Venous system diseases mainly include varicose veins and venous malformations of lower limbs and the genital system. Most of them are chronic diseases that cause serious clinical symptoms to patients and affect their health and quality of life. Sclerotherapy has become the first-line therapy for venous system diseases. However, there are problems such as incomplete fibrosis and vascular recanalization after sclerotherapy, and improper operation will cause serious adverse consequences. Therefore, exploring a safe and effective sclerotherapy strategy is essential for developing clinically successful sclerotherapy. To solve the above problems, we proposed a new sclerotherapy strategy with a dual mechanism of "vascular damage and plasmin (PLA) system inhibition." We intended to construct a novel cationic surfactant (AEO_x-TA) by reacting tranexamic acid (TA), a parent structure, with fatty alcohol polyoxyethylene ether (AEO_x) by ester bonds. AEO_x-TA could damage vascular endothelium and initiate a coagulation cascade effect to induce thrombus. Furthermore, AEO_x-TA could be degraded by esterase and release the parent drug, TA, which could inhibit the PLA system to inhibit the degradation of thrombus and extracellular matrix and promote the process of vascular fibrosis. In addition, such surfactant-based sclerosants have foam-forming properties, and they can be blended with polyvinyl alcohol (PVA) to prepare a highly stable foam formulation (AEO_x-TA/P), which can achieve a precise drug delivery and prolonged drug retention time, thereby improving drug efficacy and reducing the risk of ectopic embolism. Overall, the novel cationic surfactant AEO_x-TA provides a new avenue to resolve the bottleneck: surfactant sclerosants' efficiency is relatively low in the current sclerotherapy.

OBJECTIVE: To analyze the efficacy and access safety of extracorporeal membrane oxygenation (ECMO) in series with continuous renal replacement therapy (CRRT) access for critically ill patients using propensity score matching analysis, and to explore the potential influencing factors of infection. METHODS: A total of 200 critically ill patients who received both ECMO and CRRT treatment in the intensive care unit (ICU) of Huai'an Second People's Hospital from December 2020 to December 2024 were retrospectively selected as the research subjects. They were divided into the independent operation group (72 cases) and the series system group (128 cases) according to the access connection mode of ECMO and CRRT. Propensity score matching analysis was used to perform 1 : 1 matching for patients of the two groups. The general data [age, gender, body mass index (BMI), clinical diagnosis, underlying disease, intubation method, intubation position, disease severity, ECMO support duration, catheter indwelling duration, oxygenation index (PaO₂/FiO₂) at 48 hours after ECMO initiation, serum creatinine (SCr), procalcitonin (PCT), hemoglobin (Hb), white blood cell count (WBC), platelet count (PLT)], treatment status [ECMO initiation duration, ECMO operation duration, ECMO flow, left ventricular ejection fraction (LVEF), CRRT initiation duration, CRRT catheter indwelling duration, inflow and outflow volume of replacement fluid], clinical outcome indicators (28-day survival rate, length of ICU stay, renal function recovery, fluid balance compliance rate), and access safety indicators (incidence of ECMO access thrombosis, incidence of infection, and incidence of bleeding events) of all the patients were collected. Subgroup analysis was conducted based on the occurrence of infection, and multivariate Logistic regression analysis was used to screen the potential risk factors for infection in critically ill patients receiving both ECMO and CRRT treatment. RESULTS: Finally, a total of 120 patients were successfully matched, with 60 patients in both the independent operation group and the series system group. No statistically significant differences were observed in the general data between the two groups, indicating comparability. Compared with the independent operation group, the ECMO flow at 48 hours after ECMO initiation, SCr, and alanine transaminase (ALT) of the patients in the series system group were significantly decreased, while the LVEF at 48 hours after ECMO initiation was significantly increased, additionally, the CRRT initiation duration, CRRT catheter indwelling duration, and the length of ICU stay were significantly shortened, and the inflow and outflow volume of replacement fluid were significantly increased. The incidence of infection and bleeding events in the series system group was significantly lower than that in the independent operation group [infection incidence: 11.67% (7/60) vs. 36.67% (22/60), bleeding event incidence: 8.33% (5/60) vs. 48.33% (29/60), both P < 0.05]. No significant difference was found in the other general data, treatment status, clinical outcome indicators, or access safety indicators between the two groups. Among the 120 patients, 29 cases developed infection (accounting for 24.17%), and 91 cases had no infection (accounting for 75.83%). Compared with the non-infection group, the catheter indwelling duration was significantly prolonged and PCT was significantly increased in the infection group, while the PLT and the proportion of patients with ECMO and CRRT access connected via the series system were significantly decreased. Multivariate Logistic regression analysis showed that catheter indwelling duration [odds ratio (OR) = 1.277, 95% confidence interval (95%CI) was 1.001-1.629, P = 0.049], PCT (OR = 1.529, 95%CI was 1.222-1.914, P < 0.001], PLT (OR = 0.953, 95%CI was 0.926-0.981, P = 0.001), and access connection mode (OR = 0.289, 95%CI was 0.090-0.930, P = 0.037) were potential risk factors for infection in critically ill patients. CONCLUSIONS The ECMO-in-series CRRT access can accelerate the initiation of CRRT, avoid local bleeding, stabilize patients' cardiac, hepatic and renal functions, reduce potential infection risks, and improve the prognosis of patients.
Humans ; Extracorporeal Membrane Oxygenation/adverse effects* ; Critical Illness/therapy* ; Retrospective Studies ; Continuous Renal Replacement Therapy ; Male ; Female ; Intensive Care Units ; Propensity Score ; Middle Aged ; Renal Replacement Therapy ; Adult ; Aged ; Risk Factors

Background:Following the short-term outbreak of coronavirus disease 2019(COVID-19)in December 2022 in China,clinical data on kidney transplant recipients(KTRs)with COVID-19 are lacking.Methods:We conducted a single-center retrospective study to describe the clinical features,complications,and mortality rates of hospitalized KTRs infected with COVID-19 between Dec.16,2022 and Jan.31,2023.The patients were followed up until Mar.31,2023.Results:A total of 324 KTRs with COVID-19 were included.The median age was 49 years.The median time between the onset of symptoms and admission was 13 d.Molnupiravir,azvudine,and nirmatrelvir/ritonavir were administered to 67(20.7%),11(3.4%),and 148(45.7%)patients,respectively.Twenty-nine(9.0%)patients were treated with more than one antiviral agent.Forty-eight(14.8%)patients were treated with tocilizumab and 53(16.4%)patients received baricitinib therapy.The acute kidney injury(AKI)occurred in 81(25.0%)patients and 39(12.0%)patients were admitted to intensive care units.Fungal infections were observed in 55(17.0%)patients.Fifty(15.4%)patients lost their graft.The 28-d mortality rate of patients was 9.0%and 42(13.0%)patients died by the end of follow-up.Multivariate Cox regression analysis identified that cerebrovascular disease,AKI incidence,interleukin(IL)-6 level of>6.8 pg/mL,daily dose of corticosteroids of>50 mg,and fungal infection were all associated with an increased risk of death for hospitalized patients.Conclusions:Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality.The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival,while higher doses of corticosteroids may increase the death risk.

Objective To explore the safety and efficiency of sequential operation of Tirelizumab combined with chemotherapy in neoadjuvant therapy for locally advanced esophageal cancer.Methods A retrospective analysis was conducted on 60 patients with locally advanced esophageal cancer admitted to Renmin Hospital of Wuhan University from August 2018 to June 2022.The immunotherapy combined with chemotherapy sequential surgery patients were selected as the observation group(29 cases)and the chemotherapy sequential surgery patients were selected as the control group(31 cases)according to the treatment method.The study aimed to analyze whether there were differences in efficacy and safety between the two groups.Results There are 28 patients with R0 resection in the observation group,and 14 case reached ORR.In the control group,29 cases were resected with R0,and 7 cases reached ORR.The proportion of ORR patients in the observation group was significantly higher than that in the control group,which was statistically significant(P＜0.05).There were 9 patients with pCR in the observation group and 2 patients with pCR in the control group,and the proportion of pCR patients in the two groups was significantly different(P＜0.05).There were no significant differences between the two groups for preoperative and postoperative adverse events.Conclusion Immune checkpoint inhibitors combined with chemotherapy sequential surgery are safe and reliable in patients with locally advanced esophageal cancer,with significant short-term efficacy,and long-term efficacy remains to be observed.

Objective To summarize the clinical experience in the treatment of postoperative upper gastrointestinal cancer of esophageal cancer.Methods The clinical data of 16 patients with postoperative upper gastrointestinal malignancies treated in our hospital from January 2018 to June 2022 were retrospectively analyzed.Results All the 16 patients successfully completed the operation,and no perioperative death occurred.The cumulative length of hospitalization was 18-38 days.After operation,2 cases of pulmonary infection,1 case of respiratory failure,and 1 case of cervical anastomotic fistula were cured after conservative treatment.All patients could eat normally during postoperative follow-up,and no tumor recurrence and metastasis was found.Conclusion For patients with recurrent upper gastrointestinal cancer after esophageal cancer surgery,if the lesion is relatively limited,surgical treatment is reliable and an optional treatment plan.

Objective To establish a novel chronic compressive cervical spinal cord injury rat model,to validate the chronic pathological characteristic.Methods Fifty-four SD rats were randomly divided into 3 groups,including control group(n =6),acute compressive group(4 h,24 h,respectively.n =6),and chronic compressive group(4 h,12 h,24 h,48 h,72 h and 1week,respectively.n =6).Two sizes of water-absorbing polyurethane polymer sheets were implanted into C5～6 epidural space on postero-lateral side in acute and chronic compressive group respectively,to induce a consistent compression in the cord after expanded.While a laminectomy on C5～6 was performed only in control group.The neurological integrity,MRI signal change in the cords,large motoneuron number in the ventral horn,and myelin staining intensity on posterior funiculus were studied.Results In the acute group at 4-24 h,the compression was confirmed significantly on T2WI image,as well as hypointense signal change intramedullary.These changes were consisted with intramedullary bleeding,tissue necrosis.Large motoneuron number(P ＜ 0.05),rather than myelin staining intensity (P ＞ 0.05),was significantly decreased compared with the control group and chronic compressive group.BBB score was 6.0 at 24 h.In the chronic group:cord distortion with progressive compression was observed on T2WI image,but without intramedullary bleeding signal change.At 4-12 h,intramedullary edema,central canal distortion were seen in the cords.Large motoneuron number and myelin staining intensity decrement were not significant(P ＞0.05).BBB score was 20.6.At 24-72 h,central canal enlargement,venous congestion,and edema were observed.Large motoneuron number was less than that in the control group.In the compressive epicenter,nerve fiber disorganization or rupture was observed.Myelin staining intensity decreased significantly after 48 h and 72 h compression (P ＜0.05).BBB score was 19.3.At lweek,vacuolation changes were noted and large motoneuron decreased (P ＜ O.05),as well as myelin density and staining intensity (P ＜ 0.05),suggesting nerve fiber demyelination.BBB score was 17.5.In the control group,there was no neurological deficit and pathological change in the cords.Conclusion The pathology and MRI characteristic consistent with chronic compressive injury change,which proved this method is able to induce a chronic course on the rat model,and established a reliable model foundation for cervical myelopathy.

Objective To investigate the clinical features,diagnosis and treatment of pure redcell aplasia cased by human parvovirus B19 infection after renal transplantation.Method The clinical data including clinical symptoms and physical signs,laboratory and pathological examinations and outcomes of treatment in 8 cases at our hospital from Aug.2011 to Mar.2012 were analyzed retrospective,and relative literatures were reviewd.Result Pure red-cell aplasia occurred in all 8 cases 1 to 3 months after kidney transplantation,and one case had recurremt pure red-cell aplasia.The manifestations including recurrent reduction of hemoglobin,and pure red-cell aplasia was definitely diagnosed by bone marrow morphology,pathology,and polymerase chain reaction assay PVB19 DNA.Treatment of intravenous immunoglobulin and conversion of tacrolimus into ciclosporin was effective.Conclusion PVB19 is a rare but clinically significant infection that manifests as pure red cell aplasia during the early post-transplantation.Treatment of intravenous immunoglobulin and conversion of tacrolimus into ciclosporin in most cases was effective.