Objective To observe the expression changes in apoptosis-related microRNA(miRNA) in cerebral cortex after cardiac arrest-cardiopulmonary resuscitation(CA-CPR)in rats and explore the factors that may affect the mechanism of CPR. Methods 24 clean male Sprague-Dawley(SD)rats were randomly divided into three groups,the normal control group,sham operation group and CA-CPR group(each n=8). The animal model of CA induced by asphyxia was established and CPR was performed. In the normal control group,no special management was performed. In the sham operation group,only abdominal cavity anesthesia,tracheotomy,vascular puncture and electrocardiogram(ECG)were performed without clamping the trachea and resuscitating. Normal feeding in normal control group and 24 hours after tracheotomy in sham operation group,at 24 hours after recovery of spontaneous circulation(ROSC)in CA-CPR group,cerebral cortex specimens were obtained for detection of the expression of miRNA by using real time fluorescence quantitative reverse transcription - polymerase chain reaction(RT-PCR). Flow cytometry(FCM)was used to detect the neurocyte apoptotic rate. Results Compared between normal control and sham operation groups,there were no significant differences in the expression of apoptosis-related miRNA and neurocyte apoptosis rate of cerebral cortex(both P>0.05). Compared with sham operation group,in CA-CPR group, 16 miRNA expressions were up-regulated,including Let-7c,miR-15a,miR-21,miR-24,miR-29,miR-29b, miR-34a, miR-103, miR-200a, miR-200b, miR-200c, miR-210, miR-326, miR-338-3p, miR-494 and miR-497,and there were 22 down-regulated,being Let-7a,Let-7b,Let-7d,Let-7e,miR-19a,miR-19b-1, miR-20a,miR-20b,miR-23a,miR-23b,miR-25,miR-98,miR-107,miR-122a,miR-125a,miR-125b, miR-145,miR-181a,miR-181c,miR-335,miR-384-5p and miR-422a. Eight miRNA had significant changes at 24 hours after ROSC,in which miR-15a,miR-21,miR-34a,miR-497 were up-regulated respectively for 6.831±2.625,8.122±3.442,5.349±2.010,6.590±3.689 times,and miR-125b,miR-145,Let-7a,Let-7e were down-regulated respectively for 0.122±0.039,0.199±0.096,0.191±0.069,0.160±0.082 times. The apoptosis rate of cerebral cortex was increased significantly in CA-CPR group〔(32.23±5.31)%〕compared with that in normal control group〔(3.66±1.34)%〕and sham operation group〔(4.98±1.84)%,both P<0.01〕. Conclusions In early period after CA-CPR,obvious neurocyte apoptosis may be found in brain tissue of rats,and in the mean time, changes in apoptosis-related miRNA expression in cerebral cortex occur. The various types of miRNA with significant changes possibly play important roles in cerebral protection after CA-CPR in rats.
down-regulated respectively for 0.122±0.039,0.199±0.096,0.191±0.069,0.160±0.082 times. The apoptosis rate of cerebral cortex was increased significantly in CA-CPR group〔(32.23±5.31)%〕compared with that in normal control group〔(3.66±1.34)%〕and sham operation group〔(4.98±1.84)%,both P<0.01〕. Conclusions In early period after CA-CPR,obvious neurocyte apoptosis may be found in brain tissue of rats,and in the mean time, changes in apoptosis-related miRNA expression in cerebral cortex occur. The various types of miRNA with significant changes possibly play important roles in cerebral protection after CA-CPR in rats.

Objective To study the effects of exogenous phosphocreatine (CP) on brain injury after cardiopulmonary resuscitation (CPR) in rats.Methods A total of 160 male adult SD rats were randomly ( random number) divided into 4 groups:sham-operation control group ( group A),CPR group ( group B),low-dose CP group ( group C),high-dose CP group ( group D),and each group was further divided into 5 subgroups (n =8) as per study at different intervals,0.5,3,6,12 and 24 h after restoration of spontaneous circulation (ROSC) in groups B,C and D or after tracheotomy in group A.Cardiac arrest (CA) was induced by using asphyxia to establish CPR model in group B,C and D.The CP0.5 g/kg used in group C or CP 1.0 g/kg used in group D was injected into femoral vein at beginning of ROSC.Rats in each subgroup were sacrificed and the tissues of frontal lobe of brain of rats were taken at different intervals.The levels of adenosine triphosphate (ATP),adenosine diphosphate (ADP) and adenosine monophosphate (AMP) in cerebral cortex were measured by high performance liquid chromatography (HPLC),and values of total adenine nucleotides ( TAN ) and energy charge ( EC ) were detected.The activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase in cerebral cortex were assayed by spectrophotometric method. The pathological changes of cerebral cortex were observed under optical microscope.The experimental data were processed with analysis of variance by using SPSS 16.0 package. Results Compared with group A,the levels of ATP,TAN,EC,Na + -K + -ATPase,Ca2+ -Mg2+ -ATPase were lower ( P ＜ 0.05 or P ＜ 0.01 ) at each interval in groups B and C,and at intervals of 0.5,3,6,12 h in group D,and the levels of AMP were higher (P ＜ 0.01 ) at each interval in group B and at intervals of 0.5 h and 3 h in groups C and D.Compared with group B,the levels of ATP,TAN,EC,Na + -K + -ATPase,Ca2 + -Mg2+ -ATPase were higher ( P ＜ 0.05 or P ＜ 0.01 ),and the levels of AMP were lower ( P ＜ 0.05 or P ＜ 0.01 ) at intervals of 6,12 and 24 h in groups C and D.Compared with group C,the levels of ATP at interval of 24 h and TAN,Na +- K + -ATPase,Ca2 + -Mg2 + -ATPase at intervals of 6,12 and 24 h were higher in group D ( P ＜ 0.05 or P ＜ 0.01 ).There were severe pathological changes in cerebral cortex in group B,and mild changes in groups C and D. Conclusions There was obvious energy metabolism disorder after CPR in rats.Treatment with exogenous CP could increase the levels of ATP and activities of ATPase,alleviate pathological changes,especially in high-dose,and mitigate injury in cerebral cortex after CPR in rats.

Objective To study the effect of Hemin on the level of neuroglobin (NGB) in cerebral cortex,neurodeficit score (NDS) and pathological changes in cerebral cortex after cardiopulmonary resuscitation (CPR) in rats. Method A total of 120 male Sprague Dawley(SD) rats were divided randomly into control group(A), CPR group(B) and Hemin group(C). The animal model of cardiac arrest (CA) induced by asphyxia was established and CPR was performed. The NGB level in cerebral cortex, NDS and pathological changes in cerebral cortex were examined 0.5 h,3 h,6 h, 12 h, 24 h after restoration of spontaneous circulation (ROSC) in each group. Experimental data were analyzed by using one-factor analysis of variance and Tukey test. Results In comparison with group A, the levels of NGB were significantly higher 12 h,and 24 h after ROSC (P ＜0.05 and P ＜0.01), the values of NDS were significantly lower at each interval after ROSC ( P ＜ 0.01 ) ,and the pathological changes were more severe at each interval after ROSC in group B. In comparison with group A, the levels of NGB were significantly higher 6 h, 12 h and 24 h after ROSC ( P ＜ 0.05 and P ＜ 0.01 ), and the values of NDS were significantly lower 3 h, 6 h, 12 h after ROSC ( P ＜ 0.01) in group C. In comparison with group B, the levels of NGB were significantly higher 12 h and 24 h after ROSC, the values of NDS were significantly higher 12 h and 24 h after ROSC, and the pathological changes were less in group C. Conclusions The NGB level increased in cerebral cortex, the NDS level decreased and severe pathological changes occurred in rats after CPR. The hemin treatment up-regulated the level of NGB, improved the NDS, mitigated pathological changes, alleviating the cerebral injury after CPR.

OBJECTIVETo explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture.

METHODSFor a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation.

RESULTSThe operation was completed successfully with a shortened postoperative recovery time.

CONCLUSIONSThe application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Adult ; Bone Screws ; Fracture Fixation, Internal ; methods ; Hip Fractures ; rehabilitation ; Humans ; Imaging, Three-Dimensional ; Male ; Postoperative Period ; Printing, Three-Dimensional ; Rehabilitation ; instrumentation ; methods

Objective To explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture. Methods For a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation. Results The operation was completed successfully with a shortened postoperative recovery time. Conclusions The application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Objective To explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture. Methods For a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation. Results The operation was completed successfully with a shortened postoperative recovery time. Conclusions The application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Objective:To develop a self-directed learning feedback system for patients with post-stroke dysphagia (PSD) and analyze its effectiveness.Methods:From November 2022 to July 2023, convenience sampling was used to select 108 PSD patients from the Neurological Disease Center of Taiyuan Central Hospital as the research subject. The patients were divided into a control group and an experimental group using a random number table method, with 54 cases in each group. The control group received routine nursing upon discharge, while the experimental group was treated intervention measures through the self-directed learning feedback system. The self-efficacy, quality of life, swallowing function, and psychological status of two groups of patients were compared before intervention and one and three months after intervention, respectively.Results:A total of 52 patients in the experimental group and 50 patients in the control group completed the study. Repeated measures analysis of variance showed that the self-efficacy and quality of life scores of both groups improved with the extension of intervention time, and the self-efficacy and quality of life scores of the experimental group were higher than those of the control group at one and three months after intervention, with statistical differences ( P<0.01). After one and three months of intervention, the severity scores of dysphagia in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.01). As the intervention time extended, the psychological status scores of the experimental group were lower than those of the control group at different time periods, and the differences were statistically significant ( P<0.05) . Conclusions:The application of self-directed learning feedback system in the rehabilitation of PSD patients at home can improve their self-efficacy, quality of life and swallowing function, and relieve negative emotions, which is worthy of further promotion.

Objective To assess the factors associated with the restoration of spontaneous circulation (ROSC) and 2-year survival prognosis in patients with cardiac arrest (CA) after acute myocardial infarction (AMI),and after ROSC,the effects of various factors on midian survival time and on 2-year survival.Methods In a registry study from January 2005 to January 2015,all consecutive AMI-induced CA patients treated with cardiopulmonary resuscitation (CPR) admitted to our hospital were enrolled.The survivors were followed-up for 2 years.Univariate analysis was applied to evaluate factors associated with rate of ROSC and 2-year survival.Multivariable logistic regression analysis was applied to evaluate statistically significant factors in the univariate analysis.Medians with inter-quartile ranges were used to describe 2-year survival time affected by various factors after ROSC.Kaplan-Meier survival curve analysis was used to evaluate the effect of factors on 2-year survival.Results A total of 254 cases with CA after AMI were enrolled,including 129 cases of ROSC and 71 cases of 2-year survival.Univariate analysis showed age ≥ 70 years,CA occurred during 22:00-8:00,the duration time ofCPR ≥ 15 min and adrenaline dosage ＞ 5 mg were unfavorable predictors of ROSC;while,left ventricular ejection fraction (LVEF) ≥ 40％ before CA,shockable rhythm and percutaneous coronary intervention (PCI) therapy were favorable predictors.Besides,age ≥ 70 years,intubation during CPR,adrenaline dosage ＞ 5 mg and cardiogenic shock were unfavorable predictors of 2-year survival;While,male,normal daily activity before CA and PCI treatment were favorable predictors.Multivariable analysis showed age,the duration of CPR,adrenaline dosage,LVEF before CA,the rhythm during CPR and PCI therapy were independent predictors of ROSC.Age and PCI therapy were independent predictors of 2-year survival.Among patients,the survival time was affected by various factors after ROSC,and the factors with minimum 25％ and small median value were associated with cardiac rupture,cancer,adrenaline dosage ＞ 5 mg and cardiogenic shock.The factor with maximum 25％ value was PCI treatment (216 days).Kaplan-Meier survival analysis suggested that age ≥ 70 years was an unfavorable factor of 2-years survival (Log-rank test,P=0.007);while,PCI treatment was a favorable factor (Log-rank test,P＜0.01).PCI-related prognosis analysis showed that the effectiveness of PCI was related to the timing of PCI,the number of infarctrelated artery and the difference in culprit lesion.Conclusions The age ≥ 70 years was disadvantageous to both ROSC and 2-year survival.PCI treatment was favorable to both ROSC and 2-year survival.

Objective To determine the predictive factors for antiviral therapy in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection [HBeAg(-) CHBI] patients with HBV DNA＜4.3 lg IU/mL.Methods A total of 179 HBeAg (-) CHBI patients were retrospective analyzed.Histology activity index (HAI) and fibrosis (S) were scored according to the Knodell HAI scoring system,and HAI＞3 and/or S≥3 was adopted as indications for treatment.Univariate and multiple regression analysis were used to assess factors associated with treatment indications.Receiver operating curves (ROC) and area under curve (AUC) were used to determine the predictive value of relevant factors.Results There were 81 cases with HAI＞3 (45.3％) and 72 with S≥3 (40.22％),and the proportion of patients with indications for treatment was 54.7 ％.Multiple regression analysis showed that age,γ-glutamyl transpeptadase (γ-GT),platelet (PLT) and albumin (Alb) were the predictive factors for the severity of liver damage and indication for treatment (all P＜0.05).The AUC for age,PLT,γ-GT and Alb were 0.655,0.657,0.726 and 0.65,respectively,and the corresponding Yoden index for age,PLT,γ-GT,and Alb were 0.297,0.426,0.03 and 0.012,respectively,the sensitivities of predicting HBeAg (-CHBI for treatment indications were 0.643,0.842,0.705 and 0.653,respectively.Conclusions This study shows that 54.7％ of HBeAg(-)CHBI patients with HBV DNA＜4.3 lg IU/ml have significant liver histological changes and require antiviral treatment.Older age,higher γ-GT,lower PLT and lower Alb levels are the predictive factors for treatment.

Transanal total mesorectal excision is a new surgical procedure which has emerged in the recent years.This procedure performs a "bottom-to-up" resection of the rectum and its surrounding mesenteries through the anus,which provides better view compared with laparoscopic or open total mesorectal excision.However,it is undeniable that as a new surgical procedure,transanal total mesorectal excision is also bound to have some complications of surgery.Therefore,how to prevent and treat the complications of transanal total mesorectal excision is still a problem that must be faced in the future.This article intends to review the prevention and treatment of surgical complications and provide some experience for the development of transanal total mesorectal excision.