Admission delay is associated with worse surgical outcomes for elderly hip fracture patients:A retrospective observational study

BACKGROUND:The influence of surgical delay on mortality and morbidity has been studied extensively among elderly hip fracture patients.However,most studies only focus on the timing of surgery when patients have already been hospitalized,without considering pre-admission waiting time.Therefore,the present study aims to explore the infl uence of admission delay on surgical outcomes.METHODS:In this retrospective study,we recorded admission timing and interval from admission to surgery for included patient.Other covariates were also collected to control confounding.The primary outcome was 1-year mortality.The secondary outcomes were 1-month mortality,3-month mortality,ICU admission and postoperative pneumonia.We mainly used multivariate logistic regression to determine the effect of admission timing on postoperative outcomes.An additional survival analysis was also performed to assess the impact of admission delay on survival status in the fi rst year after operation.RESULTS:The proportion of patients hospitalized on day 0,day 1,day 2 after injury was 25.4%,54.7%and 66.3%,respectively.And 12.6%patients visited hospital one week later after injury.Mean time from admission to surgery was 5.2 days(standard deviation 2.8 days).Hospitalization at one week after injury was a risk factor for 1-year mortality(OR 1.762,95%CI 1.026–3.379,P=0.041).CONCLUSION:Admission delay of more than one week is signifi cantly associated with higher 1-year mortality.As a supplement to the current guidelines which emphasizes early surgery after admission,we also advocate early admission once patients get injured.

Monodisperse magnetic metallic nanoparticles: synthesis,performance enhancement, and advanced applications

Monodisperse Fe-based and Co-based nanopar-ticles exhibit unique magnetic properties. They play important roles in magnetic storage and biomedical application. Their chemical synthesis and performance enhancement draw a lot of study interest. Investigations of magnetic metallic nano-particles are very active in many scientific fields. This paper reviews the present advances in chemical synthesis, perfor-mance enhancement, and potential applications of monodis-perse Fe-based and Co-based nanoparticles.

Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect:A case report

BACKGROUND Preoperative conditions in pediatric liver transplant recipients are understandably complex.Compared with adults,children have lesser compensatory abilities and demand greater precision during procedural executions.In the setting of endstage liver disease,the heightened perioperative risk of coexistent cardiovascular pathology may impact graft survival as well.Requirements for anesthesia and perioperative management are thus more rigorous,calling for individualized treatments that reflect specific cardiovascular constraints and proposed surgical plans.CASE SUMMARY Reports of perioperative anesthesia management and liver transplant prognostication in pediatric patients with concurrent atrial septal defects are scarce.Herein,we detail the course of liver transplantation in a child with dual afflictions,focusing on perioperative anesthesia management and the important contributions of the anesthesiologist(pre-and perioperatively) to a positive therapeutic outcome,despite the clinical hurdles imposed.CONCLUSION Children with atrial septal defects bear substantially more than customary perioperative risk during orthotopic liver transplants,given their compromised cardiopulmonary reserves and functional states.Comprehensive preoperative cardiovascular assessments,including use of agitated-saline contrast echocardiography(to characterize intracardiac shunting) and multidisciplinary deliberation,may offer insights into structural cardiac pathophysiologic effects and transplantrelated hemodynamic changes that impact new grafts.At the same time,active and effective monitoring and other measures should be taken to maintain hemodynamic stability in the perioperative period,avoid entry of bubbles into the circulation,and ease congestion in newly grafted livers.Such efforts are crucial for transplantation success and graft survival.

Microvesicles derived from mesenchymal stem cells inhibit acute respiratory distress syndrome-related pulmonary fibrosis in mouse partly through hepatocyte growth factor

BACKGROUND Pulmonary fibrosis is one of the main reasons for the high mortality rate among acute respiratory distress syndrome(ARDS)patients.Mesenchymal stromal cell-derived microvesicles(MSC-MVs)have been shown to exert antifibrotic effects in lung diseases.AIM To investigate the effects and mechanisms of MSC-MVs on pulmonary fibrosis in ARDS mouse models.METHODS MSC-MVs with low hepatocyte growth factor(HGF)expression(siHGF-MSC-MVs)were obtained via lentivirus transfection and used to establish the ARDS pulmonary fibrosis mouse model.Following intubation,respiratory mechanics-related indicators were measured via an experimental small animal lung function tester.Homing of MSC-MVs in lung tissues was investigated by near-infrared live imaging.Immunohistochemical,western blotting,ELISA and other methods were used to detect expression of pulmonary fibrosis-related proteins and to compare effects on pulmonary fibrosis and fibrosis-related indicators.RESULTS The MSC-MVs gradually migrated and homed to damaged lung tissues in the ARDS model mice.Treatment with MSC-MVs significantly reduced lung injury and pulmonary fibrosis scores.However,low expression of HGF(siHGF-MSC-MVs)significantly inhibited the effects of MSC-MVs(P<0.05).Compared with the ARDS pulmonary fibrosis group,the MSC-MVs group exhibited suppressed expression of type I collagen antigen,type III collagen antigen,and the proteins transforming growth factor-βandα-smooth muscle actin,whereas the siHGF-MVs group exhibited significantly increased expression of these proteins.In addition,pulmonary compliance and the pressure of oxygen/oxygen inhalation ratio were significantly lower in the MSC-MVs group,and the effects of the MSC-MVs were significantly inhibited by low HGF expression(all P<0.05).CONCLUSION MSC-MVs improved lung ventilation functions and inhibited pulmonary fibrosis in ARDS mice partly via HGF mRNA transfer.

Sevoflurane postconditioning reduces myocardial reperfusion injury in rat isolated hearts via activation of PI3K/Akt signaling and modulation of Bcl-2 family proteins

Sevoflurane postconditioning reduces myocardial infarct size.The objective of this study was to examine the role of the phosphatidylinositol-3-kinase(PI3K)/Akt pathway in anesthetic postconditioning and to determine whether PI3K/Akt signaling modulates the expression of pro-and antiapoptotic proteins in sevoflurane postconditioning.Isolated and perfused rat hearts were prepared first,and then randomly assigned to the following groups:Sham-operation(Sham),ischemia/reperfusion(Con),sevoflurane postconditioning(SPC),Sham plus 100 nmol/L wortmannin(Sham+Wort),Con+Wort,SPC+Wort,and Con+dimethylsulphoxide(DMSO).Sevoflurane postconditioning was induced by administration of sevoflurane(2.5%,v/v) for 10 min from the onset of reperfusion.Left ventricular developed pressure(LVDP),left ventricular end-diastolic pressure(LVEDP),maximum increase in rate of LVDP(+dP/dt),maximum decrease in rate of LVDP(?dP/dt),heart rate(HR),and coronary flow(CF) were measured at baseline,R30 min(30 min of reperfusion),R60 min,R90 min,and R120 min.Creatine kinase(CK) and lactate dehydrogenase(LDH) were measured after 5 min and 10 min reperfusion.Infarct size was determined by triphenyltetrazolium chloride staining at the end of reperfusion.Total Akt and phosphorylated Akt(phospho-Akt),Bax,Bcl-2,Bad,and phospho-Bad were determined by Western blot analysis.Analysis of variance(ANOVA) and Student-Newman-Keuls' test were used to investigate the significance of differences between groups.The LVDP,±dP/dt,and CF were higher and LVEDP was lower in the SPC group than in the Con group at all points of reperfusion(P<0.05).The SPC group had significantly reduced CK and LDH release and decreased infarct size compared with the Con group [(22.9±8)% vs.(42.4±9.4)%,respectively;P<0.05].The SPC group also had increased the expression of phospho-Akt,Bcl-2,and phospho-Bad,and decreased the expression of Bax.Wortmannin abolished the cardioprotection of sevoflurane postconditioning.Sevoflurane postconditioning may protect the isolated rat heart.Activation of PI3K and modulation of the expression of pro-and antiapoptotic proteins may play an important role in sevoflurane-induced myocardial protection.

Effects of sevoflurane preconditioning and postconditioning on rat myocardial stunning in ischemic reperfusion injury

Ischemic preconditioning and postconditioning distinctly attenuate ventricular arrhythmia after ischemia without affecting the severity of myocardial stunning. Therefore,we report the effects of sevoflurane preconditioning and postconditioning on stunned myocardium in isolated rat hearts. Isolated rat hearts were underwent 20 min of global ischemia and 40 min of reperfusion. After an equilibration period (20 min),the hearts in the preconditioning group were exposed to sevoflurane for 5 min and next washout for 5 min before ischemia. Hearts in the sevoflurane postconditioning group underwent equilibration and ischemia,followed immediately by sevoflurane exposure for the first 5 min of reperfusion. The control group received no treatment before and after ischemia. Left ventricular pressure,heart rate,coronary flow,electrocardiogram,and tissue histology were measured as variables of ventricular function and cellular injury,respectively. There was no significant difference in the duration of reperfusion ventricular ar-rhythmias between control and sevoflurane preconditioning group (P=0.195). The duration of reperfusion ventricular arrhythmias in the sevoflurane postconditioning group was significantly shorter than that in the other two groups (P<0.05). ±(dP/dt)max in the sevoflurane preconditioning group at 5,10,15,20,and 30 min after reperfusion was sig-nificantly higher than that in the control group (P<0.05),and there were no significant differences at 40 min after reperfusion among the three groups (P>0.05). As expected,for a 20-min general ischemia,infarct size in heart slices determined by 2,3,5-triphenyltetrazolium chloride staining among the groups was not obvious. Sevoflurane postcon-ditioning reduces reperfusion arrhythmias without affecting the severity of myocardial stunning. In contrast,sevoflu-rane preconditioning has no beneficial effects on reperfusion arrhythmias,but it is in favor of improving ventricular function and recovering myocardial stunning. Sevoflurane preconditioning and postconditioning may be useful for correcting the stunned myocardium.

Activation of Akt and cardioprotection against reperfusion injury are maximal with only five minutes of sevoflurane postconditioning in isolated rat hearts

It had been proved that administration of sevoflurane for the first two minutes of reperfusion effectively protects the heart against reperfusion injury in rats in vivo.Our aim was to investigate the duration of effective sevoflurane administration and its underlying mechanism in isolated rat hearts exposed to global ischemia/reperfusion(I/R) injury.Adult male Sprague-Dawley rats were randomly divided into six groups(n=12):a sham-operation group,an I/R group,and four sevoflurane postconditioning groups(S2,S5,S10,and S15).In the S2,S5,S10,and S15 groups,the duration times of sevoflurane administration were 2,5,10,and 15 min after the onset of reperfusion,respectively.The isolated rat hearts were mounted on the Langendorff system,and after a period of equilibrium were subjected to 40 min global ischemia and 120 min reperfusion.Left ventricular(LV) hemodynamic parameters were monitored throughout each experiment and the data at 30 min of equilibrium and 30,60,90,and 120 min of reperfusion were analyzed.Myocardial infarct size at the end of reperfusion(n=7 in each group) and the expression of myocardial phosphorylated Akt(p-Akt) after 15-min reperfusion were determined in a duplicate set of six groups of rat hearts(n=5 in each group).Compared with the I/R group,the S5,S10,and S15 groups had significantly improved left ventricular end-diastolic pressure(LVEDP),left ventricular developed pressure(LVDP),and the maximal rate of rise or fall of the LV pressure(±dP/dtmax),and decreased myocardial infarct size(P<0.05),but not the S2 group.After 15 min of reperfusion,the expression of p-Akt was markedly up-regulated in the S5,S10,and S15 groups compared with that in the I/R group(P<0.05),but not in the S2 group.Sevoflurane postconditioning for 5 min was sufficient to activate Akt and exert maximal cardioprotection against I/R injury in isolated rat hearts.

Association of sexually transmitted infection with semen quality in men from couples with primary and secondary infertility

This study aims to compare the prevalence of sexually transmitted infections(STIs)with semen quality in men from couples with primary and secondary infertility.Semen samples were collected from 133 men who requested fertility evaluation.Seminal tract infection with Ureaplasma spp.(UU),Mycoplasma hominis(MH),Mycoplasma genitalium(MG),Chlamydia trachomatis(CT),Neisseria gonorrhoeae(NG),and herpes simplex virus-2(HSV-2)was assessed by PCR-based diagnostic assays.Among all patients,the prevalence of STIs was higher in men from couples with primary infertility than that in men from couples with secondary infertility(39.7%vs 21.7%,P=0.03).The prevalence of UU was 28.8%and 13.3%in men from couples with primary and secondary infertility,respectively.Men from couples with primary infertility were more likely to be positive for UU than men from couples with secondary infertility(P=0.04).Regarding the UU subtype,the prevalence of Ureaplasma urealyticum(Uuu)and Ureaplasma parvum(Uup;including Uup1,Uup3,Uup6,and Uup14)did not differ between the two groups.No associations between the prevalence rates of MH,MG,and CT were found in men from either infertility group.A lower sperm concentration was associated with STI pathogen positivity in men with primary infertility according to the crude model(P=0.04).The crude and adjusted models showed that semen volume(both P=0.03)and semen leukocyte count(both P=0.02)were independently associated with secondary infertility.These findings suggest the importance of classifying the type of infertility during routine diagnosis of seminal tract infections.

ERK5信号通路在病理性疼痛中的作用及其机制的研究进展（英文）

细胞外信号调节蛋白激酶5(ERK5),也称大丝裂原活化蛋白激酶1,是ERK家族(MAPK大家族的一个亚家族)的一个重要成员。ERK5在背根神经节和脊髓中均有表达。本文着重阐述ERK5相关的信号通路在病理性疼痛中的作用:ERK5/CREB通路在疼痛信号的传递和痛觉过敏的形成中起重要作用;脊髓背角中ERK5的活化主要在小角质细胞;ERK5的活化可由NMDA受体介导。同时,我们细述了在病理性疼痛中,ERK5活化与NGF-TrkA和BDNF的关联。