Castleman Disease ; Heart Neoplasms ; Humans ; Myxoma ; Retroperitoneal Space

OBJECTIVETo appraise the significance of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and intrathoracic blood volume index (ITBVI) in the differential diagnosis of the type of burn-induced pulmonary edema.

METHODSThe clinical data of 38 patients, with severe burn hospitalized in our burn ICU from December 2011 to September 2014 suffering from the complication of pulmonary edema within one week post burn and treated with mechanical ventilation accompanied by pulse contour cardiac output monitoring, were retrospectively analyzed. The patients were divided into lung injury group ( L, n = 17) and hydrostatic group (H, n = 21) according to the diagnosis of pulmonary edema. EVLWI, PVPI, ITBVI, oxygenation index, and lung injury score ( LIS) were compared between two groups, and the correlations among the former four indexes and the correlations between each of the former three indexes and types of pulmonary edema were analyzed. Data were processed with t test, chi-square test, Mann-Whitney U test, Pearson correlation test, and accuracy test [receiver operating characteristic (ROC) curve].

RESULTSThere was no statistically significant difference in EVLWI between group L and group H, respectively (12.9 ± 3.1) and (12.1 ± 2.1) mL/kg, U = 159.5, P > 0.05. The PVPI and LIS of patients in group L were respectively 2.6 ± 0.5 and (2.1 ± 0.6) points, and they were significantly higher than those in group H [1.4 ± 0.3 and (1.0 ± 0.6) points, with U values respectively 4.5 and 36.5, P values below 0.01]. The ITBVI and oxygenation index of patients in group L were respectively (911 197) mL/m2 and (136 ± 69) mmHg (1 mmHg = 0.133 kPa), which were significantly lower than those in group H [(1,305 ± 168) mL/m2 and (212 ± 60) mmHg, with U values respectively 21.5 and 70.5, P values below 0.01]. In group L, there was obviously positive correlation between EVLWI and PVPI, or EVLWI and ITBVI (with r values respectively 0.553 and 0.807, P < 0.05 or P < 0.01), and there was obviously negative correlation between oxygenation index and EVLWI, or oxygenation index and PVPI (with r values respectively -0.674 and -0.817, P values below 0.01). In group H, there was obviously positive correlation between EVLWI and ITBVI (r = 0.751, P < 0.01) but no obvious correlation between EVLWI and PVPI, oxygenation index and EVLWI, or oxygenation index and PVPI (with r values respectively -0.275, 0.197, and 0:062, P values above 0.05). The total area under ROC curve of PVPI value for differentiating the type of pulmonary edema was 0.987 [with 95% confidence interval (CI) 0.962-1.013, P < 0.01], and 1.9 was the cutoff value with sensitivity of 94.1% and specificity of 95.2% . The total area under ROC curve of ITBVI value for differentiating the type of pulmonary edema was 0.940 (with 95% CI 0.860-1.020, P < 0.01), and 1,077. 5 mL/m2 was the cutoff value with sensitivity of 95.2% and specificity of 88.2%.

CONCLUSIONSEVLWI, PVPI, and ITBVI have an important significance in the differential diagnosis of the type of burn-induced pulmonary edema, and they may be helpful in the early diagnosis and management of burn-induced pulmonary edema.

Blood Gas Analysis ; Blood Volume ; Burns ; complications ; Capillary Permeability ; Diagnosis, Differential ; Extravascular Lung Water ; Humans ; Lung ; blood supply ; Lung Injury ; physiopathology ; therapy ; Monitoring, Physiologic ; Pulmonary Edema ; diagnosis ; etiology ; ROC Curve ; Respiration, Artificial ; Retrospective Studies

Objective: To determine the change of gene expressions in human perirenal adipose tissue (PAT) and oblique abdomen subcutaneous adipose tissue (SAT) of overweight and obese subjects. Methods: Ninety-seven patients, including 35 overweight/obese patients and 62 non-obese patients, who underwent renal surgery were included. The clinical data and various gene expressions in PAT and SAT of two groups were analyzed. Results: Body mass index, waist circumference, systolic blood pressure, resting heart rate, fasting blood glucose, and serum creatinine were significantly higher in overweight/obese patients than those in non-obese patients(P<0.05 or P<0.01). Compared with non-obese patients, PAT adipocytes showed bigger, and the expressions of uncoupling protein-1 (UCP1) mRNA and protein were markedly lower in overweight/obese patients. The mRNA expressions of CIDEA and adiponectin in PAT of overweight/obese patients were significantly lower, while leptin, monocyte chemotactic protein 1, interleukin (IL)-6, and IL-10 mRNA expressions were significantly higher. There were no significant differences in the related gene expressions of SAT between the two groups. Conclusions Different parts of adipose tissue reveal various characteristics, and play different roles in the occurrence and development of obesity. UCP1 expression is decreased in PAT of overweight/obese patients, with the changes of adipocytokine expressions. (Chin J Endocrinol Metab, 2018, 34: 567-572)

To clone Uroplakin Ⅱ gene from Chinese transitional cell carcinoma (TCC) of bladder and construct its eukaryotic expression vector, the molecular cloning method was used to extract total RNA from a GⅢ/ T3N0M0 tissue sample of the bladder TCC patients. The primers were designed by Primer 5.0 software. Full length cDNA of Uroplakin Ⅱ gene was amplified by reverse transcription polymerase chain reaction (RT-PCR), assayed by nucleic acid sequencing and then inserted between Xba Ⅰ and HindⅢ restrictive sites of eukaryotic expression vector pcDNA3.0. The recombinant was assayed by restricted enzyme digestion. Under the induction of Lipofectamine 2000, the recombinant was transfected into Uroplakin Ⅱ negative bladder cancer cell line EJ. Cellular expression levels of Uroplakin Ⅱ were detected by RT-PCR. The nucleic acid sequencing results indicated that Chinese Uroplakin Ⅱ cDNA (555 bp) was successfully cloned. The BLAST analysis demonstrated that the cloned sequence is 100 % homologous with sequences reported overseas. The GenBank accession number AY455312 was also registered. The results of restricted enzyme digestion indicated that eukaryotic vector pcDNA-UP Ⅱ for Uroplakin Ⅱ was successfully constructed.After being transferred with pcDNA-UPⅡ for 72 h, cellular Uroplakin Ⅱ mRNA levels were significantly improved (P＜0.01). It is concluded that human Uroplakin Ⅱ gene was successfully cloned from Chinese TCC tissues, which provided a basis for further exploration of the roles of Uroplakin Ⅱ gene in TCC biological behaviors and potential strategies for targeted biological therapy of TCC.

Forty trainees who underwent position-transition training for general practitioner in the Affiliated Huai′an First People′s Hospital of Nanjing Medical University from August 2021 to July 2022 were randomly divided into the control group and the trial group with 20 in each group. The traditional teaching methods were applied in control group and the problem-based learning/case-based learning (PBL/CBL) combined scenario simulation teaching method were applied in trial group. The effect of the two teaching methods was evaluated by the examination results and the teaching satisfaction was assessed by the questionnaire survey. The exam scores of general practice thinking, comprehensiveness of inquiry content, integrity of preliminary diagnosis, comprehensiveness of preliminary treatment, ability to deal with critical and severe cases, ability of chronic disease management and concept of holistic care in trial group were significantly higher than those in control group( t=-15.79,-15.74,-16.67,-13.66,-18.57,-18.55,-19.74,all P<0.05). The satisfaction of trainees in the trial group was also significantly higher than that in the control group in terms of teaching methods, stimulating learning interest; and improvement of independent learning ability, general practice clinical thinking, doctor-patient communication ability, teamwork ability and community problem-solving ability( χ2=12.10,10.03,12.22,10.03,8.18,10.03,8.18,all P<0.05). The study shows that PBL/CBL combined scenario simulation teaching method can improve the learning effect and satisfaction of the trainees in position-transition training for general practitioner.

Objective:To evaluate the effect of uncoupling protein 1 (UCP1) expression of perirenal fat on the prognosis of clear cell renal cell carcinoma (ccRCC) .Methods:From Feb. 2013 to Oct. 2013 and Mar. 2015 to Oct. 2015, 98 patients with ccRCC who underwent retroperitoneal laparoscopic radical nephrectomy were analyzed. UCP1 mRNA of perirenal fat around tumor was detected by RT-qPCR. Preoperative Computed tomography (CT) images were used to evaluate the thickness and adhesiveness of perirenal fat. According to the UCP1 mRNA value, the patients were divided into high UCP1 group (42 cases) and low UCP1 group (56 cases) . The general clinical data, perirenal fat thickness and adhesiveness were compared, and Kaplan Meier curve was used to evaluate the difference of progression free survival (PFS) between the two groups. Univariate and multivariate Cox analysis were used to determine the potential independent prognostic factors of PFS.Results:In the high UCP1 group, the renal fat thickness, the ratio of fat adhesion, the ratio of Ⅲ to Ⅳ in Fuhrman grade and the ratio of >T2 in T stage were higher than those in the low UCP1 group[ (13.84±2.41) vs (10.75±1.99) , 42.86% vs 16.07%, 28.57% vs 8.93%, 21.43% vs. 5.36%; P=0.000, P=0.003, P=0.011, P= 0.037]. During the follow-up period (median, 62.0 months) , 15 cases (12 cases of high UCP1 group, 3 case of low UCP1 group) developed tumor progression. Kaplan Meier curve showed that PFS of high UCP1 group was worse than that of low UCP1 group (71.43% vs 94.64%, P=0.001) . Cox regression analysis showed that high UCP1 expression and high T stage were significantly correlated with low PFS ( β=1.334, RR=3.796, 95% CI=1.009-14.280, P= 0.048; β=2.886, RR=17.930, 95% CI=5.538-58.047, P=0.000) . Conclusions:The increased UCP1 expression of perirenal fat may be an independent risk factor of tumor progression in ccRCC. Combined with the assessment of browning of perirenal adipose tissue may be helpful for risk stratification of ccRCC patients after surgery.

【Objective】 To evaluate the significance of Mayo adhesive probability (MAP) in predicting surgical difficulty and postoperative recovery in patients with renal cell carcinoma (RCC) undergoing laparoscopic radical nephrectomy (LRN). 【Methods】 The clinical data of 168 RCC patients who received transabdominal LRN during Jan.2017 and Dec.2020 were retrospectively analyzed. According to MAP, the patients were divided into low MAP group (n=100) and high MAP group (n=68). The differences in perioperative clinical data were compared between the two groups. 【Results】 Compared with low MAP group, the high MAP group had longer operation time (P<0.001), more intraoperative blood loss (P<0.001), higher Clavien-Dindo grade complications (P=0.008), longer hospital stay (P=0.003), higher levels of c-reactive protein (P=0.030) and IL-6 (P=0.009), lower levels of albumin (P<0.001) and prealbumin (P=0.020). 【Conclusion】 MAP can assess the risk of prolonged operation time, increased bleeding during transabdominal LRN, and postoperative recovery, thus guiding the preoperative planning.

Objective: To summarize the experience of surgical treatment of 18 cases of severe aortic stenosis with ventricular septum hypertrophy. Methods: Clinical data of 18 patients with severe aortic stenosis admitted to the first affiliated hospital of zhengzhou university from January 2013 to December 2016 were collected. There were 7 males and 11 females. The mean age was (50.4±4.2) years old. All patients were diagnosed with severe stenosis of main artery valve by echocardiography before surgery, with mean aortic valve orifice area (0.57±0.11) cm^2, cardiac function (NYHA classification) grade Ⅱ in 4 patients, grade Ⅲ in 9 patients, and grade Ⅳ in 5 patients. There were 8 patients with mild aortic valve insufficiency, 4 patients with mild to moderate mitral valve insufficiency, 2 patients with moderate to severe aortic valve insufficiency, 3 patients with ascending aorta dilatation (ascending aorta inner diameter>4.5 cm), and 1 patient with atrial fibrillation. Interventricular septum thickness (15.82±2.04)mm, left ventricular posterior wall thickness (14.04±1.28)mm, ratio of interventricular septum thickness to left ventricular posterior wall thickness (IVS/LVPW) 1.12±0.91, inner diameter of left ventricular outflow tract (19.01±1.74)mm, cross-lobe differential pressure (102±8.40) mmHg (1 mmHg=0.133 kPa), left ventricular ejection fraction (LVEF) mean 0.49±0.05. Left ventricular end-diastolic diameter (LVEDD) (53.33±4.00) mm, left ventricular end-systolic diameter (LVESD) (27.11±1.99) mm, and left ventricular mass index (277.1±37.3) g/m². All patients underwent aortic valve replacement (AVR) and partial interventricular septum resection under general anesthesia and conventional extracorporeal circulation, 2 patients underwent mitral valve formation (artificial valve ring), 2 patients underwent ascending aorta formation, and 1 patient underwent ascending aorta wrapping. During the operation, the time of extracorporeal circulation, aortic occlusion, number of defibrillation during the operation, type of valve implantation and postoperative complications were recorded. Regular follow-up was conducted to analyze the changes of various indexes at different preoperative and postoperative time. Results: There was no death in the whole group. 2 patients were treated with temporary pacemakers. After drug treatment, sinus rhythm was restored on the 3rd and 6th day after surgery, and temporary pacemakers were removed. Echocardiography reexamination 1 week after the operation showed that all patients had a good artificial valve function and 2 patients had minor regurgitation of mitral valve. The difference in pressure across the valve, inner diameter of the left ventricular outflow tract, cardiac function classification, ventricular septum thickness, valve orifice area, and left ventricular mass index were significantly improved compared with the preoperative level (P<0.05). LVEF, LVEDD, and LVESD were compared with the preoperative level (P<0.05). After 6 months of follow-up, the difference in LVEF and LVEDD was statistically significant compared with the preoperative level (P<0.05). Conclusion Severe aortic stenosis combined with ventricular septum hypertrophy and partial ventricular septal muscle resection is a simple additional procedure in the AVR process, which does not increase the surgical risk and has a significant effect, and is conducive to postoperative left ventricular function recovery.

Objective To investigate and analyze the current situation of nuclear technology utilization and radiation workers' occupational health management in non-medical institutions in Huai'an City, and to strengthen the prevention and control of occupational radiation diseases. Methods 37 non-medical institutions of nuclear technology utilization in Huai'an City were surveyed by questionnaire, including radioisotope and radiation apparatus, personal dose monitoring of radiation workers, implementation of occupational health examination, protective equipment, etc. Results The industry covers manufacturing industry, transportation, warehousing and postal industry, scientific research and technical service industry, residential service, repair and other service industries, 0 class I radiation device, 15 class II radiation devices, 67 class III radiation devices; 0 class I and II radiation sources, 1 class III radiation device, 16 class IV radiation sources, 51 class V radiation sources, 1 unsealed radioactive material Class B workplace; 493 radiation workers, 90.5% with certificates, 85.4% with personal dose monitoring rate, rate of 37.8% with radiation protection monitoring equipment, and 68.0% with occupational health examination rate. It has 13 institutions equipped with personal protective equipment, 23 with dose alarming devices and 14 with radiation protection monitors. 30 radiation workplace tests have been carried out in the past two years. Conclusion The occupational health management of radiation workers in non-medical institutions is weak. At present, the responsibility of occupational health supervision has been assigned to the health department. Therefore, the health administrative department should strengthen the supervision of non-medical nuclear technology utilization institutions and improve the emergency mechanism of radiation emergencies in Huai'an city.

A method was established for simultaneous determination of 21 active constituents including flavanols, isoflavones, flavonols, dihydroflavones, dihydroflavonols, chalcones, pterocarpan, anthocyanidins and phenolic acids in Spatholobi Caulis by ultra fast liquid chromatography with triple quadrupole linear ion trap mass spectrometry(UFLC-QTRAP-MS/MS). Then, it was employed to analyze and evaluate the dynamic accumulation of multiple bioactive constituents in Spatholobi Caulis. The chromatographic separation was performed on a XBridge®C_(18)(4.6 mm×100 mm, 3.5 μm) at 30 ℃ with a gradient elution of 0.3% formic acid aqueous solution-methanol, and the flow rate was 0.8 mL·min~(-1), using multiple-reaction monitoring(MRM) mode. A comprehensive evaluation of the multiple bioactive constituents was carried out by gray correlation analysis(GRA). The 21 target components showed good linearity(r>0.999 0) in the range of the tested concentrations. The average recovery rates of the 21 components were from 97.46% to 103.6% with relative standard deviations less than 5.0%. There were differences in the contents of 21 components in Spatholobi Caulis at diffe-rent harvest periods. Spatholobi Caulis had high quality from early November to early December, which is consistent with the local tradi-tional harvest period. This study reveals the rule of the dynamic accumulation of 21 components in Spatholobi Caulis and provides basic information for the suitable harvest time. At the same time, it provides a new method reference for the comprehensive evaluation of the internal quality of Spatholobi Caulis.
Chromatography, High Pressure Liquid ; Fabaceae/chemistry* ; Phytochemicals/isolation & purification* ; Plant Stems/chemistry* ; Plants, Medicinal/chemistry* ; Tandem Mass Spectrometry