1.Results of 50 adult patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock
Jingwen LI ; Cun LONG ; Song LOU ; Feilong HEI ; Kun YU ; Shigang WANG ; Shengshou HU ; Jianping XU ; Qian CHANG ; Ping IIU ; Haitao ZHANG ; Hansong SUN ; Wei WANG
Chinese Journal of Thoracic and Cardiovascular Surgery 2011;27(2):102-104,83
Objective Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. Since 2004, our institution has adopted venoarterial ECMO for adult patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing postcardiotomy cardiogenic shock and/or pulmonary dysfunction unresponsive to conventional treatment algorithms. In this study, we reviewed our experience with ECMO support and tried to identify measurable values which might predict in-hospital mortality. Methods From January 2004 through December 2008, 50 of 21,298 adult patients received VA ECMO. We retrospectively analyzed clinical records of these 50 consecutive patients. Demographics, preoperative measurements, clinical characteristics at the time of ECMO implantation, ECMO related complications and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A p value ≤0. 05 was accepted as significant. Results Mean ECMO duration was ( 110 ± 17 ) hours. 38 patients were weaned from ECMO and 33 patients survived upon discharge. The overall survival was 66%. In univariate analyses, duration of ECMO support, receiving cardiopulmonary resuscitation prior to ECMO setup, ECMO setup in ICU, pre-ECMO plasma lactate level, infection, lower limbs ischemia, renal failure, experiencing at least one ECMO related complications were all associated with in-hospital death. In a multiple logistic regression adjusted for other factors mentioned above, blood lactate level before initiation of ECMO was a risk factor associated with in-hospital mortality (OR 1. 27 95% CI 1. 042-1. 542 ). To evaluate the utility of pre-ECMO lactate in predicting mortality, a conventional receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 12.6 mmol/L, with an AUC of 0. 752. The positive and negative predictive values were 73.3% and 83.9% respectively. Conclusion ECMO is a justifiable alternative treatment for postoperative refractory cardiac and pulmonary dysfunction which could rescue more than 60 percent of otherwise fatal patients. Patients with pre-ECMO lactate above 12.6mmol/L are at higher risks for in-hospital death. Evidence based therapy for this group of high risk patients is needed.
2.Experimental model of renovascular hypertension
Xicai CAO ; Nengshu HE ; Enhui WU ; Jingwen BAI ; Haixian YANG ; Jiwu CHANG
Chinese Medical Journal 1998;111(5):450-452
Objective To establish a model of renovascular hypertension.Methods A 4/0 resorbable chromic catgut ligature was used to ligate subtotally the renal arteries of 18 dogs, forming experimental renovascular hypertension steadily. Blood pressure, plasma renin activity, the ultrastructural changes of juxtaglomerular apparatus and renal artery wall were studied after the constriction.Results It was reasonable that renal blood flow measured with an electromagnetic flowmeter was reduced by 30% after the constriction. The pathological changes of the induced renal artery stenosis were similar to those of fibromuscular dysphasia. Conclusion The findings provide valuable evidence for the treatment of renovascular hypertension.
3.Metabolite Changes during the Transition from Hyperthyroidism to Euthyroidism in Patients with Graves’ Disease
Ho Yeop LEE ; Byeong Chang SIM ; Ha Thi NGA ; Ji Sun MOON ; Jingwen TIAN ; Nguyen Thi LINH ; Sang Hyeon JU ; Dong Wook CHOI ; Daiki SETOYAMA ; Hyon-Seung YI
Endocrinology and Metabolism 2022;37(6):891-900
Background:
An excess of thyroid hormones in Graves’ disease (GD) has profound effects on systemic energy metabolism that are currently partially understood. In this study, we aimed to provide a comprehensive understanding of the metabolite changes that occur when patients with GD transition from hyperthyroidism to euthyroidism with methimazole treatment.
Methods:
Eighteen patients (mean age, 38.6±14.7 years; 66.7% female) with newly diagnosed or relapsed GD attending the endocrinology outpatient clinics in a single institution were recruited between January 2019 and July 2020. All subjects were treated with methimazole to achieve euthyroidism. We explored metabolomics by performing liquid chromatography-mass spectrometry analysis of plasma samples of these patients and then performed multivariate statistical analysis of the metabolomics data.
Results:
Two hundred metabolites were measured before and after 12 weeks of methimazole treatment in patients with GD. The levels of 61 metabolites, including palmitic acid (C16:0) and oleic acid (C18:1), were elevated in methimazole-naïve patients with GD, and these levels were decreased by methimazole treatment. The levels of another 15 metabolites, including glycine and creatinine, were increased after recovery of euthyroidism upon methimazole treatment in patients with GD. Pathway analysis of metabolomics data showed that hyperthyroidism was closely related to aminoacyl-transfer ribonucleic acid biosynthesis and branched-chain amino acid biosynthesis pathways.
Conclusion
In this study, significant variations of plasma metabolomic patterns that occur during the transition from hyperthyroidism to euthyroidism were detected in patients with GD via untargeted metabolomics analysis.
4. Analysis of P gene variations among fourteen patients with oculocutaneous albinism type Ⅱ
Jianqiang TAN ; Lizhen PAN ; Jun HUANG ; Wugao LI ; Zhetao LI ; Rongni CHANG ; Jingwen LI ; Tizhen YAN ; Jiwei HUANG ; Dejian YUAN ; Ren CAI
Chinese Journal of Medical Genetics 2019;36(12):1163-1166
Objective:
To analyze variations of
5.Risk factors of anastomotic leakage after robotic surgery for low and mid rectal cancer
Jingwen CHEN ; Wenju CHANG ; Zhiyuan ZHANG ; Guodong HE ; Qingyang FENG ; Dexiang ZHU ; Tuo YI ; Qi LIN ; Ye WEI ; Jianmin XU
Chinese Journal of Gastrointestinal Surgery 2020;23(4):364-369
Objective:To investigate the risk factors associated with anastomotic leakage after robotic surgery in mid-low rectal cancer.Methods:A retrospective case-control study method was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) pathologically confirmed rectal cancer; (3) distance <10 cm from tumor to anal margin; (4) robotic anterior rectal resection. Patients with previous history of colorectal cancer surgery, distant metastases or other malignant tumors, undergoing emergency surgery, with severe abdominal adhesions or those receiving combined organ resection were excluded. Based on the above criteria, 636 patients undergoing robotic radical sphincter-preserving surgery for mid-low rectal cancer in Zhongshan Hospital from January 2015 to December 2018 were included in this study, including 398 males (62.6%) and 238 females (37.4%) with a mean age of (61.9±11.3) years. Sixty-eight cases (10.7%) received neoadjuvant chemoradiotherapy. Amony the 636 included patients, 123(19.3%) underwent natural orifice specimen extraction surgery (NOSES) and 15 (2.3%) underwent preventive stoma. According to the cirteria developed by the International Rectal Cancer Research Group in 2010, the anastomotic leakage was classified as grade A (no requirement of intervention), B (requirement of intervention), and C (requirement of operation). Logistic regression was used to analyze the relationship between anastomotic leakage and clinicopathological factors. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results:Anastomotic leakage occurred in 38 cases (6.0%). The grading of anastomotic leakage was grade A in 13 cases (2.0%), grade B in 19 cases (3.0%), and grade C in 6 cases (0.9%). The 3-year disease-free survival rate of patients with anastomotic leakage and without anastomotic leakage was 83.5% and 83.6% respectively ( P=0.862); the 3-year overall survival rate of the two group was 85.1% and 87.5% respectively ( P=0.296). The results of univariate logistic regression analysis showed that male ( P=0.011), longer operation time ( P=0.042), distance ≤5 cm from tumor to anal margin ( P=0.012), more intraoperative blood loss ( P=0.048) were associated with anastomotic leakage (all P<0.05). NOSES was not associated with anastomotic leakage ( P=0.704). Multivariate analysis confirmed that male (OR=3.03, 95%CI: 1.37 to 7.14, P=0.010), operation time ≥180 minutes (OR=2.04, 95%CI: 1.03 to 3.99, P=0.040), distance ≤5 cm from tumor to anal margin (OR=2.56, 95%CI:1.28 to 5.26, P=0.008) were independent risk factors for anastomotic leakage. Conclusion:Male, short distance from tumor to anal margin, and long operation time are independent risk factors for anastomotic leakage in patients undergoing robotic mid-low rectal cancer radical surgeries. These patients need to be cautiously treated during surgery.
6.Risk factors of anastomotic leakage after robotic surgery for low and mid rectal cancer
Jingwen CHEN ; Wenju CHANG ; Zhiyuan ZHANG ; Guodong HE ; Qingyang FENG ; Dexiang ZHU ; Tuo YI ; Qi LIN ; Ye WEI ; Jianmin XU
Chinese Journal of Gastrointestinal Surgery 2020;23(4):364-369
Objective:To investigate the risk factors associated with anastomotic leakage after robotic surgery in mid-low rectal cancer.Methods:A retrospective case-control study method was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) pathologically confirmed rectal cancer; (3) distance <10 cm from tumor to anal margin; (4) robotic anterior rectal resection. Patients with previous history of colorectal cancer surgery, distant metastases or other malignant tumors, undergoing emergency surgery, with severe abdominal adhesions or those receiving combined organ resection were excluded. Based on the above criteria, 636 patients undergoing robotic radical sphincter-preserving surgery for mid-low rectal cancer in Zhongshan Hospital from January 2015 to December 2018 were included in this study, including 398 males (62.6%) and 238 females (37.4%) with a mean age of (61.9±11.3) years. Sixty-eight cases (10.7%) received neoadjuvant chemoradiotherapy. Amony the 636 included patients, 123(19.3%) underwent natural orifice specimen extraction surgery (NOSES) and 15 (2.3%) underwent preventive stoma. According to the cirteria developed by the International Rectal Cancer Research Group in 2010, the anastomotic leakage was classified as grade A (no requirement of intervention), B (requirement of intervention), and C (requirement of operation). Logistic regression was used to analyze the relationship between anastomotic leakage and clinicopathological factors. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results:Anastomotic leakage occurred in 38 cases (6.0%). The grading of anastomotic leakage was grade A in 13 cases (2.0%), grade B in 19 cases (3.0%), and grade C in 6 cases (0.9%). The 3-year disease-free survival rate of patients with anastomotic leakage and without anastomotic leakage was 83.5% and 83.6% respectively ( P=0.862); the 3-year overall survival rate of the two group was 85.1% and 87.5% respectively ( P=0.296). The results of univariate logistic regression analysis showed that male ( P=0.011), longer operation time ( P=0.042), distance ≤5 cm from tumor to anal margin ( P=0.012), more intraoperative blood loss ( P=0.048) were associated with anastomotic leakage (all P<0.05). NOSES was not associated with anastomotic leakage ( P=0.704). Multivariate analysis confirmed that male (OR=3.03, 95%CI: 1.37 to 7.14, P=0.010), operation time ≥180 minutes (OR=2.04, 95%CI: 1.03 to 3.99, P=0.040), distance ≤5 cm from tumor to anal margin (OR=2.56, 95%CI:1.28 to 5.26, P=0.008) were independent risk factors for anastomotic leakage. Conclusion:Male, short distance from tumor to anal margin, and long operation time are independent risk factors for anastomotic leakage in patients undergoing robotic mid-low rectal cancer radical surgeries. These patients need to be cautiously treated during surgery.
7. Effects of Shenqi fuzheng injection on low-glucose-mediated immunosuppressive microenvironment and its mechanism of action
Wangbo MA ; Yue MA ; Fangtian FAN ; Yuhan ZHANG ; Jingwen CHANG ; Zhihua ZHOU ; Wangbo MA ; Yue MA ; Fangtian FAN ; Yuhan ZHANG ; Jingwen CHANG ; Zhihua ZHOU
Chinese Journal of Clinical Pharmacology and Therapeutics 2022;27(2):136-143
AIM: To investigate the effect of Shenqi fuzheng injection (SFI) on tumor immunity and its preliminary molecular mechanism. METHODS: The animal model of low glucose tumor microenvironment was established by B16-PKM2-OE; the level of interleukin-2(IL-2) and interferon-γ(IFN-γ), CD40L and transforming growth factor-β1(TGF-β1) were detected by ELISA kit; the expressions of glucose transporter-1 (Glut-1) and key enzymes of glycolysis ( HK, PFK and PK ) in CD4
8.Clinical observation of Microbotox in lower face and neck rejuvenation of patients with fatty chin
Chang ZHANG ; Lehao WU ; Jiaqi WANG ; Xiangyue WANG ; Zheng ZHU ; Meng YUE ; Jingwen LIU ; Haili YUE ; Chunling ZHAO
Chinese Journal of Plastic Surgery 2021;37(4):359-364
Objective:To study the clinical effect of Microbotox in improving mandibular fat accumulation, lifting mandibular contour and achieving lower face and neck rejuvenation.Methods:From May 2020 to January 2021, patients with mandibular fat accumulation and skin relaxation of mandible and neck were treated in Plastic Surgery Hospital, Chinese Academy of Medical Sciences. Multiple microdroplets of botulinum toxin type A was injected into the dermis or the interface between the dermis and the superficial muscle layer in lower face and neck. Botulinum toxin was diluted to 20 U/ml and injected with 0.6 U per point. The scope of Microbotox was demarcated by the line between earlobe-mouth corner as the upper border, the depressor anguli oris as the anterior border, the front edge of sternocleidomastoid muscle front edge as the posterior border, and the jugular notch as the inferior border. Treatment effect was evaluated postoperatively by the subjective satisfaction of patients and the accessment of a third-party physicians.Results:A total of 25 patients were included, including 10 males and 15 females, with the age of 39.4±3.7 years. The patient subjective satisfaction was 96%(24/25), and 96%(24/25) of patients received improved result , evaluated by a third-party physician. There were no serious complications except one case of local congestion and four cases of local pain and swelling, which could be relieved in a short time.Conclusions:Characterized by improving mandibular fat accumulation, lifting mandibular contour, reducing cervicomental angle, improving skin texture and neck wrinkles, Microbotox is effective and practical.
9.Clinical observation of Microbotox in lower face and neck rejuvenation of patients with fatty chin
Chang ZHANG ; Lehao WU ; Jiaqi WANG ; Xiangyue WANG ; Zheng ZHU ; Meng YUE ; Jingwen LIU ; Haili YUE ; Chunling ZHAO
Chinese Journal of Plastic Surgery 2021;37(4):359-364
Objective:To study the clinical effect of Microbotox in improving mandibular fat accumulation, lifting mandibular contour and achieving lower face and neck rejuvenation.Methods:From May 2020 to January 2021, patients with mandibular fat accumulation and skin relaxation of mandible and neck were treated in Plastic Surgery Hospital, Chinese Academy of Medical Sciences. Multiple microdroplets of botulinum toxin type A was injected into the dermis or the interface between the dermis and the superficial muscle layer in lower face and neck. Botulinum toxin was diluted to 20 U/ml and injected with 0.6 U per point. The scope of Microbotox was demarcated by the line between earlobe-mouth corner as the upper border, the depressor anguli oris as the anterior border, the front edge of sternocleidomastoid muscle front edge as the posterior border, and the jugular notch as the inferior border. Treatment effect was evaluated postoperatively by the subjective satisfaction of patients and the accessment of a third-party physicians.Results:A total of 25 patients were included, including 10 males and 15 females, with the age of 39.4±3.7 years. The patient subjective satisfaction was 96%(24/25), and 96%(24/25) of patients received improved result , evaluated by a third-party physician. There were no serious complications except one case of local congestion and four cases of local pain and swelling, which could be relieved in a short time.Conclusions:Characterized by improving mandibular fat accumulation, lifting mandibular contour, reducing cervicomental angle, improving skin texture and neck wrinkles, Microbotox is effective and practical.
10.Enhancement of anti-tumor effect of immune checkpoint inhibitor anti-PD-L1 by shenqifuzheng injection and the mechanism study
Zhihua ZHOU ; Jingwen CHANG ; Yuanyuan YAN ; Yanan QI ; Jingjing HAN ; Xinyi ZHU ; Chen YU ; Hongyan WU ; Fangtian FAN
Chinese Journal of Clinical Pharmacology and Therapeutics 2024;29(7):792-799
AIM:To investigate of the effect of Shenqifuzheng injection(SFI)combined with PD-L1 antibody on tumor immune microenvironment and its efficacy.METHODS:A subcutaneous transplanta-tion tumor model for B16F10-LUC melanoma was created.The expression of Ki67,CD31,CD8,CD16,CD163,FOXP3,LY6C,LY6G with labeling antibodies was used to detect CD8+T cells,Treg cells,NK cells,MDSCs cells,centrocytes,and granulocytes in the tumor tissues via immunohistochemistry.Flow cy-tometry was used to measure the ratios of CD11c+,IA/IE+,and CD80+cells in splenic tissue,as well as the ratios of CD8+T,CD4+T,and Treg cells in tumor tissue.Additionally,granulocyte count and NK cell expression were analyzed.RESULTS:The immuno-histochemistry results indicate that the drug admin-istration group effectively suppressed tumor angio-genesis and cell proliferation,while decreasing the expression level of immunosuppressive cytokines CD4+T cells,Treg cells,MDSCs and centroblasts.Ad-ditionally,CD8 and NK cell infiltration was promot-ed compared to the control group.The results of the flow analysis demonstrated a significant in-crease in the expression level of CD8+T cells within tumor tissues,as well as inhibition of CD4+T,Treg,and DC cell infiltration within the spleen in the drug administration group.Additionally,the tumor volume analysis indicated that the drug administra-tion group effectively inhibited tumor growth.The flow results illustrate that the group administering treatment exhibited significant increases in CD8+T cell expression levels in tumor tissue and DC cells in the spleen.Furthermore,the treatment effec-tively inhibited the infiltration of CD4+T and Treg cells.The results also indicate that the treatment significantly reduced tumor growth,with the tumor inhibition rate being better with PD-L1 antibody alone than with the SFI group.Additionally,combin-ing drugs resulted in superior results compared to the PD-L1 antibody group alone.CONCLUSION:SFI combined with a PD-L1 antibody can have synergis-tic anti-tumor effects,potentially enhancing DC cell infiltration and promoting T cell activation.Immu-nohistochemistry results indicate a positive impact on the tumor immune microenvironment.