Objective To compare gene express difference ofkeloid and normal skin tissues by using the suppression subtractive hybridization (SSH) so asto find the differential express gene in keloid. Methods mRNA extracted fromkeloid and normal skin tissues was used as the template to synthesis cDNA of keoid and normal skin. The cDNA of keloid served as a tester, the cDNA of normal skin as a driver. cDNA was digested with RsaⅠ. Adaptor-ligated tester cDNA was prepared. Then first hybridization, second hybridization and PCR amplificationwere done. Differentially expressed cDNA was selectively amplified during thesereactions. After SSH, the PCR mixture was ligated with T-vector. The positive clones were selected and the insert gene fragments were analyzed. Southern hybridization identified the keloid differential express genes. The positive clones ofSouthern hybridization were selected, and these sequences were analyzed. The results were compared with that of GeneBank. Results Thirteen differential genes were found in keloid, of which 11 gene clones have been known their function, and 2 clones have not known their function. 〖WTHZ〗Conclusion Keloid differentially expressed gene was screened successfully by SSH.
Objective To explore the effects of enteral tube feeding on moderate AECOPD patients who underwent noninvasive positive pressure ventilation ( NPPV) . Methods Sixty moderate AECOPD patients with NPPV admitted from January 2009 to April 2011 were recruited for the study. They were randomly divided into an enteral tube feeding group (n=30) received enteral tube feeding therapy, and an oral feeding group (n=30) received oral feeding therapy. Everyday nutrition intake and accumulative total nutrition intake in 7 days, plasma level of prealbumin and transferrin, success rate of weaning, duration of mechanical ventilation, length of ICU stay, rate of trachea cannula, and mortality rate in 28 days were compared between the two groups. Results Compared with the oral feeding group, the everyday nutrition intake and accumulative total nutrition intake in 7 days obviously increased (Plt;0.05) , while the plasma prealbumin [ ( 258.4 ±16.5) mg/L vs. (146.7±21.6) mg/L] and transferrin [ ( 2.8 ±0.6) g/L vs. ( 1.7 ±0.3) g/L] also increased significantly after 7 days in the enteral tube feeding group( Plt;0.05) . The success rate of weaning ( 83.3% vs. 70.0%) , the duration of mechanical ventilation [ 5. 6( 3. 2-8. 6) days vs. 8. 4( 4. 1-12. 3) days] , the length of ICU stay [ 9. 2( 7. 4-11. 8) days vs. 13. 6( 8.3-17. 2) days] , the rate of trachea cannula ( 16. 6% vs. 30. 0% ) , the mortality rate in 28 days ( 3. 3% vs. 10. 0% ) all had significant differences between the enteral tube feeding group and the oral feeding group. Conclusions For moderate AECOPD patients with NPPV, enteral tube feeding can obviously improve the condition of nutrition and increase the success rate of weaning, shorten the mechanical ventilation time and the mean stay in ICU, decrease the rate of trachea cannula and mortality rate in 28 days. Thus enteral tube feeding should be preferred for moderate AECOPD patients with NPPV.
Objective To observe barrier function changes of gut mucosa in rats with acute respiratory distress syndrome(ARDS)．Methods Forty SD rats were randomized to an experiment group (n：30)and a control group(n=10)．Oleic acid was injected via vena femoralis to establish ARDS ratmode1．Subgroups in the experiment group were randomly divided by time 30 min，2 h，4 h interval after injection(n=10 in each subgroup)．Concentration of D-lactate and endotoxin and activity of diamineoxidase in blood plasma were measured．Histopathological changes of small intestine were observed under light microscope．Results Compared with the control group，the activation of diamine oxidase in the experiment group was higher after 30 min of injection(Plt;0.01)．Concentration of D-lactate，the activity ofdiamine oxidase and endotoxin level in the experiment group were all elevated after 2 hours of injection(all Plt;0.05)，and further elevated after 4 hours．In the rats’villous interstitial after 2 hours of the injection，there were edema，hyperemia，and infiltration of neutrophils，eosinophils and lymphocytes．After 4 hours ofthe injection，the villous epithelium showed desquamation，necrosis，denaturalization and erosion，associated with infihration of lymphocytes and neutrophils in the mucosa．Conclusion In oleic acid-induced ARDS．permeability of gut mueosa increases and gut barrier is dysfunctional．
Objective To evaluate the subjective outcomes of sleepiness behavior and mood status applying continuous positive airway pressure（CPAP） in adults of elderly and middle-aged with obstructive sleep apnea syndrome（OSAS）. Methods Nine randomized controlled trails comparing nocturnal CPAP with inactive control appliances in adults with OSAS with the use of computerized search in related medical databases（MEDLINE，EMBASE，CBMdisk，etc） were included.The quality of literature was reviewed，and all data were extracted by two reviewers independently.Meta analysis was conducted used RevMan 4.2 software.Results 9 RCT involving 665 patients of elderly and middle-aged met the inclusion criteria.Meta analysis indicated that the score of Epworth sleepiness scale（ESS） and general health questionnaire-28（GHQ-28） declined significantly after CPAP treatment on effectiveness with WMD（random） －2.94，95 %CI －4.68 to －1.20，or WMD（fixed） －2.26，95 %CI －3.79 to －0.72，Plt;0.01.Nevertheless，hospital anxiety and depression scale（HADS） was not significantly different between CPAP and control with WMD（random） －0.89，95%CI －1.98 to 0.20，Pgt;0.05.Conclusion Current clinical evidence suggested that CPAP was effective in improving day-time subjective outcomes of sleepiness behavior and general mental health status in OSAS patients of elderly and middle-aged，although evidence of improving emotion disorder of anxiety and depression was not confirmed.
Objective To study the effect of tumor necrosis factor-α( TNF-α) onhypermetabolism of skeletal muscle protein in rats with chronic obstructive pulmonary disease ( COPD) and explore its underlying mechanism. Methods Forty-five SD rats were randomly divided into a normal control group, a COPD group and a COPD + TNF-α group, with 15 rats in each group. COPD model was established by passive cigarette smoking in COPD group and COPD + TNF-αgroup. Then the extensor digitorium longus muscles ( EDL) were dissected and incubated in vitro muscle incubation system with adequate oxygen supply. The EDL were either cultured with or without recombinant rat TNF-α( 10 μg/L) . The mRNA and protein expressions of proteasome subunit C2 in EDL were quantified by real-time quantitative PCR and Western blot analysis, respectively. Results The mRNA and protein expressions of proteasome subunit C2 were both significant higher in the COPD group and COPD + TNF-αgroup than those in the normal control group( P lt;0. 01 or 0. 05) . The COPD+TNF-αgroup had higher expression of proteasome subunit C2 mRNA than that in the COPD group( P lt; 0. 01) , whereas the protein expression was not significantly different( P gt; 0. 05) . Conclusion Incresed proteolytic metabolism in skeletal muscle in COPD might be regulated by TNF-αactivated ubiquitin-dependent pathway.
Objective To study the role of ubiquitin-proteasome pathway in diaphragm of COPD rats. Mathods Thirty rats were divided into a normal control group and a COPD group. COPD model was established by exposure to cigarette smoke for three months. The protein levels of E2-14k and proteasome subunit C8 in diaphragms were measured by Western blot. The mRNA levels of ubiquitin and proteasome subunit C2 in diaphragms were measured bymeans of realtime polymerase chain reaction( RT-PCR) . Results Compared with the control group, the protein expression of E2-14k increased significantly in the COPD group ( 0. 81 ±0. 28 vs 0. 50 ±0. 25, P lt;0. 05) , but C8 protein level was not significantly different between the two groups( P gt;0. 05) . The mRNA expression of ubiquitin increased significantly in the COPD group( 0. 89 ±0. 20 vs 0. 50 ±0. 15, P lt;0. 05) , but C2 mRNA level was not significantly different between the two groups ( P gt; 0. 05 ) . Conclusions The mRNA and protein expressions of ubiquitin-proteasome pathway in diaphragmincreased significantly in COPD rats, suggesting that the activity of ubiquitin-proteasome pathwayincreased, which lead to an increase of protein degradation.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
目的 探讨单用和联用盐酸氨基葡萄糖与非甾体抗炎药（NSAID）在椎间盘源性腰痛（DLBP）治疗中的有效性。 方法 2011年1月－12月72例DLBP患者，男42例，女30例；年龄22～71岁；体重43～84 kg；病程0.5～10年。通过随机数字表的方法，将患者分为3组。A组给予盐酸氨基葡萄糖胶囊750 mg，2次/d，同时给予尼美舒利分散片100 mg，2次/d；B组给予盐酸氨基葡萄糖胶囊750 mg，2次/d；C组给予尼美舒利分散片100 mg，2次/d。3组均用药8周后停药，用药期间停用其他活血化瘀类药物及物理治疗。选取治疗前及治疗后第4、8、16周4个时间点，运用疼痛数字评价量表（NRS）、Oswestry功能障碍指数（ODI）、生活质量评价量表SF-36分别对3组患者的腰痛、腰部功能及生活质量进行评价。 结果 63例获得随访，失访率12.5%。各组患者NRS评分、ODI评分、SF-36评分在治疗前后比较差异均有统计学意义（P＜0.05），A组疗效明显优于B、C两组，B组治疗后各项数据较治疗前明显改善（P＜0.05）。 结论 单用盐酸氨基葡萄糖治疗DLBP有效，且在停药后，仍有一定疗效，联用NSAID效果更佳；远期疗效有待进一步随访。
Objective To investigate the value of extravascular lung water index ( EVLWI) and intrathoracic blood volume index ( ITBVI) monitoring in fluid management of severe pneumonia patients with sepsis shock.Methods A prospective controlled study was conducted in106 patients who were diagnosed as severe pneumonia with sepsis shock in intensive care unit fromJanuary 2010 to February 2013. 54 patients who received pulse indicator continuous output ( PiCCO) monitoring were enrolled into the EVLWI + ITBVI group, and EVLWI and ITBVI were used as indicator of fluid management. 52 patients who received central venous pressure ( CVP) as indicator of traditional fluid managementwere enrolled into the control group. The time and the rate to achieve early goal-directed therapy ( EGDT) target were compared between two groups. Acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) , sepsis related organ failure assessment ( SOFA) , noradrenaline dosage, serumlactic acid, serum creatinine were compared between 1 day and 3 days after treatment. The characteristics of fluid management were recorded and compared within 72 hours. Mechanical ventilation ratio, duration of mechanical ventilation, ICU stay and 28-day mortality were compared between two groups. Results The ratio of achieving EGDT target in 6 hours was significantly higher in the EVLWI + ITBVI group than that in the control group ( 75.9% vs. 55.7% , Plt;0.05) , whereas the time and the ratio to achieve EGDT target in 24 hours were not statistically different. APACHE Ⅱ, SOFA, norepinephrine dosage, serum lactate were significantly decreased 3 days after treatment in the EVLWI + ITBVI group, but did not change significantly in the control group. On3 days after treatment, serumcreatinine was increased in the control group, and did not change significantly in the EVLWI + ITBVI group. The fluid intake and fluid balance volume during 0-6 hours period were significantly higher in the EVLWI + ITBVI group than those in the control group ( Plt;0.05) , but showed no difference ( Pgt;0.05) in other periods. Mechanical ventilation ratio, duration of mechanical ventilation, ICU stay and 28-days mortality were significantly lower in the EVLWI + ITBVI group compared with the control group ( Plt;0.05) . Conclusion Compared with CVP, ITBVI and EVLWI can more accurately assess and guide fluid management in severe pneumonia patients with septic shock with less duration of mechanical ventilation, ICU stay and mortality.