A case with no administration of protamine to neutralize heparin in aortic valve replacement with cardiopulmonary bypass

Systemic heparinization is necessary before cardiopulmonary bypass (CPB) in cardiac surgery, and protamine administration to neutralize heparin for hemostasis is required at the end of CPB. Because protamine is an allogeneic protein extracted from the sperm of specific fish, serious adverse reactions can occur during clinical application, with potentially catastrophic outcomes. A male patient received aortic valve replacement with CPB. Severe allergic reactions occurred postoperatively after protamine administration for neutralization. Emergency heparinization and CPB re-establishment were conducted with no further hemostatic treatment with protamine. However, the patient suffered a massive hemorrhage and was treated symptomatically with blood transfusion and rehydration. Following two thoracotomies for hemostasis, the patient healed and was eventually discharged. Protamine is irreplaceable as the only hemostatic that neutralizes heparin for cardiac CPB at present. However, because it is an alloprotein, it can cause serious allergic reactions after entering the human body, and caution should be exercised during the process of its clinical application.     

Comparative study of the outcomes of the second kidney transplantation from the young deceased donors versus living-unrelated donors

PurposeTo compare the kidney graft function and survival in patients who had second kidney transplantation from living donors versus those who had a second transplant from young deceased donors.MethodsIn this retrospective cohort study, a total of 86 patients who underwent second kidney transplantation in Shariati hospital from 2001 until 2017 were enrolled. Baseline clinical data on the age, sex, type of kidney donor (living unrelated or deceased), duration of pretransplant dialysis, and the length of hospitalization were recorded. As the indicators of the graft function, we used the serum creatinine level and estimated glomerular filtration rate (eGFR) at time intervals during the study. The 1, 5, and 10-year graft survival rates were reported using life tables and the relative hazard ratios of the graft failure were calculated using the forward stepwise Cox proportional hazard model.ResultsForty-six of our patients were men (53.5%), with a mean ± SD age of 44.3 ± 12.3 years at the time of transplantation. The majority of the enrolled patients received the kidney from living unrelated donors (50 vs. 36 patients). In terms of serum creatinine and eGFR, at time intervals, no significant difference was found between the two recipient groups. In the living donor group, the 1, 5, and 10-year graft survival rates of the second transplant were 91% (95%CI: 73–96%), 87% (95%CI: 69–95%), and 82% (95%CI: 59–92%), and for the deceased donor group were 95% (95% CI: 69–99%), 95% (95%CI: 69–99%), and 79% (95%CI: 31–95%), respectively.ConclusionConsidering the long-term outcomes of the second kidney transplantation, in our experience, the graft function and survival, either from the living or deceased donors, were favorable; and the type of organ donation had no significant effect on the risk of graft failure.     

Th17/Treg cell balance in stable liver transplant recipients

BackgroundImmune monitoring of transplanted patients may provide a reliable basis for the individualization of immunosuppressive therapy. In addition, it might be applied for realizing the early and non-invasive diagnosis of acute allograft rejection.MethodsPercentages of TCD4 + IL-17+ (Th17) and TCD4 + CD25 + CD127^dim/− (Treg) cells, as well as serum levels of interleukin (IL)-17 and transforming growth factor (TGF)-β1, were evaluated in 30 stable patients using flow cytometry and ELISA techniques before and six months after liver transplantation. Besides, the same cells and cytokines were quantified in 10 recipients with acute allograft rejection.ResultsSix months post-transplant, the percentage of Th17 and Treg cells in the peripheral blood of stable liver transplant recipients reduced significantly, but the Th17/Treg ratios were comparable to the pre-transplant period (1.24 vs. 1.56); however, Th17/Treg ratios in the rejection group was significantly higher than in the stable recipients (4.06 vs. 1.56, P-value = 0.001). Stable patients showed decreased amounts of serum IL-17 which was remarkably lower than in the rejection group (P-value = 0.01). Moreover, there was a significant correlation between the serum level of IL-17 and the percentage of Th17 cells (P-value <0.001). Th17 frequency was negatively associated with the liver allograft function. Notably, TGF-β1 levels differed neither between pre-and post-transplant samplings nor between stable and rejection groups.ConclusionSix months after liver transplantation, the mean Th17/Treg ratio in stable recipients remained comparable to the pre-transplant values; however, it was significantly elevated in patients with acute allograft rejection, suggesting the Th17/Treg ratio as a probable predictor of acute rejection.     

Prognostic implications of ferroptosis-associated gene signature in colon adenocarcinoma

BACKGROUNDColon adenocarcinoma (COAD) is one of the most common and fatal malignant tumors, which increases the difficulty of prognostic predictions. Thus, new biomarkers for the diagnosis and prognosis of COAD should be explored. Ferroptosis is a recently identified programmed cell death process that has the characteristics of iron-dependent lipid peroxide accumulation. However, the predictive value of ferroptosis-related genes (FRGs) for COAD still needs to be further clarified. AIMTo identify some critical FRGs and construct a COAD patient prognostic signature for clinical utilization. METHODSThe Cancer Genome Atlas database (TCGA) and Gene Expression Omnibus databases were the data sources for mRNA expression and corresponding COAD patient clinical information. Differentially expressed FRGs were recognized using R and Perl software. We constructed a multi-FRG signature of the TCGA-COAD cohort by performing a univariate Cox regression and least absolute shrinkage and selection operator Cox regression analysis. COAD patients from the Gene Expression Omnibus cohort were utilized for verification. RESULTSOur research showed that most of the FRGs (85%) were differentially expressed between the corresponding adjacent normal tissues and cancer tissues in the TCGA-COAD cohort. Seven FRGs were related to overall survival (OS) in the univariate Cox analysis (all P < 0.05). A model with five FRGs (AKR1C1, AKR1C3, ALOX12, CRYAB, and FDFT1) was constructed to divide patients into high- and low-risk groups. The OS of patients in the high-risk group was significantly lower than that of the low-risk group (all P < 0.01 in the TCGA and Gene Expression Omnibus cohorts). The risk score was an independent prognosticator of OS in the multivariate Cox analysis (hazard ratio > 1, P < 0.01). The predictive capacity of the model was verified by a receiver operating characteristic curve analysis. In addition, a nomogram based on the expression of five hub FRGs and risk score can precisely predict the OS of individual COAD cancer patients. Immune correlation analysis and functional enrichment analysis results revealed that immunology-related pathways were abundant, and the immune states of the high-risk group and the low-risk group were different.CONCLUSIONIn conclusion, a novel five FRG model can be utilized for predicting prognosis in COAD. Targeting ferroptosis may be a treatment option for COAD.     

超声引导下细针穿刺细胞学检查联合分子标志物诊断乳头状甲状腺癌伴颈部淋巴结转移

乳头状甲状腺癌（PTC）伴颈部淋巴结转移预后较差。超声引导下细针穿刺细胞学检查（US-FNAC）诊断PTC颈部淋巴结转移具有一定局限性，且目前针对本病尚无有效的分子标记物。US-FNAC联合分子标志物有利于诊断PTC伴颈部淋巴结转移。本文就相关研究进展进行综述。     

间歇性外斜视儿童术后视感知觉训练对各级视功能恢复的临床观察

目的:探讨视感知觉训练在间歇性外斜视(IXT)儿童患者术后各级视功能恢复以及知觉眼位改善中的作用。方法:前瞻性临床研究。收集2022-01/06就诊于兰州市第一人民医院眼科行斜视矫正手术且完成术后3mo随访的IXT患者74例。术后1d随机将患者分为2组：训练组35例患者进行双眼视感知觉训练,对照组39例患者不进行任何训练。观察两组患者术后1d, 3mo各级视功能和知觉眼位变化情况。结果:术后1d训练组有同时视者24例(69%),术后3mo同时视功能恢复患者为34例(97%),显著高于术后1d(P=0.002);术后3mo对照组有融合功能者22例(56%)、远立体视者13例(33%)、动态立体视者20例(51%)、静态精细立体视者17例(44%),训练组有融合功能者31例(89%)、远立体视者25例(71%)、动态立体视者30例(86%)、静态精细立体视者27例(77%),均显著高于对照组(均P<0.05);训练组患者知觉眼位偏移程度较对照组下降更明显(均P<0.05)。结论:IXT儿童患者术后进行视感知觉训练可以促进各级视功能恢复,并改善知觉眼位,提高大脑知觉水平对眼位的控...     

毛细胞白血病的治疗新进展北大核心

毛细胞白血病(hairy cell leukemia,HCL)是一种罕见的B细胞肿瘤性疾病,主要是由BRAF V600E突变引起。常规的治疗药物是克拉屈滨、喷司他汀及干扰素,疗效显著,但50%的HCL患者仍会复发,急需新的药物来联合治疗。近年来,关于HCL的临床试验层出不穷,给HCL的治疗带来新的希望。因此,本文就HCL最新的治疗进展作一综述。     

自噬、炎症反应及免疫功能异常在急性胰腺炎中的研究进展

急性胰腺炎(acute pancreatitis,AP)是临床较常见的由不同原因引起的一种急危重病,其发病机制复杂多样,易并发多脏器损伤,导致死亡率升高,故充分了解AP的发病机制可为临床早期干预、准确治疗及判断预后提供重要的参考价值。虽然启动该病发生和影响其进展的机制复杂多样,并且目前对AP的病理生理方面的认识已取得很大进步,但关键问题是其机制中精确而关键的分子机制尚不清楚,目前尚无特效的治疗方法。由于胰腺的解剖位置和担心获取人胰腺组织的操作会加重胰腺炎的严重程度而无法取样,因此,实验动物模型的研究证明,自噬、炎症反应和免疫功能异常在AP发病机制中的作用尤为重要。为此,本文探讨上述机制在AP中的作用,可能为AP的缓解及治疗提供新的靶点。     

超声引导下髋关节囊周围神经阻滞的研究进展

在髋部骨折围术期提高区域阻滞镇痛效果较为困难,以往多采用腰丛、髂筋膜间隙、“三合一”或股神经阻滞,但对关节囊附近的镇痛效果较差。与上述技术不同,髋关节囊周围神经(PENG)阻滞是一项针对关节前囊感觉神经阻滞的新技术,能为髋部骨折提供有效镇痛,同时基本不影响股四头肌肌力,极大保留了下肢运动功能,有效降低围术期并发症,利于早期康复。随着研究不断深入,PENG阻滞在髋关节和下肢手术及急慢性疼痛诊疗中的应用潜力巨大。本文就超声引导下PENG阻滞的方法、对比和联合常规阻滞技术以及在临床应用中的最新研究进展予以综述,以期为临床实践提供参考。     

肝硬化失代偿期上消化道出血的机制研究进展

肝硬化的病因很多,但在我国大部分肝硬化主要从慢性病毒性肝炎发展而来,肝硬化失代偿期多以门静脉高压、上消化道出血和腹水为主要表现。肝硬化失代偿期在门静脉高压基础上发生上消化道出血是重要的病情转归之一。肝硬化失代偿期发生的上消化道出血机制复杂,而其根本病理基础在于门脉高压症所引起的交通支血管结构和功能的改变以及一系列继发病...