2013 Vol. 4, No. 3

Display Method:
Original Contributions
Abstract:
  Objective  To explore the role of exogenous corticotropin-releasing hormone (CRH) in cerebral infarction-related gastrointestinal barrier dysfunction.  Methods  Forty male Wistar rats were randomly divided into pseudo-operation group (group C), cerebral infarction group (group Ⅰ), cerebral infarction + intracerebroventricular CRH antagonist group (group A), and cerebral infarction + intraperitoneal CRH group (group H), 10 rats for each group. Urine samples were collected to determine the levels of 24-hour urine epinephrine, norepinephrine, cortisol, and sucrose. Blood samples were taken 24 hours after establishment of the models to determine the activity of diamine oxidase (DAO) and the concentration of D-lactic acid (D-lac). The stomach was taken to determine gastric Guth score, and the tissues of hypothalamus, stomach, jejunum and colon were all taken to determine tissue CRH protein expression using Western blot.  Results  The changes of urinary cortisol and catecholamine were nearly the same:these indicators in group Ⅰ and group H were significantly higher than those in group C (P < 0.05);in group A were significantly lower than those in group Ⅰ (P < 0.05), in group H were slightly higher than those in group Ⅰ, but with no significant difference; in group H were significantly higher than those in group A (P < 0.05). The changes of urine sucrose exertion, gastric Guth score, plasma DAO activity, plasma D-lac, as well as hypothalamus and gastrointestinal CRH protein content were nearly the same:these indicators in group Ⅰ were significantly higher than those in group C (P < 0.05);in group A were significantly lower than those in group Ⅰ (P < 0.05), in group H were also significantly lower than in group Ⅰ (P < 0.05);however, there was no significant difference between group A and group H.  Conclusions  After cerebral infarction, gastrointestinal barrier function is damaged. Central use of CRH blocker can decrease cerebral infarction-related gastrointestinal barrier dysfunction. Peripheral use of exogenous CRH can decrease the expression of CRH protein in the brain and the gastrointestinal tract, and also can decrease cerebral infarction-related gastrointestinal barrier dysfunction.
Abstract:
  Objective  To study the effect of hypertonic saline solution (HS) on lung function in intestinal ischemia-reperfusion (ⅡR) models.  Methods  Totally 72 rabbits were randomly divided into 4 groups (n=18):control group, ⅡR group, 4%HS group, and 7.5%HS group. The ⅡR models were produced by clamping super mesenteric artery (SMA) for 1 hour and declamping SMA for 6 hours in ⅡR group, 4%HS group, and 7.5%HS group, whereas animals in control group underwent sham operation. The corresponding sodium chloride solution was infused in the 2 treatment groups in 5 minutes before declamping SMA. Before and 2, 4, 6 hours after ⅡR, the plasma levels of tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) were measured. At 6 hours after ⅡR, 8 rabbits in each group were killed to measure the levels of lung water and myeloperoxidase (MPO) activity in lung tissue. Meanwhile, lung morphological changes were observed under light microscope.  Results  The plasma TNF-α and IL-10 levels, the levels of lung water and MPO activity in lung tissue, and lung morphological score significantly increased in ⅡR group when compared with the control group(P < 0.05). Compared with the ⅡR group, the TNF-α levels in plasma, the levels of lung water and MPO activity in lung tissue, and lung morphological score in both two HS groups significantly decreased (P < 0.05), particularly in 7.5%HS group which was significantly lower than those in the 4%HS group (P < 0.05).  Conclusions  HS has a protective effect on the lung function during ⅡR. Such a protective effect increases along with the increase of HS concentration within certain range.
Abstract:
  Objective  To explore the influence of an endotoxin lipopolysaccharide (LPS) injection on the expressions of lipocalin 2 (LCN2) and its relative cytokines in mice.  Methods  C57BL/6 mice were randomly divided into 3 groups (n=8 each) according to the serial LPS dosages of 10, 20, and 30 mg/kg. The control group (n=8) received only isotonic saline injection. Twenty-four hours later, cecum and blood samples were collected, and enzyme-linked immunosorbent assay (ELISA) and Western blot were performed to detect the serum levels of interleukin(IL)-1β, IL-6, IL-17A, and LCN2, and real-time polymerase chain reaction (PCR) to determine the LCN2 mRNA level in cecum lysate.  Results  The serum levels of IL-6 and LCN2 and the levels of IL-1β, IL-6, IL-17A, and LCN2 in cecum lysate in two large-dosage LPS groups (20 mg/kg and 30 mg/kg) were significantly higher than their counterparts in control group (P < 0.05). Compared with the 10 mg/kg LPS group, the levels of IL-6 and LCN2 in serum and the levels of IL-1β, IL-17A, and LCN2 in cecum lysate significantly increased in the 30 mg/kg LPS group (P < 0.05). 2-ΔΔCT was used to indicate fold changes of LCN2 mRNA in intestine. The results expressed as mean±standard deviation were as follows:1.548±0.417 for con-trol group, 3.184±0.716 for 10 mg/kg LPS group, 4.875±0.547 for 20 mg/kg LPS group, and 7.489±0.820 for 30 mg/kg LPS group, and the difference was significant between either two groups (P < 0.05).  Conclusions  LPS dose-dependently increases the level of LCN2 expression in cecum. The serum IL-6 level as well as the cecum IL-1β and IL-17A levels have certain correlations with the LCN2 level.
Abstract:
  Objective  To study the strategy of mechanical ventilation in pulmonary fibrosis with severe respiratory failure.  Methods  Fifty-four pulmonary fibrosis patients with severe respiratory failure requiring ventilatory support were divided into noninvasive ventilation group (n=21) and invasive ventilation group (n=33). The patients in noninvasive ventilation group were treated with noninvasive bi-level positive airway pressure (BiPAP) ventilation, and the patients in invasive ventilation group underwent endotracheal intubation and mechanical ventilation. Arterial blood gas was detected before ventilation and after one hour of ventilatory support. The complications of mechanical ventilation, mortality rate, and length of hospital stay were recorded.  Results  Significant improvements in PaO2 after one hour of ventilatory support were noted in both groups(P < 0.01). The incidence rate of complications in noninvasive ventilation group was lower than that in invasive ventilation group (23.8% versus 51.5%, P=0.043). No significant difference was found in the mortality rate between these two groups (90.5% versus 93.9%, P=0.636). The hospital stay of noninvasive ventilation group was significantly shorter than that of invasive ventilation group (13.1±11.7 days versus 19.4±15.8 days, P=0.008).  Conclusions  Neither noninvasive ventilation nor invasive mechanical ventilation can remarkably improve the survival of pulmonary fibrosis patients with severe respiratory failure. However, noninvasive ventilation can be applied in selected patients due to its lower incidence of complication and shorter hospital stay.
Abstract:
  Objective  To study the effect of mild hypothermia after resuscitation on rat neuronal apoptosis and its gene expression.  Methods  Sixty healthy male SD rats were equally randomized into two groups:normal temperature group(T=37℃±0.5℃) and mild hypothermia group (T=33℃±1.0℃).A rat model of asphyxial cardiac arrest and cardiopulmonary resuscitation was established. The neurological functions were assessed using neurological deficit score (NDS) 12 and 24 hours after the restoration of spontaneous circulation. Also, the expressions of the apoptosis-inducing factor (AIF), caspase-3, and Fas mRNA were detected using reverse transcription-polymerase chain reaction (RT-PCR) at 0, 2, 6, 12, and 24 hours, respectively.  Results  Compared with the normal temperature group, the mild hypothermia group had significantly higher NDS at 12 and 24 hours(P < 0.05) and lower number of apoptotic brain cells at 6, 12, and 24 hours(P < 0.05). The mRNA expressions of AIF and caspase-3 at each time point and Fas at 6, 12, 24 hours were significantly reduced after resuscitation in mild hypothermia group(P < 0.05).  Conclusion  Therapeutic hypothermia after resuscitation may improve NDS and thus protect brain by inhibiting expressions of apoptotic genes including AIF, caspase-3, and Fas.
Abstract:
  Objective  To investigate whether the triage mode influence the prognosis of acute appendicitis.  Methods  We retrospectively analyzed the triage conditions of 98 appendicitis patients and their prognostic information. Meanwhile, their preoperative examination results and pathology were also analyzed.  Results  Sixty-nine patients (70.41%) with acute abdominal pain were triaged at the surgical admission room. The disease onset time significantly differed among patients triaged at different admission rooms (P=0.0001). All patients had abdominal pain, and 40(40.82%) of them had migrating right low abdominal pain. All patients had right low abdominal tenderness, and 40 (40.82%) of them had rebound tenderness. Eighty-two patients (83.67%) had increased white blood cell (WBC) count. Patients admitted to the surgery department had the longest preoperative preparation time, followed by those in the department of internal medicine and department of obstetrics and gynecology, although the difference was not significant(P=0.723). The WBC count was not significantly different among patients admitted to the three departments(P=0.653). In addition, it was not significantly different between 28 patients complicated with peritonitis and 70 patients without peritonitis (P=0.648). The incidence of peritonitis in patients admitted to different departments was not significantly different(P=0.542).  Conclusions  The departments where the patients visit do not affect the prognosis of acute appendicitis. However, the relations of prognosis with the preoperative preparation time, triage, and WBC count require more trials with larger sample sizes.
Abstract:
  Objective  To analyze the chief complaints of patients with systemic lupus erythematosus (SLE) presenting to emergency department (ED).  Methods  The chief complaints of 200 patients with SLE who admitted to the ED in our hospital from September 2009 to January 2013 were retrospectively analyzed. Clinical data queried included:the number and distribution of chief complaint symptoms, the chief complaint symptoms of the untreated patients with SLE, and the causes of fever.  Results  Two different symptoms were most commonly reported at presentation to the ED (47.5%, 95/200), with fever being the most common (58%, 116/200). Other common symptoms involved the central nervous system (38.5%, 20/52), respiratory system (23.1%, 12/52), and digestive system (19.2%, 10/52) were prone to be complicated with fever. The most common cause of fever was lupus activity in untreated patients with SLE (78.8%, 26/33) and infection in patients with SLE exacerbation (69.9%, 58/83). In patients with infection-induced fever, the most common location of infection was respiratory system (81.5%, 53/65).  Conclusion  SLE patients admintted to ED have a variety of chief complaints, which should be carefully distinguished for particular features during the diagnosis.
Abstract:
  Objective  To evaluation the airway management effect of mechanically ventilation patients at offline stage with the implementation of T tube warming humidification.  Methods  Sixty critically ill patients using mechanical ventilation and meeting the offline indications after treatment were randomly assigned to receive humidification with T tube (control group, 30 cases) or warming humidification with T tube (study group, 30 cases). The control group used T tube connected with the adjustable infusion device to control the humidification fluid velocity, whereas the study group used a heater placed at adjustable infusion set 10 cm from T tube to maintain the heat and humidity. Patients were observed for sputum viscosity, irritating cough, airway bleeding, phlegm scab formation, success rate of extubation, oxygen saturation, and average time with endotracheal intubation.  Results  Compared with the control group, the study group had significantly decreased sputum viscosity(P=0.03), irritating cough (P=0.04), airway bleeding (P=0.01), phlegm scab formation (P=0.02), increased oxygen saturation (P=0.03), and shorter average time with endotracheal intubation (P=0.01). The success rate of extubation between two groups had no significant difference (P=0.44).  Conclusion  T tube warming humidification in mechanically ventilated patients at offline stage can achieve good airway management by reducing airway irritation, decreasing sputum production, and enhancing the effectiveness of oxygen therapy.
Abstract:
  Objective  To construct a cancer-specific magnetic resonance contrast agent targeting C-X-C motif chemokine receptor 4 (CXCR4) on cancer cell surface and to discuss its ability to quantify the CXCR4 expression level of various cancer cells in vitro through the changes of magnetic resonance (MR) signal.  Methods  Cellular immunofluorescence and flow cytometry assays were introduced to observe CXCR4 expression pattern and to quantify CXCR4 expression level in 3 different cancer cell lines (pancreatic cancer cell line PANC-1, breast cancer cell line MCF-7, and lung cancer cell line A549), respectively. By replacing the CXCR4 monoclonal antibody with a novel peptide, Pep12, we carried out these experiments again in the same condition, to prove its ability to bind to CXCR4 specifically. Ultrasmall paramagnetic iron oxide nanoparticle(USPIO-Np) was synthesized de novo and conjugated to Pep12 after surface modification. Dynamic light scattering (DLS) method was introduced to measure its hydro diameter, MTS assay was performed to test its cell toxicity, and 1.5T MR scan were carried out to evaluate the T2/T2* signal changes. Prussian blue staining was introduced to observe the binding pattern of Pep12-USPIO to 3 cancer cell lines, and MR scanning of cells cultured with Pep12-UPSIO were done to evaluate its ability to quantify the CXCR4 expression level on different cancer cells by T2/T2* signal changes.  Results  CXCR4 expression was observed in different patterns and levels in all 3 cancer cell lines. Flow cytometry showed that the CXCR4 positive cell proportions were 18.7% in PANC-1, 2.9% in A549, and 1.7% in MCF-7, respectively. Pep12 was able to bind to all 3 cancer cell lines specifically in a CXCR4 level dependent manner (r=0.999, P=0.027). Pep12-USPIO formed stable aqueous colloid in PBS/water under room temperature. The hydro diameter was (86.60±1.48) nm. The cytoxicity of Pep2-USPIO was low. When the concentration of iron was less than 25 μg/ml, the values of △R2 and △R2* were in line with concentration of iron (△R2:R2=0.996;△R2*:R2=0.977). Prussian blue stain showed pep12-USPIO was bound to PANC-1, A549, and MCF-7 cells, while USPIO alone could not. PANC-1, A549, and MCF-7 cells were incubated with Pep12-USPIO/USPIO, and underwent MR scan. A significant T2/T2* signal dropdown was observed in Pep12-USPIO-incubated cell suspension, while USPIO-incubated cell suspension only had slight T2/T2* signal change(P < 0.01). The value of △R2/△R2* change had positive correlation with the expression level of CXCR4 in those tumor cells(△R2:r=0.997, P=0.050; △R2*:r=1.000, P=0.019).  Conclusions  Pep12-USPIO is stable and hypotoxic. It can specifically bind to CXCR4-expressing cancer cells and produce MR signal change. The value of T2/T2* change may be used for the prediction of CXCR4 expression.
Abstract:
  Objective  To study the methodological factors that influence the application of virtual touch tissue quantification (VTQ) technique in chronic kidney disease (CKD).  Methods  A total of 62 CKD patients who underwent kidney biopsy in Peking Union Medical College Hospital between September 2011 and April 2012 were enrolled in this study. Under the same positions, the tissue shear wave velocity (SWV) of left kidney cortex and spleen parenchyma at the same depth were measured with VTQ technique for 15 times, respectively. The coefficient of variation (CV) was calculated to identify the variability of measurements. With regard to repetition number, measuring depth, pathologic etiology, and CKD stage, their impacts on CV were analyzed and compared between kidney and spleen.  Results  The CV level did not reduce when the number of measurements increased (P > 0.05), while the stability of mean value of SWV was improved (P=0.000). Kidney CV had a significantly positive correlation with the depth of measurement (r=0.370, P=0.003), while such a tendency was not observed in spleen (P > 0.05). Spearman analysis indicated that neither CKD stage nor pathologic etiology showed a significant correlation with kidney CV level (P > 0.05).  Conclusion  When VTQ technique is applied to measure the renal tissue elasticity, more standardized methodologies should be developed to improve the stability of measurement results.
Abstract:
  Objective  To investigate the strategy of diagnosis and surgery for intrathyroidal parathyroid lesions in patients with primary hyperparathyroidism.  Methods  The clinical data of patients with primary hyperparathyroidism who had undergone parathyroidectomy between September 2003 and September 2012 in Peking Union Medical College Hospital were retrospectively analyzed for intrathyroidal parathyroid lesions.  Results  Of 547 patients who had received surgical treatment due to primary hyperparathyroidism, 7(1.28%) were confirmed to be with intrathyroidal ectopic parathyroid by intraoperative exploration and postoperative pathology. Preoperative high-calcium crisis was noted in one of these seven cases. Ultrasound evaluation revealed lesion in thyroid in all seven patients before operations, and parathyroid was considered in five patients. 99Tcm methoxyisobutylisonitrile(99Tcm MIBI) single photon emission computed tomography (SPECT) was performed preoperatively in 6 patients, among whom 5 were found to be with abnormally hyperdense areas. Cervical computed tomography (CT) revealed intrathyroidal round-like lesions in 5 patients, although whether it was ectopic parathyroid could not be confirmed. Pathologic examinations of the resected lesions revealed adenoma (n=4), adenocacinoma (n=2), and hyperplasia (n=1). No relapse was noted after surgery. One patient who had repeatedly received three parathyroid surgeries developed mild hoarseness after the surgeries.  Conclusions  Intrathyroidal parathyroid lesions in patients with primary hyperparathyroidism are rare conditions and therefore their preoperative diagnoses can be challenging. Multiple localization techniques should be employed to improve the surgical effectiveness and increase the accuracy of localization.
Abstract:
  Objective  To analyze the correlation of arterial blood gas with pulmonary CT scan image after sustained inflation (SI) with the attempt to explore the optimal recruitment maneuvers (RMs) in acute respiratory distress syndrome.  Methods  Dynamic pulmonary CT scan was performed to monitor the intrapulmonary gas volume and distribution during increment and decrement of airway pressure gradually in 10 warm-saline-lavaged New Zealand rabbits. CT scan was analyzed by Images-J software. In order to explore optimal airway pressure for opening lung and optimal positive end-expiratory pressure (PEEP) for maintaining lung open, five different SIs were implemented individually and randomly, and rabbits' arterial blood gases were measured in 2 and 20 minutes after every SI. Pulmonary CT scan and PaO2 under different airway pressure were combined to be analyzed.  Results  After different airway pressure of SI and equal PEEP ventilation, PaO2 was increased accompanied with airway pressure of SI both in 2 and 20 minutes after RMs (P < 0.05). When PaO2 was combined with CT images, we found PaO2 was positively correlated with the volume partition of normal aeration region (r=0.597, P=0.001), negatively correlated with the insufficient aeration region (r=-0.592, P=0.001) and nonaeration region (r=-0.475, P=0.012), while not correlated with the overdistension region (r=0.202, P=0.311). While after equal airway pressure of SI and different PEEP ventilation, the difference of PaO2 was not significant in 2 minutes after RMs (P>0.05), and PaO2 was increased accompanied with PEEP in 20 minutes (P < 0.05). In this situation, we found PaO2 was positively correlated with the volume partition of normal aeration region (r=0.635, P=0.000), negatively correlated with the insufficient aeration region (r=-0.609, P=0.000) and nonaeration region (r=-0.544, P=0.002), while not correlated with the overdistension region (r=0.058, P=0.762).  Conclusions  High airway pressure is needed for opening up the lung and keeping the lung open. Arterial oxygenation is determined by the volume partition of normal aeration region after SI.
2013, 4(3): 221-223. doi: 10.3969/j.issn.1674-9081.2013.03.001
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The objective of the study was to design and implement the emergency information system based on cognitive task analysis. Firstly, we carried out a survey on the current information systems in the emergency department in our hospital to identify the needs and key issues in the development of emergency information system. Secondly, based on cognitive task analysis, we tried to identify the key links during the emergency services as well as the potential measures that are able to improve the healthcare efficiency and protect patients' safety. Finally, we successfully completed the design of the emergency information system. Results showed that the currently available emergency department information system had gradually been out-of-dated and needed improvement. By thoroughly analyzing the core needs of the emergency services, we found the key issues to be addressed in the new information system and developed the new architecture of emergency information system in our hospital. The emergency department has unique features and needs supports from a more sophiscated information system. In our current study, we successfully developed a new information system that is suitable for emergency services based on cognitive task analysis.
2013, 4(3): 233-237. doi: 10.3969/j.issn.1674-9081.2013.03.003
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2013, 4(3): 332-333. doi: 10.3969/j.issn.1674-9081.2013.03.024
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