Objective:To compare the effect of two hemostatic drugs, tranexamic acid and hemocoagulase, on postoperative bleeding in adult patients with Kashin-Beck disease undergoing total knee arthroplasty.Methods:A retrospective analysis was conducted to select 80 adult patients with Kashin-Beck disease who underwent unilateral primary total knee arthroplasty at Linyou County Hospital from January 2021 to March 2023. According to the inclusion and exclusion criteria, 19 cases with chronic anemia, long-term oral anticoagulants implanted with cardiac stents, and hematological diseases were excluded. Among the remaining 61 adult patients, 24 cases with preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity were selected as the experimental group, and 37 cases with preoperative intravenous application combined with intraoperative local application of hemocoagulase in articular cavity were selected as the control group. The preoperative general condition, postoperative drainage volume, total perioperative blood loss, occult blood loss, and hemoglobin levels at different time points before and after surgery were compared between the two groups of patients.Results:There was no statistically significant difference in age, gender distribution, body mass index, preoperative hemoglobin level, preoperative prothrombin time, and preoperative activated partial thromboplastin time between the two groups of patients ( P > 0.05). The total perioperative blood loss [(1 027.78 ± 472.71) ml], drainage volume 48 h after surgery [(336.67 ± 112.74) ml] in the experimental group were all lower than those in the control group [(1 390.39 ± 454.01), (498.65 ± 187.57) ml], and the differences were statistically significant ( P < 0.05). The hemoglobin levels on the second and fifth day after surgery were significantly higher than those in the control group, and the differences were statistically significant ( P < 0.05). Conclusion:For total knee arthroplasty for adult patients with Kashin-Beck disease, preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity is superior to hemocoagulase, which can effectively reduce total perioperative blood loss and postoperative drainage volume, and is worthy of clinical promotion.

Adrenocortical carcinoma（ACC）is a rare and highly aggressive malignant tumor. Currently，mitotane is the first-line treatment. However，reports on neoadjuvant therapy for ACC using mitotane combined with immune checkpoint inhibitors remain scarce. This article reports a case of ACC. The patient was asymptomatic，and a right adrenal mass was detected during examination. Diagnostic imaging and endocrine evaluation confirmed the diagnosis of ACC. Due to the large tumor size，radical resection was initially considered unfeasible. After 7 months of mitotane therapy and two courses of tislelizumab，significant tumor shrinkage was achieved，allowing for successful open resection of the large right adrenal tumor combined with right nephrectomy. Postoperative histopathological examination confirmed the diagnosis of ACC. During the 3-month postoperative follow-up，no evidence of recurrence or metastasis was observed.

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) in improving early enteral nutrition tolerance in patients with acute pancreatitis (AP) under the concept of accelerated rehabilitation, and to explore the related mechanism based on the changes in autonomic nerve characteristics. METHODS: A total of 42 patients with AP were randomized into an observation group (21 cases, 1 case dropped out) and a control group (21 cases, 1 case dropped out). The control group received standard basic treatment for AP. On the basis of the treatment in the control group, EA was applied in the observation group, bilateral Zusanli (ST36), Yixian point (Extra), Tianshu (ST25), Neiguan (PC6) and Zhongwan (CV12) were selected as the main points, and the supplementary points were selected according to syndrome differentiation. Ipsilateral Zusanli (ST36) and Yixian point (Extra) were connected to EA, using discontinuous wave, in frequency of 2 Hz, 30 min a time, once a day for 6 continuous days. The enteral nutrition tolerance score was observed before treatment and after 3 and 5 days of treatment; the visual analogue scale (VAS) score for abdominal pain was observed before treatment and after 3 days of treatment; the time of reaching the feeding goal and hospital stay was recorded; the levels of C-reactive protein (CRP) and amylase were measured before treatment and after 5 days of treatment; the heart rate variability (HRV) indexes (standard deviation of NN intervals [SDNN], average standard deviation of NN intervals [SDANN], root mean square of successive NN interval differences [rMSSD], low frequency [LF] and high frequency [HF], ratio of low frequency to high frequency [LF/HF]) were monitored in the two groups. RESULTS: After 3 and 5 days of treatment, the enteral nutrition tolerance scores were decreased compared with those before treatment in both groups (P<0.01), the reductions in the observation group were larger than those in the control group (P<0.01). After 3 days of treatment, the VAS scores for abdominal pain were decreased compared with those before treatment in both groups (P<0.01), the reduction in the observation group was larger than that in the control group (P<0.01). The time of reaching the feeding goal and hospital stay in the observation group was shorter than that in the control group (P<0.05). After 5 days of treatment, the CRP and amylase levels were decreased compared with those before treatment in both groups (P<0.01), the reduction of CRP level in the observation group was larger than that in the control group (P<0.01). In the observation group, SDNN, SDANN and LF/HF were lower than those in the control group (P<0.05, P<0.01), while rMSSD was higher than that in the control group (P<0.01). SDNN, SDANN and LF/HF were positively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.05), while rMSSD was negatively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.01). CONCLUSION Electroacupuncture can improve enteral nutrition tolerance in patients with AP by regulating autonomic nervous function, alleviating the inflammation, promoting accelerated recovery, and reducing the length of hospital stay.
Humans ; Electroacupuncture ; Male ; Female ; Enteral Nutrition ; Middle Aged ; Adult ; Pancreatitis/physiopathology* ; Aged ; Acupuncture Points ; Young Adult ; Acute Disease/therapy* ; Autonomic Pathways/physiopathology*

Objective:To compare the effect of two hemostatic drugs, tranexamic acid and hemocoagulase, on postoperative bleeding in adult patients with Kashin-Beck disease undergoing total knee arthroplasty.Methods:A retrospective analysis was conducted to select 80 adult patients with Kashin-Beck disease who underwent unilateral primary total knee arthroplasty at Linyou County Hospital from January 2021 to March 2023. According to the inclusion and exclusion criteria, 19 cases with chronic anemia, long-term oral anticoagulants implanted with cardiac stents, and hematological diseases were excluded. Among the remaining 61 adult patients, 24 cases with preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity were selected as the experimental group, and 37 cases with preoperative intravenous application combined with intraoperative local application of hemocoagulase in articular cavity were selected as the control group. The preoperative general condition, postoperative drainage volume, total perioperative blood loss, occult blood loss, and hemoglobin levels at different time points before and after surgery were compared between the two groups of patients.Results:There was no statistically significant difference in age, gender distribution, body mass index, preoperative hemoglobin level, preoperative prothrombin time, and preoperative activated partial thromboplastin time between the two groups of patients ( P > 0.05). The total perioperative blood loss [(1 027.78 ± 472.71) ml], drainage volume 48 h after surgery [(336.67 ± 112.74) ml] in the experimental group were all lower than those in the control group [(1 390.39 ± 454.01), (498.65 ± 187.57) ml], and the differences were statistically significant ( P < 0.05). The hemoglobin levels on the second and fifth day after surgery were significantly higher than those in the control group, and the differences were statistically significant ( P < 0.05). Conclusion:For total knee arthroplasty for adult patients with Kashin-Beck disease, preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity is superior to hemocoagulase, which can effectively reduce total perioperative blood loss and postoperative drainage volume, and is worthy of clinical promotion.

Adrenocortical carcinoma（ACC）is a rare and highly aggressive malignant tumor. Currently，mitotane is the first-line treatment. However，reports on neoadjuvant therapy for ACC using mitotane combined with immune checkpoint inhibitors remain scarce. This article reports a case of ACC. The patient was asymptomatic，and a right adrenal mass was detected during examination. Diagnostic imaging and endocrine evaluation confirmed the diagnosis of ACC. Due to the large tumor size，radical resection was initially considered unfeasible. After 7 months of mitotane therapy and two courses of tislelizumab，significant tumor shrinkage was achieved，allowing for successful open resection of the large right adrenal tumor combined with right nephrectomy. Postoperative histopathological examination confirmed the diagnosis of ACC. During the 3-month postoperative follow-up，no evidence of recurrence or metastasis was observed.

The CRISPR/Cas9 based prime editing (PE) technique enables all 12 types of base substitutions and precise small DNA deletions or insertions without generating DNA double-strand breaks. Prime editing has been successfully applied in plants and plays important roles in plant precision breeding. Although plant prime editing (PPE) can substantially expand the scope and capabilities of precise genome editing in plants, its editing efficiency still needs to be further improved. Here, we review the development of PPE technique, and introduce structural composition, advantages and limitations of PPE. Strategies to improve the PPE editing efficiency, including the T_m-directed PBS length design, the RT template length, the dual-pegRNA strategy, the PlantPegDesigner website, and the strategies for optimizing the target proteins of PPE, were highlighted. Finally, the prospects of future development and application of PPE were discussed.
CRISPR-Cas Systems/genetics* ; DNA ; Gene Editing ; Genome, Plant/genetics* ; Plant Breeding ; Plants/genetics*

Objective To study and analyze the therapeutic effects of intravenous low dose recombinant tissue plasminogen activator (rt-PA) in the treatment of transient ischemic attack (TIA).Methods A total of 86 TIA patients were selected as the research subjects and divided into observation group (intravenous low dose rt-PA thrombolysis treatment combined with aspirin antiplatelet therapy applied,41 cases) and the control group (single aspirin antiplatelet therapy applied,45 cases) according to the treatment methods.The plasma tissue plasminogen activator (t-PA),the plasminogen activator inhibitor-1 (PAI-1) on admission,at 1,3,7,14 d of the treatment were detected and compared.The control rates of TIA of the patients in the two groups were observed and compared.The patients in the two groups were followed up for 1 year,the ratios of transformation to acute cerebral infarction in the two groups were observed and compared.Results At 1,3 d of the treatment,the plasma t-PA levels of the patients in the observation group were significantly higher than that in the control group,and the differences between the two groups were statistically significant (P ＜ 0.05).At every time points before and after the treatment,the differences of the plasma PAI-1 levels between the two groups were not statistically significant (P ＞ 0.05).There were no statistically significant differences in control rates of TIA in each period of time between the patients in the two groups (P ＞ 0.0 5).During the period of following-up,there were 2 cases and 4 cases of patients with transformation to acute cerebral infarction in the observation group and the control group,respectively,and there was no significant differences in the ratios of transformation to acute cerebral infarction between the two groups (P ＞ 0.05).Conclusion The application of intravenous infusion of low dose of rt-PA for thrombolysis on the basis of the antiplatelet therapy of aspirin can increase the plasma t-PA level in early period of patients with TIA,help to reduce the risk of thrombosis,but has no obvious influences on the plasma PAI-1 levels,the clinical efficacy and the long-term prognosis.

Objective To study and analyze the therapeutic effects of intravenous low dose recombinant tissue plasminogen activator (rt-PA) in the treatment of transient ischemic attack (TIA).Methods A total of 86 TIA patients were selected as the research subjects and divided into observation group (intravenous low dose rt-PA thrombolysis treatment combined with aspirin antiplatelet therapy applied,41 cases) and the control group (single aspirin antiplatelet therapy applied,45 cases) according to the treatment methods.The plasma tissue plasminogen activator (t-PA),the plasminogen activator inhibitor-1 (PAI-1) on admission,at 1,3,7,14 d of the treatment were detected and compared.The control rates of TIA of the patients in the two groups were observed and compared.The patients in the two groups were followed up for 1 year,the ratios of transformation to acute cerebral infarction in the two groups were observed and compared.Results At 1,3 d of the treatment,the plasma t-PA levels of the patients in the observation group were significantly higher than that in the control group,and the differences between the two groups were statistically significant (P ＜ 0.05).At every time points before and after the treatment,the differences of the plasma PAI-1 levels between the two groups were not statistically significant (P ＞ 0.05).There were no statistically significant differences in control rates of TIA in each period of time between the patients in the two groups (P ＞ 0.0 5).During the period of following-up,there were 2 cases and 4 cases of patients with transformation to acute cerebral infarction in the observation group and the control group,respectively,and there was no significant differences in the ratios of transformation to acute cerebral infarction between the two groups (P ＞ 0.05).Conclusion The application of intravenous infusion of low dose of rt-PA for thrombolysis on the basis of the antiplatelet therapy of aspirin can increase the plasma t-PA level in early period of patients with TIA,help to reduce the risk of thrombosis,but has no obvious influences on the plasma PAI-1 levels,the clinical efficacy and the long-term prognosis.

Objective To evaluate the effect of special rectification of clinical antimicrobial use in a hospital. Methods Medical records of patients receiving inguinal hernia repair before (in 2011)and after (in 2012)the per-formance of special rectification were reviewed,and the rationality of perioperative antimicrobial prophylaxis was compared.Results Prophylactic antimicrobial usage rate in patients receiving inguinal hernia repair decreased from 53.90%(76/114)in 2011 to 5.59%(10/179)in 2012,the difference was significant (χ2 =93.68,P <0.05);aver-age expense of antimicrobial use per patient decreased by 86.95% (from ￥ 624.73 in 2011 to ￥ 81 .52 in 2012);Combination use and single use was 93.42% and 80.00% respectively.Surgical site infection did not occur in both groups.Conclusion Through the special rectification activities of the clinical antimicrobial use,perioperative anti-microbial prophylaxis and expense of antimicrobial agents in patients receiving inguinal hernia repair is effectively re-duced.

Objective To observe the effect of acupuncture, neuromuscular electrical stimulation and swallowing training on acute stroke patients with dysphagia and the incidence of post-stroke pneumonia (PSP). Methods Acute stroke patients with dysphagia were divided into 3 groups. Routine group (n=188) received routine swallowing training. Stimulation group (n=196) received routine swallowing training and neuromuscular electrical stimulation. Acupuncture group (n=112) received routine swallowing training, neuromuscular electrical stimulation, and acupuncture. The incidence of improvment of dysphagia and PSP, and the improvement of National Institutes of Health Stroke Scale (NIHSS) within 3 weeks were compared. They were followed up for 3 months for the incidence of PSP. Results The incidence of improvment of dysphagia was the most in the acupuncture group (P<0.05), while the incidence of PSP was the least (P<0.05). The improvement of NIHSS was the most in the acupuncture group (P<0.05). The incidence of PSP was not significantly different (P>0.05) within 3 months followed up. Conclusion The acupuncture, neuromuscular electrical stimulation and swallowing training combination can improve the swallowing function and decrease the incidence of PSP in stroke patients with dysphagia.