Inhibition of the cGAS–STING pathway:contributing to the treatment of cerebral ischemia-reperfusion injury

The cGAS–STING pathway plays an important role in ischemia-reperfusion injury in the heart,liver,brain,and kidney,but its role and mechanisms in cerebral ischemia-reperfusion injury have not been systematically reviewed.Here,we outline the components of the cGAS–STING pathway and then analyze its role in autophagy,ferroptosis,cellular pyroptosis,disequilibrium of calcium homeostasis,inflammatory responses,disruption of the blood–brain barrier,microglia transformation,and complement system activation following cerebral ischemia-reperfusion injury.We further analyze the value of cGAS–STING pathway inhibitors in the treatment of cerebral ischemia-reperfusion injury and conclude that the pathway can regulate cerebral ischemia-reperfusion injury through multiple mechanisms.Inhibition of the cGAS–STING pathway may be helpful in the treatment of cerebral ischemia-reperfusion injury.

Ethanol steam reforming over Ni/ZSM-5 nanosheet for hydrogen production

Compared to reforming reactions using hydrocarbons,ethanol steam reforming(ESR)is a sustainable alternative for hydrogen(H_(2))production since ethanol can be produced sustainably using biomass.This work explores the catalyst design strategies for preparing the Ni supported on ZSM-5 zeolite catalysts to promote ESR.Specifically,two-dimensional ZSM-5 nanosheet and conventional ZSM-5 crystal were used as the catalyst carriers and two synthesis strategies,i.e.,in situ encapsulation and wet impregnation method,were employed to prepare the catalysts.Based on the comparative characterization of the catalysts and comparative catalytic assessments,it was found that the combination of the in situ encapsulation synthesis and the ZSM-5 nanosheet carrier was the effective strategy to develop catalysts for promoting H_(2) production via ESR due to the improved mass transfer(through the 2-D structure of ZSM-5 nanosheet)and formation of confined small Ni nanoparticles(resulted via the in situ encapsulation synthesis).In addition,the resulting ZSM-5 nanosheet supported Ni catalyst also showed high Ni dispersion and high accessibility to Ni sites by the reactants,being able to improve the activity and stability of catalysts and suppress metal sintering and coking during ESR at high reaction temperatures.Thus,the Ni supported on ZSM-5 nanosheet catalyst prepared by encapsulation showed the stable performance with~88% ethanol conversion and~65% H_(2) yield achieved during a 48-h longevity test at 550-C.

Stress granules: friend or foe in neurodegenerative disorders?

Neurodegenerative diseases,such as Alzheimer’s disease,Parkinson’s disease,and amyotrophic lateral sclerosis,despite the diversity in clinical symptoms,share a striking feature at the cellular level:the accumulation of insoluble aggregates of misfolded proteins that are sequestered in intraneuronal inclusion bodies.Besides mutations in disease-associated proteins that render them aggregation-prone,the decline of protein homeostasis(i.e.proteostasis)with aging is also believed to be a contributing factor to the accumulation of protein aggregates.

Application of Grooved Negative Pressure Drainage Tube in Surgical Stabilization of Rib Fractures

Objective: To explore the application value of disposable grooved negative pressure drainage tubes in rib fracture incision and internal fixation. Methods: Seventy-five patients admitted to our Department of Trauma Surgery from June 2022 to April 2024 who underwent rib fracture osteotomy and internal fixation were selected. According to the types of drainage tubes left in the patients after the operation, they were divided into the observation group (35 cases who were left with disposable grooved negative pressure drainage tubes) and the control group (40 cases who were left with closed silicone thoracic drainage tubes). Comparison of chest drainage, pain, postoperative complications, secondary chest penetration rate, drain placement time, hospitalization time, and treatment costs were compared between the two groups. Results: The total postoperative chest drainage volume of the observation group was less than that of the control group (P < 0.05);the degree of pain, the incidence of postoperative complications, and the rate of secondary chest puncture in the observation group were lower than that of the control group three days after the operation (P < 0.05);and the time of drain placement in the observation group was shorter than that of the control group (P < 0.05). Conclusion: The application of disposable grooved negative pressure drainage tubes in rib fracture incision and internal fixation can significantly improve patients’ postoperative pain and discomfort, reduce complications, lower the rate of secondary chest penetration, promote patients’ postoperative recovery, decrease the amount of postoperative chest drainage, and shorten the time of drain placement, which is worthy of clinical promotion and application.

工艺条件对制备改性脲醛树脂浆料中的甲醛含量的影响

本实验采用羟甲基松香与脲醛共聚合,旨在减少脲醛树脂分子结构中可降解或分解生成甲醛的结构单元,从而有效地降低脲醛树脂浆料中甲醛的释放,制得低甲醛环保型改性脲醛树脂浆料。实验中对不同的酸性催化剂、碱性调节剂、甲醛/尿素投料比、硫脲的添加量等工艺条件下所制得的不同批次的脲醛树脂浆料中甲醛含量和固含量进行测定,筛选出最优工艺条件。实验所制得的脲醛树脂浆料为乳浊液,颜色呈淡黄色,固含量>40%,游离甲醛为1.09%,pH值6.8~7.2,固化时间超过30 d。

Recent advances in non-thermal plasma(NTP)catalysis towards C1 chemistry

C1 chemistrymainly involves the catalytic transformation of C1molecules(i.e.,CO,CO2,CH4 and CH3OH),which usually encounters thermodynamic and/or kinetic limitations.To address these limitations,non-thermal plasma(NTP)activated heterogeneous catalysis offers a number of advantages,such as relatively mild reaction conditions and energy efficiency,in comparison to the conventional thermal catalysis.This review presents the state-of-the-art for the application of NTP-catalysis towards C1 chemistry,including the CO2 hydrogenation,reforming of CH4 and CH3OH,and water-gas shift(WGS)reaction.In the hybrid NTP-catalyst system,the plasma-catalyst interactions aremultifaceted.Accordingly,this reviewalso includes a brief discussion on the fundamental research into themechanisms of NTP activated catalytic C1 chemistry,such as the advanced characterisation methods(e.g.,in situ diffuse reflectance infrared Fourier transform spectroscopy,DRIFTS),temperatureprogrammed plasma surface reaction(TPPSR),kinetic studies.Finally,prospects for the future research on the development of tailor-made catalysts for NTP-catalysis systems(which will enable the further understanding of its mechanism)and the translation of the hybrid technique to practical applications of catalytic C1 chemistry are discussed.

Removal process and mechanism of hexavalent chromium by adsorption-coupled reduction with marine-derived Aspergillus niger mycelial pellets

In order to remove hexavalent chromium(Cr(Ⅵ))from solutions efficiently,the mycelial pellets with a marine-derived fungus Aspergillus niger as a biosorbent were prepared.The effects of removal process parameters such as solution pH,initial Cr(Ⅵ)concentration and biomass concentration on Cr(Ⅵ)removal process were investigated.The results showed that Cr(Ⅵ)removal rate up to 100%could be achieved under optimized conditions,which indicated the excellent Cr(Ⅵ)removal performance of the Aspergillus niger pellets.As a more important point,the Cr(Ⅵ)removal mechanism was studied,and the results revealed that Cr(Ⅵ)removal was achieved in the adsorption-coupled reduction process.A little of Cr(Ⅵ)was reduced to less toxic trivalent chromium(Cr(Ⅲ))in solution,while some was absorbed on the surface of mycelial pellets.Then they may be reduced on the surface or transferred into cells and then be reduced.The marine-derived A.niger mycelial pellets show properties of easy preparation and separation and cost effectiveness,which are potential biosorbent and reductant in the treatment of trace chromate containing wastewater.

Multifunctional self-delivery micelles targeting the invasion-metastasis cascade for enhanced chemotherapy against melanoma and the lung metastasis

Metastasis is closely related to the high mortality of cancer patients,which is regulated by multiple signaling pathways.Hence,multiphase blocking of this biological process is beneficial for cancer treatments.Herein,we establish a multifunctional self-delivering system by synthesizing D-α-tocopheryl succinates(TOS)-conjugated chondroitin sulfate(CS)(CT NPs),which both serve as nanocarrier and antimetastatic agent that affects different phases of the metastatic cascade.TOS as the hydrophobic segment of CT NPs can inhibit the secretion of matrix metalloproteinase-9,while the hydrophilic segment CS targets B16F10 cells through CD44 receptors and reduces the interaction between tumor cells and platelets.The results show that CT NPs are able to inhibit metastasis successfully both in vitro and in vivo by interfering the multiphase of the metastatic cascade.Following encapsulating chemotherapeutic drug doxorubicin(DOX),the obtained micelles CT/DOX efficiently suppress both primary-tumor growth and metastases in B16F10 bearing mice.As a result,the rationally designed multifunctional NPs composing of biocompatible materials provide excellent therapeutic effects on solid tumors and metastases。

Research on the Fragment Impact Resistance of a Composite Mast

Due to the unique structural mode and material property of a composite sandwich plate, related research such as fragment impact resistance of a composite mast is short of publication and urgent in this field. In this paper, the commonly accepted sandwich core board theory was modified. Damage caused by a fragment attack was simulated onto a sandwich plate model built with solid and shell elements. It was shown that shear failure and vast matrix cracking are the main reasons for outer coat damage, and tension failure and partial matrix cracking are the cause for inner coat damage. Additionally, according to complexities in actual sea battles, different work conditions of missile attacks were set. Ballistic limit values of different fragment sizes were also obtained, which provides references for enhancing the fragment impact resistance of a composite mast.

采用综合消肿疗法联合淋巴管-静脉吻合术治疗继发性淋巴水肿的临床效果

目的比较综合消肿治疗(CDT)联合淋巴管-静脉吻合术(LVA)与单纯CDT对继发性淋巴水肿的临床疗效。方法选取2023年3月至7月深圳市大鹏新区南澳人民医院康复科收治的33例继发性下肢淋巴水肿患者。根据是否行LVA分为CDT联合LVA组及CDT组,其中CDT联合LVA组12例,CDT组21例。CDT组采用标准CDT治疗,CDT联合LVA组在CDT的基础上,采用LVA治疗。比较两组治疗前、治疗1个月及随访6个月患肢周径、视觉模拟量表(VAS)评分及生活质量核心问卷量表(QLQ-C30)评分。结果两组患者治疗1个月患肢周径、VAS评分及QLQ-C30评分均较治疗前显著改善,差异有统计学意义(P<0.05),两种治疗方式均可改善患肢肿胀、疼痛及生活质量。CDT联合LVA组与CDT组比较,患肢踝部[(3.00±1.49)cm vs(1.35±1.08)cm]、髌骨下缘下10 cm[(2.87±1.51)cm vs(1.64±1.25)cm]、膝中[(3.50±2.44)cm vs(1.34±1.27)cm]、髌骨上缘上10 cm[(3.87±1.94)cm vs(1.67±1.17)cm]周径,VAS评分[(4(3,5)分vs 3(2,4)分]及QLQ-C30评分[(11.50±4.40)分vs(7.43±2.42)分]治疗前后差值差异均有统计学意义(P<0.05),CDT联合LVA组较CDT组改善更明显。随访6个月,CDT联合LVA组患肢踝部、髌骨下缘下10 cm、膝中、髌骨上缘上10 cm处周径相较于治疗1个月差异无统计学意义(P>0.05),CDT组相较于治疗1个月差异有统计学意义(P<0.05)。结论CDT联合LVA能较大程度改善继发性淋巴水肿患者肢体肿胀程度,缓解疼痛,提高生活质量,其效果优于单纯CDT,且短中期疗效较佳。

The Convergence of Euler-Maruyama Method of Nonlinear Variable-Order Fractional Stochastic Differential Equations

In this paper,we first prove the existence and uniqueness theorem of the solution of nonlinear variable-order fractional stochastic differential equations(VFSDEs).We futher constructe the Euler-Maruyama method to solve the equations and prove the convergence in mean and the strong convergence of the method.In particular,when the fractional order is no longer varying,the conclusions obtained are consistent with the relevant conclusions in the existing literature.Finally,the numerical experiments at the end of the article verify the correctness of the theoretical results obtained.

海南省二级与三级医院超声医学质量控制指标分析

目的了解海南省二、三级医院超声医学科质量控制指标和医疗服务质量现状,为超声诊断质量持续改进和提升提供参考。方法海南省超声医学质量控制中心于2024年1月收集2023年1月1日至12月31日海南省46家二、三级医院(其中二级医院21家,三级医院25家)超声诊断专业质控指标数据,包括结构质量分析指标(超声医师月均工作量、超声仪器质检率、超声科医患比、超声医师数与诊断仪数比)、过程质量分析指标[住院超声检查48 h内完成率、超声危急值10 min内通报完成率、超声报告书写合格率、乳腺病变超声报告进行乳腺影像报告和数据系统(BI-RADS)分类率]和结果质量分析指标(门急诊超声报告阳性率、住院超声报告阳性率、超声筛查中胎儿重大致死性畸形的检出率、超声诊断符合率、乳腺占位超声诊断准确率)。采用秩和检验比较二级医院与三级医院各指标的差异。结果结构质量分析指标方面,三级医院超声医师月均工作量明显大于二级医院[795.75(551.86,972.45)人次/月vs 461.63(347.00,597.23)人次/月],三级医院医患比较二级医院低[1.04(0.86,1.51)人/万人次vs 1.80(1.39,2.40)人/万人次],差异具有统计学意义(U=135.00、134.50,P均=0.005);超声仪器质检率及超声医师数与诊断仪数比二项指标比较差异均无统计学意义(P均>0.05)。过程质量分析指标方面,三级医院超声危急值10 min内通报率、乳腺病变超声报告进行BI-RADS分类率高于二级医院[100(100,100)%vs 100(100,100)%;99.46(97.30,100)%vs 95.06(88.88,99.12)%],差异均具有统计学意义(U=212.50、130.50,P=0.024、0.003);超声报告书写合格率和住院超声检查48 h内完成率比较,差异均无统计学意义(P均>0.05)。结果质量分析指标方面,三级医院门急诊超声报告阳性率、超声诊断符合率、乳腺占位超声诊断准确率、超声筛查中胎儿重大致死性畸形的检出率均高于二级医院[76.75(65.51,81.96)%vs 64.86(54.30,72.21)%;92.08(88.84,94.34)%vs 85.30(83.20,90.44)%;86.29(79.03,92.07)%vs 79.63(76.12,85.00)%;0.03(0.00,0.08)%vs 0.00(0.00,0.00)%],差异均具有统计学意义(U=153.00、116.50、103.00、109.00,P=0.016、0.009、0.046、0.004);二、三级医院住院超声报告阳性率比较,差异无统计学意义(P>0.05)。结论海南省二、三级医院超声医学科多项质量控制指标存在一定差异,海南省超声医学质量控制中心基于海南省二、三级医院超声科的发展现状,尤其是二级医院较三级医院超声诊断符合率低的现状,将进一步完善质量控制体系、程序、标准和计划,规范开展质量控制与改进工作,以实现海南省超声医学专业的规范化、标准化和同质化。

Pentacam眼前节分析系统在巩膜镜验配初始矢高选择中的应用

目的:评估Pentacam眼前节分析系统测量的眼前节生物学参数在巩膜镜(SL)验配初始镜片矢高(LSD)选择中的应用价值。方法:回顾性系列病例研究。选取2020年10月至2021年6月于南京医科大学附属眼科医院验配SL的角膜不规则散光或干眼患者32例(53眼)。所有患者均行SL验配前一般眼科检查,采用Pentacam采集角膜前表面平坦曲率(Kf)、陡峭曲率(Ks)、散光量、非球面参数Q值、中央角膜厚度(CCT)、角膜直径、前房深度(ACD)等数据。此外,采用Pentacam自带软件测量受检眼于13.50 mm弦长下的角膜矢高(CSH)。采用Pearson或Spearman相关以及线性回归分析各眼前节生物学参数与最终试戴评估修正后LSD的关系。结果:患者均完成初次SL试戴验配。Pentacam眼前节分析系统Scheimpflug images模式下所测量的13.50 mm弦长下CSH为(3746±187)μm,试戴修正后LSD为(3622±206)μm。相关分析结果显示:角膜前表面Kf、Ks、散光量、ACD及Pentacam测量的CSH与试戴修正后的LSD均呈正相关(r=0.36~0.84,均P<0.05);CCT与试戴修正后LSD呈负相关(r=-0.35,P=0.011);非球面参数Q值、角膜直径与试戴修正后LSD无相关性。将试戴修正后LSD作为因变量,校正相关因素后的线性回归方程显示Pentacam测量的CSH与试戴修正后LSD高度相关,即试戴修正后LSD=416.996+0.854×CSH(调整R2=0.63,F=89.17,P<0.001)。结论:Pentacam测量的部分眼前节生物学参数与SL试戴修正后的LSD相关,其中CSH可作为LSD选择的重要参考依据。

Fe_(3)O_(4)对施氏假单胞菌反硝化过程的影响

生物反硝化是目前废水深度处理中应用最为广泛的硝酸盐氮处理技术,但该方法一般停留时间较长,在冬季因低温处理效果欠佳,因此有必要开发反硝化强化技术。以施氏假单胞菌Pseudomonas stutzeri为研究对象,考察了不同投加量下Fe_(3)O_(4)对P.stutzeri反硝化过程的影响。结果显示当Fe_(3)O_(4)投加量由0 mg/L增至4000 mg/L时,硝酸盐氮最大比降解速率由18.0 h^(-1)增加至23.7 h^(-1),体系中的总蛋白含量以及细菌体内的铁含量显著增加。RT-qPCR和非标记(Label-free)定量蛋白组学分析表明,投加4000 mg/L Fe_(3)O_(4)体系中的P.stutzeri,其反硝化功能基因napA、narJ、nirB、norR、nosZ表达量分别提高了55.7%、24.9%、24.5%、36.5%、120%,对应反硝化还原酶Nap、Nar、Nir、Nor、Nos表达量提高了85.0%、147%、16.5%、47.1%、95.9%。对比体系中“游离细菌”和“Fe_(3)O_(4)粘附细菌”,发现二者的反硝化功能基因以及反硝化相关酶没有显著差别;而Fe_(3)O_(4)粘附细菌电子传递相关蛋白表达量有所提高,说明了Fe_(3)O_(4)通过与细菌直接接触促进其生长代谢,导致体系中细菌总量的增加,从而提高反硝化速率。该结果可为反硝化强化技术的开发提供理论支撑。

mRNA治疗及其应用前景

信使核糖核酸(mRNA)是由DNA的一条链作为模板转录而来的携带遗传信息、指导蛋白质合成的一类单链核糖核酸.随着mRNA体外合成中修饰调控/序列优化系统的日益完善和体内递送系统的逐渐成熟,mRNA缺乏稳定性及无法有效递送等缺点已经逐渐被克服,基于mRNA的治疗方法已逐步成为研究热点.通过体外转录技术合成的mRNA,借助脂质纳米颗粒递送系统运送到特定的组织细胞内,由细胞自身的翻译系统翻译出目标蛋白.这些蛋白或是作为抗原激发免疫反应,或是补充细胞内缺少的蛋白以行使功能,最终达到治疗的目的.mRNA治疗具有的制备快速、成本低、安全等优点让它在众多治疗方法中脱颖而出,被广泛地应用于癌症疫苗、感染性疾病疫苗、蛋白替代治疗和罕见病治疗等领域.为了解全球mRNA治疗的开发和研究现状,本文重点对mRNA治疗的修饰调控/序列优化系统、递送系统以及临床研究现状进行分析和总结.

巩膜镜矫正圆锥角膜的临床效果观察

目的:探讨临床上巩膜镜治疗圆锥角膜的有效性。方法:回顾性研究。选择2020年10月至2021年3月于南京医科大学眼科医院验配巩膜镜的圆锥角膜患者18例(26眼)。根据圆锥角膜Amesler-Krumeich分级,I级9眼,II级3眼,III级4眼,IV级10眼。所有患者均经规范验配程序试戴硬性透气性接触镜(RGPCL),因RGPCL不耐受、RGPCL适配不佳等原因选择验配巩膜镜。所有患者均进行视力、屈光度、裂隙灯显微镜、眼底和Pentacam检查等。应用巩膜镜试戴片试戴,分别通过裂隙灯显微镜观察、荧光素染色及眼前节光学相干断层扫描(OCT)进行适配评估。评估镜片与中央角膜和周边间隙,以及周边着陆区匹配情况,并评估戴镜后的最佳矫正视力(BCVA)及主观舒适度。采用Friedman检验进行统计学分析。结果:所有圆锥角膜患者初戴巩膜镜时,裂隙灯显微镜观察示巩膜镜定位良好。通过前节OCT观察初始角膜中央间隙为(212±58)μm;配戴巩膜镜4 h后,角膜中央间隙为(164±58)μm,鼻侧为(101±38)μm,下方为(224±135)μm,颞侧为(103±72)μm,上方为(89±45)μm,镜片边缘结膜血管未见异常。裸眼视力(UCVA)、框架眼镜BCVA、RGPCL配戴后BCVA及巩膜镜配戴后BCVA(LogMAR)分别为1.35(1.00,2.00)、0.52(0.22,0.79)、0.15(0,0.30)、0.10(0,0.22),各视力差异有统计学意义(Χ^(2)=67.11,P<0.001)。巩膜镜配戴后BCVA较UCVA、框架眼镜BCVA明显改善,差异有统计学意义(Χ^(2)=59.90,P<0.001;Χ^(2)=31.08,P=0.001);巩膜镜配戴后BCVA与RGPCL配戴后BCVA差异无统计学意义(P=1.000)。配戴巩膜镜4 h后,22眼(22/26)主诉戴镜后舒适或非常舒适;24眼(24/26)主诉戴镜视物良好或非常良好。结论:圆锥角膜配戴巩膜镜定位良好,舒适度也良好,通过配戴巩膜镜可有效提升矫正视力。巩膜镜是圆锥角膜患者一种有效的治疗方式。

Surface structure change properties:Auto-soft bionic fibrous membrane in reducing postoperative adhesion

Peritoneal adhesion is the most common adverse effect following abdominal surgery or inflammation.The occurrence in clinical trials has been successfully reduced using barriers.However,the shortcomings of frequently used adhesion barriers,such as rapid degradation rate of gel barrier and inadequate operation ability of solid barrier,cannot be ignored.In this study,a fibrous membrane with an ECM-like structure was prepared.The adhesion properties were reduced significantly by changing the surface structure.The fibrous membrane caused less inflammatory response and much less peripheral adhesion and intestinal obstruction compared to the casting film and the commercial film with smooth surface,though with the same components.Because of the auto-soft bionic structure and similarity in the mechanical modulus of the tissues,the fibrous membrane was more flexible when it adhered to the tissues,showed excellent effectiveness and biocompatibility.In addition to the rat and miniature pig models,a randomized,placebo-controlled,and multicenter clinical pilot study with 150 patients confirmed that because of its flexibility,biodegradability,and similarity to mechanical modulus and structure with tissues involved,the fibrous membrane served as a favorable implant for preventing post-operation adhesion.

Lnc-RP5 Regulates the mi R-129-5p/Notch1/PFV Internal Promoter Axis to Promote the Expression of the Prototype Foamy Virus Transactivator Tas

Prototype foamy virus(PFV)is a unique retrovirus that infects animals and humans and does not cause clinical symptoms.Long noncoding RNAs(lncRNAs)are believed to exert multiple regulatory functions during viral infections.Previously,we utilized RNA sequencing(RNA-seq)to characterize and identify the lncRNA lnc-RP5-1086 D14.3.1-1:1(lnc-RP5),which is markedly decreased in PFV-infected cells.However,little is known about the function of lnc-RP5 during PFV infection.In this study,we identified lnc-RP5 as a regulator of the PFV transcriptional transactivator(Tas).Lnc-RP5 enhanced the activity of the PFV internal promoter(IP).The expression of PFV Tas was found to be promoted by lnc-RP5.Moreover,mi R-129-5 p was found to be involved in the lnc-RP5-mediated promotion of PFV IP activity,while the Notch1 protein suppressed the activity of PFV IP and the expression of Tas.Our results demonstrate that lnc-RP5 promotes the expression of PFV Tas through the miR-129-5 p/Notch1/PFV IP axis.This work provides evidence that host lnc RNAs can manipulate PFV replication by employing mi RNAs and proteins during an early viral infection.

参照肛直线的内镜下套扎术治疗Ⅰ-Ⅲ度内痔临床效果研究

目的观察参照肛直线的内镜下套扎术(ERBL)治疗Ⅰ-Ⅲ度内痔的临床效果.方法回顾性分析2020年4月至2020年12月期间,河南省人民医院消化内科收治的67例进行参照肛直线的ERBL治疗并成功随访的Ⅰ-Ⅲ度内痔患者的临床资料,并对其一般资料、临床特点及治疗效果进行分析.结果67例患者中,Ⅰ度35例(52.2%)、Ⅱ度15例(22.4%)、Ⅲ度17例(25.4%);出血者35例(52.2%)、脱垂者9例(13.4%)、出血合并脱垂者23例(34.3%).手术成功率为100%,治疗总体有效率为88.1%(59/67),其中治愈38例(56.7%)、好转21例(31.3%)、复发2例(3.0%).术后不良事件方面,疼痛23例(34.3%),其中轻度11例(16.4%)、中度8例(11.9%)、重度4例(6.0%),疼痛患者术后用药百分比为17.4%(4/23),均为重度疼痛患者;肛门坠胀37例(55.2%)、尿潴留12例(17.9%)、发热1例(1.5%).结论参照肛直线的ERBL治疗Ⅰ-Ⅲ度内痔操作简单、安全、疗效显著.

Risk factors of major intraoperative bleeding and postoperative bleeding associated with endoscopic submucosal dissection for gastric neoplasms

Background:Endoscopic resection bleeding(ERB)classification was proposed by the authors’team to evaluate the severity of intraoperative bleeding(IB)during endoscopic submucosal dissection(ESD).This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB(MIB)and postoperative bleeding(PB)associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital.All patients were divided into the non-MIB group(including ERB-0,ERB-controlled 1[ERB-c1],and ERB-c2)and the MIB group(including ERB-c3 and ERB-uncontrolled[ERB-unc])according to the ERB classification.Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients,773(57.95%)had ERB-0,477(35.76%)had ERB-c1,77(5.77%)had ERB-c2,7(0.52%)had ERB-c3,and no patients had ERB-unc.The rate of PB in patients with IB classifications of ERB-0,ERB-c1,ERB-c2,and ERB-c3 were 2.20%(17/773),3.35%(16/477),9.09%(7/77),and 2/7,respectively.In multivariate analysis,proximal location(odds ratio[OR]:1.488;95%confidence interval[CI]:1.045-3.645;P=0.047)was the only significant risk factor of MIB.Chronic kidney disease(CKD)(OR:7.844;95%CI:1.637-37.583;P=0.010)and MIB(ERB-c3)(OR:13.932;95%CI:2.585-74.794;P=0.002)were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB.Additionally,CKD and MIB(ERB-c3)were independent risk factors of PB.More attention should be paid to these high-risk patients for MIB and PB.