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AIM: To explore whether free radicals participate in cerebral ischemic tolerance and the up-regula-tion of p38 MAPK and ERK signaling pathways in rats induced by limb ischemic preconditioning (LIP). METHODS: A total of 128 Wistar rats with permanent occlusion of bilateral vertebral arteries were randomly divided into sham group (n=16), cerebral ischemia (CI) group (n=16), LIP+CI group (n=16), DMTU (a free radical scavenger)+LIP+CI group (n=64) and DMTU+sham group (n=16). Six rats in each group were used to observe the delayed neuronal death (DND) in hippocampal CA1 region by thionin staining at 7 d after the end of operation. Other 10 rats in each group were used to de-tect the expression of p38 MAPK and ERK in hippocampal CA1 region by immunohistochemistry and Western blot. RE-SULTS: Lethal CI resulted in obvious DND in hippocampal CA1 region. However, LIP reversed the above injurious changes, represented by the decrease in histological grade and the increase in neuronal density compared with CI group (P<0. 01). Moreover, LIP significantly up-regulated the expression of p38 MAPK and ERK in hippocampal CA1 region com-pared with CI group (P<0. 01). Administration of free radical scavenger DMTU via femoral vein before LIP partially re-versed the neuroprotective effect of LIP, and blocked the up-regulation of p38 MAPK and ERK expression in hippocampal CA1 region in rats compared with LIP+CI group (P<0. 01). CONCLUSION: Free radicals are involved in the neuropro-tection and up-regulation of p38 MAPK and ERK expression induced by LIP in rats.
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AIM: To investigate the effectiveness of panretinal photocoagulation(PRP)combined with intravitreal conbercept(IVC)for patients with different stages of proliferative diabetic retinopathy(PDR).METHODS: Retrospective study. The medical records for 100 patients(100 eyes)with PDR treated with PRP combined with IVC from January 2018 to June 2020 were reviewed, including 34 eyes with early PDR(group A), 43 with high-risk PDR(group B), and 23 with fibrovascular PDR(group C). The baseline information, best corrected visual acuity(BCVA), central macular thickness(CMT), the rate of vitrectomy and retinal detachment of the patients in the three groups at 1, 3, 6mo and the last follow-up after combination treatment were observed.RESULTS: The patients were followed up for 14.60±11.64mo(6-52mo), with a mean age of 54.22 ±9.32 years. We found 15 eyes(15.0%)who underwent vitrectomy after the combination treatment. The vitrectomy rates of the three groups were 2.9% in group A, 13.9% in group B, and 34.7% in group C. We found no instances of retinal detachment after the treatments. Most patients demonstrated improved BCVA and CMT values with the treatments.CONCLUSION: PRP combined with IVC is safe and effective in patients with different PDR stages.
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Objective To elucidate the mechanism of dl-3-N-butylphthalide (NBP) on renal ischemia-reperfusion injury (IRI) in rat models. Methods Forty SD rats were randomly divided into the sham operation group (Sham group), model group (IRI group), NF-κB inhibitor pyrrolidine dithiocarbamate group (PDTC group), low-dose NBP group (NBP-L group) and high-dose NBP group (NBP-H group), with 8 rats in each group. Serum creatinine (Scr), serum cystatin C(Cys-C), blood urea nitrogen (BUN) and serum interleukin (IL)-1β and IL-18 levels were detected in all groups. Pathological injury of renal tissues in each group was observed by Hematoxylin-eosin (HE) staining. The expression levels of inflammatory factors and nuclear factor (NF)-κB signaling pathway and cell pyroptosis-related proteins in renal tissues were measured by Western blot and immunohistochemical staining. Results Compared with the Sham group, renal tissue injury was more severe, and the levels of Scr, Cys-C, BUN and serum IL-1β and IL-18 were all up-regulated in the IRI group. Western blot showed that the relative expression levels of NOD-like receptor protein (NLRP3), Gasdermin D(GSDMD), cysteinyl aspartate specific proteinase (Caspase)-1, IL-18, IL-1β, NF-κB p65 and p-NF-κB p65 proteins were all up-regulated, and immunohistochemical staining revealed that the expression levels of NF-κB p65 and p-NF-κB p65, IL-1β, IL-18 and NLRP3 proteins were all up-regulated in the IRI group. Compared with the IRI group, renal tissue injury was alleviated, and the levels of Scr, Cys-C, BUN and serum IL-18 and IL-1β were down-regulated in the PDTC, NBP-L and NBP-H groups. Western blot showed that the expression levels of NLRP3, GSDMD, Caspase-1, IL-1β, IL-18, NF-κB p65 and p-NF-κB p65 proteins were down-regulated, and immunohistochemical staining indicated that the expression levels of NF-κB p65, p-NF-κB p65, IL-1β, IL-18 and NLRP3 proteins were down-regulated in the PDTC, NBP-L and NBP-H groups, respectively. Compared with the NBP-L group, renal tissue injury was mitigated, and the levels of Scr, Cys-C, BUN, serum IL-18 and IL-1β were all down-regulated in the NBP-H group. Western blot showed the expression levels of NLRP3, GSDMD, Caspase-1, IL-1β, IL-18, NF-κB p65 and p-NF-κB p65 proteins were down-regulated in the NBP-H group. Immunohistochemical staining indicated that the expression levels of NF-κB p65, p-NF-κB p65, IL-1β, IL-18 and NLRP3 proteins were down-regulated in the NBP-H group. Conclusions NBP may down-regulate the activity of NF-κB/NLRP3 signaling pathway and reduce the expression levels of cell pyroptosis-related proteins and inflammatory factors after renal IRI, thereby suppressing cell pyroptosis and alleviating renal IRI.
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Objective: To explore the application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy (CRRT) of severe burn patients. Methods: A non-randomized controlled study was conducted. Forty-six patients who met the inclusion criteria and received regular nursing of citric acid extracorporeal anticoagulation during CRRT in the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from January to December 2017 were included in regular nursing group (30 males and 16 females, aged 42.0 (38.7,47.0) years, with 201 times of CRRT performed), and 48 patients who met the inclusion criteria and received bundle nursing of citric acid extracorporeal anticoagulation during CRRT in the same hospital from January to December 2018 were included in bundle nursing group (32 males and 16 females, aged 41.0 (36.0,46.0) years, with 164 times of CRRT performed). The clinical data of all the patients in the two groups were recorded, including the length of intensive care unit (ICU) stay, total cost of treatment in ICU, cost of CRRT, unplanned ending of treatment, ending of treatment due to operation (with the rates of unplanned ending of treatment and ending of treatment due to operation calculated), times of disposable hemodialysis filter and supporting pipeline filter (hereinafter referred to as filter) with use time>24 h, times of CRRT, and lifetime of filter. For the patients in both groups who continuously received CRRT for 3 days or more from the first treatment, the prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), total calcium, ionic calcium (with the difference of total calcium or ionic calcium between before and after treatment calculated), creatinine, urea, β2 microglobulin, cystatin C, platelet count, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid levels before the first treatment (hereinafter referred to as before treatment) and 3 days after the first treatment (hereinafter referred to as after 3 days of treatment). The treatment-related complications of all patients in the two groups were recorded during hospitalization. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. Results: Compared with those in regular nursing group, the length of ICU stay was significantly shortened (Z=-4.71, P<0.01), the total cost of treatment in ICU was significantly reduced (t=-1.39, P<0.01), the cost of CRRT had no significant change (P>0.05), the rates of unplanned ending of treatment and ending of treatment due to operation were both significantly decreased (with χ2 values of 12.20 and 17.83, respectively, P<0.01), the times of filter service time>24 h was increased significantly (Z=-5.93, P<0.01), the times of CRRT were significantly reduced (Z=-4.75, P<0.01), and the filter service life was significantly prolonged (Z=-9.24, P<0.01) among patients in bundle nursing group. Thirty-one patients in bundle nursing group and 28 patients in regular nursing group continuously received CRRT for 3 days or more from the first treatment. Before treatment, PT, APTT, and INR of patients in bundle nursing group were 24.10 (16.08, 39.20) s, 38.81 (32.32, 45.50) s, and 1.17 (1.12, 1.19), respectively, similar to 31.75 (22.99, 40.96) s, 41.82 (35.05, 48.06) s, and 1.15 (1.11, 1.19) of patients in regular nursing group (P>0.05); the levels of total calcium and ionic calcium of patients in the two groups were similar (P>0.05). After 3 days of treatment, PT, APTT, and INR of patients in bundle nursing group and regular nursing group were 29.06 (20.11, 39.46) s, 35.25 (30.06, 40.28) s, 1.13 (1.09, 1.17) and 36.51 (26.64, 42.92) s, 39.89 (34.81, 46.62) s, 1.14 (1.10, 1.18), respectively, similar to those before treatment (P>0.05); the level of ionic calcium of patients in regular nursing group was significantly higher than that before treatment (Z=-2.08, P<0.05); the levels of total calcium and ionic calcium of patients in bundle nursing group were both significantly higher than those before treatment (with Z values of -3.55 and -3.69, respectively, P<0.01); compared with those in regular nursing group, APTT of patients was significantly shorter (Z=-2.29, P<0.05), while the total calcium level of patients was significantly higher in bundle nursing group (Z=-2.26, P<0.05). The difference of total calcium between before and after treatment of patients in bundle nursing group was significantly higher than that in regular nursing group (Z=-3.15, P<0.01). The differences of ionic calcium between before and after treatment of patients in the two groups were similar (P>0.05). Before treatment, the level of β2 microglobulin of patients in bundle nursing group was significantly higher than that in regular nursing group (Z=-2.84, P<0.01), the platelet count of patients in bundle nursing group was significantly lower than that in regular nursing group (Z=-2.44, P<0.05), while the levels of creatinine, urea, cystatin C, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid of patients in the two groups were similar (P>0.05). After 3 days of treatment, the levels of creatinine, urea, β2 microglobulin, cystatin C, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -2.10, -2.90, -3.11, -2.02, -2.34, -2.63, and -2.84, respectively, P<0.05 or P<0.01), while the levels of platelet count, oxygenation index, and mean arterial pressure of patients were all significantly higher than those before treatment in bundle nursing group (with Z values of -6.65 and -2.40, respectively, t=-9.97, P<0.05 or P<0.01); the levels of creatinine, urea, β2 microglobulin, cystatin C, platelet count, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -5.32, -2.31, -2.41, -2.21, -3.68, -2.93, -2.20, and -2.31, respectively, P<0.05 or P<0.01), while the oxygenation index and mean arterial pressure of patients were both significantly higher than those before treatment in regular nursing group (Z=-5.59, t=-7.74, P<0.01). After 3 days of treatment, compared with those in regular nursing group, the levels of creatinine, cystatin C, platelet count, oxygenation index, bicarbonate radical, and mean arterial pressure of patients were all significantly higher (with Z values of -2.93, -1.99, -6.39, -2.09, and -2.52, respectively, t=-3.28, P<0.05 or P<0.01), while the levels of urea, β2 microglobulin, pH value, and lactic acid of patients were all significantly lower (with Z values of -3.87, -2.58, -4.24, and -2.75, respectively, P<0.05 or P<0.01) in bundle nursing group. During hospitalization, there were no treatment-related bleeding events or hypernatremia related to citric acid treatment of patients in the two groups. The ratio of total calcium to ionic calcium in one patient in bundle nursing group was >2.5, but there was no manifestation of citric acid accumulation poisoning; 1 patient had hypoionic calcemia, and 1 patient had severe metabolic alkalosis. Five patients had hypoionic calcemia and 2 patients had severe metabolic alkalosis in regular nursing group. Conclusions: The implementation of bundle nursing of citric acid extracorporeal anticoagulation during CRRT for severe burn patients shortens the length of ICU stay, reduces the total cost of treatment in ICU and the occurrence of treatment-related complications, relieves the economic burden of patients, and improves the continuity and quality of treatment.
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Adult , Female , Humans , Male , Anticoagulants , Burns/therapy , Citric Acid , Continuous Renal Replacement Therapy , Retrospective StudiesABSTRACT
Kidney ischemia-reperfusion injury (IRI) is the major cause of poor prognosis after kidney transplantation and partial nephrectomy. Besides, it is also a critical pathophysiological process of acute kidney injury. Consequently, the prevention and treatment of kidney IRI are of significance to improve clinical prognosis of recipients undergoing kidney transplantation. However, the mechanism underlying IRI is complex, and the exact mechanism remains elusive. Inflammation, as one of the main pathogenesis of IRI, plays a significant role in IRI-induced kidney injury. Nuclear factor (NF)-κB, as a rapid response transcription factor, has been proven to be involved in the regulation of inflammation during kidney IRI. Therefore, in this article, the structure of NF-κB, the activation pattern of NF-κB signaling pathway, the regulatory mechanisms of NF-κB upstream and downstream signaling pathways in kidney IRI were reviewed, and the role of NF-κB signaling pathway in kidney IRI was investigated, aiming to provide novel clinical ideas for the prevention and treatment of kidney IRI.
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Objective:To explore the feasibility, efficacy and limitation of robot-assisted laparoscopic surgery in the treatment of adrenal tumors in children.Methods:The clinical data of 5 children with adrenal tumors treated with robot-assisted laparoscopic surgery in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from October 2020 to March 2021 were retrospectively analyzed. All patients were males aged between 2 years and 4 months to 13 years and 1 month (median: 7 years and 7 months). One case had left adrenal adenomas and 4 cases had right adrenal adenomas.The maximum diameter of tumors was 3.0-6.0 cm (median: 4.8 cm).Results:Robot-assisted laparoscopic adrenalectomy was performed successfully on all 5 patients.The ope-ration time was 215-325 min (median: 275 min). The intraoperative bleeding was 10-50 mL (median: 28 mL). The indwelling time of the drainage tube after surgery was 3-5 days (median: 4 days). The postoperative hospital stay was 9-13 days (median: 11 days). The hospitalization cost was 51 268-58 157 yuan (median: 53 485 yuan). No complications occurred during or after the operation.Postoperative pathological tests suggested adrenal cortex adenocarcinoma in 1 case, pheochromocytoma in 1 case, gangliocytoma in 2 cases, and ganglioneuroblastoma in 1 case.Conclusions:Robot-assisted laparoscopic surgery is safe and feasible in children with adrenal tumors, but there are some limitations.This approach needs to be verified by further clinical research.
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Renal ischemia-reperfusion injury often occurs during operations that need to block the blood supply of the kidneys. It is an important pathophysiological process that affects the recovery of kidney function and causes acute renal failure. Activated NLRP3 inflammasome can mediate the maturation and release of a variety of pro-inflammatory factors, and participate in the inflammatory response in renal ischemia-reperfusion injury, thereby regulating body inflammation and related cell functions. This article summarized how NLRP3 inflammasome mediated the occurrence of inflammation in renal ischemia reperfusion injury, and further provied a new basis for the prevention and treatment of renal ischemia-reperfusion injury.
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Objective To investigate the effect and mechanism of artesunate on renal ischemia-reperfusion injury (IRI) in rat. Methods Twenty-five SD rats were randomly divided into the sham operation group (Sham group), model group (IRI group), low-dose artesunate group (ART-L group), high-dose artesunate group (ART-H group) and NLRP3 inflammasome inhibitor group (INF39 group), with 5 rats in each group. The levels of serum creatinine (Scr), blood urea nitrogen (BUN) and pathological damage of renal tissue were analyzed. The levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in serum were quantitatively measured. The expression level of IL-1β in renal tissues was determined by immunohistochemical staining. The expression levels of pyroptosis-related proteins were detected by fluorescent staining and Western blot. Results Compared with the Sham group, the levels of Scr and BUN were higher, the renal tissue injury was aggravated, the expression levels of TNF-α, IL-6 and IL-1βwere higher, and the expression levels of kidney injury molecule (KIM-1), pyroptosis-related protein NOD-like receptor protein 3 (NLRP3), cysteinyl aspartate specific proteinase (Caspase-1), Gasdermin D (GSDMD) and IL-1β proteins were higher in the IRI group. Compared with the IRI group, the levels of Scr and BUN were decreased, the renal tissue injury was mitigated, the expression levels of TNF-α, IL-6 and IL-1β were down-regulated, and the expression levels of KIM-1, NLRP3, Caspase-1, GSDMD and IL-1β proteins were down-regulated in the ART-L, ART-H and INF39 groups. Conclusions Artesunate may inhibit pyroptosis induced by NLRP3 inflammasome, down-regulate the expression levels of pyroptosis -related proteins, reduce the release of inflammatory factors after renal IRI and alleviate renal IRI.
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The present study was conducted to clarify the therapeutic effect of cornuside on experimental autoimmune encephalomyelitis (EAE) and its influence on T helper 17 (Th17) cell and regulatory T (Treg) cell infiltration into the central nervous system. Rats were randomly placed into four treatment groups: control, EAE, EAE+cornuside, and EAE+prednisolone. The neurological function scores of rats were assessed daily. On the second day after EAE rats began to show neurological deficit symptoms, the four groups were treated with normal saline, normal saline, cornuside (150 mg/kg), and prednisolone (5 mg/kg), respectively. The treatment was discontinued after two weeks, and the spinal cord was obtained for hematoxylin and eosin (H&E) and luxol fast blue staining, as well as retinoic acid receptor-related orphan receptor γ (RORγ) and forkhead box protein P3 (Foxp3) immunohistochemical staining. Blood was collected for Th17 and Treg cell flow cytometry testing, and the serum levels of interleukin (IL)-17A, IL-10, transforming growth factor-β (TGF-β), IL-6, IL-23, and IL-2 were measured via enzyme-linked immunosorbent assay (ELISA). Compared with rats in the EAE group, rats in the EAE+cornuside and EAE+prednisolone groups began to recover from neurological deficits earlier, and had a greater degree of improvement of symptoms. Focal inflammation, demyelination, and RORγ-positive cell infiltration were reduced by cornuside or prednisolone treatment, whereas the Foxp3-positive cell numbers were not significantly different. Meanwhile, the number of Th17 cells and the IL-17A, IL-6, and IL-23 levels were lower in the blood after cornuside or prednisolone treatment, whereas the number of Treg cells or the levels of IL-10, TGF-β, and IL-2 were not markedly different. Cornuside can alleviate symptoms of EAE neurological deficits through its anti-inflammatory and immunosuppressive effects, and Th17 cells may be one of its therapeutic targets.
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Renal ischemia-reperfusion injury (IRI) commonly occurs in renal transplantation, which is an important pathophysiological process that causes acute renal failure and severely affects clinical prognosis of the recipients. Inflammatory response plays a critical role in the pathogenesis and pathological process of IRI. Activated NOD-like receptor protein 3(NLRP3) inflammasome can mediate the maturation and release of various pro-inflammatory cytokines, thereby regulating the inflammatory response and relevant cell functions. In this article, the mechanism underlying NLRP3 inflammasome and its related inflammatory signaling pathway in renal IRI were reviewed, aiming to provide novel ideas for clinical prevention and treatment of renal IRI.
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Objective:To investigate the efficacy of atenolol combined with perindopril in the treatment of chronic heart failure in older adult patients and its effects on ventricular function, serum connective tissue growth factor (CTGF), and nexin.Methods:120 older adult patients with chronic heart failure who received treatment in the Department of Cardiology, the First People's Hospital of Fuyang District from January 2016 to January 2018 were included in this study. They were randomly assigned to receive either basic treatment + atenolol treatment (control group, n = 60) or atenolol combined with perindopril treatment (observation group, n = 60). Clinical efficacy and clinical symptom, serum CTGF, nexin level and ventricular function pre- and post-treatment, as well as adverse reactions were compared between the control and observation groups. Results:After treatment, effective rate in the observation group was significantly higher than that in the control group (91.6% vs. 78.3%, χ2 = 4.183, P = 0.041). After treatment, CTGF and nexin levels in the control and observation groups were decreased compared with before treatment (both P < 0.05). After treatment, CTGF and nexin levels in the observation group were (4.42 ± 0.46) μg/L and (0.82 ± 0.03) μg/L, respectively, which were significantly lower than those in the control group [(4.82 ± 0.51) μg/L, (0.98 ± 0.04) μg/L, t = 18.153, 4.511, 19.335, 24.787, all P < 0.05]. After treatment, left ventricular end diastolic diameter and left ventricular end systolic diameter in the control and observation groups were deceased compared with before treatment (both P < 0.05). After treatment, left ventricular end diastolic diameter and left ventricular end systolic diameter in the observation group were (48.73 ± 4.41) mm and (41.13 ± 4.15) mm, respectively, which were significantly lower than those in the control group [(56.01 ± 4.67) mm, (47.45 ± 4.17) mm, t = 5.700, 8.799, 8.317, 8.351, all P < 0.05]. After treatment, left ventricular ejection fraction in the control and observation groups was significantly increased compared with before treatment. After treatment, left ventricular ejection fraction in the observation group was significantly higher than that in the control group [(44.86 ± 4.59) % vs. (39.05 ± 4.69) %, P < 0.05]. Conclusion:Atenolol combined with perindopril in the treatment of older adult patients with chronic heart failure can reduce clinical symptoms, improve ventricular function, decrease serum CTGF and nexin levels and is highly safe. Therefore, this method is worthy of clinical application.
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The maintenance of human pregnancy and the initiation of parturition are closely related with the dynamic balance of the maternal-fetal immune microenvironment. Implantation of the blastocyst into the maternal decidua is the first step in pregnancy establishment, which is favored by the abundant blood flow and the immunotolerant microenvironment maintained by the balance of immune cells. The parturition resembles an inflammatory response that includes secretion of cytokines by resident and infiltrating immune cells into reproductive tissues and the maternal-fetal interface, which promotes the delivery of fetus from maternal organism. Therefore, the immune microenvironment in maternal-fetal interface regulates the critical steps of pregnancy and parturition. When the maternal-fetal immune microenvironment is imbalanced or impaired, miscarriage or preterm labor would happen. This article reviews the roles and mechanisms of several important immune cells in the maternal-fetal interface during the parturition and preterm labor.
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Objective:To compare the clinical effects of oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative scoliosis.Methods:A retrospective study was performed in 116 patients with lumbar degenerative scoliosis and spinal stenosis, who were admitted to Beijing Jishuitan Hospital from January 2015 to May 2018. The patients were divided into two groups according to the surgical method. Among them, 56 patients underwent the OLIF approach (OLIF group), consisting of 21 men and 35 women, with an average age of 65.2±8.7 years. According to Lenke-Silva classification, there were 41 cases of type II and 15 cases of type III in OLIF group. 60 cases underwent the TLIF approach (TLIF group), consisting of 19 men and 41 women, with an average age of 61.3±11.6 years. There were 43 cases of type II and 17 cases of type III in TLIF group. The preoperative and last follow up visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups. The coronal and sagittal Cobb angle changing and the offset distance for apical midline of the lumbar vertebrae between pre-operation and last follow-up were measured. The respective complications of the two groups were collected.Results:For OLIF group, VAS decreased from 7.7±1.6 at pre-operation to 1.9±1.5 at the last follow up; for TLIF group, VAS decreased from 8.1±1.2 at pre-operation to 2.2±0.9 at the last follow up. Although there were obvious improve for both group compared pre-operation to last follow-up, there was no significant difference between the two groups. For OLIF group, ODI decreased from preoperative 47.5%±9.1% to last follow up 22.4%±6.7%; for TLIF group, ODI decreased from preoperative 52.6%±5.8% to last follow up 25.1%±8.4%. Obvious changes were foundin both group between pre-operation and last follow up, but there was no significant difference between the two groups. For sagittal lumbar cobb angle, OLIF group changed from preoperative 8.6°±5.7° to last follow-up 23.6°±4.3°. TLIF group changed from pre-operation 9.2°±4.2° to last follow-up 21.3°±4.8°. Obvious changes were found in both group between pre-operation and last follow up, while OLIF group had better improvement than TLIF group ( P=0.01). For lumbar coronal Cobb angle, OLIF group changed from preoperative 16.4°±9.6° to last follow-up 2.8°±2.1°, and TLIF group from preoperative 15.2°±7.8° to last follow-up 6.4°±2.7°. Obvious changes were found in both group comparing pre-operation to last follow up, while OLIF group had better improvement. The offset distance for apical midline of the lumbar vertebrae in OLIF group improved from preoperative 26.3±9.4 mm to 4.3±1.9 mm; TLIF group improved from preoperative 23.4±5.5 mm to 7.5±4.2 mm. Obvious changes were found between pre-operation and last follow up for both group, while OLIF group has better improvement compared to TLIF group ( t=-5.26, P=0.03). The fusion rate was 97.7% (127/130) in OLIF group, and 91.1% (164/180) in TLIF group. There was no statistically significant difference between the two groups ( χ2=1.15, P=0.097). The neural complication rate was 16.1% (9/56) in OLIF groupand 8.3% (5/60) in TLIF group. There was no statistical difference between the two groups ( χ2=1.63, P=0.201). The cage subsidence was 12.3% (16/130) in OLIF group and 21.9% (35/180) in TLIF group. There was statistically significant difference between the two groups ( χ2=4.53, P=0.03). Conclusion:OLIF can be considered as an effectivesurgical option for the treatment of lumbar degenerative scoliosis with spinal stenosis, since it can achieve similar clinical effects and better correction of coronal and sagittal imbalances compared to TLIF.
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Objective:To observe the effects of Shexiang Wulong pill on serum interleukin-1 (IL-1), transforming growth factor-β(TGF-β1), matrix metalloproteinase-3 (MMP3), matrix tissue inhibitors of metalloproteinase 1(TIMP-1) in patients with knee osteoarthritis (KOA) expression.Methods:Using prospective cohort study method, the subjects were KOA patients from Department of Rheumatology and Immunology clinic of North China University of Science and Technology Affiliated Hospital from March 2016 to June 2018.According to random number table The patients were divided into two groups: the treatment group (treated with shexiangwulong pill) with 46 cases and the control group (Kanggu Zengsheng tablet) with 46 cases.The treatment group was treated with Shexiang Wulong pill, 30 capsules per time, twice a day; the control group was treated with Kanggu Zengsheng tablet, four tablets per time, twice a day.The treatment period was 8 weeks.The levels of IL-1, TGF-β1, MMP3 and TIMP-1 in the serum of the patients in the treatment group and the control group were measured by enzyme-linked immunosorbent assay, and the differences of relevant indexes between the two groups were statistically analyzed.Results:Forty-six cases were completed in the treatment group and 44 cases were completed in the control group.After treatment with Shexiang Wulong pill and Kanggu Zengsheng tablet, the levels of IL-1 were (30.99±2.80) μg/L, (32.90±2.84) μg/L in the treatment group and the control group, resectively( t=3.21, P<0.001). There was no significant difference of TGF-β1 levels between the treatment group((214.87±17.30) μg/L) and the control group ((208.85±15.53) μg/L, ( t=1.73, P=0.08). The levels of TIMP-1 were (139.60±6.79) μg/L, (135.09±6.16) μg/L in the treatment group and the control group, resectively( t=3.29, P<0.001). The levels of MMP3 were (1.19±0.10) μg/L, (1.23±0.06) μg/L in the treatment group and the control group, resectively ( t=2.28, P=0.03). The rate of TIMP1/MMP3 were 111.04±8.81, 118.46±12.06 in the treatment group and the control group, resectively( t=3.34, P<0.001). Conclusion:Shexiang Wulong pill can decrease the levels of IL-1 and MMP-3, and increase the levels of TGF-β1, TIMP-1, and the rate of TIMP1/MMP3, so as to protect the articular cartilage and improve the knee joint function in patients with KOA.
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Objective To explore the value of C-arm CT in transjugular intrahepatic portosystemic shunt (TIPS).Methods Between June 2015 and October 2017,a total of 16 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertention in our center were retrospectively enrolled in the study.Abdominal enhanced CT was routinely performed before surgery.Postprocessing images of portal vein were used as a guidance of TIPS in real time after integrated with intraoperative c-arm CT images during selective operations.Results The success rate of C-arm CT-guided TIPS was 100％.Portal vein angiography showed the position basically consistent with CT matched images reference position.No obvious abdominal hemorrhage,injury of biliary tract and other complications occurred in all patients.The mean number of needle passes was 2.1 ±0.9 passes(range of 1.0-4.0 passes),the mean time of portal vein entry was 4.3 ± 1.9 min (range of 2.0-8.0 min),the mean fluoroscopy period was 22.6 ± 4.8 min (range of 17.0-32.0 min),DAP was (256.2± 96.7)mGy/cm2.Conclusion C-arm CT-guided TIPS is technically feasible and safe.
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Objective@#To determine imaging features that may help predict the presence of placenta accreta, placenta increta or placenta percreta on prenatal MRI scanning in order to identify the most diagnostic findings.@*Methods@#The prenatal MRI scan data of placenta accreta, placenta increta or placenta percreta (placenta implantation group, n=15) and normal placenta(placenta normal group, n=15) diagnosed and treated by surgical pathology from January 2010 to December 2017 in the People's Hospital of Huadu District were retrospectively analyzed.Two expert MRI doctors were blinded to the patients' true diagnosis and were asked to score a total of 10 MRI features of the placenta and adjacent structures.The interrater reliability was assessed using kappa statistics.The features with a moderate kappa statistic or better(kappa>0.40 ) were then compared with the true diagnosis for each observer.@*Results@#Eight of the scored features had an interobserver reliability of kappa>0.40: placenta previa(κ=0.89); abnormal uterine bulging(κ=0.57); intraplacental hemorrhage(κ=0.45); the presence of dark intraplacental bands on T2W imaging(κ=0.76); flow-empty blood vessels in placenta(κ=0.67); border on placenta and uterus blurring(κ=0.63); heterogeneity of signal intensity on T2-weighted(T2W) imaging(κ=0.53); and continuity of myometrium was interrupted(κ=0.64). Using Fisher's two-sided exact test, there were statistically significant differences between the proportion of patients with placental invasion and those without placental invasion for three of the features: abnormal uterine bulging(P=0.015, P=0.011); heterogeneity of T2W imaging signal intensity(P=0.006, P=0.013); and presence of dark intraplacental bands on T2W imaging(P=0.032, P=0.010).@*Conclusion@#MRI can be a useful adjunct to ultrasound in diagnosing placenta accreta prenatally.Three features that are seen on MRI in patients with placental invasion appear to be useful for diagnosis: uterine bulging; heterogeneous signal intensity within the placenta; and the presence of dark intraplacental bands on T2W imaging.
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Objective@#To evaluate the response of neoadjuvant chemotherapy on osteosarcoma by semi-quantitative parameters of dynamic contrast-enhancement magnetic resonance imaging (DCE-MRI).@*Methods@#Retrospectively analysis 25 cases of osteosarcoma confirmed by pathology.All cases received DCE-MRI scan before and after 4 cycles of neoadjuvant chemotherapy.The following semi-quantitative parameters were calculated by post-processing software: early dynamic enhancement wash-in slope (Slope), maximum signal intensity (SImax), time to peak (TTP), signal enhanced extent (SEE), peak percent enhancement (PPE), wash out rate (WOR), enhancement rate (R). All cases were divided into good response group (tumor necrosis rate ≥90%, n=12) and non-response group (tumor necrosis rate <90%, n=13) according to the Huvos grading method. Semi-quantitative parameters of DCE-MRI before and after neoadjuvant chemotherapy between good response group and non-response group were compared by Mann-whitney U test. Receiver operating characteristic curve (ROC) analysis was performed to evaluate the efficacy of different good response group and non-response group after neoadjuvant chemotherapy (NAC).@*Results@#Slope, SImax, TTP, SEE, PPE, WOR, R, TTP, WOR before and after NAC in good response group were significant different (P<0. 05), but only SImax, SEE in non-response group. TTP, R were significant different between the above two groups before NAC, and Slope, SImax, TTP, SEE, WOR, R were significant different after NAC (P<0.05). ROC was used to predict the diagnostic efficiency of various parameters for tumor necrosis rate after osteosarcoma NAC. It was found that the sensitivity and specificity of Slope, TTP and R parameters for predicting the response of osteosarcoma after chemotherapy were 83.3% and 92.3%, 91.7% and 69.2%, 84.6% and 75.0% respectively. The area under the curve (AUC) were 0.872 (95% CI: 0.716 to 1.027), 0.846 (95% CI: 0.685 to 1.007), 0.833 (95% CI: 0.662 to 1.004), the cut-off value were 0.032, 175 s, 5.441, Youden index were 0.756, 0.609, 0.596, respectively.@*Conclusions@#Slope, TTP, R were the most valuable semi-quantitative parameter of DCE-MRI to predict the response of NAC in osteosarcoma.
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Objective To evaluate the response of neoadjuvant chemotherapy on osteosarcoma by semi-quantitative parameters of dynamic contrast-enhancement magnetic resonance imaging (DCE-MRI).Methods Retrospectively analysis 25 cases of osteosarcoma confirmed by pathology.All cases received DCE-MRI scan before and after 4 cycles of neoadjuvant chemotherapy.The following semi-quantitative parameters were calculated by post-processing software:early dynamic enhancement wash-in slope (Slope),maximum signal intensity (SImax),time to peak (TTP),signal enhanced extent (SEE),peak percent enhancement (PPE),wash out rate (WOR),enhancement rate (R).All cases were divided into good response group (tumor necrosis rate ≥90％,n =12) and non-response group (tumor necrosis rate ＜90％,n =13) according to the Huvos grading method.Semi-quantitative parameters of DCE-MRI before and after neoadjuvant chemotherapy between good response group and non-response group were compared by Mannwhitney U test.Receiver operating characteristic curve (ROC) analysis was performed to evaluate the efficacy of different good response group and non-response group after neoadjuvant chemotherapy (NAC).Results Slope,SImax,TTP,SEE,PPE,WOR,R,TTP,WOR before and after NAC in good response group were significant different (P ＜ 0.05),but only SImax,SEE in non-response group.TTP,R were significant different between the above two groups before NAC,and Slope,Simax,TTP,SEE,WOR,R were significant different after NAC (P ＜ 0.05).ROC was used to predict the diagnostic efficiency of various parameters for tumor necrosis rate after osteosarcoma NAC.It was found that the sensitivity and specificity of Slope,TTP and R parameters for predicting the response of osteosarcoma after chemotherapy were 83.3％ and92.3％,91.7％ and 69.2％,84.6％ and 75.0％ respectively.The area under the curve (AUC)were 0.872 (95％ CI:0.716 to 1.027),0.846 (95％ CI:0.685 to 1.007),0.833 (95％ CI:0.662 to 1.004),the cut-off value were 0.032,175 s,5.441,Youden index were 0.756,0.609,0.596,respectively.Conclusions Slope,TTP,R were the most valuable semi-quantitative parameter of DCE-MRI to predict the response of NAC in osteosarcoma.
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OBJECTIVE： To establish the quality standard for Bushen quyu granules. METHODS： TLC was used for qualitative identification of Rosa laevigata， Cuscuta chinensis， processed Fallopia multiflora and Lithospermum erythrorhizon in Bushen quyu granules. And then， the content of total polysaccharides in Bushen quyu granules was determined by UV spectrophotometry. HPLC method was used for the content determination of rutin， quercetin and hyperin in Bushen quyu granules. The determination was performed on BDS C18 column with mobile phase consisted of acetonitrile-0.08％ phosphoric acid solution （gradient elution） at the flow rate of 1 mL/min. The column temperature was 30 ℃， and detection wavelength was set at 370 nm. The sample size was 10 μL. RESULTS： TLC test sample chromatogram of 4 medicinal materials showed the same spot or fluorescence at the corresponding position with the reference substance and control medicinal materials. The linear range of glucose， rutin， quercetin and hyperin were 0.003-0.018 mg/mL， 0.225-7.20 μg/mL， 0.07-2.24 μg/mL and 1.25-39.88 μg/mL（r＝0.999 5 or 0.999 9， n＝6）. RSDs of precision， stability and reproducibility tests were all less than 3％ （n＝6）. Average recoveries were 102.2％， 101.2％， 100.9％， 101.0％ （RSD＝1.28％， 2.93％， 2.41％， 1.59％， n＝6）. Average contents were 0.46 g/g， 5.48 μg/g， 8.18 μg/g and 102.88 μg/g（n＝3）. CONCLUSIONS： Established quality standard of Bushen quyu granules is accurate and reliable， and can provide scientific reference for quality control of Bushen quyu granules.
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Objective To investigate the clinical efficacy and safety of transcatheter arterial chemoembolization(TACE) before percutaneous microwave ablation(MWA) on liver cancer in elderly patients.Methods Eighty elderly patients with primary liver cancer admitted into our hospital from January 2015 to December 2017 were randomly divided into the MWA group(n=32)and the MWA combined with TACE group(n=48).The MWA group received percutaneous microwave ablation,and the MWA combined with TACE group were treated with transcatheter arterial chemoembolization before percutaneous microwave ablation.The therapeutic effects were compared between groups.Results The total effective rate was increased in the MWA combined with TACE group vs.MWA group(79.2％ vs.56.3％,x2 =7.064,P =0.008).The proportion of patients who presented with serum AFP level ＞200 mg/L had no significant difference between the combination group and the MWA group(68.8％ vs.70.8％,x2 =0.040,P =0.842).While,after treatment,the proportion of patients who presented with serum AFP level decreased by ＞ 50％ was higher in the combination group than in the MWA group(79.2％ vs.56.3％,x2 =7.064,P =0.008).There was no significant difference in the incidences of adverse reactions between the two groups (P ＞ 0.05).Conclusions Compared with percutaneous microwave ablation,transcatheter arterial chemoembolization combined with percutaneous microwave ablation has a better efficacy and higher safety.