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Objective:In this study, the liver, spleen, and hepatic portal vein in the portal venous phase images of abdominal enhanced computed tomography (CT) are artificially segmented and annotated, and the radiomics features are extracted from them. A model for predicting portal pressure in patients with hepatitis B virus (HBV) related cirrhosis is constructed by combining radiomics features with clinical indicators.Methods:A total of 171 patients who had abdominal enhancement CT examination and trans-jugular hepatic venous pressure gradient (HVPG) measurement at the same time were enrolled from January 2016 to May 2020 in the Zhongshan Hospital Affiliated to Fudan University. The liver, spleen, and hepatic portal vein in the portal venous phase images of the CT were manually labeled by using ITK-SNAP 3.8 software. The radiomics features of these three sites were extracted using Python programming, and an HVPG prediction model was established.Results:A total of 171 patients was included in the study. The average age was (51.1±10.3)years, of which 134(78.4%) were males, and the average HVPG was 16.87±5.695. A total of 2 553 radiomics features were extracted from three sites of the portal venous phase images of abdominal enhanced CT in each patient. The 2 553 features extracted were screened using LASSO, and by combing with clinical features and radiomics features, the predictive model of HVPG was obtained: m_HVPG=31.622+ 0.028 8T×total bile acids-6.31(portal venous wavelet-LHH_glcm_ClusterShade)=0.253(portal venous wavelet-LHL_glszm_LargeAreaLowGrayLevelEmphasis)-20.9(spleen wavelet-LLH_glcm_Correlation)-0.000 127(liver original_shape_SurfaceArea)+ 2.79(liver wavelet-LLH_glcm_ClusterShade). The coefficient of determination R2 was 0.345. Conclusions:The study suggests that radiomics features of the liver, spleen, and portal venous combined with clinical features may be used as a non-invasive method to assess the portal pressure in patients with HBV-related cirrhosis.
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@#Objective To review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects. Methods A total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2012 to January 2020 were continuously collected. According to the inclusion and exclusion criteria, 37 patients were finally included. There were 20 males and 17 females with an average age of 55.55±10.49 years. Chylothorax was diagnosed primarily by triglyceride levels (above 110 mg/dL) or the Sudan triple stain test. Treatment included surgical and non-surgical treatment. The overall incidence, high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed. According to the treatment methods, the patients were divided into a surgical treatment group and a non-surgical treatment group. The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed. Results Included patients accounted for 0.3% (37/12 515) of lung cancer thoracoscopic surgery in our hospital during the same period. The incidence of postoperative chylothorax in patients with right lung surgery (0.2%, 29/12 515) was higher than that of patients with left lung surgery (0.1%, 8/12 515). Of 37 patients with chylothorax after lung cancer surgery, 32 patients were in the non-surgical treatment group (86.5%, 32/37), and the rate was higher compared with the surgical treatment group (13.5%, 5/37, P=0.000). The average daily drainage in the surgical treatment group was 777 mL more than that in the non-surgical treatment group (95%CI 588.58 to 965.55, P<0.001). The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group (8 609.2卤4 680.3 mL vs. 4 911.2卤3 925.5 mL, P=0.055). The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment group (P=0.162, P=0.118). The tube indwelling time (8.2卤2.7 d) was shorter than that of the non-surgical treatment group (12.3卤6.8 d, P=0.204). Conclusion 聽 聽The treatment of chylothorax after radical resection of VATS lung cancer is still mainly non-surgical treatment. Surgical treatment should be initiated as early as possible when the drainage volume is too large 72 hours after chylothorax surgery after radical resection of VATS lung cancer.
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AIM:A total of 1 084 preschool children in 4 kindergartens in Xining City were surveyed on their visual acuity and refraction status to find out abnormal vision and refraction beyond the normal range. METHODS: A cross-sectional survey study. The overall sampling method was used on October 2019, a total of 1 084 preschool children aged 3-6 years were selected from a kindergarten in the east, west, south and north of Xining City. The children were checked for uncorrected distance vision and refractive status was checked by using a refractive screener.RESULTS: The detection rate of abnormal vision in preschool children in Xining City was 12.21%, and the detection rate of abnormal vision increased with the increasing age(χ2lineartrend=94.40, P<0.05), and there were differences among different age groups(χ2=293.55, P<0.05). Refractive abnormalities accounted for 6.09% of the total number of examinations. With the increasing age, the proportion of compound hyperopic astigmatism decreased(χ2lineartrend=1.79, P>0.05).CONCLUSION: The abnormal visual acuity of preschool children in Xining City gradually increases with the increasing age; The refractive state is dominated by astigmatism, among which the proportion of mixed astigmatism and pure myopia astigmatism is the highest, followed by pure hyperopic astigmatism and compound hyperopic astigmatism; With the increase of age, the diopter of compound hyperopic astigmatism gradually decreases, which is in line with the law of children's eye refractive development.
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Objective:To compare the image quality of turbo gradient and spin echo-BLADE diffusion weighted imaging (TGSE-BLADE-DWI) with that of readout segmentation of long variable echo-trains (RESOLVE) at the sellar region.Methods:From September 15 th, 2019 to February 15 th, 2020, 38 patients with suspected sellar abnormalities were enrolled prospectively to perform RESOLVE and TGSE-BLADE-DWI at a 3.0 T MR scanner in Department of Radiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. Totally, 32 patients were identified with sellar lesions. The DWI images were evaluated subjectively and objectively. Two experienced radiologists scored images of the two DWI methods for anatomical structures (including the internal carotid arteries, optic chiasm, pituitary stalk and pituitary gland), lesion conspicuity, susceptibility artifacts, geometric distortions and overall image quality using a five-point scale respectively. Objective parameters on the images of the two DWI methods were analyzed, including lesion size, signal to noise ratio (SNR) and apparent diffusion coefficient (ADC). The consistency of subjective scores of two radiologists was tested by Kappa test. Paired t-test, Wilcoxon signed rank test, Kappa statistics were used for statistical evaluation. Results:TGSE-BLADE-DWI performed significantly better than RESOLVE in depicting the sellar anatomical structures, lesion conspicuity, geometric distortion and overall image quality (all P<0.05). There were no significant differences in SNR, maximum longitudinal diameter of lesions and ADC of lesions between the two DWI methods(all P>0.05). The maximum transverse diameter measured by TGSE-BLADE-DWI was significantly smaller than that of RESOLVE ( Z=3.31, P=0.001). Conclusions:Compared with RESOLVE, TGSE-BLADE-DWI is superior in depicting the anatomical structures, decreasing susceptibility artifacts and geometric distortions at the sellar region and effectively improves the image quality of DWI, which has great value in clinical applications.
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@#As the prevalence of myopia continues to increase, our society shows increasing interest in the visual impairment associated with myopia and methods for myopia control. Current methods for myopia control include atropine, orthokeratology, dual-focus contact lenses, multifocal contact lenses, and functional frame glasses, <i>etc</i>. Low-concentration atropine(0.01%, 0.05%)became the first-line medication which has been administrated and shown to be effective in controlling the occurrence and progression of myopia. Meanwhile, low-concentration atropine shows longer-lasting effects, less frequent adverse effects and higher patients' acceptance than high-concentration atropine. This article reviews the efficacy, safety, time-to-treatment, and effects when combined with other treatments to provide evidence for the clinical application of low-concentration atropine on myopia control.
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Objective:To analyze the risk factors,clinical characteristics and prognosis of the pneumocystis pneumonia(PCP) that is one of the severe pulmonary complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical features,laboratory data,treatment and outcomes of patients with PCP after allo-HSCT in our hospital from January,2016 to January,2021 were retrospectively collected and analyzed.Results:Twenty three cases who met the clinical diagnostic criteria of PCP were enrolled. The median time of diagnosed as PCP after transplantation was 221 days. The computed tomography (CT) of chest indicated diffuse ground glass opacity.The median of β-1,3-D glucan consentration was 894.25 ng/L, and 91.3% of the cases were over 60 ng/L.The lymphocyte count in 60.9% cases was lower than 1×10 9/L;CD4 +T lymphocyte count in 65.2% of patients was less than 200/μL. Pneumocytis sequences of mNGS were positive in all 21 cases.15 patients were complicated with mixed infection.All patients were treated with TMP-SMX,18 patients were cured and 5 patients died. Conclusions:Patients with PCP after allo-HSCT progresses rapidly, and which is usually with multiple infections. Serum β-1,3-D glucan concentration increase contributes to the diagnosis of PCP.And mNGS in alveolar lavage fluid is highly sensitive to Pneumocystis, which helps patients get treatment in time, so as to reduce mortality.Patients with respiratory failure progressing to a need for mechanical ventilation and high flow oxygen inhalation suggest a poor prognosis.
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Objective: To study the efficacy and patient comfort of absorbable hemostatic powder after endoscopic sinus surgery (ESS). Methods: A total of 21 (17 males, 4 females) patients with an average age of 42(ranging from 18 to 65) underwent bilateral ESS for chronic rhinosinusitis(CRS) in Beijing Tongren Hospital, Capital Medical University between October 2015 and July 2019 were enrolled to compare the effect of absorbable hemostasis powder with Nasopore using an intrapatient control design. A randomized controlled trial was conducted in the left and right nasal cavities of the same patient. If hemostatic powder was applied in the experiment nasal cavity, the Nasopore was applied in the control nasal cavity. The mean preoperative sinus computed tomography (CT) score was 6.25. All patients competed for symptom diaries using a visual analog scale (VAS, score out of 10) at baseline, through 1, 7, 14 and 30 days. Outcomes including bleeding, facial pain, nasal obstruction, nasal discharges using VAS were recorded separately for both sides. Postoperative endoscopic scores were also investigated. SPSS 22 and Graphpad prism 8.0 statistical softwares were used for the analysis. Paired t-test or nonparametric test was used between the test side and the control side. The difference was statistically significant (P<0.05). Results: The bleeding score and total nasal symptom VAS scores at postoperative days (POD) 1, 7, 14 and 30 were not significantly different(t=1.341, 0.552, 0.631, 0.158, all P>0.05;t=0.944, 1.471, 1.612, 2.251, all P>0.05). There was no significant difference between absorbable hemostasis powder and Nasopore side on POD 1, 7, 14 and 30 in terms of each nasal symptom VAS scores(all P>0.05). On POD 1, 7 and 14, the packing material degeneration scores of the absorbable hemostasis powder side were significantly lower than those of the Nasopore side [(1.33±0.21)vs(2.00±0.00),(0.38±0.18) vs (1.95±0.22), 0 vs (1.80±0.13), all P<0.01]. There were significant differences between absorbable hemostasis powder and Nasopore side on POD 1, 7, 14 and 30 in terms of endoscopic scores (edema, crusting, discharges, scar, polyps and material degeneration, t=3.07, 7.00, 6.41, 2.69, all P<0.05). Conclusions: The absorbable hemostasis powder and Nasopore has similar postoperative hemostasis effect. The absorbable hemostasis powder is rapidly cleared and without negative effects on mucosal wound healing 14 days postoperatively.
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@#AIM: To detect the relative expression levels of microRNA-27a(miR-27a)and nuclear factor erythroid-2-related factor 2(NRF2)in serum of patients with age-related macular degeneration(ARMD)bleeding, and to explore the correlation between the expression levels and the prognosis of ARMD bleeding. <p>METHODS: A retrospective case series observation was carried out.From June 2018 to October 2019, 80 patients with ARMD bleeding who were treated in our hospital were selected as ARMD bleeding group, and 80 healthy people who had routine examination in our hospital were selected as control group. The relative expression levels of miR-27a and NRF2 were detected by real-time fluorescent quantitative PCR(qRT-PCR), the diagnostic value of serum miR-27a and NRF2 expression for ARMD bleeding was evaluated by receiver operating characteristic curve(ROC). The incidence of poor prognosis was analyzed; in addition, Logistic regression was used to analyze the influencing factors of poor prognosis in patients with ARMD bleeding. <p>RESULTS: The relative expression level of miR-27a in serum of ARMD bleeding group was significantly higher than that of control group(<i>P</i><0.01), and the relative expression level of NRF2 mRNA in serum was significantly lower than that in control group(<i>P</i><0.01). ROC results showed that the AUC of serum miR-27a and NRF2 in the diagnosis of ARMD bleeding was 0.867 and 0.820 respectively, and the cutoff value was 1.10 and 1.08 respectively, at this time, the corresponding sensitivity was 71.3% and 91.3%, and the specificity was 90.0% and 63.7%, respectively. The AUC of serum miR-27a combined with NRF2 in the diagnosis of ARMD bleeding was 0.912, and the corresponding sensitivity and specificity were 86.3% and 85.0%, respectively. The incidence of poor prognosis in high miR-27a group was significantly higher than that in low miR-27a group(<i>P</i><0.05); and the incidence of poor prognosis in high NRF2 group was significantly lower than that in low NRF2 group(<i>P</i><0.05). Logistic analysis showed that the high expression of serum miR-27a was an independent risk factor for poor prognosis in patients with ARMD bleeding, and the high relative expression of NRF2 in serum was a protective factor for the poor prognosis of patients with ARMD bleeding. <p>CONCLUSION: The relative expression level of miR-27a in the serum of patients with ARMD hemorrhage is significantly increased, and the relative expression level of NRF2 is significantly decreased, both of them have certain diagnostic value for ARMD bleeding, and their relative expressions are closely related to the prognosis of patients, which is suggested that miR-27a and NRF2 can be used as potential biological indexes for early diagnosis and prognosis evaluation of ARMD bleeding.
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Objective To investigate the characteristics of five hormone levels of hypertension in patients with essential hypertension,and explore the correlation between them and essential hypertension.Methods The clinical data of 1 731 patients with essential hypertension and 305 healthy people in General Hospital of Heilongjiang Province Land Reclamation Bureau from April 2018 to March 2019 were analyzed retrospectively.The levels of renin,angiotension Ⅱ (AT Ⅱ),aldosterone,adrenocorticotropic hormone (ACTH) and cortisol were measured by magnetic particle chemiluminescence,and the ratio of aldosterone to renin (ADRR) was calculated.Results The renin,AT Ⅱ,aldosterone,ACTH,cortisol and ADRR in patients with essential hypertension were significantly higher than those in healthy controls:(13.58 ± 9.78) ng/L vs.(9.20 ± 2.12) ng/L,(181.06 ± 89.82) ng/L vs.(133.49 ± 5.47) ng/L,(174.96 ± 103.14) ng/L vs.(136.04 ± 15.48) ng/L,(76.39 ± 61.43) ng/L vs.(26.98 ± 5.10) ng/L,(176.4 ± 88.8) μg/L vs.(145.1 ± 18.9) μg/L and 27.71 ± 18.37 vs.15.18 ± 1.77,and there were statistical differences (P＜0.01).The renin and AT Ⅱ in male patients with essential hypertension (904 cases) were significantly higher than those in female patients with essential hypertension (827 cases):(16.04 ± 10.67) ng/L vs.(10.34 ± 8.59) ng/L and (194.28 ± 96.22) ng/L vs.(166.37 ± 83.42) ng/L,the aldosterone was significantly lower than that in female patients with essential hypertension:(166.31 ± 101.91) ng/L vs.(184.68 ± 104.37) ng/L,and there were statistical differences (P＜0.01 or ＜0.05);there were no statistical difference in ACTH,cortisol and ADRR (P＞0.05).The renin and AT Ⅱ in patients aged 51 to 60 years (610 cases) and ＞60 years (572 cases) were significantly lower than those in patients aged ＜ 50 years (549 cases):(12.67 ± 10.76),(12.43 ± 8.29) ng/L vs.(16.05 ± 10.29) ng/L and (172.62 ± 81.63),(166.04 ± 79.09) ng/L vs.(208.94 ± 108.75) ng/L,and there were statistical differences (P＜0.05 or ＜0.01);there were no statistical difference in aldosterone,ACTH,cortisol and ADRR (P＞0.05).Multivariate linear regression analysis result showed that renin and AT Ⅱ were negatively correlated with systolic blood pressure and diastolic blood pressure (P＜0.01 or ＜0.05),and aldosterone,ACTH and cortisol were positively correlated with systolic blood pressure and diastolic blood pressure (P＜0.05 or ＜0.01).Conclusions Renin and AT Ⅱ are negatively correlated with systolic blood pressure and diastolic blood pressure;aldosterone,and ACTH and cortisol are positively correlated with systolic blood pressure and diastolic blood pressure.The five hormone levels of hypertension can reflect the function of renin-angiotension-aldosterone (RAAS) system and hypothalamus pituitary adrenocortical axis (HPA axis),which are the influencing factors of essential hypertension.
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BACKGROUND@#The types and number of day surgery are increasing, what is the result of day surgery of selected patients with lung cancer? To explore the operation process and clinical effect of day surgery in patients with lung cancer by fusing the concept of enhanced recovery after surgery (ERAS) and minimally invasive surgical techniques.@*METHODS@#A prospective study was planned with the approval of our institutional review board. 153 lung cancer patients who underwent anatomic resection in a single medical group between June 2019 and Nov 2019 were randomized. 20 patients were applied day surgery and 28 patients by inpatient surgery and the average length of stay, average hospital cost , complications and adverse reactions were analysed.@*RESULTS@#The average hospital day in DSG group (1 d) was significantly shorter than in ISG group (7.7±2.8) d (P=0.000). The average hospital cost in DSG group (38,297.3±3,408.7)¥ was significantly lower than in ISG group (47,831.1±7,376.1)¥ (P=0.000). There was no significant difference in the incidence of postoperative complications between the daytime surgery group (5.0%) and the inpatient surgery group (3.6%) (P=0.812). The postoperation adverse reactions in DSG (10.0%) and ISG (17.9%) is no difference (P=0.72).@*CONCLUSIONS@#Our study showed that the same clinical effect achieved between DSG and ISG, and recover quickly lung cancer patients after day surgery.
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OBJECTIVE@#To explore the application value of 3D printing technology in preoperative surgery plan and intraoperative auxiliary operation for adult kyphoscoliosis deformity.@*METHODS@#The clinical data of 12 adult patients with kyphoscoliosis deformity treated from September 2017 to January 2019 were retrospectively analyzed. There were 3 males and 9 females, aged from 21 to 63 years old with an average of (47.67±13.32) years old. Among them, 4 cases were congenital kyphoscoliosis, 2 cases were old tuberculosis thoracolumbar kyphosis ; 2 cases were idiopathic kyphoscoliosis, 4 cases were degenerative kyphoscoliosis. The CT scan data of the patient's spine was imported into Mimics17.0 software to establish the three dimensional model of the spine, and the spine model was produced by 3D printer. Using the spine model simulated operation, preoperative surgery program planning and formulated a precise surgery, and further analysed postoperative imaging parameters improvement. All the patients were followed up for more than 1 year. Before and after operation and at the last follow-up, the scoliosis Cobb angle, maximum kyphosis Cobb angle, and coronal plane balance (distance between C 7 plumbline and center sacral vertical line, CPL-CSVL), sagittal plane balance (sagittal vertical axis, SVA), pelvic parameters and other related imaging parameters were measured to further evaluate its orthopedic effect.@*RESULTS@#Twelve patients with spine deformity were treated with different osteotomy and internal fixation fusion methods under the guidance of a 1∶1 spine model (pedicle screw placement of 4 patients with severe deformity were assisted by pedicle screw guide plates), nail placement and osteotomy have good effects, no major tissue damage such as blood vessels, nerves and spinal cord during and after surgery, no complications such as cerebrospinal fluid leakage and infection. Preoperative Cobb angle of scoliosis was (56.5±22.5) °, Cobb angle of kyphosis was (65.2±19.5) °, C PL-CSVL was (45.8±16.9) mm, SVA was (48.7±25.4) mm. Postoperative at 4 weeks, Cobb angle of scoliosis was (20.8±11.5) °, and Cobb angle of kyphosis was (22.0±6.6) °, with correction rates of (65.1±9.7)% and (64.6± 10.6)%, respectively ; C PL-CSVL was (22.3±8.9) mm, and SVA was (23.3±13.1) mm, all of which were significantly improved compared with preoperative results. The mean follow-up time was (18.5±7.9) months in 12 patients. At the last follow-up, the Cobb angles of scoliosis and kyphosis were (22.2±10.8) ° and (23.6±7.7) °, respectively, C PL-CSVL was (23.5±10.8) mm, and SVA was (24.7±12.5) mm. The results were statistically significant compared preoperative (0.05).@*CONCLUSION@#The 3D print model can visually and clearly show the vertebral morphology and structure of adult kyphoscolisis and its spatial relationship with the adjacent vertebrae, blood vessels, and nerves, which provides a good and intuitive stereoscopic anatomical structure observation for the individualization of the surgical plan. Pre-simulation of operations to determine the internal fixation, fusion segment and osteotomy orthopedic way, may to provide a reference for actual clinical surgery, and can improve the accuracy and safety of surgery.
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The good results of enhanced recovery after surgery (ERAS) combined with minimally invasive surgery are reflected in reducing the incidence of perioperative complications and shortening the length of hospitalization (LOS). It has been widely used in surgical fields of different specialties. The implementation of the day surgery mode can shorten the waiting time for patients and reduce the financial burden. Especially in thoracic surgery, the shorter the waiting time in the hospital, the more beneficial for the patient's physical and psychological recovery. With the widespread implementation of minimally invasive technology and accelerated rehabilitation procedures, the application of ERAS in thoracic surgery has made it possible for some thoracic surgery to be completed in the day surgery. This article summarizes the current application of ERAS in the field of thoracic surgery and the development prospects of day surgery models in China.
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OBJECTIVE@#To evaluate accuracy and safety of individualized 3D printing guided template for thoracolumbar pedicle screw placement in patients with ankylosing spondylitis.@*METHODS@#From January 2016 to September 2019, thoracolumbar spine three-dimensional CT data of 8 patients with ankylosing spondylitis were included, Mimics 17.0 and ideaMaker computer software were applied to design thoracolumbar pedicle screw guided template of patients with AS, physical model of all patients (T-L)were printed by 3D printer, 2 parts in each patient, and divided into guide-plate-assisted screw group (experimental group) and free-hand nail group (control group). Thoracolumbar pedicle screws of both groups were placed by the same spinal surgeon. The accuracy of pedicle screw placement between two groups were evaluated according to results of postoperative CT, the accuracy of the fixation of thoracolumbar pedicle screw was divided into 4 grades, grade 0 and 1 screws were acceptable nails, grade 2 and 3 screws were unacceptable nails. The diameter and length of pedicle screws, the distance between entry point and posterior median line designed by preoperative 3D printing were compared with actual use in operation.@*RESULTS@#Twenty three blocks of thoracolumbar 3D printing screw of ankylosing spondylitis guided templates were designed and printed in guide-plate-assisted screw group, 46 screws were inserted and 44 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was (4.20±1.15) min, the frequency of X-ray was (5.00±1.25) times and the average adjustment times of screw and Kirschner needle during screw placement was (1.76±1.32) times. In the control group, 46 nails were placed by traditional surgical method and 30 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was (14.67±2.23) min, the frequency of X-ray fluoroscopy was (14.46±2.21) times and the average times of Kirschner needle adjustment was (4.76±3.39) times. The success rates between experimental group and control group were 95.65%(44 / 46) and 56.22%(30 / 46) respectively, and had statistical difference (χ=13.538, 0.05). The operation time of inserting a single screw, the times of X-ray fluoroscopy, and the average times of adjustment screw and Kirschner needle in experimental group were significant less than those in control group(<0.01).@*CONCLUSION@#The personalized guide template assisted the thoracolumbar fixation designed by 3D printing could significantly improve safety, accuracy and efficiency of surgery, especially suitable for thoracolumbar vertebral bodies requiring posterior pedicle screw fixation for fracture or dislocation with AS.
Subject(s)
Fluoroscopy , Humans , Pedicle Screws , Printing, Three-Dimensional , Spinal Fusion , Spondylitis, Ankylosing , Surgery, Computer-AssistedABSTRACT
The good results of enhanced recovery after surgery (ERAS) combined with minimally invasive surgery are reflected in reducing the incidence of perioperative complications and shortening the length of hospitalization (LOS). It has been widely used in surgical fields of different specialties. The implementation of the day surgery mode can shorten the waiting time for patients and reduce the financial burden. Especially in thoracic surgery, the shorter the waiting time in the hospital, the more beneficial for the patient's physical and psychological recovery. With the widespread implementation of minimally invasive technology and accelerated rehabilitation procedures, the application of ERAS in thoracic surgery has made it possible for some thoracic surgery to be completed in the day surgery. This article summarizes the current application of ERAS in the field of thoracic surgery and the development prospects of day surgery models in China.
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OBJECTIVE@#To test the role of psoralidin in human liver cancer HepG2 cells in vitro.@*METHODS@#Cell viability was assessed by methylthiazolyldiphenyl-tetrazolum bromide assay and apoptotic cells were labeled by annexin V then sorted by flow cytometry. Protein expressions of caspase-3, caspase-8, caspase-9, Bax, Bid, Bcl-2, Bcl-xL and p53 were examined by western blot while activity of caspase-3, -8 and -9 were also determined.@*RESULTS@#Psoralidin reduces cell viability greatly in a time dependent manner (64%, 40%, 21%, 12% at 2, 6, 24 and 48 h treatment with 64 μmol/L psoralidin respectively) and up-regulates activities of caspase-3, -8 and -9 in a concentration dependent manner (between 4 to 64 μmol/L). Psoralidin also increases the expression of pro-apoptosis genes Bax, Bid and p53 while decreases the expression of pro-survival genes Bcl-2 and Bcl-xL, both in a concentration dependent manner between 4 and 64 μmol/L (P<0.05 at 16 and 64 μmol/L). Caspase-3 inhibitor (Ac-DEVD-CHO at concentrations between 10 to 20 μmol/L), p53 inhibitor (pifithrin-α at 5 μmol/L) and cyclosporin A can attenuate the apoptotic effect of psoralidin.@*CONCLUSION@#The cytotoxic role of psoralidin might work through both intrinsic and extrinsic apoptotic pathway.
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Objective@#To evaluate the clinical value of four items of thrombosis detection, including thrombin-antithrombin complex (TAT), α2-plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM) and tissue plasminogen activator-inhibitor complex (t-PAIC), combined with D-dimer (D-D) and fibrin degradation products (FDP) in venous thrombosis in patients with malignant tumor.@*Methods@#A total of 904 patients with malignant tumor from October 2017 to March 2019 in General Hospital of Heilongjiang Province Land Reclamation Bureau were selected (malignant tumor group), and 200 healthy physical examination patients were selected as healthy control group. Among 904 patients with malignant tumor, 92 patients had venous thrombosis (thrombosis group), and 812 patients had not venous thrombosis (non-thrombosis group). The TAT, PIC, TM, t-PAIC, FDP and D-D were detected. The relationship between TAT, PIC, TM, t-PAIC, D-D, FDP and venous thrombosis was analyzed by binary Logistic regression. The receiver operating characteristic (ROC) curve was used to determine the diagnostic performance of each index, and the maximum value of the Youden index was the optimal cut-off value.@*Results@#The TAT, PIC, TM, t-PAIC, D-D and FDP in malignant tumor group were significantly higher than those in healthy control group, and there were statistical differences (P<0.01). The TAT, PIC, TM, t-PAIC, D-D and FDP in thrombosis group were significantly higher than those in non-thrombosis group: 20.20 (12.30, 59.45) μg/L vs. 8.60 (4.87, 15.15) μg/L, 1.23 (0.69, 2.84) mg/L vs. 0.70 (0.37, 1.45) mg/L, 14.55 (8.12, 21.10) kU/L vs. 10.05 (7.975, 13.90) kU/L, 10.20 (7.30, 15.17) μg/L vs. 7.40 (5.20, 12.65) μg/L, 3.42 (1.38, 7.07) μg/L vs. 1.69 (0.53, 4.64) μg/L, 6.41 (3.21, 17.05) mg/L vs. 5.15 (2.26, 10.01) mg/L, and there were statistical differences (P<0.01 or <0.05). Binary Logistic regression analysis result showed that TAT, PIC, TM, t-PAIC, D-D and FDP were correlated with venous thrombosis in patients with malignant tumor (OR = 1.277, 1.209, 1.107, 1.089, 1.260, 1.078 and 0.002; P<0.01 or <0.05). ROC curve result showed that the optimal cut-off values of TAT, PIC, TM, t-PAIC, D-D and FDP in the diagnosis of venous thrombosis in patients with malignant tumor were 24.450 μg/L, 2.624 mg/L, 17.750 kU/L, 13.250 μg/L, 5.290 μg/L and 22.435 mg/L; and the area under curve (AUC) were 0.788, 0.659, 0.621, 0.597, 0.626 and 0.598, respectively. The AUC of TAT + PIC + TM + t-PAIC and TAT + PIC + TM + t-PAIC + D-D + FDP in the diagnosis of venous thrombosis in patients with malignant tumor were significantly higher than D-D + FDP (0.808 and 0.796 vs. 0.633). Ninety patients with TAT>24.450 μg/L or PIC>2.624 mg/L were selected. Fourty-five cases of them were injected with low molecular weight heparin (experimental group) for 6 weeks, and another 45 cases were not treated with low molecular weight heparin (control group). Both groups were followed up for 1 year. The incidence of venous thrombosis in the experimental group was significantly lower than that in control group: 2.22% (1/45) vs. 15.56% (7/45), the survival time was significantly longer than that in control group: (10.6 ± 3.1) months vs. (8.5 ± 2.8) months, and there were statistical differences (P<0.05), and no bleeding occurred in experimental group.@*Conclusions@#Four items of thrombosis detection combined with D-D and FDP is better than single detection. It is the best non-invasive method to detect venous thrombosis. It can predict the possibility of venous thrombosis in patients with malignant tumor at an early stage, and help patients actively use preventing drug, determine the best and most reasonable treatment time, improve the prognosis of patients, and prolong survival time.
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Aim To discuss the neuroprotection of an-tioxidant α-phenyl-N-tert-butyl nitrone ( PBN) in Par-kinson's disease ( PD) model. Methods The neuro-protective effects of PBN was explored on 1-methyl-4-phenylpyridinium/1-methyl-4-phenyl-1,2,3,6-tetrahy-dropyridine ( MPP+/MPTP ) induced PD models through a chemical releasing of free radicals in neurons and in vivo. Results PBN significantly scavenged chemical derived free radicals, reduced MPP+induced SH-SY5Y injury and enhanced neurons' viability. In MPTP induced PD model, PBN significantly enhanced the number of tyrosine hydroxylase ( TH)-positive do-pamine ( DA) neurons in the substantia nigra, restored the expression of Nrf2 and HO-1, and raised striatal contents of DA and its metabolites. Conclusion PBN has a potent neuroprotective effect against MPP+/MPTP induced PD models.
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Objective To compare the vision and visual quality after implantation of refractive rotationally asymmetric mutifocal IOL (SBL-3) and diffractive mutifocal IOL (Zeiss809) in cataract surgery.Methods Totally 80 patients (100 eyes) who underwent cataract surgery in our hospital from May 2016 to June 2017 were chosen in the research,followed by the implantation of SBL-3 in 39 patients (50 eyes,SBL group) and Zeiss809 in other 41 patients (50 eyes,Zeiss group).The gender,age,length of optic axis and corneal curvature between the both groups were not significantly different (all P ＞ 0.05) before surgery.Variables including far,middle and near uncorrected vision acuity,defocus curves,vision quality were observed 3 months after surgery.Objective scattering index (OSI),modulation transfer function cutoff frequency(MTFcutoff) and Strehl ratio (SR) were detected,and objective optical quality analysis system was conducted.Results Both groups has no ocular hypertension and complications after surgery.The far uncorrected vision acuity of both groups in 3 months after surgery showed significant statistic difference from preoperation (both P ＜ 0.01).There has no statistic difference between both groups in far and near uncorrected vision acuity 3 months after surgery (both P ＞0.05).SBL group showed better outcomes than that in Zeiss group in the middle uncorrected vision acuity 3 months after surgery (P =0.04).Defocus curves showed the better middle uncorrected vision acuity in SBL group than that in Zeiss group when the degree was-1.50 D (70 cm).The OSI,MTFcutoff and SR in both groups significantly improved after surgery when compared with before surgery (all P ＜0.05).And the OSI,MTFcutoff and SR 3 months after surgery had no statistic difference between the two groups (all P ＞ 0.05).Questionnaire results showed there were 3 patients in SBL group and 4 in Zeiss group complaining glare at night,and there was no statistic difference between the two groups (P ＞ 0.05).Conclusion Both refractive rotationally asymmetric mutifocal IOL and diffractive multifocal IOL shows satisfactory vision acuity after cataract surgery.Significant improvement of vision quality in both groups can be presented after IOL implantation.
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BACKGROUND: Mesenchymal stem cells are a kind of adult stem cells with self-renewal and multi-directional differentiation potential. These cells have the functions of immunoregulation, regulation of cell growth and repair of injury. In recent years, it has been found that when inflammatory injury occurs, mesenchymal stem cells can regulate the secretion of inflammatory factors, and function on the damaged region, thereby repairing and improving tissue damage caused by inflammation. OBJECTIVE: To review the immunoregulatory effects of mesenchymal stem cells on T lymphocytes, B lymphocytes, dendritic cells and natural killer cells when the body is in an inflammatory state. METHODS: A computer-based search of PubMed and CNKI was performed for articles published from 2000 to 2018 using the keywords of"inflammatory microenvironment, mesenchymal stem cell, immune response, T cell, B cell, DC, NK cell" in English and Chinese, respectively. Seventy-six articles related to the topic and with reliable arguments were finally included in result analysis. RESULTS AND CONCLUSION: The interaction between mesenchymal stem cells and inflammatory cells determines the result of tissue damage repair. In an inflammatory state, the biological characteristics of mesenchymal stem cells will undergo certain changes, but mesenchymal stem cells can still exert immunomodulatory effects by secretion of various soluble cytokines or via cell contact. There are still many problems to be further explored to facilitate better clinical application of mesenchymal stem cells.
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Objective To explore the effect of cadmium chloride on mitochondrial function of hematopoietic stem cells in mouse bone marrow .Methods After being quarantined for one week , male Kunming mice weighted 20 ±2 g were randomly divided into three groups: control group , low dose cadmium-exposure group and high dose cadmium-exposure group.Mice in low dose and high dose cadmium-exposure groups were exposed to cadmium chloride solution at a dose of 7.5, 15 mg/kg body mass while those in control group were given an equal volume of distilled water through gavage administration every Monday , Wednesday and Friday for six consecutive weeks before cells in mouse bone marrow were collected at the 8th week.Mitochondrial membrane potential and ROS levels of mouse hematopoietic stem cells were detected using a flow cytometry .Results Compared with control group , the gain of body weight was significantly suppressed in cadmium-exposure group (P<0.01).Compared with control group, mitochondrial ROS levels of hematopoietic stem cells significantly increased in cadmium-exposure group and was dose-related(P<0.05,P<0.01). Besides, mitochondrial membrane potential of hematopoietic stem cells decreased in cadmium -exposure group compared with control group and was dose-related(P<0.05,P<0.01).Conclusion Cadmium exposure can lead to dose-related mitochondrial dysfunction of hematopoietic stem cells via oxidative damage in Kunming mice .