Mid-term outcomes of microfragmented adipose tissue plus arthroscopic surgery for knee osteoarthritis:A randomized,activecontrol,multicenter clinical trial

BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment.Emerging regenerative therapies,such as those involving platelet-rich plasma,mesenchymal stem cells,and microfragmented adipose tissue(MFAT),have been pushed to the forefront of treatment to prevent the progression of OA.Currently,MFAT has been successfully applied to treat different types of orthopedic diseases.AIM To assess the efficacy and safety of MFAT with arthroscopic surgery in patients with knee OA(KOA).METHODS A randomized,multicenter study was conducted between June 2017 and November 2022 in 10 hospitals in Zhejiang,China.Overall,302 patients diagnosed with KOA(Kellgren-Lawrence grades 2-3)were randomized to the MFAT group(n=151,were administered MFAT following arthroscopic surgery),or the control group(n=151,were administered hyaluronic acid following arthroscopic surgery).The study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,the visual analog scale(VAS)score,the Lequesne index score,the Whole-Organ Magnetic Resonance Imaging Score(WORMS),and safety over a 24-mo period from baseline.RESULTS The changes in the WOMAC score(including the three subscale scores),VAS pain score,and Lequesne index score at the 24-mo mark were significantly different in the MFAT and control groups,as well as when comparing values at the posttreatment visit and those at baseline(P<0.001).The MFAT group consistently demonstrated significant decreases in the WOMAC pain scores and VAS scores at all follow-ups compared to the control group(P<0.05).Furthermore,the WOMAC stiffness score,WOMAC function score,and Lequesne index score differed significantly between the groups at 12 and 24 mo(P<0.05).However,no signicant between-group differences were observed in the WORMS at 24 mo(P=0.367).No serious adverse events occurred in both groups.CONCLUSION The MFAT injection combined with arthroscopic surgery treatment group showed better mid-term clinical outcomes compared to the control group,suggesting its efficacy as a therapeutic approach for patients with KOA.

Electroacupuncture alleviates orofacial allodynia and anxiety-like behaviors by regulating synaptic plasticity of the CA1 hippocampal region in a mouse model of trigeminal neuralgia

OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infraorbital nerve transection model(pTION)of neuropathic pain was established,and EA or sham EA was used to treat ipsilateral acu⁃puncture points(GV20-Baihui and ST7-Xia⁃guan).Golgi-Cox staining and transmission elec⁃tron microscopy(TEM)were administrated to observe the changes of synaptic plasticity in the hippocampus CA1.RESULTS Stable and persistent orofacial allodynia and anxiety-like behav⁃iors induced by pT-ION were related to changes in hippocampal synaptic plasticity.Golgi stain⁃ings showed a decrease in the density of dendritic spines,especially mushroom-type dendritic spines,in hippocampal CA1 neurons of pT-ION mice.TEM results showed that the density of synapses,membrane thickness of the postsynaptic density,and length of the synaptic active zone were decreased,whereas the width of the synaptic cleft was increased in pTION mice.EA attenu⁃ated pT-ION-induced orofacial allodynia and anx⁃iety-like behaviors and effectively reversed the abnormal changes in dendritic spines and syn⁃apse of the hippocampal CA1 region.CONCLU⁃SION EA modulates synaptic plasticity of hippo⁃campal CA1 neurons,and reduces abnormal oro⁃facial pain and anxiety-like behavior,providing evidence for a TN treatment strategy.

Review:Mechanism of acute pancreatitis complicated with injury of intestinal mucosa barrier

Acute pancreatitis (AP) is a common acute abdomen in clinic with a rapid onset and dangerous pathogenetic condition. AP can cause an injury of intestinal mucosa barrier, leading to translocation of bacteria or endotoxin through multiple routes, bacterial translocation (BT), gutorigin endotoxaemia, and secondary infection of pancreatic tissue, and then cause systemic in- flammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS), which are important factors influencing AP’s severity and mortality. Meanwhile, the injury of intestinal mucosa barrier plays a key role in AP’s process. Therefore, it is clinically important to study the relationship between the injury of intestinal mucosa barrier and AP. In addition, many factors such as microcirculation disturbance, ischemical reperfusion injury, excessive release of inflammatory mediators and apoptosis may also play important roles in the damage of intestinal mucosa barrier. In this review, we summarize studies on mechanisms of AP.

Study on protecting effects of Baicalin and Octreotide on hepatic injury in rats with severe acute pancreatitis

AIM: To investigate the protective effects and mechanisms of Baicalin and Octreotide on hepatic injury in rats with severe acute pancreatitis (SAP). METHODS: The SAP rat models were prepared and randomly assigned to the model control group, Baicalin treated group, and Octreotide treated group while other healthy rats were assigned to the sham-operated group. Rat mortality, levels of ALT, AST, liver and pancreas pathological changes in all groups were observed at 3, 6 and 12 h after operation. Tissue microarray (TMA) sections of hepatic tissue were prepared to observe expression levels of Bax, Bcl-2 protein and Caspase-3, and changes of apoptotic indexes.RESULTS: Rat survival at 12 h, expression levels of Bax, Caspase-3 protein and apoptotic indexes of liver were all significantly higher in treated groups than in model control group. While the liver and pancreas pathological scores, contents of ALT, AST, and expression levels of Bcl-2 protein were all lower in treated groups than in the model control group. CONCLUSION: Both Baicalin and Octreotide can protect rats with SAP by decreasing the contents of ALT, AST and expression levels of Bcl-2 protein, and improving the expression levels of Bax protein, Caspase-3 protein, and inducing apoptosis.

Effects of Granule Dendrobii on chronic atrophic gastritis induced by N-methyl-N'-nitro-N-nitrosoguanidine in rats

BACKGROUND Dendrobium officinale is an herb of Traditional Chinese Medicine(TCM)commonly used for treating stomach diseases.One formula of Granule Dendrobii(GD)consists of Dendrobium officinale and American Ginseng(Radix Panacis quinquefolii),and is a potent TCM product in China.Whether treatment with GD can promote gastric acid secretion and alleviate gastric gland atrophy in chronic atrophic gastritis(CAG)requires verification.AIM To determine the effect of GD treatment on CAG and its potential cellular mechanism.METHODS A CAG model was induced by feeding rats N-methyl-N'-nitro-N-nitrosoguanidine(MNNG)for 12 wk.After oral administration of low,moderate,and high doses of GD in CAG rats for 8 wk,its effects on body weight,gastric mucosa histology,mucosal atrophy,intestinal metaplasia,immunohistochemical staining of proliferating cell nuclear antigen(PCNA)and B-cell lymphoma-2,and hemoglobin and red blood cells were examined.RESULTS The body weights of MNNG-induced CAG model rats before treatment(143.5±14.26 g)were significantly lower than that of healthy rats(220.2±31.20 g,P<0.01).At the 8th week of treatment,the body weights of rats in the low-,moderate-,and high-dose groups of GD(220.1±36.62 g)were significantly higher than those in the untreated group(173.3±28.09 g,all P<0.01).The level of inflammation in gastric tissue of the high-dose group(1.68±0.54)was significantly reduced(P<0.01)compared with that of the untreated group(3.00±0.00,P<0.05).The number and thickness of gastric glands in the high-dose group(31.50±6.07/mm,306.4±49.32μm)were significantly higher than those in the untreated group(26.86±6.41/mm,244.3±51.82μm,respectively,P<0.01 and P<0.05),indicating improved atrophy of gastric mucosa.The areas of intestinal metaplasia were significantly lower in the high-dose group(1.74%±1.13%),medium-dose group(1.81%±0.66%)and low-dose group(2.36%±1.08%)than in the untreated group(3.91%±0.96%,all P<0.01).The expression of PCNA in high-dose group was significantly reduced compared with that in untreated group(P<0.01).Hemoglobin level in the high-dose group(145.3±5.90 g/L),medium-dose group(139.3±5.71 g/L)and low-dose group(137.5±7.56 g/L)was markedly increased compared with the untreated group(132.1±7.76 g/L;P<0.01 or P<0.05).CONCLUSION Treatment with GD for 8 wk demonstrate that GD is effective in the treatment of CAG in the MNNG model by improving the histopathology of gastric mucosa,reversing gastric atrophy and intestinal metaplasia,and alleviating gastric inflammation.

Up-regulation of Human Leukocyte Antigen G Expression in Primary Cutaneous Malignant Melanoma Associated with Host-vs-tumor Immune Response

Human leukocyte antigen G(HLA-G) is one of the molecules implicated in immunotol-erance.To investigate the role of HLA-G in primary cutaneous malignant melanoma(CMM),a series of 47 skin melanocytic lesions were immunohistochemically evaluated.The correlation between HLA-G expression and CMM clinicohistopahtological data and Bcl-2 expression was also analyzed.HLA-G expression was detected in a variety of cell types.No significant difference in HLA-G ex-pression was observed between malignant and non-malignant melanocytic lesions.HLA-G expres-sion was significantly correlated with the inflammatory infiltration and Bcl-2 expression,whereas no significant correlation with ulceration,tumor thickness,clinical stage,histopathological subtypes were observed.HLA-G expression may be the result of host immune reaction in tumor microenvi-ronment rather than a malignant feature of CMM.

Efficacy of Removing Dislocated Lens using Intravitreal Phacoemulsification

Purpose:To evaluate the efficacy of intravitreal phacoemulsification in the removal of dislocated crystalline lenses.Methods:Twenty-two cases (22 eyes) with posterior dislocated lens induced by ocular trauma or capsule rupture during phacoemulsification between January 2008 and December 2010 were retrospectively analyzed in this study.Total vitrectomy was first performed through standard closed three-port incisions at the pars plana,and dislocated lenses were removed using the phacoemulsification tip without the silicone sleeve.Extraction of intraocular foreign body,endolaser retinal photocoagulation and intraocular lens implantation were performed simultaneously.Visual acuity,intraocular pressure (IOP) and postoperative complications were assessed over 1 to 3 months of follow up.Results:All dislocated lenses were extracted without severe complication.The final corrected visual acuity was ≥ 6 /15 in 7 cases,6 /100-6 /18 in 5 cases and ≤ 6 /120 in 10 cases,a significant improvement over preoperative values (P <0.05).The IOP in 10 cases (10 eyes) with secondary glaucoma was < 21 mmHg post-operatively.Intraocular foreign bodies in 3 eyes were removed.Nine patients (9 eyes) underwent intraocular lens implantation.No instances of retinal detachment,retinal hemorrhage or scleral wound burn were observed after surgery.Conclusion:Intravitreal phacoemulsification combined with vitrectomy yielded good efficacy and safety in the treatment of posteriorly dislocated lens.It may be an alternative to phacofragmentation in the treatment of posteriorly dislocated lenses.

Subchondral bone as a novel target for regenerative therapy of osteochondritis dissecans:A case report

BACKGROUND Osteochondritis dissecans(OCD)is a rare disease of unclear cause characterized by subchondral bone damage and overlying cartilage defects.The current report presents the results of subchondral bone as a novel target for implantation of peripheral blood stem cells(PBSCs)in the treatment of OCD.CASE SUMMARY A 16-year-old patient diagnosed with OCD underwent subchondral bone implantation of PBSCs.Four months later,the patient's visual analog scale scores,Western Ontario and McMaster University osteoarthritis index,and whole-organ magnetic resonance imaging score improved significantly,and regeneration of cartilage and subchondral bone was observed on magnetic resonance imaging.CONCLUSION This is the first case of OCD treated with subchondral bone as an implantation target of PBSCs,which highlights the importance of subchondral bone for cartilage repair.This treatment could be a potential option for articular cartilage and subchondral bone recovery in OCD.

Meta-analysis of efficacy and safety of Endostar combined with vinorelbine and cisplatin in the treatment of non-small cell lung cancer

Objective:To systematically evaluate the efficacy and safety of rh-endostain(YH-16,Endostar)combined with vinorelbine and cisplatin(NP regimen)in the treatment of non-small cell lung cancer(NSCLC),and to provide evidence-based reference for clinical drug use.Methods:Retrieved from PubMed,EMBASE,the Cochrane Library,Clinical Trials,CNKI,VIP and Wan Fang database,randomized controlled trials(RCT)about YH-16 combined with NP regimen(NPY regimen,trial group)vs.NP regimen(control group)for NSCLC were collected.After screening the literature and extracting the data,the two persons evaluated the quality of the included studies,and used Rev Man 5.3 software to merge effect size.Results:A total of 18 articles were included,with a total of 2051 patients.Results of Meta-analysis showed that response rate[RR=1.66,95%CI(1.44,1.91),P<0.00001]、clinical benefit rate[RR=1.21,95%CI(1.14,1.29),P<0.00001]and quality of life improvement rate[RR=3.42,95%CI(2.45,4.79),P<0.00001]of trial group were significantly higher than those of control group.Besides,the serum CEA level[MD=-4.78,95%CI(-7.11,-2.46),P<0.0001]and CA125 level[MD=-16.44,95%CI(-20.83,-12.05),P<0.00001]of trial group were significantly lower than that of control group.There was no statistical significance in the 1-year survival rate and the incidence of myelosuppression,cardiotoxicity,gastrointestinal reaction,damage to the kidneys and liver,and alopecia(P>0.05).Conclusion:Compared with NP regimen alone,NPY regimen can improve the efficacy and quality of life of NSCLC patients,reduce the level of tumor markers,and does not increase the occurrence of adverse reactions,and has good efficacy and safety.However,the existing evidence shows that NPY regimen has the same effect as NP regimen alone in improving the 1-year survival rate of patients.The above conclusions need to be confirmed by further studies.

Mechanism of Yiyi Fuzi Baijiang powder in treatment of ulcerative colitis on network pharmacology and m olecular docking

Objective:To explore the mechanism of Yiyi Fuzi Baijiang p owder in treatment of ulcerative colitis in Coix Lacryma-jobi based on network pharmacology and molecular docking technology.Methods:Search for Yiyi Fuzi Baijiang powder’s active ingredient by traditional Chinese medicine database and analysis platform system pharmacology,Genecards,Uniprot database and Cytoscape software were used to construct the active component-ulcerative colitis disease target network,and gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis was performed,Autodock Vina was used for molecular docking verification.Results:Quercetin,luteolin,kaempferol,chrysin,macroanol B,β-sitosterol,stigmasterol,deltoan and rhizoctonine may play a role in the treatment of ulcerative colitis.KEGG pathway enrichment analysis showed that Yiyi Fuzi Baijiang p owder mainly involved i nterleukin-17 signaling pathway and cancer pathway,among which the key targets were PTGS2,HSP90AA1 and CASP3 and had a good binding activity with 10 main active components.Conclusion:The treatment of ulcerative colitis by Yiyi Fuzi Baijiang p owder may be mainly through quercetin,luteolin,macroanol B,β-sitosterol and other chemical components involved in cancer pathway,i nterleukin-17 signaling pathway acting on PTGS2,HSP90AA1,CASP3 and other disease targets in response to inorganic substances,response to cytokines and other biological processes f actor receptor binding and other molecular functions to achieve the purpose of treating u lcerative colitis.

Network pharmacology and molecular docking to explore Polygoni Cuspidati Rhizoma et Radix treatment for acute lung injury

BACKGROUND Polygoni Cuspidati Rhizoma et Radix(PCRR),a well-known traditional Chinese medicine(TCM),inhibits inflammation associated with various human diseases.However,the anti-inflammatory effects of PCRR in acute lung injury(ALI)and the underlying mechanisms of action remain unclear.AIM To determine the ingredients related to PCRR for treatment of ALI using multiple databases to obtain potential targets for fishing.METHODS Recognized and candidate active compounds for PCRR were obtained from Traditional Chinese Medicine Systems Pharmacology,STITCH,and PubMed databases.Target ALI databases were built using the Therapeutic Target,DrugBank,DisGeNET,Online Mendelian Inheritance in Man,and Genetic Association databases.Network pharmacology includes network construction,target prediction,topological feature analysis,and enrichment analysis.Bioinformatics resources from the Database for Annotation,Visualization and Integrated Discovery were utilized for gene ontology biological process and Kyoto Encyclopedia of Genes and Genomes network pathway enrichment analysis,and molecular docking techniques were adopted to verify the combination of major active ingredients and core targets.RESULTS Thirteen bioactive compounds corresponding to the 433 PCRR targets were identified.In addition,128 genes were closely associated with ALI,60 of which overlapped with PCRR targets and were considered therapeutically relevant.Functional enrichment analysis suggested that PCRR exerted its pharmacological effects in ALI by modulating multiple pathways,including the cell cycle,cell apoptosis,drug metabolism,inflammation,and immune modulation.Molecular docking results revealed a strong associative relationship between the active ingredient and core target.CONCLUSION PCRR alleviates ALI symptoms via molecular mechanisms predicted by network pharmacology.This study proposes a strategy to elucidate the mechanisms of TCM at the network pharmacology level.

Mn-SOD and CuZn-SOD polymorphisms and interactions with risk factors in gastric cancer

AIM: To investigate the effects of superoxide dismutase (SOD) polymorphisms (rs4998557 , rs4880), Helicobacter pylori (H. pylori ) infection and environmental factors in gastric cancer (GC) and malignant potential of gastric precancerous lesions (GPL). METHODS: Copper-zinc superoxide dismutase (SOD1, CuZn-SOD)-G7958A (rs4998557 ) and manganese superoxide dismutase (SOD2, Mn-SOD)-Val16Ala (rs4880 ) polymorphisms were genotyped by SNaPshot multiplex polymerase chain reaction (PCR) in 145 patients with GPL (87 cases of gastric ulcer, 33 cases of gastric polyps and 25 cases of atrophic gastritis), 140 patients with GC and 147 healthy controls. H. pylori infection was detected by immunoblotting analysis. RESULTS: The SOD1-7958A allele was associated with a higher risk of gastric cancer [odds ratio (OR) = 3.01, 95% confidence intervals (95% CI): 1.83-4.95]. SOD216Ala/Val genotype was a risk factor for malignant potential of GPL (OR = 2.04, 95% CI: 1.19-3.49). SOD216Ala/genotype increased the risk of gastric cancer (OR = 2.85, 95% CI: 1.66-4.89). SOD1-7958A/genotype, SOD2-16Ala/genotype, alcohol drinking, positive family history and type Ⅰ H. pylori infection were associated with risk of gastric cancer, and there were additive interactions between the two genotypes and the other three risk factors. SOD2-16Ala/Val genotype and positive family history were associated with malignant potential of GPL and jointly contributed to a higher risk for malignant potential of GPL (OR = 7.71, 95% CI: 2.10-28.22). SOD1-7958A/genotype and SOD2-16Ala/genotype jointly contributed to a higher risk for gastric cancer (OR = 6.43, 95% CI: 3.20-12.91). CONCLUSION: SOD1-7958A/and SOD2-16Ala/-genotypes increase the risk of gastric cancer in Chinese Han population. SOD2-16Ala/-genotype is associated with malignant potential of GPL.

Effects of Acupuncture on Endometrium and Pregnancy Outcomes in Patients with Polycystic Ovarian Syndrome Undergoing in vitro Fertilization-Embryo Transfer:A Randomized Clinical Trial

Objective:To observe the effect of acupuncture on endometrium and pregnancy outcomes in patients with polycystic ovary syndrome(PCOS)infertility undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods:Eighty-three patients were randomly assigned to observation group(40 cases)and control group(43 cases)according to the random numbers generated by SPSS software.The patients of the two groups received GnRH agonist long protocol as a routine treatment.In the observation group,acupuncture was given at two acupoint groups for 30 min once every other day.Group 1 included Guanyuan(CV 4),Qihai(CV 6),Zhongji(CV 3),bilateral acupoints Zigong(EX-CA1).Group 2 included Mingmen(GV 4),Yaoyangguan(GV 3),bilateral Shenshu(BL 23)and Ciliao(BL 32).The two groups of acupoints were used alternately.The whole needling process was performed at the time of ovulation induction until the transplantation day and consisted of3 courses,while the control group did not receive acupuncture interventions.The Gn dosage and Gn stimulation time,endometrial thickness and type(A,B,and C),serum oestradiol(E2)and progesterone(P)levels on the day of injection of human chorionic gonadotropin(hCG),clinical pregnancy rate,as well as live birth rate were observed.Adverse reactions were also be recorded.All patients were followed up for the pregnant rate 14 days after IVF-ET and live birth rate after pregnancy.All adverse reactions(AEs)of acupuncture were recorded during the trial.Ressults:The Gn dosage and Gn stimulation time in the observation group were lower in the observation group than in the control group(P<0.01).The proportion of type A endometrium in the observation group were higher than that in the control group(P<0.05).The serum E2 and P levels on the day of hCG injection was lower and the clinical pregnancy rate was higher in the observation group compared to those in the control group(P<0.05).There was no serious AEs during this trial.Conclusion:Acupuncture can improve the proportion of type A endometrium,regulate the levelse of serum Eand P on the day of hCG injection,and improve the pregnancy rate in patients with PCOS infertility undergoing IVF-ET.

Efficacy and Safety of Jianpi Jieyu Decoction for Patients with Mild-to-Moderate Depression of Xin(Heart)-Pi(Spleen)Deficiency Syndrome:A Multi-centre Randomized Controlled Study

Objective:To evaluate the efficacy and safety of Jianpi Jieyu Decoction(JJD)for treating patients with mild-to-moderate depression of Xin(Heart)-Pi(Spleen)deficiency(XPD)syndrome.Methods:In this multi-center,randomized,controlled study,140 patients with mild-to-moderate depression of XPD syndrome were included from Xiyuan Hospital of China Academy of Chinese Medical Sciences and Botou Hospital of Traditional Chinese Medicine from December 2017 to December 2019.They were randomly divided into JJD group and paroxetine group by using a random number table,with 70 cases in each group.The patients in the JJD group were given JJD one dose per day(twice daily at morning and evening,100 m L each time),and the patients in the paroxetine group were given paroxetine(10 mg/d in week 1;20 mg/d in weeks 2-6),both orally administration for a total of 6 weeks.The primary outcome was the change of 17-item Hamilton Depression Rating Scale(HAMD-17)score at week 6 from baseline.The secondary outcomes included the Hamilton Anxiety Scale(HAMA)score,Traditional Chinese Medicine Symptom Scale(TCMSS),and Clinlcal Global Impression(CGI)scores at the 2nd,4th,and 6th weekends of treatment,HAMD-17 response(defined as a reduction in score of>50%)and HAMD-17 remission(defined as a score of 7)at the end of the 6th week of treatment.Adverse events(AEs)were also recorded.Results:From baseline to week 6,the HAMD-17 scores decreased 10.2±4.0 and 9.1±4.9 points in the JJD and paroxetine groups,respectively(P=0.689).The HAMD-17 response occurred in 60%of patients in the JJD group and in 50%of those in the paroxetine group(P=0.292);HAMD-17 remission occurred in 45.7%and 30%of patients,respectively(P=0.128).The differences of CGI scores at the 6th week were not statistically significant(P>0.05).There were significant differences in HAMD-17 scores between the two groups at 2nd and 4th week(P=0.001 and P=0.014).The HAMA scores declined 8.1±3.0 and 6.9±4.3 points from baseline to week 6 in the JJD and paroxetine groups,respectively(P=0.905 between groups).At 4th week of treatment,there was a significant difference in HAMA between the two groups(P=0.037).TCMSS decreased 11.4±5.1,and 10.1±6.8 points in the JJD and paroxetine groups,respectively(P=0.080 between groups).At the 6th week,the incidence of AEs in the JJD group was significantly lower than that in the paroxetine group(7.14%vs.22.86%,P<0.05).Conclusion:Compared with paroxetine,JJD was associated with a significantly lower incidence of AEs in patients with mild-tomoderate depression of XPD syndrome,with no difference in efficacy at 6 weeks.(Trial registration No.Chi CTR2000040922).

Concealed mesenteric ischemia after total knee arthroplasty:A case report

BACKGROUND In critical care medicine,mesenteric ischemia(MI)is a life-threatening disease that can be present in both critically ill patients and those undergoing major surgery.For the first time,we report a case of concealed MI with a long course after knee arthroplasty.CASE SUMMARY A male patient underwent left total knee arthroplasty for gouty arthritis and developed a persistent fever and persistently high levels of serum infection markers after surgery.He was considered to have a periprosthetic site infection and treated with antibiotics and colchicine,periprosthetic debridement was performed,and the spacer was replaced,but no improvement was seen.At 54 d after arthroplasty,the patient developed gastrointestinal symptoms of nausea and vomiting,abdominal distention,and subsequently,cloudiness of consciousness,and hypotensive shock.Finally,the patient was diagnosed with ascending colonic mesentery ischemia with necrosis after laparotomy,which improved after right hemicolectomy.CONCLUSION Concealed MI without gastrointestinal symptoms after major surgery is rare and easily misdiagnosed.Orthopedic surgeons need to be aware of this complication.

Nutrition: A Crucial Role in Cancer

It has been observed that cancer-associated malnutrition could lead to a reduction of the therapeutic efficacy of chemotherapy, suggesting that early and aggressive nutritional support is necessary for cancer patients with malnutrition. The use of chemotherapy drugs may result in gastrointestinal dysfunction, which could affect the absorption and digestion of nutrients, further worsening malnutrition. The purpose of nutritional support in combination with chemotherapy is to ameliorate the nutritional deficiencies of patients and improve their tolerance of chemotherapy, thus improving the quality of life of patients. In this article, the metabolic abnormalities of cancer patients, the effects of malnutrition during chemotherapy and the current research on nutritional support for chemotherapy are reviewed.

Review:Advances in researches on the immune dysregulation and therapy of severe acute pancreatitis

During the development and progression of severe acute pancreatitis(SAP) ,conspicuous immune dysregulation develops,which is mainly manifested as excessive immune response in the early stage and immunosuppression in the late stage. This process involves complex changes in a variety of immune molecules and cells,such as cytokines,complements,lymphocytes,and leukocytes. With the gradual deepening of studies on the development and progression of SAP,the role of immune dysregulation in the pathogenesis of SAP has attracted more and more attention. In this article,we review the advances in research on the immune dysregulation in SAP and the immunotherapy of this disease through exploring the formation of excessive immune response and immune suppression as well as their mutual transformation.

Protective effects of Salvia miltiorrhizae on the hearts of rats with severe acute pancreatits or obstructive jaundice

Objective:To investigate the therapeutic effects and mechanisms of Salvia miltiorrhizae(Danshen) in the treatment of severe acute pancreatitis(SAP)-or obstructive jaundice(OJ)-induced heart injury. Methods:A total of 288 rats were used for SAP(n=108) and OJ-associated(n=180) experiments. The rats were randomly divided into sham-operated,model control,and Salvia miltiorrhizae-treated groups. According to the difference of time points after operation,SAP rats in each group were subdivided into 3,6 and 12 h subgroups(n=12),whereas OJ rats were subdivided into 7,14,21,and 28 d subgroups(n=15). At the corresponding time points after operation,the mortality rates of the rats,the contents of endotoxin and phospholipase A2(PLA2) in blood,and pathological changes of the hearts were investigated. Results:The numbers of dead SAP and OJ rats in the treated groups declined as compared with those in the model control group,but not significantly(P>0.05). The contents of endotoxin(at 6 and 12 h in SAP rats and on 7,14,21,and 28 d in OJ rats,respectively) and PLA2(at 6 and 12 h in SAP rats and on 28 d in OJ rats,respectively) in the treated group were significantly lower than those in the model control group(P<0.01 and P<0.001,respectively). Besides,myocardial pathological injuries were mitigated in SAP and OJ rats. Conclusion:In this study,we found that Salvia miltiorrhizae improved myocardial pathological changes,reduced the content of PLA2 in blood,and decreased the mortality rates of SAP and OJ rats,exerting protective effects on the hearts of the rats.

Protective Effect of Zengye Decoction(增液汤)on Submandibular Glands in Nonobese Diabetic Mice

Objective: To investigate the protective effect of Zengye Decoction(增液汤, ZYD) on the submandibular glands(SMGs) in nonobese diabetic(NOD) mice. Methods: Twenty-seven female NOD mice were randomly equally divided into 3 groups: the model group, the hydroxychloroquine(HCQ) group, and the ZYD group. Nine C57/B6 mice served as the normal group. After 1-week acclimation, the HCQ and ZYD groups were intragastrically administered with HCQ and ZYD, respectively, and the normal and model groups were administered with normal saline. Changes in the salivary flow rate were observed. Mice from all 4 groups were sacrificed at the age of 20 weeks. The serum and SMGs were collected. Serum cytokines gamma-interferon(IFN-γ), interleukin-10(IL-10) were detected by enzyme-linked immunosorbent assay. Histological changes in the submandibular glands were examined by hematoxylin and eosin staining. The mRNA expression of IFN-γ, IL-10 and vasoactive intestinal peptide(VIP) in the submandibular glands were measured by realtime polymerase chain reaction. Results: Compared with the model group, the salivary flow of the ZYD group significantly increased(P<0.05), the extent of the histological changes was ameliorated(P<0.05), and the Th1/Th2 cytokine imbalance was remedied(P<0.05). In the ZYD-treated mice, the VIP mRNA was up-regulated(P<0.05). Conclusions: ZYD is beneficial in protecting structure and function of SMGs in NOD mice. The mechanism may be associated with the correction of the Th1/Th2 cytokine imbalance, and with the prevention of a progressive decline of the VIP level.

Evaluation of recombinant endostatin in the treatment of atherosclerotic plaques and neovascularization in rabbits

Objective:Atherosclerotic plaques and neovascularization play an important role in the course of coronary atherosclerosis.This study evaluated the effect of recombinant endostatin on experimental atherosclerotic plaques and neovascularization in rabbits.Methods:Eighteen healthy male rabbits were divided into three groups:control group,atherosclerotic model group,and recombinant endostatin treated group.The atherosclerotic model was established via a high-cholesterol diet after balloon catheter injury.The subject weights,serum total cholesterol,creatine kinase-myocardial band fraction(CKMB),and matrix metalloproteinase-2(MMP-2) were measured.Six weeks after treatment,the aortic roots were taken for pathological assay.The thickness ratio of the intima to media was measured by hematoxylin and eosin(HE) staining,and the number of neovessels was measured by immunohistochemistry via monoclonal antibody CD31 staining.Results:The weight,plasma total cholesterol,and CKMB were not significantly different between the atherosclerotic model group and the recombinant endostatin treated group,but much higher than those of the control group(P<0.05).The thickness ratio of the intima to media in the recombinant endostatin treated group was distinctly less than that in the atherosclerotic model group(P<0.05).The number of neovessels decreased dramatically(P<0.05) and the content of MMP-2 decreased slightly without statistical difference(P>0.05) in the recombinant endostatin treated group,compared to the atherosclerotic model group.Conclusions:Recombinant endostatin is able to inhibit the growth of neovascularization in the atherosclerotic plaque and the development of plaque.