Objective To determine platelet count (PLT),mean platelet volume (MPV),and hemodynamic changes in patients with cir-rhotic portal hypertension (CPH)post splenectomy plus pericardial devascularization (SPPD),and to assess the surgical effect on coagula-tion function.Methods A retrospective analysis was performed on 83 CPH patients undergoing SPPD in our hospital from January 2008 to December 2012.Results Compared with preoperative levels,postoperative portal venous pressure decreased,blood flow was reduced,and portal vein diameter was significantly reduced;additionally,postoperative hepatic artery diameter was increased,and hepatic artery blood flow increased.Blood alanine aminotransferase,albumin,total protein,and fibrinogen levels,thrombin time,and MPV did not significantly change 30 days postoperatively versus 7 days preoperatively(P>0.05 );the corresponding total bilirubin,activated partial thromboplastin time and prothrombin time relatively declined(P<0.05),whereas PLT and prothrombin time activity increased(P<0.05).There was a significant increase in PLT (P<0.05)but no significant change in MPV 30 days postoperatively versus 7 days preoperatively (P>0.05). Conclusion SPPD can significantly improve liver functional reserve and coagulation function in patients with CPH.

Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 80 years by analyzing the surgical treatment procedures. Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2000 and June 2008. There were 25 males and 36 females, at average age of 83.4 years (80-94 years). Of all, there were 53 patients with fresh fractures including six with type Garden Ⅰ or Ⅱ fractures and 47 with type Garden Ⅲ or Ⅳ fractures, eight with old fractures ( all type Garden Ⅳ). Fifty-one patients (84%) were accompanied with preexisted internal medical or neurological diseases. Six patients with type Garden Ⅰ or Ⅱ fractures were treated with cannulated screw fixation (CSF). Among 55 patients with type Garden Ⅲ or Ⅳ fractures inclu-ding 47 fresh fractures and 8 old ones, 53 patients were treated by hip hemiarthroplasty (HHA) but the other two by cemented total hip arthroplasty (THA) because of preexisting hip osteoarthritis. Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group, 81 minutes and 180 ml in HHA group, 105 minutes and 350 ml in THA group. Fifteen patients (25%) had postoperative com-plications, mostly hypotension, cardiac insufficiency and atrial fibrillation, accounting for 12%. Postoperative hemoglobin was decreased by 11.9%, 17.1% and 18. 1% on average respectively in CSF group, HHA group and THA group, and postoperative albumin decreased by 10.8%, 18. 1% and 20.2% on average respectively in CSF group, HHA group and THA group. There were 17 patients (28%) with hemoglobin below 100 g/L and four (7%) with albumin below 30 g/L after operation. Conclusions The patients aged ≥80 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurological diseases and have high risk in operation. Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.

Objective To investigate the role of hybrid bone grafting using autograft and freezedried allograft bone in restoration of acetabular bone defect,as well as to evaluate the clinical results of this grafting technique combined with acetabular scaffold in dealing with massive acetabular deficiency.Methods Between April 1999 to December 2007,18 patients (19 hips) underwent acetabular revision by using a mixture of autograft and allogenic freeze-dried cancellous bone particles plus acetabular scaffold.There were 8males and 10 females,aged from 33 to 76 years (average,64.7 years).The acetabular defects were caused by aseptic loosening of primary total hip arthroplasty in 17 patients and osteoarthritis secondary to osteotomy in 1 case of acetabular dysplasia.There were 5 cases of Paprosky Ⅱ B defect,2 Paprosky Ⅱ C defect,6 Paprosky ⅢA defect and 6 Paprosky ⅢB defect.Results All patients were followed up for 3.6 to 12.3 years (average,6.5 years).Harris hip score improved from preoperative 38.7±9.6 to 87.6±7.8 at final follow-up.According to X-rays,bone incorporation evidenced by trabecular bridging of the host-donor interface was found at 3to 6 months postoperatively,and effective bone incorporation was achieved in all cases one year postoperatively.Polyethylene wear occurred in one case.Acetabular component loosening was not found at final follow up.Conclusion Impacted bone grafting using a mixture of autograft and freeze-dried allograft bone can efficiently restore acetabular bone defect.Adding autograft bone to freeze-dried allograft bone is a highly effective way of achieving graft incorporation.Hybrid bone grafting technique with acetabulum scaffold is an attractive option for the treatment of extensive acetabular deficiency.

Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage.

OBJECTIVETo study the effect of chromomycin A(2) in inducing apoptosis of HepG2 cells and explore the molecular mechanism.

METHODSHepG2, MCF-7, A549, and 7901 cells were exposed to chromomycin A(2) and the changes in the cell viability were detected using MTT assay. The changes in the chromatins were observed with laser scanning confocal microscope after incubation of the cells with chromomycin A(2) (60 nmol/L) for 24 h. The changes in cell morphology were examined with a phase-contrast microscope, and the apoptotic cell populations, fluorescent intensity of reactive oxygen species (ROS) and mitochondrial membrane potential were determined using flow cytometry.

RESULTSChromomycin A(2) significantly inhibited the proliferation of the cells in a time- and dose-dependent manner, and caused changes in the cell morphology and cell apoptosis. Exposure of the cells to chromomycin A(2) resulted in chromatin condensation, ROS generation, and reduction of the mitochondrial membrane potential.

CONCLUSIONIncreased ROS and mitochondria damage may importantly contribute to chromomycin A(2)-induced apoptosis in HepG2 cells.

Apoptosis ; drug effects ; Cell Survival ; Hep G2 Cells ; drug effects ; Humans ; Membrane Potential, Mitochondrial ; Mitochondria ; pathology ; Plicamycin ; analogs & derivatives ; pharmacology ; Reactive Oxygen Species ; metabolism

Objective:To explore the characteristics and typology of self-care behavior among patients with chronic heart failure (CHF), and analyze their influencing factors.Methods:A cross-sectional study was used. A total of 318 patients with CHF who were hospitalized in the Heart Center of Zhongshan Hospital, Fudan University from November 2022 to July 2023 were selected by continuous enrollment method. The General Information Questionnaire, Heart Failure Self-care Index Scale, Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease 6-item Scale, Perceived Social Support Scale, Atlanta Heart Failure Knowledge Test-V2 and Self-Care Confidence Scale were used to investigate. Latent profile analysis was utilized to delineate the characteristics and subtypes of self-care behaviors in CHF patients and examine the influencing factors.Results:A total of 291 patients were included in this study, including 190 males and 101 females, aged 67 (61, 74) years old. The analysis identified three latent categories of self-care behaviors among CHF patients: 26 cases in high self-care group, 131 cases in moderate self-care with deficiencies in maintenance and symptom perception group, and 134 cases in low self-care group.Ordered multicategorical Logistic regression analysis revealed that age ( OR=1.023, 95% CI 1.001-1.046, P<0.05), self-care confidence ( OR=0.859, 95% CI 0.817-0.904, P<0.01), and social support ( OR=0.966, 95% CI 0.940-0.993, P<0.05) were the factors influencing the potential categories of self-care behavior in CHF patients. Conclusions:The study identifies distinct categorical characteristics of self-care behaviors in patients with CHF. Healthcare professionals can leverage these findings to identify the self-care behavior characteristics and influencing factors for each patient category at an early stage, thereby providing personalized and precise support strategies to help patients enhance self-care behaviors.

Objective To explore the functional connectivity characteristics and intensity of brain network in depression at rest.Methods Patients with major depressive disorder(MDD)and healthy controls(HCs)underwent resting state functional magnetic resonance imaging.The total brain degree centrality(DC)of the two groups was calculated to assess the functional connection strength.Support vector machine(SVM)method was used to investigate whether abnormal DC value can recognize MDD.Results A total of 26 patients and 37 controls were included in the analysis.Compared to HCs,MDD group showed decreased DC value in the left middle frontal gyrus(t=-4.98,P＜0.05,GRF corrected)and increased DC value in the right middle temporal gyrus(t=5.02,P＜0.05,GRF corrected),right parahippocampal gyrus(t=4.80,P＜0.05,GRF corrected),and right posterior cerebellar gyrus(t=4.98,P＜0.05,GRF corrected).Additionally,no significant correlations were found between abnormal DC values and clinical variables(i.e.,17-item Hamilton depression scale and Beck depression scale scores)in MDD group(P＞0.05).SVM analysis showed that decreased DC value in the left middle frontal gyrus might be used to distinguish MDD group from HCs with an accuracy of 84.13%,a specificity of 81.08%,and a sensitivity of 88.46%,the area under the operational characteristic curve is 0.87.Conclusions Altered DC values in the left middle frontal gyrus and right middle temporal gyrus,right parahippocampal gyrus,right posterior cerebellum may contribute to the pathophysiology of MDD.The change of functional connection strength of the left medial frontal gyrus may be helpful for the recognition of MDD.