BACKGROUND While acute exposure to high-altitude hypoxic environments can lead to increased thrombosis risk,preventive measures are currently limited.Recently,human umbilical cord mesenchymal stem cell(hUC-MSC)transpl...BACKGROUND While acute exposure to high-altitude hypoxic environments can lead to increased thrombosis risk,preventive measures are currently limited.Recently,human umbilical cord mesenchymal stem cell(hUC-MSC)transplantation has been found effective in preventing and treating various clinical conditions,including thro-mbotic diseases.Platelets are crucial for thrombus formation,and theirα-granules are key determinants of platelet function.However,little is known about the influence of hUC-MSCs on plateletα-granules.METHODS Rats were assigned to three groups,namely,low-altitude,high-altitude,and hUC-MSC-treated groups.The low-altitude group was pretreated with normal saline and housed at an altitude of 1500 m.Rats in the high-altitude group received similar pretreatment and were housed in a simulated hypobaric hypoxia chamber with an altitude of 6500 m and oxygen partial pressure of 7.7 kPa.hUC-MSC-treated rats were pretreated with hUC-MSCs and exposed to hypoxic conditions.Aortic blood was collected after three days to assess platelet counts and mor-phology andα-granule release.RESULTS Compared to the low-altitude group,the high-altitude group exhibited significantly higher platelet counts,plasma levels of von Willebrand factor,platelet factor 4,beta-thromboglobulin,as well as surface P-selectin(CD62p)and p-protein kinase B,p-mitogen-activated protein kinase,and p-extracellular-signal regulated kinase expression in platelets.Platelet morphology in the high-altitude group was irregular,with extended pseudopodia and increasedα-granule densities.However,these changes were not apparent in the hUC-MSC-treated group.CONCLUSION Acute exposure to high-altitude hypoxia increased platelet counts,altered platelet morphology,and increasedα-granule density and release.These effects were mitigated by hUC-MSC treatment,mediated by the protein kinase B/mitogen-activated protein kinase/extracellular-signal regulated kinase pathway.The results indicate that hUC-MSCs may represent a promising and effective approach for the prevention and treatment of acute high-altitude-associated thrombosis,providing an experimental foundation for the development of clinical applications.展开更多
Concrete material model plays an important role in numerical predictions of its dynamic responses subjected to projectile impact and charge explosion.Current concrete material models could be distinguished into two ki...Concrete material model plays an important role in numerical predictions of its dynamic responses subjected to projectile impact and charge explosion.Current concrete material models could be distinguished into two kinds,i.e.,the hydro-elastoplastic-damage model with independent equation of state and the cap-elastoplastic-damage model with continuous cap surface.The essential differences between the two kind models are vital for researchers to choose an appropriate kind of concrete material model for their concerned problems,while existing studies have contradictory conclusions.To resolve this issue,the constitutive theories of the two kinds of models are firstly overviewed.Then,the constitutive theories between the two kinds of models are comprehensively compared and the main similarities and differences are clarified,which are demonstrated by single element numerical examples.Finally,numerical predictions for projectile penetration and charge explosion experiments on concrete targets are compared to further demonstrate the conclusion made by constitutive comparison.It is found that both the two kind models could be used to simulate the dynamic responses of concrete under projectile impact and blast loadings,if the parameter needed in material models are well calibrated,although some discrepancies between them may exist.展开更多
Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in...Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.展开更多
In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in ped...In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in pediatric liver transpl-antation(LT),as well as the relationship between immune rejection after LT and DSA.Currently,LT remains the standard of care for pediatric patients with end-stage liver disease or severe acute liver failure.However,acute and chronic re-jection continues to be a significant cause of graft dysfunction and loss.HLA mismatch significantly reduces graft survival and increases the risk of acute rejection.Among them,D→R one-way mismatch at three loci was significantly related to graft-versus-host disease incidence after LT.The adverse impact of HLA-DSAs on LT recipients is already established.Therefore,the evaluation of HLA and DSA is crucial in pediatric LT.展开更多
Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19...Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19 pediatric heart transplant recipients,divided into two groups:ECMO and non-ECMO,based on whether preoperative ECMO was utilized.We evaluated the patients'surgical conditions,postoperative complications,and survival rates.Additionally,the analysis focused on the differences and correlations in clinical characteristics,inflammatory markers,and long-term survival outcomes.Results:There was no statistically significant difference in perioperative survival rates between the ECMO group(85.7%)and the non-ECMO group(83.3%).However,the ECMO group exhibited significantly higher levels of inflammatory markers,including Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-6(IL-10),Tumor Necrosis Factor-a(TNF-α),and C-reactive protein(CRP),compared to the non-ECMO group(p<0.05).Notably,IL-6,IL-8,and CRP levels in the ECMO group were found to normalize to the levels of the non-ECMO group 24 h after the operation.The cohort demonstrated a mean donor-recipient weight ratio of 1.38±0.39,with successful cardiac remodeling observed in recipients of oversized grafts,with the highest Donor-RecipientWeight Ratio(DRWR)reaching 3.0.Conclusions:The donor-recipient size mismatch plays a significant role in influencing the success rate of PHT.Despite the inflammatory response and perioperative complications,ECMO proves to be an effective bridging strategy,ultimately enhancing overall outcomes in PHT.展开更多
BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognos...BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.展开更多
BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factor...BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factors of POD is crucial,as it can significantly affect patients’prognosis and healthcare costs.AIM To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.METHODS Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD.Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included.Duplicated,data-deficient,non-English,and non-original data studies were excluded.Data were extracted independently by two researchers and then cross-checked.The Newcastle-Ottawa scale was used to evaluate the quality of the included studies.RevMan 5.3 was employed for data analysis.The pooled incidence of POD was calculated according to the data type,and the fixed or random effect model was employed to analyze risk factors based on heterogeneity.Subsequently,sensitivity analysis and publication bias assessments were performed.RESULTS A total of 39 relevant literatures were included.The overall incidence of POD in the organ transplant group was 20%[95%confidence interval(CI):18%-22%];liver transplant group,22%(95%CI:17%-26%);lung transplant group,34%(95%CI:23%-45%);and kidney transplant group,6%(95%CI:2%-10%).Primary graft dysfunction increased the POD risk,with a pooled odds ratio(OR)(95%CI)of 1.78(1.09-2.91).A history of hepatic encephalopathy increased the POD risk,with a pooled OR(95%CI)of 3.19(2.30-4.43).The higher the Acute Physiology and Chronic Health Evaluation II score,the greater the POD risk,with a pooled OR(95%CI)of 1.52(1.09-2.12).A history of alcohol abuse increased the POD risk,with a pooled OR(95%CI)of 2.84(1.74-4.65).Thus,the higher the model for end-stage liver disease score,the greater the POD risk,with a pooled OR(95%CI)of 2.49(1.14-5.43).POD was more likely to develop in patients with preoperative infections,with a pooled OR(95%CI)of 2.78(1.56-4.97).The use of diuretics increased the POD risk,with a pooled OR(95%CI)of 2.36(1.38-4.04).CONCLUSION In this study,the overall incidence of POD in patients who underwent organ transplantation is 20%.The incidence varies among different types of organ transplantation,and multiple factors can increase the POD risk.展开更多
Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regene...Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.展开更多
The reform stems from honesty and determination. Since 2005, organ donation and transplantation in China has undergone thorough reform, which complies with legislation requirements and ethical principles established b...The reform stems from honesty and determination. Since 2005, organ donation and transplantation in China has undergone thorough reform, which complies with legislation requirements and ethical principles established by the World Health Organization(WHO). Reform in China has demonstrated the unwavering confidence and utmost determination of the Chinese government and the Chinese transplantation community. The year 2015 marked a historic turning point when voluntary donations from Chinese citizens became the sole legitimate source for organ transplantation. Since 2015, China has gradually established and refined the “Chinese Mode” and “China System” for organ donation and transplantation, fulfilling its political pledge of reform, and has garnered international recognition, and fostered a social culture which promotes organ donation. This article reviewed the history of reform on organ donation and transplantation in China, presented a new pattern of establishment of organ donation system in the new era of the country, and the direction of advances in the future.展开更多
Neuroendocrine neoplasms(NENs)are highly heterogeneous and potentially malignant tumors arising from secretory cells of the neuroendocrine system.Gastroenteropancreatic NENs(GEP-NENs)are the most common subtype of NEN...Neuroendocrine neoplasms(NENs)are highly heterogeneous and potentially malignant tumors arising from secretory cells of the neuroendocrine system.Gastroenteropancreatic NENs(GEP-NENs)are the most common subtype of NENs.Historically,GEP-NENs have been regarded as infrequent and slow-growing malignancies;however,recent data have demonstrated that the worldwide prevalence and incidence of GEP-NENs have increased exponentially over the last three decades.In addition,an increasing number of studies have proven that GEP-NENs result in a limited life expectancy.These findings suggested that the natural biology of GEP-NENs is more aggressive than commonly assumed.Therefore,there is an urgent need for advanced researches focusing on the diagnosis and management of patients with GEP-NENs.In this review,we have summarized the limitations and recent advancements in our comprehension of the epidemiology,clinical presentations,pathology,molecular biology,diagnosis,and treatment of GEP-NETs to identify factors contributing to delays in diagnosis and timely treatment of these patients.展开更多
BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-fla...BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-flap transfer combined with plate fixation,contributing insights into effective management strategies for these complex cases.AIM To evaluate free-flap transfer with plate fixation for managing Gustilo ⅢB fractures in diabetic patients,focusing on outcomes.METHODS A retrospective analysis of six cases was conducted with a minimum follow-up period of three years.Patients underwent free-flap transfer and plate fixation for fracture management.Outcomes assessed included bone union,flap viability,and complications requiring intervention or plate removal.The follow-up period ranged from three to four years.Persistent infections beneath the flap developed in two patients,necessitating daily wound care.RESULTS Bone healing occurred within 17 to 34 months,with plate removal required in three patients after fracture consolidation.Traumatic osteomyelitis was observed in at least one patient.Despite challenges such as sinus formation and variations in flap pedicle anatomy,successful bone union and flap viability were achieved in all cases.Freeflap transfer combined with plate fixation shows promise for treating Gustilo type ⅢB fractures in patients with diabetes.While infection and the need for plate removal surgeries were observed,consistent success in bone healing and flap viability highlights the potential of this approach.CONCLUSION Free-flap transfer with plate fixation effectively manages Gustilo ⅢB fractures in diabetics,achieving bone/flap healing despite infection risks.Careful patient selection and further validation are critical.展开更多
Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelin...Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.展开更多
Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential inf...Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.展开更多
BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe ...BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe perfusion on the LGA.Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications.Unrecognized,this anatomy carries significant intraoperative injury risk during hepatobiliary/upper gastrointestinal surgery.CASE SUMMARY A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer.During dissection of the hepatogastric ligament,an unexpected vascular anatomy was encountered:The LHA originated exclusively from the LGA,with no conventional branch from the hepatic artery proper.Recognizing this variant artery was essential for left liver perfusion,the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA.The gastrectomy and reconstruction were completed without complication.Postoperative recovery was smooth,with serial liver function tests remaining normal,confirming preserved hepatic arterial supply.CONCLUSION Preoperative mapping detected a critical aberrant left hepatic artery;its preser-vation prevented liver ischemia,ensured safety.展开更多
The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a...The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.展开更多
Objective Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures.However,the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge ev...Objective Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures.However,the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge even for the most experienced surgeon.In this study,we describe in detail a novel unlocking closed reduction technique(UCRT)frame that allows strong traction for bilateral posterior pelvic ring displacement and presents preliminary clinical outcomes.Methods We retrospectively reviewed 32 patients with bilateral displaced posterior pelvic ring disruptions(AO/OTA 61-C2 and C3)who were initially treated with this technique between July 2017 and July 2022.According to the AO/OTA clas-sification,there were 9 cases(28.12%)of 61-C2,and 23 cases(71.88%)of 61-C3.There were 11 males,21 females,with an average age of 38.1 years.The interval from injury to operation was 4-27 days,with a cut-off of 12.5 days(receiver operat-ing characteristic curve).Operative time,blood loss,and postoperative radiographic findings were recorded.The functional outcomes and complications were followed.Results A total of 30(93.8%)patients achieved successful closed reduction,whereas 2 required open reduction.The success-ful closed reduction rate was 95.5%(21/22)in patients whose injury-to-operation time was less than 12.5 days.The vertical displacement percent correction of the obviously displaced hemipelvis was 70.20%±16.79%on average.The average degree of pelvic deformity correction was 64.86%±17.71%.Thirty patients were followed up for at least 12 months(12-36 months),and no complications of nonunion or redisplacement were observed.The Matta-Tornetta scoring standard revealed that the excellent(25/30)and good(4/30)rate was 96.7%.The Majeed clinical efficacy score revealed that the overall excellent and good rate was 100%.One patient had INFIX-related infection,and 2 reported numbness in the lateral thigh.The numbness was improved after INFIX removal.Conclusions This study presents an updated technique for closed reduction using a UCRT frame for bilateral posterior pelvic ring disruption,which has been shown to be effective,as indicated by excellent surgical and functional outcomes.展开更多
Pre-stretching and annealing treatments were conducted on twin roll cast Mg-2Al-1Zn-1Ca(AZX211,in wt.%)plates with a rare earth-like texture.Varying amounts of deformation were applied along the rolling direction(RD)a...Pre-stretching and annealing treatments were conducted on twin roll cast Mg-2Al-1Zn-1Ca(AZX211,in wt.%)plates with a rare earth-like texture.Varying amounts of deformation were applied along the rolling direction(RD)and transverse direction(TD)of AZX211 alloy in order to modify its mechanical proper-ties at room temperature.The results demonstrate that pre-stretching treatment effectively enhances the yield strength(YS),especially along the RD.The strengthening mechanism is attributed to the production of a large number of dislocations and sub-grain boundaries,but the work-hardening ability of the plate will be greatly weakened.Additionally,annealing treatment substantially improves the plasticity and in-plane anisotropy and restores the work-hardening ability.The notable distinction in the pre-stretching process between different directions lies in the underlying deformation mechanism.In case of RD,de-formation is predominantly governed by the slip mechanism of{0002}{11−20}basal slip and{10−10}{11−20}prismatic slip,while along the TD,deformation is primarily controlled by{0002}{11−20}basal slip without significant twinning deformation.When a 6%pre-stretching is conducted,the initial rare earth-like texture of the sample transforms into a symmetrically distributed double-peak basal texture,accompanied by grain refinement.This texture transformation is chiefly due to the dominance of{0002}{11−20}basal slip-driven deformation.Moreover,the annealed sample maintains a strong basal texture,owing to strain-induced recrystallization.展开更多
Background:The essential roles of platelets in thrombosis have been well recognized.Unexpectedly,thrombosis is prevalent during thrombocytopenia induced by cytotoxicity of biological,physical and chemical origins,whic...Background:The essential roles of platelets in thrombosis have been well recognized.Unexpectedly,thrombosis is prevalent during thrombocytopenia induced by cytotoxicity of biological,physical and chemical origins,which could be suffered by military personnel and civilians during chemical,biological,radioactive,and nuclear events.Especially,thrombosis is considered a major cause of mortality from radiation injury-induced thrombocytopenia,while the underlying pathogenic mechanism remains elusive.Methods:A mouse model of radiation injury-induced thrombocytopenia was built by exposing mice to a sublethal dose of ionizing radiation(IR).The phenotypic and functional changes of platelets and megakaryocytes(MKs)were determined by a comprehensive set of in vitro and in vivo assays,including flow cytometry,flow chamber,histopathology,Western blotting,and chromatin immunoprecipitation,in combination with transcriptomic analysis.The molecular mechanism was investigated both in vitro and in vivo,and was consolidated using MK-specific knockout mice.The translational potential was evaluated using a human MK cell line and several pharmacological inhibitors.Results:In contrast to primitive MKs,mature MKs(mMKs)are intrinsically programmed to be apoptosis-resistant through reprogramming the Bcl-xL-BAX/BAK axis.Interestingly,mMKs undergo minority mitochondrial outer membrane permeabilization(MOMP)post IR,resulting in the activation of the cyclic GMP-AMP synthase-stimulator of IFN genes(cGAS-STING)pathway via the release of mitochondrial DNA.The subsequent interferon-β(IFN-β)response in mMKs upregulates a GTPase guanylate-binding protein 2(GBP2)to produce large and hyperreactive platelets that favor thrombosis.Further,we unmask that autophagy restrains minority MOMP in mMKs post IR.Conclusions:Our study identifies that megakaryocytic mitochondria-cGAS/STING-IFN-β-GBP2 axis serves as a fundamental checkpoint that instructs the size and function of platelets upon radiation injury and can be harnessed to treat platelet pathologies.展开更多
BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with c...BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.CASE SUMMARY A 64-year-old female with cervical cancer developed abdominal pain,diarrhea,and blood in the stool 1 year after radiotherapy.An electronic colonoscopy was performed to diagnose chronic radiation enteritis.Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed.The patient experienced short-and long-term relief from symptoms without adverse effects.Whole 16S rRNA sequencing revealed significant differences in the intestinal flora’s composition between patient and healthy donors.Pathogenic bacteria,such as Escherichia fergusonii and Romboutsia timonensis,were more in the patient.Beneficial bacteria such as Faecalibacterium prausnitzii,Fusicatenibacter saccharivorans,Ruminococcus bromii,and Bifidobacterium longum were more in the healthy donors.Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition.The composition converged with the donor's flora,with an increase in core beneficial intestinal bacteria,such as Eubacterium rectale,and a decrease in pathogenic bacteria.Changes in the intestinal flora corresponded with the patients'alleviating clinical symptoms.CONCLUSION Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora.This study provides a new approach for treating patients with chronic radiation enteritis.展开更多
β-Sitosterol is a type of phytosterol that occurs naturally in plants.Previous studies have shown that it has anti-oxidant,anti-hyperlipidemic,anti-inflammatory,immunomodulatory,and anti-tumor effects,but it is unkno...β-Sitosterol is a type of phytosterol that occurs naturally in plants.Previous studies have shown that it has anti-oxidant,anti-hyperlipidemic,anti-inflammatory,immunomodulatory,and anti-tumor effects,but it is unknown whetherβ-sitosterol treatment reduces the effects of ischemic stroke.Here we found that,in a mouse model of ischemic stroke induced by middle cerebral artery occlusion,β-sitosterol reduced the volume of cerebral infarction and brain edema,reduced neuronal apoptosis in brain tissue,and alleviated neurological dysfunction;moreover,β-sitosterol increased the activity of oxygen-and glucose-deprived cerebral cortex neurons and reduced apoptosis.Further investigation showed that the neuroprotective effects ofβ-sitosterol may be related to inhibition of endoplasmic reticulum stress caused by intracellular cholesterol accumulation after ischemic stroke.In addition,β-sitosterol showed high affinity for NPC1L1,a key transporter of cholesterol,and antagonized its activity.In conclusion,β-sitosterol may help treat ischemic stroke by inhibiting neuronal intracellular cholesterol overload/endoplasmic reticulum stress/apoptosis signaling pathways.展开更多
基金Supported by the Major Science and Technology Project of Gansu Province-Social Development Field,No.25ZDFA007Health Industry Research Funding Project of Gansu Province,No.GSWSKY2024-54+3 种基金Youth Science and Technology Fund Program of Gansu Province,No.21JR11RA014National Natural Science Foundation of China,No.81273568Health Industry Research Funding Project of Gansu Province,No.GSWSKY2022-03Logistics Scientific Research Independent Project of the PLA.
文摘BACKGROUND While acute exposure to high-altitude hypoxic environments can lead to increased thrombosis risk,preventive measures are currently limited.Recently,human umbilical cord mesenchymal stem cell(hUC-MSC)transplantation has been found effective in preventing and treating various clinical conditions,including thro-mbotic diseases.Platelets are crucial for thrombus formation,and theirα-granules are key determinants of platelet function.However,little is known about the influence of hUC-MSCs on plateletα-granules.METHODS Rats were assigned to three groups,namely,low-altitude,high-altitude,and hUC-MSC-treated groups.The low-altitude group was pretreated with normal saline and housed at an altitude of 1500 m.Rats in the high-altitude group received similar pretreatment and were housed in a simulated hypobaric hypoxia chamber with an altitude of 6500 m and oxygen partial pressure of 7.7 kPa.hUC-MSC-treated rats were pretreated with hUC-MSCs and exposed to hypoxic conditions.Aortic blood was collected after three days to assess platelet counts and mor-phology andα-granule release.RESULTS Compared to the low-altitude group,the high-altitude group exhibited significantly higher platelet counts,plasma levels of von Willebrand factor,platelet factor 4,beta-thromboglobulin,as well as surface P-selectin(CD62p)and p-protein kinase B,p-mitogen-activated protein kinase,and p-extracellular-signal regulated kinase expression in platelets.Platelet morphology in the high-altitude group was irregular,with extended pseudopodia and increasedα-granule densities.However,these changes were not apparent in the hUC-MSC-treated group.CONCLUSION Acute exposure to high-altitude hypoxia increased platelet counts,altered platelet morphology,and increasedα-granule density and release.These effects were mitigated by hUC-MSC treatment,mediated by the protein kinase B/mitogen-activated protein kinase/extracellular-signal regulated kinase pathway.The results indicate that hUC-MSCs may represent a promising and effective approach for the prevention and treatment of acute high-altitude-associated thrombosis,providing an experimental foundation for the development of clinical applications.
基金supported by the National Natural Science Foundations of China (Grant Nos. 52178515, 52078133)
文摘Concrete material model plays an important role in numerical predictions of its dynamic responses subjected to projectile impact and charge explosion.Current concrete material models could be distinguished into two kinds,i.e.,the hydro-elastoplastic-damage model with independent equation of state and the cap-elastoplastic-damage model with continuous cap surface.The essential differences between the two kind models are vital for researchers to choose an appropriate kind of concrete material model for their concerned problems,while existing studies have contradictory conclusions.To resolve this issue,the constitutive theories of the two kinds of models are firstly overviewed.Then,the constitutive theories between the two kinds of models are comprehensively compared and the main similarities and differences are clarified,which are demonstrated by single element numerical examples.Finally,numerical predictions for projectile penetration and charge explosion experiments on concrete targets are compared to further demonstrate the conclusion made by constitutive comparison.It is found that both the two kind models could be used to simulate the dynamic responses of concrete under projectile impact and blast loadings,if the parameter needed in material models are well calibrated,although some discrepancies between them may exist.
文摘Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.
文摘In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in pediatric liver transpl-antation(LT),as well as the relationship between immune rejection after LT and DSA.Currently,LT remains the standard of care for pediatric patients with end-stage liver disease or severe acute liver failure.However,acute and chronic re-jection continues to be a significant cause of graft dysfunction and loss.HLA mismatch significantly reduces graft survival and increases the risk of acute rejection.Among them,D→R one-way mismatch at three loci was significantly related to graft-versus-host disease incidence after LT.The adverse impact of HLA-DSAs on LT recipients is already established.Therefore,the evaluation of HLA and DSA is crucial in pediatric LT.
基金supported by National Key Research and Development Program of China(Grant Nos.2021YFC2701700&2021YFC2701703)Special Research Project on Family Planning of the Logistics Support Department of the Military Commission(20JSZ15).
文摘Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19 pediatric heart transplant recipients,divided into two groups:ECMO and non-ECMO,based on whether preoperative ECMO was utilized.We evaluated the patients'surgical conditions,postoperative complications,and survival rates.Additionally,the analysis focused on the differences and correlations in clinical characteristics,inflammatory markers,and long-term survival outcomes.Results:There was no statistically significant difference in perioperative survival rates between the ECMO group(85.7%)and the non-ECMO group(83.3%).However,the ECMO group exhibited significantly higher levels of inflammatory markers,including Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-6(IL-10),Tumor Necrosis Factor-a(TNF-α),and C-reactive protein(CRP),compared to the non-ECMO group(p<0.05).Notably,IL-6,IL-8,and CRP levels in the ECMO group were found to normalize to the levels of the non-ECMO group 24 h after the operation.The cohort demonstrated a mean donor-recipient weight ratio of 1.38±0.39,with successful cardiac remodeling observed in recipients of oversized grafts,with the highest Donor-RecipientWeight Ratio(DRWR)reaching 3.0.Conclusions:The donor-recipient size mismatch plays a significant role in influencing the success rate of PHT.Despite the inflammatory response and perioperative complications,ECMO proves to be an effective bridging strategy,ultimately enhancing overall outcomes in PHT.
文摘BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.
基金Supported by the Health Commission of Guangxi Zhuang Autonomous Region Self-Funded Research Projects,No.Z20180575 and No.Z-A20231058.
文摘BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factors of POD is crucial,as it can significantly affect patients’prognosis and healthcare costs.AIM To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.METHODS Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD.Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included.Duplicated,data-deficient,non-English,and non-original data studies were excluded.Data were extracted independently by two researchers and then cross-checked.The Newcastle-Ottawa scale was used to evaluate the quality of the included studies.RevMan 5.3 was employed for data analysis.The pooled incidence of POD was calculated according to the data type,and the fixed or random effect model was employed to analyze risk factors based on heterogeneity.Subsequently,sensitivity analysis and publication bias assessments were performed.RESULTS A total of 39 relevant literatures were included.The overall incidence of POD in the organ transplant group was 20%[95%confidence interval(CI):18%-22%];liver transplant group,22%(95%CI:17%-26%);lung transplant group,34%(95%CI:23%-45%);and kidney transplant group,6%(95%CI:2%-10%).Primary graft dysfunction increased the POD risk,with a pooled odds ratio(OR)(95%CI)of 1.78(1.09-2.91).A history of hepatic encephalopathy increased the POD risk,with a pooled OR(95%CI)of 3.19(2.30-4.43).The higher the Acute Physiology and Chronic Health Evaluation II score,the greater the POD risk,with a pooled OR(95%CI)of 1.52(1.09-2.12).A history of alcohol abuse increased the POD risk,with a pooled OR(95%CI)of 2.84(1.74-4.65).Thus,the higher the model for end-stage liver disease score,the greater the POD risk,with a pooled OR(95%CI)of 2.49(1.14-5.43).POD was more likely to develop in patients with preoperative infections,with a pooled OR(95%CI)of 2.78(1.56-4.97).The use of diuretics increased the POD risk,with a pooled OR(95%CI)of 2.36(1.38-4.04).CONCLUSION In this study,the overall incidence of POD in patients who underwent organ transplantation is 20%.The incidence varies among different types of organ transplantation,and multiple factors can increase the POD risk.
基金supported by the National Natural Science Foundation of China(81925027,82002275,and 32271421)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.
文摘The reform stems from honesty and determination. Since 2005, organ donation and transplantation in China has undergone thorough reform, which complies with legislation requirements and ethical principles established by the World Health Organization(WHO). Reform in China has demonstrated the unwavering confidence and utmost determination of the Chinese government and the Chinese transplantation community. The year 2015 marked a historic turning point when voluntary donations from Chinese citizens became the sole legitimate source for organ transplantation. Since 2015, China has gradually established and refined the “Chinese Mode” and “China System” for organ donation and transplantation, fulfilling its political pledge of reform, and has garnered international recognition, and fostered a social culture which promotes organ donation. This article reviewed the history of reform on organ donation and transplantation in China, presented a new pattern of establishment of organ donation system in the new era of the country, and the direction of advances in the future.
基金supported by the National Natural Science Foundation of China(82104596)the Shenzhen Key Medical Discipline Construction Fund&Sanming Project of Medicine in Shenzhen(SZSM202111002)+1 种基金the Medicine-Engineering Interdisciplinary Research Foundation of Shenzhen University(2023YG019)the Shenzhen Science and Technology Program(GJHZ20220913143005010)。
文摘Neuroendocrine neoplasms(NENs)are highly heterogeneous and potentially malignant tumors arising from secretory cells of the neuroendocrine system.Gastroenteropancreatic NENs(GEP-NENs)are the most common subtype of NENs.Historically,GEP-NENs have been regarded as infrequent and slow-growing malignancies;however,recent data have demonstrated that the worldwide prevalence and incidence of GEP-NENs have increased exponentially over the last three decades.In addition,an increasing number of studies have proven that GEP-NENs result in a limited life expectancy.These findings suggested that the natural biology of GEP-NENs is more aggressive than commonly assumed.Therefore,there is an urgent need for advanced researches focusing on the diagnosis and management of patients with GEP-NENs.In this review,we have summarized the limitations and recent advancements in our comprehension of the epidemiology,clinical presentations,pathology,molecular biology,diagnosis,and treatment of GEP-NETs to identify factors contributing to delays in diagnosis and timely treatment of these patients.
文摘BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-flap transfer combined with plate fixation,contributing insights into effective management strategies for these complex cases.AIM To evaluate free-flap transfer with plate fixation for managing Gustilo ⅢB fractures in diabetic patients,focusing on outcomes.METHODS A retrospective analysis of six cases was conducted with a minimum follow-up period of three years.Patients underwent free-flap transfer and plate fixation for fracture management.Outcomes assessed included bone union,flap viability,and complications requiring intervention or plate removal.The follow-up period ranged from three to four years.Persistent infections beneath the flap developed in two patients,necessitating daily wound care.RESULTS Bone healing occurred within 17 to 34 months,with plate removal required in three patients after fracture consolidation.Traumatic osteomyelitis was observed in at least one patient.Despite challenges such as sinus formation and variations in flap pedicle anatomy,successful bone union and flap viability were achieved in all cases.Freeflap transfer combined with plate fixation shows promise for treating Gustilo type ⅢB fractures in patients with diabetes.While infection and the need for plate removal surgeries were observed,consistent success in bone healing and flap viability highlights the potential of this approach.CONCLUSION Free-flap transfer with plate fixation effectively manages Gustilo ⅢB fractures in diabetics,achieving bone/flap healing despite infection risks.Careful patient selection and further validation are critical.
基金funded by National Natural Science Foundation of China(82072846 to Xu B).
文摘Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.
基金supported by the National Natural Science Foundation of China(82422045).
文摘Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.
基金Supported by Lanzhou Science and Technology Project,No.2024-9-139.
文摘BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe perfusion on the LGA.Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications.Unrecognized,this anatomy carries significant intraoperative injury risk during hepatobiliary/upper gastrointestinal surgery.CASE SUMMARY A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer.During dissection of the hepatogastric ligament,an unexpected vascular anatomy was encountered:The LHA originated exclusively from the LGA,with no conventional branch from the hepatic artery proper.Recognizing this variant artery was essential for left liver perfusion,the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA.The gastrectomy and reconstruction were completed without complication.Postoperative recovery was smooth,with serial liver function tests remaining normal,confirming preserved hepatic arterial supply.CONCLUSION Preoperative mapping detected a critical aberrant left hepatic artery;its preser-vation prevented liver ischemia,ensured safety.
文摘The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.
基金supported by the National Key Research and Development Program of China(2022YFC2504303)Innovation Foundation of National Clinical Research Center for Orthopaedics,Sports Medicine&Rehabilitation(2021-NCRC-CXJJ-ZH-24)Medical Innovation and Transformation Incubation Project of Tongji Hospital(2022ZHFY10).
文摘Objective Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures.However,the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge even for the most experienced surgeon.In this study,we describe in detail a novel unlocking closed reduction technique(UCRT)frame that allows strong traction for bilateral posterior pelvic ring displacement and presents preliminary clinical outcomes.Methods We retrospectively reviewed 32 patients with bilateral displaced posterior pelvic ring disruptions(AO/OTA 61-C2 and C3)who were initially treated with this technique between July 2017 and July 2022.According to the AO/OTA clas-sification,there were 9 cases(28.12%)of 61-C2,and 23 cases(71.88%)of 61-C3.There were 11 males,21 females,with an average age of 38.1 years.The interval from injury to operation was 4-27 days,with a cut-off of 12.5 days(receiver operat-ing characteristic curve).Operative time,blood loss,and postoperative radiographic findings were recorded.The functional outcomes and complications were followed.Results A total of 30(93.8%)patients achieved successful closed reduction,whereas 2 required open reduction.The success-ful closed reduction rate was 95.5%(21/22)in patients whose injury-to-operation time was less than 12.5 days.The vertical displacement percent correction of the obviously displaced hemipelvis was 70.20%±16.79%on average.The average degree of pelvic deformity correction was 64.86%±17.71%.Thirty patients were followed up for at least 12 months(12-36 months),and no complications of nonunion or redisplacement were observed.The Matta-Tornetta scoring standard revealed that the excellent(25/30)and good(4/30)rate was 96.7%.The Majeed clinical efficacy score revealed that the overall excellent and good rate was 100%.One patient had INFIX-related infection,and 2 reported numbness in the lateral thigh.The numbness was improved after INFIX removal.Conclusions This study presents an updated technique for closed reduction using a UCRT frame for bilateral posterior pelvic ring disruption,which has been shown to be effective,as indicated by excellent surgical and functional outcomes.
基金supported by the National Natural Science Foundation of China(No.52001106)Hebei province(No.E2022202158).
文摘Pre-stretching and annealing treatments were conducted on twin roll cast Mg-2Al-1Zn-1Ca(AZX211,in wt.%)plates with a rare earth-like texture.Varying amounts of deformation were applied along the rolling direction(RD)and transverse direction(TD)of AZX211 alloy in order to modify its mechanical proper-ties at room temperature.The results demonstrate that pre-stretching treatment effectively enhances the yield strength(YS),especially along the RD.The strengthening mechanism is attributed to the production of a large number of dislocations and sub-grain boundaries,but the work-hardening ability of the plate will be greatly weakened.Additionally,annealing treatment substantially improves the plasticity and in-plane anisotropy and restores the work-hardening ability.The notable distinction in the pre-stretching process between different directions lies in the underlying deformation mechanism.In case of RD,de-formation is predominantly governed by the slip mechanism of{0002}{11−20}basal slip and{10−10}{11−20}prismatic slip,while along the TD,deformation is primarily controlled by{0002}{11−20}basal slip without significant twinning deformation.When a 6%pre-stretching is conducted,the initial rare earth-like texture of the sample transforms into a symmetrically distributed double-peak basal texture,accompanied by grain refinement.This texture transformation is chiefly due to the dominance of{0002}{11−20}basal slip-driven deformation.Moreover,the annealed sample maintains a strong basal texture,owing to strain-induced recrystallization.
基金supported by the Key Program of the National Natural Science Foundation of China(81930090)the National Science Foundation for Distinguished Young Scholars of China(81725019)+2 种基金the National Natural Science Foundation of China(32171104,82273571,and 81874256)the Chongqing Natural Science Foundation(2023NSCQ-MSX0687,CSTB2023NSCQ-JQX0015,and cstc2015jcyjys10001)the Chongqing Talent Program(CQYC20220511002).
文摘Background:The essential roles of platelets in thrombosis have been well recognized.Unexpectedly,thrombosis is prevalent during thrombocytopenia induced by cytotoxicity of biological,physical and chemical origins,which could be suffered by military personnel and civilians during chemical,biological,radioactive,and nuclear events.Especially,thrombosis is considered a major cause of mortality from radiation injury-induced thrombocytopenia,while the underlying pathogenic mechanism remains elusive.Methods:A mouse model of radiation injury-induced thrombocytopenia was built by exposing mice to a sublethal dose of ionizing radiation(IR).The phenotypic and functional changes of platelets and megakaryocytes(MKs)were determined by a comprehensive set of in vitro and in vivo assays,including flow cytometry,flow chamber,histopathology,Western blotting,and chromatin immunoprecipitation,in combination with transcriptomic analysis.The molecular mechanism was investigated both in vitro and in vivo,and was consolidated using MK-specific knockout mice.The translational potential was evaluated using a human MK cell line and several pharmacological inhibitors.Results:In contrast to primitive MKs,mature MKs(mMKs)are intrinsically programmed to be apoptosis-resistant through reprogramming the Bcl-xL-BAX/BAK axis.Interestingly,mMKs undergo minority mitochondrial outer membrane permeabilization(MOMP)post IR,resulting in the activation of the cyclic GMP-AMP synthase-stimulator of IFN genes(cGAS-STING)pathway via the release of mitochondrial DNA.The subsequent interferon-β(IFN-β)response in mMKs upregulates a GTPase guanylate-binding protein 2(GBP2)to produce large and hyperreactive platelets that favor thrombosis.Further,we unmask that autophagy restrains minority MOMP in mMKs post IR.Conclusions:Our study identifies that megakaryocytic mitochondria-cGAS/STING-IFN-β-GBP2 axis serves as a fundamental checkpoint that instructs the size and function of platelets upon radiation injury and can be harnessed to treat platelet pathologies.
文摘BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.CASE SUMMARY A 64-year-old female with cervical cancer developed abdominal pain,diarrhea,and blood in the stool 1 year after radiotherapy.An electronic colonoscopy was performed to diagnose chronic radiation enteritis.Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed.The patient experienced short-and long-term relief from symptoms without adverse effects.Whole 16S rRNA sequencing revealed significant differences in the intestinal flora’s composition between patient and healthy donors.Pathogenic bacteria,such as Escherichia fergusonii and Romboutsia timonensis,were more in the patient.Beneficial bacteria such as Faecalibacterium prausnitzii,Fusicatenibacter saccharivorans,Ruminococcus bromii,and Bifidobacterium longum were more in the healthy donors.Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition.The composition converged with the donor's flora,with an increase in core beneficial intestinal bacteria,such as Eubacterium rectale,and a decrease in pathogenic bacteria.Changes in the intestinal flora corresponded with the patients'alleviating clinical symptoms.CONCLUSION Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora.This study provides a new approach for treating patients with chronic radiation enteritis.
基金supported by the National Natural Science Foundation of China,Nos.82104158(to XT),31800887(to LY),31972902(to LY),82001422(to YL)China Postdoctoral Science Foundation,No.2020M683750(to LY)partially by Young Talent Fund of University Association for Science and Technology in Shaanxi Province of China,No.20200307(to LY).
文摘β-Sitosterol is a type of phytosterol that occurs naturally in plants.Previous studies have shown that it has anti-oxidant,anti-hyperlipidemic,anti-inflammatory,immunomodulatory,and anti-tumor effects,but it is unknown whetherβ-sitosterol treatment reduces the effects of ischemic stroke.Here we found that,in a mouse model of ischemic stroke induced by middle cerebral artery occlusion,β-sitosterol reduced the volume of cerebral infarction and brain edema,reduced neuronal apoptosis in brain tissue,and alleviated neurological dysfunction;moreover,β-sitosterol increased the activity of oxygen-and glucose-deprived cerebral cortex neurons and reduced apoptosis.Further investigation showed that the neuroprotective effects ofβ-sitosterol may be related to inhibition of endoplasmic reticulum stress caused by intracellular cholesterol accumulation after ischemic stroke.In addition,β-sitosterol showed high affinity for NPC1L1,a key transporter of cholesterol,and antagonized its activity.In conclusion,β-sitosterol may help treat ischemic stroke by inhibiting neuronal intracellular cholesterol overload/endoplasmic reticulum stress/apoptosis signaling pathways.
