Comprehensive minimally invasive treatment for biliary anastomotic stenosis after orthotopic liver transplantation: a single center analysis of 60 cases / 器官移植

Objective To evaluate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP)-based comprehensive minimally invasive treatment for biliary anastomotic stenosis (BAS) after liver transplantation. Methods Clinical data of 60 BAS recipients after liver transplantation were retrospectively analyzed, 54 male and 6 female, aged (48±10) years. ERCP was initially carried out. If it succeeded, plastic or metallic stents were placed into the biliary tract. If it failed, percutaneous transhepatic cholangial drainage (PTCD) or single-operator cholangioscopy (SpyGlass) was adopted to pass through the stenosis. If all these procedures failed, magnetic anastomosis or other special methods were delivered. The incidence and treatment of BAS after liver transplantation were summarized. The efficacy, stent removal and recurrence were observed. Results The median time of incidence of BAS after liver transplantation was 8 (4, 13) months. Within postoperative 1 year, 1-2 years and over 2 years, 39, 16 and 5 recipients were diagnosed with BAS, respectively. All 60 BAS recipients after liver transplantation were successfully treated, including 56 cases initially receiving ERCP, and 41 completing BAS treatment, with a success rate of 73%. The failure of guide wire was the main cause of ERCP failure. The success rates of PTCD, SpyGlass and magnetic anastomosis were 5/9, 5/7 and 7/8, respectively. Two recipients were successfully treated by percutaneous choledochoscope-assisted blunt guide wire technique and stent placement in the biliary and duodenal fistula. After 3 (3, 4) cycles of ERCP and 13 (8, 18) months of stent indwelling, 38 recipients reached the stent removal criteria, including 25 plastic stents and 13 metallic stents. The indwelling time of plastic stents was longer than that of metallic stents (P < 0.05). Six cases suffered from stenosis recurrence at 12 (8, 33) months after stent removal, and the recurrence rate was 16%. Six patients were treated with ERCP, and 5 of them did not recur after the stents were successfully removed. Multivariate analysis showed that delayed diagnosis of stenosis and frequent ERCP before stent removal were the independent risk factors for BAS recurrence (both P < 0.05). Conclusions ERCP-based comprehensive minimally invasive treatment may improve the success rate of BAS treatment after liver transplantation and yield satisfactory long-term efficacy. Delayed diagnosis of BAS and high frequent ERCP required for stent removal are the independent risk factors for BAS recurrence.

Visualization analysis of literature information in Organ Transplantation from 2010 to 2019 based on information metrology / 器官移植

Objective To analyze the characteristics of papers published in Organ Transplantation in the past ten years. Methods The academic papers published in Organ Transplantation from January 2010 to December 2019 were retrieved from China National Knowledge Infrastructure (CNKI). The publication volume, the funded paper ratio, authors, research institutions and keywords were analyzed by information visualization software CiteSpace 5.3 and VOSviewer 1.6. Results From 2010 to 2019, a total of 919 academic papers were published in Organ Transplantation, with an average annual publication volume of 92, showing an overall stable trend. The funded paper ratio and the ratio of papers with funding support at the provincial level or above increased year by year, reaching 100% in 2019. High-yield authors mainly formed two research teams led by Shi Bingyi and Chen Guihua respectively. The first authors were distributed across China. In recent years, as many as 58 programmatic papers were published by national academic institutions, especially signed by Branch of Organ Transplantation of Chinese Medical Association. The average number of authors per paper was 4.94 in Organ Transplantation, and the proportion of papers contributed by two or more authors remained above 90% in recent years. According to the analysis of research institutions, the average number of institutions per paper was 1.60 in Organ Transplantation. Keyword co-occurrence network analysis demonstrated that liver transplantation, renal transplantation and organ transplantation were the research hotspots in the field of organ transplantation. Keyword cluster analysis showed that research mainly focused on 9 fields, such as liver transplantation, renal transplantation, organ transplantation, organ donation, posttransplantation complications, transplantation immunity, end-stage liver disease, xenotransplantation and stem cell transplantation. Keyword burst analysis showed that xenotransplantation, α-1, 3-galactose, transplantation immunity, apoptosis, donor specific antibody (DSA), antibody-mediated rejection (AMR) and flow cytometry were the research hotspots. Conclusions The authors that publish academic papers in Organ Transplantation come from major transplantation centers all over the country. The papers of Organ Transplantation cover the research hotspots of each branch in the field of organ transplantation, and include a large quantity of programmatic papers signed and published by national academic institutions, which show the frontier hotspots and the highest level of research in the field of organ transplantation in China, making Organ Transplantation an excellent academic journal.

Neutrophil to lymphocyte ratio predicts early stroke risk after transient ischemic attack / 国际脑血管病杂志

Objective To investigate the predictive value of peripheral blood neutrophil to lymphocyte ratio (NLR) for early stroke risk after transient ischemic attack (TIA).Methods Patients with TIA admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University from August 2015 to July 2017 were enrolled retrospectively.According to whether or not ischemic stroke occurred within 90 d after the onset of TIA,they were divided into stroke group and non-stroke group.Multivariate logistic regression analysis was used to determine the independent risk factors for early stroke after TIA,and the receiver operating characteristic curve was used to evaluate the predictive value of baseline NLR for early stroke risk after TIA.Results A total of 131 patients with TIA were enrolled.Among them,23 (17.5％) had a stroke within 90 d,mainly within 7 d after the onset of TIA (n =13,56.5％).Univariate analysis showed that the differences between the two groups were statistically significant in terms of age,ABCD2 score,hypertension,duration of symptoms ≥60 min,diabetes,triglyceride,baseline NLR level,intracranial artery stenosis,use of antiplatelet drugs and dual antiplatelet drugs (all P ＜ 0.05).Multivariate logistic regression analysis showed that after adjusting for the confounding factors,the baseline NLR level (odds ratio [OR]2.631,95％ confidence interval [CI] 1.372-5.046;P =0.004) and ABCD2 score (OR 3.049,95％ CI 1.130-8.226;P =0.028) were the independent risk factors for early stroke after TIA,and use of dual antiplatelet agents (OR 0.195,95％ CI 0.046-0.826;P =0.026) were the independent protective factor.The receiver operating characteristic curve analysis showed that when the NLR cut-off value was 2.84,the area under the curve was 0.803 (95％ CI 0.716-0.889),and the sensitivity and specificity of predicting early stroke risk after TIA were 80.8％ and 69.5％,respectively.Conclusion Higher baseline NLR has certain predictive value for early stroke risk after TIA.

Neutrophil to lymphocyte ratio predicts long-term recurrence risk of acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of early neutrophil to lymphocyte ratio(NLR) in peripheral blood for long-term recurrence of ischemic stroke. Methods Patients w ith first-ever acute ischemic stroke w ere enrolled prospectively. The demographics and baseline clinical data of the patients at admission w ere documented and NLR w as calculated. According to the results of 2-year follow-up, they w ere divided into the recurrence group and the non-recurrence group. Multivariate Cox regression analysis w as used to identify the independent risk factors for stroke recurrence and receiver operator characteristic (ROC) curve w as used to evaluate the predictive value of baseline NLR level for recurrent risk of ischemic stroke. Results A total of 395 patients w ith acute ischemic stroke w ere enrolled, 76 patients had recurrence (19.2%) during the follow-up period. Univariate analysis show ed that there w ere significant differences in age,smoking,hyperlipidemia, atrial fibrillation, baseline National Institutes of Health Stroke Scale (NIHSS) score, total cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, homocysteine, NLR, and discontinuation of statins betw een the recurrence group and the non-recurrence group (all P<0.05). Multivariate Cox regression analysis show ed that the baseline NLR level w as an independent risk factor for the recurrence of ischemic stroke (hazard ratio 1.087,95% confidence interval 1.025-1.363; P=0.021). ROC curve analysis show ed that w hen the baseline NLR cutoff value w as 3.61,the area under ROC curve w as 0.756 (95%confidence interval 0.692-0.821).The sensitivity and specificity of predicting recurrence in patients w ith ischemic stroke w ere 73.7% and 73.0%, respectively. Conclusion The higher baseline NLR has a certain predictive value for recurrence of ischemic stroke.

Low-Intensity Shock Wave Therapy and Its Application to Erectile Dysfunction

Although phosphodiesterase type 5 inhibitors (PDE5Is) are a revolution in the treatment of erectile dysfunction (ED) and have been marketed since 1998, they cannot restore pathological changes in the penis. Low-energy shock wave therapy (LESWT) has been developed for treating ED, and clinical studies have shown that LESWT has the potential to affect PDE5I non-responders with ED with few adverse effects. Animal studies have shown that LESWT significantly improves penile hemodynamics and restores pathological changes in the penis of diabetic ED animal models. Although the mechanisms remain to be investigated, recent studies have reported that LESWT could partially restore corpus cavernosum fibromuscular pathological changes, endothelial dysfunction, and peripheral neuropathy. LESWT could be a novel modality for treating ED, and particularly PDE5I non-responders with organic ED, in the near future. However, further extensive evidence-based basic and clinical studies are needed. This review intends to summarize the scientific background underlying the effect of LESWT on ED.

The effects of arsenic trioxide eluting stents on expression of inflammatory factors in injured coronary arteries in pigs / 中华老年医学杂志

Objective To observe the effects of eluting stents coated with arsenic trioxide(As2O3)and suspended in poly-L-lactic acid(PLLA)on expression of monocyte chemoattractant protein-1 (MCP-1)and interleukin-6(IL-6)and to assess the effects of As2O3 eluting stents on local inflammatory reaction in injured coronary arteries in pigs. Methods Bare metal stents,rapamycin eluting stents and As2O3-eluting stents were randomly and double-blindly implanted into the anterior descending branches,circumflex branches and right coronary arteries in eight pigs.Animals were sacrificed and coronary arteries were isolated 7 days after stents implantation.The expression levels of protein and mRNA of MCP-1 and IL-6 were determined by Western blot analysis and reverse transcription polymerase chain reaction(RT-PCR),and the inflammatory cell infiltration was observed by HE staining and immunohistochemistry. Results Compared to bare metal stents,As2O3-eluting stents and rapamycin-eluting stents identically and markedly inhibited the protein expression level of MCP-1(0.421±0.055 and 0.406±0.042 vs.0.857±0.053,P＜0.01)and IL-6(0.151±0.032 and 0.146±0.051 vs.0.551±0.032,P＜0.01)and correspondingly lowered the mRNA expression level of MCP-1(0.338±0.047 and 0.327±0.051 vs.0.724±0.027,P＜0.01)and IL-6(0.531±0.052 and 0.523±0.061 vs.1.015±0.041,P＜0.01),and significantly reduced the inflammatory cell infiltration of injured coronary arteries in pigs. Conclusions As2O3-eluting stents can effectively inhibit the expressions of MCp-1 and IL-6 and reduce the inflammatory cell infiltration of injured coronary arteries in pigs.

Factors influencing the in vitro culture of osteoblasts / 中国组织工程研究

OBJECTIVE: Osteoblasts are essential for osteogenesis and bone metabolism, the in vitro culture of osteoblasts is the foundation for studies on bone metabolism and osteogenetic mechanism. Therefore, it is of great significance to study the related factors affecting it.DATA SOURCES: Related literature about the influencing factors of in vitro culture of osteoblasts were searched for in Medline from January 1980 to December 2004 with retrieval words of "osteoblasts, culture in vitro, in fluencing factors", with the language limited to English. Meanwhile, it was also searched in the CBM between January 1995 and December 2004 with the retrieval words of "osteoblasts, in vitro culture, influencing factors",with the language of the articles limited to Chinese.STUDY SELECTION: After preliminary examination, literature that met the need of this study was searched for the full text. Inclusion criteria: Factors influencing the in vitro culture of osteoblasts included ① physical factors; ② microelements; ③ growth factors; and ④ hormones.Reviews were removed from this study because of summary or repetitive research.DATA EXTRACTION: A total of 105 articles related to the influencing factors of the in vitrocul ture of osteoblasts were obtained, articles of repetitive and similar researchwere removed; thereby 17 articles were included in the study.DATA SYNTHESIS: ① Physical factors: Ionizing radiation, microgravity,external force, and oxygen pressure. ② Microelements: microelement deficiency would hinder the skeletal growth, or even lead to malformation. Osteoblastic proliferation is closely related to some microelements, mainly including zinc, aluminum, fluorine, copper, manganese, calcium, and magnesium. ③ Growth factors closely related to osteogenesis mainly consist of bone morphogenetic protein, platelet-derived growth factor, fibroblast growth factor, transforming growth factor-beta, insulin like growth factor,and osteogenic growth peptide (OGP). ④ Hormones capable of promoting the proliferation and differentiation are growth hormone, estrogen, thyroxine, parathyroxine, and glucocorticosteroid.CONCLUSION: Multiple factors are involved in the in vitro culture of osteoblasts. It is helpful to understand these influencing factors to seek an effective way for the in vitro culture ofosteoblasts that is applied in tissue engineering.