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Objective:To compare the clinical efficacy and cost of robot-assisted laparoscopic adrenalectomy with da Vinci Xi and Si surgical system in the treatment of adrenal tumors.Methods:The clinical data of 99 patients performing robotic-assisted laparoscopic adrenalectomy in our hospital between June 2019 and December 2020 were retrospective analyzed. Among them, 57 cases were Si system robot assisted laparoscopic adrenalectomy (group Si), 35 male, 22 female; age (45.6±14.0)years; BMI(21.0±1.2); 6 with diabetes, 10 hypertension, 14 with abdominal surgery; 28 left, 29 right; 9 ASA score ≥3; tumor diameter (3.9±1.2)cm. There were 42 cases of Xi system robot-assisted laparoscopic adrenalectomy (group Xi), 21 male, 21 female; age(44.8±14.5)years; BMI(21.4±1.8); 2 with diabetes, 12 hypertension, 11 with abdominal surgery; 15 left, 27 right; 7 with ASA score ≥3; tumor diameter (3.7±1.1) cm. Sex, age, BMI, comorbidities, history of abdominal surgery, lateral division, ASA score, and tumor diameter were not significantly different between the two groups ( P>0.05). Operation method: except for the different docking procedures, the same surgical procedures were roughly performed in the two groups. The docking method of the Si group was the doctor holding the attractor as the guide. The operating room nurse introduced the robot cart under the guidance of the attractor, and then completed the docking.Group Xi docking adoptd the own laser positioning system of the robot system, without manual positioning and guidance; the mechanical arm of the Xi system was also more flexible. Complications were graded according to the Clavien-Dindo grading system. Comparing the treatment effect, safety, and cost of the two groups were compared. Results:The anesthesia times in the Si and Xi groups were (140.0±24.3) min and (125.6±26.4) min ( P=0.006), respectively. The surgical times in the Si and Xi groups were (109.0±18.8) min and (98.8±20.7) min (P=0.013), respectively. The docking times between the Si and Xi groups were (7.8±1.4) min and (5.0±0.9) min ( P<0.001), respectively. The estimated intraoperative blood loss in the Si and Xi groups was (121.5±70.8) ml and (124.7±68.9) ml ( P=0.824), respectively. The postoperative indwelling times of the drainage tube in the Si and Xi groups were (3.4±1.2) d and (3.4±1.3) d ( P=0.892), respectively. Postoperative bed times in the Si and Xi groups were (2.3±1.0) d and (2.5±1.2) d ( P=0.419), respectively. Postoperative hospitalization times in the Si and Xi groups were (6.4±1.5) d and (6.2±1.5) d ( P=0.484), respectively. Post Clavien ≥ grade 3 complications were four and two in groups Si and Xi, respectively ( P=0.642). The total cost during hospitalization in the Si and Xi groups was (51 975.2±7 320.8) Yuan and (56 830.9±8 392.5) Yuan, respectively ( P=0.003). The surgery and consumables costs for the Si and Xi groups were (23 785.3±4 063.1) Yuan and (28 021.2±6 066.8) Yuan ( P<0.001), respectively. Conclusions:Compared with the Si system, the Xi system robot-assisted laparoscopic adrenalectomy can provide similar perioperative results and safety, and shorten the time of anesthesia and surgery, but the total cost of hospitalization is increased.
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【Objective】 To evaluate the efficacy and safety of human coagulation factor Ⅷ developed by Shenzhen Weiguang Biological products Co, Ltd in the treatment of patients with hemophilia A. 【Methods】 A prospective, multi-center, open, single-group clinical study was conducted. A total of 65 subjects with hemophilia A were enrolled, and human coagulation factor Ⅷ(FⅧ) was injected according to the patients’ bleeding severity. The improvement score of bleeding symptoms and signs after the first infusion of the first bleeding event and the transfusion efficiency of FⅧ activity at 10 min and 1 hour after infusion were taken as the main efficacy indexes. The improvement scores of bleeding symptoms and signs after the first infusion and the increase of FⅧ activity at 10 min and 1 hour after infusion were the secondary efficacy indexes. 【Results】 The 65 subjects were enrolled in safety analysis set (SS) and full analysis set (FAS), and 58 of them were enrolled in protocol analysis set (PPS). Ten minutes and one hour after the first infusion, the level of factor Ⅷ activity in the subjects increased significantly, and the FⅧ activity increased by 100% or more in more than 79% of the subjects. The average infusion efficiency of FⅧ activity in all subjects was more than 100%. In 70% of the subjects, the pain was relieved rapidly and /or the bleeding symptoms were significantly improved 8 hours after each bleeding infusion, and the improvement rate of bleeding symptoms and signs reached 100% 72 hours after infusion. 【Conclusion】 After infusion of human coagulation factor Ⅷ, the activity level of factor Ⅷ in patients with hemophilia A significantly increased. The infusion efficiency can reach a optimal level, and the bleeding symptoms can be significantly improved.
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BACKGROUND: Exhaustive exercise is a vigorous physical activity performed by an organism beyond its physiological limits, and it causes a series of histological changes in the body. Myocardial exercise-induced oxidative stress injury means that the organism generates free radicals through oxidative stress signal pathway to damage myocardial cells under exhaustive exercise. OBJECTIVE: To explore the mechanism of oxidative stress injury in rat myocardium caused by one-time exhaustive exercise based on the protein kinase C (PKC)/ NOX pathway. METHODS: Thirty adult male Sprague-Dawley rats were randomly divided into a control group, an exhaustive exercise group, and an exhaustive exercise+drug group, with 10 rats in each group. The exhaustive exercise+drug group was injected with PKC inhibitor chelerythrine (5 mg/kg body weight) for 3 consecutive days. Rats in the two exercise groups exercised at a speed of 25 m/min on a 0° incline treadmill until exhaustion. Immediately after exercise, blood sample was collected from each rat, and then the rat’s left ventricle was removed for hematoxylin-eosin staining to observe the morphological changes of myocardial cells. Serum and myocardial malondialdehyde and myocardial reactive oxygen species levels were detected. The protein expressions of PKC, NOX2, NOX4 and 3-NT in rat myocardial tissue were determined by western blot. RESULTS AND CONCLUSION: The myocardial tissues in the exhaustive exercise and exhaustive exercise+drug groups were damaged, but the damage was significantly eased in the exhaustive exercise+drug group compared with the exhaustive exercise group. Compared with the control group, the reactive oxygen species level in the myocardial tissue of the exhaustive exercise group increased significantly (P < 0.05). Compared with the control group, the content of malondialdehyde in the myocardial tissues of the exhaustive exercise and exhaustive exercise+drug groups was significantly increased (P < 0.01), and the concentration of serum malondialdehyde in the exhaustive exercise group was significantly increased (P < 0.05). Compared with the control group, the expression levels of PKC, NOX2, NOX4 and 3-NT proteins in the myocardium of rats after exhaustive exercise were significantly increased (P < 0.01). Compared with the exhaustive exercise group, the expression levels of NOX2 and NOX4 in the myocardial tissue of rats significantly decreased in the exhaustive exercise+drug group (P < 0.01), and the expression of 3-NT significantly decreased (P < 0.05). Therefore, one-time exhaustive exercise can activate PKC and increase its protein expression in rat myocardial cells, which in turn induces an increase in the expression of NOX2 and NOX4 proteins in the myocardium, catalyzes the generation of large amounts of reactive oxygen species, and leads to the excessive production of peroxynitrite anions, thereby causing oxidative damage to the myocardium.
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【Objective】 To establish and evaluate a nephelometric assay for the determination of immunoglobulin A (IgA) residues in human intravenous immunoglobulin(IVIG). 【Methods】 BN ProSpec© automatic protein analyzer and its supporting immunoglobulin A determination kit (nephelometry) produced by German Siemens and the national standard of human IgA were used to establish the nephelometric assay to determine IgA residue in test products and verify the methodology. The test products include IVIG (pH4) prepared by low-temperature ethanol protein separation process and a novel IVIG prepared by chromatography. 【Results】 The average deviation of three calibration curves for IgA residues determination by the nephelometric assay were 1.08%, 0.95% and 1.54%,, and the three deviations of the quality control were 4.00%, -2.30% and -0.20%, respectively, which indicated good calibration and quality control. In the specificity test, the average recovery rates of IgA for reference substance 1 containing 100g/L maltose and reference substance 2 containing 20g/L glycine were 102.7% and 105.8%, respectively. The relative standard deviation (RSD) values of the repeatability tests of the two test products were 3.9% and 1.9%, and the RSD values of the intermediate precision test were 3.6% and 2.3%, respectively.The difference values at each time point in the durability test of test products′ storage time were all less than 10%, and the RSD values of the two test products in the durability test of kits of different batches were 2.8% and 2.2%, respectively. In the accuracy test, the average recovery rates of IVIG (pH4) added to the standard were 94.2%, 101.7% and 96.2%, respectively, and the average recovery rates of the novel IVIG added to the standard were 102.8%, 106.3% and 99.7%, respectively. The average recovery rate of the limit quantification test was 101.0%, and the RSD was 4.0%. 【Conclusion】 Nephelometric assay has the advantages of strong specificity, high precision and accuracy, good repeatability, simple and rapid operation, and automation, and can be used for the determination of IgA residue in IVIG (pH4) and novel IVIG products.
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Objective:To compare the therapeutic effects and safety of dexmedetomidine and midazolam on patients with severe coronavirus disease 2019 (COVID-19) who received non-invasive ventilation.Methods:Patients with COVID-19 who needed non-invasive ventilation in one critical care medicine ward of Wuhan Jinyintan Hospital during the team support period from the department of critical care medicine of Renmin Hospital of Wuhan University from January 23rd to February 15th in 2020 were investigated retrospectively. Ramsay score, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), arterial oxygen partial pressure (PaO 2) before sedation and at 1, 12, 24 hours after sedation, sleep time were collected, and the side effects such as excessive sedation, fall of tongue, abdominal distension, aspiration, bradycardia, escalation to invasive mechanical ventilation during 24 hours were also collected. According to different sedative drugs, patients were divided into the control group (without sedative drugs), dexmedetomidine group and midazolam group. The changes of indicators among the three groups were compared. Results:Fourteen patients were injected with dexmedetomidine (loading dose of 1 μg/kg for 10 minutes, maintained at 0.2-0.7 μg·kg -1·h -1); 9 patients were injected with midazolam (loading dose of 0.05 mg/kg for 2 minutes, maintained at 0.02-0.10 mg·kg -1·h -1); 12 patients didn't use sedative drugs due to limitations of previous hospital or patients' rejection. In dexmedetomidine group and midazolam group, the Ramsay score was maintained at 2-3 points after sedation, which were higher than those of control group at different time points after sedation, and there was no significant difference between dexmedetomidine group and midazolam group. MAP of dexmedetomidine group and midazolam group decreased gradually after sedation. MAP after 1-hour sedation was significantly lower than that before sedation, and MAP after 24 hours sedation was significantly lower than that in the control group [mmHg (1 mmHg = 0.133 kPa): 109.7±11.5, 107.1±12.3 vs. 121.1±13.3, both P < 0.05]. HR decreased gradually after sedation treatment, which was significantly lower after 12 hours of sedation than that before sedation, and HR in dexmedetomidine group was significantly lower than that in control group after 12 hours of sedation (bpm: 84.0±13.9 vs. 92.8±15.4 at 12 hours; 81.0±16.7 vs 92.6±12.7 at 24 hours, both P < 0.05). PaO 2 increased and RR decreased in all three groups after ventilation. PaO 2 in dexmedetomidine group and midazolam group were significantly higher than that in the control group after 12 hours of sedation [cmH 2O (1 cmH 2O = 0.098 kPa): 79.0±6.5, 79.0±8.9 vs. 70.0±7.8, both P < 0.05]; the decreases of RR in dexmedetomidine group and midazolam group were significant than that in control group after 1 hour of sedation (bpm: 34.0±3.9, 33.8±4.6 vs. 39.0±3.6, both P < 0.05). There were no differences of MAP, HR, PaO 2 and RR between dexmedetomidine group and midazolam group at different time points. The sleep duration in dexmedetomidine group and midazolam group were significantly longer than that in the control group (hours: 4.9±1.9, 5.8±2.4 vs. 3.0±1.8, both P < 0.05), but there was no difference between dexmedetomidine group and midazolam group ( P > 0.05). Adverse events occurred in all three groups. In midazolam group, there were 2 cases of excessive sedation with fall of tongue and abdominal distension, including 1 case of aspiration, 1 case receiving intubation due to refractory hypoxemia and 1 case due to unconsciousness. In dexmedetomidine group, there were 2 cases of bradycardia, 1 case of intubation due to refractory hypoxemia. In control group, 4 cases underwent intubation due to refractory hypoxemia. Conclusions:Non-invasive mechanical ventilation is an important respiratory support technology for patients with severe COVID-19. Appropriate sedation can increase the efficiency of non-invasive mechanical ventilation. Dexmedetomidine is more effective and safer than midazolam in these patients, but attention should be paid to HR and blood pressure monitoring.
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Objective To investigate the efficacy and prognosis of using midazolam combined with atracurium for treatment of a patient with super-refractory status epilepticus (SRSE) and coma. Methods A case of SRSE and coma admitted to the Department of Critical Care Medicine of Renmin Hospital of Wuhan University in May 2018 was enrolled. The symptoms, signs, laboratory examinations and treatment process were summarized, and combined with the literature review, the therapeutic course and prognosis were analyzed. Results A male patient, 24 years old, had convulsions after 4-day fever, blood routine, blood biochemistry, coagulation function and infection indexes were basically normal on admission. There was no obvious abnormality in cerebrospinal fluid examination; blood pathogenic microorganism examination suggested that viral infection possibly occur. Electroencephalogram (EEG) showed that the lesions involved the right frontal pole-frontal area-temporal area; cranial magnetic resonance imaging (MRI) suggested that sinusitis and meningeal and hippocampal infections might be present. Although several antiepileptic drugs had been used, the convulsions could not be controlled, after combined with the application of midazolam and atracurium, the convulsions were controlled, in the mean time, antiviral drug, glucocorticoid and immunoglobulin and therapies for prevention of complications were applied. Forty-three days later, the patient's consciousness was recovered and muscle strength was gradually improved. Conclusion The combination of midazolam and atracurium is effective for controlling epileptic activities and alleviating sequelae in patients with SRSE and coma.
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Objective To explore the clinical efficacy of intensity-modulated radiotherapy combined with chemotherapy in the treatment of advanced cervical cancer.Methods All 121 patients with advanced cervical cancer (stage Ⅱ B &Ⅲ A & Ⅲ B) selected in our hospital from June 2012 to June 2014, who were treated with combined chemoradiotherapy, were divided into observation group [intensity modulated radiation therapy (IMRT)group)] and control group [3-dimensional conformal radiation therapy (3D-CRT) group].There was no significant difference between two groups in mean age, body mass index, International Federation of Gynecology and Obstetrics (FIGO) clinical stage, pathological type and chemotherapy mode (P ＞ 0.05).The clinical features of two groups were compared.The treatment and follow-up of two groups were recorded.Results The bone marrow suppression [32.2％ (19/59) vs 51.6％ (32/ 62)], gastrointestinal reaction [42.4％ (25/59) vs 62.9％ (39/62)], and rectal reaction rate [27.1％ (16/59) vs 45.2％ (28/62)] of the observation group were significantly less than that of the control group (P ＜ 0.05).The incidences of genitourinary tract injury [18.6％ (11/59) vs 24.2％ (15/62)], radiation proctitis [23.7％ (i4/59) vs 25.8％ (16/62)] and radiation cystitis [16.9％ (10/59) vs 20.9％ (13/ 62)] of two groups had no significant difference (P ＞ 0.05).Two groups were followed up for 3 years, the local control rate of the observation group was significantly higher than that of the control group (86.3％ vs 70.1％) (P ＜ 0.05).Conclusions IMRT combined with chemotherapy in the treatment of advanced cer vical cancer can improve the local control rate of tumor, protect the endangered organ, and reduce the side effects of radiotherapy.
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Purpose To investigate the diagnostic criteria and value of angle parameters in female stress urinary incontinence (SUI),and to provide an objective basis for clinical diagnosis of SUI.Materials and Methods In retrospective analysis,138 patients with SUI diagnosed by clinic from December 2014 to December 2016 were selected as the study group,while 100 normal females receiving the routine medical examination were selected as the control group.All subjects in both groups were examined by pelvic floor ultrasound to observe the urethral inclination angle,urethral rotation angle (URA) and posterior urethrovesical angle (PUVA) to obtain the standard in diagnosis of female SUI.30 SUI patients from January to February 2017 were prospectively analyzed,and the above results were verified to evaluate their value in the diagnosis of SUI.Results There was no significant difference in age,body mass index,gravidity and parity history and resting state PUVA between the two groups (P＞0.05).There was significant difference in the resting state urethral inclination angle,Valsalva urethral inclination angle,PUVA and URA between the two groups (P＜0.05).The receiver operating characteristic curve was used to find the cut-off value of SUI:urethral inclination angle in resting state ＜14.5°,urethral inclination angle in Valsalva state ＞32.5 °,and URA ＞49.5 °,PUVA ＞154.5 °,with their sensitivity of 62％,73％,67％ and 57％,respectively;the specificity of 61％,84％,82％ and 70％,respectively;and the area under the curve of 0.633,0.809,0.768 and 0.658,respectively.By verification,when the urethral inclination angle was 14.5° in the resting state,the coincidence rate of the diagnosis of SUI was 63％;when the urethral inclination angle of Valsalva was 32.5°,83％;when the URA was 49.5°,77％;when the PUVA was 154.5 °,60％.Conclusion Pelvic floor ultrasound can clearly observe angle parameters of females,the determination of the cut-off value of ultrasound is helpful for clinical diagnosis and evaluation of SUI,and the urethral inclination angle in Valsalva state and URA are of high diagnostic value in the diagnosis of female SUI,providing an objective basis for clinical diagnosis of SUI.
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Objective To explore the effects of miRNA-204 targeted LC3B expression on Ang Ⅱ induced cardiomyocytes hypertrophy.Methods The primary neonatal rat cardiomyocytes served as the research objects and divided into the control group,AngⅡ group,combination-treated group 1 (cardiomyocytes were given Ang Ⅱ stimulation,meanwhile infected by negative control lentivirus vector),combination-treated group 2 (cardiomyocytes were given Ang Ⅱ stimulation,meanwhile infected by lentivirus carrying miRNA-204 overexpression vector) according to different treatments.About 48 h to 72 h after intervention treatment,the cardiomyocyte hypertrophy change was detected by confocal microscopy,the expression of miRNA-204 was analyzed by real time PCR,the protein expression of LC3B was measured by Western blot and targeted gene of miRNA-204 was demonstrated by dual-luciferase reporter assay system.Results Compared with the control group,the cardiomyocyte relative surface area in the Ang Ⅱ group was significantly enlarged,the protein expression of LC3B was significantly increased,the expression of miRNA-204 was upregulated,the differences were statistically significant (P＜0.05).Whereas comparing the combination-treated group 1 with combination-treated group 2,the protein expression of LC3B in the latter was down-regulated and the cell area was reduced (P＜0.05).The further luciferase activity report gene experiment results suggested that miRNA-204 was able to bind to LC3B 3'-UTR and decreased the luciferase activities (P＜0.05),but not to bind its mutated fragment for inactivating luciferase activity(P＞0.05).Conclusion miRNA-204 is able to inhibit Ang Ⅱ induced cardiomyocytes hypertrophy,its action is realized by targeting the expression of LC3B.
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Objective To explore the effects of miR-34a and the alteration of AMPK/mTOR signal pathway on angiotensin (Ang)Ⅱ-stimulated cardiomyocytes hypertrophy. Methods Neonatal rat cardiomyocytes were cultrued in vitro and were divided into 3 groups:negative control for lentivirus carrying miR-34a group (NC), AngⅡplus lentivirus carrying negative control group (AngⅡ+NC) and AngⅡplus lentivirus carrying miR-34a group (AngⅡ+miR-34a). The relative cell area was detected by confocal microscopy. The expression of miR-34a and hypertrophy-related genes (ANP and β-MHC) were analyzed by real time PCR. The AMPK/mTOR signal pathway was measured by Western blot assay. Results Compared to NC group, the relative cell area was increased in AngⅡ+NC group (P<0.05). But compared with AngⅡ+NC group, the relative cell area was decreased in AngII+miR-34a group (P<0.05). Moreover, compared with NC group, the expression of miR-34a was decreased, and the expression of hyperthophy-related genes(ANP and β-MHC) was up-regulated in AngⅡ+NC group. However, the expression of miR-34a was decreased, and the expression of hyperthophy-related genes (ANP and β-MHC) was down-regulated (P<0.05). Finally, compared to NC group, the ratio of phosphop-AMPK/AMPK was significantly induced in AngII + NC group, but the ratio of phosphop-mTOR/mTOR was significantly decreased (P<0.05). However, compared to AngⅡ+NC group, the ratio of phosphop-AMPK/AMPK was significantly decreased in AngII + miR-34a group, but the ratio of phosphop-mTOR/mTOR was significantly increased (P<0.05). Conclusion miR-34a is able to inhibit myocardial hypertrophy of neonatal rat cardiomyocytes, and its mechanism is partly carried out by the alteration of the signal pathway of AMPK/mTOR.
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Objective To explore the effect and mechanism of renal denervation combined with Losartan on cardiac hypertrophy in spontaneous hypertensive rats. Methods Spontaneous hypertensive rats with cardiac hypertrophy underwent renal denervation combined with following 4 weeks drug treatments. Transthoracic two-dimensional guided M-mode echocardiography was performed. The expression of hypertrophy-related gene was detected. Left ventricularmass index was calculated and histological sectionsstained with hematoxylin and eosin (HE). Results The characteristics of cardiac hypertrophy was observed in left ventricular tissues with HE staining in12 weeks old spontaneous hypertensive rats.The thickness was increased in those ventricular (IVSs, IVSd, LVPWs and LVPWd). After4 weeks after treatment, histological improvements were observed in both RDN and R+L groups compared with sham group. The improvement was more obvious in R+L group. Similar results were observed in histological sections, ventricular thicknesses (IVSs, IVSd, LVPWs and LVPWd), related-hypertrophy genes (ANP and β-MHC) expression, left ventricular mass idex (LVMI) and the protein expression of inflammatory cytokines (TNF-α and IL-6). Conculsion Renal denervation therapy can improve hypertensive-induced cardiac hypertrophy in spontaneous hypertensive rats. The effect was more significant when combined with Losartan. The mechanism might be involved in inhibiting inflammatory cytokines.
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regulatory T cell(Treg)is a subset of immunosuppressive Th cell lines with ability to sup-press anti-tumor immunity. Tregs are recruited into local tumor microenvironment by tumor-released chemokine CCL22. Tregs induce Th2-type immune responses which contribute the host ignorance and tolerance to tumor cells via releasing of immunosuppressive cytokines and immunosuppressive receptors. Accumulating evidences indicate that inhibiting Treg can break immune tolerance,and subsequently inhibit the growth and progress of cancer. These discoveries and exploration of Treg provide us a new therapeutic target and strategy with promising clinic application.