Advances in the study of artificial intelligence in Esophagogastroduodenoscopy / 中国综合临床

In recent years, artificial intelligence technology has made a number of technical progress in almost all fields, including the medical field. At present, AI-assisted upper gastrointestinal endoscopy has been introduced into clinical practice as a clinical decision support tool.With the help of artificial intelligence and the expertise of endoscopy experts, artificial intelligence is expected to be an effective tool to improve the diagnostic ability of endoscopy,especially for endoscopy beginners and inexperienced endoscopists.The emergence of artificial intelligence is of great significance to improve the working efficiency and diagnostic ability of endoscopists. However, the application of artificial intelligence in upper gastrointestinal endoscopy is still in the exploratory stage and has not been widely applied in clinical practice.

Application of back-forward Bending CT localization image in the prediction of proximal junctional kyphosis after spinal deformity surgery in adults / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility of predicting proximal junctional kyphosis (PJK) in adults after spinal deformity surgery based on back-forward Bending CT localization images and related predictive indicators.@*METHODS@#A retrospective analysis was performed for 31 adult patients with spinal deformity who underwent posterior osteotomy and long-segment fusion fixation between March 2017 and March 2020. There were 5 males and 26 females with an average age of 62.5 years (range, 30-77 years). The upper instrumented vertebrae (UIV) located at T 5 in 1 case, T 6 in 1 case, T 9 in 13 cases, T 10 in 12 cases, and T 11 in 4 cases. The lowest instrumented vertebrae (LIV) located at L 1 in 3 cases, L 2 in 3 cases, L 3 in 10 cases, L 4 in 7 cases, L 5 in 5 cases, and S 1 in 3 cases. Based on the full-length lateral X-ray film of the spine in the standing position before and after operation and back-forward Bending CT localization images before operation, the sagittal sequence of the spine was obtained, and the relevant indexes were measured, including thoracic kyphosis (TK), lumbar lordosis (LL), local kyphosis Cobb angle (LKCA) [the difference between the different positions before operation (recovery value) was calculated], kyphosis flexibility, hyperextension sagittal vertical axis (hSVA), T 2-L 5 hyperextension C 7-vertebral sagittal offset (hC 7-VSO), and pre- and post-operative proximal junctional angle (PJA). At last follow-up, the patients were divided into PJK and non-PJK groups based on PJA to determine whether they had PJK. The gender, age, body mass index (BMI), number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, osteotomy grading, and related imaging indicators were compared between the two groups. The hC 7-VSO of the vertebral body with significant differences between groups was taken, and the receiver operating characteristic curve (ROC) was used to evaluate its accuracy in predicting the occurrence of PJK.@*RESULTS@#All 31 patients were followed up 13-52 months, with an average of 30.0 months. The patient's PJA was 1.4°-29.0° at last follow-up, with an average of 10.4°; PJK occurred in 8 cases (25.8%). There was no significant difference in gender, age, BMI, number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, and osteotomy grading between the two groups ( P>0.05). Imaging measurements showed that the LL recovery value and T 8-L 3 vertebral hC 7-VSO in the PJK group were significantly higher than those in the non-PJK group ( P>0.05). There was no significant difference in hyperextension TK, hyperextension LL, hyperextension LKCA, TK recovery value, LL recovery value, kyphosis flexibility, hSVA, and T 2-T 7, L 4, L 5 vertebral hC 7-VSO ( P>0.05). T 8-L 3 vertebral hC 7-VSO was analyzed for ROC curve, and combined with the area under curve and the comprehensive evaluation of sensitivity and specificity, the best predictive index was hC 7-L 2, the cut-off value was 2.54 cm, the sensitivity was 100%, and the specificity was 60.9%.@*CONCLUSION@#Preoperative back-forward Bending CT localization image can be used to predict the occurrence of PJK after posterior osteotomy and long-segment fusion fixation in adult spinal deformity. If the patient's T 8-L 2 vertebral hC 7-VSO is too large, it indicates a higher risk of postoperative PJK. The best predictive index is hC 7-L 2, and the cut-off value is 2.54 cm.

A consensus on the management of allergy in kindergartens and primary schools / 中国学校卫生

Abstract@#Allergic diseases can occur in all systems of the body, covering the whole life cycle, from children to adults and to old age, can be lifelong onset and even fatal in severe cases. Children account for the largest proportion of the victims of allergic disease, Children s allergies start from scratch, ranging from mild to severe, from less to more, from single to multiple systems and systemic performance, so the prevention and treatment of allergic diseases in children is of great importance, which can not only prevent high risk allergic conditions from developing into allergic diseases, but also further block the process of allergy. At present, there is no consensus on the management system of allergic children in kindergartens and primary schools. The "Consensus on Allergy Management and Prevention in Kindergartens and Primary Schools", which includes the organizational structure, system construction and management of allergic children, provides evidence informed recommendations for the long term comprehensive management of allergic children in kindergartens and primary schools, and provides a basis for the establishment of the prevention system for allergic children.

Correlation between intestinal flora characteristics and hepatic and renal impairments in HIV-infected heterosexual men / 上海预防医学

ObjectiveTo explore the relationship between the intestinal flora and the impairment of liver and kidney in HIV-infected men who have heterosexual sex with healthy women. MethodsFecal samples from 41 HIV-infected heterosexual men who have sex with women （PMSW） and 43 age- and BMI-matched healthy heterosexual men who have sex with women （NMSW） were collected and subjected to 16S rDNA sequencing. The blood levels of AST， ALT， TBIL， UREA， Cr， UA， β2-MG and other liver and kidney function indicators were measured. Bioinformatics methods were used to analyze the characteristics of the intestinal flora of the patients in these two groups， to compare the differential bacteria strains， and to analyze their correlation with liver and kidney function indicators. ResultsIn comparison with NMSW， the alpha diversity of intestinal flora was decreased in PMSW， and the beta diversity analysis showed significant differences in flora characteristics between the two groups （P<0.05）. The abundance of Clostridium， Phylum thick-walled， Trichosporon， and Clostridium tumefaciens decreased but Fusobacteriota increased （LDA score >4）. The comparison of liver and kidney function indexes revealed that AST， β2-MG levels were higher in PMSW than in NMSW， while TBIL was lower in PMSW than in NMSW. The number of patients with abnormal β2-MG was much higher in PMSW than in NMSW， and the difference was statistically significant （P<0.001）. It was also found that AST was negatively correlated with Clostridium （P<0.05）； TBIL was negatively correlated with Clostridium and positively correlated with Phylum thick-walled and Trichosporon （P<0.05）. β2-MG was negatively correlated with Phylum thick-walled， Clostridium， Trichosporon and Rumenococcus （P<0.05） and positively correlated with Clostridium （P<0.05）. ConclusionIn PMSW group， the alpha diversity of the flora is decreased. AST and β2-MG levels are increased， and TBIL level is decreased. These changes were significantly correlated with different strains of bacteria in the intestinal flora.

A Case of Distal Arthrogryposis Combined with Scoliosis / 罕见病研究

Distal arthrogryposis is a rare disease caused by mutations in genes encoding proteins involved in muscle fiber contraction. Its joint contracture mainly involves distal joint contracture, and scoliosis is often accompanied by pelvic tilt and abnormal lordosis.This article reviewed the clinical characteristics of a patient with distal arthrogryposis combined with scoliosis. The patient was a 14-year-old male. His back was found that uneven 6 years ago for no obvious reason, and his scoliosis was gradually worsened. The patient had flexion contractures of both hands and bilateral knees since childhood, and no special treatment was given. There was no obvious restriction in the movement of the spine, the thoracic segment was convex on the right side, and the lumbar segment was convex on the left side. The genetic diagnosis was MYL11 gene mutation, which was consistent with the clinical manifestations of distal arthrogryposis combined with scoliosis. Posterior scoliosis correction and growing rod placement were performed electively. The operation went smoothly and the trunk balance was satisfactory. The clinical characteristics of this disease are summarized to improve our understanding of the disease.

The Performance of Graduation from Traditional Growing Rods with Apical Control Technique in Patients with Congenital Early-Onset Scoliosis / 罕见病研究

  Objective  Different from other etiologies of early-onset scoliosis (EOS), congenital early-onset scoliosis (CEOS) is mainly linked to vertebral anomalies, such as formation failures and segmentation failures at the apex segments. So far, there is little research on CEOS patients who have completed traditional growing rods (TGR) treatment, and the initial outcomes of TGR with or without apical control technique (ACT) are different. Therefore, we compared the "final" results of CEOS patients who completed TGR treatment with or without ACT.  Methods  We conducted a retrospective study of CEOS patients who completed TGR treatment from 2007—2020. They either had final fusion or were followed up after reaching skeletal maturity. We split the patients into two groups based on whether they had ACT with TGR or not. The ACT-TGR group had apical vertebrectomy/hemivertebrectomy with short fusion and TGR. The TGR-only group had only TGR. We looked at their demographic features, radiographic measurements, and complications.  Results  This study enrolled 46 CEOS patients, of which 13 patients were in the ACT-TGR group and 33 patients in the TGR group. The ACT-TGR group had a longer distraction interval (1.17 years vs. 0.75 years). The ACT-TGR group had a larger preoperative main curve [87.00(63.50, 98.00)], but the residual curve degrees were comparable between the two groups at the last follow-up (P=0.354). At the last follow-up, the T1-12 and T1-S1 heights were similar between the two groups. The ACT-TGR group had a lower number of implant-related complications per patient (0.77 vs. 1.48). Three patients in the ACT-TGR group underwent final fusion, while 17 patients in the TGR group underwent final fusion (P=0.060).  Conclusions  Both ACT-TGR and traditional TGR coud effectively correct deformity and preserve spinal growth in CEOS patients. ACT-TGR had a better corrective effect on patients with severe deformity and did not have a significant impact on spinal height. For patients with acceptable correction, spontaneous fusion and without implant failure, retaining the implant and continuing observation could be a strategy for graduating from growing rod treatment.

Relationship between preoperative serum albumin concentrations and postoperative delirium in patients undergoing total knee/hip arthroplasty / 中华麻醉学杂志

Objective:To evaluate the relationship between preoperative serum albumin concentrations and postoperative delirium (POD) in the patients undergoing total knee/hip arthroplasty.Methods:Five hundred patients of both sexes, aged 50-90 yr, with body mass index of 50-80 kg, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective total knee or hip replacement under combined spinal-epidural anesthesia in our hospital from December 2021 to December 2022, were selected. Cerebrospinal fluid (CSF) samples were collected after successful subarachnoid puncture for determination of amyloid-beta 42 (Aβ42), total tau protein (T-tau) and phosphorylated tau protein (P-tau) concentrations using enzyme-linked immunosorbent assay. Confusion Assessment Method and Memorial Delirium Assessment Scale were used to evaluate the occurrence and severity of POD at 1-7 days after surgery (or before discharge), and the patients were divided into POD group and non-POD group (NPOD group). Logistic regression analysis was used to identify the risk factors for POD. The accuracy of plasma albumin concentration and CSF biomarker concentration in predicting POD was evaluated by the receiver operating characteristic (ROC) curve, and the mediating effect of CSF biomarker was analyzed.Results:A total of 343 patients were finally enrolled in the study, and the incidence of POD was 23.3%. There were statistically significant differences in age, preoperative plasma albumin concentration and Memorial Delirium Assessment Scale score in POD group as compared with NPOD group ( P<0.05). Before and after adjusting for confounding factors, decreased plasma albumin and increased concentrations of P-tau and T-tau in CSF before operation were the risk factors for POD, and increased concentrations of Aβ42, Aβ42/P-tau and Aβ42/T-tau ratio in CSF were protective factors for POD. The area under the ROC curve of preoperative plasma albumin concentrations in predicting POD was 0.668, and the area under the ROC curve of preoperative plasma albumin concentrations combined with CSF biomarker concentrations in predicting POD was 0.810 ( P<0.05). The direct effect of plasma albumin on POD was -0.009 869 2, the total effect was 0.029 443 7, and the mediating effect of P-tau accounted for 33.53% of the total effect. Conclusions:Decreased preoperative plasma albumin concentration is a risk factor for POD, and P-Tau in CSF serves as a key mediator in the relationship between serum albumin concentrations and postoperative delirium in the patients undergoing total knee/hip arthroplasty.

Relationship between preoperative estimated glomerular filtration rate and postoperative delirium / 中华麻醉学杂志

Objective:To evaluate the relationship between preoperative estimated glomerular filtration rate (eGFR) and postoperative delirium (POD) in the patients.Methods:Six hundred and twenty-five patients, aged ≥60 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅱ, scheduled for elective total knee and hip arthroplasty under combined spinal-epidural anesthesia, were included. Peripheral blood samples were collected before surgery, and serum creatinine levels were measured by the sarcosine oxidase method, and eGFR was calculated using the MDRD equation. After successful spinal-epidural puncture, cerebrospinal fluid 2 ml was collected for determination of β-amyloid 42 (Aβ42), total tau protein (T-tau) and phosphorylated tau protein (P-tau) by enzyme-linked immunosorbent assay. The patients were divided into POD group and non-POD group (NPOD group) according to the occurrence of POD. The logistic regression analysis was used to identify the risk factors for POD, and the mediating effect of CSF biomarkers was analyzed. The receiver operating characteristic (ROC) curve was drawn to evaluate the accuracy of eGFR and biomarkers in predicting POD.Results:A total of 514 patients were finally enrolled in this study, and the incidence of POD was 16.7%. The logistic regression analysis showed that decreased eGFR and increased levels of P-tau and T-tau in CSF were risk factors for POD, while increased CSF Aβ42 level, Aβ42/P-tau ratio and Aβ42/T-tau ratio were protective factors for POD after adjusting for multiple confounding variables ( P<0.05). Analysis of mediating effet: The direct effect of eGFR on POD was -0.0 005 267, the total effect was 0.0 046 446, T-tau had a partly mediating role and the mediating effect accounted for 11.3% of the total effect. The area under the ROC curve of eGFR and CSF biomarker in predicting POD was 0.812( P<0.001). Conclusions:Preoperative decrease in eGFR is a risk factor for POD, and T-tau in CSF serves as a key mediator in the relationship between eGFR and POD.

Relationship between hippocampal macrophage polarization and perioperative neurocognitive disorders in mice with tibial fracture / 中华麻醉学杂志

Objective:To evaluate the relationship between hippocampal macrophage polarization and perioperative neurocognitive disorders in mice with tibial fractures.Methods:Forty-five clean-grade healthy male C57/BL6 mice, aged 5-7 months, were divided into 3 groups ( n=15 each) using the random number table method: control group (group C), anesthesia group (group A) and anesthesia surgery group (group AS). Group C received no treatment. Group A was anesthetized with isoflurane inhaled for 15 min. In AS group, intramedullary nail fixation of tibial fracture was performed under anesthesia through inhalation of 2% isoflurane. Morris water maze test and open field test were performed before anesthesia/on 1 day before surgery and after anesthesia/on 1, 3 and 7 days after operation. Five mice were randomly selected after the behavioral experiments were completed at each time point, and hippocampal tissues were taken after the animals were sacrificed for determination of the expression of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, chemokine (c-c motif) ligand 12 (CCL2), CCL5, CCL8, iNOS and Arg-1 mRNA (by quantitative real-time polymerase chain reaction), expression of iNOS and Arg-1 proteins (by Western blot), and percentage of CD11b, CD45, CD86 and CD206 cells in hippcampal area (by immunofluorescence staining). Results:Compared with group C, the escape latency was significantly prolonged after operation, the number of crossing the platform was reduced after operation, the expression of TNF-ɑ, IL-6, CCL5 and CCL8 mRNA and iNOS protein and mRNA was up-regulated, the expression of Arg-1 protein and mRNA was down-regulated, the percentages of CD11b + CD45 + cells and CD11b + CD86 + cells in the hippocampus were increased, and the percentages of CD11b + CD206 + cells were decreased in AS group ( P<0.05), and no significant change was found in the parameters mentioned above in group A ( P>0.05). Compared with group A, the escape latency was significantly prolonged after surgery, the frequency of crossing the platform was reduced after surgery, the expression of iNOS mRNA was up-regulated, the percentages of CD11b + CD45 + cells and CD11b + CD86 + cells were increased, and the percentages of CD11b + CD206 + cells were decreased in AS group ( P<0.05). Conclusions:The occurrence of PND may be related to increased polarization to M1 macrophages in the hippocampus and decreased polarization to M2 macrophages in mice with tibial fracture, which further leads to central inflammatory responses.

Relationship between preoperative SARS-CoV-2 vaccination and postoperative delirium / 中华麻醉学杂志

Objective:To evaluate the relationship between preoperative SARS-CoV-2 vaccination and postoperative delirium(POD) in the patients.Methods:A total of 938 participants of either sex, aged 50-90 yr, weighing 50-90 kg, of American Society of Anesthesiologists Physical Status classificationⅠorⅡ, with preoperative Mini-Mental State Examination score ≥24, without communication barriers, undergoing elective knee or hip joint replacement under combined spinal-epidural anesthesia from June 2020 to June 2022 in Qingdao Municipal Hospital, were enrolled. The vaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation was recorded. The cerebrospinal fluid 2 ml was extracted after the puncture needle was successfully inserted into the subarachnoid space for determination of the concentrations of Aβ42, total tau protein (t-tau), and phosphorylated tau protein (p-tau) by enzyme-linked immunosorbent assay (by enzyme-linked immunosorbent assay). The Aβ42/t-tau and Aβ42/p-tau ratios were calculated. POD was assessed using the Confusion Assessment Method twice a day within 7 days after surgery or before discharge.The patients were divided into POD group and non-POD group according to whether they developed POD. The risk factors of which P values were less than 0.20 in the univariate logistic regression would enter the multivariate logistic regression analysis to investigate the relationship between SARS-CoV-2 vaccine and level of cerebral spinal fluid (CSF) biomarkers and POD. Results:Eight hundred and seventy-four patients were finally enrolled in the analysis, of which 169 patients developed POD, with an incidence of 19.3%.The results of logistic regression showed that vaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation, preoperative concentrations of Aβ42 in CSF, and increase in Aβ42/t-tau and Aβ42/p-tau ratios were protective factors for POD, and preoperative elevated concentrations of t-tau and p-tau in CSF were risk factors for POD ( P<0.05). After gender, age, preoperative Mini-Mental State Examination score, years of education, history of drinking, hypertension, diabetes mellitus and coronary heart disease were added to eliminate the influence of confounding factors, the results still showed that vaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation was a protective factor for POD. Conclusions:Vaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation is a protective factor for POD in patients.

Monitoring of sunitinib blood concentration and analysis of its safety and efficacy in Chinese patients with metastatic renal cell carcinoma / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of individualized sunitinib schedule for patients with metastatic renal cell carcinoma (mRCC) according to the monitoring results of plasma drug concentration.Methods:The clinical data of patients with mRCC who received sunitinib treatment in our center from January 2014 to December 2020 were retrospectively analyzed, including 20 patients who underwent monitoring of plasma drug concentration (monitoring group), and 45 patients, matched by propensity score matching, received sunitinib but did not undergo monitoring of plasma drug concentration during the same period (unmonitored group). In the monitoring group, there were 12 males and 8 females. The mean age was 52.9 years, and ECOG score ≤1 in 16 cases (80%). Three patients were in the IMDC favorable-risk group, 15 patients were in the intermediate-risk group, and 2 patients were in the high-risk group. There were 18 cases of clear cell carcinoma and 2 cases of non-clear cell carcinoma, 5 cases of ISUP grade 1-2 and 11 cases of grade 3-4. In the unmonitored group, there were 31 males and 14 females. The mean age was 57.7 years, and 30 patients had ECOG score ≤1, 15 cases ≥2. There were 10 cases in IMDC favorable-risk group, 23 cases in intermediate-risk group, and 12 cases in high-risk group. Thirty-seven cases were clear cell carcinoma and 8 cases were non-clear cell carcinoma, 8 cases were in ISUP grade 1-2 and 28 cases in grade 3-4. There were no statistically significant differences between the two groups in the above parameters ( P>0.05). The monitoring group used the regimen of taking sunitinib for 4 weeks and stopping for 2 weeks (4/2 week) in the first cycle. The blood concentration of sunitinib was monitored before the first cycle and on days 4, 7, 10, 14, 21 and 28, and personalized medication plan was formulated according to the curve of the blood concentration. The 4/2 week scheme was adopted in the undetected monitoring group.The two groups were compared in the incidence of adverse events (AEs), progression-free survival (PFS), overall survival (OS), tumor treatment response and other clinical outcomes. Results:In the monitoring group, 90% (18/20) of patients receiving sunitinib had a steady-state plasma concentration of more than 150ng/ml, of which 10 patients (50%) had a plasma concentration of 150-200 ng/ml and 8 patients (40%) had a plasma concentration of more than 200 ng/ml. Meanwhile, all patients with plasma concentration higher than 150 ng/ml developed severe AEs (grade 3 and above) after treatment. The other two patients' plasma concentration were 100-150 ng/ml, and did not have severe AEs.All patients in the monitoring group received individualized medication schedule adjustment according to the plasma drug concentration and the occurrence point of severe AEs, ensuring that the peak plasma drug concentration was maintained at about 100-150 ng/ml. Among them, 6 patients were changed to take 2 weeks and stop for 1 week (2/1 week schedule), 4 patients were changed to take 10 days and stop for 5 days (10/5 d schedule), 7 patients were changed to take 7 days and stop for 3 days (7/3 d schedule), and 3 patients were changed to take 5 days and stop for 2 days (5/2 d schedule). The incidence of severe AEs significantly decreased from 90% (18/20) to 35% (7/20), and the difference was statistically significant ( P=0.003), while the incidence of grade 3 and higher AEs was 55.6% (25/45) in the standard group, which was statistically significant compared with the incidence of severe AEs before adjustment in the monitoring group ( P=0.006). Further analysis of the efficacy difference between the two groups showed that the overall objective response rate in the monitoring group (40%, 8/20) was higher than that in the standard group (20%, 9/45), although the difference was not statistically significant ( P=0.09). Median PFS and OS were significantly longer in the monitored group than in the standard group (PFS: 23 vs. 10 months, P=0.002; OS: not reached vs.25 months, P=0.005). Conclusions:The bioavailability of sunitinib is high in mRCC patients, which may lead to higher plasma drug concentration, adjustment of medication regimen based on blood concentration monitoring significantly improved patient safety and clinical outcomes. However, further validation by larger-scale, multi-center and prospective studies is needed.

Reducing neuroinflammation and improving neurobehavioral functions: the protective roles of resveratrol for germinal matrix hemorrhage in neonatal rat model / 中国新生儿科杂志

Objective:To study the roles of resveratrol in reducing neuroinflammation and improving neurobehavioral functions after germinal matrix hemorrhage (GMH) in neonatal rat model.Methods:GMH model was established intraparenchymally injecting bacterial collagenase in 7-day-old SD rats. 108 rats were randomly assigned into 18 groups (6 in each group), including 4 sham groups, GMH (12 h, 24 h, 72 h, 7 d) groups, 3 GMH+vehicle (dimethylsulfoxide, DMSO) groups, 5 GMH+resveratrol (10 mg/kg, 100 mg/kg, 1 000 mg/kg) groups and 2 GMH+resveratrol+EX527 (SIRT1 inhibitor) groups. Negative geotaxis and righting reflex tests were used to evaluate the short-term neurobehavior. Water maze, foot fault and Rotor-Rod tests were used to assess the long-term neurobehavior. Immunofluorescence was used to quantify the IL-1β and MPO positive cells (inflammatory markers) in peri-hematoma area. Western blot was used to evaluate the expression of relevant proteins in the brain.Results:Endogenous sirtuin-1(SIRT1) decreased to the lowest level at 24 h and then increased gradually. Phosphorylated NF-κB increased at 12 h, peaked at 72 h and returned to normal level at 7 d after GMH. Compared with the control group and other doses groups, GMH treated with resveratrol (100 mg/kg) had higher short-term behavioral scores at 48 h and 72 h. Compared with the control group, the resveratrol (100 mg/kg) group also had higher scores in water maze, foot fault and Rotor-Rod tests 22 days later. Immunofluorescence showed less positive IL-1β and MPO cells around hematoma in GMH+resveratrol group than both GMH+vehicle group and GMH+resveratrol+EX527 group. Western blot indicated that IL-1, TNF-α and IL-6 expressions were decreased in GMH+resveratrol group and Ex527 could offset the effects of resveratrol.Conclusions:Resveratrol (optimal dose: 100 mg/kg) can improve the short-term and long-term neurobehavioral functions of neonatal GMH rats. It can reduce GMH cells with positive inflammatory markers around the hematoma, possibly via inhibition of the SIRT1/NF-κB pathway. Resveratrol may be promising for the treatment of GMH patients.

Effects of remazolam on sublagal microcirculation during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting / 中华麻醉学杂志

Objective:To evaluate the effects of remazolam on sublingual microcirculation during anesthesia induction in the patients undergoing off-pump coronary artery bypass grafting under general anesthesia.Methods:Forty-two patients of both sexes, of American Society of Anesthesiologists Physical Status classification Ⅲ or IV, aged 45-75 yr, with body mass index of 18-30 kg/m 2, undergoing off-pump coronary artery bypass grafting under total intravenous anesthesia, were divided into 2 groups ( n=21 each) using a random number table method: propofol group (group P) and remazolam group (group R).Remazolam 0.15-0.35 mg/kg was intravenously infused in group R, and propofol 1.5-2.0 mg/kg was intravenously infused in group P, when patients lost consciousness and they did not response to shoulder tapping, the maintenance dose was adjusted as follows: remazolam 0.15-0.30 mg·kg -1·h -1 in group R and propofol 2.0-4.0 mg·kg -1·h -1 in group P. The BIS value was maintained at 45-55 during operation in the two groups.The proportion of perfused vessels for all vessels (PPV (all)), proportion of perfused small vessels (PPV (small)), perfused vessel density of all vessels (PVD (all)), and perfused small vessel density (PVD (small)) were recorded before induction (T 1), immediately after intubation (T 2) and 30 min after intubation (T 3).The cardiovascular events were recorded during anesthesia induction. Results:Compared with the baseline at T 1, PPV (all), PPV (small) and PVD (all) were significantly decreased at T 3 ( P<0.05), and no significant change was found in PPV (all), PPV (small), PVD (all) and PVD (small) at T 2 in group P ( P>0.05), and no significant change was found in PPV (all), PPV (small), PVD (all) and PVD (small) at T 2 and T 3 in group R ( P>0.05).Compared with group R, PPV (small) was significantly decreased at T 3 in group P ( P<0.01). Conclusions:Remazolam exerts less inhibitory effect on sublingual microcirculation than propofol during anesthesia induction in the patients undergoing off-pump coronary artery bypass grafting.

Effects of thoracic paravertebral block on graft patency in off-pump coronary artery bypass grafting / 中华麻醉学杂志

Objective:To evaluate the effects of thoracic paravertebral block (TPVB) on graft patency in off-pump coronary artery bypass grafting.Methods:Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-75 yr, weighing 50-80 kg, undergoing elective off-pump coronary artery bypass grafting under combined intravenous-inhalational anesthesia, were divided into 2 groups using a random number table method: control group (group C, n=30) and TPVB group (group T, n=20). In group T, TPVB was performed at T 4, 5 interspace under the guidance of ultrasound, a test dose of 1% lidocaine 5 ml was injected on both sides, and 2 min later 0.375% ropivacaine 15 ml was injected.According to the anatomy of coronary artery, the graft was divided into 4 parts: left internal thoracic artery-anterior descending branch (arterial graft), the middle branch or the first diagonal branch, blunt marginal branche, and right posterior descending branch or left ventricular posterior branch.The blood flow was measured and pulsatility index was calculated after graft transplantation.Central venous pressure, mean pulmonary artery pressure, cardiac output, systemic resistance index and pulmonary resistance index were recorded immediately after placement of floating catheter (T 1), immediately after sawing sternum (T 2), immediately after anastomosis of all grafts (T 3) and 5 min before leaving the room (T 4). The intraoperative cardiovascular adverse events and consumption of sufentanil were recorded. Results:Compared with group G, central venous pressure, systemic resistance index and pulmonary resistance index were significantly decreased, cardiac output were increased, the incidence of intraoperative tachycardia was decreased, the incidence of hypotension was increased, the consumption of sufentanil was reduced, the flow of left internal thoracic artery-anterior descending branch was increased, and the pulsatility index was decreased at T 3 and T 4 in group T ( P<0.05). Conclusion:TPVB can improve the patency of left internal thoracic artery-anterior descending branch in off-pump coronary artery bypass grafting.

Correlation study of gamma-glutamyl transferase/high density lipoprotein cholesterol ratio,neutrophil/lymphocyte ratio and coronary heart disease / 中国综合临床

Objective:To investigate the correlation between gamma-glutamyl transferase/high-density lipoprotein cholesterol ratio (GHR), neutrophil/lymphocyte ratio (NLR) and coronary heart disease (CHD), and evaluated its pathogenic risk and predictive value for CHD.Methods:A total of 694 patients admitted to our hospital from December 2017 to December 2018 for suspected CHD and coronary angiography were selected. According to the results of coronary angiography,the patients were divided into CHD group ( n=527) and non-CHD group ( n=167). The clinical data of all patients were recorded. Gamma-glutamyl transferase (GGT), high-density lipoprotein cholesterol (HDL-C) and other biochemical indicators were recorded. Neutrophils, lymphocyte count and other hematological indicators were recorded. GHR, NLR and Gensini scores of the patients were calculated. Clinical data and GHR, NLR and other indicators were compared between the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of GHR, NLR in CHD, and to determine the optimal cut-off value; Logstic regression analysis was used to investigate the risk factors of CHD.Spearman correlation analysis was used to analyze the correlation between serum OPN, OPG and Gensini score in patients with CHD. Results:The GHR and NLR were 32.59(21.05, 48.24) and 3.53(2.18, 8.46) significantly higher in the CHD group than in the non-CHD group 16.56(10.07, 25.21) and 2.20(1.45, 3.28) respectively, with statistically significant differences ( Z=11.094, 9.055, P<0.05). ROC curve analysis showed that the AUC of NLR and MLR in diagnosing CHD was 0.785 and 0.732( P<0.05). When the critical values of GHR and NLR respectively were 19.805 and 2.678, respectively, the diagnostic efficiency of CHD was the highest, and the sensitivity and specificity were 79.30%, 62.90% and 63.80%, 68.30%, and the AUC of GGT in diagnosing CHD was 0.628. When the critical value was 19.500, the sensitivity and specificity were 80.50% and 39.50%, respectively,the AUC of GHR was greater than that of GGT ( Z=12.973, P<0.05). Multivariate Logistic regression analysis showed that Smoking ( OR=2.887, 95% CI:1.850-4.505, P<0.05), hypertension ( OR=2.009, 95% CI: 1.311-3.080, P<0.05), fasting plasma glucose ( OR=1.109, 95% CI:1.034-1.189, P<0.05), age ≥60 years ( OR=1.567, 95% CI:1.179-2.415, P<0.05), NLR ≥2.687 ( OR=3.152, 95% CI:2.066-4.808, P<0.05) and GHR ≥19.805 ( OR=4.768, 95% CI:3.131-7.262, P<0.05) was an independent risk factor for CHD. After gradually adjustment for risk factors such as smoking, hypertensive, fasting plasma glucose, age ≥60 years and NLR ≥2.687, GHR ≥19.805 was still an independent risk factor for coronary heart disease(OR and 95% CI were 4.620 (3.049-7.000), 4.768 (3.131-7.262), 6.567 (4.408-9.810), 4.768 (3.131-7.262), 4.768 (3.131-7.262), respectively; all P<0.001). Spearman correlation analysis showed that GHR and NLR were positively correlated with Gensini score ( r=0.312, 0.394; all P<0.05). Conclusion:GHR and NLR were positively correlated with the severity of coronary artery disease, which is of significance in the diagnosis of coronary heart disease. NLR ≥2.687 and GHR ≥19.805 were independent risk factors for CHD. GHR was superior to GGT and HDL-C alone in the diagnosis of CHD,and has certain clinical application value

A new perspective of triptolide-associated hepatotoxicity: the relevance of NF- B and NF- B-mediated cellular FLICE-inhibitory protein

Previously, we proposed a new perspective of triptolide (TP)-associated hepatotoxicity: liver hypersensitivity upon lipopolysaccharide (LPS) stimulation. However, the mechanisms for TP/LPS-induced hepatotoxicity remained elusive. The present study aimed to clarify the role of LPS in TP/LPS-induced hepatotoxicity and the mechanism by which TP induces liver hypersensitivity upon LPS stimulation. TNF- inhibitor, etanercept, was injected intraperitoneally into mice to investigate whether induction of TNF- by LPS participated in the liver injury induced by TP/LPS co-treatment. Mice and hepatocytes pretreated with TP were stimulated with recombinant TNF- to assess the function of TNF- in TP/LPS co-treatment. Additionally, time-dependent NF-B activation and NF-B-mediated pro-survival signals were measured and . Finally, overexpression of cellular FLICE-inhibitory protein (FLIP), the most potent NF-B-mediated pro-survival protein, was measured and to assess its function in TP/LPS-induced hepatotoxicity. Etanercept counteracted the toxic reactions induced by TP/LPS. TP-treatment sensitized mice and hepatocytes to TNF-, revealing the role of TNF- in TP/LPS-induced hepatotoxicity. Mechanistic studies revealed that TP inhibited NF-B dependent pro-survival signals, especially FLIP, induced by LPS/TNF-. Moreover, overexpression of FLIP alleviated TP/LPS-induced hepatotoxicity and TP/TNF--induced apoptosis . Mice and hepatocytes treated with TP were sensitive to TNF-, which was released from LPS-stimulated immune cells. These and other results show that the TP-induced inhibition of NF-B-dependent transcriptional activity and FLIP production are responsible for liver hypersensitivity.

A magnetism/laser-auxiliary cascaded drug delivery to pulmonary carcinoma

Although high-efficiency targeted delivery is investigated for years, the efficiency of tumor targeting seems still a hard core to smash. To overcome this problem, we design a three-step delivery strategy based on streptavidin-biotin interaction with the help of c(RGDfK), magnetic fields and lasers. The ultrasmall superparamagnetic iron oxide nanoparticles (USIONPs) modified with c(RGDfK) and biotin are delivered at step 1, followed by streptavidin and the doxorubicin (Dox) loaded nanosystems conjugated with biotin at steps 2 and 3, respectively. The delivery systems were proved to be efficient on A549 cells. The co-localization of signal for each step revealed the targeting mechanism. The external magnetic field could further amplify the endocytosis of USPIONs based on c(RGDfK), and magnify the uptake distinctions among different test groups. Based on photoacoustic imaging, laser-heating treatment could enhance the permeability of tumor venous blood vessels and change the insufficient blood flow in cancer. Then, it was noticed that only three-step delivery with laser-heating and magnetic fields realized the highest tumor distribution of nanosystem. Finally, the magnetism/laser-auxiliary cascaded delivery exhibited the best antitumor efficacy. Generally, this study demonstrated the necessity of combining physical, biological and chemical means of targeting.

The impact of different metastatic sites on the prognosis of mRCC patients and its value for modification of International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model / 中华泌尿外科杂志

Objective:To evaluate the impact of metastatic site on the prognosis in patients with metastatic renal cell carcinoma (mRCC), and it′s value for modifying the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria.Methods:The data of 218 patients pathologically diagnosed with mRCC were analyzed retrospectively in West China Hospital from Jan. 2009 to Dec. 2019. Among all patients, 71.6%(156/218) were male, and 89.0% (194/218) underwent nephrectomy. Most of the patients were pathologically diagnosed with renal clear cell carcinoma (176 patients, 80.7%). Lung (137/218, 62.8%) was the most observed metastatic site, following by bone (47/218, 26.1%), lymph node (37/218, 17.0%) and liver (23/218, 10.6%). All patients were classified into favorable (26 patients, 11.9%), intermediate (126 patients, 57.8%) or poor (37 patients, 17.0%) risk group according to IMDC criteria. Endpoints of this study were progression-free survival (PFS), overall survival (OS) and tumor response. The impact of metastatic sites on patients’ prognosis was analyzed, and those that had significant relationship with prognosis were then added into IMDC criteria and a modifying IMDC model was established. Predictive value of this model was further evaluated by calculating concordance index (C-index).Results:In the whole cohort, median PFS and OS were 13.0 and 33.0 months. Survival analysis suggested that patients with bone ( P=0.004), brain ( P=0.042) and liver ( P=0.046) had significantly shorter OS. Thus, patients were divided into two groups: patients with bone/brain/liver metastasis (82 patients, 37.6%) and patients with other metastatic sites (136 patients, 62.4%). Compared with patients with other metastatic sites, those who with bone/brain/liver metastasis had inferior tumor response by TKIs treatment (disease control rate: 51.2% vs. 73.5%, P=0.004). Multivariate analysis suggested that bone/brain/liver metastasis had negative impact on OS (25.0 vs. 47.0 mo, P=0.039). Furthermore, bone/brain/liver metastasis also showed significant relationship with shorter OS in IMDC low (30.0 vs. 62.0 months, P=0.036), intermediate (31.0 vs. 48.0 months, P=0.048) or high (7.0 vs. 18.0 months, P=0.037) risk group, indicating that metastatic site had predictive value for prognosis of mRCC patients. Based on that, bone/brain/liver metastasis were added into the IMDC criteria, and weighting each parameter was weighted according to its coefficient to patients’ OS. Finally, a modified IMDC scoring system were established. C-index of this modified model was 0.669 (0.599 for current IMDC criteria). Conclusions:Bone/brain/liver metastasis in mRCC patients indicated a shorter OS duration. When adding bone/brain/liver metastasis as a predictive parameter for prognosis of mRCC patients into IMDC criteria, the modified IMDC criteria could offer more accurate prediction for patients’ survival.

Epidemiological characters of patients with spinal metastases: a multi-center case study / 中华骨科杂志

Objective:To observe the epidemiological characteristics of spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:Patients with spinal metastases were identified from several clinical centers between January 2007 and July 2019. A total of 1 976 patients were included in this study, including 1 129 males (57.14%) and 847 females (42.86%). The mean age was 58.6±11.6 years (range 13-92 years). The demographic characteristics, primary tumor types, spinal involvement of each patient were summarized and their clinical indicators were obtained by consulting medical records, including: Frankel grade, visual analog scale (VAS), metastatic spinal cord compression (MSCC), Tokuhashi revised score, the spinal instability neoplastic score (SINS), Karnofsky performance status (KPS), and history of malignant tumors. Finally, the intervention influencing factors of patients undergoing surgical treatment were statistically analyzed.Results:The ratio of male to female in 1 976 spinal metastases was 1.33∶1. The median age was 59.0, and most patients (63.71%) were in the ages range of 50-69. The average age of female was younger than male, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than females, and the difference was statistically significant. The most common primary tumor was lung cancer (n=730, 36.94%), followed by unknown origin (n=326, 16.50%), breast cancer (n=159, 8.05%), kidney cancer (n=120, 6.07%), gastrointestinal cancer (n=109, 5.52%), etc. The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. In the past 10 years, the proportion of unknown origin has decreased, and the proportion of breast cancer has increased. According to the Tomita score, 1 284 patients (64.98%) were rapid growth tumors, 211 patients (10.68%) were moderate growth tumors, and 481 patients (24.34%) were slow growth tumors. There were 730 patients (57.14%) in the subgroup of the number<3, the most level of which was lumbar vertebrae, with 368 patients (32.60%). The remaining 847 patients (42.86%) were included in the subgroup of the number≥3, the most level of which was multiple-level of spine, with 617 patients (72.85%). Among the 1 976 patients, spinal cord injury occurred in 50.76% of patients, in which 77.18% of patients developed moderate and above pain, 14.02% of patients appeared metastatic spinal cord compression, and only 28.95% of patients had a clear history of primary tumor. In terms of treatment, 34.92% of patients underwent surgery, 5.97% underwent radiotherapy on spinal metastases, 6.02% underwent chemotherapy, and 1.77% underwent targeted therapy. Preoperative Frankel grade, SINS, and Tokuhashi revised score were important factors affecting the surgical treatment of patients.Conclusion:This study describes the epidemiological characteristics of multicenter spinal metastases in detail, which could assist orthopedic surgeons to understand the clinical characteristics of spinal metastases and was of great significance on guiding the clinical diagnoses and scientific researches.

Video essentials of minimally invasive McKeown esophagectomy with systematic lymph node dissection / 中国胸心血管外科临床杂志

@#（正）食管癌位于我国恶性肿瘤发病率第 5 位及死亡率第 4 位，每年大约有 10 万新增病例，占全球50% 以上。食管癌病因复杂，发病隐匿，目前公认的治疗方案是以手术为主、放化疗为辅的综合治疗。而传统开胸手术治疗创伤大，并发症多，恢复时间长，预后较差。经过多年的不断探索与发展以及腔镜技术的日益成熟，以三野清扫为目的的胸腹腔镜联合食管癌切除已成为一种趋势，其在切除范围、淋巴结清扫程度、切口疼痛程度、快速康复以及预后等方面较传统术式有明显优势，同时并发症发生率并未增加[1]。本视频旨在展示胸腹腔镜食管癌切除术的手术入路、操作要点及术后情况。