Effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To investigate the effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection (ATAAD). Methods    The clinical data of 88 patients with ATAAD who were treated in our hospital from January 2018 to January 2020 were retrospectively analyzed. Patients were divided into a SIRS group (n=37) and a non-SIRS group (n=51) according to whether SIRS occurred within 24 hours after surgery. The perioperative data of the two groups were compared. Results    There was no significant difference between the two groups in general clinical data, preoperative left ventricular ejection fraction, white blood cell (WBC) and body temperature (P>0.05). Compared with the non-SIRS group, the cardiopulmonary bypass time in the SIRS group was significantly longer (P<0.05), and the WBC and body temperature within 1 day after surgery in the SIRS group were higher (P<0.01). A significant difference was revealed in the mechanical ventilation time, ICU stay, total hospitalization time and hospitalization costs between two groups (P<0.01). Patients in the SIRS group had higher postoperative acute physiology and chronic health evaluationⅡscores, sequential organ failure assessment score as well as a greater risk of developing postoperative acute lung injury, acute kidney injury, continuous renal replacement therapy, delirium, liver dysfunction and morbidity (P<0.05). Conclusion    Early postoperative SIRS significantly increases the incidence of major adverse complications and the mortality rate of patients with ATAAD.

Effect of Huatan Tongluo Decoction on Gut-Brain Axis in Rats with Cerebral Ischemia/Reperfusion / 中国实验方剂学杂志

Objective:To explore the effects of Huatan Tongluo Decoction （HTTLD） on the morphology and function of brain tissues and intestine in rats with cerebral ischemia/reperfusion based on the gut-brain axis. Method:Sixty SPF male rats were randomly divided into a sham operation group， a model group， high- （28.66 g·kg^-1）， medium- （14.33 g·kg^-1）， and low-dose （7.16 g·kg^-1） HTTLD groups， and an edaravone （4 g·kg^-1）+<italic>Clostridium butyricum</italic> （5.0×10⁸ cfu·mL^-1） group. The model was established by focal cerebral ischemia/reperfusion in rats. The drugs were administered by gavage. The brain tissue injury was determined by neurological deficit score and 2，3，5-triphenyl tetrazolium chloride （TTC） staining. The effect of cerebral ischemia/reperfusion on intestinal motility was assessed by the propulsion rate of small intestine. The intestinal mucosal cell damage was evaluated by the pathomorphological examination of the duodenal mucosa. Enzyme-linked immunosorbent assay （ELISA） was used to determine the content of <italic>D</italic>-lactate （<italic>D</italic>-LAC）， diamine oxidase （DAO）， and bacterial endotoxin （lipopolysaccharide， LPS） in serum. Western blot was used to detect the expression of Occludin， Claudin-5， and zonula occludens 1 （ZO-1） in the duodenum. Result:After cerebral ischemia/reperfusion， rats developed neurological deficit symptoms. The neurological deficit score in the model group was higher than that in the sham operation group （<italic>P<</italic>0.01）. Compared with the model group， the high- and medium-dose HTTLD groups could relieve the symptoms of neurological deficits and lower neurological deficit scores （<italic>P<</italic>0.01）. The results of TTC staining showed that the model group presented obvious infarcts in brain tissues compared with the sham operation group （<italic>P<</italic>0.01）. The cerebral infarction volumes of HTTLD groups were reduced compared with that in the model group （<italic>P<</italic>0.01）， especially the high-dose HTTLD group， and the effect was dose-dependent. Furthermore， the propulsion rate of small intestine in the model group was significantly reduced compared with that in the sham operation group （<italic>P<</italic>0.01）. Compared with the model group， HTTLD groups could increase propulsion rates of small intestine （<italic>P<</italic>0.01）， especially the high-dose HTTLD group， and the effect was dose-dependent. After cerebral ischemia/reperfusion， obvious duodenal mucosal damage could be observed， which was relieved after the administration of HTTLD. Western blot results showed that the protein expression of ZO-1， Occludin， and Claudin-5 in the model group was reduced compared with that in the sham operation group （<italic>P<</italic>0.01）. Compared with the model group， the HTTLD groups could up-regulate the expression of ZO-1， Occludin， and Claudin-5 to varying degrees （<italic>P<</italic>0.05， <italic>P<</italic>0.01）， especially the high-dose HTTLD group. ELISA showed that the serum <italic>D</italic>-LAC， DAO， and LPS of the model group were elevated compared with those in the sham operation group （<italic>P<</italic>0.01）. Compared with the model group， the HTTLD groups showed reduced <italic>D</italic>-LAC and DAO （<italic>P<</italic>0.05， <italic>P<</italic>0.01）， and the medium- and high-dose HTTLD groups showed reduced LPS （<italic>P<</italic>0.05， <italic>P<</italic>0.01）， especially the high-dose HTTLD group. Conclusion:After cerebral ischemia/reperfusion， the rats showed damaged brain tissues， neurological dysfunction， intestinal mucosal injury， weakened intestinal motility， and destroyed the intestinal mucosal barrier. HTTLD can protect against brain-gut axis injury after cerebral ischemia/reperfusion by reducing the damage on brain tissues and gastrointestinal mucosa， relieving the symptoms of neurological deficits， promoting gastrointestinal motility， improving intestinal barrier function， and reducing the release of intestinal bacterial metabolites or poisons.

Effects of intervention of hot spring bathing on antioxidation functions in population / 上海预防医学

Objective To understand the influence of hot spring bathing intervention on population's antioxidation functions. Methods Three typical types of hot spring(metasilicic acid type, warm mineral type and temperature type)in Guizhou Province were selected for investigation. According to the inclusion-exclusion criteria, questionnaires and physical examinations results, 421 individuals were selected as observation subjects for hot spring bathing intervention, of which 311 subjects completed 40 to 50 minutes of intervention once a day, 5 days a week, and for 4 weeks. Two physical examinations before and after the intervention were conducted for the 311 subjects. The fasting venous blood samples on the mornings of two physical examinations were collected and the serum was separated. Levels of serum oxidative stress-related parameters including total superoxide dismutase(T-SOD), copper zinc superoxide dismutase(Cu-Zn SOD), glutathione sulfur transferases(GSTs)glutathione peroxidase(GSH-px), sulfhydryl(-SH)and malondialdehyde(MDA)were measured by enzymatical methods. Results The overall comparison showed that compared with before the bathing intervention, the levels of antioxidant enzymes including T-SOD, Cu-Zn SOD, GSTs and GSH-px significantly increased in serum after the intervention(all P < 0.05). There was an increasing trend of serum -SH level after the intervention, but with no statistical differences were seen(P > 0.05). MDA, a product of lipid peroxidation, significantly decreased in serum after the intervention(P < 0.05). The results of classified comparison showed that the effects of different hot spring types on antioxidant enzymes were different. Metasilicic acid type significantly increased the activities of GSTs and GSH-px in serum(all P < 0.05), warm mineral type significantly increased the activities of T-SOD and Cu-Zn SOD in serum(all P < 0.05), and temperature type significantly increased the activities of T-SOD, Cu-Zn SOD and GSTs in serum(all P < 0.05). There were increasing trends of serum -SH levels after bathing intervention of all three hot spring types, but no statistical differences were seen(all P > 0.05). The serum MDA levels decreased significantly after bathing intervention of all three types of hot springs(all P < 0.05). Conclusion Overall, bathing intervention of hot springs can improve the activities of antioxidant enzymes and reduce lipid peroxidation products in population. The results of oxidative stress parameters are slightly different in different types of hot springs. The subjects mainly show the elevation of glutathione related enzyme(GSTs and GSH-px)activities after intervention of metasilicic acid type, the elevation of superoxide dismutase(SOD)activities after intervention of warm mineral type and temperature type, and the decline of lipid peroxidation levels after intervention of all three types. It suggests that hot spring bathing may have certain effects on improving the body's antioxidation functions.

Regulating effect of hot spring bathing therapy on the balance of element metabolism in the human body / 上海预防医学

Objective To analyze the changes of major and trace elements in urine before and after hot spring bathing, and to explore the effect of hot spring bathing on element metabolism, so as to provide theoretical reference for the physiotherapeutic efficacy of hot spring bathing. Methods The content of Ca, K, Mg, Na, P, S, Sr, Zn, B, Mn, Ni, V, Se, Co, Cr, Cu, Fe, Mo, As, Cd, Hg, Li, Pb and Al in warm mineral springs, metasilicic springs and mineral springs in Guizhou Province was determined by ICP-MS. On the basis of physical examination, 421 people in hot spring areas of Guizhou Province were selected as the subjects. Under the guidance of professionals, the volunteers took a hot spring bath with the whole body immersed for four weeks, once a day, five times a week, for 40-50 minutes each time. Finally, 311 volunteers completed the standard bath required by this study. The content of major elements(Ca, K, Mg, Na, P, and S), essential trace elements(Co, Cr, Cu, Fe, Mo, Se, Sr, and Zn), possibly essential trace elements(B, Mn, Ni, and V)and potentially toxic elements(Al, As, Cd, Hg, Li, and Pb)in urine was analyzed by ICP-MS. Wilcoxon test was used to compare the differences of various elements in urine before and after bathing. Results The water of the warm mineral spring pool mainly contained Mo, Sr, Zn, B, Al, and Pb. The metasilicic acid water mainly contained Cu, V, and As. The water of the mineral spring bubble pool mainly contained Ca, K, Mg, S, Cr, Fe, Se, Mn, Ni, and Li. Compared with before intervention, the content of major elements(Ca, K, Mg, S), essential trace elements(Co, Cr, Cu, Fe, Mo, Se, Zn)and possibly essential trace elements(B, Mn, Ni, V)significantly increased, and the content of potential toxic elements(Al, Li, Pb)significantly decreased after intervention(all P < 0.05). The results showed that the content of P, S, Co, Cr, Mo, Se, Zn, Mn and Ni increased significantly and the content of Hg decreased significantly after metasilicic acid hot spring bathing compared with that before bathing(all P < 0.05). After warm mineral hot spring bathing, the content of Ca, Mg, S and Zn increased significantly, while the content of Al and Pb decreased significantly(all P < 0.05). The content of Mg, S, Co, Cr, Se and Ni increased significantly and the content of Al decreased significantly(all P < 0.05). Conclusion There are many kinds of mineral elements in hot springs in Guizhou Province. After hot spring bathing, the essential trace elements and possible essential trace elements in human body increased, and the potential toxic elements decreased, but there was no gender difference.

Effect of hot spring bathing on rheumatoid related indicators and joint pain / 上海预防医学

Objective To observe the intervention effect of typical hot spring bathing in Guizhou province on joint pain, serum anti-keratin antibody(AKA), anti-perinuclear factor antibody(APF)and anti-cyclic citrullinated peptide antibody(CCP). Methods A total of 160 people with joint pain symptoms from five typical hot spring areas in Guizhou province were selected as the subjects. They were treated with hot spring bathing intervention for 4 weeks, once a day, 5 times a week, 40 to 50 minutes each time. According to the evaluation index of physiotherapy natural mineral water in the Code for Geological Exploration and Evaluation of Natural Warm Mineral Water Resources(GB/T 13727-2016)and geological types, the five typical hot springs were divided into three different types, namely water temperature type hot springs(water temperature > 36 ℃), metasilicate type hot springs(metasilicate > 50 mg/L)and warm mineral spring type hot springs(total dissolved solids > 1 000 mg/L). WHO pain grading standard was used to score the degree of joint pain before and after hot spring bathing intervention. Serum APF, AKA and CCP antibodies were detected by ELISA kit before and after hot spring bathing. Results The joint pain score of the subjects was 2.60±0.60, and the joint pain score of the total population decreased after intervention(0.61±0.57, P < 0.05). Before intervention, the joint pain scores of water temperature type, metasilicic acid type and warm mineral spring type were 2.78±0.96, 1.98±1.15 and 3.31±0.57, respectively. After intervention, the scores of joint pain of the three kinds of hot spring bathing patients all decreased(P < 0.05), and were 0.50±0.65, 0.48±0.74 and 0.85±0.90, respectively. Before intervention, AKA(ng/L)and CCP(μg/mL)antibody levels of the observed subjects were 34.89±16.06 and 107.58±10.40, respectively, which significantly decreased after intervention(both P < 0.05), namely 26.06±10.68 and 102.93±6.01, respectively. AKA(ng/L)was 35.04±20.01 before intervention, but decreased significantly after intervention(26.61±7.54, P < 0.05). AKA(ng/L)and CCP(μg/mL)were 31.09±17.26 and 106.51±10.13 before intervention, respectively. After intervention, the above two antibody indexes significantly decreased(all P < 0.05)to 24.53±13.98 and 98.57±5.68, respectively. Before intervention, the AKA(ng/L), APF(ng/mL)and CCP(μg/mL)antibody levels were 38.40±8.66, 349.46±118.43 and 104.96±9.66, respectively. After intervention, the above three antibody indexes significantly decreased(all P < 0.05). The values were 34.00±7.55, 269.38±127.55 and 101.65±3.04, respectively. Conclusion The typical hot spring bathing intervention in Guizhou province can relieve the symptoms of joint pain, and the three types of hot springs can reduce the levels of AKA, APF and CCP antibodies to different degrees, and the warm mineral spring type of hot spring is better than the other types of hot spring.

Analysis of the effect of hot spring bathing on serum melatonin levels and its association with sleep and anxiety / 上海预防医学

Objective To explore the improvement effect of typical hot spring bathing on sleep and anxiety and its correlation with serum melatonin level in Guizhou province. Methods Five typical characteristic hot springs in Guizhou were selected according to the geological type of hot spring water. A total of 226 residents in these areas were selected for the survey and the self-rating scale of sleep(SRSS)and the self-rating anxiety scale(SAS)were used to measure their scores before and after hot spring bathing, and the correlation between the changes of SRSS and SAS scores and the serum melatonin levels were analyzed. Results The SRSS and SAS scores of the respondents after hot spring bathing were lower than before, and the difference was statistically significant(P < 0.05). Serum melatonin levels after hot spring bathing were significantly higher than before(P < 0.05), and there was a negative correlation between the changes of SRSS and SAS scores and serum melatonin levels(P < 0.05). Conclusion Typical hot springs in Guizhou Province can significantly improve the sleep quality and anxiety state, which are related to the elevation of serum melatonin level.

Study on the effect of hot spring bath therapy on sleep quality based on health bracelets / 上海预防医学

Objective To study the relieving effects of hot spring bath therapy on sleep quality for people with sleep disorders based on data from health bracelets. Methods After health examinations, 311 people with sleep disorders who participated in the bath therapy in five typical hot spring areas in Guizhou Province were selected as the subjects. A four-week hot spring bath therapy was implemented, and the bathing method and the classification of hot springs were the same as the"Overview of study of the physiotherapy efficacy of typical hot springs in Guizhou Province". The daily sleep time at night(minutes), deep sleep ratio(%), light sleep ratio(%)and rapid eye movement ratio(%)for all subjects were collected using the Huawei Honor Band 3 health bracelets. Repeated measures analysis of variance was used to compare the differences in sleep quality indicators of each group at night each week. The effect of three different hot spring bath therapies on the improvement of night sleep quality was evaluated by factor analysis. Results Hot spring bath therapy can increase night sleep time and deep sleep ratio, while reducing light sleep ratio. Compared with the first week, the night sleep time in the following three weeks significantly increased(P < 0.05), especially in the fourth week; the deep sleep ratio during the third and fourth weeks was significantly higher than during the first and second weeks(P < 0.05), but the light sleep ratio was lower than during the first and second weeks(P < 0.05). The rapid eye movement ratio did not change significantly throughout the 4 weeks(P > 0.05). Further classified according to the physiotherapy components of geological hot springs, the results showed that the water temperature type of hot springs can increase night sleep time and reduce light sleep ratio; the warm mineral type of hot springs has a certain regulatory effect on increasing night sleep time, deep sleep ratio and reducing light sleep ratio; the metasilicic acid type of hot springs can improve night sleep quality by increasing night sleep time and deep sleep ratio, while reducing light sleep ratio and rapid eye movement ratio. The factor analysis results suggest that the metasilicic acid type of hot springs is better than the water temperature type and warm mineral type of hot springs in improving night sleep quality. Conclusion Hot spring bath therapy can improve the night sleep quality for people with sleep disorders to varying degrees, and the metasilicic acid type of hot springs is relatively better than other types.

Ameliorative effect of hot spring bathing on the elevation of blood lipid in population / 上海预防医学

Objective To explore the effect of typical hot spring bathing of Guizhou Province on dyslipidemia, which could provide scientific basis for clarifying the physiotherapy effect of hot springs. Methods The typical hot spring sites of three main types(hydrothermal hot spring, warm mineral hot spring and metasilicate hot spring)in Guizhou Province were selected as investigation sites. 189 residents with hyperlipidemia near the investigation sites were selected as subjects and were treated with hot spring baths for 4 weeks, once a day, 5 times a week and 40-50 minutes each time. The age and gender distribution of the subjects were obtained by a questionnaire. The levels of TC, TG, LDL-C and HDL-C in serum were measured by automatic biochemical analyzer at baseline and at the end of hot spring baths. The differences of the three kinds of hot spring baths on improvement rate of dyslipidemia, the changes of abnormal blood lipid indexes and their improvement rates were compared. Results After baths of hydrothermal hot springs, warm mineral hot springs and metasilicate hot springs, the improvement rates of abnormally elevated lipids were 15.6%, 40.4% and 47.9%, respectively. The improvement rates of abnormally elevated lipids after baths of warm mineral hot springs and metasilicate hot springs were significantly higher than that after hydrothermal spring baths(all P < 0.05). Compared with before hot spring bathing, the levels of TC, TG, LDL-C and non-HDL-C in serum significantly decreased in all three kinds of hot springs. Moreover, the degree of decrease of TG in serum and the improvement rate of abnormal TG after baths of warm mineral spring and metasilicate hot spring were significantly higher than that after hydrothermal spring baths. The degree of decrease of LDL-C in serum and the improvement rate of abnormal LDL-C after baths of metasilicate hot spring were significantly higher than that after baths of hydrothermal spring and warm mineral spring(all P < 0.05). Conclusion The three types of typical hot spring baths in Guizhou Province can mitigate the elevation of blood lipid. Compared with hydrothermal spring, warm mineral spring and metasilicate hot spring may have better improvement effect on blood lipid elevation due to their more significant improvement effect on abnormal elevation of TG and LDL-C in serum.

Intervention effects of hot spring bathing on blood pressure, resting heart rate, cardiovascular function indicators and physical signs in population with high-normal blood pressure / 上海预防医学

Objective To investigate the effects of hot spring baths on blood pressure, resting heart rate, cardiovascular function related indicators and physical signs in population with high-normal blood pressure. Methods Residents of typical hot spring areas in Guizhou Province were included as the subjects. According to the epidemiological survey of the research group and the physical examination results before the intervention, combined with the inclusion and exclusion criteria, a total of 217 people with high normal blood pressure were selected as the observation subjects. The intervention of hot spring baths was carried out for four weeks, once time per day, 5 times per week, for 40-50 minutes each time. After the intervention, the blood pressure, resting heart rate and serum levels of creatine kinase(CK), lactate dehydrogenase(LDH), and α-hydroxybutyrate dehydrogenase(α-HBDH)were detected, and the improvement of cardiovascular related signs(palpitation, dizziness/headache, cough/sputum and night sweats)were clinically examined. SPSS 23.0 software was used for statistical analysis. Results Paired t-test results showed that the systolic blood pressure, diastolic blood pressure and resting heart rate of 217 high normal blood pressure subjects were significantly lower after hot spring baths(P < 0.01). Further analysis revealed that the number of people with high normal blood pressure dropped from 217 to 128 after the hot spring baths. Before the intervention, 95 of the 217 people with high-normal blood pressure had resting heart rates between 80 and 90 beats/min, and 35 of them above 90 beats/min. After the intervention, the resting heart rates of those above people decreased to 68 and 14, respectively. Serum levels of cardiovascular related indicators showed that CK, LDH, and α-HBDH levels in people with high-normal blood pressure decreased to some extent after the intervention, and CK level was significantly lower than that before the intervention(P < 0.05). The results of clinical examination showed that hot spring baths had a significant improvement effect on palpitation, dizziness/headache, cough/expectoration, and night sweats in people with high-normal blood pressure. Conclusion The typical hot spring baths in Guizhou Province can reduce the blood pressure and resting heart rate in population with high-normal blood pressure, and improve the cardiovascular function related indicators and physical signs to a certain extent.

Overview of study of the physiotherapy efficacy of typical hot springs in Guizhou Province / 上海预防医学

To implement the Guizhou Provincial Party Committee and the Provincial Government's strategic goal of building a"Chinese Hot Spring Province"in an all-round way, promote the development of Guizhou's"big health, big tourism, big poverty alleviation"and other industries, and enhance the development and utilization of Guizhou hot springs and their health and wellness value. With the support of the provincial Geological Prospecting Fund project Guizhou Province Physiotherapy Hot Springs(Geothermal Water)Survey and Evaluation, Guizhou Medical University was responsible for completing the topic"Study on the Physiotherapy Efficacy of Typical Hot Springs in Guizhou Province". Here, the background, study and design plan, quality control, and features and limitations of this project are briefly introduced.

Progress of clinical application of autologous plateletpheresis technology in cardiovascular surgery / 中国胸心血管外科临床杂志

@#The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.

Construction and immunocompetence of recombinant DNA E.coli ghosts expressing Treponema pallidum adhesin Tp0751 / 中国免疫学杂志

Objective:To construct the recombinant DNA E.coli ghosts (EBGs) expressing Treponema pallidum adhesin Tp0751 (pcD/Tp0751-BG) and determine its immunocompetence in immunized mice,and provide a potential novel method for syphilis vaccine developing.Methods:The recombinant eukaryotic expression plasmid pcDNA3.1(+)/Tp0751 was constructed and loaded into empty EBGs to create pcD/Tp0751-BG.The loading rate was determined accordingly.Macrophages cell line RAW264.7 was transfected with pcD/Tp0751-BG,and the expression of recombinant Tp0751(rTp0751) protein was detected by Western blot(WB).For immuno-competence in mice,the female BALB/c mice were randomly divided into 6 groups,including three control groups,A (PBS),B (EBG),C (empty pcDNA),and experimental group D(naked pcD/Tp0751),E (pcD/Tp0751-BG) and F (pcD/Tp0751-BG+rTp0751).All the mice were immunized as indicated for three times by intramuscular injection at two weeks intervals.The levels of specific IgG in sera and SIgA in genital tract lavage fluid were measured by ELISA.Levels of lymphocyte proliferation and IFN-γ secretion in spleen cells were measured by CCK-8 Cell Counting Kit and ELISA as well,respectively.Results:The loading rate of pcD/Tp0751 to EBGs was 76.1%.WB showed that the target recombinant protein pcD/Tp0751 expressed in RAW264.7 cells was active with Tp-infected rabbit sera.The titers of specific IgG and SIgA in group D,E,F gradually increased to significantly higher level as compared to the control groups (P<0. 01),which reached its peak at wk 8 after last immunization(the titers of IgG and SIgA were 1 :102 400 and 1 :12 800 in group F,respectively). Higher levels of specific IgG and SIgA were observed in groups E and F as compared to group D after first boost (P<0. 01),with groups F higher than group E after last boost(P<0. 01). At wk 8 after the last boost,the stimulation index (SI) and levels of IFN-γ in group D,E,F were all significant higher than the control groups (P<0. 01), with group E and F higher than group D (P<0. 01),and group E higher than group F (P<0. 05). Conclusion: The recombinant DNA EBGs of T. pallidum adhesin Tp0751 (pcD/ Tp0751-BG) possesses the immunocompetence to induce not only strong mucosal and systemic humoral immune response but also systemic cellular immune response in BALB/ c mice. The heterologous boost can be more efficient than homologous boost during immunization process.

Purtscher-like retinopathy associated with antibiotic anaphylaxis / 南方医科大学学报

We report a case of an 18-year-old woman with systemic antibiotic anaphylaxis who presented anasarca and bilateral visual loss two weeks after the intravenous use of pazufloxacin. Ancillary fundus tests revealed bilateral cotton-wool spots, Purtscher flecken, edema, and retinal arteriolar occlusion around the optic disc. After pulse corticosteroid, administration of anti-anaphylactic agent, and general support therapy for one month, the patient showed a favorable change, with the symptoms lessened or free systemically, except the continuous aggravation of fundus ischemic change. After two intravitreal injections of Ranibizumab, there were still a large area of capillary non-perfusion and neovacularizations in the binocular retina, resulting in vitreous hemorrhage. The patient's visual acuity had still light perception after right-eye vitrectomy and presented no improvement during the postoperative follow-up of two years. Literature review revealed that there were many causes associated with Purtscher-like retinopathy, and the consequent visual impairment varied significantly. Prompt management of the underlying condition is crucial in giving the patient the best chance to restore vision.

Effect of ASCT2 gene knock-down by shRNA on biological behaviors of colorectal cancer cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of ASCT2 gene (glutamine transporter) knock-down by shRNA on biological behaviors of colorectal cancer cells.</p><p><b>METHODS</b>shRNA was transfected into colorectal cancer cells Lovo and SW480 to knockdown ASCT2 mediated by Lipofectamine 2000. Reverse transcription-PCR and Western blot were used to examine the mRNA and protein expression of ASCT2. MTT and transwell assay were used to determine the proliferation and invasiveness of Lovo and SW480 cells. Radioactive-tracer was used to detect the uptake of glutamine.</p><p><b>RESULTS</b>ASCT2 mRNA and protein levels were significantly down-regulated by shRNA in Lovo and SW480 cells(P<0.01). MTT and transwell assays showed that ASCT2 knock-down could significantly inhibit the proliferation of Lovo and SW480 cells (A490) and decrease the number of invasive Lovo and SW480 cells from the membrane (both P<0.01). The number of membrane Lovo cells in shASCT group and control group was 46.3±5.9 and 197.7±9.1, respectively while the number of membrane SW480 cells in shASCT group and control group was 29.7±3.8 and 139.0±9.5, respectively. Radioactive-tracer showed that shASCT2 transfection could significantly reduce the uptake of glutamine, with an inhibition rate of 79.15% in Lovo and 67.22% in SW480 cells (both P<0.01).</p><p><b>CONCLUSIONS</b>ASCT2 plays an oncogenic role in colonic cancer, and its promotion mechanism may be associated with glutamine metabolism. ASCT2 may be a novel therapeutic target of colonic cancer.</p>

Preparation of nanoparticles for sustained insulin release using poly (ethylene glycol) -poly (ε-caprolactone)-poly (N, N-diethylamino-2-ethylmethaerylate) / 南方医科大学学报

<p><b>OBJECTIVE</b>To prepare an insulin-loaded nanoparticle assembled using pH-sensitive poly(ethylene glycol)-poly(ε-caprolactone)-poly(N,N-diethylamino-2-ethylmethaerylate) (mPEG-PCL-PDEAEMA) and investigate its performance of sustained insulin release in vitro and its hypoglycemic effects in diabetic rats. METHDOS: mPEG-PCL-PDEAEMA triblock copolymers with different hydrophobic lengths were synthesized by ring opening polymerization (ROP) combined with atom transfer radical polymerization (ATRP). The copolymers were characterized using Fourier-transform Infrared (FT-IR) spectroscopy and proton nuclear magnetic resonance spectroscopy (H-NMR). Insulin-loaded nanoparticles were prepared by nanoprecipitation technique, in which the reversible swelling of the pH-sensitive material was used for insulin loading and release. The obtained nanoparticles were further confirmed by dynamic light scattering (DLS) and transmission electron microscopy (TEM). The entrapment efficiency (EE%), drug loading (DL%) and in vitro release characteristics of the insulin- loaded nanoparticles were assessed using BCA protein assay kit. The hypoglycemic effects of the nanoparticles were evaluated by monitoring the glucose levels.</p><p><b>RESULTS</b>The size of the nanoparticles decreased as pH value increased within the range of 1.2 to 7.4. Using copolymers mPEG5k-PCL13k- PDEAEMA10k and mPEG5k-PCL10k-PDEAEMA10k as the drug carriers, the nanoparticles prepared with an optimal insulin-coplymer mass ratio of 90% had an average size of 181.9∓6.67 nm and 169∓7.1 nm, maximal EE% of (81.99∓1.77)% and (53.12∓0.62)%, and maximal DL% of (42.46∓0.53)% and (32.34∓0.26)%, respectively. Compared with free insulin, the insulin-loaded nanoparticles was capable of sustained insulin release and the release rate was lowered as the hydrophobic length increases. In diabetic rats, the insulin-loaded nanoparticles based on mPEG5k-PCL13k- PDEAEMA10k maintained a sustained hypoglycemic effect for 48 h, which was significantly longer than the time of free insulin.</p><p><b>CONCLUSION</b>The pH-sensitive triblock copolymer mPEG-PCL-PDEAEMA can serve as a promising candidate of carrier for sustained release of insulin.</p>

Application of 3D visualization technique in breast cancer surgery with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the value of 3D visualization technique in breast-preserving surgery for breast cancer with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap.</p><p><b>METHODS</b>From January, 2015 to May, 2016, 30 patients with breast cancer underwent breast-preserving surgery with immediate breast reconstruction using pedicled latissimus dorsi muscle flap. The CT data of the arterial phase and venous phase were collected preoperatively and imported into the self-developed medical image 3D visualization system for image segmentation and 3D reconstruction. The 3D models were imported into the simulation surgery platform for virtual surgery to prepare for subsequent surgeries. The cosmetic outcomes of the patients were evaluated 6 months after the surgery. Another 18 patients with breast cancer who underwent laparoscopic latissimus dorsi muscle breast reconstruction without using 3D visualization technique from January to December, 2014 served as the control group. The data of the operative time, intraoperative blood loss and postoperative appearance of the breasts were analyzed.</p><p><b>RESULTS</b>The reconstructed 3D model clearly displayed the anatomical structures of the breast, armpit, latissimus dorsi muscle and vessels and their anatomical relationship in all the 30 cases. Immediate breast reconstruction was performed successfully in all the cases with median operation time of 226 min (range, 210 to 420 min), a median blood loss of 95 mL (range, 73 to 132 mL). Evaluation of the appearance of the breast showed excellent results in 22 cases, good appearance in 6 cases and acceptable appearance in 2 cases. In the control group, the median operation time was 283 min (range, 256 to 313 min) and the median blood loss was 107 mL (range, 79 to 147 mL) with excellent appearance of the breasts in 10 cases, good appearance in 4 cases and acceptable appearance in 4 cases.</p><p><b>CONCLUSION</b>3D reconstruction technique can clearly display the morphology of the latissimus dorsi and the thoracic dorsal artery, allows calculation of the volume of the breast and the latissimus dorsi, and helps in defining the scope of resection of the latissimus dorsi to avoid injuries of the pedicled vessels. This technique also helps to shorten the operation time, reduce intraoperative bleeding, and improve the appearance of the reconstructed breast using pedicled latissimus dorsi muscle flap.</p>

Outcomes of 25-gauge vitrectomy with air tamponade for idiopathic macular hole repair surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the anatomic and visual outcomes of 25-gauge vitrectomies combined with air tamponade for the treatment of idiopathic macular hole (IMH).METHODS: Thirty eyes of 27 patients with IMH were included in this prospective interventional study.All patients underwent 25-gauge pars plana vitrectomy (PPV) combined with phacoemulsification and air tamponade.Best corrected visual acuity (BCVA, logMAR), perimetry and multifocal electroretinography (mfERG) were conducted before and after the operation.Anatomical changes were evaluated with optical coherence tomography (OCT).RESULTS: The macular holes closed successfully in 28 eyes after the primary vitrectomy.The mean BCVA improved from 0.72±0.22 logMAR preoperatively to 0.29±0.18 logMAR postoperatively (P<0.001).In the visual field of central 10°, the average mean deviation (MD) decreased from-3.59±1.83 dB preoperatively to-2.51±1.36 dB postoperatively (P<0.001) and the average pattern standard deviation (PSD) decreased from 1.86±0.68 dB preoperatively to 1.33±0.32 dB postoperatively (P=0.001).The retinal response densities of mfERG in the foveal and perifoveal area increased significantly, and implicit times of rings 4-6 prolonged significantly (P<0.05).The symptom duration and baseline N1 amplitude densities at ring 1 had a significant impact on postoperative BCVA (P<0.001, P=0.001, respectively).CONCLUSION: The 25-gauge PPV and air tamponade with 1 day prone positioning produce favorable anatomic and functional outcomes.

Effects of intraarticular tranexamic acid injection combined with 3-hour drainage tube occlusion postoperatively on blood loss in unicompartmental knee arthroplasty / 中国组织工程研究

BACKGROUND:Unicompartmental knee arthroplasty has become mainstream operation for treatment of unicompartmental osteoarthritis of the knee, but unicompartmental knee arthroplastystil has some problems, such as excessive bleeding-induced postoperative blood transfusion, increased blood transfusion rate, hospitalization expense and complication of blood transfusion. As tranexamic acid for total knee arthroplasty has achieved good effects. It is significant to investigate whether local application of tranexamic acid can effectively reduce blood loss in unicompartmental arthroplasty. OBJECTIVE:To investigate the efficacy and safety of the intra-articular tranexamic acid injection in treating perioperative blood loss in patients undergoing unicompartmental knee arthroplasty. METHODS:122 patients with knee osteoarthritis undergoing unicompartmental knee arthroplastyinthe Department of Orthopedics, the Second Affiliated Hospital ofDalian Medical University from January 2014 to August 2015wereenroled in this study. Al patients were randomly divided into two groups. Patients in the tranexamic acid group were injected with 10 mL of tranexamic acid (containing 1000 mg) + 10 mL of sodium chloride injection in the articular cavity before loosening the tourniquet. Patients in the control group received 20 mL of sodium chloride injection in the articular cavity. In both groups, the drainage tube was clipped for 3 hours after injection.At 48 hours after replacement, the drainage tube was puled out. We compared and analyzed hemoglobin levels and hematocrit at 2 days and 1 month postoperatively, total blood loss and drainage volume at 2 days postoperatively, the number of patients receiving blood transfusion, Hospital for Special Surgery scores of knee function at 1 week and 1 month postoperatively, and thrombosis at 1 week postoperatively, and evaluated effects of tranexamic acid on blood loss after unicompartmental knee arthroplasty. RESULTS AND CONCLUSION:(1) Hemoglobin levels and hematocrit were significantly higher in the tranexamic acid group than in the control group at 2 days postoperatively (P 0.05). (2) Drainage volume and total blood loss were significantly less in the tranexamic acid group than in the control group at 2 days postoperatively (P< 0.05). (3) The number of patients receiving blood transfusion was significantly less in the tranexamic acid group (0 case) than in the control group (6 cases) (P< 0.05). (4) Scores of Hospital for Special Surgery were significantly higher in the tranexamic acid group than in the control group at 1 week postoperatively (P< 0.05). No significant difference in above socres was identified between the two groups at 1 month postoperatively. (5) No venous thrombosis was found at 1 week postoperatively in both groups. (6) These results confirm that during knee medial unicompartmental arthroplasty, intra-articular injection of tranexamic acid combined with 3 hours of blood occlusion can effectively reduce drainage volume, perioperative blood loss, blood transfusion, is beneficial to the early recovery of knee jointfunction after replacement, and does not increase the risk of lower extremity deep venous thrombosis.

Consistency analysis of Keratograph and traditional methods to evaluate tear film function / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To investigate repeatability and accuracy of a latest Keratograph for evaluating the tear film stability and to compare its measurements with that of traditional examination methods. ?METHODS: The results of noninvasive tear film break-up time ( Nl-BUT ) including the first tear film break-up time ( BUT-f ) and the average tear film break-up time ( BUT - ave ) were measured by Keratograph. The repeatability of the measurements was evaluated by coefficient of variation ( CV ) and intraclass correlation coefficient ( lCC) . Wilcoxon Signed-Rank test was used to compare Nl-BUT with fluorescein tear film break-up time ( FBUT) to confirm the correlation between Nl-BUT and FBUT, Schirmer l test values. Bland-Altman analysis was used to evaluate consistency. ?RESULTS: The study recruited 48 subjects ( 48 eyes ) (mean age 38. 7±15. 2 years). The CV and lCC of BUT-f were respectively 12. 6% and 0. 95, those of BUT-ave were 9. 8% and 0. 96. The value of BUT-f was lower than that of FBUT. The difference had statistical significance ( 6. 16±2. 46s vs 7. 46±1. 92s, P ?CONCLUSlON: Keratograph can provide Nl-BUT data that has a better repeatability and reliability, which has great application prospects in diagnosis and treatment of dry eye and refractive corneal surgery.

Effect of uric-acid-lowering therapy on progression of chronic kidney disease: a meta-analysis / 华中科技大学学报（医学）（英德文版）

The efficacy and safety of uric-acid-lowering therapy (UALT) on slowing the progression of chronic kidney disease (CKD) accompanied by hyperuricemia were assessed. We searched Cochrane Library, PubMed, EMbase, CNKI, Wanfang and Vip databases up to November 15, 2012 for randomized controlled trials (RCTs) which compared the effect of UALT to control therapy in hyperuricemic patients secondary to CKD, and then performed quality evaluation and meta-analysis on the included studies. Seven RCTs involving 451 cases were included. UALT delayed the increase of serum creatinine (MD=-62.55 μmol/L, 95% CI: -98.10 to -26.99) and blood urea nitrogen (MD= -6.15 mmol/L, 95% CI: -8.17 to -4.13) as well as the decrease of glomerular filtration rate [MD=5.65 mL/(min·1.73 m2), 95% CI: 1.88 to 9.41], decreased systolic blood pressure (SBP) (MD= -6.08 mmHg, 95% CI: -11.67 to -0.49), and reduced the risk of the renal disease progression (RR=0.30, 95% CI: 0.19 to 0.46). However, there was no statistically significant difference in 24-h urinary protein quantity and diastolic blood pressure (P>0.05). We identified that UALT could delay the progression of CKD with secondary hyperuricemia. And this also indirectly proved that hyperuricemia was a risk factor for the CKD progression.