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Objective:To investigate the impact of intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control on incidence of acute cerebral infarction after carotid endarterectomy.Methods:A retrospective study was peformed; 305 patients with atherosclerotic stenosis of the carotid artery admitted to and accepted carotid endarterectomy in Department of Vascular Neurosurgery, Dong'e County People's Hospital from January 2020 to September 2023 were selected. Intraoperative multimodal neurophysiological monitoring combined with traditional empirical modalities for blood pressure control was applied to 153 patients admitted to our hospital from January 2020 to December 2021 (control group), and intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control (based on monitored sensory or motor wave amplitude changes) was applied to 152 patients admitted to our hospital from January 2022 to September 2023 (experimental group). Difference in postoperative acute cerebral infarction incidence between the 2 groups was compared.Results:The experimental group had significantly lower postoperative acute cerebral infarction incidence compared with the control group (4.6% vs. 13.0%, P<0.05). The experimental group had significantly lower postoperative asymptomatic acute cerebral infarction incidence compared with the control group (3.3% vs. 9.8%, P<0.05), while no significant difference was noted in postoperative symptomatic acute cerebral infarction incidence between the 2 groups ( P>0.05). Conclusion:Intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control can reduce the postoperative acute cerebral infarction incidence in patients accepted carotid endarterectomy, especacailly postoperative asymptomatic acute cerebral infarction incidence, thereby enhancing surgical safety.
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Objective:To explore the efficacy and safety of camrelizumab combined with apatinib as the second-line treatment for patients with advanced gastric cancer.Methods:The clinical data of 19 patients with advanced gastric cancer in Hebei General Hospital from August 2019 to March 2022 were retrospectively analyzed. All patients received camrelizumab combined with apatinib as the second-line treatment. The treatment efficacy and adverse reactions were evaluated; the survival analysis was performed using Kaplan-Meier method; Cox proportional hazards model was used to analyze the influencing factors for overall survival (OS) of patients.Results:Among 19 patients, no one achieved complete remission, 4 patients (21.1%) achieved partial remission, 9 patients (47.4%) had stable disease. The objective response rate (ORR) and disease control rate (DCR) were 21.1% (4/19) and 68.4% (13/19), respectively. The ORR of patients with deficient mismatch repair (dMMR) was higher than that of patients with proficient mismatch repair (pMMR) [100.0% (2/2) vs. 11.8% (2/17), P < 0.05], and patients with programmed death receptor ligand 1 (PD-L1) combined positive score (CPS) ≥1 had a higher DCR than patients with PD-L1 CPS < 1 [100.0% (5/5) vs. 25.0% (1/4), P < 0.05]. The median follow-up time of 19 patients was 14.7 months (12.0-17.4 months), the median progression-free survival time and OS time were 2.8 months and 5.7 months (95% CI 2.4-8.9 months). Increased lactate dehydrogenase (LDH) was negatively correlated with OS ( χ2 = 10.262, P = 0.001). Multivariate Cox regression analysis showed that LDH was an independent influencing factor for the OS of patients (<250 U/L vs. ≥250 U/L: HR = 0.149, 95% CI 0.039-0.657, P = 0.005). The most common treatment-related adverse reactions were fatigue (52.6%, 10 cases), anemia (47.4%, 9 cases), thrombocytopenia (36.8%, 7 cases), rash (36.8%, 7 cases), and reactive capillary hemangioma (36.8%, 7 cases). Conclusions:Camrelizumab combined with apatinib as the second-line treatment for advanced gastric cancer have good efficacy and safety.
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Objective:To explore the values of ultrasound, pathology combined with inflammatory indicators in predicting high nodal burden (HNB) in patients with early breast cancer and to construct a nomogram to provide reference for individualized diagnosis and treatment.Methods:The ultrasonographic, pathological features and preoperative inflammatory indicators of 378 female patients diagnosed with early breast cancer confirmed by pathology in the South Hospital of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from January 2014 to July 2022 were retrospectively analyzed. They were randomly divided into training set ( n=302) and test set ( n=76) in a ratio of 8∶2, and the baseline data of the two groups were compared. The optimal cutoff values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were obtained by ROC curve. In the training set, with axillary high lymph node load (≥3 metastatic lymph nodes) as the dependent variable, independent influencing factors of HNB were identified by univariate and multivariate Logistic regression analyses, and the nomogram was established. The test set data were used to verify the model. The discrimination, calibration and clinical applicability of the model were assessed by the area under the ROC curve (AUC), C-index, the calibration curve, Brier score and the decision curve analysis, respectively. Results:There were no significant differences in all variables between the training set and the test set (all P>0.05). ROC curve analysis results showed that AUCs of NLR, PLR and LMR were 0.578, 0.547 and 0.516, respectively, and the optimal cut-off values were 2.184, 150 and 3.042, respectively. Univariate Logistic regression analysis showed that age, pathological type, histological grade, Ki-67, lymphovascular invasion, NLR, PLR, ultrasonic characteristics (maximum diameter of primary tumor, shape, long/short diameter of lymph node, cortical thickness, cortical and medullary boundary, lymph node hilum, lymph node blood flow pattern) were correlated with HNB of early breast cancer (all P<0.05). Multivariate Logistic regression analysis showed that ultrasonic characteristics (maximum diameter of primary tumor >2 cm, effacement of lymph node hilum, non-lymphatic portal blood flow), lymphovascular invasion, Ki-67>14% and NLR>2.184 were independent risk factors for HNB in early breast cancer ( OR=7.258, 8.784, 6.120, 8.031, 3.394 and 3.767, respectively; all P<0.05) and were used to construct the nomogram model. The AUC of the training set was 0.914 (95% CI=0.878-0.949), C-index was 0.914; The AUC of the test set was 0.871 (95% CI=0.769-0.973), C-index was 0.871, indicating good discrimination. Calibration curve and Brier score were 0.090, indicating high calibration degree of the model. The clinical decision curve indicated good clinical benefit. Conclusions:The nomogram based on ultrasonic characteristics (maximum diameter of primary tumor, lymph node hilum, lymph node blood flow pattern), lymphovascular invasion, Ki-67 and NLR can effectively predict the risk of HNB in patients with early breast cancer, and provide a reference for precision diagnosis and treatment to avoid excessive or insufficient treatment.
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Objective:To investigate the relationship between prolonged PR interval and carotid atherosclerosis(CAS)in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 537 middle-aged and elderly inpatients with T2DM in the Southern Branch of the Sixth People′s Hospital of Shanghai Jiaotong University from January 2019 to January 2021 were selected as the research objects. Color Doppler ultrasound was used to detect bilateral carotid artery intima-media thickness(CIMT). The subjects were divided into carotid atherosclerosis group(CAS group, n=352)and non-carotid atherosclerosis group(NCAS group, n=185). The difference in the PR interval of ECG between the two groups was compared. Pearson or Spearman rank correlation analysis was used for evaluating the correlation of PR interval and CAS lesions with various clinical index. The relationship between PR interval and CAS lesions was adopted by multivariate logistic regression analysis. Results:The average PR interval of middle-aged and elderly patients with T2DM was(164.57±23.02)ms. The average PR interval in CAS group was significantly higher than that in NCAS group [(169.76±24.28) vs (154.70±16.42)ms, P<0.01]. The results of multifactorial logistic regression analysis showed that age, low density lipoprotein-cholesterol, serum osteocalcin, and PR interval were independent factors influencing the development of CAS lesions in middle-aged and elderly patients with T2DM( OR=1.079, 1.936, 0.879, 1.039, respectively, P<0.05 or P<0.01)where each 1 ms increase in PR interval was associated with a 3.9% increase in the risk of CAS in middle-aged and elderly patients with T2DM( OR=1.039, 95% CI 1.006-1.073, P=0.020). Multivariate logistic regression analysis showed that middle-aged and elderly type 2 diabetic patients with PR interval≥158 ms were 4.072 times more likely to have CAS lesions than those with PR interval<158 ms( OR=4.072, 95% CI 1.417-11.702, P<0.01). Conclusion:The PR interval of electrocardiogram is correlated with CAS lesions in middle-aged and elderly patients with T2DM. Middle-aged and elderly type 2 diabetic patients with significantly prolonged PR interval should be reminded to screen for CAS lesions early.
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AIM:To explore the therapeutic effect of Buyang-Huanwu decoction (BYHWD) on experimental au-toimmune encephalomyelitis ( EAE) and its immunoregulatory effect on monocyte-macrophages .METHODS: Chronic EAE was induced by myelin oligodendrocyte glycoprotein peptide fragment 35-55 ( MOG35-55 ) in the female C57BL/6 mice, which were randomly divided into saline group and BYHWD group .On day 3 after immunization , the mice in BYHWD group were orally administrated with BYHWD , while normal saline was given to the control mice .The clinical score and body mass were recorded every other day .At day 17 after immunization , the mice were sacrificed and spinal cords were obtained for HE staining and myelin staining .The M1 and M2 macrophage phenotypes of splenic cells were detected by flow cytometry and immunofluorescence staining .The protein expression of iNOS , TNF-α, arginase and IL-10 in the spinal cord macro-phages was determined by Western blotting .RESULTS:BYHWD delayed the onset of EAE , reduced the clinical scores of EAE, inhibited the inflammatory cell infiltration and demyelination in the spinal cord , and promoted the conversion of M 1 macrophages into M2 phenotype in the spinal cord and spleen .CONCLUSION:BYHWD intervention attenuates the be-havioral and pathological changes in the EAE mice , and its mechanism may be related to the macrophage conversion .
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Objective To study the protective effect of Shenkang injection on peritoneal mesothelial cells (PMCs) of continuous ambulatory peritoneal dialysis (CAPD) mice, and explore the possible mechanism. Methods Forty ICR mice were randomly divided into blank control (A) group, peritoneal dialysis (B) group, low dose of Shenkang (C) group ( 2.5%dialysate+5 mL/kg Shenkang injection), medium (D) group (2.5% dialysate+10 mL/kg Shenkang injection) and high (E) group (2.5% dialysate+ 20 mL/kg Shenkang injection). Mice were observed for 4 weeks. Fasting blood glucose, total cholesterol, triglyceride and C-reactive protein (CRP) were detected by biochemical assay. Tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta 1 (TGF-β1), vascular endothelial growth factor (VEGF) and connective tissue growth factor (CTGF) levels of serum and dialysate were detected by ELISA. Pathological changes of peritoneal tissue were observed by HE staining. Expression and mRNA transcription levels of these four cytokines in the peritoneal tissue were detected by immunohistochemical staining and real-time PCR respectively. Results There were no significant differences in body weight, fasting blood glucose, total cholesterol and triglyceride between 5 groups of mice (P>0.05). Compared with group B, there was no significant difference in CRP level between group C and group E, but which was significantly decreased in group D (P<0.05). The serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were decreased in group C and group D. The serum and dialysate levels of TNF-αand TGF-β1 were significantly increased in group E (P<0.05), but there was no significant difference between VEGF and CTGF in group E. Compared with group E, except for CTGF in dialysate of group C, the serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were significant decreased in group C and group D (P<0.05). Damaged PMCs were found in group B, which were improved in various degrees in group C, group D and group E. Compared with group B, the protein expression and mRNA relative transcription levels of TNF-α, TGF-β1, VEGF and CTGF tended to decrease gradually in group C, group D and group E (P<0.05). Conclusion A certain concentration of Shenkang injection can protect PMCs by inhibiting the expression of TNF-α, TGF-β1, VEGF and CTGF in CAPD mice, so as to control the occurrence and development of peritoneal fibrosis.
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Objective To investigate the recurrence and satisfaction of paracentesis and segment resection on patients with early plasma cell mastitis,and to choose a more effective and cost-effective treatment.Methods Eighty-nine patients with early plasma cell mastitis received paracentesis in the treatment group and 101 cases received segment resection therapy in the comparison group.The recurrence and satisfaction of patients with early plasma cell mastitis in the two groups were compared.Results (1) The recurrence rates of patients with early plasma cell mastitis received paracentesis or segment resection were 29.21％ and 21.78％,without significant difference (x2 =5.437;P =0.285).(2) No significant differences in pain degree and time of therapy Were observed (P =0.323;P =0.102),but obvious difference in aesthetic measure was found between two groups (P =0.01).Conclusion Ultrasound guided puncture is used to treat patients with early plasma cell mastitis resulted in the therapeutic effect of segmental excision and better patient satisfaction,which has important significance and clinical promotion value for early plasma cell mastitis treatment.
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BACKGROUND: Representative formulae of Qi-Benefiting and Blood-Activating Chinese medicinal herbs Bu Yang Huan Wu Tang (BYHWT) can improve microcirculation and hypoxia, decrease fibrinogen, resist platelet aggregation, reduce blood lipid, dilate blood vessel, resist thrombosis, and reduce neonatal plaque rupture, and has a multi-target, multi-channel anti-atherosclerotic effect. OBJECTIVE: To observe the influence of representative formulae of Qi-Benefiting and Blood-Activating Chinese medicinal herbs BYHWT on aorta Rho kinase, tissue factor, matrix metal oproteinase-2, matrix metal oproteinase-9 mRNA expression in atherosclerosis models, and to explore the action mechanism of BYHWT on anti-atherosclerosis. METHODS: Vitamin D3 and high fat diet induced atherosclerosis in rats. 60 rats were randomly divided into normal control group, model group, 10 g/kg BYHWT therapy group, 20 g/kg BYHWT therapy group, simvastatin control group and BYHWT prevention group (n=10). At 28 days after model establishment, the expression level of Rho kinase, tissue factor, matrix metal oproteinase-2, matrix metal oproteinase-9 mRNA expression and blood lipid level were detected. RESULTS AND CONCLUSION: (1) High fat diet and vitamin D3 could induce atherosclerosis in rats. Atherosclerotic plaque formed in the model group. (2) Rho kinase, tissue factor, matrix metal oproteinase-2, matrix metal oproteinase-9 mRNA expression and blood lipid were significantly lower in the normal control group, 20 g/kg BYHWT therapy group, simvastatin control group and BYHWT prevention group than in the model group (P 0.05). (3) Results indicated that Qi-Benefiting and Blood-Activating BYHWT can resist atherosclerosis, down-regulate the expression of Rho kinase, tissue factor, matrix metal oproteinase-2, and matrix metal oproteinase-9 mRNA expression, which may be one of the mechanisms of anti-atherosclerosis.
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Objective To investigate the clinical and epidemiologic features of infection in patients with lupus nephritis (LN). Methods The incidence, sites and pathogen species of infection 1 year after diagnosis in 189 patients with LN were retrospectively analyzed, and the relationships between the clinical, histological types, treatment programs and infection were analyzed. Results Among 189 LN patients (16 males and 173 females), 97 patients had infection (infection group), and 92 patients had not infection (non-infection group). The incidence of infection was 51.3% (97/189), while the incidence of nosocomial infection was 39.7%(75/189). In infection group, the patients had 133 infection episodes, and the principal infection sites were lung and urinary tract system, accounting for 67.7% (90/133); the principal pathogen was bacteria, accounting for 72.9%(97/133), and the second was virus, accounting for 17.3% (23/133). Different clinical or pathological types and treatment options of LN had different infection rates, but there were no statistical differences (P>0.05). The incidence of nosocomial infection in patients with glucocorticoid + cyclophosphamide double impact was significantly higher than that in patients treated with glucocorticoid + mycophenolate mofetil: 52.9% (45/85) vs. 7.7% (2/26), and there was statistical difference (P<0.01). One year after diagnosis, the mortality in infection group was significantly higher than that in non-infection group:8.2%(8/97) vs. 1.1%(1/92), and there was statistical difference (P<0.05). Conclusions The more serious the clinical and pathological types, the higher the incidence of infection. The incidence of infection is associated with the treatment options. Infection is still the most important reason for LN patients′death.
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Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.
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Objective To study the expression of PINCH and vascular endothelial growth factor C (VEGF-C) in cervical squamous cell carcinoma.Methods We detected the expression of PINCH and VEGF-C by immunohistochemistry SP in 58 cervical squamous cell carcinoma cases and 30 normal cervical epithelial tissue and analyzed their relationship to the clinical pathological features.Results The expression of PINCH and VEGF-C in 58 cervical squamous cell carcinoma(62.1％,36/58 ;67.2％,39/58 ) were higher than that in normal cervical epithelial tissue(0,0/30).The difference was significant( x2 =31.512,12.534,P ＜ 0.001 ).The expression of PINCH protein was not significantly associated with the age,tumor size and tumor differentiation grade ( P ＞ 0.05 ),but was associated with the lymph node metastasis and clinical stage ( x2 =9.090,8.236,P ＜ 0.001 ).The expression of VEGF-C had no significant correlationship with the age and tumor size( P ＞ 0.05 ) but had a correlationship with the lymph node metastasis,tumor differentiation grade and clinical stage( x2 =10.775,13.496,5.001,P ＜ 0.05 ).The expression of VEGF-C was correlated with the expression of PINCH protein( C =0.341,P ＜ 0.01 ).Conclusion It is possible that VEGF-C and PINCH take part in the development and progress of cervical squamous cell carcinoma and play an important role in the invasion and metastasis mechanism altogether.
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BACKGROUND: In traditional Chinese medicine, both deficiency as primary and excess as secondary and deficiency of qi and blood stasis are common symptoms in dialectical logy of atherosclerosis (AS). Therefore, qi-benefiting drugs are the main component of qi-benefiting and blood-activating intervention. However, the best dose relationship between qi-benefiting and blood-activating drugs needs to be further studied.OBJECTIVE: To observe the effect of qi-benefiting and blood-activating intervention on the expression of aortic vascular cell adhesion molecule-1mRNA (VCAM-1mRNA) in AS models and analyze dose-effect relationship between astragalus and sanchi.DESIGN: Randomized control animal study.SETTING: Shanxi Medical University.MATERIALS: The experiment was carried out in the Shanxi Medical University in April 2005. A total of 60 healthy male Wistar rats were selected in this study. The main reagents were quercetin (Shaanxi Huike Plant Co., Ltd., batch number:20041112), saponins of panax notoginseng (PNS, Kunming Yagechen Pharmaceutical Co., Ltd., batch number:20050118) and ligustrazine (Yuxin Guoji Longyuan Pharmaceutical Co., Ltd., batch number: 20041204).METHODS: Model establishment: Wistar rats were administrated AS feeds (including 10% yolk powder, 5% lard, 0.5% bile salt and 85% basic feed) for 3 months. Grouping and administration: At threedays after suitability feeding, 8 rats were randomly selected, regarded as the normal control group and given general feeds, and other 52 rats were fed with AS feeds. Three months later, 4 rats were randomly selected for the measurements of lipid and aortic tissue. And then, the models were established successfully. In addition, 48 rats were randomly divided into 6 groups. ① Astragalus treatment group: Rats were perfused with 0.1 g/(kg·d) quercetin. ② Sanchi treatment group: Rats were perfused with 0.1 g/(kg·d)PNS. ③ 2∶1 of astragalus/sanchi treatment group: Rats were perfused with 0.1 g/(kg·d) quercetin and 0.05 g/(kg·d) PNS.④ 3∶1 of astragalus/sanchi treatment group: Rats were perfused with 0.15 g/(kg·d) quercetin and 0.05 g/(kg·d) PNS. ⑤Ligustrazine treatment group: Rats were perfused with 0.2 g/(kg ·d) ligustrazine (Yuxin Guoji Longyuan Pharmaceutical Co., Ltd.). ⑥ Normal control group: Rats were fed with general feeds. ⑦ Model group: Rats were fed with general feeds after successful model estalishement. Thirty days after administration, relative expression of VCAM-1mRNA inaorta was measured with reverse transcription polymerase chain reaction (RT-PCR) technique; moreover, 2 mL venous blood was collected from tail to measure the levels of serum total cholesterol (TC), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C).MAIN OUTCOME MEASURES: ① Relative expression of VCAM-1mRNA in aorta; ② level of lipid.RESULTS: Among 60 male Wistar rats, three rats in the treatment group died because of perfusion and two rats in the model group died due to accident; therefore, a total of 51 rats were involved in the final analysis. ① High-lipid diet could promote the formation of AS models. Level of lipid was higher in the model group than that in the normal control group (P＜ 0.05), and leves of serum TC, TG and LDL-C were lower in the interventions group than those in the model group (P ＜0.05). ② Expression of VCAM-1mRNA was not found in the normal control group. Expression of VCAM-1mRNA was lower in the intervention groups than that in the model group. Expression of VCAM-1mRNA (0.42±0.02) was the lowest in 3∶1 of astragalus/sanchi treatment group, and there were significant differences as compared with other intervention groups (P ＜ 0.05).CONCLUSION: Astragalus and sanchi, a main component of qi-benefiting and blood-activating herbs, can down-regulate the level of lipid and resist AS; meanwhile, the combination of them is superior to the single application; in addition, with the increasing deal of qi-benefiting drugs, the function against AS is strengthened.
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This article explores the teaching methods of laparosopic operation training of the begnners. In teaching emphasis should be put on the accumulation of the learners'operation experience,the study of the relative theory,the simulative training and the relative practice.
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Objective To study the effects of skeleton musclular relaxation on nerve conduction and regeneration. Methods Musclocontaneous nerve injury model was established in 96 mice and the animals were divided into skeleton muscle relaxation, skeleton muscle relaxation and neurotrophic drugs, neurotrophic drugs and control group. Nerve conduction and regeneration were evaluated by electromyography; muscle weight and counting of distal regenerated myelinated nerve fibers. Results The velocity of nerve conduction and regeneration in skeletal muscle group was the same as that in skeleton muscle relaxation and neurotrophic group, and higher than that in control group. Conclusion Skeleton muscle can enhance nerve conduction and regeneration.