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Objective To investigate the effect of BIS-guided closed-loop target-controlled infusion on perioperative Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy under different anesthesia and sedation depths. Methods We applied random number table method to divide 73 elderly patients undergoing elective laparoscopic radical gastrectomy into BIS closed-loop target-controlled infusion group with BIS value of 55(group H, n=36) and BIS value of 45(group L, n=37).Intravenous blood samples were collected immediately before surgery (T1), 2h after surgery (T2), 24h after surgery (T3) and 72h after surgery (T4).IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ were determined by flow cytometry microsphere array.We compared operation duration, postoperative PACU stay time and postoperative hospitalization time between two groups. Results Compared with T1, IL-6 and IL-10 concentration in group H at T2, T3 and T4 significantly increased (P < 0.05), IL-4 and TNF-α in group H at T4 were significantly increased (P < 0.05), IL-2 and IFN-γ in group H at T2 and T4 were significantly increased (P < 0.05), the concentration of IL-6 and IL-10 in group L at T2, T3 and T4 were increased (P < 0.05), IL-2 in group L at T4 was decreased (P < 0.05), and IFN-γ/IL-6 in two groups were decreased at T2, T3 and T4(P < 0.05).Compared with group L, IL-6 and IL-10 in group H were significantly increased at T2(P < 0.05), IFN-γ/IL-6 in group H was significantly decreased (P < 0.05), IL-2 and IL-10 in group H were significantly increased at T4(P < 0.05).Operation duration, postoperative PACU stay time and postoperative hospitalization time had no statistical significance between two groups (P > 0.05). Conclusion The anesthesia and sedation depth of BIS-guided closed-loop target-controlled infusion set at 45 is better than 55 in maintaining Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy, but it has no obvious effect on long-term prognosis.
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Objective:To survey the public attitude towards xenotransplantation and examine its influencing factors.Methods:A survey form with 46 multiple-choice questions is offered. It is composed of general profiles of respondent and scale. The questionnaire is distributed online through the platform of Wenjuanxing(https: //www.wjx.cn). All adult respondents filled in anonymously online. Statistical processing included descriptive analysis, reliability and validity testing and variance and correlation analysis.Results:A total of 4 414 valid questionnaires are obtained between December 1, 2021 and January 31, 2022. Cronbach's alpha coefficient is 0.912 and the scale has decent reliability. Based upon the results of exploratory factor analysis, the items are grouped into five main factors, namely organ source, decision, psychosocial change, infection risk and other risks. If pig organs are proven feasible, the risks and prognosis are basically the same as human organs, 65.4% of the respondents definitely supported xenotransplantation. Among the respondents, individuals aged 31~50 years, male, born or resident in Chinese western region, higher education, non-medical institution practitioners, self/family members/friends have done or awaiting organ transplantation, self/partners supporting organ donation, future needs for organ transplantation, previous discussion of organ donation or organ transplantation with family/friends, blood donation, volunteer social worker, atheist or Buddhist/Christianc and hearing about xenotransplantation are more inclined to support xenotransplantation.Correlation analysis showed significant correlations among five main factors.Conclusions:Despite differences in attitudes towards xenotransplantation among different populations, overall attitude is favorable. Respondents are more concerned about their associated risks, especially psychosocial changes. The related researches should be stressed. And for different groups of people, corresponding stratified tutoring should be carried out. Strengthening clinical trials, heightening public attention and training medical staff are expected to further popularize this new technology.
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Objective:To explore a new method of diagnosing and identifying renal transplantation clinical almost tolerance through a diagnostic model using plasma proteomics.Methods:From November 2011 to November 2012, plasma samples from 43 subjects were collected and divided into the groups of clinical almost tolerance(18 cases), rejection(12 cases)and healthy control(13 cases). Protemic analysis of plasma samples was performed by surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS). Differential mass spectrometry peaks were screened and diagnostic model was established by Biomarker Wizard and Biomarker Pattern software. Identification of mass spectrometric peaks of nodes in the diagnostic model was carried out by searching the databases of SWISS-PROT and TrEMBL using ExPASy's TagIdent tool.Results:A total of 21 differential proteins peaks were obtained( P<0.05). Diagnostic model was composed of five mass spectrum peaks of 2 565.15, 1 966.28, 6 674.78, 1 103.27, 1 716.69 and 1 966.28.The sensitivity, specificity and area under the ROC curve of model were 83.3%, 92.0% and 0.951 respectively for diagnosing clinical almost tolerance.Bioinformatic identification results of mass spectrometric peaks of nodes in model were proteins of ANFB, MCH, TFF1, PDYN and PSME3. Conclusions:Establishing a diagnostic mode by plasma proteomics may be effectively employed for diagnosing clinical almost tolerance in kidney transplant.
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Objective:To improve the level of detection method and quality control at different transplant centers in China and comprehensively analyze the data of tacrolimus(Tac)detection in multiple transplant centers and provide data supports.Methods:Low, medium and high concentration commercial quality control products in triplicate samples were delivered to 34 domestic organ transplantation centers and testing repeated for 2~3 times during different time periods. The detection results of 240 quality control samples were summarized. The methods, accuracy and stability of Tac detection results were analyzed.Results:In international standard laboratories, mean±standard deviation(SD)of Tac detection results of low/medium/high concentration commercial quality control products was(4.70±0.325), (8.46±0.548)and(13.50±0.966)respectively. Here the results were (4.79±0.605), (8.49±0.948)and(13.99±1.604)respectively. In contrast, SD and degree of variation of international standard data were smaller, indicating that the accuracy and stability of international standard laboratories in detecting Tac were higher. SD of Tac concentrations detected by international standard laboratory for low/medium/high concentrations was approximately 0.3, 0.5 and 1.0 respectively, i.e.International first-class level. Here SD was approximately 0.5, 1.0 and 1.5 respectively, i.e. Chinese industry level.Conclusions:The "Chinese industry level" is recommended. Before using a new batch of "testing reagents" , "standard control samples" must be employed for calibrating the calculated curve. The calculated curve should be re-calibrated at least once per month. And clinicians should be consulted frequently.
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Objective:To compare the curative efficacy in the treatment of humeral surgical neck fractures between open reduction and locking plating versus closed reduction and interlocking intramedullary nailing.Methods:From July 2018 to July 2020, 60 patients with humeral surgical neck fracture were treated at Department of Orthorpaedic Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine. They were 24 males and 36 females, aged from 40 to 70 years and injured at the left side in 35 cases and at the right side in 25 ones. Of them, 30 underwent open reduction and locking plating (open group) and the other 30 closed reduction and interlocking intramedullary nailing (closed group). The 2 groups were compared in terms of operation time, intraoperative blood loss, surgical incision length, fracture healing time, Neer shoulder function scoring 3 months after surgery, and postoperative complications.Results:There were no statistically significant differences between the open and closed groups in preoperative general data, showing they were comparable ( P>0.05). The length of surgical incision [(5.2±1.1) cm], operation time [(34.3±12.7) min], intraoperative blood loss [(52.5±7.3) mL] and fracture healing time [(9.2±1.5) weeks] in the closed group were significantly better than those in the open group [(11.1±2.5) cm, (69.4±21.4) min, (123.5±5.2) mL and (14.2±3.4) weeks)] ( P<0.05). The excellent and good rate by Neer shoulder function scoring at 3 months after operation in the closed group (93.3%, 28/30) was significantly higher than that in the open group (66.7%, 20/30) ( P<0.05). There were no postoperative complications in either group. Conclusion:In the treatment of humeral surgical neck fractures, the curative efficacy of closed reduction and interlocking intramedullary nailing is better than that of open reduction and locking plating.
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Objective To evaluate the minimally invasive treatment of calcaneal fractures of Sanders Ⅱ &Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires.Methods From June 2016 to February 2018,53 patients (60 feet) were treated at Department of Hand and Foot Surgery,Central Hospital of Linyi for closed intra-articular calcaneal fractures.Of them,24 (28 feet) received the minimally invasive treatment and 29 (32 feet) open surgery via the conventional lateral L-shaped incision.The 2 groups were compared in terms of B(o)hler angle,Gissane angle,and the width,length and height of the calcaneus before operation,one week after operation and at the final follow-up,as well as in terms of preoperative preparation time,operation time,surgical bleeding volume,incision complications,subtalar joint stiffness,and anklehindfoot score of the American Foot and Ankle Surgery Association (AOFAS).Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data (P ＞ 0.05).All the patients were followed up for 10 to 22 months (average,16 months).The B(o)hler angles,Gissane angles,and the widths,lengths and heights of the calcaneus after operation and at the final follow-up were significantly better than the preoperative values in the minimally invasive group (all P ＜ 0.05).The preoperative preparation time (2.5 d ± 1.2 d) and operation time (62.6 min ± 6.3 min) in the minimally invasive group were significantly shorter than those (7.6 d ± 3.5 d and 85.9 min ± 9.7 min) in the conventional group (P ＜ 0.05),the surgical bleeding volume in the former (30.5 mL ± 3.8 mL) was significantly smaller than that in the latter (80.9 mL ± 8.3 mL) (P ＜ 0.05),and the rates of incision complications (0) and subtalar joint stiffness (10.7％) in the former were significantly lower than in the latter (9.4％ and 43.7％) (P ＜ 0.05).However,there was no significant difference between the 2 groups in the AOFAS anlle-hindfoot score (92.8 ± 5.9 versus 89.5 ± 7.5) (P ＞ 0.05).Conclusion The minimally invasive treatment of calcaneal fractures of Sanders Ⅱ & Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires can lead to satisfactory clinical results,because this method shortens significantly the time for hospitalization and leads to less invasion,fewer complications,accurate reposition and reliable fixation.
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Objective To explore the influencing factors and treatment strategies of long-term survival after simultaneous pancreas and kidney transplantation (SPK ) .Methods One case of long-term post-SPK survival was reviewed and its influencing factors were analyzed along with the relevant literature .Results At 10 years post-SPK ,the patient lost transplanted kidney due to rejection and underwent secondary kidney transplantation . The transplanted pancreas functioned well and has survived for more than 18 years .Conclusions Strict preoperative screening ,adopting mature surgical approaches ,aggressive managements of various perioperative complications ,strengthening of health education of recipients ,improving of compliance and long-term regular follow-ups are conducive for enhancing long-term survival of recipients and grafts of SPK .
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Objective To investigate the clinical outcome of single kidney transplantation from pediatric donors and to explore the application criteria.Methods The clinical data of 14 recipients undergoing renal transplantation from October 2006 to October 2016 were retrospectively analyzed.All the recipients received primary kidney transplantation from pediatric donor and the renal artery was anastomosed with external iliac artery.Based on the length of the kidney donor,the recipients were divided into two groups as group A (length beyond 6 cm) and group B (length 5-6 cm).The clinical effect and complications of the 14 recipients,the survival of the recipients and grafts,the recovery of renal function,the change of the renal length and the postoperative complications were compared between the two groups.Results The renal length in group A (n =7) was (7.5 ± 1.2) cm,and (5.7 ± 0.1) cm in group B (n =7).During the follow up period,all renal grafts and recipients survived.No significant difference was observed between two groups in renal graft function evaluated by serum creatinine and estimated glomerular filtration rate (eGFR) at 7th day,14th day,1st,2nd,3rd and 6th month postoperatively,P＞0.05.The length of transplanted kidney increased after operation in both groups,with results of 9.9 ± 0.6 cm in group A and 10.4 ± 1.5 cm in group B (P＞0.05),respectively,at 2nd month post-transplantation.Delayed graft function (DGF) occurred in 2 cases of group A and 1 case of group B.Seven cases developed proteinuria (50.0％),including 2 cases in group A (28.6％) and 5 cases in group B (71.4％).Four cases suffered hematuria (28.6％),including 2 cases in group A (28.6％) and 2 cases in group B (28.6％).One recipient in group B suffered acute rejection.No vascular embolization,urine leakage,pulmonary infection and other complications were observed in all the recipients.Conclusion The length beyond 5 cm is acceptable for single pediatric kidney donor for adult recipients with a promising clinical outcome in short-term.However,the high incidence of proteinuria and hematuria remains obstacle,and the long-term outcome needs further exploration.
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Objective To evaluate the effect of dexmedetomidine on the postoperative pulmonary function in patients undergoing laparoscopic operation.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 45-64 yr,weighing 45-70 kg,undergoing laparoscopic radical resection of rectal cancer,were divided into 2 groups (n =40 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).General anesthesia combined with epidural anesthesia was used.In group Dex,dexmedetonidine was intravenously infused as a bolus of 0.3 μg/kg over 10 min after epidural catheterization and before induction of general anesthesia,followed by an infusion of O.4 μg · kg-1 · h-1 starting from the end of tracheal intubation until 30 min before the end of operation.The equal volume of normal saline was given instead in group C.After epidural catheterization and before infusion of dexmedetomidine (T0),immediately before termination of pneumoperitoneum (T1) and at 1,6 and 24 h after operation (T2-4),blood samples were taken from the peripheral vein for determination of concentrations of serum interleukin-6 (IL-6),IL-10,tumor necrosis factor-alpha and malondialdehyde,and arterial blood gas analysis was performed simultaneously.Respiratory index and oxygenation index (OI) were calculated,and the occurrence of OI ≤ 300 mmHg was recorded.Results Compared with group C,the serum IL-6 and tumor necrosis factor-alpha concentrations and respiratory index were significantly decreased,and IL-1O concentrations and OI were increased at T1-4,and malondialdehyde concentrations were decreased at T1-3,and the incidence of OI ≤ 300 mmHg was decreased in group Dex (P＜0.05).Conclusion Dexmedetomidine can inhibit inflammatory responses and improve the postoperative pulmonary function in patients undergoing laparoscopic operation.
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ObjectiveTo investigate the clinical therapeutic effect of gemcitabine hydrochloride combined with stereotactic radiotherapy for locally advanced pancreatic cancer. MethodsA total of 122 previously untreated patients with locally advanced pancreatic cancer who were not able to undergo surgical resection and were admitted to Fuzhou General Hospital from June 2008 to June 2013 were selected, and according to the therapies, they were divided into the group with a combination of gemcitabine hydrochloride and stereotactic radiotherapy (group A, n=56) and the group with gemcitabine therapy alone (group B, n=66). The changes in condition, toxic and side effects, and death time were recorded. The chi-square test was applied for comparison between groups, and the Kaplan-Meier method was applied for plotting survival curves. ResultsThere was a significant difference in response rate between group A and group B ［67.8% (38/56) vs 227% (15/66), χ2=25.11, P＜0.01］; the effective pain-relieving rate showed a significant difference between group A and group B (95.8% vs 77.2%, χ2=7.39, P＜0.01); there were significant differences in 1-year survival rate, 2-year survival rate, and median survival time between the two groups ［58.9% (33/56) vs 31.8% (21/66), χ2=9.03, P＜0.01; 28.6% (16/56) vs 106% (7/66), χ2=6.39, P＜0.01; 12.8 months vs 7.9 months; χ2=15.51, P＜0.01］. ConclusionGemcitabine hydrochloride combined with stereotactic radiotherapy has good short- and long-term efficacy, and toxic and side effects are tolerable.
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Objective To investigate the clinical characteristics and strategies of early stage antibody-mediated rejection after renal transplantation.Method The clinical data of early stage AMR of 3 cases of renal transplantation,and 1 case of pancreas transplantation after renal transplantation were retrospectively analyzed.(1) The case 1 was diagnosed as having early severe acute AMR.Serum creatinine was increased,urine volume rapidly reduced,the blood flow of transplanted kidney reduced on the postoperative day 8;the positive rate of panel reactive antibody (PRA) class Ⅰ and Ⅱ was 74.6％,and 2.7％ respectively on the postoperative day 12.Biopsy showed widely ischemia and local bleeding in transplanted kidney and DSA showed anti-B62 mean fluorescence intensity (MFI) increased to 6800 on the postoperative day 14.(2) The case 2 was diagnosed as having early mild acute AMR.The positive rate of PRA class [and Ⅱ was 65.6％ and 78.9％ respectively.DSA Ⅰ was positive,anti A11 MFI was 3059,and DSA Ⅱ was negative on the postoperative day 13.Biopsy showed mild ischemia reperfusion injury in transplanted kidney on the postoperative day 21.(3) The case 3 was diagnosed as having early severe chronic AMR,and the recipient received pancreas transplantation 1 year after kidney transplantation.Eight months after pancreas transplantation,DSA for pancreas donor was detectable,anti A2 MFI was 7514,anti B46 MFI was 3 159 and anti DQ7 MFI was 1 503.(4) The case 4 was diagnosed as having early mixed rejection.Serum creatinine was elevated on the postoperative day 8;PRA testing showed that the positive rate of class Ⅰ and Ⅱ was 3％ and 70％ respectively,DSA was positive,and anti DR16 MFI was 15 170 on the postoperative day 14;transplanted kidney biopsy showed acute mixed rejection on the postoperative day 16.Result Case 1 and case 3 were not diagnosed and treated in time and graft loss developed.Case 2 and case 4 were functionally recovered after combined treatment of plasmapheresis,IVIG and bortezomib.Conclusion Diagnosis of antibody-mediated rejection is based on transplant graft dysfunction,positive DSA and graft biopsy.Early diagnosis,early treatment and combined therapy can improve the curative rate of AMR.
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Objective To explore the immunoregulatory and lethal effects of natural killer T lymphocytes(NKTs) in vitro .Meth‐ods The mixed lymphocyte cultured(MLC) system was established ,in which the B16F10‐luc‐G5 cells were set as target cells ,the total lymphocyte cells were set as effector cells .(1)In the experiment on immunoregulatory effects ,NKT lymphocytes or CD4+CD25+ T lymphocytes were set as regulating cells ,there was three groups ,including the NKT group ,CD4+CD25+ T group and pure target cell control group .Otherewise ,the 1640 blank control group was set by only adding RPMI1640 solution .(2)In the ex‐periment on antitumor effects ,the NKT or natural killer(NK) lymphocytes were set as killer cells ,there was three groups ,inclu‐ding the NKT group ,NK group and pure target cell control group .Mixed culturing 24 ,48 and 72 hours ,the bioluminescence of target cells in MCL system was detected by using the in vivo imaging system .Results (1)In the experiment on immunoregulatory effects ,there were statistically significant differences in measured average photon numbers between NKT group ,CD4+ CD25+ T group and the two control groups(P<0 .05) .The statistically significant differences were also found in the NKT group between 24 hours and 72 hours (P<0 .05) .(2)In the experiment on antitumor effects ,there were statistically significant differences in meas‐ured average photon numbers ,when the NKT group and NK group were compared to the pure target cell control group(P<0 .05) . After culturing 24 and 72 hours ,statistically significant differences were found between NKT group and NK group(P<0 .05) .Con‐clusion The NKT cells could inhibit the lethal effects of lymphocyte cells on target cells ,and the inhibitory effects are changed by the length of culturing .Compared with the CD4+CD25+ T lymphocytes ,NKT lymphocytes have strongger regulatory effects .Addi‐tionally ,the NKT cells have lethal effects on target cells ,which might be weaker than that of NK cells .
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Objective To evaluate the analysis capability of urine protein qualitative test between AX-4030 and Cobas U411 u-rine dry chemistry analyzer,and study on evaluating the performance of qualitative test.Methods According to Clinical and Laboratory Standards Institute(CLSI)EP12-A2 document,analyzed the bias and imprecision of urineprotein qualitative test between the Aution MAX AX-4030 and Roche CobasU411 system.Their C50 ,C5 ~C95 intervals and imprecision curves were compared.The protein of 310 specimens were simultaneously determined by both Cobas U411 and AX-4030,in order to eval-uate their concordance.Results C50 for AX-4030 system was less than that for Cobas U411;C5 ~C95 interval of AX-4030 system was narrower than CobasU411.The imprecision curve of AX-4030 system was steeper than Cobas U411.The com-parison of the two analysis systems showed that the concordance was 96.8%,the positive concordance was 82.7%,and the negative concordance was 99.6%.The 95% credibility interval (CI)was 94.2%~98.16% and the Kappa value was 0.88. Conclusion For the sensitivity and imprecision of urine protein test in the C50 critical value,the AX-4030 system was better than Cobas U411.The concordance of them in determining clinical specimens was pole-strength.The evaluation recommen-ded by the EP12-A2 document is practical and effective.
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siRNA drug research and development is becoming one of the main objectives in the future. However, due to the in-stability of siRNA and the complex environment in vivo, the safe and effective delivery of siRNA is limited in vivo. Thus, special vectors are used to assist siRNA to express biological effects. This paper reviews the advances in non-viral vector for delivery of siRNA in vivo.
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Aim To construct eukaryotic expressing plasmid of hi FGF2 ( high molecular weight isoform fi-broblast growth factor-2,hi FGF2) gene and to investi-gate its effect on apoptosis after its overexpression in HEK293 cells. Methods The DNA template primer was designed and synthesized. The pDsRed1-N1 plas-mids were digested by the restriction enzymes of Nhel and Hind III. The hi FGF2 was ligated with linearized pDsRed1-N1 by T4 DNA Ligase. The recombinant plasmid was identified by endonuclease digestion and sequenced. The recombinant hi FGF2 plasmid was transient transfected into HEK293 cells by Lipofectami-neTM 2000 Reagent. The transfection efficiency was de-tected by fluorescence inversion microscope. The cell apoptosis was detected by Annexin V-FITC/PI apopto-sis detection kit with flow cytometry analysis. Results The pDsRed1-N1 eukaryotic expression vector was consistent with the design. The recombinant hi FGF2 plasmid was transfected in HEK293 cells. The trans-fection rate was more than 70%. The FITC/PI dyeing rate in hi-FGF2 over-expression HEK297 cells was a-bout ( 29. 12 ± 2. 81 )%. Conclusions pDsRed1-N1 eukaryotic expression vector is successfully constructed and transfected into HEK293 cells. Over-expression of hi FGF2 induces cell apoptosis.
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Objective To evaluate the correlation between intracranial hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery(FLAIR) and the degree of the stenosis of internal carotid artery (ICA).The effect of carotid endarterectomy(CEA) on HVS was assessed.Methods A retrospective analysis of MR FLAIR sequence and cerebral-cervical computed tomography angiography(CTA) was performed in 1 total of 491 patients.Of the 491 patients,41 treated with CEA were evaluated using their pre-and post-operative image data.Patients were divided into ICA stenosis group and non-stenosis group according to the CTA imaging findings.The ICA stenosis group was subdivided into unilateral group and bilateral stenosis group.Furthermore,we measured and graded the ICA of the unilateral stenosis group into seven stenotic degrees,they were＜50％(n=40),50％-＜60％(n=15),60％-＜70％(n=17),70％-＜80％ (n=6),80％-＜90％ (n=7),90％-＜100％ (n=23),100％ (n=24),respectively.Chi square test was used to analyze the occurrence rates of HVS between ICA stenosis and non-stenosis group,and between ICA unilateral and bilateral stenosis group,respectively.Spearman rank correlation was performed to evaluate the correlation between the presence of HVS and stenotic degrees of the ICA.For the 41 patients who underwent CEA,pre-and post-operative image data were compared,focusing on the presence or disappearance of the HVS on MR FLAIR imaging.Results HVS on FLAIR images were observed in 81 of 177 patients(45.76％) with ICA stenosis,and in 59 of 314 patients(18.79％) without ICA stenosis.The occurrence rate of HVS was significantly higher in patients with ICA stenosis than those without ICA stenosis (x2=40.40,P＜0.01).There was no statistical significance in the occurrence rates of HVS between ICA unilateral stenosis group and bilateral stenosis group(x2=0.24,P＞0.05).The occurrence rates of HVS of ICA graded as the seven stenotic degrees were 22.00％(8/40),26.67％(4/15),35.29％(6/17),33.33％ (2/6),42.86％ (3/7),69.57％ (16/23),83.33％ (20/24),respectively.There was a significant positive correlation between the occurrence rates of HVS and the degrees of ICA stenosis(r=0.964,P＜0.01).HVS disappeared in 19(86.36％) out of 22 patients with HVS on pre-operative MR images after CEA in The remaining HVS in 3(13.64％) patients was attributed to the failure of completely recanalization of ICA.Conclusions A close relationship exists between HVS and ICA stenosis.The presence of HVS indicates a high probability of the existence of severe ICA stenosis.A further assessment for ICA stenosis is warranted.HVS disappearance after successful CEA indicates that HVS can be a useful marker for the the evaluation of consequence associated with CEA.
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Objective To investigate the clinical effects of reconstruction by using the free iliac flap with nerve anastomosis to repair the composite tissue defects of heel.Methods From March 2009 to August 2012,five cases with the composite tissue defects of heel,including 2 cases with the bottom defects and 3 cases with the tibial defects of heel,were repaired by the free iliac flap,and the feeling of the heel were reconstructed by nerve anastomosis of the flap.The ventral wound were sutured simply.Results All iliac flaps survived and the wound healed in one stage.Patients were followed up from 6 months to 12 months.Appearance and function recovered and the feeling recovered from S2-S3.The foots walked freely.The skin of iliac abdomen were scarred and lead to hyperpigmentation.Conclusion Using the free iliac flap with nerve anastomosis could repair the bone and soft tissue defects of heel and reconstruct the sensation of warmth and sense of pain of the heel.With the characteristics of hidden wound and little damage,the clinical effects was satisfied.
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<p><b>OBJECTIVE</b>To investigate the differences in the gene expression profiles of the peripheral blood immune cells between liver and kidney transplantation recipients.</p><p><b>METHODS</b>A dataset containing the gene expression profiles of 27 liver transplantation recipients and 25 kidney transplantation recipients (from GSE22229 and GSE28842, respectively) was downloaded from the GEO database. By combining gene set enrichment analysis (GSEA) and biological network analysis of the differentially expressed genes using Cytoscape software, we analyzed the core genes closely related to liver or kidney transplantations.</p><p><b>RESULTS</b>GSEA identified 20 highly overlapping genes for liver transplantation and another 20 for kidney transplantation using leading edge analysis. Fourteen hub nodes (gene) for liver transplantation and 13 for kidney transplantation were identified by cytoscape software using interaction network analysis. Five core genes related to liver transplantation and 5 to kidney transplantation were obtained by integrating GSEA and biological network analysis.</p><p><b>CONCLUSION</b>Controlling the transcription and translation of the genes of the peripheral blood immune cells is the main immune regulation mechanism in liver transplantation recipients, but in the recipients of kidney transplantation, the protein interaction network plays a more prominent role. Energy metabolism and functional regulation of the immune cells are closely related. The core genes in peripheral blood immune cells related to liver or kidney transplantation may play key roles in regulating immune functions.</p>
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Humans , Gene Regulatory Networks , Kidney Transplantation , Liver Transplantation , Oligonucleotide Array Sequence Analysis , TranscriptomeABSTRACT
Objective To evaluate the efficacy and safety of self-management anticoagulation treatment for low pulmonary embolism severity index (PESI) outpatient with acute pulmonary embolism (APE).Methods Sixty-eight patients with APE of PESI grade Ⅰ-Ⅱ were divide into inpatient group and outpatient group with 34 cases each by random digits table.All the patients were treated with low molecular heparin followed by oral anticoagulation,and self-management was used in outpatient group.The efficacy was observed within 14 days and 3 months.The efficacy outcome included recurrent venous thromboembolism (VTE),standardization time of international normalized ratio (INR),VTE-related emergency department visit times,bleeding events and total mortality.Results There were 2 cases(5.9％,2/34) in inpatient group and 1 case (2.9％,1/34) in outpatient group with recurrent VTE,and there was no statistical significance between two groups (P ＞ 0.05).Standardization time of INR in inpatient group [(8.5 ± 2.9) d] was shorter than that in outpatient group [(16.1 ± 4.4) d],and there was significant difference (P＜ 0.01).There was no significant difference in the VTE-related emergency department visit times between two groups (P ＞ 0.05).There was 1 case with major bleeding and 1 death respectively in outpatient group.Conclusion It is effective and safe to give early self-management anticoagulation treatment to APE patients with PESI grade Ⅰ-Ⅱ,which could shorten time spending in hospital and release burden both physically and mentally.
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Objective To investigate the effects of positive end-expiratory pressure (PEEP) after recruitment maneuvers (RM) on respiratory mechanics and gas exchange during laparoscopy in obese patients.Methods Sixty-three ASA physical status Ⅱ or Ⅲ patients,aged 42-64 yr,with body mass index 30-40kg/m2,were randomly allocated into 3 groups (n=21 each):PEEP0 group,PEEP5 group and PEEP10 group.PEEP was not given after RM in PEEP0 group.In PEEP5 and PEEP10 groups,a recruiting maneuver was followed by PEEP 5 and 10 cm H2 O,respectively,until the end of pneumoperitoneum.The intraabdominal pressure was set at 12mmHg in the three groups.Parameters of respiratory mechanics including peak airway pressure (Ppeak),airway plateau pressure (Peat),chest wall plateau pressure (PplatCW),airway resistance (Raw),elastance of respiratory system (ERS),elastanc of chest wall (ECW) and elastance of lung (EL) and parameters of gas exchange including oxygenation index (PaO2/FiO2),arterial to end-tidal difference in carbon dioxide (Da-ETCO2),alveolar-arterial oxygen tension difference (DA-aO2),and dead space/tidal volume ratio (VD/VT) were measured before pneumoperitoneum (T0),at 20 min of pneumoperitoneum (T1),at 10 min after the end of recruitment (T2),and at the end of pneumoperitoneum (T3).Results Da-ETCO2,ERS and Raw were decreased at T2,ECW and EL were decreased at T3 in PEEP5 group,and Da-ETCO2,VD/VT,DA-aO2,Pplatcw Raw and EL were decreased at T2.3,and PaO2/FiO2 was increased at T2,ECW was decreased at T3 in group PEEP10 as compared with that in group PEEP0 (P ＜ 0.05).Da-ETCO2 and VD/VT were decreased and PaO2/FiO2 was increased at T2,3,Raw was increased and EL was decreased at T2 in group PEEP10 as compared with that in group PEEP5 (P ＜ 0.01).Conclusion PEEP after RM can improve respiratory mechanics and gas exchange during laparoscopy in obese patients and PEEP maintained at 10 cm H2O after RM provides better efficacy than PEEP at 5 cm H2 O.