Abstract Vascular hypo-responsiveness to vasopressors in patients with obstructive jaundice (OJ) is a common anesthetic event, which leads to perioperative complications and increased mortality. The cause of this clinical issue remains unclear. In this study, we estimated the actin cytoskeleton and arterial protein level in the artery of OJ patients by proteomic analysis. Ten patients with OJ due to bile duct diseases or pancreatic head carcinoma were enrolled, while another ten non-jaundice patients with chronic cholecystitis or liver hemangioma as the control group. Vascular reactivity to noradrenaline was measured before anesthesia on the day of surgery. Artery samples in adjacent tissues of removed tumor were collected and evaluated by 2-dimensional electrophoresis. Proteins with differential expression were detected by MALDI-TOF mass spectrometry with immunoblot confirmation. The results confirmed the phenomenon of vascular hypo-reactivity in OJ patients as suppressed aortic response to noradrenaline were existed in these patients. We also found that actin cytoskeleton and several actin-binding proteins were up- or down-regulated in the artery of OJ patients. These proteins changed in OJ patents might be the basic mechanism of vascular hypo-reactivity, further studies to uncover the role of these proteins in OJ is critical for clinical treatment of these patients.

RESUMO Objetivo: Este estudo explorou a aplicação clínica do desenho pré-operatório preciso para impressão 3D e reconstrução do polegar, para ajudar no controle e melhorar função e aparência. Métodos: Estudo retrospectivo de 20 pacientes submetidos à cirurgia de colheita de transplante de dedo do pé e reconstrução do polegar entre janeiro de 2015 e dezembro de 2016. O modelo 3D do defeito do polegar foi confeccionado e impresso. As dimensões da pele e dos ossos da área doadora foram precisamente projetadas como referência para a operação cirúrgica, realizada de acordo com o modelo. Resultados: O reparo perfeito foi alcançado com aparência e função satisfatórias. Todos os polegares reconstruídos sobreviveram (taxa de sobrevivência de 100%). O acompanhamento foi de 3-9 meses. A dorsiflexão máxima foi de 8-30° e a flexão máxima foi de 38-58°. A discriminação sensorial de dois pontos foi de 9-11 mm. No total, 17 pacientes reportaram índice “Excelente” e três índice “Bom” cada para a função reconstruída do polegar e da mão, respectivamente. O índice de satisfação foi de 85%. Conclusão: O design digital pré-operatório e a impressão 3D de acordo com os locais doador e receptor permitiram uma operação customizada. A operação foi mais precisa, com bom aspecto. Nível de Evidência II, Estudo Retrospectivo.

ABSTRACT Objective: This study aimed to explore the clinical application of preoperative precise design for 3D printing and thumb reconstruction, which could help manage the patients with thumb defect and achieve better function and appearance. Methods: This was a retrospective study of 20 patients who underwent the surgery of harvesting toe transplant and thumb reconstruction between January 2015 and December 2016. The 3D model of the thumb defect was created and printed. The dimensions of skin and bones from donor site were precisely designed as reference for surgical operation. The surgery was performed according to the model. Results: Perfect repair of defects was achieved with satisfying appearance and function. The reconstructed thumbs all survived (survival rate of 100%). Follow-up was 3-9 months. The maximum dorsiflexion was 8-30° and the maximum flexion was 38-58°. The two-point sensory discrimination was 9-11 mm. In total, 17 patients reposted “Excellent” satisfaction and three “Good”, each for the reconstructed thumb and hand function, respectively. The satisfaction rate was 85%. Conclusion: Preoperative digital design and 3D printing according to the donor and recipient sites allowed a tailored operation. The operation was more precise, the appearance of the reconstructed thumb was good. Level of Evidence II, Retrospective Study.

Abstract Background: Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS. Methods: Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software. Results: Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = − 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype. Conclusion: This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings. Trial registration: This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426.

Abstract Background: Leaves of the natural plant lotus are used in traditional Chinese medicine and tea production. They are rich in flavonoids. Methods: In this study, lotus leaf flavonoids (LLF) were applied to human lung cancer A549 cells and human small cell lung cancer cells H446 in vitro to verify the effect of LLF on apoptosis in these cells through the ROS/p38 MAPK pathway. Results: LLF had no toxic effect on normal cells at concentrations up to 500 μg/mL, but could significantly inhibit the proliferation of A549 cells and H446 cells. Flow cytometry showed that LLF could induce growth in A549 cells. We also found that LLF could increase ROS and MDA levels, and decrease SOD activity in A549 cells. Furthermore, qRT-PCR and western blot analyses showed that LLF could upregulate the expression of p38 MAPK (p-p38 MAPK), caspase-3, caspase-9, cleaved caspase-3, cleaved caspase-9 and Bax and downregulate the expression of Cu/Zn SOD, CAT, Nrf2, NQO1, HO-1, and Bcl-2 in A549 cells. Results of HPLC showed that LLF mainly contain five active substances: kaemp-feritrin, hyperoside, astragalin, phloridzin, and quercetin. The apoptosis-inducing effect of LLF on A549 cells came from these naturally active compounds. Conclusions: We have shown in this study that LLF is a bioactive substance that can induce apoptosis in A549 cells in vitro, and merits further research and development.

ABSTRACT Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

In this work, thermal properties and kinetics of Al-nanoparticles/α-MnO2 nanorods thermite were reported. The α-MnO2 nanorods were synthesized using a hydrothermal method and were characterized by X-ray powder diffraction (XRD) and X-ray photoelectron spectra (XPS), then combined with Al nanoparticles based on the ultrasonic mixing method to prepare the nanostructure thermite. Besides, both pure components and mixture were characterized by field emission scanning electron microscopy (FE-SEM) to observe their morphologies and structures. Subsequently, the thermal properties of Al/α-MnO2 nanostructure thermite were studied on the basis of thermogravimetric-differential scanning calorimetry (TG-DSC). According to the TG-DSC tests, the calculation results of activation energy for kinetics of Al/α-MnO2 thermite were obtained using different isoconversional methods. It was found that Al/α-MnO2 nanostructure thermite has high heat release and low onset temperature, and the heat release of the nanostructure thermite was approximately 1146.6 J g -1.

SUMMARY: Ghrelin is the endogenous ligand for the growth hormone secretagogue receptor, and has been found in the liver of multiple vertebrates. While ghrelin has been identified in the gastrointestinal tract of African ostrich chicks, little is known regarding its distribution in the liver of the African ostrich. In the present study, the distribution and morphological characteristics of ghrelin-immunopositive (ghrelin-ip) cells in the liver of the African ostrich were investigated using immunohistochemistry. Our results indicate that the liver is divided into two sections: the capsule and the parenchyma, which comprises hepatic lobules and the hepatic portal area. The hepatic lobules include the central vein, hepatocellular cord, and the hepatic sinusoid. The hepatocellular cord is composed of hepatocytes, and Macrophagocytus stellatus (Kupffer cells) as well as endothelial cells reside within the hepatic sinusoid. ghrelin-ip cells were detected among both the Macrophagocytus stellatus and endothelial cells of the hepatic sinusoid in the African ostrich liver. In contrast, no ghrelinip cells were located within the hepatocytes or the hepatic portal area. These results clearly demonstrated the presence of ghrelin-ip cells in the liver of the African ostrich. Therefore, ghrelin may have a physiological function in the liver of the African ostrich.

RESUMEN: La ghrelina es el ligando endógeno para el receptor secretagogo de la hormona del crecimiento, y se ha encontrado en el hígado de múltiples vertebrados. A pesar que la ghrelina ha sido identificada en el tracto gastrointestinal de polluelos de avestruz africanas, poco se sabe sobre su distribución en el hígado de esta ave. En el presente estudio se investigó la distribución y características morfológicas de las células ghrelininmunopositivas (ghrelin-ip) en el hígado del avestruz africana mediante inmunohistoquímica. Nuestros resultados indican que el hígado se divide en dos secciones: la cápsula y el parénquima, que comprende los lóbulos hepáticos y el área portal hepática. Los lóbulos hepáticos incluyen la vena central, el cordón hepatocelular y el sinusoide hepático. El cordón hepatocelular está compuesto de hepatocitos y de Macrophagocytus stellatus (células de Kupffer) y las células endoteliales se localizan dentro del sinusoide hepático. Fueron detectacas células ghrelin-ip entre los Macrophagocytus stellatus y las células endoteliales del sinusoide hepático en el hígado de avestruz africana. En contraste, no se localizaron células de ghrelin-ip dentro de los hepatocitos o en el área portal hepática. Estos resultados demuestran claramente la presencia de células de ghrelin-ip en el hígado. Por lo tanto, la ghrelina puede tener una función fisiológica en el hígado de avestruz africana.

Background: The impact of enteral nutrition (EN) on surgical risk in Crohn's disease (CD) patients suffering from spontaneous intra-abdominal abscess (IAA) was evaluated. Methods: CD patients diagnosed with spontaneous IAA from 2008 to 2015 were included in the study. The impact of EN on surgical risk was evaluated using both univariate and multivariate analyses. Results: A total of 87 patients were enrolled, 66 (75.9%) were male. The mean age at the development of an abscess was 30.2 ± 10.1 years and the median duration of illness from CD diagnosis until the development of an abscess was three (2-6) years. After a median follow-up of 1.9 (1.1-2.9) years, surgical intervention was performed in 42 patients (48.3%). Patients treated with EN were less likely to require surgical intervention (26.1% vs 56.3%, p = 0.01). Multivariate analysis showed that EN was an independent protective factor for the risk of surgery with a hazard ratio of 0.27 (95% confidence interval: 0.11-0.65, p = 0.004) after adjusting for abdominal pain, history of abdominal surgery, concomitant intestinal stenosis and prior use of antibiotics within three months. Conclusions: Surgical intervention is common for CD patients with IAA. Appropriate application of EN may help obviate the need for surgical treatment.

Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor, has been detected in the thymus of multiple vertebrates. However, little is known about its distribution in the thymus of the African ostrich. In this study, we evaluated the distribution and morphological characteristics of ghrelin-producing cells in the thymus of the African ostrich. Our results revealed that the thymus consists of a capsule and a parenchyma, which comprises the cortex and medulla. Compared to the cortex, the medulla had a fewer number of thymocytes and a greater number of epithelial cells. Additionally, three thymic corpuscles were identified. Ghrelin-immunopositive (ghrelin-ip) cells were detected both in the cortex and medulla of the African ostrich thymus, specifically within epithelial cells and thymic corpuscles. On the other hand, no ghrelin-ip cells were detected within thymocytes. These results clearly demonstrate the presence of ghrelin-ip cells in the thymus of the African ostrich.

La ghrelina, un ligando endógeno para el receptor secretor de la hormona del crecimiento, se ha detectado en el timo de múltiples vertebrados. Sin embargo, poco se sabe sobre su distribución en el timo de la avestruz africana. En este estudio se evaluó la distribución y características morfológicas de las células productoras de ghrelina en el timo de la avestruz africana. Nuestros resultados revelaron que el timo consiste en una cápsula y un parénquima, que comprende la corteza y la médula. En comparación con la corteza, se observó un número menor de timocitos en la médula y un mayor número de células epiteliales. Además, se identificaron tres corpúsculos tímicos. Se detectaron células inmunopositivas a la ghrelina (ghrelin-ip) tanto en la corteza como en la médula del timo de la avestruz africana, específicamente dentro de células epiteliales y corpúsculos tímicos. Por otra parte, no se detectaron células ghrelin-ip dentro de los timocitos. Estos resultados demuestran claramente la presencia de células ghrelin-ip en el timo de la avestruz africana.

Klebsiella pneumoniae is an important cause of healthcare-associated infections worldwide. Selective pressure, the extensive use of antibiotics, and the conjugational transmission of antibiotic resistance genes across bacterial species and genera facilitate the emergence of multidrug-resistant (MDR) K. pneumoniae. Here, we examined the occurrence, phenotypes and genetic features of MDR K. pneumoniae isolated from patients in intensive care units (ICUs) at the First Affiliated Hospital of Xiamen University in Xiamen, China, from January to December 2011. Thirty-eight MDR K. pneumoniae strains were collected. These MDR K. pneumoniae isolates possessed at least seven antibiotic resistance determinants, which contribute to the high-level resistance of these bacteria to aminoglycosides, macrolides, quinolones and β-lactams. Among these isolates, 24 strains were extended-spectrum β-lactamase (ESBL) producers, 2 strains were AmpC producers, and 12 strains were both ESBL and AmpC producers. The 38 MDR isolates also contained class I (28/38) and class II integrons (10/38). All 28 class I-positive isolates contained aacC1, aacC4, orfX, orfX’ and aadA1 genes. β-lactam resistance was conferred through blaSHV (22/38), blaTEM (10/38), and blaCTX-M (7/38). The highly conserved blaKPC-2 (37/38) and blaOXA-23(1/38) alleles were responsible for carbapenem resistance, and a gyrAsite mutation (27/38) and the plasmid-mediated qnrB gene (13/38) were responsible for quinolone resistance. Repetitive-sequence-based PCR (REP-PCR) fingerprinting of these MDR strains revealed the presence of five groups and sixteen patterns. The MDR strains from unrelated groups showed different drug resistance patterns; however, some homologous strains also showed different drug resistance profiles. Therefore, REP-PCR-based analyses can provide information to evaluate the epidemic status of nosocomial infection caused by MDR K. pneumoniae; however, this test lacks the power to discriminate some isolates. Thus, we propose that both genotyping and REP-PCR typing should be used to distinguish genetic groups beyond the species level.

OBJETIVO: Investigar a eficácia e a exequibilidade da aplicação da lise percutânea de aderências epidurais na síndrome pós-laminectomia usando um fio-guia tipo Stiff e um cateter vascular 4F. MÉTODOS: Noventa e dois pacientes com síndrome pós-laminectomia foram randomizados em dois grupos: grupo controle (tratado somente com injeção de dexametazona) e grupo lise percutânea de aderências epidurais. Escores de escala visual analógica (VAS) e avaliação terapêutica foram observadas no pré-operatório, no sétimo dia de pós-operatório, um mês e seis meses de pós-operatório. RESULTADOS: Escores VAS para dor foram significantemente reduzidos em ambos os grupos aos sete dias. Os escores VAS foram mais altos no grupo controle comparado ao da lise epidural nos tempos de um mês e seis meses. Entretanto, não há diferença estatística nos escores VAS de um mês e seis meses quando comparados, respectivamente, àqueles de antes da operação do grupo controle. Pacientes com a lise epidural relataram taxa de eficiência de 50%. Nos pacientes do grupo controle foi 5,26%, havendo diferença estatística entre os dois grupos. CONCLUSÃO: A lise percutânea de aderências epidemias usando um fio-guia tipo Stiff e um cateter vascular 4F mostrou-se um método efetivo no tratamento de FBSS e tem valor na aplicação clínica.

PURPOSE: To investigate the efficacy and the feasibility of application of percutaneous lysis of epidural adhesions in failed back surgery syndrome (FBSS) using a stiff type guide wire and 4F vascular catheter. METHODS: Ninety two patients with FBSS were randomly divided into two groups, the control group (treated by injection dexamethasone only) and percutaneous lysis of epidural adhesions group. Visual analog scale scores (VAS) and therapeutic evaluation were observed in the preoperative, seven days postoperative, one month and six months postoperative. RESULTS: VAS scores for pain were significantly reduced in both groups at seven days. The VAS scores were in controlled group at one month, six months was significantly higher than that in epidural lysis group. However, there was no statistical difference in VAS scores of one month and six months when respectively compared to that of before operation in controlled group. Patients on epidural lysis reported clinical effectiveness rate was 50%. Patients on control was 5.26%, there was a statistical difference between two groups. CONCLUSION: Percutaneous lysis of epidural adhesions by using a stiff type guide wire and 4F vascular catheter is an effective method in the treatment of FBSS and it has a value in clinical application.