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Objective: To analyze the cardiac magnetic resonance (CMR) imaging feature of clinically diagnosed myocarditis patients with negative endocardial biopsy (EMB) results, and to further demonstrate the diagnostic value of CMR in these patients. Methods: This was a retrospective case series study. Fourteen patients, who were clinically diagnosed as myocarditis according to 2013 European Society of Cardiology (ESC) clinical diagnostic criteria for myocarditis, but with negative EMB results, were enrolled. All patients underwent CMR examinations. The morphological, functional and histological changes of the heart were assessed based on black blood sequence, cine sequence, T2W-STIR sequence and contrast agent late gadolinium enhancement,(LGE). Results: There were 10 males and 4 females in this cohort, the age was (25.6±13.2) years. The interval between symptom onset and CMR was 21 (13, 60) days, and the interval between symptom onset and EMB was 19 (9, 40) days. There were 13 patients with abnormal CMR results including myocardial oedema, fibrosis, decreased ejection fraction, pericardial effusion or increased cardiac chamber dimension. Nine out of 14 patients had CMR morphological and/or functional abnormalities, including 1 case of left atrium enlargement, 1 case of left ventricle enlargement, 3 cases of right ventricle enlargement, 4 cases of increased left ventricular end diastolic volume index. Left ventricular ejection fraction was<50% in three cases, right ventricular ejection fraction was<40% in 5 cases, and pericardial effusion depth>3 mm was detected in 3 cases. Of the 14 patients, 11 had histological changes, of which 6 had T2 ratio≥2. Among the 10 patients (10/14) with positive LGE, the most common patterns were subepicardial LGE of the lateral wall and/or midwall LGE of the septum (n=9); 2 cases showed extensively subendocardial LGE of the left ventricular wall. No LGE involved in the right ventricular wall in the whole cohort. Conclusion: CMR plays a complementary role in the diagnosis of myocarditis in clinically diagnosed myocarditis patients with negative EMB findings.
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ObjectiveThere are few animal experiments on ICU acquired weakness (ICU AW), and suitable animal models are the main constraints. The study was to explore the method of ICU AW animal model which satisfies the clinical requirements of ICU and suitable for large-scale animal trials.MethodsThirty six SD rats were randomly divided into Control group(0.9%NS at 2.5 ml/kg intraperitoneal injection once a day for consecutive 3 days), immobilization group(the left hindlimb was immobilizated for 7d, then the immobilization was removed to 14 d), sepsis group(lipopolysaccharide at 2.5 mg/kg intraperitoneal injection once a day for consecutive 3 days) and sepsis-immobilization group(the left hindlimb was immobilizated for 7d, then the immobilization was removed to 14 d and lipopolysaccharide at 2.5 mg/kg intraperitoneal injection once a day for consecutive 3 days).To determine whether the model was successful, the muscle strength of left hindlimb, gastrocnemius/body weight ratio and pathological changes of gastrocnemius were measured at 0 d( immediately after intervention), 3d, 7 d, 10 d, 14 d. To explore the possible pathological mechanism, creatinine/body weight ratio, albumin, lymphocyte, and gastrocnemius pathological scores were measured.Results7 days later, the scores of left hindlimb muscle strength and pathology in sepsis immobilization group were significantly higher than those in the sepsis group and the control group(P<0.05), contary body weight and gastrocnemius weight were lower than those in control group, immobilization group and sepsis group(P<0.05), and gastrocnmiu/body weight ratio(0.528±0.018) was significantly lower than those in control group(0.756±0.315) and sepsis group(0.813±0.040)(P<0.05). Creatinine / body weight in sepsis immobilization group(0.283±0.0268) was significantly higher than those of blank group (0.185±0.022), immobilization group (0.207±0.027) and sepsis group (0.246±0.043)(P<0.05). The lymphocyte count [(5.193±1.493) ×109/L] was significantly lower than that in the blank group[(7.005±0.702) ×109/L] and the immobilization group[(7.208±0.832) ×109/L)](P< 0.05). 14 days later, the scores of left hindlimb muscle strength, body and gastrocnemius weight in sepsis immobilization group were significantly lower than those in control group, immobilization group and sepsis group(P<0.05). Gastrocnmiu/body weight ratio in sepsis immobilization group(0.519± 1.493) was significantly lower than those in control group(0.798±0.015), immobilization group (0.570±0.022)and sepsis group(0.693±0.022)(P<0.05).ConclusionThe qualified animal model of ICU AW can be established by repeated intraperitoneal injection in low dose of lipopolysaccharide combined with limb immobilization. Immunosuppression and Hypercatabolism in ICU AW rats is an important reason that ICU AW can not to be mitigated. Thus, we supposed that it may be the mechanisms for the development of ICU AW,which needs further experimental verification.
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BACKGROUND:Gastrodin has been shown to inhibit the in vivo astrocyte activation after injury,improve the microenvironment of spinal cord injury (SCI), and reduce secondary injuries. OBJECTIVE: To observe the effects of gastrodine on the neural functional recovery and glial fibrillary acidic protein in a rat model of clamping-induced SCI. METHODS: Forty-eight adult Sprague-Dawley rats were randomly divided into three groups, and the models of clamping-induced SCI were established. The rats in sham group were only subjected to laminectomy; gastrodine group was given 100 mg/kg?d gastrodine; the sham and SCI groups were given equal volume of normal saline. The function recovery of spinal cord was evaluated by Basso, Beattie, Bresnahan (BBB) scores, and Rivlin inclined plane experiment at postoperative 1, 3, 7, 14, 21 and 28 days. The morphological changes of spinal cord were observed after perfusion at 28 days, expression level of glial fibrillary acidic protein was detected by immunofluorescence, and changes of Nissl body were observed through Nissl staining. RESULTS AND CONCLUSION: BBB and Rivlin inclined plane scores in each group were significantly decreased postoperatively, and the scores then increased with time; the scores at each time point in the sham group were significantly higher than those in the other groups (P <0.05); the scores in the gastrodine group were significantly higher than those in the SCI group from day 3 (P < 0.05). At postoperative 28 days, the expression level of glial fibrillary acidic protein was the lowest in the sham group, followed by gastrodine group, and the highest in the SCI group (P < 0.05). In the gastrodine and SCI groups, Nissl bodies were slightly stained partially dissolved, and the account of Nissl bodies in this two groups was less than that in the sham group (P < 0.05), but the gastrodine group had significantly more Nissl bodies than the SCI group (P < 0.05). The spinal cord in the sham group revealed the complete structure; in the SCI group, the structure of spinal cord was in disorder, syringomyelia formatted, and the gray-white matter boundary was obscure; gastrodine group showed smaller syringomyelia and gray-white matter boundary were clear. These results show that gastrodin can inhibit the proliferation of astrocytes after SCI, play neuroprotection, and improve motor function.
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Objective To summarize the clinical experience and the clinical therapeutic effect of minimally invasive surgery for congenital heart disease under thoracoscope. Methods A total of 154 patients of congenital heart disease treated by minimally invasive surgery through thoracoscopic surgery were divided into two groups,adult group(n=112)and minor group (n=42). Through the right chest intercostal incision, thoracoscopic assisted exposure of the surgical field of visual, superior vena cava and femoral vein catheterization, cardiopulmonary bypass were established. The principle of operation was the same as that of thoracotomy.Data of operation time,extraeorporeal circulation time,cross-clamping time, ICU time, length of hospital stay, amount of drainage and the complications were observed in two groups of patients. Results Operations were successful and all patients recovered well.There were no significant differences in operation time, extraeorporeal circulation time,cross-clamping time,ICU time and length of hospital stay between two groups of patients.In adult group, the amount of drainage was significantly increased than that in minor group (P<0.05). In adult group, there were 4 cases with complications (3.6%), 1 case was changed to median thoracotomy surgery, 1 case was undergone reoperation for bleeding, 1 case had delayed pleural effusion,and 1 case had pneumothorax.In minor group,there were 2 cases with complications(4.8%),1 case had injury of femoral artery and had bypass operation immediately and 1 case had delayed pleural effusion.There was no significant difference in complications between 2 groups(P>0.05).There was neither serious complication nor death in both adult and minor groups. Conclusion Minimally invasive thoracoscopic surgery for congenital heart disease is safe and reliable for both adults and minors.It has the advantages of small trauma,less bleeding, less serious complications and quick recovery after operation.However,it takes surgeons some time to grasp the operative skill skillfully,and the operative indication should be controlled strictly.
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Objective To analyze the clinical features of melioidosis,explore its diagnosis and treatment methods.Methods 35 patients who were with pathogenic evidence of melioidosis and admitted in a hospital between March 2012 and February 2017 were analyzed retrospectively.Results Of 35 patients at admission,2 (5.7％) were with confirmed culture result of melioidosis in the other hospitals,3 (8.6％) highly suspected patients had relatively typical clinical features,30 (85.7％) were misdiagnosed,suspected patients were all confirmed melioidosis through the cultured result of Burkholderia pseudomallei from all kinds of specimens.Through treatment of anti-infection,surgical drainage (11.4％) and operation (20.0％),26 cases (74.3 ％) were improved or recovered,2 (5.7％) abandoned treatment,and 7 (20.0％) died.The most common initial symptom was fever (88.6％),followed by cough (34.3％),shortness of breath(28.6％),abdominal pain (14.6％),extremity pain (11.4％),and joint pain (5.7％);the top five infection sites were blood (85.7％),lung (54.3％),spleen (20.0％),skin and soft tissue (20.0％),and liver (14.3％);85.7％ of Burkholderia pseudomallei were isolated from blood culture,37.1％ and 20.0％ were isolated from all kinds of puncture fluid and sputum respectively.Conclusion Clinical features of melioidosis are diverse,misdiagnosis rate is high.Early,timely,rational,and enough treatment course can reduce the mortality and recurrence rate of melioidosis.
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In this study, we intend to confirm our hypothesis that cold inducible RNA-binding protein (CIRP) can inhibit neuronal apoptosis through suppressing the formation of oxygen free radicals under hypothermia. Primary rat hippocampal neurons were isolated and cultured in vitro, and were divided into five groups: (1) normal control group (37 °C), (2) cells infected by empty viral vector group, (3) CIRP over-expressed group, (4) CIRP knock-down group, and (5) hypothermia control group. Cells in groups 2-5 were cultured under 32 °C, 5% CO2. Apoptosis of hippocampal neurons were detected by Annexin V-FITC/PI staining and flow cytometry; Expression of CIRP was determined by Western blot; Redox-related parameters (T-AOC, GSH-Px, SOD, MDA) were detected by ELISA kits. Results showed that CIRP expression levels were significantly increased (P < 0.01) and the apoptotic rates were significantly decreased (P < 0.01) in hypothermia control group and CIRP over-expressed group when compared with normal control group. On the other hand, the apoptotic rate was significantly increased (P < 0.05) in CIRP knock-down group compared with that in hypothermia control group. The levels of redox parameters in hypothermia control group and CIRP over-expressed group were significantly changed in comparison with those in normal control group, CIRP knock-down group and empty viral vector infected group, respectively (P < 0.05 or P < 0.01). These results suggest that up-regulation of CIRP by hypothermia treatment can protect the neuron from apoptosis through suppressing the formation of oxygen free radicals.
Subject(s)
Animals , Rats , Apoptosis , Cells, Cultured , Cold Shock Proteins and Peptides , Metabolism , Cold Temperature , Hippocampus , Cell Biology , Hypothermia , Neurons , Cell Biology , Oxidation-Reduction , RNA-Binding Proteins , Metabolism , Up-RegulationABSTRACT
<p><b>BACKGROUND</b>The prognosis for patients with gastric cancer and synchronous liver metastases is very poor. However, a standard therapeutic strategy has not been well established. The clinical benefit and prognostic factors after hepatic surgical treatment for liver metastases from gastric cancer remain controversial.</p><p><b>METHODS</b>Records of 105 patients who underwent gastrectomy regardless of hepatic surgical treatment for gastric cancer with synchronous liver-only metastases in our center between 1995 and 2010 were retrospectively reviewed.</p><p><b>RESULTS</b>The overall survival rate for the 105 patients was 42.1%, 17.2%, and 10.6% at 1, 2, and 3 years, respectively, with a median survival time of 11 months. Multivariate survival analysis revealed that the extent of lymphadenectomy (D) (P < 0.001), lymph node metastases (P < 0.001), extent of liver metastases (H) (P = 0.008), and lymphovascular invasion (P = 0.002) were significant independent prognostic factors for survival. Among patients who underwent D2 lymphadenectomy, those who underwent hepatic surgical treatment had a significantly improved survival compared with those who underwent gastrectomy alone (median survival, 24 vs. 12 months; P < 0.001). However, hepatic surgical treatment was not a prognostic factor for patients who underwent D1 lymphadenectomy (median survival, 8 vs. 8 months; P = 0.495). For the 35 patients who underwent gastrectomy plus hepatic surgical treatment, D2 lymphadenectomy (P < 0.001), lymph node metastases (P = 0.015), and extent of liver metastases (H1 vs. H2 and H3) (P = 0.017) were independent significant prognostic factors for survival.</p><p><b>CONCLUSIONS</b>D2 lymphadenectomy plus hepatic surgical treatment may provide hope for long-term survival of judiciously selected patients with hepatic metastases from gastric cancer. Patients with a low degree of lymph node metastases and H1 liver metastases would make the most appropriate candidates. However, if D2 dissection cannot be achieved, hepatic surgical treatment is not recommended.</p>
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Aged , Female , Humans , Male , Middle Aged , Gastrectomy , Liver Neoplasms , Mortality , General Surgery , Lymph Node Excision , Prognosis , Stomach Neoplasms , Mortality , General Surgery , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To discuss the present status and progress of clinical research on recurrence of gastric cancer after surgery, including patterns, clinicopathologic factors, prognosis, detection, diagnosis, prevention, and treatment strategies.</p><p><b>DATA SOURCES</b>The data used in this review were mainly from PubMed articles published in English from 2000 to August 2011. The search terms were "gastric cancer" and "recurrence".</p><p><b>STUDY SELECTION</b>Articles were selected if they involved clinicopathologic factors, detection methods, and treatment strategies of recurrence of gastric cancer.</p><p><b>RESULTS</b>Peritoneal recurrence is the most common pattern in recurrence of gastric cancer. The main risk factors for recurrence of gastric cancer are tumor stage, including depth of tumor invasion and lymph node metastasis, and Borrmann classification. The prognosis of patients with recurrence is very poor, especially patients with peritoneal recurrence. Systemic chemotherapy is still the main treatment method for patients with recurrent cancer. If complete resection can be accomplished, some benefits may be obtained from surgery for recurrence. However, standard treatment for patients with recurrence has not yet been established.</p><p><b>CONCLUSIONS</b>Early detection and diagnosis of recurrence is quite crucial for treatment and prognosis. The optimal therapeutic strategy for recurrence should be based on a multidisciplinary assessment and the patient's individual state and should involve combined therapy.</p>
Subject(s)
Humans , Biomarkers, Tumor , Neoplasm Recurrence, Local , Diagnosis , Rehabilitation , General Surgery , Therapeutics , Neoplasm Staging , Prognosis , Stomach Neoplasms , Diagnosis , Mortality , Pathology , General SurgeryABSTRACT
<p><b>BACKGROUND</b>The seed cell is a core problem in bone tissue engineering research. Recent research indicates that human dental pulp stem cells (hDPSCs) can differentiate into osteoblasts in vitro, which suggests that they may become a new kind of seed cells for bone tissue engineering. The aim of this study was to evaluate the osteogenic differentiation of hDPSCs in vitro and bone-like tissue formation when transplanted with three-dimensional gelatin scaffolds in vivo, and hDPSCs may become appropriate seed cells for bone tissue engineering.</p><p><b>METHODS</b>We have utilized enzymatic digestion to obtain hDPSCs from dental pulp tissue extracted during orthodontic treatment. After culturing and expansion to three passages, the cells were seeded in 6-well plates or on three-dimensional gelatin scaffolds and cultured in osteogenic medium. After 14 days in culture, the three-dimensional gelatin scaffolds were implanted subcutaneously in nude mice for 4 weeks. In 6-well plate culture, osteogenesis was assessed by alkaline phosphatase staining, Von Kossa staining, and reverse transcription-polymerase chain reaction (RT-PCR) analysis of the osteogenesis-specific genes type I collagen (COL I), bone sialoprotein (BSP), osteocalcin (OCN), RUNX2, and osterix (OSX). In three-dimensional gelatin scaffold culture, X-rays, hematoxylin/eosin staining, and immunohistochemical staining were used to examine bone formation.</p><p><b>RESULTS</b>In vitro studies revealed that hDPSCs do possess osteogenic differentiation potential. In vivo studies revealed that hDPSCs seeded on gelatin scaffolds can form bone structures in heterotopic sites of nude mice.</p><p><b>CONCLUSIONS</b>These findings suggested that hDPSCs may be valuable as seed cells for bone tissue engineering. As a special stem cell source, hDPSCs may blaze a new path for bone tissue engineering.</p>