Objective To assess the prognostic significance of serum cystatin C(CysC)in combination with bedside renal ultrasound for patients diagnosed with sepsis-induced acute kidney injury(AKI).Methods The study cohort comprised 134 patients with sepsis-induced AKI who were admitted to our hospital between October 2019 and October 2023.Based on the 30 day prognosis,the patients were categorized into a survival group(n=93)and a death group(n=41).Collected clinical data included gender,age,heart rate,underlying diseases,treat-ment modalities,duration of hospital stay,basic biochemical indicators,and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)scores.Renal function markers such as serum creatinine(SCr),blood urea nitrogen(BUN),and cystatin C levels were measured;renal blood flow resistance index(RI)was assessed using bedside routine ultrasound.Cox regression analysis was employed to evaluate factors influencing poor prognosis in patients with sepsis-induced AKI while analyzing the prognostic assessment value of combining cystatin C with bedside renal ultrasound through ROC curves.Results The death group exhibited significantly higher APACHEⅡ scores,SCr,BUN,CysC levels,and RI(all P<0.05)compared to the survival group.Cox regression analysis revealed that both CysC levels and RI were significant prognostic indicators(P<0.05).ROC curve analysis demonstrated that the combined assessment of CysC levels and RI yielded a high diagnostic accuracy of 97.5%in predicting outcomes for patients with sepsis-induced AKI.Conclusion CysC levels and bedside renal ultrasound can serve as prognostic indicators for patients with sepsis-induced acute kidney injury(AKI),thereby guiding clinical treatment.

Objective:To establish a rat model of transverse tibial bone transfer on the diabetic foot.Methods:A diabetic model was created by intraperitoneal injection of streptozotocin into 40 SD rats after 5 weeks of high-fat feeding, taking random blood glucose ≥16.7 mmol/L as the criterion for successful modeling. Changes in body weight, food intake, water intake, faecal output and blood glucose were monitored every week after the acclimatization period until random blood glucose ≥16.7 mmol/L was observed for 3 running weeks. After the blood glucose was stabilized, 34 surviving diabetic rats were divided into 2 groups using a random number table. In the experimental group, a transverse transfer outer frame was installed and transverse tibial bone transfer performed after removal of the skin over the dorsal foot; in the control group, a transverse transfer outer frame was installed and the skin over the dorsal foot removed but no transverse tibial bone transfer performed. The wound changes were recorded on the 1, 5, 10, 15 and 20 days after installation of the transverse transfer outer frame. After completion of transverse tibial bone transfer (24 days after modeling of transverse tibial bone transfer), one rat was randomly chosen from each of the 2 groups for angiography while the rest rats were sacrificed for observation of the skin changes on the lower limbs. The densitometric values of CD31 immunohistochemical staining were compared between the 2 groups.Results:The random blood glucose increased from (6.89±1.03) mmol/L before modeling to (25.91±6.42) mmol/L at the last test, keeping at ≥16.7 mmol/L for 3 running weeks. The percentages of ulcer healing of the foot dorsal wound in the experimental group on days 5, 10, and 20 were significantly higher than those in the control group ( P<0.05). Gross observation and angiography found more abundant vessels in the lower extremity on the side of transverse transfer in the experimental group. The immunohistochemical staining of the lower limb skin tissue for CD31 found an AOD value of 0.60±0.23 in the experimental group, significantly higher than that in the control group (0.37±0.13) ( t=3.722, P=0.001). Conclusion:A rat model of transverse tibial bone transfer has been successfully established through installation of a self-designed transverse transfer outer frame on the basis of a successful rat model of diabetic foot, characterized by improved microcirculation in the lower limbs.

Objective:To explore the effects of 3 osteotomy methods on the bone healing in Ilizarov tibial bone transport.Methods:The data of 93 patients were retrospectively reviewed who had been treated by Ilizarov single-segment tibial bone transport at Department of Hand Surgery, The Second Hospital of Tangshan from December 2003 to April 2019. Minimally invasive osteotomy was performed in 16 patients [group A: 16 males with an age of (37.1±8.3) years; 5 cases of type Ⅱ and 11 ones of type Ⅲ by Gustilo classification], subperiosteal saw osteotomy in 57 patients [group B: 47 males and 10 females with an age of (39.1±11.8) years; 17 cases of type Ⅱ and 40 ones of type Ⅲ by Gustilo classification] and extraperiosteal wire saw osteotomy in 20 patients [group C: 19 males and one female with an age of (37.7±11.2) years; 18 cases of type Ⅱ and 2 cases of type Ⅲ by Gustilo classification]. The 3 groups were compared in terms of the bone healing index and the Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores.Results:The 3 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). All the patients were followed up for 19 to 50 months (average, 27.4 months). All patients achieved bony healing, and their associated complications were cured after corresponding treatments. There were no significant differences in the bone healing index between the 3 groups [(53.09±21.88) d/cm for group A, (59.97±33.29) d/cm for group B and (46.20±14.11) d/cm for group C] ( P>0.05). There were no significant differences either in the good to excellent rate by the ASAMI functional scores between the 3 groups (87.5% for group A, 89.5% for group B and 90.0% for group C) ( P> 0.05). Conclusion:All the 3 osteotomy methods may achieve good bony union, leading to similar bone healing indexes and postoperative functional scores.

Objective:To explore the risk factors of skin flap pigmentation after repairing skin and soft tissue defects of extremities using cutaneous neurovascular flap and to give some suggestions for prevention and treatment.Methods:From January 2013 to March 2020, 160 cases of extremities cutaneous nerve vascular flap with survival in Tangshan Second Hospital were retrospectively studied. According to the occurrence of pigmentation, they were divided into two groups: Group A (pigmentation group) and Group B (non-pigmentation group). The observation indexes included sex, age, injury cause, defect size, complete debridement, anastomosis of skin flap, sunscreen measures and postoperative infection. First, univariate analysis was carried out to screen the influencing factors of pigmentation in the cutaneous neurovascular flap, and then Logistic regression was used for multivariate analysis to screen the risk factors.Results:The postoperative follow-up time was 12 to 24 months, with an average of 17.9 months. A total of 29 patients (18.1%) had skin flap pigmentation. Univariate analysis showed that there was no significant difference in sex, age, cause of injury and defect area between the two groups ( P>0.05). Further multivariate analysis showed that incomplete debridement, lack of venous anastomosis, failure to take sunscreen measures and postoperative infection were the risk factors of pigmentation of cutaneous neurovascular flap ( OR=0.310, 0.335, 0.355、5.878, 95% CI=0.112-0.863, 0.115-0.975, 0.133-0.949, 2.069-16.697, P<0.05). Conclusions:Incomplete debridement, lack of venous anastomosis, failure to take sunscreen measures and postoperative infection are the risk factors resulting in pigmentation of neurovascular flap. It is important to perform prevention to reduce the incidence of pigmentation.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective To investigate the changes of extraceUular regulated kinase 1/2 (ERK1/2) phosphorylation and assess the effects of blocking the ERK1/2 phosphorylation on rats with acute necrotizing pancreatitis (ANP). Methods The ANP model was induced by retrograde injection of 5% sodium tanrocholate into the biliary and pancreatic duct. 5 rats were treated as normal control. Other 75 Sprague-Dawley (SD) rots were randomly divided into sham operations(SO) group (n =25), ANP group (n =25) and PD98059 group (n =25). The rats were sacrificed at 15 min, 30 min, 1 h, 3 h and 6 h after ANP induction, the blood and pancreatic sample were taken. Pathological changes of pancreas were observed with light microscope and scored. The serum level of TNF-α and IL-1β was determined by ELISA. MPO activities in pancreas were measured by enzyme chemistry assay. Western blotting was performed to determine the phosphorylations of ERK1/2 in the pancreas homogenates. Results There was no significant pathologic changes in rats of SO group;but significant injuries occurred in ANP group, the pathologic score at 3 h was 9.9 ± 0.4;the extent of injuries attenuated in PD98059 group, the pathologic score at 3 h was 4.0 ± 0.4 (P < 0.05). The serum levels of TNF-α at 3 h in SO, ANP and PD98059 groups were (65.8 ± 20.5) pg/ml, (286.5 ± 50.3) pg/ml, (180.4±32.9)pg/ml, respectively;the serum levels of IL-1β at 3 h in SO, ANP and PD98059groups were (85.8 ± 25.5) pg/ml, (293.8 ± 46.3) pg/ml, (200. 5 ± 33.6) pg/ml, respectively;MPOactivities in pancreas were (0. 19 ± 0.02)U/g, (0.61±0.05)U/g, (0.52±0.03) U/g, and the values in ANP and PD98059 groups were significantly higher than those in SO group, while the values in PD98059 group were significantly lower than those in ANP group (P < 0.01). The expression of ERK1/2 phosphorylation in normal pancreas was 1100 ± 141, the expressions of ERK1/2 phosphorylation in ANP group at 15 min, 30 min were 5300 ± 486, 5621 ± 384, respectively;the expressions began to decrease 1 h later and returned the similar level as SO group at 6 h;the expressions of ERK1/2 phosphorylation in PD98059 group at 15 min, 30 rain were 4200 ± 370, 3600 ± 290, respectively;which were signifieanfly lower than those in ANP group (all P value < 0. 01). Conclusions The ERK1/2 signal transduetion pathway plays an important role in the pathogenesis of ANP. Inhibition of ERK1/2 phosphorylation by PD98059 may decrease the production of IL-1β, TNF-α and pancreatic MPO, attenuate the extent of pancreatic pathologic injuries.

Objective To investigate the expression of Fascin mRNA and its protein in human pancreatic carcinoma cell line and pancreatic cancer tissues and to explore the relationship between the expression of Fascin protein and the clinicopathologic parameters. Methods The expression of Fascin mRNA in pancreatic cancer cell lines (SW1990, Patu8988, BxPC3, cfPAC1) were measured by RT-PCR and the expression of Fascin protein in 54 samples of pancreatic career tissues and 42 adjacent normal pancreatic tissues was detected by immunohistochemical method. Results The expression of Fascin mRNA was confirmed in 3 of 4 pancreatic cancer cell lines (SW1990, Patu8988, cfPAC1), but not in the cell line of BxPC3; the rate of positive expression of Fascin protein in pancreatic cancer tissues was 64.81% (35/54) and there was no positive expression in adjacent normal pancreas tissues; the expression of Fascin protein correlated with the differentiation degree (P < 0.01) and with the lymphatic metastasis of the carcinoma (P <0.05), but not with the size and distant metastasis of the carcinoma (P > 0. 05). Conclusions Fascin protein was highly positively expressed in pancreatic cancer tissues, and the expression of Fascin protein may help diagnose pancreatic, carcinoma and predict the malignant degree.

Objective To investigate the effect of esophageal mucosal acid exposure on visceral sensation of patients with non-erosive gastroesophageal reflux disease (NERD) and to evaluate the role of visceral hypersensitivity in NERD pathogenesis. Methods We recruited 21 NERD patients and 10 normal healthy volunteers. Mechanical distentions stimulation and acid perfusion through esophagus were performed using the balloon-affixed and polyvinyl multilumen catheter. Esophageal visceral perception thresholds were examined before and after acid perfusion with esophageal balloon distention by means of a computer-controlled barostat. Results As compared with healthy subjects, NERD patients demonstrated significantly lower initial perception threshold and maximally tolerated pain threshold (P

OBJECTIVETo determine the efficacy of adenovirus mediated suicide gene transduction combined with prodrug 5-fluorocytosine (5FC) as a therapeutic protocol for pancreatic cancer.

METHODSCytosine Deaminase(CD) gene was cloned into pAdTrack-CMV-CD, pAdTrack-CMV-CD and pAdEasy-1 were recombined in bacteria. The newly recombined adenovirus (Ad)-CD containing green fluorescent protein (GFP) were packaged and propagated in 293 cells and purified by cesium chloride gradient centrifugation. Human pancreatic carcinoma cell line-Patu8988 was infected with this virus, then 5FC was added. XTT assay was used to estimate relative numbers of viable cells. In vivo model of pancreatic cancer was established by injecting 1.0 x 10(7) Patu8988 cells subcutaneously in Balb/c nude mice. When tumors were palpable, Ad-CD was injected into each tumor and 5FC was administered.

RESULTSPositive clones were selected using endonuclease to digest the recombinants and the concentration of viral liquids containing the CD gene was 2 x 10(11) pfu /ml. Significant cytotoxic activity as shown for 5FC in the CD gene transduced 8988 cell line, while little effect was found in the nontransduced pancreatic carcinoma cells. Antitumor effect was observed in Patu8988 xenograft nude mice with in situ CD gene transduction.

CONCLUSIONSCD gene mediated by adenovirus has high infectivity and may be useful for gene therapy in pancreatic carcinoma. These data demonstrate the use of an enzyme prodrug strategy in experimental pancreatic cancer.

Adenoviridae ; genetics ; Animals ; Cytosine Deaminase ; Gene Transfer Techniques ; Genetic Therapy ; Genetic Vectors ; Humans ; Mice ; Mice, Inbred BALB C ; Nucleoside Deaminases ; genetics ; Pancreatic Neoplasms ; therapy

Objective To explore the potential role of cytokine-induced neutrophil chemoattractant (CINC) and monocyte chemoattractant protein-1/JE (MCP-1/JE) in the pathogenesis of early acute pancreatitis(AP). Methods Acute edematous pancreatitis(AEP) and acute necrotizing pancreatitis(ANP) were induced by retrograde infusion of 0.5% or 5% sodium taurocholate into the biliary pancreatic duct. The activity of serum amylase and the level of serum calcium were studied, wet to weight ratio,the activity of myeloperoxidase (MPO) and pathological changes of pancreas were observed. The expression of gene and protein of CINC and MCP-1/JE in pancreatic constitution were detected. Results Compared with that in controls,pancreatic acinar cells were found to express CINC and MCP-1/JE protein in certain intensity. With the induction and the progress of AP,the expression of the activity of MPO,CINC and MCP-1/JE gene in pancreatic parenchyma were all significantly increased ( P