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BACKGROUND:Acupotomy is effective in the treatment of knee osteoarthritis,but its mechanism is not very clear. OBJECTIVE:To observe the effect of acupotomy on the apoptosis of knee chondrocytes in knee osteoarthritis rats based on osteoclast associated receptor(OSCAR)-tumor necrosis factor-associated apoptosis-inducing ligand(TRAIL)-osteoprotetin(OPG)pathway. METHODS:Twenty-seven Sprague-Dawley rats were randomly divided into normal group(n=9),model group(n=9)and acupotomy group(n=9).Rats in the normal group were routinely housed without any treatment.Animal models of knee osteoarthritis were established by knee injection of papain.Acupotomy intervention was performed 1 week after modeling,once a week for a total of three times.Relevant tests were performed at the end of the intervention. RESULTS AND CONCLUSION:The Lequesne MG behavioral scores of rats in the model group were elevated compared with the normal group(P<0.01),while the Lequesne MG behavioral scores of rats in the acupotomy group were decreased comparedwith the model group(P<0.01).Hematoxylin-eosin staining results showed that compared with the normal group,the cartilage surface of the rat's knee joints in the model group was worn and uneven and the chondrocytes were swollen,ruptured,reduced in number,and arranged disorderly;while the cartilage surface of the rat's knee joints in the acupotomy group was relatively smooth,and the chondrocytes were high in number and arranged in an orderly manner,with the structure basically clear.Immunohistochemical staining results showed that compared with the normal group,the positive expressions of OSCAR and TRAIL were increased in the model group(P<0.01),while the positive expression of OPG was decreased(P<0.01).Compared with the model group,the positive expressions of OSCAR and TRAIL in the acupotomy group were decreased(P<0.01),while the positive expression of OPG was increased(P<0.01).TUNEL staining results showed that compared with the normal group,the number of apoptotic cells in the model group were increased(P<0.01);compared with the model group,the number of apoptotic cells in the acupotomy group decreased(P<0.01).RT-qRCR and western blot results showed that compared with the normal group,the protein expressions of OSCAR,TRAIL and Bax in the model group were increased(P<0.01),and the protein expressions of OPG and Bcl-2 were decreased(P<0.01);compared with the model group,the protein expressions of OSCAR,TRAIL,and Bax in the acupotomy group were decreased(P<0.01),and the protein expressions of OPG and Bcl-2 were increased(P<0.01).To conclude,acupotomy can reduce cartilage injury of the knee joint in rats with knee osteoarthritis,which may be related to the blockage of mitochondrial pathway apoptotic signaling release by the OSCAR-TRAIL-OPG pathway.
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Objective:To study the clinical characteristics of different types of neonatal sepsis.Methods:From January 2012 to December 2019, neonates with confirmed sepsis from 5 neonatal centers of central-south China were reviewed. The neonates were assigned into early-onset sepsis (EOS) and late-onset sepsis (LOS) group, and the latter was further subgrouped into hospital-acquired LOS (hLOS) group and community-acquired LOS (cLOS) group. The etiological and clinical characteristics were analyzed. SPSS 26.0 was used for statistical analysis.Results:A total of 580 neonates were enrolled, including 286 (49.3%) in the EOS group and 294 (50.7%) in the LOS group. In LOS group, 147 were in hLOS group and 147 were in cLOS group. The gestational age and birth weight of hLOS group were significantly lower than the other two groups [(32.7±3.6) weeks vs. (37.1±3.7) weeks and (37.7±3.0) weeks, (1 810±717) g vs. (2 837±865) g and (3 024±710) g] ( P<0.05). The common pathogens in EOS and cLOS groups were coagulase-negative staphylococci and Escherichia coli, while Klebsiella pneumoniae was common in hLOS group. Carbapenems usage in the hLOS group was significantly higher than the other two groups [62.6% vs. 28.7% and 16.2%] ( P<0.05). Antibiotics duration in the hLOS group was longer than the other two groups [19 (14, 27) d vs. 15 (12, 20) d and 14 (12, 19) d] ( P<0.05). Conclusions:The clinical characteristics of neonatal sepsis vary among different types of infections, and it is necessary to establish appropriate prevention, control, diagnosis and treatment protocols.
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Objective:With the development of perinatal and neonatal intensive care medicine,the survival rate of very premature infants increases year by year.However,the incidence of bronchopulmonary dysplasia(BPD)increases year by year,which seriously affects the survival prognosis of very premature infants.How to prevent and treat BPD effectively has become the focus of neonatologists.This study aims to provide ideas for the prevention and treatment of BPD in very preterm infants via analyzing the clinical characteristics of BPD. Methods:A total of 472 cases of very premature infants admitted to the Divison of Neonatology,Department of Pediatrics at the Second Xiangya Hospital of Central South University were retrospectively selected and assigned into a BPD group(n=147)and a non-BPD group(n=325)according to the diagnosis of BPD.Clinical data of each group were collected to find out the clinical characteristics of BPD in very preterm infants.Basic information,maternal pregnancy data,laboratory findings,nutritional support,respiratory support patterns and duration,and systemic complications were included. Results:Compared with the non-BPD group,gestational age,birth weight,head circumference and body length in the BPD group were lower,the Apgar score in 1st min and 5th min and average body weight growth rate were lower(all P<0.05);the ratios of male,very low birth weight(VLBW),and extremely low birth weight(ELBW)in the BPD group were higher than those in the non-BPD group(all P<0.5);the incidence of maternal cervical insufficiency and the rate of using embryo transfer technology in the BPD group were higher than those in the non-BPD group,and the rate of using prenatal hormone in the BPD group was lower than that in the non-BPD group(all P<0.05).The positive rate of sputum culture in the BPD group was higher than that in the non-BPD group(P<0.05),and the white blood cell count,neutrophil ratio,and procalcitonin in the BPD group were higher than those in the non-BPD group(all P<0.05).The period of fasting,minimal feeding,total parenteral nutrition(TPN),and partial parenteral nutrition(PPN)in the BPD group were longer than those in the non-BPD group(all P<0.05).The duration of nasal catheter oxygen inhalation and mechanical ventilation in the BPD group was longer than that in the non-BPD group,and the rates of mechanical ventilation at Day 1,3,7,14,21 and 28 after birth were higher than those in the non-BPD group(all P<0.05).The incidence of respiratory distress syndrome,apnea of prematurity,respiratory failure,pneumonia,pulmonary hemorrhage,pleural effusion,persistent pulmonary hypertension,hemodynamic patent ductus arteriosus,cytomegalovirus infection,neonatal necrotic enterocolitis,cholestasis,anemia,abnormal blood system,hypothyroidism,retinopathy of prematurity,and internal environment disorders in the BPD group were significantly higher than those in non-BPD group(all P<0.05). Conclusion:There are significant differences between very premature infants with BPD and those without BPD in general information,maternal history,inflammatory indicators,nutritional support,respiratory support,comorbidities and complication rates.To ensure normal fetal development,reducing the inflammatory reaction of very premature infants,establishing enteral nutrition as early as possible,shortening the time of mechanical ventilation,and reducing the occurrence of complications are beneficial to decrease the incidence of BPD in very premature infants and improve the long-term prognosis of BPD.
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Objective:To establish and validate a model predicting the age at which a child with cerebral palsy will be able to walk independently.Methods:Data spanning 2016 to 2020 were collected from the cerebral palsy registration platform to build a database. Then, 70% of the patients were randomly assigned to the modeling group, while the remaining 30% were reserved for validation. Factors such as gender, bilirubin encephalopathy, neonatal asphyxia, extremely low birth weight, early pre-term birth, cerebral palsy type, magnetic resonance classification, gross motor function classification (GMFCS) score before 2 years of age, independent sitting age, ability to sit independently at 2 years of age, sections A through E of the gross motor function measure (GMFM-88), epilepsy, intellectual disability, visual impairment and surgery were analyzed applying Cox univariate regression analysis. The variables highlighted by the univariate regression analysis were included in Cox multivariate regression analyses, and a prediction model for the independent walking of children with cerebral palsy was established. It is presented as a linear graph. The C-statistic and calibration curve were used to evaluate the graph′s discrimination ability and calibration. Net reclassification improvement (NRI) was used to evaluate the linear graph′s net benefit.Results:A total of 807 cases were included in the study, with 565 and 242 in the model and validation groups, respectively. GMFCS score before 2 years of age, cerebral palsy type, independent sitting age, intellectual disability and early pre-term birth were found to be independent predictors of the age of independent walking. The C-statistics for 1-6 year-olds were all >0.8, indicating that the prediction model had good discrimination. The calibration curve showed that the predicted probability of independent walking at 1-4 years old was consistent with the observed probability, while the predicted probability of independent walking at 5-6 years old was higher than the observed probability. NRI suggested that the net benefit of the linear graph prediction model was not less than that of the full-factor model.Conclusion:A linear model was developed which can usefully predict the age of independent walking for children with cerebral palsy.
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Objective:To evaluate the immunogenicity of a quadrivalent influenza virus subunit vaccine in a healthy population aged 3-64 years.Methods:Healthy people aged 3-64 years old were selected as the study subjects, and a randomized, blind, positive controlled, non-inferiority test was adopted. The subjects were randomly inoculated with one dose of the corresponding experimental vaccine or control vaccine in a ratio of 1∶1. Blood samples were collected from all subjects before and at 28 d after immunization, and hemagglutination inhibition (HI) test was used to measure the levels of antibodies against H1N1, H3N2, B/Victoria (BV) and B/Yamagata (BY) in serum. The geometric mean titers (GMT), geometric mean increase (GMI), positive conversion rates and protection rates of antibodies against the four types of viruses were analyzed.Results:A total of 2 157 subjects aged 3-64 years were included, including 1 074 in the experimental group and 1 083 in the control group. There were no significant differences in the GMT or protection rates of antibodies against H1N1, H3N2, BV or BY before immunization between the two groups ( P>0.05), and the two groups were balanced at baseline. After full immunization, the GMI of antibodies to H1N1, H3N2, BV and BY in the experimental group was 11.16, 17.77, 9.61 and 15.13, respectively; the positive conversion rates were 84.08% (903/1 074), 92.46% (993/1 074), 86.03% (924/1 074) and 91.71% (985/1 074), respectively; the protection rates were 96.74% (1 039/1 074), 97.58% (1 048/1 074), 88.08% (946/1 074) and 94.97% (1 020/1 074), respectively. In the experimental group, the GMT of each antibody increased by more than 2.5 times after immunization; the lower limit of the 95%CI of the positive conversion rate was higher than 40%, and the lower limit of the 95%CI of the protection rate was higher than 70%. The lower limit of the 95%CI of the difference in the positive conversion rate of each antibody between the experimental group and the control group was >-10%, and the lower limit of the 95%CI for GMT (experimental group)/GMT (control group) was over 2/3. Conclusions:The experimental vaccine had good immunogenicity and was non-inferior to the control vaccine in the population aged 3-64 years.
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Based on the biomechanical mechanism of human upper limb, the disadvantages of traditional rehabilitation training and the current status of upper limb rehabilitation robot, a six degree of freedom, flexible adjustment, wearable upper limb rehabilitation exoskeleton design scheme is proposed. Firstly, the mechanics of each joint of the upper limb is analyzed, and the virtual prototype design of the whole mechanical structure of the upper limb rehabilitation wearable exoskeleton is carried out by using CATIA three-dimensional software. The tooth transmission of the forearm and the upper arm single row four point contact ball bearing with internal/external rotation and the shoulder flexible passive adjustment mechanism (viscoelastic damper) are innovatively designed. Then, the joints of the upper limb rehabilitation exoskeleton are analyzed, theoretical analysis and calculation of the driving torque, the selection of the motor and gearbox of each driving joint are carried out. Finally, the whole finite element analysis of the upper limb exoskeleton is carried out. The research and experimental results showed that the design scheme of the upper limb exoskeleton assist structure is highly feasible, which can help the patients with upper limb paralysis and motor dysfunction self-rehabilitation.
Sujet(s)
Humains , Phénomènes biomécaniques , Dispositif d'exosquelette , Robotique , Réadaptation après un accident vasculaire cérébral , Moment de torsion , Membre supérieur , Dispositifs électroniques portablesRÉSUMÉ
【Objective】 To investigate the diagnostic value of neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte (MLR), and lymphocyte (LYM) count in children with infectious mononucleosis (IM). 【Methods】 Clinical and laboratory data of 134 IM children hospitalized between September 2017 and March 2020 were collected. A total of 60 healthy children during the same period were selected as the control group. The subjects’ NLR, MLR, and LYM were calculated according to the results of peripheral blood. The values of NLR, MLR, and LYM in diagnosing and predicting IM were analyzed with ROC. 【Results】 The MLR and LYM values of IM children were significantly higher than those of the control group (P0.05). ROC results showed that the area under the ROC curve (AUC) of NLR was 0.397, AUC of MLR was 0.648, and LYM's AUC was 0.680. The ROC curve AUC of MLR+LYM was 0.878, the optimal threshold was 0.59, the sensitivity was 82.09%, and the specificity was 85.00%. 【Conclusion】 MLR and LYM are independent biomarkers for the prediction of IM in children.
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Objective:To investigate the regulatory effects and mechanism of mannan-binding lectin (MBL) on adipogenic differentiation of 3T3-L1 preadipocytes.Methods:3T3-L1 preadipocytes were induced to differentiate into adipocytes in vitro, and stimulated with different concentrations of MBL (0, 1, 10, 20 μg/ml). Firstly, changes in cell proliferation ability were detected by CCK-8. Then lipid accumulation was analyzed by Oil red O staining and intracellular triglyceride content determination. Further, the expression of adipogenic differentiation-related factors PPARγ and C/EBPα at protein and mRNA levels were detected by Western blot and qRT-PCR, respectively. Finally, Western blot was used to analyze the expression and phosphorylation of Akt, a signal molecule related to adipogenic differentiation. Results:MBL at the concentrations of 0, 1, 10 and 20 μg/ml had no effect on the proliferation of 3T3-L1 preadipocytes. The level of triglyceride in MBL treatment groups decreased in a dose-dependent manner on 3 d after 3T3-L1 preadipocyte differentiation. Results of Oil red O staining showed that the number of lipid droplets in MBL treatment groups reduced significantly, and the absorbance values also decreased significantly in a concentration-dependent manner. Western blot and qRT-PCR results showed that the expression of PPARγ and C/EBPα at both protein and mRNA levels in MBL treatment groups decreased significantly in a dose-dependent manner, and the phosphorylation level of Akt was significantly down-regulated as well.Conclusions:MBL regulates the adipogenic differentiation of 3T3-L1 preadipocytes via Akt signaling pathway.
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Objective To investigate the regulation of Treg/Th17 axis by mannan-binding lectin (MBL) in mice with Candida albicans ( C. albicans ) infection. -ethods MBL gene-knockdown (MBL-/-) C57BL/6 mice and wild-type (WT) C57BL/6 mice were divided into four groups. C. albicans strains (2×107 CFU) were injected intraperitoneally into the mice of infection groups. Paraffin sections of mouse liver and kidney tissues were prepared on 3 d. Histopathological changes were observed with hematox-ylin and eosin ( HE) and Periodic acid-Schiff ( PAS) staining. Flow cytometry was performed to analyze Th17 and Treg cells in mice on 7 d. The levels of IL-10 and IL-17A were measured by ELISA. CD4+T cells were obtained from spleen cells by magnetic sorting. Expression of Foxp3 and RORγt at mRNA and protein levels were detected by qRT-PCR and Western blot, respectively. Results The mouse model of C. albicans infection was established successfully. After infection, the MBL-/- mice had higher percentages of Th17 cells, but lower percentages of Treg cells than the WT mice. ELISA results showed that compared with the WT mice with C. albicans infection, the MBL-/- mice had significantly increased IL-17A and decreased IL-10 after infection. Moreover, the expression of RORγt at both mRNA and protein levels was up-regula-ted, while that of Foxp3 was down-regulated in the MBL-/- mice than in the WT mice following infection. Conclusions MBL regulates the immune balance of Treg/Th17 cells in mice infected with C. albicans through promoting the differentiation of CD4+ T cells into Treg cell subsets and inhibiting the differentiation into Th17 cell subsets.
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Objective To evaluate the lung protection of remote limb ischemic preconditioning during one-lung ventilation (OLV) in the patients undergoing esophageal cancer resection.Methods Seventyone patients of both sexes,aged 30-64 yr,with body mass index of 15-28 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective esophageal cancer resection,were randomly divided into control group (group C,n =34) and remote limb ischemic preconditioning group (group RLIP,n =37) using a random number table.Patients in group RLIP received three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on one upper arm before OLV.Before OLV (T0),at 1 and 2 h of OLV (T1,2),at 20 min after re-expansion of the collapsed lung (T3),and at 2 h after operation (T4),blood samples were drawn from the radial artery for blood gas analysis,oxygenation index (PaO2/FiO2) and alveolar-arterial oxygen gradient (A-aDO2) were calculated.At T0,T2,T3 and T4,blood samples were collected from the radial artery for determination of plasma tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6),and IL-10 concentrations.Results Compared with group C,PaO2/FiO2 was significantly increased,and A-aDO2was decreased at T1,2,the plasma TNF-α concentrations were decreased at T2-4 (P＜0.05),and no significant change was found in the plasma IL-6 and IL-10 concentrations and rate of abnormal pulmonary function at T1-4 in group RLIP (P＞O.05).Conclusion Although remote limb ischemic preconditioning can produce lung protection during OLV in the patients undergoing esophageal cancer resection,it provides no clinical significance.