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Objective:To probe into Rab25 Gene’s Effect on TGF-β inhibition of proliferation, invasion and epithelial mesenchymal transformation (EMT) of breast cancer MDA-MB-231 cells and explore its molecular mechanism.Methods:The experiment was divided into three groups: control group,TGF-β Group and si-Rab25 group. TGF-β induced MDA-MB-231 cell model of EMT was built. CCK-8 assay was used to detect cell proliferation. Transwell assay was used to detect the ability of cell invasion and migration.Western blot was used to detect the changes of related proteins in each group.Results:After stimulating MDA-MB-231 cells with TGF-β, Rab25 gene was highly expressed. Compared with TGF-β group (57.48±%3.62%), the migration ability and invasion ability of cells in si-Rab25 group (33.49%±2.93%) decreased by 41.7%, with a significant difference ( P<0.05). Compared with TGF-β group (153.21%±4.17%), the proliferation ability of cells in si-Rab25 group (115.32%±5.69%) decreased by 24.73%, with a significant difference ( P<0.05). The expression of MDA-MB-231 fine EMT related protein in si-Rab25 group was significantly different from that in TGF-β group ( P<0.05). The expression of p-AKT and Snail protein in si-Rab25 group was significantly lower than that in TGF-β group ( P<0.05) . Conclusions:Rab25 gene is highly expressed in MDA-MB-231 cells. Silencing Rab25 gene can activate AKT signal pathway, inhibit Snail protein expression, regulate EMT related protein expression, and inhibit EMT transformation.
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Objective@#Based on the application and funding of Otorhinolaryngology Head and Neck Surgery (H13) funded by the Nature Science Foundation of China (NSFC), we analyzed the basic research status of the field of Otorhinolaryngology Head and Neck Surgery, and provided the references for developing the discipline development plan, optimizing the discipline strategic layout and promoting the discipline progress.@*Method@#The data of both applied and funded grants of Otorhinolaryngology Head and Neck Surgery in NSFC from 2009 to 2019 were collected for further analysis.@*Results@#From 2009 to 2019, H13 received 5 103 applications, accounting for 1.00% of the total number of applications in the department of health science, and 922 applications were funded (mainly from the General Projects and the Youth Science Fund Projects), with a funding rate of 18.07% and a funding amount of 445.509 million yuan, accounting for 1.02% of the total funding amount of the department of health science. Among the seven sub-categories of H13, H1304 (Hearing abnormal and balance disorders) received 1 845 applications, and 352 were funded. H1301 (Disease of smell, nose and anterior skull base) received 1 217 applications, and 248 were founded, H1303 (Ear and lateral skull base disease) and H1305 (Otorhinolaryngology and developmental related diseases) received 498 and 488 applications,and 83 and 112 were founded respectively. The National Science Fund for Distinguished Young Scholars received 33 applications, and 5 were founded, with a funding rate of 15.15%. Clinicians accounted for 81% of the General Projects principals, and researchers and technicians accounted for 19%. Clinicians accounted for 72% of the Youth Science Fund Projects principals, and researchers and technicians accounted for 24%.@*Conclusion@#The basic research of Otorhinolaryngology Head and Neck Surgery in China has some shortcomings, such as small volume, uneven development of various disciplines, less leading academic leaders, less training of young leading talents, less major projects, more clinicians instead of researchers engaged in the basic scientific research.
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Objective@#To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.@*Methods@#The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications.@*Results@#All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).@*Conclusions@#RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective:To explore the correlation between the levels of peripheral blood T lymphocyte subsets (CD3 +, CD4 +, CD8 +) and natural killer cells (NK cells) in the early stage of sepsis and intestinal injury and prognosis of patients, so as to provide the basis of immunotherapy for clinical treatment of sepsis. Methods:A prospective case-control study was conducted. Sixty-one patients with sepsis admitted to Department of Critical Care Unit (ICU) of Ningxia Medical University from September 2018 to May 2019 were selected as subjects (sepsis group). Seventeen patients with common postoperative non-sepsis were used as controls (non-sepsis group). Venous blood samples were collected from all subjects within 24 h of ICU admission, and the levels of T lymphocyte subsets and NK cells were measured. At the same time, 35 sepsis patients without chronic gastrointestinal tract and chronic renal insufficiency were selected from the sepsis group, and their serum levels of intestinal fatty acid binding protein (I-FABP) and D-lactic acid were measured. Age, sex, and underlying disease were recorded for all subjects. The acute physiology and chronic health evaluationⅡ(APACHEⅡscore) within 24 h of ICU in the sepsis group were evaluated, and the patients were followed up for 28 days. T lymphocyte subsets and NK cells, I-FABP, D-lactic acid levels were compared between the sepsis group and non-sepsis group. T lymphocyte subsets and NK cell levels were compared between the survival and death groups. Spearman correlation method was used to analyze the correlation between serum I-FABP and D-lactic acid in the early stage of sepsis and levels of CD3 +, CD4 +, CD8 + and NK cells, and multivariate logistic regression analysis was used to assess the risk factors of death in sepsis patients. Results:Compared with the non-sepsis group, serum I-FABP and D-lactic acid levels were increased in the sepsis group [I-FABP (μg/L): 18.36 (14.75, 28.34) vs 16.17 (12.12, 18.40), D- Lactic acid (mg/L): 18.70 (10.10, 40.60) vs 8.85 (7.10, 15.76), all P < 0.05]. Peripheral blood CD3 +, CD4 +, NK cells in the sepsis group were decreased [CD3 +(%): 54.30 (37.48 , 61.65) vs 60.75 (48.88, 69.95), CD4 +(%): 24.60 (17.65, 32.15) vs 31.90 (24.95, 37.10), NK cells (%): 18.20 (11.95, 31.10) vs 24.70 (19.30, 32.65), P<0.05], but there was no significant difference in peripheral blood CD8 + levels between the two groups ( P>0.05). There were no significant differences in CD3 +, CD4 +, CD8 + and NK cell levels between the survival group and death group (all P>0.05).Correlation analysis of T lymphocyte subsets, NK cells and intestinal injury markers ( n=35) showed that I-FABP was negatively correlated with CD3 + and CD8 + ( r=-0.478 and r=-0.415, respectively, both P<0.05), but not correlated with CD4 + and NK cells (both P>0.05). D-lactic acid was negatively correlated with CD3 + and CD4 + ( r=-0.344 and r=-0.423, respectively, P<0.05), and positively correlated with NK cells ( r=0.393, P<0.05), but there was no correlation between D-lactic acid and CD8 + (both P>0.05). Multivariate logistic regression analysis showed that only the APACHEⅡ score was an independent risk factor for 28-day mortality in patients with sepsis ( OR=1.222, 95% CI:1.084-1.378, P<0.01), but the early CD3 +, CD4 +, CD8 +, NK cell levels were not associated with 28-day prognosis in patients with sepsis ( P>0.05). Conclusions:Immunosuppression can occur in the early stage of sepsis, which is related to intestinal damage, but is not associated with patient prognosis.
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@#Objective To give an annual data report of surgical treatment of esophageal cancer in Shanghai Chest Hospital to provide reference for treatment and research on esophageal cancer. Methods The clinical data of 414 patients with esophageal cancer who underwent endoscopy (9 patients) and esophagectomy (405 patients) in Shanghai Chest Hospital in 2015 were reviewed, including 334 males and 80 females. Their tumor biological characteristics and short-term and long-term treatment results were analyzed. Results Patients in this group were predominantly aged 60 to 69 years (46.9%), and the tumor was mainly located in the middle thorax (50.7%). About 79.9% of the patients received trans-right thoracic esophagectomy, 44.4% received minimally invasive surgery; 388 (93.7%) patients accepted upfront esophagectomy without induction therapy, and 179 (43.2%) patients received postoperative adjuvant therapy. The R0 resection rate was 90.6%, and the 30- and 90-day mortality rates were 1.4% and 2.4%, respectively. The 4-year overall survival rate of the R0 resection patients was 65.7%. Conclusion Satisfactory long-term survival results can be obtained for thoracic esophageal cancer if R0 resection can be achieved by trans-right thoracic esophagectomy and extended lymphadenectomy combined with appropriate postoperative adjuvant treatment.
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Objective To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed.There were 424 males and 216 females.The awerage age was (46.2 ± 12.8) years old,ranging 18 to 76 years old.The maximum diameter of the stone is (1.4 ±0.7) cm,ranging 0.6-3.2 cm.There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi.There were 196 cases with unilateral ureteral calculi,118 unilateral ureteral calculi cases with renal calculi,236 cases with unilateral renal stones,and 90 cases with double kidney stones.104 cases were placed with double J tube before operation and 496 cases were not placed before operation.There were 8 cases of horseshoe kidney,30 cases of isolated kidney with renal insufficiency,4 cases of pelvic ectopic kidney with dysplasia,6 cases of congenital ureteral malformation and 2 cases of sponge kidney.Preoperative average hemoglobin was (133.2 + 5.6) g/L,ranging 126-188 g/L.And average serum creatinine was (84.4 + 12.2) μmol/L,ranging 74-242μmol/L before operation.All patients were treated with general anesthesia under the lithotomy position.The ureteroscopy combined with holmium laser lithotripsy was performed.The 200tμm fiber was used,which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz).The stone baskets were used to take stones according to actual conditions.The operation was performed by doctors of the same qualifications.Results All patients underwent successful operation.The mean operation time was (45.6 + 14.6) min.The average postoperative hospitalization was (4.8 ± 1.5) d.The postoperative serious complication rate was 0.9％,including(2 cases of sepsis and 1 case of subcapsular hematoma.Of the 640 patients,596 were admitted to the hospital for a double J tube and 44 were lost of follow-up.552 patients met the stone removal criteria,44 patients did not meet the stone removal criteria for other treatments,such as extracorporeal shock wave lithotripsy,ureteroscopy or observed regularly.The stone-free rate (SFR) was 92.6％ (552/596) after 1-3 months.On the first postoperative day,serum creatinine was (76.0 ±10.6) (58-156) μmol/L,and postoperative hemoglobin was (126.4 ±9.6) (120-176) g/L.There was no significant difference in preoperative and postoperative hemoglobin (t =2.02,P =0.064).Preoperative and postoperative creatinine (t =64.76,P ＜ 0.05) was statistically significant.Meanwhile,the stone size (x2 =29.569,P ＜ 0.05) and position (x2 =44.949,P ＜ 0.05) versus SFR the impact was statistically significant.Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P =0.639).The stone position was an independent risk factor for stone clearance (P =0.013).Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract.The curative effect of stone removal is clear,the complications are few,the safety is high.However,there are certain limitations to the efficacy in the treatment of large stones and lower calculi.Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective To investigate the changes and clinical significances of intestinal fatty acid binding protein (I-FABP) and D-lactic acid levels in early intestinal injury of patients with sepsis and septic shock. Methods A prospective observational study was conducted. Thirty septic patients (septic group) and 30 septic shock patients (septic shock group) were admitted to the intensive care unit (ICU) of General Hospital of Ningxia Medical University from August 2018 to December 2018, and 20 healthy adults were served as healthy control group. Serum samples were collected within 24 hours after ICU admission in septic shock and septic groups, and in healthy control group during physical examination. The serum I-FABP, D-lactic acid, endotoxin, hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and lactic acid (Lac) were determined. Gender and age of all subjects, and basic diseases, the main area of infection and acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores within 24 hours after ICU admission of all patients were recorded. At the same time, the survival of the patients was followed up for 28 days. Spearman correlation analysis was used to analyze the correlation between serum I-FABP, D-lactic acid and other parameters. Risk factors of death in patients with sepsis and septic shock were screened by multivariate Logistic regression analysis of bicategorized variables. Results There was no significant difference in gender or age among the groups, as well as in the proportion of basic diseases, celiac infection or non-celiac infection between the sepsis group and the septic shock group, indicating that the general clinical baseline data among the groups were comparable. Serum levels of I-FABP and D-lactic acid in the sepsis group and the septic shock group were significantly higher than those in the healthy control group [I-FABP (μg/L): 27.46 (22.52, 34.39), 36.95 (29.82, 44.24) vs. 17.93 (14.65, 22.11), D-lactic acid (mg/L): 15.32 (9.84, 38.62), 27.95 (10.01, 47.69) vs. 9.38 (8.81, 14.48), all P < 0.01]. The serum level of I-FABP in the septic shock group was significantly higher than that in the sepsis group (P < 0.05), but the difference in serum D-lactic acid level between the two groups was not statistically significant (P > 0.05). Serum I-FABP level in the celiac infection group (n = 40) was significantly higher than that in the non-celiac infection group [n = 20; μg/L: 34.76 (27.46, 43.90) vs. 25.71 (20.55, 37.77), P < 0.01], but the difference in serum D-lactic acid level was not statistically significant [mg/L: 25.13 (9.83, 40.55) vs. 30.36 (10.17, 50.00), P > 0.05]. There was no significant difference in serum I-FABP or D-lactic acid levels between the survival group (n = 34) and the death group [n = 26; I-FABP (μg/L): 33.39 (25.20, 39.50) vs. 29.26 (22.50, 43.81), D-lactic acid (mg/L): 14.83 (9.71, 38.45) vs. 33.90 (11.93, 45.34), both P > 0.05]. Correlation analysis between serum I-FABP, D-lactic acid level and endotoxin, inflammatory factors, Lac and APACHEⅡ score in septic and septic shock patients showed that only D-lactic acid was significantly positively correlated with TNF-α and Lac (r values were 0.455 and 0.406, respectively, both P < 0.01), while I-FABP was not correlated with endotoxin, inflammatory factors, Lac or APACHEⅡscore. Multivariable Logistic regression analysis showed the APACHEⅡ score was an independent risk factor to affect the prognosis (death for 28 days) of septic and septic shock patients [odds ratio (OR) = 1.248, 95% confidence interval (95%CI) = 1.091-1.427, P = 0.001], while I-FABP, D-lactic acid, endotoxin, hs-CRP, TNF-α, IL-6, and Lac had no impact on 28-day prognosis of patients. Conclusion Serum I-FABP and D-lactic acid levels can evaluate early intestinal injury in patients with sepsis and septic shock, but neither of them is related to the prognosis of patients.
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Objective To investigate the characteristics of gut microbiota dysbosis in septic and non-septic patients in ICU.Methods A prospective observational research was conducted.Ten septic patients(septic group),ten patients without sepsis(non-septic group) were admitted to Department of Critical Care Medicine of General Hospital of Ningxia Medical University from February 2017 to June 2017 were enrolled.And ten healthy persons was enrolled as control group.Stool samples were collected from septic and non-septic patients within two days following admission to the intensive care unit (ICU);healthy persons' was random.High throughput 16S rRNA gene sequencing technology was used to detect fecal bacterium of three groups.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,Sequential Organ Failure Assessment (SOFA) score of patients were recorded on the first day after admission to ICU.Results Compared with the control group,the α diversity of gut microbiota in non-septic and septic groups showed a downward trend,the [3 diversity showed that the structure of gut microbiota in non-septic and the septic groups was significant different,and the individual differences were more obvious.At the level of phylum,compared with the control group,the proportion of Firmicutes+Bacteroidetes in non-septic and septic groups decreased significantly(P=0.013,0.028),and the proportion of Proteobacteria increased(P=0.017,0.026),while the proportion of Fusobacteria just increased in the non-septic group(P ＜ 0.01).At the level of genus,compared with the control group,the proportion of beneficial symbiotic genus in non-septic and septic groups can be seen decreased,such as Ruminococcus(P=0.045,0.026),Pseudobutyrivibrio(P=0.009,＜ 0.01),Anaerostipes(P=0.011,0.003),Coprococcus(P=0.045,0.011),Phascolarctobacterium(P=0.008,0.022),Subdoligranulum(P=0.006,0.026).The proportion of Lactobacillus,Dorea,Faecalibacterium,Roseburia and Blautia showed downward trend in non-septic and septic groups,but only the decline of Lactobacillus in non-septic group had statistical difference(P=0.005),and the decline of Dorea,Faecalibacterium,Roseburia and Blautia in septic group had statistical differences(P=0.037,0.038,0.002 and 0.017,respectively).The proportion of conditional pathogenic Fusobacterium,Actinomyces,Peptstreptococcus,Streptococcus increased in non-septic group(P=0.001,0.019,0.011 and 0.014,respectively),the proportion of pathogenic Staphylococcus(P=0.035,0.006),Enterococcus(P=0.001,0.001),Anaerococcus(P=0.006,0.006) and Bacillus(both P ＜ 0.01) increased in non-septic and septic groups.Conclusions Gut microbiota dysbiosis occured in septic and non-septic patients in the ICU,and showed that diversity decreased,structure of intestinal flora changed,obligate anaerobic bacteria decreased,facultative anaerobic bacteria increased,benefical symbiotic bacteria decreased,pathogenic bacteria increased and can be the dominate genus.
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Objective To evaluate the safety and efficacy of flexible ureteroscopy lithotripsy (FURL) for the treatment of renal stone in solitary kidney patients.Methods The clinical data of 46 patients of solitary kidney,who were treated with FURL from March 2015 to May 2018 in our hospital,were analyzed retrospectively.There were 34 males and 12 females,aged (48.6 ± 9.6) years.Maximum diameter of stone was (15.3 ±4.8) mm,and 29 cases in left kidney and 17 cases in right.34 cases were non-renal calcaneal calculi,12 cases were subrenal calyceal stones.There were 3 cases of congenital solitary kidney,31 cases of functional solitary kidney (contralateral kidney GFR ＜ 10 ml/min) and 12 cases of acquired solitary kidney (7 cases of renal calculi,4 cases of tumor,1 case of tuberculosis).The mean reoperative serum creatinine was (116.38 ± 25.77)μmol/L.All patients were treated with general anesthesia,lithotomy,soft ureteroscopy combined with holmium laser lithotripsy,and assisted lithotripsy.All operations were performed by the same surgeon.The data of operation time,hospital stay,blood loss,renal function before and after operation,postoperative complications and stone clearance rate were recorded.Results In this study,46 cases of the operation were successfully completed.The mean operation time was (58.6 ±16.4) min,the average hospitalization time was (5.6 ± 1.4) days.The mean hemoglobin was decreased (1.4 ± 0.9) g/L.The mean operative time was (58.6 ± 16.4) min.The average postoperative hospitalization time was (5.6 ± 1.4) days.The Postoperative hematuria occurred in 32 cases,low back pain in 3 cases and fever in I case.Stone-free reached in 39 of 46 patients,the stone-free rate(SFR)of primary operation was 84.8％ (39/46).There were 7 cases of residual calculi,five patients were treated with secondary FURL,2 patients were required conservative treatment.The SFR was 95.7％ (44/46) after the second stage operation.The mean serum creatinine was (112.29 ± 20.62) μ mol/L on the first day after operation,which was not different statistically with that before operation (P =0.177).The mean serum creatinine was (81.54 ± 10.75) μmol/L one month after operation,which was significantly lower than preoperative and 1 day postoperative (P ＜ 0.05).Conclusions FURL could be a safe and effective treatment for renal stone in solitary kidney patients.It has a definite stone-free effect,low incidence of complications.
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Objective@#To investigate the characteristics of gut microbiota dysbosis in patients with severe pneumonia using 16SrDNA sequencing.@*Methods@#A prospective observational research was conducted. The stool samples retained by natural defecation or enema within 2 days after hospital were collected from 16 patients with severe pneumonia admitted to department of intensive care unit (ICU) of General Hospital of Ningxia Medical University from June to December in 2018 and 10 persons for physical exam were enrolled as the healthy control group. The 16SrDNA sequencing technology was used to detect fecal flora and analyze biological information.@*Results@#① 1 015 475 effective sequences were obtained from the stool samples from the severe pneumonia group and the healthy control group. Using 16SrDNA method, it was found that the average effective length of the sample sequence was 458.35 bp and the average sequence number of the total samples was 39 056.73. ② Analysis of α diversity of gut microbiota showed that, compared with the healthy control group, the Ace index, Chao index and the Shannon index of gut microbiota diversity in the severe pneumonia group were significantly decreased [Ace index: 167.23 (143.14, 211.26) vs. 227.71 (214.53, 247.05), Chao index: 152.38 (138.09, 182.54) vs. 228.25 (215.49, 248.95), Shannon index: 2.37 (1.68, 2.89) vs. 3.39 (3.03, 3.63), all P < 0.01], and the Simpson index was significantly increased [0.21 (0.11, 0.33) vs. 0.07 (0.06, 0.12), P < 0.01], which indicated the gut microbiota diversity of the severe pneumonia group was decreased. ③ Analysis of β diversity of gut microbiota, principal coordinate analysis (PCoA) showed that gut microbiota structural with the healthy control group was similar, while that in the severe pneumonia group was different. Adonis analysis showed that the structural of the gut microflora revealing significant differences between the severe pneumonia group and the healthy control group (R2 = 0.061, P = 0.05). ④ Analysis of phylum difference gut microflora showed that, compared with the healthy control group, the proportion of Firmicutes in severe pneumonia group was decreased [27.36 (18.12, 39.28)% vs. 52.25 (38.36, 63.82)%, P = 0.02], the proportions of Actinobacterias, Synergistetes and Fusobacterias were increased [2.30 (0.30, 4.80)% vs. 0.02 (0.00, 0.06)%, 0.36 (< 0.01, 0.57)% vs. < 0.01 (< 0.01, < 0.01)%, 0.01 (< 0.01, 0.08)% vs. < 0.01 (< 0.01, < 0.01)%, all P < 0.05]. ⑤ Analysis of genus difference gut microflora showed that, the proportions of Bifidobacterium, Ruminococcus, Pseudobutyrivibrio, Coprococcus, Lachnospira and Prevotella in the severe pneumonia group were significantly lower than those in healthy control group [0.18 (0.01, 0.25)% vs. 3.40 (0.46, 5.78)%, 0.01 (< 0.01, 0.29)% vs. 2.26 (0.84, 4.86)%, 0.01 (< 0.01, 0.02)% vs. 2.73 (1.87, 5.74)%, 0.02 (< 0.01, 0.07)% vs. 0.80 (0.50, 2.32)%, < 0.01 (< 0.01, < 0.01)% vs. 0.88 (0.33, 2.08)%, 0.02 (< 0.01, 0.31)% vs. 7.74 (0.07, 36.27)%, all P < 0.05]; the proportions of Escherichia and Enterococcus in the severe pneumonia group were higher than those in healthy control group, but there was no difference between the two groups [2.00 (0.57, 10.23)% vs. 1.16 (0.23, 2.68)%, 0.02 (< 0.01, 0.42)% vs. < 0.01 (< 0.01, 0.04)%, both P > 0.05]; the proportions of Fusobacterium and Staphylococcus in severe pneumonia group were significantly higher than those in healthy control group [0.01 (< 0.01, 0.08)% vs. < 0.01 (< 0.01, < 0.01)%, 0.01 (< 0.01, 0.02)% vs. < 0.01 (< 0.01, < 0.01)%, both P < 0.05].@*Conclusion@#Gut microbiota dysbiosis in patients with severe pneumonia shows that the abundance and diversity decrease, structure of intestinal flora changes, and beneficial symbiotic bacteria decrease and pathogenic bacteria increase, which may be associated with the occurrence and development of severe pneumonia.
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Objective To investigate the characteristics of gut microbiota dysbosis in patients with severe pneumonia using 16SrDNA sequencing. Methods A prospective observational research was conducted. The stool samples retained by natural defecation or enema within 2 days after hospital were collected from 16 patients with severe pneumonia admitted to department of intensive care unit (ICU) of General Hospital of Ningxia Medical University from June to December in 2018 and 10 persons for physical exam were enrolled as the healthy control group. The 16SrDNA sequencing technology was used to detect fecal flora and analyze biological information. Results ① 1015475 effective sequences were obtained from the stool samples from the severe pneumonia group and the healthy control group. Using 16SrDNA method, it was found that the average effective length of the sample sequence was 458.35 bp and the average sequence number of the total samples was 39056.73. ② Analysis of α diversity of gut microbiota showed that, compared with the healthy control group, the Ace index, Chao index and the Shannon index of gut microbiota diversity in the severe pneumonia group were significantly decreased [Ace index: 167.23 (143.14, 211.26) vs. 227.71 (214.53, 247.05), Chao index: 152.38 (138.09, 182.54) vs. 228.25 (215.49, 248.95), Shannon index:2.37 (1.68, 2.89) vs. 3.39 (3.03, 3.63), all P < 0.01], and the Simpson index was significantly increased [0.21 (0.11, 0.33) vs. 0.07 (0.06, 0.12), P < 0.01], which indicated the gut microbiota diversity of the severe pneumonia group was decreased. ③ Analysis of β diversity of gut microbiota, principal coordinate analysis (PCoA) showed that gut microbiota structural with the healthy control group was similar, while that in the severe pneumonia group was different. Adonis analysis showed that the structural of the gut microflora revealing significant differences between the severe pneumonia group and the healthy control group (R2 = 0.061, P = 0.05). ④ Analysis of phylum difference gut microflora showed that, compared with the healthy control group, the proportion of Firmicutes in severe pneumonia group was decreased [27.36 (18.12, 39.28)％ vs. 52.25 (38.36, 63.82)％, P = 0.02], the proportions of Actinobacterias, Synergistetes and Fusobacterias were increased [2.30 (0.30, 4.80)％ vs. 0.02 (0.00, 0.06)％, 0.36 (< 0.01, 0.57)％ vs. < 0.01 (< 0.01, < 0.01)％, 0.01 (< 0.01, 0.08)％ vs. < 0.01 (< 0.01, < 0.01)％, all P < 0.05]. ⑤ Analysis of genus difference gut microflora showed that, the proportions of Bifidobacterium, Ruminococcus, Pseudobutyrivibrio, Coprococcus, Lachnospira and Prevotella in the severe pneumonia group were significantly lower than those in healthy control group [0.18 (0.01, 0.25)％ vs. 3.40 (0.46, 5.78)％, 0.01 (< 0.01, 0.29)％ vs. 2.26 (0.84, 4.86)％, 0.01 (< 0.01, 0.02)％ vs. 2.73 (1.87, 5.74)％, 0.02 (< 0.01, 0.07)％vs. 0.80 (0.50, 2.32)％, < 0.01 (< 0.01, < 0.01)％ vs. 0.88 (0.33, 2.08)％, 0.02 (< 0.01, 0.31)％ vs. 7.74 (0.07, 36.27)％, all P < 0.05]; the proportions of Escherichia and Enterococcus in the severe pneumonia group were higher than those in healthy control group, but there was no difference between the two groups [2.00 (0.57, 10.23)％ vs. 1.16 (0.23, 2.68)％, 0.02 (< 0.01, 0.42)％ vs. < 0.01 (< 0.01, 0.04)％, both P > 0.05]; the proportions of Fusobacterium and Staphylococcus in severe pneumonia group were significantly higher than those in healthy control group [0.01 (< 0.01, 0.08)％ vs. < 0.01 (< 0.01, < 0.01)％, 0.01 (< 0.01, 0.02)％ vs. < 0.01 (< 0.01, < 0.01)％, both P < 0.05]. Conclusion Gut microbiota dysbiosis in patients with severe pneumonia shows that the abundance and diversity decrease, structure of intestinal flora changes, and beneficial symbiotic bacteria decrease and pathogenic bacteria increase, which may be associated with the occurrence and development of severe pneumonia.
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INTRODUCTION@#Paraquat (PQ) intoxication is frequently associated with a high mortality rate. No specific treatment has been shown to reduce mortality in victims within the first 72 hours. We investigated the protective effects of rapamycin (Rapa) against PQ-induced toxicity in a zebrafish model.@*METHODS@#To determine the maximum nonlethal concentration (MNLC) and lethal concentration 50 (LC50) of Rapa, zebrafish were treated at 2-5 days post fertilisation (dpf) and their mortality was recorded every 24 hours. At 5 dpf, the zebrafish were treated with PQ 100 µg/mL or PQ+Rapa (MNLC, 1/3 MNLC or 1/9 MNLC) for 72 hours, and the rate of survival was recorded every 24 hours. Reverse transcription-polymerase chain reaction was used to test the signalling pathway of mTOR (mammalian target of rapamycin).@*RESULTS@#MNLC and LC50 of Rapa were determined to be 6.7 µg/mL and 28.9 µg/mL, respectively. At 48 hours, the PQ+Rapa groups had much lower mortality than the PQ group. The rates of survival of the PQ+Rapa groups were 43.33% (MNLC), 53.89% (1/3 MNLC) and 44.45% (1/9 MLNC), as compared to 19.45% in the PQ group, with the 1/3 MNLC group showing the highest rate of survival (p < 0.001). atg1 was slightly activated in the PQ group. In the PQ+Rapa groups, the expression of atg1 was markedly increased, suggesting strengthening of the autophagy process.@*CONCLUSION@#Rapa can increase the rate of survival of PQ-intoxicated zebrafish by inhibiting mTOR complex 1 and activating autophagy. Rapa could be an alternative first-line drug in the treatment of PQ poisoning.
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Objective: To determine expression of brain-derived neurotrophic factor antisense (BDNF-AS) long non-coding RNA (ln-cRNA) in breast cancer, and to investigate its effects on proliferation, apoptosis, migration and invasion. Methods: Between 2016 and 2018, samples from 88 cases of breast cancer were collected at the First Hospital of Lanzhou University. RT-qPCR was used to deter-mine expression of lncRNA BDNF-AS in breast cancer tissue and cells. A pcDNA3.1 plasmid was used to overexpress BDNF-AS in MDA-MB-231 cells. Cell viability was quantified using an MTT assay, proliferative capacity was determined using an EdU assay and a colori-metric assay was used to measure the Caspase-3 activity. Moreover, the protein levels of Bax, Bcl-2, MMP-9, E-cadherin, and BDNF were quantified by Western blot. Scratch and transwell assays were used to determine cell migration and invasion. Results: Lower ln-cRNA BDNF-AS expression was observed in breast cancer tissue and cells compared with normal paracancerous tissues (P<0.05), and with normal, HBL-100 breast cells (P<0.01). BDNF-AS expression negatively correlated with tumor-node-metastasis (TNM) stage (P<0.05) and lymphatic metastasis (P<0.05) of breast cancer. Overexpression of BDNF-AS with the pcDNA3.1 plasmid decreased viability of MDA-MB-231 cells (P<0.01), EdU-positive cells (P<0.01), and Caspase-3 activity (P<0.01). Additionally, Bcl-2, MMP-9, and BDNF ex-pression was downregulated (P<0.01), while Bax and E-cadherin expression was upregulated (P<0.01). Overexpression of BDNF-AS al-so inhibited cell healing and invasion which were determined by scratch assays (P<0.01). Conclusions: LncRNA BDNF-AS expression is downregulated in breast cancer, which inhibits breast cancer cell proliferation, migration, invasion, and promotes apoptosis.
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Objective To investigate the correlation between serum adropin protein and homocysteine (Hcy) level in the patients with coronary artery disease (CAD) ,and to study their relationship with CAD se-verity .Methods One hundred and seventy cases of CAD in this hospital from August 2015 to October 2016 were selected as the research subjects .Peripheral blood was collected for measuring serum adropin protein , Hcy and other conventional biochemical indicators ,and the coronary artery lesion was detected by coronary an-giography ,the severity of coronary artery lesion was assessed by SYNTAX score .Results In 170 cases of CAD ,mean serum Hcy level was (15 .92 ± 8 .31)μmol/L ,the adropin protein level in the hyperhomocysteine-mia group was lower than that in the non-hyperhomocysteinemia group ,the difference was statistically signifi-cant(P<0 .05) .Mean SYNTAX score in all cases was (21 .51 ± 11 .20) points ,and serum adropin protein was negatively correlated with Hcy level (r= -0 .169 ,P= 0 .028) ,serum Hcy level had no obvious correlation with SYNTAX score (r= 0 .124 ,P=0 .108) ,the adropin protein level was negatively correlated with SYN-TAX score (r= -0 .181 ,P=0 .018) .Generalized structural equation model showed that with the decrease of adropin protein level ,the SYNTAX score was increased (P=0 .019) ,compared with the patients without com-plicating hyperhomocysteinemia ,the SYNTAX score in the patients with hyperhomocysteinemia was much higher(P=0 .005) .Conclusion The lower the adropin protein level ,the higher the Hcy level and the severe the coronary artery lesion .
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Objective To investigate the safety and efficacy of definitive chemoradiotherapy(dCRT) in esophageal cancer.Methods A retrospective analysis of 18 consecutive cases ofsalvage esophagectomy after dCRT by the single operation groupin department of Thoracic surgery,Shanghai chest hospital affiliated to Shanghai Jiaotong University from December 2014 to March 2017.Results 16 males and 2 females.There were 6 cases and 12 cases of recurrent and persistent tumor after dCRT respectively.All the patients were treated with McKeown operation stytle combing thoracic and abdominal lymph nodes dissection.Esophagus was replaced by stomach of 15 cases and colon of 3 cases respectively.Radical resection (R0) was performed in 12 cases,palliative resection (R2) in 6 cases.There were 4 cases of pathological complete response (pCR).The incidence of postoperative complications was 11 cases,including 6 cases of pulmonary infection,4 cases of anastomotic leak,2 cases of incision infection,one case of respiratory insufficiency,one case of recurrent laryngeal nerve paralysis,one case of chylothorax,one case of aortic bleeding caused by empyema.One patient died in perioperative period because of aortic bleeding due to empyema.The follow-up period was from 2 to 26 months,and the median follow-up time was 9 months.There were 13 patients survived and 5 patients died at the last follow-up date including one death in perioperative period,2 cases died of local-regional recurrence and metastasis respectively.Conclusion Salvage esophagectomy is a treatment option for the recurrent or persistent disease after dCRT,but the incidence of postoperative complications is high.Accurate clinical staging is especially important after dCRT and ycT4,ycN + patientsshould be avoided.R0 resection and recurrence after long disease free period are favorable prognostic factors.
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Objective To explore the clinical safety of peroral endoscopic cardial constriction for gastro-esophageal reflux.Methods Clinical data of 47 patients with gastro-esophageal reflux who underwent peroral endoscopic cardial constriction in Chinese PLA General Hospital were retrospectively studied from August 2013 to August 2016.Results A total of 47 patients underwent peroral endoscopic cardial constriction successfully with no perforation or fever.Retrostemal vague pain and discomfort occurred in 7 cases,mild dysphagia occurred in 2 cases,and mild hemoptysis occurred in one patient the day after the operation.No special measures were taken and all 10 patients showed symptom remission in less than two days.As for the postoperative treatment,22 (46.8％) patients were given a liquid diet on the day of operation,39(82.9％) patients were given semi-or liquid diet on the first day after the operation,and two days later,43 (91.5％) resumed semi-or liquid diet.Only 9 cases were given antibiotics for prophylaxis for infection.Conclusion Peroral endoscopic cardial constriction is safe and effective for gastro-esophageal reflux.The hospitalizing time is short and postoperative recovery is quick.
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Objective To investigate our early results of robot-assisted esophagectomy (RAE) and present our learning curve experience with the largest study from one-single institution of China.Methods Between November 2015 and April 2017,a series of consecutive patients undergoing RAE at Shanghai Chest Hospital were reviewed.The patients'demographics,operative and postoperative outcomes were demonstrated.Results A total of 154 patients underwent RAE during the study.All patients received Mckeown esophagectomy and extensive thoraco-abdominal two-field lymph node dissection.Of these,122 were male and 32 were female.The mean total operative duration was 179-445 (271.0 ±61.5) min and the operative duration of the thoracic phase was 51-142 (96.7 ± 27.0)min.The mean estimated blood loss was 100 -1 000 (230.4 ±74.4)ml.The pathological results showed that 150 had squamous cell carcinoma,2 had adenocarcinoma,and 2 had small cell carcinoma.The R0 resection was 92.2％.The mean number of lymph node dissection was 11-64 (20.4 ± 8.5) and the lymph node sampling rate along left and right recurrent laryngeal nerve (RLN) were 92.2％ and 88.3％.The morbidity was present in 64 of 154 patients (41.6％).The major complications rate was anastomotic leak (12.3％),and vocal cord paralysis (16.9％).Intensive care unit (ICU) hospital stay time was 0-27 (2.7 ± 3.6) d,the median length of hospital stay was 7-81 (15.8 ± 11.6)days.There was no 90-day mortality.Conclusions RAE is a safe and feasible alternative for treatment of esophageal cancer.RAE can improve the efficacy of lymph node dissection,especially for the lymphadenectomy along recurrent laryngeal nerve.
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Objective To compare the clinical efficacy of Da Vinci robot-assisted esophagectomy and combined thoracoscopy-and laparoscopy-assisted esophagectomy for esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 116 patients who underwent minimally invasive radical resection of esophageal cancer in the Shanghai Chest Hospital of Shanghai Jiaotong University between November 2015 and September 2016 were collected.Fifty-eight patients undergoing combined thoracoscopy-and laparoscopy-assisted esophagectomy and 58 undergoing Da Vinci robot-assisted esophagectomy were respectively allocated into the thoracoscopy-and laparoscopy-assisted and Da Vinci robot-assisted groups.Patients received esophagectomy by right thorax-left cervico-abdominal triple incisions,thorax-cervico 2-field lymph node dissection of esophageal cancer and digestive tract reconstruction via assisted incision.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were described as (x)±s.Measurement data with skewed distribution were described as M (range).Comparison between groups was analyzed by the nonparametric test,and comparisons of count data were done by the chi-square test and Fisher's exact probability.Results (1) Surgical and postoperative situations:all patients received successful surgery,without conversion to open surgery.The number of lymph nodes dissected along the recurrent laryngeal nerve (RLN) and duration of postoperative hospital stay were 2.8±2.2,13 days (range,9-131 days) in the thoracoscopy-and laparoscopy-assisted group and 4.8±3.7,11 days (range,7-81 days) in the Da Vinci robot-assisted group,respectively,with statistically significant differences between the 2 groups (t =3.480,Z =2.361,P＜0.05).The total operation time,numbers of patients with overall complications,anastomotic leakage,injury of the RLN,pleural effusion,pulmonary infection,respiratory failure,chylothorax,arrhythmia and tracheoesophageal fistula were respectively (276±61)minutes,24,15,7,6,5,4,2,1,0 in the thoracoscopy-and laparoscopy-assisted group and (261±50)minutes,21,8,10,4,2,2,1,1,1 in the Da Vinci robot-assisted group,with no statistically significant difference (t =1.296,x2 =0.327,2.657,0.620,0.438,1.368,0.703,0.342,1.009,P＞0.05).Some of the patients had postoperative multiple complications.Patients with anastomotic leakage received local dressing changes,continuous gastrointestinal decompression and vacuum aspiration.The pronunciation and bucking response were observed in patients with injury of the RLN (unilateral injury).Patients with pleural effusion received pleural puncture fluid or closed thoracic drainage.Patients with pulmonary infection underwent antibiotic therapy and regular aerosol inhalation.Patients with respiratory failure underwent tracheotomy and assisted breathing with ventilator.Patients with chylothorax received fasting and closed thoracic drainage.Patients with arrhythmia were treated by drug.Patients with tracheo-esophageal fistula underwent conservative treatment.All the patients with complications were improved or cured.There were no wotmd infection,deep venous thrombosis of lower extremity,pulmonary embolism,reoperation and death within 30 days postoperatively in patients of 2 groups.(2) Follow-up and survival situations:all the 116 patients were followed up for 5-15 months,with a median time of 8 months.Numbers of patients with tumor-free survival,tumor recurrence and tumor metastasis were 50,6,4 (2 with simultaneous tumor recurrence and metastasis) in the thoracoscopy-and laparoscopy-assisted group and 51,5,4 (2 with simultaneous tumor recurrence and metastasis) in the Da Vinci robot-assisted group,respectively,showing no significant difference between the 2 groups (x2=0.077,1.000,P＞0.05).Conclusions Da Vinci robot-assisted esophagectomy is safe and feasible in the treatment of esophageal cancer.Compared with combined thoracoscopy-and laparoscopy-assisted esophagectomy,Da Vinci robot-assisted esophagectomy has comparable operation time,and is associated with a greater yield of lymph nodes along the RLN.
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Objective To investigate the association between DNA methylation of matrix metallo-proteinase 9(MMP-9) gene and cognitive function including continuous attention,cognitive flexibility and visuospatial memory in patients with chronic schizophrenia.Methods 71 male schizophrenia patients and 69 healthy controls were recruited and detected their cognitive function.Pyrosequencing was used to determine DNA methylation at CpG site in exon 4 and exon 5 of MMP-9 gene.RT-qPCR was used to detect MMP-9 gene expression.Clinical symptoms were assessed by BPRS.Results (1) Cognitive function including Trail Making Test A,Trail Making Test B,Stroop words only,Stroop colors only,Stroop interference,Spatial Processing Block design and Block Design all scores were significantly lower in schizophrenia patients with schizophrenia than those in health controls (P＜0.01);(2) The MMP-9 gene expression in PBMCs was significantly higher in schizophrenia patients (1.31± 0.48) than that in health control (1.11 ± 0.45,P＜ 0.05).The DNA methylation of CpG4-1,CpG4-2,CpG4-3,CpG4-4,CpG4-5,CpG5-1,CpG5-2,CpG5-4 of MMP-9 gene in schizophrenia patients were lower than those in health controls (P＜0.01).(3)DNA methylation of CpG4-3 was positive correlated with Stroop interference (r=0.324,P＜0.01) in health controls.Correlation analysis showed that DNA methylation of CpG4-1 was negatively correlated with sustained attention function (r =-0.329,P＜0.01),cognitive flexibility (r =-0.337,P＜ 0.01) and visuospatial memory (r =-0.308,P＜ 0.05) in schizophrenia patients.There were positive correlations between DNA methylation of CpG4-5 (r=0.305,P＜0.05),CpG5-1 (r=0.262,P＜0.05),CpG5-3 (r=0.260,P＜0.05),average DNA methylation at exon 5 (r=0.288,P＜0.05) and visuospatial memory.DNA methylation of CpG5-4 was positive correlated with sustained attention function (r=0.251,P＜0.05) and visuospatial memory (r=0.350,P＜ 0.01) respectively.Conclusion Male patients with schizophrenia suffer from extensive cognitive impairment,and methylation of MMP-9 gene may be associated with cognitive impairment of schizophrenia.
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Objective To study the relativity between imageology and pathology during lung cancer,and estimate whether the lung cancer is preinvasive lesions,which can support evidences for the operation methods.Methods Clinical data of 624 patients who were diagnosed as lung adenocarcinoma and had solitary pulmonary nodule(diameter≤3 cm) were collected,all of them were scanned by thin layer CT scan(1 mm).The correlation between imageology and pathology data were analyzed.Results In 125 cases of GGO,the ratio of invasive lesions were 0 (0/72),6.1％ (3/49) and 100％ (4/4) in stage T1a,T1b and T1c respectively.In 285 cases of mGGO,if solid component was less than 0.5 cm,the ratio of invasive lesions were 1.7％ (1/58),6.9％ (2/29) and 50.0％ (2/4) in stage T~,T1b and Tic;but the ratio of invasive lesions were 81.3％ (13/16),94.1％ (96/102) and 97.4％ (74/76) respectively when the solid component was more than 0.5 cm.In 214 cases with solid nodules,the ratio of invasive lesions were 87.1％ (27/31),98.8％ (84/85) and 99.0％ (97/98) in stage T1 a,T1b and T1c.Conclusion The ratio of invasive lesions and solid component increased gradually along with the growing of tumor diameter in stage T1 lung cancer.CT imaging was highly correlated with the pathology diagnosis of preinvasive lesions and invasive lesions,which can be used as the guidance for operation methods.