Objective To investigate the effect of machine-enzyme digestion method on the residual quantity of small intestinal submucosa (SIS) cell and the content of growth factors. Methods Fresh jejunum of pig within 4 hours after harvesting was prepared into SIS after machine digestion (removing placenta percreta, mucosa, and muscular layer), degrease,trypsinization, abstergent processing, and freeze drying. Samples were kept after every preparation step serving as groups A, B, C, D, and E, respectively (n=4 per group). And the fresh jejunum served as control group (group F, n=4). The histological alteration in each preparation process was reviewed with HE staining and scanning electron microscope (SEM). Nest-polymerase chain reaction (PCR) was used to determine the content of death associated protein 12 (DAP12), and enzyme-linked immunosorbent assay (ELISA) was appl ied to detect the content of vascular endothel ial growth factor (VEGF), basic fibroblast growth factor (bFGF), transforming growth factor β (TGF-β), tumor necrosis factor α (TNF-α). Results HE staining and SEM observation showed that there were residual cells in groups A and B, and there were no residual cells in groups C, D, and E. Nest-PCR test revealed the occurrence of DAP12 in each group. The contents of DAP12 in groups A, B, C, D, E, and F were (18.01 ± 9.53), (11.87 ± 2.35), (0.59 ± 0.27), (0.29 ± 0.05), (0.19 ± 0.04), and (183.50 ± 120.13) copy × 106/cm2. The content of DAP12 in group F was significant higher than that of other groups (P lt; 0.05), groups A and B was higher than groups C, D, and E (P lt; 0.05), there were significantdifferences among groups C, D, and E (P lt; 0.05), and there was no significant difference between groups A and B (P gt; 0.05). The ELISA test showed the content of VEGF, bFGF, TGF-β, and TNF-α in group A was significantly higher than that of groups B, C, D, and E (P lt; 0.05), and there was no significant difference among groups B, C, D, and E (P gt; 0.05). Conclusion SIS prepared by simple mechanical method has more residual cells, while the machine-enzyme digestion method can effectively remove the cells and significantly reduce the DAP12 content. This approach can not obviously reduce the growth factor content in SIS.
Objective To investigate the causes of death and evaluation of injury severity in patients with thoracic trauma so as to enhance the diagnosis and treatment of thoracic trauma. Methods A retrospective study was carried out in 687 patients with thoracic trauma, which were divided into different groups according to their condition of injury (chest injury group and multiple injuries group) and outcome (survival group and death group) and penetrating into pleural cavity (penetrating injury group and blunt trauma group), then trauma scores(revised trauma score,abbreviated injury scale,injury severity score,probability of survival)were compared respectively. In addition, the highrisk causes of trauma death were analyzed. Results Among 687 cases, there are 488 cases with blunt trauma and 199 cases with penetrating injury. The causes of trauma death in blunt trauma group were brain injury (10 cases) and acute respiratory failure (6 cases) and multiple organ dysfunction syndrome (4 cases) and hypovolemic shock (1 case). The causes of trauma death in penetrating trauma group were hypovolemic shock (9 cases). There were statistically difference of trauma score in the death group and the survival group（GCS：t=4.648,P=0.000; RTS:t=4.382,P=0.000;thoracic AIS：t=2.296,P=0.027;ISS：t=4.871，P=0.000; Ps：t=4.254,P=0.000）. There was no statistically difference of thoracic AIS in the chest injury group and the multiple injuries group (t=0.723, P=34.567), and there were statistical significances in RTS（t=2.553,P=0.032）, ISS（t=10.776,P=0.000）, Ps（t=3.868,P=0.007）. There were statistically difference of RTS（t=3.161,P=0.007）and ISS （t=4.118,P=0.005） in the blunt trauma survival group and penetrating injury survival group, and there was no statistical significance in Ps（t=0.857,P=97.453）. The blunt trauma death group had statistical difference compared with penetrating injury death group in trauma score（GCS：t=4.016,P=0.001，RTS:t=3.168,P=0.006;thoracic AIS：t=2.303, P=0.043;ISS：t=4.218,P=0.002;Ps：t=4.624,P=0.001）. The mortality of trauma was gradually increased with the trauma scores. The mortality was 10.7% when whole ISS was 20.25. The mortality in penetrating injury group was higher than that in blunt trauma group with the same ISS between two groups. Conclusion Applying trauma score is conducive to the judgement of trauma severity and optimizing clinical treatment. The death causes in blunt trauma group were more complex than in penetrating injury group. Severe trauma and multiple injuries are the main death causes of thoracic trauma.
ObjectiveTo investigate the role of D-dimer in predicting the prognosis of the patients with acute pancreatitis (AP). MethodsThe medical records of 324 patients with a diagnosis of AP in West China Hospital from April to June 2014 were retrospectively analyzed. ResultsOverall mortality rate was 3%, the median hospital stay was (11±3) days, and the median Intensive Care Unit stay was (1±1) day. The prothrombin time, activated partial prothrombin time, fibrinogen, international normalized ratio, antithrombinⅢ, D-dimer, C-reactive protein, and procalitonin level in the organ failure (OF) patients were significantly higher than those in the non-OF patients (P<0.05). The D-dimer, C-reactive protein, and procalcitonin level in the patients with infection were significantly higher than those in the non-infectious onse (P<0.05). The D-dimer and procalcitonin level in the death group were significantly higher than those in the survivor group (P<0.05). D-dimer and procalcitonin level increased as the grade of AP increased (P<0.05); the difference in C-reactive protein between the light and middle type was not significant (P>0.05), while was significant between middle and severe, and light and severe (P<0.05). The area under the receiver operating characteristic curve (AUC) of OF predicted by D-dimer was higher than C-reactive protein and procalcitonin; AUC of infection predicted by D-dimer was lower than procalcitonin; AUC of death predicted by D-dimer was higher than C-reactive protein but lower than procalcitonin. ConclusionD-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the complications and death of AP. D-dimer provide a more accurate assessment of prognosis than C-reactive protein and procalcitonin in patients with AP.
Objective To evaluate the effect of methylation determination about the peripheral plasma DNA in diagnose of hepatocellular carcinoma （HCC） and select the highly sensitive and specific methylated cancer suppressor genes. Methods Methylation-specific PCR （MSP） was used to detect the degree of methylation about SLIT2 and DAPK genes in peripheral plasma and associated cancer tissues of 34 patients with HCC confirmed by pathology, then analyzed their relationship to clinicopathologic feature. Results The positive rate of the promoter methylation of SLIT2 and DAPK genes in cancer tissues in 34 cases were 70.6% （24/34） and 79.4% （27/34）, while the relevant promoter methylation rate in plasma were 44.1% （15/34） and 50.0% （17/34） correspondingly. The sensitivity of detection of DNA methylation about SLIT2 and DAPK genes in plasma was 62.5% and 63.0%, respectively；both of the specificity for them were 100%. The negative predicted value was 52.6% and 41.2%, respectively；while both of the positive predicted value were 100%. There were no significant correlation between the clinicopathologic features and the methylation rate in cancer tissues and plasma （P＞0.05）. In plasma of patients whose AFP＜400 μg/L, the positive rate of combined detection of DNA methylation of SLIT2 and DAPK was 61.1% （11/18）. Conclusions The detection rate of DNA methylation of SLIT2 and DAPK genes in plasma is higher, and there is a significant correlation between the DNA methylation in HCC tissue and plasma, based on MSP method. DNA methylation in plasma, as an non-invasive method, could be used to diagnose HCC, especially for the patients whose AFP is negative. HBV infection may be only associate with DNA methylation of part gene.
Objective To analyze the death constitution of inpatients in The Tibet Autonomous Region People's Hospital from 2014 to 2015 and to provide baseline data for further rational drug use. Methods The medical records of death inpatients between 2014 and 2015 were collected. We classified all diseases according to the international classification of diseases coding (ICD-10) and analyzed the general situation, main death discharge diagnosis and single death diseases. Distribution of inpatients frequency, constituent ratio, cumulative frequency of death diseases were calculated by EXCEL 2007 software. Results (1) A total of 40 147 patients were discharged and 339 (8.44‰) inpatients died between 2014 and 2015. The sex ratio of male to female was 2.08 to 1 for death inpatients. (2) Death constitution of four diseases' categories were over 10%, including circulatory system diseases, exogenous injury or poisoning system diseases, respiratory system diseases, and digestive system diseases. (3) Death constitution of 3 diseases' categories were between 5% to 10%, including tumor, abnormal signs and symptoms, urogenital system diseases. (4) The main death cause single diseases were cerebral hemorrhage diseases, myocardial infarction, respiratory failure, damage, pneumonia, cancer, neonatal hypoxic-ischemic encephalopathy. Conclusion The main death inpatients of the Tibet Autonomous Region People's Hospital are of the age 25 to 59, and the main death cause diseases are circulatory system diseases.
Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD， 8 patients died during perioperatively， received endovascular repair in 1-5 days after admission （mean 2.4 d）， and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation， among them 2 cases occurred in 1 h after operation， the other 1 case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection， 2 cases died of cerebral infarction， 1 case died of multiple organ failure， and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.
Objective To systematically review the risk factors for death in children with tuberculous meningitis (TBM). Methods The CNKI, VIP, WanFang Data, CBM, Cochrane Library, Web of Science, PubMed, EMbase and CINAHL databases were electronically searched to collect studies on the risk factors for death in children with TBM from inception to October 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 15 studies involving 2 597 patients were included. The results of meta-analysis showed that male (OR=2.41, 95%CI 1.61 to 3.61, P<0.01), no history of BCG vaccination (OR=3.74, 95%CI 1.96 to 7.12, P<0.01), TBM stage (stage Ⅲ) (OR=2.04, 95%CI 1.26 to 3.28, P<0.01), HIV infection (OR=3.28, 95%CI 1.20 to 8.93, P=0.02), convulsion (OR=3.61, 95%CI 3.31 to 3.94, P<0.01), disturbance of consciousness (OR=3.58, 95%CI 2.40 to 5.34, P<0.01), cerebrospinal fluid protein concentration increased (OR=1.87, 95%CI 1.39 to 2.51, P<0.01), hydrocephalus (OR=2.44, 95%CI 1.60 to 3.71, P<0.01) and short hospitalization (OR=2.89, 95%CI 2.05 to 4.06, P<0.01) were risk factors for death in children with TBM. Under 5 years old, negative PPD skin test, positive meningeal irritation sign, malnutrition and history of contact with TB may not be associated with the death of TBM in children. Conclusion Male, no history of BCG vaccination, TBM stage (stage Ⅲ), HIV infection, convulsions, disturbance of consciousness, cerebrospinal fluid protein concentration increased, hydrocephalus and short hospitalization are risk factors for death in children with TBM. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To explore the association between plasma IgG and acute exacerbation (AE) or death risk in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 262 COPD patients treated in our hospital from February 2018 to February 2020 were recruited in our study. All patients were divided into AE≥2 group and AE≤1 group according to AE frequency during follow-up of 1 year. Basic data and laboratory data such as IgG, IgA and IgM of two groups were comparatively analyzed. Univariate analysis and COX regression were performed to analyze the related factors of frequency of AE≥2 times in 1 year. Depicting restricted cubic spline was performed to analyze the relation between IgG and AE by R software. All patients were also divided into high IgG group, low IgG group, high IgA group and low IgA group based on median of patients’ baseline plasma IgG and IgA level, depicting survival curve by Kaplan-Meier to analyse differences between the groups with different IgG or IgA level in the risk of AE and death respectively. ResultsFinally, there were 14 patients lost to follow-up and 248 cases were included (AE≤1 group contained 154 cases, AE≥2 group contained 94 cases) until February 28, 2021. Age and COPD Assessment Test (CAT) scores in the AE≥2 group were higher than those in the AE≤1 group; Albumin, IgG and IgA level in the AE≥2 group were lower than those in the AE≤1 group; Neutrophil to lymphocyte ratio (NLR) in the AE≥2 group was higher than that in the AE≤1 group (all P<0.05). There were 99 and 114 cases of AE in the high IgG and low IgG groups respectively within 1 year. Kaplan Meier survival analysis showed that risk of AE in the high IgG group and high IgA group were lower than that in the low IgG group and the low IgA group (log rank χ2=23.791, 67.153, both P=0.000). Risk of death in the high IgG group was lower than that in the low IgG group (log rank χ2=6.214, P=0.013), there was no statistically difference in the risk of death in the high IgA group compared to the low IgA group (log rank χ2=2.400, P=0.121). Multivariate Cox regression analysis showed that CAT score (HR=1.096, P=0.001) and NLR (HR=2.061, P=0.000) were independent risk factors of frequency of AE≥2 times in 1 year for COPD patients, albumin (HR=0.921, P=0.006) and IgG (HR=0.572, P=0.000）were the independent protective factors. Restricted cubic spline analysis showed that combining the COX regression model, after adjusting for IgA, albumin, NLR and other variables, there was non-linear relationship between IgG level and AE (P=0.000).Conclusion Plasma IgG level is related to AE in COPD patients, and may become a reliable predictor of acute exacerbation risk in the future.
Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
Objective To access and identify risk factors related to death and injuries in earthquakes. Method We searched The Cochrane Library, SCI, PubMed, CBM and CNKI from establishment to June 2008 to identify cohort, case-control and cross-sectional studies involving risk factors related to death and injuries in earthquakes. The methodological quality of included cohort and case-controlled studies were assessed, and the potential risk factors of earthquake related death and injuries were systematically enumerated. Results Two cohort, 2 case-control and 4 cross-sectional studies were included. Some included studies might be associated with selection bias. Risk factors for earthquake death and injuries included age, gender, mental disease, physical disabled, socioeconomics status, type/ age/ height/ collapse of building, motor vehicle driver and geographical location when the earthquake occurred. Conclusions Death and injuries in earthquakes may be attributed to 3 categories: demographic characteristics, building features, and seismic/ geographical/ location factors. However, the conclusion of this review and its implications may be limited by the potential selection bias of included studies and the regional characteristics of the included populations. Original studies from Chinese seismic areas are especially needed.