癌胚抗原相关细胞黏附分子和人胸肾表达趋化因子在婴幼儿血管瘤组织中的表达

目的 检测癌胚抗原相关细胞黏附分子(CEACAM-1)和人胸肾表达趋化因子(CXCL-14)在不同时期婴幼儿血管瘤组织中的表达,并探讨其在血管瘤发生发展过程中的作用和意义.方法 应用免疫组化法和Western免疫印迹检测CEACAM-1和CXCL-14在增生期、消退期和消退完成期婴幼儿血管瘤组织中的表达,利用计算机图像分析技术测量平均吸光度.结果 CEACAM-1在增生期血管瘤组织中不表达或低表达,消退期呈强阳性表达,消退完成期呈阳性表达;各期之间CEACAM-1的表达差异有统计学意义(P<0.05);CXCL-14在增生早期血管瘤组织中不表达或低表达,消退期呈阳性表达,消退完成期呈强阳性表达,各期之间CXCL-14表达差异有统计学意义(P<0.05).结论 CEACAM-1和CXCL-14可能参与了婴幼儿血管瘤病理变化过程,在该病发生发展过程中起一定的作用.     

The 16 golden hours for conservative treatment in children with postoperative small bowel obstruction

Background

Conservative treatment of postoperative small bowel obstruction in children is widely accepted, provided that there are no clinical signs of bowel strangulation. However, the length of time surgery can be safely deferred remains unclear.

Purpose

The aim of this study was to determine the time limit for observant management of postoperative small bowel obstruction.

Methods

The medical records of 128 children with 174 episodes of postoperative small bowel obstruction were reviewed.

Results

Spontaneous resolution occurred in 63% of cases, 85% within 48 hours of admission. Bowel compromise was noted in 31% of the operated cases, and about half of them underwent bowel resection, accounting for 6% of all admissions. None of the cases treated surgically within 16 hours of admission was associated with bowel strangulation or need for resection.

Conclusions

In children presenting with postoperative small bowel obstruction, prolonging observant treatment for more than 48 hours yields only a small benefit in terms of spontaneous resolution. Bowel strangulation can occur within 16 hours of admission. On the basis of these findings, we suggest raising the index of suspicion for compromised bowel after 16 hours and making the decision for surgery at around 48 hours.     

未损伤背根神经节GABAA受体在大鼠神经病理性痛中的作用

目的 评价未损伤背根神经节(L4 背根神经节)γ氨基丁酸A受体(GABAA受体)在大鼠神经病理性痛中的作用.方法 成年雌性SD大鼠30只,体重200～250 g,随机分为3组(n=10):对照组(C组)、蝇蕈醇组(M组)和荷包牡丹碱组(B组).采用结扎L5脊神经的方法制备大鼠神经病理性痛模型.C组于L4 背根神经节局部注射生理盐水50μl;M组于L4背根神经节局部注射GABAA受体激动剂蝇蕈醇50μl;B组于L4背根神经节局部注射GABAA受体拮抗剂荷包牡丹碱50μl;各组注射时间均大于1 min.于术前1 d至术后10 d,每天测定大鼠的热痛阈和机械痛阈.结果 与C组比较,M组热痛阈差异无统计学意义(P＞0.05),机械痛阈升高,B组热痛阈和机械痛阈均降低(P＜0.05).结论 未损伤背根神经节GABAA受体激活参与了神经病理性痛大鼠机械痛敏的发生发展,对热痛敏的发生发展可能不起主导作用.     

Platelets in Early Antibody-Mediated Rejection of Renal Transplants

Antibody-mediated rejection is a major complication in renal transplantation. The pathologic manifestations of acute antibody-mediated rejection that has progressed to functional impairment of a renal transplant have been defined in clinical biopsy specimens. However, the initial stages of the process are difficult to resolve with the unavoidable variables of clinical studies. We devised a model of renal transplantation to elucidate the initial stages of humoral rejection. Kidneys were orthotopically allografted to immunodeficient mice. After perioperative inflammation subsided, donor-specific alloantibodies were passively transferred to the recipient. Within 1 hour after a single transfer of antibodies, C4d was deposited diffusely on capillaries, and von Willebrand factor released from endothelial cells coated intravascular platelet aggregates. Platelet-transported inflammatory mediators platelet factor 4 and serotonin accumulated in the graft at 100- to 1000-fold higher concentrations compared with other platelet-transported chemokines. Activated platelets that expressed P-selectin attached to vascular endothelium and macrophages. These intragraft inflammatory changes were accompanied by evidence of acute endothelial injury. Repeated transfers of alloantibodies over 1 week sustained high levels of platelet factor 4 and serotonin. Platelet depletion decreased platelet mediators and altered the accumulation of macrophages. These data indicate that platelets augment early inflammation in response to donor-specific antibodies and that platelet-derived mediators may be markers of evolving alloantibody responses.     

Incomplete Administration of Intravenous Vancomycin Prophylaxis is Common and Associated With Increased Infectious Complications After Primary Total Hip and Knee Arthroplasty

BackgroundVancomycin is often used as antimicrobial prophylaxis in patients undergoing total hip or knee arthroplasty. Vancomycin requires longer infusion times to avoid associated side effects. We hypothesized that vancomycin infusion is often started too late and that delayed infusion may predispose patients to increased rates of surgical site infections and prosthetic joint infections.MethodsWe reviewed clinical data for all primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients at our institution between 2013 and 2020 who received intravenous vancomycin as primary perioperative gram-positive antibiotic prophylaxis. We calculated duration of infusion before incision or tourniquet inflation, with a cutoff of 30 minutes defining adequate administration. Patients were divided into two groups: 1) appropriate administration and 2) incomplete administration. Surgical factors and quality outcomes were compared between groups.ResultsWe reviewed 1047 primary THA and TKA patients (524 THAs and 523 TKAs). The indication for intravenous vancomycin usage was allergy (61%), methicillin-resistant staphylococcus aureus colonization (17%), both allergy and colonization (14%), and other (8%). 50.4% of patients began infusion >30 minutes preoperatively (group A), and 49.6% began infusion <30 minutes preoperatively (group B). Group B had significantly higher rates of readmissions for infectious causes (3.6 vs 1.3%, P = .017). This included a statistically significant increase in confirmed prosthetic joint infections (2.2% vs 0.6%, P = .023). Regression analysis confirmed <30 minutes of vancomycin infusion as an independent risk factor for PJI when controlling for comorbidities (OR 5.22, P = .012).ConclusionLate infusion of vancomycin is common and associated with increased rates of infectious causes for readmission and PJI. Preoperative protocols should be created to ensure appropriate vancomycin administration when indicated.     

节段内U形钛棒固定系统结合峡部植骨治疗腰椎峡部裂的临床效果

目的 研究U形钛棒内固定系统结合峡部植骨治疗腰椎峡部裂的临床疗效.方法 纳入2015年2月～2018年12月本科收治的50例不伴有椎间盘突出及腰椎滑脱的单纯性腰椎峡部裂患者;累及节段L34例,L414例,L532例.采用节段内U形钛棒固定系统结合峡部植骨治疗30例(U形钛棒组),节段间椎弓根螺钉系统结合峡部植骨治疗20例(椎弓根钉组).对比两组术前及末次随访时的VAS评分、ODI指数以及腰椎活动度以及并发症发生情况.通过腰椎CT评价峡部骨折愈合情况.结果 所有患者随访12～24个月,平均(18.2±7.3)个月.末次随访时两组疼痛VAS评分、ODI指数较术前均显著降低(P<0.05),但两组间差异无统计学意义(P>0.05),但U形钛棒组腰椎活动度显著大于椎弓根钉组,差异有统计学意义(P<0.05).末次随访两组患者峡部裂骨性愈合时间无显著性差异(P>0.05).所有手术切口均Ⅰ期愈合,植骨骨性融合,无感染、慢性疼痛、内固定松动等并发症发生.结论 对于不伴有椎间盘突出及腰椎滑脱的单纯性腰椎峡部裂患者,节段内U形钛棒固定与节段间椎弓根钉固定结合峡部植骨治疗均能取得良好疗效,但前者更有利于保留腰椎的活动度.     

Novel glucose-lowering drugs for non-alcoholic fatty liver disease

BACKGROUNDThe efficacy of novel glucose-lowering drugs in treating non-alcoholic fatty liver disease (NAFLD) is unknown.AIMTo evaluate the efficacy of glucose-lowering drugs dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors in treating NAFLD and to perform a comparison between these treatments.METHODSElectronic databases were systematically searched. The inclusion criteria were: Randomized controlled trials comparing DPP-4 inhibitors, GLP-1 RAs, or SGLT2 inhibitors against placebo or other active glucose-lowering drugs in NAFLD patients, with outcomes of changes in liver enzyme [alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST)] from baseline.RESULTSNineteen studies were finally included in this meta-analysis. Compared with placebo or other active glucose-lowering drug treatment, treatment with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors all led to a significant decrease in ALT change and AST change from baseline. The difference between the DPP-4 inhibitor and SGLT2 inhibitor groups in ALT change was significant in favor of DPP-4 inhibitor treatment (P < 0.05). The trends of reduction in magnetic resonance imaging proton density fat fraction and visceral fat area changes were also observed in all the novel glucose-lowering agent treatment groups.CONCLUSIONTreatment with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors resulted in improvements in serum ALT and AST levels and body fat composition, indicating a beneficial effect in improving liver injury and reducing liver fat in NAFLD patients.     

The prognostic value of platelet-to-lymphocyte ratio on the long-term renal survival in patients with IgA nephropathy

Purpose

Platelet-to-lymphocyte ratio (PLR) was established showing the poor prognosis in several diseases, such as malignancies and cardiovascular diseases. But limited study has been conducted about the prognostic value of PLR on the long-term renal survival of patients with Immunoglobulin A nephropathy (IgAN).

Methods

We performed an observational cohort study enrolling patients with biopsy-proven IgAN recorded from November 2011 to March 2016. The definition of composite endpoint was eGFR decrease by 50%, eGFR?<?15 mL/min/1.73 m², initiation of dialysis, or renal transplantation. Patients were categorized by the magnitude of PLR tertiles into three groups. The Kaplan–Meier curves and multivariate Cox models were performed to determine the association of PLR with the renal survival of IgAN patients.

Results

330 patients with a median age of 34.0 years were followed for a median of 47.4 months, and 27 patients (8.2%) had reached the composite endpoints. There were no differences among the three groups (PLR?<?106, 106?≤?PLR?≤?137, and PLR?>?137) in demographic characteristics, mean arterial pressure (MAP), proteinuria, and estimated glomerular filtration rate (eGFR) at baseline. The Kaplan–Meier curves showed that the PLR?>?137 group was significantly more likely to poor renal outcomes than the other two groups. Using univariate and multivariate cox regression analyses, we found that PLR?>?137 was an independent prognostic factor for poor renal survival in patients with IgAN. Subgroup analysis revealed that the PLR remained the prognostic value for female patients or patients with eGFR less than 60 mL/min/1.73 m².

Conclusions

Our results underscored that baseline PLR was an independent prognostic factor for poor renal survival in patients with IgAN, especially for female patients or those patients with baseline eGFR less than 60 mL/min/1.73 m².

     

亚慢性染毒丙烯酰胺对雄性大鼠生殖及睾丸内分泌功能的影响

目的:探讨亚慢性丙烯酰胺染毒对雄性大鼠生殖及睾丸内分泌功能的影响。方法:选择SD雄性成年大鼠40只,随机分成4组,每组10只,灌胃给予丙烯酰胺,剂量分别为0、4、10、18mg/(kg.d),染毒9周。染毒结束后,测量大鼠后肢支撑力,精子存活率、精子畸形率、睾丸匀浆中碱性磷酸酶(ALP)和酸性磷酸酶(ACP)活性、血清和睾丸匀浆中T及E2浓度。建立睾丸Leydig细胞体外原代培养模型,丙烯酰胺体外染毒剂量分为0、0.1、0.75、4、8mmol/L,通过CCK-8法观察Leydig细胞活性。结果:随着染毒剂量的增加,后肢展开距离显著加宽(P<0.01)。精子存活率分别为(76.86±5.46)%、(65.43±5.16)%、(60.86±4.26)%和(46.86±2.73)%,各剂量组与对照组比较显著下降(P<0.01);畸形率分别为(39.00±10.95)%、(35.43±7.54)%、(45.71±13.28)%和(56.71±17.01)%,10、18mg/(kg.d)剂量组明显上升(P<0.05)。ACP活性为(82.93±11.05)、(73.52±8.77)、(77.67±3.04)、(68.56±3.09)U/gprot,呈下降趋势;ALP活性为(0.96±0.15)、(1.07±0.22)、(1.12±0.22)、(0.74±0.10)U/gprot,呈现先上升后下降的趋势。两者的活性在18mg/(kg.d)剂量组与对照组比较差异显著(P<0.05)。血清T浓度分别为(13.44±4.76)、(7.69±3.84)、(5.23±1.42)、(1.36±0.86)ng/ml,睾丸匀浆中T浓度分别为(4.95±1.64)、(3.01±0.76)、(2.44±0.91)、(0.85±0.49)ng/mgprot,两者各剂量组与对照组比较都显著下降(P<0.01)。各剂量组E2水平无明显差异。丙烯酰胺染毒24h后,培养细胞A值分别为0.82±0.06、0.56±0.07、0.44±0.06、0.26±0.03和0.45±0.21,0.1、0.75、4、8mmol/L剂量组Leydig细胞活性受到显著抑制(P<0.01)。结论:亚慢性丙烯酰胺染毒,影响精子正常发育,引起睾丸一些生化酶活性改变;大鼠后肢运动协调性明显受到影响;丙烯酰胺对Leydig细胞有直接损伤作用,影响其内分泌功能。