Objective To evaluate the efficacy and safety of intra?articular injections of tranexamic acid (TXA) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty (TKA). Methods Primary TKA was per?formed on a total of 380 patients (380 knees) affected to various degrees by knee osteoarthritis. All the patients are divided into three groups according to different joint injection for 5 min at the end of surgery in which:120 patients received 1.5 g TXA injec?tion,136 patients received 0.5 g TXA injection, 124 patients no pharmacological intervention (control group). Blood loss, hidden blood loss, blood transfusion, drainage volume and limb circumference change after TKA were assessed. Results All the surger?ies were well performed. No complication including infection, necrosis, and fat liquefaction has been observed. The results indicat?ed no significant difference with pairwise comparisons in intra?operative time, intra?operative blood loss, hospitalization time, anes?thesia, and drainage volume and limb circumference change. The mean postoperative hidden blood loss (1.5 g TXA group 693.29± 377.91 ml, 0.5 g TXA group 835.41±481.97 ml, the control group 1 032.75±322.19 ml) and transfusion (1.5 g TXA group 7.5%, 0.5 g TXA group 13.2%, the control group 20.2%) requests were significantly different with pairwise comparisons among the three groups. Compared with the control group, both 1.5 g TXA group and 0.5 g TXA group showed better effects (P<0.05). Compared with the 0.5 g TXA group, 1.5 g TXA group showed better effects (P<0.05). Conclusion It can be concluded that intra?articular injection of TXA in patients undergoing unilateral TKA could significantly reduce postoperative hidden blood loss and blood trans?fusion, and did not increase the risk of phlebothrombosis. This efficacy demonstrated a concentration dependent effect. Compared with 0.5 g TXA, 1.5 g TXA performed a better efficacy.

Objective To study the sugical treatment of elderly patients with acute intestinal ob-struction caused by colorectal cancer. Methods The clinical data of 56 elderly patients of acute colonic ob-struction caused by colorectal cancer from Janury 2002 to Janury 2007 were analyzed retrospectively. There were 20 cases with right side coloniclesion,32 cases with left side coloniclesion and 4 cases with rectal lesion. All patients received emergency operation. One stage tumor resection and anastomosis was performed in 20 cases with right side coloniclesion and in 25 cases with left side coloniclesion,Hartmann operation in 4 cases,proximal colostomy in 3 cases were performed with left side coloniclesion. Dixon operation in 2 cases and proximal colostomy in 3 cases were performed with rectum cancer. Results Postoperative complications occurred in 18 cases,including wound infection,intraperitoneal sepsis and intestinal fistula. Fifty-five cases recovered,there was one perioperative death. Conclusions Positive operation should be taken when the diagnosis of acute obstructing colorectal cancer the elderly is made. The operative methods depended on the patient'conditions. The perioperative managment should be emphasized and selection of rational operation procedure is important for decreasing mortality and complications of acute obstructing colorectal cancer in the elderly.

Objective To investigate the effects of microRNA-294 (miR-294) on tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and high mobility group box 1 (HMGB 1) secretion in sepsis by targeting triggering receptor expressed on myeloid cell-1 (TREM-1).Methods miRNA-294 was predicted to regulate TREM-1 specially through bioinformatics analysis.Mice macrophage cell lines RAW264.7 were cultured in vitro,the cells were divided into non-inflammatory stage and inflammatory stage,and the cells in the two stages were subdivided into five groups as follows:normal control (NC),NC mimic transfection (NCm),NC inhibitor transfection (NCi),miR-294 mimic transfection (miR-294m) and miR-294 inhibitor transfection (miR-294i) groups.The ability of miR-294 was confirmed with dual-luciferase activity assay.At non-inflammatory stage,the cells were transfected with mimic or inhibitor of miR-294 or NC using TurboFectTM siRNA Transfection Reagent for 48 hours,mRNA expression of TREM-1 was detected by real-time reverse transcription-polymerase chain reaction (RT-PCR).At inflammatory stage,6 hours after stimulation by lipopolysaccharide (LPS,1 mg/L),the concentrations of TNF-α,IL-6 and HMGB1 were determined by enzyme linked immunosorbent assay (ELISA),the protein expression of TREM-1 was determined by Western Blot.Results ① Dual-luciferase activity assay demonstrated that TREM-1 was the target of miR-294.② In non-inflammatory stage,the expression of TREM-1 mRNA (2-ΔΔ~) in miR-294m group was significantly lower than that of the NC and NCm groups (0.673 ± 0.049 vs.1.000 ± 0.003,0.915 ± 0.039,t1=2.184,t2=5.421,both P＜0.001),the expression of TREM-1 protein (gray scale) was (50.00 ± 1.19)％ of NCm group (t=41.586,P＜0.001).③ In inflammatory stage,the concentrations of TNF-α (ng/L) in miR-294m group was significantly lower than that of the NC group (1 547.18 ±47.18 vs.2 702.11 ± 327.20,t=4.212,P=0.010),the concentrations of IL-6 (ng/L) was significantly lower than that of the NC and NCm groups (505.28 ± 33.33 vs.837.66 ± 69.43,918.72 ± 119.39,t1 =4.382,P1=0.015; t2=5.451,P2=0.021),the level of TREM-1 protein (gray scale) was (51.33 ±0.88)％ of NCm group (t=63.368,P＜0.001).Conclusion miR-294 reduce TNF-α and IL-6 secretion in LPS-induced RAW264.7 through inhibiting the expression of TREM-1 specifically.

BACKGROUND: Angiotensin Ⅱ (Ang-Ⅱ) can stimulate vascular endothelial cells to excrete endothelin, a kind of potent vasoconstrictor. The content of endothelin in blood or cell culture media directly reflects the function and injured status of vascular endothelial cells. Therefore, it is significant for strengthening vascular endothelial cells to resist the injured factors. Tea polyphenols is a mainly active component of tea, and it is considered as a reagent for anti-atherosclerosis, protecting injuries of vascular endothelial cells and preventing cardiovascular diseases. OBJECTIVE: To observe the effects of tea polyphenols in different concentrations on endothelin content in vascular endothelial cells induced by Ang-Ⅱ at various time points through establishing Ang-Ⅱ-induced vascular endothelial cell injury models and further to investigate the protective effect of tea polyphenols on vascular endothelial cells. DESIGN: Observational study.SETTING: Aerospace and Diving Medical Center, Navy General Hospital of Chinese PLA.MATERIALS: The experiment was carried out in Laboratory of Aerospace and Diving Medical Center, Navy General Hospital of Chinese PLA from March to September 2005. Main materials were detailed as follows: Ang-Ⅱ (Sigma Company), tea polyphenols (Department of Tea Science, Zhejiang University) and vascular endothelial cells (human large artery vascular endothelial cell system, CBI Company, USA).METHODS: Cultured vascular endothelial cells were divided into 4 groups: ① Control group: The normal culture media was added in the isopyknic vascular endothelial cells, and 100 μL supernatant was extracted before and at 0.5, 6 and 24 hours after filling moisturized liquid. ② Ang-Ⅱ group: Cell culture media containing 10-7 mol/L Ang-Ⅱ was added in the vascular endothelial cells, and other operations were as the same as those in the control group. ③ High-concentration tea polyphenols + Ang-Ⅱ group: Cell culture media containing 50 mg/L tea polyphenols was added in the vascular endothelial cells, and other operations were as the same as those in the Ang-Ⅱ group. ④ Low-concentration tea polyphenols + Ang-Ⅱ group: Cell culture media containing 25 mg/L tea polyphenols. 100 μL supernatant was extracted before and after 0.5, 6 and 24 hours treatment in each group. Thereafter, radioimmunoassay was used to measure the content of endothelin. MAIN OUTCOME MEASURES: Content of endothelin.RESULTS: ① Content of endothelin in Ang-Ⅱ group was higher than that in the control group (P ＜ 0.01). ② At 6 and 24 hours after high-concentration tea polyphenols incubation, content of endothelin in high-concentration tea polyphenols + Ang-Ⅱ group was lower than that in Ang-Ⅱ group (P ＜ 0.01). Moreover, the content of endothelin in low-concentration tea polyphenols + Ang-Ⅱ group was lower than that in both high-concentration tea polyphenols + Ang-Ⅱ group and angiotensin Ⅱ group (P ＜ 0.01). CONCLUSION: Tea polyphenols has inhibitory effects on endothelin releasing function of vascular endothelial cells induced by Ang-Ⅱ, suggesting that tea polyphenols has protective effect on vascular endothelial cells, and the effect of low-concentration tea polyphenols is superior to that of the high-concentration one.

Objective To investigate the correlation between cornexin37 (Cx37) CI019T polymorphism and ischemic stroke and its outcome.Methods Restriction fragment length polymorphism analysis was used to detect the distribution of Cx37 C1019T polymorphism in a ischemic stroke group and a control group.The modified Rankin scale (mRS) was used to evaluate the neurological outcome at 3 months after onset.Results A total of 235 patients in the control group,and 232 patients in the ischemic stroke goup were recruited.In the ischemic stroke group,210 had a good outcome (mRS ＜3) and 22 had a poor outcome (mRS≥ 3).The TT genotype (12.93％ vs.6.39％ ; x2 =10.087,P =0.006) and T allele (31.25％ vs.21.49％ ; x2 =11.466,P=0.001) frequency in the ischemic stroke group were significantly higher than those in the control group.Multivariatelogistic regression analysis showed that TT genotype (odds ratio [OR] 5.794; 95％ confidence interval [CI] 1.405-23.894; P =0.015) and T allele (OR 131.016,95％ CI 6.943 -2 472.477; P =0.001)signifkantly increased the risk of ischemic stroke.Univariate analysis showed that TT genotype (OR 0.650,95％ CI 0.144 - 2,934; P =0.575),CT genotype (OR 0.622,95％ CI 0.234 - 1.655; P =0.342),and CC genotype (OR 0.654,95％ CI 0.268 - 1.595; P =0.350) had no significant correlation with the outcome of ischemic stroke.Conclusions Cx37 1019TT genotype and T allele may increase the risk of ischemic stroke.T allele is one of genetic susceptibility factors for ischemic stroke; however,its gene polymorphism is not associated with the outcome of ischemic stroke at 3 months after onset.

Objective To establish a direct reverse transcription real-time fluorescence quantitative polymerase chain reaction ( RT-qPCR-D ) method for detecting serum circulating B cell-specific moloney murine leukemia virus integration site-1 (Bmi-1) mRNA, and analyze the levels of serum circulating Bmi-1 mRNA in colorectal cancer patients by using of this method for exploring its diagnosis value in colorectal cancer.Methods Methodology establishment.RNA was extracted from colorectal cancer HT 29 cell line, and detection standard curves of Bmi-1, ubiquitin C ( UBC), glyceraldehyde-3-phosphate dehydrogenase ( GAPDH) mRNAs were established , then the amplification efficiencies were calculated.Bmi-1 mRNA level was directly detected in serum and preparation buffer mixture , then the specificity of assay was evaluated by melting curve, and detection limit was observed through diluted serum samples.The serum circulating Bmi-1 mRNA levels were detected by ELISA in 158 cases with colorectal cancer , of which there were 26 cases of tumor node metastasis ( TNM)Ⅰstage, 53 cases of TNMⅡ, 47 cases of TNMⅢ, 32 cases of TNMⅣand 53 cases of controls with normal colonoscopy collected from January 2008 to January 2009 in Qilu Hospital of Shandong University.Comparisons of groups were determined by applying Mann-Whitney U test or Kruskal-Wallis test, and receiver operating characteristic ( ROC) curves were established to illustrate the diagnostic performance.Results The log values of Bmi-1, UBC and GAPDH showed good linear correlations with quantification cycle (Cq) values(R2 =0.990, 0.990, 0.991, all P <0.001), and the amplification efficiencies were 0.875, 0.917 and 0.935, respectively.Using the established RT-qPCR-D method, the peak of melting curve of Bmi-1, UBC and GAPDH mRNAs were single, the detection limit was up to 1.25μl.The levels of serum circulating Bmi-1 mRNA detected by RT-qPCR-D were 0.138 ( 0.078-0.228 ) in colorectal cancer stage Ⅰ patients, 0.163(0.067 -0.287) instage Ⅱ patients, 0.217(0.072-0.267) instage Ⅲpatients, 0.273(0.139 -0.419) in stage Ⅳ patients and 0.021(0.008 -0.029) in health controls, a significant difference was found among groups ( H =89.5, P <0.001 ).The levels of serum circulating Bmi-1 mRNA in each stage colorectal cancer were all significantly higher than that in control group(U=58.0, 287, 246, 72.5,all P<0.001).The levels in Ⅳstage patients were significantly higher than those in other stages patients (U=247, 590, 540,P=0.008, 0.020, 0.035), while no significant differences among Ⅰstage,Ⅱstage and Ⅲstage patients(U=633, 514, 1170,all P>0.05).ROC curve analysis showed area under the ROC curve ( AUC) for serum circulating Bmi-1 mRNA was 0.921(95%CI=0.876-0.953), which was significantly superior to the AUC of CEA (0.745, 95%CI=0.680-0.802, Z=4.697, P<0.001 ).When cutoff value was 0.034, the diagnostic sensitivity and specificity was 89.2%(141/158) and 90.6%(48/53), while 41.8%(66/158) and 73.6%(39/53) using CEA.The AUC for combination of circulating Bmi-1 mRNA and CEA was 0.933(95%CI=0.890-0.963 ) , which was no statistical significance when compared with the AUC of circulating Bmi-1 mRNA(Z=4.697, P>0.05).Conclusions The study establishes a higher sensitive, specific for detecting serum circulating Bmi-1 mRNA. Based on this method , serum circulating Bmi-1 mRNA is found to be increased in colorectal cancer , and is superior to traditional tumor marker CEA in diagnosis of colorectal cancer, which may become a potential detection index for early detection of colorectal cancer.

This study was aimed to prepare the spraying agent of prescriptions of Miao nationality herb and investigate the effect of Miao nationality herbs spray for serum SOD, MDA, and expression of Fas and Caspase-3 mRNA in lung tissues of silica-treated rats. The healthy SD rats were divided into 5 groups. Silica dust suspension was used in the model establishment of 4 groups. After the model was successfully established, 3 groups were randomly selected and given glucocorticoids atomization inhalation, Miao nationality herbs spray, Miao nationality herbs spray combined with intragastric administration of herbal medicine, respectively. After 40-day treatment, water-solubletetrazolium salt (WST-1) was used in the detection of serum superoxide dismutase (SOD). Thiobarbituric acid (TBA) was used in the detection of malondialdehyde (MDA). The mRNA expression variance of the Fas and Caspase-3 were detected by RT-PCR. The results showed that compared with the silica dust suspension group, the SOD activity of serum in the Miao nationality herbs spray group was significantly increased (P< 0.05). MDA content and the mRNA of Fas and Caspase-3 were significantly lower in the Miao nationality herbs spray group (P< 0.05). It was concluded that Miao nationality herbs spray group was able to increase the SOD activity of serum, decrease MDA content, and obviously decrease the expression of Fas and Caspase-3 of lung tissues among silica dust suspension rats.

Objective:To analyze the alternative splicing (AS) events of patients with thyroid carcinoma (THYC) and explore the correlation between AS events and the prognosis of THYC.Methods:The clinical data and the Percent Splice In (PSI) value of AS events of THYC were downloaded from The Cancer Gene Atlas (TCGA) database and the TCGA SpliceSeq database respectively. The occurrence of seven kinds of AS events including AA, AD, AF, AP, ME, ES and RI in THYC was investigated and the matrix of AS events and survival data was constructed. Univariate Cox regression analysis was used to screen AS events related to prognosis of THYC. To avoid over-fitting, the least absolute shrinkage and selection operator (LASSO) regression analysis was performed. Then Multivariate Cox regression analysis was used to construct prognosis model. Kaplan-Meier curve and receiver operating characteristic (ROC) curve were performed to evaluate the prognosis ability of the risk model. We also used Pearson correlation analysis to select splicing factors (SF) which were correlated with survival associated AS events. Above SF genes were enrolled to gene ontology (GO) enrichment and KEGG pathway analysis.Results:A total of 10 447 genes and 45 150 AS events in 507 THYC patients were found in the present study. Among them, ES was the main type (38.84%) and ME was the type with the least frequency (0.51%). Totally 1 842 AS events associated with prognosis of THYC patients were identified. Three AS events including USHBP1-48249-AA、CACNB1-40626-AT and BEX5-89679-AP were selected to construct the prognosis model. The risk score of 0.807 was indicated as the best cut-off value of prognosis model. The patients were divided into high-risk group (240 cases) and low-risk group (241 cases) based on the risk score. The results demonstrated that the risk model could be used as a valuable prognostic factor for THYC ( P<0.001, AUC=0.929). The SF-AS network was constructed and several SF genes, including CDK12, RBM25, DDX39B, SRRM2 and DDX46 were identified as hub genes. Conclusions:The risk model based on 3-AS events was valuable prognosis predictor of THYC. The SF-AS network provided new insight for the exploration of tumorigenesis and development of THYC.

OBJECTIVETo apply low-dose multi spiral computed tomography (MSCT) chest scans in the early diagnosis and differential diagnosis of pneumoconiosis.

METHODSOne hundred and twenty dust-exposed volunteers were examined by MSCT chest scans at conventional dose and low dose, and the results of conventional-dose scans were set as the gold standard. Comparative analysis was performed on the major CT findings and quality of post-processing images, including 1.5 mm and 5.0∼10.0 mm thick high -resolution reconstructed images, multiplanar reformat images, and maximum intensity projection images.

RESULTSOne hundred and twenty cases of small circular shadows, 36 cases of ribbon shadows in pulmonary parenchyma, 1 case of honeycombing shadow, and 13 cases of big shadows were all showed on low -dose MSCT. But 94 (95.9%) of 98 cases of interlobular septal thickening shadows and 98 (93.3%) of 105 cases of short branched shadows were detected on low-dose MSCT. There were no significant differences in display of the mentioned large and small shadows between low-dose scans and conventional-dose scans (P > 0.05). Eighty-five cases of small airway disease, 8 cases of pulmonary inflammatory lesions, and 47 cases of hilar and mediastinal lymph node swelling were all detected by MSCT. As for the 46 cases of emphysema, 38 (82.6%) were shown. The low-dose MSCT images of 1.5 mm thickness had more artifacts than those of other thickness. The radiation dose of low-dose MSCT was about 1/3-1/5 of that in the conventional-dose MSCT.

CONCLUSIONThere is no difference in display of pneumoconiosis between low-dose and conventional-dose MSCT chest scans. With lower radiation dose, low-dose MSCT can be applied in the diagnosis of pneumoconiosis.

Adult ; Aged ; Dust ; Female ; Humans ; Lung ; diagnostic imaging ; Male ; Middle Aged ; Occupational Exposure ; Pneumoconiosis ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.