AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from Sept...AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P < 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P < 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P < 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.展开更多
Background：Pyroptosis is the term for caspase-l-dependent cell death associated with pro-inflammatory cytokines.The role of alveolar macrophage （AM） pyroptosis in the pathogenesis of the acute lung injury and acute...Background：Pyroptosis is the term for caspase-l-dependent cell death associated with pro-inflammatory cytokines.The role of alveolar macrophage （AM） pyroptosis in the pathogenesis of the acute lung injury and acute respiratory distress syndrome （ALI/ARDS） remains unclear.Methods：C57BL/6 wild-type mice were assigned to sham,lipopolysaccharide （LPS） ＋ vehicle,LPS ＋ acetyl-tyrosyl-valyl-alanyl-aspartyl-chloromethylketone （Ac-YVAD-CMK） and LPS ＋ Z-Asp-Glu-Val-Asp-fluoromethylketone groups.Mice were given intraperitoneal （IP） injections of LPS.Drugs were IP injected 1 h before LPS administration.Mice were sacrificed 16 h after LPS administration,and AMs were isolated.Western blot analysis for active caspase-1 and cleaved caspase-3,evaluation of lung injury and a cytokine release analysis were performed.AMs were treated with LPS and adenosine triphosphate （ATP）;caspase-l-dependent cell death was evaluated using flow cytometry;the apoptosis-associated speck-like protein containing a caspase recruitment domain （ASC） pyroptosomes were examined by immunofluorescence.Results：The expression of activated caspase-1 in AMs was enhanced following LPS challenge compared with the sham group.In the ex vivo study,the caspase-1/propidium iodide-positive cells,caspase-1 specks and ASC pyroptosomes were up-regulated in AMs following LPS/ATP stimulation.The specific caspase-1 inhibitor Ac-YVAD-CMK inhibited the activation of caspase-1 and pyroptotic cell death.Ac-YVAD-CMK also reduced the lung injury,pulmonary edema and total protein in bronchoalveolar lavage fluid （BALF）.In addition,Ac-YVAD-CMK significantly inhibited interleukin-β （IL-lβ） release both in serum and BALF and reduced the levels of IL-18,tumor necrosis factor-α （TNF-α）,High Mobility Group Box 1 （HMGB1） in BALF during LPS-induced ALI/ARDS.Conclusions：This study reported AM pyroptosis during LPS-induced ALI/ARDS in mice and has demonstrated that Ac-YVAD-CMK can prevent AM-induced pyroptosis and lung injury.These 展开更多
Background Radial artery spasm （RAS） is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures...Background Radial artery spasm （RAS） is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures in Chinese, find out the independent predictors through multiple regression, and analyze the clinical effect of RAS during follow-up. Methods Patients arranged to receive transradial coronary angiography and intervention were consecutively enrolled. The incidence of RAS was recorded. Univariate analysis was performed to find out the influence factors of RAS, and logistic regression analysis was performed to find out the independent predictors of RAS. The patients were asked to return 1 month later for the assessment of the radial access.Results The incidence of RAS was 7.8% （112/1427） in all the patients received transradial procedure. Univariate analysis indicates that young （P=0.038）, female （P=0.026）, small diameter of radial artery （P 〈0.001）, diabetes （P=0.026）, smoking （P=0.019）, moderate or severe pain during radial artery cannulation （P〈0.001）, unsuccessful access at first attempt （P=0.002）, big sheath （P=0.004）, number of catheters （〉3） （P=0.048）, rapid baseline heart rate （P=0.032） and long operation time （P=0.021） were associated with RAS. Logistic regression showed that female （OR=1.745, 95% CI： 1.148-3.846, P=0.024）, small radial artery diameter （OR=4.028, 95%CI： 1.264-12.196, P=0.008）, diabetes （OR= 2.148, 95%CI： 1.579-7.458, P=0.019） and unsuccessful access at first attempt （OR=1.468, 95%CI： 1.212-2.591, P=0.032） were independent predictors of RAS. Follow-up at （28±7） days after the procedure showed that, compared with non-spasm patients, the RAS patients had higher portion of pain （11.8% vs. 6.2%, P=0.043）. The occurrences of hematoma （7.3% vs. 5.6%, P=0.518） and radial artery occlusion （3.6% vs. 2.6%, P=0.534） were similar. Conclusions The incidence of RAS during transradial coronary展开更多
Background： Chronic kidney disease （CKD） is an independent risk factor for cardiovascular disease （CVD）. However, the association between CKD and CVD risk in patients with type 2 diabetes mellitus （T2DM） in Chi...Background： Chronic kidney disease （CKD） is an independent risk factor for cardiovascular disease （CVD）. However, the association between CKD and CVD risk in patients with type 2 diabetes mellitus （T2DM） in China has not yet been well investigated. This study aimed to determine the association of CKD with the risks of coronary heart disease （CHD） and stroke in a Chinese population with T2DM. Methods： A total of 1401 inpatients with T2DM at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2008 and November 2013 were included in this study. The CKD-Epidemiology Collaboration equation for Asians was used to classify CKD. The UK Prospective Diabetes Study risk engine was used to estimate the risks of CHD and stroke. Results： CHD risk was significantly increased with CKD stage （20.1%, 24.8%, and 34.3% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P 〈 0.001 for all）. The stroke risk was also increased with CKD stage （8.6%, 12.7%, and 25.4% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P 〈 0.001 for all）. Compared with no-CKD group, the odds ratios （ORs） for high CHD risk were 1.7 （P 〈 0.001） in the CKD Stage 1-2 group and 3.5 （P 〈 0.001） in the CKD Stage 3-5 group. The corresponding ORs for high stroke risk were 1.9 （P 〈 0.001） and 8.2 （P 〈 0.001）, respectively. Conclusion： In patients with T2DM, advanced CKD stage was associated with the increased risks of CHD and stroke.展开更多
Background： In vitro experiments have revealed that toll-like receptor 4 （TLR4） pathway is involved in the progression ofimmunoglobulin A nephropathy （IgAN） by induction of proinflammatory cytokines. Evidence sho...Background： In vitro experiments have revealed that toll-like receptor 4 （TLR4） pathway is involved in the progression ofimmunoglobulin A nephropathy （IgAN） by induction of proinflammatory cytokines. Evidence showed that, in other disease models, peroxisome proliferator-activated receptor-7 （PPAR-7） agonists have been shown to exert anti-inflammatory effects through suppression of the expression and activity of TLR4. However, the interaction between PPAR-7 and TLR4 in IgAN has not been fully studied both in vitro and in vivo. In this study, we explored whether TLR4 pathway attributed to the progression of IgAN in experimental rats. Methods： Bovine gamma globulin was used to establish IgAN model. Fifty-four Lewis rats were randomly divided into six groups： ControliaK242, IgANTAK242, toll-like receptor 4 inhibitor （TAK242） groups （rats were administrated with TLR4 inhibitor, TAK242） and Controlpo, IgANpo, Pio groups （rats were administrated with PPAR-y agonist, pioglitazone）. Urinary albumin-to-creatinine ratio （ACR）, serum creatinine, and blood urea nitrogen were detected by automatic biochemical analyzer. Renal histopathological changes were observed after hematoxylin-eosin staining, and the IgA deposition in glomeruli was measured by immunofluorescence staining. Real-time polymerase chain reaction and Western blotting were used to detect TLR4 and interleukin- 1 beta （IL- 1β） message ribonucleic acid （mRNA） and protein expression in renal tissues. Results were presented as mean -4- standard deviation. Differences between groups were analyzed by one-way analysis of variance. Results： Compared to normal rats, experimental rats showed higher ACR （4.45 ± 1.33 mg/mmol vs. 2.89 ± 0.96 mg/mmol, P 〈 0.05）, obvious IgA deposition with mesangial hypercellularity, hyperplasia of mesangial matrix accompanied by increased serum IL-Iβ （48.28 ± 13.49 μg/ml vs. 35.56 ± 7.41μg/ml, P 〈 0.05）, and renal expression of IL-Iβ and TLR4. The biochemical parameters and rena展开更多
文摘AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P < 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P < 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P < 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.
基金The author thanks the National Natural Science Foundation of China （No. 81470266）.
文摘Background：Pyroptosis is the term for caspase-l-dependent cell death associated with pro-inflammatory cytokines.The role of alveolar macrophage （AM） pyroptosis in the pathogenesis of the acute lung injury and acute respiratory distress syndrome （ALI/ARDS） remains unclear.Methods：C57BL/6 wild-type mice were assigned to sham,lipopolysaccharide （LPS） ＋ vehicle,LPS ＋ acetyl-tyrosyl-valyl-alanyl-aspartyl-chloromethylketone （Ac-YVAD-CMK） and LPS ＋ Z-Asp-Glu-Val-Asp-fluoromethylketone groups.Mice were given intraperitoneal （IP） injections of LPS.Drugs were IP injected 1 h before LPS administration.Mice were sacrificed 16 h after LPS administration,and AMs were isolated.Western blot analysis for active caspase-1 and cleaved caspase-3,evaluation of lung injury and a cytokine release analysis were performed.AMs were treated with LPS and adenosine triphosphate （ATP）;caspase-l-dependent cell death was evaluated using flow cytometry;the apoptosis-associated speck-like protein containing a caspase recruitment domain （ASC） pyroptosomes were examined by immunofluorescence.Results：The expression of activated caspase-1 in AMs was enhanced following LPS challenge compared with the sham group.In the ex vivo study,the caspase-1/propidium iodide-positive cells,caspase-1 specks and ASC pyroptosomes were up-regulated in AMs following LPS/ATP stimulation.The specific caspase-1 inhibitor Ac-YVAD-CMK inhibited the activation of caspase-1 and pyroptotic cell death.Ac-YVAD-CMK also reduced the lung injury,pulmonary edema and total protein in bronchoalveolar lavage fluid （BALF）.In addition,Ac-YVAD-CMK significantly inhibited interleukin-β （IL-lβ） release both in serum and BALF and reduced the levels of IL-18,tumor necrosis factor-α （TNF-α）,High Mobility Group Box 1 （HMGB1） in BALF during LPS-induced ALI/ARDS.Conclusions：This study reported AM pyroptosis during LPS-induced ALI/ARDS in mice and has demonstrated that Ac-YVAD-CMK can prevent AM-induced pyroptosis and lung injury.These
文摘Background Radial artery spasm （RAS） is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures in Chinese, find out the independent predictors through multiple regression, and analyze the clinical effect of RAS during follow-up. Methods Patients arranged to receive transradial coronary angiography and intervention were consecutively enrolled. The incidence of RAS was recorded. Univariate analysis was performed to find out the influence factors of RAS, and logistic regression analysis was performed to find out the independent predictors of RAS. The patients were asked to return 1 month later for the assessment of the radial access.Results The incidence of RAS was 7.8% （112/1427） in all the patients received transradial procedure. Univariate analysis indicates that young （P=0.038）, female （P=0.026）, small diameter of radial artery （P 〈0.001）, diabetes （P=0.026）, smoking （P=0.019）, moderate or severe pain during radial artery cannulation （P〈0.001）, unsuccessful access at first attempt （P=0.002）, big sheath （P=0.004）, number of catheters （〉3） （P=0.048）, rapid baseline heart rate （P=0.032） and long operation time （P=0.021） were associated with RAS. Logistic regression showed that female （OR=1.745, 95% CI： 1.148-3.846, P=0.024）, small radial artery diameter （OR=4.028, 95%CI： 1.264-12.196, P=0.008）, diabetes （OR= 2.148, 95%CI： 1.579-7.458, P=0.019） and unsuccessful access at first attempt （OR=1.468, 95%CI： 1.212-2.591, P=0.032） were independent predictors of RAS. Follow-up at （28±7） days after the procedure showed that, compared with non-spasm patients, the RAS patients had higher portion of pain （11.8% vs. 6.2%, P=0.043）. The occurrences of hematoma （7.3% vs. 5.6%, P=0.518） and radial artery occlusion （3.6% vs. 2.6%, P=0.534） were similar. Conclusions The incidence of RAS during transradial coronary
基金This study was supported in part by the grants from the National Natural Science Foundation of China （No. 81370968, No. 81670744）, the Chinese Society of Endocrinology （No. 13040620447）, and the Science Technology Department of Zhejiang Province of China （No. 2012R10038）.
文摘Background： Chronic kidney disease （CKD） is an independent risk factor for cardiovascular disease （CVD）. However, the association between CKD and CVD risk in patients with type 2 diabetes mellitus （T2DM） in China has not yet been well investigated. This study aimed to determine the association of CKD with the risks of coronary heart disease （CHD） and stroke in a Chinese population with T2DM. Methods： A total of 1401 inpatients with T2DM at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2008 and November 2013 were included in this study. The CKD-Epidemiology Collaboration equation for Asians was used to classify CKD. The UK Prospective Diabetes Study risk engine was used to estimate the risks of CHD and stroke. Results： CHD risk was significantly increased with CKD stage （20.1%, 24.8%, and 34.3% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P 〈 0.001 for all）. The stroke risk was also increased with CKD stage （8.6%, 12.7%, and 25.4% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P 〈 0.001 for all）. Compared with no-CKD group, the odds ratios （ORs） for high CHD risk were 1.7 （P 〈 0.001） in the CKD Stage 1-2 group and 3.5 （P 〈 0.001） in the CKD Stage 3-5 group. The corresponding ORs for high stroke risk were 1.9 （P 〈 0.001） and 8.2 （P 〈 0.001）, respectively. Conclusion： In patients with T2DM, advanced CKD stage was associated with the increased risks of CHD and stroke.
文摘Background： In vitro experiments have revealed that toll-like receptor 4 （TLR4） pathway is involved in the progression ofimmunoglobulin A nephropathy （IgAN） by induction of proinflammatory cytokines. Evidence showed that, in other disease models, peroxisome proliferator-activated receptor-7 （PPAR-7） agonists have been shown to exert anti-inflammatory effects through suppression of the expression and activity of TLR4. However, the interaction between PPAR-7 and TLR4 in IgAN has not been fully studied both in vitro and in vivo. In this study, we explored whether TLR4 pathway attributed to the progression of IgAN in experimental rats. Methods： Bovine gamma globulin was used to establish IgAN model. Fifty-four Lewis rats were randomly divided into six groups： ControliaK242, IgANTAK242, toll-like receptor 4 inhibitor （TAK242） groups （rats were administrated with TLR4 inhibitor, TAK242） and Controlpo, IgANpo, Pio groups （rats were administrated with PPAR-y agonist, pioglitazone）. Urinary albumin-to-creatinine ratio （ACR）, serum creatinine, and blood urea nitrogen were detected by automatic biochemical analyzer. Renal histopathological changes were observed after hematoxylin-eosin staining, and the IgA deposition in glomeruli was measured by immunofluorescence staining. Real-time polymerase chain reaction and Western blotting were used to detect TLR4 and interleukin- 1 beta （IL- 1β） message ribonucleic acid （mRNA） and protein expression in renal tissues. Results were presented as mean -4- standard deviation. Differences between groups were analyzed by one-way analysis of variance. Results： Compared to normal rats, experimental rats showed higher ACR （4.45 ± 1.33 mg/mmol vs. 2.89 ± 0.96 mg/mmol, P 〈 0.05）, obvious IgA deposition with mesangial hypercellularity, hyperplasia of mesangial matrix accompanied by increased serum IL-Iβ （48.28 ± 13.49 μg/ml vs. 35.56 ± 7.41μg/ml, P 〈 0.05）, and renal expression of IL-Iβ and TLR4. The biochemical parameters and rena
