Multi‐center Retrospective Study of Factors Affecting Perioperative Transfusion of Packed Red Blood Cells for Pelvic Fracture Patients

ObjectiveTo analyze the use of packed red blood cells (PRBCs) for patients with pelvic fracture and evaluate factors associated with PRBC transfusion for patients with pelvic fracture.MethodsThis retrospective cohort study collected 551 patients with pelvic fractures from six hospitals between September 1, 2012, and June 31, 2019. The age span of patients varied from 10 to 95 years old, and they were classified into two groups based on high‐energy pelvic fractures (HE‐PFs) or low‐energy pelvic fractures (LE‐PFs). The study''s outcome was the use of PRBCs, fresh frozen plasma (FFP), and albumin. Demographic data, characteristics, laboratory tests, clinical treatment details, and clinical outcomes were compared between the two groups. Factors that were statistically associated with perioperative PRBCs in univariate analyses were included to conduct an optimal scale regression to determine the independent factors for perioperative PRBCs.ResultsA total of 551 patients were screened from six hospitals, and after inclusion and exclusion, 319 were finally included and finished the follow‐up from admission to discharge, while four patients died during hospitalization. Three hundred and nineteen patients were classified into two groups by their injury mechanisms. A total of 230/319 (72.1%) patients were classified into the HE‐PF group, and 89/319 (27.8%) patients were classified into the LE‐PF group. Patients in the HE‐PF group were transfused with 4.5 (3–8) units of PRBCs, 300 (0–600) ml of FFP, and 0 (0–30) g of albumin, while patients in the LE‐PF group were transfused with 3.5 (2–4.5) units of PRBCs, 0 (0–295) ml of FFP, and 0 (0–0) g of albumin (all P < 0.001). There were higher proportions of male patients and patients under 65 in the HE‐PF group (all P < 0.001). HE‐PF group patients were more severely injured and likely to take external fixation. The optimal scale regression revealed four significant factors associated with perioperative transfused PRBCs, which were patients on admission with hemorrhagic shock (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.148, P = 0.039), and methods of pelvic fixation (importance = 0.008, P = 0.026), ranked by the importance.ConclusionPatients with HE‐PFs had increased transfusions of PRBCs, FFP, and albumin, and hemorrhagic shock on admission, Tile classification, Hb levels, and stabilization methods were found to be associated with perioperative PRBCs.     

Selenium substituted axitinib reduces axitinib side effects and maintains its anti-renal tumor activity

Axitinib is a potent vascular endothelial growth factor receptor (VEGFR) inhibitor, which has a strong inhibitory effect on the three isoforms of VEGFR 1–3. Having strong therapeutic efficacy, its broad use is limited by its side effects such as hypertension, proteinuria, cardiovascular damage, and liver and kidney dysfunction. Selenium compounds are broadly reported to have a good protective effect on cardiovascular disease, inflammation, infection, and immune function. In this study, a selenium substitute of axitinib was synthesized, and its anti-renal cell carcinoma activity and side effects were investigated. The results of the study indicated that Se-axitinib had potent antitumor activity on renal cell carcinoma (RCC), alleviated vascular hyperpermeability, and also alleviated axitinib-related side effects including hypertension, liver dysfunction and kidney dysfunction significantly. Therefore, we suggest that Se-axitinib could be a solution to the severe side effects of VEGFR inhibitors and provide evidence to improve the outcome of RCC treatment.

Se-axitinib is a selenium substitution of sulfur in axitinib, which reduced the side effect of VEGFR inhibitors and maintained the potent anticancer activity of the original drug.     

氯沙坦和卡维地洛对大鼠心肌缺血再灌注后c-Myc基因表达影响的比较

目的研究氯沙坦和卡维地洛对大鼠心肌缺血再灌注后c-Myc基因表达变化影响比较。方法20只W istar大鼠,随机分为手术对照组、氯沙坦治疗组、卡维地洛治疗组和假手术组,每组各5只;制备大鼠在体心肌缺血再灌注模型;治疗组分别予氯沙坦和卡维地洛每日一次灌胃(共3次),手术对照组和假手术组分别给予相应容积量生理氯化钠溶液;术后48 h断头处死后取左心室前壁缺血再灌注区,使用原位杂交和免疫组化检测c-Myc基因表达的mRNA和蛋白质,经图象分析系统测量阳性染色区域平均光密度值对原位杂交和免疫组化检测物质进行量化分析。结果免疫组化检测手术对照组、氯沙坦治疗组和假手数组之间无明显差异(P>0.05),卡维地洛治疗组明显高于其它组(P<0.01);原位杂交检测:氯沙坦和卡维地洛治疗组以及假手术组c-Myc基因表达水平明显高于手术对照组(P<0.001),而氯沙坦治疗组和假手术组之间表达水平相近(P>0.05),卡维地洛治疗组最高(P<0.01)。结论氯沙坦和卡维地洛治疗组c-Myc基因表达水平明显高于手术对照组,氯沙坦治疗组同假手术组表达水平无明显差异,而卡维地洛治疗组c-Myc基因表达水平明显高于所有分组提示,氯沙坦对大鼠心肌缺血再灌注后c-Myc基因表达的影响可能是阻止缺血再灌注后可能受到相对抑制的c-Myc基因保持正常表达水平,而无促进c-Myc基因过度表达的作用,而卡维地洛治疗组c-Myc基因表达水平明显高于所有分组提示可能有促进该基因表达的作用。     

印迹基因Snrpn在人类卵母细胞及植入前胚胎mRNA表达

目的了解印迹基因Snrpn在人类卵母细胞和植入前胚胎的表达,以分析Snrpn基因表达对人类卵母细胞和早期胚胎发育的影响。方法采用单细胞巢式逆转录多聚酶链式反应(Single Cell Nested RT-PCR)方法,检测人类卵子和植入前各个阶段胚胎的印迹基因Snrpn mRNA表达情况。结果Snrpn在人类卵母细胞GV、MI、MII和植入前胚胎2、4、6、8细胞期都有表达,单卵母细胞扩增成功率为87.5%,单个胚胎为75.8%,平均扩增成功率为79.1%。单个卵母细胞和单个卵裂球扩增成功率无显著性差异(P>0.05),但单卵母细胞较单个卵裂球高。结论建立了比较稳定、可靠的单细胞巢式RT-PCR技术检测基因表达。印迹基因Snrpn在人类卵细胞和植入前胚胎的表达对卵子生长和胚胎发育有着重要意义,为早期胚胎阶段该基因表达正常图谱提供实验依据     

ELISA法检测乙肝5项指标室内质控初探

目前,市县级医院普遍采用固相酶联免疫法（ELISA）检测乙肝5项指标,该法操作方便、快捷,特别适合大批标本的筛查。但由于ELISA方法学特点,批内批间的CV值较大。因此,做好该项检测的质量控制是保证结果真实可靠的基础。现就本室开展此项室内质控若干措施和体会报告如下。     

Evaluation of physician experience in achieving non-perfused volume ratio of high-intensity focused ultrasound ablation for uterine fibroids: a multicentre study

ObjectiveTo evaluate the effect of different levels of physician experience on the high-intensity focused ultrasound (HIFU) ablation of uterine fibroids and to provide a reference for the use of non-perfused volume ratio (NPVR) standards during training.MethodsThis prospective multicentre study enrolled patients with uterine fibroids. The effect of the physician’s level of experience on the outcomes under different NPVR standards and the learning curve of six centres without HIFU experience were analysed. The impact of patient demographic and clinical characteristics were also evaluated.ResultsA total of 1352 patients from 20 centres were included in the study. The median NPVRs were 92.00%, 88.10% and 92.86% in the no experience group, inexperienced group and experienced group, respectively. Posterior wall fibroids, lateral wall fibroids and fundus fibroids were inversely correlated with NPVR, while experienced physicians were positively correlated with NPVR. With NPVR ≥ 70% and NPVR ≥ 80% standards, physicians in the no experience group completed the learning curve on the 11th and 16th procedure, respectively. Physicians under a standard of an NPVR ≥ 90% did not complete the learning curve.ConclusionsNPVR ≥ 80% is a standard that is worth using for HIFU treatment of uterine fibroids.     

PRRSV Induces HMGB1 Phosphorylation at Threonine-51 Residue to Enhance Its Secretion

Porcine reproductive and respiratory syndrome virus (PRRSV) induces secretion of high mobility group box 1 (HMGB1) to mediate inflammatory response that is involved in the pulmonary injury of infected pigs. Our previous study indicates that protein kinase C-delta (PKC-delta) is essential for HMGB1 secretion in PRRSV-infected cells. However, the underlying mechanism in HMGB1 secretion induced by PRRSV infection is still unclear. Here, we discovered that the phosphorylation level of HMGB1 in threonine residues increased in PRRSV-infected cells. A site-directed mutagenesis study showed that HMGB1 phosphorylation at threonine-51 was associated with HMGB1 secretion induced by PRRSV infection. Co-immunoprecipitation (co-IP) of HMGB1 failed to precipitate PKC-delta, but interestingly, mass spectrometry analysis of the HMGB1 co-IP product showed that PRRSV infection enhanced HMGB1 binding to ribosomal protein S3 (RPS3), which has various extra-ribosomal functions. The silencing of RPS3 by siRNA blocked HMGB1 secretion induced by PRRSV infection. Moreover, the phosphorylation of HMGB1 at threonine-51 was correlated with the interaction between HMGB1 and RPS3. In vivo, PRRSV infection also increased RPS3 levels and nuclear accumulation in pulmonary alveolar macrophages. These results demonstrate that PRRSV may induce HMGB1 phosphorylation at threonine-51 and increase its interaction with RPS3 to enhance HMGB1 secretion. This finding provides insights into the pathogenesis of PRRSV infection.     

鹦鹉热衣原体肺炎 28例临床特征分析

目的分析经宏基因组二代测序技术(metagenopmic next generation sequencing,mNGS)确诊的 28例鹦鹉热衣原体肺炎病人的临床特点。方法回顾性分析 2019年 10月 1日至 2022年 4月 1日长沙市第一医院采用 mNGS诊断的 28例鹦鹉热衣原体肺炎病人的诊治情况。结果 28例病人中 10例为女性, 18例为男性,中位年龄 60岁; 27例病人有明确禽类接触史, 1例无。重症病例占 32.1%,多为有慢性阻塞性肺疾病(COPD)糖尿病、高血压、冠心病或尿毒症等基础疾病病人。临床表现包括发热(100%)、畏寒(28.6%)、咳嗽、咳痰(71.4%)、气促(53.6%)。、外周血中白细胞总数多在正常范围, 96.4%的病人中性粒细胞比例增高、淋巴细胞比例降低; 96.4%病人 PCT升高,所检测病人中 ESR和 CRP升高者达 100%;分别有 71.4%和 50%病人乳酸脱氢酶和肌酸激酶增高;有 82.1%的病人谷草转氨酶增高,有 78.6%的病人白蛋白降低。胸部 CT表现单侧病变 25例、其中右肺病变 19例,常见影像改变是斑片状阴影(78.6%)、大片实变(21.4%),26例伴有胸腔积液。治疗情况:单用氟喹诺酮类(莫西沙星或者左氧氟沙星)治疗 9例,单用多西环素治疗 2例;联合用药 13例,其中青霉素类(哌拉西林他唑巴坦或头孢哌酮舒巴坦钠)联用喹诺酮类有 10例,青霉素类联合多西环素 3例。有 2例病人初始选择青霉素类加喹诺酮类药物治疗无效,改用多西环素或联用多西环素后症状缓解。 28例病人均预后良好,无死亡病例。结论鹦鹉热衣原体肺炎病人的职业史、临床表现、实验室检查结果及肺部 CT具有一定的特点;临床对可疑病例应尽早行 mNGS检测,快速过渡到精准治疗,能明显改善预后。     

痛风

患者男,48岁。 主诉：双手、足关节反复疼痛伴皮下结节20年。     

犬恒牙牙根发育过程中牙髓炎症对细胞凋亡的影响

目的：探讨牙髓炎症对牙根发育过程中细胞凋亡的影响。方法：建立犬年轻恒牙实验性牙髓炎模型,采用原位末端标记技术（TUNEL）观测牙根发育过程中犬恒牙牙髓炎症对各组织中凋亡细胞分布的影响。结果：与炎症区相邻的牙髓组织中细胞凋亡数量增多,参与牙根发育的各种功能细胞（成牙本质细胞、成牙骨质细胞、上皮根鞘细胞、成骨细胞和牙周膜细胞）也出现非生理性的凋亡。结论：牙根发育过程中牙髓炎症状态下细胞凋亡一方面参与牙髓组织自身防御,另一方面则干扰了牙根的正常发育。