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Objective:To investigate the characteristics and relationship between the location of lower extremity deep vein thrombosis (DVT) and the site of pulmonary embolism in hospitalized patients.Methods:The data of patients with lower extremity DVT diagnosed by ultrasound examination and pulmonary embolism diagnosed by CT pulmonary angiography from December 2017 to December 2021 were analyzed retrospectively. According to the location of lower extremity DVT, the patients were divided into mixed DVT, proximal DVT, and distal DVT which was further divided into anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis. Mixed DVT was referred to the presence of both proximal and distal DVT. According to the involved site of pulmonary artery, pulmonary embolism was divided into three types: main pulmonary artery, left or right pulmonary artery trunk embolism, lobar pulmonary artery embolism and segmental pulmonary artery embolism. The location of lower extremity DVT, the site of pulmonary embolism, the clinical manifestation (shortness of breath, chest tightness, chest pain, hemoptysis, cough, lower limb swelling, lower limb pain, syncope, fever) and risk factors (fracture/trauma, tumor, diabetes, hypertension, atrial fibrillation, infection, surgery, autoimmune diseases, paralysis, pregnancy) of venous thromboembolism (VTE), and the level of D-dimer were analyzed.Results:A total of 209 patients were enrolled finally, including 127 patients with left lower extremity DVT (60.8%) and 82 with right lower extremity DVT (39.2%). Mixed DVT accounted for 39.2%, proximal DVT accounted for 17.3%, and distal DVT accounted for 43.5% (anterior/posterior tibial vein and peroneal vein thrombosis accounted for 14.8%, calf muscular venous thrombosis accounted for 28.7%). The incidences of main pulmonary artery embolism, left or right pulmonary artery trunk embolism in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [41.5% (34/82), 38.8% (14/36) vs. 16.2% (5/31), 10.0% (6/60)], with statistically significant differences (all P < 0.05). The incidences of pulmonary segmental artery embolism in the anterior/posterior tibial vein or peroneal vein thrombosis were higher than those in the mixed DVT and proximal DVT [41.9% (13/31) vs. 26.8% (22/82), 30.6% (11/36)], but the difference was not statistically significant (both P > 0.05). The incidences of pulmonary segmental artery embolism in the calf muscular venous thrombosis were significantly higher than those in the mixed DVT and the proximal DVT [66.7% (40/60) vs. 26.8% (22/82), 30.6% (11/36)], and the difference was statistically significant (both P < 0.05). The levels of D-dimer in patients with calf muscular venous thrombosis combined with main pulmonary artery embolism, left or right pulmonary artery trunk embolism were significantly higher than those in patients with calf muscular venous thrombosis combined pulmonary segmental artery embolism (mg/L: 6.08±3.12 vs. 3.66±2.66, P < 0.05). There were no significant differences in D-dimer levels in other patients with DVT combined with pulmonary embolism in different sites. In terms of the clinical manifestations of VTE, the incidences of lower limb swelling in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [54.9% (45/82), vs. 29.0% (9/31), 15.0% (9/60), both P < 0.05], the incidences of lower limb swelling in the proximal DVT were significantly higher than those in the calf muscular venous thrombosis [41.7% (15/63) vs. 15.0% (9/60), P < 0.05], there were no significant difference in the other clinical manifestations among the DVT groups. There was no significant difference in the incidence of VTE risk factors among the groups. Conclusions:The DVT of inpatients mostly occurred in the left lower limb, and the incidence of distal DVT was higher than that of proximal DVT. Mixed DVT and proximal DVT combined with pulmonary embolism mostly occurred in the main pulmonary artery, left or right pulmonary artery trunk, while distal DVT combined with pulmonary embolism mostly occurred in the pulmonary segmental artery. The levels of D-dimer in patients with lower extremity DVT combined with main pulmonary artery or left and right pulmonary artery trunk embolism were higher than those in patients with pulmonary lobe and segmental artery embolism. The incidence of lower extremity swelling in patients with mixed DVT and proximal DVT was higher than that in patients with distal DVT.
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Hederin is a natural active component of triterpenoid saponins extracted from many medicinal herbs， such as Lithospermum erythrorhizon， Pulsatilla chinensis， and Clematis florida. It has attracted much attention from doctors for its anti-inflammatory， anti-convulsive， anti-oxidation and anti-leishmaniasis activities. Hederin has significant anti-tumor bioactivity and is expected to be a potential drug for the treatment of malignant tumors. The available studies have demonstrated that hederin can promote the apoptosis， inhibit the proliferation， metastasis， and invasion， and induce the autophagy of tumor cells， exhibiting a promising prospect in the treatment of breast cancer， lung cancer， liver cancer， and pancreatic cancer. Specifically， hederin can regulate the phosphoinositide 3-kinase/protein kinase B （PI3K/Akt） pathway， reactive oxygen species （ROS）， and microRNA （miRNA） to trigger tumor cell apoptosis. Its anti-proliferation activity is mainly reflected in the regulation of cyclin and cyclin-dependent kinase （CDK）. Hederin inhibits the metastasis and invasion of tumor cells by blocking epithelial-mesenchymal transformation （EMT）. In addition， hederin can influence metabolic reprogramming to induce tumor cell autophagy. Hederin is involved in a variety of pathways to exert its anti-tumor activity and may become a novel anti-tumor drug in the future， which give new sights into the study of hederin in the anti-tumor field. There are few studies about hederin and no systematic review of its anti-tumor mechanisms. Therefore， this study reviewed the studies about the anti-tumor mechanism of hederin， aiming to provide reference and information for researchers and clinical staff.
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Objective:To investigate the regulatory effect of miRNA-21-5p on peripheral blood B lymphocyte proliferation and apoptosis in systemic lupus erythematosus (SLE) patients by targeting program-med cell death protein 4 (PDCD4) .Methods:Thirty patients with SLE diagnosed clinically in our hospital were enrolled. Peripheral blood lymphocyte (PBL) was extracted by gradient centrifugation, and B cells were separated by magnetic beads. The proportion of B lymphocyte in peripheral blood was detected by flow cytometry. The cells were divided into five groups by electrotransfection: blank control group, miRNA-21-5p negative control (NC) group, miRNA-21-5p group and miRNA-21-5p inhibitor group, PDCD4 negative control group and PDCD4 siRNA group. Cells were collected 48 hours after transfection. The expression levels of miRNA-21 and PDCD4 were detected by real-time polymerase chain reaction (RT-PCR). Western blotting assay was used to detect the expression of PDCD4 in cells of each group. The targeting relationship between miRNA-21-5p and PDCD4 was verified by double luciferase target experiment. Flow cytometry was used to detect the apoptosis of cells in each group, and CCK-8 method was used to detect the proliferation of cells in each group. Western blotting and RT-PCR were used to detect the expression levels of Fas, FasL, CD40 and CD40L, respectively. Independent sample t test was used to compare the data between the two groups; single factor analysis of variance was used to analyze the results of multiple samples; chi square test was used to compare the positive rate of anti dsDNA antibody. Results:The levels of serum complement [C3 (0.85±0.11) g/L and C4 (0.54±0.09) g/L] in patients with SLE were lower ( t=7.524, P<0.05; t=38.471, P<0.05) than [C3 (1.16±0.17) g/L and C4 (1.57±0.09) g/L] in healthy controls. The levels of anti-dsDNA antibodies (47%), IgG(15.46±0.75) g/L, and IgA (2.68±0.20) g/L were increased than the levels of anti-dsDNA antibodies (17%), IgG (11.95±0.80) g/L, and IgA (2.16±0.11) g/L in healthy controls ( χ2=4.427, P<0.05; t=15.218, P<0.05; t=10.125, P<0.05). The proportion of B lymphocyte [(6.78±0.29)%] and the expression levels of miRNA21-5p (7.52±0.59) in peripheral blood of SLE patients was significantly higher than the proportion of B lymphocyte [(2.03±0.24)%] and the expression levels of miRNA21-5p (3.60±0.62) in healthy controls ( t=59.064, P<0.05; t=19.317, P<0.05), while the expression levels of PDCD4 gene (1.54±0.35) in peripheral blood of SLE patients was significantly lower than that (4.42±0.42) in healthy controls ( t=19.126, P<0.05). Compared with the blank control group and the miRNA-21-5p NC group, cell proliferation in the miRNA-21-5p Inhibitor group was inhibited, and the proportion of apoptotic cells increased ( F=5.244, P<0.05; F=37.903, P<0.05). Compared with the blank control group and PDCD4 NC group, cell proliferation in PDCD4 siRNA group was significantly enhanced, and apoptotic rate decreased ( F=5.956, P<0.05; F=25.431, P<0.05). The results of double luciferase reporter gene assay showed that PDCD4 is the target gene of miRNA-21-5p. Conclusion:miRNA-21-5p may promote the proliferation of peripheral blood B lymphocyte in SLE patients by inhibiting the expression of PDCD4, leading to abnormal lymphocyte apoptosis. miRNA-21-5p can be used as a new target gene for the treatment of systemic lupus erythematosus.
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Objective To study the value of miR-202-3p detection in the diagnosis and treatment of systemic lupus erythematosus (SLE) patients.Methods Two hundred and fifty cases of SLE and 100 cases of healthy controls from January 2017 to December 2018 were involved in the study.The expression of serum miR-202-3p in the 2 groups was detected by real-time quantitative polymerase chain reaction method,and its association with the clinicopathological features was analyzed.Statistical analyses were performed using t/Z-test,one-way analysis of variance,Pearson correlation,and receiver operating characteristic (ROC) curve.Results Compared with that in the control group (26.30±0.43),RA group (25.59±0.38)],the expression level of serum miR-202-3p in the SLE group (9.84±0.46) was significantly decreased (F=320.5,P＜0.01).The expression was lower in patients with active SLE (2.10±0.140) than that in those with stable SLE(14.67±0.39) and the difference was statistically significant (t =24.864,P＜0.01).The expression of miR-202-3p was negatively correlated with disease activity in systemic lupus erythematosus (SLEDAI) (r=-0.809 3,P＜0.01).The expression of miR-202-3p in patients with lupus nephritis combined with SLE (0.74±0.06) was significantly lower than that in patients without nephritis (2.81 ±0.15) and the difference was statistically significant (t=9.991,P＜0.01).The area under the ROC curve of serum miR-202-3p as a diagnosis of SLE was 0.974 [95％CI(0.955,0.988),P＜0.01],and its sensitivity and specificity was 90％ and 96.4％,respectively.Conclusion Serum miR-202-3p is highly expressed in SLE patients and is related to disease activity and renal injury in SLE patients.miR-202-3p may be used for SLE diagnosis.
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Objective To study the protective effect of quercetin on the kidney of mice with systemic lupus erythematosus (SLE) and to explore its effect on transforming growth factor (TGF)-β1 and monocyte chemoattractant protein-1 (MCP-1).Methods Thirty BALB/c female mice were randomly divided into control group,model group and drug group according to the envelope method,with 10 mice in each group.A mouse model of SLE was established by intra-peritoneal injection of pristane method.The drug group was given quercetin treatment,and the control group and the model group were given the same dose of normal saline.The renal function index and autoanti-body level in each group of mice were compared.The pathological changes of renal tissues were observed by HE staining.The expressions of TGF-β1 and MCP-1 were determined by Western blotting and real-time fluorescence quantitative reverse transcription polymerase chain reaction (qRT-PCR).The renal function index,autoantibody level,TGF-β1,and MCP-1 expression were statistically analyzed by analysis of one-way analysis of variance (ANOVA).Results The levels of blood urea nitrogen (BUN),serum creatinine (Scr),24 h urine protein,kidney hypertrophy index,antinuclear antibody (ANA) antibody,anti-dsDNA antibody and anti-snRNP/Sm in the model group and the drug group were higher than those in the control group.Compared with the model group,the levels of BUN,Scr,24 h urine protein,kidney hypertrophy index,ANA antibody,anti-dsDNA antibody,anti-snRNP/Sm in the drug group were(11.3±1.1) mmol/L,(45±4) μmol/L,(25.7±2.6) mg/24 h,(4.3±0.4)×10-3,(30.3±3.1) ng/L,(472±48) μmol/L and (17.6±1.8) ng/L,which were decreased (q =10.678,6.698,14.948,14.412,9.226,4.691,8.226,P＜0.01).The glomerular score,tubulointerstitial score and tubulointer-stitial score of the model group were higher than those of the control group.The glomerular score,tubulointer-stitial score and tubular score of the drug group were lower than those of the model group (q=10.935,49.537,20.439,P＜0.01).HE staining showed that the kidney structure of the control group was no obvious damage.In the model group,the glomerular volume of the mice increased,and the inflammatory cells in the renal interstitial and renal tubules infiltrated.The pathological changes in the drug group were significantly reduced compared with the model group.Compared with the control group,the expression levels of TGF-β1,MCP-1 protein and mRNA in the model group and the drug group were significantly increased.Compared with the model group,TGF-β1 and MCP-1 protein and mRNA expression levels the mice in the drug group were significantly reduced.Conclusion Quercetin can improve renal function in mice with SLE by down-regulating the expression of TGF-beta 1 and MCP-1.
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Objective To investigate MRI features for differentiating borderline from benign mucinous cystadenoma ( MC )of the ovary.Methods Twenty three patients with 23 benign MCs and 19 patients with 20 borderline mucinous cystadenomas (BMC)proven by surgery and pathology underwent MRI,with 23 benign MCs and 20 BMC. MRI features of tumor were evaluated and compared between two groups including location,shape,size,loculation,signal intensity of the fluid,thickness of septa and wall,and vegetations.The findings were correlated with those of pathology.The loculation,the signal intensity of the intracystic content,the thickness of the septation and the wall,and the vegetations between the benign MCs and the BMCs were compared using the Chi-square test.ResultsHomogenous low signal on T1WI and homogenous high signal on T2WI were the main signal patterns of benign MC seen more commonly in benign MC (18/23 and 17/23,respectively) than in BMC (5/20 and 8/20,respectively) (x2 =12.1979,5.0553 ;P ＜0.05).The honeycomb loculi,high signal on T1 WI,low signal on T2WI,thickened septa or wall ( ≥5 mm),and vegetations ( ≥5 mm) were significantly more common in BMC( 10/20,9/20,8/20,10/20 and 14/20,respectively)than in benign MC(4/23,3/23,1/23,1/23 and 1/23,respectively) (x2 =5.1804,5.4300,8.2163,11.7113 and 20.2990,P ＜ 0.05 ),with the sensitivity and specificity for characterizing BMC of 50.0％ and 82.6％,45.0％ and 87.0％,40.0％ and 95.7％,50.0％ and 95.7％,and 70.0％ and 95.7％,respectively.When one of honeycomb loculi with low signal on T2WI,thickened septa or wall ( ≥5 mm),and vegetations ( ≥5 mm) were found,the sensitivity,specificity and accuracy for characterizing BMC were 90.0％,91.3％ and 90.7％ respectively. Conclusion MRI is accurate for demonstrating morphological features of ovarian MC which well correlated to pathological characteristics,and for differentiating BMC from benign MC,thus helpful for making surgery strategy.
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In order to investigate the neuroprotective effects of cyclin-dependent kinase-5 (cdk-5) inhibition in mice with Niemann-Pick disease type C (NPC) (npc(-/-)), recombinant adeno-associated virus (rAAV) carrying the small interfering RNA (siRNA) specific for cdk-5 gene was injected into 3-day-old npc(-/-) mice intracerebroventricularly. The rAAV-GFP-injected age-matched npc(-/-) mice and non-surgery age-matched npc(-/-) mice were employed as controls (n=6-10/group). From the 4th to 8th week after the treatment, mice were weighed, and evaluated for limb motor activity by using the coat hanger test once a week. Eight-week-old npc(-/-) mice were sacrificed by decapitation, and brains were quickly dissected and halved sagittally. Immunohistochemistry, Western blotting, and HE staining were used to evaluate the neuropathology in npc(-/-) mice. The results showed that rAAV-cdk-5-siRNA-GFP significantly reduced the number of axonal spheroids, delayed the death of Purkinje neurons, ameliorated motor defects in npc(-/-) mice, and significantly attenuated the hyperphosphorylation of tau proteins. These data suggested that inhibition of cdk-5 activity has neuroprotective effect on neurons in NPC mice.
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In order to better understand the clinical manifestation of systemic lupus erythematosus (SLE) with intracranial hypertension syndrome (IHS), we analyzed the clinical features and treatment of a typical SLE patient with IHS. SLE is one of the most unpredictable autoimmune diseases involving multiple organ systems that is defined clinically and associated with antibodies directed against cell nuclei. IHS is an uncommon manifestation of neuropsychiatric SLE (NPSLE) and is characterized by an elevated intracranial pressure, papilledema, and headache with occasional abducens nerve paresis, absence of a space-occupying lesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents. IHS has been reported in a few sporadic cases in patients with SLE worldwide, but rarely has been reported in China. In this study, a 34-year-old female SLE patient with IHS was reported and pertinent literature reviewed. The clinical presentation, image logical features, and investigatory findings were discussed.
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Diagnosis, Differential , Intracranial Hypertension/diagnosis , Intracranial Hypertension/etiology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosisABSTRACT
Objective To established a diagnostic methods to idenfity Niemann-Pick disease type C (NPC) in China. Methods Two patients aged 5 and 20 years respectively who presented progressive neurologic regression and splenomegaly were subjected to filipin staining of cultured skin fibroblasts and genetic analyses of NPC1 gene. Results Although there were differences in onset ages and clinical presentations, filipin staining of the cultured skin fibroblasts confirmed the clinical diagnosis of NPC, showing an intense punctate pattern of fluorescence concentrating around the nuclei, consistent with the accumulation of unesterified cholesterol in NPC cells. Genetic sequence analysis further verified the results of filipin staining. The case 1 was compound heterozygous for M1142T(3425T＞C),R1186H(3557T＞C)and case 2 for Q88H(264G＞T),469_470insGT.The latter 2 mutations were novel, and the possibility of polymorphisms was not supposed by analyzing 134 DNA samples obtained form normal controls. Conclusions Filipin stainning of the cultured skin fibroblasts is a reliable method to clinically diagnose NPC with a sensitivity. Genetic diagnose should be performed where genetic analysis is allowed.
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Objective To discuss the nursing care for patients with placenta previa,who receive uterine arterial catheterization and embolization in the second trimester of pregnancy. Methods By using superselective catheterization with Seldinger technique,bilateral uterine artery angiography and embolization were performed in 16 patients with placenta previa in the second trimester of pregnancy. Two to four hours after the procedure,rivanol intra-amniotic injection was employed to induce the abortion. Close perioperative observation and careful nursing were carried out. Results The fetus with its subsidiary tissue was delivered in a mean time of 4.5 hours after the operation in 15 cases. No postpartum hemorrhage occurred. Induced abortion failed in one case with 26 weeks pregnancy because of a scar uterus and cervical dystocia. Hysterotomy was performed 6 days later,blood loss during the operation was about 100 ml. No nursing care related complications occurred in all 16 patients. Conclusion Uterine arterial embolization is very helpful in making the induced abortion for the treatment of bleeding placenta previa in the second trimester of pregnancy. Strengthening of perioperative care can improve successful rate of interventional therapy and prevent the occurrence of complication.
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Objective To study changes of urinary protein in premature infants after asphyxia in order to explore influence of asphyxia on the renal function. Methods Microalbumin(mAlb),retinal-bindingprotein (RBP) ,N-acety-?-D-aminoglucosidase in urine and serum urea nitrogen(BUN),creatinine(Cr) were performed in 56 normal premature infants and 49 asphyxia ones with immunoturbidimetric method, ELISA method, rate method , enzymic method and picric acid method when they were 1,4,7 day age after born. Results (1)With ages increasing urinary mAlb took on decreasing trend in the same gestation age but there was no different while with the gestation age increasing in the same ages urinauy mAlb was decreased significantly (P