Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

PurposeThe purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).Materials and methodsFour databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.ResultsFive eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).ConclusionsOur results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.     

Stress protein synthesis in human keratinocytes treated with sodium arsenite,phenyldichloroarsine, and nitrogen mustard

Cells from bacteria to man respond to sublethal thermal and certain chemical stresses by synthesis of heat shock, or stress, proteins. The human epidermal keratinocyte is a target for a variety of cytotoxic substances. One response of cells exposed to such agents may be the synthesis of stress proteins. Human epidermal keratinocytes were treated thermally (43°C) or chemically with sodium arsenite and the skin irritants phenyldichloroarsine and mechlorethamine. Proteins synthesized by keratinocytes were radiolabeled with [³⁵S]methionine, separated on polyacrylamide gels under denaturing conditions, and visualized by fluorography. Quantitation by computer-assisted densitometry of fluorograms revealed different patterns of synthesis of two heat shock proteins (hsp's) with apparent molecular weights of 70 and 90 kDa after treatment with heat, sodium arsenite, phenyldichloroarsine, or mechlorethamine. Sodium arsenite induced the highest levels of synthesis of these two proteins, approximately 10-fold and 3-fold increases in hsp-70 and hsp-90, respectively. Phenyldichloroarsine at 0.5 μm produced a 2-fold increase in hsp-70 but no significant increase in hsp-90. Mechlorethamine, in contrast, had an apparent inhibitory effect on hsp-70 synthesis. These results suggest that some but not all skin irritants induce the synthesis of heat shock proteins in human keratinocytes.     

A型肉毒毒素治疗疼痛的机制研究进展

A型肉毒毒素(botulinum toxin-A,BTX-A)是由100 ku的重链和50 ku的轻链通过二硫键相连形成的双链多肽式结构,其中轻链是一种蛋白酶可与神经肌肉接头处的融合蛋白结合,防止突触小泡锚定在细胞膜上释放乙酰胆碱,从而干扰神经冲动传递,因此在临床中作用效果广泛。近年来针对BTX-A临床应用范围的讨论也一直是热点,研究显示,A型肉毒毒素(BTX-A)能有效治疗疼痛,具有可持续性发挥疗效和无成瘾性等特点,但对于BTX-A作用机制仍旧存有争议。本篇文章将分别对BTX-A在外周神经系统和中枢神经系统中作用机制的相关研究进行综述。     

自发性腹膜炎患者腹水中IL-18的表达水平及临床意义

摘要：目的  探讨自发性腹膜炎患者腹水中白介素18（IL-18）的表达水平及其影响因素。方法  前瞻性选取2014年1月-2016年1月浙江省宁波市鄞州人民医院和浙江大学医学院附属第一医院收治的乙型肝炎性肝硬化合并腹水患者231例,根据患者是否发生自发性腹膜炎将患者分为观察组（41例）和对照组（190例）,检测两组患者腹水中IL-18水平,并分析IL-18的临床意义及影响因素。结果  与对照组比较,观察组患者腹水中IL-18水平升高（P <0.05）。多因素Logistic回归分析显示,腹水中IL-18水平升高是乙型肝炎性肝硬化患者自发性腹膜炎的危险因素[■=1.32（95%CI：1.14,1.50）P =0.000]。多元线性回归分析显示,腹水中白介素6（IL-6）、肿瘤坏死因子-α（TNF-α）,以及血清CD4+ T细胞、TNF-α、IL-6、IL-18水平是影响腹水中IL-18水平的因素（b=0.362、0.318、0.253、0.247、0.262和0.427）。结论  腹水中IL-18水平升高是乙型肝炎性肝硬化患者自发性腹膜炎的危险因素;腹水中IL-6、TNF-α,以及血清CD4+ T细胞、TNF-α、IL-6、IL-18水平是腹水中IL-18水平的影响因素。

     

In vitro characterization of polycaprolactone matrices generated in aqueous media

In this study, a novel process of dissolving polycaprolactone (PCL) matrices in glacial acetic acid was explored in which matrices spontaneously formed upon contact with water. Scanning electron microscopy analysis showed rough architecture and holes on the self-assembled matrix relative to matrices formed after dissolving in chloroform. Immersion in the gelatin solution reduced its roughness and number of micropores. Atomic force microscopy (AFM) analysis confirmed the increased roughness of the self-assembled matrices. The roughness of the matrices decreased after incubation in 1 N NaOH for 10 min. AFM analysis also revealed that the self-assembled matrix had a net positive surface charge, whereas chloroform–cast matrix had a negative surface charge. The surface charge of self-assembled matrix after immersion in gelatin changed to negative. However, incubation in NaOH did not affect the surface charge. The tensile properties were tested in both the dry state (25 °C) and the wet state (37 °C) by immersion in phosphate-buffered saline. Self-assembled matrix had lower elastic modulus, break stress and break strain than chloroform–cast matrix in both states. The elastic modulus in the wet condition was reduced by half in self-assembled matrix but tensile strain increased. Samples were further analyzed by ramp-hold test for assessing stress relaxation behavior. Both self-assembled and chloroform–cast matrices had similar trends in stress relaxation behavior. However, stress accumulation in self-assembled matrix was half that of chloroform–cast matrix. In vitro cell cultures were conducted using human foreskin fibroblast (HFF-1) in serum-free medium. Cytoskeletal actin staining showed cell adhesion and spreading on all matrices. Cell retention was significantly increased in self-assembled matrix compared to chloroform–cast matrix. Addition of gelatin improved the retention of seeded cells on the surface. In summary, PCL matrices generated using this novel technique show significant promise in biomedical applications.     

超声特征预测甲状腺微小乳头状癌颈侧区淋巴结转移的临床应用价值分析

目的探讨超声特征预测甲状腺微小乳头状癌颈侧区淋巴结转移的临床应用价值。方法采取回顾性方法对宁波市鄞州区第二医院超声科2011年1月～2012年1月120例甲状腺微小乳头状癌患者术前超声诊断资料与术后颈侧区淋巴结转移病理结果进行分析。结果颈侧区淋巴结转移阳性患者的肿瘤边界、钙化、肿瘤位置、甲状腺被膜与肿瘤关系和颈侧区淋巴结转移阴性患者的肿瘤边界、钙化、肿瘤位置、甲状腺被膜与肿瘤关系情况比较具有明显的差异（P〈0．05）,有统计学意义。颈侧区淋巴结转移阳性患者不同超声积分与颈侧区淋巴结转移阴性患者不同超声积分比较具有明显的差异,有统计学意义（P〈0．05）。以超声积分为2．5作为临界点,积分≥2．5分时甲状腺微小乳头状癌患者颈侧区淋巴结很有可能发生转移,临床诊断敏感性与特异性分别是86．0％、90．0％。结论临床中对于甲状腺微小乳头状癌患者应用超声积分能够有效地对颈侧区淋巴结转移进行诊断,在临床中具有重要的应用价值。     

Unsupervised domain adaptation for clinician pose estimation and instance segmentation in the operating room

The fine-grained localization of clinicians in the operating room (OR) is a key component to design the new generation of OR support systems. Computer vision models for person pixel-based segmentation and body-keypoints detection are needed to better understand the clinical activities and the spatial layout of the OR. This is challenging, not only because OR images are very different from traditional vision datasets, but also because data and annotations are hard to collect and generate in the OR due to privacy concerns. To address these concerns, we first study how joint person pose estimation and instance segmentation can be performed on low resolutions images with downsampling factors from 1x to 12x. Second, to address the domain shift and the lack of annotations, we propose a novel unsupervised domain adaptation method, called AdaptOR, to adapt a model from an in-the-wild labeled source domain to a statistically different unlabeled target domain. We propose to exploit explicit geometric constraints on the different augmentations of the unlabeled target domain image to generate accurate pseudo labels and use these pseudo labels to train the model on high- and low-resolution OR images in a self-training framework. Furthermore, we propose disentangled feature normalization to handle the statistically different source and target domain data. Extensive experimental results with detailed ablation studies on the two OR datasets MVOR+ and TUM-OR-test show the effectiveness of our approach against strongly constructed baselines, especially on the low-resolution privacy-preserving OR images. Finally, we show the generality of our method as a semi-supervised learning (SSL) method on the large-scale COCO dataset, where we achieve comparable results with as few as 1% of labeled supervision against a model trained with 100% labeled supervision. Code is available at https://github.com/CAMMA-public/HPE-AdaptOR.     

非结核分枝杆菌的耐药性分析及临床意义

目的分析非结核分枝杆菌的感染、耐药情况,为临床合理用药提供科学依据。方法采用快速全自动分枝杆菌培养/药敏检测系统(Bactec MGITsyste)检测标本,阳性标本采用VITEK MS质谱分析仪鉴定。结果2016年-2018年3年共检出非结核分枝杆菌157株,主要来自ICU、呼吸内科、神经内科、血液科,分别占31.2%、22.3%、13.4%、13.4%,居前三位的分别为胞内分枝杆菌、鸟分枝杆菌、脓肿分枝杆菌,对常用的抗结核药物敏感性较低,克拉霉素敏感性较好。结论NTM感染应尽早鉴定菌株并根据药敏结果合理选用抗菌药物,避免更多耐药菌株出现。     

The effect of high glucose-based peritoneal dialysis fluids on thioredoxin-interacting protein expression in human peritoneal mesothelial cells

BackgroundIt has been demonstrated that thioredoxin-interacting protein (TXNIP) interacted with NACHT, LRR and PYD domains-containing protein 3 (NLRP3) and participated in the NLRP3 inflammasome activation. Our previous study has demonstrated that in human peritoneal mesothelial cells (HPMCs), exposure to high glucose-based peritoneal dialysis (PD) solutions induced mitochondrial reactive oxygen species (ROS) production, activation of NLRP3 inflammasome and IL-1β expression. This study aimed to investigate the effect of high glucose-based PD fluids on the TXNIP expression and the underlying mechanisms by which TXNIP-NLRP3 interaction mediates the inflammatory injury to HPMCs in high glucose-based PD fluids conditions.MethodsTXNIP gene and protein expression was detected by real-time polymerase chain reaction (RT-PCR) and immunoblot. Immunoprecipitation was used to evaluate the interaction between TRX1 and TXNIP, TXNIP and NLRP3. ROS production and IL-1β expression was examined by flow cytometry and immunoblot and enzyme-linked immunosorbent assay (ELISA) respectively.ResultsIt was identified that high glucose-based PD solutions enhance the level of TXNIP gene and protein in cultured HPMCs and a rat-based PD model. We also found that ROS generation induced by high glucose-based PD solutions disrupts the TRX1-TXNIP association, while promoting the binding of TXNIP to NLRP3 in HPMCs. Furthermore, the application of a ROS inhibitor (APDC) to HPMCs blocked the high glucose-based PD solution-induced TXNIP-NLRP3 binding, in addition to ROS production and IL-1β expression.ConclusionThe results of the present study revealed a novel mechanism underlying high glucose-containing PD-mediated peritoneal inflammatory injury, supporting the attenuation of ROS generation as a potential therapeutic strategy to alleviate such pathology.