Objective To evaluate the role of 5-hydroxy trptarine 2A receptor (5-HT2A) in the pathogenesis of biliary fibrosis after liver transplantation in rats.Method Rats were randomly divided into control group Ⅰ and control group Ⅱ[(supplied livers were preserved for 1 or 12 h),ketanserin group (recipients of control group Ⅱ were intraperitoneally injected with ketanserin 24 h postoperatively at the dosage of 5 mg · kg-1 · day-1),and sham group (rats were subjected to transverse laparotomy and closure without manipulation of the liver).During 4-week observation period,serum biliary enzymes,5-HT content in the liver,the expression of fibrosis-related genes,cholangiocytes proliferation and biliary fibrosis were evaluated.Result Compared with the sham group,the serum ALP,GGT,TBil and 5-HT contents in the liver homogenate were increased on the postoperative day 1 (POD1) and then restored to the normal level.There was slight proliferation of bile duct epithelial cells on POD3 in the control group Ⅰ,with fewer collagen fibers and α-sooth muscle actin (α-SMA)-positive myofibroblasts in the portal area.The expression of matrix metalloproteinase-2 (MMP-2) and procollagen α1-mRNA in graft livers was not significantly increased in the control group Ⅰ.To the contrast,the control group Ⅱ demonstrated high levels of serotonin in the liver homogenate and enhanced serum biliary enzymes.Active cholangiocytes proliferation was triggered on POD3 and remained higher than in the control group Ⅰ and the sham group.The control group Ⅱ showed a large number of α-SMA-positive myofibroblasts and collegan fibers at the postoperative week 4.In parallel,the major profibrogenic transcripts MMP2 and procollagen α1 were significantly increased at 2nd,and 4th week postoperation in the control group Ⅱ.Importantly,we also found that ketanserin relieved the signs of biliary fibrosis at 4th week postoperation in 5-HT2A group by the demonstration of reduced collagen fibers and a-SMA-positive myofibroblast in the portal area,as well as the decrease in the fibrosis-related gene expression.In addition to the lower cholangiocytes proliferation,serum levels of biliary enzymes including GGT,ALP and TBil in 5-HT2A group were significantly decreased at 4th week postoperation as compared with the control group Ⅱ.Conclusion Selective 5-HT2A receptor antagonist,Ketanserin retards biliary fibrosis progression posttransplantation,suggesting that 5-HT2A receptor is a potential therapeutic target for ischemia-related biliary fibrosis after DCD liver transplantation.

Objective To explore the status and influencing factors of surgical site infection (SSI)following lapa-roscopic surgery in patients in department of general surgery,so as to take effective measures to reduce SSI. Methods Active monitoring method was used to survey SSI among 401 patients undergoing laparoscopic surgery from January 1 ,2013 to December 31 ,2013,univariate analysis and multivariate analysis on risk factors for SSI were conducted.Results Of 401 investigated patients,12 (2.99%)developed SSI.Univariate analysis showed that risk factors for SSI in patients with laparoscopic surgery were elderly patients,emergency operation,infected wound,gastrointestinal tract operation,and grade Ⅳof ASA score (all P <0.05 ).Multivariate logistic regression analysis revealed that elderly patients (OR,5.02[95%CI ,1 .38 -30.25]),emergency operation (OR,4.37 [95%CI ,1 .96-28.55]),infected wound (OR,7.27[95%CI ,2.54-25.05]),and gastrointestinal tract operation (OR, 8.13 [95%CI ,1 .38 - 18.33 ])were high risk factors for SSI following laparoscopic surgery (all P < 0.05 ). Conclusion Thereare multiple factors influencing SSI after laparoscopic surgery,diversified prevention and control measures can effectively reduce the incidence of postoperative SSI.

Objective To investigate the clinical utility of keyhole craniotomy for Cholesteatmas in the cerebello-pontine angle region presenting as Trigeminal neuralgia by using keyhole craniotomy. Methods Clinical data of 35 pa-tients with Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia was analyzed retrospec-tively. All patients received suboccipital retrosigmoid keyhole craniotomy. Thirty cases who received conventional craniot-omy group were served as control group. A comparative analysis was conducted to assess the difference between these two groups in microsurgical methods, effects and complications. Results All patients were confirmed with MR diagnosis. In keyhole group, all patients had no pain symptoms of trigeminal neuralgia after surgical operation. The symptoms disap-peared immediately in 33 cases and gradually disappeared in 2 cases within one month following keyhole craniotomy. The tumors were totally removed in 25 cases and almost completely in 10 cases. The surgical duration was shorten in key-hole group than in conventional group (126±48 vs. 216±66 min;t=2.536, P<0.05). The amount of bleeding was smaller in keyhole group than in conventional group (91.3±52.2 vs. 186.3±65.4 mL;t=2.163, P<0.05). Postoperative neurologi-cal function was assessed in House-Brackmann. In keyhole group, there were 32 cases in class Ⅰ and 3 in grade Ⅱ. Two patients had hearing loss which was improved gradually in three months. In conventional group, there were 25 cases in class Ⅰ and 5 in grade Ⅱ (χ2=4.158, P<0.05). Postoperative hearing evaluation (AAO-HNS) revealed that there were 33 cases in grade A , and 2 in grade B in the keyhole group, whereas there were 27 cases in grade A and 3 in grade B in the conventional group(χ2=5.167, P<0.05). There were no relapse of tumors and death during 3 month to 5 years follow-up. Conclusions The suboccipital retrosigmoid keyhole craniotomy is a valid choice for Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia.

Objective To investigate the association between the minisatellite polymorphism in the first exon of PLA2G4C gene and schizophrenia, and to reveal the important role of DNA sequence polymorphism in the pathogenesis of schizophrenia.Methods The minisatellite polymorphisms in the first exon of PLA2G4C gene in 91 patients with schizophrenia (case group)and 81 healthy persons (control group)were detected with PCR-sequencing analysis.The chi-square (χ2 )goodness-of-fit test was used to analyze the distribution of the PLA2G4C minisatellite polymorphism in various groups and to explore the association between the minisatellite polymorphism in the first exon of PLA2G4C gene and schizophrenia. Results There were minisatellite polymorphisms in PLA2G4C gene.Three kinds of polymorphisms 1×27 bp,2×27 bp and 3×27 bp were found by sequencing.The distribution of allelic frequencies at PLA2G4C polymorphism showed no statistical significance between case group and control group (P>0.05 ). No statistically significant difference was found in 3-homozygous haplotypes in PLA2G4C gene between case group and control group (P>0.05).At the same time,there was no statistically significant difference between 3-heterozygous haplotypes in PLA2G4C gene between case group and control group (P>0.05).Conclusion The minisatellite polymorphisms in the first exon of PLA2G4C gene are found,but the minisatellite polymorphism in the first exon of PLA2G4C gene may be not associated with the occurrence of schizophrenia.

Objective To explore whether inhibiting autophagy can enhance the sensitivity of photothermal treatment under mild photothermal conditions. Methods CQ@PLGA@PDA NPs were prepared by an improved double emulsification method and a PDA-based surface modification method. After basic characterization, CCK-8 method was used to detect the cytotoxicity of nanoparticles; the near-infrared laser irradiation nanoparticle solution was used to detect the heating effect; CCK-8 method and live-dead cell staining were used to detect the killing effect of tumor cells; Western blot was used to detect the expression of autophagy-related proteins. Results The CQ@PLGA@PDA NPs were successfully prepared, with a particle size of 253.10±2.39 nm, a zeta potential of -22.57±0.80 mV, uniform particle size and good dispersion. The temperature of nanoparticle solution increased to 45℃ after the near-infrared laser irradiation for 10 min. CQ@PLGA@PDA NPs had no obvious toxicity to cells. The survival rates of breast cancer cell MDA-MB-231 and mouse embryonic fibroblast NIH-3T3 cell were above 95%. The inhibition of autophagy under mild photothermal conditions could improve the sensitivity of photothermal therapy. Conclusion The prepared CQ@PLGA@PDA NPs have good photothermal performance and high biological safety; by inhibiting autophagy, they can effectively kill tumor cells under mild photothermal conditions(< 50℃).

Objective:To study the effects of T-2 toxin on expression of fibroblast growth factor 8 (FGF8) and fibroblast growth factor receptor 3 (FGFR3) in articular cartilage and subchondral marrow of rats under low selenium condition, and to explore the mechanism of deep cartilage injury and secondary complications in Kaschin-Beck disease (KBD).Methods:Twenty-four healthy male SD rats weighted 60 - 80 g were selected, they were divided into conventional feed group (selenium content of 101.5 μg/kg) and low-selenium feed group (selenium content of 1.1 μg/kg) by random number table method, with 12 rats in each group. After 30 days of feeding, the conventional feed group was further divided into control group and T-2 toxin group (100 μg·kg -1·d -1), and the low-selenium feed group was further divided into low-selenium group and low-selenium+ T-2 toxin group, with 6 rats in each group. After 30 days of feeding, the rats were sacrificed and the knee cartilage with cancellous bone was taken. Pathological changes of knee cartilage were observed by HE staining. Immunohistochemical method was used to detect the expression of FGF8 and FGFR3 in cartilage and subchondral marrow of knee joint, positive expression rates of FGF8 and FGFR3 in articular cartilage were calculated, and the integrated optical density (IOD) values of FGF8 and FGFR3 positive expression in subchondral marrow were analyzed by Image-Pro Plus 6.0 software. Results:Under light microscope, chondrocytes in low-selenium+ T-2 toxin group were sparse, and empty chondrocytes in the deep and middle layers of articular cartilage increased, and chondrocytes died and became red cell shadows. The extracellular matrix dissolved and was slightly stained in deep region, turning into necrotic and unstructurized areas. Proliferating granulation tissue was visible nearby. The positive expression rate of FGF8 in articular cartilage of rats in low-selenium+ T-2 toxin group [(88.61 ± 10.97)%] was higher than that in control, low-selenium and T-2 toxin groups [(10.35 ± 2.48)%, (19.26 ± 3.08)%, (58.89 ± 9.29)%, P < 0.05]; IOD value of FGF8 positive expression in subchondral marrow [(16.73 ± 1.72) × 10 6] was higher than that in control, low-selenium and T-2 toxin groups [(1.20 ± 0.41) × 10 6, (4.33 ± 0.97) × 10 6, (12.80 ± 1.12) × 10 6, P < 0.05]. The positive expression rate of FGFR3 in articular cartilage of rats in low-selenium+ T-2 toxin group [(89.76 ± 8.59)%] was higher than that in control, low-selenium and T-2 toxin groups [(13.18 ± 2.25)%, (21.15 ± 2.33)%, (32.55 ± 6.72)%, P < 0.05]; IOD value of FGFR3 positive expression in subchondral marrow [(16.50 ± 5.36) × 10 6] was higher than that in control, low-selenium and T-2 toxin groups [(7.58 ± 1.02) × 10 6, (10.73 ± 7.13) × 10 6, (9.83 ± 5.63) × 10 6, P < 0.05]. Conclusion:Under low selenium condition, T-2 toxin changes expression of FGF8 and FGFR3 in deep chondrocytes of articular cartilage and subchondral marrow in rats, elevated expression of FGF8 and FGFR3 may be involved in the occurrence and development of secondary changes in KBD.

Objective To investigate the predictive effect of antithrombin Ⅲ(AT-Ⅲ)combined with procalcitonin(PCT)on sepsis-associated acute kidney injury(SA-AKI).Methods A total of 96 patients with sepsis who met the inclusion criteria were in-cluded,all patients were divided into the AKI group(n=42)and non-AKI group(n=54),and the data between the two groups were compared.We used the receiver operating characteristic(ROC)curves to evaluate the predictive effect of antithrombin Ⅲ level,procalCI tonin level,and combination on SA-AKI.Multivariate Logistic regression analysis was used to study the influencing factors of SA-AKI.Results The proportion of PCT,CRP,fibrinogen,SOFA score,APACHE Ⅱ score,vasoactive drug use,and blood purification applica-tion in the AKI group was higher than that in the non-AKI group(P＜0.05),as well as the AT-Ⅲ,and platelet count were lower than those in the non-AKI group(P＜0.05).The area under the ROC curve for predicting SA-AKI in patients with sepsis was 0.876(95％CI:0.793-0.935,P＜0.01),the sensitivity was 78.6％,and the specificity was 88.9％.Multivariate Logistic regression anal-ysis showed that AT-Ⅲ(OR=0.907,95％CI:0.860-0.956)and PCT(OR=1.037,95％CI:1.002-1.074)were independent influencing factors for SA-AKI.Conclusion AT-Ⅲ combined with PCT could be used to predict SA-AKI and has good predictive ef-ficacy.

Objective:To explore the effectiveness of applying the ADDIE (analysis, design, develop, implement, evaluate) Model in clinical teaching for nursing interns in spine surgery department.Methods:Using a convenience sampling method, 44 nursing interns in the Department of Orthopedics at Peking Union Medical College Hospital were selected as the control group from July 2021 to May 2022, and were taught using traditional methods. From July 2022 to May 2023, 45 nursing interns were selected as the observation group, and a teaching team was formed to design a training program based on the five stages of the ADDIE instructional design model. This program was tailored to improve the overall clinical competence of the spinal surgery nursing interns. After training, the teaching effects were evaluated based on knowledge test scores, skills test scores, overall clinical competence, and teaching satisfaction.Results:After the training, the skills test scores in specialized nursing for the observation group were (94.87±1.10) points, higher than the control group's (93.98±1.41) points, with a statistically significant difference ( P<0.01). The observation group also scored higher than the control group in clinical judgment, organizational effectiveness, overall performance, and total score in the Mini-Clinical Evaluation Exercise, with statistically significant differences ( P<0.01). Additionally, the observation group reported higher satisfaction with the teaching plan and methods compared to the control group ( P<0.05) . Conclusions:Clinical teaching for spinal surgery nursing interns based on the ADDIE instructional design model can improve their specialized practical skills and overall clinical competence. The interns also expressed a high level of acceptance for this teaching design model.

Retinal vein occlusion-induced macular edema(RVO-ME)is a severe complication of retinal vein occlusion, known for its challenging treatment, persistence, and tendency to recur. Recent studies have demonstrated that combined therapy offers advantages over single therapy, effectively reducing macular edema, enhancing visual function, decreasing the frequency of treatments, lowering overall costs, and easing the patient's burden. This approach addresses the limitations of single treatment methods and has garnered significant clinical interest. This article reviews the current status and future prospects of combined treatments for RVO-ME.

BACKGROUND/AIMS: Patients with irritable bowel syndrome (IBS) are characterized by abnormal central processing with altered brain activation in response to visceral nociceptive signals. The effect of electroacupuncture (EA) on IBS patients is unclear. The study is set to study the effect of EA on brain activation during noxious rectal distension in IBS patients using a randomized sham-controlled model. METHODS: Thirty IBS-diarrhea patients were randomized to true electroacupuncture or sham acupuncture. Functional MRI was performed to evaluate cerebral activation at the following time points: (1) baseline when there was rectal distension only, (2) rectal distension during application of EA, (3) rectal distension after cessation of EA and (4) EA alone with no rectal distension. Group comparison was made under each condition using SPM5 program. RESULTS: Rectal distension induced significant activation of the anterior cingulated cortex, prefrontal cortex, thalamus, temporal regions and cerebellum at baseline. During and immediately after EA, increased cerebral activation from baseline was observed in the anterior cingulated cortex, bilateral prefrontal cortex, thalamus, temporal regions and right insula in both groups. However, true electroacupuncture led to significantly higher activation at right insula, as well as pulvinar and medial nucleus of the thalamus when compared to sham acupuncture. CONCLUSIONS: We postulate that acupuncture might have the potential effect of pain modulation in IBS by 2 actions: (1) modulation of serotonin pathway at insula and (2) modulation of mood and affection in higher cortical center via ascending pathway at the pulvinar and medial nucleus of the thalamus.
Acupuncture ; Acupuncture Therapy ; Brain ; Cerebellum ; Electroacupuncture ; Humans ; Irritable Bowel Syndrome ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Neural Pathways ; Pain Perception ; Prefrontal Cortex ; Pulvinar ; Salicylamides ; Serotonin ; Thalamus