Progress in diagnosis and treatment of percutaneous endoscopic lumbar discectomy / 中国医师杂志

Lumbar disc herniation is one of the common orthopedic diseases. Percutaneous endoscopic lumbar discectomy (PELD) has gradually become a first-line surgical approach. Compared with open discectomy and open lumbar microdiscectomy, PELD has shorter operation time, less bleeding and lower complication rate, but the postoperative recurrence rate is relatively high and the learning curve is steep. Unilateral biportal endoscopic discectomy and full endoscopic transforaminal lumbar interbody fusion may be effective supplements to PELD. New technologies such as the combination of navigation and 3D printing technology, multi-mode nonlinear optical microscope, the combination of nuclear magnetic resonance imaging and artificial intelligence (such as deep learning and convolution neural network) will help to improve the accuracy of positioning and tissue discrimination of PELD, predict the surgical difficulty and postoperative recurrence, shorten the learning curve, and promote the popularization and application of PELD.

Risk factors of venous thromboembolism after lower extremity orthopedic surgery in the elderly / 中国医师杂志

Objective:To evaluate the risk factors of venous thromboembolism (VTE) after lower extremity orthopedic surgery in the elderly.Methods:The case data of 114 patients who underwent lower extremity orthopedic surgery in Jingdong Yumei Integrated Traditional Chinese and Western Medicine Kidney Disease Hospital from January 2018 to January 2019 were retrospectively collected. According to the presence or absence of VTE, they were divided into non VTE group (103 cases) and VTE group (11 cases). Univariate and multivariate logistic regression were used to analyze the independent risk factors of VTE after lower extremity surgery in the elderly. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficacy of independent risk factors for VTE.Results:Compared with the non VTE group, the VTE group had more male patients, less preventive application of traditional Chinese medicine, higher preoperative D-dimer levels, longer operation time and less drainage 48 hours after operation (all P<0.05). Multivariate analysis showed that long operation time was an independent risk factor for VTE ( OR=1.021, 95% CI: 1.007-1.036, P=0.004), and more postoperative drainage was an independent protective factor for VTE ( OR=0.993, 95% CI: 0.988-0.998, P=0.006). The AUC of VTE predicted by operation time and postoperative drainage volume were 0.691 (95% CI: 0.548-0.834, P=0.038) and 0.767 (95% CI: 0.679-0.856, P=0.004), respectively. The AUC of combined diagnosis of the two was 0.807 (95% CI: 0.731-0.883, P=0.001). Conclusions:The operation time >107 min and the drainage volume <225 ml 48 hours after operation are independent risk factors for VTE in elderly patients undergoing lower extremity orthopedic surgery. Orthopedic doctors should try to shorten the operation time and keep the postoperative drainage unobstructed in order to reduce the incidence of VTE.

The Novel Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) Directly Decimates Human Spleens and Lymph Nodes

While lymphocytopenia is a common characteristic of patients infected by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the mechanisms responsible for this depletion are unclear. Through careful inspection of the spleens and lymph nodes (LNs) from six cases with postmortem examinations, we observed that SARS-CoV-2 could directly infect secondary lymphoid organs to induce cell death. Immunohistochemistry demonstrated ACE2 (angiotensin-converting enzyme 2), the potential receptor of SARS-CoV-2, expresses on tissue-resident CD169+ macrophages in spleens and LNs. Immunofluorescent staining confirmed that viral nucleocaspid protein (NP) can be found in ACE2+ cells, CD169+ macrophages, but not in CD3+ T cells or B220+ B cells in spleens and LNs. SARS-CoV-2 infection induces severe tissue damage including lymph follicle depletion, splenic nodule atrophy, histiocyte hyperplasia and lymphocyte reductions. Moreover, in situ TUNEL staining illustrated that viral infection leads to severe lymphocyte apoptosis, which might be mediated by viral antigens inducing Fas upregulation. Furthermore, SARS-CoV-2 also triggers macrophages to produce IL-6, a proinflammatory cytokine that directly promotes lymphocyte necrosis. Collectively, these results demonstrate that SARS-CoV-2 directly neutralizes human spleens and LNs through infecting tissue-resident CD169+ macrophages.

Human Kidney is a Target for Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

BACKGROUNDThe outbreak of a novel coronavirus (SARS-CoV-2, previously provisionally named 2019 novel coronavirus or 2019-nCoV) since December 2019 in Wuhan, China, has become an emergency of major international concern. Apart from the respiratory system, it is unclear whether SARS-CoV-2 can also directly infect other tissues such as the kidney or induce acute renal failure. METHODSWe conducted a retrospective analysis of estimated glomerular filtration rate (eGFR) along with other clinical parameters from 85 patients with laboratory-confirmed COVID-19 admitted to a hospital in Wuhan from January 17, 2020 to March 3, 2020. Kidney tissues from six patients with postmortem examinations were analyzed by Hematoxylin and Eosin (H&E) and in situ expression of viral nucleocaspid protein (NP) antigen, immune cell markers (CD8, CD68 and CD56) and the complement C5b-9 was detected by immunohistochemistry. Moreover, the viral particles in kidneys were also investigated by transmission electronic microscope (EM). RESULTS27.06% (23/85) patients exhibited acute renal failure (ARF). The eldery patients and cases with comorbidities such as hypertension and heart failure more easily developed ARF (65.22% vs 24.19%, p< 0.001; 69.57% vs 11.29%, p< 0.001, respectively). H&E staining demonstrated kidney tissues from postmortems have severe acute tubular necrosis and lymphocyte infiltration. Immunohistochemistry showed that SARS-CoV-2 NP antigen was accumulated in kidney tubules. EM observation also demonstrated that viruses-like particles are visible in the kidneys. Viral infection not only induces CD68+ macrophages infiltrated into tubulointerstitium, but also enhances complement C5b-9 deposition on tubules. CONCLUSIONSSARS-CoV-2 induces ARF in COVID-19 patients. Viruses directly infect human kidney tubules to induce acute tubular damage. The viruses not only have direct cytotoxicity, but also initiate CD68+ macrophage together with complement C5b-9 deposition to mediate tubular pathogenesis.

Study of hemodynamics during cardiac arrest and after restoration of spontaneous circulation in a porcine cardiac arrest model induced by acute pulmonary embolism / 中华急诊医学杂志

Objective To observe the hemodynamic change during cardiac arrest (CA) and after restoration of spontaneous circulation (ROSC) in a porcine acute pulmonary embolism model. Methods A total of 14 inbred Beijing Landraces were used to estalish the model of CA and ROSC induced by acute pulmonary embolism through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Five resuscitated pigs restored spontaneous circulation. Hemodynamic changes were determined at baseline, CA, ROSC, and 0.5, 1, 1.5, 2, 2.5, 4, and 6 h after ROSC. Results Compared with the baseline, mean arterial pressure was decreased significantly, mean pulmonary arterial pressure and right ventricular pressure were increased significantly, and the heart rate had no change during CA induced by acute pulmonary embolism. The mean arterial pressure restored normal level gradually after ROSC, but was decreased at 4 h after ROSC compared with the baseline (P<0.05). The heart rate was faster at ROSC and 0.5-2 h after ROSC than the baseline (P<0.05). The mean pulmonary arterial pressure restored the baseline level after ROSC; The right ventricular pressure were decreased at 2.5 h (26.5±11.4)mmHg and 4 h (24.8±9.3)mmHg after ROSC compared with the level during CA (46.2±13.01)mmHg (P<0.05). The systemic vascular resistance peaked at 4 h after ROSC. The pulmonary vascular resistance level at ROSC was higher than the baseline [(96.5±24.8)DS/cm5 vs. (26.5±13.4)DS/cm5, P<0.05], and was decreased at 1 h and 2 h after ROSC, but was increased at 4 h and 6 h after ROSC [(98.5±0.7)DS/cm5 and (98.0±1.4)DS/cm5]. The changes of heart function: compared with the baseline, the left ventricular function at ROSC and 1-6 h after ROSC were declined significantly (all P<0.05), and right cardiac output declined at ROSC and 4 h and 6 h after ROSC (all P<0.05), and the level of cardiac function index was dropped at 1 h and 2 h after ROSC (P<0.05). Conclusions The mean arterial pressure was declined, mean pulmonary arterial pressure, right ventricular pressure and pulmonary vascular resistance were increased, cardiac function was decreased during CA induced by acute pulmonary embolism; After ROSC, hemodynamic changes were described as compensated in the early stage (1-2 h after ROSC) and decompensated (4 h after ROSC) with time.

Myocardial apoptosis and anti-apoptotic mechanism of captopril on cardiac arrest after resuscitation of pulmonary embolism / 中华急诊医学杂志

Objective To observe the myocardial apoptosis and the molecular mechanism of captopril inhibiting myocardial apoptosis on cardiac arrest (CA) after resuscitation in a porcine acute pulmonary embolism (APE) model. Methods In this study, 29 inbred Beijing Landrace wererandomly (random number)divided into four groups (n=5, each group): control, APE-CA, restoration of spontaneous circulation (ROSC)-captopril, and ROSC-saline. The model of CA and ROSC was induced by APE through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Ten of 19 pigs with CA recovered to spontaneous circulation were divided randomly into the ROSC-captopril and ROSC-saline groups. Pigs in the ROSC-captopril group were treated with captopril (22.22 mg/kg) via porcine femoral vein at 30 min after ROSC. Pigs in the ROSC-saline group were treated with equal normal saline at 30 min after ROSC. The myocardial tissues were evaluated at 6 h after ROSC. Western blot was used to evaluate the protein levels of Bax, Bcl-2, Caspase-3, phosphorylated (p)-Src and phosphorylated extracellular regulated protein kinase (p-ERK1/2). Immunohistochemistry was used to evaluate the protein expression of p-Src and p-ERK1/2. Enzyme-linked immunosorbent assay was used to detect myocardial Na+-K+-ATPase levels. Statistical analysis was performed using one-way analysis of variance and pearson correlation test. Results Compared with the control group, the protein expression of Bax (0.25±0.01, 0.53±0.01, 0.37±0.05, F=14.16, P<0.05) and Caspase-3 (0.24±0.01, 0.33±0.01, 0.34±0.06, F=7.32, P<0.05) in the APE-CA and ROSC- saline group were increased significantly, and the Bcl-2 expression was significantly decreased (0.56±0.02, 0.19±0.01, 0.37±0.10, F=6.68, P<0.05). Captopril reduced the protein levels of Caspase-3 and Bax, while stimulated the Bcl-2 expression (all P<0.05). Compared with the control group, the protein expression of p-Src and p-ERK1/2 were higher and the Na+-K+-ATPase level was decreased on CA and ROSC induced by APE (all P<0.05). Compared with the APE-CA group, the p-Src expression in the ROSC-captopril group (0.46±0.01 vs. 0.35±0.06, P<0.05) was decreased significantly. Captopril inhibited the activation of p-ERK1/2 than saline group (0.41±0.10 vs. 0.26±0.07, P<0.05), but has no effect on the Na+-K+-ATPase level. The protein expression of p-Src and p-ERK1/2 were positively correlated with the Bax, and negatively correlated with the Bcl-2 respectively. The myocardial Na+-K+-ATPase level negatively correlated with Caspase-3 protein expression. Conclusions The molecular mechanism of cardiomyocyte apoptosis on CA and ROSC induced by APE might be related to decreased Na+-K+-ATPase level and activation of p-Src and p-ERK1/2. The cardiomyocyte apoptosis were inhibited by captopril through reducing the expression of p-Src and p-ERK1/2 in myocardium.

iASPP on apoptosis in breast cancer cells which expressed wild type p53 / 中国病理生理杂志

AIM: To investigate the RNAi effect of the inhibitory member of the ASPP family (iASPP) on the apoptosis of human breast cancer cell MCF-7 which expressed the wild type p53 gene. METHODS: The recombinant plasmid pAd-iASPP-RNAi was transfected into MCF-7 cells. The expression of iASPP mRNA and protein was analyzed by RT-PCR and Western blotting, respectively. The cell apoptosis was detected by FCM, and then the MCF-7 cells were transplanted into nude mice to set up transplantation model. The expression of iASPP RNA and protein in transplanted neoplasm were determined by RT-PCR and Western blotting, the apoptosis index was detected by FCM at the same time. RESULTS: The results showed that the expression of iASPP descended in MCF-7 cells (mRNA 95.4% and protein 96.8%, respectively, P<0.01) and the apoptosis rate and necrosis rate of MCF-7 cells increased (P<0.01) after transfection. As treated with pAd-iASPP-RNAi, the expression of iASPP in transplantation tumor cells descended 87.4% (mRNA) and 89.2% (protein), respectively (P<0.01), and the apoptosis rate and necrosis rate increased accordingly (P<0.01, P<0.05). CONCLUSION: The inhibition of iASPP may resume the ability of p53 to induce apoptosis in breast cancer cells which is able to express wild type p53.

Effects of Xijiao Dihuang decoction on the expressions of bcl-2, caspase-3, TNF-alpha and IL-6 after acute intracerebral hemorrhage in rats / 中国中药杂志

<p><b>OBJECTIVE</b>To study the effects of xijiao dihuang decoction on the expressions of Bcl-2 and caspase-3 protein positive cells in brain tissue, TNF-alpha and IL-6 in blood after acute intracerebral hemorrhage in rat.</p><p><b>METHOD</b>The experimental ICH model was established by injection of non-heparinized autologous arterial blood into the right basal ganglia. Immunohistochemistry and radioimmunity methods were used to detect expressions of Bcl-2 and caspase-3 protein positive cells in brain tissue, TNF-alpha and IL-6 in blood.</p><p><b>RESULT</b>After ICH, caspase-3 protein positive cells in brain tissue, TNF-alpha and IL-6 in blood increased obviously in the model group, caspase-3 protein positive cells, TNF-alpha and IL-6 were significantly reduced by treatment with Xijiao Dihuang decoction, on the contrary, Bcl-2 protein positive cells in brain tissue increased markedly.</p><p><b>CONCLUSION</b>Xijiao Dihuang decoction can pretect nerve cell by reducing the expression of caspase-3, TNF-alpha and IL-6, increasing the expression of Bcl-2 after ICH in hemorrhagic brain damage.</p>

Review on Objective Research of Four Diagnoses of TCM / 浙江中医药大学学报

The researches of making "four diagnoses of TCM" objective have been practicing for decades,and some good results have been produced during the researches;but for general viewpoints,the research results don't bring fundamental influence to diagnostic modes and means of TCM,then,the viewpoints of how in the world to regard the reseaches being done are discussed in the articles.

Bioactivity of scFv antibody against human NH-lipopolysaccharide binding protein in vitro and in vivo / 第三军医大学学报

Objective To observe the bioactivity of recombinant human scFv antibody against NH-lipopolysaccharide binding protein in vitro and in vivo. Methods KM mice, weighing 20-25 g, were burnt on the back to the third degree covering 20% total body surface area. The mice in only burn group were intraperitoneally injected with 1 ?g/g LPS and those in scFv-treated group with 1 ?g/g LPS and 0.5 ?g/g scFv after burn. The mice without any treatment served as controls. All mice were sacrificed in 1, 3, 6, 12, 24 h after all treatment and the whole blood, the tissues of liver, lung and kidney were collected. The serum concentration of TNF-?, IL-6 in burnt mice with endotoxemia was detected by ELISA and the pathological changes of liver, lung and kidney tissues were observed by light microscope. The inhibition of scFv antibody of different concentrations against NH-lipopolysaccharide binding protein on FITC-LPS binding with U937 cells was assayed by FCM. Results The histopathological changes of liver, lung and kidney in mice of scFv-treated group revealed that less inflammatory cell infiltration, less degenerated cells, weaker congestion in tissue as compared with control and only burnt mice. The serum concentration of TNF-? in only burnt mice increased significantly than that of the controls (P

Construction of recombinant adenovirus vector containing human survivin gene and expression in dentritic cells / 第三军医大学学报

Objective To construct the recombinant adenovirus vector containing human survivin, and transfect it into dendritic cells. Methods Full length survivin cDNA was obtained from recombinant plasmid pCITE-survivin by PCR. The PCR product was double-digested with restriction endonucleases KpnⅠ and XholⅠ, and inserted orientationally into pAdTrack-CMV. The plasmid of pAdTrack-survivin was lined with PmeⅠ, and the fragment containing survivin was reclaimed and transfected into E. coli. BJ5183. After having been screened, the extracted plasmid of positive bacteria was transfected into HEK293 cells with liposome and was identified by the green fluorescence protein (GFP) expression and by PCR method. The virus was transfected into dentritic cells, and the expression of survivin was proved by the GFP expression and Western blot analysis. Results The recombined adenovirus-survivin was constructed successfully and the titer was about 1.65?10 8 pfu/ml. A band was observed by Western boltting and its relative molecular mass was about 16.5?10 3. Conclusion A recombinant adenovirus vector containing human survivin was constructed successfully, and the survivin protein was expressed by dendritic cells.