Clinical significance of leukocyte infiltrative response in deep wound of patients with major burns

OBJECTIVE: To investigate the time course of infiltrated leukocytes and the subpopulations of infiltrated lymphocytes in deep wounds, and their relationship with injury severity in seriously burned patients. METHODS: Six patients with major burns were enrolled in the study. Specimens were taken from deep partial-thickness burn wounds of all patients at 3 days, 1 week, 2 weeks and 3 weeks after burn. The appearance time and cellular components of infiltrated leukocyte zone in the burn wound were evaluated by histological and immunohistochemistry examination with lymphocyte monoclonal antibodies. RESULTS: The infiltrated leukocyte zone of burn wound formed 1-2 weeks after burn. The more severe the degree of injury (including burn area, depth and combined injuries) was, the later the infiltrated leukocyte zone appeared. The infiltrated cells mainly consisted of polymorphonuclear leukocytes (PMN) during the early period after burn while macrophages and lymphocytes appeared later. There were some changes of the T lymphocyte subsets and their activation degree in the burn wound. CONCLUSION: The changes of infiltrated leukocyte zone of wound following burns were closely related to the injury severity, and represented alteration of the anti-infection ability and immune rejection of local wound. These results provide important evidence for appropriate wound treatment and prolonging the survival of skin allograft.     

自身免疫性肝炎患者健康相关生活质量及焦虑和抑郁情况分析

目的:调查分析自身免疫性肝炎患者的生活质量、焦虑及抑郁情绪状况.方法:选取2014年7月-2015年7月我院诊治的60例自身免疫性肝炎患者为研究对象,另选取同期60例酒精性肝炎患者为对照组.采用生活质量综合评定问卷、焦虑自评量表和抑郁自评量表对两组受试者的生活质量、焦虑和抑郁情绪进行测评,并将其结果与中国常模比较.结果:自身免疫性肝炎患者的生活质量综合评定问卷总分及躯体功能、心理功能、社会功能和物质生活4项评分均明显低于酒精性肝炎对照组(P＜0.05),焦虑、抑郁情绪评分均明显高于对照组和常模,且自身免疫性肝炎患者焦虑、抑郁发生率明显高于对照组(P＜0.01).自身免疫性肝炎患者的生活质量与焦虑、抑郁情绪呈负相关,差异具有统计学意义(P＜0.01).结论:自身免疫性肝炎患者生活质量较差,且受患者的焦虑、抑郁情绪影响,应注意调整患者心理状态,提高患者生活质量.     

血清iPTH、Ca、P和血液透析患者死亡率之间的关系

目的 探讨长沙市第一医院血透患者CKD-MBD标志物的达标率,以及它们和血液透析患者死亡率之间的关系.方法 对2014年1月至2016年12月期间,在本院进行血液透析的177例患者的病史、实验室检查结果进行了回顾性分析.以2009年KDIGO指南为标准,了解177例患者CKD-MBD标志物的达标率.根据临床结局将患者分为死亡组35例,存活组142例.使用广义估计方程比较死亡组和存活组患者的iPTH、钙、磷.再用Logistic回归模型评估血透患者血清磷、钙和甲状旁腺素与全因死亡率之间的关系.结果 本院177例血透患者中,有102例(57.6％)血清钙浓度、51例(28.8％)血清磷浓度、81例(45.8％) iPTH达到指南标准.死亡组和存活组患者的钙、iPTH有差异,而磷无差异.在本次研究中,钙和磷与血透患者的全因死亡率相关,而iPTH与全因死亡率无关.结论 本研究所显示的结果要不同于之前欧美国家观察性研究的结果,KDIGO指南的建议是否适合中国血透人群仍需要进一步的证明.     

二甲双胍对异氟醚麻醉小鼠血糖的影响

目的 观察二甲双胍对异氟醚麻醉小鼠血糖的影响.方法 156只8周龄雄性C57BL/6小鼠分两部分进行实验.①血糖检测:这部分实验分两步进行.首先,28只小鼠按照按随机数字表法分为未禁食组(n组)和禁食12 h组(f组);各组再分为2个亚组,对照组(Cn组/Cf组),麻醉组(An组/Af组).进一步实验使用56只小鼠按随机数字表法分为n组和f组,每组28只.两组均再按随机数字表法分为4个亚组,Cn组/Cf组,An组/Af组,二甲双胍组(Mn组/Mf组)和二甲双胍麻醉组(MAn组/MAf组),每亚组均为7只.Mn组、Mf组、MAn组和MAf组于麻醉前1.5 h腹腔注射二甲双胍40 mg/kg,An组、Af组、MAn组和MAf组均行异氟醚6h麻醉.通过尾静脉取血检测围麻醉期各时间点血糖值.②荧光定量核酸扩增检测系统(quantitative polymerase chain reaction detecting system,Q-PCR)检测:共72只小鼠.各亚组分组方法同上,分别于麻醉1、4、6h取材下丘脑,每组每个时间点取3只.Q-PCR检测腺苷酸活化蛋白激酶(adenosine monophosphate activated protein kinase,AMPK)两个亚型AMPKα1、AMPKα2的mRNA表达水平.结果 血糖水平变化:与n组比较,f组小鼠血糖显著降低[(8.25±1.02) mmol/L比(6.46±0.65) mmol/L,P＜0.05].在f组和n组中,麻醉组小鼠均出现血糖水平升高;与Cn组和Cf组比较,An组和Af组分别在麻醉0.5、1、2h和1、2、3h升高(P＜0.05);分别与Cn组和Cf组比较,Mn组和Mf组血糖水平差异无统计学意义(P＞0.05);MAn组和MAf组均于麻醉2h开始出现低血糖并持续(P＜0.05),这种差异分别在麻醉结束4h和1h后消失.下丘脑AMPK mRNA表达:1h,与Cf组比较,MAf组AMPKα1和AMPKα2mRNA表达下调(P＜0.05);4h,与Cn组和Cf组比较,An组、MAn组和Af组AMPKα1表达下调(P＜0.05),AMPKα2 mRNA表达在MAf组降低(P＜0.05);6h,与Cn组和Cf组比较,AMPKα1和AMPKα2在An组和MAn组、Af组和MAf组mRNA表达都降低(P＜0.05).结论 长时程异氟醚麻醉可使小鼠血糖呈“先高后低”改变,二甲双胍预处理后麻醉小鼠可出现持续低血糖,这一过程与下丘脑AMPK转录活性无明显关联.     

右美托咪定预处理对内毒素血症大鼠海马区Bcl-2、Bax表达及认知功能的影响

目的 探讨右美托咪定(dexmedetomidine,Dex)预处理对内毒素血症大鼠海马区凋亡蛋白Bcl-2、Bax的表达及认知功能的影响. 方法 健康清洁SD雄性大鼠24只,6周龄,体重200～250 g,采用随机数字表法将其分为3组(每组8只):对照组(C组)、内毒素组(E组)和Dex组(D组).D组腹腔注射Dex 50 μg/kg,30min后尾静脉注射脂多糖(lipopolysaccharide,LPS)5 mg/kg;E组腹腔注射等容量(2ml)生理盐水,30 min后尾静脉注射LPS 5 mg/kg;C组腹腔注射等容量生理盐水,30 min后尾静脉注射等容量生理盐水.各组于给药后12h,用Morris迷宫测试大鼠认知功能的变化,其后处死大鼠,取大脑海马组织.TUNEL法检测组织凋亡指数(apoptosis index,AI),免疫组织化学法分别检测Bcl-2、Bax蛋白的表达.结果 与C组比较,E组和D组潜伏期和游泳总距离增加,穿越平台次数减少(P＜0.05);与C组比较,E组Bcl-2表达差异无统计学意义(P＞0.05),Bax表达上调,Bcl-2/Bax比值降低(P＜0.05);D组Bcl-2和Bax表达上调,Bcl-2/Bax比值升高(P＜0.05).与E组比较,D组AI明显降低,Bcl-2表达上调,Bax表达下调,Bcl-2/Bax升高(P＜0.05). 结论 Dex可以改善内毒素血症大鼠的认知功能,其机制可能与调节Bcl-2和Bax蛋白表达,减轻海马区神经元凋亡有关.     

右侧入路联合反向染色法处理肝尾状叶肝癌破裂出血1例并文献复习

目的:探讨单纯经右侧入路联合反向染色法完整切除肝尾状叶肝癌破裂出血的安全性及可行性。方法:回顾性分析1例肝尾状叶肝癌伴破裂出血患者的临床资料并复习相关文献。结果:术前对患者的肝功能及肿瘤情况进行严密评估,排除手术禁忌证后,患者成功行右侧入路联合反向染色法(对肝右后叶染色区分尾状叶的右侧边界)完整切除肝尾状叶,术中未阻断入肝血流、出肝血流、下腔静脉,术后患者肝功能恢复良好。术后6个月复查,未见肿瘤复发。结论:单纯行右侧入路联合反向染色法完整切除肝尾状叶肿瘤破裂出血是安全可行的。     

Incidence and mortality of acute kidney injury in coronary care unit: a retrospective study from a single center

Objective To evaluate the incidence and mortality of acute kidney injury (AKI) in coronary care unit (CCU), and to identify the risk factors of the incidence of AKI and the mortality of CCU patients. Methods A total of 414 patients in CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University were enrolled. Based on the KDIGO-AKI criteria, these patients were classified into two groups: NAKI group (patients without AKI) and AKI group. Clinical characteristics and laboratory data of two groups were compared. The risk factors of the incidence of AKI and the mortality of CCU patients was analyzed by logistic regression, and then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of these risk factors. Results (1) Among 414 patients, 136(32.9%) patients fulfilled the criteria for AKI, and 14.0% patients in AKI stage 1, 10.9% in AKI stage 2 and 8.0% in AKI stage 3. (2) The total CCU mortality was 15.0%. Mortality of AKI patients in the CCU was 33.3%, higher than 6.1% in patients without AKI (OR=7.735, 95%CI 4.215-14.196, P＜0.001). The mortality worsened with increasing severity of AKI (22.4% for AKI stage 1 group, 37.8% for AKI stage 2 group, 45.4% for AKI stage 3 group). (3) Anemia (OR=8.274, 95%CI 4.363-15.689), history of chronic illness (OR=2.582, 95%CI 1.400-4.760), APACHEⅡ scores (OR=1.813, 95%CI 1.739-1.895), male (OR=3.666, 95%CI 1.860-7.226) were the independent risk factors for AKI, while the normal mean arterial pressure (MAP) (OR=0.292, 95%CI 0.153-0.556) and normal estimated glomerular filtration rate (eGFR) (OR=0.166, 95%CI 0.090-0.306) are the protective factors for AKI (all P＜0.05). (4) AKI was the most powerful independent factor associated with the mortality of CCU patients (OR=7.050, 95%CI 2.970-16.735, P＜0.001). Other independent risk factors for CCU mortality included history of chronic illness, ejection fraction and APACHEⅡ≥15 scores (all P＜0.05), while the normal MAP and normal eGFR were the protective factors (all P＜0.05). (5) For predicting AKI, eGFR displayed an excellent areas under the ROC curve (AUC=0.815, P＜0.001), and for CCU mortality, APACHEⅡ scores had the highest overall correctness of prediction (AUC=0.757 P＜0.001). Conclusions CCU patients have high morbidity of AKI, which is the most powerful independent factor associated with the increased CCU mortality. The eGFR is the best predictor for AKI, and then through the evaluation of eGFR for CCU patients, we can evaluate high-risk groups, make early interventions and then improve the prognosis of CCU patients.     

A highly reproducible cervical cuff technique for rat‐to‐mouse heterotopic heart xenotransplantation

Xenotransplantation is an effective way to solve the problem of donor shortage in clinical transplantation. However, clinical use of xenotransplantation is currently limited due to immunological challenges such as acute vascular rejection and cell‐mediated rejection. To finally surpass this immunological barrier, more preclinical research is needed into the molecular mechanisms of rejection and the possible effects of new immunosuppressants. Our aim was to create a refined, highly reproducible protocol to establish the most suitable rat‐to‐mouse heterotopic heart transplantation model using the cuff technique.     

Annulus fibrosus cells express and utilize C-C chemokine receptor 5 (CCR5) for migration

Background Context

Disc degeneration is associated with the progressive loss of the proteoglycan content of the intervertebral disc, decreased matrix synthesis, higher concentrations of proteolytic enzymes, and increased levels of proinflammatory cytokines. In previous studies, we have shown that C-C chemokine ligand (CCL)2, CCL3, and CCL5 are highly expressed by cultured nucleus pulposus (NP) and annulus fibrosus (AF) cells that have been treated by interleukin-1. The major function of these chemokines is to recruit immune cells into the disc. It is unclear if disc cells can respond to these chemokines. Recent studies by Phillips et al. (2015) showed that NP cells express a number of cytokines and chemokine receptors.

Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position: Our Experiences and Early Results

Background

The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject.