Acute hypobaric hypoxic brain damage is a potentially fatal high-altitude sickness. Autophagy plays a critical role in ischemic brain injury, but its role in hypobaric hypoxia (HH) remains unknown. Here we used an HH chamber to demonstrate that acute HH exposure impairs autophagic activity in both the early and late stages of the mouse brain, and is partially responsible for HH-induced oxidative stress, neuronal loss, and brain damage. The autophagic agonist rapamycin only promotes the initiation of autophagy. By proteome analysis, a screen showed that protein dynamin2 (DNM2) potentially regulates autophagic flux. Overexpression of DNM2 significantly increased the formation of autolysosomes, thus maintaining autophagic flux in combination with rapamycin. Furthermore, the enhancement of autophagic activity attenuated oxidative stress and neurological deficits after HH exposure. These results contribute to evidence supporting the conclusion that DNM2-mediated autophagic flux represents a new therapeutic target in HH-induced brain damage.
Mice ; Animals ; Hypoxia ; Oxidative Stress ; Autophagy ; Cognition ; Sirolimus/therapeutic use*

Primary hyperparathyroidism is a disease with a large potential population. Some cases of primary hyperparathyroidism are non-primary, preventable and curable at early stage, requiring long-term follow-up after surgery. Therefore, all-round and full-cycle management are necessary for primary hyperparathyroidism, which involves an enhancing focus on etiological prevention, early detection, prompt diagnosis, timely intervention, multi-disciplinary standardized diagnosis and treatment, and postoperative scientific management. Meanwhile, implementing a "12+5+1" multidisciplinary joint diagnosis and treatment model, along with a two-way referral model, to achieve the transition from a disease-oriented diagnostic and treatment model to a patient-oriented, all-round and full-cycle interdisciplinary management model. This management can reduce the incidence and recurrence rate of primary hyperparathyroidism, and related osteoporosis or osteopenia, fractures, nephrolithiasis, metastatic vascular calcification, and systemic abnormal migratory calcium deposits, improve the overall quality of life and prognosis of patients.

Objective:To investigate the clinical efficacy and safety of heat-clearing and spleen-invigorating method in the treatment of Helicobacter pylori (Hp) initial treatment failure population.Methods:The clinical data of 155 patients with initial Hp failure in our hospital from January 2021 to December 2022 were retrospectively analyzed. According to the treatment plan, they were divided into TCM group (66 cases) and Western medicine group (89 cases). Python 3.70 was used for bias score matching (PSM) to obtain samples with balanced covariates between groups. Finally 66 pair of cases were successfully matched according to the propensity score and the 1:1 matching principle.The TCM group was given Yiqing Capsule + Jianpi Pills (4 weeks) as a course of treatment. The Western medicine group was given four anti-Hp remedial regimen, 2 weeks for 1 course. 2 groups were treated for 1 course. Hp was detected by 14C breath test and its clearance rate was calculated. The overall symptoms of functional dyspepsia (FD) were evaluated from four aspects: postprandial fullness, early satiety, middle and upper abdominal pain, and middle and upper abdominal burning sensation. The adverse reactions during treatment were observed and the clinical efficacy was evaluated. Results:After treatment, the Hp clearance rate was 75.76% (50/66) in the TCM group and 83.33% (55/66) in the Western medicine group, which was significantly improved compared with that before treatment, without statistical significance ( χ2=1.16, P=0.281). After treatment, the scores of fullness and discomfort after meal [1 (0,2) vs. (2,4), Z=-6.85], early satiety [2 (0,2) vs. 4 (4, 6), Z=-8.02], middle and upper abdominal pain [2 (2, 4) vs. 4 (4, 6), Z=-4.48] in the TCM group were lower than those in Western medicine group ( P<0.01). The total effective rate was 75.76% (50/66) in the TCM group and 69.70% (46/66) in the Western medicine group, without statistical significance ( χ2=2.00, P=0.573). No adverse reactions occurred in the 2 groups during treatment. Conclusion:In terms of heat-clearing and spleen-invigorating method for Hp initially failed patients, its Hp clearance rate and clinical total effective rate are comparable to Western medicine, and can effectively improve the clinical symptoms of patients with Hp initial treatment failure.

Metastatic vascular calcification and calcinosis universalis, as severe complications of parathyroid hyperfunction and hyperparathyroidism, have attracted more attention in patients with renal secondary hyperparathyroidism and primary hyperparathyroidism. But, they are of little concern in patients with long-term negative calcium balance related parathyroid hyperfunction or hyperparathyroidism caused by calcium and/or vitamin D insufficiency (CVI). CVI is common in the population. Relatively low level of serum calcium and negative calcium balance caused by long-term CVI result in parathyroid hyperfunction or hyperparathyroidism, which may cause secretion of PTH beyond the physiological level, leading to bone absorption and release of a large amount of bone calcium into the blood. It may not only cause bone loss and osteoporosis, but also form metastatic vascular calcification or calcinosis universalis presented by cardiovascular diseases and other multi-organ lesions. Early calcium deposition can gradually fade after reasonable treatment, but middle arterial calcification is not easy to fade once it occurs. Therefore, vascular calcification and calcium deposition should be actively prevented and early screened and diagnosed. The early prevention, diagnosis and treatment of parathyroid hyperfunction or hyperparathyroidism can prevent, delay, or even reverse the occurrence and development of metastatic vascular calcification and calcinosis universalis, which is significant for disease prevention and protecting the patients' health influenced by these diseases.

Objective To teach neurosurgical residents of standardized training by using teaching method with multi-modality visualization and to explore its application effects.Methods Total 122 students were randomly divided into two groups:multi-modality visualization teaching group (n=61) and traditional teaching group (n=61).The evaluation of teaching effect was conducted by questionnaire of students and the analysis of test scores after the course.Comparison between the two groups was made by using independent sample t test.Results Questionnaire showed that the satisfaction of teaching mode (88.5％),learning efficiency (93.4％),and training results (90.1％) with multi-modality visualization teaching group were statistically higher than traditional group (P＜0.05).Test score showed that results of theory test (88.5 ± 5.1),on-spot examination (91.6 ± 5.5),and overall score (89.3 ± 5.2) were also statistically higher in multi-modality visualization teaching group than that of control group (P＜0.05).There was no significant difference in clinical skills assessment between two groups.Conclusions Teaching with multi-modality visualization can significantly improve the efficiency of neurosurgical clinical teaching and promote the training effect of students,which provides a new strategy of neurosurgical clinical teaching.

OBJECTIVE： To investigate the clinical distribution and drug resistance of pathogenic bacteria of bloodstream infection in Zigong area， and to provide reference for the diagnosis and treatment of bloodstream infection in the region. METHODS： The blood culture positive strains and drug susceptibility results of 3 third-class comprehensive hospital of Zigong district during Jan.-Dec. 2017 were collected. Using Escherichia coli ATCC25922， Staphylococcus aureus ATCC25923， Pseudomonas aeruginosa ATCC27853， Streptococcus pneumoniae ATCC49619 as quality control bacteria， clinical distribution and drug resistance of pathogens of bloodstream infection were analyzed by using WHONET 5.6 and SPSS 19.0 software. RESULTS： A total of 879 strains of bacteria were isolated， including 212 strains of Gram-positive bacteria （24.1％） and 667 strains of Gram-negative bacteria （75.9％）. Top 5 bacteria were E. coli （50.7％）， Klebosiella pneumoniae （10.2％）， Staphylococcus aureus （6.5％）， S. epidermidis （3.2％） and S. pneumoniae （2.6％）， respectively. The age and gender distribution of pathogenic bacteria was 88.5％ in the population over 40 years old， and the scale of male to female was 1.15 ∶ 1. Drug resistance of common Gram-positive bacteria showed that S. aureus， Coagulase negative staphylococcus， Enterococcus faecalis， Enterococcus faecium and S. pneumoniae resistant to vancomycin and linezolid were not isolated； the detection rates of MRSA and MRCN were 15.8％ and 64.2％， respectively. E. faecium was more resistant to common antibiotics than E. faecalis. Drug resistance rate of E. faecalis to penicillin and ampicillin was 0， and penicillin-resistant S. pneumoniae was not detected. The drug resistance of common Gram-negative bacteria showed that E. coli and K. pneumoniae resistant to ertapenem were not isolated. The drug resistance of two bacteria to amikacin， cefotetan， cefepime， piperacillin/tazobactam and imipenem were lower （＜10％）， among which the detection rates of ESBLs-producing stain were 42.2％ and 24.4％； detection rate of ESBLs-producing stain to common antibiotics was higher than that of non-producing ESBLs stain. The resistance of Acinetobacter baumannii was higher than that of P. aeruginosa to common antibiotics， and the resistant rates to imipenem were 68.8％ and 13.6％， respectively. And amikacin-resistant or tobramycin-resistant P. aeruginosa were not isolated. CONCLUSIONS： The bloodstream infection is mainly caused by Enterobacteriaceae in Zigong area， and the drug resistance of A. baumannii is serious. It is necessary to strengthen the hospital infection control and management.

Objective: To explore the effects of local transplantation of autologous adipose-derived stromal vascular fraction (SVF) on the hyperplastic scar (HS) formation in rabbit ears and the mechanism. Methods: Twenty-four New Zealand white rabbits were used to reproduce HSs by making four full-thickness skin defect wounds with a diameter of 1 cm on the ventral surface of left ear of each rabbit. Wound epithelization and local-tissue proliferation were observed, and wound healing (complete epithelization) time and formation time of HS were recorded. The 24 rabbits were divided into SVF group, pure DMEM group, and pure HS group according to the random number table, with 8 rabbits and 32 wounds in each group. On post injury day (PID) 25 (after the complete epithelization of wounds), 0.2 mL of low glucose DMEM medium containing CM-Dil labeled autologous SVF was injected into HSs of rabbits in SVF group, while the same amount of low glucose DMEM medium was injected into HSs of rabbits in pure DMEM group. The frequency of injection was once every 5 days, totally for 3 times. HSs of rabbits in pure HS group did not receive any treatment. On PID 40, HSs of rabbits′ ears in each group were harvested, then the histological form was observed by hematoxylin and eosin staining, the arrangement of collagen in HS was observed by Van Gieson staining, the distribution of CM-Dil-labeled SVF in the HS was observed with fluorescence microscope, and the mRNA expression and the protein expression of transforming growth factor β₁ (TGF-β₁), Smad3, and Smad7 in HS were determined by real-time fluorescent quantitative reverse transcription-polymerase chain reaction and Western blotting, respectively. Data were processed with one-way analysis of variance and Tukey test. Results: (1) Complete epithelization time of wounds of rabbits′ ears was (20.0±2.0) d post injury, and HSs were formed on PID 25. On PID 40, HSs of rabbits′ ears in pure DMEM group and pure HS group were still in hyperplasia, while those in SVF group became smaller, flat, soft, and light colored. (2) On PID 40, compared with those in pure DMEM group and pure HS group, the number of epithelium foot like structures was more and the amount of inflammatory cells was less. The collagen of HSs of rabbits′ ears in SVF group was arranged more regularly with broader gap between collagens. (3) On PID 40, CM-Dil-labeled SVF could still be observed in the HSs of rabbits′ ears in SVF group. (4) On PID 40, compared with those in pure DMEM group and pure HS group, the mRNA expressions of TGF-β₁ and Smad3 in the HSs of rabbits′ ears in SVF group were significantly down-regulated (P<0.05), while the mRNA expression of Smad7 was significantly up-regulated (P<0.05). There were no significant differences in the mRNA expressions of TGF-β₁, Smad3, and Smad7 in the HSs of rabbits′ ears between pure DMEM group and pure HS group (P>0.05). (5) On PID 40, compared with those in pure DMEM group (0.74±0.03, 0.73±0.10, 0.54±0.09) and pure HS group (0.72±0.08, 0.71±0.12, 0.53±0.06), the protein expressions of TGF-β₁ and Smad3 in the HSs of rabbits′ ears in SVF group (0.57±0.06, 0.42±0.09) were significantly down-regulated (P<0.05), while the protein expression of Smad7 (0.71±0.05) was significantly up-regulated (P<0.05). The protein expressions of TGF-β₁, Smad3, and Smad7 in the HSs of rabbits′ ears in pure DMEM group and pure HS group were close (P>0.05). Conclusions Autologous SVF transplantation can inhibit the formation of HS in the early stage of scar formation of rabbit, the mechanism may be related to the TGF-β₁/Smad signaling pathway.

Objective To investigate the effect of lycium barbarum polysaccharides (LBP) on apoptosis and autophagic death in primary cultured hippocampal neurons after oxygen glucose deprivation and reoxygenation (OGD/R) injury.Methods Primary cultured hippocampal neurons were exposed to OGD/R.The cells were randomly divided into 5 groups:control group,OGD/R group,and OGD/R+LBP groups (15,30 and 60 μg/mL LBP).The cell viability was assessed by MTT assay.The cell damage was evaluated through detecting the lactate dehydrogenase (LDH) release rate.Apoptosis rate was detected by TUNEL,and cleaved Caspase-3 was identified by immunofluorescence staining.Protein expression was detected by Western blotting.Results As compared with the control group,OGD/R group had significantly decreased cell viability (P＜0.05);and significantly increased cell viability and decreased LDH release rate were noted in the LBP (15,30 and 60 μg/mL) treatment groups as compared with those in the OGD/R group (P＜0.05).The 60 μg/mL LBP treatment group had significantly smaller number of TUNEL-positive cells than the OGD/R group(P＜0.05).Immunofluorescence staining and Western blotting both revealed that 60 μg/mL LBP treatment group had significantly decreased Beclinl level and ratio of cleaved Caspase-3/Caspase-3 and ratio of microtubule-associated protein light chain (LC)3 Ⅱ/LC3Ⅰ,and statistically increased p62 level and ratio of Bcl-2/Bax as compared with OGD/R group (P＜0.05).Conclusion LBP treatment protects primary hippocampal neurons from OGD/R injury via inhibiting apoptosis and autophagic cell death.

Objective To explore the haemostatic efficacy of cervical progressing suture in treating intractable cervical canal hemorrhage during cesarean section(CS) in placenta previa.Methods Sixty patients suffering from intractable cervical canal hemorrhage during CS due to central placenta previa were chosen and divided into the cervical progressing suture(observation roup,30 cases) and the uterine cavity ribbon gauze packing group(control group,30 cases).The intraoperative operating time,intraoperative bleeding amount,postoperative 24 h hemorrhage amount,hysterectomy and puerperal infection were compared between the two groups.Results The intraoperative operation time in the observation group and control group were (3.15± 1.60)min and (6.10±2.35) min respectively,the intraoperative bleeding amount in the observation group and control group were (422.00 ±-186.98)mL and (642.25±344.42)mL respectively,postoperative 24 h bleeding amounts were (583.23±=198.33)mL and (825.23±=373.50)mL respectively,the differences between the two groups were statistically significant(P＜0.05).No hysterectomy and no complications ocurred in each group.Conclusion Adopting the cervical progressing suture in treating intractable cervical canal hemorrhage during cesarean section(CS) due to placenta previa is simple to operate and has good effect.

OBJECTIVETo explore the curative effect of reverse bi-pedicle posterior interosseous artery perforator flap in repairing skin and soft tissue defects on the wrist.

METHODSSeven patients with soft tissue defects on the wrist, including simple skin and soft tissue defects in 4 cases and skin and soft tissue defects combined with radial tendon injury in 3 cases, were hospitalized from December 2010 to March 2012. The area of skin defect on the volar side of the wrist ranged from 4.8 cm x 4.0 cm to 6.2 cm x 4.5 cm, while that on the dorsal side ranged from 3.5 cm x 3.2 cm to 6. 5 cm x 5.4 cm. These wounds were respectively caused by traffic injury (3 cases), reamer injury (2 cases), burn (1 case), and tumor resection (1 case). Reverse bi-pedicle posterior interosseous artery perforator flaps were used to repair these defects, with area of one pedicle ranging from 2.5 cm x 2.0 cm to 3.5 cm x 2.5 cm and the area of the other pedicle ranging from 2.5 cm x 2.5 cm to 4.0 cm x 3.0 cm. The donor sites were closed by suturing.

RESULTSAll flaps survived completely. Patients were followed up for 6 to 36 months. The color, texture, and appearance of all flaps were satisfactory. At last follow-up, distances of two-point discrimination of flaps ranged from 9 to 13 mm. The dorsal extension and palmar flexion functions of wrist were satisfactory. The results of function evaluation of 7 wrists were excellent in 6 cases and good in 1 case according to the tentative standards for the evaluation of upper extremity function of Society of Hand Surgery of Chinese Medical Association. A linear scar was formed at the donor site.

CONCLUSIONSThe reverse bi-pedicle posterior interosseous artery perforator flap, with advantages of flexible design, easy to achieve, less injury to donor site, and reliable blood supply, etc., is another choice for repairing skin and soft tissue defects over the wrist.

Burns ; Cicatrix ; Humans ; Perforator Flap ; blood supply ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Tendon Injuries ; Treatment Outcome ; Ulnar Artery ; Wound Healing ; Wrist Injuries ; surgery