Acute respiratory distress syndrome(ARDS)is a common and clinically devastating disease that causes respiratory failure.Morbidity and mortality of patients in intensive care units are stubbornly high,and various compl...Acute respiratory distress syndrome(ARDS)is a common and clinically devastating disease that causes respiratory failure.Morbidity and mortality of patients in intensive care units are stubbornly high,and various complications severely affect the quality of life of survivors.The pathophysiology of ARDS includes increased alveolar–capillary membrane permeability,an influx of protein-rich pulmonary edema fluid,and surfactant dysfunction leading to severe hypoxemia.At present,the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema,which primarily improves symptoms,but the prognosis of patients with ARDS is still very poor.Mesenchymal stem cells(MSCs)are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation.MSCs can be isolated from a variety of tissues,such as the umbilical cord,endometrial polyps,menstrual blood,bone marrow,and adipose tissues.Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases.Recently,the potential of stem cells in treating ARDS has been explored via basic research and clinical trials.The efficacy of MSCs has been shown in a variety of in vivo models of ARDS,reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury.This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.展开更多
BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue...BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.展开更多
BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hem...BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95% confidence interval [95% CI] 2.481-17.227,P=0.009) and modified Fisher scores(β 10.349,95% CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio [OR] 1.015,95%CI 1.000-1.031,P=0.047) and DCI(OR 1.018,95% CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95% CI 0.682-0.845) and 0.777(95% CI 0.688-0.850),respectively.Serum A20 levels ≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9% and specificity of 74.2%,and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with65.5% sensitivity and 89.2% specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.展开更多
Objective:To observe the effects of and explore the underlying mechanisms of Periplogenin(PPG)on the regulation of proliferation,apoptosis and migration of hepatocellular carcinoma Hep3B cell.Methods:Hep3B cells were ...Objective:To observe the effects of and explore the underlying mechanisms of Periplogenin(PPG)on the regulation of proliferation,apoptosis and migration of hepatocellular carcinoma Hep3B cell.Methods:Hep3B cells were divided into control group and PPG group.The Hep3B cells in the control group were not treated with PPG,and the other in the PPG group were intervened with 2.5,5 and 12.5µmol/mL PPG for 48 h.Cell viability was measured using the CCK-8 assay.Cell morphological changes was observed using by light microscope;the apoptotic state was observed by DAPI/PI staining.The colony-formation assay and scratch method was used for detecting the cell clone forming ability and cell migration ability,respectively.The cell apoptosis-related proteins Caspase-3,Cleaved Caspase-3,Bcl-2 and cell migration-related protein Matrix metalloproteinase-9(MMP-9)were detected byWestern Blot.Results:Compared with the control group,the cell proliferation level and the cell number in each PPG group were decreased,accompanying by cell volume reduction,chromatin pyknosis,and nuclear rupture in Hep3B cells.After PPG treatment,the clone formation level and cell mobility of Hep3B cells were decreased.Compared with the control group,the level of Bcl-2 protein was decreased,while the proportion of Cleaved Caspase-3/Caspase-3 protein was increased.The expression of MMP-9 proteins was decreased,with significantly statistically differences(P<0.05).Conclusion:Periplogenin could inhibit the proliferation,and migration of Hep3B cells and also promote the cell apoptosis in a dose-dependent manner,which might be related to the activation of Caspase signaling pathway and inhibition of MMP-9 activity.展开更多
The cell membrane structure is closely related to the occurrence and progression of many metabolic bone diseases observed in the clinic and is an important target to the development of therapeutic strategies for these...The cell membrane structure is closely related to the occurrence and progression of many metabolic bone diseases observed in the clinic and is an important target to the development of therapeutic strategies for these diseases.Strong experimental evidence supports the existence of membrane microdomains in osteoclasts(OCs).However,the potential membrane microdomains and the crucial mechanisms underlying their roles in OCs have not been fully characterized.Membrane microdomain components,such as scaffolding proteins and the actin cytoskeleton,as well as the roles of individual membrane proteins,need to be elucidated.In this review,we discuss the compositions and critical functions of membrane microdomains that determine the biological behavior of OCs through the three main stages of the OC life cycle.展开更多
Purpose:To screen potential tumor antigens for melanoma vaccine development and identify different immune subtypes.Methods:Transcriptional data(HTSEQ-FPKM)and clinical information of a 472 Melanoma cohort GDC TCGA Mel...Purpose:To screen potential tumor antigens for melanoma vaccine development and identify different immune subtypes.Methods:Transcriptional data(HTSEQ-FPKM)and clinical information of a 472 Melanoma cohort GDC TCGA Melanoma(SKCM)were downloaded from the UCSC XENA website(http://xena.ucsc.edu/).Subsequently,transcriptome data and clinical information of 210 melanoma cohort GSE65904 were downloaded from Gene Expression Omnibus(GEO),a large global public database.All the transcriptome expression data matrices were log2 transformed for subsequent analysis.GEPIA,TIMER,and IMMPORT databases are also used for analysis.Cell function experiments were performed to validate the role of the IDO1 gene in melanoma cell line A375.Results:Our study provides potential tumor antigens for vaccine development in melanoma patients:GZMB,GBP4,CD79A,APOBEC3F,IDO1,JCHAIN,LAG3,PLA2G2D,XCL2.In addition,we divide melanoma patients into two immune subtypes that have significant differences in tumor immunity and may have different responses to vaccination.In view of the unclear role of IDO1 in melanoma,we selected IDO1 for cell assay validation.Cell function assay showed that IDO1 was significantly overexpressed in the melanoma A375 cell line.After IDO1 knockdown,the activity,invasion,migration and healing ability of A375 cell lines were significantly decreased.Conclusion:Our study could provide a reference for the development of vaccines for melanoma patients.展开更多
BACKGROUND Primary schwannoma is a rare submucosal tumor of the esophagus,which is most often benign,and surgery is the only effective treatment.So far,only a few cases have been reported.Herein,we reported a single c...BACKGROUND Primary schwannoma is a rare submucosal tumor of the esophagus,which is most often benign,and surgery is the only effective treatment.So far,only a few cases have been reported.Herein,we reported a single case diagnosed with primary esophageal schwannoma that was totally removed by submucosal tunneling endoscopic resection(STER).CASE SUMMARY A 62-year-old man presented to the hospital with a history of resection of a malignant gastric tumor and mild dysphagia.Endoscopic examination revealed a large submucosal elevated lesion in the esophagus 25-30 cm from the incisors.Endoscopic ultrasonography detected a 45 mm×35 mm×31 mm hypoechoic lesion;chest computed tomography showed a mass of approximately 55 mm×35 mm×29 mm.A preliminary examination showed features suggestive of a stromal tumor.Pathological findings indicated esophageal schwannoma.Next,STER alone was performed to completely resect the mass,and the patient recovered well post-surgery.Afterward,the patient was discharged and showed no tumor recurrence at 33 mo of follow-up.CONCLUSION Endoscopic resection is still an effective treatment for large esophageal schwannomas(>30 mm)under meticulous morphological evaluation.展开更多
AIM: To explore the effects and mechanisms of mechanical stress and transforming growth factor-beta2(TGF-β2) on epithelial-mesenchymal transition(EMT) in cultured human retinal pigment epithelial(RPE) cells. METHODS:...AIM: To explore the effects and mechanisms of mechanical stress and transforming growth factor-beta2(TGF-β2) on epithelial-mesenchymal transition(EMT) in cultured human retinal pigment epithelial(RPE) cells. METHODS: Human RPE cells were inoculated on BioF ex 6-well plates and RPE cells received 0, 1, 2, 3, or 4 mild stretch injuries delivered 3h apart after 24h of culture. The device of mechanical stress parameters were set to sine wave, frequency 1 Hz, stretch strength 20%. For treatment with TGF-β2, when the inoculated RPE cells in 6-well plates were around 60% confluent, serum was reduced to 0 for 12h and recombinant human TGF-β2(0, 1, 5, 10 ng/mL)was added for 48h. α-SMA, Vimentin and N-Cadherin, fibronectin proteins expressions were detected by Western blotting, confocal cell immunofluorescence and quantitative real-time polymerase chain reaction(q RT-PCR). Then we detected the change of mi RNA-29b and ascertained the changes of phosphatidylinositol 3-kinase-serine threonine protein kinase(PI3K/Akt) pathway after RPE cells were stretched by the device of mechanical stress and induced by TGF-β2 by Western blotting, confocal cell immunofluorescence and qR T-PCR. RESULTS: Mechanical stress induce EMT and activate the PI3K/Akt pathway in ways that lead to the EMT process. TGF-β2 induce RPE cells EMT and in a certain range and TGF-β2 decrease the miR NA-29b expression in RPE cells, and the inhibitory effect is more obvious with the increase of TGF-β2 concentration. CONCLUSION: Our findings are crucial steps in determining the critical roles of the PI3K/Akt signaling pathway and mi RNA-29b in pathogenesis of proliferative vitreoretinopathy(PVR) which may be a potential target for preventing or treating PVR.展开更多
Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Ca...Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Care Medicine Committee of Chinese People’s Liberation Army(PLA)worked with Chinese Society of Laboratory Medicine,Chinese Medical Association to develop this consensus to provide guidance for clinical practice.The consensus includes five sections and 27 items:the definition of thrombocytopenia,etiology and pathophysiology,diagnosis and differential diagnosis,treatment and prevention.展开更多
BACKGROUND In general,malignant tumors metastasize to the pancreas in<1%of cases.Most patients miss the opportunity for further surgery due to distant metastases;however,for fibrosarcomas,aggressive surgery may be ...BACKGROUND In general,malignant tumors metastasize to the pancreas in<1%of cases.Most patients miss the opportunity for further surgery due to distant metastases;however,for fibrosarcomas,aggressive surgery may be helpful even if distant metastases occur.Hence,we report such a case and share some valuable information about the disease.CASE SUMMARY A 45-year-old man was admitted with recurrent epigastric pain for 10 days.The abdominal pain was mainly related to bloating with nausea,but no other associated symptoms.No particular signs were found on abdominal examination or laboratory testing.In 2003,a local distal expanded resection of the primary fibrosarcoma in the left chest wall was performed.Then,a left pneumonectomy was performed in 2017 due to diffuse metastases from the fibrosarcoma to the left lung.Enhanced computed tomography(CT)and magnetic resonance imaging of the upper abdomen suggested multiple masses of different sizes involving the head and tail of the pancreas;no local lymph node enlargement was noted.The postoperative pathologic diagnosis revealed a fibrosarcoma of the pancreas.A CT re-examination 6 mo postoperatively showed no local recurrence or distant metastases.CONCLUSION A fibrosarcoma is a rare low-grade malignant tumor,and metastases to the pancreas are even rarer.Patients with a history of a fibrosarcoma should consider the possibility of metastasis when a pancreatic neoplasm is demonstrated.Surgical resection is the preferred treatment.展开更多
Overexpression of heat shock protein 27(HSP27)in gastric cancer is correlated with poor clinical prognosis.Melatonin,an endogenous hormone,shows promise in gastric cancer therapy.However,there is limited study on the ...Overexpression of heat shock protein 27(HSP27)in gastric cancer is correlated with poor clinical prognosis.Melatonin,an endogenous hormone,shows promise in gastric cancer therapy.However,there is limited study on the biological activity of HSP27 in response to melatonin treatment.In this study,we show an anti-proliferative action of melatonin on human gastric cancer cell lines BGC-823 and MGC-803.Biochemically,the inhibitory effect of melatonin is accompanied by the upregulation of HSP27 phosphorylation level.Transfection of gastric cancer cells with HSP27-specific siRNA effectively reduces HSP27 phosphorylation and potentiated melatonininduced inhibitory effect on cell proliferation.The reduction of cyclin D1 in melatonin-treated cells is also aggravated by HSP27 depletion.Moreover,melatonin stimulation increases p38 phosphorylation.Pretreatment with p38 inhibitor SB203580 not only remarkably suppresses melatonin-induced HSP27 phosphorylation,but also augment the inhibitory effect of melatonin on cyclin D1 expression as well as cell proliferation.Taken together,our study indicates the protective pathway of p38/HSP27 against melatonin-induced inhibitory effect on gastric cancer cell proliferation,suggesting that combined with p38/HSP27 pathway inhibitor,the therapeutic efficacy of melatonin on gastric cancer may be improved.展开更多
BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever,which makes it easy to be confused with other diseases.Here we report a case of pyogenic spondylitis and describe the diagnosis a...BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever,which makes it easy to be confused with other diseases.Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.CASE SUMMARY The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess.Acute pyelonephritis was initially diagnosed due to atypical symptoms.Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction.One month post the admission,the patient underwent anterior lumbar debridement+autogenous iliac bone graft fusion+posterior percutaneous screw-rod internal fixation,and received 6 wk of antibiotic treatment after the operation.Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist,and walked well with no evident dysfunction of lower limbs.CONCLUSION Here we describe the application value of several imaging examinations,such as X-ray,computed tomography and magnetic resonance imaging,and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis.This disease requires early diagnosis and treatment.Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary,which may help for a speedy recovery and prevent the occurrence of severe complications.展开更多
Liver transplantation(LT)is a highly curative therapy for patients with hepatocellular carcinoma(HCC).However,due to the shortage of donor livers and rapid progression of HCC,a majority of patients are dropped out fro...Liver transplantation(LT)is a highly curative therapy for patients with hepatocellular carcinoma(HCC).However,due to the shortage of donor livers and rapid progression of HCC,a majority of patients are dropped out from the waitlist.Recently,immunotherapy has shown great promise in the treatment of advanced HCC.However,the use of immunotherapy is limited in LT mainly due to the potentially increasing risk of graft rejection.One of the main challenges for researchers is the protection of donor graft from an immunotherapy-boosted immune response mounted by the host.Besides,the safety,availability,and costs of immunotherapy are other challenges that need to be addressed.Here,we reviewed the literature involving patients who received immunotherapy prior to transplant to avoid waitlist dropouts and following transplantation to prevent the progression of tumor recurrence and metastasis.Statistically,the incidence of rejection was 25.0%pre-transplant and 18.5%post-transplant.Based on the review of these clinical studies,we can conclude that conducting clinical trials on the safety and efficacy of currently available immunotherapy drugs and identifying novel immunotherapy targets through extensive research may be promising for patients who do not meet the selection criteria for LT and who experience post-transplant recurrence.To date,the clinical experience on the use of immunotherapy before or after LT comes from individual case studies.Although some of the reported results are promising,they are not sufficient to support the standardized use of immunotherapy in clinical practice.展开更多
BACKGROUND Synovial sarcoma,a rare mesenchymal tumor type with unclear histological origin and direction of differentiation,accounts for 6%–10%of soft tissue tumors.It is mainly located near the joints and tendons of...BACKGROUND Synovial sarcoma,a rare mesenchymal tumor type with unclear histological origin and direction of differentiation,accounts for 6%–10%of soft tissue tumors.It is mainly located near the joints and tendons of the limbs,and occurs primarily in children or young adults.Primary renal synovial sarcoma(PRSS)is very rare,accounting for approximately 1%of synovial sarcomas.It is a spindle cell tumor type affecting mesenchymal tissue,and has morphological,genetic,and clinical characteristics,and a certain degree of epithelial differentiation.It is highly malignant and has the fourth highest incidence among soft tissue sarcomas.Here,we report a case of PRSS and share some valuable information about the disease.CASE SUMMARY A 54-year-old male patient was admitted to the hospital for a space-occupying lesion in the right kidney for 2 d upon ultrasound examination.The patient had no cold or fever;no frequency,urgency or pain of urination;and no other discomfort.The results of a hemogram,blood biochemistry,and tumor markers were in the normal range.The patient was examined by computed tomography(CT),which indicated the presence of a soft tissue density shadow with a diameter of approximately 6.8 cm in the right renal pelvis area,showing uneven enhancement.Ultrasound indicated a cystic solid mass of approximately 6.8 cm×6.5 cm in the right kidney,with an unclear boundary and irregular shape.Meanwhile,color Doppler flow imaging showed dotted blood flow signals in the periphery and interior.Contrast-enhanced ultrasound(CEUS)showed"slow in and fast out"hyperenhancement of the right renal mass after contrast agent injection.The postoperative pathological diagnosis was(right kidney)synovial sarcoma.Despite postoperative adjuvant chemotherapy,tumor recurrence was detected two years later.CONCLUSION PRSS is a rare malignant tumor.To date,no characteristic imaging findings have been observed.The diagnosis is confirmed primarily through postoperative pathological immunohistochemistry and SS18(SYT)gene detection.In this case,CEUS was used preoperatively.We found that PRSS has the characteristic of"slow in and fast out"hyperenhancement,and its particular characteristics have diagnostic value.Postoperative adjuvant chemotherapy is not very effective.展开更多
BACKGROUND Kawasaki disease(KD) is a self-limiting febrile illness and an acute vasculitis with an unknown origin.It predominantly affects children aged < 5 years.KD is the common cause of acquired heart disease in...BACKGROUND Kawasaki disease(KD) is a self-limiting febrile illness and an acute vasculitis with an unknown origin.It predominantly affects children aged < 5 years.KD is the common cause of acquired heart disease in children.We here report a case of KD in an asymptomatic young female patient diagnosed with multiple coronary aneurysms with calcification.CASE SUMMARY A 29-year-old female patient admitted to Hangzhou First People’s Hospital with coronary artery abnormality identified for 1 wk.The patient was asymptomatic;however,chest computed tomography occasionally revealed strip-like dense shadows in the coronal sulcus.After coronary angiography and Doppler echocardiography,the final diagnosis was coronary artery aneurysms(CAAs) caused by KD.Although the patient was asymptomatic with no history of KD in childhood,the definitive diagnosis was CAAs caused by KD.The patient was administered anticoagulant,and surgical treatment was recommended.CONCLUSION KD potentially causes CAAs in 25% of untreated cases,primarily occurring in the proximal portions of the coronary arteries.展开更多
Although the development of covID-19 vaccines has been a remarkable success,the heterogeneous individual antibody generation and decline over time are unknown and still hard to predict.In this study,blood samples were...Although the development of covID-19 vaccines has been a remarkable success,the heterogeneous individual antibody generation and decline over time are unknown and still hard to predict.In this study,blood samples were collected from 163 participants who next received two doses of an inactivated COvVID-19 vaccine(CoronaVac)at a 28-day interval.Using TMT-based proteomics,we identified 1,715 serum and 7,342 peripheral blood mononuclear cells(PBMCs)proteins.We proposed two sets of potential biomarkers(seven from serum,five from PBMCs)at baseline using machine learning,and predicted the individual seropositivity 57 days after vaccination(AUC=0.87).Based on the four PBMC's potential biomarkers,we predicted the antibody persistence until 180 days after vaccination(AUC=0.79).Our data highlighted characteristic hematological host responses,including altered lymphocyte migration regulation,neutrophil degranulation,and humoral immune response.This study proposed potential blood-derived protein biomarkers before vaccination for predicting heterogeneous antibody generation and decline after coVID-19 vaccination,shedding light on immunization mechanisms and individual booster shot planning.展开更多
Background:The open reduction and internal fixation(ORIF)was a standard treatment approach for fracture at distal humerus intercondylar,whereas the optimal way before ORIF remains inconclusive.We,therefore,performed a...Background:The open reduction and internal fixation(ORIF)was a standard treatment approach for fracture at distal humerus intercondylar,whereas the optimal way before ORIF remains inconclusive.We,therefore,performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs.triceps-sparing approach for patients with distal humerus intercondylar fracture.Methods:The electronic searches were systematically performed in PubMed,EmBase,Cochrane library,and Chinese National Knowledge Infrastructure from initial inception till December 2019.The primary endpoint was the incidence of excellent/good elbow function,and the secondary endpoints included Mayo elbow performance score,duration of operation,blood loss,and complications.Results:Nine studies involving a total of 637 patients were selected for meta-analysis.There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function(odds ratio[OR]:1.37;95%confidence interval[CI]:0.69-2.75;P=0.371),Mayo elbow performance score(weight mean difference[WMD]:0.17;95%CI:-2.56 to 2.89;P=0.904),duration of operation(WMD:4.04;95%CI:-28.60 to 36.69;P=0.808),blood loss(WMD:33.61;95%CI:-18.35 to 85.58;P=0.205),and complications(OR:1.93;95%CI:0.49-7.60;P=0.349).Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function,longer duration of operation,greater blood loss,and higher incidence of complications as compared with triceps-sparing approach.Conclusions:This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function,while the duration of operation,blood loss,and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.展开更多
Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial...Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial.The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.Methods:The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017.The glenoid bone defect was measured by three surgeons on‘self-confirmed’and‘designated’3-D en-face views,and repeated after an interval of 3 months.Measurements included the ratio of the defect area to the best-fit circle area,and the ratio of the defect width to the diameter of the best-fit circle.The inter-and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients(ICCs).The maximum absolute inter-and intra-observer differences and the cumulative percentages of cases with inter-and intraobserver differences greater than these respective levels were calculated.Results:Almost all linear defect values were bigger than the areal defect values.The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the‘self-confirmed’group and 0.549 and 0.431 in the‘designated’group.The inter-observer reliabilities for the linear defect were moderate or fair in the‘self-confirmed’group(ICC=0.446,0.374)and‘designated’group(ICC=0.402,0.327).The ICCs for intra-observer measurements were higher than those for inter-observer measurements.The respective maximum interand intra-observer absolute differences were 13.9%and 13.2%in the‘self-confirmed’group,and 15.8%and 9.8%in the‘designated’group.Conclusions:The areal measurement of the glenoid bone defect is more reliable than the linear measurement.The reliability of the glenoid defect areal measurement is moderate or worse,suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination.Subjective factors affecting the glenoid bone loss measurement should be minimized.展开更多
Background:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge.In China,most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days.Howeve...Background:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge.In China,most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days.However,delayed surgery is associated with increased complications and mortality in the older adults.This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.Methods:Acute hip fracture patients(≥65 years)who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed.Sixty patients taking clopidogrel before injury and discontinued<5 days before surgery constituted the clopidogrel group.The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex,fracture type,operative procedure,and time from injury to operation(±10 h).The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement,complications,and mortality.The Student’s t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.Results:Age,body mass index,American Society of Anesthesiologists score,and percentage undergoing general anesthesia were comparable between the groups(P>0.050).The percentages of patients with coronary heart disease(61.7%vs.18.3%;P<0.001)and cerebrovascular disease(45.0%vs.15.0%;P<0.010)were significantly higher in the clopidogrel vs.control groups,respectively.The median clopidogrel discontinuation time before operation was 73.0(range:3.0–120.0)h.There was no significant difference in the estimated perioperative blood loss between the clopidogrel group(median:745 mL)and control group(median:772 mL)(P=0.866).The intra-operative transfusion rate was higher in the clopidogrel group(22/60,36.7%)than that in the control group(12/60,20.0%)(P<0.050).However,there was no significant difference in the blood transfusion rate during the entire perioperative period(26/60,43.3%vs.20/60,33.3%;clopidogrel group vs.control group,respectively;P>0.050).There was no significant difference in perioperative complications,and 30-day and 1-year mortality rates between the groups.Conclusions:Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal,without increased perioperative blood loss,transfusion requirement,complications,and mortality compared with patients not taking antiplatelet drugs.展开更多
Measuring the sagittal canal diameter(SCD)is crucial for cervical spine assessment.A small SCD predisposes patients to myelopathy.[1]Stenosis is less common at the C1 level than at the levels below C2.[2,3]The existin...Measuring the sagittal canal diameter(SCD)is crucial for cervical spine assessment.A small SCD predisposes patients to myelopathy.[1]Stenosis is less common at the C1 level than at the levels below C2.[2,3]The existing literature regarding hypoplastic stenosis at the C1 level includes a few case reports;based on the literature,C1 hypoplasia seems to be more common in Chinese populations.[3,4]Normative values of C1 SCD may help in the evaluation of potential cervical stenosis in a given clinical situation;they were reported as adequately powered for defining pure C1 hypoplasia.[2,5]However,there is a paucity of data on C1 SCD in Chinese populations compared with those in other populations[Supplemental Table 1,http://links.lww.com/CM9/A538].Among several measurement methods,in vivo computed tomography(CT)-based measurements have been validated and found to be as accurate as measurements in cadaver studies.[1]Thus,we aimed to use CT-based measurements to establish normative values for C1 SCD in Chinese adults and to define C1 hypoplasia.展开更多
基金Supported by The Youth Fund project of the Natural Science Foundation of Zhejiang Province,No.LQ20H15010Zhejiang Traditional Chinese Medicine Science and Technology Planning Project,No.2023ZL575.
文摘Acute respiratory distress syndrome(ARDS)is a common and clinically devastating disease that causes respiratory failure.Morbidity and mortality of patients in intensive care units are stubbornly high,and various complications severely affect the quality of life of survivors.The pathophysiology of ARDS includes increased alveolar–capillary membrane permeability,an influx of protein-rich pulmonary edema fluid,and surfactant dysfunction leading to severe hypoxemia.At present,the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema,which primarily improves symptoms,but the prognosis of patients with ARDS is still very poor.Mesenchymal stem cells(MSCs)are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation.MSCs can be isolated from a variety of tissues,such as the umbilical cord,endometrial polyps,menstrual blood,bone marrow,and adipose tissues.Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases.Recently,the potential of stem cells in treating ARDS has been explored via basic research and clinical trials.The efficacy of MSCs has been shown in a variety of in vivo models of ARDS,reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury.This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.
基金supported by Hangzhou Construction Fund of Key Medical Disciplines(OO20200265)Zhejiang Medical and Health Science and Technology Plan Project(2020KY687)+1 种基金Hangzhou Science and Technology Development Project(20200401B04)Hangzhou Biomedical and Health Industry Development Supporting Technology Projects(2021WJCY256).
文摘BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.
基金financially supported by grants from Key Research and Development Projects of Zhejiang Province (2020C03071)the Construction Fund of Medical Key Disciplines of Hangzhou (OO20200485, OO20200055)。
文摘BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95% confidence interval [95% CI] 2.481-17.227,P=0.009) and modified Fisher scores(β 10.349,95% CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio [OR] 1.015,95%CI 1.000-1.031,P=0.047) and DCI(OR 1.018,95% CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95% CI 0.682-0.845) and 0.777(95% CI 0.688-0.850),respectively.Serum A20 levels ≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9% and specificity of 74.2%,and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with65.5% sensitivity and 89.2% specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.
基金National Natural Science Foundation of China(82205209)Shenzhen Science and Technology Program(JCYJ20210324120405015)。
文摘Objective:To observe the effects of and explore the underlying mechanisms of Periplogenin(PPG)on the regulation of proliferation,apoptosis and migration of hepatocellular carcinoma Hep3B cell.Methods:Hep3B cells were divided into control group and PPG group.The Hep3B cells in the control group were not treated with PPG,and the other in the PPG group were intervened with 2.5,5 and 12.5µmol/mL PPG for 48 h.Cell viability was measured using the CCK-8 assay.Cell morphological changes was observed using by light microscope;the apoptotic state was observed by DAPI/PI staining.The colony-formation assay and scratch method was used for detecting the cell clone forming ability and cell migration ability,respectively.The cell apoptosis-related proteins Caspase-3,Cleaved Caspase-3,Bcl-2 and cell migration-related protein Matrix metalloproteinase-9(MMP-9)were detected byWestern Blot.Results:Compared with the control group,the cell proliferation level and the cell number in each PPG group were decreased,accompanying by cell volume reduction,chromatin pyknosis,and nuclear rupture in Hep3B cells.After PPG treatment,the clone formation level and cell mobility of Hep3B cells were decreased.Compared with the control group,the level of Bcl-2 protein was decreased,while the proportion of Cleaved Caspase-3/Caspase-3 protein was increased.The expression of MMP-9 proteins was decreased,with significantly statistically differences(P<0.05).Conclusion:Periplogenin could inhibit the proliferation,and migration of Hep3B cells and also promote the cell apoptosis in a dose-dependent manner,which might be related to the activation of Caspase signaling pathway and inhibition of MMP-9 activity.
基金supported by the National Nature Science Fund of China(Grant No.82102313)Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project(Grant No.2023ZL497)+1 种基金Zhejiang Province Medical and Health Science and Technology Project(Grant No.2022519563)National Health and Medical Research Council of Australia(Grant No.app1107828,app1163933)。
文摘The cell membrane structure is closely related to the occurrence and progression of many metabolic bone diseases observed in the clinic and is an important target to the development of therapeutic strategies for these diseases.Strong experimental evidence supports the existence of membrane microdomains in osteoclasts(OCs).However,the potential membrane microdomains and the crucial mechanisms underlying their roles in OCs have not been fully characterized.Membrane microdomain components,such as scaffolding proteins and the actin cytoskeleton,as well as the roles of individual membrane proteins,need to be elucidated.In this review,we discuss the compositions and critical functions of membrane microdomains that determine the biological behavior of OCs through the three main stages of the OC life cycle.
基金supported by the Top Talent Project of Jiangsu Provincial People’s Hospital(No.YNRCZN0310).
文摘Purpose:To screen potential tumor antigens for melanoma vaccine development and identify different immune subtypes.Methods:Transcriptional data(HTSEQ-FPKM)and clinical information of a 472 Melanoma cohort GDC TCGA Melanoma(SKCM)were downloaded from the UCSC XENA website(http://xena.ucsc.edu/).Subsequently,transcriptome data and clinical information of 210 melanoma cohort GSE65904 were downloaded from Gene Expression Omnibus(GEO),a large global public database.All the transcriptome expression data matrices were log2 transformed for subsequent analysis.GEPIA,TIMER,and IMMPORT databases are also used for analysis.Cell function experiments were performed to validate the role of the IDO1 gene in melanoma cell line A375.Results:Our study provides potential tumor antigens for vaccine development in melanoma patients:GZMB,GBP4,CD79A,APOBEC3F,IDO1,JCHAIN,LAG3,PLA2G2D,XCL2.In addition,we divide melanoma patients into two immune subtypes that have significant differences in tumor immunity and may have different responses to vaccination.In view of the unclear role of IDO1 in melanoma,we selected IDO1 for cell assay validation.Cell function assay showed that IDO1 was significantly overexpressed in the melanoma A375 cell line.After IDO1 knockdown,the activity,invasion,migration and healing ability of A375 cell lines were significantly decreased.Conclusion:Our study could provide a reference for the development of vaccines for melanoma patients.
基金Supported by National Natural Science Foundation of China,No.81871337Medical and Health Science and Technology Projects of Zhejiang Province,No.2019KY117.
文摘BACKGROUND Primary schwannoma is a rare submucosal tumor of the esophagus,which is most often benign,and surgery is the only effective treatment.So far,only a few cases have been reported.Herein,we reported a single case diagnosed with primary esophageal schwannoma that was totally removed by submucosal tunneling endoscopic resection(STER).CASE SUMMARY A 62-year-old man presented to the hospital with a history of resection of a malignant gastric tumor and mild dysphagia.Endoscopic examination revealed a large submucosal elevated lesion in the esophagus 25-30 cm from the incisors.Endoscopic ultrasonography detected a 45 mm×35 mm×31 mm hypoechoic lesion;chest computed tomography showed a mass of approximately 55 mm×35 mm×29 mm.A preliminary examination showed features suggestive of a stromal tumor.Pathological findings indicated esophageal schwannoma.Next,STER alone was performed to completely resect the mass,and the patient recovered well post-surgery.Afterward,the patient was discharged and showed no tumor recurrence at 33 mo of follow-up.CONCLUSION Endoscopic resection is still an effective treatment for large esophageal schwannomas(>30 mm)under meticulous morphological evaluation.
基金Supported by the National Natural Science Foundation of China (No.81600754)
文摘AIM: To explore the effects and mechanisms of mechanical stress and transforming growth factor-beta2(TGF-β2) on epithelial-mesenchymal transition(EMT) in cultured human retinal pigment epithelial(RPE) cells. METHODS: Human RPE cells were inoculated on BioF ex 6-well plates and RPE cells received 0, 1, 2, 3, or 4 mild stretch injuries delivered 3h apart after 24h of culture. The device of mechanical stress parameters were set to sine wave, frequency 1 Hz, stretch strength 20%. For treatment with TGF-β2, when the inoculated RPE cells in 6-well plates were around 60% confluent, serum was reduced to 0 for 12h and recombinant human TGF-β2(0, 1, 5, 10 ng/mL)was added for 48h. α-SMA, Vimentin and N-Cadherin, fibronectin proteins expressions were detected by Western blotting, confocal cell immunofluorescence and quantitative real-time polymerase chain reaction(q RT-PCR). Then we detected the change of mi RNA-29b and ascertained the changes of phosphatidylinositol 3-kinase-serine threonine protein kinase(PI3K/Akt) pathway after RPE cells were stretched by the device of mechanical stress and induced by TGF-β2 by Western blotting, confocal cell immunofluorescence and qR T-PCR. RESULTS: Mechanical stress induce EMT and activate the PI3K/Akt pathway in ways that lead to the EMT process. TGF-β2 induce RPE cells EMT and in a certain range and TGF-β2 decrease the miR NA-29b expression in RPE cells, and the inhibitory effect is more obvious with the increase of TGF-β2 concentration. CONCLUSION: Our findings are crucial steps in determining the critical roles of the PI3K/Akt signaling pathway and mi RNA-29b in pathogenesis of proliferative vitreoretinopathy(PVR) which may be a potential target for preventing or treating PVR.
文摘Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Care Medicine Committee of Chinese People’s Liberation Army(PLA)worked with Chinese Society of Laboratory Medicine,Chinese Medical Association to develop this consensus to provide guidance for clinical practice.The consensus includes five sections and 27 items:the definition of thrombocytopenia,etiology and pathophysiology,diagnosis and differential diagnosis,treatment and prevention.
文摘BACKGROUND In general,malignant tumors metastasize to the pancreas in<1%of cases.Most patients miss the opportunity for further surgery due to distant metastases;however,for fibrosarcomas,aggressive surgery may be helpful even if distant metastases occur.Hence,we report such a case and share some valuable information about the disease.CASE SUMMARY A 45-year-old man was admitted with recurrent epigastric pain for 10 days.The abdominal pain was mainly related to bloating with nausea,but no other associated symptoms.No particular signs were found on abdominal examination or laboratory testing.In 2003,a local distal expanded resection of the primary fibrosarcoma in the left chest wall was performed.Then,a left pneumonectomy was performed in 2017 due to diffuse metastases from the fibrosarcoma to the left lung.Enhanced computed tomography(CT)and magnetic resonance imaging of the upper abdomen suggested multiple masses of different sizes involving the head and tail of the pancreas;no local lymph node enlargement was noted.The postoperative pathologic diagnosis revealed a fibrosarcoma of the pancreas.A CT re-examination 6 mo postoperatively showed no local recurrence or distant metastases.CONCLUSION A fibrosarcoma is a rare low-grade malignant tumor,and metastases to the pancreas are even rarer.Patients with a history of a fibrosarcoma should consider the possibility of metastasis when a pancreatic neoplasm is demonstrated.Surgical resection is the preferred treatment.
基金supported by the Training Programs of Innovation and Entrepreneurship for Undergraduates by Jiangsu Province(201810312018Z)to Jun Du,Chenchen Zhu,Kaiquan Lithe Training Programs of Innovation and Entrepreneurship for Undergraduates by Nanjing Medical University to Jun Du,Yuting Wang
文摘Overexpression of heat shock protein 27(HSP27)in gastric cancer is correlated with poor clinical prognosis.Melatonin,an endogenous hormone,shows promise in gastric cancer therapy.However,there is limited study on the biological activity of HSP27 in response to melatonin treatment.In this study,we show an anti-proliferative action of melatonin on human gastric cancer cell lines BGC-823 and MGC-803.Biochemically,the inhibitory effect of melatonin is accompanied by the upregulation of HSP27 phosphorylation level.Transfection of gastric cancer cells with HSP27-specific siRNA effectively reduces HSP27 phosphorylation and potentiated melatonininduced inhibitory effect on cell proliferation.The reduction of cyclin D1 in melatonin-treated cells is also aggravated by HSP27 depletion.Moreover,melatonin stimulation increases p38 phosphorylation.Pretreatment with p38 inhibitor SB203580 not only remarkably suppresses melatonin-induced HSP27 phosphorylation,but also augment the inhibitory effect of melatonin on cyclin D1 expression as well as cell proliferation.Taken together,our study indicates the protective pathway of p38/HSP27 against melatonin-induced inhibitory effect on gastric cancer cell proliferation,suggesting that combined with p38/HSP27 pathway inhibitor,the therapeutic efficacy of melatonin on gastric cancer may be improved.
基金Supported by Medicine and Health Foundation of Zhejiang Province,No.2021KY864.
文摘BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever,which makes it easy to be confused with other diseases.Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.CASE SUMMARY The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess.Acute pyelonephritis was initially diagnosed due to atypical symptoms.Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction.One month post the admission,the patient underwent anterior lumbar debridement+autogenous iliac bone graft fusion+posterior percutaneous screw-rod internal fixation,and received 6 wk of antibiotic treatment after the operation.Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist,and walked well with no evident dysfunction of lower limbs.CONCLUSION Here we describe the application value of several imaging examinations,such as X-ray,computed tomography and magnetic resonance imaging,and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis.This disease requires early diagnosis and treatment.Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary,which may help for a speedy recovery and prevent the occurrence of severe complications.
基金supported by grants from National Key Research and Development Program of China(No.2021YFA1100500)the Major Research Plan of the National Natural Science Foundation of China(No.92159202)+3 种基金Key Program,National Natural Science Foundation of China(No.81930016)Key Research&Development Plan of Zhejiang Province(No.2019C0350)Key Research&Development Program of Zhejiang Province(No.2022C03108)Young Program of National Natural Science Funds(No.81802889).
文摘Liver transplantation(LT)is a highly curative therapy for patients with hepatocellular carcinoma(HCC).However,due to the shortage of donor livers and rapid progression of HCC,a majority of patients are dropped out from the waitlist.Recently,immunotherapy has shown great promise in the treatment of advanced HCC.However,the use of immunotherapy is limited in LT mainly due to the potentially increasing risk of graft rejection.One of the main challenges for researchers is the protection of donor graft from an immunotherapy-boosted immune response mounted by the host.Besides,the safety,availability,and costs of immunotherapy are other challenges that need to be addressed.Here,we reviewed the literature involving patients who received immunotherapy prior to transplant to avoid waitlist dropouts and following transplantation to prevent the progression of tumor recurrence and metastasis.Statistically,the incidence of rejection was 25.0%pre-transplant and 18.5%post-transplant.Based on the review of these clinical studies,we can conclude that conducting clinical trials on the safety and efficacy of currently available immunotherapy drugs and identifying novel immunotherapy targets through extensive research may be promising for patients who do not meet the selection criteria for LT and who experience post-transplant recurrence.To date,the clinical experience on the use of immunotherapy before or after LT comes from individual case studies.Although some of the reported results are promising,they are not sufficient to support the standardized use of immunotherapy in clinical practice.
文摘BACKGROUND Synovial sarcoma,a rare mesenchymal tumor type with unclear histological origin and direction of differentiation,accounts for 6%–10%of soft tissue tumors.It is mainly located near the joints and tendons of the limbs,and occurs primarily in children or young adults.Primary renal synovial sarcoma(PRSS)is very rare,accounting for approximately 1%of synovial sarcomas.It is a spindle cell tumor type affecting mesenchymal tissue,and has morphological,genetic,and clinical characteristics,and a certain degree of epithelial differentiation.It is highly malignant and has the fourth highest incidence among soft tissue sarcomas.Here,we report a case of PRSS and share some valuable information about the disease.CASE SUMMARY A 54-year-old male patient was admitted to the hospital for a space-occupying lesion in the right kidney for 2 d upon ultrasound examination.The patient had no cold or fever;no frequency,urgency or pain of urination;and no other discomfort.The results of a hemogram,blood biochemistry,and tumor markers were in the normal range.The patient was examined by computed tomography(CT),which indicated the presence of a soft tissue density shadow with a diameter of approximately 6.8 cm in the right renal pelvis area,showing uneven enhancement.Ultrasound indicated a cystic solid mass of approximately 6.8 cm×6.5 cm in the right kidney,with an unclear boundary and irregular shape.Meanwhile,color Doppler flow imaging showed dotted blood flow signals in the periphery and interior.Contrast-enhanced ultrasound(CEUS)showed"slow in and fast out"hyperenhancement of the right renal mass after contrast agent injection.The postoperative pathological diagnosis was(right kidney)synovial sarcoma.Despite postoperative adjuvant chemotherapy,tumor recurrence was detected two years later.CONCLUSION PRSS is a rare malignant tumor.To date,no characteristic imaging findings have been observed.The diagnosis is confirmed primarily through postoperative pathological immunohistochemistry and SS18(SYT)gene detection.In this case,CEUS was used preoperatively.We found that PRSS has the characteristic of"slow in and fast out"hyperenhancement,and its particular characteristics have diagnostic value.Postoperative adjuvant chemotherapy is not very effective.
基金Supported by Scientific Research Fund of Zhejiang Provincial Education Department,No.Y202145971。
文摘BACKGROUND Kawasaki disease(KD) is a self-limiting febrile illness and an acute vasculitis with an unknown origin.It predominantly affects children aged < 5 years.KD is the common cause of acquired heart disease in children.We here report a case of KD in an asymptomatic young female patient diagnosed with multiple coronary aneurysms with calcification.CASE SUMMARY A 29-year-old female patient admitted to Hangzhou First People’s Hospital with coronary artery abnormality identified for 1 wk.The patient was asymptomatic;however,chest computed tomography occasionally revealed strip-like dense shadows in the coronal sulcus.After coronary angiography and Doppler echocardiography,the final diagnosis was coronary artery aneurysms(CAAs) caused by KD.Although the patient was asymptomatic with no history of KD in childhood,the definitive diagnosis was CAAs caused by KD.The patient was administered anticoagulant,and surgical treatment was recommended.CONCLUSION KD potentially causes CAAs in 25% of untreated cases,primarily occurring in the proximal portions of the coronary arteries.
基金supported by the National Natural Science Foundation of China(32200763)Key medical disciplines of Hangzhou,the Medical Health Science and Technology Project of Hangzhou municipal Health Commission(A20210205)+1 种基金the National Key R&D Program of China(2020YFE0202200)Funding for Clinical Trials from the Affiliated Drum Tower Hospital,Medical School of Nanjing University(2022-LCYJ-MS-08).
文摘Although the development of covID-19 vaccines has been a remarkable success,the heterogeneous individual antibody generation and decline over time are unknown and still hard to predict.In this study,blood samples were collected from 163 participants who next received two doses of an inactivated COvVID-19 vaccine(CoronaVac)at a 28-day interval.Using TMT-based proteomics,we identified 1,715 serum and 7,342 peripheral blood mononuclear cells(PBMCs)proteins.We proposed two sets of potential biomarkers(seven from serum,five from PBMCs)at baseline using machine learning,and predicted the individual seropositivity 57 days after vaccination(AUC=0.87).Based on the four PBMC's potential biomarkers,we predicted the antibody persistence until 180 days after vaccination(AUC=0.79).Our data highlighted characteristic hematological host responses,including altered lymphocyte migration regulation,neutrophil degranulation,and humoral immune response.This study proposed potential blood-derived protein biomarkers before vaccination for predicting heterogeneous antibody generation and decline after coVID-19 vaccination,shedding light on immunization mechanisms and individual booster shot planning.
基金This study was supported by the grants from the Beiing Municipal Health Commission(No.BMHC2019-9)Beiing Natural Science Foundation(No.L192049)Beiing Jishuitan Hospital's“Discipline new star”Plan(No.XKXX201604)。
文摘Background:The open reduction and internal fixation(ORIF)was a standard treatment approach for fracture at distal humerus intercondylar,whereas the optimal way before ORIF remains inconclusive.We,therefore,performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs.triceps-sparing approach for patients with distal humerus intercondylar fracture.Methods:The electronic searches were systematically performed in PubMed,EmBase,Cochrane library,and Chinese National Knowledge Infrastructure from initial inception till December 2019.The primary endpoint was the incidence of excellent/good elbow function,and the secondary endpoints included Mayo elbow performance score,duration of operation,blood loss,and complications.Results:Nine studies involving a total of 637 patients were selected for meta-analysis.There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function(odds ratio[OR]:1.37;95%confidence interval[CI]:0.69-2.75;P=0.371),Mayo elbow performance score(weight mean difference[WMD]:0.17;95%CI:-2.56 to 2.89;P=0.904),duration of operation(WMD:4.04;95%CI:-28.60 to 36.69;P=0.808),blood loss(WMD:33.61;95%CI:-18.35 to 85.58;P=0.205),and complications(OR:1.93;95%CI:0.49-7.60;P=0.349).Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function,longer duration of operation,greater blood loss,and higher incidence of complications as compared with triceps-sparing approach.Conclusions:This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function,while the duration of operation,blood loss,and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.
文摘Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial.The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.Methods:The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017.The glenoid bone defect was measured by three surgeons on‘self-confirmed’and‘designated’3-D en-face views,and repeated after an interval of 3 months.Measurements included the ratio of the defect area to the best-fit circle area,and the ratio of the defect width to the diameter of the best-fit circle.The inter-and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients(ICCs).The maximum absolute inter-and intra-observer differences and the cumulative percentages of cases with inter-and intraobserver differences greater than these respective levels were calculated.Results:Almost all linear defect values were bigger than the areal defect values.The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the‘self-confirmed’group and 0.549 and 0.431 in the‘designated’group.The inter-observer reliabilities for the linear defect were moderate or fair in the‘self-confirmed’group(ICC=0.446,0.374)and‘designated’group(ICC=0.402,0.327).The ICCs for intra-observer measurements were higher than those for inter-observer measurements.The respective maximum interand intra-observer absolute differences were 13.9%and 13.2%in the‘self-confirmed’group,and 15.8%and 9.8%in the‘designated’group.Conclusions:The areal measurement of the glenoid bone defect is more reliable than the linear measurement.The reliability of the glenoid defect areal measurement is moderate or worse,suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination.Subjective factors affecting the glenoid bone loss measurement should be minimized.
基金the Capital’s Funds for Health Improvement and Research(No.2018-1-2071)the National Natural Science Foundation of China(No.82072445).
文摘Background:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge.In China,most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days.However,delayed surgery is associated with increased complications and mortality in the older adults.This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.Methods:Acute hip fracture patients(≥65 years)who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed.Sixty patients taking clopidogrel before injury and discontinued<5 days before surgery constituted the clopidogrel group.The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex,fracture type,operative procedure,and time from injury to operation(±10 h).The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement,complications,and mortality.The Student’s t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.Results:Age,body mass index,American Society of Anesthesiologists score,and percentage undergoing general anesthesia were comparable between the groups(P>0.050).The percentages of patients with coronary heart disease(61.7%vs.18.3%;P<0.001)and cerebrovascular disease(45.0%vs.15.0%;P<0.010)were significantly higher in the clopidogrel vs.control groups,respectively.The median clopidogrel discontinuation time before operation was 73.0(range:3.0–120.0)h.There was no significant difference in the estimated perioperative blood loss between the clopidogrel group(median:745 mL)and control group(median:772 mL)(P=0.866).The intra-operative transfusion rate was higher in the clopidogrel group(22/60,36.7%)than that in the control group(12/60,20.0%)(P<0.050).However,there was no significant difference in the blood transfusion rate during the entire perioperative period(26/60,43.3%vs.20/60,33.3%;clopidogrel group vs.control group,respectively;P>0.050).There was no significant difference in perioperative complications,and 30-day and 1-year mortality rates between the groups.Conclusions:Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal,without increased perioperative blood loss,transfusion requirement,complications,and mortality compared with patients not taking antiplatelet drugs.
文摘Measuring the sagittal canal diameter(SCD)is crucial for cervical spine assessment.A small SCD predisposes patients to myelopathy.[1]Stenosis is less common at the C1 level than at the levels below C2.[2,3]The existing literature regarding hypoplastic stenosis at the C1 level includes a few case reports;based on the literature,C1 hypoplasia seems to be more common in Chinese populations.[3,4]Normative values of C1 SCD may help in the evaluation of potential cervical stenosis in a given clinical situation;they were reported as adequately powered for defining pure C1 hypoplasia.[2,5]However,there is a paucity of data on C1 SCD in Chinese populations compared with those in other populations[Supplemental Table 1,http://links.lww.com/CM9/A538].Among several measurement methods,in vivo computed tomography(CT)-based measurements have been validated and found to be as accurate as measurements in cadaver studies.[1]Thus,we aimed to use CT-based measurements to establish normative values for C1 SCD in Chinese adults and to define C1 hypoplasia.
