Application prospect of endoscopic ultrasound-guided portal pressure gradient measurement / 临床肝胆病杂志

Portal pressure measurement plays an important role in the diagnosis and evaluation of portal hypertension, and at present, there is still no unified method for the assessment of portal vein pressure. With the wide application of endoscopic ultrasound in digestive system diseases, endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement was included in the research agenda of the 2021 Baveno-VII conference, thus attracting widespread attention of scholars. This article reviews portal pressure measurement techniques, the development of EUS-PPG measurement technique, and two commonly used methods for EUS-PPG measurement in China and globally and elaborates on the application prospect of EUS-PPG measurement technique. A number of studies around the world have shown that EUS-PPG measurement technique is a direct, minimally invasive, simple, accurate, and radiation-free technique with strong clinical operability, and it is an important supplement to portal pressure measurement methods and may gradually become one of the main methods for portal pressure measurement.

Cerebral Arterial Stiffness as Measured Based on the Pulse Wave Velocity Is Associated With Intracranial Artery Calcification in Patients With Acute Stroke

Background@#and Purpose By measuring a newly defined parameter, the carotid–cerebral pulse wave velocity (ccPWV), this study aimed to determine the association of intracranial artery calcification (IAC) with arterial stiffness as reflected by the pulse wave velocity between the carotid and middle cerebral arteries using transcranial Doppler sonography in patients with acute stroke. @*Methods@#We recruited 146 patients with ischemic stroke from our stroke center. Computed tomography of the head was used to assess the presence and severity of IAC. Arterial stiffness was evaluated using ccPWV. Data are presented as quartiles of ccPWV. A multivariable logistic regression model was used to assess the independent relationship between ccPWV and IAC. @*Results@#The IAC prevalence increased with the ccPWV quartile, being 54%, 76%, 83%, and 89% for quartiles 1, 2, 3, and 4, respectively (p<0.001) as did IAC scores, with median [interquartile range] values of 0 [0–2], 3 [2–4], 4 [2–5], and 5 [4–6], respectively (p<0.001). After additionally adjusting for age and hypertension, a significant correlation was only found between quartiles 3 and 4 of ccPWV and IAC scores. The odds ratio (95% confidence interval) for the IAC scores was 1.78 (1.28–2.50) (p=0.001) in quartile 4 of ccPWV and 1.45 (1.07–1.95) (p=0.015) in quartile 3 compared with quartile 1. @*Conclusions@#We found that in patients with acute ischemic stroke, ccPWV was positively related to the degree of IAC. Future longitudinal cohort studies may help to identify the potential role of IAC in the progression of cerebral arterial stiffness.

Clinical effects of robot-assisted minimal invasive transforaminal lumbar interbody fusion in the treatment of single-segment lumbar disc herniation / 西安交通大学学报(医学版)

【Objective】 To compare the clinical effects and screw placement accuracy for treating lumbar disc herniation between robot-assisted minimal invasive transforaminal lumbar interbody fusion (RA-MIS-TLIF) and minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF). 【Methods】 We retrospectively recruited 69 patients with single segment lumbar disc herniation treated between January 2018 and August 2019 at Honghui Hospital of Xi’an Jiaotong University. There were cases of 33 RA-MIS-TLIF (RA group) and 36 MIS-TLIF (MIS-TLIF group). Subsequently, the patients’ baseline characteristics were collected, including age, gender, body mass index, complication with diabetes, duration of symptoms, operated segment, and follow-up time. We also collected perioperative parameters such as operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, screw placement accuracy, wound drainage, hospitalization duration, postoperative complicatins, and fusion rate. Lower back pain, lower extremity pain visual analogue score (VAS), and lumbar Japanese Orthopaedic Association Scores (JOA) were obtained preoperatively, postoperative 3 days/6 months/12 months, and the last follow-up. 【Results】 All the procedures were successfully completed and the follow-up time was 14.82±1.83 (RA group) and 15.11±1.62 (MIS-TLIF group) months, without significant difference (P>0.05). Compared with MIS-TLIF group, RA group had less intraoperative blood loss [(116.67±18.48) min vs. (128.06±22.53) min], fluoroscopy frequency [(12.42±2.28) vs. (15.67±2.46)], screw placement accuracy (93.18% vs. 84.03%), postoperative drainage [(73.03±23.52) mL vs. (88.33±28.54) mL], and shorter hospitalization stay [(6.45±1.52)d vs. (7.69±1.85) d] (all P0.05). The VAS of lower back pain and lower extremity pain, and lumbar JOA were significantly improved after the operation (P0.05). Meanwhile, fusion rate and incidence of complications did not significantly differ between the two groups (P>0.05). 【Conclusion】 Both robot-assisted MIS-TLIF and MIS-TLIF can achieve excellent clinical effects in treating single-segment lumbar disc herniation. However, the former can improve the accuracy of screw placement and reduce intraoperative blood loss, fluoroscopy frequency, postoperative drainage and hospitalization time, which indicates a promising application.

Clinical effects of treatment of single-segment lumbar tuberculosis by oblique lateral interbody fusion and percutaneous pedicle screw fixation / 西安交通大学学报(医学版)

【Objective】 To investigate the clinical effects of treatment of single-segment lumbar tuberculosis by oblique lateral interbody fusion with autologous iliac bone and percutaneous pedicle screw fixation. 【Methods】 We collected the clinical data of 47 patients with lumbar tuberculosis treated in The First Affiliated Hospital of Xi’an Jiaotong University from March 2017 to January 2020. Among them， 22 patients underwent oblique lateral interbody fusion with autologous iliac bone and percutaneous pedicle screw fixation （minimally invasive group） and 25 patients underwent open surgery combined anterior-debridement and posterior-fixation （control group）. The related data were collected， including gender， sex， body mass index （BMI）， systemic symptoms of tuberculosis， operation duration， intraoperative bleeding， postoperative drainage， hospital stay， complications， visual analogue score （VAS）， erythrocyte sedimentation rate （ESR）， and Oswestry disability index （ODI）. 【Results】 Baseline clinical characteristics did not significantly differ between the two groups （P>0.05）. Compared with control group， the minimally invasive group had shorter operation duration ［（188.64±18.59） min vs. （201.60±22.67） min］， less intraoperative blood loss ［（118.64±22.95） mL vs. （553.60±100.54） mL］， less postoperative drainage ［（134.55±36.48） mL vs. （291.20±61.53） mL］， and shorter hospitalization time ［（12.86±2.17） d vs. （15.80±3.03） d］ （all P0.05）. Compared with the preoperative ones， ESR， VAS score and ODI score significantly decreased and Cobb angle significantly increased in both groups （all P0.05）. 【Conclusion】 Both minimally invasive technique and open surgery can achieve excellent clinical results， but the minimally invasive technique can reduce the surgical trauma and shorten the hospitalization time.

Anesthetic effect of ultrasound-guided retrolaminar block during percutaneous transforaminal lumbar spine endoscopic surgery / 西安交通大学学报(医学版)

【Objective】 To compare the anesthestic effects of ultrasound-guided retrolaminal block （RLB） and local anesthesia during posterior approach vertebral surgery. 【Methods】 Forty patients （ASA physical status Ⅰ or Ⅱ） scheduled for transforaminal lumbar spine endoscopic surgery were recruited and randomly divided into two groups （n=20）： RLB group and local anesthesia group （Group C）. RLB group received the ultrasound-guided retrolaminar block using parasagittal in plane method by an anesthesiologist while Group C received layer-by-layer local infiltration anesthesia according to the operation location； 0.5% ropivacaine of 20 mL was used in the two groups. We recorded visual analogue score （VAS） and Ramsay sedation score at admission （T0）， during skin incision （T1）， puncture （T2）， foraminoplasty （T3）， nerve root decompression （T4） and suture （T5）. We also recorded remedial analgesia rate， scores of the patients’ satisfaction and the intraoperative occurrence of side effects （respiratory depression， tachycardia and hypertension）. The patients were followed up. Their functional status was assessed by the Oswestry Disability Index （ODI） score before surgery and three months after surgery. 【Results】 Compared with Group C， RLB group had significantly decreased visual analogue score at T2-4 and lower remedial analgesia rate （P<0.05）. The patients’ satisfaction was higher in group RLB than in Group C （P<0.05）. The intraoperative occurrence of hypertension and tachycardia were significantly lower in RLB group than in Group C （P<0.05）. ODI score was significantly decreased three months after surgery in both groups （P<0.05）， but it did not differ significantly between the two groups （P>0.05）. 【Conclusion】 Ultrasound-guided RLB can provide satisfactory analgesia with greater safety when trasforaminal endoscopic surgery is used.

Homeobox Gene Six3 is Required for the Differentiation of D2-Type Medium Spiny Neurons / 神经科学通报·英文版

Medium spiny neurons (MSNs) in the striatum, which can be divided into D1 and D2 MSNs, originate from the lateral ganglionic eminence (LGE). Previously, we reported that Six3 is a downstream target of Sp8/Sp9 in the transcriptional regulatory cascade of D2 MSN development and that conditionally knocking out Six3 leads to a severe loss of D2 MSNs. Here, we showed that Six3 mainly functions in D2 MSN precursor cells and gradually loses its function as D2 MSNs mature. Conditional deletion of Six3 had little effect on cell proliferation but blocked the differentiation of D2 MSN precursor cells. In addition, conditional overexpression of Six3 promoted the differentiation of precursor cells in the LGE. We measured an increase of apoptosis in the postnatal striatum of conditional Six3-knockout mice. This suggests that, in the absence of Six3, abnormally differentiated D2 MSNs are eliminated by programmed cell death. These results further identify Six3 as an important regulatory element during D2 MSN differentiation.

Decoding Cortical Glial Cell Development / 神经科学通报·英文版

Mouse cortical radial glial cells (RGCs) are primary neural stem cells that give rise to cortical oligodendrocytes, astrocytes, and olfactory bulb (OB) GABAergic interneurons in late embryogenesis. There are fundamental gaps in understanding how these diverse cell subtypes are generated. Here, by combining single-cell RNA-Seq with intersectional lineage analyses, we show that beginning at around E16.5, neocortical RGCs start to generate ASCL1

Clinical analysis of three cases of ocular flutter-opsoclonus in adults / 中华神经科杂志

Objective Through an analysis of three cases of ocular flutter-opsoclonus in adults and a review of the relevant literature,we summarized its characteritics to improve the clinical awareness of this sign.Methods Three cases of adult-onset ocular flutter-opsoclonus from July 2014 to July 2017 were retrospectively analyzed in terms of clinical features,cerebrospinal fluid (CSF) analysis,brain imaging,etiologies and treatment,and followed up through telephone calls.Results Case 1:A 68-year-old man presented with ocular flutter,vertigo,myoclonus,ataxia and conscious disturbance.CSF analysis demonstrated pleocytosis and mildly elevated protein level.Brain MR imaging revealed ischemia,and SPECT showed hypoperfusion involving left frontal and occipital lobes.Paraneoplastic syndrome was considered as the etiology.The symptoms subsided without any specific treatment.He died from lung cancer within one year.Case 2:A 66-year-old man presented with ocular flutter,vertigo,ataxia,conscious disturbance and fever.CSF protein level was severely elevated.Brain MR imaging revealed ischemia.Epstein-Barr virus infection was considered as the etiology.The symptoms improved with the administration of antiviral drugs and steroid.Relapse was not observed in the two-year follow-up.Case 3:A 34-year-old woman presented with opsoclonus,oscillopsia,vertigo,ataxia,conscious disturbance and fever.MR imaging showed midbrain lesions.Viral brainstem encephalitis was considered as the etiology.The symptoms improved with the administration of antiviral drugs,steroid,intravenous immunoglobulin and clonazepam.Relapse was not observed in the two-year follow-up.Conclusions Infection and tumors are common etiologies of ocular flutter-opsoclonus.Treatment includes etiological management for infection or tumors and immunosuppressive therapy.The clinical outcomes vary with the underlying etiologies.

Effect of Klotho protein on renal oxidative stress in rat with calcium oxalate nephrolithiasis / 中华泌尿外科杂志

Objective To investigate the protective effect and mechanism of Klotho protein on oxidative stress in renal tubular epithelial cells of experimental rat nodels of renal calcium oxalate stone.Methods The 30 SD rats,6-8 weeks old,were randomly divided into 3 groups (10 of each),normal control group(group A),calcium oxalate model group(group B),drug plus calcium oxalate model group (group C).Group A was established with physiological saline by garage each day,group B was established with 1％ ethylene glycol in drinking water + 2％ ammonium chloride by garage (2 ml/d),group C was established with Fosinopril 2.5mg + Valsartan 15mg aqueous solution 2 ml by gavage on the basis of group B (2 ml/d).4 weeks later,the level of malondialdehyde (MDA),superoxide dismutase (SOD),catalase (CAT) and glutathione peroxidase (GSH) in the kidney homogenate were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA),Polymerase chain reaction (RT-PCR) was used to measure expression of Klotho and Nrf2 mRNA,and Western Blot was used to measure the expression of Klotho and Nrf2 protein.Results The level of MDA in group B [(12.43 ± 0.43) μmol/mg] was significantly increased compared to group A[(8.67 ±0.84) μmol/mg,P ＜0.05] and group C [(7.97 ±0.81) μmol/mg,P＜0.05],while group A was close to group C (P ＞0.05).In group A,B,and C,the levels of SOD were (247.89 ± 2.45),(109.54 ± 4.21),and (189.74 ± 10.47) U/mg,respectively;the levels of GSH were (38.98 ± 4.55),(26.87 ± 3.92),and (31.29± 2.54) μmol/mg,respectively;CAT were (138.47 ± 8.74),(119.87 ± 8.45),and (127.46 ± 7.45) U/mg,respectively.The levels of SOD,GSH,CAT in group B were significantly lower than that in group A and C,while those in group B were close to group A (P ＞ 0.05).The expression of Klotho and Nrf2 mRNA in group B [(0.208 ± 0.036) and (0.499 ± 0.086)] were significantly lower than group A (1.011 ± 0.174 and 1.023 ± 0.139,P ＜ 0.05)and group C(1.123 ±0.248 and 1.023 ±0.139,P ＜0.05).The expression of Klotho and Nrf2 protien were also significantly lower than that in group A and C (P ＜0.05).Conclusions Valsartan and Fosinopril could prevent the formation of renal CaOx stones by upregulating expression of low level Klotho gene induced by ethylene glycol.This effect may be involved with activation of Keapl-Nrf2-ARE signaling pathway.

In-vitro study of epithelial-mesenchymal transition mediated by HBX protein and M2 macrophages in hepatocellular carcinoma cells / 中华普通外科杂志

Objective To explore the synergetic effect of HBX protein and M2 macrophages in inflammatory microenvironment on invasion and metastasis of hepatocellular carcinoma cells.Methods Hep3B cells were infected with recombinant lentivirus carrying HBx gene,following co-culture with THP-1 original M2 macrophages.The cells were divided into six groups:two infected groups (Hep3B +and Hep3B + + M2),four non-infected groups (Hep3B-,Hep3B-+ LV5,Hep3B-+ M2,Hep3B-+LV5 + M2).Western blot (WB) was used to assess the expression changes of E-cadherin and N-cadherin,markers of epithelial-mesenchymal transition (EMT).The cellular location of EMT markers was observed by immunofluorescence confocal microscopy.Transwell assay was used to evaluate the invasion ability of Hep3B cells.Results HBX protein overexpressed in Hep3B cells by lentivirus infection.After 72 h co-culture with M2 macrophages,WB results showed that E-cadherin descreased significantly in Hep3B+ (0.42 ±0.11) when compared with Hep3B-(1.00 ±0.18) (t =4.762,P ＜0.05),while N-cadherin was significantly higher in Hep3B + (2.85 ± 0.44) than in Hep3B-(1.00 ± 0.17) (t =4.762,P ＜ 0.05).M2macrophages decreased E-cadherin expression in Hep3 B + + M2 (0.1 ± 0.13) compared with Hep3 B + (t =3.255,P ＜0.05),while N-cadherin expression increased in Hep3B+ + M2 (4.18 ± 0.52) (t=10.009,P ＜ 0.05).Non-Infected groups didn't change the markers of E-cadherin and N-cadherin.It was suggested that invasion ability of Hep3B increased by HBx overexpression.Conclusions HBX protein and M2 macrophages synergetically mediated the invasion and metastasis of hepatocellular carcinoma cells by EMT.

Effects of Yiniao Recipe on serum antidiuretic hormone level and plasma ratio of cAMP to cGMP in rats with kidney-yang deficiency / 中西医结合学报

To investigate the effects of Yiniao Recipe, a compound traditional Chinese herbal medicine, on contents of serum antidiuretic hormone, and plasma cyclic adenosine monophosphate and cyclic guanosine monophosphate in rats with kidney-yang deficiency.

Hepatitis B virus genotypes and alanine aminotransferase levels in HBeAg negative patients with chronic hepatitis B and liver cirrhosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate genotypes of the hepatitis B virus (HBV) and alanine aminotransferase (ALT) levels of HBeAg negative patients with chronic hepatitis B and liver cirrhosis.</p><p><b>METHODS</b>HBV serological markers and ALT levels were detected in 62 patients with chronic hepatitis B and 41 cases with liver cirrhosis, using enzyme linked absorbent immunoassays and an enzyme method, respectively. A polymerase chain reaction of S region was used for HBV genotyping.</p><p><b>RESULTS</b>Of the 62 patients with chronic hepatitis B, 21 (33.9%) were HBeAg negative, and 41 (66.1%) HBeAg positive. Among 41 cases with liver cirrhosis, 28 (68.3%) were HBeAg negative, and 13 (31.7%) HBeAg positive. Of these 62 patients with chronic hepatitis B, 53 (85.5%) were infected with HBV genotype C, and 9 (14.5%) with genotype B. Thirty-nine (95.1%) of the 41 patients with liver cirrhosis were infected with genotype C, and 2 (4.9%) with genotype B. The proportion of HBeAg negative chronic hepatitis B patients with ALT level > 40 U/L was lower than that of the HBeAg positive group (47.6% and 85.4%, respectively) (P < 0.01). The percentage of ALT levels > 40 U/L of the negative patients with liver cirrhosis was also lower as compared to that of the HBeAg positive patients, but there was no statistical difference between the two groups, because of the small sample size (P > 0.05).</p><p><b>CONCLUSION</b>The proportion of HBeAg negative patients is high in the group of chronic hepatitis B and liver cirrhosis. These patients have relatively low ALT levels, and mainly have HBV genotype C infection.</p>

Methods for concentration of urinary immunoreactive insulin

Insulin is readily concentrated from 10 to 50 ml of urine with better than 75% recovery using octadecylsilyl (ODS) silica columns (C18Sep-Pak cartridge) and can then be measured by radioimmunoassay. Fractionation on Sephadex G50 gel filtration reveals that the apparent immunoreactivity corresponds for the most part to 6000 dalton insulin. Renal clearance of insulin in 5 normal subjects does not appear to differ in the fasted or fed state and ranged from 0.34 to 0.58 ml/min with an average of 0.44 +/- 0.10 (S.D.) ml/min. Increased urinary insulin output was observed following feeding and fell during prolonged fasting. Insulin output in urine from 7 non-diabetic subjects ranged from 11 to 39 mU/24 hr, averaging 25 +/- 10 mU/24 hr. In normal subjects without renal disease a single determination of renal insulin clearance and a timed urinary insulin output appear to be sufficient for determination of mean plasma insulin during that time period. Concentration of urine using this methodology could provide the material for HPLC screening for abnormal insulins and for their subsequent purification to determine the site of change in amino acid sequence.