Objective To investigate the pathological changes in the neuromuscular junction during ischemiareperfusion(IR) in the skeletal muscle. Methods Forty-eight healthy adult Wistar rats (24 male, 24 female) were equally randomised into the following 6 groups: Group A (control group): no ischemiareperfusion; Group B: ischemia by clamping the blood vessels of the right hindlimb for 3 hours; Group C: ischemia by clamping for 4.5 hours;Group D: ischemia by the clamping for 4.5 hours followed by reperfusion for 1.5hours; Group E: ischemia for 4.5 hours followed by reperfusion for 24 hours; and Group F: ischemia for 4.5 hours followed by reperfusion for 2 weeks. Then, the medial head of the gastrocnemius muscle flap model was applied to the right hindlimb of each rat. The medial head of the gastrocnemius muscle was isolated completely,leaving only the major vascular pedicle, nerve and tendons intact.The proximal and distal ends (tendons) were ligated while the vessel pedicle was clamped. And then, Parameters of the muscle (performance,contraction index,colour,edema,bleeding) were observed. The muscle harvested was stained with gold chloride(AuCl3) and the enzymhistochemistry assay (succinate dehydrogenase combined with acetylcholine esterase) was performed. Morphology and configuration of the neuromuscular junction were observed during the ischemiareperfusion injury by means of the AuCl-3 staining. The result of the enzymhistochemical reactions was quantitatively analyzed with the computer imageanalysis system. And then, additional 5 rats were prepared for 3 different models identical with those in Groups A, C and E separately. The specimens were harvested from each rat and were stained with HE and AuCl-3, and they were examined under the light microscope. Results During the period of ischemia, the skeletal muscle of Group B showed the colour of purple and edema.The colour and edema became worse in Group ,while dysfunction of elasticity and contraction appeared obviously with plenty of dark red hemorrhagic effusion at the same time.After reperfusion,the color and edema of muscle in Group D became improved while the elasticity and function of contraction was not improved. Hemorrhagic effusion of Group D turned clearer and less than Group C.Group E was similar to Group D in these aspects of muscle except for much less hemorrhagic effusion. Skeletal muscle in Group F showed colour of red alternating with white, adhesion,contracture of muscle, exposure of necrotic yellow tissue and almost lost all its functions. The AuCl3 staining showed that during IR, necrosis of the myocytes was followed by degeneration of their neuromuscular junctions, and finally the nerve fibers attached to these neuromuscular junctions were disrupted like the withering of leaves. The enzymhistochemistry assay showed thatthere was no significant difference in the level of acetylcholine esterase between the ischemic group (Groups B and C) and the control group (Group A) (Pgt;0.05). However, the level of acetylcholine esterase in all the reperfused groups (Groups D, E and F) decreased significantly when compared with the control group（Group A）and the ischemic groups (Groups B and C) (Plt;0.01). Conclusion The distribution of the nerve fibers and the neuromuscular junctions in the mass of the muscles is almost like the shape of a tree. The neuromuscular junction seems to be more tolerant for ischemia than the myocyte. Survival ofthe neuromuscular junction depends on its myocytes alive. Therefore, an ischemiareperfusion injury will not be controlled unless an extensive debridement of the necrotic muscle is performed.
ObjectivesTo systematically review the efficacy of lidocaine injected prior to tracheal extubation in preventing hemodynamic responses to tracheal extubation in general anesthesia.MethodsPubMed, Ovid, Web of Science, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of lidocaine administrated prior to extubation in preventing hemodynamic responses to tracheal extubation in patients undergoing general anesthesia from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 13.0 software.ResultsA total of 10 RCTs involving 525 patients were included. The results of meta-analysis showed that: compared with control group, lidocaine could reduce mean arterial pressure in 5 min after extubation (MD=–5.10, 95%CI –9.41 to –0.79, P=0.02), weaken the increase in systolic blood pressure caused by extubation from the moment before extubation to 5 minutes after extubation (before extubation: MD=–7.22, 95%CI –10.34 to –4.11, P<0.000 01; at extubation: MD=–14.02, 95%CI –19.42 to –8.62, P<0.000 01; 1 minutes after extubation: MD=–15.82, 95%CI –22.20 to –9.45, P<0.000 01; 3 minutes after extubation: MD=–12.55, 95%CI –20.36 to –4.74, P=0.002; and 5 minutes after extubation: MD=–12.05, 95%CI –20.35 to –3.74, P=0.004), and weakened extubation-induced increase in diastolic blood pressure at extubation (MD=–9.71, 95%CI –16.57 to –2.86, P=0.005). In addition, lidocaine inhibited heart rate in all time points except the moment of before and at 10 minutes after extubation.ConclusionsCurrent evidence shows that lidocaine can inhibit the increase in blood pressure and heart rate caused by extubation at certain times. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
To investigate the influence of injury of nutrient artery on the blood supply of inner 2/3 of cortical and intramedullary tissue, the experiment was carried out on twenty-four rabbits. Four rabbits were killed and perfused with Chinese ink in femoral artery to survey the blood supply of intramedullary vessels. Others were received fracture on tibia and sacrificed respectively on the third, eighth, eighteenth, twenty-eighth, and forty-second days after fracture. Chinese ink was also perfused through femoral artery on those rabbits. The relative density of capillary vessels were determined. The results were as follows: when the nutrient artery was injured after fracture, blood supply to the intramedullary tissue and the inner 2/3 of cortical bone was interrupted. The intramedullary vessels were increared and dilated. During the whole course of healing of fraeture, the density of intramedullary capillary vessels were higher than normal. It was concluded that the anastomosis between the epiphysis and metaphysis was important in the reconstruction of collateral circulation in healing of fracture.
ObjectiveTo investigate the dynamic changes of nodule volume in benign thyroid tumors after radiofrequency ablation (RFA), and to analyze the predictive value of risk factors for nodule regeneration. MethodsA total of 165 patients with benign thyroid nodules who received RFA treatment in the People’s Hospital of Yuechi County from June 2019 to June 2021 were retrospectively collected and divided into small nodule volume group (≤15 mL, n=116) and large nodule volume group (>15 mL, n=49) according to the median nodule volume at admission. The clinical data and serological data of the two groups were compared. Multivariate Cox proportional hazard regression model was used to adjust confounding factors to explore the relationship between initial nodule volume, vascular density, nodule location near critical structure and postoperative nodule regeneration in patients with benign thyroid nodules. According to the proposed Nomogram of the model, Bootstrap method was adopted for sampling verification, calibration curve was adopted to evaluate the calibration degree of the model, and area under the curve (AUC) of receiver operating characteristics (ROC) curve was adopted to evaluate the model differentiation. ResultsIn the small volume nodule group, the proportion of unilateral nodule was higher, and the preoperative beauty score, preoperative symptom score, radiofrequency power, ablation time, total energy, operative time, intraoperative blood loss and hospital stay were lower or short, P<0.05. The change value of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), catalase (CAT) after operation in small volume nodule group were higher than those in the large nodule volume group (P<0.05), but change value of the free thyroxine (FT4), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were lower than those in the large nodule volume group (P<0.05). At 1, 3, 6, 12, and 24 months after RFA operation, the nodule volume of the two groups decreased successively, and volume reduction rate (VRR) increased successively. The changes of nodule volume and VRR in the small nodule volume group were better than those in the large nodule volume group. In the large nodule group, the nodule volume was larger at 1, 3, 6, 12, and 24 months after operation, and the VRR was higher at 1 month after operation, the regeneration time was shorter, the number of residual nodules was higher, and the initial ablation rate (IAR) was lower (P<0.05). After adjusting for age, gender and other factors, the correlation effect value increased with the increase of initial volume and blood vessel density, and the differences in trend test were statistically significant (Ptrend <0.05). Nodules located near the critical structure had an increased risk of regeneration (OR=1.76, P<0.001). The Nomogram constructed according to the multi-factor model has good differentiation (AUC before and after ROC curve validation were 0.854 and 0.814, respectively) and accuracy (mean absolute error of 0.023). ConclusionsRFA achieved clinically relevant volume reduction in both ≤15 mL and >15 mL of single benign thyroid nodules, lasting for at least 2 years. However, the nodule VRR and cosmetic effect were better in the small volume nodule group, and the initial nodule volume, blood vessel density and location were closely related to nodule regeneration. The Nomogram model showed good differentiation and accuracy in predicting the risk of nodule regeneration, providing strong support for clinical decision-making.
Objective To investigate the consistency of regions of interest (ROI) volume among different radiological treatment planning systems (TPS) for the same group of patient data, and analyze the tendency and degree of differences caused by data transfer. Methods Between October 2010 and December 2013, the data of 10 nasopharyngeal carcinoma patients treated in West China Hospital were transferred from Monaco TPS into various other treatment planning systems. Based on different ROI volumes, they were divided into 8 groups. We counted the volume differences between these TPS and Monaco TPS, and carried out the statistical analysis. Results For small ROI volume, the calculated difference reached up to 65% in our study. As a general trend, differences became less and less with the increasing of volumes. But for single ROI, the volume difference was likely to vary randomly. The percentage of ROI volumes which were smaller than that of Monaco TPS was 70% for Raystation TPS, 38.75% for Pinnacle TPS, 88.75% for Eclipse TPS, 97.5% for Masterplan TPS, and 83.13% for iPlan TPS. Conclusions ROI volume differences exist generally among different treatment planning systems when ROIs are transferred among them by DICOM protocol. The volume variations may be affected by multiple factors. The volume consistency should be evaluated before any direct comparison of dose volu me histogram parameters which are done between different systems.
ObjectiveTo analyze the disease burden and evolving trends for gastric cancer in China and worldwide from 1990 to 2021. MethodsBased on the 2021 Global Burden of Disease (GBD) database, we analyzed the burden of gastric cancer using indicators such as incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lost due to disability (YLDs). Joinpoint regression analysis was used to calculate the average annual percentage change (AAPC) of these indicators to show trends over time. ResultsIn 2021, the standardized incidence rate of gastric cancer was 14.33 (per 100 000) worldwide and 29.05 (per 100 000) in China, with corresponding standardized mortality rates of 11.20 (per 100 000) and 21.51 (per 100 000). The standardized incidence rate of gastric cancer in China trended downward during 1990–2021 (AAPC=–1.61%, P<0.05), but was lower than the global decline (AAPC=–1.77%, P<0.05). During 1990-2021 in China, the rates of standardized DALYs (AAPC=–2.76%, P<0.05), standardized YLLs (AAPC=–2.78%, P<0.05) and standardized YLDs (AAPC= –1.25%, P<0.05) all showed a significant decrease. The global rates of standardized DALYs (AAPC=–2.42%, P<0.05), standardized YLLs (AAPC=–2.44%, P<0.05) and standardized YLDs (AAPC=–1.56%, P<0.05) all showed a significant decrease. These AAPC values above indicated a general attenuation in the gastric cancer burden across all age groups, both in China and worldwide. ConclusionsDespite these signs of a decline in disease burden indicators for gastric cancer in China and worldwide, the number of cases and deaths in gastric cancer remains substantial coupled with the heavy burden on the healthcare system. Therefore, increased efforts in early detection and prevention strategies are of utmost importance to further reduce the impact of this malignant disease.
【Abstract】ObjectiveTo investigate the effects of CO2 pneumoperitoneum on blood flow of carotid arteries in atherosclerosis rabbits.MethodsFifty Japan white rabbits were randomly divided into control group and three atherosclerosis groups. In atherosclerosis group, the rabbits were randomly subjected to CO2 pneumoperitoneum with an intraabdominal pressure of 0 mm Hg, 10 mm Hg or 15 mm Hg for 2 hours, after the model were created by feeding the rabbits with high fatty diet. The blood flow of the common carotid arteries were measured by electromagnetic blood flowmeter. Artery blood samples were collected for blood gas analysis at 30 minute intervals. ResultsHigher insufflation pressures and longer duration of CO2 pneumoperitoneum were associated with greater increase in blood flow of common carotid arteries. Compared with those in control group and atherosclerosis group with 0 mm Hg CO2 pneumoperitoneum, there were statistically significant increases in blood flow of the common carotid arteries during CO2 pneumoperitoneum in 10 mm Hg and 15 mm Hg pneumoperitoneum group, the changes in 15 mm Hg pneumoperitoneum group were more significant than those in 10 mm Hg pneumoperitoneum group (Plt;0.05). When compared with the blood flow before insufflation, those in 10 mm Hg and 15 mm Hg pneumoperitoneum group also increased significantly during CO2 pneumoperitoneum, even at 30 minute after desufflation (Plt;0.05). However, those in control group and 0 mm Hg pneumoperitoneum group did not change significantly (Pgt;0.05). There were significant decrease in pH and significant increase in PCO2 in both 10 mm Hg and 15 mm Hg groups, when compared with presufflation values or those in control group and 0 mm Hg pneumoperitoneum group(Plt;0.05). The changes in pH and PCO2, however, were no significant at any time point in control group and 0 mm Hg pneumoperitoneum group (Pgt;0.05). HCO3- did not change significantly in either group(Pgt;0.05).ConclusionUnder atherosclerosis conditions, CO2 pneumoperitoneum has an adverse influence on the blood flow of the common carotid arteries which may be associated with increased intrabdominal pressure,absorbed CO2 gas.
Deep brain stimulation (DBS), which usually utilizes high frequency stimulation (HFS) of electrical pulses, is effective for treating many brain disorders in clinic. Studying the dynamic response of downstream neurons to HFS and its time relationship with stimulus pulses can reveal important mechanisms of DBS and advance the development of new stimulation modes (e.g., closed-loop DBS). To exhibit the dynamic neuronal firing and its relationship with stimuli, we designed a two-dimensional raster plot to visualize neuronal activity during HFS (especially in the initial stage of HFS). Additionally, the influence of plot resolution on the visualization effect was investigated. The method was then validated by investigating the neuronal responses to the axonal HFS in the hippocampal CA1 region of rats. Results show that the new design of raster plot is able to illustrate the dynamics of indexes (such as phase-locked relationship and latency) of single unit activity (i.e., spikes) during periodic pulse stimulations. Furthermore, the plots can intuitively show changes of neuronal firing from the baseline before stimulation to the onset dynamics during stimulation, as well as other information including the silent period of spikes immediately following the end of HFS. In addition, by adjusting resolution, the raster plot can be adapted to a large range of firing rates for clear illustration of neuronal activity. The new raster plot can illustrate more information with a clearer image than a regular raster plot, and thereby provides a useful tool for studying neuronal behaviors during high-frequency stimulations in brain.
Objective To analyze the prevalence of leukemia in China from 1990 to 2019, predict the incidence, morbidity and mortality of leukemia in China from 2020 to 2040, and provides reference for the formulation of leukemia-related prevention and treatment strategies in China. Methods Based on the 2019 Global Burden of Disease database, the incidence, morbidity and mortality data of leukemia in China from 1990 to 2019 were collected, and the rate of change and annual estimated percentage of change (EAPC) were used to describe the epidemic trend of the disease. The Autoregressive Moving Average (ARIMA) model was used to predict the prevalence of leukemia in China from 2020 to 2040. Results In 2019, the age-standardized incidence, age-standardized prevalence and age-standardized mortality rate of leukemia in China decreased by 17.62%, 10.97%, and 41.56%, respectively, compared with 1990, and an average annual decrease of 1.06%, 0.89%, and 2.05%, respectively (P<0.05). From 1990 to 2019, the reduction age-standardized incidence rate, age-standardized prevalence rate and age-standardized mortality rate in Chinese women (EAPC was 1.56%, 1.38%, and 2.62%, respectively) was higher than that of men (EAPC was 0.61%, 0.43%, and 1.59%, respectively). In 2019, the incidence and prevalence were highest in the age group under 5 years of age, and the mortality rate was the highest in the age group over 80 years old. The prediction results of ARIMA model showed that the age-standardized incidence rate and prevalence of leukemia in China showed an increasing trend from 2020 to 2040, while the age-standardized mortality rate showed a decreasing trend. It is estimated that by 2040, the age-standardized incidence rate, age-standardized prevalence rate, and age-standardized mortality rate of leukemia will be 14.06/100 000, 108.23/100 000, and 2.83/100 000. Conclusions From 1990 to 2019, the age-standardized incidence rate, age-standardized prevalence rate and age-standardized mortality rate of leukemia in China decreased year by year, but they were still at a high level. The prediction results show that the age-standardized incidence rate and age-standardized prevalence rate of leukemia in China will continue to increase from 2020 to 2040, and it is necessary to continue to strengthen the surveillance, prevention and control of leukemia in the future.