الملخص
Objective To observe the effect of exsanguination at jing points and auricular tips on antipyretic effect and inflammation factors level in patients with fever caused by coronavirus disease 2019(COVID-19).Methods A retrospective study was conducted.A total of 521 febrile patients with COVID-19 admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from January 1 to 10,2023 were selected as the study subjects.The patients were divided into the control group(treated with conventional treatment)and the experimental group(treated with exsanguination of jing points and auricular tips based on the control group)according to whether they received traditional Chinese medicine(TCM)exsanguination treatment.The body temperature before treatment and 30 minutes and 4 hours,24 hours after treatment,the immediate(within 30 minutes)antipyrexia efficiency,the time of body temperature returning to normal,and the levels of inflammatory factors before treatment and 48 hours after treatment were collected,and the differences between the two groups were compared.According to the standard of fever relief≥1℃within 4 hours,the differences of the average onset time of fever and the rate of fever relief at 2.5,3 and 4 hours after treatment were compared between the two groups.Kaplan-Meier curve was drawn to analyze the change of 4-hour antipyrexia rate in the two groups before and after matching.Results A total of 169 cases in the experimental group and 352 cases in the control group were finally included.Because this study was retrospective,there were significant differences in the course of disease and underlying diseases(chronic bronchitis,diabetes,renal insufficiency,hepatobiliary diseases)between the two groups at baseline(all P<0.05).In order to reduce the differences,the above 4 factors were included in the predictor variables,and a 1∶1 propensity matching was performed to match 166 pairs of case samples,which were comparable.The result showed body temperature of the two groups gradually decreased with the extension of time,and the body temperature of the experimental group was significantly lower than that of the control group at each time point(℃:30 minutes was 38.32±0.22 vs.38.43±0.24,4 hours was 37.67±0.32 vs.38.13±0.51,24 hours was 37.03±0.38 vs.37.14±0.51,all P<0.05),the immediate antipyrexia efficiency was significantly higher than that of the control time group[63.86%(106/166)vs.44.58%(74/166),P<0.05],and the time of body temperature recovery to normal was significantly shorter than that of the control group(hours:19.25±7.79 vs.38.90±17.17,P<0.05).In terms of the 4 hours antipyretic onset dynamic time,the average antipyretic onset time of the experimental group was significantly shorter than that of the control group[hours:4.39(4.11,4.68)vs.7.16(6.71,7.61),P<0.05],the fever relief rates at 2.5,3 and 4 hours were significantly higher than those in the control group[6.63%(11/166)vs.0.60%(1/166),24.10%(40/166)vs.4.82%(8/166),74.10%(123/166)vs.38.55%(64/166),respectively,all P<0.05].Kaplan-Meier curve analysis showed that there were statistically significant differences in 4 hours fever reduction rates between the two groups before and after matching(all P<0.05).In terms of inflammatory factors,high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the two groups after treatment were significantly lower than those before treatment[hs-CRP(mg/L):control group was 32.03±15.38 vs.79.78±13.34,experimental group was 33.21±16.07 vs.80.03±14.66;TNF-α(μg/L):control group 2.91±0.88 vs.5.09±0.95,experimental group 2.83±0.98 vs.5.10±0.87;IL-6(ng/L):control group was 96.30±48.12 vs.206.48±56.70,experimental group was 94.01±45.13 vs.202.38±55.38,all P<0.05],but there was no significant difference in the levels of the above indicators between the two groups after treatment.Conclusion Exsanguination at the jing points and auricular tips has a good antipyretic effect in the treatment of fever caused by COVID-19,which can accelerate the antipyretic time,improve the antipyretic efficiency,and reduce the level of inflammatory factors.
الملخص
Objective:To report the surgical techniques and clinical outcomes of multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates.Methods:A retrospective study was performed in the 26 patients with patellar multi-fragmentary fracture who had undergone open reduction and 3-D internal fixation with locking plates from November 2016 to July 2020 at Department of Orthopaedic Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University. There were 17 males and 9 females, with an average age of 62.6 years (from 31 to 90 years). The patellar fractures were exposed and reduced via the longitudinal anterior midline incision of the knee. After the reduction was initially maintained with a cerclage wire, a trimmed and pre-contoured 3.5 mm locking plate was applied onto the patellar surface. After-wards, locking screws were inserted from the lower pole to the upper pole of the patella, from the anterior to the posterior and from the lateral to the medial, respectively, to complete the multi-planar fixation. Follow-ups assessed the B?stman score, knee pain visual analogue scale (VAS), radiographic image and fracture healing, range of motion of the knee, and complications.Results:All the 26 patients were followed up for 12 to 56 months (average, 28 months). Crutches were used while walking until an average of 1.6 months (from 1 to 3 months) after operation in all patients. At the last follow-up, the B?stman score averaged 27.5 points (from 17 to 30 points), yielding 12 excellent, 13 good and 1 poor case with an excellent to good rate of 96.2% (25/26); the knee pain VAS averaged 1.2 points (from 0 to 5 points); the active knee flexion averaged 125° (from 100° to 150°). No breakage, loosening or displacement of the patellar plates or screws was observed during follow-up, but cerclage wire breakage occurred without any symptom in 11 cases. Four patients complained of hardware irritation, and 4 patients underwent hardware removal after fracture union.Conclusion:Multi-dimensional fixation with locking plates is a viable and safe surgical option for patellar multi-fragmentary fractures, due to its satisfactory therapeutic outcomes.
الملخص
Objective: To observe the expression changes of insulin-like growth factor 1 (IGF-1) and mammalian target of rapamycin (mTOR) in the peripheral blood of patients with advanced non-small cell lung cancer (NSCLC) treated with chemotherapy combined with metformin, and to elucidate its mechanism. Methods: Sixty patients with NSCLC were divided into chemotherapy group (15 cases of adenocarcinoma and squamous cell carcinoma, treated with chemotherapy alone) and combination group (15 cases of adenocarcinoma and squamous cell carcinoma, treated with chemotherapy combined with metformin). The expression levels of IGF-1 and mTOR protein and mRNA in peripheral blood of the patients in two groups were detected by ELISA and quantitative real-time PCR (QT-PCR) method. Pearson univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors of the treatment of patients with advanced NSCLC; the curative effect was comprehensively evaluated. Results: Compared with chemotherapy group, the differences of the levels of IGF-1 and mTOR and the mRNA expression levels of IGF-1 and mTOR of the patients in combination group before and after treatment were decreased (t=-3.207, P=0.003; t=2.414, P=0.019; t=-3.635, P= 0.001; t=-3.737, P=0.001). In adenocarcinoma, compared with chemotherapy group, the differences the levels of IGF-1 and mTOR and the mRNA expression levels of IGF-1 and mTOR of the patients in combination group before and after treatment were decreased (t=5.270, P0.05). Conclusion: Chemotherapy combined with metformin is more effective in the treatment of the patients with NSCLC and can reduce its adverse reactions, its mechanism may be related to the reduction of IGF-1 and mTOR levels in the peripheral blood of the patients.
الملخص
Unnatural amino acid orthogonal translation machinery can insert unnatural amino acids at desired sites of protein through stop codon by means of foreign orthogonal translation system composed of aminoacyl-tRNA synthetase and orthogonal tRNA genes. This new genetic engineering technology is not only a new tool for biochemical researches of proteins, but also an epoch-making technology for the development of new-type live viral vaccines. The mutated virus containing premature termination codon in genes necessary for replication can be propagated in transgenic cells harboring unnatural amino acid orthogonal translation machinery in media with corresponding unnatural amino acid, but it cannot replicate in conventional host cells. This replication-deficient virus is a new-type of live viral vaccine that possesses advantages of high efficacy of traditional attenuated vaccine and high safety of killed vaccine. This article reviews the application and prospect of unnatural amino acid orthogonal translation machinery in the development of novel replication-deficient virus vaccines.
الموضوعات
Amino Acids , Genetics , Amino Acyl-tRNA Synthetases , Genetic Engineering , Protein Engineering , RNA, Transfer , Viral Vaccinesالملخص
Primary hepatocytes are widely used in drug metabolism and toxicity assessment. As the culture of primary hepatocytes in vitro is a process of dedifferentiation, hepatocytes lose normal metabolic detoxification function gradually. The mechanism of hepatocyte dedifferentiation has been not clear so far. TFs play an important role in the dedifferentiation and non-parenchymal cells can maintain the function of hepatocytes in vitro. However, the current methods cannot be used in effective identification and quantitative analysis of a large number of TFs. In this paper, the mo-culture system (only primary hepatocytes) and co-culture system (primary hepatocytes and non-parenchymal cells) were established. The cells were cultured for 24 h, 48 h, 72 h as monolayer. The changes of TFs during the culture were obtained by TOT (Transcription factor response elements on tip) transcription factor enrichment method and mass spectrometry. A total of 219 TFs were identified in three individual replicates. The result revealed that up-regulated TFs were enriched in cell proliferation, death and immune response pathways, and down-regulated TFs were involved in metabolism pathway. The establishment of such culture-TFs identification system is of great significance to reveal the mechanism of primary hepatocyte dedifferentiation and crosstalk between hepatocytes and non-parenchymal cells.
الملخص
<p><b>OBJECTIVE</b>To evaluate the clinical value of a preoperative predictive scoring system which was established by the National Cancer Center Hospital (NCCH) for the postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.</p><p><b>METHODS</b>The clinical data of 269 patients who underwent pancreaticoduodenectomy at the Affiliated Provincial Hospital of Anhui Medical University from February 2008 to February 2014 were studied retroprospectively. The five indexes which including gender, portal invasion, pancreatic cancer, main pancreatic duct index and intra abdominal fat thickness were calculated in the NCCH predictive score system. Patients with a score over 4 were defined as high risk of POPF, and those with score less than 4 were defined as low risk of POPF. Then the factors associated with POPF were analyzed by Logistic regression test. The enumeration data and measurement data were compared with χ2 test and t test. Risk factors for postoperative pancreatic fistula were analyzed through single factor and multiple factors Logistic regression analysis. The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC) curve analysis.</p><p><b>RESULTS</b>A total of 33 patients were diagnosed as POPF, including 15 in grade A, 11 in grade B and 7 in grade C. The univariate analysis showed that the factors associated with POPF are gender, total serum bilirubin level, pancreatic cancer, portal invasion, the pancreatic texture, main pancreatic duct diameter and the pancreaticojejunostomy. The multivariate analysis showed that gender, pancreatic texture, portal invasion and main pancreatic duct diameter were the independent risk factor of POPF. The rate of pancreatic fistula of high risk group was 53.8% (14/26), and the rate of pancreatic fistula of the low risk group was 7.8% (19/243). There were significant differences in the pancreatic fistula rate between the high risk and low risk of POPF (χ2=46.231, P<0.01). The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 87.9% and 94.1%, respectively. The area under the curve was 0.946 (95% CI: 0.895-0.997).</p><p><b>CONCLUSIONS</b>The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF. While large, multicenter prospective randomized controlled trials is still needed to further confirm it.</p>
الموضوعات
Humans , Intestines , Logistic Models , Multivariate Analysis , Pancreas , Pancreatectomy , Pancreatic Ducts , Pancreatic Fistula , Pancreaticoduodenectomy , Pancreaticojejunostomy , Postoperative Complications , Postoperative Period , Prospective Studies , ROC Curve , Risk Factors , Sensitivity and Specificityالملخص
Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.
الملخص
Objective To compare two operative approaches for treatment of distal hypospadias. Methods One hundred and seven patients were recruited into the study. Group1(n=51) underwent OUPF and group2(n= 56) underwent TIPU repair. The results were analyzed with Chi-square and two Sided test. Results Operative times for OUPF and TIPU repair were (103±29) min and (92±21)min respectively (P>0.05). Fistula occurred rates were 7.8% (4/51)and 14.2% (8/56) (P>0.05). Satisfied rates for the appearance of the penis post-operation were 84.8% (39/46)and 87.8%(36/41) respectively (P>0.05). 87 patients were followed up. With mean follow-ups of 15 months (range 6 to 47) , the overall complication rates were 15.7% (8/51) and 32.1 % (18/56)(P<0. 05) for OUPF and TIPU repair. Only 4 of 51 patients (7.8%) undergoing OUPF underwent re-operations, compared to 15 of 56 patients (26.8%) undergoing TIPU repair (P<0.001). A plateau uroflow curve (vs normal bell curve)was observed in 33.3% (13/39)and 67.6(25/37) ,respectively(P<0. 001). The average flow rate was 9. 4 ml per second (range 3. 2 to 17. 1) in patients undergoing OUPF repair, compared to 6. 8 ml per second (3. 3 to 15, P<0. 05) for those undergoing TIPU repair. Mean peak flow rates were12.2 ml per second (range 3.9 to 22.9) and 8. 3 mi per second (range 3.7 to 18. 1, P<0.01) for OUPF and TIPU procedures. Conclusion OUPF is superior to TIPU in the surgical treatment of distal hypospadias.