BACKGROUND:Current studies have confirmed that Ganoderma lucidum polysaccharides can promote nerve regeneration in neurodegeneration-related diseases.The occurrence of neurodegenerative diseases is closely related to mitochondrial dysfunction,but the role of Ganoderma lucidum polysaccharides on the regulation of apoptosis and mitochondrial function in neurodegenerative diseases is not yet clarified. OBJECTIVE:To explore the regulatory effects and mechanisms of Ganoderma lucidum polysaccharides on apoptosis and mitochondrial dysfunction in H2O2-induced SH-SY5Y cells. METHODS:SH-SY5Y cells were divided into three groups:control group,H2O2 group,and Ganoderma lucidum polysaccharides group.Cells in the control group were normally cultured.Cells in the H2O2 group were treated with 300 μmol/L H2O2 for 24 hours.In the Ganoderma lucidum polysaccharides group,the intervention with 300 μg/L Ganoderma lucidum polysaccharides was conducted first for 1-2 hours,followed by the addition of 300 μmol/L H2O2 for 24 hours.The mitochondrial membrane potential was detected by JC-1 kit.Apoptosis was detected by TUNEL staining kit.The activities of malondialdehyde and superoxide dismutase were detected by malondialdehyde test kit and superoxide dismutase test kit,respectively.The apoptosis and expression of mitochondrial dynamics-related proteins were detected by immunofluorescence staining and western blot assay. RESULTS AND CONCLUSION:(1)Compared with the control group,the mitochondrial membrane potential and superoxide dismutase activity were significantly reduced,as well as apoptotic rate and malondialdehyde levels were significantly increased in the H2O2 group(P<0.05).After treatment with Ganoderma lucidum polysaccharides,the membrane potential and superoxide dismutase activities were significantly increased,and apoptotic rate and malondialdehyde levels were significantly reduced compared with the H2O2 group(P<0.05).(2)The expression levels of pro-apoptotic proteins Bax and Caspase-3 were significantly increased,but the expression of anti-apoptotic protein Bcl-2 was significantly decreased in the H2O2 group compared with the control group(P<0.05).Compared with the H2O2 group,the levels of Bax and Caspase-3 were significantly decreased,but the expression of anti-apoptotic protein Bcl-2 was significantly increased in the Ganoderma lucidum polysaccharides group(P<0.05).(3)Compared with the control group,the expression of mitochondrial splitting proteins Fis1 and p-Drp1 was significantly increased,but the expression of mitochondrial fusion proteins OPA1,Mfn1,and Mfn2 was decreased in the H2O2 group(P<0.05).Compared with the H2O2 group,Fis1 and p-Drp1 expression was significantly reduced,but the expression levels of OPA1,Mfn1,and Mfn2 were significantly increased in the Ganoderma lucidum polysaccharides group(P<0.05).(4)The above results confirm that Ganoderma lucidum polysaccharides can attenuate H2O2-induced oxidative stress damage and apoptosis in SH-SY5Y cells by ameliorating mitochondrial dysfunction.

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Objective:To evaluate the effect of age factor on the potency of cisatracurium-induced neuromuscular block in the obese patients.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ obese patients, with a body mass index of 30-35 kg/m 2 and waist circumference (female ≥ 80 cm, male ≥ 90 cm), 40 elderly patients (age 65-75 yr) and 40 young and middle-aged patients (age 18-64 yr), scheduled for elective surgery with general anesthesia, were included in this study. Based on the random number table method, the patients were assigned into dosage groups of 40, 50, 60 and 70 μg/kg, served as OF1-4 groups and YF1-4 groups, with 10 patients in each group. The consumption of cisatracurium was calculated based on fat-free mass using a single-dose method. The neuromuscular block of cisatracurium was monitored by recording the response of the adductor pollicis muscle to TOF stimulation, the maximum suppression degree of T 1 and onset time were recorded using the Mindray BeneVision N17 monitor, and the dose-response relationship regression equation was developed to calculate the median effective dose. Results:There was no significant difference in the onset time among groups ( P>0.05). The median effective dose in elderly obese patients and young and middle-aged obese patients were 50.01 and 48.71 μg/kg, respectively, and there was no significant difference between the two groups ( P>0.05). Conclusions:There is no significant difference in the potency of cisatracurium-induced neuromuscular block between elderly obese patients and young and middle-aged obese patients, suggesting that age factor has no significant effect on it.

Purpose To evaluate the efficacy of T2-weighted imaging combined with diffusion weighted imaging in differential diagnosis of peripheral lung cancer(PLC)and focal organizational pneumonia(FOP).Materials and Methods A total of 36 patients with FOP and PLC diagnosed pathologically in the Affiliated Hospital of Shaanxi University of Chinese Medicine from November 2016 to December 2021 were retrospectively included.Two experienced radiologists independently read MR Images,and measured T2 contrast ratio(T2CR)and apparent diffusion coefficient(ADC)respectively.The T2CR and ADC values of the two groups were compared,and the diagnostic efficacy of MR-T2WI and diffusion weighted imaging was evaluated using the receiver operating characteristic curve.Results Two radiologists demonstrated good inter-observer agreement for T2CR and ADC values(ICC values of 0.951 and 0.955,respectively).The FOP group exhibited significantly higher T2CR and ADC values compared to the PLC group(t=3.920 and 5.819,both P<0.001),with threshold values of 2.29 for T2CR and 1 048×10-6 mm2/s for ADC being identified.ADC values accurately diagnosed FOP in 33 cases and PLC in 28 cases,while T2CR correctly diagnosed FOP in 20 cases and PLC in 33 cases.Combining both T2CR and ADC values resulted in accurate diagnoses of FOP in 29 cases and PLC in 33 cases.The diagnostic accuracy and area under the curve were improved by combining ADC and T2CR values compared with using them alone(accuracy:86.1%vs.84.7%,73.6%;AUC:0.924 vs.0.879,0.740;Z=2.208,P<0.05).Conclusion The combination of T2CR and ADC values aids in distinguishing FOP from PLC,exhibiting a higher diagnostic efficiency compared to their individual use.

Objective:To investigate the preventive effect of postoperative pancreatic fistula by pedicled omentum wrapping pancreaticojejunostomy in pancreaticoduodenectomy.Methods:The clinical data of 78 patients who underwent pancreaticoduodenectomy in Songjiang Hospital Affiliated to Shanghai Jiao Tong University from September 2017 to August 2020 were retrospectively analyzed. Patients were divided into the modified pancreaticojejunostomy group (conventional approach group, n=43) and the pedicled omentum wrapping pancreaticojejunostomy group (omentum wrapping group, n=35) according to the surgical mode. Postoperative pancreatic fistula, postoperative abdominal bleeding, delayed gastric emptying and postoperative hospital stay were compared between the two groups. Results:Compared with the conventional approach group, the postoperative pancreatic fistula rate in omentum wrapping group was significantly reduced (2.9% vs 18.6%), and the difference was statistically different ( P=0.030); postoperative abdominal bleeding rate(0 vs 4.7%)and the delayed gastric emptying rate were significantly reduced (8.6% vs 25.6%), but both of them were not statistically different ( all P value>0.05); the length of postoperative hospital stay was significantly reduced [(11.3±2.9) days vs (12.8±3.5)days], and the difference was statistically different ( P=0.045). Conclusions:The pedicled omentum wrapping pancreaticojejunostomy was simple and convenient, which can significantly reduce the rate of postoperative pancreatic fistula. It can shorten the time of the length of hospital stay after surgery.

Objective:To explore the safety, efficacy and preliminary clinical application of the single plantar approach or in combination with the dorsalis pedis approach in the treatment of Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions.Methods:(1) Six fresh cadaveric specimens of adult foot were collected and dissected through the plantar approach in order to determine the skin incision of the plantar approach and the safe area for plate-screw internal fixation, including start-stop points and courses of plantar nerves, blood vessels, tendons and ligaments, followed by plate-screw fixation on the specimens. (2) After feasibility of the plantar approach was confirmed by our anatomical study, it was used to treat the 3 patients who were admitted to Department of Orthopedics, The Third Hospital Affiliated to Southern Medical University between September 2020 and November 2021 for Lisfranc injury with severe necrosis due to dorsalis pedis skin contusion or metatarsal base avulsion fracture. They were 2 males and one female, with an average age of 51 years (from 34 to 68 years). The preliminary clinical efficacy was evaluated in terms of visual analogue scale (VAS), midfoot score of American Orthopaedic Foot and Ankle Surgeons (AOFAS), Maryland score, Kofoed score, fracture healing at the last follow-up and postoperative complications.Results:(1) Regarding the anatomical exposure range, the metatarsal side of the first metatarsal wedge joint was exposed medially and the metatarsal side of the third metatarsal wedge joint was exposed laterally; the peroneus longus tendon, Lisfranc plantar ligament and interosseous ligament were explored. X-ray films after the simulated operation showed satisfactory plate positions. (2) As for the preliminary clinical application, all patients were followed up for 6 to 14 months (mean, 11 months). At the last follow-up, the VAS score ranged from 0 to 1 (mean, 0.5), AOFAS score from 85 to 92 (mean, 89), Maryland score from 93 to 96 (mean, 95), and Kofoed score from 92 to 95 (mean, 94). There were no early complications such as fascial compartment syndrome, skin necrosis or infection. All fractures got united, with no complications like traumatic arthritis, muscle atrophy or screw loosening.Conclusion:Testified by the anatomical study, the plantar approach can be used to treat Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions, leading to safe, effective and satisfactory clinical outcomes.

Objective:To investigate the safety and feasibility of modified pararectus abdominis approach in the anterior plate fixation of sacral fractures.Methods:In 5 fresh adult cadavers (3 males and 2 females), gross anatomy was performed on one pelvic side using a modified pararectus abdominis approach to clarify the anatomical structures around the approach. On the other side of the pelvis, the anterior structures of the sacrum were exposed in simulated anterior plate fixation of sacral fracture via the modified pararectus abdominis approach. The exposed anatomic range of the approach, and the locations and courses of lumbosacral trunk nerve and iliac vessels were observed and recorded.Results:(1) The modified pararectus abdominis approach exposed the whole S1 vertebral body from the sacroiliac joint to the medial side, the L5 vertebral body cephalally, the S1 foramina in the true pelvis, and the same structures laterally as a traditional pararectus abdominis approach did. (2) Via the modified pararectus abdominis approach, exploration and decompression of the lumbosacral plexus (from L4 to S1) (including S1 foraminoplasty) were performed under direct vision to decompress the nerve entrapment from anterior compressed fracture fragments and hyperplastic callus. (3) There was a safe surgical area in anterior L5 and S1 where a plate could be safely fixed to the S1 vertebral body. (4) Since the maximum vertical distance from the lumbosacral trunk nerve lifted above the periost to the sacral ala was 1.4 cm (range, from 1.2 to 1.5 cm), a plate could be safely placed from the subperiosteum to the S1 vertebral body to fix the fracture.Conclusions:The modified pararectus abdominis approach is safe and feasible for exploration and decompression of lumbosacral nerves in the anterior sacral region (from L4 to S1) because it has significant advantages in vision and operation. It also broadens the range of anterior sacral plate fixation because a sacral fracture displacement can be reduced under direct vision and a plate can be fixated to the S1 vertebral body along the alae sacralis and across the sacroiliac joint to the iliac bone.

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Objective:To evaluate the effect of remimazolam combined with remifentanil used for painless gastroscopy.Methods:A total of 150 patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective painless gastroscopy, were divided into 3 groups ( n=50 each) using a random number table method: propofol combined with remifentanil group (group P), remimazolam 0.3 mg/kg combined with remifentanil group (group R1) and remimazolam 12 mg combined with remifentanil group (group R2). Drugs were administrated according to body weight, and calculation was carried out according to ideal body weight.Remifentanil 0.25 μg/kg was injected intravenously, propofol 1.5 mg/kg was then injected intravenously in group P, remimazolam 0.3 mg/kg was injected intravenously in group R1, and remimazolam 12 mg was injected intravenously in group R2.When Modified Observer′s Assessment/Alertness and Sedation (MOAA/S) score was≤3, gastroscopy was performed.It was defined as sedation failure when MOAA/S score was still ≥4 at 3 min after administration of propofol or remimazolam.When intraoperative body movement occurred, 1/4 of the initial dose of propofol was injected intravenously in group P, 1/4 of the initial dose of remimazolam was injected intravenously in group R1, and remimazolam 2.5 mg was injected intravenously in group R2 to maintain MOAA/S score ≤3.It was defined as sedation failure when sufficient sedation was not maintained after the additional drugs were given more than 3 times within 15 min.The success of sedation, time for gastroscopy, emergence time and discharge time were recorded.The occurrence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was recorded. Results:Compared with group P, no significant change was found in the success rate of sedation ( P>0.05), and the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was decreased in group R1, and the success rate of sedation was significantly decreased, the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, coughing and injection pain was decreased, and the incidence of hiccup was increased in group R2 ( P<0.05). Compared with group R2, the success rate of sedation was significantly increased, and the incidence of intraoperative body movement, coughing and hiccup was decreased in group R1 ( P<0.05). Conclusion:Remimazolam 0.3 mg/kg combined with remifentanil can be safely and effectively used for painless gastroscopy.

Leishmaniasis is a prevalent cause of death and animal morbidity in underdeveloped countries of endemic area. However, there is few vaccine and effective drugs. Antimicrobial peptides are involved in the innate immune response in many organisms and are being developed as novel drugs against parasitic infections. In the present study, we synthesized a 5-amino acid peptide REDLK, which mutated the C-terminus of Pseudomonas exotoxin, to identify its effect on the Leishmania tarentolae. Promastigotes were incubated with different concentration of REDLK peptide, and the viability of parasite was assessed using MTT and Trypan blue dye. Morphologic damage of Leishmania was analyzed by light and electron microscopy. Cellular apoptosis was observed using the annexin V-FITC/PI apoptosis detection kit, mitochondrial membrane potential assay kit and flow cytometry. Our results showed that Leishmania tarentolae was susceptible to REDLK in a dose-dependent manner, disrupt the surface membrane integrity and caused parasite apoptosis. In our study, we demonstrated the leishmanicidal activity of an antimicrobial peptide REDLK from Pseudomonas aeruginosa against Leishmania tarentolae in vitro and present a foundation for further research of anti-leishmanial drugs.