AIM: To investigate the protective effect of ischemic-preconditioning under the mild hypothermia against small intestine ischemia-reperfusion injury in rats and its mechanism. METHODS: Thirty-two rats were randomized into 4 groups (8 rats in each group): sham operated group (Sham), ischemia-reperfusion (I/R) group, ischemic-preconditioning (IP) group, mild hypothermia ischemic-preconditioning (MHIP) group. The wet/dry ratio, Ca 2+ -Mg 2+ -ATPase activity in intestine tissue, the malondialdehyde (MDA) content, activities of lactate dehydrogenase (LDH), superoxide dismutase (SOD) and total antioxdase (TAX) in blood were determined. Ultrastructure, Bcl-2 and Bax expression in intestinal mucosa tissue were also observed. RESULTS: After I/R, the intestinal tissue wet/dry ratio, the content of MDA, LDH activity, the optic density of Bcl-2 and Bax proteins were significantly higher in I/R group than those in sham group (P

AIM and METHODS: To study the protective effects of liposomes containing L-Arg,Se and taurine on intestinal ischemia-reperfusion injury in rats. Wistar rats were divided randomly into sham operated group,ischemia-reperfusion(I/R) group,pretreatment with liposomes group and treatment with liposomes at reperfusion group. In the experiments, superior mesenteric artery was clipped for 60 min, and then unclipped. 2 hours of reperfusion later, MDA content, T-SOD and Ca 2+ -Mg 2+ -ATPase activities in intestinal tissues were detected respectively, ultrastructure and bcl-2 expression in intestinal mucosa tissue were observed. RESULTS: MDA content in liposomes-treated group was less than I/R group ( P 0.05). CONCLUSION: Liposomes containing L-arginine, Se and taurine can protect intestine against ischemia-reperfusion injury in rats,which may be related to inhibiting lipid peroxidation, stabilizing internal circumstances and inducing bcl-2 protein expression.

Objective To observe the effect of dynamic articulars panning external fixation combined with limited internal fixation for distal radius comminuted fracture.Methods 100 comminuted distal radius fractures patients during September 2014 and September 2014 in our hospital were selected and randomly divided into control group and research group,50 cases in each group.Patients of the control group accepted conventional manual reduc-tion combined with plaster external fixation,patients of the research group accepted dynamic articulars panning exter-nal fixation combined with limited internal fixation treatment.Curative effect,the palm inclination angle and feet were compared between the two groups.Results (1)After surgical treatment and rehabilitation therapy,15 patients in the control group achieved optimal degree,28 cases in the research group achieved optimal degree(P =0.086);9 cases in the control group were the poor degree;only 2 patients in the research group were poor degree(P =0.025).Statistical analysis showed that two differences were statistically significant,(P <0.05).(2)After 3 months,the palmar tilt of patients in the control group was (6.5 ±2.2)°,while that of the research group was (8.5 ±2.5)°(t =4.25,P <0.000 1 );The average ulnar deviation of control group was (12.3 ±4.3)°,and that of the research group was (15.6 ±6.6)°(t =2.96,P =0.003 8).In a word,the average palmar tilt and ulnar deviation of the research group were greater than those in the control group,the difference showed statistically significant.6 months later,the average palmar tilt of the control group patients was (6.2 ±2.3)°,that of the research group was (8.8 ±2.5)°(t =5.41, P <0.000 1 );the ulnar deviation of the control group was (12.1 ±4.1 )°,and that of the research group was (16.3 ±4.4)°(t =4.93,P <0.000 1),the difference was statistically significant.Conclusion Dynamic articulars panning external fixation combined with limited internal fixation for the treatment of distal radius comminuted fracture effect is significant,which is worthy of clinical promotion.

Objective To investigate the serum levels of IL-10 and TGF-β1 and their significance for patients with sys-temic lupus erythematosus( SLE) .Methods A total of 135 cases were available for the study including 63 cases in primary group(A), 40 cases in remission group(B) and 32 cases in healthy control group(C).ELISA method was used to deter-mine the concentrations of IL-10 and TGF-β1 in serum.Finally, the results of group A were analyzed on the basis of System-ic Lupus Erythematosus Disease Activity Index( SLEDAI) .Results The level of IL-10 in serum of group A was significant-ly higher than that of group B and group C.The level of IL-10 in serum of group B was significantly higher than that of group C(P<0.05).The level of IL-10 in group A had active correlation with SLEDAI.The level of TGF-β1 in serum of group A was significantly lower than that of group B and group C.There was no statistical difference between group B and group C(P>0.05).The level of TGF-β1 in serum of group A had negative correlation with SLEDAI.The cases in group A were divided into three subgroups by SLEDAI:21 cases in mild activities subgroup, 30 cases in moderate activities sub-group,and 12 cases in severe activities subgroup, the levels of IL-10 and TGF-β1 in the three subgroups were significantly different(P<0.05).Conclusions IL-10 and TGF-β1 are involved in activity and severity of SLE.

Objective:To retrospectively assess the relationship between immune disorder and acute gastrointestinal injury (AGI) in patients after severe polytrauma.Methods:Totally 205 patients with severe polytrauma admitted to Tongji Hospital from April 2018 to October 2019 were enrolled as the observation group, and 23 healthy volunteers were served as the control group. According to the diagnostic criteria of AGI, all patients were divided into the AGI group (with AGI) or N-AGI group (without AGI), AGI patients were divided into the S-AGI group or L-AGI group according to the severity. The levels of cytokines and lymphocyte subset were evaluated at day 1, 7, and 14 after severe polytrauma. The differences between groups were statistically analyzed. The independent risk factors of AGI were analyzed by Logistic regression analyzed.Results:Totally 79.5% (163/205) of patients with severe polytrauma were accompanied by AGI. There were significant differences in the ratio of Tc, Th at day 1 after trauma, the levels of IL-6, TNF-α, IL-8, IL-10, the ratio of Ts, Th/Ts, Treg at day 7 after trauma, and the levels of IL-8, IL-10,the ratio of Ts, Th/Ts, Treg at day 14 after trauma between the AGI group and N-AGI group ( P<0.05). There were significant differences in the ratio of Tc, Th, the levels of IL-6, TNF-α at day 1 after trauma and the ratio of Ts, Th/Ts, Treg, the levels of IL-8, IL-10 at day 7 and 14 after trauma between the S-AGI group and L-AGI group ( P<0.05). Logistic regression analysis showed that Ts 7 d ( OR=2.018, 95% CI: 1.105-5.364, P=0.013), Treg 14 d ( OR=3.612, 95% CI: 1.375-8.476, P=0.006), IL-6 7 d ( OR=1.824, 95% CI: 1.011-5.835, P=0.024), IL-10 14 d ( OR=2.847, 95% CI: 1.241-6.216, P=0.014), TNF-α 7 d ( OR=1.754, 95% CI: 1.215-5.441, P=0.018) were independent risk factors in patients with AGI after severe polytrauma. Conclusions:AGI is more easily occurred in patients with the heavier immune disorders after severe polytrauma. AGI can also aggravate pre-existing immune disorders in patients after severe polytrauma.

Objective To discuss the curative effect of double targets percutaneous radiotfrequency thermocoagulation (PRT) on primary trigeminal neuralgia (PTN) and its safety.Methods Sixty patients with PTN were randomly divided into single target treatment group and double targets treatment group.CT guided stereotactic location was used to navigate PRT;patients in the single target treatment group only accepted one target damage and those in the double targets treatment group accepted target damage with 3 mm of deep and shallow interval.The curative effects and complications were compared one week,3 months,one and 2 years after the surgery.Results The percentage of patients with good curative effect in double targets treatment group was significantly higher than that in single target treatment group one and 2 years after surgery,with statistically significant difference (86.7％ vs.60％,70％ vs.45％,P＜0.05).Recurrence rates of double targets treatment group 3 months,one and 2 years after surgery were 0％,3.3％ and 6.7％,which were lower than those in single target treatment group (3.3％,10％ and 16.7％),without significant difference (P＞0.05).Ipsilateralfacial hypaesthesia of different degrees appeared in both groups,but complications as keratohelcosis,diplopia,chewing weakness or difficulty in opening mouth did not appear.And the degree of facial numbness in double targets treatment group was a little higher than that in single target treatment group without statistical significance (P＞0.05).Conclusion Double targets PRT used in PTN treatment can obviously improve the postoperative pain relief and do not apparently increase the degree of postoperative facial numbness as compared with single target PRT.

In order to study the chemical constituents of the leaves of Tripterygium wilfordii and provide references for the bio-active study, we isolated nine compounds from the dried leaves of Tripterygium wilfordii. Their structures were determined by application of spectroscopic (NMR, MS) and chemical methods. These compounds were isolated and identified as (+)-lyoniresinol (1), (+)-isolariciresinol (2), burselignan (3), dibutyl phthalate (4), cyclo-(S-Pro-R-Phe) (5), cyclo-(S-Pro-R-Leu) (6), cyclo-(S-Pro-S-Ile) (7), 3-hydroxy-1-(4-hydroxy-3,5-dimethoxyphenyl)-1-propanone (8) and daucosterol (9). Compounds 1-3, 5-8 were isolated from this plant for the first time.
Anisoles ; chemistry ; isolation & purification ; Dibutyl Phthalate ; chemistry ; isolation & purification ; Lignin ; chemistry ; isolation & purification ; Magnetic Resonance Imaging ; methods ; Mass Spectrometry ; methods ; Naphthalenes ; chemistry ; isolation & purification ; Naphthols ; chemistry ; isolation & purification ; Peptides, Cyclic ; chemistry ; isolation & purification ; Plant Extracts ; chemistry ; isolation & purification ; Plant Leaves ; chemistry ; Sitosterols ; chemistry ; isolation & purification ; Tripterygium ; chemistry

Objective:To compare the clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy (RARP) versus extraperitoneal single port RARP.Methods:A retrospective analysis was perfoumed on 142 cases of RARP from July 2019 to June 2020 in Robotic Minimally Invasive Center of Sichuan Provincial People's Hospital, including 82 cases(Group A) , aged 70.0(65.6-78.0), undergoing transperitoneal RARP and 60 cases(Group B), aged 68.2 years old(60.1-79.2), undergoing extraperitoneal single port RARP. For group A, PSA was 12.9(5.6-64.0) ng/ml, with 26 cases of less than 10 ng/ml(31.7%), 40 cases of 10-20 ng/ml(48.8%), and 16 cases of more than 20 ng/ml(19.5%), the Gleason score was 7.2(6.0-10.0), with 14 cases(17.1%) of ≤6, 56 cases(68.3%) of 7, and 12 cases(14.6%) of ≥8, and the prostate volume was 61.3(29.0-112.0) ml. There were 49 cases with BMI≤25 kg/m 2, accounting for 59.8%, and 33 cases with BMI>25 kg/m 2, accounting for 40.2%. There were 17 cases(20.7%) of T 1, 44 cases(53.7%) of T 2 and 21 cases(25.6%) of T 3. The proportion of lymph node dissection was 17.1%, and 4 cases(4.9%)had a history of operation. For group B, the PSA was 12.2(1.0-42.6)ng/ml, with 20 cases (33.3%) of <10 ng/ml, 31 cases(51.7%)of 10-20 ng/ml, and 9 cases (15%) of >20 ng/ml. Gleason score was 7.1(6.0-9.0), with 12 cases (20.0%) of ≤6, 42 cases (70.0%) of 7, and 6 cases (10.0%)of ≥8. Prostate volume was 42.4(31.2-72.8)ml on average. There were 37 cases (61.7%) with BMI≤25 kg/m 2, and 23 cases (38.3%)with BMI >25 kg/m 2 . There were 17 cases(28.3%)of T 1, 32 cases(53.3%)of T 2 and 11 cases(18.3%)of T 3.The proportion of lymph node dissection was 11.7% and 4 cases (6.7%) had a history of operation.There was no statistically significant difference in term of age, PSA level, Gleason score, BMI, clinical stage, proportion of lymph node dissection or history of operation between the two groups( P>0.05), but there was statistically significant difference for prostate volume( P<0.05). All operations were performed by the same operator. Four different ways of bladder neck and urethral dissociation was selected according to the intraoperative conditions in Group A, include VIP style, T-shape incision style, VIP plus T-shape incision style or the style along the lateral side of the bladder neck. Small and single anterograde incision stripping of bladder neck was routinely performed in the Group B. Postoperative follow-up was performed to compare the operation time, intraoperative blood loss, bladder neck and urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, postoperative complications, positive rate of surgical margin, indwelling time of urinary catheter, urinary continence satisfaction rate of immediately after operation, 3 months and 6 months after operation, wound healing and aesthetics. Results:All of the operations were successfully completed under robot-assisted laparoscopy, and there was no conversion to open surgery. The operation time was 56.0(45.0-112.0) min in the Group A and 65.4(55.5-96.8) min in the Group B, and there was no statistically significant difference( P>0.05). The intraoperative blood loss was 76.2(30.0-120.5) ml and 55.6(45.5-114.6) ml, respectively, and the difference was not statistically significant( P>0.05). The time of bladder neck urethral anastomosis was 18.9(12.6-25.6) min and 16.2(10.7-19.3) min, respectively, and the difference was not statistically significant( P>0.05). The postoperative hospital stay days were 9.3(8.0-16.0) d and 8.4(7.0-13.0) d, respectively, and the difference was not statistically significant( P>0.05). The postoperative exhaust time was 1.3(0.7-3.0) d and 3.4(2.0-7.0) d, respectively, and the difference was statistically significant( P<0.05). There was 1 case of anastomotic fistula with ureteral injury in Group A, and no serious complication in Group B, and the difference was not statistically significant( P>0.05). The number of positive surgical margin in the two groups was 13(15.9%)and 9(15.0%)respectively, and the difference was not statistically significant( P>0.05). The indwelling time of urinary catheter after operation was 9(7-21) d and 6(4-8) d, respectively, and the difference was statistically significant( P<0.05). The number of patients with satisfactory urinary continence immediately after surgery, 3 months and 6 months after surgery in the two groups were 8(9.8%), 51(62.2%), 62(75.6%) and 17(28.3%), 43(71.7%) and 54(90.0%), respectively. The differences were statistically significant( P<0.05). The total incision lengths in the two groups were 12.1(10.4-13.4) cm and 5.6(5.0-6.0) cm, respectively, and the difference was statistically significant( P<0.05). Conclusions:The extraperitoneal single port RARP is safe and feasible, and the postoperative effect is similar to that of transperitoneal RARP. It has the advantages of shorter recovery time, higher urinary continence satisfaction rate, neater and more beautiful incision. The long-term therapeutic effect needs further confirming by prospective study.

Objective:To retrospectively assess early risk factor of persistent inflammation, immunosuppression and catabolism syndrome (PICS) in patients with severe polytrauma, in order to deepen the understanding of the pathological changes of chronic critical illness (CCI) after severe polytrauma.Methods:A total of 276 patients with severe polytrauma admitted to Department of Trauma Surgery of Tongji Hospital from March 2019 to December 2020 were enrolled. Inclusion criteria included patients who suffered severe polytrauma, and injury severity score (ISS) ≥27, age ≥18 years old, and had length of hospital stay >15 days. Exclusion criteria included previous medical history of malignancy, or immunological, consumptive, and metabolic diseases. The patient’s clinical characteristics, ISS scores, Glasgow coma scale (GCS), sequential organ failure assessment, APACHEⅡ scores, and nutrition and immune indexes on day 3 after injury were collected. The difference between the PICS group and N-PICS group were performed by Student’s t test, χ2 test or Mann-Whitney U test. The early risk factors were assessed in patients with PICS after severe polytrauma by logistic regression analysis. Results:According to the diagnostic criteria of PICS, all enrolled patients were divided into two groups: PICS group ( n=102) and N-PICS group (without PICS, n=174). Compared with the N-PICS group, patients in the PICS group were older and associated with more brain and chest injuries. On the third day after injury, serum levels of IL-6 and IL-10, and the ratio of Treg cells were significantly higher, the number and ratio of NK cells subset, and the ratio of activated T lymphocyte were significantly lower in the PICS group than in the N-PICS group ( P<0.05). Logistic regression analysis showed that the age>65 years old ( OR=2.375, 95% CI: 1.442-4.531), GCS ≤8 scores ( OR=3.431, 95% CI: 1.843-8.512), IL-10 >10 pg/mL ( OR=2.173, 95% CI: 1.751-5.614), the ratio of Treg cells >7% ( OR=3.871, 95% CI: 1.723-6.312), and the occurrence of traumatic brain and chest injuries ( OR=2.846, 95% CI: 1.522-5.361) were the early risk factors in patients with PICS after severe polytrauma. Conclusions:Age>65 years old, GCS score, IL-10, the ratio of Treg cells, and the occurrence of traumatic brain and chest injuries could be used as the early risk factors in patients with PICS after severe polytrauma. The discovery of early risk factors will help identify patients at high risk of PICS after severe polytrauma, and create the possibility for early intervention.

Objective: To analyze the clinical value of real-time PCR for virus detection in the diagnosis and treatment of patients after allo-HSCT who had no infection evidence of pneumonia using routine pathogen detection panel. Methods: The clinical data of 71 episodes with acute lung injury from May 2015 to March 2017 after allo-HSCT in hematology department of Peking University People’s Hospital (PKUPH) were retrospectively analyzed. PCR for virus detection and other routine pathogen detection tests were performed on bronchoalveolar lavage fluid (BALF) samples. Results: Among 71 episodes with acute lung injury, a total of 15 patients were diagnosed as lower respiratory tract disease merely associated with virus (detection rate of 21.13%) , 19 episodes were absent of lower respiratory tract infection. The median time from allo-HSCT to the occurrence of lung injury were 176 (49-1 376) d and 196 (57-457) d respectively (z=-0.191, P=0.864) . There were no statistical differences for baseline characteristics and clinical features between two groups. The 100-day attributable mortalities were 13.3% (2/15) and 26.3% (5/19) (χ²=0.864, P=0.426) . Patients with low-dose steroids treatment had favorable outcome than those with high-dose steroids treatment (the dose of methylprednisolone ≥250 mg/d as standard) [4.2% (1/24) vs 60.0% (6/10) ]. In patients with detectable virus in BALF, 2 patients died with early high-dose steroids treatment, while 11 patients survived with no steroids treatment or late application. Conclusions Virus infection should be considered in post-HSCT pneumonia patient with negative result using routine pathogen detection panel. Expanding virus detection panel by PCR in BALF could increase diagnostic precision and might be instructive to treatment.