Chinese Critical Care Medicine, December 2003, Vol.15,No.12
PAGE: 707
Strengthen the study of emergency medical system on disaster and incident
LI Tan-shi, HUANG Zhi-qiang
The General Hospital of People’s Liberation Army, Beijing 100853, China
PAGE：710
Measure on medicial care and rescue for the first Chinese astronaut during manned space flight
YUE Mao-xing， ZOU De-wei, ZHANG Jian, LIU Zhi-guo, CUI Shao-jie, FANG Wei-wu, ZHOU Xue-feng, GAO Tie-shan, HUA Nan
, http://www.100md.com
306 th Hospital of the People's Liberation Army, Beijing 100101, China
OBJECTIVE: To discuss the experience of medical care and rescue for the first Chinese astronaut during manned space flight. METHODS: Review the experiences of foreign nations in respect to accidental injuries of astronaut during manned space flight, the possible reasons were analyzed, and accordingly a reasonable and effective prophylactic measures and health care were formulated. RESULTS: An effective mobile intensive care unit (ICU) was established on desert or prairie where the capsule would land, so as to ensure the safety of the first Chinese astronaut, and to provide intensive care as well as successful emergency treatment in case of accidental injuries. CONCLUSION: Reasonable and effective prophylactic measures and health care appear to be an important aspect of the successful manned space flight.
, 百拇医药
PAGE：715
Biologic significance of neurofilament protein expression in scar tissue
CHENG Biao, FU Xiao-bing, SHENG Zhi-yong, SUN Tong-zhu
The Key Laboratory of Wound Repairement, People's Liberation Army, 304 th Hospital, Beijing 100037, China
OBJECTIVE: To investigate the situation of neurofilament protein (NFP) and epidermal growth factor receptor (EGFR) staining in scars and normal human skin, and attempt to explain the etiology of scarring formation. METHODS: The samples of scar were obtained from post-burn (11-26 months) patients undergoing plastic operation in our burn unit recently, and the samples of control came from skin donor site of the same patient correspondingly. Immunohistochemistry staining technique was employed to examine the protein expression in scars and skin. The expression of neurofilament protein (NFP-200) and EGFR in hyperplastic scars (n=12) and normal human (n=12) were investigated with light microscope. RESULTS: The expression of NFP-200 and EGFR in hyperplastic scars were much higher than that in normal human skin,and NFP-200 immuno-reaction nerve fibers were progressively stronger with scarring formation, then were gradually reduced with scarring maturation. The change of EGFR expression was similar to NFP-200 expression. CONCLUSION: These studies are undertaken to elucidate the relationship between scars formation and nerve reinnervation in cutaneous cells. The activity of EGFR might be associated with the nerve reinnervation. The expression of EGFR influence on wound healing. Therefore, neuroregulation might play a role in the pathogenesis of scars.
, http://www.100md.com
PAGE：718
Clinical significance of detection of serum hyaluronic acid concentration in severe burn patients
JIANG Du-yin, ZHOU Bing, FU Xiao-bing
Research Department of Burn of Wound and Plastic Institute, the Fourth People's Hospital, Taizhou 225300, Jiangsu, China
OBJECTIVE: To study the relationship between the changes in serum hyaluronic acid (HA) concentrations and injury of hepatocytes in severe burn patients. METHODS: Radioimmunoassay and emzyme-linked immunosorbent assay (ELISA) were used to detect HA and tumor necrosis factor-α(TNF-α) concentrations in serum, and biochemical indexes for hepatic function and renal function in burn patients that were divided into different groups: systemic inflammatory response syndrome(SIRS),multiple organ dysfunction syndrome(MODS)， multiple organ failure(MOF) and non-surviving patient groups. RESULTS: In two weeks after burns, the serum HA concentration attained a high level. With the increase of severity of disease, the values of the serum HA concentration were elevated progressively (P<0.001). At the onset of MOF till death, the serum HA content was rapidly decreased. Lineal correlation analysis indicated that the change in the serum HA concentration was closely correlated with SIRS, burn sepsis, MODS and death (P<0.01). It was positively correlated with TNF-α, aspartate aminotransferase (AST) and total bilirubin (P<0.05 or P<0.01), and negatively correlated with plasma albumin and albumin/globulin(both P<0.05). CONCLUSION: The increment in serum HA levels is relate with the impairment of the hepatic endothelial cells due to TNF-α etc. The HA content in serum can be used as a sensitive indicator for judging injury of liver, seriousness of the injury, and prognosis of the patient.
, 百拇医药
PAGE：721
Treatment for a case of hepatorrhexis-induced hemorrhage
HOU Jing-dong, ZHANG Xiang-dong, WANG Kun
Department of Anesthesiology, Jining First Hospital, Jining 272011, Shangdong, China
PAGE: 722
Primary research of the effect of intestinal ischemia/reperfusion injury on Leptin concentrations
, http://www.100md.com
LIN Ji, YAN Guang-tao, HAO Xiu-hua, ZHANG Kai, WANG Lu-huan, XUE Hui
Research Laboratory of Biochemistry, Basic Medical Institute, General Hospital of People's Liberation Army, Beijing 100853, China
OBJECTIVE: To explore the effect of intestinal ischemia/reperfusion injury on Leptin concentrations in serum and adipose tissue, and to find out the role of Leptin in acute inflammatory responses. METHODS: An intestinal ischemia-reperfusion injury model of rats was established, and used a highly-sensitive murine Leptin radioimmunoassay to check the change of Leptin concentrations in serum and adipose tissue. RESULTS: Serum Leptin level(10.82±0.83)μg/L significantly decreased after an injury of 60-minute ischemia and 30-minute reperfusion versus pre-experimental serum levels (16.46±3.21)μg/L; Leptin level in serum was higher than that in adipose tissue (4.46±2.63)mg/100 g, and they both showed a similar changeable trend to increase step by step as reperfusion time extended(P=0.047). CONCLUSION: Leptin may be an inflammatory cytokine and may play a role in inflammatory responses such as intestinal ischemia/reperfusion.
, http://www.100md.com
PAGE：726
Localization and role of dendritic cells in rat kidney with renal ischemia/ reperfusion injury
SUN Gui-zhi, ZHOU Tong, ZHANG Yu-mei, ZHANG Dong-qing, CHEN Yu-ying， HU Qing-shen, CHEN Nan
Department of Nephrology, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China
OBJECTIVE: To investigate the localization and the role of dendritic cells (DCs) in rat kidney with renal ischemia/reperfusion injury, and to explore the effect of anti-P-selectin Lectin-epidermal grouth factor (EGF) domain monoclonal antibody (PsL-EGFmAb) on DCs. METHODS: ①Rat model of renal ischemia/reperfusion was established and rats were divided into treated group with PsL-EGFmAb(n=20) and untreated group(n=20), which included four sub-groups repectively according to reperfusion time (1-hour,3-hour, 6-hour, 24-hour), sham group(n=5) severed as control. CD1a+CD80+DC was observed with microscopy images method and P-selectin was analysed with immunohistochemistry. RESULTS: ①In renal tissues of untreated group, CD1a+CD80+DC was found in renal tubules, interstitium and vessels, especially in renal tubules and interstitium, but DCs were hardly observed in sham group(P<0.001). The number of CD1a+CD80+DC in 24-hour group was greater than those in other groups(P<0.01). The number of DCs was positively associated with blood uria nitrogen and serum creatinine (both P<0.05). ②P-selectin content was increased significantly after ischemia/reperfusion 1 hour. ③The contents of DC and P-selectin were decreased after treated(P<0.05 and P<0.01) in rat renal tissues. CONCLUSION: DCs play an important role in immune pathogenesis after renal ischemia/reperfusion injury, which is related to renal immigration of DCs mediated by P-selectin. PsL-EGFmAb may inhibit local DCs immigration and accumulation in kidney.
, http://www.100md.com
PAGE：730
Application of non-invasive hemodynamic monitoring on high-risk surgical patients in the early stages after emergency admission
LU Jun-qiang, LI Chun-sheng, YANG Jia-yong， Jay Zhu, Charles Wo， William C. Shoemaker
Shenzhen Nanshan Hospital, Shenzhen 51805
OBJECTIVE: Pulmonary artery (PA) catheterization monitoring (Swan-Ganz) is usually not available to critically high-risk surgical patients before admission to ICU, where action to correct values derived from such monitoring may be too late. To explored the effect of non-invasive monitoring systems that allow hemodynamic monitoring during the early stages after trauma. METHODS: The early temporal hemodynamic patterns after high-risk trauma with non-invasive monitoring systems were evaluated, and compared these to invasive PA monitoring. The study included 156 patients monitored shortly after admission to the emergency department. RESULTS: The non-invasive impedance cardiac output estimations under extenuating emergency conditions were similar to those of the thermodilution method: r=0.69, r2=0.87, P<0.001; bias and precision were (0.62±0.38)L· min-1·m-2. In ICU, these values improved further to: r=0.84, r2=0.93, P<0.001; bias and precision were(0.36±0.15)L·min-1·m-2. Monitoring revealed episodes of hypotension, low cardiac index, arterial hemoglobin desaturation, low transcutaneous oxygen and high transcutaneoua carbon dioxide tension, and low oxygen consumption during initial resuscitation. Low flow and poor tissue perfusion were more pronounced in non-survivors by both METHODS. CONCLUSION: Multicomponent non-invasive monitoring systems offer continuous on-line, real-time display of hemodynamic data， they allow early recognition of circulatory dysfunction. Such systems provide information similar to that provided by the invasive themodilution method, and are more effective and safer.
, 百拇医药
PAGE：734
Clinical research on the trans-mouth tracheal cannula technic of intensive patient with consloushess
TIAN Yue-qiang
Department of Emergency, General Hospital of People’s Liberation Army, Beijing 100853, China
PAGE：735
Escharectomy during burn shock stage on Th1/Th2 polarization of helper T lymphocytes in rats after thermal injury
, http://www.100md.com
PANG Wei，SHUAI Xiu-rong，GUO Zhen-rong，YAO Yong-ming，SUN Dan，YANG Li-hongBurn Center of Secondary Artillery General Hospital of People's Liberation Army, Beijing 100088, China
OBJECTIVE: To determine the type-1/type-2 cytokine response of helper T lymphocytes after thermal injury, and to investigate the effects of escharectomy during burn shock stage on the polarization of Th cells. METHODS: One hundred and sixty male Wistar rats were randomized into four groups. In group A, animals were subjected to a 30 percent full-thickness thermal injury without escharectomy. In groups B, C and D, escharectomy and skin allograft were done at 8, 24, and 96 hours postburn, respectively. At 4, 12, 24, 48, 96, 120 and 168 hours postburn, animals were killed and bloods samples as well as spleens were harvested. Enzyme linked immunoadsorbent assay (ELISA) was applied to determine interferon-γ (IFN-γ) and interleukin-4(IL-4) levels in blood and spleen tissues. RESULTS: Levels of IFN-γ and IL-4 rapidly and significantly were increased after scald injury. IFN-γ levels began to rise within 4 hours postburn, peaking at 24 hours later. IL-4 showed a persistent elevation up to 168 hours postburn, thereby leading to a dominant tendency of Th2 cytokine response on postburn day 7. In group A, all above parameters revealed most obvious changes compared with controls, then ranked in group D, B and C. CONCLUSION: Escharectomy during burn shock stage is helpful to prevent the shift to Th2 cell response after severe thermal injury.
, http://www.100md.com
PAGE：738
Hemoper Fusion in the treatment of 411 acute oral organophosphate poisoning patients
ZHANG Xiu-fang, TANG Wen-hua, GUO Guang-qin
Emergency Department, gaotang people’s hospital, shangDong Province, shangdong 252800, China
PAGE：739
Fluid resuscitation in traumatic shock
FU Wei-jun, TENG Qing-shan, LI Tan-shi, ZHOU Bao-lin
, 百拇医药
Department of Emergency, General Hospital of People's Liberation Army, Beijing 100853, China
OBJECTIVE: To investigate fluid resuscitation affecting the result of treatment of patients with traumatic shock. METHODS: Two hundred and fifty-six cases of patients with traumatic shock treated in our hospital between January 1989 and December 2002 were analysed retrospectively, and the volume-effect relationship between fluid resuscitation during the first hour and future of traumatic shock was summarised. RESULTS: The successful rate of resuscitation was 73.05 percent (187 cases), and traumatic mortality was 26.95 percent (69 cases). After 1-hour trauma, the survival rate was 52.27 percent in patients with 1 liter of resuscitation fluid, 75.90 percent in patients with 15-20 liter of resusictation fluid, and 78.29 percent of more than 20 liter resuscitation fluid, 86.79 percent in mild shock, 80.34 percent in middle shock and 54.65 percent in severe shock. CONCLUSION: Severe trauma and shock, hypotension and incorrect resuscitation manipulation are the main factors affecting the result of resuscitation and treatment of traumatic shock. It is important to early and correctly expand, especially at the first hour. The aim of resuscitation of traumatic shock is to maintain the hemodynamics and correct O.2 defect.
, 百拇医药
PAGE：742
Comparison of serum Leptin clearance with different blood purification
LOU Tan-qi, YOU Yu-ping, CHEN Zhu-jiang, SHI Cheng-gang, LIU Xun, TANG Hua
The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
OBJECTIVE: To compare the serum Leptin clearance efficiency with different blood purification treatment. METHODS: Thirty-one chronic end-stage renal failure hemodialysis (HD) patients 〔16 men, 15 women, mean age (54.0±11.0) years〕 were enrolled into the study. All the patients were treated with routine hemodialysis, the serum Leptin levels were examined before and after HD. Then they were divided into two groups, one was to be treated with hemodiafiltration (12 patients), and the other was to be treated with blood adsorption (8 patients). The same serum Leptin levels were examined before and after treatment. Serum Leptin concentration was detected by radioimmunoassay (RIA). RESULTS: The concentration of serum Leptin was not significantly decreased after routine hemodialysis in HD patients 〔(11.820±5.507)μg/L vs. (12.255±5.172)μg/L， P>0.05〕. Leptin concentrations after hemodiafiltration and blood adsorption therapy were decreased to the levels of (29.07±8.56) percent and (40.29±8.33) percent respectively, and their curative effect was significantly different (P=0.001). CONCLUSION: Routine hemodialysis can influence serum Leptin levels in HD patients. Hemodiafiltration and blood adsorption therapy can lower serum Leptin levels. Blood adsorption therapy is better than hemodiafiltration in the clearence of serum Leptin.
, 百拇医药
PAGE：745
Development and its clinical application of an acid-base balance computer software
XIE Xiao-qian, CHEN Jian-rong, LI Min, CAI Ying-yun
Second Affiliated Hospital of Nantong Medical College, Nantong 226001, Jiangsu, China
OBJECTIVE: To develop acid-base balance computer software for estimating acid-base disturbance rapidly and accurately. METHODS: The data module was set up, based on Henderson-Hasselbalch (H-H) and compensation formula, and the program was written with Delphi 5.0. RESULTS: The right RESULTS was 100.0 percent in 118 cases of acid-base disturbance patients by the software, while those with the right RESULTS was 89.8 percent by hands (P<0.05). In 20 cases pure acid-base disturbance, 70 cases double acid-base disturbance and 28 cases with triple acid-base disturbance, it took only (9.0±0.6)seconds， (8.9±1.3) seconds and (9.1±1.6)seconds respectively, with software, while which were much less than those by hands 〔(20.4±16.8) seconds, (92.4±45.3) seconds and (128.6±66.4) seconds, respectively, P<0.001〕. CONCLUSION: This software has a terse interface, by which the acid-base disturbance was concluded exactly and quickly.
, 百拇医药
PAGE：748
Carbachol alleviates inflammation in gut tissue during ischemia/reperfusion in rats
HU Sen, JIANG Xiao-guo, SHI De-guang, LU Yi, LI Jun-you, SUN Dan, SHENG Zhi-yong
Burns Institute, 304 th Hospital, Beijing 100037, China
OBJECTIVE: To investigate the effects of carbachol on local inflammation in gut tissue during ischemia/reperfusion (I/R). METHODS: A jejunal sac was formed in Wistar rats. The superior mesenteric artery was occluded (SMAO) for 60 minutes followed by reperfusion for another 60 minutes. Animals were divided into three groups, pretreatment group (carbachol was injected into the jejunal sac 30 minutes after SMAO, 0.1 mg/kg), treatment group (carbachol was injected in same dosage into the jejunal sac 30 minutes after reperfusion), and controls (saline injection). The contents of tumor necrosis factor-α(TNF-α) and activity of myeloperoxidase (MPO) in gut tissue were determined at 1 hours, 2.5 hours and 6 hours after SMAO. RESULTS: The contents of TNF-α and activity of MPO were significantly decreased in pretreatment and treatment groups compared with control group at 2.5 hours after SMAO (both P<0.05 ). There were no differences in both contents between pretreatment group and treatment group at any specified time. It was also found that there were less inflammatory pathological changes in the gut tissues in the two treated groups than that of control. CONCLUSION: The RESULTS suggest that carbachol could alleviate gut inflammatory response during gut ischemia/reperfusion injury by inhibiting proinflammatory cytokine release.
, 百拇医药
PAGE：751
Study on the relationship between changes of adrenomedulin in plasm and vascular resistance during traumatic shock in rats
SUN Gao-bin, HUANG Zong-hai， LI Zhou， SONG Hui-juan， TAO Wei-guo, LONG JunDepartment of General Surgery, First Military Medical University, Guangzhou 510280, Guangdong, China
OBJECTIVE: To observe the changes of adrenomedulin in plasm and vascular resistance during traumatic shock in rats. METHODS: The concentration of adrenomedulin in plasm of rats after traumatic shock was detected by radio immunization. Mean arterial pressure, total peripheral vascular resistance (TPVR) and cardiac index (CI) were estimated by electrical conductance method. RESULTS: The concentration of adrenomedulin in plasm of traumatic shock without resuscitation group(68.34±3.71)ng/L and traumatic shock with resuscitation group (146.27±9.83)ng/L were higher than that of control group(32.63±7.55)ng/L (P<0.01 and P<0.05). TPVR of traumatic shock with resuscitation group (10.57±0.35) kPa·s·L-1 was lower than that of traumatic shock without resuscitation group (16.75±0.23) kPa·s·L-1(P<0.01) and its CI (215.59±1.29) ml·min-1·kg-1 was higher than that of traumatic shock without resuscitation group (143.11±0.86) ml·min-1·kg-1 (P<0.01). CONCLUSION: Adrenomedulin is closely correlated with changes of vascular resistance and plays an important role during pathophysiological processes in rats after traumatic shock.
, http://www.100md.com
PAGE：754
Role of activation of renin angiotensin system in cyclosporine A nephropathy
ZHANG Guo-hua, ZHANG Xun, HOU Fan-fan, WANG Li
Department of Nephrology, Nanfang Hospital, The First Military Medical University, Guangzhou 510515, Guangdong, China
OBJECTIVE: To investigate the role of renin angiotensin system (RAS) activation in cyclosporine A nephropathy. METHODS: Rats were fed with low salt diet. After seven days, they were randomly divided into four groups: vehicle (n=7), CsA treated (n=7), CsA+verapamil (n=7), CsA+enalapril (n=7). All rats except vehicle received a daily subcutaneous injection of CsA (15 mg/kg) for four weeks. Plasma and renal tissue angiotensinⅡ(Ang Ⅱ) levels were measured by radioimmunoassay. The expression of angiotensin Ⅱtype 1 receptor (AT1R) was examined by Northern blot. RESULTS: Plasma and renal tissue angiotensin Ⅱ levels were significantly elevated in CsA treated rats when compared to that in vehicle rats〔(190±36)ng/L vs. (492±92)ng/L, (29.8±6.0)ng/g vs. (8.7±1.7)ng/g, P<0.001〕. Enalapril reduced angiotensin Ⅱ levels significantly (both P<0.05). The expression of AT1R mRNA was down-regulated by CsA, this down-regulation was reversed by enalapril. CsA treated animals showed marked tubulointerstitial fibrosis, enalapril lessened the tubulointerstitial fibrosis significantly (P<0.05). Verapamil did not improve tubulointerstitial fibrosis significantly(P>0.05). CONCLUSION: RAS activation plays an important part in CsA nephropathy. Blockade of RAS may retard the progression of tubulointerstitial fibrosis caused by CsA.
, http://www.100md.com
PAGE：758
Value and economic analysis of emergency endoscopy in the diagnosis and treatment of massive upper gastrointestinal hemorrhage
GAN Ai-hua, XU An-gao, LING Hong, CHEN Hui-xin, ZHANG Yu-ming, TONG Zhi-yong, ZHONG Xu-hui, XU Yong-cheng
Department of Digestion, Huizhou Municipal Central Hospital, Huizhou 516001, China
OBJECTIVE: To study the application value of emergency endoscopy in the diagnosis and treatment of massive upper gastrointestinal hemorrhage, and to evaluated by the economic analysis whether the emergency endoscopy was safe and effective,or shorten the hospitalization days and reduced the medical costs. METHODS: Ninty-one patients with massive upper gastrointestinal hemorrhage were randomly divided into emergency endoscopy group (group A) and non-emergency endoscopy group (group B).The patients in group A were endoscopied as soon as the blood pressures were normal and the patients of group B were endoscopied at 24-48 hours after hospitalization. They would be treated depending on the conditions by endoscopy. Then the correct diagnosis rates, rebleeding rates, complication rates, mean hospitalization days, the endoscopy costs, the blood transfusion costs, the drugs costs and the total hospitalization costs of two groups were evaluated and the cost-effect ratio(C/E) was calculated. RESULTS: The correct diagnosis rates and the endoscopy costs of group A were higher than the group B 〔100.0 percent vs.90.2 percent, P<0.05; (714.78±263.54) yuan vs. (383.57±251.72)yuan, P<0.01〕, and the rebleeding rates, the mean hospitalizations days, the blood transfusion costs and the drugs costs and the total hospitalization costs were all lower compared to the group B 〔6.1 percent vs. 26.8 percent, P<0.05; (5.42±1.70)days vs. (8.51±2.30)days, P<0.01;(791.80±258.35)yuan vs. (1270.29±569.21)yuan, P<0.01；(945.22±125.82)yuan vs. (1223.81±254.44)yuan, P<0.01；(2785.76±353.26)yuan vs. (3 527.76±555.62)yuan, P<0.01. The C/E of group A was lower than the group B 〔2785.76 yuan per patient vs. 3527.76 yuan per patient, P<0.01〕.CONCLUSION: Emergency endoscopy is not only safe and effective but also economical in the diagnosis and treatment of massive upper gastrointestinal hemorrhage.
, 百拇医药
PAGE：762
Dynamic change of vascular active materials and inflammatory mediums after acute organophosphate poisoning and its clinical significance
ZHANG Zai-qi, LIANG Ren, HUANG Tao, YANG Hua-xi, PENG Wei, LI Feng, YIN Fu-rong, YI Gao, WANG Cheng-zhi
Huaihua the Second Hospital, Hongjiang 418200, Hunan, China
PAGE：764
Application of continuous reral replacement therapy in patients with acute renal failure and multiple organ dysfunction syndromes
YANG Yong-ming, LIU Guan-xian, ZHONG Wei-qiang, CHEN Wei-ling
Central People Hospital, Huizhou 516001, Guangdong, China, 百拇医药
Strengthen the study of emergency medical system on disaster and incident
LI Tan-shi, HUANG Zhi-qiang
The General Hospital of People’s Liberation Army, Beijing 100853, China
PAGE：710
Measure on medicial care and rescue for the first Chinese astronaut during manned space flight
YUE Mao-xing， ZOU De-wei, ZHANG Jian, LIU Zhi-guo, CUI Shao-jie, FANG Wei-wu, ZHOU Xue-feng, GAO Tie-shan, HUA Nan
, http://www.100md.com
306 th Hospital of the People's Liberation Army, Beijing 100101, China
OBJECTIVE: To discuss the experience of medical care and rescue for the first Chinese astronaut during manned space flight. METHODS: Review the experiences of foreign nations in respect to accidental injuries of astronaut during manned space flight, the possible reasons were analyzed, and accordingly a reasonable and effective prophylactic measures and health care were formulated. RESULTS: An effective mobile intensive care unit (ICU) was established on desert or prairie where the capsule would land, so as to ensure the safety of the first Chinese astronaut, and to provide intensive care as well as successful emergency treatment in case of accidental injuries. CONCLUSION: Reasonable and effective prophylactic measures and health care appear to be an important aspect of the successful manned space flight.
, 百拇医药
PAGE：715
Biologic significance of neurofilament protein expression in scar tissue
CHENG Biao, FU Xiao-bing, SHENG Zhi-yong, SUN Tong-zhu
The Key Laboratory of Wound Repairement, People's Liberation Army, 304 th Hospital, Beijing 100037, China
OBJECTIVE: To investigate the situation of neurofilament protein (NFP) and epidermal growth factor receptor (EGFR) staining in scars and normal human skin, and attempt to explain the etiology of scarring formation. METHODS: The samples of scar were obtained from post-burn (11-26 months) patients undergoing plastic operation in our burn unit recently, and the samples of control came from skin donor site of the same patient correspondingly. Immunohistochemistry staining technique was employed to examine the protein expression in scars and skin. The expression of neurofilament protein (NFP-200) and EGFR in hyperplastic scars (n=12) and normal human (n=12) were investigated with light microscope. RESULTS: The expression of NFP-200 and EGFR in hyperplastic scars were much higher than that in normal human skin,and NFP-200 immuno-reaction nerve fibers were progressively stronger with scarring formation, then were gradually reduced with scarring maturation. The change of EGFR expression was similar to NFP-200 expression. CONCLUSION: These studies are undertaken to elucidate the relationship between scars formation and nerve reinnervation in cutaneous cells. The activity of EGFR might be associated with the nerve reinnervation. The expression of EGFR influence on wound healing. Therefore, neuroregulation might play a role in the pathogenesis of scars.
, http://www.100md.com
PAGE：718
Clinical significance of detection of serum hyaluronic acid concentration in severe burn patients
JIANG Du-yin, ZHOU Bing, FU Xiao-bing
Research Department of Burn of Wound and Plastic Institute, the Fourth People's Hospital, Taizhou 225300, Jiangsu, China
OBJECTIVE: To study the relationship between the changes in serum hyaluronic acid (HA) concentrations and injury of hepatocytes in severe burn patients. METHODS: Radioimmunoassay and emzyme-linked immunosorbent assay (ELISA) were used to detect HA and tumor necrosis factor-α(TNF-α) concentrations in serum, and biochemical indexes for hepatic function and renal function in burn patients that were divided into different groups: systemic inflammatory response syndrome(SIRS),multiple organ dysfunction syndrome(MODS)， multiple organ failure(MOF) and non-surviving patient groups. RESULTS: In two weeks after burns, the serum HA concentration attained a high level. With the increase of severity of disease, the values of the serum HA concentration were elevated progressively (P<0.001). At the onset of MOF till death, the serum HA content was rapidly decreased. Lineal correlation analysis indicated that the change in the serum HA concentration was closely correlated with SIRS, burn sepsis, MODS and death (P<0.01). It was positively correlated with TNF-α, aspartate aminotransferase (AST) and total bilirubin (P<0.05 or P<0.01), and negatively correlated with plasma albumin and albumin/globulin(both P<0.05). CONCLUSION: The increment in serum HA levels is relate with the impairment of the hepatic endothelial cells due to TNF-α etc. The HA content in serum can be used as a sensitive indicator for judging injury of liver, seriousness of the injury, and prognosis of the patient.
, 百拇医药
PAGE：721
Treatment for a case of hepatorrhexis-induced hemorrhage
HOU Jing-dong, ZHANG Xiang-dong, WANG Kun
Department of Anesthesiology, Jining First Hospital, Jining 272011, Shangdong, China
PAGE: 722
Primary research of the effect of intestinal ischemia/reperfusion injury on Leptin concentrations
, http://www.100md.com
LIN Ji, YAN Guang-tao, HAO Xiu-hua, ZHANG Kai, WANG Lu-huan, XUE Hui
Research Laboratory of Biochemistry, Basic Medical Institute, General Hospital of People's Liberation Army, Beijing 100853, China
OBJECTIVE: To explore the effect of intestinal ischemia/reperfusion injury on Leptin concentrations in serum and adipose tissue, and to find out the role of Leptin in acute inflammatory responses. METHODS: An intestinal ischemia-reperfusion injury model of rats was established, and used a highly-sensitive murine Leptin radioimmunoassay to check the change of Leptin concentrations in serum and adipose tissue. RESULTS: Serum Leptin level(10.82±0.83)μg/L significantly decreased after an injury of 60-minute ischemia and 30-minute reperfusion versus pre-experimental serum levels (16.46±3.21)μg/L; Leptin level in serum was higher than that in adipose tissue (4.46±2.63)mg/100 g, and they both showed a similar changeable trend to increase step by step as reperfusion time extended(P=0.047). CONCLUSION: Leptin may be an inflammatory cytokine and may play a role in inflammatory responses such as intestinal ischemia/reperfusion.
, http://www.100md.com
PAGE：726
Localization and role of dendritic cells in rat kidney with renal ischemia/ reperfusion injury
SUN Gui-zhi, ZHOU Tong, ZHANG Yu-mei, ZHANG Dong-qing, CHEN Yu-ying， HU Qing-shen, CHEN Nan
Department of Nephrology, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China
OBJECTIVE: To investigate the localization and the role of dendritic cells (DCs) in rat kidney with renal ischemia/reperfusion injury, and to explore the effect of anti-P-selectin Lectin-epidermal grouth factor (EGF) domain monoclonal antibody (PsL-EGFmAb) on DCs. METHODS: ①Rat model of renal ischemia/reperfusion was established and rats were divided into treated group with PsL-EGFmAb(n=20) and untreated group(n=20), which included four sub-groups repectively according to reperfusion time (1-hour,3-hour, 6-hour, 24-hour), sham group(n=5) severed as control. CD1a+CD80+DC was observed with microscopy images method and P-selectin was analysed with immunohistochemistry. RESULTS: ①In renal tissues of untreated group, CD1a+CD80+DC was found in renal tubules, interstitium and vessels, especially in renal tubules and interstitium, but DCs were hardly observed in sham group(P<0.001). The number of CD1a+CD80+DC in 24-hour group was greater than those in other groups(P<0.01). The number of DCs was positively associated with blood uria nitrogen and serum creatinine (both P<0.05). ②P-selectin content was increased significantly after ischemia/reperfusion 1 hour. ③The contents of DC and P-selectin were decreased after treated(P<0.05 and P<0.01) in rat renal tissues. CONCLUSION: DCs play an important role in immune pathogenesis after renal ischemia/reperfusion injury, which is related to renal immigration of DCs mediated by P-selectin. PsL-EGFmAb may inhibit local DCs immigration and accumulation in kidney.
, http://www.100md.com
PAGE：730
Application of non-invasive hemodynamic monitoring on high-risk surgical patients in the early stages after emergency admission
LU Jun-qiang, LI Chun-sheng, YANG Jia-yong， Jay Zhu, Charles Wo， William C. Shoemaker
Shenzhen Nanshan Hospital, Shenzhen 51805
OBJECTIVE: Pulmonary artery (PA) catheterization monitoring (Swan-Ganz) is usually not available to critically high-risk surgical patients before admission to ICU, where action to correct values derived from such monitoring may be too late. To explored the effect of non-invasive monitoring systems that allow hemodynamic monitoring during the early stages after trauma. METHODS: The early temporal hemodynamic patterns after high-risk trauma with non-invasive monitoring systems were evaluated, and compared these to invasive PA monitoring. The study included 156 patients monitored shortly after admission to the emergency department. RESULTS: The non-invasive impedance cardiac output estimations under extenuating emergency conditions were similar to those of the thermodilution method: r=0.69, r2=0.87, P<0.001; bias and precision were (0.62±0.38)L· min-1·m-2. In ICU, these values improved further to: r=0.84, r2=0.93, P<0.001; bias and precision were(0.36±0.15)L·min-1·m-2. Monitoring revealed episodes of hypotension, low cardiac index, arterial hemoglobin desaturation, low transcutaneous oxygen and high transcutaneoua carbon dioxide tension, and low oxygen consumption during initial resuscitation. Low flow and poor tissue perfusion were more pronounced in non-survivors by both METHODS. CONCLUSION: Multicomponent non-invasive monitoring systems offer continuous on-line, real-time display of hemodynamic data， they allow early recognition of circulatory dysfunction. Such systems provide information similar to that provided by the invasive themodilution method, and are more effective and safer.
, 百拇医药
PAGE：734
Clinical research on the trans-mouth tracheal cannula technic of intensive patient with consloushess
TIAN Yue-qiang
Department of Emergency, General Hospital of People’s Liberation Army, Beijing 100853, China
PAGE：735
Escharectomy during burn shock stage on Th1/Th2 polarization of helper T lymphocytes in rats after thermal injury
, http://www.100md.com
PANG Wei，SHUAI Xiu-rong，GUO Zhen-rong，YAO Yong-ming，SUN Dan，YANG Li-hongBurn Center of Secondary Artillery General Hospital of People's Liberation Army, Beijing 100088, China
OBJECTIVE: To determine the type-1/type-2 cytokine response of helper T lymphocytes after thermal injury, and to investigate the effects of escharectomy during burn shock stage on the polarization of Th cells. METHODS: One hundred and sixty male Wistar rats were randomized into four groups. In group A, animals were subjected to a 30 percent full-thickness thermal injury without escharectomy. In groups B, C and D, escharectomy and skin allograft were done at 8, 24, and 96 hours postburn, respectively. At 4, 12, 24, 48, 96, 120 and 168 hours postburn, animals were killed and bloods samples as well as spleens were harvested. Enzyme linked immunoadsorbent assay (ELISA) was applied to determine interferon-γ (IFN-γ) and interleukin-4(IL-4) levels in blood and spleen tissues. RESULTS: Levels of IFN-γ and IL-4 rapidly and significantly were increased after scald injury. IFN-γ levels began to rise within 4 hours postburn, peaking at 24 hours later. IL-4 showed a persistent elevation up to 168 hours postburn, thereby leading to a dominant tendency of Th2 cytokine response on postburn day 7. In group A, all above parameters revealed most obvious changes compared with controls, then ranked in group D, B and C. CONCLUSION: Escharectomy during burn shock stage is helpful to prevent the shift to Th2 cell response after severe thermal injury.
, http://www.100md.com
PAGE：738
Hemoper Fusion in the treatment of 411 acute oral organophosphate poisoning patients
ZHANG Xiu-fang, TANG Wen-hua, GUO Guang-qin
Emergency Department, gaotang people’s hospital, shangDong Province, shangdong 252800, China
PAGE：739
Fluid resuscitation in traumatic shock
FU Wei-jun, TENG Qing-shan, LI Tan-shi, ZHOU Bao-lin
, 百拇医药
Department of Emergency, General Hospital of People's Liberation Army, Beijing 100853, China
OBJECTIVE: To investigate fluid resuscitation affecting the result of treatment of patients with traumatic shock. METHODS: Two hundred and fifty-six cases of patients with traumatic shock treated in our hospital between January 1989 and December 2002 were analysed retrospectively, and the volume-effect relationship between fluid resuscitation during the first hour and future of traumatic shock was summarised. RESULTS: The successful rate of resuscitation was 73.05 percent (187 cases), and traumatic mortality was 26.95 percent (69 cases). After 1-hour trauma, the survival rate was 52.27 percent in patients with 1 liter of resuscitation fluid, 75.90 percent in patients with 15-20 liter of resusictation fluid, and 78.29 percent of more than 20 liter resuscitation fluid, 86.79 percent in mild shock, 80.34 percent in middle shock and 54.65 percent in severe shock. CONCLUSION: Severe trauma and shock, hypotension and incorrect resuscitation manipulation are the main factors affecting the result of resuscitation and treatment of traumatic shock. It is important to early and correctly expand, especially at the first hour. The aim of resuscitation of traumatic shock is to maintain the hemodynamics and correct O.2 defect.
, 百拇医药
PAGE：742
Comparison of serum Leptin clearance with different blood purification
LOU Tan-qi, YOU Yu-ping, CHEN Zhu-jiang, SHI Cheng-gang, LIU Xun, TANG Hua
The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
OBJECTIVE: To compare the serum Leptin clearance efficiency with different blood purification treatment. METHODS: Thirty-one chronic end-stage renal failure hemodialysis (HD) patients 〔16 men, 15 women, mean age (54.0±11.0) years〕 were enrolled into the study. All the patients were treated with routine hemodialysis, the serum Leptin levels were examined before and after HD. Then they were divided into two groups, one was to be treated with hemodiafiltration (12 patients), and the other was to be treated with blood adsorption (8 patients). The same serum Leptin levels were examined before and after treatment. Serum Leptin concentration was detected by radioimmunoassay (RIA). RESULTS: The concentration of serum Leptin was not significantly decreased after routine hemodialysis in HD patients 〔(11.820±5.507)μg/L vs. (12.255±5.172)μg/L， P>0.05〕. Leptin concentrations after hemodiafiltration and blood adsorption therapy were decreased to the levels of (29.07±8.56) percent and (40.29±8.33) percent respectively, and their curative effect was significantly different (P=0.001). CONCLUSION: Routine hemodialysis can influence serum Leptin levels in HD patients. Hemodiafiltration and blood adsorption therapy can lower serum Leptin levels. Blood adsorption therapy is better than hemodiafiltration in the clearence of serum Leptin.
, 百拇医药
PAGE：745
Development and its clinical application of an acid-base balance computer software
XIE Xiao-qian, CHEN Jian-rong, LI Min, CAI Ying-yun
Second Affiliated Hospital of Nantong Medical College, Nantong 226001, Jiangsu, China
OBJECTIVE: To develop acid-base balance computer software for estimating acid-base disturbance rapidly and accurately. METHODS: The data module was set up, based on Henderson-Hasselbalch (H-H) and compensation formula, and the program was written with Delphi 5.0. RESULTS: The right RESULTS was 100.0 percent in 118 cases of acid-base disturbance patients by the software, while those with the right RESULTS was 89.8 percent by hands (P<0.05). In 20 cases pure acid-base disturbance, 70 cases double acid-base disturbance and 28 cases with triple acid-base disturbance, it took only (9.0±0.6)seconds， (8.9±1.3) seconds and (9.1±1.6)seconds respectively, with software, while which were much less than those by hands 〔(20.4±16.8) seconds, (92.4±45.3) seconds and (128.6±66.4) seconds, respectively, P<0.001〕. CONCLUSION: This software has a terse interface, by which the acid-base disturbance was concluded exactly and quickly.
, 百拇医药
PAGE：748
Carbachol alleviates inflammation in gut tissue during ischemia/reperfusion in rats
HU Sen, JIANG Xiao-guo, SHI De-guang, LU Yi, LI Jun-you, SUN Dan, SHENG Zhi-yong
Burns Institute, 304 th Hospital, Beijing 100037, China
OBJECTIVE: To investigate the effects of carbachol on local inflammation in gut tissue during ischemia/reperfusion (I/R). METHODS: A jejunal sac was formed in Wistar rats. The superior mesenteric artery was occluded (SMAO) for 60 minutes followed by reperfusion for another 60 minutes. Animals were divided into three groups, pretreatment group (carbachol was injected into the jejunal sac 30 minutes after SMAO, 0.1 mg/kg), treatment group (carbachol was injected in same dosage into the jejunal sac 30 minutes after reperfusion), and controls (saline injection). The contents of tumor necrosis factor-α(TNF-α) and activity of myeloperoxidase (MPO) in gut tissue were determined at 1 hours, 2.5 hours and 6 hours after SMAO. RESULTS: The contents of TNF-α and activity of MPO were significantly decreased in pretreatment and treatment groups compared with control group at 2.5 hours after SMAO (both P<0.05 ). There were no differences in both contents between pretreatment group and treatment group at any specified time. It was also found that there were less inflammatory pathological changes in the gut tissues in the two treated groups than that of control. CONCLUSION: The RESULTS suggest that carbachol could alleviate gut inflammatory response during gut ischemia/reperfusion injury by inhibiting proinflammatory cytokine release.
, 百拇医药
PAGE：751
Study on the relationship between changes of adrenomedulin in plasm and vascular resistance during traumatic shock in rats
SUN Gao-bin, HUANG Zong-hai， LI Zhou， SONG Hui-juan， TAO Wei-guo, LONG JunDepartment of General Surgery, First Military Medical University, Guangzhou 510280, Guangdong, China
OBJECTIVE: To observe the changes of adrenomedulin in plasm and vascular resistance during traumatic shock in rats. METHODS: The concentration of adrenomedulin in plasm of rats after traumatic shock was detected by radio immunization. Mean arterial pressure, total peripheral vascular resistance (TPVR) and cardiac index (CI) were estimated by electrical conductance method. RESULTS: The concentration of adrenomedulin in plasm of traumatic shock without resuscitation group(68.34±3.71)ng/L and traumatic shock with resuscitation group (146.27±9.83)ng/L were higher than that of control group(32.63±7.55)ng/L (P<0.01 and P<0.05). TPVR of traumatic shock with resuscitation group (10.57±0.35) kPa·s·L-1 was lower than that of traumatic shock without resuscitation group (16.75±0.23) kPa·s·L-1(P<0.01) and its CI (215.59±1.29) ml·min-1·kg-1 was higher than that of traumatic shock without resuscitation group (143.11±0.86) ml·min-1·kg-1 (P<0.01). CONCLUSION: Adrenomedulin is closely correlated with changes of vascular resistance and plays an important role during pathophysiological processes in rats after traumatic shock.
, http://www.100md.com
PAGE：754
Role of activation of renin angiotensin system in cyclosporine A nephropathy
ZHANG Guo-hua, ZHANG Xun, HOU Fan-fan, WANG Li
Department of Nephrology, Nanfang Hospital, The First Military Medical University, Guangzhou 510515, Guangdong, China
OBJECTIVE: To investigate the role of renin angiotensin system (RAS) activation in cyclosporine A nephropathy. METHODS: Rats were fed with low salt diet. After seven days, they were randomly divided into four groups: vehicle (n=7), CsA treated (n=7), CsA+verapamil (n=7), CsA+enalapril (n=7). All rats except vehicle received a daily subcutaneous injection of CsA (15 mg/kg) for four weeks. Plasma and renal tissue angiotensinⅡ(Ang Ⅱ) levels were measured by radioimmunoassay. The expression of angiotensin Ⅱtype 1 receptor (AT1R) was examined by Northern blot. RESULTS: Plasma and renal tissue angiotensin Ⅱ levels were significantly elevated in CsA treated rats when compared to that in vehicle rats〔(190±36)ng/L vs. (492±92)ng/L, (29.8±6.0)ng/g vs. (8.7±1.7)ng/g, P<0.001〕. Enalapril reduced angiotensin Ⅱ levels significantly (both P<0.05). The expression of AT1R mRNA was down-regulated by CsA, this down-regulation was reversed by enalapril. CsA treated animals showed marked tubulointerstitial fibrosis, enalapril lessened the tubulointerstitial fibrosis significantly (P<0.05). Verapamil did not improve tubulointerstitial fibrosis significantly(P>0.05). CONCLUSION: RAS activation plays an important part in CsA nephropathy. Blockade of RAS may retard the progression of tubulointerstitial fibrosis caused by CsA.
, http://www.100md.com
PAGE：758
Value and economic analysis of emergency endoscopy in the diagnosis and treatment of massive upper gastrointestinal hemorrhage
GAN Ai-hua, XU An-gao, LING Hong, CHEN Hui-xin, ZHANG Yu-ming, TONG Zhi-yong, ZHONG Xu-hui, XU Yong-cheng
Department of Digestion, Huizhou Municipal Central Hospital, Huizhou 516001, China
OBJECTIVE: To study the application value of emergency endoscopy in the diagnosis and treatment of massive upper gastrointestinal hemorrhage, and to evaluated by the economic analysis whether the emergency endoscopy was safe and effective,or shorten the hospitalization days and reduced the medical costs. METHODS: Ninty-one patients with massive upper gastrointestinal hemorrhage were randomly divided into emergency endoscopy group (group A) and non-emergency endoscopy group (group B).The patients in group A were endoscopied as soon as the blood pressures were normal and the patients of group B were endoscopied at 24-48 hours after hospitalization. They would be treated depending on the conditions by endoscopy. Then the correct diagnosis rates, rebleeding rates, complication rates, mean hospitalization days, the endoscopy costs, the blood transfusion costs, the drugs costs and the total hospitalization costs of two groups were evaluated and the cost-effect ratio(C/E) was calculated. RESULTS: The correct diagnosis rates and the endoscopy costs of group A were higher than the group B 〔100.0 percent vs.90.2 percent, P<0.05; (714.78±263.54) yuan vs. (383.57±251.72)yuan, P<0.01〕, and the rebleeding rates, the mean hospitalizations days, the blood transfusion costs and the drugs costs and the total hospitalization costs were all lower compared to the group B 〔6.1 percent vs. 26.8 percent, P<0.05; (5.42±1.70)days vs. (8.51±2.30)days, P<0.01;(791.80±258.35)yuan vs. (1270.29±569.21)yuan, P<0.01；(945.22±125.82)yuan vs. (1223.81±254.44)yuan, P<0.01；(2785.76±353.26)yuan vs. (3 527.76±555.62)yuan, P<0.01. The C/E of group A was lower than the group B 〔2785.76 yuan per patient vs. 3527.76 yuan per patient, P<0.01〕.CONCLUSION: Emergency endoscopy is not only safe and effective but also economical in the diagnosis and treatment of massive upper gastrointestinal hemorrhage.
, 百拇医药
PAGE：762
Dynamic change of vascular active materials and inflammatory mediums after acute organophosphate poisoning and its clinical significance
ZHANG Zai-qi, LIANG Ren, HUANG Tao, YANG Hua-xi, PENG Wei, LI Feng, YIN Fu-rong, YI Gao, WANG Cheng-zhi
Huaihua the Second Hospital, Hongjiang 418200, Hunan, China
PAGE：764
Application of continuous reral replacement therapy in patients with acute renal failure and multiple organ dysfunction syndromes
YANG Yong-ming, LIU Guan-xian, ZHONG Wei-qiang, CHEN Wei-ling
Central People Hospital, Huizhou 516001, Guangdong, China, 百拇医药