Difference and ratio of the cross-sectional area of median nerve at the carpal tunnel and the pronator quadratus muscle in diagnosing carpal tunnel syndrome: a cross-sectional study.

Background: At present, the most commonly used diagnostic method of carpal tunnel syndrome (CTS) is based on clinical manifestations and electrophysiology, but the electrophysiology is not cheap, invasive, and lacks the presentation of peripheral nerve conditions, which is exactly the advantage of ultrasound (US). The purpose of this study was to evaluate the accuracy and effectiveness of US in the diagnosis of CTS by calculating the cross-sectional area (CSA) at the carpal tunnel and proximally at the level of the pronator quadratus muscle., and to find an appropriate index that can be used to achieve the diagnosis in a more cost-effective manner. Methods: Forty-three wrists from 35 symptomatic CTS patients and 23 wrists from 18 asymptomatic volunteers were evaluated. Diagnosis in the CTS group was based on the American Academy of Neurology clinical diagnostic criteria. The ultrasonic probe was placed at the carpal tunnel and the distal 1/3 of the pronator muscle respectively, and the carpal tunnel cross-sectional area (CSAC) and the proximal cross-sectional area (CSAP) was calculated, with a further calculation of their difference (ΔCSA) and ratio (R-CSA). Results: There was a significant difference between the 2 groups regarding mean ± standard deviation (SD) of CSAC, CSAP, ΔCSA, and R-CSA (P<0.01). The cutoff value of 12.14 mm2 for CSAC had a sensitivity and specificity of 90.7% and 100%, respectively; the cutoff value of 1.235 mm2 for R-CSA had a sensitivity and specificity of 97.67% and 95.65%, respectively; and the cutoff value of 2.035 mm2 for ΔCSA had a sensitivity and specificity of 100% and 100%, respectively. Therefore, US was found to be an effective method for the diagnosis of CTS. Receiver operating characteristic curve (ROC) analysis of all patients showed area under the curve (AUC) was 0.9778 for CSAC, 0.9949 for R-CSA and 1.000 for ΔCSA. Conclusions: US can provide reference values for the diagnosis of CTS. CSAC, ΔCSA, and R-CSA can be used for CTS diagnosis and evaluation. The ROC curve analysis showed that among the 3 values, ΔCSA was the most useful in the diagnosis of patients with CTS. ΔCSA is considered a valid diagnostic value for CTS, as its threshold of 2.04 mm2 showed the highest sensitivity and specificity.

The expression of STEAP4 in peripheral blood predicts the outcome of septic patients.

BACKGROUND: Sepsis is a systemic disease characterized by extensive inflammatory responses and impaired organ function, which are characteristics that make it easily missed and complex to treat. A large number of laboratory and clinical studies on the diagnosis and treatment of sepsis have been continuously carried out, confirming the importance of mitochondrial function during the development of sepsis. STEAP4 is an important metalloreductase in mitochondria, which is involved in the biogenesis and respiratory chain of mitochondria. The role of STEAP4 in inflammation remains controversial. Research in this field may contribute to the development of new diagnostic and treatment options for sepsis. METHODS: The expression of STEAP4 was measured in the peripheral blood of patients with severe sepsis and compared with healthy controls. Cell and mouse inflammatory models were established to detect the expression of STEAP4 and other inflammatory cytokines. RESULTS: (I) The expression of STEAP4 in the peripheral blood of patients with severe sepsis is higher than that of healthy volunteers (P<0.01), which is related to the SOFA score and transaminase. (II) STEAP4 has a certain predictive effect on the outcome of patients [area under curve (AUC) =0.696, P<0.05, 95% CI: 0.528 to 0.833]. (III) Inflammation led to increased expression of STEAP4 gene in RAW264.7 cells and mouse liver tissue. CONCLUSIONS: The expression of STEAP4 is elevated in the early stage of sepsis and the degree of its elevation can be used to predict the clinical outcome of sepsis patients.

The risk factors of early hemorrhage after emergency intravenous thrombolysis in patients with acute ischemic stroke.

BACKGROUND: At present, the treatment of acute ischaemic stroke (AIS) by aticepase (rt-PA) in emergency veins has become the main treatment mode in hospital, but the research on early hemorrhage complications in patients with emergency thrombolysis is rarely reported. This research aims to study the earlier warning index of early hemorrhage complications in patients with emergency thrombolysis. METHODS: A retrospective analysis was performed on the clinical data of rt-PA intravenous thrombolysis-treated AIS patients in the advanced stroke center of the emergency department of a tertiary grade hospital from January 2018 to May 2020. Patients were divided into a hemorrhage group and non-hemorrhage group according to the hemorrhage situation within 24 hours after thrombolytic therapy. The differences between the 2 groups in terms of pre-thrombolysis risk factors were analyzed. Logistic regression analysis was used to analyze the independent risk factors associated with post-thrombolysis hemorrhage. RESULTS: After intravenous thrombolysis, the hemorrhage group had 91 cases and the non-hemorrhage group had 146 cases. Logistic regression analysis showed that atrial fibrillation, systolic blood pressure before thrombolysis, platelet count, and antiplatelet drugs were independent risk factors for hemorrhage after intravenous thrombolysis (P<0.05). CONCLUSIONS: Patients with AIS have a higher incidence of hemorrhage after intravenous thrombolysis. Atrial fibrillation, systolic blood pressure before thrombolysis, platelet count, and antiplatelet drugs were independent risk factors for hemorrhage after intravenous thrombolysis. These independent risk factors can provide a basis for clinical nurses to evaluate hemorrhage risk in AIS patients after intravenous thrombolysis.

Analysis of the epidemiological and clinical characteristics of 65 patients with scrub typhus on the east coast of China.

BACKGROUND: The present study set out to investigate the epidemiological and clinical characteristics of 65 patients with tsutsugamushi disease. METHODS: The clinical data of 65 patients with tsutsugamushi disease, who were admitted to the Affiliated Hospital of Nantong University were retrospectively analyzed. The clinical symptoms, laboratory examination results, clinical treatment plans, treatments, and outcomes of the patients were analyzed. RESULTS: The 65 patients with tsutsugamushi disease, included 40 males (61.54%) and 25 females (38.46%). The patients were aged from 1 year and 7 months to 88 years old, and the peak age was 60-70 years old. Geographically, the patients were concentrated in Rugao and Tongzhou District. Infections were most common between October and December (categorized as "autumn type"), and peaked in November. Farmers had the highest infection rate of any occupation (66%). All patients had the symptom of fever, with the body temperature of 60 (92.31%) patients exceeding 38.5 °C, while 58 (89%) and 51 (78%) patients had characteristic eschar and skin rash, respectively. There were 56 (86.15%) patients with varying degrees of liver damage, 8 (12.31%) cases of elevated D-dimer, 3 (4.62%) cases of myocardial injury, 38 (58.46%) cases of superficial lymph node enlargement, 8 (12.31%) cases of splenomegaly, and 2 cases (3.08%) of bulbar conjunctival congestion. Of the 65 patients enrolled, the overall misdiagnosis rate of first medical contact was 64.62. CONCLUSIONS: Tsutsugamushi disease, infection has obvious seasonality and a susceptible population, especially among farmers and the elderly.

In vitro bacteriostatic effects of Polymyxin B combined with Propofol medium and long chain fat emulsion injection against Escherichia coli.

BACKGROUND: Polymyxins is a class of cyclic polypeptide antibiotics with strong antibacterial activity against Gram-negative bacteria. However, bacteria become resistant to Polymyxins. Thus, Polymyxin B (PMB) in combination with other antimicrobials may be a better choice in clinic. This study aimed to evaluate the synergistic bacteriostatic effect of PMB combined with Propofol medium and long chain fat emulsion injection against Escherichia coli in vitro. METHODS: The Minimal Inhibitory Concentration of Polymyxin B combined with Propofol medium and long chain fat emulsion injection and two drugs used alone against Escherichia coli were detected with the Kirby-Bauer disk diffusion (K-B) method, and the diameter of the inhibition zone was calculated to evaluate bacteriostatic effects. RESULTS: Different concentrations of PMB all had obvious bacteriostatic effects on Escherichia coli, while different concentrations of Propofol medium and long chain fat emulsion injection had no bacteriostatic effects on Escherichia coli. The bacteriostatic effect of the combination of PMB with Propofol medium and long chain fat emulsion injection against Escherichia coli was synergistic, and no effects of uncorrelated and antagonism were observed in this combination. CONCLUSIONS: PMB combined with Propofol medium and long chain fat emulsion injection can improve the bacteriostatic effect for Escherichia coli in vitro.

G-rich sequence factor 1 serves as a prognostic biomarker in septic patients.

BACKGROUND: Sepsis is a condition of organ dysfunction caused by infection, and is unavoidably related to costs and mortality; however, no biomarker has yet been identified to clearly predict the prognosis of septic patients. In this study, we aimed to explore the role of guanine-rich sequence factor 1 (GRSF1) in evaluating the severity and prognosis of sepsis. METHODS: The expression of GRSF1 in peripheral blood was measured and analyzed in 42 septic participants and 32 healthy controls respectively by using quantitative reverse transcription polymerase chain reaction (RT-qPCR). Clinical data were assessed by correlation analysis. In addition, GRSF1 expression was investigated in cecal ligation and puncture (CLP) induced mice septic models by RT-qPCR and western blot (WB). RESULTS: The expression of GRSF1 expression in septic patients in the first day of electronic intensive care unit (eICU) administration was significantly lower in comparison with HC. Further analysis showed GRSF1 expression was strongly related to the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score. Low expression of GRSF1 predicted high mortality within 24 hours in septic patients and in CLP-induced mice. CONCLUSIONS: Decreased expression of GRSF1 was significantly correlated with high mortality in septic patients, and also in experimental septic mice. The GRSF1 protein may be a potential prognostic biomarker in sepsis.

Research progress of circRNA as a biomarker of sepsis: a narrative review.

OBJECTIVE: Explore the possibility of circRNAs as markers of sepsis. BACKGROUND: Sepsis is an abnormal immune response of our body to infection that can lead to organ failure and death. Although the research on sepsis has been extensive in the past few years, sepsis-associated morbidity and mortality are still increasing. Early diagnosis and early treatment are important for patients with sepsis. Although many markers, including procalcitonin and C-reactive protein, have been proposed as diagnostic indicators of sepsis, there are still challenges in the early diagnosis and treatment of sepsis due to the lack of sensitivity and specificity of these substances. Recently, a large number of studies have found that circular RNAs (circRNAs) participate in a variety of biological functions, such as immune response, regulating the expression of miRNAs, and they are closely related to the occurrence and development of many diseases, including sepsis. However, the clear mechanism of the role of circRNAs has not been fully elucidated. An increasing number of studies have confirmed that circRNAs have potential in the diagnosis and treatment of sepsis. By studying the regulatory mechanism of circRNAs in sepsis, we can search for new molecular intervention targets for the treatment of sepsis, which is conducive to the development of new molecular therapeutic drugs for sepsis. METHODS: In the present study, we summarize and analyze the role of circRNAs in the pathogenesis of sepsis and discuss the possibility of circRNA as a biomarker for the diagnosis of sepsis. CONCLUSIONS: The biological characteristics of circRNAs and their role in the occurrence and development of sepsis make them possible markers of sepsis.

The effect of HES130/0.4 sodium chloride solution on kidney function following early fluid resuscitation in shock patients.

BACKGROUND: Doctors often use a small dose of hydroxyethyl starch (HES) 130/0.4 sodium chloride solution in the emergency room; however, its effect on kidney function remains controversial. This study aimed to evaluate the effect of a small dose of HES130/0.4 sodium chloride solution on kidney function in shock patients during early fluid resuscitation. METHODS: This cohort study retrospectively analyzed the data of 129 shock patients requiring fluid resuscitation who had been admitted to the Emergency Department of the Affiliated Hospital of Nantong University from January 2019 to December 2020. Patients were divided into the observation group (n=40) and control group (n=89) according to the type of fluid resuscitation. In relation to the fluid resuscitation treatment, the observation group was treated with crystalloid solution, while the control group was treated with crystalloid and HES130/0.4 sodium chloride solution. To further explore the effect of a small dose of HES130/0.4 sodium chloride solution, the patients were further divided into the following 4 groups based on the specific fluid administered: (I) the HES(+), lactated Ringer's (LR)(+) group (n=85); (II) the HES(+), LR(-) group (n=4); (III) the HES(-), LR(+) group (n=31); and (IV) the HES(-), LR(-) group (n=9). The outcomes were in-hospital mortality and changes in creatinine (CR) level after fluid resuscitation. RESULTS: There were no significant differences in the in-hospital mortality rates between the observation and control groups (P=0.343). The CR levels of patients in the control and HES(+), LR(+) groups were reduced after fluid resuscitation (P=0.034; P=0.028). There was no significant change in patients' CR levels in the HES(+), LR(-) group after fluid resuscitation (P=0.999). CONCLUSIONS: Administering a small dose of HES 130/0.4 sodium chloride in patients with shock does not appear to affect kidney function and in-hospital mortality; however, these findings should be considered exploratory, and further studies should be conducted to confirm these results.

The role of lipoprotein-associated phospholipase A2 in acute kidney injury of septic mice.

BACKGROUND: This experiment aimed to investigate the role and mechanism of lipoprotein-associated phospholipase A2 (Lp-PLA2) in kidney injury in septic mice induced by cecal ligation and perforation (CLP). METHODS: Male BALB/c mice were randomly divided into two groups: sham-operation group (Sham group) and septic group (CLP group). The septic model was simulated by cecal ligation and puncture method, but only cecal ligation was used for the sham operation group. The whole serum and renal tissue samples of the mice were collected 24 hours after modeling in both groups. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of renal tissue, the renal injury score was recorded, and the creatinine (Cr) and blood urea nitrogen (BUN) levels were detected by automatic biochemical analyzer, while the serum Lp-PLA2 level was detected by enzyme-linked immunosorbent assay (ELISA). The 7-day survival rate and the survival curve of the two groups were statistically analyzed. RESULTS: Compared with the Sham group, the pathological score of renal injury in the CLP Group was higher, the level of Lp-PLA2 in serum was significantly increased (all P<0.01), and the expression of Lp-PLA2 in renal tissue was significantly elevated (all P<0.01). Furthermore, the 7-day survival rate of the Sham group was 90%, while that of CLP group was 25%. CONCLUSIONS: The expression level of Lp-PLA2 in blood and kidney tissue of septic mice was increased and correlated with prognosis. However, the predictive value of Lp-PLA2 for prognosis in septic mice needs further study.

A clinical study of preoperative carbohydrate administration to improve insulin resistance in patients with multiple injuries.

BACKGROUND: The purpose of this study was to investigate the tolerance and safety of carbohydrate administration to patients with multiple injuries prior to surgery, and to analyze the effects of carbohydrate intake on their immediate insulin resistance (IR), postoperative complications, and length of hospital stay. METHODS: A total of 125 patients with mild multiple injuries who were admitted to the Emergency Surgery Department of Affiliated Hospital of Nantong University for elective surgery were randomized to administration of either placebo or carbohydrate. Finally, 82 patients (male: 39, female: 43) successfully completed the experiment and collected data. Preoperative general condition, subjective comfort, blood glucose concentration, serum insulin and insulin resistance index (IR) were studied. RESULTS: The two groups of patients matched in gender, age, body mass index (BMI) (P>0.05). Patients in CHO group treated with carbohydrates three hours before surgery compared with patients treated with preoperative specification. The thirst, hunger and anxiety of the patients in the CHO group were significantly relieved (P<0.05). Blood glucose concentration, serum insulin, and IR were much lower in the CHO group (P<0.05). CONCLUSIONS: It is a relatively safe approach that patients took carbohydrates 3 hours before surgery, and there was no statistically significant difference in the incidence of postoperative aspiration. Taking carbohydrates before surgery can not only relieve preoperative discomfort, but also reduce postoperative insulin resistance, which is helpful to avoid postoperative metabolic disorder and speed up recovery.

The correlations between the serum expression of miR-206 and the severity and prognosis of sepsis.

BACKGROUND: An accurate assessment of the severity and prognosis of sepsis, especially septic shock, is vital for the tailored treatment of this condition. miRNA participates in the inflammatory response and cell apoptosis and regulates inflammation-related signaling pathways. Immune disorders often accompany sepsis. Since serum miRNA expression is superior to traditional biological markers in terms of sensitivity and specificity, its role in the assessment of sepsis has increasingly been recognized. METHODS: Serum miRNAs were extracted from septic patients and healthy individuals by using the ultracentrifugation method. The differential expressions of miRNAs in the serum samples were detected by high-throughput sequencing technology. The differentially expressed miRNAs between the two groups were analyzed by bioinformatics. The quantitative polymerase chain reaction real-time polymerase chain reaction (qRT-PCR) was used to amplify the sample size to verify the results and to screen the highly-expressed miR206 in septic patients. Subsequently, serum samples were collected from 63 septic patients, and 30 patients with septic shock and qRT-PCR were performed to analyze the expression of miR-206. These 93 patients were divided into the miR-206 low-expression group and miR-206 high-expression group according to miR206 expression level. The potential correlations between the miR-206 expression and the clinical data were analyzed by using SPSS 25.0. RESULTS: Serum miRNA expression significantly differed between septic patients and healthy individuals. High-throughput sequencing results showed that, compared with those in healthy individuals, 29 miRNA molecules were down-regulated, and 25 molecules were up-regulated in the serum samples of septic patients. qRT-PCR identified the significantly up-regulated miR-206 in septic patients. qRT-PCR also showed significantly higher miR-206 expression levels in patients with septic shock than in septic patients. Furthermore, we observed a significantly longer prothrombin time and activated partial thromboplastin time, and significantly higher SOFA score, APACHE-II score, and in-hospital mortality rate. miR-206 was positively correlated with SOFA sore and APACHE-II score. CONCLUSIONS: Serum miR-206 expression is positively correlated with the severity and prognosis of sepsis. Thus, it may be a potential biomarker for assessing the severity and prognosis of sepsis, although the specific mechanism warrants further investigations.

[Relationship between morphological traits and body mass of Miichthys miiuy]. / é®¸å½¢æ€æ€§çŠ¶ä¸Žä½“è´¨é‡çš„å ³ç³».

Miichthys miiuy Basilewsky is a commercially important marine fish in China. To understand the relationship between body mass and morphometric traits of M. miiuy, body mass (Y, g) and other eight morphometric traits (cm), e.g., total length (X1), body length (X2), head length (X3), trunk length (X4), tail length (X5), tail handle length (X6), tail handle height (X7), and body height (X8) of 524 individuals of about 12-month-old M. miiuy were measured in this study. The methods of correlation analysis, multiple regression analysis, and path ana-lysis were used to analyze the data. Also, the best model reflecting the relationship between morphometric traits and body mass were obtained through model fitting screening. The results showed that the correlation coefficients between every two traits ranged from 0.834 to 0.941, and all reached significance level (P<0.01). And body length was ruled out from the multiple regression analysis by the method of multicollinearity diagnosis. We established a regression equation using the rest morphologi-cal traits as variables and body mass as dependent variable, in which direct and indirect path coefficients and determinant coefficients were calculated. Four morphometric traits achieved highly significant levels (P<0.01), and they were the main decisive morphometric traits linked to body mass. The multiple linear regression model equation was established as Y＝-444.188 +7.943X1+12.861X4 +38.254X7 + 42.722X8. Among them, the trait with the strongest direct effect on body mass was the body height (0.351), then the total length (0.335). In addition, the best model fitted for the individuals was y=0.013 x2.891 for total length, y=2.028 x2.751 for body height. The method of model fit test showed the accuracy of total length estimated body mass was higher than that of body height. This research may provide an important reference for the effective use of morphological traits for breeding of M. miiuy.