【Abstract】ObjectiveThere are two main functions of gastrointestinal tract, digestion and absorption, and barrier function. The latter has an important defensive effect, which keeps the body away from the invading and damaging of bacteria and endotoxin. It maintains the systemic homeostasis. Intestinal dysfunction would happen when body suffers from diseases or harmful stimulations. The more serious intestinal disorders would harm the intestinal protective mechanism, or intestinal barrier function, and bacterial/endotoxin translocation, of intestinal failure (IF) would ensue. This article provides a critical review of the evidence indicating that an increase in bacterial translocation is associated with sepsis, and even the multiple organ failure syndrome in critically ill patients. The intransit microorganisms play an essential role in the homeostasis of local and systemic immunity. MethodsAll studies published from 2000 to June 2005 about intestinal permeability, bacterial translocation, and systemic inflammatory response syndrome were located by search of PubMed. ResultsClinical and experimental studies investigating the correlation between bacterial translocation and systemic inflammatory response syndrome, associated with the damage of the gut barrier function . To keep the mucosal barrier function intact is one of the main issues in the prevention of bacterial translocation. This could be achieved by the adequate delivery of oxygen and nutrient supplementation to the gut. Enteral nutrition, probiotic can be a good choice. ConclusionWith a better understanding of the bacteriahost interactions in health and the alterations induced by critical illness, new therapies that improve the environment of both may lead to better recovery rates in intensive care unit patients.
Objective To investigate the effect of CD44 fucosylation on fluid adhesion force of rabbit bone marrow mesenchymal stem cells (BMSCs). Methods The rabbit BMSCs were isolated and purified by density gradient centrifugation combined with adherent culture method. The morphology of cells were observed by inverted microscope, and the cell surface markers of CD44, CD34, CD29, and CD105 were assessed by flow cytometry. BMSCs fucosylated by alpha-(1, 3)-fucosyltransferase Ⅵ (FTⅥ) were as the experimental group, and the non-fucosylated BMSCs were as the control group, and then the positive rate of sialyl-LewisX (sLeX) and the binding rate of E-selectin were detected by flow cytometry. The fucosylated BMSCs resuspended in Hank balanced salt solution (HBSS) were assigned as the experimental group (group A), at same time, the non-fucosylated BMSCs resuspended in HBSS solution as the study control group (group B), and the fucosylated BMSCs resuspended in HBSS solution which was added EDTA as negative control group (group C). The fluid adhesion force of rabbit BMSCs were detected by the parallel flow chamber adhesion test. Results Primary BMSCs mainly shaped as spindle and kept strong growth. The third generation BMSCs were negative for CD34, but positive for CD44, CD29, and CD105. After fucosylation, the positive rate of sLeX in the experimental group was 32.52%±1.76%, which was significantly higher than that in the control group (1.48%±0.51%) (t=29.277, P= 0.000). The binding rate of E-selectin in the experimental group was 41.05%±1.84%, which was also significantly higher than that in the control group (4.33%±0.92%) (t=35.674, P=0.000). With the increase of fluid shear force, the number of BMSCs adhering to the surface of human umbilical vascular endothelial cells (HUVEC) in group A was increased at first and then decreased, while there was few BMSCs adhering to the surface of HUVEC in groups B and C. Under the different fluid shear stress, the number of BMSCs adhered to the surface of HUVEC in group A was significantly higher than that in groups B and C (P<0.05), and there was no significant difference between groups B and C (P>0.05). Conclusion CD44 fucosylation on BMSCs can enhance the fluid adhesion force of rabbit BMSCs.
ObjectiveTo compare the effectiveness and safety of preoperative lung localization by microcoil and anchor with scaled suture.MethodsA total of 286 patients underwent CT-guided puncture localization consecutively between October 2019 and December 2020 in our hospital. According to the different methods of localization, they were divided into a microcoil group (n=139, including 49 males and 90 females, aged 57.92±10.51 years) and an anchor group (n=147, including 53 males and 94 females, aged 56.68±11.31 years). The clinical data of the patients were compared.ResultsA total of 173 nodules were localized in the microcoil group, and 169 nodules in the anchor group. The localization success rate was similar in the two groups. However, the anchor group was significantly better than the microcoil group in the localization time (8.15±2.55 min vs. 9.53±3.08 min, P=0.001), the pathological receiving time (30.46±14.41 min vs. 34.96±19.75 min, P=0.029), and the hemoptysis rate (10.7% vs. 30.1%, P=0.001), but the pneumothorax rate was higher in the anchor group (21.3% vs. 11.0%, P=0.006).ConclusionPreoperative localization of small pulmonary nodules using anchor with suture is practical and safe. Due to its simplicity and convenience, it is worth of promotion in the clinic.
ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.
Objective To evaluate whether surgical intervention can be performed in initial onset of primary spontaneous pneumothorax (PSP) patients and whether pleural abrasion should be performed regularly in PSP treatment. Methods The clinical data of 326 PSP patients undergoing bullectomy or bullectomy combined with pleural abrasion (BLPA) between January 2008 and December 2013 were retrospectively reviewed. There were 267 males and 59 females, with a mean age of 24 years ranging from 20 to 31 years. Results The initial onset of PSP was in 229 patients, and recurrent PSP in 115 patients. Ten patients had postoperative PSP recurrence after a mean follow-up of 47 months ranging from 1 to 95 months. For the patients with initial onset of PSP, the recurrence rate was 3.1% (7/229), and that in patients with recurrent PSP was 2.6% (3/115, P=0.82). Compared with the bullectomy group (5.8%, 7/120), recurrence rate in the BLPA group was lower (1.3%, 3/224, P=0.02). There were no mortalities or significant complications in both groups. There was significant difference in body mass index (P=0.04), intraoperative adhesion (P<0.05), operation duration (P<0.01), number of bullae (P<0.01), and bullae location (P<0.01) between bullectomy and BLPA groups. Postoperative drainage (P<0.01), air leak (P=0.01) and extubation duration (P<0.01) were significantly lower in the bullectomy group. Total cost was significantly higher in the BLPA group (P<0.01). Conclusion Surgical intervention could provide satisfactory outcomes for PSP patients. Compared with bullectomy, BLPA has much lower recurrence rate, but with more drainage, longer drainage duration and higher cost.
Objective To identify risk factors that affect the verification of malignancy in patients with solitary pulmonary nodule (SPN) and verify different prediction models for malignant probability of SPN. Methods We retrospectively analyzed the clinical data of 117 SPN patients with definite postoperative pathological diagnosis who underwent surgical procedure in China-Japan Friendship Hospital from March to September 2017. There were 59 males and 58 females aged 59.10±11.31 years ranging from 24 to 83 years. Imaging features of the nodule including maximum diameter, location, spiculation, lobulation, calcification and serum level of CEA and Cyfra21-1 were assessed as potential risk factors. Univariate analysis was used to establish statistical correlation between risk factors and postoperative pathological diagnosis. Receiver operating characteristic (ROC) curve was drawn by different predictive models for the malignant probability of SPN to get areas under the curves (AUC), sensitivity, specificity, positive predictive values, negative predictive values for each model. The predictive effectiveness of each model was statistically assessed subsequently. Results Among 117 patients, 93 (79.5%) were malignant and 24 (20.5%) were benign. Statistical difference was found between the benign and malignant group in age, maximum diameter, serum level of CEA and Cyfra21-1, spiculation, lobulation and calcification of the nodules. The AUC value was 0.813±0.051 (Mayo model), 0.697±0.066 (VA model) and 0.854±0.045 (Peking University People's Hospital model), respectively. Conclusion Age, maximum diameter of the nodule, serum level of CEA and Cyfra21-1, spiculation, lobulation and calcification are potential independent risk factors associated with the malignant probability of SPN. Peking University People's Hospital model is of high accuracy and clinical value for patients with SPN. Adding serum index into the prediction model as a new risk factor and adjusting the weight of age in the model may improve the accuracy of prediction for SPN.