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Objective:To construct a nomogram prediction model for predicting the risk of death in patients with sepsis-associated thrombocytopenia (SAT) in intensive care unit (ICU) for early indentification and active intervention.Methods:Clinical data of SAT patients admitted to ICU of the First Affiliated Hospital of Nanjing Medical University from December 2019 to August 2021 were retrospectively collected, including demographic data, laboratory indicators, etc. According to the prognosis at 28 days, the patients were divided into the death group and the survival group, and the differences of clinical variables between the two groups were compared. Multivariate Logistic regression analysis was performed to analyze the independent risk factors influencing mortality of patients within 28 days, then a nomogram predictive model was constructed and its performance was verified with internal data. Receiver operator characteristic curve (ROC curve) was used to evaluate the diagnostic effectiveness of the nomogram model, and the clinical applicability of this model was evaluated by clinical decision curve analysis (DCA).Results:A total of 275 patients were included, with 95 deaths at 28 days and a 28-day mortality of 34.5%. Compared with the survival group, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), lactic acid (Lac), platelet distribution width (PDW) on day 5 of ICU admission, blood urea nitrogen (BUN), total bilirubin (TBIL), aspartate aminotransferase (AST), C-reactive protein (CRP) of patients in the death group were higher, activated partial thromboplastin time (APTT) and prothrombin time (PT) were longer, platelet count (PLT) on day 3 and day 5 of ICU admission, direct bilirubin (DBIL), fibrinogen (FIB) were lower, the history of chronic lung disease, mixed site infection, lung infection, bloodstream infection, Gram-negative bacterial infection and fungal infection accounted for a higher proportion, the history of diabetes mellitus, urinary tract infection and no pathogenic microorganisms cultured accounted for a lower proportion, and the proportion of the use of vasoactive drugs, mechanical ventilation (MV), continuous renal replacement therapy (CRRT), bleeding events and platelet transfusion were higher. Multivariate Logistic regression analysis showed that APACHEⅡ score at the day of ICU admission [odds ratio ( OR) = 1.417, 95% confidence interval (95% CI) was 1.153-1.743, P = 0.001], chronic lung disease ( OR = 72.271, 95% CI was 4.475-1?167.126, P = 0.003), PLT on day 5 of ICU admission ( OR = 0.954, 95% CI was 0.922-0.987, P = 0.007), vasoactive drug ( OR = 622.943, 95% CI was 10.060-38?575.340, P = 0.002), MV ( OR = 91.818, 95% CI was 3.973-2?121.966, P = 0.005) were independent risk factors of mortality in SAT patients. The above independent risk factors were used to build a nomogram prediction model, and the area under the curve (AUC), sensitivity and specificity were 0.979, 94.7% and 91.7%, respectively, suggesting that the model had good discrimination. The Hosmer-Lemeshow goodness of fit test showed a good calibration with P > 0.05. At the same time, DCA showed that the nomogram model had good clinical applicability. Conclusions:Patients with SAT has a higher risk of death. The nomogram model based on APACHEⅡ score at the day of ICU admission, chronic lung disease, PLT on day 5 of ICU admission, the use of vasoactive drug and MV has good clinical significance for the prediction of 28-day mortality, and the discrimination and calibration are good, however, further verification is needed.
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This study investigated the effects and mechanisms of 6-gingerol on adipose tissue insulin resistance in naturally aging rats with glycolipid metabolism disorders. Twenty-seven aging male SD rats were randomly divided into a model group(aged, n=9) and two groups treated with 6-gingerol at 0.05 mg·kg~(-1)(G-L, n=9) and 0.2 mg·kg~(-1)(G-H, n=9). Six young rats were randomly assigned to a normal control group(NC). Rats were treated for seven weeks by gavage. Non-esterified fatty acid(NEFA) and insulin content was determined by enzyme-linked immunosorbent assay(ELISA), and adipose tissue insulin resistance index(Adipo-IR) was calculated. HE staining was used to observe the size of adipocytes in epididymal white adipose tissue(eWAT). The gene and protein expression levels of adiponectin receptor 1(AdipoR1), AMP-activated protein kinase α(AMPKα), phosphorylated AMPK(p-AMPKα~(Thr172)), peroxisome proliferator-activated receptor-γ coactivator-1α(PGC-1α), phosphatidylinositol 3-kinase(PI3 K), protein kinase B(Akt), phosphorylated Akt(p-Akt~(Ser473)), tumor necrosis factor-α(TNF-α), c-Jun N-terminal kinase 1/2(JNK1/2), phosphorylated JNK1/2(p-JNK~(Thr183/Tyr185)), interleukin-1β(IL-1β), and interleukin-6(IL-6) in adiponectin(APN), insulin, and inflammatory factor signaling pathways were detected by Western blot and real-time RCR, respectively. The results showed that 6-gingerol at a high dose could significantly decrease the fasting plasma content of NEFA and insulin and reduce Adipo-IR. Additionally, 6-gingerol at a high dose significantly increased the protein and mRNA expression of APN, AdipoR1, PGC-1α, and PI3 K in eWAT, elevated the relative expression of p-AMPK~(Thr172) and p-Akt~(Ser 473), reduced the protein and mRNA expression of TNF-α, IL-1, and IL-6 in eWAT, and decreased the relative expression of p-JNK1 and p-JNK2. This study reveals that 6-gingerol can improve insulin sensitivity of adipose tissues in aging rats with glycolipid metabolism disorders, and this effect is presumedly achieved by enhancing the PI3 K/Akt signaling pathway, inhibiting adipose tissue inflammation, increasing APN synthesis, enhancing AdipoR1 expression, and activating its downstream AMPK/PGC-1α signaling pathway.
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Animales , Masculino , Ratas , Tejido Adiposo , Envejecimiento , Catecoles , Alcoholes Grasos , Resistencia a la Insulina , Ratas Sprague-DawleyRESUMEN
Objective:To investigate the correlation of monocyte/lymphocyte ratio (MLR) with the prognosis and adverse event in critically ill patients.Methods:Basic information of patients were extracted from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ), including demographics, blood routine, biochemical indexes, systemic inflammatory response syndrome score (SIRS), sequential organ failure assessment (SOFA) score, and outcome, etc. MLR on the first day of intensive care unit (ICU) admission was calculated. The receiver operating characteristic curve (ROC curve) was applied to evaluate the prognostic value of MLR on the 30-day mortality and its cut-off value. According to the cut-off value, the patients were divided into two groups, and the differences between the groups were compared. Logistic regression model was used to analyze the relationship of MLR with 30-day mortality, continuous renal replacement therapy (CRRT), mechanical ventilation, the length of ICU stay, and total hospitalization time.Results:① A total of 43 174 critically ill patients were included. ROC curve showed that area under ROC curve (AUC) of MLR in predicting 30-day mortality was 0.655 [95% confidence interval (95% CI) was 0.632-0.687]. The cut-off value of MLR calculated according to the maximum Yoden index was 0.5. There were 16 948 patients with MLR ≥ 0.5 (high MLR group) and 26 226 patients with MLR < 0.5 (low MLR group). ② Compared with the low MLR group, the high MLR group had higher age, proportion of male, body mass index (BMI) [age (years old): 66.0 (51.7, 78.4) vs. 57.6 (27.1, 74.6), proportion of male: 57.2% vs. 52.5%, BMI (kg/m 2): 26.5 (22.5, 31.1) vs. 24.7 (14.3, 29.7)]. The high MLR group also had higher incidence of complications (hypertension: 49.2% vs. 44.6%, chronic heart failure: 32.6% vs. 21.7%, diabetes mellitus: 27.0% vs. 23.4%, chronic obstructive pulmonary disease: 21.5% vs. 16.1%, renal insufficiency: 19.3% vs. 13.1%), and higher white blood cell count (WBC), blood glucose, lactate (Lac), serum creatinine (SCr), SIRS score and SOFA score [WBC (×10 9/L): 13.8 (9.6, 19.2) vs. 11.5 (8.4, 15.6), blood glucose (mmol/L): 8.66 (6.88, 11.49) vs. 8.27 (6.55, 10.88), Lac (mmol/L): 2.2 (1.5, 3.7) vs. 2.1 (1.4, 3.3), SCr (μmol/L): 106.1 (70.7, 176.8) vs. 88.4 (70.7, 132.6), SIRS score: 3 (2, 4) vs. 2 (2, 3), SOFA score: 4 (2, 7) vs. 3 (1, 5)]. The 30-day mortality, and the proportion of patients with length of ICU stay > 5 days, total hospitalization time > 14 days, CRRT and mechanical ventilation > 5 days were significantly higher in high MLR group (30-day mortality: 20.0% vs. 8.3%, length of ICU stay > 5 days: 33.2% vs. 20.4%, total hospitalization time > 14 days: 33.7% vs. 16.2%, CRRT: 3.6% vs. 0.7%, mechanical ventilation > 5 days: 18.4% vs. 5.7%), with statistically significant differences (all P < 0.05). ③ After adjusted with the related factors, multivariate Logistic regression analysis showed that elevated MLR was an independent risk factor for increased 30-day mortality [odd ratio ( OR) = 1.54, 95% CI was 1.37-1.72, P < 0.001]. Moreover, the increased MLR was independently associated with the increased risk of usage of CRRT ( OR = 2.77, 95% CI was 2.18-3.51), mechanical ventilation > 5 days ( OR = 2.45, 95% CI was 2.21-2.72), the length of ICU stay > 5 days ( OR = 2.29, 95% CI was 2.10-2.49), and total hospitalization time > 14 days ( OR = 2.28, 95% CI was 2.08-2.49), all P < 0.001. Conclusions:Retrospective analysis of large sample shows that MLR elevation is an independent risk factor for 30-day mortality, usage of CRRT, prolonged mechanical ventilation time, prolonged hospitalization, prolonged length of ICU stay. MLR can be used for risk stratification of severe patients.
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Despite the great improvements in the techniques and perioperative management of liver transplantation in recent years, there are still several perioperative complications that may lead to the poor prognosis of recipients. Prolonged mechanical ventilation (PMV) is a common complication in the early stage after surgery and may result in a high incidence rate of postoperative complications, prolonged length of stay in the intensive care unit and hospital stay, and an increase in mortality rate. In recent years, many studies have reported PMV after liver transplantation, but no summarization and statistical analysis have been performed and there are still no effective measures to prevent PMV after liver transplantation. This article summarizes the influencing factors and interventions for PMV after liver transplantation, in order to provide valuable information for reducing the duration of mechanical ventilation after liver transplantation and improving the prognosis of liver transplantation recipients.
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Objective To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function.Methods The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography.The intimal display rate of the right ventricular segments,right ventricular end diastolic longitudinal dimension (RVLD),right ventricular end diastolic area (RVEDA),right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography.Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software,and right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV) and right ventricular ej ection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard,the accuracies of measuring RVEDVand RVLD by different methods were evaluated.All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods.Results ①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P <0.05).②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens.And the correlation was higher(0.916 vs 0.843),the consistency was better than that by unenhanced echocardiography.The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens.And the correlation was higher (0.928 vs 0.850),the consistency was better than that by unenhanced echocardiography.③For inter-and intraobservers reproducibilities,the interclass correlation coefficients of RVLD,RVEDV,RVESV, RVEF,RVEDA,RVESA,RVFAC with contrast-enhanced echocardiography were higher and 95％confidence interval ranges were smaller than those with unenhanced echocardiography. Conclusions Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function,providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice.
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Objective@#To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function.@*Methods@#The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography. The intimal display rate of the right ventricular segments, right ventricular end diastolic longitudinal dimension (RVLD), right ventricular end diastolic area (RVEDA), right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography. Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software, and right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard, the accuracies of measuring RVEDVand RVLD by different methods were evaluated. All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods.@*Results@#①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P<0.05). ②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.916 vs 0.843), the consistency was better than that by unenhanced echocardiography. The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.928 vs 0.850), the consistency was better than that by unenhanced echocardiography. ③For inter- and intraobservers reproducibilities, the interclass correlation coefficients of RVLD, RVEDV, RVESV, RVEF, RVEDA, RVESA, RVFAC with contrast-enhanced echocardiography were higher and 95% confidence interval ranges were smaller than those with unenhanced echocardiography.@*Conclusions@#Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function, providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice.
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Objective@#To investigate the effect of lung rehabilitation exercise on cancer-related fatigue and quality of life in patients with non-small cell lung cancer (NSCLC) undergoing chemotherapy.@*Methods@#From October 2016 to October 2018, 82 patients with NSCLC treated in Zhejiang Rongjun Hospital were randomly divided into control group (41 cases) and observation group (41 cases) according to random number table method.The control group was given routine intervention, while the observation group was given lung rehabilitation exercise on the basis of the control group.Both two groups were evaluated after 8 weeks of intervention.The changes of lung function, cancer-related fatigue and quality of life before and after intervention were compared between the two groups.@*Results@#After intervention, the FEV1% and FEV1/FVC in the two groups were higher than those before intervention (observation group: t=18.565, 11.207; control group: t=9.363, 6.028, all P<0.05). After intervention, the FEV1% [(64.38±3.79)%] and FEV1/FVC (69.47±6.54) in the observation group were higher than those in the control group [(56.74±2.85)% and (60.10±4.25)] (t=10.316, 7.692, all P<0.05). After intervention, the scores of body, cognition, behavior and emotion in the two groups were higher than those before intervention (observation group: t=17.663, 15.167, 12.304, 14.750; control group: t=9.869, 6.617, 7.566, 9.553, all P<0.05). After intervention, the scores of body [(6.57±0.31)points], cognition[(6.15±0.42)points], behavior[(6.32±0.31)points] and emotion [(6.28±0.21)points] in the observation group were higher than those in the control group [(5.78±0.28)points, (5.41±0.48)points, (5.78±0.27)points and (5.82±0.25)points] (t=12.109, 7.429, 8.411, 9.021, all P<0.05). After intervention, the scores of social function, cognitive function, emotional function, role function, physical function and general health in the two groups were higher than those before intervention (observation group: t=14.487, 17.845, 22.025, 16.393, 11.665, 14.533; control group: t=9.880, 9.777, 10.797, 6.231, 6.838, 6.512, all P<0.05). After intervention, the scores of social function[(75.48±8.19)points], cognitive function[(72.43±6.32)points], emotional function [(71.93±5.74)points], role function[(63.25±7.86)points], physical function[(69.45±8.97)points] and general health[(68.39±7.54)points] in the observation group were higher than those in the control group [(67.31±6.74)points, (60.38±5.75)points, (59.64±6.56)points, (51.47±10.29)points, (58.83±7.09)points and (56.82±7.38)points] (t=4.932, 9.030, 9.028, 5.825, 5.947, 7.022, all P<0.05).@*Conclusion@#Lung rehabilitation exercise has good clinical effect on patients with NSCLC undergoing chemotherapy.It can alleviate cancer-related fatigue and improve the quality of life of patients.It is worthy of clinical reference.
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BACKGROUND:Icariin can promote bone formation and inhibit bone resorption,but it is difficult to dissolve in water,and its bioavailability is very low in vivo.Therefore,a suitable carrier is essential to fully utilize the biological activity of icariin.OBJECTIVE:To prepare an icariin/β-tricalcium phosphate (β-TCP) composite scaffold and to characterize its biological characteristics.METHODS:Three-dimensional printing technology was utilized to prepare porous β-TCP scaffolds carrying nano zinc oxide,and the compressive strength of porous β-TCP scaffolds was detected before and after addition of nano zinc oxide.Water absorption and porosity of the porous β-TCP scaffolds were also measured.Ultrasonic emulsification solvent dialysis was performed to prepare icariin/poly(lactic-co-glycolic acid) (PLGA) microspheres,followed by the detection of water absorption and porosity.The porous β-TCP scaffolds and icariin/PLGA microsphere suspension were mixed to prepare icariin/β-TCP composite scaffolds.Microstructure observation of the composite scaffolds was done by scanning electron microscope,and meanwhile,water absorption and porosity were detected.The composite scaffold was then immersed into PBS,and icariin concentration in the supematant was measured at corresponding time points,based on which Icariin cumulative release curve was drawn.RESULTS AND CONCLUSION:(1) The porous microstructure of the porous β-TCP scaffold was regular,well distributed,and the connectivity was good.The pore spacing was about 600 μm.After addition of nano zinc oxide particles,the surface structure of the scaffold was more compact and the crystallinity was higher.(2) PLGA microspheres were spherical with a diameter of 1-4 μm,and the microspheres were uniform in size.(3) The maximum compressive strength of the porous beta tricalcium phosphate scaffold was (2.98±0.78) MPa,and increased to (8.95±0.29) MPa after addition of nano zinc oxide.(4) The water absorption rate and porosity were (25.09±0.96)％ and (66.93±2.84)％ for the porous β-TCP scaffold,(28.46±1.85)％ and (32.65±3.32)％ for the icariin/β-TCP composite scaffold,respectively.(5)The average encapsulation efficiency of the PLGA microspheres was (78.87±2.31)％,and the drug loading was (6.04±1)％.(6) The release amount of icariin could reach 52％ of the total amount at 16 days and 60％ of the total amount at 32 days.These findings indicate that the icariin/β-TCP composite scaffold has good mechanical properties and sustained-release performance.
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Objective To explore the effect of acute respiratory distress syndrome (ARDS) induced by endotoxin on the right ventricular function in rats. Methods Sixty male Sprague-Dawley (SD) rats were randomly divided into normal saline (NS) control group and lipopolysaccharide (LPS) model group with 30 rats in each group. The rat model of ARDS was reproduced by intratracheal instillation of LPS 10 mg/kg after tracheotomy, and the rats in NS control group was intratracheally given the same volume of NS instead of LPS. The survival of rats in each group was observed. Right ventricular function was evaluated by echocardiography at 6 hours and 12 hours after instillation of LPS or NS respectively. Then the rats were sacrificed by bloodletting, and the right heart and lung tissue were harvested. The lung wet/dry weight (W/D) ratio was assessed. The pathological changes in cardiopulmonary tissue in rats were observed with hematoxylin and eosin (HE) strain, and the pathological score of lung injury was calculated. Results There was no animal death in NS control group. In LPS model group, there were 3 rats dead at 6 hours, and 4 dead at 12 hours. The pathological manifestations of lung injury were found at 6 hours after instillation of LPS, and the marked pathological changes of ARDS, such as atelectasis and hyaline membranes were observed at 12 hours. There was no obvious abnormality in the lung tissue of the NS control group. Compared with the NS control group, the 12-hour lung W/D ratio and the lung injury pathological score in the LPS model group were significantly increased (lung W/D ratio:7.69±1.02 vs. 4.14±0.48, lung injury pathological score: 8.26±2.12 vs. 1.32±0.94, both P < 0.01). Echocardiography showed that the right heart function of rats was significantly abnormal with the prolongation of LPS induction time, which showed that pulmonary arterial diameter (PAD) and right ventricular diastolic diameter (RVDd) were increased, maximum blood flow velocity of pulmonary artery (PAVmax), maximum pulmonary artery pressure gradient (PAmaxPG),pulmonary artery acceleration time (PAAT) and tricuspid annular plane systolic excursion (TAPSE) were decreased, with significant differences at 12 hours as compared with those of NS normal group [PAD (mm): 2.84±0.31 vs. 2.11±0.37, RVDd (mm): 4.18±0.71 vs. 3.17±0.40, PAVmax (mm/s): 704.00±145.13 vs. 809.59±120.48, PAmaxPG (mmHg, 1 mmHg = 0.133 kPa): 2.07±0.88 vs. 2.73±0.76, PAAT (ms): 23.80±4.87 vs. 30.01±3.02, TAPSE (mm): 2.48±0.45 vs. 3.56±0.40, all P < 0.01]. Pathological examination showed that the cardiac tissue in the LPS model group showed disorder of myocardial cells and scattered inflammatory cells at 6 hours, and cardiomyocyte degeneration, structural destruction and inflammatory cells were found at 12 hours. Conclusion ARDS induced by instillation of LPS at 12 hours causes right ventricular dysfunction in rats.
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Objective: To evaluate the efficacy and safety of qiliqiangxin capsule in treating the patients with chronic heart failure (CHF). Methods: We searched the databases of Pubmed, EMBASE, Web of science, Wanfang, VIP, CBM and CNKI from 2007-01 to 2017-03 to collect the randomized trials of qiliqiangxin capsule in treating CHF patients. Blood levels of NT-proBNP, 6 minutes walkingdistance (6MWD), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and Minnesota living with heart failure questionnaire (MLHFQ) scores were compared between qiliqiangxin capsule treated patients and control patients. Results: A total of 22 randomized trials were finally enrolled which included 1988 patients by 2 groups: Qiliqiangxin capsule group, n=1002 and Control group, n=986. Patients were followed-up at the mean 6.5 months. Compared with Control group, Qiliqiangxin capsule group had decreased blood level of NT-proBNP, weighted mean difference (WMD)= -194.97, 95％ CI (-287.95 to -101.99), increased LVEF, WMD=5.24, 95％ CI (3.38-7.11), reduced LVEDD, WMD= -0.94, 95％ CI (-1.46 to -0.43), elevated 6MWD, WMD=53.81, 95％ CI (46.9-60.73), lower MLHFQ score WMD= -8.11, 95％ CI(-10.23 to -6.0) and less adverse events occurrence, OR=0.44, 95％ CI (0.25-0.79),P<0.01. Conclusion: Qiliqiangxin capsule was safe and effective for improving the cardiac function and quality of life in CHF patients.
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Patients who suffer from the recurrent patellar dislocation mainly show the recurrent dislocation of patellar, giving way, most patients have the history of trauma or dysplasia of keen joint. Traditional therapies of recurrent patellar dislocation include medical retinaculum placation, lateral retinaculum release, tibial tubercle osteotomy, femoral trochleoplasty etc. In recent years, with the development of anatomical and biomechanical researches on medial patellofemoral ligament(MPFL), more and more experts focus on the role of MPFL played in preventing the patellar dislocation. The treatment of recovering and correcting patellar tracking through MPFL reconstruction has been increasing gradually. However, till now, there was no therapy which could heal the recurrent patellar dislocation completely. The specific therapies of recurrent patellar dislocation are combination therapies, decided according to the anatomical and biomechanical conditions of patients, for recovering the stability of patients' patellar, the lower limb alignment and the function of keen-joint.
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Mechanical stimulation widely exists in the body and participates in adjusting biological behavior of many kinds of cells. As a common stress pattern in the body, the tensile strain widely exists in many organs, such as bone and cartilage, muscle tendon, cardiac and pulmonary vessels, and so on. In recent years, with the development of the researches of biomechanics, a variety of mechanical loading devices, which are used to simulate the complex mechanical stimulation in the body to provide the tensile strain including the isometric, uniaxial and various types of mechanical waveform, came into being. This is a huge boost to biomechanical research. Many researchers have found that the tensile strain stimulation can lead to the transformation of proliferation, differentiation and apoptosis of cells and change of cell matrix. However, for the same kind of cells, different kinds of tensile strain stimulation can lead to different and even the contrary results. In this paper, the effects of the tensile strain on the proliferation, differentiation and matrix of cartilage were reviewed. Understanding these characteristics will have important implications for the mechanism of cell proliferation and differentiation under the biomechanic stimulation and the prevention and treatment of diseases.
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Acute respiratory distress syndrome (ARDS) is a severe respiratory condition that is characterized by rapidly progressive hypoxemia with noncardiogenic pulmonary edema.Despite the improvement of therapeutic methods,the mortality of ARDS is in the range of 40％-50％ all over the world.Some studies have shown that a significant number of patients with ARDS had acute cor pulmonale (ACP),and ACP is independently associated with the mortality of patients with ARDS,which has attracted wide attention in recent years.This paper reviewed recent related studies,summarized the prevalence,pathogenesis and diagnostic approaches of ACP in ARDS,especially echocardiography which was considered as a cornerstone for ACP diagnosis,and elucidated the beneficial effects of right ventricular protective ventilatory strategy and prone-positioning on the pulmonary vasculature and right heart,in order to provide a novel idea for the therapy of ACP in ARDS.
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Objective To evaluate the diagnostic accuracy of Streptocuccus pneumoniae urinary antigen test (SpUAT) in patients with community acquired Streptocuccus pneumoniae pneumoniae (SPP). Methods The clinical studies relating SpUAT diagnostic accuracy for community acquired Streptocuccus pneumoniae infection were searched via computer and manual screening of Chinese databases including China National Knowledge Internet (CNKI), China Biology Medicine disc, China Technical Journal Full-text Database, and Wanfang Database as well as English databases such as PubMed, EBSCO, Elsevier Science, Ovid Technologies, and Springer. Data were extracted according to appropriate inclusion and exclusion criteria and analyzed with Meta-disc 1.4 and Stata 12.0 software. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio as well as diagnostic odds ratio (DOR) were calculated, and summary receiver operating characteristic curve (SROC) was plotted and area under SROC (AUC) was calculated to analyze the diagnostic accuracy of SpUAT for adult community acquired SPP. Results A total of 15 studies enrolling 6 866 patients were included, all of which with a quality assessment of diagnostic accuracy studies (QUADAS) score not lower than 10, indicating a high study quality. Random effect model was applied owing to non-threshold effect associated heterogeneity. It was shown by Meta analysis that compared with routine pathogen diagnosis (hemoculture, sputum smears, sputum culture and trachea and bronchus attractive culture), the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, and pooled negative likelihood ratio was 73% [95% confidence interval (95%CI) = 71%-76%,] 91% (95%CI = 90%-92%), 6.97 (95%CI = 4.13-11.77), and 0.30 (95%CI = 0.26-0.34), respectively, pooled DOR was 24.34 (95%CI = 13.14-45.11), and AUC of SROC was 0.8051±0.0362. It was indicated by heterogeneity test that experiment design (prospective or retrospective), sample sizes (lower than 200 or higher than or equal to 200), reference test (fewer than 3 or more than or equal to 3 test methods), or literature language (Hispanic or non-Hispanic) had no effect on study heterogeneity, indicating certain other unknown factors may be involved. Funnel plot suggested that 15 involved studies uniformly distributed along the two sides of regression line, indicating no publication bias. Conclusions The use of SpUAT for the diagnosis of adult community acquired SPP has a moderate sensitivity and high specificity. Although the overall accuracy of SpUAT diagnosis is relatively high, there is significant heterogeneity among the studies, so more high-quality studies are needed.
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Objective To analyze the risk factors of postoperatively prolonged mechanical ventilation (PMV) after liver transplantation.Method The clinical data of 117 patients who received liver transplantation were retrospectively reviewed.According to the duration of postoperative mechanical ventilation (＜24 h or ≥24 h),the patients were divided into two groups.Commonly-used clinical and lab indexes before,during and after operations were analyzed by using single variance logistic regression analysis,and the screened indexes were analyzed by stepwise multiple variance logistic regression analysis.Result Forty-two patients (35.9％) were diagnosed with PMV after liver transplantation.The intensive care unit stay in the control group was (1.60 ± 1.17) days,shorter than in PMV proup (9.35 ± 10.61days).Sixty indexes were analyzed by univarite logistic regression,and 49 indexes showed statistically significant differences (P ＜ 0.2).Multiple variance logistic regression analysis revealed that the levels of preoperative blood glucose,model for end-stage liver disease score (MELD),the blood loss volume during the operation and the levels of glutamic oxalacetic transaminase within 24 h after the operation showed significant difference.Conclusion Preoperative hyperglycemia,high MELD score,excessive intraoperative blood loss volume and the high level of glutamic oxalacetic transaminase after the operation are independent risk factors of PMV.
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Objective To study and compare the protective effects of pmtease inhibitor and corticosteroid on endotoxin-indueed acute lung injury in order to guide the choice of appropriate drugs. Method Thirty-two New Zealand rabbits were randomly divided(random number) into four groups with 8 rabbits in each, namely normal controls(C) ; lipopolysaecharide(LPS) group(L) ; ulinastatin(UTI) group(U) and dexamcthasone(DEX) group (D) .Except group C, all rabbits were injected with a dose of LPS 600 μg/kg iv. Meanwhile the rabbits in group U,group D received UTI(100 000 μ/kg), DEX(5 mg/kg), respectively. The specimens were collected 4 hours later for detecting the levels of TNF-α and NO in serum, and blood gas analysis, histological manifestations, the lung wet/dry weight ratio, lung tissue MPO and SOD activity, lung tissue MDA. Data were analyzed by ANOVA (SNK- q test), and P < 0.05 was considered as significantly different. Results Compared with group C, the lungs of the rabbits in group L had inflammatory granulocyte infdtration, diffused alveolar septum thickening and hemorrhagic spots were observed in pathological examinations. The histological changes of group U and group D were much lessened than those in group L. As groups U and D were compared with group L, there were significant differences inmany biomarkers including lung wet/dry weight ratio[(5.02±0.11),(4.93±0.13) vs.(5.37 ±0.29)],lung tissue MPO activity[(0.51 ± 0.05),(0.54±0.07) vs.(0.82 ± 0.09)] and MDA[(0.82 ±0.05),(0.81 ±0.04) vs.(0.96±0.05)], NO[(296.2± 11.7),(291.7 ± 15.8) vs.(351.8±19.6)] and TNF-α[group D(2.021 ± 0.122) vs. group L(4.999 ± 0.139)],lung tissue SOD activity[(120.3 ± 6.1),(122.6±3.5) vs.(105.1 ± 8.5)] and blood gas analysis[pH(7.30±0.23),(7.30±0.17) vs.(7.22±0.45) and PaO_2( 101.9 ± 6.8).( 102.5 ± 4.7) vs.(80.3 ± 3.3)] ; but there were no differences of above mentioned biomarkers between group U and D( P > 0.05). And there were no significant differences in PaCO_2 betweeu group U and D and group L[(37.0 ± 3.3),(37.6 ± 3.0) vs.(34.8 ± 2.3)]( P > 0.05). Conclusions The protective effects of ulinastatin on endotoxin-induced acute lung injury is comparable to those of dexamethasone, thus the former may be a clinical substitute for the latter with less side effects.
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Objective To study the effects of electrical stimulation of efferent vagus nerve on the endotoxic shock in rabbits. Method Sixteen Newzealand rabbits were randomly divided into 2 groups, namely group S as the stimulation group and group C as the control group). Rabbits were subjected to bilateral cervical vagotomy and had challenge with intravenous injection of lipopolysaccharide (LPS) (E. COLI O111: B4 , DIFCO, USA) in a dose of 600 μg/kg. The distal end of the left vagus nerve trunk was connected to an electric stimulator with bipolar electrode and controlled by an acquisition system. Stimuli with stable voltage (10 V,5 Hz,5 ms) were applied twice to the nerve for 10 minutes just before and after the administration of LPS in group S. At the time before and after the infusion of LPS 30 min,60 min, 120 min, 180 min,240 min and 300 min respectively, the heart rate(HR)and the mean arterial blood pressure (MABP) in each animal were recorded, and blood samples were taken for measuring serum tumor necrosis factor-αa(TNF-α) and interleukin-10 (IL-10). Results Compared with group C,the electrical stimulation of efferent vagus nerve could significantly attenuated the LPS-induced hypotension and de-creased the contents of TNF-α[(38.12±7.85) pg/mL vs. (55.12±7.89) pg/mL, P <0.01], but increased the contents of IL-10[(55.12±9.37)pg/mL vs. (40.15±5.44) pg/mL, P <0.01]afar LPS challenge. Conclusions The stimulation of the efferent vagus nerve can down-regulate systemic TNF-α, production and attenu-ate the development of shock after LPS challenge.
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<p><b>OBJECTIVE</b>To construct TIMP-1 siRNA eukaryotic expression vectors and evaluate their effect on TIMP-1 mRNA expression in hepatic stellate cells.</p><p><b>METHODS</b>The combinant lone DNA with cutting sites of BamH I and Xho I enzyme according to the sequences of 447-465, 552-540 TIMP-1 of rats and nonspecific sequence were selected and cloned to pGEM-T vector and sub-cloned to pRNAT-U6.2. They were then identified by double enzyme digestion analysis and DNA sequencing. Three plasmids were transfected into T6 separately through an oligofectamine package. TIMP-1 mRNA expression was evaluated by RT-PCR.</p><p><b>RESULTS</b>Targeting sequences of TIMP-1 siRNA eukaryotic expression vectors were correct. TIMP-1 mRNA expression was significantly reduced by transfecting them into the T6.</p><p><b>CONCLUSION</b>We successfully constructed two TIMP-1 siRNA eukaryotic expression vectors and the transfected cells can significantly suppress the TIMP-1 expression.</p>
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Animales , Ratas , Línea Celular , Silenciador del Gen , Vectores Genéticos , Células Estrelladas Hepáticas , Plásmidos , ARN Interferente Pequeño , Inhibidor Tisular de Metaloproteinasa-1 , Genética , TransfecciónRESUMEN
OBJECTIVE@#To explore the inhibitory effect of spinal topical morphine on the dorsal horn projection neurons in nerve-injured rats and its mechanism.@*METHODS@#Single-unit activity of dorsal horn projection neurons was recorded in anesthetized L(5)/L(6) nerve-ligated rats. Allodynia was determined by a behavior test in nerve-injured rats. The evoked neuronal responses to mechanical stimuli applied to the receptive field were determined before and after the spinal topical application of morphine, bicuculline plus morphine, strychnine plus morphine, and both bicuculline and strychnine plus morphine in normal, sham operation, and nerve-injured rats.@*RESULTS@#Spinal topical application of 10 micromol/L morphine significantly inhibited the evoked responses of dorsal horn projection neurons in normal, sham, operation and nerve-injured rats. However, the inhibitory effect of morphine was significantly reduced in nerve-injured rats compared with that in normal and sham operation rats. Furthermore, the topical application of 20 micromol/L bicuculline had little effect on the inhibitory effect of morphine in nerve-injured rats but it almost abolished the effect of morphine in normal and sham operation rats. The glycine receptor antagonist strychnine at 4 micromol/L significantly decreased the effect of morphine in nerve-injured, normal, and sham operation rats.@*CONCLUSION@#The loss of tonic GABAergic inhibition contributes to the reduced inhibitory effect of morphine on dorsal horn projection neurons in nerve-injured rats.
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Animales , Masculino , Ratas , Analgésicos Opioides , Farmacología , Bicuculina , Farmacología , Electrofisiología , Hiperestesia , Morfina , Farmacología , Dolor , Células del Asta Posterior , Ratas Sprague-Dawley , Nervios Espinales , Heridas y LesionesRESUMEN
OBJECTIVE@#To observe the effect of chloroquine on the apoptosis of intestinal mucosa epithelial cell and enterogenous bacteria-endotoxin translocation after total hepatic ischemia-reperfusion in rats.@*METHODS@#The rat total hepatic ischemia-reperfusion model was built by blocking the hepatic portal, suprahepatic and infrahepatic vena cava for 20 minutes. Ninety Sprague-Dawley rats were assigned randomly into the sham operation group (Group A, n = 30), total hepatic ischemia-reperfusion treatment group (Group B, n = 30), and chloroquine administrated group (Group C, n = 30). Each group was subdivided randomly into 3 subgroups (n = 10) according to different experiment time phases as follows: after 20 minutes of total hepatic vascular exclusion (T0), 4 hours after reperfusion (T1), and the 48 hours of survival. Group A and Group B were intravenously injected with normal saline 1 mL/kg while Group C received chloroquine 10 mg/kg which dissolved in 1 mL/kg normal saline intravenously. The levels of portal blood D-lactate, TNF-alpha, endotoxin, and the intestinal mucosa MDA concentration were measured at T0 and T1; the portal blood, mesenteric lymph node, and spleen tissues were cultured for bacteria; and the apoptotic index of intestinal mucosa epithelial cells at T0 and T1 and the survival rate after 48 hour reperfusion were obtained.@*RESULTS@#Compared with Group A, the levels of portal blood D-lactate, TNF-alpha, endotoxin and the intestinal mucosa MDA in Group B and Group C were significantly higher (P < 0.05 or P < 0.01). These indexes of Group C were lower than those of Group B (P < 0.05). The portal vein blood, mesenteric lymph node and spleen tissues existed the bacterium translocation both in Group B and Group C, and the positive rate in Group C was lower than that in Group B (P < 0.05). Apoptotic index of the intestinal mucosa epithelial cell increased significantly in Group B (P < 0.01) and Group C (P < 0.05), but the apoptotic index in Group C was lower than that in Group B (P < 0.05); the 48 hour survival rate of the rats in Group C was higher than that in group B (P < 0.05).@*CONCLUSION@#Chloroquine may decrease the intestinal mucosa epithelial cell apoptosis and the enterogenous bacteria-endotoxin translocation after total hepatic ischemia-reperfusion and increase the survival rate of the rats.