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【Objective】 To explore the effect and mechanism of Fasudil in the treatment of experimental autoimmune myocarditis (EAM) in mice so as to provide a theoretical basis for the clinical use of Fasudil in treating myocarditis. 【Methods】 Balb/c male mice were used as the research objects, and the EAM mice model was constructed using MyHC-α614-629 polypeptide. Mononuclear cells were isolated and cultured to detect the number of mononuclear cells in mouse spleen. Inflammation infiltration, fibrosis and IL-6 expression in mouse myocardial tissue were detected by HE staining, Masson staining and immunohistochemistry, respectively. The protein expressions of Notch1 and IL-6 were detected by Western blotting. qRT-PCR was used to detect the expressions of pro-inflammatory factors (IL-1α, IL-1β and IL-6) as well as key genes of TLRs and NOTCH signaling pathway. 【Results】 EAM mice showed increased HW, decreased BW, increased HW/e-BW, and increased inflammatory infiltration and fibrosis in myocardial tissue. The above-mentioned symptoms or pathological features were improved in EAM mice treated with Fasudil. The analysis showed that the pro-inflammatory factors IL-1α, IL-1β and IL-6 in the myocardial tissue of EAM mice were significantly increased, but only the expression of IL-6 was statistically different after Fasudil treatment compared with the control group. In addition, TLRs signaling pathway might also play an important role in the EAM mice treated with Fasudil. The expressions of IL-6 and Notch1 were consistent, and the expressions of the key genes of NOTCH signaling pathway (Notch1, Hes1 and Jag2) were down-regulated after Fasudil treatment. 【Conclusion】 Fasudil exerts a protective effect on down-regulation of IL-6 expression by inhibiting the NOTCH signaling pathway in EAM mice.
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Objective:To investigate the mechanism that how Musashi RNA-binding protein 2 (MSI2) regulates HCC growth.Methods:Short hairpin RNA (shRNA) was transfected to inhibit MSI2 expression, and cells were divided into transfection control plasmid (sh-Ctrl) group and sh-MSI2 group. In the MSI2 overexpression experiment, cells were divided into control group (Vector group, transfected with blank plasmid Vector) and overexpression group (MSI2 group, transfected with MSI2 recombinant plasmid). Cell proliferation was detected by CCK-8 and plate cloning assays. Western blotting was used to detect the expressions of β-catenin, transcription factor 7 (TCF7) and lymphoid enhancer factor 1 (LEF1) after MSI2 intervention. In the Rescue recovery experiment, cells were divided into MSI2+ sh-Ctrl group (transfected with MSI2 recombinant plasmid and sh-Ctrl plasmid at the same time) and MSI2+ sh-β-catenin group (transfected with MSI2 recombinant plasmid and sh-β-catenin plasmid at the same time). On the basis of overexpression of MSI2, β-catenin was knocked down to detect the proliferation ability of HCC cells.Results:The proliferation rates of HepG2 and MHCC97H cells in the sh-MSI2 group were lower than those in the sh-Ctrl group, and the difference was statistically significant ( P<0.05). The proliferation rates of SMMC-7721 cells and MHCC97L cells in the MSI2 group were higher than those in the Vector group, and the difference was statistically significant ( P<0.05). The results of the clone formation experiment showed that compared with the sh-Ctrl group, the number of HepG2 cell clones in the sh-MSI2 group [(129.7±6.5) vs. (286.0±12.8)] and the number of MHCC97H cell clones [(134.0±6.7) vs. (248.0±14.1)] were reduced, and the differences were statistically significant ( P<0.05); compared with the Vector group, the number of SMMC-7721 cell clones [(242.0±5.6) vs. (135.3±8.7)] and MHCC97L cell clones [(308.0±9.0) vs. (149.7±5.9)] in the MIS2 group were increased, and the difference was statistically significant ( P<0.05). The mRNA and protein expression of β-catenin, TCF7 and LEF1 in HepG2 and MHCC97H cells in the sh-MSI2 group were lower than those in the sh-Ctrl group, and the differences between groups were statistically significant ( P<0.05). In contrast, compared with the Vector group, the mRNA and protein expression levels of β-catenin, TCF7 and LEF1 in SMMC-7721 and MHCC97L cells in the MSI2 group were all increased, and the differences were statistically significant ( P<0.05). Compared with the MSI2+ sh-Ctrl group, the cell proliferation ability of the MSI2+ sh-β-catenin group was decreased, and the difference was statistically significant ( P<0.05). Plate cloning experiments showed that the number of cell clones in the MSI2+ sh-β-catenin group was less than that in the MSI2+ sh-Ctrl group [(138.3±7.0) vs. (246.3±8.0), P=0.028]. Conclusion:MSI2 promotes HCC cell proliferation through Wnt/β-catenin signaling pathway, leading to tumor progression.
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Objective:To explore the dynamic phenotype of type Ⅱ alveolar epithelial cells(AEC Ⅱ)in radiation-induced lung fibrosisand its role in the formation of fibrosis.Methods:Totally 90 C57BL/6J female mice were divided into 2 groups: irradiation group (50, thoracic irradiation with a single dose of 20 Gy X-rays), control group (40, sham irradiation). At 24 h, 4 and 12 weeks after irradiation, 5 mice were euthanized and the lungs were collected for pathological observation. The other lungtissues were collected for the isolation of primary AEC Ⅱ cells with microbeadssorting.The mRNA expressions of proSP-C, HOPX, vimentin, β-catenin and TGF-β1 in AEC II cells were detected by RT-PCR.Results:Acute pneumonitis was observed in the lungs at 24 h after irradiation and alleviated in accompany with partial alveolar septal thickening and a small amount of collagen deposition at 4 weeks after irradiation. The collagen deposition became more pronounced at 12 weeks after irradiation, together with collapsed and fused alveolar cavities, alveolar septal hyperplasia, and pulmonary fibrosis formation.The mRNAexpression levels of proSP-C and HOPX in primary AEC Ⅱ cells increased at 24 hours after irradiation and then approached to a peak value at 4 weeks after irradiation ( F=8.441, 3.586, P=0.036). The mRNA expression levels of vimentin, a biomarker of EMT, was increased significantly at 4 weeks and continued up to 12 weeks after irradiation( F=8.358, P=0.001). The mRNA expression levels of profibrotic factors β-catenin and TGF-β1 were both significant increased at 12 weeks after irradiation( F=4.62, 3.279, P=0.044). Conclusions:The phenotypeof AECⅡ cells could not only be transformed from proSP-C+ to HOPX+ /proSP-C+ , HOPX+ /proSP-C+ /vimentin+ , and vimentin+ /proSP-C, but also differentiated into mesenchymal cells with highly expressed profibrotic factors, thereby inducing EMT process, which either played a role in the repair of radiation-induced lung injury or triggered radiation-induced fibrosis.
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Objective:To compare the clinical effectiveness of laparoscopic cholecystectomy (LC)+ laparoscopic choledocholithotomy (LCBDE)+ one-stage suture and primary choledocholithotomy with endoscopic retrograde cholangiopancreatography (ERCP)+ endoscopic duodenal sphincterotomy (EST)+ nasobiliary drainage (ENBD)+ LC in the treatment of choledocholithiasis complicated with gallbladder stones.Methods:A total of 200 patients with choledocholithiasis complicated with gallbladder stones admitted to the General Surgery Department of Shanxi Bethune Hospital from June 2015 to February 2021 were collected, and patients were divided into LC+ LCBDE+ one-stage suture (one-stage suture group, n=130) and ERCP+ EST+ ENBD+ LC (endoscopic surgery group, n=70) according to different treatments. The amount of intraoperative blood loss, operation time, postoperative feeding time, postoperative incidence of pancreatitis, cholangitis and other complications (biliary leakage, abdominal bleeding, wound infection), hospitalization costs, postoperative hospital stay, etc were compared between two groups. Results:The postoperative incidence of pancreatitis in the one-stage suture group (0.7% vs 5.7%) and the hospitalization cost [(2.74±0.39) ten thousand yuan vs (3.86±0.63) ten thousand yuan] were significantly lower than those in the endoscopic surgery group. The operation time [(103.21±9.36) min vs (88.18±7.20)min] was significantly longer than that of the endoscopic surgery group, and postoperative feeding time [(3.3±0.3)d vs (2.2±0.8)d] were significantly later than the endoscopic surgery group ( P<0.05). The amount of intraoperative blood loss [(36.0±3.0)ml vs (37.3±2.7)ml], the incidence of postoperative cholangitis (1.5% vs 2.9%) and other complications [biliary leakage (2.3% vs 1.4%), abdominal bleeding (1.5% vs 4.3%), wound infection(0 vs 0)], postoperative hospital stay [(6.8±1.3)d vs (7.1)d] had no significant differences between the two group. Conclusions:The two minimally invasive methods for the treatment of choledocholithiasis complicated with gallbladder stones had good efficacy, but LC+ LCBDE+ one-stage suture can retain the sphincter function of Oddis, maintain the normal anatomy and physiology of the biliary tract, reduce the incidence of related complications, and contribute to the recovery of patients, with high safety, effectiveness and feasibility.
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Objective:To study the clinical effect of thin replantation combined with vacuum assisted closure (VAC) in the treatment of large area retrograde skin avulsion injury.Methods:A total of 42 patients with large scale retrograde skin avulsion injury admitted to the trauma center of Zhuzhou Central Hospital from April 2017 to April 2019 were enrolled in this study, and were treated with VAC continuous negative pressure drainage after operation. The wound survival rate, wound survival area, wound infection, replantation skin performance and joint mobility were observed.Results:All of the 42 patients were followed up for 8-50(23.56±3.56)months. 35 patients survived the stage 1 skin grafting, the skin flap survived, and the wound had no obvious skin defect. After active dressing change, the wound healed well, and no second operation was needed. Small area necrosis occurred in the first stage wound of 7 patients due to large skin defect, and the wound healed well after the second stage surgical transplantation and enhanced dressing change. The Hospital for Special Surgery (HSS) score of 26 patients was 80-95(87.96±3.21), and the American Orthopaedic Foot and Ankle Society (AOFAS) score of 22 patients was 80-96(88.79±3.41). All patients had good skin sensation, elasticity, pressure resistance, wear resistance and color, and joint mobility was good without obvious limitation of movement.Conclusions:Thinning replantation combined with VAC negative pressure drainage in the treatment of large area retrograde skin avulsion injury can significantly promote the application of wound surface and skin graft, which is conducive to drain the drainage fluid out of the body, reduce the wound infection rate, improve the survival rate of skin grafting and improve joint function.
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In the past 20 years, with the development of molecular biology, the treatment of non-small cell lung cancer (NSCLC) has been developing. Targeted therapy has improved the survival period of patients with positive mutation of tumor driver gene. More and more targets have been found gradually. Drugs targeting different driving genes have brought the treatment of NSCLC into a promising target era. Among the many driving genes of NSCLC, the fusion of transfection proto oncogene (RET) is the addition of the epidermal growth factor receptor (EGFR), analytic lymphama kinase (ALK) and c-ros oncogene 1-receptor tyrosine kinase (ROS1) are emerging targets. Targeted drugs for RET gene fusion have been constantly updated. Recently, new high selective RET inhibitors blu-667 and loxo-292 have made important breakthroughs. This paper will review the review of the fusion mutation of RET gene in NSCLC, the detection methods, clinicopathological characteristics, targeted treatment and the research progress after drug resistance. .
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Objective:To evaluate the identification rate of separating gel or HB&L pretreatment methods of MALDI-TOF-MS, thereby to provide a new idea for the rapid and accurate identification of pathogens of bloodstream infections in daily clinic practice.Methods:A total of 149 alarmed positive blood culture samples of single bacterial infection by routine laboratory methods were collected between January to December 2020 from the Sixth Medical Center, Chinese PLA General Hospital. Samples were pretreated with the separation gel accelerating tube method or the HB&L microbial culture system, followed by direct MALDI-TOF MS bacterial identification, the identification rates of the two pretreatment methods were compared and results from the traditional method were used as the standard control.Results:Among the 149 positive blood culture samples, 47.0% (70/149) were gram-negative (G -) bacteria and 53.0% (79/149) were gram-positive (G +) bacteria. Identification rate of G -strain level was 78.6% (55/70) by serum separation gel coagulation tube method and 91.4% (64/70) by HB&L microbial culture system, the difference was statistically significant ( P=0.033). Identification rate of G +strain levels was 73.4% (58/79) by serum separation gel coagulation tube method and 87.3% (69/79) by HB&L microbial culture system, the difference was statistically significant ( P=0.028). For G -bacteria in the range of 3.000-2.300, the identification rate was 22.9% (16/70) by serum separation gel accelerating tube method and 38.6% (27/70) by the HB&L microbial culture system, the difference was statistically significant ( P=0.044). For G +bacteria in the range of 3.000-2.300, the identification rate was 19.0% (15/79) by serum separation gel accelerating tube method and 34.2% (27/79) by the HB&L microbial culture system, the difference was statistically significant ( P=0.031). Conclusion:The identification rate of HB&L microbial culture system is higher than that of serum separation gel coagulation tube method. Direct MALDI-TOF MS identification of pathogenic bacteria in positive blood culture samples after pretreatment is feasible in daily clinical practice.
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Objective:To investigate the safety and efficacy of early oral feeding in the treatment of mild acute pancreatitis (MAP).Methods:Data of 100 MAP patients from April 2015 to June 2018 admitted in Department of General Surgery in Shanxi Bethune Hospital were collected. According to the time of food intake through the mouth, the patients were divided into early oral feeding group (food intake started when the symptoms of abdominal pain and abdominal distension were alleviated with gastrointestinal functional recovery, but serum amylase and lipase did not decrease to a level below 2 times of normal upper limits) and traditional oral feeding group (food intake started when the symptoms of abdominal pain and abdominal distension were alleviated with gastrointestinal functional recovery, but serum amylase and lipase decreased to a level below 2 times of normal upper limits), with 50 cases in each group. The incidence of abdominal pain or bloating, serum amylase, CRP, organ dysfunction, morbidity and mortality, and median length of hospital stay after eating were compared between the two groups.Results:There were no statistically significant differences on gender, age, etiology, abdominal pain and distension, increased serum amylase, increased blood CRP, and number of organ dysfunction cases between two groups, and there were no deaths in either group. However, the feeding time and length of hospital stay in the early oral feeding group were significantly shorter than those in the traditional oral feeding group, and the differences were statistically significant [(3.00±0.18)d versus (4.84±0.27)d, (8.24±0.33) D versus (9.00±0.26)d, both P<0.05]. Conclusions:Early oral feeding in MAP patients did not aggravate the disease, but helps to correct the nutritional status of the patients, with higher safety and effectiveness.
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Objective To investigate the effects of reducing blood transfusion in ventricular septal defect surgery on the volume of blood transfusion,safety and complications of children.Methods A total of 72 children aged 4-10 years who underwent ventricular septal defect repair at Xinxiang Central Hospital between January 2018 and June 2019 were recruited in the study (38 males,34 females).The patients were randomly divided into reduced transfusion group (36 cases) and control group (36 cases) in accordance with the random number table.Reduced transfusion group:(1) after anesthesia,5 mL/kg of blood was drained from the central vein based on blood pressure and stored in a special citric acid anticoagulant blood storage bag which was then put into a 4 ℃ refrigerator.(2) hemostasis was performed strictly from skin incision,and after sternum was sawed,the whole body was heparinized,wound bleeding was recovered,and autologous blood recovery device was used.(3) the extracorporeal circulation pipeline was shortened as far as possible,and in case of the intraoperative hematokrit (Hct) of above 0.18-0.20,no red blood cells were transfused.After stopping the extracorporeal circulation,the remaining blood from the membrane lung and pipeline was transfused back.(4) antifibrinolytic drugs were adequately used during operation,and autologous blood recovery device was used to salvage blood after protamine neutralization.(5) hemostatic drugs and hemostatic materials were used.(6)after admitted to intensive care unit (ICU) postoperatively,the blood pressure was controlled at an appropriate level,to avoid bleeding caused by high blood pressure.Blind rehydration should be also avoided,and unnecessary blood thinning should be reduced.(7) encouraging children to get out of bed early after surgery,so as to improve the gastrointestinal activity of children,thus enhancing nutrition.Control group:(1) unconventional preoperative preparation of autologous blood;(2) systemic heparinization before aortic intubation;(3) conventional extracorporeal circulation device;(4) routine treatment in ICU.Primary outcomes including general situation,the rate of erythrocytic transfusion,mean consumption of erythrocytes,intraoperative blood loss,the volume of postoperative drainage,operative time,ventilator weaning time,ICU stay time,hospital stay,hospitalization costs,the incidence of pulmonary infection,secondary endotracheal intubation rate,reoperation rate,intra-transportation colloid osmotic pressure (COP),as well as the intra-transportation,preoperative and postoperative concentration of hemoglobin (Hb) and Hct and those at discharge were compared.Results All 72 patients rehabilitated and discharged from hospital successfully.The rate of erythrocytic transfusion in the reduced transfusion group and control group was 22.22％ (8/36 cases) and 83.33％ (30/36 cases),respectively,and the difference of which was statistically significant (x2 =93.12,P ＜ 0.05).The mean consumption of erythrocytes in the two groups were (1.56 ± 0.68) U and (4.26 ± 1.12) U,respectively,and the difference of which was statistically significant (t =1.18,P ＜ 0.05).Postoperative blood loss and drainage,hospital stay,and hospitalization costs in the reduced transfusion group were less than those in the control group (t =1.38,2.35,2.22,all P ＞ 0.05).There was no statistically significant differences in the operative time,ICU stay time,ventilator weaning time,the concentration of Hb and Hct at discharge between the two groups (t =0.25,0.85,0.85,0.72,all P ＞ 0.05).In addition,there were also no differences in the incidence of pulmonary infection,secondary endotracheal intubation rate and reoperation rate between the two groups (x2 =56.36,55.33,55.33,all P ＞ 0.05).Conclusions Reducing intraoperative blood transfusion is safe and feasible for children with ventricular septal defect.Besides,it also helps reduce the volume of perioperative blood confusion,save hospitalization costs and reduce transfusion complications.
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"Liquid biopsy" have been intensively studied in recent decades. The exosomes carry their maternal partial functional proteins and genes. As a form of intercellular vesicular transport, exosome-mediated intercellular communication participates in a variety of physiological and pathological processes. The information transmission mediated by exosomes is associated with pathophysiological status and plays an important role in the pathogenesis of cancer. Their detection may be beneficial for the diagnosis and treatment of tumor. This article reviews advances in knowledge on the exosome properties, the effect of exosomes on malignant tumorigenesis, and their clinical application. The data will provide a reference for clinical practitioners.
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Objective@#To investigate the effects of reducing blood transfusion in ventricular septal defect surgery on the volume of blood transfusion, safety and complications of children.@*Methods@#A total of 72 children aged 4-10 years who underwent ventricular septal defect repair at Xinxiang Central Hospital between January 2018 and June 2019 were recruited in the study (38 males, 34 females). The patients were randomly divided into reduced transfusion group (36 cases) and control group (36 cases) in accordance with the random number table.Reduced transfusion group: (1) after anesthesia, 5 mL/kg of blood was drained from the central vein based on blood pressure and stored in a special citric acid anticoagulant blood storage bag which was then put into a 4 ℃refrigerator.(2) hemostasis was performed strictly from skin incision, and after sternum was sawed, the whole body was heparinized, wound bleeding was recovered, and autologous blood recovery device was used.(3) the extracorporeal circulation pipeline was shortened as far as possible, and in case of the intraoperative hematokrit (Hct) of above 0.18-0.20, no red blood cells were transfused.After stopping the extracorporeal circulation, the remaining blood from the membrane lung and pipeline was transfused back.(4) antifibrinolytic drugs were adequately used during operation, and autologous blood recovery device was used to salvage blood after protamine neutralization.(5) hemostatic drugs and hemostatic materials were used.(6) after admitted to intensive care unit (ICU) postoperatively, the blood pressure was controlled at an appropriate level, to avoid bleeding caused by high blood pressure.Blind rehydration should be also avoided, and unnecessary blood thinning should be reduced.(7) encouraging children to get out of bed early after surgery, so as to improve the gastrointestinal activity of children, thus enhancing nutrition.Control group: (1) unconventional preoperative preparation of autologous blood; (2) systemic heparinization before aortic intubation; (3) conventional extracorporeal circulation device; (4) routine treatment in ICU.Primary outcomes including general situation, the rate of erythrocytic transfusion, mean consumption of erythrocytes, intraoperative blood loss, the volume of postoperative drainage, operative time, ventilator weaning time, ICU stay time, hospital stay, hospitalization costs, the incidence of pulmonary infection, secondary endotracheal intubation rate, reoperation rate, intra-transportation colloid osmotic pressure (COP), as well as the intra-transportation, preoperative and postoperative concentration of hemoglobin (Hb) and Hct and those at discharge were compared.@*Results@#All 72 patients rehabilitated and discharged from hospital successfully.The rate of erythrocytic transfusion in the reduced transfusion group and control group was 22.22% (8/36 cases) and 83.33% (30/36 cases), respectively, and the difference of which was statistically significant (χ2=93.12, P<0.05). The mean consumption of erythrocytes in the two groups were (1.56±0.68) U and (4.26±1.12) U, respectively, and the difference of which was statistically significant (t=1.18, P<0.05). Postoperative blood loss and drainage, hospital stay, and hospitalization costs in the reduced transfusion group were less than those in the control group (t=1.38, 2.35, 2.22, all P>0.05). There was no statistically significant differences in the operative time, ICU stay time, ventilator weaning time, the concentration of Hb and Hct at discharge between the two groups (t=0.25, 0.85, 0.85, 0.72, all P>0.05). In addition, there were also no differences in the incidence of pulmonary infection, secondary endotracheal intubation rate and reoperation rate between the two groups (χ2=56.36, 55.33, 55.33, all P>0.05).@*Conclusions@#Reducing intraoperative blood transfusion is safe and feasible for children with ventricular septal defect.Besides, it also helps reduce the volume of perioperative blood confusion, save hospitalization costs and reduce transfusion complications.
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The outbreaks caused by coronavirus (CoV) infections including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and COVID-19 have emerged in recent years, posing a continued threat to public health. Highly pathogenic CoV infections usually induce a series of immune responses, including innate immunity, humoral immunity, cellular immunity and mucosal immunity. These responses not only are critical to suppressing and eliminating the invasion of viruses, but also play an important role in immunopathological changes and disease progression. A deep understanding of the dual roles of immune responses will help to elucidate the pathogenic mechanism of CoV and maintain the balance between immune protection and immunopathology, which will be conducive to the research and development of safe and effective CoV vaccines. This review summarized the dual roles of immune responses in highly pathogenic CoV infections and discussed the implications for the research and development of novel CoV vaccines.
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Objective@#To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.@*Methods@#Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 53-68 yr, scheduled for elective total knee arthroplasty under general anesthesia, were assigned into 2 groups (n=30 each) using a random number table method: femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A). Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5% ropivacaine 20 ml in group F and group A, respectively.Patient-controlled saphenous nerve block analgesia was used in two groups, and the analgesic pump solution contained 1% ropivacaine 400 mg diluted to 160 ml in 0.9% sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose, a 30-min lockout interval and background infusion at a rate of 5 ml/h, and analgesia lasted until 72 h after operation.When visual analog scale score > 4 and pain was not relived after 30-min pressing by patients, pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4, 8, 24, 48 and 72 h after operation.The patient′s satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication, itching, dizziness, urinary retention, nausea and vomiting) were recorded within 72 h after operation.@*Results@#Compared with group F, the muscle strength of quadriceps femoris was significantly increased at 4, 8 and 24 h after operation, the rate of postoperative rescue analgesia was decreased (P<0.05), and no significant change was found in patient′s satisfaction score or incidence of adverse reactions in group A (P>0.05).@*Conclusion@#Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.
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Objective To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 53-68yr,scheduled for elective total knee arthroplasty under general anesthesia,were assigned into 2 groups (n=30 each) using a random number table method:femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A).Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5％ ropivacaine 20 ml in group F and group A,respectively.Patient-controlled saphenous nerve block analgesia was used in two groups,and the analgesic pump solution contained 1％ ropivacaine 400 mg diluted to 160 ml in 0.9％ sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose,a 30-main lockout interval and background infusion at a rate of 5 ml/h,and analgesia lasted until 72 h after operation.When visual analog scale score ＞ 4 and pain was not relived after 30-min pressing by patients,pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4,8,24,48 and 72 h after operation.The patient's satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication,itching,dizziness,urinary retention,nausea and vomiting) were recorded within 72 h after operation.Results Compared with group F,the muscle strength of quadriceps femoris was significantly increased at 4,8 and 24 h after operation,the rate of postoperative rescue analgesia was decreased (P＜0.05),and no significant change was found in patient's satisfaction score or incidence of adverse reactions in group A (P＞0.05).Conclusion Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.
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Objective To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. Methods The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. Results The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. Conclusions The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
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OBJECTIVE: To determine the feasibility of reduced field-of-view diffusion-weighted imaging (rFOV DWI) with multi-b values to detect functional variability in transplanted kidneys. MATERIALS AND METHODS: Using a 3T MRI scanner, multi-b rFOV DWI of transplanted kidney or native kidney was performed in 40 renal transplantation recipients and 18 healthy volunteers. The patients were stratified, according to an estimated glomerular filtration rate (eGFR): Group 1, eGFR ≥ 60 mL/min/1.73 m2; Group 2, eGFR ≥ 30 mL/min/1.73 m2 and < 60 mL/min/1.73 m2; Group 3, eGFR < 30 mL/min/1.73 m2. Total apparent diffusion coefficient (ADCT), perfusion-free ADC (ADCD) and perfusion fraction (FP) of kidneys were calculated and compared among the four groups. Correlations between the imaging results and eGFR were assessed. RESULTS: All volunteers had eGFR ≥ 60 mL/min/1.73 m2, while 16, 16, and 8 patients were included in Groups 1, 2, and 3, respectively. In the renal cortex, ADCT was higher in Group 1 ([1.65 ± 0.13] × 10−3 mm2/s) than Group 3 ([1.44 ± 0.11] × 10−3 mm2/s) (p < 0.05), and the inter-group differences of FP values were significant (all p < 0.05) (0.330 ± 0.024, 0.309 ± 0.019, 0.278 ± 0.033, and 0.250 ± 0.028 for control group, Groups 1, 2, and 3, respectively). Renal cortical ADCT, ADCD, FP, and renal medullary ADCT and FP correlated positively with eGFR (r = 0.596, 0.403, 0.711, 0.341, and 0.323, respectively; all p < 0.05). When using 0.278 as the cutoff value, renal cortical FP had a sensitivity of 97.1% and a specificity of 66.7% for predicting decreased renal function. CONCLUSION: Multi-b rFOV DWI presents transplanted kidneys with high resolution, which is a promising functional tool for non-invasively monitoring function of transplanted kidneys.
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Humans , Diffusion , Glomerular Filtration Rate , Healthy Volunteers , Kidney Transplantation , Kidney , Magnetic Resonance Imaging , Perfusion , Sensitivity and Specificity , Transplantation , VolunteersABSTRACT
Objective@#To investigate the key cytokine which polarizes M2 macrophages and promotes invasion and metastasis in non-small cell lung cancer (NSCLC).@*Methods@#After co-culture with A549 cells in vitro, the proportion of CD14+ CD163+ M2 macrophages in monocytes and macrophage colony stimulating factor (M-CSF) levels in culture supernatant were detected by flow cytometry, ELISA assay and real-time qPCR, respectively. The effects of CD14+ CD163+ M2 macrophages on invasion of A549 cells and angiogenesis of HUVEC cells were measured by transwell assay and tubule formation assay, respectively. The clinical and prognostic significance of M-CSF expression in NSCLC was further analyzed.@*Results@#The percentage of CD14+ CD163+ M2 macrophages in monocytes and the concentration of M-CSF in the supernatant followed by co-culture was (12.03±0.46)% and (299.80±73.76)pg/ml, respectively, which were significantly higher than those in control group [(2.80±1.04)% and (43.07±11.22)pg/ml, respectively, P< 0.05]. Human recombinant M-CSF promoted M2 polarization of macrophages in vitro. M2 macrophages enhanced the invasion of A549 cells (66 cells/field vs. 26 cells/field) and the angiogenesis of HUVEC cells (22 tubes/field vs. 8 tubes/field). The mRNA expression of M-CSF in stage Ⅰ-Ⅱ patients (16.23±4.83) was significantly lower than that in stage Ⅲ-Ⅳ (53.84±16.08; P<0.05). M-CSF levels were associated with poorer overall survival and disease-free survival in NSCLC patients (P<0.05).@*Conclusions@#Tumor-derived M-CSF can induce CD14+ CD163+ M2 polarization of macrophages, which can further promote the metastasis and angiogenesis of NSCLC. M-CSF could be used as a potential therapeutic target of NSCLC.
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Purpose To explore the effect of speckle tracking imaging (STI) in early detection of coronary artery disease (CAD) in patients with hypertension (HT),and to intervene early to alleviate or delay the progression of CAD.This would provide theoretical evidence in controlling the development and improving the prognosis of CAD.Materials and Methods From January 2013 to April 2015,a total of 166 cases of hospitalized patients from the First Affiliated Hospital of Sun Yat-sen and Jiangmen Central Hospital were retrospectively analyzed,including HT group (n=42),CAD group (n=35),HT+CAD group (n=49) and control group (n=40).Conventional measurement and STI were used to analyze the conventional values and the 17 section peak strain value of the left ventricle.Results The total mean strain,average peak strain of lesion segment and minimum peak strain in CAD group and HT+CAD group were significantly lower (P＜0.05) compared to the control group.ROC analyses showed that the AUC for total mean strain,average peak strain of lesion segment and minimum peak strain value were 0.71,0.76,and 0.70,respectively.Using a combined cut-off of ≥-18％ of average peak strain of lesion segment,≥-19％ of total mean strain and ≥-6％ of minimum peak strain value,the performance of CHD diagnosis had a sensitivity of 91.3％ and a specificity of 83.5％.Conclusion Speckle tracking automatic function imaging can be used to quantitatively analyze abnormal left ventricular segmental wall movement.It improves the detection in hypertension patients with coronary artery disease.
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BACKGROUND:Bone marrow mesenchymal stem cel s (BMSCs) are the focus of research on the proliferation and metastasis of hepatocel ular carcinoma cel s. By genetic engineering techniques, the hepatocel ular carcinoma cel s can be induced to reduce the expression of bioactive factors, thereby seeking suitable intervention targets for improving the interventional effect of BMSCs. OBJECTIVE:To silence the expression of transforming growth factor beta1 (TGFβ1) and osteopontin (OPN) in high metastatic potential hepatocel ular carcinoma cel s (MHCC97-H) fol owed by co-culture with BMSCs and then to observe the change of MHCC97-H cel invasion ability as wel as the interventional effect of BMSCs on the animal model of hepatocel ular carcinoma tissue MHCC97-H by fluorescence imaging in vivo. METHODS:MHCC97-H cel s were divided into four groups:MHCC97-H group was set as a blank control group, and MHCC97-H NC siRNA as negative control group, and MHCC97-H siRNA TGFβ1 and siRNA OPN were experimental groups. Transwel s assay was carried out for co-culture experiments. After 48 hours of co-culture, crystal violet staining was performed for cel counting in three randomly selected fields of vision. Combined with the red fluorescence protein gene, MHCC97-H cel lines in each group were inoculated via the right subaxil ary subcutaneous transplantation to make a tumor model in nude mice. When the tumor volume was up to about 50 mm3, BMSCs were injected into the tumor in the nude mice, and 4 weeks later, fluorescence images were analyzed using software for fluorescence intensity. Frozen hepatocel ular carcinoma tissue sections were taken for 4’,6-diamidino-2-phenylindole staining and fluorescence microscope observation. RESULTS AND CONCLUSION:Cel counting results showed that BMSCs significantly decreased MHCC97-H cel s after gene silencing, and crystal violet staining showed that the migration ability of MHCC97-H cel s was significantly decreased. Tumor volume shown by the fluorescence imaging was significantly reduced after the OPN gene transfection, the fluorescence intensity was lower than that in the other groups, and quantitative results showed that the absorbance value of OPN shRNA cel s decreased significantly compared with other groups, indicating the BMSCs exhibit best interventional effectiveness in OPN-silenced MHCC97-H cel s. Pathological sections showed that BMSCs were mainly distributed in the tumor necrosis area, and the fluorescence expression in the OPN siRNA group was more than that in the TGFβ1 siRNA group and the blank control group, indicating that after OPN gene silencing of MHCC97-H cel s, the distribution of BMSCs in the tumor was increased. To conclude, it is able to reduce the invasive ability of hepatocel ular carcinoma cel s by inhibiting the expression of OPN and TGFβ1 factors, and OPN silencing may be more conductive to BMSCs biotherapy.
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Objective To investigate the clinical distribution situation and drug resistance change of Klebsiella pneumoniae in the Navy General Hospital during 2011‐2015 in order to provide reference for rational use of antibacterial agents in clinic .Methods The clinically isolated Klebsiella pneumoniae in this hospital during 2011‐2015 were selected and performed the analysis on the de‐tection rate ,department distribution ,specimens source ,resistance of antibacterial drugs and change trend of resistance to carbapen‐em antibacterial drugs .Results The number the detected Klebsiella pneumoniae strains and isolation rate during 2011 -2015 showed an increasing trend year by year ,the specimens sources were mainly from 10 departments of intensive care units(ICU) ,hy‐perbaric oxygen department ,respiratory department ,radiation oncology department ,kidney disease department ,etc .;the submitted specimens were dominated by sputum and urine ,accounting for 59 .7% and 21 .4% of submitted specimens ;the drug resistance of Klebsiella pneumoniae during 2011‐2015 showed the increasing trend year by year .Klebsiella pneumoniae had higher resistance rates to piperacillin ,ampicillin ,ampicillin/sulbactam and cefuroxime and had lower resistance rate to amikacin ,imipenem ,meropen‐em and tobramycin ;the resistance rates to imipenem and meropenem were increased year by year ,and pan‐drug resistant Klebsiella pneumoniae showed a rapidly rising trend .Conclusion The drug resistance of Klebsiella pneumonia is serious ,especially carbapene‐ms‐resistant Klebsiella pneumoniae is significantly increased in the recent years ,therefore its drug resistance monitoring should be strengthened for guiding rational drug use in clinic .