[Objective]To investigate the effects of Kuanxiong aerosol(KXA)on pyroptosis and inflammatory response in isoproterenol(ISO)-induced myocardial infarction(MI)rats,and its effect on the key pathway of pyroptosis Toll-like receptor 4(TLR4)/myeloid differentiation primary response gene 88(MyD88)/NOD-like receptor pyrin domain containing 3(NLRP3)/cysteinyl aspartate specific proteinase-1(caspase-1).[Methods]Thirty male Wistar rats were randomly divided into five groups,6 rats in each group,as control group(0.9％sodium chloride solution),model group(ISO 120 mg·kg-1),isosorbide mononitrate(IMSN)group(ISO 120 mg·kg-1+IMSN 5 mg/kg·d),KXA low dose group(ISO 120 mg·kg-1+KXA 0.1 mL/kg·d),and KXA high dose group(ISO 120 mg·kg-1+KXA 0.3 mL/kg·d),gave continuous intragastric administration for 14 days,and intraperitoneal injection of ISO on the 13th and 14th day.After the last intervention,collected heart tissues and blood under anesthesia.Enzyme-linked immunosorbent assay(ELISA)was performed to investigate the expression of creatine kinase-MB(CK-MB)and cardiac troponin T(cTnT),as well as serum inflammatory indicators such as interleukin-1β(IL-1β),interleukin-18(IL-18),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α).The histopathological changes in heart tissue were evaluated using hematoxylin-eosin(HE)staining,and RNA-sequencing was used to detect the differential expression genes among groups.And the expression of the pyroptosis relevant protein was detected by Western blot.[Results]The results of the ELISA showed that CK-MB and cTnT expression in model group were significantly higher than those in control group(P＜0.01),which meant successful model construction.Pathological staining results showed disordered and fractured muscle fibers were significantly improved after KXA and IMSN intervention.RNA-seq results showed there were 2 646 different genes between model group and control group,while 714 other genes were in KXA and model group.After analyzing these two compared groups,it found that there were 130 up-regulated genes and 7 down-regulated genes;among them,inflammation related TLR4 pathway was significantly enriched.Furthermore,compared with model group,the expression of inflammatory factors IL-1β,IL-18,IL-6 and TNF-α decreased significantly in KXA groups and IMSN group(P＜0.01,P＜0.05),and Western blot showed that the protein expression of TLR4,MyD88,phospho-nuclear factor-KB(p-NF-KB)p65,NLRP3,cleaved cysteinyl aspartate specific proteinase-1(cleaved caspase-1)and Gasdermin D-N(GSDMD-N)increased significantly in model group while significantly down-regulated in KXA groups and IMSN group(P＜0.05,P＜0.01).[Conclusion]KXA can improve myocardial ischemia,reduce cardiac damage,and inhibit cardiomyocyte pyroptosis and inflammatory response,the mechanism may be related to regulating the TLR4/MyD88/NLRP3/caspase-1 signaling pathway.

Objective:Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods:The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively. Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels. The procedure began with mastectomy and axillary lymph node dissection, followed by the isolation of bilateral perforators and the main trunk of the abdominal flap. The main trunks of the bilateral inferior epigastric arteries were then transected, and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein. Both arteries and veins were joined end-to-end. The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision. Breast positioning was performed with the patient in a knee-bent and hip-flexed position. After adjusting the shape of the reconstructed breast. The donor site was closed, the umbilicus was reconstructed, drainage tubes were placed, and the breast incision was closed. Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction, utilizing a self-assessment method.Results:Four female patients were included, aged (46.0±6.5) years, ranging from 37 to 52 years. All four patients had bilateral vascular pedicles in the donor area, with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels, and one patient having anterior serratus branch of the thoracodorsal vessels at the distal and proximal ends. All drainage tubes were removed within 7 to 10 days after surgery. Patients were discharged. Follow-up period ranged from 1 to 15 months, averaging 6 months. The patients recovered well postoperatively, with no flap-related complications occurring. All four patients were satisfied with the result of the reconstruction.Conclusion:The simultaneous application of the proximal and distal ends of the thoracodorsal artery and vein can ensure the safety of flap survival while reducing damage to the ribs and intercostal muscles, achieving better aesthetic result.

Objective:Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods:The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively. Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels. The procedure began with mastectomy and axillary lymph node dissection, followed by the isolation of bilateral perforators and the main trunk of the abdominal flap. The main trunks of the bilateral inferior epigastric arteries were then transected, and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein. Both arteries and veins were joined end-to-end. The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision. Breast positioning was performed with the patient in a knee-bent and hip-flexed position. After adjusting the shape of the reconstructed breast. The donor site was closed, the umbilicus was reconstructed, drainage tubes were placed, and the breast incision was closed. Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction, utilizing a self-assessment method.Results:Four female patients were included, aged (46.0±6.5) years, ranging from 37 to 52 years. All four patients had bilateral vascular pedicles in the donor area, with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels, and one patient having anterior serratus branch of the thoracodorsal vessels at the distal and proximal ends. All drainage tubes were removed within 7 to 10 days after surgery. Patients were discharged. Follow-up period ranged from 1 to 15 months, averaging 6 months. The patients recovered well postoperatively, with no flap-related complications occurring. All four patients were satisfied with the result of the reconstruction.Conclusion:The simultaneous application of the proximal and distal ends of the thoracodorsal artery and vein can ensure the safety of flap survival while reducing damage to the ribs and intercostal muscles, achieving better aesthetic result.

Objective:To evaluate the renal injury of ultrasound-guided percutaneous fascia dilatation with one-step and multi-step percutaneous renal dilatation on renal injury in pigs.Methods:20 experimental pigs were randomly divided into 16F group and 24F group, with 10 pigs in each group. Under the guidance of ultrasound, the left and right kidneys of each experimental pig in group 16F were expanded by percutaneous renal multi-step expansion and one-step expansion (multi-step dilation subgroup and one-step dilation subgroup respectively) with 16F expander, and the same operation was performed with 24F expander in 24F group. After the operation, the left and right kidneys were left with fistula tubes for 1 week. The duration of hematuria in the renal fistula tubes was observed and compared. One month later, the experimental pigs were killed and the kidneys were removed. The histopathology of each group was observed under the naked eye and microscope. The scar tissue around the nephrostomy channel was removed, and hematoxylin-eosin (HE) and Masson staining were performed respectively. The scar volume was measured by digital image analysis technology, and the percentage of the scar volume in the renal cortex volume was calculated.Results:There was no significant difference in gross hematuria duration between one-step dilation subgroup [(4.60±1.26)d] versus multi-step dilation subgroup [(4.70±1.17)d] of 16F group ( P>0.05); There was no significant difference in gross hematuria duration between one-step dilation subgroup [(5.40±1.25)d] versus multi-step dilation subgroup [(5.50±1.08)d] of the 24F group ( P>0.05). There was no significant difference in the gross and histological observation of pig kidney specimens in 16F group and 24F group. There was no significant difference in the scar volume of the fistula channel [(0.35±0.04)cm 3, (0.36±0.03)cm 3] and its percentage in the whole renal cortical volume [(0.41±0.05)%, (0.41±0.06)%] between one-step dilation subgroup versus multi-step dilation subgroup of 16F group (all P>0.05); there was no significant difference in the scar volume of the fistula channel [(0.48±0.02)cm 3, (0.49±0.04)cm 3] and its percentage in the whole renal cortical volume [(0.52±0.04)%, (0.53±0.07)%] between one-step dilation subgroup versus multi-step dilation subgroup of 24F group (all P>0.05). The scar volume and its percentage in the whole renal cortical volume of the one-step dilation subgroup and the multi-step dilation subgroup in the 24F group were higher than that of the 16F group, with statistically significant difference (all P<0.05). Conclusions:Both one-step and multi-step percutaneous renal dilatation have less damage to renal parenchyma. The multi-step dilatation has no obvious advantage over one-step dilatation in reducing renal parenchyma injury.

Objective:To investigate the ultrasonographic features of internal jugular venous vein pseudo-aneurysm.Methods:The ultrasonographic and clinical features of a patient with internal jugular venous vein pseudo-aneurysm in Union Hospital Affiliated to Huazhong University of Science and Technology were retrospectively analyzed. These characteristics of this patient combined with cases from literatures were summarized.Results:Ultrasound showed that the 38.6 mm×14.0 mm×29.9 mm anechoic area in the soft tissue layer of the left neck communicated with the left internal jugular vein through the 3.8 mm wide breach, and a 12.9 mm×6.6 mm slightly hyperechoic mass was found in the anechoic area. Color Doppler flow imaging showed that the internal jugular vein communicated with the anechoic area through the crevasse. There was no obvious blood flow signal in slightly hyperechoic mass. The bidirectional burr-like blood flow signal could be detected by pulse-wave Doppler. Contrast enhanced ultrasound showed that the contrast agent flowed into the mass from the internal jugular vein through the breach, and the slightly hyperechoic mass appeared the contrast filling defect, and contrast agent was well filled in the rest of the anechoic area. Ultrasound diagnosis: left internal jugular vein pseudoaneurysm with thrombosis. 35 cases of cervical vein pseudo-aneurysm patients were finally included in 23 documents, including 12 males, 23 females, 15 cases on the left side, 20 cases on the right side, 6 cases of the internal jugular vein, 27 cases of the external jugular vein; one case only describes the neck veins and supraclavicular vein in another one case. Among them, 34 cases showed subcutaneous anechoic masses on ultrasound, 1 case showed slightly hyperechoic masses, and 35 cases showed venous wall breaches.Conclusions:Ultrasound examination has high diagnostic value for vein pseudo-aneurysm owing to its convenience, fast and serial observation. Therefore, it is the preferred method and can be widely used in clinical practice. Contrast-enhanced ultrasound can clearly show the blood perfusion, and help to improve the diagnostic confidence of the operator.

Objective:To explore the clinical features of decompensated liver cirrhosis patients with acute kidney injury (AKI) progressing to chronic kidney disease (CKD) and its impact on prognosis.Methods:From January 2015 to July 2019, at Tianjin Second People′s Hospital, the general data and laboratory test results of 346 hospitalized patients with decompensated liver cirrhosis were retrospectively analyzed. The patients were followed up for 12 months. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of AKI and CKD. Kaplan-Meier method was used for survival analysis. The independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:A total of 128 patients with decompensated liver cirrhosis developed AKI, and 25 of them developed into CKD. Univariate analysis showed that age, hypertension, complications of liver cirrhosis infection, ascites and hepatic encephalopathy, acute-on-chronic liver failure, Child-Turcotte-Pugh score of liver function, baseline serum creatinine, post-admission serum creatinine, serum sodium, white blood cell count, total cholesterol, triglyceride, high-density lipoprotein, total bilirubin, albumin, international normalized ratio (INR) and prothrombin time activity were risk factors of AKI in patients with decompensated liver cirrhosis ( t=3.822, χ2=12.534, 26.761, 5.035, 3.894 and 26.101, U=7 004.500, 9 132.500, 5 925.000, 10 144.000, 10 717.500, 10 827.000, 10 912.000, 5 741.500, 10 017.000, 10 187.500, 11 680.500 and 11 321.500, all P<0.05). The risk factors of AKI progressing to CKD in decompensated liver cirrhosis included the etiology of liver cirrhosis, hypertension, baseline serum creatinine, serum creatinine at the time of diagnosis of AKI, total cholesterol, INR, AKI etiology and AKI classification ( χ2=13.153 and 9.144, U=353.000, 337.000, 576.500 and 481.000, χ2=9.501 and 17.801, all P<0.05). The results of multivariate logistic regression analysis showed that the independent risk factors of AKI progressing to CKD in decompensated liver cirrhosis included baseline serum creatinine (odds ratio ( OR)=1.066, 95% confidence interval ( CI) 1.020 to 1.114, P=0.005) and AKI classification ( OR=6.086, 95% CI 1.828 to 20.260, P=0.003). The Kaplan-Meier survival curve showing that after following up for 12 months, the survival rate of patients with decompensated liver cirrhosis patients who progressed to CKD from AKI was lower than that of patients who did not developed into CKD (52.0%, 13/25 vs. 86.4%, 51/59), and the difference was statistically significant ( χ2=11.482, P=0.001). Conclusion:The transition from AKI into CKD is common in patients with liver cirrhosis, which affects the clinical prognosis and reduces the survival rate.

Objective To assess the morphological changes of tricuspid annulus in patients with functional tricuspid regurgitation(FTR)by real-time three-dimensional echocardiography.Methods Seventy-five FTR patients were divided into 4 groups according to the tricuspid regurgitation and transverse diameter of tricuspid annulus,which were group A(regurgitation more than moderate and dilated transverse diameter,n=21),group B(regurgitation less than moderate and dilated transverse diameter,n =18), group C(regurgitation more than moderate and normal transverse diameter,n = 1 9),group D (regurgitation less than moderate and normal transverse diameter,n =17).And 21 healthy controls were chosen to be group E.The 3D parameters including annular anterior-posterior diameter(AP),annular left-right diameter(SM),sphericity index(SI),non-planar angle(NPA),anterior annular length(Ant Ann), posterior annular length(Post Ann),annular circumference(Ann)and annular area(Area)were analyzed. Results SM,AP,Post Ann,Ann and Area of group A and B were larger than those in group E,whereas SI and Ant Ann only larger in group A(P<0.05).There were positive correlations between SM,AP,Post Ann,Ann,Area and the degree of regurgitation in group A(P <0.05).The patients of group C showed larger SM,Ant Ann,Post Ann,Ann and Area compared with patients in group E(P <0.05).There were no significant difference in all 3D parameters between group D and E(P >0.05).Conclusions FTR patients with regurgitation more than moderate or dilated transverse diameter are accompanied with changes of 3D annular parameters. The real-time three-dimensional echocardiography is helpful to judge morphological changes of tricuspid annulus in patients with FTR.

Objective To investigate the effect of low dose low molecular weight heparin (LMWH) on acute pancreatitis (AP). Methods 98 AP patients who were admitted in our hospital from 2002 to 2008 were randomly divided into anticoagulant therapy group (n = 40) and control group (n = 58). Anticoagulant therapy group consisted of 15 cases of severe acute pancreatitis (SAP) and 25 cases of mild acute pancreatitis (MAP) ; while there were 19 cases of SAP and 39 cases of MAP in control group. The patients of control group received conventional treatment, and conventional therapy together with 3 000 U LMWH subcutaneous injection every 12 hours were used in anticoagulant therapy group for two weeks. The changes of APACHE II score, complication rate, mortality and length of hospital stay were observed and the coagulation changes before and after anticoagulant therapy were documented. Results 7 days later, the APACHE II score, complication rate, mortality and length of hospital stay of SAP patients in the anticoagulant therapy group were 9. 9 ±4. 9, 20% , 13.3% , (20.6 ±10.4)d, respectively; while they were 12. 2 ±4.8, 42. 1%, 47.4%, (28. 2 ± 12. 5) d, respectively, in the control group, and the difference was statistically significant (P < 0. 05). The corresponding values were not statistically significantly different among MAP patients in the two groups. The coagulation after treatment in anticoagulant therapy group was not statistically different with that before treatment. Conclusions Low dose LMWH could reduce the rate of complication rate, mortality and decrease the length of hospital stay, without complication of hemorrhage, which should be recommended in the early phase of SAP.

OBJECTIVETo evaluate the role of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and plasma homocysteine levels in Chinese patients with type 2 diabetes mellitus and diabetic retinopathy (DR).

METHODSMTHFR genetic C677T polymorphisms were determined by PCR-restriction fragment length polymorphism. Total plasma homocysteine levels were measured using high-performance liquid chromatography (HPLC) with fluorescence detection.

RESULTSThe frequencies of MTHFR T homogenetic type and CT heterogenetic type and allele T (28.18%, 41.82%, 49.09%) in type 2 diabetic patients with diabetic retinopathy were significantly higher than those in diabetic patients without retinopathy (18.37%,29.59%,33.16%) or the normal controls (17.54%, 28.07%, 31.58%). Howerver, there were no significant differences in the frequency of MTHFR genotype and allele between the type 2 diabetic patients without retinopathy and the normal controls. The presence of T allele appeared to have a strong association with the development of diabetic retinopathy. The odds ratio was 1.94 and the 95% confidence interval was 1.31-2.88. Moreover, the plasma homocysteine levels in patients with TT or CT genotype were markedly higher than those in patients with CC genotype.

CONCLUSIONMTHFR gene C677T mutation associated with a predisposition to increase of plasma homocysteine may represent a genetic risk factor for diabetic retinopathy in Chinese type 2 diabetes mellitus.

Adult ; Alleles ; DNA ; genetics ; metabolism ; Deoxyribonucleases, Type II Site-Specific ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; complications ; genetics ; Diabetic Retinopathy ; blood ; etiology ; genetics ; Female ; Gene Frequency ; Genotype ; Homocysteine ; blood ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; Middle Aged ; Oxidoreductases Acting on CH-NH Group Donors ; genetics ; Point Mutation ; Polymorphism, Genetic