As the preferred treatment for most patients with hemodynamic instability in the intensive care unit (ICU),the fluid resuscitation can be limited by the cardiac function,that makes the fluid treatment has no responsiveness and may cause the risk of pulmonary edema increase.So,good fluid responsiveness is the basic condition to make fluid therapy successfully.For those patients,in order to lower the risk and correctly evaluate the fluid responsiveness,there are a large number of studies direct at the static and the dynamic pre-load parameters in animals and clinical patients.Those studies show that how to avoid the blindness of fluid expansion,accurately and effectively evaluate and forecast the fluid responsiveness.

BACKGROUND:In recent years, with the use of new immunosuppressive agents, the survival rate of renal graft is greatly improved, but accompanied by lots of side effects and unchanged long-term graft survival. Mesenchymal stem cel s (MSCs) have aroused people’s great interest, while their efficacy in kidney transplantation remains controversial.
OBJECTIVE:To evaluate the efficacy of MSCs transplantation on post-transplant renal graft function with a systematic review.
METHODS:PubMed, EMBASE, the Cochrane Library database, the Cochrane Central Register of Control ed Trials, Wanfang database and China National Knowledge Infrastructure (CNKI) were searched until November 2015. Revman 5.3 was used for statistical analysis.
RESULTS AND CONCLUSION:A total of 6 randomized control ed trials were included, including 1 166 patients. Meta-analysis results showed that at 1, 2 weeks and 1 month after kidney transplantation, the posttransplantation estimated glomerular filtration rates in the MSC-treated group were significantly higher than those in the control group (P<0.05). At 1, 3, 6, 12 months after kidney transplantation, the posttransplantation serum creatinine levels showed no significant difference between the MSC-treated group and the control group (P>0.05). To conclude, MSC-based immunosuppression regimen is superior to current standard immunotherapy in improving renal graft function in the early stage after kidney transplantation, but the clinical efficacy is diminished in the later period. Therefore, further investigation using large-scale randomized control ed trials is warranted.

Objective Compare the clinical efficacy between anterior cervical decompressions, internal fixation with steel plate and zero profile interbody fusion system (Zero-P) in the treatment of cervical spondylotic myelopathy.Methods From October 2010 to May 2013, a total of 47 patients with cervical myelopathy were included in prospective randomized controlled study.All patients were randomly divided into two groups, respectively using plate fixation (screw plate system group, 26 cases)and Zero-P (Zero-P group, 21 cases).Compared operation time, intraoperative blood loss, postoperation flow and the incidence of postoperative discomfort swallowing.Evaluated the Japanese Orthopaedic Association (JOA) score of nerve function and calculated improvement rate;measured cervical Cobb Angle on X-ray film, observed abnormal activity of surgical clearance, evaluated degree of bone graft fusion and related internal fixation complications.Results The average operation time of screw plate system group was 71.2±26.8 min, which was 53.4±28.6 min in Zero-P group, significant difference was found in two groups.The average bleeding volume was 78.1 ±46.7 ml, and average volume of postoperation drainage was 63.3±37.7 ml in screw plate system group;the average bleeding volume was 77.5±50.4 ml, and the average volume of postoperation drainage was 60.7±28.6 ml in Zcro-P group, no significant difference was found.5 cases in screw plate system group remained swallowing discomfort 3 weeks after operation, but non in Zero-P group.Followed-up lasted for 24-42 months, an average of 23±2.16 months, nerve function were significantly improved at the end of the follow-up of both two groups, the JOA score of screw plate system group was 14.28±2.96, the improvement rate was 68.91％±7.9％, and Zero-P group was 14.32±2.87, the improvement rate was 69.79％±11.2％, there were no significant difference;curvature of cervical vertebrae of screw plate system group was 15.2°±5.7° at the end of follow-up;Zero-P group was 18.1°±7.9°, which with significant difference.Bone graft fusion were found in all patients at the end of follow-up, and no abnormal activities and fixation loosening was found during follow-up period.Conclusion Zero-P compared with traditional fracture-fixation techniques in treating single or double segments of cervical spondylotic myelopathy, can shorten operation time, reduce the incidence of postoperative chronic discomfort swallowing, and maintain in favour of cervical curvature.

Background Juvenile Graves ophthalmopathy has a low prevalence and few relevant studies.Analyzing and reviewing the clinical features and therapeutic effectiveness of juvenile Graves ophthalmopathy is helpful to its diagnosis and management.Objective This study was to evaluate the clinical characteristics of Graves ophthalmopathy and its management in children and adolescents.Methods The clinical data of 54 eyes from 29 patients with Graves ophthalmopathy who were diagnosed in Shanghai Changzheng Hospital from January 2007 to December 2012 were retrospectively analyzed.The ocular manifestations,thyroid function,CT or MRI testing results were collected,and the activity of Graves ophthalmopathy was scored based on the criteria of CAS.Artificial tears was topically administered in 44 eyes with CAS ≤ 2.In the eyes with CAS ≥ 3,corticosteroids drug was systemically used in 3 patients,and orbital decompression surgery and excision of Müller muscle were performed in 3 eyes of 2 patients respectively.The follow-up was carried out for 1.5-6 years.The treatment outcomes were evaluated according to the reduction of exophthalnos and the improvement of upper eyelid retraction.Results The patients were 5-18 years old with an average age of 12.9 years old.Out of 29 Graves ophthalmopathy patients,5 males and 24 females were included.The initial clinical manifestations were proptosis,eyelid retraction and swelling,and accompanied by conjunctival congestion and hypophasis.The best corrected visual acuity (BCVA) was ≥ 0.8 in all the eyes.CAS scores wcre 0-2 in 48 eyes of 26 patients and ≥ 3 (active Graves ophthalmopathy) in 6 eyes of 3 patients.The increase of orbital adipose volume was exhibited in all the eyes and the enlargement of extraocular muscle was revealed in parts of eyes by CT/MRI.Laboratory examination showed normal thyroid function in 12 patients (41.4％),hyperthyreosis in 15 patients (51.7％) and hypothyroidism in 2 patients (6.9％).The ocular symptom was improved in 20 eyes of 11 patients (37.9％),stabilized in 29 eyes of 16 patients (55.2％) and worsen in4 eyes of 2 patients (6.9％) in following-up duration.Conclusions Graves ophthalmopathy occurs much more in female than in male.The clinical manifestations are mild,with low activity and good prognosis in children and adolescents Graves ophthalmopathy.

Objective To use ultrasonic cardiac output monitor(USCOM)to monitor the hemodynamics of children who un-derwent congenital heart disease(CHD)surgery before and after fluid therapy,and to examine the accuracy of the hemodynamic parameters central venous pressure(CVP),stroke volume variation(SVV),corrected flow time(FTc)and smith madigan inotro-py index(SMII)in predicting fluid responsiveness of children post operation.Methods USCOM was used to monitor the hemo-dynamic parameters of post-operative children before and after fluid therapy.The change of SVI(ΔSVI)was calculated based on the stroke volume index(SVI)before and after fluid therapy,and the inotropic scores(IS)were obtained based on the doses of in-otropic drugs used.Children with ΔSVI≥ 15% were defined to be responders who responded to fluid resuscitation and those with ΔSVI < 15% as non-responders.Two subgroups were also established in terms of IS:IS ≤ 10 group and IS > 10 group.Results Among the parameters(CVP,FTc and SM,etc.),only the area under the ROC curve(AUC)of SVV was signifi-cantly different between before and after fluid therapy(AUC 0.776,P < 0.01).Subgrouping analysis also showed significant difference in only the AUC of SVV between IS≤ 10 group and IS> 10 group(AUC:0.732,P =0.045 or 0.813,P =0.002). Conclusion SVV monitored by USCOM,in contrast to CVP,FTc and SMII,can predict the fluid responsiveness in children af-ter congenital heart surgery.Prediction of fluid responsiveness by SVV shows higher accuracy in IS>10 group than in IS≤10 group.

Objective To compare the effectiveness of 3D cervical spine versus titanium mesh cage in the treatment of fractures of lower cervical vertebrae.Methods From May 2016 to March 2017,a total of 31 patients with cervical spine fracture were enrolled in this prospective randomized controlled trial at Department of Orthopaedics,Luohe Central Hospital.Of them,16 cases were randomized to receive anterior cervical sub-total resection and decompression followed by internal fixation with implant of 3D printed cervical spine (3D group) and 18 to receive anterior cervical sub-total resection and decompression followed by internal fixation with implant of titanium mesh cage (TM group).The 2 groups were compared in terms of operation time,intraoperative bleeding,score and improvement rate of Japanese Orthopaedic Association (JOA),vertebral height change,cobb angle change and bone graft fusion.Results Eventually,included for this study were 15 cases in the 3D group and 16 in the TM group who had been completely followed up.Operations were well done for all the patients.The operation time for the 3D group (83.9 ± 21.4 min) was significantly shorter than that for the TM group (116.2 ± 27.8 min) (t =5.039,P ＜ 0.001).There was no significant difference between the 2 groups in intraoperative bleeding (92.6 ± 25.4 mL versus 105.6 ± 21.7 mL) (t =0.950,P =0.350).Follow-ups for 6 to 15 months revealed no implants failure or displacement in either group.By the final follow-up,bony union was achieved in all.Their preoperative JOA scores were all improved at the final follow-ups.There was no significant difference in JOA scores between the 2 groups (P ＞0.05).The vertebral heights and cobb angles at postoperative 3 months and at the final follow-up in the 3D group were significantly larger than those in the TM group (P ＜ 0.05);the vertebral heights and cobb angles at postoperative 3 months and at the final follow-up were significantly improved than the preoperative values in all the patients (P ＜ 0.05);there was no significantly difference between the vertebral height and cobb angle at postoperative 3 months and those at the final follow-up in either group (P ＞ 0.05).The incidence of prosthesis settlement in the 3D group (6.7％) was significantly lower than that in the TM group (43.75％)(P ＜ 0.05).Conclusions Both surgical procedures can reconstruct cervical stability.Compared with titanium mesh cage,3D printed cervical spine may lead to shorter operation time,better bone-material bonding interface,less prosthesis sinking and superiority in maintaining the cervical height and curvature.

Objective:To investigate the risk factors of bone cement leakage after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).Methods:A multi-center, large-sample, case-control study was carried out to analyze the clinical data of 2 273 OVCF patients (2 689 vertebrae) undergone PVP at four hospitals between May 2018 and October 2021, including 994 males and 1 279 females, with the age of 52-91 years [(69.1±3.1)years]. Of all, 581 patients (604 vertebrae) were allocated to leakage group and 1 692 patients (2 085 vertebrae) to no leakage group according to the occurrence of bone cement leakage. The gender, age, fracture sites, vertebral compression degree, endplate integrity of fractured vertebrae, surgical segments, surgical approaches and bone cement injection volume were recorded. Univariate analysis was used to investigate the correlation between those indicators with bone cement leakage. Multivariate Logistic regression analysis was used to identify the independent risk factors for bone cement leakage.Results:Univariate analysis showed that gender, age, fracture sites, vertebral compression degree, bone cement injection volume were related to bone cement leakage after PVP ( P<0.05 or 0.01), but no correlation was found in the endplate integrity of fractured vertebrae, surgical segments and surgical approaches (all P>0.05). Multivariate Logistic regression analysis showed that fracture sites ( OR=1.68, 95% CI 1.11-2.55, P<0.05), vertebral compression degree more than 40% ( OR=1.98, 95% CI 1.29-3.02, P<0.01), bone cement injection volume greater than or equal to 5.5 ml ( OR=1.55, 95% CI 1.07-2.26, P<0.05) were significantly associated with bone cement leakage after PVP. Conclusion:Thoracic vertebral fracture, vertebral compression degree more than 40% and bone cement injection volume greater than or equal to 5.5 ml are independent risk factors for bone cement leakage after PVP in OVCF.

Objective : To explore the association of time in range(TIR) and glucose management indicator ( GMI) with the risk of type 2 diabetic nephropathy (DN) ． Methods : The clinical data of 215 patients with type 2 diabetes mellitus (T2DM) were collected and analyzed．According to the results of estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio( UACR) ，they were divided into 117 patients with T2DM and 98 patients with DN．The clinical data，biochemical indicators and continuous glucose monitoring ( CGM) indicators of the two groups were compared．Logistic regression was used to analyze the influencing factors of DN risk．The predictive value of TIR and GMI on the risk of DN was evaluated by receiver operating characteristic (ROC) curve. Results: There were significant differences in age，duration of diabetes，systolic blood pressure，glycosylated hemoglobin ( HbA1c) ，fasting plasma glucose (FPG) ，2 hour postprandial plasma glucose (2hPG) ，creatinine( Cr) ，UACR, eGFR between the two groups(P＜0. 05) ．There were statistically significant differences between the two groups in the CGM indexes of GMI，mean absolute difference of mean of daily differences ( MODD) ，glucose above target range time(TAR) and TIR(P＜0. 05) ．The results of logistic regression analysis showed that TIR was a protective factor of DN．In the ROC curve analysis of TIR prediction DN，the area under the ROC curve was 0. 718 (95% CI = 0. 648 ～0. 789，P＜0. 001) ，and the Yoden index was 0. 38．At this time，the sensitivity was 66. 7% ，and the specificity was 71. 3%．In the ROC curve analysis of GMI prediction DN，the area under the ROC curve was 0. 701 (95% CI = 0. 629 ～0. 774，P＜0. 001) ，and the Yoden index was 0. 368．At this time，the sensitivity was 63. 3% ， and the specificity was 73. 5%． Conclusion Specifically，lower TIR and higher GMI increase the risk of DN.

【Objective】 To investigate the binding and carrying effects of human serum albumin (HSA) from various sources on sphingosine-1-phosphate (S1P). 【Methods】 Utilizing human plasma-derived HSA (pHSA) and recombinant HSA (rHSA) samples as the focal points of our investigation, LC-MS/MS technology was employed to meticulously compare and analyze the disparities in S1P content among the aforementioned samples. Subsequently, under physiological concentration conditions, S1P was directly introduced to HSA samples for loading processing, facilitating a comprehensive comparison of the binding efficacy of HSA from different sources to S1P. Within a serum-free culture setting, HSA samples from various sources were co-cultured with HUVEC cells. The alterations in S1P content within the cell culture supernatant across different treatment groups were meticulously analyzed, allowing for a nuanced comparison of the S1P carry effects exerted by HSA from different sources on cells.The interaction between HSA and S1P molecules from different sources was analyzed and their affinity was calculated using surface plasmon resonance (SPR) technology. Furthermore, leveraging AutoDock Vina software and the Molprophet platform, the molecular docking analysis of HSA and S1P was conducted, aiming to predict the key binding pocket domain of S1P within HSA. 【Results】 All pHSA samples exhibited detectable levels of S1P (ranging from 3.31±0.03 to 30.35±0.07 μg/L), with significant variations observed among pHSA samples from different manufacturers (P<0.001). Conversely, S1P was undetectable in all rHSA samples. Upon load treatment, the binding affinity of HSA from diverse sources to S1P demonstrated significant discrepancies (P<0.001), with rHSA exhibiting approximately double the average S1P loading compared to pHSA (ΔCrHSA=801.75±142.45 μg/L vs ΔCpHSA=461.94±85.73 μg/L; P<0.001, t=5.006). Co-culture treatment outcomes revealed a significant elevation in S1P concentration within the supernatant after 6 hours of co-culture across all HSA sample processing groups with HUVEC cells, while no changes were observed in the supernatant of the blank control group. Notably, significant differences in supernatant S1P concentration were observed among treatment groups at 6 h, 12 h, and 24 h (P<0.001). SPR analysis unveiled a stronger affinity of pHSA for S1P compared to rHSA (KDpHSA-S1P: 2.38E-06, KDrHSA-S1P: 3.72E-06). Molecular docking analysis and binding pocket prediction suggested that the key binding pocket of HSA and S1P may reside in the IB subdomain of the HSA molecule. 【Conclusion】 HSA from various sources exhibits distinct binding and carrying effects on S1P, which appear to be closely associated with the IB subdomain of the HSA molecule.

【Objective】 To investigate the preventive effects of early apoptotic splenic mononuclear cells induced by extracorporeal photopheresis (ECP) on acute graft versus host disease (aGVHD) in mice and explore the underlying mechanisms. 【Methods】 1) Splenic mononuclear cells were extracted from C57BL/6 mice and treated with different concentrations of 8-MOP (50 ng/mL, 100 ng/mL, 200 ng/mL, 300 ng/mL, 600 ng/mL). After treatment, irradiate the cells with 2 J/cm² of ultraviolet light. Then, use the Annexin V-FITC/PI apoptosis detection kit to assess the early apoptosis rate of the cells and determine the optimal concentration of 8-MOP for the experiment.2) There were 35 SPF-grade female BALB/C mice (H-2Kd) aged 6-8 weeks. After whole-body irradiation with 8Gy X-rays, the mice were divided into five groups: sham irradiation group received intravenous infusion of 0.2 mL of normal saline, the syngeneic bone marrow transplantation group received intravenous infusion of 0.2 mL of BALB/C mouse bone marrow nucleated cell suspension (including a cell count of 1×10⁷), the allogeneic bone marrow transplantation group received intravenous infusion of 0.2 mL of C57BL/6 mouse bone marrow nucleated cell suspension (including a cell count of 1×10⁷), the aGVHD group received intravenous injection of a mixture of C57BL/6 mouse bone marrow nucleated cells (including a cell count of 1×10⁷) and splenic mononuclear cells (including a cell count of 1×10⁷) in 0.2 mL, the ECP prevention group received pre-transplant intravenous infusion of 0.2 mL of ECP-treated splenic mononuclear cells of C57BL/6 mice (including a cell count of 1×10⁷ ) 48 hours before transplantation, and on the day of transplantation, intravenous injection of a mixture of C57BL/6 mouse bone marrow nucleated cells (including a cell count of 1×10⁷) and splenic mononuclear cells (including a cell count of 1×10⁷ ) in 0.2 mL.The preventive effects of ECP on aGVHD were observed, and the concentrations of IFN-γ, IL-2, TNF, IL-4 and IL-6 in mouse serum were measured using CBA. Th1 cell counts were determined by flow cytometry. 【Results】 Different concentrations of 8-MOP (50 ng/mL,100 ng/mL, 200 ng/mL, 300 ng/mL, 600 ng/mL) were used to treat mouse splenic mononuclear cells. The early apoptosis rates (%), observed after treatment were as follows: (14.18±0.865) vs (16.76±0.407) vs (18.83±0.404) vs (19.27±0.404) vs (14.5±0.529). The appropriate concentration of 8-MOP was determined to be 200 ng/mL.In vivo experiment, the results showed that the aGVHD group had decreased survival rate, reduced body weight, and increased clinical scores compared to the syngeneic and allogeneic bone marrow transplantation groups (P<0.01), and the chimerism of bone marrow cells in mice after transplantation was over 90%. ECP significantly improved the survival rate of mice after transplantation, reduced clinical scores (P<0.05), and decreased the concentrations of Th1 cell cytokines in serum (P<0.05) and the counts of Th1 cells in the spleen (P<0.05). 【Conclusion】 ECP-induced early apoptotic single nuclear cells from the spleen can prevent the occurrence of aGVHD by reducing the Th1 response in mouse.