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Objective:To construct a representative index system for evaluating pediatric orthopedic nursing quality, providing a basis for hospital pediatric orthopedic nursing quality assessment and monitoring.Methods:From April to July 2023, using the "structure-process-outcome" three-dimensional quality structure model as the theoretical framework, a literature review was conducted, and an item pool was formulated. Through two rounds of Delphi method expert consultations, the hierarchical analysis method was finally employed to determine the indicators and their weights at each level.Results:The effective recovery rates of the questionnaire of the two rounds of expert consultations were 100% (20/20), the authority coefficients of experts were 0.87 and 0.88, the coefficients of variation were 0.00 to 0.27 and 0.00 to 0.24. The Kendell harmony coefficients of the second and third indicators in the two rounds of inquiry were 0.140, 0.166 and 0.192, 0.161(all P<0.05). The final pediatric orthopedic nursing quality evaluation index system included 3 primary indicators, 21 secondary indicators and 83 tertiary indicators. Among the primary indicators, the weight of process quality was the highest at 0.493 4, followed by outcome quality at 0.310 8, and the lowest was structural quality at 0.195 8. In the secondary indicators, "assessment criteria of limb blood circulation" had the highest weight at 0.099 8. Conclusions:The constructed pediatric orthopedic nursing quality evaluation index system covers key aspects and is more operationally feasible. It provides better guidance for nursing interventions and quality control.
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BACKGROUND:Free vascularized fibular grafting is an effective hip preservation treatment for femoral head osteonecrosis,but its influencing factors are still controversial. OBJECTIVE:To explore the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis,and the influence of the etiology and severity of femoral head osteonecrosis on its efficacy. METHODS:Clinical data and clinical efficacy scores of preoperative and postoperative hip joints in 63 patients with femoral head osteonecrosis(73 cases of hip)were enrolled.The subjects were divided into three groups by the etiological classification criteria of femoral head osteonecrosis,including glucocorticoid-associated,alcohol-associated,and idiopathic groups,and also were divided into three groups by the Ficat classification system,including Ficat Ⅱ,Ficat Ⅲ and Ficat Ⅳ groups.The effects of etiological classification and lesion degree on the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis were analyzed. RESULTS AND CONCLUSION:(1)The visual analog scale scores in all periods after free vascularized fibular grafting for femoral head osteonecrosis were significantly decreased compared with preoperative data(P<0.001),and Harris scores were significantly increased compared with preoperative data(P<0.001).(2)In the glucocorticoid-associated,alcohol-associated,and idiopathic groups,except the glucocorticoid-associated group,postoperative Harris scores were significantly increased 2 and 3 years after surgery in other groups compared with preoperative data(P<0.05).(3)In the three groups of Ficat Ⅱ,Ficat Ⅲ,and Ficat Ⅳ,the postoperative Harris scores of Ficat Ⅱ and Ficat Ⅲ groups were significantly increased compared with preoperative data(P<0.05),while the difference was not significant in the Ficat Ⅳ group between the preoperative and postoperative data(P>0.05).(4)These results indicate that the clinical effect of free vascularized fibular grafting for the femoral head osteonecrosis is significant,which can reduce hip pain and improve hip joint function.It may not be affected by the etiology,but by the severity of the femoral head osteonecrosis.
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BACKGROUND:Semaphone 3A(Sema3A)is an important neurovascular growth inhibitor.It is not clear how Sema3A is involved in the pathogenesis of discogenic low back pain.Exploring the potential mechanism of Sema3A in intervertebral disc degeneration can provide a new target and theoretical basis for the prevention and treatment of discogenic low back pain. OBJECTIVE:To explore the mechanism of interleukin-1β inhibiting the expression of Sema3A by activating the nuclear factor-κB signaling pathway to induce intervertebral disc degeneration in rats. METHODS:RT-qPCR was used to detect the expression of Sema3A mRNA in normal and degenerative human nucleus pulposus tissues.Nucleus pulposus cells of Sprague-Dawley rats were isolated,cultured,and passaged to the 3rd generation.Then,passage 3 cells were divided into three groups:the blank control group was routinely cultured for 48 hours,the degeneration group was intervened with 10 ng/mL interleukin 1β for 48 hours,and the degeneration+inhibitor group was treated by 5 μmol/L nuclear factor-κB signaling pathway-specific inhibitor BAY11-7082 for 1 hour,followed by interleukin-1β for 48 hours.At the end of the intervention,cell viability was detected by cell counting kit-8,cell apoptosis was detected by Annexin V/FITC staining,mRNA expression of cellular matrix,vascular and neural markers and Sema3A was detected by RT-qPCR,and protein expression of marker proteins,p65 and p-p65 was detected by western blot. RESULTS AND CONCLUSION:RT-qPCR assay showed that the expression of Sema3A mRNA was lower in degenerative human nucleus pulposus tissue than in normal human nucleus pulposus tissue(P＜0.05).Compared with the blank control group,the nucleus pulposus cell viability decreased and the apoptotic rate increased in the degeneration group(P＜0.05);compared with the degeneration group,the nucleus pulposus cell viability increased and the apoptotic rate decreased in the degeneration + inhibitor group(P＜0.05).Compared with the blank control group,mRNA expression of type Ⅱ collagen,polyproteoglycan,and Sema3A was decreased in the degeneration group(P＜0.05),while mRNA expression of CD31 and neurofilament 200 was increased(P＜0.05).Compared with the degeneration group,mRNA expression of type Ⅱ collagen,polyproteoglycan,and Sema3A was elevated in the degeneration+inhibitor group(P＜0.05)and mRNA expression of CD31 and neurofilament 200 decreased(P＜0.05).Compared with the blank control group,the protein expression of type Ⅱ collagen,polyproteoglycan,and Sema3A was decreased in the degeneration group(P＜0.05),and the protein expression of CD31,neurofilament protein 200,p65,and p-p65 was elevated(P＜0.05);compared with the degeneration group,the protein expression of type Ⅱ collagen,polyproteoglycan,and Sema3A was elevated in the degeneration+inhibitor group(P＜0.05),and protein expression of CD31,neurofilament 200,p65,and p-p65 was decreased(P＜0.05).To conclude,interleukin-1β does inhibit the expression of Sema3A by activating the nuclear factor-κB signaling pathway,which can also increase the degradation of extracellular matrix,promote the innervation and angiogenesis in degenerative intervertebral disc,and may be one of potential factors that contribute to intervertebral disc degeneration and discogenic low back pain.
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BACKGROUND:In clinical application,simple interspinous fixation without additional interbody fusion has similar fixation effects to pedicle screw and rod fusion internal fixation,and can effectively reduce the range of motion of the responsible segment and the stress of the articular process.However,after simple placement of the new interspinous fusion fixation device BacFuse,the stress at the root of the spinous process is relatively concentrated,and the spinous fracture is prone to occur.If an intervertebral fusion cage is inserted in conjunction with interspinous fixation,Von Mises stress can theoretically be dispersed to reduce the risk of spinous fracture.However,there are few studies on biomechanics and finite element analysis. OBJECTIVE:To observe the biomechanical stability of interspinous fixation-assisted endoscopic interbody fusion in the treatment of severe lumbar spinal stenosis. METHODS:The normal finite element model M0 of the L4-L5 segment of the lumbar spine was established by Mimics,Geomagic,Solidworks,and ANSYS software based on the lumbar CT images of a 26-year-old adult male volunteer excluding spinal diseases.On the basis of M0,the immediate model M1 after endoscopic decompression combined with interbody fusion,the interspinous fixation device(BacFuse)model M2 after endoscopic decompression,and the interspinous fixation(BacFuse)model M3 after endoscopic-assisted interbody fusion were established.The same stress was applied to the upper surface of the L4 vertebral body in the four groups,and the lower surface of the L5 vertebral body was fixed and supported.The range of motion and the extreme Von Mises stress of the endplate bone and the posterior ligament complex of the vertebral body were analyzed under six working conditions of flexion,extension,left/right bending,and left/right rotation. RESULTS AND CONCLUSION:(1)Compared with model M0,the range of motion value of model M1 increased significantly under six working conditions.Model M2 and model M3 had a significant reduction in range of motion.(2)Compared with model M0,the maximum stress of the vertebral body in model M1 did not change significantly under the six working conditions.The maximum stress at the rear of the M2 vertebral body increased significantly.(3)Compared with model M1,the maximum stress of model M3 did not change significantly under the six working conditions.Compared with model M2,the maximum stress of model M3 decreased significantly.(4)Compared with the model M0,the extreme Von Mises stress of the L4 and L5 endplates of the model M1 was significantly increased.The extreme Von Mises stress in L4 and L5 endplates of models M2 and M3 decreased slightly.Compared with model M1,the Von Mises stress of the bone under the L4 and L5 endplate of models M2 and M3 was significantly reduced.(5)It is concluded that the implantation of BacFuse can effectively reduce the bone stress under the endplate during simple interbody fusion,decrease the risk of cage subsidence,diminish the risk of facet joint fracture on the decompression side,and provide a good stable environment for interbody fusion.The placement of an intervertebral fusion cage can reduce the stress of the root of the spinous process,which is beneficial to decrease the risk of fracture of the root of the spinous process.
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Objective:A three-dimensional (3D) finite element model of the ankle joint of marathon runners was constructed to simulate the changes of the lateral collateral ligament (LCL) injury on the stability of the ankle joint and the force distribution of talar talus cartilage during exercise.Methods:The 3D MRI images of the right ankle joint of one marathon runner were acquired and imported into Mimics software in DICOM format for preliminary 3D model reconstruction of the images. The boundary conditions and loads were loaded on the model using Ansys Workbench software, and the ankle joint forces were analyzed by Ansys Workbench for marathon runners in the sports condition, and four kinds of ankle LCL injury finite element models were established, i.e., the normal model of LCL, the injury model of anterior talofibular ligament (ATFL), the injury model of AFTL merged with the calcaneofibular ligament (CFL), and the injury model of AFTL merged with the CFL and the posterior talofibular ligament (PTFL). The peak talus slide cartilage stress and its distribution were observed under the four models, and one-way ANOVA was used to compare the values of talus advancement, and the SNK- q test was used for two-by-two comparisons. Results:In the LCL normal model, the maximum stress peak of the talar slide was 0.21 MPa, which was mainly distributed in the junction area of the anterior medial (MA) and anterior lateral (LA) parts and part of the LA region. In ATFL injury, the peak stress of talar cartilage increased compared with the normal model, with a maximum value of 0.65 MPa, which was mainly distributed in the MA region. In ATFL combined with CFL injury, the peak stress increased, and the peak was mainly distributed in the MA region, and was shifted from the MA to the LA region. In ATFL combined with CFL and PTFL injuries, the peak cartilage stress in the talus slide was up to 2.29 MPa, and the maximum stress was mainly distributed in MA and LA, which had a comparable range of distribution. The anterior talar displacement values were (3.2±0.4), (3.4±0.4), (3.7±0.5), and (6.5±0.7) mm for normal LCL, AFTL injury, AFTL combined with CFL injury, ATFL combined with CFL, PTFL injuries, respectively, with a statistically significant difference ( F=109.08, P<0.001). The anterior talar displacement of ATFL combined with CFL, PTFL injuries was larger than those of normal LCL, AFTL injury, and AFTL combined with CFL injury ( P<0.05). Conclusions:A 3D finite element model is successfully constructed based on 3D MRI of the ankle joint in marathon runners. The peak and range of cartilage stresses in the talar glide change during LCL injury, and the talar glide displaces anteriorly.
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Objective:To compare the efficacy and safety of robotic surgery and open surgery in the treatment of hilar cholangiocarcinoma.Methods:PubMed, Embase, Cochrane Library, Web of Science, CNKI and Wanfang database were searched to compare the treatment of hilar cholangiocarcinoma by robotic surgery and traditional open surgery. Literatures were searched from the establishment of the database to July 2023. Compare operation time, intraoperative blood transfusion rate, R 0 resection rate, lymph node metastasis rate, postoperative complication rate and hospital stays between the two groups. The combined odds ratio ( OR) and mean difference ( MD) and 95% confidence interval (95% CI) were calculated using RevMan 5.4 software. Results:A total of 4 studies were included, including 267 patients with hilar cholangiocarcinoma. There were 177 males and 90 females, aged (58.8±5.7) years. A total of 267 patients were divided into open surgery group ( n=165) and robotic surgery group ( n=102) according to the surgical formula. The extract results show: operative time ( MD=-103.96, 95% CI: -216.90-8.98, P=0.070) and intraoperative blood transfusion rate ( OR=1.32, 95% CI: 0.43-4.07, P=0.630), R 0 resection rate ( OR=1.41, 95% CI: 0.71-2.81, P=0.330), lymph node metastasis rate ( OR=1.62, 95% CI: 0.46-5.63, P=0.450), postoperative complications ( OR=0.60, 95% CI: 0.28-1.31, P=0.200), and postoperative hospital stay ( MD=2.17, 95% CI: -11.56-15.90, P=0.760). Conclusion:In the treatment of hilar cholangiocarcinoma, robotic surgery is as safe and feasible as open surgery. However, due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.
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【Objective】 To comprehensively compare the quality and filtration efficiency of medicinal maltose between two domestic manufacturers(B, C) and one foreign manufacturer(A), compare their product quality as an excipient for intravenous immunoglobulin(IVIG), so as to determine the feasibility and substitutability of maltose as an excipient for IVIG from different manufacturers. 【Methods】 Quality inspection and comparison of maltose from different manufacturers, small-scale filtration tests, and product quality comparision of IVIG(pH4) were conducted. 【Results】 The comparis on results showed that there was no significant difference in the quality of medicinal maltose between manufacturer B and A, and there was no significant difference in the quality of IVIG (pH4) produced. The quality of manufacturer C did not meet the requirements. 【Conclusion】 There is no significant difference in the quality of medicinal maltose produced by manufacturer B and A, which can be used for the production of IVIG (pH4).
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Objective To explore the efficacy and safety of recombinant human anti-severe acute respiratory syn-drome coronavirus 2(anti-SARS-CoV-2)monoclonal antibody injection(F61 injection)in the treatment of patients with coronavirus disease 2019(COVID-19)combined with renal damage.Methods Patients with COVID-19 and renal damage who visited the PLA General Hospital from January to February 2023 were selected.Subjects were randomly divided into two groups.Control group was treated with conventional anti-COVID-19 therapy,while trial group was treated with conventional anti-COVID-19 therapy combined with F61 injection.A 15-day follow-up was conducted after drug administration.Clinical symptoms,laboratory tests,electrocardiogram,and chest CT of pa-tients were performed to analyze the efficacy and safety of F61 injection.Results Twelve subjects(7 in trial group and 5 in control group)were included in study.Neither group had any clinical progression or death cases.The ave-rage time for negative conversion of nucleic acid of SARS-CoV-2 in control group and trial group were 3.2 days and 1.57 days(P=0.046),respectively.The scores of COVID-19 related target symptom in the trial group on the 3rd and 5th day after medication were both lower than those of the control group(both P＜0.05).According to the clinical staging and World Health Organization 10-point graded disease progression scale,both groups of subjects improved but didn't show statistical differences(P＞0.05).For safety,trial group didn't present any infusion-re-lated adverse event.Subjects in both groups demonstrated varying degrees of elevated blood glucose,elevated urine glucose,elevated urobilinogen,positive urine casts,and cardiac arrhythmia,but the differences were not statistica-lly significant(all P＞0.05).Conclusion F61 injection has initially demonstrated safety and clinical benefit in trea-ting patients with COVID-19 combined with renal damage.As the domestically produced drug,it has good clinical accessibility and may provide more options for clinical practice.
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It remains unclear whether heart transplantation is still feasible on patients who develop neurological complications before surgery and underwent successful neurological treatment.This article reported the diagnosis and treatment process of a heart failure patient complicating with acute ischemic stroke,who underwent successful heart transplantation after thrombectomy for acute ischemic stroke,aiming to provide clinical evidence and decision-making plan on diagnosis and treatment options for this group of patients with severe neurological complications.
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Lymphatic metastasis is the main metastatic route for colorectal cancer, which increases the risk of cancer recurrence and distant metastasis. The properties of the lymph node metastatic colorectal cancer (LNM-CRC) cells are poorly understood, and effective therapies are still lacking. Here, we found that hypoxia-induced fibroblast activation protein alpha (FAPα) expression in LNM-CRC cells. Gain- or loss-function experiments demonstrated that FAPα enhanced tumor cell migration, invasion, epithelial-mesenchymal transition, stemness, and lymphangiogenesis via activation of the STAT3 pathway. In addition, FAPα in tumor cells induced extracellular matrix remodeling and established an immunosuppressive environment via recruiting regulatory T cells, to promote colorectal cancer lymph node metastasis (CRCLNM). Z-GP-DAVLBH, a FAPα-activated prodrug, inhibited CRCLNM by targeting FAPα-positive LNM-CRC cells. Our study highlights the role of FAPα in tumor cells in CRCLNM and provides a potential therapeutic target and promising strategy for CRCLNM.
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At present, the heart of donor from donation after brain death are the primary organ sources for heart transplantation. After brain death, severe hemodynamic changes and a series of organ functional changes will occur, thereby leading to the functional damage or even loss of tissues and organs, especially the heart. Intimate relationship and interaction have been found in the physiology and pathophysiology between nervous and cardiovascular systems. After stroke, autonomic nervous disorder, neuroendocrine disorder and intense and persistent inflammatory reaction could be caused by the brain-heart axis reaction, leading to stroke-induced cardiac injuries, such as sympathetic storm, catecholamine storm, inflammatory storm, etc. In this article, research progresses on the mechanism of myocardial injury in heart from donors with stroke and the effect on clinical efficacy and prognosis after heart transplantation were reviewed, aiming to provide reference for clinical practice and subsequent research.
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Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on early allograft dysfunction (EAD) after heart transplantation. Methods Clinical data of 614 heart transplant recipients were retrospectively analyzed. All recipients were divided into the ECMO group (n=43) and non-ECMO group (n=571) according to postoperative application of ECMO. In the ECMO group, the conditions of recipients undergoing ECMO after heart transplantation were summarized. Perioperative status and long-term prognosis of recipients were compared between two groups. Results Among 43 recipients undergoing ECMO, 17 cases underwent thoracotomy due to bleeding, 10 cases of infection, 4 cases of venous thrombosis of the lower limbs, and 1 case of stroke, respectively. Twenty-six recipients were recovered and discharged after successful weaning from ECMO, six died during ECMO support, six died after weaning from ECMO, five received retransplantation due to unsuccessful weaning from ECMO, and only one survived after retransplantation. Compared with the non-ECMO group, intraoperative cardiopulmonary bypass duration was significantly longer, the proportion of recipients requiring postoperative intra-aortic balloon pump (IABP), dialysis due to renal insufficiency, reoperation for hemostasis, infection, mechanical ventilation time≥96 h and tracheotomy was significantly higher, and the length of postoperative intensive care unit (ICU) stay was significantly longer in the ECMO group (all P < 0.05). The survival rate after discharge and 90-d survival rate in the ECMO group were 63% and 96%, significantly lower than 97% and 100% in the non-ECMO group (both P < 0.05). Survival analysis showed that the long-term survival rate in the ECMO group was significantly lower than that in the non-ECMO group (P < 0.05). After excluding the recipients who died within 90 d after heart transplantation, no significant difference was observed in the long-term survival rate (P > 0.05). Conclusions ECMO is an effective treatment of EAD after heart transplantation. The short-term survival rate of recipients using ECMO after heart transplantation is lower than that of those who do not use ECMO, and there is no significant difference in long-term survival of recipients surviving 90 d after heart transplantation.
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OBJECTIVE@#To investigate clinical effect of percutaneous reduction combined with internal fixation of calcaneal nail in treating Sanders typeⅡto Ⅲ calcaneal fractures.@*METHODS@#From July 2017 to August 2019, clinical data of 98 patients with Sanders typeⅡto Ⅲ calcaneal fractures treated were retrospectively analyzed, and divided into observation group and control group according to different surgical methods. In observation group, there were 35 males and 21 females, aged from 23 to 58 years old with an average of (34.50±7.81) years old;29 patients with Sanders typeⅡand 27 patients with Sanders type Ⅲ;30 patients on the left side and 26 patients on the right side;the time from fracture to operation ranged from 1 to 4 days with an average of (3.45±0.54) days;and treated with percutaneous reduction combined with internal fixation of calcaneal nail system. In control group, there were 25 males and 17 females, aged from 25 to 60 years old with an average of (35.27±7.64) years old;23 patients with Sanders type Ⅱ and 19 patients with Sanders type Ⅲ;24 patients on the left side and 18 patients on the right side;the time from fracture to operation ranged from 2 to 5 days with an average of (3.42±0.62) days;and treated with open reduction and internal fixation. Operation time, blood loss, hospital stay, fracture healing time, and postoperative visual analogue scale (VAS) at 1 day, preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Böhler angle, Gissane angle and calcaneus width, and postoperative complications were compared between two groups.@*RESULTS@#All patients were followed up from 13 to 18 months with an average of (15.6±2.2) months. There were significant differences in operation time, blood loss, hospital stay, fracture healing time and postoperative VAS at 1 day between two groups (P<0.05). There was statistical difference in postoperative AOFAS score at 12 months between two groups (P<0.05), and AOFAS score at 12 months after operation was higher than that before operation (P<0.05). According to AOFAS score, 21 patients got excellent result, 30 good and 5 moderate in observation group, and 10 excellent, 22 good, 7 moderate and 3 poor in control group, which had statistical difference between two groups (P<0.05). Postoperative Böhler angle, Gissane angle and calcaneus width at 6 months were better than that before operation between two groups(P<0.05). One patient in observation and 20 patients in control group occurred skin numbness after operation, and 14 patients occurred skin necrosis in control group, there were obvious difference between two groups(P<0.01).@*CONCLUSION@#Compared with open reduction and internal fixation, percutaneous reduction combined with internal fixation system in treating Sanders typeⅡto Ⅲ calcaneal fractures is feasible for fracture repair without waiting for foot deswelling, which could accurately restore normal shape and position of the fractured heel bone, completely eliminate fracture malunion, and reduce postoperative complications. Therefore, it could shorten operation time, hospital stay, fracture healing time, reduce amount of blood loss, promote postoperative recovery, and less complications, high safety, which could be used as a choice of orthopedic surgery for foot and ankle trauma.
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Male , Female , Humans , Infant, Newborn , Calcaneus/injuries , Retrospective Studies , Treatment Outcome , Fractures, Bone/surgery , Fracture Fixation, Internal , Ankle Injuries , Bone Screws , Foot Injuries , Knee Injuries , Ankle Joint , Postoperative ComplicationsABSTRACT
Objective To analyze the burden of chronic kidney disease (CKD) attributable to metabolic factors in Jiangsu Province from 1990 to 2019, and to provide evidence for the formation and implementation of intervention policies. Methods Using data from Jiangsu Province from the 2019 Global Burden of Disease Study (GBD 2019), mortality and disability-adjusted life-years (DALYs) were selected as indicators for analysis and standardized with the age structure of the world standard population. The effects of three metabolic factors including high systolic blood pressure (SBP), high fasting glycaemic index (FPG) and high body mass index (BMI) on the disease burden of CKD were analyzed, and the attributable disease burden by gender and age was compared. Results The rank of the three attributable risk factors was high SBP, high FPG, and high BMI. Standardized mortality rates attributable to high SBP, high FPG, and high BMI all showed an overall upward trend from 1990 to 2019, with annual average percent changes (AAPCs) of 0.3%, 0.0%, and 2.8%, respectively. Age-standardized DALYs attributed to high SBP and high BMI showed increasing trends, with the AAPCs of 0.5% and 3.1% (both P＜0.05), respectively. There was no statistical significance of high FPG (P > 0.05). Mortality and disease burden attributed to high SBP both showed upward trends with increasing age. Age-standardized mortality and age-standardized DALYs attributed to high FPG peaked at 45-49 and 50-54 age-group, respectively. Both age-standardized mortality and age-standardized DALYs attributed to high BMI peaked at ages 60-64 age-group. Conclusion The trends of mortality and DALYs attributed to the three risk factors can reflect the changes of population structure and lifestyle in Jiangsu Province in the past 30 years to a certain extent. Early screening of population at high risk of CKD and targeted provision of health policies can reduce the mortality and disease burden of CKD.
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Objective To evaluate the effect of renal insufficiency before heart transplantation on perioperative death, complications and long-term survival, and to compare the differences between preoperative serum creatinine (Scr) and estimated glomerular filtration rate (eGFR) in preoperative risk assessment. Methods Clinical data of 1 095 heart transplant recipients were retrospectively analyzed. According to preoperative Scr level, all recipients were divided into the Scr < 133 μmol/L(n=980), Scr 133-176 μmol/L (n=83) and Scr≥177 μmol/L groups (n=32). According to preoperative eGFR, all recipients were divided into eGFR≥90 mL/(min·1.73m2) (n=436), eGFR 60-89 mL/(min·1.73m2) (n=418) and eGFR < 60 mL/(min·1.73m2) groups (n=241). Clinical prognosis of postoperative renal function, perioperative and long-term outcomes of recipients were compared among different groups. The effect of eGFR and Scr level on renal function injury and long-term survival after heart transplantation was assessed. Results With the increase of preoperative Scr level, the proportion of recipients undergoing postoperative continuous renal replacement therapy (CRRT) was increased, the proportion of recipients receiving postoperative mechanical circulatory support was elevated, the incidence of postoperative complications was increased, the duration of mechanical ventilation and intensive care unit(ICU) stay was prolonged, and the in-hospital fatality was increased. The differences among three groups were statistically significant (all P < 0.05). With the decrease of preoperative eGFR, the proportion of recipients receiving postoperative CRRT was increased, the proportion of recipients using postoperative intra-aortic balloon pump (IABP) was elevated, the duration of mechanical ventilation and ICU stay was prolonged, and the in-hospital fatality was increased. The differences among three groups were statistically significant (all P < 0.05). Scr≥177 μmol/L was an independent risk factor for postoperative death [adjusted hazard ratio (HR) 3.64, 95% confidence interval (CI) 1.89-6.99, P < 0.01]. Among different groups classified by Scr and eGFR, the cumulative incidence rate of postoperative renal function injury and long-term survival rate were statistically significant among three groups (all P < 0.05). In patients with preoperative Scr < 133 μmol/L, the cumulative incidence rate of postoperative long-term renal function injury was significantly increased with the decrease of preoperative eGFR (P < 0.01). There was no significant difference in postoperative long-term survival rate among patients stratified by different eGFR (P > 0.05). Conclusions Renal insufficiency before heart transplantation is associated with poor perioperative and long-term prognosis. Preoperative Scr and eGFR are the independent risk factors for postoperative renal function injury. Scr yields low sensitivity in the assessment of preoperative renal function, whereas it has high accuracy in predicting perioperative death risk. And eGFR is a more sensitive parameter to evaluate preoperative renal function, which may identify early-stage renal functional abnormality and take effective measures during early stage to reduce adverse effect on prognosis.
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One of the traditional prescriptions for treating lung diseases, Jiegeng decoction (JGT), is still unknown in terms of its chemical makeup and mechanism. In this study, Q-Exactive-Orbitrap MS technology was used to identify the chemical constituents of JGT, and metabolomics was used to examine the effect of JGT on metabolites in the lung tissue of mice with acute lung injury (ALI) model. The potential biomarkers were screened by fold change (FC) > 1.5 or FC < 0.67 and P < 0.05, and enriched for metabolic pathways. A total of 40 compounds, including triterpenoid saponins, flavonoids and glycosides, were identified by mass spectrometry analysis of JGT. All animal experiments were approved by the Experimental Animal Ethics Committee of Tianjin University of Traditional Chinese Medicine (No. TCM-LAEC2021106). The results showed that JGT improved the lung coefficient, and lung tissue morphology of mice with ALI, lowered the levels of malondialdehyde (MDA), tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) in bronchoalveolar lavage fluid (BALF), and reduced myeloperoxidase (MPO) content in lung tissue. The metabolomic results showed that JGT could regulate 22 metabolites associated with ALI, among which leukotriene D4, docosapentaenoic acid, hypoxanthine, L-5-oxoproline, and other metabolites were mainly associated with the body′s inflammatory response and oxidative stress, and were enriched in the pathways of glutathione metabolism, purine metabolism, and primary bile acid biosynthesis. This study analyzed the potential mechanism of JGT in the treatment of ALI through metabolomics, providing an important theoretical basis for the clinical application of JGT.
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A dry suspension of Indigo Naturalis (IN) based on lactose-IN composite particles was designed by powder modification technology to meet the clinical needs of IN. The contact angle was used as an evaluation index to investigate the effects of the type of modifier lactose, the amount of lactose, and the co-grinding time of lactose and IN on the hydrophilicity of IN. The difference between IN before and after modification was compared through physical properties such as particle size and scanning electron microscope, as well as hydrophilic properties such as surface free energy and multiple light scattering. The optimal process of lactose-IN composite particles is as follows: after lactose is ground alone for 2 minutes, it is co-ground with IN at a ratio of 1∶1 for 6 minutes. The results of the investigation of powder properties show that the particle size d0.9 of IN is reduced from 112.75 μm to 87.30 μm after modification. The BET and Langmuir specific surface areas decreased by 8.661 m2·g-1 and 12.512 m2·g-1, respectively. SEM shows that lactose is attached to the surface of modified IN (MIN); surface element analysis shows that Si, Ca, and Mg elements of MIN are smaller than IN, and O elements are larger. The infrared spectrum shows that the MIN possesses the characteristic peaks of both IN and lactose. Compared MIN with IN, the contact angle and the non-polar surface free energy decreased by 35.1° and 9.975 mJ·m-2, respectively; the polar surface free energy and the surface free energy increased by 36.956 and 26.950 mJ·m-2, respectively. The results of multiple light scattering showed that the light transmittance of MIN was 35% lower than that of IN, and the backscattered light intensity was increased by about 25%. Only one excipient was used to successfully prepare IN dry suspension with good wettability and suspending property, which provided a basis for the development of new preparations of IN.
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Venous thromboembolism (VTE) is a complication in children with acute lymphoblastic leukemia (ALL). The Chinese Children's Cancer Group-ALL-2015 protocol was carried out in China, and epidemiology, clinical characteristics, and risk factors associated with VTE were analyzed. We collected data on VTE in a multi-institutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019. First, VTE occurred in 159 (2.08%) patients, including 90 (56.6%) during induction therapy and 108 (67.92%) in the upper extremities. T-ALL had a 1.74-fold increased risk of VTE (95% CI 1.08-2.8, P = 0.022). Septicemia, as an adverse event of ALL treatment, can significantly promote the occurrence of VTE (P < 0.001). Catheter-related thrombosis (CRT) accounted for 75.47% (n = 120); and, symptomatic VTE, 58.49% (n = 93), which was more common in patients aged 12-18 years (P = 0.023), non-CRT patients (P < 0.001), or patients with cerebral thrombosis (P < 0.001). Of the patients with VTE treated with anticoagulation therapy (n = 147), 4.08% (n = 6) had bleeding. The VTE recurrence rate was 5.03% (n = 8). Patients with VTE treated by non-ultrasound-guided venous cannulation (P = 0.02), with residual thrombus (P = 0.006), or with short anticoagulation period (P = 0.026) had high recurrence rates. Thus, preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.
Subject(s)
Humans , Child , Venous Thromboembolism/etiology , East Asian People , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Risk Factors , Thrombosis/chemically induced , China/epidemiology , Anticoagulants/adverse effects , RecurrenceABSTRACT
Objective:To investigate the effect and mechanism of local gastric hypothermia in rats with pancreatitis based on a GC?MS and LC?MS dual metabolomics strategy.Methods:Eighteen SD rats were randomly divided into the sham operation (SO), acute pancreatitis (AP) and acute pancreatitis hypothermia (APH) groups. The AP model was established by retrograde injection of 3.5% sodium taurocholate solution into the pancreaticobiliary duct in the AP and APH groups. In the APH group, gastrotomy was performed near the cardia, and a cooling balloon with 2 silicone catheters was placed in the stomach. After the successful establishment of the rat pancreatitis model in the APH group, the speed of ice water circulation was controlled and the output power of the heating pad was adjusted to achieve pancreatic surface temperature reduction while avoiding systemic hypothermia. Temperatures were not monitored and controlled in the SO and AP groups. Serum amylase was detected by ELISA. Pancreatic tissues were stained with HE and histopathologically scored. The expression of NF-κB, IL-6, TNF-α and IκBα in pancreatic tissue was detected by Western blotting. The AP and APH groups were compared by full-scan analysis, and the serum differential metabolites and metabolic pathways were detected by GC?MS- and LC?MS-based metabolomics strategies.Results:Compared with the SO group, the serum amylase level in the AP group and APH group were increased (all P<0.05). Compared with the AP group, the amylase levels at 3 h and 5 h after the operation were decreased in the APH group (both P<0.05). The pathological scores of the AP and APH groups were higher than those of the SO group (both P<0.05), and the pathological damage to pancreatic tissue in the APH group was less than that in the AP group ( P<0.05). IL-6, TNF-α and NF-κB were decreased and IκBα was increased in the APH group compared with the AP group by Western blotting (all P<0.05). A total of 53 differential metabolites were identified by GC?MS, and 236 differential metabolites were identified by LC?MS in the serum samples of the APH group compared with the AP group. The differential metabolites obtained from the blood samples of the APH group and AP group were imported into MetaboAnalyst 4.0 software for analysis, and the root data-log ( P value)>2, P<0.05, three major metabolic pathways were obtained, including ascorbate and aldarate metabolism, pentose and glucuronate interconversions and tryptophan metabolism. Conclusions:Local gastric hypothermia has a protective effect on the expression of inflammatory factors and alleviates pathological damage in rats with acute pancreatitis, which may be related to ascorbate and aldarate metabolism, pentose and glucuronate interconversions and tryptophan metabolism.
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Objective To explore the safety and efficiency of sequential operation of Tirelizumab combined with chemotherapy in neoadjuvant therapy for locally advanced esophageal cancer.Methods A retrospective analysis was conducted on 60 patients with locally advanced esophageal cancer admitted to Renmin Hospital of Wuhan University from August 2018 to June 2022.The immunotherapy combined with chemotherapy sequential surgery patients were selected as the observation group(29 cases)and the chemotherapy sequential surgery patients were selected as the control group(31 cases)according to the treatment method.The study aimed to analyze whether there were differences in efficacy and safety between the two groups.Results There are 28 patients with R0 resection in the observation group,and 14 case reached ORR.In the control group,29 cases were resected with R0,and 7 cases reached ORR.The proportion of ORR patients in the observation group was significantly higher than that in the control group,which was statistically significant(P＜0.05).There were 9 patients with pCR in the observation group and 2 patients with pCR in the control group,and the proportion of pCR patients in the two groups was significantly different(P＜0.05).There were no significant differences between the two groups for preoperative and postoperative adverse events.Conclusion Immune checkpoint inhibitors combined with chemotherapy sequential surgery are safe and reliable in patients with locally advanced esophageal cancer,with significant short-term efficacy,and long-term efficacy remains to be observed.