Objective:To compare the mid-term clinical effects of AngioJet rheolytic thrombectomy assisted catheter-directed thrombolysis (ART+CDT) with catheter-directed thrombolysis (CDT) in the treatment of acute deep venous thrombosis of lower extremities.Methods:Ninety-one patients admitted to the Department from Jan 2016 to Dec 2017 were placed with inferior vena cava filters and divided into ART+CDT group (30 cases)and CDT group (61 cases). Total urokinase dosge, thrombolytic time, operative cost, length of hospital stay, detumescence rate, thrombus clearance rate, cumulative patency rate of lower limb veins, Villalta score at 2 years and 5 years, thrombosis recurrence rate and chronic venous insufficiency quality of life questionnaire were compared between the two groups.Results:The success rate of surgery was 100% in both groups, there was no mortality. There were significant differences in the short-term postoperative outcomes between the two groups in terms of total dosage of urokinase, thrombolysis time, total cost of surgery, length of hospital stay, detumescence rate, venous patency scores before and after treatment, and venous patency rate (all P<0.05). For the mid- and long-term postoperative outcomes of 2 and 5 years, there were no significant differences in the incidence of PTS, recurrence rate of thrombus, chronic venous function scale, and cumulative patency rate at 2 years (all P>0.05). Conclusions:ART+CDT has a significant advantage over CDT alone in terms of early efficacy and early reopening of blood flow in patients. Both ART+CDT and CDT have a low incidence of PTS and a low recurrence rate of thrombus in the mid-term follow-up, and both have satisfactory performance in the mid- and long-term efficacy of interventional treatment of deep venous thrombosis of lower limbs.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

The bursa of Fabricius (BF) is a central humoral immune organ unique to birds. Four bursal peptides (BP-I, BP-II, BP-III, and BP-IV) have been isolated and identified from the BF. In this study, the immunoadjuvant activities of BPs I to IV were examined in mice immunized with H9N2 avian influenza virus (AIV) vaccine. The results suggested that BP-I effectively enhanced cell-mediated immune responses, increased the secretion of Th1 (interferon gamma)- and Th2 (interleukin-4)-type cytokines, and induced an improved cytotoxic T-lymphocyte (CTL) response to the H9N2 virus. BP-II mainly elevated specific antibody production, especially neutralizing antibodies, and increased Th1- and Th2-type cytokine secretion. BP-III had no significant effect on antibody production or cell-mediated immune responses compared to those in the control group. A strong immune response at both the humoral and cellular levels was induced by BP-IV. Furthermore, a virus challenge experiment followed by H&E staining revealed that BP-I and BP-II promoted removal of the virus and conferred protection in mouse lungs. BP-IV significantly reduced viral titers and histopathological changes and contributed to protection against H9N2 AIV challenge in mouse lungs. This study further elucidated the immunoadjuvant activities of BPs I to IV, providing a novel insight into immunoadjuvants for use in vaccine design.
Adjuvants, Immunologic ; Animals ; Antibodies, Neutralizing ; Antibody Formation ; Birds ; Bursa of Fabricius ; Cytokines ; Immunity, Cellular ; Immunity, Humoral ; Influenza A Virus, H9N2 Subtype ; Influenza in Birds ; Lung ; Mice ; Peptides ; T-Lymphocytes, Cytotoxic

Objective To explore the risk factors,prevention and treatments for liver failure after hepatectomy for hepatic alveolar echinococcosis.Methods Clinical data of 117 patients with hepatic alveolar echinococcosis admitted to the Affiliated Hospital of Qinghai University from August 2016 to August 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among 117 patients,47 cases were male and 70 female,aged (36±13) years on average.According to whether liver failure occurred after operation,the patients were divided into liver failure group (n=28) and non-liver failure group (n=89).The risk factors of liver failure after hepatectomy were analyzed by univariate and multivariate logistic regression.Results The incidence of postoperative liver failure was 24％ (28/117) and its mortality was 21％ (6/28).21 patients were classified as Child-Pugh grade A,4 grade B and 3 grade C.Multivariate logistic regression analysis showed that Child-Pugh grading,complicated with primary liver diseases,AST,operation time,intraoperative blood loss and intraoperative blood transfusion were the independent factors affecting the occurrence of liver failure (OR=0.089,7.412,1.010,7.926,5.961,11.341;P＜0.05).Conclusions The risk of liver failure after hepatectomy is high in patients with hepatic alveolar echinococcosis.Child-Pugh liver function grading,complicated with primary liver diseases,AST,operation time,intraoperative blood loss and intraoperative blood transfusion are the independent factors for liver failure.Preoperative comprehensive assessment of liver function reserve,shortening the operation time,managing intraoperative bleeding and timely diagnosis and treatment after operation are important measures to prevent the postoperative liver failure.

Objective To study the browning-related genes of Poria cocos mycelia,so as to provide a basis for their further verification and to discuss the browning molecular mechanism of Poria cocos.Methods Four samples of normal and brown Poria cocos mycelia were analyzed by transcriptome sequencing.After aligned with the reference genome sequence of Poria cocos,the expression levels of the genes in different samples were analyzed.Results A total of 12 383 transcripts were identified.Among them,1 017 genes were firstly found,and 260 genes were functionally annotated.Based on the alignment results,336 common differentially-expressed genes overlapped between the normal mycelia and 3 browned mycelia were obtained,and part of them were evaluated.Conclusion Transcriptome sequencing results showed that plenty of differentially-expressed genes were found in brown Poria cocos mycelia,and the difference of the expression levels of some genes was up to several hundred folds or even thousands of folds,whose related-functions were worth of further analysis.

Objective To determine the influence of continuous mild sedation versus usual sedation on the sedative effect and inflammatory factor level in ICU patients with multiple trauma.Methods In this prospective, randomized double-blind investigation, 58 multiple trauma patients hospitalized from October 2013 to April 2015 were randomized into continuous mild sedation group (continuous group, n =30) and conventional sedation group (conventional group, n =28) using the sealed envelopes.Between-group differences were made on the duration of mechanical ventilation, length of stay in the ICU, ratio of inception of continuous renal replacement therapy (CRRT), tracheotomy rate, accidental extubation rate, sepsis rate, multiple organ failure (MOF) rate and mortality.Serum inflammatory factor levels of the patients were recorded.Results There were 3 deaths (10％) in continuous group versus 4 deaths (14％) in conventional group (P ＞ 0.05).Patients in continuous group showed significantly less time spent on mechanical ventilation [(4.8 ±2.7) vs.(8.9 ±3.1)d] and in the ICU [(10.7 ± 5.4) vs.(16.9 ± 7.3) d] compared with conventional group (P ＜ 0.01).Between-group differences were insignificant regarding the ratio of CRRT inception, tracheotomy rate, accidental extubation rate, sepsis rate and MOF rate (P ＞ 0.05).Serum levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, Creactive protein (CRP) were lower in continuous group than those in conventional group at 24 h, 48 h and 72 h post-ICU, but significant differences were only observed at 48 h (P ＜ 0.05).At these time periods, serum IL-10 levels in continuous group were significantly higher than those in conventional group (P ＜0.05).In receiver operative characteristic curve (ROC) analysis, the area under the curve for IL-6, IL-10, TNF-α and CRP in continuous group was 0.726, 0.608, 0.729 and 0.757 respectively at 48 h post-ICU, indicating a predictive value of these markers for sepsis.Conclusion Continuous mild sedation results in shortened length of stay in the ICU and decreased inflammatory response in the treatment of patients with multiple trauma.

OBJECTIVETo determine the prevalence of mutations in the non-structural protein 5B (NS5B) of the hepatitis C virus (HCV),which are associated with natural resistance to non-nucleoside and nucleoside polymerase inhibitors (PIs),in treatment-naive hepatitis C patients in south China.

METHODSA nested PCR protocol that amplified three different regions of NS5B was used to detect the naturally occurring drag-resistant substitutions.Direct PCR sequencing was performed to analyze the sequences.

RESULTSNS5B mutations known to confer resistance to nucleoside PIs,such as A15G,S96T and S282T,were mainly detected in HCV genotype 6a (20/88,22.73%).Of the NS5B mutations known to confer resistance to non-nucleoside PIs,C316N and S365A were detected in HCV genotype lb (60/60,100% and 2/60,3.33%, respectively) and I482L and V499A were mainly detected in HCV genotype 2a (9/9,100% and 4/4,100%, respectively) and HCV genotype 6a (9/9,100% and 4/4,100%, respectively).Other NS5B mutations found in the study population included A1 5S,S365F,S365P,S368A and S368L;although none of these has been previously shown to confer resistance to PIs.

CONCLUSIONNaturally occurring dominant PI resistance mutations in NS5B exist in treatment-na(i)ve hepatitis C patients in south China and may be related to the virus genotype.

Antiviral Agents ; pharmacology ; China ; Drug Resistance, Viral ; Genotype ; Hepacivirus ; drug effects ; genetics ; Hepatitis C ; drug therapy ; virology ; Humans ; Mutation ; Viral Nonstructural Proteins ; genetics

Objective To investigate the impact of splenectomy with periesophagogastric devascularization on liver function of patients with liver cirrhosis and hypersplenism. Methods Clinical data of 177 patients with liver cirrhosis and hypersplenism who underwent splenectomy with periesophagogastric devascularization in the Third Affiliated Hospital of Sun Yat-sen University from January 2010 to December 2012 were retrospectively analyzed. There were 120 males and 57 females with the mean age of (54±13) years old. The informed consents of all patients were obtained and the ethical committee approval was received. Firstly splenectomy was performed during the operation, and then the dilated esophageal and gastric fundus veins were dissected and cut off. The changes of blood routine and liver function of the patients before and 5 d, 10 d, 3 months after operations were observed. The measurement data between multiple groups were compared by one-way analysis of variance and LSD-t test. Results The hypersplenism of patients improved markedly. The white blood cell (WBC) and platelets (Plt) levels 5 d, 10 d, 3 months after operations signiifcantly increased when compared with those before operations (LSD-t=14.37, 10.67, 6.60 and 5.06, 11.43, 12.10;P<0.05). And the liver function of patients also improved markedly. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB) levels 10 d, 3 months after operations signiifcantly decreased when compared with those before operations (LSD-t=7.80, 10.09, 8.21 and 10.76, 12.51, 11.13;P<0.05). Conclusion Splenectomy with periesophagogastric devascularization can not only cure the hypersplenism of patients with liver cirrhosis and hypersplenism, but also markedly improve the liver function of them.

Objective To investigate the role of miR-126 (micro RNA-126) in rat endothelial progenitor cells (EPCs) proliferation and migration and the starget gene of miR-126 by bioinformatics and experimental survey.Method EPCs were transfected with control oligoes and miR-126 mimics or inhibitor by electroporation.MTT was performed to evaluate the growth of EPCs subjecting to miR-126 overexpression.Cell migration analysis was done by wound healing and transwell assay.The target genes of miR-126 were predicted by TargetScan and validated by Western blot.Result (1) miR-126 mimics promoted EPCs growth at 24 h post cell transfection (P ＜ 0.01).In contrast,the EPCs growth was immue from miR-126 application at 48 and 72 h.(2) Both the wound healing and transwell assay show that miR-126 promotes EPCs migration (P ＜ 0.01) and miR-126 inhibitor inhibits EPCs migration (P ＜ 0.01).(3)It is predicted that KANK2 is the potential target gene of miR-126 by TargetScan online software.(4) The results of Western blot indicated that miR-126 mimics repress the expression of KANK2 compared with NC but miR-126 inhibitor enhances KANK2 expression.Conclusions miR-126 has a transient effect on the promotion of EPCc growth.miR-126 promotes EPCs migration and targets KANK2 protein.

Objective To investigate the efficacy of pegylated interferon (PEG-IFN)+ ribavirin (RBV) treatment in patients with chronic hepatitis C (CHC),and to evaluate the predictors of treatment response.Methods One hundred and thirty CHC patients treated with PEG-IFN a-2a 180 μg weekly or PegIFNα-2b 80 μg weekly plus RBV 900-1200 mg/d for 48 weeks in Guangdong Province were enrolled.The clinical data including age,gender,body mass index (BMI),spleen index (SPI),the diameter of portal vein (PV),hepatitis C virus (HCV) genotype,HCV RNA level were collected at baseline,week 4,12,24,48 of treatment and week 24 of follow-up.Patients obtained sustained virological response (SVR) were compared to those with non-sustained virological response (NSVR).The related factors of SVR were analyzed.The data were compared by t test,chi square test or Logistic regression.Results The total SVR rate was 84％ (109/130),among which rapid virological response ( RVR ),early virological response ( EVR ),and end-of-treatment virological response (ETVR) were 21％ (27/130),72％ (94/130) and 93％ (121/130),respectively.HCV genotype was determined in 70 patients and the SVR rate was 82 ％ (45/55) in the genotype 1 patients and 87％ (13/15) in the genotype non-1 patients.Age,baseline HCV RNA,BMI and SPI were all negatively associated with SVR rate (regression coefficient＜0,all OR＜1,all P＜0.05),while EVR and total cumulative treatment dose of RBV were positively associated with SVR rate (regression coefficient＞0,both OR＞ 1,both P＜0.05).However,RVR,PV and total cumulative treatment doses of PEG-IFN were not associated with SVR rate (P＞0.05).Conclusions The SVR rate of PEG-IFN plus RBV combined treatment is high in CHC patients and more than 80％ of patients can be cured.However,the SVR rates are lower in patients elder than 35 years,with previous treatment failure history,baseline HCV RNA＞6 × 105 IU/mL,BMI＞26 kg/m2,SPI＞40 cm2,or the total cumulative treatment doses of RBV less than 80 ％ of standard dose.