than that before 2000. The highest proportion of cases was found in women aged from 21 to 25 and the menopause-time of the cases decreased when compared with that in 1990s,which indicated that early detection and early diagnosis of hydatidiform mole was increased. Vaginal bleeding was still a common accompanying symptom. The cases with history of pregnancy exceeded the cases without by 15.7 times;the pluriparas exceeded the nulliparae by 1.4 times and the cases with abortion history exceeded the cases without by 2.8 times in the incidence of HM. Conclusions Since 2000,HM has been dominated by PHM in Guangdong;the diagnosis time is advanced and the patients aged from 21 to 25 are in the majority. Previous pregnancy is an important risk factor for HM in Guangdong.

Objective To analyze the early outcomes of the Sun' s procedure,which is an approach integrating total arch replacement using a 4-branched graft with implantation of a special stented graft in the descending aorta,and observe the mortality,morbidity and mid-term clinical results of postoperative in patients with acute type A aortic dissection (AAAD).Methods Clinical data of 61 consecutive AAAD patients undergoing the Sun' s procedure were analyzed.There were 53 male and 8 female,aged (54 ± 12) years.61 patients had postoperative follow-up and the clinical effect of Sun' s procedure were retrospectively analyzed.Results Cardiopulmonary bypass time was (229 ± 46) min,aortic clamping time was (147 ± 37) min and unilateral selective cerebral perfusion time was (35 ± 9) min.Reoperation for excessive bleeding in 5 cases (8.2％),acute renal failure in 3(4.9％),tracheotomy patients for pulmonary infection in 3(4.9％),and spinal cord injury in 2 (3.3％),delayed thoracic incision healing in 1 (1.6％),and osteofascial compartment syndrome of the right lower limb in 1 (1.6％).The 30 day mortality is 8.2％,and the leading causes was low cardiac output syndrome in 2(3.3％),multi-organ failure in 1 (1.6％),pulmonary infection in 1 (1.6％) and ruptured of abdominal aortic dissection in 1 (1.6％).The average follow-up time is(5.1 ± 0.7) years.Postoperative 1 year survival rate was 91.8％,5 year survival rate was 83.6％.Conclusion The Sun' s procedure has generated a relatively lower mortality rate in 61 patients with AAAD.Postoperative survival rate is high,and the reoperation rate is low.

This study was aimed to investigate the blood-enriching effect of processed Radix Polygoni Multiflori on blood deficiency rats. A total of 140 SD rats were randomly divided into 14 groups, which were the blank control group, blood deficiency model group, positive control group and 11 test groups. The blank control group and model control group were treated with distilled water and the positive control group was given X ue b ao Buxue soluble granules. The test groups were treated with 11 different kinds of processed Radix Polygoni Multiflori sam-ples at a dosage of 2 g?kg-1 respectively. All rats were given drugs once a day. After 10 days, blood samples were collected and the amount of red blood cell (RBC), hemoglobin (Hb), haematocrit (HCT), whole blood viscos-ity and plasma viscosity, prothrombin time were estimated. The results showed that 9 processed Radix Polygoni Multiflori groups can increase the number of RBC and Hb significantly ( P < 0 . 05 or P < 0 . 01 ) in blood deficien-cy rat models. They were the sample processed with decoction of black soybean (DBS) for 24 h, with wine and DBS combination for 24 h , steamed for 4 h and 8 h under high pressure , with DBS for 6 h and 8 h , with wine for 6 h, with wine and DBS combination under high pressure, respectively. The samples processed with DBS un-der high pressure for 8 h increased RBC and Hb were more obviously ( P < 0 . 01 ) . The 8 groups can improve the situation of functional disorder of blood rheology significantly ( P < 0 . 05 or P < 0 . 01 ) . They were the unprocessed samples, processed with DBS and wine for 24 h respectively, with DBS and wine combination for 24 h, steamed for 4 h and 8 h or steamed with DBS for 6 h and 8 h or with wine for 6 h under high pressure respectively. It was concluded that the blood-enriching effect was improved while the R adix Polygoni Multiflori was processed with DBS or wine and under high pressure for 6-8 h .

Objective To evaluate the efficiency and the timing of continuous blood purification(CBP) in patients with multiple or-gan dysfunction syndrome(MODS) and acute renal failure(ARF) following cardiac surgery. Methods From November,2003 to July,2007,thirty-one patients with MODS and ARF following cardiac surgery were treated with CBP. They were divided into two groups, alive group ( group A) and dead group ( group B). Clinical data of the two groups were reviewed. Before CBP, duration of extracorporeal circulation, du-ated. Mean arterial pressure (MAP), heart rate (HR), oxygenic index (PaO2/FiO2), white blood cell count (WBC), platelet count (PLT) and renal function (blood urea nitrogen, BUN, ercatinine, Cr) were observed before and after CBP. Results The number of im-paired organs of patients in group B was significantly more than that in group A before CBP ( P＜0.05). MODS scores ( 12.9±3.2 vs 6.9 ±2.3, P＜0.05) and APACHE Ⅱ scores (26.3±10.4 vs 17.2±5.1, P＜0.05)of group B were significantly higher than those of group A before CBP. After treatment of CBP for 24 hours, APACHE Ⅱ scores and MODS scores only significantly decreased in group A (P＜0.05 ). After treatment of CBP, Cr and BUN significantly reduced, while MAP and PaO2/FiO2 increased, in all patients, but HR was signif-icantly lower than that before CBP in group A (P＜0.05). The duration of ARF (34.67±32.79 hours vs 13.05±14.09 hours,P＜cantly higher than those of group A. Conclusion MODS scores and APACHE II scores can be used to evaluate the severity of patients with MODS and ARF after cardiac surgery. CBP is an effective treatment for these patients. It is suggested that early CBP therapy is important for reducing the chances of the multiple organ dysfunction syndrome and mortality of these patients.