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3. [A study of rate of compliance with sepsis bundle in patients with severe sepsis and septic shock in emergency department]

Author

Ying, Zhu, Ran-jun, Tao, Wen, Shi, Jian-jing, Tong, and Yi-ming, Lu

Subjects
Adult, Aged, 80 and over, Male, Sepsis, Humans, Female, Guideline Adherence, Prospective Studies, Middle Aged, Emergency Service, Hospital, Shock, Septic, Aged
Abstract

To evaluate the occurrence of severe sepsis and septic shock and the rate of compliance with sepsis bundle in patients with severe sepsis and septic shock in emergency department.A prospective study was conducted on consecutive adult patients who were sent to Emergency Department of Ruijin Hospital, Shanghai Jiaotong University School of Medicine by ambulance from May to June in 2009. The occurrence of severe sepsis and septic shock, and the number of the patients in whom who met the criteria of compliance with sepsis bundle were analyzed.Nine hundred and seventeen patients who were sent to the emergency department by ambulance in that period were enrolled in the study. The number of patients with severe sepsis and septic shock was 96. The incidence of severe sepsis and septic shock was 10.47%. Among these patients, the number of patients in whom the sepsis bundle was complied, i.e. sepsis bundle, appropriate cultures were taken before antimicrobial therapy, placement of central venous catheter and monitoring of central venous pressure (CVP) as well as central venous oxygen saturation (ScvO₂) within 2 hours, antibiotic therapy within 3 hours, early goal directed therapy (EGDT) within 6 hours, and lactate clearance in 12 hours reached 1.04%, 3.12%, 2.08%, 83.33%, 1.04%, 23.96%. The Results were 1.19%, 3.57%, 2.38%, 83.33%, 1.19%, 26.19% and 0, 0, 0, 83.33%, 0, 8.33% in medical and surgical emergency department respectively. There was no statistical difference between the two divisions (all P0.05).The incidence of severe sepsis and septic shock was high in emergency department, but the rate of recognition of it and the compliance with sepsis bundle were inadequate. It is urgently necessary to enhance the learning and implementation of the guideline.

Published
2011

4. Functional brain imaging in irritable bowel syndrome with rectal balloon-distention by using fMRI

Author

Yao-Zong Yuan, Fei Miao, Ran-Jun Tao, Jing Sun, Ke-Min Chen, Bin Xu, Zhong-Wei Zhang, and Jia-Yu Xu

Subjects
Adult, Male, Abdominal pain, Rectum, Colonic Diseases, Functional, Insular cortex, Catheterization, Clinical Research, medicine, Humans, Irritable bowel syndrome, Anterior cingulate cortex, medicine.diagnostic_test, business.industry, Gastroenterology, Magnetic resonance imaging, Visceral pain, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Oxygen, medicine.anatomical_structure, Cerebrovascular Circulation, Anesthesia, Female, medicine.symptom, Rectal Balloon, business
Abstract

AIM: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls. METHODS: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 mL and 120 mL rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 mL, 60 mL, 90 mL, and 120 mL rectal balloon-distention in all subjects. RESULTS: Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37), prefrontal cortex (37/37), and thalamus (35/37) in most cases. At 120 mL of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 mL and 120 mL rectal balloon-distention was significantly higher in patients with IBS than that in controls. CONCLUSION: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.

Published
2003

6. [Short-term preoperative treatment of celecoxib, a selective cyclooxygenase-2 inhibitor, on E-cadherin expression in gastric carcinoma tissues].

Author

Ran JT, Zhou YN, Tang CW, Li HH, Li XW, and Lu H

Subjects
Adenocarcinoma metabolism, Adenocarcinoma surgery, Adult, Cadherins blood, Celecoxib, Cyclooxygenase 2 metabolism, Female, Humans, Immunohistochemistry, Male, Middle Aged, Preoperative Period, Stomach Neoplasms metabolism, Stomach Neoplasms surgery, Up-Regulation, Adenocarcinoma drug therapy, Cadherins metabolism, Cyclooxygenase 2 Inhibitors therapeutic use, Pyrazoles therapeutic use, Stomach Neoplasms drug therapy, Sulfonamides therapeutic use
Abstract

Background and Objective: Cyclooxygenase-2 (COX-2) inhibitors have been shown to exert chemopreventive effects against gastrointestinal carcinomas. This study was to investigate the effect of celecoxib, a selective COX-2 inhibitor, on the expression of E-cadherin and serum levels of soluble E-cadherin in gastric carcinomas., Methods: Fifty-nine gastric carcinoma patients were randomly divided into two groups: surgery group (n=22) and celecoxib plus surgery group (n=37). Patients in the surgery group underwent surgical resection after diagnosis, while patients in the celecoxib plus surgery group received oral celecoxib, 200 mg twice daily for six days before curative resection. Twenty healthy subjects were recruited as normal controls. COX-2 and E-cadherin expressions were detected by immunohistochemistry. Serum levels of soluble E-cadherin were quantitatively measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit., Results: Compared to the surgery group, the expression of COX-2 was significantly lower while that of E-cadherin was significantly higher in celecoxib plus surgery group. The concentrations of serum soluble E-cadherin before treatment were significantly higher in the surgery [(53.47+/-9.62) ng/mL] and the celecoxib plus surgery [(51.57+/-9.79) ng/mL] groups than in the control group [(37.17+/-5.38) ng/ml] (P<0.01). The soluble E-cadherin levels after surgery in both groups [(39.29+/-7.72) ng/mL and (29.29+/-8.28) ng/mL] were significantly lower than those before surgery (P<0.01). The soluble E-cadherin level on the sixth day [(44.11+/-8.36) ng/mL] was significantly lower than that before treatment in the celecoxib plus surgery group (P<0.01)., Conclusion: Short-term preoperative treatment of celecoxib up-regulates the expression of E-cadherin in gastric carcinomas.

Published
2009

7. [Celecoxib induces apoptosis and inhibits angiogenesis in gastric cancer].

Author

Ran JT, Zhou YN, Tang CW, Lu JR, Wu J, Lu H, and Yang GD

Subjects
Adenocarcinoma metabolism, Adenocarcinoma pathology, Adult, Aged, Celecoxib, Cyclooxygenase 2 metabolism, Cyclooxygenase 2 Inhibitors therapeutic use, Female, Humans, Male, Microvessels pathology, Microvessels ultrastructure, Middle Aged, Pyrazoles therapeutic use, Stomach Neoplasms metabolism, Sulfonamides therapeutic use, Vascular Endothelial Growth Factor A metabolism, Apoptosis drug effects, Cyclooxygenase 2 Inhibitors pharmacology, Neovascularization, Pathologic prevention & control, Pyrazoles pharmacology, Stomach Neoplasms pathology, Sulfonamides pharmacology
Abstract

Objective: The aim of this study was to explore the effect of celecoxib, a cyclooxygenase-2 inhibitor, on induction of apoptosis and inhibition of angiogenesis in gastric cancer., Methods: Fifty nine gastric cancer patients were randomly divided into 2 groups: celecoxib group (n = 37) and control group (n = 22). The patients in the celecoxib group were treated orally with celecoxib 200 mg twice daily for 7 days before resection. The patients in the control group received surgical resection alone. Another group of 20 healthy subjects were recruited as normal control. The number of apoptotic tumor cells was measured by terminal deoxynucleotidyl transferse-mediated dUTP nick end labeling (TUNEL). The expression of COX-2, VEGF and the microvessel density (MVD) were evaluated by immunohistochemistry., Results: The TUNEL results showed an increase of apoptosis in the tumor cells after celecoxib treatment in comparison with that in the control group (7.1% +/- 1.0% vs. 6.2% +/- 0.9%, P < 0.05). The expression level of COX-2 and VEGF in the gastric cancer tissues was significantly decreased in the celecoxib group compared with those in the control group (P < 0.05). Furthermore, MVD was also significantly lower in the celecoxib group when compared with that in the control group (30.48 +/- 5.02 vs. 38.98 +/- 4.58, P < 0.05)., Conclusion: Oral intake of celecoxib can induce apoptosis and suppress angiogenesis in gastric cancer. It may become an effective agent in the treatment of gastric cancer.

Published
2008

8. Effects of nociceptin/orphanin FQ on rats with cathartic colon.

Author

Li HY, Yan X, Xue QL, Zhou YN, Gao Y, Wang R, Liu YM, and Ran JT

Subjects
Animals, Colon innervation, Colon pathology, Colonic Diseases, Functional drug therapy, Colonic Diseases, Functional pathology, Colonic Diseases, Functional physiopathology, Disease Models, Animal, Electromyography, Enteric Nervous System physiopathology, Female, Gastrointestinal Motility physiology, Male, Muscle Contraction drug effects, Muscle Contraction physiology, Muscle, Smooth drug effects, Muscle, Smooth physiopathology, Peristalsis drug effects, Peristalsis physiology, Rats, Rats, Wistar, Nociceptin, Cathartics pharmacology, Colon drug effects, Colon physiopathology, Gastrointestinal Motility drug effects, Opioid Peptides pharmacology
Abstract

Aim: To demonstrate the change and effect of nociceptin/orphanin FQ in the colon of rats with cathartic colon., Methods: The cathartic colon model was established by feeding rats rhubarb for 3 mo, the changes of colonic electromyography were investigated by both suspension muscle strips test and serosal recordings of colonic myoelectrical activity. Immunohistochemical staining (S-P methods) and image analysis were used to determine the changes of nociceptin/orphanin FQ in the proximal colon and distal colon of rats with cathartic colon., Results: Suspension muscle strips test in vitro showed OFQ (10(-9)-10(-6) mol/L) concentration dependently caused an immediate tonic contraction in the isolated colon. But the increase of tension in cathartic colon was less than control groups (P < 0.01). Intravenous administration of OFQ (1 microg/kg) caused phasic contractions in the proximal colon, while the amplitude of phasic contractions caused by OFQ in cathartic colon was much lower than that in the control groups (2.58 +/- 0.41 vs 4.16 +/- 0.53, t = -2.6, P = 0.012). OFQ was highly expressed in the myenteric plexus of the rat colon but not in the muscle cells. The immunoreactivity of OFQ in the proximal colon in cathartic colon rats decreased significantly compared with the control group (P = 0.001)., Conclusion: Colonic smooth muscle of cathartic colon showed low sensitivity to the stimulation of OFQ, suggesting that it might be caused by the abnormal distribution of OFQ or the abnormalities of receptors, leading to the disorganization of dynamic and incoordinated contractions.

Published
2007
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