Xiaobin Chen

Objective: This study evaluated the efficacy and safety of a series of prototype intestinal diversion devices in a Beagle hemorrhagic shock model comprising four complex bowel-injury patterns (small and large bowel). Methods: Sixteen Beagle dogs were randomized to four intestinal injury models (n = 4 each): (1) single-site small bowel transection, (2) suspected long-segment small-bowel ischemia/necrosis, (3) two-site small bowel transection, and (4) combined small-bowel injury with colon rupture. Within each cohort, animals were allocated to either conventional suture ligation of the bowel ends (bowel left in discontinuity) or device-mediated diversion to temporarily restore luminal continuity. Systemic inflammation (blood pH, endotoxin, TNF-α, IL-6, IL-10) was monitored at baseline and 2, 4, 8, and 24 h postoperatively. On postoperative day 30, tissue samples from the intestinal stump were excised to evaluate morphological changes and the extent of inflammatory infiltration via light microscopy. Results: Baseline characteristics were comparable between groups, and all animals (16/16) survived to day 30. Postoperatively, endotoxin, TNF-α, and IL-6 increased in both groups but were markedly attenuated in the diversion group. IL-10 showed a higher increase in the diversion group. The length of necrotic bowel requiring resection was consistently shorter with diversion. On postoperative day 30, histology showed well-perfused anastomoses with mild inflammation in the diversion group, whereas the ligation group exhibited ischemic necrosis with severe transmural inflammation. Conclusion: Preliminary findings suggest that the new intestinal diversion devices represent a feasible and promising strategy for damage control in complex intestinal trauma, particularly in the setting of combined injuries and hemorrhagic shock.

Pregnancy induced hypertension (PIH) is characterized by aberrant uterine arterial remodeling, a process tightly associated with an imbalance between placental growth factor (PlGF) and soluble fms like tyrosine kinase 1 (sFlt 1) as well as the down regulation of matrix metalloproteinases 2/9 (MMP 2/9). This study investigated the regulatory effect of PlGF on the two pore domain potassium channel KCNK2 and its downstream targets MMP 2/9, and explored the role of the PlGF KCNK2 MMP 2/9 axis in PIH related uterine arterial dysfunction. In vitro, human aortic endothelial cells (HAECs) were assessed for proliferation and migration using CCK 8 and Transwell assays. Nitric oxide (NO) and endothelin 1 (ET 1) levels were quantified by ELISA, while KCNK2 and MMP 2/9 expression was analyzed by Western blotting. In vivo, a Sprague Dawley rat PIH model was established to monitor blood pressure and 24 h urinary protein. Hematoxylin–eosin staining was used to measure uterine arterial intimal thickness; endothelial nitric oxide synthase (eNOS) and ET 1 localization was determined by immunohistochemistry, and KCNK2 as well as MMP 2/9 expression was quantified by immunohistochemistry and Western blotting. 2,2,2 Trichloroethanol and PlGF significantly enhanced endothelial cell proliferation and migration, increased NO, decreased ET 1, and up regulated KCNK2 and MMP 2/9 expression (P < 0.05); ropivacaine produced opposite effects. PIH rats exhibited markedly elevated blood pressure and urinary protein, intimal thickening, reduced eNOS and elevated ET 1, together with diminished MMP 2/9 expression. Combined treatment with PlGF and 2,2,2 trichloroethanol lowered blood pressure and urinary protein, attenuated intimal thickness, increased eNOS and decreased ET 1, and up regulated KCNK2 and MMP 2/9 (P < 0.05). 2,2,2 Trichloroethanol activates KCNK2, elevates MMP 2/9, and improves uterine arterial endothelial function, while PlGF synergizes with KCNK2 signaling to potentiate these effects. The PlGF KCNK2 MMP 2/9 axis plays a pivotal regulatory role in the vascular pathology of PIH, highlighting its potential as a therapeutic target for PIH related vascular dysfunction.

Purpose This study aimed to evaluate the prognostic value of preoperative systemic immune inflammatory index (SII) and prognostic nutritional index (PNI) in patients with renal cell carcinoma (RCC) undergoing surgery, and to establish a nomogram for predicting overall survival (OS). Methods We retrospectively analyzed clinical data from 240 RCC patients who underwent surgery. SII and PNI values were calculated, and optimal cutoff value were determined by receiver operating characteristic curves. Patients were classified into high and low SII/PNI groups. Survival outcomes were assessed using Kaplan–Meier analysis and log-rank tests. Univariate and multivariate Cox regression models were used to identify independent prognostic factors, which were incorporated into a nomogram. The model’s accuracy and discrimination were evaluated by the consistency index (C-index) and calibration curves. Results The 1-, 3- and 5-year survival rates were significantly higher in low SII group were (98.10%, 92.30%, and 87.20%) compared to the high SII group (90.00%, 72.90%, and 57.40%), and higher in the high PNI group (97.60%, 93.00%, and 87.60%) compared to the low PNI group (86.90%, 67.90%, and 40.80%; P < 0.001). Multivariate Cox regression model analysis showed that SII, PNI, hemoglobin, tumor necrosis, surgical method, pathological type, AJCC stage and Fuhrman grade were independent prognostic factors. The nomogram model demonstrated excellent predictive ability with a C index was 0.915. Conclusions Preoperative SII and PNI are independent predictors of postoperative prognosis in RCC patients. The constructed nomogram based on multiple factors provides accurate individualized survival predictions.

Background To explore the correlation between the levels of D-dimer (D-D), fibrinogen (FIB), fibrinogen degradation products (FDP) and platelets (PLT) in peripheral blood of patients with lower limb fractures and the formation of deep vein thrombosis in lower limbs, and to establish a new thrombosis prediction model for patients with lower limb fractures. Methods The patients were divided into DVT group and non DVT group according to whether there was deep vein thrombosis of the lower extremity. The differences in the levels of D-D, FIB, FDP and platelets between the two groups were analyzed and compared. ROC curve was used to evaluate the levels of D-D, FIB, FDP and PLT in the peripheral blood of patients with lower extremity fracture to predict the formation of deep vein thrombosis of the lower extremity. Logistic regression analysis was used to analyze the related risk factors of deep vein thrombosis, and the corresponding nomogram risk prediction model of lower limb deep vein thrombosis in patients with lower limb fractures was drawn according to the regression coefficient, which was verified by calibration curve, receiver operating characteristic curve (ROC) and consistency index (C-index). Results The levels of D-D, FIB, FDP, and PLT in the DVT group were higher than those in the non DVT group, with statistical significance (P < 0.05); Moreover, FIB is superior to D-D, FDP, and PLT in predicting the risk of fractures and thrombosis, while PLT has the weakest predictive power. Multivariate logistic analysis showed that platelet, D-D, FIB and FDP were independent risk factors for deep vein thrombosis in patients with lower limb fractures (P < 0.05); Based on the independent risk factors mentioned above, the complex logistic regression formula was transformed into a visual column chart, and the consistency index (C-index) was 0.962 and 0.936, and the external verification C-index was 0.841. The calibration curve showed that the nomogram is in high agreement with the actual results. The AUC value of ROC curve indicated that the nomogram has high prediction value. Conclusions The levels of D-D, FIB, FDP and PLT in peripheral blood of patients with lower limb fracture and DVT were significantly increased. Early monitoring of D-D, FIB, FDP and PLT levels in patients with lower limb fracture can effectively screen for lower limb deep vein thrombosis.

Background: Complicated Periumbilical abscess in late pregnancy is rare in clinical practice. Pubmed searches for articles published from January 1980 to September 2021. Such related reports did not retrieve article about “pregnancy” and “periumbilical abscess.” Case presentation: We reported on a 34-year-old female patient who was admitted to the hospital with periumbilical pain for 3 days at 34 + 1 weeks of pregnancy. The result of imaging examination showed that there was an inflammatory mass in the middle and lower abdominal wall in the third trimester of pregnancy. The periumbilical abscess was punctured and drained first, and then the pregnant woman was assisted to give birth to a baby girl through vagina after the condition was stable. Subsequently, laparotomy + abdominal abscess resection and drainage + partial small bowel resection + ileostomy were performed. Pathology showed inflammatory mass. Conclusions: Periumbilical abscess in the third trimester of pregnancy is rare clinically. For some pregnant women with previous trauma and surgical history, obstetric examination should not be restricted. For example, pregnant women with a history of abdominal surgery should expand the range of abdominal color Doppler ultrasound during the prenatal examination. When necessary, combine with computed tomography for diagnosis and treatment, avoid missed diagnosis, which will make the treatment more difficult and increase the risk. If the pregnant women has corresponding symptoms in the third trimester, vaginal delivery can be performed to terminate the pregnancy, and then the periumbilical abscess can be removed. At the same time, closely monitor the vital signs of newborn and mothers.

Background. Gastric cancer is among the most common malignant tumors at home and abroad, because its early symptoms are mostly insidious, which leads to distant metastasis when gastric cancer is first diagnosed. The common metastatic sites of gastric cancer are mainly the liver, lung, and peritoneum, but bone metastasis is relatively rare, and the prognosis of gastric cancer bone metastasis is very poor. Therefore, this study is built on the SEER database to analyze the related risk factors of gastric cancer bone metastasis and related factors affecting the prognosis of gastric cancer patients, aiming at improving clinicians’ understanding of clinical diagnosis and prognosis of bone metastasis of gastric cancer, thus reducing misdiagnosis and missed diagnosis. Methods. The SEER database was collected to screen out patients with gastric cancer bone metastases and nonbone metastases matched with them from 2010 to 2016, and the Kaplan-Meier method was used to draw survival curves, and the comparison between survival curves was performed by Log-rank test to analyze the overall survival of the two groups of patient’s time. Logistic regression analysis was used to analyze the related risk factors of gastric cancer bone metastasis, and the Cox regression proportional hazard model was used to analyze the relationship between gastric cancer bone metastasis and patient prognosis. Results. Using Kaplan-Meier survival curve to analyze the 1, 3, and 5-year survival rates of gastric cancer patients with bone metastasis and non-metastasis groups were 14.2%, 1.8%, 0.6% and 71.4%, 44.3%, 36.4%, respectively; the average survival rate of the metastatic group was The time was 4.0 months (95%CI: 3.475~4.525), and the average survival time of the non-metastatic group was 30.0 months (95%CI: 26.778~33.222). The difference between the two groups was statistically significant ( , ). Multivariate logistic regression analysis showed that race ( , ), grade ( , ), marital status ( , ), tumor size ( , ), TNM stage ( ), T stage ( ,

Background: To explore the correlation between the preoperative systemic immune inflammation index (SII) and the prognosis of patients with gastric carcinoma (GC). Methods: The clinical data of 771 GC patients surgically treated in the Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital from June 2010 to June 2015 were retrospectively analyzed, and their preoperative SII was calculated. The optimal cut-off value of preoperative SII was determined using the receiver operating characteristic (ROC) curve, the confounding factors between the two groups were eliminated using the propensity score matching (PSM) method, and the correlation between preoperative SII and clinicopathological characteristics was assessed by chi-square test. Moreover, the overall survival was calculated using Kaplan-Meier method, the survival curve was plotted, and log-rank test was performed for the significance analysis between the curves. Univariate and multivariate analyses were also conducted using the Cox proportional hazards model. Results: It was determined by the ROC curve that the optimal cut-off value of preoperative SII was 489.52, based on which 771 GC patients were divided into high SII (H-SII) group and low SII (L-SII) group, followed by PSM in the two groups. The results of Kaplan-Meier analysis showed that before and after PSM, the postoperative 1-, 3-, and 5-year survival rates in L-SII group were superior to those in H-SII group, and the overall survival rate had a statistically significant difference between the two groups (P < 0.05). Before PSM, preoperative SII [hazard ratio (HR) = 2.707, 95% confidence interval (CI) 2.074-3.533, P < 0.001] was an independent risk factor for the prognosis of GC patients. After 1:1 PSM, preoperative SII (HR = 2.669, 95%CI 1.881–3.788, P < 0.001) was still an independent risk factor for the prognosis of GC patients. Conclusions: Preoperative SII is an independent risk factor for the prognosis of GC patients. The increase in preoperative SII in peripheral blood indicates a worse prognosis.