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Pathological vascular remodeling is a hallmark of various vascular diseases. Previous research has established the significance of andrographolide in maintaining gastric vascular homeostasis and its pivotal role in modulating endothelial barrier dysfunction, which leads to pathological vascular remodeling. Potassium dehydroandrographolide succinate (PDA), a derivative of andrographolide, has been clinically utilized in the treatment of inflammatory diseases precipitated by viral infections. This study investigates the potential of PDA in regulating pathological vascular remodeling. The effect of PDA on vascular remodeling was assessed through the complete ligation of the carotid artery in C57BL/6 mice. Experimental approaches, including rat aortic primary smooth muscle cell culture, flow cytometry, bromodeoxyuridine (BrdU) incorporation assay, Boyden chamber cell migration assay, spheroid sprouting assay, and Matrigel-based tube formation assay, were employed to evaluate the influence of PDA on the proliferation and motility of smooth muscle cells (SMCs). Molecular docking simulations and co-immunoprecipitation assays were conducted to examine protein interactions. The results revealed that PDA exacerbates vascular injury-induced pathological remodeling, as evidenced by enhanced neointima formation. PDA treatment significantly increased the proliferation and migration of SMCs. Further mechanistic studies disclosed that PDA upregulated myeloid differentiation factor 88 (MyD88) expression in SMCs and interacted with T-cadherin (CDH13). This interaction augmented proliferation, migration, and extracellular matrix deposition, culminating in pathological vascular remodeling. Our findings underscore the critical role of PDA in the regulation of pathological vascular remodeling, mediated through the MyD88/CDH13 signaling pathway.
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Mice , Rats , Animals , Myeloid Differentiation Factor 88/metabolism , Vascular Remodeling , Cell Proliferation , Vascular System Injuries/pathology , Carotid Artery Injuries/pathology , Molecular Docking Simulation , Muscle, Smooth, Vascular , Cell Movement , Mice, Inbred C57BL , Signal Transduction , Succinates/pharmacology , Potassium/pharmacology , Cells, Cultured , Diterpenes , CadherinsABSTRACT
In recent years, radiotherapy has been widely applied in tumor patients. The short-term and long-term impact on the cardiovascular system has captivated increasing attention from radiologist and cardiologist. Along with higher radiation dose and longer follow-up, the incidence rate of coronary artery disease tends to significantly elevate, especially in patients with breast cancer and lung cancer. With the advancement of radiotherapy technologies, different tumors, different radiation doses and different modes of radiation delivery exert different effects on coronary artery. There are still some disputes about how to prevent, diagnose, evaluate, and treat the high-risk population of coronary artery diseases after radiotherapy. How to optimize the treatment strategy before and after radiotherapy to reduce the incidence of short-term and long-term coronary artery diseases in cancer patients needs further clinical research.
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Objective:To analyze the feasibility of applying transcutaneous electrical nerve stimulator and high-frequency ultrasound in superficial nerve positioning for detection anatomical location in the area of lateral lip of the iliac crest by lateral cutaneous branch of subcostal nerve(LCSN). The significance of using the nerve as a free sensory superficial circumflex iliac artery perforator flap was discussed.Methods:The data of patients who underwent the repair of defects on limbs with free perforator flap or composite flap of superficial iliac circumflex artery carrying sensory nerve and the volunteers who agreed to have the location of the LCSN measured between October, 2018 and October, 2020 were collected. The LCSN were located by percutaneous electrical nerve stimulation and ultrasound, and the patients were measured and located during surgery. Using Passing-Bablok regression and Bland-Altman graph to evaluated the consistency between transcutaneous electrical nerve stimulation, ultrasound and the surgical positioning.Results:A total of 43 subjects, including 22 patients and 21 volunteers, were selected for locating the LCSN. Thirty-nine males and 4 females, with an average age of 39 years old and an average BMI of 24.08. The operation time of percutaneous nerve electrical stimulation was(6±1) min, and the detection distance was(80.7±5.9) mm. The high-frequency ultrasound was(23±4) min, and the distance was(81.2± 6.6) mm. The average operation time of surgical measured distance was(80.9±8.2)(65-100) mm, the diameter of nerve was(2.3±0.8)(1.0-4.0) mm, and the operation time was(5±1) min. A 95% CI of Passing-Bablok regression intercept and slope of operation, percutaneous electrical nerve stimulation and ultrasoundincluded 0 and 1, respectively. The points on Bland-Altman plot were distributed on both sides, and 95% CI of total mean difference, total intercept and slope included 0. Therefore, it was can be considered that the application of percutaneous electrical nerve stimulation and ultrasound in LCSN localization has good consistency.Conclusion:The location point of the LCSN crossing the iliac crest which detected by transcutaneous electrical nerve stimulation and high-frequency ultrasound detection was close to the measurement taken during the operation. It was also showed that both of them can be used for preoperative locationing of the sensory branch of the sensory nerve flap, optimizing the design of the flap, shortening the operation time, and reducing the unnecessary injury in operation.
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Objective:To investigate the efficacy of free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve for repair of soft tissue defect in the foot and ankle.Methods:A retrospective case series study was made on clinical data of 9 patients with soft tissue defect in the foot and ankle admitted to 80th Group Military Hospital from December 2017 to December 2019. There were 8 males and 1 females, with the age of 28-63 years [(47.3±12.3)years] and the body mass index (BMI) of 16.7-27.8 kg/m 2 [(23.9±3.9)kg/m 2]. The size of soft tissue defect ranged from 10 cm×6 cm to 20 cm×12 cm. All patients were treated with the free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve. After debridement or tumor resection, a thin sensate flap was harvested by intra-adipose tissue dissection between the superficial and deep fat layers. The size of flap ranged from 13 cm×8 cm and 13 cm×10 cm. The thickness of the defatted flap ranged from 3-6 mm. The distance from the anterosuperior iliac spine to the point where the lateral cutaneous branch of the subcostal nerve crossed the iliac crest ranged from 7.5-10.0 cm. The flap survival, complications, and reoperation were observed after operation. The sensory recovery of the flap was evaluated using Tinel sign and nine-grid method including monofilament touch perception, vibration perception, pinprick perception, temperature perception, and static two-point discrimination test. The joint range of motion, and shoewear and walking problems were recorded. At the last follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to assess the affected foot and ankle. The injury at the donor site was detected as well. Results:All patients were followed up for 6-35 months [(21.1±10.1)months]. All flaps survived without infection or tumor reoccurrence. One patient developed ulceration, then surplus skin on the reconstructed heel was resected. One patient underwent flap debulking and removal of internal fixation. One or more sensory modalities within the nine areas in each flap could be detected at postoperative 3-6 months. The monofilament touch, vibration, pinprick, and temperature perception were presented in almost all regions of each flap at postoperative 12 months. However, only one patient in one region was noted with the static two-point discrimination, in which the distance of the two points was set as 25 mm. The range of ankle motion was slightly limited in 2 patients who underwent osseoligamentous complex reconstruction. All patients were able to wear normal shoes and walk without pain. At the last follow-up, the AOFAS ankle-hindfoot score ranged from 78 to 97 points [(86.4±7.4)points], significantly improved from preoperative 10-70 points [(44.2±18.4)points] ( P<0.01). No patients complained of pain at the donor site, but the widening linear scar was noted. Conclusion:For medium-sized soft tissue defect of the foot and ankle, the free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve can be defatted with the requirement and has advantages in defect site appearance, sensory restoration, wearing ordinary shoes, painless walking, good functional recovery, and minimal donor site morbidity.
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Objective To investigate the correlation of clinicopathological features and maximum standardized uptake value (SUVmax) detected by 18F-FDG PET-CT in pulmonary large cell neuroendocrine carcinoma(LCNEC).Methods The clinicopathological data of 43 pulmonary LCNEC patients who underwent 18F-FDG PET-CT and were confirmed by pathology in the First Affiliated Hospital with Nanjing Medical University From October 2009 to May 2017 were retrospectively analyzed.Univariate and multivariate analyses were performed on factors that may affected SUVmax in the primary tumor,including the patient's age,gender,tumor location,tumor type,tumor maximum diameter,T stage,N stage,M stage,and TNM stage.Results The SUVmax and tumor maximum diameter of 43 pulmonary LCNEC patients were 11.9 ±4.9 and (3.2±1.4) cm,and there was a positive relation between SUVmax and tumor maximum diameter (r =0.533,P =0.000).The univariate analysis showed that SUVmax was correlated with tumor maximum diameter,T stage,N stage,M stage and TNM stage (all P ＜ 0.05),but was not correlated with patient's age,gender,tumor location,and tumor type (all P ＞ 0.05).The multivariate analysis showed that tumor location,N stage,M stage and TNM stage were the independent influencing factors of SUVmax (OR =2.087,2.852,2.315,-2.200,all P ＜ 0.05).Primary tumor SUVmax had predictive value for lymph node metastasis,when the cut-off value was 13.5,the diagnostic efficiency was the highest,the sensitivity was 64.7 ％,and the specificity was 92.3 ％.Conclusions The SUVmax detected by 18F-FDG PET-CT in pulmonary LCNEC is correlated with tumor maximum diameter,N stage,M stage and TNM stage.Primary tumor SUVmax has a certain reference value for predicting lymph node metastasis.
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Methods: Thirty-six New Zealand rabbits were used to prepare the model of early implantation-associated infection after internal fixation of tibial fracture, and randomly divided into 3 groups ( n=12) . The infected wounds were covered with Drawtex hydroconductive dressing (group A), chitosan solution gauze (group B), and normal saline gauze (group C), respectively. The dressing was changed every 2 days. X-ray films were performed at 1, 14, and 21 days. The gross observation, microbiological evaluation, and histological observation were done at 21 days.
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Objective To observe the clinical effect of tongluozhitong capsule combined with carbamazepine on the treatment of trigeminal neuralgia.Methods94 patients with trigeminal neuralgia from January 2012 to May 2014 in Dongyang people's hospital were randomized double-blindly divided into the control group and the observation group, 47 cases in each group.The control group received carbamazepine treatment, and the observation group received tongluozhitong capsule combined with carbamazepine.VAS score, the effect and adverse reaction were recorded and analyzed before treatment, atwo weeks and four weeks after.Recurrence was followed-up a half and one year after treatment.Results①VAS scores in the observation group 2 weeks and 4 weeks after treatment were (3.78±0.44), (2.01±0.23) points separately, which were lower than those in the control group (5.96±0.53), (4.02±0.38) points separately, and the differences were statistically significant (P<0.05).②The total effective rate in the observation group 4 weeks after treatment was 95.74%, which significantly higher than that in the control group 78.72%, and the difference was statistically significant (P<0.05).③ The adverse reactions in the observation group 4 weeks after treatment was 21.28%, 27.66% in the control group, the difference was not significant;④ The recurrence rate in the observation group six months and one year after treatment were 6.38% and 10.64%, which significantly lower than those in the control group 23.40% and 29.79%, and the differences were statistically significant (P<0.05).ConclusionIt can effectively relieve pain, reduce the recurrence rate, and will not increase the adverse reactions which tongluozhitong capsule combined with carbamazepine were used on the treatment of trigeminal neuralgia.It is a safe and effective treatment program.
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BACKGROUND/AIMS: Neurotensin is a gut-brain peptide with both inhibitory and excitatory actions on the colonic musculature; our objective was to understand the implications of this for motor patterns occurring in the intact colon of the rat. METHODS: The effects of neurotensin with concentrations ranging from 0.1-100 nM were studied in the intact rat colon in vitro, by investigating spatio-temporal maps created from video recordings of colonic motility before and after neurotensin. RESULTS: Low concentration of neurotensin (0.1-1 nM) inhibited propagating long distance contractions and rhythmic propagating motor complexes; in its place a slow propagating rhythmic segmental motor pattern developed. The neurotensin receptor 1 antagonist SR-48692 prevented the development of the segmental motor pattern. Higher concentrations of neurotensin (10 nM and 100 nM) were capable of restoring long distance contraction activity and inhibiting the segmental activity. The slow propagating segmental contraction showed a rhythmic contraction—relaxation cycle at the slow wave frequency originating from the interstitial cells of Cajal associated with the myenteric plexus pacemaker. High concentrations given without prior additions of low concentrations did not evoke the segmental motor pattern. These actions occurred when neurotensin was given in the bath solution or intraluminally. The segmental motor pattern evoked by neurotensin was inhibited by the neural conduction blocker lidocaine. CONCLUSIONS: Neurotensin (0.1-1 nM) inhibits the dominant propulsive motor patterns of the colon and a distinct motor pattern of rhythmic slow propagating segmental contractions develops. This motor pattern has the hallmarks of haustral boundary contractions.
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Animals , Rats , Absorption , Baths , Colon , In Vitro Techniques , Interstitial Cells of Cajal , Lidocaine , Myenteric Plexus , Neural Conduction , Neurotensin , Peristalsis , Receptors, Neurotensin , Video RecordingABSTRACT
Objective To investigate the predictive value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) calculated from 18F-FDG PET-CT results for postoperative recurrence and prognosis in patients with resectable pancreatic cancer. Methods From may 2009 to December 2015, 30 patients with pancreatic cancer who underwent curative resection after PET-CT examination were enrolled, and the clinic pathological data and 18F-FDG PET-CT data were retrospectively analyzed. The prognostic value of SUVmax, SUVmean, MTV, TLG and other prognosis factors were analyzed. Results In 30 patients with pancreatic cancer, preoperative 18F-FDG PET-CT detected all primary lesion (10 0%). 29 patients were recurrence or metastasis, and 26 patients were died with median of 17.8 months (2.6-39.6 months) follow-up. The median progression-free survival (PFS) time was 6.5 months and the median overall survival (OS) time was 11.6 months. The multivariate analysis revealed the histological differentiation and MTV were the independent influencing factors for PFS (both P<0.05). The lymph node metastasis, MTV and TLG were the independent influencing factors for OS (all P<0.05). Conclusion The MTV and TLG of PET-CT may be predicting the recurrence and survival of patients with pancreatic cancer after curative resection, suggesting that it can be used to guide the individual treatment.
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OBJECTIVE:To investigate clinical efficacy and safety of recombinant human tissue type plasminogen activator (rt-PA) intravenous thrombolytic in the treatment of elderly patients (over 75 years old) with acute cerebral infarction (ACI). METHODS:78 elderly ACI patients,on the basis of routine treatment,were divided into thrombolysis group (40 cases) and non-thrombolysis group (38 cases) according to the will of patients or family members. Non-thrombolysis group received aspirin 200 mg,qd;thrombolysis group was given rt-PA 0.9 mg/kg(maximum dose of 90 mg)by intravenous push of 10% dose within 1 min,and intravenous dripping of residue dose within 60 min;receiving aspirin 200 mg,qd,24 h after thrombolytic therapy with-out contraindications. Both groups were treated for 14 days. The effective rate,NIHSS score before treatment and 24 h,7 d and 14 d after treatment,prognosis after 90 d were compared between 2 groups,and the occurrence of ADR was observed in 2 groups. RE-SULTS:The total effective rate was 67.50% in thrombolysis group and 52.63% in non-thrombolysis group,with statistical signifi-cance(P0.05). CONCLUSIONS:4.5 h time window rt-PA intravenous thrombolytic therapy is safe and effective for elderly patients with ACI,and can reduce disability and fatality,im-prove prognosis.
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Objective To assess the feasibility,safety,and effectiveness of early rapid icy normal saline infusion to attain mild hypothermia in cardiac arrest patients. Methods A single-center prospective randomized controlled trial was conducted. From March 2011 to October 2013,patients who had recovery of spontaneous circulation (ROSC)after cardiopulmonary resuscitation (CPR)in Beijing Daxing District People's Hospital were randomly divided into two groups. In icy normal saline group,patients received a rapid infusion of 1 000 mL of 4 ℃ normal saline intravenously to attain a mild hypothermia. In the control group,the patients were treated with ice bag on head,and axillary temperature was monitored. For all patients,rectal temperature was measured and recorded immediately and 1 hour later . The occurrence of pulmonary edema on initial chest X-ray at 6 hours ,occurrence of tremor within 48 hours,ventricular fibrillation recurring within 48 hours,and consciousness or death within 14 days were recorded. Results A total of 45 patients were enrolled,including 23 patients in icy normal saline group and 22 in control group. The patients in icy normal saline group had a rectal temperature descended from(36.7±0.9)℃to(34.9±0.7)℃1 hour later,while the patients in control group had a rectal temperature risen from(36.5±1.0)℃to(37.9±0.9)℃1 hour later. There was significant difference in rectal temperature between two groups (t=2.228,P=0.031). The number of patients who successfully awaken within 14 days in ice normal saline group was significantly larger than that in control group (13 cases vs. 7 cases,χ2=65.710,P=0.021). There was no statistical difference in the occurrence of acute pulmonary edema (4 cases vs . 6 cases),tremor (2 cases vs . 0 case),ventricular fibrillation recurrence (4 cases vs. 5 cases)and death within 14 days (11 cases vs. 12 cases,all P>0.05). Conclusions The study shows that early rapid i.v. infusion of 4℃normal saline is feasible,safe and effective for cerebral resuscitation.
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Objective To evaluate the efficacy and safety of alteplase (rt-PA) thrombolytic therapy on patients with acute ischemic stroke aged over 80 years old.Methods The observational cohort study were conducted.One hundred and thirty-six patients with acute cerebral infarction and received rt-PA thrombolytic treatment were selected as our subjects with incidence time of 4.5 h,and the rt-PA dose of 0.9 mg/kg.The patients were divided into ≥80 years old group(n =34) and ＜80 years old group(n =102).U.S.A national institutes of health stroke scale (NIHSS) score of two groups evaluated before thrombolysis,immediately after thrombolysis 24 h,7 d and 14 d.The incidence and mortality rate of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH) of two group were compared; and the score of modified Rankin's Scale (mRS) followed-up of 90 d were evaluated.Results NIHSS score after thrombolysis 24 h,7 d and 14 d of two groups were significantly lower than that before thrombolysis,and the differences were statistically significant (t =4.123,9.936,9.679,5.657,8.154,6.956,P ＜0.01).The score after thrombolysis 24 h,7 d and 14 d of two groups were no statistically significant difference.The efficient rate of treatment of two group were 55.88％ and 61.76％ respectively(P =0.54).Mter follow-up of 90 d,the prognosis rate were 47.06％ and 64.71％ respectively(P =0.07),and there were no statistically significant difference.Incidence rate of ICH were 11.76％ and 5.88％ respectively(P =0.07).Occurrence rates of sICH were 5.88％ and 2.94％ (P =0.43).Mortality rate were 11.76％ and 9.80％ (P =0.33),and there were no statistically significant difference.Conclusion This study shows that 80 years of age or older patients with acute ischemic cerebral apoplexy patients using rt-PA intravenous thrombolytic therapy is safe and effective,but RCT need further study.
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Objective To investigate the application and clinical outcomes of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps for the treatment of complex limb wound.Methods Data of 10 patients,who had undergone free tissue transfer of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps (iliac osteocutaneous flap,iliac crest flap and ilioinguinal flap) for the complex limb wound from March 2009 to January 2011,were retrospectively analyzed.There were 9 males and 1 female,aged from 21 to 57 years (average,39.7 years).Iliac osteocutaneous flap was used in 7 patients,iliac crest flap in 2 patients and ilioinguinal flap in 1 patient.The free tissue transfer was performed for hand reconstruction in 3 cases,foot reconstruction in 4 cases and leg reconstruction in 3 cases.The mean size of soft tissue defect was 20 cm × 9.7 cm.Results The mean size of the anterolateral thigh flap and the ilioinguinal flap was 17.8 cm×9.4 cm and 8.4 cm×4.5 cm,respectively.The mean volume of iliac crest was 5.4 cm×2.1 cm×0.8 cm,and the mean length of flow-through conduit was 10.5 cm.Except for the distal necrosis of iliac osteocutaneous flap in 1 case,which were treated by dressing change and skin grafting,the other flaps survived without complications.All patients were followed up for 6 to 36 months (average,12 months).The average bone union time was 3 months in the hand group,4 months in the foot group,and 4.5 months in the leg group.The disabilities of the arm,shoulder,and hand questionnaire score averaged 43,the mean Japanese Orthopaedic Association's foot rating scale was 71.3,and the mean Puno's functional score was 91.Donor site scars were mostly flat,pale and soft but widened in the thigh in 6 patients and in the ilioinguinal region in 3 patients,and numbness was reported in 2 patients.Conclusion In clinical situation that requires for coverage of complex and extensive limb defects,the free tissue transfer of anterolateral thigh perforator flap bridging superficial circumflex iliac artery flap is a better method,which can meet specific reconstructive demands with minimal donor site morbidity.However,a relative high risk has to be considered.
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Objective To calculate the volume and to study the correlated risk factors of hidden blood loss after artificial hip or knee joint replacement. Methods From July to November in 2008, 38patients with age of (65.11±13.51) years old were treated with artificial hip or knee joint replacement, and were divided by age into four groups. Using Gross formula, total blood loss was calculated depending on height, weight and pre- and post-operation hematocrit, and the hidden blood loss was acquired by subtracting the visible blood loss from the total blood loss. The correlation between age,body mass index( BMI),gender and hidden blood blood loss was observed. Differences of hidden blood loss of artificial hip or knee joint replacement were compared. Results The total blood loss of all arthroplasties was ( 1563.52 ± 693.10) ml,and the hidden blood loss was (538.70 ± 529.77) ml,the percentage of hidden blood loss was 33%. The hidden blood loss was inversely related to age (P＜ 0.05 ). There was no correlation between BMI and hidden blood loss (P＞0.05). The percentage of hidden blood loss in total blood loss in woman was significantly higher than that in man. With age and gender paired, the percentage of hidden blood loss in total blood loss in artificial hip joint replacement was significantly higher than that in artificial knee joint replacement (P＜0.05 ). Conclusions Both of age and gender are risk factors influencing hidden blood loss after artificial hip or knee joint replacement. And compared with artificial knee joint replacement, the percentage of hidden blood loss in artificial hip joint replacement is higher.
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OBJECTIVE:To observe the efficacy and safety of adjuvant Shensong Yangxin Capsule(SYC)in patients with stable angina(SA)receiving conventional therapy.METHODS:Fifty-eight chronic stable angina(CSA)patients were randomly assigned to 2 groups:the SYC group(n=28)treated with SYC plus conventional therapy while the control group(n=28)with conventional therapy alone.The patients were allowed to take nitroglycerine if number of the angina attacks ≥ 2 per day.The course of treatment fro both groups was 12 weeks.RESULTS:The total ischemic time during 24 hours,the ST segment decreasing amplitude and the frequency of angina pectoris attacks in two groups were all improved significantly after treatment(P