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Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.
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The WUSCHEL related-homeobox (WOX) family is one of the plant-specific transcription factor families, playing important roles in plant growth and development. In this study, 51 WOX gene family members were identified from the genome data of Brassica juncea by searching and screening with HUMMER, Smart and other software. Their protein molecular weight, amino acids numbers, and isoelectric point were analyzed by using Expasy online software. Furthermore, bioinformatics software was used to systematically analyze the evolutionary relationship, conservative region, and gene structure of the WOX gene family. The mustard WOX gene family was divided into three subfamilies: ancient clade, intermediate clade, and WUS clade/modern clade. Structural analysis showed that the type, organization form and gene structure of the conservative domain of WOX transcription factor family members in the same subfamily were highly consistent, while there was a certain diversity among different subfamilies. 51 WOX genes are distributed unevenly on 18 chromosomes of mustard. Most of the promoters of these genes contain cis acting elements related to light, hormone and abiotic stress. Using transcriptome data and real-time fluorescence quantitative PCR (qRT-PCR) analysis, it was found that the expression of mustard WOX gene was spatio-temporal specific, among which BjuWOX25, BjuWOX33, and BjuWOX49 might play an important role in the development of silique, and BjuWOX10, BjuWOX32, and BjuWOX11, BjuWOX23 respectively might play an important role in the response to drought and high temperature stresses. The above results may facilitate the functional study of mustard WOX gene family.
Subject(s)
Mustard Plant/genetics , Multigene Family/genetics , Transcription Factors/metabolism , Plants/genetics , Promoter Regions, Genetic , Phylogeny , Gene Expression Regulation, Plant , Plant Proteins/metabolismABSTRACT
Objective:To investigate the risk factors for acute cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) and to construct its nomogram.Methods:Clinical data of patients who underwent ERCP for common bile duct stones in the First Hospital of Lanzhou University from January 2014 to December 2019 were retrospectively analyzed. A total of 95 patients with acute cholangitis after the operation (the acute cholangitis group) were included and 285 patients without acute cholangitis after the operation (the non-acute cholangitis group) were selected by random sampling at 1∶3 via the software. Logistic regression analysis was used to evaluate the risk factors for acute cholangitis after ERCP. A nomogram model was established to predict the incidence of acute cholangitis after ERCP based on the results of multivariate analysis.Results:Univariate analysis showed that there were significant differences in age, combination with diabetes, levels of alanine aminotransferase, alkaline phosphatase and glucose, roughness in gallbladder wall, bile duct diameter, stenosis in lower bile duct, proportion of patients who underwent endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage between the two groups ( P<0.05). Logistic multivariate regression analysis showed that advanced age ( OR=1.108, 95% CI:1.079-1.138, P<0.001), combination with diabetes ( OR=4.524, 95% CI:1.299-15.758, P=0.018), roughness in gallbladder wall ( OR=2.495, 95% CI:1.106-5.630, P=0.028), increased bile duct diameter ( OR=1.303, 95% CI:1.181-1.437, P<0.001), and stenosis in lower bile duct ( OR=4.192, 95% CI:2.508-7.005, P<0.001) were independent risk factors for acute cholangitis after ERCP. Based on the results of multivariate analysis, the nomogram of acute cholangitis after ERCP was established. The area under the receiver operator characteristic curve was 0.887. Conclusion:Advanced age, combination with diabetes, rough gallbladder wall, increased diameter of bile duct and stenosis in lower bile duct are independent risk factors for acute cholangitis after ERCP. Clinicians can make clinical intervention based on the nomogram of risk factors above to improve the prognosis of patients.
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Objective:To analyze the correlation between the severity of acute pancreatitis (AP) and the levels of zonulin, zonula occludens protein-1 (ZO-1), tumor necrosis factor -α (TNF -α) in the peripheral blood of patients with acute pancreatitis (AP), and the value of predicting moderate and severe AP.Methods:The clinical data of 115 AP patients admitted to the Second Affiliated Hospital of Anhui Medical University from June 2020 to January 2022 were retrospectively analyzed. They were divided into mild group (69 cases) and moderate severe group (46 cases). The blood levels of zonulin, ZO-1, and TNF-α were measured for all patients on the 1st, 3rd, and 7th day after admission, and the results of the two group tests were compared. The correlation between zonulin, ZO-1, TNF -α and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores on the 1st day was and the value of various indicators for predicting moderate to severe AP were analyzed.Results:The C-reactive protein (CRP) levels of AP patients in the moderate to severe group were higher than those in the mild group, and the difference was statistically significant (all P<0.05). The levels of zonulin, ZO-1, and TNF -α in AP patients in the moderate to severe group showed an upward trend on the 1st, 3rd, and 7th days after admission. The levels of zonulin, ZO-1, and TNF -α in AP patients in the moderate to severe group were higher than those in the mild group at the same time point, and the differences were statistically significant (all P<0.05). The APACHE Ⅱ score of AP patients on the first day of admission was positively correlated with the levels of zonulin, ZO-1, and TNF -α ( r=0.736, 0.552, 0.621, all P<0.05). Zonulin had the highest area under the curve (AUC) for predicting moderate to severe AP, at 0.892, with an optimal threshold of 2.075 pg/ml. Zonulin had the highest sensitivity, at 0.804, and ZO-1 had the highest specificity, at 0.926. Using zonulin ≥2.075 pg/ml, ZO-1≥399.4 ng/ml, and TNF -α≥40.88 pg/ml as thresholds; the sensitivity and specificity obtained from parallel experiments were 0.976 and 0.710, respectively; The sensitivity and specificity obtained from the series of experiments were 0.326 and 0.999, respectively. Conclusions:There is a correlation between the serum levels of zonulin, ZO-1, and TNF -α in AP patients and the severity of AP. Zonulin, ZO-1, and TNF -α have certain clinical value in predicting moderate to severe AP.
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Objective:To investigate the influencing factors for endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events in novice trainees and establishment of its prediction model.Methods:The prospective study was conducted. The clinical data of 12 novice trainees of ERCP in the First Hospital of Lanzhou University from July 2016 to July 2019 were selected. The operation was performed by 12 novice trainees of ERCP under the guidance of the endoscopic experts. Observation indicators: (1) ERCP-related adverse events in novice trainees; (2) analysis of influencing factors for ERCP-related adverse events in novice trainees; (3) establishment of a prediction model for ERCP-related adverse events in novice trainees. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M(range), and com-parison between groups was analyzed by the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. The Logistic regression model was used for univariate and multivariate analyses. The regression coefficients were used to construct a prediction model. The receiver operating characteristic curve was drawn, and the area under curve was used to evaluate the predictive ability. Results:(1) ERCP-related adverse events in novice trainees. Of the 300 patients with ERCP operated by 12 novice trainees, 52 cases had ERCP-related adverse events and 248 cases had no ERCP-related adverse events. Cases in grade 1?2 or grade 3?4 of ERCP difficulty classification, score for intubation time, score for cannulation time, cases with or without completion of the cannulation, cases with or with-out basket stone removal, cases with or without stenosis expansion, score for contrast-enhanced interpretation, score for implementation of reasonable treatment and score for expected purpose reached were 22, 30, 8(range, 5?10), 20(rang, 9?20), 24, 28, 11, 41, 0, 52, 39±17, 39±19 and 44±23 for novice trainees with ERCP-related adverse events, versus 146, 102, 6(range, 4?9), 12(range, 8?20), 163, 85, 94, 154, 20, 228, 52±22, 80±20, 52±23 for novice trainees without ERCP-related adverse events, showing significant differences in the above indicators between them ( χ2=4.79, Z=?2.46, ?2.72, χ2=7.01, 5.30, 4.49, t=?4.00, ?2.97, ?2.29, P<0.05). (2) Analysis of influencing factors for ERCP-related adverse events in novice trainees. Results of univariate analysis showed that the diffi-culty classification of ERCP, intubation time, cannulation time, completion of cannulation, basket stone extraction, contrast-enhanced interpretation, implementation of reasonable treatment and expected purpose reached were related factors for ERCP-related adverse events in novice trainees ( odds ratio=1.95, 1.11, 1.08, 0.45, 0.44, 0.97, 0.98, 0.98, 95% confidence intervals as 1.07?3.58, 1.02?1.22, 1.02?1.14, 0.24?0.82, 0.22?0.90, 0.96?0.99, 0.96?0.99, 0.97?1.00, P<0.05). Results of multi-variate analysis showed that difficulty classification of ERCP and contrast-enhanced interpretation were independent influencing factors for ERCP-related adverse events in novice trainees ( odds ratio=2.08, 0.95, 95% confidence intervals as 1.10?3.96, 0.92?0.99, P<0.05). (3) Establishment of a predic-tion model for ERCP-related adverse events in novice trainees. According to the important outcome indicators of clinical training and results of multivariate analysis, 4 indicators including difficulty classification of ERCP, intubation time, cannulation time and contrast-enhanced interpretation were included to establish a prediction model for ERCP-related adverse events in novice trainees, which indicated that trainees with the predicted score >0.4 were in high risk of ERCP-related adverse events. The area under receiver operating characteristic curve of the prediction model was 0.72(95% confidence interval as 0.65?0.79, P<0.05), with the best cut-off value as 0.40, the sensitivity as 76.9% and the specificity as 63.3%. Conclusion:The difficulty classification of ERCP and contrast-enhanced interpretation are independent influencing factors for ERCP-related adverse events in novice trainees. Novice trainees with a predicted score >0.4 are high-risk groups of ERCP-related adverse events.
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Objective To explore the value of preoperative LAR combined with AFP in evaluating the prognosis of patients with HCC. Methods We retrospectively analyzed the clinical data of 106 patients with HCC. Kaplan-Meier method was used to draw the survival curve. Univariate analysis was used to analyze possible variables affecting LAR. Cox risk regression model was used to evaluate the clinical value of preoperative LAR and AFP on the prognosis of HCC patients. Results The DFS and OS of the high LAR group and the high AFP group were shorter than those of the low LAR group and the low AFP group (P < 0.05). LAR≥4.58, AFP≥400μg/L and T3-T4 were independent risk factors affecting DFS and OS of HCC patients (P < 0.05). Postoperative interventional surgery was an independent factor influencing OS prolongation (P < 0.05). The DFS and OS were the shortest in the high LAR and high AFP group, and the DFS and OS were the longest in the low LAR and low AFP group (P < 0.05). Conclusion Preoperative LAR and AFP are independent poor prognostic factors of HCC. Preoperative LAR combined with AFP has a certain value in judging the prognosis of HCC patients.
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Three-amino acid loop extension (TALE) transcription factors play important roles in plant growth and cell differentiation. There are plenty of studies on TALE transcription factors in several model plants, but not in radish (Raphanus sativas). A genome-wide bioinformatics analysis identified 33 TALE family genes in the Xiang-Ya-Bai (XYB) radish, These genes, are distributed on nine chromosomes and all contain 4-6 exons. The 33 TALE genes in radish showed a co-linearity relationship with the 17 homologous genes in Arabidopsis thaliana. Moreover, a large number of stress response cis-elements were found in the promoter regions of these genes. Expression analysis showed that four genes in the BELL subfamily were highly expressed in roots, and two genes in the KNOX subfamily were highly expressed in shoots of bolting plants and callus. All radish TALE genes contain sequences encoding the conserved HOX domain, except for the gene RSA10037940, which is homologous to Arabidopsis KNATM. The deduced 3D structures of the TALE proteins irrespective of subtypes are highly similar. All the encoded proteins were weakly acidic and hydrophilic. The radish TALE gene family is relatively evolutionarily conserved, which was consistent with results from Arabidopsis, but quite different from that of rice. This study provides important clues for studying the biological functions of TALE transcription factors in radish.
Subject(s)
Amino Acids , Arabidopsis/metabolism , Gene Expression Regulation, Plant , Phylogeny , Plant Proteins/metabolism , Raphanus/metabolism , Transcription Factors/metabolismABSTRACT
Objective:To investigate the risk factors for common bile duct calculi recurrence and application value of its prediction model after endoscopic retrograde cholangiopancreato-graphy (ERCP) .Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 506 patients with common bile duct calculi who were admitted to the First Hospital of Lanzhou University from January 2015 to December 2017 for ERCP routine treatment were collected. There were 251 males and 255 females, aged (59±15)years. Patients received ERCP for common bile duct calculi. Observation indicators: (1) clinicopathological data of patients with common bile duct calculi; (2) risk factors for common bile duct calculi recurrence after ERCP; (3) establishment of prediction model for common bile duct calculi recurrence after ERCP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analysis were conducted using the COX proportional hazard model. The prediction model for the recurrence of common bile duct stones after ERCP was established according to the coefficient of regression equation. The receiver operating characteristic curve(ROC) was drawed for efficiency evaluation with area under curve (AUC). Results:(1) Clinicopathological data of patients with common bile duct calculi: 104 of 506 patients with common bile duct calculi had recurrence and 402 had no recurrence. There were significant differences in the age, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, gallbladder status, history of biliary tract surgery, endoscopic spinecterotomy, postoperative drainage mode between patients with and without recurrence ( Z=?2.844, χ2=6.243, Z=?2.897, χ2=11.631, 4.617, 16.589, 18.679, 2.070, 50.274, P<0.05). (2) Risk factors for common bile duct calculi recurrence after ERCP: Results of univariate analysis showed that age, time of first attack, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, the maximum calculi diameter, gallbladder status, history of biliary tract surgery and postoperative biliary drainage mode were related factors for common bile duct calculi recurrence after ERCP ( hazard ratio=1.656, 2.179, 1.712, 1.657, 2.497, 1.509, 1.971, 2.635, 3.649,95% confidence interval as 1.113?2.463, 1.135?4.184, 1.122?2.644, 1.030?2.663, 1.501?4.154, 1.025?2.220, 1.122?3.464, 1.645?4.221, 1.575?8.456, P<0.05). Results of multivariate analysis showed that time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were independent risk factors for common bile duct calculi recurrence after ERCP ( hazard ratio=2.332, 1.676, 2.088, 2.566, 3.712, 95% confidence interval as 1.089?4.998, 1.060?2.649, 1.189?3.668, 1.456?4.521, 1.296?10.635, P<0.05). (3) Establishment of prediction model for common bile duct calculi recurrence after ERCP: based on multivariate analysis, indicators including time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were included into the coefficient of regression equation, and the prediction model for common bile duct calculi recurrence after ERCP was established: ln[(λ(t))/(λ 0(t))]=0.847×time of first attack+0.516×hyperlipidemia+0.736×distal bile duct stricture+0.942×history of biliary tract surgery+1.312×cholangiopancreatic stent. The perfor-mance evaluation showed that the AUC of ROC of prediction model was 0.757 (95% confidence interval as 0.713?0.811, P<0.05), and the optimal cut-off value was 1.41, the sensitivity and specificity were 69.2% and 72.9% respectively. Conclusions:The time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent are independent risk factors for common bile duct calculi recurrence after ERCP. Patients with evaluation score >1.41 in prediction model were at high risk for common bile duct calculi recurrence after ERCP.
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Objective:To analyze the monitoring results of iodine deficiency disorders among residents in Rizhao City, Shandong Province, from 2016 to 2018.Methods:Information of monitoring data on iodine deficiency disorders of residents of Rizhao City, Shandong Province from 2016 to 2018 was collected from the Center for Disease Control and Prevention of Rizhao City, Shandong Province. The analysis carried out included iodine content of drinking water for residents of Rizhao City in 2017; iodine contents of salt in the home of 8 - 10 years of children, pregnant women; urine iodine levels of 8 - 10 years of children, pregnant women; and thyroid volume of 8 - 10 years of children from 2016 to 2018.Results:A total of 431 drinking water samples were collected in Rizhao City in 2017, the median of iodine in water was 4.8 μg/L. In 2016 - 2018, the rate of non-iodized edible salt in the homes of children and pregnant women in Rizhao City were 11.09% (153/1 380), 19.07% (302/1 584) and 6.92% (90/1 301); the consumption rate of qualified iodized salt were 80.94% (1 117/1 380), 65.03% (1 030/1 584) and 84.63% (1 101/1 301), respectively. Of these, the highest rate of non-iodized edible salt was in 2017 (χ 2 = 75.38, P < 0.05), and with the lowest consumption rate of qualified iodized salt (χ 2 = 56.52, P < 0.05). Totally 829, 891 and 881 urine samples were tested for 8 - 10 years of children, and the medians of urine iodine were 195.8, 243.0 and 164.8 μg/L, respectively. Totally 396, 381 and 420 urine samples were tested for pregnant women, and the medians of urine iodine were 161.5, 148.3 and 105.2 μg/L, respectively. The rates of goiter in 8 - 10 years of children were 1.50% (13/866), 0.89% (8/901) and 1.25% (11/881), respectively, and the difference between years was not statistically significant (χ 2 = 1.41, P > 0.05). Conclusions:Rizhao City is an area of environmental iodine deficiency, local residents iodine nutrition in general is at an appropriate level. However, pregnant women show iodine deficiency in recent years, which will be the focus of scientific iodine supplementation measures.
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Objective:To observe the effects of early rehabilitation intervention on the short-term outcome of patients with postoperative spinal cord injury after Stanford type A aortic dissection.Methods:Patients with postoperative spinal cord injury after Stanford type A aortic dissection admitted in our hospital from January 2009 to December 2019 were selected. There were 29 males and 8 females. Age ranged from 29 to 54, with an average age of(41.37±12.21) years. The observation group(16 cases) received early rehabilitation treatment in ICU after surgery, while the control group(21 cases) started after admission to rehabilitation center. The Modified Ashworth Scale(MAS), ASIA Lower Extremity Motor Scores(LEMS), Spinal Cord Independence Measure(SCIM Ⅲ) and Modified Barthel Index(MBI) were analyzed to compare the differences of short-term outcome between the two groups.Results:After 28 days, the scores of MAS, SCIM Ⅲ and MBI in the observation group were obviously better than the control group. Compared to the time of admission, the improvements of LEMS, SCIM Ⅲ and MBI in the observation group were significantly greater than that of the control group.Conclusion:Early rehabilitation intervention can further enhance clinical efficacy and improve short-term functional outcome.
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Objective@#To explore the regulatory mechanism of E2F1 transcription factor on M2 macrophages in full-thickness skin defect wounds of mice.@*Methods@#E2F1 gene knockout heterozygotes C57BL/6 mice and wild-type C57BL/6 mice were introduced and self-reproduced. Two weeks after birth, E2F1 gene knockout homozygotes mice and wild-type mice were identified by polymerase chain reaction (PCR). Twelve identified 6-8 weeks old male E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were selected respectively according to the random number table and set as E2F1 gene knockout group and wild-type group. A full-thickness skin defect wound was made on the back of each mouse. On post injury day (PID) 2 and 7, 6 mice in each group were selected according to the random number table and sacrificed, and the wound tissue was excised. The expression of CD68 and CD206 double positive M2 macrophages was observed by immunofluorescence method, and the percentage of CD206 positive cells was calculated. The protein expression of CD206 was detected by Western blotting. The mRNA expression of arginase 1 was detected by real-time fluorescent quantitative reverse transcription PCR (RT-PCR). Wound tissue specimens of the two groups on PID 7 were obtained, and the protein and mRNA expressions of peroxisome proliferator-activated receptor gamma (PPAR-γ) were detected by Western blotting and real-time fluorescent quantitative RT-PCR respectively. The above-mentioned experiments were repeated four times. Three specimens of wound tissue of mice in wild-type group on PID 7 were obtained to detect the relationship between E2F1 and PPAR-γ by co-immunoprecipitation and Western blotting, and this experiment was repeated two times. Data were processed with unpaired t test.@*Results@#The size of PCR products of E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were 227 and 172 bp respectively, which were the same as those of the designed DNA fragments. On PID 2 and 7, the number of CD68 and CD206 double positive M2 macrophages in the wound tissue of mice in E2F1 gene knockout group was more than that of wild-type group, and the percentages of CD206 positive cells in the wound tissue of mice in E2F1 gene knockout group were (0.234±0.032)% and (0.584±0.023)% respectively, which were significantly higher than (0.129±0.017)% and (0.282±0.071)% of wild-type group (t=3.29, 3.54, P<0.05). On PID 2 and 7, the protein expression of CD206 in the wound tissue of mice in E2F1 gene knockout group were 1.00±0.23 and 1.63±0.26 respectively, which were significantly higher than 0.43±0.06 and 0.97±0.08 of wild-type group (t=2.41, 2.45, P<0.05). On PID 2 and 7, the mRNA expressions of arginase 1 in the wound tissue of mice in E2F1 gene knockout group were 0.482±0.105 and 0.195±0.031 respectively, which were significantly higher than 0.163±0.026 and 0.108±0.017 of wild-type group (t=3.04, 2.86, P<0.05). On PID 7, the protein and mRNA expressions of PPAR-γ in the wound tissue of mice in E2F1 gene knockout group were 0.61±0.12 and 0.51±0.13 respectively, which were significantly higher than 0.20±0.04 and 0.20±0.04 of wild-type group (t=3.36, 2.86, P<0.05). On PID 7, detection of the wound tissue of mice in wild-type group showed that PPAR-γ had unidirectional effect on E2F1.@*Conclusions@#E2F1 transcription factor affects the polarization of M2 macrophages by inhibiting the expression of PPAR-γ, thereby inhibiting the healing process of full-thickness skin defect wounds in mice.
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Objective To compare the antibacterial activity in vitro of Haizhengmeite and Mepem. Methods Four hundreds and eighteen bacteria isolated were collected from clinical settings in different area,including 104 strains of Escherichia coli(52 strains of ESBLs +and 52 strains of ESBLs -), 104 strains of Klebsiella pneumonia(52 strains of ESBLs +and 52 strains of ESBLs -),56 strains of Proteus spp. (28 strains of ESBLs +and 28 strains of ESBLs -), 52 strains of other Enterobacteriaceae, 51 strains of Acinetobacter baumanii and 51 strains of Pseudomonas aeruginosa.Two pharmaceutical products of meropenem injection were Mepem from Japan Sumitomo Pharmaceuticals Co., Ltd and Haizhengmeite from Zhejiang Haizheng Pfizer pharmaceuticals Co.Ltd in China, respectively.Minimum inhibitory concentrations(MIC)of two products of meropenem were determined by broth microdilution method and agar dilution method according to the Clinical and Laboratory Standards Institute(CLSI,2016).Results The sensitive rates of Escherichia coli, Klebsiella pneumoniae, and Proteus spp.to Haizhengmeite and Mepem were >85%,while the rates of the sensitivity to Acinetobacter baumanii and Pseudomonas aeruginosa were lower,with the rates of 33.3%,31.4% and 58.8%,52.9%,respectively.Conclusions Haizhengmeite and Mepem both show good antibacterial activity against Enterobacteriaceae, but lower activity against Acinetobacter baumanii and Pseudomonas aeruginosa.Both products are stable to ESBLs,and no significant difference is observed between the two products in antibacterial activity in vitro.
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Objective To expore the effects of FGF-2 and TGF-β1 on the differentiation of rat bone mar-row mesenchymal stem cells(BMSCs)towards cardiocytes. Methods BMSCs were isolated from bones of SD rats and cultured and identified by flow cytometry.The cells were divided into four groups:group A(FGF-2),group B (TGF-β1),group C(FGF-2+TGF-β1)and group D(blank control).The morphological changes were observed by the microscope. The expressions of Desmin,α-sarcomeric actin and cTnI were detected by immunocytochemical stainning.The expressions of GATA-4 and Nkx2.5was detected by RT-qPCR.Result The positive expression rate of CD90,CD29 and CD45 was 84.7%,86.5%,0.3% respectively. After induction,group C presence of myotube structures and the shape is fusiform.The positive rate of combined induction group was higher than the others (P < 0.05). The expression of GATA-4 and Nkx2.5 genes was higher than that in the other groups(P < 0.05). Conclution FGF-2 and TGF-β1 can be used to induce BMSCs into cardiocytes,and the combined group has the better effect.
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Objective To study the epidemiology and genotypes of extended-spectrum beta-lactamases (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae (KP) that caused community-onset bloodstream infections (COBSI) in 9 county hospitals of Zhejiang Province.Methods This is a multi-center, prospective, observational study.The cases and isolates with COBSI caused by EC and KP were consecutively collected from 9 county hospitals in Zhejiang Province between 1st March 2014 and 30th April 2015.The double disk diffusion method was used to confirm the production of ESBL.The ESBL genotypes were determined by polymerase chain reaction(PCR) amplification and sequence analysis.Multi-locus Sequence Typing (MLST) was used to analyze the homology of ESBL-producing isolates.Minimal inhibitory concentration (MIC) of frequently used drugs for ESBL-producing isolates was determined by in-vitro antimicrobial susceptibility tests.Results During the study period, a total of 172 cases with COBSI were collected and 171 cases were eligible, among which 126 were caused by EC and 45 were caused by KP.The overall prevalence of ESBL was 34.5% (59/171),and the prevalence of ESBL-EC and-KP was 41.3% (52/126) and 15.6% (7/45), respectively.CTX-M-type ESBL accounted for 96.6% (57/59) of all the ESBLs-producing isolates, and the most common type was CTX-M-14 (27.1%, 16/59), followed by CTX-M-55 (22%, 13/59).MLST analyses revealed significant genetic diversity among ESBL-EC and-KP.The most prevalent ST of ESBL-EC was ST131 (23.1%).In addition to carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam, moxalactam, amikacin and fosfomycin also showed good in-vitro activity against ESBL-EC and-KP.Conclusions The prevalence of ESBL in EC and KP is high in 9 county hospitals of Zhejiang Province, and the most common genotypes are CTX-M-14 and CTX-M-55.The detection rate of ESBL in EC is higher than in KP.It could be considered adequate empirical therapy according to the results of antimicrobial susceptibility tests.Carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam, moxalactam, amikacin and fosfomycin have good in-vitro activity against ESBL-EC and-KP.
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Objective@#To investigate an effective method for solving the venous stasis in reverse peri-auricular flap pedicled on the frontal branch of superficial temporal artery(STA).@*Methods@#From October 2013 to May 2016, 5 patients with peri-orbital defects were reconstructed with a retrograde flap pedicled on the frontal branch of STA that incorporated additional venous anastomosis. The additional venous anastomosis was created between the parietal branch of STV (superficial temporal vein) and the middle temporal vein. The defects at donor sites were directly sutured.@*Results@#The size of flaps ranged from 2 cm×2 cm to 2 cm×8 cm. All flaps survived without venous stasis. Color and texture match of the flap were excellent .In three cases, flaps were thinned in secondary operation. During the follow-up period(6 months to 2 years, average of 12.4 months), flaps survived well on early period. Excellent color and tissue match with peri-orbital tissue were achieved on later stage. The scar at the donor site was inconspicuous.@*Conclusions@#Retrograde island flaps pedicled on the frontal branch of superficial temporal artery with vein anastomosis has the advantages of robust blood supply, good texture, and color match, and acceptable donor mobidity, while avoiding the venous stasis and flap necrosis.
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Objective To observe the protective and regeneration-promoting effects of Ruyi Zhenbao Pill (RZP) on nerve injury in zebrafish.Methods The zebrafish model of central nervous injury was induced by mycophenolate mofetil,the model of peripheral motor nerve and axonal injury was induced by ethanol,and the model of myelin damage was induced by ethidium bromide.The variations of central nerve,axon and myelin sheath fluorescence intensity,and peripheral motor nerve length in zebrafish,which exposed to the different concentration (10.0,33.3,and 100.0 μ.g/mL) of RZP,were observed with fluorescence microscope.The effective protection rates of RZP on zebrafish central nerve and axone,and the regeneration-promoting effect on peripheral motor nerve and myelin sheath were analyzed and calculated with the image processing software NIDS-Element's.Results In 10.0,33.3,and 100.0 μg/mL RZP groups,the zebrafish central nervous injury protective rates were 2％,24％,and 50％ (P ＜ 0.001),respectively,the peripheral nerve regeneration promoting rates were 44％ (P ＜ 0.05),49％ (P ＜ 0.01),and 93 ％ (P ＜ 0.001),the axonal injury recovery rates were 3％,29％ and 48％ (P ＜ 0.05),and the myelin sheath regeneration promoting rates were 36％ (P ＜ 0.01),37％ (P ＜ 0.001),and 41％ (P ＜ 0.001),compared with model group.Conclusions RZP could not only protect the central nervous and axonal injury,but also promote the regeneration of peripheral nerve and myelin sheath in zebrafish.
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Objective To probe into the optimal concentration of Wnt-11 to induce the differentiation of bone marrow mesenchymal stem cells (BMMSCs)into cardiomyocyte-like cells in vitro.Methods BMMSCs were isolated from the bone marrow of SD rats using whole bone marrow culture method.After cultured for 48 h, BMMSCs of the second generation were utilized for directed induction.Based on the final concentration of Wnt-11 , BMMSCs were divided up into Group A (100 ng/mL),Group B (200 ng/mL),Group C (400 ng/mL)and Group D (blank control).After 72-hour induction,the cells were cultured in complete medium for 4 weeks while cells in Group D were cultured only in the complete medium.The morphological changes were observed under the phase contrast microscope.Surface antigen expression of BMMSCs was identified by flow cytometry.When cells were cultured for 4 weeks,the expressions of Desmin,Connexin43 and cTnI were detected by immunocytochemistry. Meanwhile, the ultrastructural changes were observed using transmission electron microscope. The mRNA expressions of cardiac transcription factors GATA-4,Nkx2.5 andα-MHC in BMMSCs were detected by RT-qPCR at 1,2 and 4 weeks after induction.Results Primary BMMSCs formed cell colonies at 2 weeks;the cells were mainly fusiform or star-shape,and a few irregularly-shaped ones were also visible.The passaged cells were larger than those of primary culture.After induction,the cells exhibited long shuttle-shape and were aligned in parallel. Flow cytometery displayed that the positive rate of the surface antigens of BMMSCs CD29,CD45,and CD90 was 97.9%,0.4% and 99.5%,respectively.When BMMSCs-induced via Wnt-11 were cultured for 4 weeks,Desmin, cTnI and Connexin43 were all positively expressed in induction groups.Whereas in the blank control group they were slightly positive or negative;the positive rate in Group B was the highest (P<0 .05 ).Transmission electron microscopy exhibited that organelles such as rough endoplasmic reticulum,mitochondria,as well as some ribosomes were visible in the cytoplasm of these cells in each induction group.In addition,myofilaments were arranged in parallel in the cytoplasm.The cells in induction groups could express GATA-4 and Nkx2 .5 in the first week,and then the expression of them decreased in the second week,but then increased in the fourth week;gene expression in induction Group B was significantly higher than in the other two induction groups (P<0 .05 ).The expression of GATA-4 and Nkx2 .5 in Group D was 1 ,α-MHC was not expressed in the four groups during the culture period. Conclusion Wnt-11 can induce the differentiation of BMMSCs into cardiomyocyte-like cells in vitro,and the optimal concentration of Wnt-11 is 200 ng/mL.
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Objective To investigate the MRI features of supratentorial solid hemangioblastoma and to improve its diagnostic accuracy.Methods MRI image manifestations of 7 cases with supratentorial solid hemangioblastoma confirmed by operation and pathology were analyzed retrospectively.Results 7 cases of supratentorial solid hemangioblastoma were solitary.All tumors appeared as round or quasi-round masses with clear boundary, and showed equal or long T1 signal and slight long or long T2 signal,the obvious enhancement was seen in all tumors.There was mild to moderate edema around the tumors.The blood vessel was found within or around the tumors.Conclusion MRI manifestations of supratentorial solid hemangioblastoma have certain characteristics.
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Purpose To investigate the expression of programmed death ligand-1 (PD-L1) in breast cancer tumor cells and stromal tumor-infiltrating lymphocyte (sTIL),and to study the relationship between the expression of PD-L1 and the clinicopathological characteristics of the patients.Method The protein expression of PD-L1 was detected by immunohistochemistry of EliVision two-step method in 68 cases of non special type of invasive breast cancer,and the relationship between the expression of PD-L1 protein and the immunohistochemistry subtypes and clinical parameters was analyzed.Results The total expression rate of PD-L1 was 35.3％ in breast tumor tissue,specially in triple negative breast cancer (TNBC) which occupy the highest positive rate.The expression rates of PD-L1 in tumor tissue of the luminal subtype,HER-2 over-expression subtype and TNBC subtype were 16.1％,37.5％ and 61.9％ respectively,and the difference was statistically significant.The total expression rate of PD-L1 in sTIL was 51.5％,and the highest expression rate was 81.0％ in TNBC.There were significant differences of PD-L1 expression in sTIL of the luminal subtype,HER-2 over-expression subtype and TNBC subtype.Expression of PD-L1 in tumor tissue and sTIL had a significant positive correlation.Conclusion PD-L1 expressed in TNBC was significantly higher than other types of breast cancer,which suggest the blocking of signal pathway of PD-1/PD-L1 may expected to become a new immunotherapy for breast cancer,especially for TNBC subtype.
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Objective To explore the factors that affect the teaching effect of medical statistics study for clinical postgraduates and to provide a reference for further improving teaching Quality. Methods Four hundred and eighty-nine students who had attended Medical statistics in 2013 Fall semester were surveyed by the self-designed questionnaire. The Logistic regression model was used to analyze the factors affecting the learning effect. Results A total of 489 questionnaires were distributed and 488 valid questionnaires were returned (the return rate was 99.80%). 71.11% (347/488) were entirely in favor of giving medical statistics course while 23.98% were relatively supportive. Statistics recognition, learning motivation, finishing homework and the satisfaction of learning were the factors that affect the grades. The OR values are 1.547, 1.723, 1.374, 1.433 for the above four factors respectively. The difference was statistically significant (P<0.05). Conclusion In medical statistics teaching, it can improve students' performance by introducing case study, simplifying the mathematical formula, combi-ning the theory and computer statistical software practice, and improving teaching methods, which helps improve the quality of teaching.