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ObjectiveTo observe the effect of Momordica charantia extract （MCE） on the gluconeogenesis signaling pathway in diabetes rats. MethodMale Zucker Diabetic Fatty （ZDF） rats aged 5-6 weeks were randomly divided into a model group and an MCE group （administered MCE at a dose of 0.40 g·kg-1 by gavage）. Additionally， seven healthy male ZDF （fa/+） rats were assigned to the normal group and received administration once daily for six consecutive weeks. During the experiment， the general condition of the rats was observed， and body weight was recorded. Fasting blood glucose and random blood glucose levels were measured in the 1st， 3rd， and 5th weeks. In the 6th week， an oral glucose tolerance test （OGTT） was conducted， and serum levels of triglycerides （TG）， free fatty acid （FFA）， total cholesterol （TC）， aspartate aminotransferase （AST）， and alanine aminotransferase （ALT） were measured. Hematoxylin-eosin （HE） staining was performed to examine liver morphology， periodic acid-Schiff （PAS） staining was used to assess hepatic glycogen storage， and Real-time polymerase chain reaction （PCR） was employed to measure the mRNA expression of phosphoenolpyruvate carboxykinase （PEPCK） and glucose-6-phosphatase （G6Pase） in the liver. Western blot analysis was conducted to measure the phosphorylation level of forkhead box protein O1 （FoxO1） and the protein expression of PEPCK and G6Pase in the liver. ResultCompared with the model group， the MCE group showed significant improvements in body weight， fasting blood glucose， random blood glucose， and glucose tolerance （P<0.05， P<0.01） and reduced serum levels of FFA， TC， and TG （P<0.05， P<0.01）. There were no significant differences in ALT and AST between the two groups. In the MCE group， the HE staining revealed more orderly liver cell arrangement and reduced hepatic steatosis and the PAS staining showed increased hepatic glycogen storage. The protein expression of p-FoxO1 in the liver was significantly elevated （P<0.01）， while there was no significant difference in FoxO1 protein expression. The mRNA and protein expression of PEPCK and G6Pase significantly decreased （P<0.05）. ConclusionMCE exhibits glucose-lowering and lipid-lowering effects， improves glucose tolerance， and enhances hepatic glycogen storage. These effects may be attributed to the upregulation of p-FoxO1， leading to the inhibition of PEPCK and G6Pase expression and the regulation of gluconeogenesis-related processes.
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ObjectiveTo observe the glucose-lowering， insulin resistance-improving， and anti-inflammatory effects of flavonoids from mulberry leaves （FML） and explore their underlying mechanism. MethodMale db/db mice aged 6-7 weeks were randomly divided into a model group， a high-dose FML group （1.00 g·kg·d-1）， and a low-dose FML group （0.50 g·kg-1·d-1）. C57BL mice of the same age were assigned to the normal group. After six weeks of intervention， fasting blood glucose （FBG）， serum fasting insulin levels （Fins）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， free fatty acid （FFA）， blood creatinine （SCr）， blood urea nitrogen （BUN）， and aspartate aminotransferase （AST） levels were measured， and the homeostasis model assessment of insulin resistance （HOMA-IR） was calculated. Superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）， and catalase activities in the liver were measured. Morphological changes in the liver were assessed by hematoxylin-eosin （HE） staining. The protein expression of cyclooxygenase-2 （COX-2）， inducible nitric oxide synthase （iNOS）， and nuclear factor-κB （NF-κB） in the liver was detected by Western blot. ResultCompared with the model group， the high-dose and low-dose FML groups showed significant reductions in FBG， Fins， HOMA-IR， IL-6， TNF-α， and FFA levels （P<0.05， P<0.01）， and increased levels of SOD， GSH-Px， and catalase in the liver （P<0.05， P<0.01）. HE staining of the liver in the FML groups showed improved arrangement of hepatocytes， reduced inflammatory cell infiltration， and alleviated cellular steatosis compared with the model group. The protein expression of COX-2， iNOS， and NF-κB in the liver significantly decreased in the FML groups as compared with that in the model group （P<0.05， P<0.01）. ConclusionFML have glucose-lowering and insulin resistance-improving effect， which may be attributed to their regulation of the NF-κB pathway in the liver of diabetic mice， leading to the suppression of the release of COX-2， iNOS， and inflammatory cytokines， thereby improving the inflammatory state.
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Objective:To summarize the safety and efficacy of aortic banding in the treatment of refractory endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).Methods:The clinical and follow-up data of 10 patients with refractory endoleaks EVAR undergoing aortic banding at Peking University People's Hospital from Jun 2019 to Aprl 2022 were retrospectively analyzed.Results:The aortic banding was indicated for type Ⅰ endoleak in 6 patients, type Ⅱ endoleak in 3 patients and internal tension in 1 patient with persistent aneurysm enlargement or rupture. The surgical procedure was based on laparotomy. The proximal aortic neck was exposed and re-fixation with artificial strip to prevent bleeding. The surgical procedures was successful in all the 10 cases without residual endoleak or re-bleeding. The post-operative contrast-enhanced ultrasonography revealed neither new-onset endoleak nor occlusion of stent-grafts. Perioperative complications included one case of delayed wound healing and one case of incomplete ileus. No perioperative deaths occurred. Midterm follow-up was achieved in 10 patients with a mean follow-up time of 13 months. No recurrence of endoleak was found. One patient underwent endovascular repair for independent thoracic aortic aneurysm 6 months after surgery. There were no other aorta-related secondary surgeries or aortic-related deaths.Conclusion:Aortic banding for refractory endoleaks after EVAR is minimally invasive and reliable. It can effectively eliminate the refractory endoleaks, and reduce the risks of aortic-related secondary surgery or death.
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Objective:To evaluate the diagnosis and surgical treatment of abdominal aortic vascular endograft infections.Methods:Clinical data of 13 patients of abdominal aortic vascular endograft infections undergoing surgical treatment at Department of Vascular Surgery, Peking University People's Hospital from Jan 2015 to Jan 2021 was retrospectively analyzed.Results:All 13 patients underwent infected graft resection under axillobifemoral bypass. Three patients died perioperatively and 10 recovered. Eight patients were followed-up,with bypass graft being occluded and another one with bypass graft infections exposure.Conclusions:Abdominal aortic vascular endograft infections are catastrophic diseases with high surgical difficulty and risk. Extra-anatomic reconstruction with graft removal is a safe and effective treatment for the eradication of infection.
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Objective:To explore the effect of exercise intervention on regulation of Toll-like receptor 4 (TLR4) signaling pathway in overweight and obese pregnant women.Methods:The cohort was based on a randomized controlled trial (RCT) carried out by the same research group in Peking University First Hospital from December 2014 to July 2016. Overweight and obese patients who delivered by elective cesarean section without pregnancy complications were recruited, among which 12 cases in the exercise group and 11 cases in the control group were selected. Real-time polymerase chain reaction, Western Blot, and Luminex experiments were used to compare the expression of TLR4-myeloid differentiation factor 8(MyD88)-nuclear factor-κB(NF-κB) pathway in peripheral blood mononuclear cell (PBMC), rectus abdominis muscle, omental adipose, and subcutaneous adipose, as well as the levels of inflammatory factors (TNF-α, IL-1β, IL-10) in plasma between the two groups. Two independent samples t-test, generalized estimating equation, Chi-square test, and Pearson correlation analysis were adopted for statistical analysis. Results:(1) The expression of inflammatory factors TNF-α and IL-1β in the exercise group showed a downward trend compared with the control in the second and third trimester, but none of the differences were statistically significant (all P>0.05). (2) The mRNA expression of TLR4, MyD88, and NF-κB and the protein expression of TLR4 and NF-κB in PBMC of the exercise group were significantly lower than those in the control group during pregnancy (TLR4 mRNA: 0.06±0.03 vs 0.10±0.04 in the second trimester, 0.05±0.02 vs 0.11±0.05 in the third trimester, χ2=8.07; MyD88 mRNA: 0.09±0.03 vs 0.11±0.03 in the second trimester, 0.10±0.04 vs 0.17±0.06 in the third trimester, χ2=5.81; NF-κB mRNA: 0.10±0.03 vs 0.17±0.08 in the second trimester, 0.08±0.03 vs 0.20±0.08 in the third trimester, χ2=14.71; TLR4 protein: 1.7±0.5 vs 1.9±0.8 in the second trimester, 1.7±0.4 vs 2.3±0.8 in the third trimester, χ2=5.83; NF-κB protein: 1.0±0.4 vs 1.5±0.4 in the second trimester, 1.2±0.3 vs 1.5±0.5 in the third trimester, χ2=4.73; all P<0.05). Moreover, the differences in the mRNA expression of TLR4, MyD88, and NF-κB and TLR4 protein expression in PBMC between the two groups gradually increased. (3) NF-κB in rectus abdominis and omental adipose tissue (0.04±0.02 vs 0.08±0.04, t=－3.72; 0.25±0.05 vs 0.63±0.21, t=－5.41; both P<0.05) and TLR4 and MyD88 in subcutaneous adipose tissue (0.12±0.03 vs 0.30±0.10, t=－5.30; 0.24±0.09 vs 0.44±0.08, t=－5.38; both P<0.05) were observed a decreased mRNA level in the exercise group compared with the control group. The protein level of MyD88 and NF-κB in omental adipose tissue and NF-κB in subcutaneous adipose tissue in the exercise group were significantly lower than those in the control group (1.1±0.5 vs 2.0±0.8, t=－3.15; 1.3±0.5 vs 2.0±0.9, t=－2.23; 1.2±0.5 vs 1.9±0.8, t=－2.80, all P<0.05). (4) The expressions of TLR4 and NF-κB mRNA ( r=0.453 and 0.485) in rectus abdominis muscle, NF-κB mRNA, TLR4 and MyD88 protein ( r=0.539, 0.437 and 0.527) in omental adipose in the two groups were positively correlated with the level of fasting blood glucose ( P<0.05). Conclusions:Regular exercise during pregnancy can down-regulate the expression and activation of the TLR4-MyD88-NFκB pathway in overweight and obese pregnant women. The expression of related factors along this pathway has a certain correlation with fasting blood glucose.
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Objective:To study the effect of Wuzhi capsules on tacrolimus trough concentration in kidney transplant recipients with different CYP3A5 genotypes.Methods:From June 2015 to October 2019, 162 patients who underwent renal transplantation for the first time were retrospectively analyzed. The patients were divided into two groups, combined and uncombined, according to whether combined with Wuzhi capsules. There were 81 cases in the uncombined group (55 males and 26 females), and 81 in the combined group (62 males and 19 females). There was no significant difference between the two groups( P=0.219). The ages of the uncombined group and the combined group were (39.26±11.91) years old and (37.21±10.88) years old ( P=0.103), the weights were (62.39±11.64) kg and (66.18±13.89)kg ( P=0.298), systolic blood pressure were (147.28±20.24) mmHg and (145.00±16.42) mmHg (1 mmHg=0.133 kPa)( P=0.276), diastolic blood pressure were (92.25±13.87) mmHg and (92.20±12.53) mmHg ( P=0.886), alanine aminotransferase were (12.24±8.59) U/L and (17.06±13.11) U/L ( P=0.015), aspartate aminotransferase were (17.76±9.12) U/L and (16.57±8.37) U/L ( P=0.463), fasting blood glucose were (8.70±3.48) mmol/L and (7.18±2.74)mmol/L ( P=0.006), hemoglobin were (98.96±17.53) g/L and (101.05±18.67) g/L ( P=0.789), creatinine were (665.22±296.55) μmol/L and (797.32±279.32) μmol/L ( P=0.007), estimated glomerular filtration rate were (11.47±14.11) ml/(min·1.73m 2) and (8.85±3.71) ml/(min·1.73m 2) ( P=0.130)in the kidney transplant recipients before surgery. Among the 162 cases in this study, there were 86 cases (53.09%) of CYP3A5*1*3 genotype, 17 cases (10.49%) of CYP3A5*1*1 genotype, 59 cases (36.42%) of CYP3A5*3*3 genotype, and the minimum allele frequency of CYP3A5*1 was 37.04%. In the uncombined group, CYP3A5*1*3 genotype 39 cases (48.15%), CYP3A5*1*1 genotype 5 cases (6.17%), and CYP3A5*3*3 genotype 37 cases (45.68%). In the combined group, CYP3A5*1*3 genotype 47 cases (58.02%), CYP3A5*1*1 genotype 12 cases (14.81%), and CYP3A5*3*3 genotype 22 cases (27.16%), with statistically significant differences in the two groups ( P=0.024). The patients were treated with a triple immunosuppressive regimen (tacrolimus+ mycophenolate mofetil+ glucocorticoid) based on tacrolimus [initial dose: 0.15-0.30 mg/(kg·d)], combination of Wuzhi capsules in the combination group (11.25 mg, twice a day). The trough concentration of tacrolimus was detected by enzyme-linked immunosorbent assay, compare the difference in the trough concentration of tacrolimus between the two groups. The relationship between the effect of Wuzhi capsules and CYP3A5 gene polymorphism was compared, and compare the changes before and after the application of CYP3A5 genotype combined with Wuzhi Capsules. The influencing factors of tacrolimus trough concentration were analyzed by multiple linear regression. Results:In the combined with Wuzhi capsules, the dose corrected trough concentration (C 0/D) of tacrolimus was higher than that in patients without Wuzhi capsules, and the extent of increase was related to genotype. The C 0/D of tacrolimus in patients with CYP3A5*3*3 genotype in the combination and non-combination groups were (12.15±2.95) (ng·ml -1/0.1mg·kg -1·d -1) and (9.99±2.33) (ng·ml -1/0.1mg·kg -1·d -1) ( P=0.004), CYP3A5*1*3 genotype were (11.11±3.20) (ng·ml -1/0.1mg·kg -1·d -1) and (6.86±1.62) (ng·ml -1/0.1mg·kg -1·d -1) ( P<0.001), and there were significant difference. However, CYP3A5*1*1 genotype were(8.29±2.64) (ng·ml -1/0.1mg·kg -1·d -1) and (6.16±2.87) (ng·ml -1/0.1mg·kg -1·d -1) ( P=0.160), there was no significant difference. The tacrolimus C 0/D of the combined group before and after the Wuzhi capsule were as follows: CYP3A5*3*3 genotype: (7.18±2.33)(ng·ml -1/0.1mg·kg -1·d -1) and (13.33±3.09) (ng·ml -1/0.1mg·kg -1·d -1) ( P<0.001); CYP3A5*1*3 genotype: (5.14±2.14) (ng·ml -1/0.1mg·kg -1·d -1) and (10.61±3.20) (ng·ml -1/0.1mg·kg -1·d -1) ( P<0.001); CYP3A5*1*1 genotype: (5.17±3.75) (ng·ml -1/0.1mg·kg -1·d -1) and (8.31±2.74) (ng·ml -1/0.1mg·kg -1·d -1)( P=0.002), and the differences were statistically significant. The results of multiple linear regression showed that the combination of Wuzhi capsules (β=0.508, P<0.001) and CYP3A5 genotype(CYP3A5*1*3 and CYP3A5*3*3: β=-0.361, P<0.001; CYP3A5*1*1 and CYP3A5*3*3: β=-0.425, P<0.001)could influence the trough concentration. The sex (β=-0.100, P=0.124) and age (β=-0.003, P=0.967) of renal transplant recipients had no statistical significance to tacrolimus C 0/D. Conclusions:In the renal transplant patients, CYP3A5 genotype and combined use of Wuzhi capsules are the main factors affecting tacrolimus C 0/D. In order to achieve the expected trough concentration as soon as possible, the interaction between CYP3A5 genotypes and drug combination should be considered.
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Objective:To investigate the safety and efficacy of simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) for patients with concomitant severe carotid and coronary artery disease.Methods:The clinical data of 19 patients with concomitant severe carotid artery stenosis and coronary artery disease undergoing simultaneous CEA and CABG at Peking University People′s Hospital from Jan 2011 to Dec 2019 were retrospectively analyzed.Results:The mean ages was 69 years old.The operation adopted the strategy of CEA first and then CABG. Conventional CEA with carotid arterial shunting was performed. The primary composite end points were perioperative cardiovascular and neurological adverse event rates, as well as the late follow-up outcomes. The technical success rate was 100%. There were no adverse cardiovascular events during the perioperative period. Ischemic stroke occurred in 2 patients. No early death was observed. Seventeen cases were successfully followed up for 1-103 months. One patient developed cerebral infarction after 8 months, one developed acute myocardial infarction 43 months after surgery. No cases suffered from carotid artery restenosis. The 5-year overall survival rate was 91%.Conclusions:Simultaneous CEA and CABG treatment for patients with concomitant carotid and coronary artery disease is safe with few perioperative cardiovascular events and no deaths.
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Objective:To explore the application value of enhanced recovery after surgery (ERAS) in laparoscopic radical resection of bladder cancer and ileal bladder surgery under modular operation procedures.Methods:A retrospective selection of 42 cases of laparoscopic radical radical resection of bladder cancer and ileal bladder surgery performed by the Department of Urology, General Hospital of Southern Theater Command from January 2017 to December 2019 were divided into two groups according to the different management methods adopted during the perioperative period: ERAS management group and conventional management group, each with 21 cases. Among them, patients in the ERAS management group were managed by ERAS during the perioperative period, and patients in the conventional management group were managed by conventional management during the perioperative period. The postoperative hospital stay, first exhaust time, first defecation time, first time to get out of bed, first liquid food time, postoperative visual analogue scale (VAS) score, as well as transferrin, upper arm circumference, body mass index, plasma albumin, total protein, and total protein were compared between the two groups of patients after surgery. The measurement data conforming to the normal distribution were expressed as mean±standard deviation ( Mean± SD), and the in dependent t-test was used for comparison between groups; the measurement data of non-normal distribution were expressed as the median (interquartile range) [ M( P25, P75)], the independent sample Mann-Whitney U test was used for comparison between groups; the Chi-square test was used for comparison of enumeration data between groups. Results:The postoperative hospital stay in the ERAS group was (8.9±1.8) d, the first exhaust time was (33.4±3.2) h, the first defecation time was (60.3±7.8) h, the first time to get out of bed was (23.1±6.7) h, the first liquid food time was (82.7±18.5) h and postoperative VAS was (1.3±0.6), that were significantly reduced compared with the conventional treatment group [(12.3±2.3) d, (51.4±5.2) h, (73.0±8.1) h, (34.7±8.2) h, (109.7±21.6) h, (3.6±0.8)], the difference were statistically significant ( P<0.05). In the ERAS group, the decreased value of transferrin was [0.8 (-0.4, 2.2) g/L], the decreased value of body mass index was[1.61±0.73], the decreased value of plasma albumin was [3.5±1.5 g/L], the decrease value of total protein was[10.1±5.6 g/L] and the decrease value of prealbumin was [90.5±11.3 mg/L] were significantly lower than those of the conventional management group[(1.9(0.9, 3.6) g/L, (2.32±1.05) kg/m 2, (9.6±2.0) g/L, (16.3±4.9) g/L, (131.3±7.4) g/L], and the difference were statistically significant ( P<0.05). Conclusion:Modular laparoscopic precision resection of bladder cancer and ERAS concept after ileal bladder surgery is beneficial to shorten the hospital stay, reduce postoperative pain, have less impact on the patient′s body loss and immune function, and can speed up the patient′s postoperative recovery.
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Objective:To explore the outcomes of standard endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with complex neck anatomical features.Methods:Clinical data of AAA patients received standard EVAR from Jan 2004 to Dec 2018 were retrospectively collected. Based on pre-operative computed tomography angiography (CTA) data, patients were divided into complex neck group and non-complex neck group to compare the results between them.Results:There were 88 patients (66.2%) in complex neck group and 45 patients (33.8%) in non-complex group. There was no significant difference in peri-operative characters (blood loss, contrast volume used, hospital stay time, technical success rate) and follow-up results (late re-intervention, late endoleak, aneurysm enlargement, survival rate),all P>0.05.Multivariant logistic regression analysis revealed neck diameter larger than 31 mm was related with late re-intervention ( OR=24.975, P=0.02). Conclusion:Standard EVAR for AAA with complex neck characters does not cause higher perioperative complications and less favorable long term survival rate.
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Objective:To compare the clinical results of different endovascular thrombus reduction techniques in the treatment of acute lower extremity arterial thrombosis.Methods:The clinical data of 96 consecutive patients with acute femoral popliteal arterial thrombosis who were treated with catheter directed thrombolysis (CDT) and mechanical thrombus aspiration system (PMT) between Jan 2016 and Dec 2018 at Cangzhou People's Hospital and Peking University People's Hospital were retrospectively analyzed.Results:Ninty-six patients underwent thrombolytic surgery,including 36 with CDT thrombolysis, 28 with AngioJet aspiration alone and 32 with Rotarex aspiration alone. Angiojet thrombus aspiration reduced thrombus rate by 89.3% (25/28) and clinical success rate by 92.8% (26/28).The thrombus reduction rate of Rotarex group was 87.5% (28/32), and the clinical success rate was 96.8% (31/32). In the CDT thrombolytic group, the thrombolytic reduction rate was 61.1% (22/36), including 8 patients who underwent thrombectomy and 6 patients with PMT, with a clinical success rate of 86.1% (31/36). The rate of distal arterial embolization, puncture point and local subcutaneous hematoma and vascular rupture was 21.4%, 10.7% and 2.1%, respectively. There were no amputation cases reported during a mean 13 months follow-up.The survival rate was 97.9%. The first-stage patency rate of 67.8%, while the second-stage artery patency rate of 85.7% during the follow-up.Conclusion:Compared with CDT, PMT has higher efficiency and lower complication rate in the treatment of acute lower extremity arterial thrombosis.
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Objective:To investigate the relationship between previous bleeding history and poor prognosis of patients with acute upper gastrointestinal bleeding.Methods:This study was a prospective multicentre real-world study (Acute Upper Gastrointestinal Real-word study, AUGUR study). The data of patients with UGIB who were admitted to the emergency department of 20 tertiary hospitals in China from June 30, 2020 to February 10, 2021 were collected. According to the number of previous bleeding history, the patients were divided into three groups (0 time, 1-3 times, and≥4 times). Based on the patient’s demographic data, clinical characteristics, laboratory data, treatment, and outcomes, univariate and logistic regression analysis were performed to investigate the correlation between the number of previous bleeding and the 90-day mortality and rebleeding of patients with gastrointestinal bleeding.Results:A total of 1 072 patients with acute UGIB were included in this study. The all-cause mortality and rebleeding rate of all patients were 10.9% (117/1 072) and 11.8% (129/1 072), respectively. Among them, 712 patients (66.42%) had no previous bleeding, 297 patients (27.71%) had previous bleeding 1-3 times, and 63 patients (5.88%) had previous bleeding≥4 times. In univariate analysis, age, vital signs and consciousness on admission, history of liver cirrhosis, onset with hematemesis, admission hemoglobin, varicose veins bleeding, peptic ulcer bleeding, red blood cell infusion, tracheal intubation and the use of vasopressors after admission were risk factors for the 90-day mortality and rebleeding rate. Multivariate logistic regression analysis showed that patients with previous bleeding≥4 times had a higher risk of the 90-day mortality ( OR=2.17, 95% CI: 1.04-4.57, P=0.040) and rebleeding ( OR=2.32, 95% CI: 1.19-4.53, P=0.013). Conclusions:The history of previous bleeding≥ 4 times can be used as an independent risk factor for the 90-day mortality and rebleeding in patients with acute UGIB.
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ObjectiveTo assess the specificity of P50 auditory-evoked potential in schizophrenic patients with violent and aggressive behaviors， so as to provide objective biological markers for predicting violent behaviors of schizophrenic patients. MethodsA total of135 schizophrenic patients who met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10） were divided into aggressive group （n=70） and non-aggressive group （n=65） according to the assessment results of the Modified Overt Aggression Scale （MOAS）， meantime， another 60 healthy individuals matched for age and gender were set as healthy group. Then the P50 auditory-evoked potentials of all selected individuals were measured using EP/EMG system （MEB-9200， Nihon Kohden， Japan）. ResultsAmp S2 of the aggressive group was significantly higher than those of the non-aggressive group and healthy control group， with statistical differences ［（9.86±6.04）μV vs. （7.06±3.88）μV， P=0.004； （9.86±6.04）μV vs. （7.82±3.87）μV， P=0.031］. The proportion of S2/S1 ratio ≥0.5 was 72.88%， 43.86% and 30.00% in aggressive group， non-aggressive group and healthy group， which was the highest in aggressive group， with statistical differences （P<0.01）. The amplitude difference of P50 （S1-S2） of the aggressive group was lower than those of the non-aggressive group and the healthy control group， the differences were of statistical significance ［（4.35±9.39）μV vs.（9.89±8.48）μV， P=0.001； （4.35±9.39）μV vs.（13.42±9.81）μV， P<0.01］. ConclusionThe violent and aggressive behaviors in schizophrenic patients may be related to the sensory gating deficit.
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Objective:To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms.Methods:Clinical data of 36 patients with incomplete spinal cord injury who underwent SNM from February 2015 to April 2019 were retrospectively analyzed and were divided into group NUR (16 cases neurogenic urinary retention group) and group NOAB (20 cases of neurogenic bladder overactive group). If at least 50% clinical improvement occurred, the patient would undergo a permanent SNM procedure. The patients were evaluated by using bladder diary, postvoid residual volume measurement, frequency of clean catheterization and urodynamic parameters before and during the test, and after the permanent SNM.Results:Among the 36 patients, 21 cases (58.3%) were tested effectively and received permanent stimulator implantation, 7(19.4%) in NUR group and 14(38.9%) in NOAB group. The residual urine volume of bladder, the average number of catheterization and the average number of urination in NUR group were improved in different degrees. After operation, the symptoms of frequent urination, urgency of urination and incontinence in NOAB group were relieved to varying degrees. During the follow-up, 2 patients with urinary retention failed the treatment. After the Ⅰ phase of the contralateral S3, the curative effect was recovered. A patient were infected after operation, and the wound healed after removal of the infection.Conclusions:The SNM is safe and effective in the treatment of neurogenic lower urinary tract symptoms in some incomplete spinal cord injury patients, and is helpful to protect renal function in patients with spinal cord injury. SNM can not improve all symptoms at times, but the SNM can be considered in patients with ineffective or intolerant traditional treatment.
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Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.
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Objective:To investigate the clinical treatment of large segmental humeral defects with unilateral external fixation and bone transport.Methods:A retrospective study was conducted of the 9 patients who had been treated at Department of Orthopedics, Shenzhen People's Hospital for large segmental humeral defects from September 2017 to June 2019. They were 5 males and 4 females with an average age of 29 years (from 21 to 41 years). Their defects were caused by trauma in 2 cases, by chronic osteomyelitis in 6 cases and by bone tumor in one case. The length of bone defect ranged from 4.2 to 9.0 cm, with an average of 5.9 cm. A unilateral external fixator was placed in operation, and adjusted regularly 7 to 10 days after operation for bone transport and bone lengthening to restore the length of humerus gradually. The external fixation bracket was removed after 3 to 4 layers of cortex were observed on X-ray films. Recorded were length and rate of humeral lengthening, fracture healing time, time for carrying external fixator and complications; the Disabilities of the Arm, Shoulder and Hand (DASH) scores were compared between preoperation and 15 months postoperation.Results:All the patients were followed up for 15 to 36 months (mean, 19 months). The length of lengthening averaged 5.9 cm (from 4.2 to 9.0 cm) with an average lengthening rate of 26%, the healing index 31 d/cm, the bone healing time 8.3 months, and the time for carrying external fixator 10.8 months(from 8.0 to 13.5 months). Their average DASH scores improved significantly from 25.0 ± 2.4 preoperation to 12.0 ± 1.8 at 15 months postoperation ( P<0.05). Good correction of large humeral defects was achieved in all but one case who reported temporary radial nerve paralysis. There were no such complications as neurovascular injury. The shoulder and elbow functions were basically normal after operation. Conclusions:In the treatment of large segmental humeral defects, unilateral external fixation plus bone transport can quickly repair the defects and recover the upper limb function of the patients.
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Objective To investigate the changes in neutrophil immunophenotypes in neonates with late-onset sepsis and their clinical significance.Methods A total of 42 neonates with late-onset sepsis were enrolled prospectively as sepsis group from Children's Hospital of Fudan University from January 2015 to October 2016,which included 26 preterm infants and 16 term infants.Another 33 neonates without infectious diseases consisting of 20 preterm infants and 13 term infants were selected as control group.According to the severity of sepsis,neonates in the sepsis group were further divided into severe (n=11)and mild sepsis (n=31) subgroups.Expression of CD16 and CD62L on neutrophils was measured by flow cytometry to determine the distribution of neutrophil subsets in neonatal peripheral blood.Differences in the distribution of neutrophil subsets between the two groups and two subgroups were compared using Wilcoxon rank-sum test.Multivariate logistic regression analysis was used to investigate the relationship between neutrophil subsets and the severity of neonatal sepsis.Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of neutrophil subsets for the severity of sepsis.Results Four neutrophil subsets were identified in neonatal peripheral blood,including early-stage neutrophils (CD16-/CD62L-),immature neutrophils (CD16-/CD62L+),mature neutrophils (CD16+/CD62L+) and activated neutrophils (CD16+/CD62L-).Activated [preterm:61.1％ (20.2％-79.4％),term:47.6％ (15.2％-70.1％)] and mature neutrophils [preterm:35.7％ (19.9％-75.8％),term:52.0％ (25.6％-82.8％)] were the dominant subsets in the control group.In preterm infants,the proportion of early-stage [3.5％ (1.7％-9.4％) vs 1.9％ (0.6％-4.0％),Z=-2.501,P=0.012] and immature neutrophils [6.3％ (0.7％-45.5％) vs 0.4％ (0.3％-0.7％),Z=-3.878,P＜0.001] were higher,but that of activated neutrophils [8.3％ (2.3％-49.2％) vs 61.1％ (20.2％-79.4％),Z=2.991,P=0.002] were lower in the sepsis group than those in the control group;same differences were found in the absolute counts of each neutrophil subsets.Among term infants,more immature neutrophils were found in the sepsis group than those in the control group [49 (18-200) vs 13 (5-36)/μl,Z=-2.193,P=0.028].The proportion and the absolute counts of early-stage and immature neutrophils in the severe sepsis subgroup were all higher than those in the mild cases [early-stage neutrophils:5.8％ (3.4％-17.8％) vs 3.0％ (1.4％-7.3％),304 (137-1478) vs 158 (53-321)/μl;immature neutrophils:23.0％ (6.3％-47.0％) vs 0.9％ (0.5％-6.8％),1003 (487-2818) vs 85 (18-275)/μl;all P＜0.05].Multivariate logistic regression analysis showed that the proportion of early-stage neutrophils was associated with the severity of sepsis (OR=1.2,95％CI:1.0-1.4,P=0.012).In addition,the diagnostic value of the proportion of early-stage neutrophils for severe sepsis was the highest when the cut-off value was 3.3％,with the area under the ROC curve was 0.7 (95％CI:0.6-0.9),sensitivity of 81.8％ (95％CI:48.2％-97.7％) and specificity of 62.3％ (95％CI:42.2％-78.2％).Conclusions There are four neutrophil subsets in the peripheral blood of neonates and autoactivation of neutrophils may exist.With the onset of sepsis,neutrophil subsets react differently between preterm and term infants.The proportion of early-stage neutrophils may be correlated with the severity of neonatal sepsis,which may have a predictive value for severe sepsis.
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Objective To investigate the long-term effects of regular exercise during pregnancy on overweight and obese gravidas. Methods This study was based on a previous randomized controlled trial (RCT) regarding Effect of Regular Exercise Commenced in Early Pregnancy on the Incidence of Gestational Diabetes Mellitus in Overweight and Obese Pregnant Women conducted at Peking University First Hospital from December 2014 to July 2016. Totally 265 women whose prepregnant body mass index (BMI) ≥24.0 kg/m2 were enrolled in the RCT and were randomly assigned to exercise group (n=132) and control group (n=133). This study was a follow-up of all the participants at one year after delivery from March 2016 to August 2017. Body weight, body fat, fasting and 2 h glucose level in 75 g oral glucose tolerance test (OGTT), insulin resistance index and lipid profiles were compared. We also evaluated their physical activities with International Physical Activity Questionnaire (IPAQ), their dietary habits with modified Adult Dietary Behavior Assessment Scale and depression condition with Postpartum Depression Screen Scale (PDSS). Two independent samples t-test, Mann-Whitney U test and Chi-square test were used for statistical analysis. ResuLts The overall follow-up rate was 51.7% (137/265), while 64.4% (85/132) in the exercise group and 39.1% (52/133) in the control group. No significant difference in body weight loss [2.3 ( － 6.0 to 5.0) vs 1.0 ( － 1.3 to 4.7) kg], body fat percentage [(38.04±4.54)% vs (37.51±4.90) %], 2 h glucose level in 75 g OGTT [(7.30±2.80) vs (7.32±1.61) mmol/L], abnormal glucose tolerance ratio [30.0% (9/30) vs 28.8% (17/59)] or insulin resistance index (2.92±1.77 vs 2.86±1.92) was found between the control and exercise group (t or Z= － 0.940, 0.312, 3.415, 0.005, 1.743, all P>0.05). However, the fasting blood glucose in 75 g OGTT was higher in the control group [(5.53±0.92) vs (5.28±0.43) mmol/L, t=9.268, P=0.003]. The two groups showed no significant difference (exercise group vs control group) in physical activity level [219 (99-504) vs 195 (99-351)], total score of dietary habits [79.00 (72.50-87.50) vs 76.00 (70.00-82.00)] or PDSS score of depression [55.00 (41.00-77.00) vs 70.00 (46.25-84.75)] at follow-up (Z=－0.808, －1.822, －1.620, all P>0.05). Moreover, there was no significant difference in the level of serum triglyceride [(1.25±1.04) vs (1.42±0.85) mmol/L], total cholesterol [(4.56±0.71) vs (4.40±0.67) mmol/L], high density lipoprotein-cholesterol [(1.32±0.29) vs (1.22±0.21) mmol/L] or low density lipoprotein-cholesterol [(2.67±0.56) vs (2.55±0.52) mmol/L] between the exercise and control group (t=0.001, 0.020, 3.255, 0.303, all P>0.05). ConcLusions Regular exercise during pregnancy has no long-term effect on maternal health in the absence of continuing lifestyle intervention after delivery. Therefore, postpartum follow-up and continued education on healthy lifestyle should be emphasized.
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Objective To observe the results and reality of transurethral resection of bladder tumor with preexcitation of electric cutting loop in the prevention of obturator nerve reflex.Methods The clinical data of 186 patients with bladder tumors admitted from January 2015 to August 2018 were retrospectively analyzed.There were 112 males and 74 females aged 35 to 83 years,average (59 ± 11)years.76 patients were admitted because of intermittent gross hematuria and 110 patients were admitted because of physical check-up.All patients underwent ultrasound,CT (plain scan/enhancement) and cystoscopy before operation.The pathological diagnosis of cystoscopy biopsy was bladder urothelial cell carcinoma.There were 105 cases clinical stage Ta stage,81 cases of T1 stage.There were 103 single cases and 39 multiple cases of non-muscular invasive bladder.According to the different surgical techniques,the patients were divided into two groups:the pre-excitation group and lateral incision group.There were 142 cases in pre-excitation group.In the pre-excitation group,the tumors were removed routinely by the resection ring.When the resection ring was far away from the tumors,the pedal switch was pressed to excite the resection ring.The resection ring was moved to the location of the tumors,and the tumors were cut to the muscular layer.The operation was completed after 2 cm electric cauterization around the wound and hemostasis.In the lateral incision group,the tumors were removed routinely by the electric resection ring.The operation time,incidence of obturator nerve reflex,incidence of bladder perforation,amount of bleeding,retention time of catheter,pathological grading,risk grading,hospitalization time and recurrence rate of tumors at 6 months after operation were compared between the two groups.Results The operation was successfully completed in both groups,and there was no transition to open operation.In the pre-excitation group,the operation time was 10 minutes to 56 minutes,with an average of (28 ± 12) minutes,and the intraoperative blood loss ranged from 5 ml to 70 ml,with an average of (35 ± 15) ml.In the lateral incision group,the operation time was 15 minutes to 65 minutes,with an average of (28 ± 11) minutes,and the blood loss was 10 ml to 80 ml,with an average of (40 ± 15) ml.There was no significant difference in operation time and blood loss between the two groups (P ＞ 0.05).There were only 3 cases of obturator nerve reflex in preexcitation group,the incidence was 2.1％.There were 13 cases of obturator nerve reflex in lateral resection group,the incidence was 29.5％.There was significant difference of nerve reflex incidence between the two groups (P ＜ 0.05).Conclusions In transurethral resection of bladder tumors,the method of pre-excitation of plasma resection ring can effectively decrease obturator nerve reflex and make the operation safer.
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BACKGROUND: At present, there is no uniform standard for the treatment time of chemical reagents for surface treatment of glass fiber posts. Therefore, studying the effect of treatment time of glass fiber post surface treatment reagents on the bond strength between fiber posts and resin cements is of great significance. OBJECTIVE: To evaluate the effect of two chemical agents on the bonding strength of glass fiber post and resin cement after surface pretreatment of glass-fiber posts at different times. METHODS: Forty-eight glass fiber posts were randomly divided into eight groups according to different surface treatment methods, six in each group. Group A received no special treatment; group B was treated with silanization for 1 minute; group C1 underwent a 30% hydrogen peroxide surface treatment for 5 minutes prior to 1-minute silanization; group C2underwent a 30% hydrogen peroxide surface treatment for 10minutes prior to 1-minutesilanization; group C3 underwent a 30% hydrogen peroxide surface treatment for 15 minutes prior to 1-minute silanization; group D1 underwent a 35% phosphoric acid surface treatment for 30 seconds prior to 1-minute silanization; group D2 underwent a 35% phosphoric acid surface treatment for 60 seconds prior to 1-minute silanization; group D3 underwent a 35% phosphoric acid surface treatment for 90 seconds prior to 1-minute silanization. The surface morphology of the treated glass fiber posts was observed under scanning electron microscope. The glass fiber post was bonded to the resin cement to form a cylindrical resin block and cut into a thin sample. The sheet was placed on a universal testing machine for micro-extrusion experiments. The failure mode of the specimens was observed under a stereomicroscope. RESULTS AND CONCLUSION: (1) Scanning electron microscope: the surface of the fiber post had different degrees of matrix dissolution and fiber bundle exposure after hydrogen peroxide and phosphoric acid treatment, but did not destroy the integrity of the fiber bundle. (2) Micro-extrusion experiments: the order of the bonding strength was as follows: group C3 > group C2 > group C1 > group D2 > groupD3 > groupD1> group B > group A, and there was significant difference between groups (P< 0.05) except for groups A and B, groups C2 andC3, and groups D2and D3. (3) Stereo microscope: the failure mode in the groups A and B was almost destruction in adhesion. The other six groups showed destruction in adhesion, but the cohesive failure and mixed failure were increased, and the failure mode changed from destruction in adhesion into cohesive failure and mixed failure. (4) These results indicate that the optimal treatment time of 30% hydrogen peroxide is 10 minutes, and the optimal treatment time of 35% phosphoric acid is 60 seconds. 30% hydrogen peroxide solution treatment of fiber post surface for 10 minutes has great clinical application value.
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Objective To investigate the sleep quality at home and the influencing factors in patients with colorectal tumor after enterostomy. Methods Using convenience sampling method, during March 2016 to December 2017 in Anhui Provincial Cancer Hospital wound and stoma outpatient, choose 276 patients with enterostomy (including temporary enterostomy and permanent enterostomy), using self-made general questionnaire ostomy, Pittsburgh Sleep Quality Index (PSQI) and self nursing competence scale to investigate them. Results The total PSQI score of enterostomy patients was 6.39±4.07, among which 150 patients (57.0%) had poor sleep (PSQI>7). The score of the 7 dimensions of PSQI from high to low was sleep time (1.22 ± 1.05), sleep time (1.12 ± 0.98), subjective sleep quality (1.00 ± 0.92), sleep disorder (1.02±0.95), sleep efficiency (0.95±0.43), daytime dysfunction (0.83±0.76), hypnotic drugs (0.25± 0.24).There were statistically significant differences in sleep quality among patients with different ages (Z=-2.937), duration of stoma (t=3.450-3.896), types of stoma (t=3.998-4.011), whether or not they had a history of leakage within 1 month (t=3.454-6.774), whether or not they had bloating bags (t=3.230-4.001), stoma complications (t=2.976-3.582), enterostomy self-care knowledge (Z=-3.202,t=3.971) and nursing skills (t=3.061)(P<0.05). Conclusions The present study shows that the sleep quality of patients with enterostomy is generally poor, and targeted measures should be taken to reduce its incidence or to intervene in time.