Neuro-Interventional Diagnosis and Treatment Using the Right Transradial Approach in Patients with Aberrant Right Subclavian Artery.

OBJECTIVE: To assess the effectiveness and safety of neurological interventions using the right transradial approach (R-TRA) in patients with aberrant right subclavian artery (ARSA). METHODS: We retrospectively analyzed cases that underwent cerebral angiography and interventions at Huangpi District People's Hospital from January 2023 to July 2023. Out of 335 cases, 5 patients with ARSA were identified. RESULTS: All 5 cases underwent diagnostic cerebral angiography via R-TRA. Two of the patients received interventions via R-TRA: 1 underwent right internal carotid artery balloon dilation angioplasty, while another underwent left vertebral artery stenting. No surgery-related complications were observed during these procedures. CONCLUSIONS: R-TRA proves to be a safe and effective option for neuro-interventional surgery in patients with ARSA.

Combinatorial expression of γ-protocadherins regulates synaptic connectivity in the mouse neocortex.

In the process of synaptic formation, neurons must not only adhere to specific principles when selecting synaptic partners but also possess mechanisms to avoid undesirable connections. Yet, the strategies employed to prevent unwarranted associations have remained largely unknown. In our study, we have identified the pivotal role of combinatorial clustered protocadherin gamma (γ-PCDH) expression in orchestrating synaptic connectivity in the mouse neocortex. Through 5' end single-cell sequencing, we unveiled the intricate combinatorial expression patterns of γ-PCDH variable isoforms within neocortical neurons. Furthermore, our whole-cell patch-clamp recordings demonstrated that as the similarity in this combinatorial pattern among neurons increased, their synaptic connectivity decreased. Our findings elucidate a sophisticated molecular mechanism governing the construction of neural networks in the mouse neocortex.

Storage stability and shelf-life of soymilk obtained via repeated boiling and filtering: A predictive model.

This study investigated the effects of different processing methods on the quality and nutrition of soymilk, as well as the changes in storage stability (centrifugal sedimentation rate (CSR), viscosity, and particle size) and shelf-life of soymilk at different storage temperatures (25°C, 35°C, 45°C, and 55°C). Results showed that soymilk processed via the repeated boiling-to-filtering method (RBFM) exhibited the highest protein content (3.89 g/100 g), carbohydrate content (1.27 g/100 g), and stability coefficient (0.950). The CSR and particle size of RBFM soymilk increased gradually during storage at different temperatures, while the viscosity and sensory score decreased. The correlation between the CSR and the sensory score of RBFM soymilk was the highest (R 2 = .9868). The CSR was selected as the key indicator to predict the shelf-life of RBFM soymilk. The average residual variation in RBFM soymilk shelf-life based on the predictive model was 10.78%, indicating the strong accuracy of the model for predicting the shelf-life of RBFM soymilk stored at temperatures ranging from 25-45°C. This study provides a theoretical basis and technological support for the development, transportation, and storage of soymilk and soymilk beverage products.

The MBD-ACD DNA methylation reader complex recruits MICRORCHIDIA6 to regulate ribosomal RNA gene expression in Arabidopsis.

DNA methylation is an important epigenetic mark implicated in selective rRNA gene expression, but the DNA methylation readers and effectors remain largely unknown. Here, we report a protein complex that reads DNA methylation to regulate variant-specific 45S ribosomal RNA (rRNA) gene expression in Arabidopsis (Arabidopsis thaliana). The complex, consisting of METHYL-CpG-BINDING DOMAIN PROTEIN5 (MBD5), MBD6, ALPHA-CRYSTALLIN DOMAIN PROTEIN15.5 (ACD15.5), and ACD21.4, directly binds to 45S rDNA. While MBD5 and MBD6 function redundantly, ACD15.5 and ACD21.4 are indispensable for variant-specific rRNA gene expression. These 4 proteins undergo phase separation in vitro and in vivo and are interdependent for their phase separation. The α-crystallin domain of ACD15.5 and ACD21.4, which is essential for their function, enables phase separation of the complex, likely by mediating multivalent protein interactions. The effector MICRORCHIDIA6 directly interacts with ACD15.5 and ACD21.4, but not with MBD5 and MBD6, and is recruited to 45S rDNA by the MBD-ACD complex to regulate variant-specific 45S rRNA expression. Our study reveals a pathway in Arabidopsis through which certain 45S rRNA gene variants are silenced, while others are activated.

A review of clinical application and ethical research on medical genetic testing / 中国医学伦理学

The ethical issue of medical genetic testing is one of the highly concerned and controversial issues in the field of life sciences.With the rapid development of genomics research,the possibility of using genetic testing for disease risk assessment in clinical events has been increased,especially in precision medical genetic testing and preventive testing.By reviewing the current status and common ethical issues of the clinical application of genetic testing,and sorting out the corresponding ethical principles,this paper proposed the ethical principles of equal respect,informed consent,privacy protection,and non-harm,aiming to help medical staff to regulate diagnosis and treatment behavior,enhance their awareness of the ethical aspects of genetic testing,as well as promote the better development of genomics research.

Application Value of Target Calyx Pretreatment Technique for Treating Complete Staghorn Calculi by Endoscopic Combined Intrarenal Surgery / 中国微创外科杂志

Objective To investigate the safety and efficacy of target calyx pretreatment technique in the treatment of complete staghorn calculi by endoscopic combined intrarenal surgery(ECIRS).Methods Clinical data of 21 patients with complete staghorn calculus treated by ECIRS from October 2019 to September 2021 in our hospital were retrospectively analyzed.There were 8 cases in the left side and 12 cases in the right side.One case of bilateral kidney calculus was given right side treatment in the first stage.The stone density was(1101±185)HU.The operation was performed by two surgeons.Under general anesthesia,the patient was placed in an oblique supine lithotomy position.The target calyx was designed according to preoperative imaging examination.The stone in the target calyx was broken up by flexible ureteroscope in advance to expose the papillary dome.Percutanous nephrostomy of the target calyx was performed,and F18 or F20 percutaneous work access was established under surveillance by using flexible ureteoscope and ultrasound.Results The operation was successfully accomplished in one stage in all the 21 cases.The mean operation time was(121.8±21.2)min,the postoperative hemoglobin reduction was(9.38±4.36)g/L,the postoperative hospital stay was(4.4±1.4)d,and the postoperative stone free rate(SFR)was 85.7％(18/21).A total of 6 patients had postoperative complications,including 1 case of bleeding requiring blood transfusion,3 cases of fever,1 case of hydrothorax,and 1 case of postoperative pain in the operative area requiring analgesic treatment.Conclusion For complete staghorn calculus,using flexible ureteroscope to pretreat stones of target calices and then puncturing to establish percutaneous renal working channel can significantly increase the success rate of surgery and the immediate postoperative stone free rate,reduce the number of percutaneous renal channels,and improve the safety of surgery.

Machine Learning Enabled Decoding of Color-coded Droplet Arrays and Its Application in Multiplex Digital Nucleic Acid Analysis / 分析化学

To address the throughput limitations of digital nucleic acid analysis,a tricolor combination-based droplet coding technique was developed to achieve multiplex digital nucleic acid analysis with flexible throughput expansibility.To improve the analysis efficiency,a machine learning-based method was further developed for automatic decoding of color-coded droplet array.The machine learning algorithm empowered the computer program to automatically extract the color-position-quantity information of the droplets.By correlating this color-position-quantity of droplets before and after nucleic acid amplification,the proportion of positive droplets for each target was rapidly determined.This droplet decoding strategy was applied to multiplex digital nucleic acid analysis.The experimental results demonstrated that this droplet decoding method was fast and accurate,with a decoding process completed within 2 min.Furthermore,the droplet identification accuracy exceeded 99%.Additionally,the obtained nucleic acid quantification results exhibited a good correlation(R2＞0.99)with those reported by a commercial digital PCR instrument.

CRH neurons in the lateral hypothalamic area regulate feeding behavior of mice.

Food cues serve as pivotal triggers for eliciting physiological responses that subsequently influence food consumption. The magnitude of response induced by these cues stands as a critical determinant in the context of obesity risk. Nonetheless, the underlying neural mechanism that underpins how cues associated with edible food potentiate feeding behaviors remains uncertain. In this study, we revealed that corticotropin-releasing hormone (CRH)-expressing neurons in the lateral hypothalamic area played a crucial role in promoting consummatory behaviors in mice, shedding light on this intricate process. By employing an array of diverse assays, we initially established the activation of these neurons during feeding. Manipulations using optogenetic and chemogenetic assays revealed that their activation amplified appetite and promoted feeding behaviors, whereas inhibition decreased them. Additionally, our investigation identified downstream targets, including the ventral tegmental area, and underscored the pivotal involvement of the CRH neuropeptide itself in orchestrating this regulatory network. This research casts a clarifying light on the neural mechanism underlying the augmentation of appetite and the facilitation of feeding behaviors in response to food cues. VIDEO ABSTRACT.

[Detection and analysis of moving reaction boundary-based electrophoresis distance using smartphone images].

Electrophoresis titration (ET) based on the moving reaction boundary (MRB) theory can detect the analyte contents in different samples by converting content signals into distance signals. However, this technique is only suitable for on-site qualitative testing, and accurate quantification relies on complex optical equipment and computers. Hence, applying this method to real-time point-of-care testing (POCT) is challenging. In this study, we developed a smartphone-based ET system based on a visual technique to achieve real-time quantitative detection. First, we developed a portable quantitative ET device that can connect to a smartphone; this device consisted of five components, namely, an ET chip, a power module, a microcontroller, a liquid crystal display screen, and a Bluetooth module. The device measured 10 cm×15 cm×2.5 cm, weighed 300 g, and was easy to hold. Thus, it is suitable for on-site testing with a run time of only 2-4 min. An assistant mobile software program was also developed to control the device and perform ET. The colored electrophoresis boundary can be captured using the smartphone camera, and quantitative detection results can be obtained in real time. Second, we proposed a quantitative algorithm based on ET channels. The software was used to recognize the boundary migration distance of three channels, a standard curve based on two given contents of the standards was established using the two-point method, and the content of the test sample was calculated. Human serum albumin (HSA) and uric acid (UA) were used as a model protein and biosample, respectively, to test the performance of the detection system. For HSA detection, different HSA solutions were mixed with a polyacrylamide gel (PAG) stock solution, phenolphthalein was added as an indicator, and sodium persulfate and tetramethyl ethylenediamine (TEMED) were used to promote polymerization to form a gel. For UA detection, agarose gel was filled into the ET channel, the UA sample, urate oxidase, and leucomalachite green were added into the anode cell and incubated for 20 min. ET was then performed. The fitting goodness (R2) values of HSA and UA were 0.9959 and 0.9935, respectively, with a linear range of 0.5-35.0 g/L and a log-linear range of 100-4000 µmol/L. The limits of detection for HSA and UA were 0.05 g/L and 50 µmol/L, respectively, and the corresponding relative standard deviations (RSDs) were not greater than 2.87% and 3.21%, respectively. These results demonstrate that the detection system has good accuracy and sensitivity. Clinical samples collected from healthy volunteers were used as target blood samples, and the developed system was used to measure serum total protein and UA levels. Serum samples from five volunteers were selected, standard curves of total serum protein and UA were established, and the test results were compared with hospital standard testing results. The relative errors for serum total protein and UA were less than 6.03% and 6.21%, respectively, and the corresponding RSDs were less than 3.72% and 5.84%, respectively. These findings verify the accuracy and reliability of the proposed detection system. The smartphone-based ET detection system introduced in this paper presents several advantages. First, it enables the portable real-time detection of total serum protein and UA. Second, compared with traditional ET strategies based on colored boundaries, it does not rely on optical detection equipment or computers to obtain quantitative detection results; as such, it can reduce the complexity of the operation and provide portability and real-time metrics. Third, the detection of two biomarkers, serum total protein and UA, is achieved on the same device, thereby improving the multitarget detection potential of the ET method. These advantages render the developed method a promising detection platform for clinical applications and real-time POCT.

[Determination of human serum total protein via electrophoresis titration and capacitively coupled contactless conductivity detection].

Serum total protein refers to the sum of all proteins in the serum, and its content determination is relevant to human health monitoring and disease diagnosis. However, existing detection techniques present a number of limitations; for example, the Kjeldahl method suffers from the negative effects of interfering substances such as non-protein nitrogen (NPN). Although the electrophoresis titration (ET) method has solved interference problems to some extent, the current ET technique relies on optical detection methods, which increases the tediousness of the operation. This study addresses the challenge of accurate serum total protein detection by combining the traditional ET technique with capacitively coupled contactless conductivity detection (C4D). The research contributions of this work are multifold. First, it presents the first development of an ET-C4D detection system, which consists of six components: an ET power module, an ET chip, a C4D sensing module, a detection module, a data acquisition card, and software. The developed system can capture the conductivity of substances in the channel using the software developed by our laboratory during ET. The detection system can be used to quantify the total protein content in human serum without the addition of specific labeling reagents or using optical detection equipment, and its running time is approximately 300 s. Second, this research proposes the corresponding principle of the system. Under an electric field, ion migration results in different pH levels before and after the boundary, leading to a protein surface charge difference. The maintenance of the electrical neutrality of the substances in the detection channel is related to the protein surface charge; therefore, the ion concentration distribution of the substances in the detection channel changes as the protein surface charge varies. A plot of conductivity as a function of running time showed an "inverted clock shape", first falling and then rising. Owing to the addition of different types and concentrations of proteins, the microenvironment of the entire system changes, resulting in different changes in conductivity. Third, the performance of the detection system was tested using human serum albumin (HSA) standard protein, which was mixed with polyacrylamide gel (PAG) mother liquor, riboflavin, etc., and irradiated under ultraviolet light for 10 min to form a gel. The ET experiments were then carried out. The shape of the conductivity curve was consistent with the proposed principle, and the higher the HSA concentration, the lower the conductivity curve trough, followed by a lagged time of the trough. Quantitative analysis of the conductivity signals showed that the linear range was 0.25-3.00 g/L, with a linearity of up to 0.98. The limit of detection (LOD) was 0.01 g/L, the relative standard deviation (RSD) was 1.90%, and the relative error of the test values was <7.20%, indicating the good detection stability and sensitivity of the system. Clinical samples collected from healthy volunteers were used as target blood samples for serum total protein content measurement using our detection system. Blood samples from a volunteer were used to obtain a standard curve, and the serum samples of other four volunteers were selected for ET-C4D and biuret detection. The results showed that the relative errors between the two methods were within 4.43%, indicating the accuracy and reliability of the detection system. The advantages of the ET-C4D detection system proposed in this paper are as follows: (i) ET-C4D realizes the rapid detection of total serum protein content based on the ET technique; (ii) compared with the traditional protein ET technique, the ET-C4D method does not rely on specific labeling components or optical detection equipment, thereby reducing the complexity of the operation; and (iii) the output signal of ET-C4D can be used for quantitative analysis with excellent analytical performance and high accuracy. These merits highlight the potential of the developed system for clinical application and biochemical analysis.

Massive Open Online Courses and intercultural competence: analysis of courses fostering soft skills through language learning.

This paper aims to survey language teaching MOOCs that promote intercultural competence (IC). Specifically, the survey aims to identify the keywords most relevant to MOOCs with IC components, the languages taught, the offering countries, and the embedded soft skills. The selection of keywords is important because they can indicate connection between different disciplines. After trialing a broader set of keywords in several rounds of initial search, we identified five keywords that are the most relevant to language education with IC components on MOOCs: culture, intercultural, cross culture, multi culture, and society. Then courses with these five keywords on language learning are selected for further analysis. The results are summarized as follows: (1) Most language teaching MOOCs are found under the keyword "culture," indicating a strong connection between language education and intercultural communication; (2) In terms of the target languages and the offering countries, it is found that English, Chinese, and Spanish are the major languages widely taught in the context of intercultural competence; China, United States, and Ireland are the three countries which offer the highest numbers of MOOCs in this respect; United States, United Kingdom, and Australia are the three countries which offer the highest numbers of MOOCs of different languages. The results indicate that a limited number of languages and offering countries dominate the language learning MOOCs. The study calls for a plurality of languages and cultures to be taught through MOOCs, making more diversified knowledge systems accessible to global audiences. (3) The language teaching MOOCs not only focus on language but also aim to foster five types of soft skills (language learning skills, communication skills, business and entrepreneurship skills, career development skills, and cultural development skills), suggesting that intercultural competence and its related soft skills are usually important components embedded in such MOOCs courses.

A novel microbe-drug association prediction model based on stacked autoencoder with multi-head attention mechanism.

Microbes are intimately tied to the occurrence of various diseases that cause serious hazards to human health, and play an essential role in drug discovery, clinical application, and drug quality control. In this manuscript, we put forward a novel prediction model named MDASAE based on a stacked autoencoder (SAE) with multi-head attention mechanism to infer potential microbe-drug associations. In MDASAE, we first constructed three kinds of microbe-related and drug-related similarity matrices based on known microbe-disease-drug associations respectively. And then, we fed two kinds of microbe-related and drug-related similarity matrices respectively into the SAE to learn node attribute features, and introduced a multi-head attention mechanism into the output layer of the SAE to enhance feature extraction. Thereafter, we further adopted the remaining microbe and drug similarity matrices to derive inter-node features by using the Restart Random Walk algorithm. After that, the node attribute features and inter-node features of microbes and drugs would be fused together to predict scores of possible associations between microbes and drugs. Finally, intensive comparison experiments and case studies based on different well-known public databases under 5-fold cross-validation and 10-fold cross-validation respectively, proved that MDASAE can effectively predict the potential microbe-drug associations.

Minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis in children: Less blood loss and shortened segmental fusions/fewer pedical screws.

Objective: To explore the feasibility of a minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis. Materials and methods: From April 2022 to August 2022 in the hospital, three patients with torticollis and/or shoulder imbalance due to a cervicothoracic hemivertebra were performed on by hemivertebra resection and short fusion of the adjacent vertebrae. Resection was operated by a posterior approach. The average age of three patients of surgery was 8 years 2 months and the mean follow-up period was 6 months. Radiographic assessments and cosmetic outcomes were documented on changes in measurements of segmental scoliosis, neck tilt, head shift, shoulder balance, and sagittal profiles. Results: The mean operating time of the procedure was 283 min and the instrumentation density was 1.5 pedicle screws per vertebra. The mean estimated blood loss was 257 ml, which was 20% less than the data described in various literatures. The mean segmental Cobb angle at the cervicothoracic deformity was 35.9° before surgery, 20.7° after surgery, and 16.3° at the latest follow-up, with a correction rate of 54.59%. Neck tilt decreased from 17.3° before surgery to 14.3° after surgery, and 11.7° at the latest follow-up, with a correction rate of 32.37%. T1 tilt improved from 16.5° before surgery to 12.9° after surgery, and 7.6° at the latest follow-up, with a correction rate of 53.94%. The clavicle angle improved from 4.8° before surgery to 3.1° after surgery, and 1.9° at the latest follow-up, with a correction rate of 60.42%. Head shift improved from 21.4 mm before surgery to 9.2 mm after surgery, and 12.3 mm at the latest follow-up, with a correction rate of 42.52%. The correction of torticollis and shoulder asymmetry was achieved in all cases. Conclusions: Minimally invasive spine surgery strategy may be an option for congenital cervicothoracic scoliosis. A good correction of cervicothoracic dissymmetry is achieved, accompanied by fewer pedicle screws and less blood loss. By deliberate operation in young kids, surgical intervention for severe compensatory curves can be prevented.

Lipoprotein-Associated Phospholipase A2 Correlates with Reduced Left Ventricle Ejection Fraction in Hemodialysis Patients.

OBJECTIVE: Reduced left ventricular ejection fraction (LVEF) is common in hemodialysis (HD) patients. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is considered an important determinant of cardiovascular events. The aim of the study was to evaluate the relationship between Lp-PLA2 and LVEF in HD patients. METHODS: Fifty-seven HD patients with coronary heart disease were enrolled. Predialysis and postdialysis venous whole blood samples were collected. The patients were divided into preserved and reduced LVEF groups. The relationship between Lp-PLA2 and LVEF was assessed. RESULTS: A significant difference in C-reactive protein (CRP) and Lp-PLA2 was observed, with higher levels noted in patients with reduced LVEF (P ≤ .001). Both Lp-PLA2 and CRP were negatively correlated with LVEF in the HD patients. Only Lp-PLA2 remained associated with LVEF in multiple regression analysis. CONCLUSION: Lipoprotein-associated phospholipase A2 levels are associated with LVEF and could potentially be used to evaluate chronic heart failure with reduced LVEF in HD patients for risk stratification management.

A systematic review and meta-analysis comparing cardiac CT angiography with transesophageal echocardiography in planning left atrial appendage closure / 中国介入心脏病学杂志

Objective To systematically evaluate the differences in preoperative planning for left atrial appendage closure(LAAC)using cardiac CT angiography(CCTA)and transesophageal echocardiography(TEE).Methods Relevant studies comparing CCTA and TEE for preoperative assessment of LAAC published from the inception of each database to July 18,2023,were searched in PubMed,EMBASE,the Cochrane Library,CNKI,Wanfang,and CBM database.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results A total of 21 studies with 2 137 patients were included.Compared to TEE,preoperative CCTA measurement of the left atrial appendage(LAA)showed a larger maximum diameter(MD 2.27 mm,95％CI 1.70-2.83,P＜0.001)and higher accuracy in predicting occlusion device(RR 1.67,95％CI 1.39-2.01,P＜0.001).Subgroup analysis based on whether 3D reconstruction was performed and occlusion device type showed similar results.There was no statistically significant difference in the surgical success rate(RR 1.03,95％CI 0.98-1.08,P=0.230)between the two imaging methods.Additionally,preoperative 3D reconstruction based on CCTA resulted in fewer occlusion devices used(MID-0.29,95％CI-0.53--0.04,P=0.020),less contrast agent usage(MD-4.48 ml,95％CI-7.40—-1.56,P=0.003),shorter operative time(MD-14.98 min,95％CI-17.79—-12.17,P＜0.001),and a lower rate of postoperative residual leakage(RR 0.59,95％CI 0.36-0.99,P=0.040).Conclusions Compared to TEE,preoperative CCTA for LAAC improves the accuracy of occlusion device prediction.3D reconstruction based on CCTA reduces the occlusion devices used and the usage of contrast agents,shortens the operative time,improves surgical efficiency,and is associated with a lower rate of postoperative residual leakage.Therefore,CCTA has more advantages in preoperative planning for LAAC.

Construction and Application of Rib Fracture Diagnosis Model Based on YOLOv3 Algorithm / 法医学杂志

OBJECTIVES@#The artificial intelligence-aided diagnosis model of rib fractures based on YOLOv3 algorithm was established and applied to practical case to explore the application advantages in rib fracture cases in forensic medicine.@*METHODS@#DICOM format CT images of 884 cases with rib fractures caused by thoracic trauma were collected, and 801 of them were used as training and validation sets. A rib fracture diagnosis model based on YOLOv3 algorithm and Darknet53 as the backbone network was built. After the model was established, 83 cases were taken as the test set, and the precision rate, recall rate, F1-score and radiology interpretation time were calculated. The model was used to diagnose a practical case and compared with manual diagnosis.@*RESULTS@#The established model was used to test 83 cases, the fracture precision rate of this model was 90.5%, the recall rate was 75.4%, F1-score was 0.82, the radiology interpretation time was 4.4 images per second and the identification time of each patient's data was 21 s, much faster than manual diagnosis. The recognition results of the model was consistent with that of the manual diagnosis.@*CONCLUSIONS@#The rib fracture diagnosis model in practical case based on YOLOv3 algorithm can quickly and accurately identify fractures, and the model is easy to operate. It can be used as an auxiliary diagnostic technique in forensic clinical identification.

Xuebijing injection inhibits the degradation of pulmonary vascular endothelial calyx to improve acute lung injury induced by severe heatstroke / 解放军医学杂志

Objective To investigate the possible mechanism of Xuebijing injection in regulating abnormal degradation of pulmonary vascular endothelial calyx to improve acute lung injury induced by severe heatstroke.Methods Forty-eight Wistar rats were randomly divided into control group,heatstroke group and Xuebijing group.Before heatstroke induction,rats in Xuebijing group were administrated with Xuebijing injection(2 ml/kg,2 times/d)for 3 days.All rats were exposed to an environment with temperature of(40±2)℃and humidity of 65%±5%for 60 minutes to induce heatstroke.Two hours later,the lung wet/dry weight ratio was recorded;the concentration of proteins in BALF was measured;the pulmonary vascular permeability was measured by Evans blue(EB);HE staining was used to observe the pathological changes of lung tissue;the changes of hyaluronic acid(HA)on the surface of pulmonary vessels were observed by immunofluorescence;Western blotting was used to detect the expression of Syndecan-1,Glypican-1,VE-Cadherin,Occludin,VCAM-1 and E-selectin in lung tissues;Enzyme-linked immunosorbent assay(ELISA)was utilized to quantify the concentration of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)in serum and heparanase(HPA)in lung tissue.Results Xuebijing could decrease the lung wet/dry weight ratio,reduce protein exudation and improve pulmonary vascular permeability(P<0.01);reduce the histological injury(P<0.01);reduce the degradation of HA,Syndecan-1 and Glypican-1 on the surface of pulmonary vessels(P<0.01);increase the expression of VE-Cadherin and Occludin(P<0.01);regulate the overexpression of VCAM-1 and E-selectin(P<0.01);down-regulate the expression of TNF-α,IL-6 and HPA(P<0.01).Conclusion Xuebijing injection decrease the expression of HPA,improve the disintegration of pulmonary vascular endothelial calyx,repair the integrity of pulmonary vessels,reduce the damage of cell connections,down-regulate the expression of adhesion molecules,inhibit the inflammatory reaction,relieving acute lung injury caused by severe heat stroke.

Analysis of chest imaging features of novel coronavirus pneumonia, bacterial pneumonia and viral pneumonia / 中华危重病急救医学

Objective:To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia (COVID-19), bacterial pneumonia and other viral pneumonia.Methods:Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed, including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020, 16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020, and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020. Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease.Results:Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia, and the incidence was significantly higher than that of bacterial pneumonia (91.6%, 75.0% vs. 26.0%, P < 0.05). Compared with other viral pneumonia and COVID-19, bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion (62.0% vs. 18.8%, 5.6%, P < 0.05), accompanied by pleural effusion and lymph node enlargement. The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%, that of patients with other viral pneumonia was 56.2%, and that of patients with bacterial pneumonia was only 2.0% ( P < 0.05). The incidence rate of lung tissue consolidation (25.0%, 12.5%), air bronchial sign (13.9%, 6.2%) and pleural effusion (16.7%, 37.5%) in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia (62.0%, 32.0%, 60.0%, all P < 0.05), paving stone sign (22.2%, 37.5%), fine mesh sign (38.9%, 31.2%), halo sign(11.1%, 25.0%), ground-glass opacity with interlobular septal thickening (30.6%, 37.5%), bilateral patchy pattern/rope shadow (80.6%, 50.0%) etc. were significantly higher than those of bacterial pneumonia (2.0%, 4.0%, 2.0%, 0%, 22.0%, all P < 0.05). The incidence of local patchy shadow in patients with COVID-19 was only 8.3%, significantly lower than that in patients with other viral pneumonia and bacterial pneumonia (8.3% vs. 68.8%, 50.0%, P < 0.05). There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19, other viral pneumonia and bacterial pneumonia (27.8%, 12.5%, 30.0%, P > 0.05). Conclusions:The probability of ground-glass opacity, paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia, and it was more common in the lower lungs and lateral dorsal segment. In other patients with viral pneumonia, ground-glass opacity was distributed in both upper and lower lungs. Bacterial pneumonia is usually characterized by single lung consolidation, distributed in lobules or large lobes and accompanied by pleural effusion.

Periprosthetic fractures: the increasing challenges / 中华创伤骨科杂志

Surgery for periprosthetic fractures (PPF) is one of the most complex procedures in orthopedics. It is difficult, highly risky and extremely challenging, because the patients are usually advanced in age and suffering from essential organ dysfunction, numerous comorbidities, poor overall body condition, poor bone quality combined with osteolysis and even bone loss, and because the surgeons have to apply the concepts and techniques of Modern Orthopedic Trauma and artificial joint revision techniques in fracture fixation and prosthesis revision. This paper expounds on the clinical challenges due to the characteristics of PPF in order to call on clinical surgeons to update their concepts, deal with seriously and standardize their PPF treatment, and effectively improve their efficacy.

Combination pattern of internal fixation for periprosthesis fractures of the proximal femur after hip replacement / 中华骨科杂志

Objective:To investigate the combination of internal fixation for periprosthetic fractures of the proximal femur (PFFF) after hip arthroplasty.Methods:The data of 58 patients with periprosthetic fractures after hip arthroplasty from May 2008 to March 2022 were retrospectively analyzed, including 31 males and 27 females. The average age was 75.5±18.2 years (range, 35-95 years). There were 39 total hip arthroplasty and 19 hemiarthroplasty; 37 biological prosthesis and 21 cemented prosthesis. Intraoperative periprosthetic fractures occurred in 6 cases and 52 cases postoperatively. Unified classification system (UCS): UCS IV.3A1 type 2 cases, 3A2 type 1 case, 3B1.1 type 19 cases, 3B2.1 type 25 cases, 3B3 type 2 cases, 3C type 9 cases. Fracture site: 3 cases in zone A (greater trochanter), 46 cases in zone B (around the femoral stem), and 9 cases in zone C (distal to the tip of the femoral stem. Internal fixation is composed of primary and secondary fixation, the main fixation method was the cerclage of steel wire or titanium cable, locking compression plate, and locking attachment plate fixation. The secondary fixation method was the cerclage of titanium cable, which was required to cover three zones A, B and C to form an overall balanced fixation. The modified Harris hip scores (mHHS), plate length, working length and screw number of different internal fixation combinations were compared.Results:The follow-up time was 54.2±21.6 months (range, 11-86 months). All patients showed signs of fracture healing at 10.2±1.5 weeks (range, 7-13 weeks) after operation, and bony union was observed at 19.6±1.3 weeks (range, 17-22 weeks) after operation. No delayed union or nonunion was observed. After operation, one case had a stress fracture and was revised with double-plate internal fixation; one case had a failed internal fixation and was revised with double-plate internal fixation and a large allograft bone graft. The mHHS score of UCSIV.3B2.1 group (80.3±4.6) was the lowest at 6 months after operation, and the difference between the groups of different types was statistically significant ( F=256.72, P<0.001). The score of simple internal fixation group (91.6±4.2) was higher than that of revision combined with internal fixation group (81.9±4.1), and the difference was statistically significant ( t=8.32, P<0.001). The plate length and working length were 24.9±2.5 cm and 12.6±1.7 cm for UCS IV.3B1.1, 25.4±2.6 cm and 13.6±1.8 cm for 3B2.1 and 28.1±2.5 cm and 4.9±1.9 cm for 3C, respectively ( F=5.33, P=0.005; F=6.78, P<0.001). The number of screws in zone A was significant difference among different UCS types ( F=52.67, P<0.001); UCS IV.3B1.1 (6.5±2.3) and 3B2.1 (6.7±2.2) were more than 3B3 (3.5±1.5) and 3C (3.7±1.6). The number of screws in zone B was significant difference among different UCS types ( F=42.15, P<0.001); The number of UCS IV.3B1.1 (2.3±1.6) and 3B2.1 (2.8±1.9) were significantly more than that of 3B3 (1.0±0.5) and 3C (1.2±0.6). The number of screws in zone C was significant differences among different UCS types ( F=39.62, P<0.001); The number of UCS IV.3B1.1 (3.8±1.9) and 3B2.1 (3.9±1.7) were more than that of 3B3 (2.0±0.5), the difference was statistically significant ( P<0.05). Conclusion:The function of hip after simple internal fixation of proximal femoral periprosthetic fractures was better than that of those who underwent revision at the same time; the number of screws of UCSIV.B1 and B2 is more than that of B3.