Objectives:to analyze the efficacy of percutaneous coronary intervention(PCI)for complex left main(LM)lesions combined with chronic total occlusion(CTO)of the right coronary artery. Methods:Ninety patients with complex left main lesions hospitalized in Hunan Provincial People's Hospital from January 2019 to December 2022 were consecutively included.According to the coronary angiographic vascular lesions,patients were divided into complex left main lesions combined with right coronary artery CTO(observation group,n=30)and complex left main lesions without right coronary artery CTO(control group,n=60).The baseline clinical data,intraoperative conditions,angiographic results,and postoperative follow-up results of the patients were analyzed and compared between the two groups. Results:Fifty-eight(64.4%)out of the 90 patients were male.There was no statistically significant difference between the two groups in terms of baseline clinical data(all P>0.05),left main lesion condition(P=1.000),left main calcification condition(P=0.249),and preoperative TIMI flow grading(P=1.000).In the comparison between observation group and the control group,intraoperative occurrence of no-reflow(3.3%vs.5.0%,P=1.000),hypotension(10.0%vs.8.3%,P=1.000),pericardial effusion(3.3%vs.0%,P=0.333),the percentage of intravascular ultrasound(IVUS)use(86.7%vs.90.0%,P=0.635),and the use of circulatory assist device(P=0.699),and the proportion of intraoperative coronary spinning(26.7%vs.21.7%,P=0.597)were all similar between the two groups.The median follow-up time was 14.50(11.83,15.85)months,and the differences in the incidence of major adverse cardiovascular events(MACE)such as recurrent angina,acute myocardial infarction,rebleeding,readmission for heart failure,and cardiac death(31.0%vs.32.1%,P=1.000)were not statistically significant between the observation group and the control group. Conclusions:PCI revascularization may be a viable approach for elderly patients with complex LM lesions with multiple underlying disease,and combined right coronary artery CTO,intolerance and reluctance to CABG.

Objective To investigate the inhibitory effect of harmine on osteosarcoma cell proliferation and apoptosis by down regulating cyclooxygenase-2 (COX-2) expression.Methods Human osteosarcoma cell line U2OS was cultured in vitro and randomly divided into control group,study group 1,study group 2 and study group 3.The cells were cultured in 0,5 μmol/L,10 μmol/L and 20 μmol/L concentration of harmine for 48 hours.Cell counting kit-8 (CCK-8) method and flow cytometry were used to detect cell viability and apoptosis.The expression level of COX-2,proliferation and apoptosis related proteins and mRNA were detected by Western blot and real-time quantitative polymerase chain reaction (RT-qPCR),respectively.Results After cultured with different concentrations of harmine for 12,24 hours and 48 hours,the cell viability of the three study groups were significantly lower than that of the control group (P ＜ 0.05),while that of the study groups 2 and 3 were significantly lower than that of the study group 1 (P ＜ 0.05).The apoptosis rate of the three study groups were significantly higher than that of the control group (P ＜0.05),while that of the two groups were significantly higher than that of the study group 1 (P ＜ 0.05).After 48 hours of culture,the levels of COX-2,cyclin D1,proliferating cell nuclear antigen (PCNA),B-cell lymphoma-2 (Bcl-2) protein and mRNA expression in study group 2 were significantly lower than those in control group,while the expression levels of cleaved caspase-3 and BCL2-Associated X (Bax) in study group 2 were significantly higher than those in control group (P ＜ 0.05).Conclusions Harmine can inhibit the proliferation and promote the apoptosis of osteosarcoma cells by inhibiting the expression of COX-2 and regulating the expression of cell cycle and apoptosis related protein.

Objective To determine whether a periprosthetic joint infections (PJI) patient derived S.aureus is an appropriate candidate tool bacterium for studying the pathogenesis of S.aureus-induced PJI.Methods Whole genome sequencing data of ST1792 was obtained using the Illumina Hiseq platform of a Staphylocuccal.aureus(S.aureus) strain derived from a PJI prosthesis,and gene functional enrichment analysis based on gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) database was performed.Besides,its biofilm formation ability in drainage fluid,synovial fluid and human plasmin were compared to that in experimental cultures,in order to determine differences in biofilm forming ability in different environment.In addition,based on Illumina Hiseq platform,transcriptome analysis of the S.aureus in the three types of fluid above was performed to determine its gene expression profile and functional enrichment analysis of the differentially expressed genes was conducted through the GO and KEGG database.Finally,adaptability in different human fluid of the S.aureus was analyzed with the transcriptome profile and biofilm formation data.Results The genome of ST1792 consisted of 2 718 coding sequences,including main virulence encoding genes and regulation related genes.Functional enrichment showed no sign of significant missing or major recombination in the bacterial genome.The biofilm mass in plasmin was much higher than that in synovial fluid,both significantly higher than the biofilm mass in TSB.But the biofilm mass in drainage fluid was not statistically different from that in TSB.This revealed that the bacterial biofilm phenotype was significantly altered in PJI human fluid.Transcriptomics sequencing revealed that a huge number of genes were differentially expressed in drainage fluid,synovial fluid and human plasmin compared to TSB.Functional enrichment revealed that the bacterial gene expression profile was different in PJI human fluids,which showed the sophisticated adaptation of the bacterium to human fluid environment.Conclusion As a clinical S.aureus isolated from a PJI patient,ST1792 presents distinct phenotypes and adaptations in vivo,so it is a proper candidate for future studies in the pathogenesis of S.aureus induced PJI.

Objective:To explore the efficacy of etanercept combined leflunomide to treat ankylosing spondylitis (AS) and its safety.Methods:90 cases with AS patients admitted in our hospital from June 2016 to January 2015 were selected.The patients were divided into observation group and control group by random number table method,45 cases in each group.Observation group was treated with etanercept combined with leflunomide,the control group were treated by leflunomide only.Morning stiffness time,AS activity index (BASDAI),AS measurement index (BASMI) were recorded before and after treatment in two groups,the total effective rate and adverse reaction were compared between the two groups.Results:After treatment,the BASDAI and morning stiffness time,BASMI of two groups of patients compared with before treatment were decreased,and the indexes above of the observation group were significantly lower than the control group,the difference was statistically significant (P＜0.05);The effective rate of the observation group was significantly higher than that of the control group,the difference was statistically significant (P＜0.05);During the course of treatment,the main adverse reactions occurred in patients with liver function damage,diarrhea and allergic skin rash,but there was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion:Etanercept combined with leflunomide can obtain ideal effect,and low incidence rate of adverse reaction,it is worth popularizing in clinical use.

In the present study, packaging system composed of pAAV-CMV-GFP, pAAV-RC and pHelper were transfected into human embryonic kidney 293 cells (HEK293 cells) mediated by polyethyleneimine (PEI) to explore an optimal transfection condition. Different total plasmid DNA dosages (1, 2, 3, 4, 5, 6 μg) and different PEI/Plasmid ratios (1:1, 3:1, 5:1, 7:1) were tested with detection of green fluorescence protein (GFP) with ImagePro Plus6. 0 Software. Then transfection efficiency of the optimized transfection system was further observed for different time periods(12, 24, 36, 48, 60, 72 h). The results showed that total plasmid dosage of 4 μg/well with PEI/plasmid ratio of 3 : 1-5 : 1 was an efficient transfection condition. Transfection efficiency-time curve was an S-shaped curve. Transfection efficiency reached a plateau at 60 h after transfection. The optimized conditions for PEI-mediated transfection at the optimal time result in enhanced transfection efficiency of triple plasmid into HEK293 cells.
Green Fluorescent Proteins ; HEK293 Cells ; Humans ; Plasmids ; Polyethyleneimine ; Transfection ; methods

OBJECTIVETo explore the clinical characteristics and significance of RET proto-oncogene screening in multiple endocrine neoplasia type 2A (MEN2A).

METHODSComprehensive medical history was obtained for 5 members from a 3-generation family from southern China. Clinical investigations have included biochemical testing, imaging, and screening of germline RET proto-oncogene mutations.

RESULTSGenetic screening has revealed a missense mutation at codon 618(TGC>CGC) of exon 10 in 3 patients(p.C618R), which was consistent with their clinical manifestations. For the 3 individuals, the age at diagnosis was 21, 26 and 36 yr, and the maximum diameter of medullary thyroid carcinoma was 22, 25 and 39 cm, respectively. The 36-year-old female patient initially underwent right total thyroidectomy plus right neck lymph node dissection. Four years later, she again underwent left adrenal tumorectomy and left total thyroidectomy plus left neck lymph node dissection. The 21-year-old male patient underwent right total thyroidectomy plus right modified neck dissection. The follow-up was respectively 146 and 26 months following the initial operation. Two patients still presented elevated calcitonin and had bilateral neck lymph node masses and/or left thyroid masses on imaging examination. The 26-year-old female patient, who presented bilateral thyroid masses and elevated calcitonin, has refused thyroidectomy.

CONCLUSIONCombined family survey and RET gene screening can facilitate early diagnosis and surgical treatment to improve the prognosis.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Carcinoma, Neuroendocrine ; Exons ; Female ; Humans ; Male ; Molecular Sequence Data ; Multiple Endocrine Neoplasia Type 2a ; enzymology ; genetics ; Mutation, Missense ; Pedigree ; Proto-Oncogene Proteins c-ret ; genetics ; Thyroid Neoplasms ; enzymology ; genetics ; Young Adult

BACKGROUNDDiversity of orthopedic infections with various local environments affects the pattern and prevalence of pathogens. It is not well-characterized whether different pathogens have different propensity to cause different types of orthopedic infections. We aimed to investigate the frequency of different pathogens derived from orthopedic infections, and determine the relationship between the prevalence of clinical isolates and the type of orthopedic implants, especially focusing on staphylococci.

METHODSFrom January 2006 to December 2011, orthopedic infections were identified retrospectively from clinical microbiology laboratory and orthopedic medical records. The sources of orthopedic infections were divided into two main groups: those associated with implants and those not associated with implants. Implants-associated infections were further subdivided into five subgroups: arthroplasty, internal fixation, external fixation, internal and external fixation, and others. We analyzed microbiological spectrum in different groups and subgroups. Antibiotic susceptibility of staphylococci was analyzed.

RESULTSOnly coagulase-negative staphylococci (CoNS) was significantly more likely to be associated with implants-associated infections (P = 0.029). The overall pathogens prevalence of arthroplasty was significantly different from other subgroups (P < 0.05). 65% isolates from external fixation was Gram-negative bacteria. Some percentage (55%) of S. aureus and (83%) CoNS were resistant to methicillin. No resistance to glycopeptide was seen in all of staphylococci.

CONCLUSIONSStaphylococcus aureus was the most frequent isolates in orthopedic infections but was not associated with the presence or absence of implants. Only CoNS was implants-associated, especially for arthroplasty infection. Cefazolin alone is not enough for orthopedic surgery prophylaxis in settings with a high prevalence of methicillin-resistant staphylococci.

Humans ; Orthopedic Procedures ; adverse effects ; Prostheses and Implants ; microbiology ; Retrospective Studies ; Staphylococcus aureus ; pathogenicity ; physiology

Objective To explore the clinical significance of integrated screening of RET in a Chinese multiple endocrine neoplasia type 2A(MEN 2A)family and to evaluate the feasibility and effectiveness of prophy-lactic total thyroidectomy to MEN 2A-related medullary thyroid carcinoma ( MTC).Methods Medical history was obtained from 10 family members in a 3-generation south China family .Systemic investigations including bio-chemical tests, imaging examinations and germline RET screening were performed .3 asymptomatic mutation car-riers underwent prophylactic total thyroidectomy .Results RET screening showed a heterozygous missense muta-tion of TGC to CGC at codon 634 on exon 11 in 6 members(p.C634R), which was completely consistent with the clinical manifestations.There were 4 males and 2 females.The initial mean diagnostic age of 33.5 years(ranging from 19 years to 65 years) and the mean maximum diameter of MTC was 2.3 cm(ranging from 0.7 cm to 5.2 cm). Among them 3 members had palpable neck masses (1 case with diarrhea).Right total thyroidectomy +right level Ⅵlymph-node dissection with modified right neck dissection in one case , and bilateral total thyroidectomy +bilat-eral level Ⅵlymph-node dissection in 2 were performed .In other 3 asymptomatic mutation carriers , prophylactic total thyroidectomy +bilateral level Ⅵ lymph-node dissection were also performed .Among them, 1 case of a-symptomatic pheochromocytom ( PHEO) underwent cortical-sparing adrenalectomy before MTC .After the first op-eration, 4 patients still presented a high value of calcitonin , among whom 1 patient( T3N 1bM 0-1) underwent re-operation for 3 times after the initial operation and presented metastasis to bone after 130 months, taking vandet-anib orally up to now;2 patients underwent reoperation at 6 and 7 months after initial operation respectively (T1N 1bM0 and T2N 1bM0), and the other one patient was closely monitored and followed up for 22 months(T2N 1b M0).Moreover, The calcitonin levels dropped to normal in the other 2 asymptomatic cases(T1N0M0) who were followed up for 20 months.Conclusions Pedigree screening can work up an early diagnosis and improve the prognosis of MEN 2A.Integrated screening of RET and pre-operative calcitonin level measurement and prophylac-tic thyroidectomy for asymptomatic RET mutation carriers are reasonable and effective .

Objective: To explore the risk factors for Type 1 cardio-renal syndrome (CRS1) atfer ST-segment elevation myocardial infarction (STEMI). Methods: A total of 378 patients with STEMI were divided into two groups: a CRS1 group (n=98) and a non-CRS1 group (n=280). Clinical characteristics in the 2 groups were compared, and independent risk factors for CRS1 after STEMI were analyzed, and the effect of emergency Results: In the 378 STEMI patients, CRS1 was found in 98 patients (25.9%). Between the 2 groups, there was significant difference in 12 parameters, including age, history of diabetes, admission mean arterial pressure, admission systolic blood pressure, admission heart rate, Killip classification, left ventricular ejection fraction, baseline serum creatinine, baseline evaluated glomerular ifltration rate (eGFR), emergency PCI, β-blockers and angiotensin converting enzyme inhibitor/angiotensin, receptor antagonist (ACEI/ARB) application (allP<0.05). Multivariate logistic regression showed that age, history of diabetes, admission systolic blood pressure, Killip classification, reduced left ventricular ejection fraction, reduced eGFR, emergency PCI non-undergo and ACEI/ARB non-use were independent risk factors for CRS1 atfer STEMI. In the 256 patients undergoing emergency PCI, 50 patients (19.5%) had CRS1. hTe door-ball time and the amount of contrast agent in the CRS1 group were signiifcantly higher than those in the non- CRS1 group (bothP<0.05), but there was no signiifcant difference in the blood lfow in the “culprit vessel”atfer the PCI (P>0.05). Conclusion: CRS1 is a common complication of STEMI, which is associated with many factors. Immediate revascularization can reduce the incidence of CRS1 in patients with ST-segment elevation myocardial infarction.

ObjectiveTo investigate the correlation between femoral distal medial torsion and patellofemoral joint malalignment and analyze the causes of patellofemoral joint disorders,which provide the new theory with clinical treatment.MethodsFrom May 2007 to June 2009,124 knees(95 cases) with patellofemoral joint disorders were enrolled in this study randomly.Each knee was scanned with CT in dynamic 20° -30° knee flax position.Femoral distal medial torsion angle (FMTA),patellar congruence angle (CA) and patellar tilt angle(PTA) were measured.The correlation between FMTA and CA or PTA was analyzed.Results FMTA ＜ 5° in 25 knees,≥5° in 99 knees,6 knees with trochlear dysplasia who were excluded.FMTA in 93 knees was 16.06° ± 5.68°,CA was 16.40° ± 5.48° and PTA was 19.59° ± 3.32°.The positive correlation was found between FMTA and CA when FMTA ＞ 10°through scatter diagram analysis (r =0.709,P ＜ 0.05 ).The positive correlation was found between FMTA and PTA when FMTA ＞10°( r =0.652,P ＜ 0.05),the positive trend declined when FMTA ＞ 27°.ConclusionsFemoral distal medial torsion is an important risk factor of patellofemoral joint malalignment.When FMTA ＞ 10°,FMTA and CA,PTA has positive correlation,but the positive tend between FMTA and PTA declines when FMTA ＞ 27°.