Objective To investigate the protective effects of antitumor necrosis factor-α antibody （TNF-αAb） on lung injury after cardiopulmonary bypass （CPB） and their mechanisms. Methods Forty healthy New Zealand white rabbits，weighting 2.0-2.5 kg，male or female，were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ，the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ，the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ，the rabbits received CPB only. In group Ⅳ，the rabbits only received sham surgery. Neutrophils count，TNF-α and malondialdehyde （MDA） concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content，TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ，after CPB，the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count，TNF-α and MDA（P＜0.05），higherTNF-α mRNA expression，apoptosis index and water content of the lung tissues （P＜0.05），and significantly lower oxyg-enation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ，after CPB，the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α （5 minutes after aortic declamping，220.43±16.44 pg/ml vs.185.27±11.78 pg/ml，P＜0.05；249.99±14.09 pg/ml vs.185.27±11.78 pg/ml，P＜0.05），significantly higher apoptosis index （at the time of CPB termination，60.7‰±13.09‰ vs. 37.9‰±7.78‰，P＜0.05；59.6‰±7.74‰ vs. 37.9‰±7.78‰，P＜0.05），significantly higher blood levels of neutrophils count and MDA （P＜0.05），significantly higher TNF-α mRNA expression and water content of the lung tissues （P＜0.05），and significantly loweroxygenation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ，rabbits in group Ⅲ had significantly higher above parameters （P＜0.05） but lower oxygenation index （P＜0.05） only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.
ObjectiveTo introduce a new medical heat preservation device, and to explore the application value and effectiveness in replantation of severed fingers. MethodsThe medical heat preservation device was design, water was used as the heating medium, and temperature was set and controlled by microcomputer. Between November 2010 and January 2014, 421 cases undergoing replantation of severed fingers were divided into 2 groups. Within 9 days after operation, the medical heat preservation device was used in 210 cases (experimental group), and the conventional heat lamp was used in 211 cases (control group). There was no significant difference in gender, age, injury cause, the interval between injury and admission, injury finger side, and operation time between 2 groups (P>0.05). The vascular crisis rate, success rate of replantation of severed fingers, comfort, sleep quality, and the influence on roommates were compared. ResultsThe comfort and the influence on roommates were good in 188 cases (89.52%) and 201 cases (95.71%) in the experimental group, which were significantly higher than those in the control group (25/211, 11.85%; 145/211, 68.72%). According to Pittsburgh sleep quality index (PSQI) for sleep quality, the results were good in 105 cases, fair in 85 cases, and poor in 20 cases in the experimental group; the results were good in 45 cases, fair in 95 cases, and poor in 71 cases in the control group. Blood vessel crisis occurred in 35 cases (16.67%) of the experimental group, which was significantly lower than that in the control group (76/211, 36.02%) (P<0.05). The survival rate of replantation in the experimental group (196/210, 93.3%) was significantly higher than that in the control group (181/211, 85.78%) (P<0.05). Significant differences were found between 2 groups (P<0.05) in above indexs. ConclusionMedical heat preservation device for replantation of severed fingers can improve the comfortable degree of patients and the quality of sleep, increase the survival rate of finger replantation, and reduce the occurrence of vascular crisis after operation.
目的:总结215例浅低温体外循环下不停跳心内直视手术的临床应用经验。方法:215例行心脏不停跳心内直视手术病例，并行循环者阻断上下腔静脉而不阻断升主动脉，不使用心脏停跳液；逆行灌注者，阻断升主动脉后经冠状静脉窦逆行持续灌注机器氧合血，鼻咽温度在(33±1)℃，均在心脏空跳下完成心内直视手术。结果:心脏手术完毕后顺利停机，术后血液动力学平稳，低心输出量综合征发生率低，无1例发生神经系统并发症及空气栓塞，早期死亡率0.93％（2/215）。结论:浅低温体外循环下不停跳心内直视手术技术安全可行，是一种接近生理状态的心肌保护方法，可应用于绝大部份心内直视手术。
Objective To investigate the relationship between gene expression of endothelin-3 (ET-3） and inflammation of acute pancreatitis （AP） in rats. Methods Fifty-four rats were divided randomly into 4 groups: sham operation group, AP group, arterial injection group and vein injection group. AP was induced by reverse intra-bile duct infusion 4.5% sodium taurocholate, treated with low dose dopamine 〔5 μg/（kg·min）〕 by injecting arterial or tail vein. Rats were sacrificed at 1， 6 and 24 h after the induction of AP. The mRNA expression of ET-3 was evaluated by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) and pathological changes was observed in rats. Results Expression of ET-3 mRNA could be detected from 1 up to 24 h after the induction of pancreatitis. Expression of ET-3 mRNA of sham operation group was decreased significantly compared with other three groups. Expression of ET-3 mRNA showed a significant decrease by arterial injection dopamine than that by tail vein (P＜0.05， P＜0.01). The pathologic score in AP group was the highest, vein injection group was the next one, and score in sham operation group was the lowest. Conclusion There are significant relationship between inflammation of AP and expression of ET-3 mRNA. Dopamine administration by arterial injection is more effective than that by tail vein injection.
【Abstract】Objective To study the change of pancreatic microcirculation in the early phase of acute pancreatitis. MethodsLiteratures on acute pancreatitis and microcirculation were collected and reviewed.ResultsPancreatic microcirculation has changed in the early phase of acute pancreatitis, including contraction of interlobular arteriole, slowing of blood fluid, increasing of pancreatic vascular permeability, leukocyte adherence in postcapillary venules, and decreasing of pancreatic perfusion.Conclusion Impairment of pancreatic microcirculation in the early phase of acute pancreatitis may play a key role in the progression of this disease.
【Abstract】Objective To investigate the appropriate reconstruction techniques of multidetectorrow spiral CT angiography (MDCTA) to depict the collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC). Methods MDCTA scanning was performed during the portal venous phase after intravenous contrast materials in 18 HCC patients with CTPV induced by tumor thrombosis. Raw data were reconstructed with thin slice thickness followed by 2D and 3D angiographic reconstruction methods, including maximum intensity projection(MIP), shade surface display （SSD） and volume rendering technique(VRT). Results MDCTA with MIP reconstruction accurately depicted both the tumor thrombus within the portal vein and the collateral vessels of CTPV including the biliary (cystic vein and pericholedochal veinous plexus) and the gastric (left and right gastric veins) branches. However, VRT and SSD methods did poorly in showing the tumor thrombus and the collateral vessels. Conclusion MDCTA with MIP reconstruction is the method of choice to evaluate the collateral vessels of CTPV.
ObjectiveTo explore the effects of urinastatin(UTI) on microcirculation of extrapancreatic organs in rats with acute necrotizing pancreatitis(ANP). Methods A total of 48 rats were randomized into control group, ANP group and UTI group. The model of ANP was established by uniform injection of 5% sodium taurocholate solution under pancreatic capsule, only injection of normal saline in control group. Then the rats of UTI group were injected with UTI through the femoral vein, the rats of ANP group and control group were injected with normal saline. The blood flow of lung, kidney and distal small intestine was measured by radioactive biomicrosphere technique at 2 h and 6 h after ANP.ResultsCompared with the control group, the blood flow of lung, kidney and intestine was decreased significantly in the ANP group at the 2 h and 6 h after ANP （P＜0.05）, compared with the ANP group, the blood flow was increased significantly in UTI group （P＜0.05）. ConclusionMicrocirculation disorder is an important factor of the extrapancreatic organ damage in ANP, and UTI plays a protective role against microcirculation disorder of the extrapancreatic organ in ANP.
Objective To investigate the spiral CT manifestations of the collateral circulation pathways resulting from splenic vein occlusion (SVO) duo to pancreatic diseases. Methods The CT imaging and clinical data of 33 cases of pancreatic disease with SVO, including 28 cases of pancreatic carcinoma, 3 cases of acute pancreatitis and 2 cases of chronic pancreatitis, were retrospectively analyzed.Results Tortuous and dilated vessels were observed in the areas between splenic hilum and gastric fundus and/or along the gastric greater curvature in all 33 cases. In isolated SVO cases, the short gastric vein (SGV, 86%)，coronary vein (CV, 79%)，gastroepiploic vein (GEV, 79%) and gastrocolic trunk (GCT, 57%) were varicose and dilated. While in nonisolated SVO，other collateral veins such as the right superior colic vein (RSCV, 37%），middle colic vein (MCV, 37%） and posterior superior pancreaticoduodenal vein (PSPDV, 21%） were seen as well. Conclusion The two predominant collateral pathways of SVO are ①SGV→gastric fundal veins→CV， and ②GEV→GCT→SMV. They have characteristic imaging features on spiral CT and are of clinical significance in both preoperative staging of pancreatic carcinoma and the evaluation of pancreatogenic segmental portal hypertension.
ObjectiveTo understand the effect of nitric oxide (NO) on the formation of hyperdynamic circulatory syndrome (HCS) and the influence of level of NO on HCS. MethodsAfter establishment of stable HCS in partial portal vein ligated rats,the quantity of NO in blood of portal vein and the activity of nitric oxide synthase (NOS) in liver were determined by pre and post injection of inhabitor of NOS (NGmethylLarginine) and hemodynamics was supervised simultaneously.ResultsThe quantity of NO was paralleled with the activity of NOS and was elevated markedly by 24 hours after operation and reached the top by 48 hours after surgery. These sequential changes were coincided with the dilation of general vascularture. There was a close relation between this changes and the formation of HCS.The quantity of NO and the activity of NOS were decreased significantly to the level of the control group after injection of NGmethylLarginine (LNMMA). LNMMA inhabited the activity of NOS and blocked the production of NO. HCS ameliorated obviously. ConclusionNO plays an important role in initiating the dilation of general vascularture and plays a critical role in the formation of HCS. HCS will be ameliorated obviously or be blocked completely by eliminating the effect of NO and the portal pressure will decreased significantly or recover to normal range.
Objective To observe the blood circulation compensation in the involved area of the liver following ligation of the third grade branches of hepatic artery and portal vein and bile duct enclosed in Glisson’s capsule. Methods Ligation of the third grade branches of these ducts was carried out in 7 pigs. Uptake of 99mTc-EHIDA in the liver was scanned with SPECT pre-and post-operatively. Liver angiography of hepatic artery and portal vein were taken at regular interval. Corrosion casts of these ducts were made with ABS following extirpation of the liver at the end of experiment. The histological specimens were examined with electronic microscope. Results Compensatory circulation occurred between involved and noninvolved part of the liver through the sinusoids in 30-60 minutes after ligation. In the 6 weeks following the procedure, there was also blood supply in the affected region of liver, and collateral developed through hepatic aterioles and capillaries. Conclusion Liver has an ability to establish compensatory blood supply on the condition of ischema in a local region of liver.