Objective To investigate the clinical characteristics, therapeutic methods, and prognostic factors of patients with rectal stromal tumor. Methods The clinicopathological data of 33 patients with rectal stromal tumor who treated in the Affiliated Hospital of Xuzhou Medical University from January 2008 to November 2014 were retrospectively reviewed, and the therapeutic methods and prognostic factors of these patients were further analyzed. Results The major clinical manifestations of 33 patients included abdominal discomfort in 21 patients, changes of defecation habit and fecal property in 15 patients, bloody stool in 13 patients, and anal pain in 9 patients. CT and MRI examination showed a mass in the pelvic with the clear boundary, growed through the wall of rectum, with the heterogeneous density and signal, sometimes with necrosis, calcification, and haemorrhage. The results of immunohistochemical staining showed that, 31 patients were strongly positive for CD117, 28 patients were strongly positive for CD34, 15 patients were positive for smooth muscle actin (SMA), 13 patients were positive for vimentin, and 3 patients were positive for soluble acid protein (S-100). The therapeutic methods of 33 patients included local excision in 13 patients, low anterior resection in 11 patients, abdominal pelvic resection in 5 patients, and conservative treatment in 4 patients. A total of 26 patients underwent surgery combiend with imatinib therapy. The follow-up time was 10–102 months and the median time was 58 months. During follow-up period, there were 8 patients suffered from recurrence or metastasis, and 15 patients died. The results of Cox proportional hazards regression model showed that, postoperative relapse and metastasis were prognostic factors for survival〔RR=19.338, 95% CI was (2.821, 132.568), P=0.003〕. The survival situation of the patients suffered from postoperative relapse and metastasis was poor. Conclusions CD117 and CD34 could serve as valuable diagnostic indexes for rectal stromal tumor. Surgery is an effective treatment for rectal stromal tumor.
Objective To study polyuria during mechanical ventilation in patients with chronic obstructive pulmonary disease ( COPD) and its possible mechanisms. Methods The plasma and urine concentrations of cystatin C ( CyC) were measured by enzyme immunometric assay in 26 COPD patients who received mechanical ventilation at timepoints of 0 h, 24 h, 48 h, 72 h and 1 week. And plasma levels of atrial natriuretic factor ( ANF ) , antidiuretic hormone ( ADH) and aldosterone ( ALD) were detected byradioimmunoassay at the same time-point. The urine volume was recorded every day. The samples of 30 healthy volunteers were measured as control. Results Polyuria phenomenon was found in majority of patients in 24 to 72 hours after mechanical ventilation. At 0h, the concentrations of plasma CyC, urine CyC,plasma ANF, ADH and ALD were all increased significantly compared with those of the control, respectively [ ( 4. 87 ±0. 51) mg/L vs ( 1. 29 ±0. 27) mg/L, ( 0. 58 ±0. 13) mg/L vs ( 0. 07 ±0. 02) mg/L, ( 37. 02 ±4. 35) pmol /L vs ( 22. 51 ±1. 18) pmol /L, ( 8. 61 ±1. 43) pmol /L vs ( 0.94 ±0. 34) pmol /L, ( 925. 4 ±142. 7) pmol /L vs ( 297. 5 ±135. 8) pmol /L, all P lt; 0. 01] , then decreased gradually after mechanical ventilation. The levels of plasma CyC and ANF at 24 h, plasma ADH at 72 h, and urine CyC at 1 week were similar to those of the control( all P gt;0. 05) , respectively, except the level of plasma ALD was still higher by 1 week( P lt; 0. 05) . Conclusions Polyuria is not a rare phenomenon for COPD patients receiving mechanical ventilation. Polyuria is related to the readjustment and mal-adaptation of ADH and reninangiotensin-aldosterone-systems during mechanical ventilation.
Objective To explore the role of over-expression of TBX3 and TBX18 in inducing human induced pluripotent stem cells (HiPS) to enrich and differentiate into sinoatrial node-like cells. Methods The expression of stemness markers OCT3/4, SOX2, and NANOG in HiPS was detected by real-time fluorescence quantitative PCR (qRT- PCR), and compared with human embryonic stem cells (hESCs). Immunofluorescence staining was used to observe the expression of HiPS stemness markers OCT3/4, NANOG, SSEA4, and TRA-1-60. The HiPS were directional differentiated into cardiomyocytes, the expressions of ISL1, NK2 homeobox 5 (NKX2-5), ACTN1, and TNNT2 were detected by qRT-PCR, and human adult cardiomyocytes (hACM) were used as positive control. Immunofluorescence staining was used to observe the expressions of NKX2-5, cardiac troponin (cTnT), α-actinin, atria myosin light chain 2A (MLC-2A), and ventricular myosin light chain 2V (MLC-2V). The positive rate of α-actinin was detected by flow cytometry. On the 3rd day after HiPS were differentiated into cardiomyocytes (mesodermal stage), lentiviral over-expressions of sinoatrial node-related genes TBX3 and TBX18 were carried out for 21 days. The relative expressions of specific markers TBX3, TBX18, SHOX2, NKX2-5, HCN4, and HCN1 in sinoatrial node cells were detected by qRT-PCR, and compared with enhanced green fluorescent protein blank virus. Results OCT3/4, SOX2, and NANOG were highly expressed in HiPS and ESCs, and there was no significant difference in the relative expression of each gene (P>0.05); OCT3/4 and NANOG were specifically distributed in the nucleus of HiPS, while SSEA4 and TRA-1-60 were distributed in the cell membrane. The relative expressions of ISL1 gene at 5, 7, 21, and 28 days and NKX2-5 gene at 7, 21, and 28 days of HiPS differentiation into cardiomyocytes were significantly higher than those of hACM (P<0.05), and the relative expressions of ACTN1 and TNNT2 genes at 3, 5, 7, and 21 days of HiPS differentiation into cardiomyocytes were significantly lower than those of hACM (P<0.05). NKX2-5 was expressed in most of the nuclei, cTnT and α-actinin, MLC-2A and MLC-2V signals were localized in the cytoplasm, presenting a texture-like structure of muscle nodules. Flow cytometry results showed that HiPS was successfully induced to differentiate into cardiomyocytes. The expressions of TBX18, SHOX2, HCN4, and HCN1 in the over-expression TBX3 group were up-regulated when compared with the control group, and difference in the relative expression of SHOX2 gene was significant (P<0.05); the relative expression of NKX2-5 gene was lower than that in the control group, but there was no significant difference (P>0.05). There was no significant difference in the relative expression of each gene between the over-expressed TBX18 group and the control group (P>0.05). Conclusion HiPS and hESCs have similar pluripotency, and we have established a stable method for maintaining and culturing the stemness of HiPS. A technological platform for the efficient differentiation of HiPS into cardiomyocytes has been successfully established. Although TBX3 and TBX18 do not play a significant role in promoting the enrichment and differentiation of HiPS into sinoatrial node-like cells, TBX3 shows a certain promoting trend, which can be further explored in the future.
ObjectiveTo explore the role of joint regulation of Wnt and bone morphogenetic protein (BMP) signaling pathways in the differentiation of human induced pluripotent stem cells (hiPSCs) into cardiomyocytes.MethodsHiPSCs were cultured and observed under inverted phase contrast microscope. Immunofluorescence staining was used to observe the expressions of hiPSCs pluripotent markers (OCT3/4, NANOG, and TRA-1-60). HiPSCs were passaged which were taken for subsequent experiments within the 35th passage. When the fusion degree of hiPSCs was close to 100%, the CHIR99021 (Wnt pathway activator) was added on the 0th day of differentiation. Different concentrations of IWP4 (inhibitor of Wnt production) were added on the 3rd day of differentiation, and the best concentration of IWP4 was added at different time points. The optimal concentration and the best effective period of IWP4 were obtained by detecting the expression of troponin T (TNNT2) mRNA by real-time fluorescence quantitative PCR. Then, on the basis of adding CHIR99021 and IWP4, different concentrations of BMP-4 were added on the 5th day of differentiation, and the best concentration of BMP-4 was added at different time points. The optimal concentration and best effective period of BMP-4 were obtained by detecting the expression of TNNT2 mRNA. Finally, hiPSCs were divided into three groups: Wnt group, BMP group, and Wnt+BMP group. On the basis of adding CHIR99021 on the 0th day of differentiation, IWP4, BMP-4, and IWP4+BMP-4 were added into Wnt group, BMP group, and Wnt+BMP group respectively according to the screening results. Cells were collected on the 7th and the 15th days of differentiation. The expressions of myocardial precursor cell markers [ISL LIM homeobox 1 (ISL1), NK2 homeobox 5 (NKX2-5)] and cardiomyocyte specific markers [myocyte enhancer factor 2C (MEF2C), myosin light chain 2 (MYL2), MYL7, and TNNT2] were detected by real-time fluorescent quantitative PCR. Cells were collected on the 28th day of differentiation, and the expression of cardiac troponin T (cTnT) was detected by flow cytometry and immunofluorescence staining.ResultsThe results of cell mophology and immunoflurescence staining showed that the OCT3/4, NANOG, and TRA-1-60 were highly expressed in hiPSCs, which suggested that hiPSCs had characteristics of pluripotency. The optimal concentration of IWP4 was 10.0 μmol/L (P<0.05) and the best effective period was the 3rd day (P<0.05) in inducing hiPSCs to differentiate into cardiomyocytes. The optimal concentration of BMP-4 was 20.0 ng/mL (P<0.05) and the best effective period was the 3rd day (P<0.05). The relative expressions of ISL1, NKX2-5, MEF2C, MYL2, MYL7, and TNNT2 mRNAs, the positive expression ratio of cTnT detected by flow cytometry, and sarcomere structure detected by immunofluorescence staining of Wnt+BMP group were superior to those of Wnt group (P<0.05).ConclusionJoint regulation of Wnt and BMP signaling pathways can improve the differentiation efficiency of hiPSCs into cardiomyocytes.
ObjectiveTo explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.MethodsA retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.ResultsWhen ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H2O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H2O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).ConclusionProne position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.
Electrical impedance tomography (EIT) is an emerging technology for real-time monitoring based on the impedance differences of different tissues and organs in the human body. It has been initially applied in clinical research as well as disease diagnosis and treatment. Lung perfusion refers to the blood flow perfusion function of lung tissue, and the occurrence and development of many diseases are closely related to lung perfusion. Therefore, real-time monitoring of lung perfusion is particularly important. The application and development of EIT further promote the monitoring of lung perfusion, and related research has made great progress. This article reviews the principles of EIT imaging, lung perfusion imaging methods, and their clinical applications in recent years, with the aim of providing assistance to clinical and scientific researchers.
Objective To explore the relationship between imbalance in sagittal plane as well as structural factors and lumbar degenerative disease. Methods Patients diagnosed between July 2012 and May 2015 were divided into 4 groups according to corresponding diagnostic criteria: lumbar disc herniation group (LDH), lumbar disc protrusion group (LDP), degenerative lumbar spondylisthesis group (DLS) and nonspecific low back pain group (NLBP); 40 patients were included in each group according to their visiting time. All patients underwent X-ray, CT, and MRI. Sagittal parameters and evaluate degeneration level of structural factors were measured, and the difference among the groups were analyzed. Results There was statistical significance in differences of pelvic incidence (PI) and lumbar lordosis (LL) among 4 groups (P<0.05). Average PI was followed in descending order: DLS, LDP, NLBP, and LDH; average LL was followed in descending order: DLS, NLBP, LDP, and LDH. There was no statistical differences in sacral slope and pelvic tilting among 4 groups (P>0.05). The difference in the level of lumbar disc degeneration between NLBP group (which had slightest lumbar disc degeneration) and the other groups was significant (P<0.001) while no statistical differences in level and rate of lumbar disc degeneration among the other three groups was found (P>0.05). As to the level of lumbar zygapophyseal joint degeneration, there was statistical differences between NLBP group (which had the lowest level of lumbar zygapophyseal joint degeneration) and the other groups (P<0.001) while no statistical differences in the grade of lumbar zygapophyseal joint degeneration among the other three groups (P>0.05). There was statistical differences in the rate of lumbar zygapophyseal joint degeneration between LDH and DLS group (χ2=11.429,P=0.001). Conclusions Vertical lunbar spine is combined with LDH of which the level of lumbar zygapophyseal joint degeneration is minimized, while crooked lunbar spine is combined with DLS of which the level of lumbar zygapophyseal joint degeneration is maximization. NLBP has the lowest level of degeneration of lumbar disc and lumbar zygapophyseal joint degeneration.
目的 研究盐酸氨基葡萄糖联合抗骨增生片治疗膝骨关节炎（KOA）的可行性及安全性。 方法 2011年1月－2012年8月选取90例KOA患者，按关节面改变部位归入A组（髌股关节面改变）、B组（胫股关节面改变）、C组（全关节软骨改变），每组30例。均予以盐酸氨基葡萄糖、抗骨增生片治疗，12周后观察治疗前后临床疗效、综合疗效及安全性等指标及评分。 结果 ① 3组比较，A组疗效高于B、C组（P＜0.05）；② A组与B、C两组在平地行走20 m疼痛评分、关节压痛度评分和骨关节炎指数（WOMAC）评分方面差异有统计学意义（P＜0.05）；③ A组和B、C两组在患者自我疗效评价、医生疗效评价方面差异有统计学意义（P＜0.05）；④ A组在治疗12周后血液血沉、C反应蛋白（CRP）、白细胞介素（IL）-1、IL-6、肿瘤坏死因子-α（TNF-α）较治疗前差异有统计表学意义（P＜0.05）；B组则在CRP、IL-6、TNF-α较治疗前有差异（P＜0.05）；C组仅在CRP、TNF-α较前有差异（P＜0.05）；⑤3组不良反应发生率则无明显差异（P＞0.05）。 结论 盐酸氨基葡萄糖联合抗骨增生片治疗髌股关节面改变的KOA疗效优于胫股关节改变，且治疗方案可行、安全、优效。