Although great progress has been achieved in the techniques and materials of cardiopulmonary bypass (CPB), cardiac surgery under CPB is still one of the surgeries with the highest complication rate. The systemic inflammatory response is an important cause of complications, mainly characterized by activation of innate immune cells and platelets, and up-regulation of inflammatory cytokines. After activation, a variety of molecules on the membrane surface are up-regulated or down-regulated, which can amplify tissue inflammatory damage by releasing cytoplasmic protease and reactive oxygen species, and activate multiple inflammatory signaling pathways in the cell, ultimately leading to organ dysfunction. Therefore, the expression of these cell membrane activation markers is not only a marker of cell activation, but also plays an important role in the process of vital organ injury after surgery. Identification of these specific activation markers is of great significance to elucidate the mechanisms related to organ injury and to find new prevention and treatment methods. This article will review the relationship between these activated biomarkers in the innate immune cells and vital organ injuries under CPB.
Objective To investigate the percentage of CD4+CD25+ Treg in peripheral blood of patients with severe multiple trauma and systemic inflammatory response syndrome（SIRS） and its effects on cellular immunity and secondary infection.Metheds Peripheral blood of 23 patients with severe multiple trauma was collected in 24 h after SIRS was diagnosed，and flow cytometry was used to determine the percentage of CD4+CD25+ Treg and CD4/CD8 ratio.Simultaneously，in order to explore the cell proliferation，silver staining was used to determine Ag-NORs of leukomonocyte in peripheral blood represented by IS%.In order to investigate the infection in patients，sputum and secretion sample were collected for bacteriological examination on 1 and 5 day after SIRS was established.Forty healthy volunteers were enrolled as control.Results Compared with the control，the percentage of CD4+CD25+ Treg was significant higher[（14.21±3.43）% vs（9.53±3.22），Plt;0.01] and the ratio of CD4/CD8 and IS% were significant lower in patients with severe multiple trauma[（5.94±0.66）% vs（6.74±0.95）%，（1.22±0.25）% vs（1.72±0.36）%，respectively，both Plt;0.01].In those patients（n=14） who developed secondary infection，Treg% was significant higher [（18.69±4.21）% vs（12.58±2.49）%，Plt;0.01]，while IS% and CD4/CD8 were significant lower [（5.79±0.68）% vs（6.15±0.57）%，（1.15±0.25）% vs（1.39±0.25）%，both Plt;0.01].compared to the patients without secondary infection Conlusion CD4+CD25+ Treg is valuable to estimate the cellular immunity and predict secondary infection in patients with severe multiple trauma.
Nuclear factor-erythroid 2-related factor 2 (Nrf2) is an important factor for cells to resist oxidative stress and electrophilic attack. It is involved in the formation and control of oxidative stress defense pathways. It is associated with oxidative stress-related diseases, including cancer, neurodegenerative diseases, cardiovascular diseases and aging, and is a potential pharmacological target for the treatment of chronic diseases. This article will review the important role of Nrf2 in the regulation of cell proliferation, including direct regulation of cell proliferation, regulation of reactive oxygen species, intracellular metabolism, regulation of mitochondrial function, cell lifespan and inflammatory response. The aim is to provide a theoretical basis for further research on how to use Nrf2 to regulate cell proliferation.
Dose-response meta-analysis, as a subset of meta-analysis, plays an important role in dealing with the relationship between exposure level and risk of diseases. Traditional models limited in linear regression between the independent variables and the dependent variable. With the development of methodology and functional model, Nonlinear regression method was applied to dose-response meta-analysis, such as restricted cubic spline regression, quadratic B-spline regression. However, in these methods, the term and order of the independent variables have been assigned that may not suit for any trend distribution and it may lead to over fitting. Flexible fraction polynomial regression is a good method to solve this problem, which modelling a flexible fraction polynomial and choosing the best fitting model by using the likelihood-ratio test for a more accurate evaluation. In this article, we will discuss how to conduct a dose-response meta-analysis by flexible fraction polynomial.
ObjectiveTo explore the influence of norepinephrine on the prediction of fluid responsiveness by passive leg raising (PLR) during septic shock. MethodsForty-six septic shock patients in intensive care unit of Nanjing Drum Tower Hospital were prospectively observed from September to November 2012. Among which 36 septic shock patients were enrolled with a positive PLR test (defined by an increase in stroke volume index ≥10%). A PLR test was performed at baseline (PLR1). A second PLR test (PLR2) was performed at returning to supine position for 10 min and the dose of norepinephrine was increased to maintain MAP ≥65 mmHg for 20 min. The changes of heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),stroke volume index(SVI),index of systemic vascular resistance(SVRI),global end-diastolic volume index(GEDVI),and cardiac function index(CFI) were monitored by transpulmonary thermodilution technique (PiCCO). ResultsPLR1 significantly increased SVI by (20.54±9.63)%,CI by (20.57±9.89)%,MAP by (7.64±5.77)%,and CVP by (25.83±23.39)%. As the dose of norepinephrine increased,SVI was increased by (16.97±9.06)%,CI by (16.78±8.39)%,GEDVI by (9.08±4.47)%,MAP by (28.07±12.48)%,and CVP by (7.86±8.52)%. PLR2 increased SVI by (13.74±8.79)%,CI by (13.79±9.08)%,MAP by (2.93±5.06)%,and CVP by (13.36±14.74)%. The PLR2 and the dose increase of norepinephrine augmented SVI to a significantly lesser extent than the PLR1 performed at baseline (both P<0.05). However,SVI increased by <10% in 6 patients while the baseline PLR was positive in these patients. ConclusionIn septic patients with a positive PLR at baseline,norepinephrine increases cardiac preload and cardiac output and influences the fluid responsiveness.
Objective To systematically evaluate the efficacy and safety of dose-dense neoadjuvant chemotherapy (ddNACT) and conventional neoadjuvant chemotherapy (cNACT) for locally advanced breast cancer (LABC). Methods PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP databases were searched for randomized controlled trials (RCT) comparing ddNACT regimen with cNACT regimen for breast cancer. The time limit for retrieval was from establishment to March 1st, 2021. Two reviewers independently screened literatures, extracted data and assessed risk bias of included studies; then, meta-analysis was performed by using Stata 15.0 software. Results A total of 13 RCTs were included, including 3 258 patients, of which 1 625 patients received ddNACT and 1 633 patients received cNACT. The results of meta-analysis showed that the ddNACT regimen could improve the pathological complete response rate (pCR, P<0.001), objective response rate (ORR, P<0.001), and disease free survival (DFS, P=0.037) as compared with the cNACT regimen, there was no significant difference in the overall survival (OS) between the two groups (P=0.098). The incidences of grade 3 or 4 oral stomatitis (P=0.005) and neurotoxicity (P<0.001) were higher and the incidence of grade 3 or 4 neutropenia was lower (P=0.025) in the patients with ddNACT regimen, there were no significant differences in grade 3 or 4 thrombocytopenia (P=0.152), grade 3 or 4 anemia (P=0.123), chemotherapy completion rate (P=0.161) and breast conservative surgery rate (P=0.186) between the two groups. Patients with hormone receptor (HR) negative (HR–) were more likely to get pCR after neoadjuvant chemotherapy (P<0.001). ConclusionsCurrent evidence shows that the use of anthracycline/taxane-based ddNACT regimen in LABC patients can improve the pCR, ORR, and DFS as compared with cNACT regimen. The pCR after neoadjuvant chemotherapy in the patients with HR– is higher than that with HR+. Prophylactic use of granulocyte-colony stimulating factor could significantly reduce the incidence of neutropenia, and most patients are tolerant to ddNACT regimen, 2 regimens have similar chemotherapy completion rates.
Objective To study the earthquake emergency response capability and post-earthquake psychological state of students after the Wenchuan earthquake. And also, to investigate the level of earthquake-related knowledge so as to provide basic information for enhancing the emergency response capabilities among college students. Methods We selected 1% Sichuan University students by convenience sample method and conducted the survey in person with a self-designed questionnaire. Results were analyzed with Epidata 3.0 and SPSS13.0 software. Results We distributed 527 questionnaires and 517 (97.27%) valid questionnaires were retrieved. Most college students had a good grasp of earthquake knowledge: 65.4% to 97.7% of the responders gave the correct answers, but only 12.77% said they had ever received earthquake survival training. 15.2% suffered from fear after the earthquake, 59.4% became uneasy, and 25.4% remained calm. Gender, grade, or major were not the factors influencing the psychological state of college students after the earthquake (P= 0.246, 0.216, and 0.406, respectively). Also, earthquake survival training did not influence the psychological state of college students after the earthquake (P=0.090). Psychological intervention after the earthquake was identified as an important factor that affected the psychological state of students (P=0.002). Conclusion College students have a good grasp of the basic knowledge regarding earthquake, but relevant survival training is far from sufficient. Universities should strengthen earthquake survival training, enhance the post-earthquake emergency response capacity of students, and carry out post-disaster psychological intervention directly following an earthquake. There is no significant difference in the mental status among students of different genders, grades, or professional backgrounds.
Objective To investigate the changes of small airway function，airway resistance and responsiveness of extrathoracic airway in chronic cough patients before and after bronchial provocation test (BPT)．Methods 68 chronic cough patients were requested to conduct lung function test and BPT．The airw ay resistance were measured via forced oscillationary technology before and after BPT．Results BPT revealed airway hyperresponsiveness in 52％subjects．MEF50 and R0 before BPT were significantly different between the patients with or without airway hyperresponsiveness．Post BPT changes in MEF50(MEF50％) were correlated positively to the changes in FEV1(FEVl％)，and negatively to the changes in R0[Ro-d]． Extrathoracic airway hyperresponsivenes(EAHR)was f0und in13 patients，in which 6 patients were not revealed by routine BPT．Conclusion There is small airway function abnormalities in chronic cough patients．Extrathoracic airway responsiveness test is a valuable supplementary index to routine BPT．
Objective To evaluate the immunological reaction and the outcome of allogeneic chondrocyte transplantation in repairing articular cartilage defects in porcins. Methods Full articular cartilage from the knee of two Shanghai white porcins about one-month-old was removed and cut mechanically, digested by 0.25% trypsin and 0.2% type Ⅱ collagenase and cultured in 10％ DMEM medium. Defects of 0.5 cm×0.5 cm involving the subchodral bone were created in both the left and right femur condyloid in 8 two-month-old Yunnai bama porcins. Allogeneic chondrocyte transplantation were implanted in defects at a density of (1.0-2.0)×106,0.2 ml. The lymphocytes from the receivers’ blood were collected before transplantation and after 3, 5, 7 and 12 weeks of transplantation, then mixed with allogeneic chondrocytes to determin the lymphocyte stimulation index(SI) in vitro. The histological observation in vivo was made after 5, 7 and 24 weeks of transplantation. Results Lymphocyte SI at 3, 5, 7 and 12 weeks(1.457±0.062,1.739±0.142,1.548±0.047，1.216±0.028) after transplantation was higher than that before transplantation(1.102±0.034，Plt;0.05). SI began to increase in the 3rd week and reached the peak value in the 5th week, then gradually declined at the 7th and 12th weeks, showing significant differences when compared with in the 5th week (Plt;0.05). Inflammation and lymphocytes infiltration could be seen in subchondral bone and the intergration area between repair tissue and normal cartilage in the 5th week, and then decreased and limited in subchondral bone in the 7th week. Defects were filled with cartilage tissue, which had good intergration with subchondral bone at 24 weeks after transplantation. Conclusion Immunological reactions can be found at early stage of allogeneic chondrocyte transplantation and then decreased with the time, the fullthickness articular cartilage defects could be repaired mainlywith hyaline cartilage by the allogeneic chondrocyte transplantation. This may provide a new method to repair articular cartilage defects clinically.
Objective To explore the impact of hospital staff’s risk perception on their emergency responses, and provide reference for future responses to public health emergencies. Methods Based on participatory observation and in-depth interviews, the staff of the First Affiliated Hospital of Guangzhou Medical University who participated in the prevention and control of the coronavirus disease 2019 from April to September 2020 were selected. The information on risk perception and emergency responses of hospital staff was collected. Results A total of 61 hospital staff were included. The positions of hospital staff were involved including hospital leading group, hospital office, medical department, logistics support department and outpatient isolation area. The interview results showed that both individual and organizational factors of hospital staff would affect the risk perception of hospital staff, thus affecting the emergency responses of hospital staff, mainly reflected in the psychological and behavioral aspects. Among them, their psychological reactions were manifested as more confidence, sensitivity, and sense of responsibility and mission; The behavior aspects was mainly reflected in the initiation time, execution ability, and standardization level of emergency responses actions. Conclusion Therefore, relevant departments should pay attention to the risk perception of hospital staff, improve the risk perception and emergency responses of hospital staff by influencing the individual and organizational factors of hospital staff, so as to respond more effectively to future public health emergencies and reduce the adverse impact of public health emergencies on the work of hospital staff.