食管贲门癌患者术后肺部感染的临床分析

目的探讨食管贲门癌患者术后肺部感染的相关危险因素及诊治对策,以提高医疗服务质量。方法回顾性分析医院2012年1月-2013年1月146例手术治疗食管贲门癌患者资料,对感染高危因素进行分析,采用SPSS13.0软件进行统计处理。结果 146例患者中27例发生术后肺部感染,感染率为18.49%;手术时间、病程、年龄、合并基础疾病、手术切口长度、营养状况、预防性使用抗菌药物、吸烟、未采用术后自控镇痛等与肺部感染密切相关(P<0.05);共培养出病原菌27株,革兰阴性菌19株占70.37%,以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和鲍氏不动杆菌为主,革兰阳性菌8株占29.63%,以金黄色葡萄球菌、表皮葡萄球菌为主;革兰阴性菌对氨苄西林、左氧氟沙星高度耐药,革兰阳性菌对万古霉素、亚胺培南敏感性较高。结论术前综合评价,掌握手术指征,发现肺部潜在疾患,合理的手术方案、娴熟的手术操作技术可降低肺部创伤,术后针对感染高危因素进行干预是降低患者肺部感染率与控制感染的有效措施。     

Development and characterization of novel microsatellite markers in yellowcheck (Elopichthys bambusa)

Out of 55 microsatellites isolated by an enriched genomic library from yellowcheck (Elopichthys bambusa), eighteen polymorphic loci were characterized in a wild population from the Zhangdu Lake of the Yangtze River. The number of alleles per locus ranged from 2 to 14, the observed and expected heterozygosity ranged from 0.019 to 0.346 and 0.019 to 0.529, respectively. Eight loci deviated from Hardy–Weinberg Equilibrium (HWE) after Bonferroni correction, and ten loci were in HWE. Lower rate of polymorphic loci and heterozygosity may suggest a relative low level genetic diversity in the studied population. These novel microsatellite markers would facilitate molecular population genetic studies for yellowcheck.     

Lidocaine attenuates lipopolysaccharide-induced inflammatory responses in microglia

Background

Lidocaine has been used as a local anesthetic with anti-inflammatory properties, but its effects on neuroinflammation have not been well defined. In the present study, we investigated the prophylactic effects of lidocaine on lipopolysaccharide (LPS)-activated microglia and explored the underlying mechanisms.

Materials and methods

Microglial cells were incubated with or without 1 μg/mL LPS in the presence or absence of lidocaine, a p38 mitogen–activated protein kinase (p38 MAPK) inhibitor (SB203580), a nuclear factor-kappa B (NF-κB) inhibitor (pyrrolidine dithiocarbamate), or small interfering RNA. The protein and expression levels of inflammatory mediators, such as monocyte chemotactic protein 1, nitric oxide, prostaglandin E₂, interleukin 1β, and tumor necrosis factor α were measured using enzyme-linked immunosorbent assays and real-time polymerase chain reaction. The effect of lidocaine on NF-κB and p38 MAPK activation was evaluated using enzyme-linked immunosorbent assays, Western blot analysis, and electrophoretic mobility shift assay.

Results

Lidocaine (≥2 μg/mL) significantly inhibited the release and expression of nitric oxide, monocyte chemotactic protein 1, prostaglandin E₂, interleukin 1β, and tumor necrosis factor α in LPS-activated microglia. Treatment with lidocaine also significantly inhibited the phosphorylation of p38 MAPK and the nuclear translocation of NF-κB p50/p65, increased the protein levels of inhibitor kappa B-α. Furthermore, our study shows that the LPS-induced release of inflammatory mediators was suppressed by SB203580, pyrrolidine dithiocarbamate, and small interfering RNA.

Conclusions

Prophylactic treatment with lidocaine inhibits LPS-induced release of inflammatory mediators from microglia, and these effects may be mediated by blockade of p38 MAPK and NF-κB signaling pathways.     

Consecutive flap transfer for repairing massive soft tissue defects in the opisthenar with improved donor site closure

Objective：To explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.Methods：Six patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps.Afterwards,a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.Results：All six free scapular flaps survived without signs of infection.Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex,which resolved after six weeks with only conservative therapy.All the incisions healed without other complications.At six-month follow-up,the patients regained full shoulder function.Conclusion：With the assistance of an adjacent pedicled flap,the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar.It can achieve positive outcomes in both reconstructive and aesthetic aspects.     

网/腹膜乳斑的巨噬细胞表型与结直肠癌分期的关系

【摘要】 目的 探讨不同分期结直肠癌网/腹膜乳斑巨噬细胞的表型及作用。 方法 收集番禺中心医院普外科2011年1月至2012年12月不同分期结直肠癌患者网/腹膜乳斑标本60例及正常人网/腹膜乳斑标本10例。分离培养巨噬细胞,通过CD68免疫荧光染色、流式细胞术(FCM)鉴定网/腹膜乳斑巨噬细胞表型,酶联免疫吸附测定(ELISA)检测网/腹膜乳斑巨噬细胞IL-10、IL-12的分泌情况。结果 对照组、T1-3期组网/腹膜乳斑M1型巨噬细胞数量明显高于T4期组(P均<0.01);T4期组M2型巨噬细胞数量则明显高于对照组及T1-3期组(P均<0.01)。网/腹膜M1型巨噬细胞与结直肠癌T分期呈负相关(P<0.01),而M2型巨噬细胞的表达则与结直肠癌T分期呈正相关(P<0.01)。各组不同时点网/腹膜乳斑巨噬细胞IL-10、IL-12的分泌有显著差异:对照组及T1-3期组IL-10均低于T4期组,而L-12则均高于T4期组(P均<0.05);乳斑巨噬细胞IL-12的分泌与结直肠癌T分期呈负相关(P均<0.01),而IL-10的分泌则与结直肠癌T分期呈正相关(P<0.01)。结直肠癌网/腹膜乳斑巨噬细胞表型与临床分期特别是浆膜是否受到肿瘤侵犯、淋巴结有否转移有关(P<0.05),而与肿瘤直径及分化程度无关(P>0.05)。 结论 网/腹膜乳斑巨噬细胞表型表达主要受浆膜是否受到肿瘤侵犯和淋巴结有否转移两方面因素影响;T1-3期结直肠癌患者,网/腹膜乳斑巨噬细胞以M1型为主,对肿瘤细胞起捕获和杀灭作用;T4期结直肠癌患者,网/腹膜乳斑巨噬细胞以M2型为主,对肿瘤生长起促进作用。     

Subclinical infections of cardiac implantable electronic devices: Insights into the host–bacteria dialog from blood and pocket tissue with pyrosequencing

While bacteria exist in CIED patients without clinical signs of infection, the underlying bacterial community structure and diversity in the bloodstream and pocket tissue of asymptomatic CIED patients remain unknown. In this study, we performed high-throughput 454 pyrosequencing of bacterial 16S rDNA of blood and pocket tissue from 54 asymptomatic CIED patients as well as blood from 30 normal individuals (normal controls). Firstly, we observed a significant increase of blood bacterial diversity in patients as compared with blood of normal subjects or patient tissues. We also found significant differences in 13 blood-associated bacterial genera between patients and normal subjects, and 14 bacteria genera between blood and tissues within patients. Secondly, we found that the serum levels of four inflammatory markers (CRP, IL-1β, IL-6, and MCP-1) in CIED patients were significantly higher than those in normal subjects. Thirdly, we found that there were significant correlations between 43 bacterial species and these inflammatory markers. Taken together, our results reveal a high diversity in the microbial community in CIED patients, and suggest the potential roles of multiple bacteria co-occurrence in the CIED subclinical infections.     

Carthamus tinctorius L. extract activates insulin‐like growth factor‐I receptor signaling to inhibit FAS‐death receptor pathway and suppress lipopolysaccharides‐induced H9c2 cardiomyoblast cell apoptosis

Carthamus tinctorius L. (Compositae) is used in Chinese medicine to treat heart disease and inflammation. In our previous study, we found that C. tinctorius L. inhibited lipopolysaccharides (LPS)‐induced tumor necrosis factor‐alpha (TNF‐α) activation, JNK expression, and apoptosis in H9c2 cardiomyoblast cells. The present study was performed to investigate the protective effect of C. tinctorius extract (CTF) on LPS‐challenged H9c2 myocardioblast cell and to explore the possible underlying mechanism. Cell viability assay showed that LPS treatment decreased the cell viability of H9c2 cell, whereas CTF treatment reversed LPS cytotoxicity in a dose‐dependent manner, especially in the LPS + CTF 25 (μg/mL) group. LPS treatment‐induced apoptosis was determined by transferase‐mediated dUTP nick end labeling assay, and by Western blot. LPS‐induced apoptotic bodies were decreased following CTF treatment. Expression of TNF‐α, FAS‐L, FAS, FADD, caspase‐8, BID, and t‐BID was significantly increased in LPS‐treated H9c2 cells. In contrast, it was significantly suppressed by the administration of CTF extract. In addition, CTF treatment activates antiapoptotic proteins, Bcl‐2 and p‐Bad, and downregulates Bax, cytochrome‐c, caspase‐9, caspase‐3, and apoptosis‐inducing factor expression. Furthermore, CTF exerted cytoprotective effects by activating insulin‐like growth factor‐I (IGF‐I) signaling pathway leading to downregulation of the apoptotic proteins involved in FAS death receptor pathway. In addition, AG1024 and IGF‐I receptor (IGF‐IR) inhibitor and siRNA silencing reverses the effect of CTF implying that CTF functions through the IGF‐IR pathway to inhibit LPS‐induced H9c2 apoptosis. These results suggest that treatment with CTF extract prevented the LPS‐induced apoptotic response through IGF‐I pathway.     

The toxicity of very prolonged courses of PEGasparaginase or Erwinia asparaginase in relation to asparaginase activity,with a special focus on dyslipidemia

We prospectively studied the incidence and clinical course of hypertriglyceridemia and hypercholesterolemia during very prolonged use of asparaginase in relation to levels of asparaginase activity in children with acute lymphoblastic leukemia. We also evaluated the incidence of pancreatitis, thrombosis, hyperammonemia and central neurotoxicity and their association with asparaginase activity levels. Eighty-nine patients were treated according to the Dutch Childhood Oncology Group Acute Lymphoblastic Leukemia 10 medium-risk intensification protocol, which includes 15 doses of PEGasparaginase (2,500 IU/m²) over 30 weeks. Erwinia asparaginase (20,000 IU/m²) was administered when allergy to or silent inactivation of PEGasparaginase occurred. Triglyceride, cholesterol and ammonia levels increased rapidly in children treated with PEGasparaginase and remained temporarily elevated, but normalized after administration of the last asparaginase dose. Among the patients treated with PEGasparaginase, hypertriglyceridemia and hypercholesterolemia (grade 3/4) were found in 47% and 25%, respectively. The correlation between PEGasparaginase activity levels and triglyceride levels was strongest at week 5 (Spearman correlation coefficient=0.36, P=0.005). The triglyceride levels were higher in children ≥10 years old than in younger patients (<10 years old) after adjustment for type of asparaginase preparation: median 4.9 mmol/L versus 1.6 mmol/L (P<0.001). In patients receiving Erwinia asparaginase, triglyceride levels increased in the first weeks as well, but no grade 3/4 dyslipidemia was found. Hyperammonemia (grade 3/4) was only found in patients treated with Erwinia asparaginase (9%). Thrombosis occurred in 4.5%, pancreatitis in 7%, and central neurotoxicity in 9% of patients using either of the two agents; these toxicities were not related to levels of asparaginase activity or to triglyceride levels. In conclusion, severe dyslipidemia occurred frequently, but was temporary and was not associated with relevant clinical events and should not, therefore, be considered a reason for modifying asparaginase treatment. Dyslipidemia was the only toxicity related to levels of asparaginase activity.     

Epidural steroids following percutaneous endoscopic interlaminar discectomy: A protocol for systematic review and meta-analysis

Background:Percutaneous endoscopic interlaminar discectomy (PEID) has been widely used in the treatment of lumbar disc herniation and spinal stenosis, epidural steroids following PEID in an effort to reduce the incidence and duration of postoperative pain. Although steroids are widely thought to reduce the effect of surgical trauma, the observation index is not uniform, so the issue is still controversial. Therefore, the purpose of this paper is to systematically evaluate the efficacy and safety of local epidural steroids application following PEID.Methods:We will search the following databases from their inception to August 2020, PubMed, Embase, Medline, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Web of Science, Wan Fang Database, Cochrane Library. The search strategy includes the MeSH terms. Meta-analysis will be performed using Rev Man V.5.3.5 statistical software.Results:This study will provide a high-quality synthesis to evaluate the efficacy and safety of local epidural steroids following PEID.Conclusion:This systematic review will provide evidence to judge whether local epidural steroids application following PEID is an effective and safe intervention for patients. It will provide reliable evidence for its extensive application.Registration number:INPLASY2020100085