This paper reports a case of disseminated intravascular coagulation(DIC) that occurred early after hybrid surgery for type B aortic dissection with an aortic arch aneurysm. Through analyzing the clinical manifestations, imaging findings, and treatment response of the patient, we propose that massive false-lumen thrombosis may serve as a critical trigger for early postoperative coagulation activation leading to DIC. Corresponding treatment strategies are suggested to enhance clinicians' ability to recognize and manage this critical condition.

OBJECTIVE: To investigate the role and mechanism of the cyclic guanosine monophosphate-adenosine monophosphate synthase/stimulator of interferon gene (cGAS/STING) pathway in oleic acid-induced acute lung injury (ALI) in mice. METHODS: Male wild-type C57BL/6J mice were randomly divided into five groups (each n = 10): normal control group, ALI model group, and 5, 50, 500 μg/kg inhibitor pretreatment groups. The ALI model was established by tail vein injection of oleic acid (7 mL/kg), while the normal control group received no intervention. The inhibitor pretreatment groups were intraperitoneally injected with the corresponding doses of cGAS inhibitor RU.521 respectively 1 hour before modeling. At 24 hours post-modeling, blood was collected, and mice were sacrificed. Lung tissue pathological changes were observed under light microscopy after hematoxylin-eosin (HE) staining, and pathological scores were assessed. Western blotting was used to detect the protein expressions of cGAS, STING, phosphorylated TANK-binding kinase 1 (p-TBK1), phosphorylated interferon regulatory factor 3 (p-IRF3), and phosphorylated nuclear factor-κB p65 (p-NF-κB p65) in lung tissue. Immunohistochemistry was performed to observe STING and p-NF-κB positive expressions in lung tissue. Serum interferon-β (IFN-β) levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared with the normal control group, the ALI model group exhibited significant focal alveolar thickening, intra-alveolar hemorrhage, pulmonary capillary congestion, and neutrophil infiltration in the pulmonary interstitium and alveoli, along with markedly increased pathological scores (10.33±0.58 vs. 1.33±0.58, P < 0.05). Protein expressions of cGAS, STING, p-TBK1, p-IRF3, and p-NF-κB p65 in lung tissue significantly increased [cGAS protein (cGAS/β-actin): 1.24±0.02 vs. 0.56±0.02, STING protein (STING/β-actin): 1.27±0.01 vs. 0.55±0.01, p-TBK1 protin (p-TBK1/β-actin): 1.34±0.03 vs. 0.22±0.01, p-IRF3 protein (p-IRF3/β-actin): 1.23±0.02 vs. 0.36±0.01, p-NF-κB p65 protein (p-NF-κB p65/β-actin): 1.30±0.02 vs. 0.53±0.02, all P < 0.05], positive expressions of STING and p-NF-κB in lung tissue were significantly elevated [STING (A value): 0.51±0.03 vs. 0.30±0.07, p-NF-κB (A value): 0.57±0.05 vs. 0.31±0.03, both P < 0.05], and serum IFN-β levels were also significantly higher (ng/L: 256.02±3.84 vs. 64.15±1.17, P < 0.05). The cGAS inhibitor pretreatment groups showed restored alveolar structural integrity, reduced inflammatory cell infiltration, and decreased hemorrhage area, along with dose-dependent lower pathological scores as well as the protein expressions of cGAS, STING, p-TBK1, p-IRF3 and p-NF-κB p65 in lung tissue, with significant differences between the 500 μg/kg inhibitor group and ALI model group [pathological score: 2.67±0.58 vs. 10.33±0.58, cGAS protein (cGAS/β-actin): 0.56±0.03 vs. 1.24±0.02, STING protein (STING/β-actin): 0.67±0.03 vs. 1.27±0.01, p-TBK1 protein (p-TBK1/β-actin): 0.28±0.01 vs. 1.34±0.03, p-IRF3 protein (p-IRF3/β-actin): 0.32±0.01 vs. 1.23±0.02, p-NF-κB p65 protein (p-NF-κB p65/β-actin): 0.63±0.01 vs. 1.30±0.02, all P < 0.05]. Compared with the ALI model group, positive expressions of STING and p-NF-κB in lung tissue were significantly reduced in the 500 μg/kg inhibitor group [STING (A value): 0.40±0.01 vs. 0.51±0.03, p-NF-κB (A value): 0.43±0.02 vs. 0.57±0.05, both P < 0.05], and serum IFN-β levels were also markedly reduced (ng/L: 150.03±6.19 vs. 256.02±3.84, P < 0.05). CONCLUSIONS The cGAS/STING pathway is activated in oleic acid-induced ALI, leading to exacerbated inflammatory responses and increased lung damage. RU.521 can inhibit cGAS, thereby down-regulating the expression of pathway proteins and cytokines, and providing protection to lung tissue.
Animals ; Acute Lung Injury/chemically induced* ; Male ; Nucleotidyltransferases/metabolism* ; Mice ; Signal Transduction ; Mice, Inbred C57BL ; Membrane Proteins/metabolism* ; Oleic Acid/adverse effects* ; Transcription Factor RelA/metabolism* ; Lung/pathology* ; Interferon Regulatory Factor-3/metabolism* ; Disease Models, Animal

Objective:To investigate the clinical characteristics of first-episode and recurrent acute hypertriglyceridemic pancreatitis (HTGP).Methods:The retrospective cohort study was con-ducted. The clinical data of 313 patients with HTGP admitted to 26 medical centers in China in the Chinese Acute Pancreatitis Clinical Research Group (CAPCTG)-PERFORM database from November 2020 to December 2021 were collected. There were 219 males and 94 females, aged 38(32,44)years. Of the 313 patients, 193 patients with first-episode HTGP were allocated into the first-episode group and 120 patients with recurrent HTGP were allocated into the recurrent group. Observation indica-tors: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) comparison of severity and prognosis in the course of disease within 14 days between the two groups; (3) the association between recurrent HTGP and the risk of persistent organ failure (POF); (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Wilcoxon rank sum test. The Kaplan-Meier method was used to plot the cumulative recurrence rate curve and Log-Rank test was used for survival analysis. The Logistic regression model was used for multivariate analysis, and continuous variables were converted into categorical variables according to the mean value or common criteria. Propensity score matching was performed by 1∶1 nearest neighbor matching method, with caliper value of 0.02. Paired t test or Wilcoxon rank sum test and McNemar′s test were used for comparison between matched groups. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 313 patients,208 cases were successfully matched, including 104 cases in the first-episode group and 104 cases in the recurrent group. After propensity score matching, there was no significant difference in demographic characteristics, severity of illness scores and laboratory test between the two groups ( P>0.05). The elimination of gender, acute physiology and chornic health evaluation (APACHE) Ⅱ score, computed tomography severity index score, systemic inflammatory response syndrome score, sequential organ failure assessment score, apolipoprotein E, C-reactive protein, creatinine, lactic acid dehydrogenase, procal-citonin confounding bias ensured comparability between the two groups. (2) Comparison of severity and prognosis in the course of disease within 14 days between the two groups. There were signifi-cant differences in POF and local complications between the first-episode group and the recurrent group ( P<0.05). (3) The association between recurrent HTGP and the risk of POF. Results of uncor-rected univariate analysis showed that there was no association between recurrent HTGP and the risk of POF ( odds ratio=0.78, 95% confidence interval as 0.46-1.30, P>0.05). Results of multivariate analysis after adjusting for covariates such as gender, age, APACHE Ⅱ score, C-reactive protein, triglyceride and total cholesterol showed that compared with first-episode HTGP, recurrent HTGP was associated with a higher risk of POF ( odds ratio=2.22, 95% confidence interval as 1.05-4.71, P<0.05). Results of subgroup analysis showed that age<40 years was associated with an increased risk of POF ( odds ratio=3.31, 95% confidence interval as 1.09-10.08, P<0.05). (4) Follow-up. Twelve of the 313 patients died during hospitalization, including 9 cases in the first-episode group and 3 cases in the recurrent group. The rest of 301 surviving patients, including 184 cases in the first-episode group and 117 cases in the recurrent group, were followed up for 19.2(15.5, 21.9)months. Results of follow-up showed that for 184 survived patients of the first-episode group, 164 cases were followed up and 24 cases experienced recurrence, for 117 survived patients of the recurrent group,29 cases experienced recurrence, showing a significant difference between the two groups ( χ2=4.67, P<0.05). Conclusion:Compared with first-episode HTGP, patients with recurrent HTGP are more prone to POF and local complications, and are more prone to recurrence after discharge. The risk of POF in recurrent HTGP patients is 2.22 times that of those with first-episode, and the risk is higher in patients with age <40 years.

Objective To discuss the application value of XperCT combined with needle-guided Glubran-2 glue for small pulmonary nodule localization in thoracoscopic pulmonary nodule resection.Methods The clinical data of 67 patients,who received XperCT combined with needle-guided Glubran-2 glue for small pulmonary nodule localization before thoracoscopic resection of a single small pulmonary nodule at the Jining Municipal First People's Hospital of China between June 2018 and February 2023,were retrospectively analyzed.The size of the pulmonary nodule,the maximum vertical distance from the visceral pleura to the lesion,the technical success rate of localization,the number of puncturing times,the complications,the time spent for operation,and the postoperative pathological diagnosis were recorded.Results The average size of the small pulmonary nodules in the 67 patients was 8.7 mm,and the average vertical distance from the visceral pleura to the lesion was 19.4 mm.Successful preoperative localization of nodule was accomplished in all patients.The average number of puncturing times was 1.1,and no serious complications occurred.The average time spent for operation was 12.7 min.Definite pathological results were obtained in all 67 patients.Conclusion XperCT combined with needle-guided Glubran-2 glue for small pulmonary nodule localization carries advantage of accurate localization with fewer complications.Therefore,this technique is a highly-efficient and quickly-accomplished positioning method,and it is highly valuable in clinical practice.(J Intervent Radiol,2024,33:623-626)

Objective To discuss the application of gelatin sponge-hemocoagulase plugging agent in patients with pulmonary puncture bleeding.Methods The clinical data of 43 patients with hemorrhage caused by DSA-guided lung puncture biopsy,who received gelatin sponge-hemocoagulase plugging agent treatment at the Jining Municipal First People's Hospital of China between September 2021 and May 2023,were collected,and the hemostatic effect of gelatin sponge-hemocoagulase plugging agent was analyzed.Results Successful lung puncture needle biopsy was achieved in all the 43 patients.The puncture needle channel occlusion was accomplished by using gelatin sponge-hemocoagulase plugging agent.Five minutes after occlusion treatment,in one patient,whose moderate hemoptysis with moderate bleeding shadow before puncture needle biopsy changed to bloody sputum,the intrapulmonary bleeding shadow displayed on image became slightly enlarged when compared the size five minutes ago,while in all the remaining patients successful hemostasis was achieved,the hemoptysis disappeared and the pulmonary hemorrhage shadow was similar to that five minutes ago.No occlusion-related complications occurred in all patients.Conclusion For the treatment of pulmonary hemorrhage caused by DSA-guided lung puncture biopsy,gelatin sponge-hemocoagulase plugging agent is clinically safe and effective.

Objective:To explore the causal relationship between vascular endothelial growth factor A (VEGF-A) and inflammatory bowel disease (IBD) using two-sample unidirectional Mendelian randomization (MR) analysis.Methods:Datasets based on genome-wide association studies (GWAS) of 91 inflammation-related proteins and GWAS datasets related to IBD were collected from the UK Biobank and the IEU OpenGWAS Project. With VEGF-A as the exposure factor, single nucleotide polymorphisms (SNP) associated with IBD were screened as genetic instrumental variables. The inverse variance weighted (IVW) approach served as the primary method in the two-sample unidirectional MR analysis was used to examine the potential causal link between VEGF-A and IBD. Cochran's Q test was utilized to detect potential heterogeneity, while the MR-PRESSO method and MR-Egger intercept test were employed to assess horizontal pleiotropy. A leave-one-out analysis was conducted to evaluate the sensitivity of the results. Results:GWAS data were sourced from the UK Biobank and the IEU OpenGWAS Project databases, including a total of 4 355 UC patients and 2 128 CD patients. The IVW results suggested that VEGF-A may play a protective role in the onset of UC after Bonferroni correction ( OR = 0.9993, 95% CI: 0.9985~0.99997, P = 0.0421; OR = 0.9991, 95% CI: 0.9984~0.9998, P = 0.0095), while no evidence of causal relationship with CD was found ( P = 0.5024, P = 0.3150). Subsequent meta-analysis of the MR results indicated that VEGF-A was a protective factor for UC ( OR = 0.9992, 95% CI: 0.9987~0.9997, P = 0.0011), while no causal association with CD was found ( OR = 1.0000, 95% CI: 0.9997~1.0004, P = 0.8352). The results of Cochran's Q test indicated no heterogeneity, the MR-Egger intercept suggested no horizontal pleiotropy, the MR-PRESSO outlier test detected no outliers, and the leave-one-out sensitivity analysis revealed no abnormal SNP, indicating that the causal inference from the Mendelian randomization analysis had a certain level of reliability. Conclusion:Mendelian randomization analysis indicates causal relationship between VEGF-A and reduced risk of UC, but no causal relationship is found between VEGF-A and CD.

Objective:To explore the causal relationship between vascular endothelial growth factor A (VEGF-A) and inflammatory bowel disease (IBD) using two-sample unidirectional Mendelian randomization (MR) analysis.Methods:Datasets based on genome-wide association studies (GWAS) of 91 inflammation-related proteins and GWAS datasets related to IBD were collected from the UK Biobank and the IEU OpenGWAS Project. With VEGF-A as the exposure factor, single nucleotide polymorphisms (SNP) associated with IBD were screened as genetic instrumental variables. The inverse variance weighted (IVW) approach served as the primary method in the two-sample unidirectional MR analysis was used to examine the potential causal link between VEGF-A and IBD. Cochran's Q test was utilized to detect potential heterogeneity, while the MR-PRESSO method and MR-Egger intercept test were employed to assess horizontal pleiotropy. A leave-one-out analysis was conducted to evaluate the sensitivity of the results. Results:GWAS data were sourced from the UK Biobank and the IEU OpenGWAS Project databases, including a total of 4 355 UC patients and 2 128 CD patients. The IVW results suggested that VEGF-A may play a protective role in the onset of UC after Bonferroni correction ( OR = 0.9993, 95% CI: 0.9985~0.99997, P = 0.0421; OR = 0.9991, 95% CI: 0.9984~0.9998, P = 0.0095), while no evidence of causal relationship with CD was found ( P = 0.5024, P = 0.3150). Subsequent meta-analysis of the MR results indicated that VEGF-A was a protective factor for UC ( OR = 0.9992, 95% CI: 0.9987~0.9997, P = 0.0011), while no causal association with CD was found ( OR = 1.0000, 95% CI: 0.9997~1.0004, P = 0.8352). The results of Cochran's Q test indicated no heterogeneity, the MR-Egger intercept suggested no horizontal pleiotropy, the MR-PRESSO outlier test detected no outliers, and the leave-one-out sensitivity analysis revealed no abnormal SNP, indicating that the causal inference from the Mendelian randomization analysis had a certain level of reliability. Conclusion:Mendelian randomization analysis indicates causal relationship between VEGF-A and reduced risk of UC, but no causal relationship is found between VEGF-A and CD.

Background:Ulcerative colitis(UC)is a chronic non-specific disease with potential for disability,and clinical treatment mainly relies on drugs.Currently,small molecule drugs(SMDs)have shown good application prospects.Aims:To evaluate the efficacy and safety of SMDs in the treatment of UC.Methods:Randomized controlled trials(RCTs)of SMDs in treatment of moderate-to-severe UC from CNKI,Wanfang Data,VIP,China Biomedical Literature Database,PubMed,Cochrane Library and Embase were searched from the establishment of the database to March 2024.References were screened and data extracted according to inclusion and exclusion criteria,and meta-analysis was performed using RevMan 5.3 software.Results:A total of 16 literatures involving 22 RCTs were finally included.Meta-analysis results suggested that SMDs had better efficacy indicators than placebo,such as clinical response rate(RR=1.86,95%CI:1.60-2.16,P<0.000 01),clinical remission rate(RR=3.01,95%CI:2.17-4.16,P<0.000 01),mucosal healing rate(RR=2.93,95%CI:2.27-3.79,P<0.000 01)and maintained response rate(RR=3.87,95%CI:3.11-4.81,P<0.000 01)were improved,and there was a statistical difference between them.And in terms of safety,SMDs compared to placebos,The incidence of adverse reactions(RR=1.02,95%CI:0.96-1.08,P=0.55),the incidence of serious adverse reactions(RR=0.77,95%CI:0.59-1.00,P=0.05),and the incidence of adverse reactions leading to drug withdrawal(RR=0.78,95%CI:0.59-1.02,P=0.07)were not statistically significant.Conclusions:SMDs are effective and safe in UC patients,which provides a new idea for the treatment of UC.

Background:Ulcerative colitis(UC)is a chronic non-specific disease with potential for disability,and clinical treatment mainly relies on drugs.Currently,small molecule drugs(SMDs)have shown good application prospects.Aims:To evaluate the efficacy and safety of SMDs in the treatment of UC.Methods:Randomized controlled trials(RCTs)of SMDs in treatment of moderate-to-severe UC from CNKI,Wanfang Data,VIP,China Biomedical Literature Database,PubMed,Cochrane Library and Embase were searched from the establishment of the database to March 2024.References were screened and data extracted according to inclusion and exclusion criteria,and meta-analysis was performed using RevMan 5.3 software.Results:A total of 16 literatures involving 22 RCTs were finally included.Meta-analysis results suggested that SMDs had better efficacy indicators than placebo,such as clinical response rate(RR=1.86,95%CI:1.60-2.16,P<0.000 01),clinical remission rate(RR=3.01,95%CI:2.17-4.16,P<0.000 01),mucosal healing rate(RR=2.93,95%CI:2.27-3.79,P<0.000 01)and maintained response rate(RR=3.87,95%CI:3.11-4.81,P<0.000 01)were improved,and there was a statistical difference between them.And in terms of safety,SMDs compared to placebos,The incidence of adverse reactions(RR=1.02,95%CI:0.96-1.08,P=0.55),the incidence of serious adverse reactions(RR=0.77,95%CI:0.59-1.00,P=0.05),and the incidence of adverse reactions leading to drug withdrawal(RR=0.78,95%CI:0.59-1.02,P=0.07)were not statistically significant.Conclusions:SMDs are effective and safe in UC patients,which provides a new idea for the treatment of UC.

Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn's disease(CD),is a systemic inflammatory disease.Nicotinamide adenine dinucleotide(NAD+)is widely used as a cofactor or substrate in biochemical reactions and is closely related to physical health.The close relationship between IBD and NAD+has been widely recognized.Ital homeostasis depends on the balance of NAD+ synthesis and breakdown,and therapeutic approaches designed to target the NAD+ pathway are expected to be used in treating IBD.This article reviews the research progress of NAD+ metabolism in treating IBD and provides directions for applying NAD+-related therapies in the treatment of IBD.