Objectives To assess the quality of clinical practice guidelines for primary hepatic carcinoma published in 2016 and 2017 in China. Methods CNKI, WanFang Data, CBM and VIP databases were searched for clinical practice guidelines for primary hepatic carcinoma in China. The search date was from Jan. 1st, 2016 to Jan. 1st, 2018. Four researchers independently selected literatures and extracted data according to the inclusion and exclusion criteria. The Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) was utilized to assess the methodological quality of the guidelines. Results A total of 7 guidelines were included. The average scores of six domains for these guidelines were: 65.1% for scope and purpose, 39.4% for stakeholders’ involvement, 64.3% for rigor of development, 55.6% for clarity of presentation, 61.8% for applicability and 6.1% for editorial independence. Conclusions The quality of clinical practice guidelines for primary hepatic carcinoma in China is relative high, of which the recommendations are of great value in clinical practice, yet still required to be improved in some ways.
ObjectiveTo explore the effects of different concentrations of sevoflurane on hyperoxia-induced lung injury in rat.MethodsThe 72 SD rats were randomly divided into control group C (n=12); sevoflurane inhalation group S, group S contains 5 subgroups (n=12) S0, S1.0, S1.5, S2.0, S2.5. Group C wasn’t given any treatment, rats in group S were inhaled 95% oxygen for 48 hours to establish a hyperoxia-induced lung injury model. then rats in each subgroup inhaled sevoflurane at different concentrations of 0%, 1.0%, 1.5%, 2.0% and 2.5% for 1 h respectively, rats in group C were breathe air freely. At the two time points which include inhaled 95% oxygen for 48 hours, and sevoflurane was inhaled for 1 h, blood was collected by the abdominal aorta, then arterial blood was used for blood gas analysis; using enzyme linked immunosorbent assay for the detection of serum tumor necrosis factor (TNF) -α and interleukin (IL) -8 and IL-6 concentration; HE staining was carried out in the right lung, and the pathological changes of lung tissue were observed under light microscope; Wet to dry ratio (W/D) of the left lung was taken.ResultsAfter inhalation of 95% oxygen for 48 hours (T1): compared with the group C, group S of arterial blood gas results suggested that the PaO2 value decreased, PaCO2 value increased. The degree of lung tissue injury and the pathological score, TNF-α, IL-8 and IL-6, W/D content increased significantly (P < 0.05), there was no significant difference between the S0 to S2.5 groups; After treatment with sevoflurane for 1 h (T2): compared with the group C, group S of arterial blood gas results suggested that the PaO2 value decreased, PaCO2 value increased. the degree of lung tissue injury and the pathological score, TNF-α, IL-8 and IL-6, W/D content increased significantly (P < 0.05); Compared with before sevoflurane treatment, the PaO2 value increased, PaCO2 value decreased, TNF-α, IL-8 and IL-6, W/D content decreased, pathological score decreased in group S1.0 to S2.5 (P <0.05), but there was no significant difference in group S0; After treatment with sevoflurane, compared with S2.0 group, the PaO2 value decreased, PaCO2 value increased, TNF-, IL-8 and IL-6, W/D content increased, pathological score increased in the group S1.0 and S1.5 (P < 0.05), but there was no significant difference in group S2.5.ConclusionSevoflurane can effectively reduce the degree of lung injury caused by hyperoxia in rats especially when the concentration is 2%.
ObjectiveTo explore a new method of developing a pre-vascularized cell sheets. MethodsBone marrow mesenchymal stem cells (BMSCs) from 3-week-old Japanese white rabbits were harvested and cultured. Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were added into the culture medium to differentiate into endothelial like cells (ECs) from BMSCs (experimental group), and non-induced cells served as the control group. The cell morphology was observed; and the von Willebrand factor (vWF) and CD31 immunofluorescent staining was used to identify the induced BMSCs. The 2nd generation BMSCs were seeded on a cell culture dish at a cell density of 9×104cells/cm2 and cultured for 14 days to form a thick cell sheet, and ECs from BMSCs were then seeded on the BMSCs sheet at a cell density of 5×104 cells/cm2 to develop pre-vascularized cell sheets and cultured for 3, 7, and 14 days (group A); non-induced BMSCs sheet and only ECs from BMSCs were used as group B and group C, respectively. The CD31 immunofluorescent staining and histological analysis were performed to evaluate the pre-vascularized cell sheet. ResultsBMSCs changed from long fusiform to cobblestone-like morphology after induced by VEGF and bFGF. The expressions of CD31 and vWF were positive in experimental group, but were negative in control group, which suggested that BMSCs have the ability to differentiate into ECs under this condition. After the ECs were seeded on the BMSCs sheet, the ECs migrated and rearranged; intracellular vacuoles and networks were observed. Furthermore, immunofluorescent staining for CD31 also revealed a developing process of tube formation after the ECs were seeded on the BMSCs sheet. The histological evaluations indicated the microvessel lumen formed. However, no similar change was observed in groups B and C. ConclusionBMSCs have the ability to differentiate into ECs after induced by VEGF and bFGF. ECs from BMSCs can develop into vascular network constructs when seeded on the BMSCs sheet, which provides a new method for engineering pre-vascularized tissue construction.
Objective To evaluate the efficacy and clinical significance of bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system. Methods From September 2009 to December 2015, 56 patients with ventricular aneurysm following myocardial infarction were enrolled. All patients suffered different levels of angina pectoris symptoms evaluated by Holter (the frequencies of ventricular arrhythmias more than 3 000 per day). They were divided into two groups according to random ballot and preoperative communication with patients' family members: a bipolar radiofrequency ablation group (n=28, 20 males, 8 females, mean age of 61.21±1.28 years) receiving off-pump coronary artery bypass grafting (OPCABG), ventricular aneurysm surgery combined with bipolar radiofrequency ablation, and a non-bipolar radiofrequency ablation group (n=28, 22 males, 6 females, mean age of 57.46±1.30 years) receiving OPCABG and single ventricular aneurysm surgery. The grade of cardiac function and ventricular arrhythmia was compared between the two groups during pre-operation, discharge and follow-up. Results All patients were discharged successfully. There was no in-hospital death in both two groups. One patient in the non-radiofrequency group had cerebral infarction. All patients were re-checked with Holter before discharge and the frequency of ventricular arrhythmias significantly decreased compared to that of pre-operation in both groups, and was more significant in bipolar radiofrequency ablation group (1 197.00±248.20 times/24 h vs. 1 961.00±232.90 times/24 h, P<0.05). There was significant difference in duration of mechanical ventilation and ICU stay between the two groups (P<0.05). The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) significantly improved (P<0.05) after operation in both groups. Conclusion The clinical efficacy of bipolar radiofrequency ablation in the treatment of ventricular aneurysm with ventricular arrhythmia guided by CARTO mapping is safe and effective, but its long-term outcomes still need further follow-up.
Objective To summarize and analyze the application value of triple stomach shaping technique in laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of patients undergoing simple LSG with triple stomach shaping technique carried out by the General Surgery Obesity and Metabolic Diseases Center of Chengdu Third People’s Hospital from January to December 2021 were retrospectively collected, recording the operative time and the occurrence of recent complications such as postoperative nausea/vomiting, gastric leakage, bleeding, obstruction/torsion within 30 days after operation. Results A total of 966 patients were collected, including 294 males and 672 females. The age was 16–65 years, average age was (32.8±8.6) years. Body mass index was 27.5–47.2 kg/m2, average was (34.2±3.5) kg/m2. All operations were successfully completed without conversion to laparotomy. The operative time was 45–170 min, average was (100.2+33.4) minutes. Postoperative nausea/vomiting occurred in 484 cases (50.10%), bleeding in 2 cases (0.21%, intraperitoneal bleeding in 1 case, intragastric bleeding in 1 case), gastric leakage in 1 case (0.10%, grade B leakage), and no perioperative death occurred. Hospitalization time was 4–24 d, average was (7.55±2.47) d. Two patients (0.21%) were hospitalized again due to nausea and vomiting within 30 days after operation, they were relieved and discharged after conservative medical treatment. Conclusion Triple gastric shaping technology is more physiological, safe and suitable for promotion.
Tripartite motif 5 (TRIM5) plays a significant function in autophagy and involves in immune and tumor processes. While the function of TRIM5 remains poorly understood in glioma. We purpose to evaluate the possible prognostic role of TRIM5 in glioma via bioinformatics analyses. The database clinical samples of glioma in this study included low grade glioma (LGG) and glioblastoma multiforme (GBM). TRIM5 expression in glioma tissues were explored in Oncomine, GEPIA and The Cancer Genome Atlas (TCGA) databases. Survival analysis and the multivariate Cox regression analysis of TRIM5 based on TCGA were used to evaluate the prognostic role of TRIM5. The protein networks of TRIM5 was detected by STRING database. KEGG enrichment analyses were performed to predict the potential molecular pathways of TRIM5 in glioma. In addition, immune infiltration analysis was conducted by CIBERSORT and TIMER databases. We found that TRIM5 was strongly increased in glioma samples compared with normal samples in Oncomine, GEPIA and TCGA databases. Higher TRIM5 was significantly contributed to worse overall survival (OS) in LGG+GBM patients and LGG patients, while was no correlated with OS of GBM patients. Interaction networks analysis identified that IRF3, IRF7, OAS1, OAS2, OAS3, OASL, GBP1, PML, BTBD1 and BTBD2 proteins were contacted with TRIM5. Moreover, KEGG revealed that apoptosis and cancer- and immune-related pathways were enriched with elevated TRIM5. Specifically, TRIM5 could influence the immune infiltration levels, such as activated NK cells, monocytes, activated mast cells and macrophages in glioma. In conclusion, our data indicated that TRIM5 was upregulated in glioma tissues and associated with poor prognosis and immune infiltration. TRIM5 may be acted as a biomarker in prognosis and immunotherapy guidance of glioma.
In response to the current situation of regional medical and health hierarchical diagnosis and treatment services and the existing problems in the continuity of medical services, this article applies supply chain management methods, system collaboration theory, and service ecosystem concepts to treat medical consortia as an organic whole. Based on the quality and efficiency of disease management in the whole life cycle of patients with difficult, complex and severe diseases, a multi-level and multi-disciplinary medical service supply chain model of difficult, complex and severe disease medical consortium is constructed with four core elements: patient flow, service flow, technology flow and information flow. This article provides a certain reference for the implementation of regional hierarchical diagnosis and treatment and the formulation of relevant policies in China from the perspective of theoretical research.
Multi-disciplinary team (MDT) is a leading diagnosis and treatment model widely respected in modern international medical field, which plays an important role in clarifying disease diagnosis, determining treatment direction, and reducing patient time and labor cost. In recent years, China has issued relevant policies to encourage hospitals to vigorously develop MDT. West China Hospital of Sichuan University established a MDT clinic in 2013. Through continuous innovation and bold breakthrough in terms of experience accumulation, clinical resource integration, disciplinary collaboration and other aspects, the hospital breaks the barriers of MDT, timely helps complex severe diseases patients to solve the diagnosis and treatment needs, provides patients with the best personalized treatment plan, and continuously improves the medical experience of patients. Therefore, this article introduces and summarizes the implementation process and experience of MDT outpatient clinic in West China Hospital of Sichuan University.