Objective:To investigate the prognoses of pulmonary adenocarcinoma patients with leptomeningeal metastases (LM) and explore their influencing factors.Methods:A retrospective analysis was performed. The clinical data, imaging features and treatment plans of pulmonary adenocarcinoma patients with LM admitted to our hospital from January 2010 to June 2021 were collected. Overall survival (OS) was used as the prognostic evaluation criterion and patients were divided into good prognosis group (OS≥6 months) and poor prognosis group (OS<6 months) accordingly. Logistic regression analysis was used to evaluate the influencing factors for prognoses of pulmonary adenocarcinoma patients with LM. These patients were grouped according to different Karnofsky performance status (KPS) scores and different treatment methods, and survival curves were drawn to compare their OS.Results:A total of 173 pulmonary adenocarcinoma patients with LM were enrolled in the study, including 75 with good prognosis and 87 with poor prognosis. There were significant differences in the KPS scores, pulmonary adenocarcinoma lesion controlled status, giving third generation tyrosine kinase inhibitor (TKI) therapy or not, giving systemic chemotherapy and/or whole brain radiotherapy or not between the two groups ( P<0.05). Multivariate Logistic regression analysis showed that KPS scores and pulmonary adenocarcinoma lesion controlled status were independent influencing factors for prognoses ( OR=4.186, 95%CI: 1.583-11.070, P=0.004; OR=4.198, 95%CI: 1.499-11.760, P=0.006). Survival curves showed median OS of 8.2 months for all patients ( 95%CI: 6.5-9.8). The OS in patients with low-risk(KPS scores≥60) was significantly higher than that in patients with high-risk(KPS scores<60), that in patients accepted TKI treatment was significantly higher than that in patients not accepted TKI treatment, and that in patients accepted TKI and systemic chemotherapy was significantly higher than that in patients accepted TKI alone ( P<0.05). Conclusion:Patients with high KPS scores and controlled pulmonary adenocarcinoma can have relatively good prognosis; TKI treatment and combination therapy may prolong OS of these patients.

Objective To evaluate the effect of oxycodone on intestinal ischemia-reperfusion injury in rats and the role of autophagy.Methods Twenty-four healthy adult male Sprague-Dawley rats,aged 6-9 weeks,weighing 180-220 g,were divided into 4 groups (n =6 each) using a random number table method:sham group (group S),intestinal I/R group (group I/R),oxycodone group (group O) and oxycodone plus autophagy inhibitor 3-methyladenine (3-MA) group (group O+3-MA).Intestinal I/R was induced via clamping the superior mesenteric artery for 1 h,followed by 2-h reperfusion in all the groups except for group S.Oxycodone 0.5 mg/kg was injected via caudal vein at 15 min before ischemia in group O and group O+3-MA.3-MA 30 mg/kg was intraperitoneally injected at 10 min before ischemia in group O+3-MA.Rats were gavaged with fluorescein-isothiocyanate-conjugated dextran (FITC-dextran) immediately before ischemia.Blood samples were collected from the cardiac apex at 2 h of reperfusion to detect the level of serum FITC-dextran.Blood samples were collected from the cardiac apex at 2 h of reperfusion to measure the concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) in serum by enzyme-linked immunosorbent assay.Small intestinal tissues were obtained at 2 h of reperfusion for examination of the pathological changes and for determination of the expression of occludin,Beclin-1 and microtubule-associated protein 1 light chain 3 (LC3) (by Western blot).Intestinal damage was assessed and scored according to Chiu.The ratio of LC3 Ⅱ expression to LC3 Ⅰ expression (LC3 Ⅱ / Ⅰ) was calculated.Results Compared with group S,the Chiu's score,levels of serum FITC-dextran,TNF-α and IL-1β and LC3 Ⅱ/Ⅰ ratio were significantly increased,the expression of Beclin-1 was up-regulated,and the expression of occludin was down-regulated in group I/R (P＜0.05).Compared with group I/R,the Chiu's score and levels of serum FITC-dextran,TNF-α and IL-1β were significantly decreased,LC3 Ⅱ / Ⅰ ratio was increased,and the expression of occludin and Beclin-1 was up-regulated in group O (P＜0.05),and no significant change was found in the parameters mentioned above in group O+ 3-MA (P＞0.05).Compared with group O,the Chiu's score and levels of serum FITC-dextran,TNF-α and IL-1β were significantly increased,LC3 Ⅱ / Ⅰ ratio was decreased,and the expression of occludin and Beclin-1 was down-regulated in group O + 3-MA (P＜ 0.05).Conclusion Oxycodone can ameliorate intestinal I/R injury,and the mechanism may be related to enhancing autophagy in intestinal tissues of rats.

Objective To explore the expression of mitochondrial ubiquitin ligase(MITOL)in the cere-brospinal fluid from patients with postherpetic neuralgia(PHN). Methods A total of 45 patients who were diag-nosed with PHN in our hospital from August 2015 to December 2016 were enrolled in this study,and 38 gender-and age-matched patients with lumbar disc herniation were recruited as IDH group.The MITOL was measured by the ELISA and Western blot methods.The correlation between the expression of MITOL in cerebrospinal fluids and clinical characteristics of patients with PHN was evaluated.Results The expression of MITOL was significantly in-creased in cerebrospinal fluids of patients with PHN compared with IDH,and it was associated with age and the pain intensity(P<0.05).Logistic regression analysis showed age(OR,2.717)and the pain intensity(OR,3.042) were risk factors for PHN. Conclusions The expression of MITOL is significantly increased in the cerebrospinal fluid of PHN,which may be associated with age and pain intensity.

Objective To evaluate the effect of oxycodone pretreatment on oxygen-glucose deprivation and restoration (OGD/R)-induced injury to small intestinal epithelial cells of rats and the role of different opioid receptors.Methods IEC-6 cells were divided into 5 groups (n=15 each) using a random number table:control group (group C),group OGD/R,oxycodone group (group O),μ opioid receptor antagonist CTOP plus oxycodone group (group CTOP+O) and κ opioid receptor antagonist BNI plus oxycodone group (group BNI+O).Cells were cultured for 8 h in normal culture atmosphere in group C.Cells were subjected to OGD for 4 h followed by restoration of oxygen-glucose supply in normal culture medium for 4 h in OGD/R,O,CTOP+O and BNI+O groups.Oxycodone at a final concentration of 1 μg/ml was added at 5 min before OGD/R in O,CTOP+O and BNI+O groups.CTOP and BNI at a final concentration of 5 μmol/L were added at 10 min before OGD/R in group CTOP+O and group BNI+O,respectively.Five holes in each group were selected at 8 h of OGD/R for determination of the cell viability (by MTT assay),lactic dehydrogenase (LDH) release rate (by colorimetry) and levels of tumor necrosis factor-alpha (TNF-α),interleukin-1beta (IL-1β) and high-mobility group box 1 protein (HMGB1) in supernatant (by enzyme-linked immunosorbent assay).Results Compared with group C,the cell viability was significantly decreased,and the LDH release rate and levels of TNF-α,IL-1β and HMGB1 were increased in OGD/R,O,CTOP+Oand BNI+ O groups (P＜ 0.05).Compared with group OGD/R,the cell viability was significantly increased,and the LDH release rate and levels of TNF-o,IL-1β and HMGB1 were decreased in group O (P＜0.05).Compared with group O,the cell viability was significantly decreased,and the LDH release rate and levels of TNF-α,IL-1β and HMGB1 were increased in CTOP+O and BNI+O groups (P＜0.05).Conclusion Oxycodone pretreatment can mitigate OGD/R-induced injury to small intestinal epithelial cells of rats and the mechanism is related to activating μ and κ opioid receptors.

OBJECTIVE: To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China. METHODS: The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI. RESULTS: A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI. CONCLUSIONS The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
Abdomen ; surgery ; Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; General Surgery ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; prevention & control ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; prevention & control

OBJECTIVETo investigate the major influence factors of child neglect among rural areas children aged 3-6 years in China.

METHODSAccording to multi-stage stratified cluster sampling, distribution characteristics and the level of economic development, we randomly sampled 10 provinces, 26 cities (8 capital cities, 16 prefecture-level cities and 2 municipalities) using lottery method. Depending on the different level of economic and cultural, we sampled one medium county from each city (municipalities sampled two counties), a total of 28 counties. All towns were divided into high, medium and low three levels in accordance with economic and cultural, each level sampled one town, each conty sampled three towns, a total of 84 towns were sampled. Each town sampled 40 children, including 20 boys and 20 girls (including each 10 children aged 3 to 6, half and half boys and girls). 4 096 rural children aged 3-6 years old were sampled and surveyed of China. Based on "the Neglect Norms for Children Aged 3 to 6 Years Old in Rural Areas of China" explored the risk factors of child neglect. SPSS 18. 0 for windows was employed for statistics analysis. Multifactorial analysis was conducted through multivariate Logistic Regression.

RESULTSThe total neglected rate of the rural children aged 3 to 6 was 53.7% (2,047/3,810), and the total neglected degree was 44.42±7.57. The multivariate logistic regression analysis showed that, neglected risk of the boys was higher than the girls (OR=1.30, 95% CI: 1.13-1.49), neglected risk of children were higher, when their mothers were migrant workers (OR=2.18, 95% CI: 1.59-3.00); the lower educational level of mothers, the higher neglected risk of children, the children in families that mothers only received primary education or was uneducated were most likely to be neglected (OR=2.92, 95% CI: 1.91-4.47), the second was the families that mothers received primary education (OR=1.86, 95% CI: 1.29-2.69); the lower the household income, the easier to be neglected the children, the easiest one was the household income less than 5000 RMB (OR=2.85, 95% CI: 2.14-3.79), the second was 5000-9,999 RMB (OR=1.76, 95% CI: 1.40-2.20); the relationship between children and mothers was distanced, neglect risk of children was higher (OR=3.88, 95% CI: 1.31-11.52); left behind children were easier to be neglected (OR=1.30, 95% CI: 1.09-1.54).

CONCLUSIONThe influence factors among children aged 3-6 years in the rural areas of China were boys, mother's occupation, maternal education level, the relationship between children and mothers, household income and left-behind children.

Child Abuse ; Child, Preschool ; China ; Demography ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Mothers ; Risk Factors ; Rural Population ; Surveys and Questionnaires ; Transients and Migrants

Objective To evaluate the effects of different head-down tilt (HDT) angles on respiratory mechanics and cerebral circulation during laparoscopic radical resection of rectal carcinoma in the patients.Methods Thirty patients of both sexes,aged 40-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index ＜ 30 kg/m2,scheduled for elective laparoscopic radical resection of rectal carcinoma,were included in the study.Anesthesia was induced with midazolam,fentanyl,propofol and cis-atracurium and maintained with targetcontrolled infusion of propofol and remifentanil and cis-atracurium when needed.At 5 min after supine position,5 min after 30° HDT,5 min after 35° HDT,5 min after 40° HDT,and 30 min after pneumoperitoneum (T1-5),airway pressure (Paw),peak airway pressure (PIP),lung compliance (Cpat) and jugular bulb blood pressure (JBP) were recorded.Blood samples were taken from the radial artery and jugular bulb for blood gas analysis and arterial partial pressure of oxygen (PaO2),partial pressure of carbon dioxide in artery (PaCO2),arterial oxygen saturation (SaO2),jugular bulb oxygen partial pressure (PjvO2),and jugular bulb venous saturation (SjvO2) were recorded at each time point mentioned above.Results Paw,PIP,MAP,PaCO2,JBP,PjvO2 and SjvO2 were significantly increased as compared with those obtained when the patients were in supine position,increased gradually with the increasing HDT angles,and decreased to the level obtained when the patients were in supine position at 30 min after pneumoperitoneum.Cpat and PaO2 were significantly decreased as compared with those obtained when the patients were in supine position decreased gradually with the decreasing HDT angles,and increased to the level obtained when the patients were in supine position at 30 min after pneumoperitoneum.Conclusion HDT-induced effects on respiratory mechanics and cerebral circulation increase with increasing angles during laparoscopic radical resection of rectal carcinoma; thus the optimum HDT angle is smaller than 40° for the patients undergoing this kind of surgery.

OBJECTIVETo explore the characteristics of cell apoptosis and proliferation of corpus cavernosum smooth muscle (CCSM) cells in diabetic rats.

METHODSFrom a SD rat model of diabetes induced by a single dose of streptozotocin, CCSM cells were isolated for primary culture and identified using immunocytochemical assays for SMα-actin. The proliferation of CCSM cells was evaluated by WST-1 assay, and flow cytometry was used to detect the cells apoptosis. Real-time fluorescence quantitative RT-PCR (qRT-PCR) was used to analyze the relative expression of proliferation cell nucleus antigen (PCNA) and caspase-3 mRNA.

RESULTSThe proliferation rate of the primarily cultured CCSM cells from diabetic rats was significantly decreased and the apoptosis rate significantly increased compared with those of the cells from the control rats. The expression of PCNA mRNA was significantly lowered while caspase-3 mRNA significantly increased in the corpus cavernosum of the diabetic rats (P<0.001).

CONCLUSIONIn rats with persisted hyperglycemia, a higher apoptosis rate and a lower proliferation rate both contribute to the reduction of CCSM cells.

Animals ; Apoptosis ; physiology ; Cell Proliferation ; Diabetes Mellitus, Experimental ; pathology ; Male ; Myocytes, Smooth Muscle ; pathology ; Penis ; cytology ; physiopathology ; Primary Cell Culture ; Proliferating Cell Nuclear Antigen ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley

Objective To explore the surgical methods for unstable fractures of distal radius and evaluate the clinical results. Methods A retrospective analysis was conducted on 87 patients with unstable fractures of distal radius treated surgically from May 2001 to June 2008. According to AO classification and comminution severity, three methods including plate fixation, external fixation and Kirschner' s pins and plate fixation plus external fixation were employed accordingly. Results Of all, 78 patients were followed up for average 18 months. The result of Cooney's assessment of the wrist was excellent in 44 patients, good in 21, fair in 11 and poor in 2, with excellence rate of 83%. Conclusions The surgical methods should be selected based on different types of unstable distal radius fractures. In the meantime, maximal recovery of the relative length of the radius and ulna, formation of articular surface, volar tilting angle and ulnar inclination angle and reasonable rehabilitation exercises are helpful for the functional recovery of the wrist to a largest extent.

BACKGROUND: Thermosensitive hydrogel has made great progresses in drug carrier and tissue engineering. However, its phase-transition temperature is lower than human body temperature, so it has not been used as implants. OBJECTIVE: To prepare and evaluate the biocompatibility of a thermosensitive hydrogel poly-(N-isopropylacrylamide-co-N-hydroxymethylacrylamide)[P(NIPAAm-co-NHMPA)] In vitro so as to assess its safety as a medical implant.DESIGN, TIME AND SETTING: Material experiment was performed at the Central Laboratory of Union Hospital of Tongji Medical College, Huazhong University of Science & Technology and Key Laboratory of Biomedical Polymers, Ministry of Education, Wuhan University Chemical Department from January to October 2007.MATERIALS: L929 mice fibroblast line was provided by Professor Chen, Stomatology Hospital of Wuhan University. N-isopropylacrylamide and N-hydroxymethylacrylamide were purchased from Aldrich.METHODS: Using ammonium persulfate and tetramethylethylenediamine as oxidateion-reduction initiation system and N, N'-methylene bisacrylamide as crosslinking agent, mass fraction 8.5% N-hydroxymethylacrylamide was added to the reaction system. The N-isopropylacrylamide and N-hydroxymethylacrylamide were dissolved in deionized water and reacted with N, N'-methylene bisacrylamide, ammonium persulfate and tetramethylethylenediamine at room temperature for 3 hours. The colorless transparent cylinder gel was obtained, soaked in deionized water and dried.MAIN OUTCOME MEASURES: Biocompatibility in vitro of the material was validated by cytotoxicity test, cells/scaffolds interaction test, hemolysis test and pyrogen test in vitro.RESULTS: Synthesized hydrogel showed thermosensitive character as expected and the lower critical solution temperature was 38 ℃. The toxicity rate was grade 0-1. Through the scanning electron microscopy, cells and scaffolds were tightly attached, producing a perfect interface, and the shape of cells was all right. Hemolysis rate was 2.54%. No pyrogen reaction was found. CONCLUSION: P(NIPAAm-co-NHMPA) has been successfully prepared with good biocompatibility in vitro and might become a good medical implant for clinical use.