Objective:To investigate the effect of dexmedetomidine on the intraoperative and early postoperative complications of patients undergoing orthotopic liver transplantation.Methods:This is a retrospective cohort study. The clinical data of 399 patients who underwent orthotopic liver transplantation at the First Affiliated Hospital of Nanjing Medical University from January 2016 to September 2020 were retrospectively collected. There were 319 males and 80 females, aged (50.9±10.2) years (range: 10 to 73 years). These patients were divided into the control group (369 cases) and the dexmedetomidine group (30 cases) according to whether dexmedetomidine was continuously pumped intravenously during the operation until the operation ended. The 1∶2 propensity score matching was used to match the preoperative and intraoperative conditions of the two groups of patients, and the caliper width was 0.2. Outcome indicators included intraoperative postreperfusion syndrome, acute kidney injury and pulmonary complications within 7 days after surgery, length of hospital stay, time of stay in ICU, duration of assisted mechanical ventilation, rate of reintubation, 6-month and 1-year survival and recurrence-free survival rate after surgery. The independent sample t test, χ2 test, Mann-Whitney U test or Fisher exact test was used to statistically analyze the data of the two groups of patients, respectively. Survival curves of overall survival and disease-free-survival were plotted by Kaplan-Meier method, and the survival rate and recurrence-free survival rate were compared by Log-rank test. Results:A total of 78 patients were included after propensity score matching, including 26 in the dexmedetomidine group and 52 in the control group. The incidence of acute kidney injury in the dexmedetomidine group within 7 days after surgery was 0 (0/26), significantly lower than that of the control group (21.2%,11/52)(corrected χ2=4.776, P=0.029). There were no significant differences in the incidence of intraoperative postreperfusion syndrome and pulmonary complications within 7 days after surgery, length of hospital stay, ICU time, the duration of assisted mechanical ventilation, rate of reintubation, 6-month and 1-year survival, and recurrence-free survival rate after surgery between the two groups (all P>0.05). Conclusion:Continuous infusion of dexmedetomidine via intravenous pump during operation may be beneficial in reducing the incidence of acute kidney injury within 7 days after orthotopic liver transplantation.

Objective:To analyze the risk factors and prognosis for early acute kidney injury (AKI) after orthotopic liver transplantation (OLT).Methods:The retrospective study was conduc-ted. The clinicopathological data of 340 pairs of donor and recipients undergoing OLT in The First Affiliated Hospital of Nanjing Medical University from January 2016 to January 2020 were collected. There were 262 males and 78 females of donors. There were 268 males and 72 females of recipients, aged (51±11)years. Of 340 recipients, 217 cases without postoperative early AKI were divided into the non-AKI group and 123 cases with postoperative early AKI were divided into the AKI group. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distri-bution were represented as M( IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the non-parameter test. Multivariate analysis was conducted using the binary Logistic regre-ssion model with forward method. The nomogram predictive model was constructed using the R software with its RMS package (R3.6.1). The efficacy of the predictive model was validated using the area under curve (AUC) of the receiver operating characteristic (ROC) curve, and internal validation of the predictive model was performed using the Bootstrap method. The Kaplan-Meier method was used to draw survival curves, and Log-rank test was used for survival analysis. Results:(1) Com-parison of preoperative clinical characteristics between donors and recipients of the non-AKI group and the AKI group. There was a significant difference in overweight of donors between the non-AKI group and the AKI group ( P<0.05). There were significant differences in preoperative hypertension, viral hepatitis, pathological types, international normalized ratio, fibrinogen levels, platelet (PLT), hemoglobin, and anemia of recipients between the non-AKI group and the AKI group ( P<0.05). (2) Comparison of surgical situations between recipients of the non-AKI group and the AKI group. There were significant differences in intraoperative urine output, volume of intraoperative blood loss, peak serum potassium after reperfusion, massive transfusion, plasma infusion, cryoprecipitate infusion, and aminocaproic acid use of recipients between the non-AKI group and the AKI group ( P<0.05). (3) Influencing factors for postoperative early AKI and construction and evaluation of the nomogram predictive model for postoperative early AKI. Results of multivariate analysis showed that donors of overweight, recipients of preoperative hypertension, recipients of non-viral hepatitis, recipients of preoperative severe PLT reduction, recipients of less intraoperative urine output, recipients of severe post-reperfusion hypotension, recipients of high peak serum potassium after reperfusion, recipients with intraoperative plasma infusion were independent risk factors for postoperative early AKI ( odds ratio=1.982, 3.365, 0.519, 3.615, 0.169, 2.480, 1.500, 1.001, 95% confidence interval as 1.160-3.388, 1.649-6.865, 0.293-0.917, 1.358-9.621, 0.061-0.464, 1.246-4.934, 1.003-2.243, 1.000-1.001, P<0.05). The nomogram predictive model for postoperative early AKI was constructed based on the results of multivariate analysis. Results of ROC curve showed the AUC was 0.769 (95% confidence interval as 0.717-0.820). Results of the calibration curve showed that the predictive results of nomogram predictive model fitted well with the actual situation, with a mean absolute error of 0.016. (4) Comparison of prognosis between recipients of the non-AKI group and the AKI group. There were significant differences in postopera-tive peak creatinine, peak brain natriuretic peptide, duration of intensive care unit stay, mechanical ventilation time, re-intubation of recipients between the non-AKI group and the AKI group ( Z=-4.836, -5.652, -5.861, -6.533, χ2=14.676, P<0.05). All 340 recipients were followed up. For recipients of hepatocellular carcinoma, the 6-month survival rates after surgery were 87.8% and 75.6% of the non-AKI group and the AKI group, respectively, showing a significant difference between them ( χ2=4.010, P<0.05), and the overall survival rates were 46.7% and 56.1% of the non-AKI group and the AKI group, respectively, showing no significant difference between them ( χ2=0.047, P>0.05). For recipients of benign liver disease, the 6-month survival rates after surgery were 89.8% and 78.0% of the non-AKI group and the AKI group, respectively, showing a significant difference between them ( χ2=6.401, P<0.05), and the overall survival rates were 81.4% and 68.0% of the non-AKI group and the AKI group, respectively, showing a significant difference between them ( χ2=4.452, P<0.05). Conclusions:Donors of overweight, recipients of preoperative hypertension, recipients of non-viral hepatitis, recipients of preoperative severe PLT reduction, reci-pients of less intraoperative urine output, recipients of severe post-reperfusion hypotension, recipi-ents of high peak serum potassium after reperfusion, recipients with intraoperative plasma transfu-sion were independent risk factors for postoperative early AKI. Nomogram predictive model has well clinical application value. For recipients of benign liver disease, the 6-month survival rate after surgery and overall survival rate of recipients in the non-AKI group are superior to those of the AKI group.

Objective:To investigate the effect of dexmedetomidine on the intraoperative and early postoperative complications of patients undergoing orthotopic liver transplantation.Methods:This is a retrospective cohort study. The clinical data of 399 patients who underwent orthotopic liver transplantation at the First Affiliated Hospital of Nanjing Medical University from January 2016 to September 2020 were retrospectively collected. There were 319 males and 80 females, aged (50.9±10.2) years (range: 10 to 73 years). These patients were divided into the control group (369 cases) and the dexmedetomidine group (30 cases) according to whether dexmedetomidine was continuously pumped intravenously during the operation until the operation ended. The 1∶2 propensity score matching was used to match the preoperative and intraoperative conditions of the two groups of patients, and the caliper width was 0.2. Outcome indicators included intraoperative postreperfusion syndrome, acute kidney injury and pulmonary complications within 7 days after surgery, length of hospital stay, time of stay in ICU, duration of assisted mechanical ventilation, rate of reintubation, 6-month and 1-year survival and recurrence-free survival rate after surgery. The independent sample t test, χ2 test, Mann-Whitney U test or Fisher exact test was used to statistically analyze the data of the two groups of patients, respectively. Survival curves of overall survival and disease-free-survival were plotted by Kaplan-Meier method, and the survival rate and recurrence-free survival rate were compared by Log-rank test. Results:A total of 78 patients were included after propensity score matching, including 26 in the dexmedetomidine group and 52 in the control group. The incidence of acute kidney injury in the dexmedetomidine group within 7 days after surgery was 0 (0/26), significantly lower than that of the control group (21.2%,11/52)(corrected χ2=4.776, P=0.029). There were no significant differences in the incidence of intraoperative postreperfusion syndrome and pulmonary complications within 7 days after surgery, length of hospital stay, ICU time, the duration of assisted mechanical ventilation, rate of reintubation, 6-month and 1-year survival, and recurrence-free survival rate after surgery between the two groups (all P>0.05). Conclusion:Continuous infusion of dexmedetomidine via intravenous pump during operation may be beneficial in reducing the incidence of acute kidney injury within 7 days after orthotopic liver transplantation.

Background::Heterogeneity of tumor cells and the tumor microenvironment (TME) is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma (UC). Comprehensive profiling of the cellular diversity and interactions between malignant cells and TME may clarify the mechanisms underlying UC progression and guide the development of novel therapies. This study aimed to extend our understanding of intra-tumoral heterogeneity and the immunosuppressive TME in UC and provide basic support for the development of novel UC therapies.Methods::Seven patients with UC were included who underwent curative surgery at our hospital between July 2020 and October 2020. We performed single-cell RNA sequencing (scRNA-seq) analysis in seven tumors with six matched adjacent normal tissues and integrated the results with two public scRNA-seq datasets. The functional properties and intercellular interactions between single cells were characterized, and the results were validated using multiplex immunofluorescence staining, flow cytometry, and bulk transcriptomic datasets. All statistical analyses were performed using the R package with two-sided tests. Wilcoxon-rank test, log-rank test, one-way analysis of variance test, and Pearson correlation analysis were used properly.Results::Unsupervised t-distributed stochastic neighbor embedding clustering analysis identified ten main cellular subclusters in urothelial tissues. Of them, seven urothelial subtypes were noted, and malignant urothelial cells were characterized with enhanced cellular proliferation and reduced immunogenicity. CD8 + T cell subclusters exhibited enhanced cellular cytotoxicity activities along with increased exhaustion signature in UC tissues, and the recruitment of CD4 + T regulatory cells was also increased in tumor tissues. Regarding myeloid cells, coordinated reprogramming of infiltrated neutrophils, M2-type polarized macrophages, and LAMP3 + dendritic cells contribute to immunosuppressive TME in UC tissues. Tumor tissues demonstrated enhanced angiogenesis mediated by KDR + endothelial cells and RGS5 +/ACTA2 + pericytes. Through deconvolution analysis, we identified multiple cellular subtypes may influence the programmed death-ligand 1 (PD-L1) immunotherapy response in patients with UC. Conclusion::Our scRNA-seq analysis clarified intra-tumoral heterogeneity and delineated the pro-tumoral and immunosuppressive microenvironment in UC tissues, which may provide novel therapeutic targets.

Objective To explore the effect of neuroendoscopic surgery for the removal of medium and large sized tuberculum sellae meningiomas through supraorbital keyhole approach.Methods A retrospective research was performed on 7 case of patients with tuberculum sellae meningioma who underwent endoscopic surgery through supraorbital keyhole approach.The main performance of patients as tumor diameter were 2.8-4.7 cm and the skin incision located at superciliary aich which size of intra-frontal bone window was 3.5 cm× 2.0 cm.Results Total removal was achieved in 7 cases(simpson Ⅰ grade in 2 patients,sirnpson 1Ⅱ grade in 5 patients).Postoperative,the visual outcomes of eyes were showed improvement in 9 eyes,remained steady in 3 eyes,and deterioration in 2 eyes.All patients were followed up for 6-13 months and no recurrence was found.Conclusion Neuroendoscopic surgery through supraorbital keyhole approach is an effective method for the resection of medium and large sized tuberculum sellae meningiomas.

Objective To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. Methods A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. Results 188 patients with high level of plasma PCT were enrolled. There were 128 male patients (68.1%) with the average age of 62 (49, 75) years. Most patients were admitted in intensive care unit (ICU, 70.7%, 133/188). Major diagnosis was sepsis (91.0%), followed by multiple organ dysfunction syndrome (MODS, 57.4%), post large operation of thorax and abdomen (20.7%), trauma/burns (13.8%) and post-cardiopulmonary resuscitation (CPR, 6.4%). Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS (84.9% vs. 40.0%), trauma/burns (26.0% vs. 6.1%), post-CPR (13.7% vs. 1.7%), ventilator support (82.2% vs. 40.9%) and shock (100.0% vs. 60.0%), the numbers of principal diagnosis [2.0 (2.0, 3.0) vs. 2.0 (1.0, 2.0)], acute physiology and chronic health evaluation Ⅱ score [APACHE Ⅱscore: 24 (19, 28) vs. 14 (10, 16)] and sequential organ failure assessment (SOFA) score [16.0 (12.5, 18.0) vs. 9.0 (6.0, 12.0)], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid (Lac) levels were significantly higher than those in the survival group, but the platelet (PLT) count in the death group was significantly lower than that in the survival group [×109/L: 62.00 (21.50, 111.00) vs. 93.00 (53.00, 136.00), all P < 0.05]. The parameters with statistical significance in the univariate analysis were enrolled in the multiple factor logistic regression analysis, which showed that patient with a high score of APACHE Ⅱ [odds ratio (OR) = 1.290, 95% confidence interval (95%CI) = 1.121-1.484, P = 0.000] or the occurrence of MODS (OR = 7.264, 95%CI = 1.762-29.941, P = 0.006) at admission had a poor prognosis. Conclusions The primary patients with high levels of plasma PCT (> 100 μg/L) were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE Ⅱ score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.

Objective To investigate the effect of gemcitabine, paclitaxel combined with nedaplatin in treatment of locally advanced nasopharyngeal carcinoma. Methods 40 patients diagnosed as locally advanced nasopharyngeal carcinoma from May 2012 to August 2014 were randomly divided into observation group and control group. Patients in the observation group received gemcitabine plus nedaplatin chemotherapy, while those in the control group received paclitaxel plus nedaplatin chemotherapy. Then chemotherapy effect, adverse reactions, survival time and tumor marker contents were compared. Results The effective rate of the observation group was 65 % (13/20), which was higher than that (30 %, 6/20) of the control group (χ2 = 4.912, P< 0.05), however, there were no statistically differences in gastrointestinal reactions, bone marrow suppression, liver damage, kidney damage between groups (P> 0.05). Before chemotherapy, the SCCAg and CYFRA21-1 content of the control group were (2.30 ±0.31) ng/L and (18.27±2.19)μg/L, and the observation group were (2.34±0.27) ng/L and (18.48±2.25)μg/L, and there was no significant difference between the groups (P>0.05). After chemotherapy, the SCCAg and CYFRA21-1 content of the control group were (1.92±0.22) ng/L and (13.72±1.74) μg/L, and the observation group were (1.20 ±0.15) ng/L and (8.49 ±0.91) μg/L (P= 0.000). Conclusion Gemcitabine combined with nedaplatin chemotherapy can improve the chemotherapy effect and reduce tumor marker content, without increasing more adverse reactions, which is an ideal chemotherapy regimen for advanced nasopharyngeal carcinoma.

Objective To provide the reference basis for reducing the occurrence of nutritional risk by analyzing possible risk factors for nutritional risk status and investigating the relationship between preoperative nutritional risk status and prognosis.Methods We retrospectively analyzed the clinical data of 894 patients(nutritional risk group of 491 cases,non-nutritional risk group of 403 cases) with esophageal cancer resection.The univariate analysis was used to analyze the relationships between nutritional risk status with postoperative complications and length of hospitalization.And the multiple Logistic regression model analysis was applied to analyze the risk factors of nutritional risk status.Results The nutritional risk group had a higher rate of postoperative complications (33.60 ％ vs.19.60 ％,U =-3.429,P =0.001),higher incidence of serious complications (23.01％ vs.8.68％,U =-3.611,P =0.000) and longer hospital stays [(37.20 ± 13.89) days vs.(31.69 ± 13.49) days,t =4.124,P =0.000] than that of non-nutritional risk group.The results of the multiple logistic regression analysis showed that the preoperative nutritional risk factors were associated with the patients' age (OR =1.58,95％ CI:1.101-2.268),number of symptoms entries(OR =7.97,95 ％ CI:6.071-10.463),symptom severity (OR =0.26,95％ CI:0.186 -0.385),and dietary intake (OR =0.62,95 ％ CI:0.482-0.813),P ＜ 0.05 for all.Conclusion The older patients with more severe symptoms and poor diet are more likely to suffer from nutritional risk.Prolonged hospital stay and postoperative complications easily happen in patients with nutritional risk.So patients with preoperative nutritional risk should be given timely and effective nutrition intervention measures,in order to reduce postoperative complications and length of hospitalization.

OBJECTIVETo observe the effects ofGynura segetum in rats with hepatic veno-occlusive disease (HVOD).

METHODSSixty Sprague-Dawley rats were assigned to a blank control group, one of three Gynura segetum treatment groups (low-dose group, 5.0 g/kg; mid-dose group, 10 g/kg; high-dose group, 20 g/kg), or a pseudo-drug group (10 g/kg of pseudo-ginseng). After 28 days of treatment, effects on white blood cell count, coagulation, secreted factors from vascular endothelium, and histopathology of the spleen were observed and inter-group differences were statistically assessed.

RESULTSAfter the 4-week administration, all rats in the Gynura segetum treatment groups showed decrease in body weight, increases in numbers of leukocytes, neutrophils, lymphocytes, monocytes and eosinophils.decreases in platelets and platelet hematocrit, and increases in mean platelet volume and platelet distribution.In addition, the Gynura segetum treatments increased the prothrombin time, activated partial thromboplastin time, thrombin time, prothrombin ratio and international normalized ratio, but decreased the PT%, fibrinogen level and platelet aggregation.Serum levels of endothelin and nitric oxide were also elevated by the Gynura segetum treatments.All measured parameters showed significant differences from the control group (P less than 0.01 or less than 0.05).Finally, the splenic follicles were significantly reduced and the spleens showed an absence of germinal centers along with a large number of diffuse lymphocytes and reduced red pulp sinusoids.

CONCLUSIONThe Gynura segetum treatment has some toxic effects; it can reduce platelet count and platelet hematocrit, inhibit blood clotting time and platelet aggregation, increase the secretion of factors from the vascular endothelium and disrupt spleen histology.

Animals ; Asteraceae ; Blood Coagulation ; Blood Platelets ; Disease Models, Animal ; Endothelium, Vascular ; Hepatic Veno-Occlusive Disease ; Platelet Count ; Prothrombin Time ; Rats ; Rats, Sprague-Dawley

Background and purpose:It is increasingly focused on that insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 4 (IGFBP-4) effect cell proliferation, differentiation and apoptosis of tumor cells, and pregnancy-associated plasma protein-A (PAPPA) plays an important role in IGF-1-dependent IGFBP-4 protease mechanism that regulats tumor cells' growth. This study aimed to investigate the serum levels and clinical signiifcance of IGF-1, IGFBP-4, and PAPPA in patients with non-small cell lung cancer (NSCLC). Methods:IGF-1, IGFBP-4, and PAPPA plasma levels were measured by enzyme-linked immunosorbent assay from 82 patients with NSCLC and 40 control subjects, then the correlations between variables were assessed by Spearman correlation analysis, and associations between the IGFs variables and lung cancer risk were calculated through the odds ratio (OR) and its 95%conifdence interval (CI) with the use of unconditional logistic regression analysis. Results:Serum levels of IGF-1, IGFBP-4 and PAPPA in NSCLC patients were signiifcantly higher than those in the control group(P<0.05). There was a signiifcant positive correlation between the serum IGF-1 levels and PAPPA levels (r=0.835,P=0.000), and a negative correlation with IGFBP-4 levels (r=-0.612,P=0.000). IGFBP-4 and PAPPA levels were negatively correlated(r=-0.673, P=0.000). High plasma levels of IGF-1(OR=2.28, 95%CI: 1.25-4.36,P=0.008) and PAPPA (OR=1.64, 95%CI: 0.89-3.01,P=0.046)were associated with an increased risk of lung cancer, however high plasma levels of IGFBP-4(OR=0.54, 95%CI:0.30-1.01,P=0.047)were associated with reduced risk of lung cancer. Conclusion:To detect IGF-1, IGFBP-4 and PAPPA in serum in NSCLC patients is meaningful for the clinical auxiliary diagnosis and biology behavior prediction of NSCLC. And further study of signal transduction pathways of IGFs with the occurrence and development of NSCLC is a meaningful research direction.