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Objective:To explore the application and effect of multidisciplinary collaboration in patients with tophi during perioperative period.Methods:Forty-five patients undergoing tophaceous gout surgery in our hospital from May to October 2020 were selected as the control group and treated with routine treatment.From November 2020 to April 2021, 41 patients undergoing tophaceous gout surgery in our hospital who were treated with multidisciplinary collaboration management mode were included as the intervention group. Postoperative pain, blood uric acid level, hospitalization expenses, hospitalization days and patient satisfaction were compared between the two groups.Results:After implementing the multidisciplinary integration man-agement mode, the pain score of the patients at 4 hours, 1 day and 3 days after operation was lower than that of the control group [(3.6±1.0) vs (4.1±1.0), t=2.33, P=0.022; (2.5±0.8) vs (3.0±0.6), t=3.85, P<0.001; (1.8±0.5) vs (2.2±0.7), t=3.52, P<0.001], the serum uric acid level was significantly lower than that of the control group at 1 month and 3 months after operation [(355±58) vs (3928±39), t=3.50, P=0.001; (316±48) vs (366±47), t=4.84, P<0.001], the hospitalization days and hospitalization expenses were significantly decreased [(8.90±2.48) d vs (10.62±3.96) d, t=2.44, P=0.017; (1.00±0.13) ten thousand yuan vs (1.11±0.17) ten thousand yuan, t=3.34, P=0.001], and the patient satisfaction was markedly improved (97.6% vs 82.2%, χ2=3.87, P=0.049). Conclusion:The multi-disciplinary collaboration mode in patients with tophi during perioperative period can effectively reduce the postoperative pain, improve the quality of care, promote reha-bilitation, improve the outcome, and reduce the economic burden of patients, which is worthy of popularization and being applied in clinic.
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Objective To explore the diagnostic value of cfDNA in pancreatic cancer. Methods A total of 467 patients with pancreatic cancer and 129 healthy controls were enrolled. cfDNA concentration was detected using the QuantiDNA Direct cfDNA Test (DiaCarta) kit. Mann-Whitney U test was used to compare cfDNA concentration between different groups, and Chi-square test was used to analyze the relationship between cfDNA and pathological data of pancreatic cancer. Diagnostic efficacy was evaluated by ROC analysis. Results The cfDNA level of patients with pancreatic cancer was significantly higher than that of healthy controls (20.85 vs. 15.15 ng/ml, P=0.0027). The positive rate of cfDNA in pancreatic cancer was higher than that in healthy controls (77.73% vs. 59.68%). The sensitivity levels of cfDNA, CEA, and CA19-9 as diagnostic markers were 62.65%, 64.04%, and 60.32%, and their specificity levels were 61.05%, 70.53%, and 87.37%, respectively. The sensitivity and specificity of the combined detection were 77.26% and 53.58% respectively. The areas under the curve of cfDNA, CEA, CA199, and combined detection were 0.62, 0.67, 0.74, and 0.67, respectively. Conclusion cfDNA is elevated in patients with pancreatic cancer and may serve as an effective marker for its diagnosis.
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Idiopathic macular hole after the internal limiting membrane (ILM) is removed during surgery, the intraoperative optical coherence tomography can be used to observe the presence of debris tissue (RF) protruding into the vitreous cavity at the edge of the hole. Current studies suggest that RF may be caused by epiretinal proliferation and vitreomacular traction, but it is still controversial, and the influence of postoperative anatomical and functional recovery is not clear. Common points can still be found, some of the studies suggest that RF is not conducive to postoperative anatomical and functional recovery during the operation, ILM fragments remain on RF tissues after ILM peeling and re-staining. However, in some studies suggest that RF is beneficial to postoperative anatomical and functional recovery, and ILM fragments on RF are removed. This suggests that whether ILM is removed on RF lead to a certain influence on the postoperative efficacy. There are few researches on RF at present, so it is necessary to understand RF from its essence and assist judgment through histological analysis.
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Objective To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.Methods A retrospective,case-controlled study.Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study.There were 5 males (5 eyes) and 24 females (24 eyes),with an average age of 55.28 ± 11.40 years.According to the surgical method,the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes).All patients underwent BCVA,spectral domain OCT and axial length measurement before surgery.There was no significant difference between the two groups in age,gender,course of disease,hole diameter,BCVA and other baseline data.Follow-up was over 4 months after surgery.The BCVA,macular hole closure and continuity of outer retina after surgery were observed.Results In ILM peeling group,11 eyes were closed (64.7％) and 6 eyes were not closed at 3 months after surgery.In ILM flap group,12 eyes were closed (100.0％).The difference of closure rate between two groups was statistically significant (x2=5.34,P=0.028).The BCVA of inverted ILM flap group was significantly improved at 1,3 months after surgery compared with preoperative measurements,and the difference was statistically significant (F=3.813,4.667;P=0.003,0.001).The BCVA of ILM peeling group was improved at 1 month after surgery,but the difference was not statistically significant (F=1.556,P=0.139).And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements,and the difference was statistically significant (F=2.453,P=0.026).But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647,0.535;P=0.551,0.612).There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008,P=0.631).Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole.The closure rate of the hole can be improved significantly.
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Objective To investigate the in vivo stress distribution of the atherosclerotic plaque at carotid bifurcation, so as to provide references for the mechanical mechanisms of plaque rupture at carotid bifurcation and the design for further medical treatment. Methods The three-dimensional geometric model of carotid bifurcation and plaque were established according to average geometric parameters of human carotid bifurcation. Residual stress of the carotid bifurcation and plague was reestablished with “thermal-structure” coupling method, and in vivo stresses of vessels with the plaque at carotid bifurcation under blood pressure and blood flow were calculated. Results Both the maximum principal stress and elastic shear stress concentrated on the shoulder of the plaque. Elastic shear stress increased with the increase of stenosis ratio and blood pressure. Wall shear stress in the upstream of the plaque was considerably higher than that of the downstream. The distribution of oscillatory shear index(OSI) was quite the opposite. The changing patterns of the elastic shear stress and flow shear stress were quite different with the change of stenosis ratios. Conclusions Tension grew gradually from the centrality to shoulder surface of the plaque. The centrality of the plaque might bear compression when the stenosis was very severe. The periodic variation of the structural stress might cause structural fatigue of the plaque, thus increasing the rupture risk. Distinction of the component and vulnerability of the plaque between upstream and downstream might be caused by differences in hemodynamic parameters of the plaque between upstream and downstream.
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Objective@#To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.@*Methods@#A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males(5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.@*Results@#In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ2=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).@*Conclusions@#Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.
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Based on my training experience in the United States,here introduced the situation of diabetes education and management in the United States,diabetes educator certification and the education program of outpatients and inpatients. This information can provide advice to improve the current status of diabetes education in China.
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Objective To investigate the expressions of RhoB and E-cadherin in non-small-cell lung cancer (NSCLC), and their clinical significances thereof. Methods Immunohistochemical staining was applied to detect expres-sions of RhoB and E-cadherin in 116 samples of NSCLC (NSCLC group) and 116 samples of normal lung tissues (control group). Correlations of expressions of RhoB and E-cadherin to clinical pathological parameters and prognosis were analyzed in two groups. Results The expression intensities of RhoB and E-cadherin were significantly lower in NSCLC group than those in control group (57.76%vs 87.07%,54.31%vs 85.34%,P＜0.01). There were significant differences in the expres-sion of RhoB between different pathological types, differentiation and lymph node metastasis in NSCLC group. There were significant differences in the expression of E-cadherin between different TNM stages, differentiation and lymph node metas-tasis in NSCLC group. The expression of RhoB was positively correlated with the expression of E-cadherin ( r=0.503,P＜0.01). The 3-year survival rates were significantly higher in patients with high expression of RhoB (83.93%) than those in pa-tients with low expression of RhoB (40.00%, Log-rank χ2=18.992,P＜0.01). The 3-year survival rates were significantly higher in patients with high expression of E-cadherin (85.11%) than those in patients with low expression of E-cadherin (44.93%, Log-rankχ2=16.680,P＜0.01). Further multivariate analysis suggested that both lower expressions of RhoB and E-cadherin and lymph node metastasis were prognostic indicators for NSCLC (P＜0.001). Conclusion The expressions of RhoB and E-cadherin showed a good correlation in NSCLC. Detecting the expression of RhoB combined with E-cadherin may give a clue on clinicopathological features and prognosis in patients with NSCLC.
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Aim To investigate the changes of content of L-carnitine (LC ), acetyl-L-carnitine (ALC ) and propionyl-L-carnitine (PLC )in patients with diabetes and its complications.Methods By replicating meth-od of pre-column derivatization HPLC,the contents of plasma LC,ALC,PLC were detercted in normal sub-jects and in patients of diabetes mellitus,diabetic reti-nopathy, diabetic nephropathy, diabetic peripheral neuropathy,diabetic hypertension,diabetic coronary heart disease.Results The concentration of LC in normal subjects and in patients of diabetes mellitus, diabetic retinopathy, diabetic nephropathy, diabetic peripheral neuropathy,diabetic hypertension,diabetic coronary heart disease were (41.01 ±8.05 )μmol · L-1 ,(36.72 ±8.23 )μmol · L-1 ,(33.3 1 ±6.26 )μmol·L-1 ,(33.81 ±5.61 )μmol·L-1 ,(33.57 ± 6.67 )μmol · L-1 , (33.67 ±5.36 )μmol · L-1 , (32.87 ±6.05 )μmol · L-1 respectively.The plasma LC concentration in diabetic group was significantly lower than that of normal control group (P<0.05 ). Moreover,the LC concentration in other groups of dia-betic complications was lower than that in diabetic group, and LC concentration showed no significant difference in various groups of diabetic complications. There was no significant difference in the plasma con-centrations of ALC and PLC of diabetes group and the diabetic complication groups too.Conclusion In Chi-nese normal subjects,patients with diabetes and dia-betic complications,the plasma concentrations of LC in diabetic patients are lower than normal,and plasma concentration of LC in diabetic complications are lower than that in patients with diabetes mellitus.
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Objective To evaluate the expression of Yes-associated protein (YAP) in colorectal carcinoma and analyze its influence on tumor cell proliferation.Methods The expressions of YAP in 94paired colorectal carcinomas and pericancerous normal tissues were detected by using immunohistochemistry method.The expressions of YAP in colorectal carcinoma cell line HCT116 were inhibited with a YAP-spe-cific siRNA.Cell proliferation was then determined by methyl thiazolyl diphenyl-tetrazolium bromide (MTT) assay.Results The positive rate of YAP in colorectal carcinomas was significantly higher than that in pericancerous normal tissues [69.1％ (65/94) vs 22.3 ％ (21/94),P ＜ 0.001].The expression of YAP was associated with tumor Node Metastasis(TNM) stage and lymph node metastasis(P ＜0.05),but not associated with gender,age,tumor location and histological grade(P ＞0.05).After YAP-specific siR-NA was transfected into HCT116 using lipofectamine,the expression of YAP mRNA and protein in the experimental group were reduced by (78.2 ±2.1)％ and (81.7 ± 1.5)％,respectively,with a statistically significant difference (t =67.55,91.601,P ＜0.01).The growth of HCT116 was significantly inhibited and the reduced rate of cell proliferation was (28.1 ± 1.6) ％,(34.7 ± 2.4) ％ and (24.7 ± 1.2) ％ at the time point of 48 h,72 h and 96 h,respectively.Conclusions Expression of YAP was upregulated in colorectal carcinomas and downregulation of YAP expression could inhibit growth of colorectal carcinoma cells.YAP can be used as a new candidate target for diagnosis and treatment of a colorectal carcinoma.
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Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre- and post-operativemanometry and 24-hour-pH monitoring. The parameters including reflux frequency 、the longest lasting-time of reflux 、the total time(min) of pH ＜4.0 and the percentage( % ) of time of pH ＜4.0 were recorded and compared using statistical mothods. Results Symptom was significantly improved in 32 patients after surgery, while 1 patient remained dysphasia as pre-operative. The LESP, the reflux frequency、the longest lasting-time of reflux 、the total time(min) of pH ＜ 4.0 and the percentage ( % ) of time of pH ＜ 4.0 also declined after operations ( P ＜ 0. 05 ). 30 patients were followed up,22 (73.3% ,22/30) were cured and 8 had mild sypmtom. Reflux did not detected in 3 cases( 16.7% ,3/18 ) with preoperative reflux. Conclusion Transabdominally Heller-Dor operation could dramadically alleviate the symptoms of patients with achalasia, moreover, it could especially prevent the postoperative-reflux, and with the advantages of simple operations, little traumas.
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Objective To investigate the effects of Blastocyst MHC gene transfection to coronary on the survival time of mouse heart grafts and the mechanism. Methods Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients respectively, to construct mouse cervical heart transplantation models. In the control group, the donor hearts were perfused using the 0～4 ℃ St. ThomasⅡ solution; in the cyclosporine A (CsA) group, the donor hearts were perfused as same as the control's and received intraperitoneal injection of CsA (5 rng·g-1·d-1) after surgery; in the transfection group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid; in the combined treatment group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid and received intraperitoneal injection of CsA (5 mg·g-1·d-1) after surgery. The survival time of transplanted heart allografts were observed, and their histopathological changes and the degrees of coronary intimal hyperplasia were estimated.Blastocyst MHC gene mRNA expression levels were detected by real-time fluorescence quantitative RT-PCR. Flow cytometry was applied in assessment of the levels of CD4+ CD25+ regulatory T cells (Treg) and CD3+ CD8+ T cells. Results The survival time in the CsA group, transfection group and combined treatment group was significantly longer than in the control group (P＜0.05) and that in the combined treatment group was the longest, up to (20. 50 ± 5. 61) days. On the postoperative day 1 and 3, Blastocyst MHC gene mRNA expression level in the transfection group was significantly higher than that in the control group (P＜0.05). On the postoperative day 7, the degrees of rejection and coronary intimal hyperplasia in the combined treatment group were the lightest. On the postoperative day 7 the number of Tregs in the CsA group and the combined treatment group was significantly increased as compared with that in the control group (P＜0.05), but that of CD3 + CD8+ T cells in the CsA group and the combined treatment group was less than that in the control group (P＜0.05). Conclusion Blastocyst MHC gene transfection in mouse transplanted cardiac allograft can extend its survival time through upregulation of Treg and downregulation of CD3 + CD8 + T cells in the mice. The combination of Blastocyst MHC gene and CsA may exert the synergic effects.
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Objective Cervical heterotopic heart transplantation model was established in different inbred strains of mice with modified cuff technique. Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients, respectively. Mice were randomly assigned into four groups: control group (the donor hearts were perfused through coronary artery with 200 μl, 0℃～4℃ St. Thomas Ⅱ solution during 2 to 3 min, then they were immersed in it for 15 min), CsA group ( the donor hearts were perfused with the same method as for the control's and intraperitoneal injection of CsA 5 mg· g-1 · d -1 was given after surgery ), H2-B1 transfection group (the donor hearts were perfused through coronary artery with 200 μl, 0℃ -4℃ St. Thomas Ⅱ solution contained with 30 μg H2-Bl plasmid vectors during 2 to 3 min, then they were immersed in it for 15 min ), and H2-B1 + CsA group ( the donor hearts were perfused with St. Thomas Ⅱ solution contained H2-Bl gene plasmid and intraperitoneal injection of CsA was given after surgery as mentioned above. ). At 1,3 and 7 days after transplantation, three allografts were harvested at each time points in all of the groups, respectively, for pathological examination and analysis of CD40 expression with immunohistochemistry assays. The expression of Th1/Th2 cytokines were also determined with flow cytometry. The survival time of rest allografts were observed. Results Histological features for rejection were observed more apparent in the grafts of control group than those in other groups, especially those in H2-Bl + CsA group. The expression of CD40 in H2-Bl + CsA group and CsA group was lower significantly than that of the control group ( P ＜0.01 ), so was the expression of CD40 in the H2-Bl group as compare with that of the control group (P ＜0.05). No significant difference between H2-Bl group and CsA group (P ＞0.05 ) at 7 days was observed. The expression of IL-2, TNF-α (Th1 cytokines) in control group was much higher than that in other groups, and the expression of IL-4 ( Th2 cytokine) in control group was much lower ( P ＜0.05 ). The level of IL-4 in CsA group increased significantly at 3 days ( P ＜ 0.05 ), with a peak level at 7 days after transplantation (P＜0.01). The survival time of grafts was significantly prolonged in CsA group (P＜0.01), H2-Bl group (P＜0.05) and H2-Bl+CsA group(P＜0.01). Conclusion Treating the donor hearts with H2-Bl plasmid vectors at the time of transplantation may suppress rejection in the heart allografts and prolong the survival time through some presumed mechanisms such as preventing upregulation of CD40 expression, relucing the production of IL-2 and TNF-α, increasing the production of IL-4, and as a result, inducing immune tolerance, as well as improving the function of transplanted heart grafts.