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Relationship between heat shock proteins and Survivin in retinoblastoma cells and its effect on the proliferation of the cellular activity

Objective To investigate the relationship of the expression between heat shock protein (HSP) 70 and 90, and Survivin and its effects on the proliferative activity in retinoblastoma (RB) cells. Methods Expression of Survivin, HSP70 and 90, and Ki-67 in conventional paraffin samples from 43 patients with RB and 6 healthy people was detected by streptavidin-biotin peroxidase (SP) immunohistochemical method. Ki67 labeling index was used to evaluate the proliferative activity in RB. Results In 43 cases of RB, positive expression of HSP70 and 90 and Survivin was found in 28 (65.12%), 37 (86.05%) and 27 (62.79%) cases, respectively. None of the 6 normal retinal tissue expressed HSP70, HSP90 or Survivin. Positive expression of Survivin was more frequent in positive expressions of HSP90 than that in negative expressions of HSP90 (P＜0.05). Ki67 labeling index was higher in positive expressions of HSP90 and positive expressions of Survivin than that in their negative expressions respectively (P＜0.05). Meanwhile, higher Ki67 labeling index was found in positive HSP90Survivin expressions than that in negative HSP90Survivin expressions and those cases where only HSP90 or Survivin was found (P＜0.05). Expression of HSP70 did not correlate with that of Survivin, nor had any significant effect on Ki67 labeling index (P＞0.05). Expression of HSPs and Survivin and Ki67 labeling index did not correlate with histological types (P＞0.05). Conclusion Expression of HSP90 correlates with that of Survivin in RB. Co-existence of Survivin and HSP90 probably plays an important role in the genesis of RB.

Ruptured Peripancreatic Arterial Aneurysms: Diagnosis and Treatment

目的探讨胰周动脉瘤破裂出血的诊治。方法回顾3例胰周动脉瘤破裂出血患者的诊治过程，并结合相关文献进行分析。 结果3例患者胰周动脉瘤破裂出血并失血性休克，其中1例术前经CT检查获得诊断，2例术前未能诊断。2例经手术止血治愈，分别随访1年和1年2个月，未见复发及相关并发症; 1例经抢救无效死亡。结论胰周动脉瘤破裂出血病情发展迅速，术前诊断困难，尽快液体复苏及积极手术探查止血是挽救生命的关键。

Veno-arterial extracorporeal membrane oxygenation in salvage of cardiogenic shock

Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.

精神分裂症合并先天性心脏病患者无抽搐电休克治疗一例的护理

HEAT SHOCK PROTEIN AND HEPATIC ISCHEMIA REPERFUSIOIN INJURY

Objective To study the effects of heat shock proteins (HSPs) in the course of hepatic ischemia reperfusion injury (HIRI), and analyze its mechanism. Methods The relationship between HSPs and HIRI was studied by reviewing literatures. Results HSPs was a kind of stress protein induced after cell was sitmulated by the stress. It could improve body′s tolerance to tough situation. Though hepatic ischemia reperfusion usually results in serious hepatic injury, at the same time it could induce can increase the production of HSPs that can protect liver from and lessen ischemia reperfusion injury. Conclusion HSPs can improve the tolerance to HIRI and lessen injury. In addition, HSPs is thought to be markers of HIRI, and can be used as a efficient indicator to test the level of hepatic injury and assess prognosis.

Discussion on Prophylaxis and Treatment Strategy of Fulminant Acute Pancreatitis

Early clinical efficacy of emergency transcatheter aortic valve replacement for severe aortic stenosis

Objective To explore the clinical effects of emergency transcatheter aortic replacement (TAVR) on the treatment of patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis during hospitalization. Methods The study selected 44 patients from 8 heart valve centers from January 2018 to January 2021. All patients received emergency TAVR treatment. The patients’ baseline clinical data, cardiac ultrasound indicators, and postoperative hospital stay were collected. Paired t-test and McNemar test were used to compare and analyze the preoperative and postoperative cardiac ultrasound indexes, moderate to severe aortic stenosis, and cardiac function. Results The average age of the patients was (72.0±7.9) years. Valve displacement occurred in one patient during the operation, and the surgical success rate was 97.7%. Four cases died during hospitalization, and the mortality rate was 9.1%. The median length of hospital stay was 11.5 d. The postoperative aortic valve area was significantly higher than that before surgery [(0.5±0.2) vs. (3.8±1.6) mm2, P<0.05], the mean transvalvular pressure of the aortic valve was significantly lower than that before operation [(64.0±24.9) vs. (11.3±4.6) mm Hg (1 mm Hg=0.133 kPa), P<0.05], the peak aortic flow velocity was significantly lower than that before operation [(4.5±0.7) vs. (1.9±0.7) m/s, P<0.05], the left ventricular end diastolic inner diameter was lower than that before operation [(59.0±7.2) vs. (56.1±7.3) mm, P<0.05], the left ventricular ejection fraction increased significantly compared with that before operation [(30.1±10.4)% vs. (40.9±11.0)%, P<0.05], and the cardiac function improved significantly compared with that before operation (P<0.05). During the operation, 2 cases (4.5%) underwent valve-in-valve implantation, 11 cases (25.0%) underwent percutaneous coronary intervention during the same period. During the postoperative hospital stay, 1 case (2.3%) developed stroke, 3 cases (6.8%) experienced severe bleeding, 5 cases (11.4%) had severe vascular complications, 2 cases (4.5%) experienced acute myocardial infarction, 30 cases (68.2%) had small or trace paravalvular regurgitation, 3 cases (6.8%) received permanent pacemaker implantation, and 5 cases (11.4%) developed acute kidney injury. Conclustion Emergency TAVR is an effective and feasible treatment plan for patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis.

早期乳酸清除率对重症感染患者预后的评估研究

目的 分析早期乳酸清除率对重症感染患者预后的临床评估价值。方法 选取2009 年1 月至2011 年12 月收治的248 例重症感染患者为研究对象进行回顾性分析。根据患者转归分为生存组和死亡组, 比较两组一般资料、APACHEⅡ 评分、脓毒症休克发生率、初始血乳酸浓度和治疗 6 h的乳酸清除率差异。根据乳酸清除率水平分为高乳酸清除率组和低乳酸清除率组, 比较两组一般资料、APACHEⅡ评分、脓毒症休克发生率、初始血乳酸浓度和病死率的差异。结果 生存组和死亡组患者的一般资料、APACHEⅡ评分、初始血乳酸浓度间的差异均无统计学意义( P gt;0. 05) 。生存组乳酸清除率明显高于死亡组[ ( 32. 6 ±11. 3) % 比( 15. 2 ±10. 1) % , P = 0. 024] , 而脓毒症休克发生率明显低于死亡组( 30. 9% 比87. 5% , P = 0. 019) 。高乳酸清除率组的脓毒症休克发生率( 34. 6% 比 53. 7%) 及死亡率( 25. 5% 比61. 1% ) 明显低于低乳酸清除率组( P 均lt;0. 05) 。结论 早期乳酸清除率可用于早期评估重度感染患者的预后转归。

Effects of Fluid Resuscitation on Homeostasis and Acute Physiology and Chronic Health EvaluationsⅡof Patients with Septic Shock

Objective　To evaluate the effects and the clinical significances of liquid resuscitation on blood gas analysis， acid-base balance， electrolytes， acute physiology and chronic health evaluationsⅡ（APACHEⅡ） score of patients with septic shock， and then to analyze the relations between serum chlorine （Cl－） level and APACHEⅡscore and the volume of liquid resuscitation. Methods　According to the target of resuscitation （centre venous pressure 8-12mm Hg and mean arterial pressure≥65mm Hg）， 21 patients with septic shock received enough fluid for resuscitation during 24h . The results of blood gas analysis， acid-base balance， electrolytes， and APACHE Ⅱ score were compared between pre-resuscitation and 24h post-resuscitation by self-controlled prospective study. The relationships of the level of serum Cl－ and APACHEⅡ score with the volume of liquid used in resuscitation were analyzed . Results　The mean resus-citation duration was （18.09±4.57） h， and the volume of liquid during 24 h resuscitation was 5 320-11 028mL with mean volume of （7 775±1 735） mL in 21 patients with septic shock. Serum sodium （Na＋， mmol/L） and Cl－（mmol/L）levels of post-resuscitation were significant higher than those of pre-resuscitation （Na＋：138.71±5.67 versus 135.62±7.23， P=0.024；Cl－：109.10±4.90 versus 101.67±8.59， P=0.000）. Compared with the levels of pre-resuscitation， the blood pH value， hematocrit （Hct，%）， anion gap （AG， mmol/L）， lactic acid （mmol/L）， and APACHE Ⅱscore significantly decreased （pH：7.31±0.05 versus 7.37±0.06， P=0.000；Hct：28.48±2.56 versus 32.76±9.19， P=0.049；AG：8.33±3.45 versus 14.17±8.83， P=0.004；lactic acid：1.66±0.89 versus 2.96±1.23， P=0.001；APACHEⅡ：10.90±3.73 versus 17.24±4.06， P=0.000） after 24h resuscitation. The correlation analysis showed that the level of serum Cl- was positively correlated with the volume of liquid used in resuscitation （r=0.717，P＜0.01）. However， there was no correlation between APACHEⅡscore and the volume of liquid used in resuscitation （P＞0.05）. Conclusions　The target of liquid resuscitation in patients with septic shock should be cautiously determined， including control of the volume of crystal liquid for resuscitation， in order to avoid acid-base imbalance or hyperchloraemia. At the same time， the change in internal environment should be monitored. An optimistic fluid resuscitation to decrease APACHE Ⅱ score in patients with septic shock is unrelated to the volume of liquid resuscitation.

热休克蛋白90抑制剂治疗新生血管性眼病的研究现状

热休克蛋白90（HSP90）作为一种广泛存在的分子伴侣，在新生血管性疾病的发生发展中起重要作用。HSP90抑制剂能抑制HSP90活性，引起与细胞增生、细胞周期调节、细胞凋亡有关的重要信号蛋白选择性降解，并通过与磷脂酰肌醇-3激酶/蛋白激酶B和类风湿性关节炎因子/蛋氨酸脑啡肽/促分裂原活化蛋白激酶等信号通路中的多种HSP90客户蛋白分子相互作用，降低血管生成因子的表达，从而抑制血管内皮细胞的增生和存活。研发特异性的HSP90抑制剂药物已经成为治疗肿瘤及相关新生血管性疾病的新选择。其可能成为治疗新生血管性眼病的全新靶点。