OBJECTIVES: To evaluate the protective effect of Schistosoma japonicum cystatin (rSj-Cystatin) in a mouse mode of "two-hit" sepsis. METHODS: Sixty male C57BL/6 mice randomized equally into sham-operated group, protein group, "two-hit" modeling group, and protein intervention group. In the former two groups, the mice received an intraperitoneal injection of 100 μL PBS followed by exposure of the cecum and then by intraperitoneal injection of 100 μL PBS or 25 μg rSj-Cystatin 30 min later; In the latter two groups, 100 μL PBS containing LPS (5 mg/kg) was injected intraperitoneally 24 h before cecal ligation and puncture (CLP), and 100 μL PBS or 25 μg rSj-Cystatin were injected 30 min after CLP. At 12 h after rSj-Cystatin treatment, 6 mice from each group were sacrificed for detection of TNF-α, IL-6, IL-10, TGF-β, iNOS and Arg-1 in the serum, spleen, liver, lung and kidney tissues using ELISA, for examinations of liver, lung and kidney pathologies with HE staining, and for analysis of CD3⁺CD4⁺CD25⁺Foxp3⁺ T cell percentage in the spleen using flow cytometry. The remaining mice were observed for general condition and 72-h survival. RESULTS: The 72-h survival rates in the 4 groups were 100%, 100%, 0% and 20%, respectively, showing significant differences between the latter two groups. The mouse models of "two-hit" sepsis exhibited obvious tissue pathologies and significant elevations of TNF-α and IL-6 in both the serum and tissue homogenate, which were significantly ameliorated by rSj-Cystatin treatment. Treatment with rSj-Cystatin also increased IL-10 and TGF-β levels and spleen CD3⁺CD4⁺CD25⁺Foxp3⁺ T cell percentage. The septic mouse models also showed increased iNOS levels in all the detected tissues and a decreased Arg-1 level in the kidney, and these changes were obviously improved by rSj-Cystatin treatment. CONCLUSIONS rSj-Cystatin has a protective effect against "two-hit" sepsis in mice by regulating the inflammatory microenvironment.
Animals ; Mice ; Sepsis/drug therapy* ; Male ; Schistosoma japonicum/chemistry* ; Mice, Inbred C57BL ; Cystatins/therapeutic use* ; Interleukin-10/metabolism* ; Interleukin-6/blood* ; Tumor Necrosis Factor-alpha/blood* ; Disease Models, Animal ; Transforming Growth Factor beta/metabolism*

In recent years, with the advancement of diagnostic and treatment technology, lumbosacral extra-canal nerve root entrapment has gradually attracted attention. Patients often have hypertrophy of the transverse process, high iliac spine, proliferation of the articular process joints and iliopsoas ligaments, and extreme lateral herniation of the intervertebral disc, mostly classified as type 1-2 in the lumbosacral triangle, because of which misdiagnosis is not uncommon in clinic. Diffusion tensor imaging and magnetic resonance neurography can display the compressed nerve root. The main purpose of surgical treatment is to fully relieve nerve compression and thus appropriate surgical techniques should be selected based on the site of compression and the classification of the lumbosacral triangle, including paraspinal or Wiltse approach TLIF, micro foraminotomy, and endoscopic decompression. Direct introduction of a co-axis endoscopic tube into the narrow space may compress or damage the nerve root; while foramen fenestration or extra-foraminal biportal endoscopy can be used to sufficiently decompress the nerve root with floating tube.

Objective To investigate the correlations of the expression of silent information regulator 2 homolog 1 (SIRT1) and colony-stimulating factor 1 receptor (CSF1R) with the clinical characteristics and prognosis of patients with colon cancer. Methods Colon cancer tissue specimens and paracancer tissue specimens were collected from 148 patients with colon cancer. The clinical and pathological features of the patients were analyzed. Immunohistochemistry was used to detect the expression of SIRT1 and CSF1R; the Spearman's correlation analysis was employed to assess the correlation between SIRT1 and CSF1R; the Kaplan-Meier analysis was conducted to evaluate the associations of the expression of SIRT1 and CSF1R with patients' prognosis; the multivariate Cox regression analysis was performed to identify prognostic factors in colon cancer patients. Results Compared with the adjacent tissues, the expression of SIRT1 protein in colon cancer tissues was significantly decreased, and the expression of CSF1R protein was significantly increased (P < 0.05). The expressions of SIRT1 and CSF1R protein were correlated with lymph node metastasis, nerve invasion and invasion depth in patients with colon cancer (P < 0.05). The protein expressions of SIRT1 and CSF1R were negatively correlated (r=-0.536, P < 0.05). The 3-year survival rate of patients with high SIRT1 expression was significantly higher than that of patients with low SIRT1 expression (P < 0.05). The 3-year survival rate of patients with high CSF1R expression was significantly lower than that of patients with low CSF1R expression (P < 0.05). The 3-year survival rate of patients with high SIRT1 expression was significantly higher than that of patients with low SIRT1 expression (P < 0.05). Conclusion In colon cancer, SIRT1 expression is significantly downregulated, whereas CSF1R expression is upregulated, and both are closely related to the clinical and pathological features such as lymph node metastasis, neural invasion, and tumor infiltration depth. Detection of these biomarkers may have important value in predicting patients' prognosis and survival.

Objective    To investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery. Methods    A retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared. Results    No massive bleeding, conversion to thoracotomy, postoperative pneumo-thorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05). Conclusion    Based on the optimized diagnosis and treatment model, thoraco-scopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.

Objective:To investigate the effect of Ponte osteotomy combined with bony bridge dissection and intervertebral bone grafting in the treatment of rigid degenerative scoliosis.Methods:From March 2017 to October 2021, this method was used to treat 21 cases of rigid degenerative scoliosis, including 7 males and 14 females, aged 59-76 years, with an average age of 67.6 years. All patients had intractable low back pain and limited standing and walking, while 15 patients had radiation pain in lower limbs. The preoperative standing X-ray film showed that the average Cobb angle of lumbar scoliosis was 51.3°±24.1°, the average lumbar lordosis was 5.4°±13.6°. The coronal balance distance (CBD) was 4.3±2.0 cm (range, 0.5-6.2 cm), and the sagittal vertical axis (SVA) was 5.9±3.1 cm (range, 1.5-6.8 cm). The bending images showed huge osteophyte with bone bridge formation in the vertebral body of the apex region, with poor mobility. Ponte osteotomy was performed according to the degeneration of the deformity. The bone bridge at apex area was cut off, and the intervertebral spaces at apex area and slipped or subluxated levels were release and grafted with granular autogenous decompression bone. During follow-up, the efficacy and deformity improvement were evaluated with visual analogue scale (VAS), Oswestry disability index (ODI) and standing X-ray films.Results:All patients successfully completed the operation. The operation time was 190-330 min, with an average of 250±68 min. The intraoperative bleeding was 700-1600 ml, with an average of 970±260ml. The patients were followed up for 12-36 months, with an average of 20.6±7.2 months. No internal fixation failure, fracture or revision occurred. At the last follow-up, the VAS of low back pain decreased from preoperative 6.1±2.2 to 2.1±1.8 ( t=6.45, P<0.001), and the leg pain decreased from 5.5±3.4 to 1.2±1.0 ( t=5.56, P<0.001).ODI decreased from 52.2%±22.2% to 16.4%±10.6% ( t=6.67, P<0.001). The Cobb angle of lumbar scoliosis was 19.3°±10.5°, with an average correction rate of 62.4%; lumbar lordosis was 34.4°±15.6 °, with average correction of 30°. CBD was 1.9±1.1 cm, with an average correction of 2.4 cm ( t=4.42, P<0.001); and SVA was 1.6±2.1 cm, with an average correction of 4.3 cm ( t=4.90, P<0.001). Conclusion:Ponte osteotomy combined with bone bridge dissection and intervertebral bone grafting is an effective method to treat rigid degenerative scoliosis, which can improve spinal sequence, CBD and SVA, avoid vertebral osteotomy and reduce fusion segments.

Objective:To investigate the efficacy of oblique lumbar interbody fusion (OLIF) combined with percutaneous transforaminal endoscopic decompression (PTED) and posterior pedicle fixation through Wiltse approach in the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis.Methods:From June 2017 to February 2022, 103 patients (50 males and 53 females) of lumbar spondylolisthesis accompanied with lumbar spinal stenosis were performed with OLIF combined with PTED and posterior pedicle fixation. The mean age was 64.1±5.2 years (range, 42-87 years). All involved cases were single-segment and included 83 cases of L 4, 5, 17 cases of L 3, 4, and 3 cases of L 2, 3. Among them, 94 cases were performed for the first time, and other 9 were revision surgery treated by posterior lumbar laminectomy previously. The visual analog scale (VAS) was used to evaluate the low back pain and leg pain, and the Oswestry disability index (ODI) was used to evaluate the lumbar function. The VAS and ODI scores were recorded respectively before the operation, at discharge, 1, 3, 6 months after the operation and at the last follow-up. Macnab criteria was used to evaluate the clinical efficacy at the last follow-up. At the same time, imaging measurements were conducted, including the anterior and posterior disc height, segmental lordotic angle, percentage of slip on lateral X-ray film and the vertebral canal area on axial MRI before and after surgery. Results:All of 103 patients were successfully operated in one stage with an average operation time of 177.7±21.5 min (range, 155-220 min), and an average intraoperative blood loss of 55.9±18.3 ml (range, 30-150 ml). The mean follow-up time were 15.1±2.6 months (range, 6-36 months). There were significant differences in both VAS scores of back and leg and ODI scores at each postoperative time point when compared with preoperative ( F=508.25, F=1524.82, F=1148.68, P<0.001). Macnab criteria of the last follow-up was evaluated as follow: excellent in 85 cases, good in 14, fair in 4, and the excellent and good rate was 96.1%. The radiographic results showed the mean immediate postoperative anterior disc height, posterior disc height, segmental lordotic angle, percentage of slip and axial area of the vertebral canal were 15.23±2.97 mm, 9.32±2.31 mm, 14.36°±4.18°, 3.89%±3.11%, 113.37±47.27 mm 2, and thus all of those increased significantly compared to the mean preoperative 11.93±3.17 mm, 7.21±2.03 mm, 6.15°±3.99°, 23.66%±7.79%, 57.63±28.91 mm 2, respectively ( t=7.84, t=7.07, t=14.91, t=27.62, t=9.68, P<0.001). All cases achieved bony fusion during 6-12 months after operation. The incidence of surgery-related complications was 10.7% (11/103). There were 3 cases of end plate fracture and 2 cases of dural injury, which had no complaint after operation. There was 1 case of pedicle screw entering into the spinal canal by mistake, and the symptoms of nerve damage appeared after operation. After 1 year it basically returned to normal. There were 2 cases of thigh numbness and 1 case of psoas major weakness after operation, all of which relieved after 4 weeks. There was 1 case continuous pain of abdominal incision after surgery. There was 1 case of cage subsidence at the last follow-up. Conclusion:OLIF combined with PTED and posterior pedicle fixation through Wiltse approach is a minimally invasive surgical method for the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis. With the combined minimally invasive techniques, the decompression, fusion and fixation of the lumbar spine can be fulfilled perfectly. It has the advantages of minimally invasive, good clical outcome, few complications and rapid rehabilitation.

Objective:To explore the application value of graded surgical strategy and balanced load concept for thoracolumbar osteoporotic compression fractures (OVCFs) with kyphosis.Methods:All of 56 patients of thoracolumbar OVCFs with kyphosis were studied, including 11 males and 45 females, with an average of 75.6±9.3 years old. All patients had back pain, and 32 patients had nerve compression, including 5 patients with aggravation of vertebral collapse after conservative treatment, and 1 patient with cement loosening after percutaneous kyphoplasty (PKP) in another hospital. A graded surgical strategy was developed according to the concept of balanced load, including whether there existed nerve compression, kyphosis, sagittal index (SI), vertebral collapse, load capacity of anterior and middle columns, and fracture reducibility. All patients were treated with anti osteoporosis therapy. 24 patients without nerve compression underwent posture reduction and PKP; 32 patients with nerve compression underwent open surgery: 5 patients with arcuate ky-phosis and SI≤15° underwent Ponte osteotomy; 15 patients with angular kyphosis or SI>15° underwent posterior pedicle subtraction osteotomy (PSO) or/and modified PSO including intervertebral space; 11 patients with SI>15° and severe vertebral collapse (the height of anterior and middle vertebral bodies <1/3 of the average height of adjacent vertebral bodies) or cement loosen after PKP underwent vertebrectomy and reconstruction, of which 4 patients underwent posterior vertebral column resection (PVCR), and 8 patients underwent combined surgery including anterior subtotal vertebrectomy with support and posterior pedicle fixation. The clinical efficacy was evaluated by pain visual analog score (VAS) and Oswestry dysfunction index (ODI).Results:All patients were followed up for 12-60 months, with an average of 24.2 months. For the 24 patients with PKP, the symptoms improved significantly, and 1 case had adjacent vertebral fracture that was improved after PKP again. For the 32 patients with open surgery, the intraoperative blood loss was 400-1 800 ml, with an average of 960 ml (PVCR > PSO and combined surgery > Ponte); the operation time was 2-7 h, with an average of 4.3±1.9 h. The neurological symptoms improved after the operation. During follow-up, the artificial vertebral body and titanium mesh collapsed in 3 cases, but did not continue to deteriorate, no vertebral fracture, internal fixation displacement or loosening failure occurred on X-ray films. At the last follow-up, the VAS score and ODI score of 56 patients decreased from 7.0±2.6 and 60.4±16.2 pre-operation to 1.4±1.1 and 9.5+5.8 respectively, and local kyphosis angle improved from 18.1±4.3 pre-operation to 5.6±4.3. According to the overall satisfaction of patients, the effect was fair in 12 cases, good in 30 cases, excellent in 14 cases, and the excellent and good rate was 78.6%.Conclusion:The graded surgical strategy for thoracolumbar OVCFs with kyphosis based on the concept of balanced load can restore the balanced load of the anterior and middle columns of the spine, reduce the fixation and fusion segments, and reduce the risk of internal fixation displacement and loosening failure.

Objective To investigate the efficacy and safety of transumbilical single-port laparoscopic appendicectomy in acute complicated appendicitis.Methods Retrospective analysis was conducted for the data of 1104 patients with complicated appendicitis who underwent emergency laparoscopic appendectomy at the Department of General Surgery of Aerospace Center Hospital from April 2014 to August 2022;among them,788 patients underwent transumbilical single-port laparoscopic appendectomy(SILA)and 316 cases underwent traditional three-port laparoscopic appendectomy(LA);the operation time,intraoperative blood loss,leukocyte value on the first day after surgery,postoperative exhaust time,hospital stay,postoperative pathology and postoperative complications were statistically analyzed.Results The surgical duration of the single hole laparoscopic appendectomy(SILA)group was(68.26±22.29)minutes,intraoperative blood loss was(15.93±13.10)ml,postoperative exhaust time was(2.29±0.52)days,and white blood cells were(11.12±1.67)× 109/L on the first day after surgery,and the surgical duration of the hree hole laparoscopic appendectomy(LA)groupwas(66.47± 20.40)minutes,intraoperative blood loss was(16.65±12.98)ml,postoperative exhaust time was(2.23±0.58)days,and white blood cells were(11.35±1.54)× 109/L on the first day after surgery,there was no statistically significant difference in the data between each group(P＞0.05).After 1 month of follow-up,no incisional hernia and other complications occurred in the two groups,the cosmetic effect of abdominal incision in SILA group was satisfactory,the hospitalization time of SILA group was(4.60± 1.18)days,which was shorter than that in the traditional LA group(4.93±1.71)days,and the difference was statistically significant(P＜0.05).Conclusion Based on proficiency in traditional LA operations,SILA is safe and viable;in addition to the hidden aesthetic function of scars,it does not prolong the operation time and increase the risk of postoperative complications.

Objective:To develop the Nutrition Knowledge, Attitude and Practice Questionnaire for Maintenance Hemodialysis (MHD) Patients and test its reliability and validity.Methods:This is a cross-sectional study. Based on the theory of knowledge, attitude and practice, and on the basis of literature analysis, semi-structured interviews and expert focus interviews, an initial questionnaire was formed through Delphi expert consultation and pre-survey. In July 2020, 200 patients with MHD were selected from the Blood Purification Center of Lu'an Hospital of Anhui Medical University by convenient sampling to carry out the first round of questionnaire survey and conduct item analysis of the questionnaire. In August 2020, 230 MHD patients were selected from 6 other Hemodialysis Centers in the same city by convenient sampling to carry out the second round of questionnaire survey and evaluate the reliability and validity of the questionnaire. In the first round of questionnaire survey, a total of 200 questionnaires were distributed, and 183 valid questionnaires were recovered, with an effective recovery rate of 91.50% (183/200) . In the second round of questionnaire survey, 230 questionnaires were distributed and 214 valid questionnaires were recovered, with an effective recovery rate of 93.04% (214/230) .Results:The formal questionnaire included 29 items in three dimensions of knowledge, attitude and practice. The total Cronbach's α coefficient of the questionnaire was 0.853, and the retest reliability coefficient was 0.880. The item-level content validity index of the questionnaire was 0.910 to 1.000. Exploratory factor analysis extracted 9 common factors, and the cumulative variance contribution rate was 62.89%. The confirmatory factor analysis showed that the fitting index of the model was ideal, the composite reliability in the convergent validity was more than 0.700, the correlation coefficient of the discriminant validity was positive and less than 0.500, less than the square root of average variance extracted, and the discriminant validity was good.Conclusions:Nutrition Knowledge, Attitude and Practice Questionnaire for MHD Patients has good reliability and validity, and can be used as a reliable tool to evaluate the nutrition knowledge, attitude and practice of MHD patients in China.

Objective:To understand the epidemiological characteristics of mpox epidemic in Guangzhou and provide scientific evidence for the prevention and control of the disease.Methods:Based on the mpox surveillance system in Guangzhou, suspected mpox cases with fever and rash were reported by local hospitals at all levels to centers for disease control and prevention in Guangzhou for sampling, investigation and diagnosis. Descriptive epidemiological analysis was conducted on the clinical characteristics and treatment of the mpox cases and positive detection rate reported in Guangzhou as of 24:00 on June 23. Whole genome sequencing of the virus isolates was performed using Illumina Miniseq high-throughput sequencing platform.Results:The first mpox case in Guangzhou was reported on June 10 in 2023. As of 24:00 on June 23, a total of 25 confirmed mpox cases were reported. All the mpox cases were men with a M( Q1, Q3) of 32 (26, 36) years, the majority of the cases were MSM (96.0%). The main clinical features were rash (100.0%, 25/25), lymphadenectasis (100.0%, 25/25) and fever (52.0%, 13/25). Rash usually occurred near the genitals (88.0%, 22/25). The close contacts, mainly family members (40.4%, 23/57), showed no similar symptoms, such as fever or rash. The positive rate of mpox virus in household environment samples was 30.5%. The analyses on 3 complete gene sequences of mpox virus indicated that the strains belonged to West African type Ⅱb clade, B.1.3 lineage. Conclusions:Hidden transmission of mpox virus had occurred in MSM in Guangzhou. However, the size of affected population is relatively limited, and the possibility of wide spread of the virus is low.