Effect of nitric oxide on toll-like receptor 2 and 4 gene expression in rats with acute lung injury complicated by acute hemorrhage necrotizing pancreatitis

BACKGROUND: Toll-like receptor (TLR) 2/4 might play important roles in mediating proinflammatory cytokine synthesis and release. And nitric oxide (NO) has been used to treat acute respiratory distress syndrome (ARDS). This study aimed to investigate the changes in TLR2/4 gene expression in the lungs of rats with acute lung injury (ALI) complicated by acute hemorrhage necrotizing pancreatitis (AHNP) and the effect of NO on the TLR2/4 gene expression. METHODS: One hundred and ten SD male rats were randomly divided into sham-operated group ( n = 10) , AHNP group (n = 30) , chloroquine-treated group ( n = 30) , and L-Arg-treated group (n =40). The lungs were dissected for lung histological scoring, and bronchoalveolar lavages were harvested for lung injury indexing. TLR2/4 mRNA expression in the lungs was measured by RT-PCR. RESULTS: TLR2/4mRNA was detected in the lungs with low values in the sham-operated group (0.016±0. 210E-2, 0.112 ±0.750E-2) , but it was markedly increased at 3 hours in the AHNP group (0.787±0.751E-2, 1.512 ±1.794E-2) , peaking at 12 hours (1.113 ±6.141E-2, 2.957±2.620E-2; P <0.05 or P <0.01). When lung injuries were aggravated, TNF-α concentrations in the lungs were increased, but NO concentrations were decreased ( P < 0.05 or P < 0.01 ) . When TLR2/4mRNA was inhibited by CQ (3h: 0.313 ± 5.491E-2, 0.005 ±1.419E-3 ; 6h: 0.488 ±7.442E-2, 0.010 ± 1.518E-3; 12h: 0.883 ± 8.911E-2, 0.024 ± 2.760E-3; P< 0.05 or P <0.01) , lung injuries were relieved. NO concentrations in the lungs were increased but TNF-α concentrations were decreased (P <0. 05 or P <0.01). When the rats with AHNP were treated with L-Arg, TLR2/4mRNA expression in the lungs could be effectively inhibited (50mg-T: 0.656 ±3. 977E-2, 1. 501 ±6.111E-2; 100mg-T: 0.260± 0.891E-2, 0.732 ±5.135E-2; 200mg-T: 0.126 ±0.914E-2, 0.414 ± 1.678E-2; 400mg-T: 0.091 ±0.399E-2, 0.287 ± 0.176E-2; P <0.05 or P <0. 01) and lung injuries were relieved. At the same time, NO concentrations in the lungs were markedly increased, but TNF-α concentrations were decreased (P <0.05 or P <0.01). CONCLUSIONS: The expression of TLR2/4mRNA is increased in the lungs in rats with AHNP and lung injuries are aggravated. TLR2/4mRNA gene expression of the lungs of rats with AHNP could be markedly inhibited by NO, leading to the relief of lung injuries.

Cerebral arterial blood flow,attention,and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage

BACKGROUND Intracerebral hemorrhage mainly occurs in middle-aged and elderly patients with hypertension,and surgery is currently the main treatment for hypertensive cerebral hemorrhage,but the bleeding caused by surgery will cause damage to the patient's nerve cells,resulting in cognitive and motor dysfunction,resulting in a decline in the patient's quality of life.AIM To investigate associations between cerebral arterial blood flow and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage.METHODS Eighty-nine patients with depression after acute hypertensive cerebral hemorrhage who were admitted to our hospital between January 2019 and July 2021 were selected as the observation group,while 100 patients without depression who had acute hypertensive cerebral hemorrhage were selected as the control group.The attention span of the patients was assessed using the Paddle Pin Test while executive function was assessed using the Wisconsin Card Sorting Test(WCST)and cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).The Hamilton Depression Rating Scale(HAMD-24)was used to evaluate the severity of depression of involved patients.Cerebral arterial blood flow was measured in both groups.RESULTS The MoCA score,net scores I,II,III,IV,and the total net score of the scratch test in the observation group were significantly lower than those in the control group(P<0.05).Concurrently,the total number of responses,number of incorrect responses,number of persistent errors,and number of completed responses of the first classification in the WCST test were significantly higher in the observation group than those in the control group(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery was significantly lower in the observation group than in the control group(P<0.05).The basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery were positively correlated with the net and total net scores of each part of the Paddle Pin test and the MoCA score(P<0.05),and negatively correlated with each part of the WCST test(P<0.05).In the observation group,the post-treatment improvement was more prominent in the Paddle Pin test,WCST test,HAMD-24 score,and MoCA score compared with those in the pre-treatment period(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery significantly improved in the observation group after treatment(P<0.05).CONCLUSION Impaired attention,and executive and cognitive functions are correlated with cerebral artery blood flow in patients with depression after acute hypertensive cerebral hemorrhage and warrant further study.

Risk factors for early rebleeding and mortality in acute variceal hemorrhage

AIM: To investigate the risk factors for 6-wk rebleeding and mortality in acute variceal hemorrhage (AVH) patients treated by percutaneous transhepatic variceal embolization (PTVE).

ADVANCES IN CLINICAL AND EXPERIMENTAL STUDIES ON ACUPUNCTURE TREATMENT OF ACUTE CEREBRAL HEMORRHAGE

In the present paper, the authors review recent advances in clinical and experimental studies on acupuncture treatment of cerebral hemorrhage(CH). Regarding clinical studies, the resuscitation-inducing needling maneuver, and main points of Shuigou(水沟GV 26),Baihui(百会 GV 20) and scalp-points Motor Area(MS 6), Sensory Area(MS 7), etc. are often involved. Concerning experimental studies, the underlying mechanisms of acupuncture of GV-26+“Neiguan”(内关 PC 6), GV-20,GV-26+GV-20, etc. in improving acute CH are introduced. In a word, acupuncture therapy works well in improving clinical symptoms and signs of CH patients, and acupuncture stimulation induced ameilioration of cerebral blood flow, favorable modulation of some bioactive substances as excitatory and inhibitory amino acids, endothelin, CGRP, heat shock protein 70, etc. and neuro-endocrine-immune network may contribute to the effect of acupuncture on CH. In addition, acupuncture combined with medicine and earlier application of acupuncture therapy in the acute stage of CH are recommended in clinical practice.

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana’a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endoscope (P - 47.29, P = 0.001) and high serum bilirubin (- 1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P - 1.41, P - 1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 109/l.

Comment on “Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage”

Dear Editor,We were interested to read the paper by Kuzmanovic Elabjer et al.The purpose of the authors was to assess ultrasound reliability in detecting retinal tears in patients with acute symptomatic posterior vitreous detachment （ASPVD）. They performed transpalpebral ultrasound of the eye and the orbit followed by fundus examination initially and in 6wk period.

The Effect of Zhu Yu Hua Tan Tang on IntracranialPressure in Case of Acute Cerebral Hemorrhage

The therapeutic effect of Zhu Yu Hua Tan Tang (逐瘀化痰汤Decoction for removing blood stasis and resolving phlegm) plus general and modern treatment on acute cerebral hemorrhage in 44 cases, and the pressure-lowering effect of Zhu Yu Hua Tan Tang and mannitol in 20 cases of acute cerebral hemorrhage in the basilar region, and in rabbits with experimental encephaledema induced by injection of olive oil into the common carotid artery were observed in this study. The results showed that Zhu Yu Hua Tan Tang plus general treatment can better improved the conscious state of the patients than western medicine, and it can make the intracranial pressure drop clinically by 40.44%. The intracranial pressure-lowering effect of Zhu Yu Hua Tan Tang, though slow, is smooth and long-lasting without any rebound phenomenon, as compared to those of mannitol. Similar results were found in animal experiments, but the intracranial pressure-lowering amplitude of Zhu Yu Hua Tan Tang was stronger than that of mannitol. The difference between the clinical and experimental results needs to be further studied.

Role of nitric oxide in Toll-like receptor 2 and 4 mRNA expression in liver of acute hemorrhagic necrotizing pancreatitis rats

AIM： To investigate the role of nitric oxide （NO） in Tolllike receptor 2 （TLR2）/4mRNA expression in livers of acute hemorrhagic necrotizing pancreatitis （AHNP） rats. METHODS： One hundred and ten SD male rats were randomly divided into sham-operated group （n = 10）, AHNP group （n = 30）, chloroquine （CQ）-treated group （n = 30） and L-Arg-treated group （n = 40）. TLR2/4mRNA expression in the liver of AHNP rats was measured by RT-PCR. RESULTS： Expression of TLR2/4mRNA could be detected in the liver of AHNP rats in sham-operated group （0.155E-5±0.230E-6 and 0.115E-2±0.545E-4）, but was markedly increased at 3 h in AHNP group （0.197E-2±0.114E-3 and 0.175±0.349E-2） peaking at 12 h （0.294E-2 ± 0.998E-4 and 2.673 ± 2.795E-2, P〈 0.01）. Hepatic injuries were aggravated, TNF-α concentration in the liver was increased and NO concentration was decreased （P〈 0.05 or P〈 0.01）. When TLR2/4mRNA expression was inhibited by CQ （3 h： 1.037E-4±3.299E-6 and 0.026±3.462E-3; 6 h： 1.884E-4±4.679E-6 and 0.108±6.115E-3; 12 h： 2.443E-4±7.714E-6 and 0.348±6.807E-3; P 〈 0.01）, hepatic injuries were relieved, NO concentration in the liver was increased and TNF-α concentration was decreased （P〈0.05 or P〈0.01）. When rats with AHNP were treated with L-Arg, TLR2/4mRNA expression in the liver could be effectively inhibited （50 mg-T： 0.232E-2±0.532E-4 and 0.230±6.883E-3; 100 mg-T： 0.210E-2± 1.691E-4 and 0.187±0.849E-2; 200 mg-T： 0.163E-2±0.404E-4 and 0.107±0.195E-2; 400 mg-T： 0.100E-2±0.317E-4 and 0.084±0.552E-2; P〈0.01） and hepatic injuries were relieved. At the same time, NO concentration in the liver was markedly increased and TNF-α concentration was decreased （P〈0.05 or P〈O.OI）, CONCLUSION： The expression of TLR2/4mRNA is increased and hepatic injuries are aggravated in the liver of AHNP rats. TLR2/4mRNA gene expression in the liver of AHNP rats can be markedly inhibited by NO, leading to the relief of hepatic injuries.

Chloroquine Relieves Acute Lung Injury in Rats with Acute Hemorrhagic Necrotizing Pancreatitis

Summary： This study preliminarily investigated the mechanism by which chloroquine （CQ） relieves acute lung injury （ALI） complicated in acute hemorrhagic necrotizing pancreatitis （AHNP）. Sixty male Wistar rats were randomized into sham-operated group （group A, n=10）, AHNP group （group B, n=10）, L-arginine-treated group （group C, n=10）, L-N-nitro-L-arginine methyl ester （NAME）-treated group （group D, n=10）, CQ-treated group （group E, n=10） and CQ＋L-NAME-treated group （group F, n=10）. TLR4 expression was measured by using real time-PCR and Western blotting respectively. The results showed that, in the group B, the expression of TLR4 and the levels of TNF-α and IL-6 in the lungs were significantly increased, and the nitric oxide （NO） concentration was reduced, as compared with those in the group A （P〈0.05 or P〈0.01）. Lung injury was aggravated with the increased expression of TLR4. When the inhibitor and stimulator of TLR4, namely L-Arg and L-NAME, were added respectively, lung injury was correspondingly relieved or aggravated （P〈0.05 or P〈0.01）. In the group E, TLR4 expres- sion was substantially lower and NO concentration higher than those in the group B （P〈0.05 or P〈0.01）. However, in the group F, NO concentration was markedly decreased, and the inhibitory effect of CQ on TLR4 expression and the relief of lung injury were weakened when compared with those in the group E （P〈0.05 or P〈0.01）. It was concluded that TLR4 may play an important role in the pathogenesis and development of ALl complicated in AHNP. CQ could relieve ALl by decreasing the TLR4 expression and increasing the NO release.

Hydroxyethylstarch revisited for acute brain injury treatment

Infusion of the colloid hydroxyethylstarch has been used for volume substitution to maintain hemodynamics and microcirculation after e.g., severe blood loss.In the last decade it was revealed that hydroxyethylstarch can aggravate acute kidney injury, especially in septic patients.Because of the serious risk for critically ill patients, the administration of hydroxyethylstarch was restricted for clinical use.Animal studies and recently published in vitro experiments showed that hydroxyethylstarch might exert protective effects on the blood-brain barrier.Since the prevention of blood-brain barrier disruption was shown to go along with the reduction of brain damage after several kinds of insults, we revisit the topic hydroxyethylstarch and discuss a possible niche for the application of hydroxyethylstarch in acute brain injury treatment.

Susceptibility-weighted imaging is suitable for evaluating signal strength in different brain regions of a rabbit model of acute hemorrhagic anemia

Acute hemorrhagic anemia can decrease blood flow and oxygen supply to brain, and affect its physiological function. While detecting changes in brain function in patients with acute hemorrhagic anemia is helpful for preventing neurological complications and evaluating therapeutic effects, clinical changes in the nervous systems of these patients have not received much attention. In part, this is because current techniques can only indirectly detect changes in brain function following onset of anemia, which leads to lags between real changes in brain function and their detection.

EFFECT OF SOMATOSTATIN ON THE EXPRESSION OF TNF α mRNA IN MULTIORGANS OF RATS WITH ACUTE HEMORRHAGIC NECROTIC PANCREATITIS

Objectives.To study the expression of TNF α mRNA and the effect of somatostatin on the expression of TNF α mRNA in multiorgans of rats with acute hemorrhagic necrotic pancreatitis(AHNP). Methods.AHNP in the rat was induced by retrograde injection of 5% sodium taurocholate into the bile-pancreatic duct. Somatostatin octapeptide (SS-OP) (2μg/kg)was injected into the femoral vein imme- diately in rats of the treatment group after inductive AHNP. Rats of the sham operative group received in- jection of saline. Sixty animals of the AHNP and sham operative groups at the designated time(0. 2h, 0. 5 h, 2h, 4h, 8h, after the operation,six animals at each time point)and tweleve animals of treatment group at 4h after the operation were sacrificed for samples of pancreas, liver and lung. The expressions of TNF α mRNA within the pancreas, liver and lung were established by RT－PCR. Results. TNF α mRNA became detectable in the pancreas as early as 0. 2h after inductive AHNP, while it was undetectable in other organs until 0. 5h. Expression of TNF α mRNA in each tissue increased continuously and reached a peak at 4h,demonstrating a significant difference compared with that at 0. 5h and 8h. Expressions of TNF α mRNA from pancreas, liver and lung were decreased 50-80% in the treat- ment group, the pancreatic necrosis was also attenuated dramatically. Conclusion. TNF α mRNA was detectable in pancreas,liver and lung tissues at the early stage of AH- NP.SS-OP can significantly inhibit the expression of TNF α mRNA and attenuate the pancreatic necrosis. We feel that this may be an important mechanism of SS-OP in the treatment of AHNP.

Phospholipase A_2 and Its Relationship with Acute Lung Injury in Acute Pancreatitis in Dogs

Acute fulminant pancreatitis was produced in dogs by injection of autobile into the main pancreatic duct.After injection the phospholipase A_2(PLA_2)activities in serum,lung lymph and bronchoalveolar lavage fluid(BAL)were elevated significantly,lung lymph flow and pulmonary transvascular potein clearance increased progressively,protein content and cell numbers in BAL in the experimental animals were significantly higher than those in the control animals.Furthermore the lung index,wet to dry lung weight ratio,extravascular lung water to bloodless dry lung weight ra- tio,extravascuar lung water to bloodless dry lung weight ratio increased significantly as compared to control animals.Pretreatment with PLA_2 inhibitor,chloroquine,blocked the changes mentioned above.This experiment suggests:1.PLA_2 activity in lung lymph fluid as well as in serum and BAL is elevated in acute hemorrhagic pancreatitis.2.Elevated PLA_2 activity may increase the pulmonary vascular permeability.3.PLA_2 is the major factor leading to pulmonary edema in acute hemorrhagic pancreatitis.4.Phagocytes contribute to the lung injury induced by PLA_2 to some ex- tent.

Visibility of the bleeding point in acute rectal hemorrhagic ulcer using red dichromatic imaging:A case report

BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.

Acute Hemorrhagic Fever: Clinical, Epidemiological and Laboratory Aspects in São Toméand Príncipe

Background: In the last 6 months, cases of acute hemorrhagic fever (AHF) have been recorded in Sao Tome and Principe (STP). Objective: To identify the clinical, epidemiological and laboratory parameters associated with AHF cases found in patients hospitalized in STP. Methods: Descriptive and quantitative analysis of AHF cases hospitalized in STP in the period December 2021 to May 19, 2022 through the variables: demographic data;clinical data;laboratory data and clinical outcome. Results: Analyzed 18 of 22 AHF cases, 50% of them male, mean age 33.7 years, 85.7% residing in the 2 largest districts of the country, 66.7% rural workers, administrative near maritime areas, sailors and domestics. 66.7% were healthy individuals. ≥50% had a fever, asthenia/weakness, myalgia, headache, lethargy, nausea, vomiting, and diarrhea. 22.2% to 33.3% had retro-orbital pain, abdominal pain, decreased consciousness, dyspnea/hypoxia, and cough. In a smaller register (5.6% - 11.1%), exanthema, convulsion, arthralgia, low back pain, chills, and chest pain. Bleeding from the digestive tract was found in 72.2%, followed by vaginal (33.3%), urethral (27.8%), nasal (22.2%), and oral (16.7%). 50% had laboratory confirmation for dengue, and another 50% with suspected clinical diagnosis without laboratory confirmation of the etiologic agent. Despite hemorrhage, 66.7% of confirmed cases were hemodynamically non-severe, and 88.9% of suspected cases were severe. Coinfection with malaria is evidenced in 11.1% of cases. 72.2% recovered and 27.8% died (deaths in 55.5% of suspected cases). Case deaths were male (100%), resident foreigners (40%), tool store employees, sailors and students, healthy (80%), and residing in the largest district in the country (60%). All deaths were hospitalized in serious condition, 80% were hospitalized for hemorrhage and shock, with bleeding arising between day 4 - 5 of illness in 60% and hospitalization on day 5 of illness. 60% died within ≤24 hours of hospitalization. 80% died from shock and multi-organ dysfunction and 20% from respiratory failure. Deaths had thrombocytopenia (100%), renal dysfunction (100%) and significantly increased transaminases (100%), anemia (75%) and leukocytosis (66.7%). 20% had a radiological change of pulmonary infiltrates. Conclusion: Our data reveal the complexity of the pathogens causing AHF and suggest the possible presence of other human pathogens usually unknown in the Santomean geographical territory.

EFFECT OF ELECTROACUPUNCTURE OF SCALP-POINTS ON ABNORMAL DISCHARGES OF NEURONS AROUND THE CEREBRAL HEMORRHAGE FOCUS IN THE RAT

Objective: To study the mechanism of electroacupuncture (EA) of scalp-points for regulating abnormal discharges of neurons in different regions around the cerebral hemorrhage focus by using neuro-electrophysiological methods. Methods: 80 Wistar rats (anesthetized with 20% urethane 1 g/kg, i.p.) were randomly divided into normal, saline, model and EA groups, with 20 cases in each group. Cerebral hemorrhage model was established by intracerebral injection of the rat’s own arterial blood sample (40 uL). In rats of saline group, the same volume of saline was given for intracerebral injection. Extracellular electrical activity of neurons of the caudate nucleus and parafascicular nucleus and Tail flicking latency (TFL) were used as the indexes. “Baihui”(百会 GV 20) and “Taiyang”(太阳 EX-HN 5) were punctured from GV 20 towards EX-HN 5 with filiform needles and stimulated electrically with stimulating parameters of strength of 1 V, frequency of 15 Hz and duration of 15 min. Results: Compared with normal group, TFL values of model group and EA group increased significantly (P<0.01); and compared with model group, those of EA group decreased significantly (P<0.01), suggesting that the pain threshold increased significantly in cerebral hemorrhage rats while after acupuncture stimulation, it lowered strikingly. Compared with normal and saline groups, the latency values of the pain excitement and inhibitory responses of the cellular discharges of the caudate and parafascicular nuclei in model and EA groups increased significantly (P<0.05～0.01), while after EA, it recovered apparently (P<0.01), showing an apparent regulative effect of EA on the abnormal changes of discharges of neurons around the cerebral hemorrhage focus. Conclusion: Scalp-acupuncture possesses an apparent regulatory effect on the abnormal electrical activity of neurons around the cerebral hemorrhage focus which may favor the early recovery of functional activity of neurons near the focus tissues.

Clinical Study of Xingnaojing Injection Combined with Craniocerebral Hypothermia Apparatus in the Treatment of Acute Hemorrhagic Stroke

Objective:To investigate the clinical effect of Xingnaojing injection combined with craniocerebral hypothermia apparatus in the treatment of acute hemorrhagic stroke.Methods:Seventy-two patients with acute hemorrhagic stroke admitted to our hospital from March 2018 to September 2019 were randomly divided into two groups,with 36 cases in each group.The control group(n=36)was treated with craniocerebral hypothermia apparatus,and the observation group(n=36)was treated with Xingnaojing injection combined with craniocerebral hypothermia apparatus.The clinical efficacy,the National Institutes of Health Stroke Scale(NIHSS)score and the activity of daily living(MBI score)after 1 month of treatment were compared.Results:The effective rate of treatment in the observation group was higher than that in the control group(P<0.05);NIHSS score was decreased in both groups(P<0.05);MBI score was increased in both groups,and the change range of the observation group was greater than that of the control group,showing statistically significant differences(P<0.05).Conclusion:Xingnaojing injection combined with craniocerebral hypothermia apparatus can improve the clinical efficacy,the neurological impairment and activity of daily living in the treatment of acute hemorrhagic stroke,which is worthy of clinical application.

Clinical Significance of Serum Myelin Basic Protein in Patients with Severe Acute Pancreatitis

Objective In order to determine serum myelin basic protein (MBP) in patients with severe acute pancreatitis and evaluate its clinical significance. Methods\ Serum MBP was measured in 20 patients with acute hemorrhagic necrotic pancreatitis (AHNP) and in 20 normal subjects by enzyme linked immunoabsorbent assay. Results\ Serum MBP content of AHNP group was significantly higher than that of normal control group (P<0.05). Serum MBP content in patients with pancreatic encephalopathy (PE) was significantly higher than that of those without PE (P<0.05). Conclusion\ ①Serum MBP content in patients with AHNP increased significantly;②Serum MBP content may reflect brain injury and its severity;③The prognosis of AHNP is correlated with its serum MBP content.\;

Effect of Tianhuang Granule(田黄冲剂) on Intracranial Pressure and Serum Matrix Metalloproteinase-9 in Patients with Acute Cerebral Hemorrhage

Objective： To study the effect and mechanism of Tianhuang Granule （田黄冲剂, THG） on hydrocephalus in the patients with acute cerebral hemorrhage （ACH） through intracranial pressure （ICP） monitoring, serum matrix metalloproteinase-9 （MMP-9） level observation, and National Institutes of Health Stroke Scale （NIHSS） scoring （for nerve function deficit）. Methods： Sixty patients with ACH were equally randomized into two groups by lottery, the control group and the THG group; all were treated with conventional therapy, but to the patients in the THG group, THG was given orally in addition for 28 days. Changes of ICP, MMP-9 expression, and NIHSS scores, as well as the degree of cerebral hematoma and hydrocephalus （by cranial CT scanning） in the patients, were estimated and compared. Results： （1） ICP was lowered more significantly in the THG group, showing a significant difference between groups on day 7 （P〈0.05）. （2） MMP-9 expression was down-regulated in the THG group more significantly and earlier than that in the control group. （3） The degrees of cerebral hematoma and hydrocephalus in the THG group on day 7 were reduced significantly as compared with those on day 3 （P〈0.05）, but in the control group, the day of significant reduction was delayed to day 14, and the degrees on day 7 and day 14 in the two groups were significantly different （P〈0.05 and P〈0.01）. （4） NIHSS score was significantly lower in the THG group than that in the control group on day 14 and day 28 （P〈0.05 and P〈0.01）. Conclusion： THG can effectively lower ICP, down-regulate MMP-9 expression, promote the absorption of cerebral hematoma and hydrocephalus, and improve the nerve function, showing a clinical effectiveness than conventional therapy.

Surgical operation of a massive retroperitoneal tumor

Summarize the surgical cooperation of a massive retroperitoneal tumor. The main surgical cooperation points include: clos e observation of the patient's vital signs and condition changes, strengthen ing the prevention of potential complications, mak ing full preoperative preparation, master ing the coordination points of hand washing, itinerant nurses, and effective massive bleeding treatment plan, etc. Through perfect surgical cooperation and nursing, the patient's condition was stable and discharged smoothly.