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Objective:To explore the risk factors for early mortality in heart transplant(HT)recipients and construct a nomogram prediction model.Methods:From 2018 to 2022, preoperative clinical data were retrospectively reviewed for 163 consecutive HT recipients.Risk factor variables were shortlisted by univariate correlation analysis based upon early(90-day)postoperative patient survival.Lasso regression was then employed for screening all variables and common variables were combined.A nomogram was constructed for predicting the probability of early mortality after considering actual circumstance.Receiver operating characteristic(ROC)curve, area under the ROC curve(AUC), Harrell's C-index and calibration curves were employed for evaluating and internally validate the performance of the model.Decision curve analysis was performed for assessing clinical utility of the model.Results:In survival and mortality groups, mechanical ventilation, nervous system lesions, use of extracorporeal membrane oxygenation, red blood cell count ≤3.52×10 12/L, mean pulmonary arterial pressure>27 mmHg, pulmonary vascular resistance>4.01 Wood Unit, albumin≤33 g/L, aspartate aminotransferase >50 U/L, hemoglobin ≤108 g/L, platelet count ≤109×10 9/L and total bilirubin>57 μmol/L demonstrated statistically significant differences( P<0.05). At the same time, according to actual situations and different variables, hemoglobin ≤108 g/L, albumin ≤33 g/L, platelet count ≤109×10 9/L, total bilirubin>57μmol/L, aspartate aminotransferase>50 U/L, nervous system lesions and average pulmonary arterial pressure >27 mmHg were seven variables.And a nomogram with relatively high reliability was constructed for predicting the probability of early mortality post-HT(nomogram model evaluation, AUC 0.917, C index 0.910 and good calibration curve). Decision curve analysis indicated that the nomogram could benefit HT recipients. Conclusions:Risk factors have been identified for early mortality in HT recipients.And the nomogram prediction model offers a simple and reliable tool for predicting early mortality post-HT.It has important implications for individualized treatment of HT candidates.
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Renal cell carcinoma is a malignant tumor originating from the renal parenchyma. Different subtypes of renal cell carcinoma have different pathological features and molecular mechanisms. Because radiotherapy and chemotherapy are difficult to achieve ideal therapeutic effect on renal cell carcinoma, targeted therapy based on vascular endothelial growth factor and mammalian target of rapamycin will eventually in the case of drug resistance, it is currently necessary to explore a new way to improve the treatment status of metastatic renal cell carcinoma. With the continuous research and exploration of programmed death-1 (PD-1)/programmed death-ligand-1 (PD-L1) inhibitors, immunotherapy certain effects have been shown in metastatic renal cell carcinoma. PD-1/PD-L1 inhibitors have considerable prospects for single-agent or other drug treatment in renal cancer, and the long-term adverse reaction rate of this drug is low. At present, there are studies that treat PD-1 or PD-L1 inhibitors in combination with radiochemotherapy, anti-tumor drugs and surgery, bringing new hope to patients who are not sensitive to radiochemotherapy, are resistant to drugs, and have lost surgery. While PD-1 or PD-L1 also significantly improves overall survival in monotherapy. This article reviews and summarizes the application and research progress of PD-1/PD-L1 inhibitors in renal cell carcinoma in recent years, and reviews them.
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Salvia miltiorrhiza Bge was first published in Shennong Bencaojing. Salviae Miltiorrhizae Radix et Rhizoma has the effect of promoting blood circulation, cooling blood and eliminating phlegm. Modern pharmacological studies have found that Salviae Miltiorrhizae Radix et Rhizoma has strong heart, improve microcirculation and antithrombotic effects. The decoction of Salviae Miltiorrhizae Radix et Rhizoma is commonly used in clinical practice. The dissolved component of Salviae Miltiorrhizae Radix et Rhizoma is mainly salvianolic acid. Among them, salvianolic acid B is one of the water-soluble components of Salviae Miltiorrhizae Radix et Rhizoma. It has strong physiology. Activity, salvianolic acid B is the strongest antioxidant activity of salvianolic acids. Salvianolic acid B regulates nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, decoupled endothelial nitric oxide synthase (eNOS) in vivo, and regulates Janus protein tyrosine kinase 2/signal transducer and transcriptional activation 3/vascular endothelial growth factor (JAK2/STAT3/VEGF) and tumor suppressor(p53), B cell lymphoma-2(Bcl-2), Bcl-2-related X protein (Bax), Caspase-3 anti-apoptotic pathway, inhibition of extracellular signal-regulated kinase/mitogen-activated protein kinase (ERK/MAPK), c-Jun N-terminal kinase/mitogen-activated protein kinase (JNK/MAPK), mitogen-activated protein kinase p38 (p38MAPK) and estrogen receptor alpha/phosphatidylinositol 3-kinase/serine-threonine protein kinase/nuclear transcription factor kappa B (ERα/PI3K/Akt/NF-κB) anti-inflammatory pathway, silencing information regulator 2 related enzyme 1/nuclear factor E2 related factor 2/Kelch-like ECH combined protein 1-antioxidant response element (SIRT1/Nrf2/Keap1-ARE) and NAD-dependent deacetylase sirtuin Forkhead transcription factor 1/superoxide dismutase on-3/β cells (NAD-dependent deace tylase sirtuin-3, SIRT3/FOXO1/SOD2) antioxidant pathway and autophagy pathway inhibit oxidative stress and protect tissues and organs from oxidative damage. Based on the study of the pathway of salvianolic acid B against oxidative stress injury, this paper reviews the related research published in domestic and foreign journals in the past five years, and provides new ideas for expanding the clinical application range of salvianolic acid B.
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Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma (HCC) patients,and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients.Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016.These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission,and staged group who underwent the procedure one week after admission.Perioperative events,overall survival (OS) and disease-freesurvival (DFS) rates,incidence of recurrent and metastatic disease were compared between the two groups.Results The perioperative blood loss and transfusion were much more in emergency group than staged group (both P ＜ 0.05).Nevertheless,the incidence of postoperative mortality was not significantly different (6.0％ vs 0％,P ＞ 0.05).The median survival was 22.5 months in emergency group versus 14.2 months in staged group.The 6-month,1-year,3-year OS rates in emergency group were 88.2％,82.4％ and 30.3％ respectively,and 6-month,1-year,3-year DFS rates were 81.3％,54.7％ and 27.3％.The 1-year OS and 6-month DFS rates were higher than those of staged group (both P ＜ 0.05).The incidence of peritoneal metastasis in staged group was higher than that in emergency group,but it was not significantly different (38.1％ vs 29.4％,P ＞ 0.05).Univariate and multivariate analysis indicated that tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage.Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage.Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis.The predictors of tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients.
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The major target of translational medicine is the rapid application of achievements in basic research to clinical medicine. How to carry out embedded subject service for translational medicine in academic library was thus described in aspects of constructing its information service platform, establishing its service team, and deciding its service methods.
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Objective To investigate the clinical value of joint detection of procalcitoninl (PCT ) ,C-reactive protein (CRP) ,and myocardial enzymes in patients with neonatal hyperbilirubinemia .Methods 30 cases of each cause were included in the study ,which were neonatal hyperbilirubinemia caused by sepsis ,pneumonia ,ABO hemolytic and breast milk jaundice .20 cases of each cause were selected including neonatal hyperbilirubinemia caused by neonatal hepatitis and low birth weight infants .All the cases involved in the study were diagnosed .30 healthy full-term newborns in the same period were recruited as control group .PCT ,CRP and myocar-dial enzymes (AST ,CK ,CK-MB ,and LDH) concentration in serum were determined .Results Compared with the control group , CRP and PCT concentration increased significantly in bacterial infected group (P< 0 .05) .Myocardial enzyme concentration in-creased significantly both in infected group and non-infected group(P<0 .05) .Among myocardial enzymes ,CK-MB concentration increased significantly in bacterial infected group ,low birth weight infants group and ABO hemolytic group(P<0 .01) and increased significantly in breast milk jaundice group and hepatitis group (P<0 .05) .AST and LDH concentration increased very significantly in hepatitis group(P<0 .01) .The specificity of PCT in bacterial infected group was significantly higher than that of CRP (P<0 .05) ,while its sensitivity was significantly lower than that of CRP in pneumonia group (P<0 .01) .Conclusion Changes of PCT , CRP and myocardial enzymes concentration are related to the occurrence and development of neonatal hyperbilirubinemia ,determi-nation of these indicators can be complementary .
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ObjectiveTo investigate the efficacy and advantages through the combination of transurethral resectoscope outer sheath and ueteroscopy for treatment of bladder stones.MethodsThe Wolf F24 transurethral resectoscope was first placed in bladder to observe the lesions in 68 patients with bladder stones.With the moving out of the body and inner sheath,F8 ureteroscopy sheath was sent into the bladder through outer sheath,then,holmium laser lithotripsy was performed.ResultsSixty-eight patients got successful operations without postoperative stones residual,significant postoperative bleeding,urethral tear,bladder injury and infection complications. The gravel rate reached 100％ 20 - 60 minutes ( 36.7 ± 5 ) min.ConclusionThe combination of transurethral resectoscope outer sheath and ueteroscopy is effective and safe for treatment of bladder stones.
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Based on the teaching practice of literature retrieval of pharmaceutical subject in our school,the paper introduces the rationality of content design,using problem-based learning teaching mode,the connection of practice contents and special subject learning contents,improving the examine mode,offering computer operation and practice,in order to improve the students' comprehensive ability to do scientific research.
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Objective To study the changes in tumor necrosis alpha(TNF ?), interleukin 6(IL 6), procalcitonin(PCT) and C reactive protein (CRP) levels and their values in the prediction and assisting diagnosis of infection complications in severe multiple trauma patients. Methods TNF ?, IL 6 and CRP were measured by enzyme linked immunosorbant assay(ELISA) and PCT was determined by immunoluminometric assay(ILMA) in serial samples of plasma from 34 patients with severe multiple trauma(ISS≥16) and compared with those of 11 normal control volunteers. Patients were divided into 2 groups(infection and non infection groups). The differences of the above parameters between groups were compared. In addition, all data were managed by receiver operating characteristic(ROC), and sensitivity, specificity, negative and positive predictive values for the diagnosis of infection complications were calculated. Results Plasma levels of TNF ?, IL 6, PCT and CRP in multiple trauma patients without infection complications were increased differently in the early posttrauma period. TNF ? and CRP levels in the early posttrauma period before infection were not significantly different from those in patients without infection complications, but they increased significantly following infection. However, during the whole observing period, plasma levels of PCT and IL 6 in the patients with infection complications were higher than those in patients without. The value of those parameters in assisting diagnosis of infection was evaluated. PCT was of the highest specificity and higher negative and positive predictive values. Conclusion All the parameters are of clinical value in infection diagnosis after severe multiple trauma. PCT is the best index for the prediction and assisting diagnosis of infection after multiple trauma.
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OBJECTIVE: To study molecular mechanism of suppressive effect of macrophages posttrauma on T cell functions. METHODS: A murine closed trauma model was used, macrophages were harvested from the abdominal cavity and added into the culture system of T cells, which were separated from splenocytes in normal mice using nylon column. T cell functions and intracellular messenger molecules were determined. In addition, the effect of macrophages' removal from splenocytes of traumatized mice on T cell functions and intracellular messenger molecules was investigated. RESULTS: Macrophages posttrauma in vitro could obviously suppress ConA stimulated normal T cell functions such as T lymphocyte transformation, interleukin 2 (IL-2) production, IL-2 receptor alpha (IL-2Ralpha) expression, IL-2 mRNA and IL-2Ralpha mRNA levels, and elevate cAMP contents of activated normal T cells while decreasing cGMP contents, intracellular free calcium ([Ca(2+)]i) concentration and protein kinase C (PKC) activity. Removal of macrophages from splenocytes of traumatized mice could at certain degree reverse the suppression of T cell functions, decrease cAMP contents while increasing cGMP contents, [Ca(2+)]i concentration and PKC activity. CONCLUSIONS: Macrophages posttrauma may suppress T cell functions via altering messenger molecule levels in activated T cells.
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OBJECTIVE: To determine whether macrophages post trauma have inhibitory effect on normal T cells via direct cell to cell contact. METHODS: A murine amputation injury model was used, macrophages were harvested from abdominal cavity and treated with mitomycin-C to abrogate the secretion of cytokines. Separation of T cells from splenocytes in normal mice was performed using nylon column method. Mitomycin-C treated macrophages from control and traumatized mice were added into the normal T cell culture systems, then various parameters of T cell functions were determined. RESULTS: The production and secretion of interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor (TNF) and prostaglandin E-2 (PGE-2) could be abrogated after macrophages were treated with 25 &mgr;g/mL mitomycin-C for 30 minutes. Mitomycin-C treated macrophages from traumatized mice could obviously suppress T lymphocyte transformation, IL-2 mRNA and IL-2Ralpha mRNA levels, IL-2 production, IL-2Ralpha expression, IL-2 mediated lymphocyte proliferation response of normal T cells, could not affect IL-2-IL-2R interaction but elevated suppressive action of Ts cells. Removal of Ts cells from T cells could almost abolish the inhibition of macrophages. CONCLUSIONS: Macrophages post trauma can suppress T cell functions by depressing IL-2 and IL-2Ralpha gene expression via direct cell to cell contact, and this effect may be mediated mainly by increasing the action of Ts cells.
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The Change in interleukin-2 (IL-2) production of splenocyte and its relationship with suppressor T cell (Ts) were studied in mice after trauma. The results showed that IL-2 production was reduced, number of Ts was increased and activity of Ts correlated with reduced IL-2 production. Removal of Ts from splenocyte improved IL-2 production in traumatized mice. It is suggested that Ts is activated after trauma, resulting in impaired IL-2 production.