Objective To evaluate the effect of esketamine combined with distal limb ischemic preconditioning(LIP)for lung protection in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods This randomized trial was conducted in 160 patients undergoing elective thoracoscopic surgery for lung cancer,who were randomized into control group(with saline injection and sham LIP),esketamine group,LIP group,and esketamine+LIP group(n=40).Before anesthesia induction,according to the grouping,the patients received an intravenous injection with 0.5 mg/kg esketamine or 10 ml saline(in control group).LIP was induced by applying a tourniquet 1-2 cm above the popliteal fossa in the left lower limb to block the blood flow for 5 min for 3 times at the interval of 5 min,and sham LIP was performed by applying the tourniquet without pressurization for 30 min.Oxygenation index(OI)and alveolar-arterial PO2 difference(A-aDO2)were calculated before induction(T0),at 30 min(T0.5)and 1 h(T1)of one-lung ventilation(OLV),and at 1 h after two-lung ventilation(T3).Serum levels of SP-D,CC-16 and TNF-α were measured by ELISA at T0,T1,T2(2 h of OLV),T3,and 24 h after the operation(T4).The length of hospital stay and postoperative pulmonary complications of the patients were recorded.Results Compared with those in the control group,the patients in the other 3 groups had significantly lower CC-16,SP-D and TNF-α levels,shorter hospital stay,and lower incidences of lung infection and lung atelectasis(all P<0.05).Serum CC-16,SP-D and TNF-α levels,hospital stay,incidences of complications were significantly lower or shorter in the combined treatment group than in esketamine group and LIP group(all P<0.05).Conclusion In elderly patients undergoing thoracoscopic radical surgery for lung cancer,treatment with esketamine combined with LIP can alleviate acute lung injury by enhancing anti-inflammatory response to shorten postoperative hospital stay,reduce lung complications and promote the patients'recovery.

Objective To evaluate the effect of esketamine combined with distal limb ischemic preconditioning(LIP)for lung protection in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods This randomized trial was conducted in 160 patients undergoing elective thoracoscopic surgery for lung cancer,who were randomized into control group(with saline injection and sham LIP),esketamine group,LIP group,and esketamine+LIP group(n=40).Before anesthesia induction,according to the grouping,the patients received an intravenous injection with 0.5 mg/kg esketamine or 10 ml saline(in control group).LIP was induced by applying a tourniquet 1-2 cm above the popliteal fossa in the left lower limb to block the blood flow for 5 min for 3 times at the interval of 5 min,and sham LIP was performed by applying the tourniquet without pressurization for 30 min.Oxygenation index(OI)and alveolar-arterial PO2 difference(A-aDO2)were calculated before induction(T0),at 30 min(T0.5)and 1 h(T1)of one-lung ventilation(OLV),and at 1 h after two-lung ventilation(T3).Serum levels of SP-D,CC-16 and TNF-α were measured by ELISA at T0,T1,T2(2 h of OLV),T3,and 24 h after the operation(T4).The length of hospital stay and postoperative pulmonary complications of the patients were recorded.Results Compared with those in the control group,the patients in the other 3 groups had significantly lower CC-16,SP-D and TNF-α levels,shorter hospital stay,and lower incidences of lung infection and lung atelectasis(all P<0.05).Serum CC-16,SP-D and TNF-α levels,hospital stay,incidences of complications were significantly lower or shorter in the combined treatment group than in esketamine group and LIP group(all P<0.05).Conclusion In elderly patients undergoing thoracoscopic radical surgery for lung cancer,treatment with esketamine combined with LIP can alleviate acute lung injury by enhancing anti-inflammatory response to shorten postoperative hospital stay,reduce lung complications and promote the patients'recovery.

OBJECTIVE: To investigate the clinical efficacy of Huang'e Capsules in the treatment of type ⅢA chronic prostatitis, and its effects on the levels of the inflammatory cytokines neutrophil elastase (NE), IL-8 and TGF-β1 in the expressed prostatic secretion (EPS) of the patients. METHODS: We selected 120 patients with type ⅢA chronic prostatitis and randomly assigned them to medication with Huang'e Capsules (the trial group, n = 60) or Levofloxacin and Tamsulosin (the control group, n = 60), both for a course of 4 weeks. We obtained the NIH-CPSI scores and the levels of NE, IL-8 and TGF-β1 in the EPS, and compared them between the two groups before and after treatment. RESULTS: Totally, 116 of the patients completed the study, 59 in the trial and 57 in the control group. The overall clinical effectiveness was significantly higher in the trial group than in the control (89.8% vs 77.2%, P<0.05). Compared with the baseline, the patients of the trial group showed significant decreases after treatment in the total NIH-CPSI scores (32.5±7.4 vs 13.2±5.1), pain symptom scores (13.7±3.9 vs 4.2±2.3), urination symptom scores (6.9±2.4 vs 5.1±3.2) and quality of life (QOL) scores (8.3±2.7 vs 3.7±1.5) (all P< 0.05), and so did the controls in the total NIH-CPSI scores (30.8±7.8 vs 13.7±3.9), pain symptom scores (14.2±4.1 vs 7.8±2.9), urination symptom scores (7.1±2.7 vs 4.9±3.4) and quality of life (QOL) scores (8.1±2.4 vs 5.6±1.9) (all P< 0.05), and the decreases were even more significant in the trial than in the control group in the pain symptom and QOL scores ( P< 0.05). The patients of the trial group also exhibited a marked reduction after treatment in the contents of NE (［1135.4±321.5］ vs ［347.6±207.3］ ng/L, P< 0.05) and IL-8 (［974.9±231.6］ vs ［ 431.3±207.2］ ng/L, P< 0.05) but an elevation in that of TGF-β1 (［591.0±172.1］ vs ［1 402.1 ± 221.5］ ng/L, P< 0.05) in the EPS, and so did the controls in the levels of NE (［1052.8±280.3］ vs ［761.1±225.1］ ng/L, P<0.05), (［1007.5±287.7］ vs ［775.7±182.5］ ng/L, P< 0.05), (［607.8±201.3］ vs ［871.3±192.5］ ng/L, P< 0.05), with even more significant improvement in the trial than in the control group (P< 0.05). CONCLUSION Huang'e Capsules has a significant clinical efficacy and safety in the treatment of type IIIA prostatitis, which can effectively relieve the pain and urination symptoms and improve the levels of the inflammatory cytokines NE, IL-8 and TGF-β1 in the patients.
Humans ; Male ; Prostatitis/metabolism* ; Interleukin-8/metabolism* ; Drugs, Chinese Herbal/therapeutic use* ; Transforming Growth Factor beta1/metabolism* ; Prostate/metabolism* ; Leukocyte Elastase/metabolism* ; Tamsulosin ; Treatment Outcome ; Capsules ; Middle Aged ; Phytotherapy ; Cytokines/metabolism* ; Adult ; Levofloxacin

Aim To investigate the effects of daidzeinDD on the proliferation and apoptosis of non-small cell lung cancer cells,with a focus on the possible role of the p53 signaling pathway in this regard. Methods CCK-8 method and flow cytometry were used to detect the effects of soy isoflavone crude extract and DD on the viability and apoptosis of HELF and H1299 cells. Gene microarray was used to detect the changes in gene expression after treatment of H1299 cells with DD. GSEA and differential analysis were used to screen the major pathways and key genes. RT-qPCR and Western blot were performed to verify the differences in mRNA and protein expression of key genesp53 and CASP9 in the major pathways. After p53 inhibitor Pifithrin-α inhibited the expression of p53,the effect of DD on p53 mRNA and protein expression levels was examined,and the proliferative effect on H1299 cells was observed. Results Soy isoflavone crude extract and DD promoted proliferation and inhibited apoptosis of normal lung cells and inhibited proliferation and promoted apoptosis of lung cancer cells. p53 signaling pathway was significantly enriched in the DD-treated groupNES=1.78,P=0.000,and the expressions of p53 and CASP9 genes were found to be significantly up-regulated in the treated group. Compared with the control group,mRNA expression of CASP9 and p53 significantly increased in both HELF and H1299 cells treated with DDP<0.05,and p53 protein expression also increased in HELF cellsP<0.05. After inhibition of p53 expression,DD significantly increased the mRNA expression of p53 in H1299 and HELF cellsP<0.05 and also markedly increased the expression of p53 protein in H1299 cellsP<0.05,and it was observed that DD inhibited the proliferation of lung cancer cells. Conclusions DD inhibits the proliferation and promotes the apoptosis of lung cancer H1299 cells,and the mechanism mainly involves the p53 signaling pathway.

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.
3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics* ; Child ; China/epidemiology* ; Cryptorchidism/genetics* ; Disorders of Sex Development/genetics* ; Female ; Genital Diseases, Male ; Genotype ; Humans ; Hypospadias/genetics* ; Male ; Membrane Proteins/genetics* ; Penis/abnormalities* ; Phenotype ; Retrospective Studies ; Steroid 21-Hydroxylase/genetics*

Objective:To establish a disease risk prediction model for the newborn screening system of inherited metabolic diseases by artificial intelligence technology.Methods:This was a retrospectively study. Newborn screening data ( n=5 907 547) from February 2010 to May 2019 from 31 hospitals in China and verified data ( n=3 028) from 34 hospitals of the same period were collected to establish the artificial intelligence model for the prediction of inherited metabolic diseases in neonates. The validity of the artificial intelligence disease risk prediction model was verified by 360 814 newborns ' screening data from January 2018 to September 2018 through a single-blind experiment. The effectiveness of the artificial intelligence disease risk prediction model was verified by comparing the detection rate of clinically confirmed cases, the positive rate of initial screening and the positive predictive value between the clinicians and the artificial intelligence prediction model of inherited metabolic diseases. Results:A total of 3 665 697 newborns ' screening data were collected including 3 019 cases ' positive data to establish the 16 artificial intelligence models for 32 inherited metabolic diseases. The single-blind experiment ( n=360 814) showed that 45 clinically diagnosed infants were detected by both artificial intelligence model and clinicians. A total of 2 684 cases were positive in tandem mass spectrometry screening and 1 694 cases were with high risk in artificial intelligence prediction model of inherited metabolic diseases, with the positive rates of tandem 0.74% (2 684/360 814)and 0.46% (1 694/360 814), respectively. Compared to clinicians, the positive rate of newborns was reduced by 36.89% (990/2 684) after the application of the artificial intelligence model, and the positive predictive values of clinicians and artificial intelligence prediction model of inherited metabolic diseases were 1.68% (45/2 684) and 2.66% (45/1 694) respectively. Conclusion:An accurate, fast, and the lower false positive rate auxiliary diagnosis system for neonatal inherited metabolic diseases by artificial intelligence technology has been established, which may have an important clinical value.

BACKGROUND: Human umbilical cord mesenchymal stem cells (hUC-MSCs) have low immunogenicity and it is unclear whether insulin producing cells (IPCs) that differentiate from hUC-MSCs have low immunogenicity. OBJECTIVE:To investigate the immunogenicity of IPCs differentiating from hUC-MSCs in vitro and after IPCs transplantation into the host. METHODS: (1) The hUC-MSCs were induced to differentiate into IPCs according to the modified scheme. Flow cytometry assay was used to detect the immunophenotype and apoptotic rate of IPCs in a cytotoxicity test. (2) Cell counting kit-8 was used to detect the proliferative capacity of human peripheral blood mononuclear cells in the one-way mixed lymphocyte assay. (3) The IPCs were then transplanted into the abdominal cavity and left renal capsule of mice, and then the infiltration of immune cells was detected by flow cytometry and immunohistochemistry. RESULTS AND CONCLUSION: The IPCs highly expressed HLA-ABC and lowly expressed HLA-DR, CD40 and CD80. The apoptosis rate of IPCs increased with the increase of pre-sensitized splenocytes in the cytotoxicity test. In the one-way mixed lymphocyte assay, IPCs inhibited the proliferation of human peripheral blood mononuclear cells when the target ratio was 10:1 and 50:1. After IPCs transplantation, the number of lymphocytes was increased in the transplanted site. In summary, our results show that IPCs that differentiate from hUC-MSCs maintain low immunogenicity in vitro,but have some immunogenicity after transplantation into the host due to microenvironment changes.

Background:The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma;therefore,the use of morcellation is limited in the USA.A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy.Methods:A national multicenter study was performed in China.From 2002 to 2014,33,723 cases were retrospectively selected.We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application.A total of 62 cases were finally pathologically confirmed as malignant postoperatively.Additionally,the medical records of the 62 patients were analyzed in details.Results:The proportion of postoperative malignancy after morcellation application was 0.18％ (62/33,723) for patients who underwent laparoscopic myomectomy.Nearly 62.9％ (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery.And,23 (37.1％) patients showed rapid growth at the final preoperative ultrasound.With respect to the pathological types,38 (61.3％) patients had detectable endometrial stromal sarcoma,13 (21.0％) had detectable uterine leiomyosarcoma,only 3 (3.2％) had detectable carcinosarcoma,and 5 (8.1％) patients with leiomyoma had an undetermined malignant potential.Conclusions:The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy.Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential,and morcellation should be avoided.

Objective:To provide a simple and replicable method of building an atherosclerotic intracranial arterial stenosis model of rabbits .Methods:Twenty‐five New Zealand white rabbits were randomly divided into three groups .Five rabbits in control group were fed with normal diet and received sham arteriotomy of femoral artery .Ten rabbits in pure high‐fat diet group were fed with high‐fat diet and received sham arteriotomy of femoral artery .Ten rabbits in balloon‐injury group were fed with high‐fat diet and underwent endovascular balloon‐injury operation of intracranial vertebral artery through femoral artery .All the operations were performed after two weeks of adaptive feed .Each group was fed with previous diet after operation .Digital subtraction angiography (DSA) of target vertebral artery was performed two and four weeks after operation (four and six weeks after the scheduled diet) .Serum lipid level was test and the histopathologic examinations were performed . Results:No significant difference was found by DSA or pathological detection of blood vessel in target vertebral artery of control group and pure high‐fat diet group .DSA revealed the mild luminal stenosis in three cases and unsmooth inner wall in six cases at the target vertebral arteries in balloon‐injury group two weeks after operation .Also the DSA revealed the mild luminal stenosis in five cases ,moderate luminal stenosis in two cases and unsmooth inner wall in two cases in balloon‐injury group four weeks after operation .Detection of serum lipid level showed that the serum lipid level of white rabbits in pure high‐fat diet group and balloon‐injury group was significantly higher than that in control group (P< 0 .05) .No significant difference of serum lipid level was found between pure high‐fat diet group and balloon‐injury group .Histopathologic examination showed the disorder of endothelial structure in target vertebral arteries ,interruption of endothelial continuity and deposition of foam cell under intima in the high‐fat diet combined balloon‐injury group .Conclusions: The method of high‐fat diet combined with endovascular balloon‐injury is beneficial to successfully build a relatively stable model of rabbits atherosclerotic intracranial arterial stenosis ,and it provides the basis for further studies .

OBJECTIVETo explore the analgesia of oxymatrine (OMT) affecting high voltage-dependent calcium channels (HVDCCs) and GABA release under neuropathic pain condition.

METHODSTotally 66 C57BL/6 mice were randomly divided into the sham-operation group, the model group, and the OMT group, 22 in each group. Neuropathic pain models were established by partial sciatic nerve ligation (PSNL). Hind paw plantar mechanical response threshold (MWT) was measured by up-and-down method with Von-Frey filament. mRNA expression of HVDCCs in brains and spinal cords was detected with Real-time PCR and concentration of GABA was determined using ELISA kit.

RESULTSCompared with day 0, the left hind paw MWTwas decreased on day 7, 10, and 14 in the model group (P < 0.05). Compared with the sham-operation group, the left hind paw MWT was significantly reduced in the model group on day 7 (P < 0.05). The MWT of PSNL ipsilateral hind paw was decreased on day 7 before OMT administration, when compared with day 0 (P < 0.05), and increased after OMT administration (P < 0.05). Compared with the sham-operation group, mRNA levels of Cav1.2, Cav1.3, Cav2.1, and Cav2.3 in brain tissues were increased and those of Cav2.2 were decreased significantly in the model group (P < 0.05). In spinal cord tissues, mRNA levels of Cav1.2 and Cav1.3 were increased, but those of Cav2.1, Cav2.2, and Cav2. 3 were decreased significantly in the model group, when compared with those of the sham-operation group (P < 0.05). Compared with the model group, mRNA levels of Cavl.2, Cavl.3, Cav2.1, and Cav2. 3 in brain tissues were decreased, and those of Cav2.2 were increased significantly in the OMT group (P < 0.05). In spinal cord tissues of the OMT group, mRNA levels of Cav1.3 decreased and those of Cav2.1, Cav2.2, and Cav2.3 increased significantly with statistical difference, when compared with those of the model group (P < 0.05). Compared with the sham-operation group, GABA levels in brain tissues decreased in the model group (P < 0.05). Compared with the model group, GABA levels in brain tissues increased in the OMT group (P < 0.05). There was no statistical difference in GABA levels of spinal cord tissues among these groups (P > 0.05).

CONCLUSIONSOMT had analgesic effect on neuropathic pain, which might be probably related to HVDDCs. Cav2.2 might directly affect GABA release.

Alkaloids ; pharmacology ; therapeutic use ; Analgesia ; methods ; Animals ; Calcium ; Calcium Channels ; drug effects ; metabolism ; Disease Models, Animal ; Mice ; Mice, Inbred C57BL ; Neuralgia ; drug therapy ; Pain Management ; Quinolizines ; pharmacology ; therapeutic use ; Spinal Cord ; metabolism ; gamma-Aminobutyric Acid