Microwave ablation for diffuse adenomyosis leading to multiple complications after hysterectomy: A case report and literature review.

RATIONALE: Hysterectomy after microwave ablation (MWA) is more difficult than conventional surgery which increases the probability of postoperative complications due to MWA's collateral thermal damage to nearby intestines. Here we report a case of multiple postoperative complications after hysterectomy following MWA. PATIENT CONCERNS: A 44-year-old female was admitted due to progressive abdominal pain during menstruation for 30 years and no relief 1 year after MWA. Hysterectomy was performed. Intraoperative findings: pelvic inflammatory exudation; the uterus and the left adnexa were extensively and densely adhered to the intestine, bladder, pelvic wall and surrounding tissues; the local tissue of the uterus was brittle and dark yellow. Intestinal obstruction, abdominal infection and urinary fistula occurred after hysterectomy. DIAGNOSES: 1. Adenomyosis. 2. Endometrial polyps. 3. Left chocolate cyst of ovary. 4. Pelvic adhesions. 5. Pelvic inflammation. INTERVENTIONS: The patient underwent intestinal obstruction catheter implantation, ultrasound-guided pelvic fluid mass puncture drainage, right kidney puncture and fistula drainage, right ureteral bladder replantation, and right ureteral stent implantation. OUTCOMES: After 48 days of comprehensive treatment, the patient was cured and discharged. LESSONS: Microwave ablation has a poor therapeutic effect on diffuse adenomyosis, and should avoid excessive ablation during the ablation process.

Risk Factors for Postoperative Puncture Site Bleeding after Interventional Treatment of Cerebrovascular Disease via Common Femoral Artery Puncture: A Retrospective Analysis of 710 Cases.

This study aimed to identify the risk factors associated with puncture site bleeding following percutaneous puncture of the common femoral artery during interventional treatment of cerebrovascular disease (CVD). A retrospective analysis was conducted on 710 patients who underwent interventional treatment for CVD via femoral artery puncture. Among them, 26 individuals (3.66%) experienced bleeding at the femoral artery puncture site. Binary logistic regression analysis was performed to identify risk factors for puncture site bleeding. The impact of salt bag compression on postoperative bleeding was evaluated in patients with intermediate to high bleeding risk scores. The bleeding group showed higher blood pressure, lower platelet counts, longer prothrombin time and activated partial thromboplastin time, as well as a higher prevalence of larger vascular sheath sizes and variations in the timing of anti-coagulant and anti-platelet therapy administration. The bleeding risk score was higher in the bleeding group, indicating its predictive value for bleeding risk. Higher bleeding risk score, unstable blood pressure, repeated puncture, and serious vascular conditions were significant risk factors for puncture site bleeding. Application of salt bag compression for a duration of 2 hours reduced postoperative puncture site bleeding in patients with intermediate to high bleeding risk scores. Our study identified several significant risk factors for puncture site bleeding after cerebral vascular intervention via femoral artery puncture, including the bleeding risk score, blood pressure, repeated puncture, and vascular conditions. Implementing salt bag compression as a preventive measure can help mitigate bleeding complications in these high-risk patients.

Different hydration methods for the prevention of contrast-induced nephropathy in patients with elective percutaneous coronary intervention: a retrospective study.

BACKGROUND: Hydration is currently the main measure to prevent contrast-induced nephropathy (CIN). We aimed to compare the preventive effect of preprocedure and postprocedure hydration on CIN in patients with coronary heart disease undergoing elective percutaneous coronary intervention (PCI). METHODS: A retrospective study included 198 cases of postprocedure hydration and 396 cases of preprocedure hydration using propensity score matching. The incidence of CIN 48 h after PCI and adverse events within 30 days after contrast media exposure were compared between the two groups. Logistic regression analysis was used to analyse the risk factors for CIN. RESULTS: The incidence of CIN in the postprocedure hydration group was 3.54%, while that in the preprocedure hydration group was 4.8%. There was no significant difference between the two groups (p = 0.478). Multivariate logistic regression analysis showed that diabetes mellitus, baseline BNP and cystatin C levels, and contrast agent dosage were independent risk factors for CIN. There was no significant difference in the incidence of major adverse events between the two groups (3.03% vs. 2.02%, p = 0.830). CONCLUSIONS: Postprocedure hydration is equally effective compared to preoperative hydration in the prevention of CIN in patients with coronary heart disease undergoing elective PCI.

Huge thymoma combined with pure red cell aplasia: a case report and literature review.

Background: Thymoma is the most common tumor of the anterior mediastinum, especially in adults, and accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal tumors. Thymomas originating from thymus epithelial cells or lymphocytes are the most common, and account for 95% of thymomas. Thymoma is a relatively rare and inert disease of the chest, and many thymoma patients have a long survival period despite disease progression. Surgery is the first choice of treatment for thymoma, but controversy remains as to the best approach for treating giant thymoma. The incidence of large tumors in the thorax is low, surgical treatment is difficult, and surgical risk is high. A thymoma with myasthenia gravis is common, but a huge thymoma with pure red cell aplasia is rare. Case Description: Our hospital (Liupanshui People's Hospital) admitted a patient with a large thymoma. The 37-year-old female patient had chest pain without obvious cause, accompanied by chest tightness and shortness of breath for 3 days. The patient appeared to have severe anemia. The patient's initial hemoglobin level was 51 g/L. A computed tomography (CT) scan after hospitalization revealed a large soft tissue mass in the left thoracic cavity, about 22.0 cm × 18.0 cm × 15.0 cm in size, of mixed density, with an intact boundary envelope, partial pulmonary atelectasis of the left lung, and pleural fluid on the left. The tumor was successfully removed by left anterolateral incision, and postoperatively, the patient s compression and anemia improved significantly, and a pathologic diagnosis of type A thymoma. Conclusions: Through a literature review and case analysis, we extend understandings of thymoma. Clinical differential diagnosis should be made before surgery, which is very important for making treatment plan. Our results can provide a reference for the clinical treatment of thymoma, and strive to provide the best treatment for patients.

Analysis of Targeted Post-operative Nursing Outcome in 1246 Patients with Percutaneous Transhepatic Biliary Drainage.

Jaundice is a detection index in many disease conditions commonly characterized by yellowish staining of the skin and mucous membranes. This work studies the postoperative care outcome in 1,246 patients (669 males and 577 females) with obstructive jaundice who underwent percutaneous transhepatic biliary drainage (PTBD). These patients were admitted to the interventional vascular surgery department of our hospital from February 2017 to February 2022. From the results, frequent wound re-dressing and maintenance of the drainage tube had significant positive influence on wound healing and patient recovery. The data also showed strict adherence by patients to the doctor's recommendation advising them to visit the interventional specialist care clinic in time for wound dressing change and drainage tube maintenance. As a result, there was no significant difference in wound allergy, exudation, redness and loosening among patients. A cross-sectional analysis of the effect of age on recovery revealed variations in the healing pattern (wound loosening and the redness) between patients of different ages although the relationship is not very clear due to the limited sample size. Efficient drainage tube maintenance promoted recovery and prevented the occurrence of related complications such as PTBD tube blockage and biliary tract infection. The establishment of the interventional specialist care clinic used in this study additionally ensures patients' safety, and the incidence of complications have been reduced drastically. These achievements are attributable to the implementation of regular dressing change, drainage tube maintenance and health education for patients with PTBD tube. These practices have also improved on the level of specialty in nursing practice, increased the professional value of nurses and better recognition by the society.

Renal sympathetic denervation attenuates left ventricle hypertrophy in spontaneously hypertensive rats by suppressing the Raf/MEK/ERK signaling pathway.

OBJECTIVE: To explore the effect of renal sympathetic denervation (RSD) on left ventricle hypertrophy and the Raf/MEK/ERK signaling pathway in spontaneously hypertensive rats (SHRs). METHODS: SHRs were divided into SHR, SHR + Sham, SHR + RSD and SHR + U0126 groups, with WKY rats as the baseline controls. The blood pressure of rats was observed, while myocardial fibrosis was evaluated through Masson staining. Thereafter, real-time quantitative polymerase chain reaction (qRT-PCR) was carried out to determine the levels of myocardial-hypertrophy-related markers, and Western blotting was used to measure the activity of the Raf/MEK/ERK signaling pathway. RESULTS: In comparison with the WKY group, significant increases were observed in the systolic pressure and diastolic pressure of rats from the other four groups at different time points after surgery. In addition, rats in these groups had obvious increases in LVMI, renal NE and IVSd and decreases in LVEDd, LVEF and LVFS. In addition, the CVF of myocardial tissues was increased, with the upregulation of ANP, BNP and ß-MHC and the downregulation of α-MHC. For the activity of the Raf/MEK/ERK signaling pathway, the levels of p-Raf/Raf, p-MEK/MEK and p-ERK1/2/ERK1/2 were all remarkably elevated (all P < .05). Further comparison with the SHR group showed that the above indexes in the rats were significantly improved in the RSD group and SHR + U0126 group (all P < .05). CONCLUSION: RSD may decrease blood pressure, mitigate hypertension-induced left ventricle hypertrophy and improve cardiac function efficiently in SHRs via the suppression of the Raf/MEK/ERK signaling pathway.

The Expression of Dynamin 1, 2, and 3 in Human Hepatocellular Carcinoma and Patient Prognosis.

BACKGROUND The classical dynamin family consists of dynamin 1, 2, and 3, which have different expression levels in different tissues to regulate cell membrane fission and endocytosis. Recent studies have reported increased expression of dynamins in human cancer, but their expression in hepatocellular carcinoma (HCC) remains to be determined. This study aimed to investigate the expression of dynamin 1, 2, and 3 in tissue sections of human HCC using quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry. MATERIAL AND METHODS The expression of dynamin 1, 2, and 3 were investigated in 192 cases of HCC and 14 paired samples of HCC and adjacent normal liver tissue by qRT-PCR and immunohistochemistry. The clinical significance of dynamin 1, 2, and 3 were determined by correlating their expression levels with patient clinicopathological factors and survival rates. Independent prognostic factors were determined using the Cox regression hazard model. RESULTS In tissue samples from 192 patients with HCC, the expression of dynamin 1, 2, and 3 were upregulated in 41.15%, 29.69%, and 8.33% of cases, respectively. Dynamin 1 had a significantly increased mRNA expression level in HCC compared with adjacent normal liver tissues and was significantly correlated with alpha fetoprotein (AFP) levels, T stage, and TNM stage. Only dynamin 1 expression was correlated with the reduced overall survival (OS), and was identified as an independent prognostic biomarker of human HCC. CONCLUSIONS Upregulation of dynamin 1 at the protein and mRNA level was an independent prognostic biomarker of reduced OS in patients with HCC.

Acetylbritannilactone attenuates contrast-induced acute kidney injury through its anti-pyroptosis effects.

Contrast-induced acute kidney injury (CI-AKI) is a severe complication caused by intravascular applied radial contrast media (CM). Pyroptosis is a lytic type of cell death inherently associated with inflammation response and the secretion of pro-inflammatory cytokines following caspase-1 activation. The aim of the present study was to investigate the protective effects of acetylbritannilactone (ABL) on iopromide (IOP)-induced acute renal failure and reveal the underlying mechanism. In vivo and in vitro, IOP treatment caused renal damage and elevated the caspase-1 (+) propidium iodide (PI) (+) cell count, interleukin (IL)-1ß and IL-18 levels, lactate dehydrogenase (LDH) release, and the relative expression of nucleotide-binding domain, leucine-rich repeat containing protein 3 (NLRP3), apoptosis-associated speck-like protein (ASC), and gasdermin D (GSDMD), suggesting that IOP induces AKI via the activation of pyroptosis. Furthermore, the pretreatment of ABL partly mitigated the CI-AKI, development of pyroptosis, and subsequent kidney inflammation. These data revealed that ABL partially prevents renal dysfunction and reduces pyroptosis in CI-AKI, which may provide a therapeutic target for the treatment of CM-induced AKI.

Apurinic/apyrimidinic endonuclease/redox factor 1 (APE1) alleviates myocardial hypoxia-reoxygenation injury by inhibiting oxidative stress and ameliorating mitochondrial dysfunction.

Oxidative stress and mitochondrial dysfunction are considered to be activators of apoptosis and serve a pivotal role in the pathogenesis of myocardial ischemia-reperfusion (MI/R) injury. Apurinic/apyrimidinic endonuclease/redox factor 1 (APE1) is a multifunctional protein that processes the cellular response to DNA damage and oxidative stress. Little is known about the role of APE1 in the pathogenesis of MI/R injury. The aim of the present study was to investigate the effects of APE1 on hypoxia-reoxygenation (H/R)-induced H9c2 cardiomyocyte injury and the underlying mechanism responsible. It was demonstrated that H/R decreased cell viability and increased lactic dehydrogenase (LDH) release, as well as reducing APE1 expression in H9c2 cells. However, APE1 overexpression induced by transfection with APE1-expressing lentivirus significantly increased H9c2 cell viability, decreased LDH release, decreased apoptosis and reduced caspase-3 activity in H/R-treated H9c2 cells. APE1 overexpression ameliorated the H/R-induced increases in reactive oxygen species and NAPDH oxidase expression, as well as the decreases in superoxide dismutase activity and glutathione expression. Furthermore, APE1 overexpression increased mitochondrial membrane potential and ATP production, stabilized electron transport chain activity (as illustrated by increased NADH-ubiquinone oxidoreductase, succinate dehydrogenase, coenzyme Q-cytochrome c oxidoreductase and cytochrome c oxidase activities) and decreased the ratio of B-cell lymphoma 2-associated X protein/B-cell lymphoma 2 in H/R, improving mitochondrial dysfunction. In conclusion, the results of the present study suggest that APE1 alleviates H/R-induced injury in H9c2 cells by attenuating oxidative stress and ameliorating mitochondrial dysfunction. APE1 may therefore be used as an effective treatment for MI/R injury.

Coenzyme Q10 combined with trimetazidine in the prevention of contrast-induced nephropathy in patients with coronary heart disease complicated with renal dysfunction undergoing elective cardiac catheterization: a randomized control study and in vivo study.

BACKGROUND: Contrast-induced nephropathy (CIN) is one of the common hospital-acquired acute renal failures. The purpose of this study was to investigate whether Coenzyme Q10 (CoQ10) and trimetazidine (TMZ) can prevent the occurrence of CIN after elective cardiac catheterization in patients with coronary artery disease complicated with renal dysfunction. METHODS: Consecutive coronary artery disease patients with renal insufficiency scheduled for coronary angiography were enrolled in randomized, paralleled, double-blind, controlled trial. The development of CIN was occurrence at the 48 or 72 h after the procedure. The changes of serum creatinine (SCr), eGFR, and Cys-C within 72 h after the procedure were measured and compared. In vivo contrast medium (CM)-induced acute kidney injury (AKI) animal model was established, and CoQ10 plus TMZ was orally administrated to evaluate its renal protective effect. RESULTS: 150 patients with renal insufficiency were enrolled finally. CIN occurred in 21 (14.00%) of the 150 patients. 72 h after the procedure, the incidence of CIN was significantly lower in CoQ10 plus TMZ group compared with control group (6.67 vs. 21.3%, p = 0.01). No cardiac death occurred in this study. No side effects were observed after administration of CoQ10 and TMZ. In vivo test demonstrated that CoQ10 and TMZ could significantly reduce the concentration of blood urea nitrogen (BUN) and SCR induced by CM i.v. injection, as well as tubular pathological injuries. Meanwhile, CoQ10 and TMZ could significantly reduce the oxidation stress in kidneys from CM-AKI animals. CONCLUSION: CoQ10 plus TMZ could decrease the incidence of CIN in patients with renal insufficiency undergoing elective cardiac catheterization, and their effect may be due to its strong anti-oxidation effect.

Amlodipine and atorvastatin improved hypertensive cardiac hypertrophy through regulation of receptor activator of nuclear factor kappa B ligand/receptor activator of nuclear factor kappa B/osteoprotegerin system in spontaneous hypertension rats.

The present study aims to study the role of receptor activator of nuclear factor kappa B ligand/receptor activator of nuclear factor kappa B/osteoprotegerin (RANKL/RANK/OPG) system in cardiac hypertrophy in a spontaneous hypertension rat (SHR) model and the effects of amlodipine and atorvastatin intervention. Thirty-six-week-old male SHRs were randomly divided into four groups: 1) SHR control group; 2) amlodipine alone (10 mg/kg/d) group, 3) atorvastatin alone (10 mg/kg/d) group, 4) combination of amlodinpine and atorvastatin (10 mg/kg/d for each) group. Same gender, weight, and age of Wistar-Kyoto (WKY) rats with normal blood pressure were used as normal control. Drugs were administered by oral gavage over 12 weeks. The thicknesses of left ventricle walls, left ventricle weight, and cardiac function were measured by transthoracic echocardiography. Left ventricular pressure and function were assessed by hemodynamic examination. Cardiomyocyte hypertrophy and collagen accumulation in cardiac tissue were measured by hematoxylin and eosin (HE) and Masson staining, respectively. The hydroxyproline content of cardiac tissue was examined by biochemistry technique. RANKL, RANK and OPG mRNA, protein expression and tissue localization were studied by RT-PCR, Immunohistochemistry and Western blot. Treatment with amlodipine or atorvastatin alone significantly decreased left ventricular mass index, cardiomyocyte cross-sectional area and interstitial fibrosis in SHR (each P < 0.05). Moreover, combined amlodipine and atorvastatin treatment induced significant reversal of left ventricular hypertrophy and decreased cardiomyocyte cross-sectional area and interstitial fibrosis in SHR to a greater extent than each agent alone (P < 0.05). Compared with WKY rats, the myocardial expression of RANKL, RANK, and OPG was increased. Both amlodipine and atorvastatin reduced RANKL, RANK, and OPG expression, with the best effects seen with the combination. Based on our results, activation of the RANKL/RANK/OPG system may be an important factor leading to ventricular remodeling in SHR rats. Amlodipine and atorvastatin could improve ventricular remodeling in SHR rats through intervention with the RANKL/RANK/OPG system.

Apigenin attenuates acute myocardial infarction of rats via the inhibitions of matrix metalloprotease-9 and inflammatory reactions.

Acute myocardial infarction (AMI) is the myocardial necrosis caused by coronary artery acute and persistent ischemia and hypoxia. Matrix metalloprotease-9 (MMP-9) plays an important role in a series of process of occurrence and development of AMI. Inflammatory reaction plays the key role in all kinds of damage factors in AMI. Apigenin (API) has effectively restrained the activity of MMP-9, anti-inflammatory and hepatic fat oxidizing properties. API significantly improved AMI of rats through inhibiting MMP-9 and inflammatory reactions in a few recent studies. Our investigation detected the infarct size of AMI rats, casein kinase (CK), the MB isoenzyme of creatine kinase (CK-MB) and lactate dehydrogenase (LDH) and cardiac troponin T (cTnT) activities in AMI rats were also analyzed with commercial kits. Additionally, Nuclear factor kappa B (NF-κB), tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6) levels of whole bloods of AMI rats were also detected using commercial kits. Next, MMP-9 protein of cardiac in AMI rats was measured with gelatin zymography assays. Finally, caspase-3 and caspase-9 activities in AMI rats were analyzed with commercial kits. In the present study, our work indicated API might significantly reduce the infarction size of AMI rat. It was shown that the treatment of API could decrease the expression of MMP-9 level and reduce the activities of NF-κB, TNF-α, IL-1ß and IL-6 in AMI rats. Next, API treatment could reduce caspase-3 and caspase-9 activities and decrease cellular apoptosis of AMI rats. Our findings concluded that API ameliorates acute myocardial infarction of rats via inhibiting MMP-9 and inflammatory reactions.