Ultrasound guiding the rapid diagnosis and treatment of perioperative pneumothorax:A case report

BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold standard for the diagnosis of pneumothorax,but is not suitable for rapid diagnosis of this complication.In contrast,lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax.CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned.Anesthesia was induced,and tracheal intubation was performed successfully with a video laryngoscope.About 2 min after tracheal intubation,the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%.According to the BLUE protocol,a recommended area of the chest was scanned by ultrasound.The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung.The boundary of pneumothorax(lung points)were rapidly confirmed by ultrasound.To avoid lung injury,a closed thoracic drainage tube was placed in the involved area.On day 9 after surgery,the patient was discharged from the hospital without any complications.CONCLUSION Perioperative pneumothorax is rare but dangerous.It can be rapidly diagnosed and treated with ultrasound guidance.

Resorption of upwardly displaced lumbar disk herniation after nonsurgical treatment: A case report

BACKGROUND The spontaneous resorption of lumbar disk herniations(LDHs)has been widely reported.However,the majority of these reports analyze the resorption of LDHs that were displaced backwards or downwards.There have been few reports on the spontaneous resorption of upwardly displaced L4/5 LDH that has caused femoral nerve symptoms.CASE SUMMARY A 55-year-old woman presented to our hospital with acute pain in her left leg.She had been suffering from recurrent lower back pain for approximately 1 year and began to feel pain accompanied with numbness at the anterior aspect of her left leg 7 d previously.On examination,a typical L4 nerve stimulation was noted.An upwardly displaced LDH at the L4/5 level was revealed by magnetic resonance imaging.The patient attained complete relief of her symptoms after 10 wk of nonsurgical treatment and the upwardly displaced herniation almost entirely disappeared.There was no recurrence during a follow-up of 2 years.CONCLUSION Clinicians should be aware that the nerves disturbed by LDHs vary according to the direction of the herniations and the probable resorption of upwardly displaced LDHs should be considered before making a decision on surgery.

Effect of aerobic exercise on GRP78 and ATF6 expressions in mice with non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD)is a prevalent medical condition with an ever-growing trend.Although multiple intracellular mechanisms are involved,endoplasmic reticulum(ER)stress has been demonstrated to play a significant role in the genesis and progression.Most of the research supports the advantages of exercise for NAFLD.However,little is known about the molecular mechanism(s)that underpin the effectiveness of exercise training in NAFLD.This study aimed to identify how aerobic exercise affected hepatic ER stress in a mouse NAFLD model.In this study,the mice were fed either a standard diet(SD)or a high-fat diet(HFD)for 17 weeks.HFD mice were trained on a treadmill during the last eight weeks.All animals were tested for serum levels of biochemical assays,protein expression,and gene expression.The hematoxylin and eosin,Oil red O,and immunohistochemistry staining were also performed.The results indicated that a high-fat diet generated NAFLD,with serum lipid disruption and hepatic function impairment,and increased GRP78 and ATF6 expressions.However,aerobic training reversed the majority of these alterations.It is concluded that NAFLD appears to be associated with hepatic ER stress response,and aerobic exercise mitigates NAFLD via lowering ER stress proteins GRP78 and ATF6.

Construction of a magnesium hydroxide/graphene oxide/hydroxyapatite composite coating on Mg-Ca-Zn-Ag alloy to inhibit bacterial infection and promote bone regeneration

The improved corrosion resistance, osteogenic activity, and antibacterial ability are the key factors for promoting the large-scale clinical application of magnesium (Mg)-based implants. In the present study, a novel nanocomposite coating composed of inner magnesium hydroxide, middle graphene oxide, and outer hydroxyapatite (Mg(OH)_(2)/GO/HA) is constructed on the surface of Mg-0.8Ca-5Zn-1.5Ag by a combined strategy of hydrothermal treatment, electrophoretic deposition, and electrochemical deposition. The results of material characterization and electrochemical corrosion test showed that all the three coatings have high bonding strength, hydrophilicity and corrosion resistance. In vitro studies show that Mg(OH)2 indeed improves the antibacterial activity of the substrate. The next GO and GO/HA coating procedures both promote the osteogenic differentiation of MC3T3-E1 cells and show no harm to the antibacterial activity of Mg(OH)2 coating, but the latter exhibits the best promoting effect. In vivo studies demonstrate that the Mg alloy with the composite coating not only ameliorates osteolysis induced by bacterial invasion but also promotes bone regeneration under both normal and infected conditions. The current study provides a promising surface modification strategy for developing multifunctional Mg-based implants with good corrosion resistance, antibacterial ability and osteogenic activity to enlarge their biomedical applications.

Novel nano-microspheres containing chitosan, hyaluronic acid, and chondroitin sulfate deliver growth and differentiation factor-5 plasmid for osteoarthritis gene therapy

Objective:To construct a novel non-viral vector loaded with growth and differentiation factor-5(GDF-5) plasmid using chitosan,hyaluronic acid,and chondroitin sulfate for osteoarthritis (OA)gene therapy.Methods: Nano-microspheres (NMPs)were prepared by mixing chitosan,hyaluronic acid,and chondreitin sulfate.GDF-5 plasmid was encapsulated in the NMPs through electrostatic adsorption.The basic characteristics of the NMPs were observed,and then they were co-cultured with chondrocytes to observe their effects on extracellular matrix (ECM) protein expression.Finally,NMPs loaded with GDF-5were inje.cted into the articular cavities of rabbits to observe their therapeutic effects on OA in vivo.Results:NMPs exhibited good physicochemical properties and low cytotoxicity.Their average diameter was (0.61±0.20)μm,and encapsulation efficiency was (38.19±0.36)%.According to Cell Counting Kit-8(CCK-8)assay,relative cell viability was 75%-99%when the total weight of NMPs was less than 560μg. Transfection efficiency was (62.0±2.1)% in a liposome group,and (60.0±1.8)% in the NMP group.There was no sig- nificant difference between the two groups (P>0.05).Immunohistochemical staining results suggested that NMPs can successfully transfect chondrocytes and stimulate ECM protein expression in vitro.Compared with the control groups, the NMP group significantly promoted the expression of chondrocyte ECM in vivo (P<0.05),as shown by analysis of the biochemical composition of chondrocyte ECM.When NMPs were injected into OA model rabbits,the expression of ECM proteins in chondrocytes was significantly promoted and the progression of OA was slowed down.Conclusions: Based on these data,we think that these NMPs with excellent physicochemical and biological properties could be promising non-viral vectors for OA gene therapy.