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Objective:To study the risk factors for early recurrence of patients undergoing radical pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) and construct a normogram model.Methods:Patients undergoing open radical PD for PDAC at Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from January 2014 to December 2021 were retrospectively screened. A total of 213 patients were enrolled, including 145 males and 68 females, aged (58.4±9.8) years. Patients were divided into the early recurrence group ( n=59, recurrence within 6 months after surgery) and a control group ( n=154, no recurrence within 6 months after surgery). Using minimum absolute value convergence and selection operator regression (LASSO) and multi-factor logistic regression analysis, we screened out the best predictor of early recurrence after PD for PDAC, and then established a nomogram model. The effectiveness of the model was validated by receiver operating characteristic (ROC) curve, calibration curves, and decision analysis curves. Results:Multivariate logistic regression analysis showed that patients with obstructive jaundice, vascular invasion, massive intraoperative bleeding, high-risk tumors (poorly differentiated or undifferentiated), high carbohydrate antigen 19-9 to total bilirubin ratio, and high fibrinogen and neutrophil to lymphocyte ratio scores had a higher risk of early postoperative recurrence. Based on the indexes above, a nomogram prediction model was constructed. The area under the ROC curve was 0.797 (95% CI: 0.726-0.854). Validation of the calibration curve exhibited good concordance between the predicted probability and ideal probability, decision curve analysis showed that the net benefits of the groupings established according to the model were all greater than 0 within the high risk threshold of 0.08 to 1.00. Conclusion:The nomogram for predicting early recurrence after PD for PDAC has a good efficiency, which could be helpful to screen out the high-risk patients for adjuvant or neoadjuvant therapy.
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Desmoplastic stroma of pancreatic ductal adenocarcinoma plays an important role in tumor progression and treatment resistance. Stroma-targeted therapies are therefore promising for clinical application and extensive related researches are undergoing. In this article, recent advances in stromal targeting strategies were reviewed from three perspectives: cancer-associated fibroblasts, extracellular matrix and angiogenesis, and an outlook for the future of this strategy was also provided.
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Intraductal papillary mucinous neoplasm (IPMN) is one of the precancerous lesions of the pancreas. Currently there is controversial over the management and follow-up strategy of IPMN, including the timing of surgery. The core problem lies in the accurate preoperative assessment of the nature of the lesions and the risk of malignant transformation. Cumulation of high-quality evidence and development of efficient evaluation methods are vital for the establishment of standardized decision-making system and the improvement of clinical benefits to patients. This review aims to summarize the consensus and controversies on surgical evaluation standards in the latest guidelines and representative literatures, and to look forward to the development direction of IPMN diagnosis and treatment decisions in combination with the progress of related evaluation techniques.
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Epidemiological and animal studies indicate that pre-existing diabetes increases the risk of Parkinson's disease(PD).However,the mechanisms underlying this association remain unclear.In the present study,we found that high glucose(HG)levels in the cerebrospinal fluid(CSF)of diabetic rats might enhance the effect of a subthreshold dose of the neurotoxin 6-hydroxydopamine(6-OHDA)on the development of motor disorders,and the damage to the nigrostriatal dopaminergic neuronal pathway.In vitro,HG promoted the 6-OHDA-induced apoptosis in PC12 cells differentiated to neurons with nerve growth factor(NGF)(NGF-PC12).Metabolomics showed that HG promoted hyperglycolysis in neurons and impaired tricarboxylic acid cycle(TCA cycle)activity,which was closely related to abnormal mito-chondrial fusion,thus resulting in mitochondrial loss.Interestingly,HG-induced upregulation of pyruvate kinase M2(PKM2)combined with 6-OHDA exposure not only mediated glycolysis but also promoted abnormal mitochondrial fusion by upregulating the expression of MFN2 in NGF-PC12 cells.In addition,we found that PKM2 knockdown rescued the abnormal mitochondrial fusion and cell apoptosis induced by HG+6-OHDA.Furthermore,we found that shikonin(SK),an inhibitor of PKM2,restored the mito-chondrial number,promoted TCA cycle activity,reversed hyperglycolysis,enhanced the tolerance of cultured neurons to 6-OHDA,and reduced the risk of PD in diabetic rats.Overall,our results indicate that diabetes promotes hyperglycolysis and abnormal mitochondrial fusion in neurons through the upre-gulation of PKM2,leading to an increase in the vulnerability of dopaminergic neurons to 6-OHDA.Thus,the inhibition of PKM2 and restoration of mitochondrial metabolic homeostasis/pathways may prevent the occurrence and development of diabetic PD.
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Objective:To study the differences in preoperative examination indexes between pancreatic head cancer and distal bile duct cancer, and to establish a preliminary prediction model to provide reference for clinical decision-making.Methods:Retrospective analysis was conducted on 243 consecutive patients who underwent open radical pancreaticoduodenectomy from January 1, 2015 to December 31, 2019 at the Chinese PLA General Hospital. There were 177 males and 66 females, aged (58.9±8.9) years old. Based on postoperative pathological results, these 243 patients were divided into the pancreatic head cancer group ( n=113) and the distal bile duct cancer group ( n=130). The clinical data of the two groups were collected. Minimum absolute value convergence and selection operator regression were used to screen the best predictors of pancreatic head cancer. The rms package was used to construct the nomogram model, and k-fold cross was used for internal validation. Results:Seven best predictive indexes are selected: age, rate of weight loss, main pancreatic duct diameter, neutrophil/lymphocyte, DTR (DBil/TBil), carcinoembryonic antigen and CA125. Based on these indexes, a nomogram prediction model was constructed with the C-index of 0.868 after k-fold cross-validation, indicating that discrimination of the model to be acceptable. Validation using calibration curve exhibited good concordance between the predicted probability with the ideal probability ( P=0.728). Conclusion:The nomogram prediction model established in this study effectively predicted patients with pancreatic head cancer, and helped preoperatively to differentiate pancreatic head cancer from distal cholangiocarcinoma.
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Objective:To construct a predictive nomogram on postoperative overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC) after R 0 radical pancreaticoduodenectomy, and to evaluate its performance. Methods:The clinicopathological data of patients who underwent radical pancreaticoduodenectomy at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from January 2014 to December 2019 for pathologically diagnosed PDAC were retrospectively collected and analyzed. There were 119 patients, with 85 males and 34 females, aged (58±11) years. Using multivariate Cox regression analysis (stepwise regression), a prediction nomogram was constructed. Concordance index (C-index), calibration curve, and time-dependent receiver operating characteristic (ROC) curve were applied to evaluate the predictive performance.Results:The 1-, 2-, and 3-year cumulative survival rates of these 119 patients were 67.2%, 35.0%, and 24.8%, respectively. High-grade tumors (poorly differentiated and undifferentiated), vascular carcinoma embolus, systemic immune inflammatory index <279.4×10 9/L, prognostic nutritional index <40.5, alanine aminotransferase-to-aspartate aminotransferase ratio>1.1, total bilirubin>258.5 μmol/L and plasma fibrinogen>3.43 g/L were independent risk factors for poor OS for PDAC patients after radical pancreaticoduodenectomy (all P<0.05). These indicators, together with age >63 years, constituted the regression formula for prediction with a C-index=0.74. The areas under the curve of ROC for the nomogram on predicting survival were 0.795, 0.803, and 0.836 at 1, 2, and 3-year respectively, and only slight deviations were observed on the calibration curves from the standard 45° line, suggesting that the survival prediction of the model in this dataset fitted well with the actual survival status. Conclusion:The predictive nomogram on OS in patients after R 0 radical pancreaticoduodenectomy based on the clinicopathological characteristics of PDAC was internally validated to have a good predictive performance on OS. The nomogram can help to optimize prognostic risk stratification and treatment decisions for this subgroup of patients. This prediction model needs to be further verified and improved by using large-scale cohort studies.
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Drug-induced liver injury (DILI) is a type of necrotizing and inflammatory liver disease caused by certain commonly-used drugs, Chinese herbal medicines or dietary supplements. In severe cases, it may lead to acute liver failure. Without liver transplantation, the fatality could reach up to 80%. It is of significance to master the indications of liver transplantation. Several prognostic scoring systems have been developed to help clinicians to decide which patients need urgent liver transplantation, such as King's College criteria (KCC) and model for end-stage liver disease (MELD) scoring systems. However, these scoring methods have been developed for a long period of time and lack of modifications. Therefore, scholars have proposed several new scoring systems, such as acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scoring systems, which provide novel ideas for the evaluation of liver transplantation. As an important treatment measure for drug-induced acute liver failure, urgent liver transplantation has greatly improved the survival rate of patients. In this article, the classification, clinical diagnosis, liver transplantation evaluation and prognosis of DILI were summarized, aiming to provide reference for the treatment of DILI by liver transplantation.
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Objective:To investigate the electrocardiographic characteristics of left and right ventricles origin of premature ventricular contractions(PVCs) during V3 transition of precordial leads, right ventricular outflow tract (RVOT) anterior septum and right coronary sinus (RCC), and RVOT middle-posterior septum and left coronary sinus (LCC).Methods:From January 2017 to September 2019, 91 patients with ventricular extrasystole of outflow tract who had V3 transition in precordial lead and had successful radiofrequency ablation in RVOT anterior septum, middle posterior septum, LCC and RCC were selected for retrospective case control study.The electrocardiography measurements of PVCs were compared between the anteroseptal RVOT group and RCC group, as well as the middle-posterior septal RVOT group and the LCC group, respectively.The measurements included the R-wave amplitude in lead Ⅰ, Ⅱ, Ⅲ and aVF, R amplitude ratio in leads Ⅲ to Ⅱ, Q-wave amplitude in lead aVL and aVR, Q amplitude ratio in leads aVL to aVR, R-wave and S-wave amplitude from leads V1 to V3, the V2S/V3R index, the transition zone index, and the V2 transition ratio.Results:Thirty-six cases originated from the anteroseptal RVOT, and 11 from the LCC.Lead I R-wave amplitude in anterior septal RVOT was higher than LCC group((0.22±0.25) mV vs.(-0.17±0.33) mV; P=0.003). R-wave amplitude in lead Ⅱ was lower than that in the LCC group((1.59±0.35) mV vs.(1.76±0.27) mV; P=0.035). R-wave amplitude in lead aVF was lower compared with the LCC group((1.53±0.35) mV vs.(1.78±0.39) mV; P=0.050). The V2S/V3R index showed a significant difference between these two groups(1.99±0.66 vs.0.76±0.38; P<0.001). The V2 transition ratio also appeared a significant difference between the two groups(0.69±0.43 vs.1.05±0.35; P=0.005). PVCs arose from the middle-posterior septal RVOT in 32 cases, and from the RCC in 12 cases.Compared with RCC group, lead Ⅰ R-wave amplitude showed lower ((0.25±0.31) mV vs.(0.57±0.12) mV; P<0.001); R amplitude ratio in leads Ⅲ to Ⅱ higher (0.89±0.14 vs.0.72±0.18; P=0.002); Q amplitude in lead aVL((0.72±0.24) mV vs.(0.51±0.16) mV; P=0.002)higher, and Q amplitude ratio in leads aVL to aVR higher in the middle-posterior septal RVOT(0.76±0.23 vs.0.50±0.21; P=0.002). Conclusion:Among the cases with lead V3 transition, PVCs originated from the anteroseptal RVOT show significantly different R wave in lead Ⅰ, Ⅱ, aVF, V2S/V3R index, and the V2 transition ratio compared with those from the LCC.The PVCs from the middle-posterior septal RVOT and the RCC have different R wave in lead Ⅰ, R amplitude ratio in leads Ⅱ and Ⅲ, Q amplitude ratio in leads aVL and aVR.Combined with its different characteristics, it can help to identify the origin of left and right ventricles.
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Paroxysmal supraventricular tachycardia includes atrioventricular node reentry tachycardia, atrioventricular reentry tachycardia and atrial tachycardia.At present, the commonly used methods in clinical diagnosis include ventricular pacing in tachycardia, pre ventricular stimulation in refractory/non refractory period of his bundle, pacing in different parts of the atrium, parahisian pacing in sinus rhythm and stimulation in different parts of the ventricle.Ventricular pacing is one of the most commonly used methods in clinical diagnosis.However, it may lead to " false V-A-A-V" sequence after pacing.The ventricular pre phase stimulation of his bundle refractory period may appear false negative or lead to termination of tachycardia, which is not condutive to differential diagnosis.The results may be affected by pacing position, bypass position and refractory period when parahisian pacing and ventricular stimulation at different sites/frequencies are performed in sinus rhythm.Because of their respective advantages and limitations, it is necessary to integrate a variety of identification methods to improve the accuracy of diagnosis and the success rate of operation.
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Objective:To study the risk factors of positive surgical margins in patients with advanced hilar cholangiocarcinoma (HCCA) undergoing curative-intent resection with the aim to provide references for clinical decision-making.Methods:The clinical pathological data of 126 patients with advanced HCCA who underwent curative-intent resection at the Chinese PLA General Hospital from January 2011 to December 2014 was retrospective analyzed. There were 78 males and 48 females, with an average age of 55 years. The patients were divided into two groups: the resection margin positive group (positive for residual tumor at any surgical margin, n=29) and the negative resection margin group ( n=97). Multivariate logistic regression analysis, in reference to the results of univariate analysis, was applied to the relevant variables to study independent risk factors of positive resection margin. Receiver operating characteristic (ROC) curves were drawn to evaluate the independent and joint predictive values of the relevant indicators. Results:Univariate analysis showed vascular involvement, tumor diameter volume ≥20.94 cm 3, plasma fibrinogen ≥3.36 g/L, and DRR≤0.61 were associated with positive resection margins (all P<0.05). A history of cholecystectomy was potentially associated with positive resection margins ( P<0.1). These variables were included in the multivariate logistic regression analysis which showed vascular involvement ( OR=4.134, 95% CI: 1.545-11.060, P=0.005), tumor size ≥ 20.94 cm 3 ( OR=2.926, 95% CI: 1.107-7.733, P=0.030) and DRR≤0.61 ( OR=3.170, 95% CI: 1.126-8.928, P=0.029) were independent risk factors of positive margins after curative resection in patients with advanced HCCA. ROC curve analysis was used to evaluate the impact of the combination of the above variables in predicting positive surgical margins. Sensitivity and specificity were calculated to be 86.2% and 65.7% respectively, and the area under the curve was 0.771. Conclusion:Vascular involvement, tumor size ≥20.94 cm 3 and DRR≤0.61 were independent risk factors of positive surfical margins in patients with advanced HCCA undergoing curative-intent resection. The combination of the above predictive indicators provided some references for treatment decisions.
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OBJECTIVE：To improve the quality standard of Xiangsha hezhong pills. METHODS ：Based on previous quality standard of Xiangsha hezhong pills ，the items of property observation and microscopic identification were revised. TLC identification methods were established for ginger-processed Magnolia officinalis ，Pogostemon cablin and Atractylodes Lancea （stir-fried with earth ）. HPLC methods were adopted for contents determination of hesperidin ，magnolol and honokiol. RESULTS ： The description of the appearance of Xiangsha hezhong pills should be modified to “yellow brown or brown water pill ”. The description of microscopical identification was adjusted slightly. TLC chromatogram of ginger-processed M. officinalis ，P. cablin and Atractylodes Lancea （stir-fried with earth ）all showed the same color spots in the same position as the corresponding substance control or reference medicinal material ，and the negative samples had no interference. The contents determination were performed on Phenomenex Luna C 18 column with mobile phase consisted of methanol-water （40 ∶ 60，V/V，hesperidin）or acetonitrile- 1％ glacial acetic acid （52∶48，V/V，magnolol and honokiol ）at the flow rate of 1.0 mL/min. The column temperature was 30 ℃. The detection wavelengths were set at 284 nm（hesperidin）or 294 nm（magnolol and honokiol ）. The linear ranges of hesperidin ， magnolol and honokiol were 0.201 8-2.018 μg，0.035 7-0.357 4 μg and 0.028 2-0.282 4 μg（all r＝0.999 9）. The detection limits were 2.0，0.72，0.45 ng；the limits of quantitation were 7.0，2.45，1.61 ng. RSDs of precision ，reproducibility，stability and durability tests were all lower than 3％. The average recoveries were 99.92％，100.49％ and 102.08％（all RSD ＜3％）. CONCLUSIONS ：The study verifies the description of character observation and microscopical identification ，adds TLC identification methods for ginger-processed M. officinalis ，P. cablin and Atractylodes Lancea （stir-fried with earth ）based on previous quality standard of Xiangsha hezhong pills. HPLC methods were adopted to determine the contents of hesperidin ，magnolol and honokiol ，and can effectively improve the quality control standard of the preparation.
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To achieve uniform soluble expression of multiple proteins in the same Escherichia coli strain, and simplify the process steps of antigen production in genetic engineering subunit multivalent vaccine, we co-expressed three avian virus proteins including the fowl adenovirus serotype 4 (FAdV-4) Fiber-2 protein, infectious bursal disease virus (IBDV) VP2 protein and egg-drop syndrome virus (EDSV) Fiber protein in E. coli BL21(DE3) cells after optimization of gene codon, promoter, and tandem expression order. The purified proteins were analyzed by Western blotting and agar gel precipitation (AGP). The content of the three proteins were well-proportioned after co-expression and the purity of the purified proteins were more than 80%. Western blotting analysis and AGP experiment results show that all the three co-expression proteins had immunoreactivity and antigenicity. It is the first time to achieve the three different avian virus antigens co-expression and co-purification, which simplified the process of antigen production and laid a foundation for the development of genetic engineering subunit multivalent vaccine.
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Animals , Antigens, Viral/genetics , Biological Assay , Chickens/immunology , Escherichia coli/genetics , Infectious bursal disease virus/immunology , Poultry Diseases , Vaccines, Synthetic/isolation & purification , Viral Structural Proteins/immunology , Viral Vaccines/immunologyABSTRACT
Objective@#To investigate the prediction of axillary lymph node metastasis in patients with early breast cancer by sentinel lymph node biopsy (SLNB) combined with preoperative ultrasound.@*Methods@#From Jun 2014 to Oct 2018, 340 patients with early breast cancer were enrolled in the 5th Department of General Surgery of Second Hospital of Lanzhou University. 113 cases were grouped into ultrasound examing, 75 patients in the SLNB, and 152 patients in the SLNB combined with preoperative ultrasound.Using the results of axillary lymph node dissection as gold standard, the 3 groups were compared.@*Results@#The sensitivity of SLNB, ultrasound and SLNB combined with ultrasound for suspicious axillary lymph node biopsy were 90.1%, 85.7%, and 96.4%, respectively. The specificity was 84.0%, 76.3%, and 100%, and the accuracy was 91.6%, 83.0%, and 97.4%, respectively. The false negative rates were 8.6%, 14.3%, and 3.6%, respectively.@*Conclusion@#Preoperative ultrasound diagnosis of axillary lymph node status combined with sentinel lymph node biopsy can significantly improve the diagnosis rate of axillary lymph node metastasis in early breast cancer.
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Objective To investigate the prediction of axillary lymph node metastasis in patients with early breast cancer by sentinel lymph node biopsy (SLNB) combined with preoperative ultrasound.Methods From Jun 2014 to Oct 2018,340 patients with early breast cancer were enrolled in the 5th Department of General Surgery of Second Hospital of Lanzhou University.113 cases were grouped into ultrasound examing,75 patients in the SLNB,and 152 patients in the SLNB combined with preoperative ultrasound.Using the results of axillary lymph node dissection as gold standard,the 3 groups were compared.Results The sensitivity of SLNB,ultrasound and SLNB combined with ultrasound for suspicious axillary lymph node biopsy were 90.1％,85.7％,and 96.4％,respectively.The specificity was 84.0％,76.3％,and 100％,and the accuracy was 91.6％,83.0％,and 97.4％,respectively.The false negative rates were 8.6％,14.3％,and 3.6％,respectively.Conclusion Preoperative ultrasound diagnosis of axillary lymph node status combined with sentinel lymph node biopsy can significantly improve the diagnosis rate of axillary lymph node metastasis in early breast cancer.
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Objective To observe whether catheter ablation for ventricular premature complexes (PVC) has an effect on ventricular diastolic function in elderly patients.Methods Elderly patients older than 65 years of age who underwent catheter ablation from March 2012 to May 2015 for idiopathic ventricular premature complexes were enrolled.Preoperative echocardiography was performed using E／e′ for left ventricular diastolic function and venous brain natriuretic peptide (BNP) levels were measured.All patients underwent catheter ablation under the guidance of a three?dimensional mapping system.Cardiac ultrasound and BNP levels were repeated 6 months after ablation, and 24?hour electrocardiogram was performed to confirm ventricular premature complexes.Results There were a total of 89 patients with idiopathic ventricular premature complexes ( PVC) who underwent catheter ablation.81 cases were successed at 6 months,with a success rate of 91.0%.At 6 months after ablation,the E／e′ values were significantly lower ((15.3±5.2) vs ( 10.2± 3.2),( P＜0.001)) and BNP levels were significantly lower (( 202.0 ± 23.2) pg／L vs (94±13.3) pg／L),(P＜0.001).For the unsuccessful subgroup,there was no significant change in E／e′values (16.3±6.3 vs 15.2±5.6) and BNP levels ((223.0±26.8) pg／L vs (245.0±23.9) pg／L), (P＞0.05).Conclusion The number of premature ventricular beats is associated with left ventricular diastolic function,and ventricular premature catheter ablation can improve left ventricular diastolic function in elderly PVC patients.
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Objective To investigate the clinical effect of internal fixation(IF)and total hip replacement(HA)for treatment of displaced femoral neck fracture in elderly patients.Methods Sixty-three cases with femoral neck fracture hospitalized in Chaoyang Central Hospital from January 2010 to January 2015 were selected as research subjects and were divided into IF group(33 cases)and HA group(30 cases) according to the different treatment methods.The patients in IF group were treated with internal fixation and the patients in HA group were treated with hip replacement.The duration of operation,intraoperative blood loss, length of hospital stay,incidence of postoperative complication and reoperation rate in both groups were recorded.The hip function was evaluated by Harris score,and the hip function of the two groups was compared in 1 year,2 years after operation.Results Compared with HA group,the patients in IF group had shorter operation time,less intraoperative blood loss and shorter hospitalization time((0.8± 0.3)h vs.(1.7± 0.2)h;(110.9 ±9.9)ml vs.(587.2±35.7)ml;(16.4±2.0)d vs.(24.8±3.7)d),the differences among the two groups were statistically significant(P=0.041,0.000,0.038).Th incidence of long term postoperative complication was 27.3%(9/33)in IF group and was 10.0%(3/30)in HA group.The reoperation rate was 24.2%(8/33)in IF group and was 6.7%(2/30)in HA group.The differences between the two groups were statistically significant (P=0.045,0.039).The excellent and good rates of hip joint function in HA group after 1 and 2 years after operation were 83.3% and 80.0%,and 63.6% and 57.6% in IF group in 1 and 2 years after operation respectively.The differences between the two groups were statistically significant(P = 0.043,0.042) .Conclusion Internal fixation and hip replacement in the treatment of displaced femoral neck fractures in the elderly effect have their own advantages and disadvantages.Internal fixation has the advantages of less trauma, less blood loss and rapid recovery,but the long-term complications and reoperation rates are higher than those in HA.The long-term clinical effect of HA for the treatment of femoral neck fracture in elderly patients is better than that of internal fixation and it is worthy of clinical promotion.
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Objective To evaluate the clinical efficacy of the dehopectoral approach and and the deltoid lateral longitudinal separate approach of locking plate fixation for the treatment of proximal humeral fractures.Methods Fifty-seven cases of proximal humerus fracture treated in Chaoyang Central Hospital from March 2010 to May 2015 were selected and were divided into the conventional group(30 cases)and the treatment group(27 cases)according to the different operative approaches.The patients in the conventional group were treated with locking plate fixation by dehopectoral approach and the patients in the treatment group were treated with locking plate fixation by deltoid lateral longitudinal separate approach.The operation time, intraoperative blood loss,fracture healing time,postoperative complication rate were observed in the two groups.Constant scores at different times after operation and the evaluation of shoulder function recovery were observed in the two groups.Results All patients were followed up for 10-25 months,with an average of 19 months.The blood loss in the treatment group was(89.7± 31.5)ml and the fracture healing time was(79.6 ±1.8)d,compared with(243.1±65.7)ml and(90.1±2)d in the conventional group,the differences between the two groups were statistically significant(P=0.000,0.035).There was no significant difference between the two groups in the operation time(P=0.079).Constant scores in the treatment group at 3 weeks and 3 months after operation were better than those in the conventional group,the differences between the two groups were statistically significant(P<0.05).At the last follow-up,there was no significant difference in Constant scores between the two groups(P>0.05).There were significant differences in the incidence of postoperative complications between the conventional group and the treatment group(13.3% vs.3.7%,P = 0.045).Conclusion In the treatment of proximal humeral fractures,the deltoid lateral longitudinal separate approach has advantages of less intraoperative blood loss,shorter fracture healing time,faster recovery of shoulder function and less postoperative complications,which is a safe and effective method for the treatment of proximal humeral fractures.
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Objective To evaluate the clinical efficacy of the dehopectoral approach and and the deltoid lateral longitudinal separate approach of locking plate fixation for the treatment of proximal humeral fractures.Methods Fifty-seven cases of proximal humerus fracture treated in Chaoyang Central Hospital from March 2010 to May 2015 were selected and were divided into the conventional group(30 cases)and the treatment group(27 cases)according to the different operative approaches.The patients in the conventional group were treated with locking plate fixation by dehopectoral approach and the patients in the treatment group were treated with locking plate fixation by deltoid lateral longitudinal separate approach.The operation time, intraoperative blood loss,fracture healing time,postoperative complication rate were observed in the two groups.Constant scores at different times after operation and the evaluation of shoulder function recovery were observed in the two groups.Results All patients were followed up for 10-25 months,with an average of 19 months.The blood loss in the treatment group was(89.7± 31.5)ml and the fracture healing time was(79.6 ±1.8)d,compared with(243.1±65.7)ml and(90.1±2)d in the conventional group,the differences between the two groups were statistically significant(P=0.000,0.035).There was no significant difference between the two groups in the operation time(P=0.079).Constant scores in the treatment group at 3 weeks and 3 months after operation were better than those in the conventional group,the differences between the two groups were statistically significant(P<0.05).At the last follow-up,there was no significant difference in Constant scores between the two groups(P>0.05).There were significant differences in the incidence of postoperative complications between the conventional group and the treatment group(13.3% vs.3.7%,P = 0.045).Conclusion In the treatment of proximal humeral fractures,the deltoid lateral longitudinal separate approach has advantages of less intraoperative blood loss,shorter fracture healing time,faster recovery of shoulder function and less postoperative complications,which is a safe and effective method for the treatment of proximal humeral fractures.
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Objective To observe the clinical efficacy of auricular point sticking plus basic nursing for constipation of excessive syndrome in acute stage of stroke.Method Ninety patients with constipation of excessive syndrome in acute stage of stroke were randomized into a treatment group and a control group, 45 cases in each group. The treatment group was intervened by auricular point sticking plus basic nursing, while the control group was by basic nursing alone. The major symptom scores were observed before intervention and after 2-treatment courses, and the clinical efficacies were compared between the two groups.Result Respectively after 1 and 2 treatment courses, there were significant differences in comparing the major symptom scores between the two groups (P<0.05). The total effective rates were respectively 60.0% and 67.5% in the treatment group respectively after 1 and 2 treatment courses, versus 37.5% and 45.0% in the control group, and the differences were statistically significant (P<0.05). Conclusion Auricular point sticking is an effective approach in treating constipation of excessive syndrome in acute stage of stroke.
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AIM:To investigate the effects of vesicular transport inhibition on the proliferation and regulation of store-operated calcium entry ( SOCE) in rat endothelial progenitor cells ( EPCs) .METHODS:EPCs were isolated from the rats with density-gradient centrifugation and confirmed via double fluorescence staining with acLDL-DiI and FITC-UEA-I.After inhibition of vesicular transport with brefeldin A ( BFA) , the proliferation of EPCs was measured by CCK-8 assay and real-time cell analyzer instrument, apoptosis was analyzed by flow cytometry, and the expression of ADP-ribosylation factor GTPase-activating protein 1 (ARFGAP1), a key protein to vesicular transport, was also detected.SOCE was ob-served under laser scanning confocal microscope after the vesicular transport was inhibited, and the protein expression of SOCC complex was determined by Western blot.Furthermore, the influences of vesicular transport inhibition on the expres-sion of transient receptor potential channel 1 ( TRPC1 ) and SOCE were examined with a RNA interference method.RE-SULTS:The acLDL-DiI and FITC-UEA-I double positive rate of the cells was 82.53%±6.12%.BFA insult significantly inhibited the proliferation of EPCs and down-regulated the expression of ARFGAP1, and no influence on the apoptosis of the EPCs was observed, suggesting that vesicular transport of EPCs was inhibited.Vesicular transport inhibition remarkably down-regulated the expression of TRPC1 and decreased SOCE level.No evident difference in the level of SOCE between siTRPC1 group and siTRPC1+BFA group, in which the cells were pretreated with siTRPC1 before BFA addition, was ob-served.CONCLUSION:Vesicular transport inhibition in EPCs reduces the proliferation of EPCs and decreases SOCE lev-el through down-regulation of TRPC1.