Résumé
Objective:To investigate the effect of low-dose ketamine on neuroinflammation and microcirculation in mice with traumatic brain injury (TBI).Methods:Sixty adult male C57BL/6 mice, weighing 22-28 g, were randomly divided into sham-operated group, TBI group, Sham+ketamine group, and TBI+ketamine group ( n=15). A controlled cortical impingement (CCI) method was used to establish TBI models in the later 2 groups. Sham+ketamine group and TBI+ketamine group were intraperitoneally injected with 30 mg/kg ketamine once daily for 3 d at 30 min after TBI; sham-operated group and TBI group were intraperitoneally injected same amount of saline at the same time points. Cerebral cortical blood flow in 6 mice from each group was measured by laser speckle contrast imaging (LSCI) before, immediately after, 30 min after, 1 d after and 3 d after modeling, respectively. Three d after modeling, immunohistochemical staining and immunofluorescent double label staining were used to detect the nuclear translocation of microglia markers, ionized calcin-antibody-1 (Iba-1) and nuclear factor (NF)-κB p65 in damaged cortical brain tissues in 6 mice from each group. The remaining 3 mice in each group were sacrificed and tissue plasma was extracted 3 d after modeling; levels of NF-κB p65, phosphorylated (p)-NF-κB p65, p-IκB and inducible nitric oxide synthase (iNOS) in cortical brain tissues were detected by Western blotting. Expressions of tumor necrosis factor-α (TNF-α), interleukin-1-β (IL-1β) and interleukin-6 (IL-6), iNOS, reactive oxygen species (ROS) and reactive nitrogen species (RNS) in cortical brain tissues were detected by ELISA. Results:LSCI indicated that, 3 d after modeling, relative blood flow in local cerebral microcirculation of TBI+ketamine group was significantly increased compared with that of TBI group ( P<0.05). Immunohistochemical staining indicated that compared with the sham-operated group and Sham+ketamine group, the TBI group and TBI+ketamine group had significantly increased number of Iba-1 positive cells in the cerebral cortex ( P<0.05); compared with the TBI group, the TBI+ketamine group had significantly decreased number of Iba-1 positive cells ( P<0.05). ELISA indicated that compared with the sham-operated group and Sham+ketamine group, the TBI group and TBI+ketamine group had significantly increased expressions of TNF-α, IL-1β, IL-6, iNOS, ROS and RNS in damaged cortical brain tissues ( P<0.05); compared with the TBI group, the TBI+ ketamine group had significantly decreased expressions of TNF-α, IL-1β, IL-6, iNOS, ROS and RNS in damaged cortical brain tissues ( P<0.05). Immunofluorescent double label staining indicated obviously inhibited NF-κB p65 nuclear translocation in TBI+ketamine group when it was compared with TBI group. Western blotting indicated that compared with the sham-operated group and Sham+ketamine group, the TBI+ketamine group had significantly increased iNOS, NF-κB p65, p-NF-κB p65 and P-IκB protein expressions in damaged cortical brain tissues ( P<0.05); compared with the TBI group, the TBI+ketamine group had significantly decreased protein expressions of iNOS, NF-κB p65, p-NF-κB p65 and p-IκB in damaged cortical brain tissues ( P<0.05). Conclusion:Low-dose ketamine reduces neuroinflammation and improves cerebral microcirculatory blood flow after open TBI, whose mechanism may be related to inhibition of microglia NF-κB/iNOS pathway.
Résumé
Objective:To evaluate the effect of goal-directed fluid therapy (GDFT) on postoperative acute kidney injury (AKI) in elderly patients undergoing long-time abdominal surgery.Methods:The medical records from elderly patients of both sexes, aged ≥ 65 yr, with a duration of operation ≥ 8 h and American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective first abdominal surgery for gastrointestinal tumors at the Shanxi Provincial People′s Hospital from October 1, 2016 to June 30, 2022, were collected from the electronic medical record database. Patients were divided into conventional fluid therapy group (group C) and GDFT group (group G) according to whether GDFT was employed during operation. In group C, blood pressure was maintained ≥90/60 mmHg or mean arterial pressure≥65 mmHg, and urine output more than 30 ml/h. In group G, the stroke volume variation was maintained ≤13%, and cardiac index ≥2.5 L·min -1·m -2. The patient general characteristics, requirement for fluid, urine output, blood loss, requirement for vasoactive agents and abdominal hyperthermic perfusion, and operation time were recorded during operation. The development of AKI within 72 h after operation and development of other complications (pneumonia, anastomotic leakage, surgical site infection, septic shock, arrhythmia) after operation were recorded. The length of hospital stay and 30-day mortality after operation were recorded. Results:A total of 125 patients were included in this study, with 41 patients in group C and 84 patients in group G. Postoperative AKI occurred in 19 patients, with an incidence of 15.2%. Compared with group C, the requirement for colloid, total volume of fluid infused and urine volume were significantly decreased during operation, the requirement for vasoactive agents was increased during operation ( P<0.05), the risk of postoperative AKI was reduced ( OR=0.23, P<0.05), and no significant change was found in the incidence of other postoperative complications, 30-day mortality, and length of hospital stay in group G ( P>0.05). Conclusions:GDFT can reduce the risk of AKI in the elderly patients undergoing long-time abdominal surgery.
Résumé
ObjectiveTo establish a rapid and stable liquid chromatography-mass spectrometry（LC-MS） for simultaneous analysis of 17 chemical components in Gnaphalium affine aboveground parts with flowers， so as to provide experimental basis for improving the quality standard of this herb. MethodUltra performance liquid chromatography-quadrupole/electrostatic field orbitrap mass spectrometry（UPLC-Q-Exactive Orbitrap MS） was used for the quantitative analysis of 17 constituents in 15 batches of G. affine from different origins， the separation was performed on an ACQUITY UPLC® BEH C18 column（2.1 mm×100 mm， 1.7 μm） with the mobile phase of methanol（A）-0.1% formic acid aqueous solution（B） for gradient elution（0-1.0 min， 8%A； 1.0-4.0 min， 8%-26%A； 4.0-9.0 min， 26%A； 9.0-14.0 min， 26%-34%A； 14.0-14.5 min， 34%-45%A； 14.5-15.0 min， 45%-60%A； 15.0-18.0 min， 60%-90%A； 18.0-19.0 min， 90%A； 19.0-19.01 min， 90%-8%A； 19.01-20.0 min， 8%A）， the flow rate was 0.3 mL·min-1， the column temperature was 40 ℃ and the injection volume was 2 μL. And the electrospray ionization was used with full scanning in both positive and negative ion modes， and the scanning range was m/z 100-1 000. ResultThe established method has been verified by the methodology and could be used for the simultaneous quantification of 17 components in G. affine. The content ranges of the 17 components（quinic acid， gallic acid， protocatechuic acid， neochlorogenic acid， chlorogenic acid， cryptochlorogenic acid， caffeic acid， 1，3-O-dicaffeoylquinic acid， isochlorogenic acid A， isoquercitrin， 1，5-O-dicaffeoylquinic acid， apigenin-7-O-glucoside， astragalin， isochlorogenic acid C， luteolin， apigenin and hispidulin） in 15 batches of G. affine samples was 39.60-179.12， 0.17-0.84， 2.41-8.38， 4.33-31.50， 13.63-180.38， 2.43-14.75， 1.16-19.68， 0.49-5.63， 55.77-445.16， 0.23-10.26， 62.04-530.10， 1.11-18.01， 11.36-90.61， 12.22-65.98， 7.22-69.84， 3.37-45.65， 0.30-2.59 μg·g-1， respectively. The content of organic acids was higher than that of flavonoids in G. affine， and the contents of 1，5-O-dicaffeoylquinic acid， isochlorogenic acid A， quinic acid and chlorogenic acid were higher. Meanwhile， the content of flavonoids in the samples from Guizhou was higher than that from Jiangsu， while the content of organic acids in the samples from Jiangsu was higher than that from Guizhou. ConclusionThe established method can be used for the rapid and accurate determination of 17 components in G. affine， which clarifies the content range of the main components in this herb， and can provide a reference for the selection of quality control markers of G. affine.
Résumé
Objective:To investigate the effects of estimated dose of radiation to immune cells (EDRIC) on overall survival (OS), local progression-free survival (LPFS) and distant metastasis-free survival (DMFS) in limited-stage small-cell lung cancer (LS-SCLC) with different tumor burdens.Methods:Clinical data of 216 patients with LS-SCLC who initially received conventional fractionated radiotherapy of the chest for radical treatment in Tianjin Medical University Cancer Institute and Hospital from 2013 to 2019 were retrospectively analyzed. EDRIC was calculated based on the model developed by Jin et al. and tumor burdens were assessed by gross tumor volume (GTV) or clinical stage. The study endpoints were OS, LPFS and DMFS, which were calculated from the date of diagnosis. The optimal cut-off value of EDRIC was calculated by R language. The correlation between EDRIC and tumor burdens was analyzed using Spearman's correlations. Survival analysis was performed by Cox proportional hazards regression model and Kaplan-Meier curve. Results:The median follow-up time for the whole group was 47.8 months, and the median OS and DMFS was 34.6 months and 18.5 months, respectively, while the median LPFS did not reach. The optimal cut-off value of EDRIC was 6.8 Gy. Cox multivariate analysis showed that EDRIC was an independent prognostic factor affecting OS and DMFS. EDRIC was weakly correlated with GTV or clinical stage. Stratified by the median GTV, OS ( P=0.021) and DMFS ( P=0.030) were significantly shortened and LPFS had a tendency of shortening ( P=0.107) when EDRIC>6.8 Gy compared with those when EDRIC ≤ 6.8 Gy in the GTV ≤ 34.6 cm 3 group; EDRIC had little effect on OS, LPFS, and DMFS ( P=0.133, 0.420, 0.374) in the GTV>34.6 cm 3 group. Stratified by clinical stage, OS ( P=0.003) and DMFS ( P=0.032) were significantly shortened and LPFS ( P=0.125) tended to shorten when EDRIC>6.8 Gy in stage I, II and IIIA groups; EDRIC exerted slight effect on OS, LPFS, and DMFS ( P=0.377, 0.439, 0.484) in stage IIIB and IIIC groups. Conclusion:EDRIC is an important factor affecting prognosis and exerts more significant impact on prognosis in patients with smaller tumor burden.
Résumé
Objective:To compare the prognosis difference between proximal gastrectomy (PG) and total gastrectomy (TG) in patients with advanced upper gastric cancer.Methods:This study included patients of upper gastric cancer admitted from Jan 2011 to Dec 2016 undergoing radical resection at Harbin Medical University Cancer Hospital. Patients were divided into TG group (178 cases) and PG group (185 cases).Results:Comapared to PG group , more TG patients were with tumor diameter >4 cm, Borrmann type Ⅲ and postoperative stage Ⅲ ( χ2=9.687, P=0.002; χ2=24.897, P=0.001; χ2=6.257 P=0.044).The 5-year overall survival (OS) of the PG group and the TG group were 64.3% (95% CI: 45.1%-50.5%) and 60.6% (95% CI: 41.3%-47.6%) ( P=0.297).After propensity score matching, the OS between the two groups was not statistically significant ( P=0.876).Subgroup analysis of chemotherapy showed that the difference in survival between TG group and PG group was not statistically significant ( P=0.309). Conclusion:There was no difference in survival between PG and TG in patients with advanced upper gastric cancer.
Résumé
Objective:To probe into the potential prognostic value of lymphocyte subsets in gastric cancer.Methods:This study included patients who underwent radical gastrectomy for gastric cancer from Aug 2014 to Dec 2016. The immunological differences was analyzed in different infiltration patterns. The overall survival of patients was analyzed by Kaplan-Meier method and Log-rank test. COX regression was performed to assess independent prognostic factors of the patients, and finally constructed nomogram.Results:The median number of peripheral CD4 and CD19 cells in infiltration pattern c was 750 (94-2 504) cells/μl and 186 (17-820) cells/μl; the median number of peripheral CD4 and CD19 cells in infiltration pattern a was 802 (203-2 071) cells/μl and 213 (5-948) cells/μl, the number of peripheral CD4,CD19 cells in infiltration pattern c was lower than that in infiltration pattern a, with statistically significant differences (CD4: Z=-3.061, P=0.002; CD19: Z=-2.016 , P=0.044). CD19 lymphocytes ( P=0.023) were associated with infiltration pattern a, CD8 lymphocytes ( P=0.027) were associated with infiltration pattern b, and CD4 lymphocytes ( P=0.026) were independent risk factors associated with the prognosis of infiltration pattern c. A nomogram can be constructed to evaluate the prognosis of patients. Conclusion:There are differences in the number of peripheral lymphocyte subsets in patients with different INF types. A nomogram can be constructed from lymphocyte subsets and clinicopathological features to assess patient prognosis.
Résumé
@#Objective To analyze the research hotspots and progress of surgical treatment of myasthenia gravis. Methods The top 100 most cited articles on surgical treatment of myasthenia gravis were identified by searching the Web of Science database, and a bibliometric analysis was conducted. Results The publication year of the top 100 most cited articles ranged from 1939 to 2021, and the number of citations ranged from 55 to 850 per article. Most of the included articles were original research articles (75/100), which were mainly retrospective studies (64/75). The United States was the country with the most published articles and most citations, and Annals of Thoracic Surgery was the most sourced journal (n=20). Through VOSviewer analysis, high-density keywords were thymectomy, maximal thymectomy, extended thymectomy, transcervical thymectomy, thymoma, and autoantibodies. Conclusion The scope of surgical resection, surgical approach and pathogenesis are the current hotspots in the field of surgical treatment of myasthenia gravis. It is hoped that this paper can provide references for future researches in this field.
Résumé
@#Objective To investigate the clinical characteristics and treatment of primary mediastinal yolk sac tumor (PMYST). Methods We collected the clinical data of PMYST patients who were admitted to the Department of Thoracic Surgery of Peking Union Medical College Hospital from September 2000 to September 2020. The clinical and pathological characteristics, treatment and prognosis of PMYST patients were retrospectively analyzed. Results Finally 18 patients were enrolled, including 17 males and 1 female with a median age of 22.0 (16.6, 26.2) years. Patients had increased level of alpha fetoprotein (AFP). The pathological type can be single yolk sac tumor or combined with other mediastinal germ cell tumors. Chemotherapy and radical surgery were the main treatment methods. Extensive resection was feasible for patients with tumor invasion of other organs. Seven patients developed lung or pleural metastasis after operation, and 3 of them had extrapleural metastasis. One patient recurred within 1 year after surgery. All patients were followed up by telephone or outpatient department. At the last follow-up, 5 patients survived, 9 died, and 4 were lost to follow up, with a median survival of 16.8 months. The median disease-free survival was 14.9 months. The survival rates at 1, 3 and 5 years were 73.3%, 28.6% and 11.8%, respectively. Conclusion PMYST often occurs in young-middle aged male patients. Preoperative puncture can provide an effective diagnostic basis. R0 resection, AFP returning to normal after treatment and no metastasis may be potential indicators of good prognosis. The overall prognosis of PMYST is poor, and some patients can achieve long-term survival after treatment.
Résumé
ObjectiveTo analyze the influencing factors of stunting among 3 to 4-year-old children in Changning District， Shanghai， in order to provide a scientific basis for early prevention and intervention for stunting. MethodsRandom cluster sampling was employed to select1 514 children from 16 kindergartens in Changning District， Shanghai as the survey subjects. Basic information such as height， weight， perinatal and infant feeding status， diet and lifestyle， as well as parental information was collected. The detection rate of stunting was calculated， and the influencing factors of stunted growth were analyzed. ResultsThe stunting detection rate of the 1 514 children was 5.4%. In terms of family-related factors， parents of stunted children had lower heights and a lower proportion of accessing growth and developmental knowledge from professional platforms compared to parents of non-stunted children （both P<0.05）. Among individual-related factors， the proportion of premature birth， low birth weight， short birth length， twin or multiple births， low fruit consumption， vitamin D intake， short outdoor playtime， and frequent nighttime waking was higher in the stunting group than in the control group （P<0.05）. Binary logistic multivariate regression analysis showed that shorter parental height （OR=4.35， 95%CI：1.20‒15.84 and OR=3.49， 95%CI：1.43‒8.51）， low birth weight （OR=2.99，95%CI：1.28‒7.05）， multiple or twin pregnancies （OR=3.78，95%CI：1.29‒11.06）， short outdoor playtime during weekends and holidays （OR=2.34，95%CI：1.02‒5.46）， frequent nighttime waking （OR=1.89， 95%CI：1.06‒3.39）， and consuming fewer fruits daily （OR=1.81， 95%CI： 1.01‒3.26） significantly increased the risk of stunting. ConclusionLow parental height， low birth weight， being twins or multiples， limited outdoor playtime during holidays， frequent nighttime waking， and low daily fruit consumption are major risk factors for stunting in infants and children.
Résumé
@#Objective To assess the safety and clinical outcomes of segmentectomy in one- or two-staged video-assisted thoracoscopic surgery (VATS) for bilateral lung cancer. Methods We retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022. We divided the patients into two groups: a one-stage group (52 patients), including 17 males and 35 females with a mean age of 55.17±11.09 years, and a two-stage group (48 patients), including 16 males and 32 females with a mean age of 59.88±11.48 years. We analyzed multiple intraoperative variables and postoperative outcomes. Results All 100 patients successfully completed bilateral VATS, and at least unilateral lung received anatomical segmentectomy. Patients in the one-stage group were younger (P=0.040), had lower rate of comorbidities (P=0.030), were less likely to have a family history of lung cancer (P=0.018), and had a shorter interval between diagnosis and surgery (P=0.000) compared with patients in the two-stage group. Wedge resection on the opposite side was more common in the one-stage group (P=0.000), while lobectomy was more common in the two-stage group. The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group (P=0.000, P=0.002). Duration of surgery and anesthesia were similar between two groups (P>0.05). Total number of lymph node stations for sampling and dissection (P=0.041) and lymph nodes involved (P=0.026) were less in the one-stage group. Intraoperative airway management was similar between two groups (P>0.05). The one-stage group was associated with lower activities of daily living (ADL) scores. Conclusion Segmentectomy is safe in one- or two-staged VATS for bilateral lung cancer, including contralateral sublobectomy and lobectomy. Duration of surgery and perioperative complications are similar between two groups, but the one-stage group is associated with lower ADL scores. On the basis of comprehensive consideration in psychological factors, physical conditions and personal wishes of patients, one-staged sequential bilateral VATS can be the first choice.
Résumé
@#Objective To systematically review the clinical utilization of robotic bronchoscopes in diagnosis of pulmonary nodules, including MonarchTM and IonTM platforms, and then evaluate the efficacy and safety of the procedure. Methods PubMed, EMbase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched by computer for literature about the biopsy of pulmonary nodules with robotic bronchoscope from January 2018 to February 14, 2022. The quality of research was evaluated with Newcastle-Ottawa Scale. RevMan 5.4 software was used to conduct the meta-analysis. Results Finally, 19 clinical studies with 1 542 patients and 1 697 targeted pulmonary nodules were included, of which 13 studies used the IonTM platform and 6 studies used the MonarchTM platform. The overall diagnostic rate of the two systems was 84.96% (95%CI 62.00%-95.00%), sensitivity for malignancy was 81.79%(95%CI 43.00%-96.00%), the mean maximum diameter of the nodules was 16.22 mm (95%CI 10.98-21.47), the mean procedure time was 61.86 min (95%CI 46.18-77.54) and the rate of complications occurred was 4.76% (95%CI 2.00%-15.00%). There was no statistical difference in the outcomes between the two systems. Conclusion Robotic bronchoscope provides a high efficacy and safety in biopsy of pulmonary nodules, and has a broad application prospect for pulmonary nodules diagnosis.
Résumé
Epilepsies are a group of chronic neurological disorders characterized by spontaneous recurrent seizures caused by abnormal synchronous firing of neurons and transient brain dysfunction. The underlying mechanisms are complex and not yet fully understood. Endoplasmic reticulum (ER) stress, as a condition of excessive accumulation of unfolded and/or misfolded proteins in the ER lumen, has been considered as a pathophysiological mechanism of epilepsy in recent years. ER stress can enhance the protein processing capacity of the ER to restore protein homeostasis through unfolded protein response, which may inhibit protein translation and promote misfolded protein degradation through the ubiquitin-proteasome system. However, persistent ER stress can also cause neuronal apoptosis and loss, which may aggravate the brain damage and epilepsy. This review has summarized the role of ER stress in the pathogenesis of genetic epilepsy.
Sujets)
Humains , Stress du réticulum endoplasmique/génétique , Réponse aux protéines mal repliées , Réticulum endoplasmique/anatomopathologie , Apoptose , Épilepsie/génétiqueRésumé
Objective To investigate the underlying mechanism of Huayu Xiaozheng granule(HYXZ)in the treatment of ectopic pregnancy(EP).Methods The potential ingredients and targets of HYXZ were identified and screened.PPI network,GO enrichment and KEGG pathway analysis were established to understand the potential and intricate mechanism of HYXZ in treating EP.The effects of HYXZ on HTR-8/SVneo cells migration and invasion were detected by wounding healing assay and transwell migration assay respectively,as well as the influence of HYXZ granule on JAK/STAT pathway and associated proteins were assessed by western blot under the control of JAK/STAT pathway inhibitor and agonist.Results A total of 375 active ingredients,45 known targets and 207 predicted targets of HYXZ were obtained.A PPI network has constructed to know the relationship of 252 common targets of drug targets and disease targets,from which we screened out 15 key targets:STAT3,MMP9,TLR4,HIF1A and others.Scratch test showed that HYXZ inhibited the migration of the HTR-8/SVneo cells cells in a time and dose-dependent manner;Transwell test showed that the number of transmembrane cells decreased significantly(P<0.05)after 48 h with various concentrations of HYXZ;Western blot experiment showed that the expression of JAK/STAT pathway protein decreased significantly(P<0.05);and the expression of its related proteins uPA,HIF1and N-cadherin were inhibited(P<0.05),the tendency of which was consistent with the inhibitor AG490,but opposite to the agonist IL-6.Conclusion HYXZ inhibited JAK/STAT pathway,and associated proteins uPA,HIF1A and N-cadherin,thereby suppressing the mobility and invasiveness of the HTR-8/SVneo cells,which is conductive to clarify the mechanism of HYXZ in the treatment of early EP.
Résumé
Objective:To evaluate the accuracy of bedside lung ultrasound in predicting postoperative pulmonary complications (PPCs) in the patients undergoing radical resection of gastrointestinal cancer.Methods:One hundred and eight patients of both sexes, aged >18 yr, undergoing elective radical resection of gastrointestinal cancer with general anesthesia, were enrolled in the study. Lung ultrasound was performed before surgery (T 1) and at 2, 4 and 7 days after surgery (T 2-4). Lung ultrasound score (LUS) and B-line score were recorded. Serum procalcitonin (PCT) concentrations and blood routine were recorded, and systemic immune-inflammatory index (SII) was calculated. All the patients underwent chest CT examination before surgery and 7 days after surgery. The results of chest CT and clinical diagnosis were used as the gold standard for PPCs. The occurrence of PPCs within 7 days after surgery was recorded. The patients were divided into PPCs group and non-PPCs group according to the development of PPCs. Spearman′s correlation analysis was used to analyze the correlation of B-line score and LUS with PPCs, PCT and SII. The receiver operating curve was used to evaluate the accuracy of B-line score and LUB in predicting PPCs. Results:One hundred and three patients were finally enrolled in the study, including 45 patients in PPCs group and 58 patients in non-PPCs group, and the incidence of PPCs was 43.7%. Both B-line score and LUS were positively correlated with PPCs at T 1 ( P<0.001), and B-line score and LUS were positively correlated with PCT and SII at T 2-4 ( P<0.001). The AUC (95% confidence interval) of B-line score and LUB in predicting PPCs were 0.926 (0.879-0.972) and 0.909 (0.852-0.965), respectively ( P<0.001), the best cut-off values of B-line score and LUB in predicting PPCs were set at 25.5 and 11.5 respectively, and the sensitivity and specificity of B-line score were 0.80 and 0.88 respectively, and the sensitivity and specificity of LUB were 0.78 and 0.93 respectively. Conclusions:Bedside pulmonary ultrasonography (B-line score and LUS) can accurately predict the occurrence of PPCs in the patients undergoing radical resection of gastrointestinal cancer and dynamically evaluate the condition of PPCs, and B-line score >25.5 and LUS score >11.5 indicate a high risk of PPCs.
Résumé
Objective:To evaluate the accuracy of ultrasound measurement of airway parameters in predicting difficult mask ventilation (DMV).Methods:Ninety-six patients, aged 18-90 yr, with body mass index of 16-39 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective endotracheal intubation under general anesthesia, were included in this study. Clinical airway evaluation was performed at 1 day before surgery, and modified Mallampati classification, thyromental distance and rating of the upper lip bite test were recorded. At 30 min before anesthesia induction, mandibular condylar motion, tongue longitudinal cross-sectional area and transverse diameter of tongue were measured by ultrasound, and the tongue volume (product of tongue longitudinal cross-sectional area and transverse diameter of tongue) was calculated. Mask ventilation was performed after induction of anesthesia, mask ventilation difficulty grade ≥Ⅲ was defined as DMV, the patients were divided into 2 groups according to whether DMV occurred: non-DMV group (NDMV group) and DMV group. Correlations between the clinical airway evaluation indexes and ultrasonic airway parameters with statistically significant differences between groups and DMV were assessed using Spearman′s rank correlation. The area under the receiver operating characteristics curve was used to evaluate the accuracy of each parameter in predicting DMV, the critical value was determined, and the accuracy, sensitivity, specificity, positive and negative predictive values were calculated. Results:The modified Mallampati classification, rating of the upper lip bite test, ultrasonic tongue longitudinal cross-sectional area, transverse diameter of tongue and tongue volume were positively correlated with DMV, and thyromental distance and mandibular condylar motion were negatively correlated with DMV ( P<0.05). The area under the receiver operating characteristics curve of mandibular condylar motion and tongue volume in predicting DMV were 0.898 and 0.862, respectively, the cut-off values were 1.19 cm and 99.94 cm 3, respectively, and the sensitivity and specificity were all over 70% and 90%, respectively, the positive predictive values were 92.31% and 88.46%, respectively. Conclusions:Ultrasonic measurements of mandibular condylar motion and tongue volume can accurately predict DMV.
Résumé
Objective:To evaluate the accuracy of airway ultrasonic parameters in predicting difficult mask ventilation (DMV) in obese patients.Methods:Ninety-six patients of both sexes, aged >18 yr, with body mass index of 28- <40 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective surgery under general anesthesia with endotracheal intubation, were selected. The airway was evaluated at 1 day before surgery to record the thyromental distance, modified Mallampati classification and upper lip bite test classification. Before anesthesia induction, the mandibular condylar motion, longitudinal cross-sectional area and transverse diameter of the tongue were measured by ultrasound, and the tongue volume was calculated. Mask ventilation was performed after anesthesia induction, DMV classification was recorded, DMV was defined as DMV classification Ⅲ and Ⅳ, and the patients were divided into non-DMV group (NDMV group) and DMV group. Spearman correlation analysis was used to analyze the correlation between each parameter and DMV, the receiver operating characteristic (ROC) curve was used to evaluate the accuracy of each parameter in predicting DMV, and the cut-off value was determined based on the principle of Jorden index at maximum. Results:Ninety-six patients were finally included in the study, with 64 patients in NDMV group and 32 patients in DMV group. Compared with NDMV group, the increase in age, modified Mallampati grade, upper lip biting test grade, longitudinal cross-sectional area of tongue, transverse diameter of tongue and volume of tongue were significantly increased, and the thyromental distance and mandibular condylar motion were decreased in DMV group ( P<0.05). Age ( r=0.283), modified Mallampati grade ( r=0.668), upper lip biting test classification ( r=0.826), tongue longitudinal cross-sectional area ( r=0.598), tongue transverse diameter ( r=0.578) and tongue volume ( r=0.707) were positively correlated with DMV ( P<0.01), and thyromental distance ( r=-0.623) and mandibular condylar motion ( r=-0.666 ) were negatively correlated with DMV ( P<0.05). The area under curve (95% confidence interval) of tongue longitudinal cross-sectional area, tongue transverse diameter, tongue volume, and mandibular condylar motion for DMV prediction were 0.870 (0.780-0.961), 0.858 (0.768-0.948), 0.937 (0.864-1.000), 0.912 (0.835-0.990), respectively ( P<0.01), and the predicted cut-off values were 22.61 cm 2, 4.29 cm, 100.60 cm 3 and 1.18 cm, respectively, the sensitivity was 90%, 83%, 90% and 90%, respectively, the specificity was 80%, 80%, 95% and 95%, respectively. Conclusions:Tongue volume and mandibular condylar motion measured by ultrasound are highly accurate in predicting DMV in obese patients. Tongue volume> 100.60 cm 3 or mandibular condylar motion< 1.18 cm suggests a high risk of DMV.
Résumé
Dorsal root ganglia (DRG) is an essential part of the peripheral nervous system and the hub of the peripheral sensory afferent. The dynamic changes of neuronal cells and their gene expression during the development of dorsal root ganglion have been studied through single-cell RNAseq analysis, while the dynamic changes of non-neuronal cells have not been systematically studied. Using single cell RNA sequencing technology, we conducted a research on the non-neuronal cells in the dorsal root ganglia of rats at different developmental stage. In this study, primary cell suspension was obtained from using the dorsal root ganglions (DRGs, L4-L5) of ten 7-day-old rats and three 3-month-old rats. The 10×Genomics platform was used for single cell dissociation and RNA sequencing. Twenty cell subsets were acquired through cluster dimension reduction analysis, and the marker genes of different types of cells in DRG were identified according to previous researches about DRG single cell transcriptome sequencing. In order to find out the non-neuronal cell subsets with significant differences at different development stage, the cells were classified into different cell types according to markers collected from previous researches. We performed pseudotime analysis of 4 types Schwann cells. It was found that subtype Ⅱ Schwann cells emerged firstly, and then were subtype Ⅲ Schwann cells and subtype Ⅳ Schwann cells, while subtype Ⅰ Schwann cells existed during the whole development procedure. Pseudotime analysis indicated the essential genes influencing cell fate of different subtypes of Schwann cell in DRG, such as Ntrk2 and Pmp2, which affected cell fate of Schwann cells during the development period. GO analysis of differential expressed genes showed that the up-regulated genes, such as Cst3 and Spp1, were closely related to biological process of tissue homeostasis and multi-multicellular organism process. The down regulated key genes, such as Col3a1 and Col4a1, had close relationship with the progress of extracellular structure organization and negative regulation of cell adhesion. This suggested that the expression of genes enhancing cell homestasis increased, while the expression of related genes regulating ECM-receptor interaction pathway decreased during the development. The discovery provided valuable information and brand-new perspectives for the study on the physical and developmental mechanism of Schwann cell as well as the non-neuronal cell changes in DRG at different developmental stage. The differential gene expression results provided crucial references for the mechanism of somatosensory maturation during development.
Sujets)
Rats , Animaux , Ganglions sensitifs des nerfs spinaux/métabolisme , Rat Sprague-Dawley , Transcriptome , Neurones/métabolisme , Cellules de Schwann/physiologieRésumé
Objective:To ascertain the endemic status of paragonimiasis in Zhejiang Province.Methods:From 2005 to 2020, 2-3 villages in 1-2 counties (cities, districts, hereinafter refferred to as counties) in historical endemic areas of paragonimiasis in Zhejiang Province were selected for monitoring each year. In each village, 50 to 150 local residents were selected as monitoring subjects, venous blood samples were collected, and serum Paragonimus antibody was detected by enzyme-linked immunosorbent assay (ELISA). Fifty to 100 intermediate hosts crabs or crayfish were collected in each village, and the infection of Paragonimus metacercaria was detected by crushing precipitation. Results:The positive rate of Paragonimus antibody was 2.9% (94/3 297); 3 929 crabs or crayfish were divided into 2 749 groups, 790 of which were found to have Paragonimus metacercaria infection, with a Paragonimus metacercaria infection rate of 28.7%. Conclusions:Paragonimus transmission chain exists in some counties of Zhejiang Province, which still has the potential risk of Paragonimus epidemic. Therefore, it is necessary to strengthen monitoring and carry out extensive health education to improve residents' self-protection awareness.
Résumé
Pulmonary inflammatory myofibroblastic tumor (PIMT) is a rare lung tumor that is poorly understood by clinicians. Based on the data of patients with PIMT in our center, a comprehensive search and a brief summary analysis of previous reports of the disease were carried out in this article. PIMTs were more likely to be present in male patients and in the right lung, and their clinical and radiographic findings were heterogeneous. Surgery is the most important treatment method, and complete resection is of great significance to the prognosis of patients. Targeted therapy represented by crizotinib may be helpful for patients with positive ALK mutations.
Résumé
OBJECTIVES@#It has been suggested that the consumption of dairy products helps lower the prevalence of type 2 diabetes (T2D). We investigated the association between the consumption of dairy products and T2D events in middle-aged Korean adults. @*METHODS@#We followed up 53,288 participants (16,895 male and 36,393 female) in the Health Examinees (HEXA) study. The consumption of dairy products was assessed using the self-administered food frequency questionnaire, and T2D was defined according to the 2015 treatment guidelines of the Korean Diabetes Association. Hazard ratios (HRs) and 95% confidence intervals (CIs) between the consumption of dairy products and the risk of T2D were calculated using Cox proportional hazards models after adjusting for potential confounders. Spline regression was used to better represent the association between the consumption of dairy products and the risk of T2D. @*RESULTS@#Among male, those with higher consumption of dairy products had a significantly lower risk of T2D than those who consumed essentially no dairy products (HR, 0.73; 95% CI, 0.58 to 0.91). In particular, consumption of yogurt (HR, 0.75; 95% CI, 0.60 to 0.93; ptrend=0.035) and cheese (HR, 0.66; 95% CI, 0.49 to 0.89; ptrend=0.005) was negatively associated with the incidence of T2D in male. In female, daily consumption of 1 serving of yogurt decreased the risk of T2D by 11%. @*CONCLUSIONS@#The association between the consumption of dairy products and the risk of T2D differed by sex and dairy product type. Further prospective studies are needed to confirm these associations.