Risk factors for respiratory failure with tetraplegia after acute traumatic cervical spinal cord injury

OBJECTIVE

To analyze risk factors for respiratory failure with tetraplegia after acute traumatic cervical spinal cord injury (CSCI).

PATIENTS AND METHODS

Total 180 tetraplegia cases after acute traumatic CSCI treated in Shanghai Changzheng Hospital from 2001 to 2011 were reviewed retrospectively and the frequency of respiratory failure in these patients were analyzed against the factors including age, gender, cause of injury, level/severity of injury, high-dose methylprednisolone (MP) therapy, and surgery intervention, using Chi-square test to look into the correlations of the prevalence of respiratory failure to those factors.

RESULTS

Of the 180 tetraplegia with acute traumatic CSCI, 29 patients (16.11%) developed respiratory failure. The factors, including age, level and severity of injury, high-dose MP therapy, and surgery intervention, were found to significantly correlate with the appearance of respiratory failure in tetraplegia after acute traumatic CSCI (p < 0.05), while no significant correlation was found between the other factors: gender and cause of injury and the frequency of respiratory failure.

CONCLUSIONS

Age, level/severity of injury, high-dose MP therapy, and surgery intervention are the four major relevant factors of respiratory failure in patients with acute traumatic CSCI. The appropriate and timing treatments involving high-dose MP therapy and surgical decompression and reconstruction can substantially increase the rates of clinical improvements and reduce the frequency of respiratory failure.

[Application of augmented reality and mixed reality navigation technology in laparoscopic limited right hepatectomy]

Objective: To investigate the application effect of augmented reality and mixed reality navigation technology in three-dimensional(3D) laparoscopic narrow right hepatectomy(LRH). Methods: A retrospective analysis was performed on the clinical data of 5 patients with hepatic malignancy admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from September 2020 to June 2021,all of whom were males,aged from 42 to 74 years.Preoperative evaluation was performed using the self-developed 3D abdominal medical image visualization system; if all the 5 patients were to receive right hemihepatectomy,the remnant liver volume would be insufficient,so LRH were planned.During the operation,the independently developed 3D laparoscopic augmented reality and mixed reality surgical navigation system was used to perform real-time multi-modal image fusion and interaction between the preoperative 3D model and 3D laparoscopic scene.Meanwhile,intraoperative ultrasound assisted indocyanine green fluorescence was used to determine the surgical path.In this way,the LRH under the guidance of augmented reality and mixed reality navigation was completed.The predicted liver resection volume was evaluated before surgery,actual resected liver volume,surgical indicators and postoperative complications were analyzed. Results: All the 5 patients completed LRH under the guidance of augmented reality and mixed reality navigation technology,with no conversion to laparotomy.The median operative time was 300 minutes(range:270 to 360 minutes),no intraoperative blood transfusion was performed,and the median postoperative hospital stay was 8 days(range:7 to 9 days).There were no perioperative deaths,or postoperative complications such as liver failure,bleeding,or biliary fistula. Conclusion: For patients who need to undergo LRH,the use of augmented and mixed reality navigation technology can safely and effectively guide the implementation of surgery,retain more functional liver volume,improve surgical safety,and reduce postoperative complications.

Predictive effect of net water uptake on futile recanalisation in patients with acute large-vessel occlusion stroke

AIM

To determine whether net water uptake (NWU) based on automated software evaluation could predict futile recanalisation in patients with acute anterior circulation large-vessel occlusion (LVO).

MATERIALS AND METHODS

Patients with acute anterior circulation LVO undergoing mechanical thrombectomy in Jinling Hospital were evaluated retrospectively. NWU and other baseline data were evaluated by performing univariate and multivariate analyses. The primary endpoint was 90-day modified Rankin scale score ≥3. A nomogram to predict poor clinical outcomes was developed based on multivariate logistic regression analysis.

RESULTS

Overall, 135 patients who underwent thrombectomy with a TICI grade ≥2b were enrolled. In multivariate logistic regression analysis, the following factors were identified as independent predictors of futile recanalisation: age (odds ratio [OR]: 1.055, 95 % confidence interval [CI]: 1.004-1.110, p=0.035), female (OR: 0.289, 95 % CI: 0.098-0.850, p=0.024), hypertension (OR: 3.182, 95 % CI: 1.160-8.728, p=0.025), high blood glucose level (OR: 1.36, 95 % CI: 1.087-1.701, p=0.007), admission National Institutes of Health Stroke Scale score (OR: 1.082, 95 % CI: 1.003-1.168, p=0.043), and NWU (OR: 1.312, 95 % CI: 1.038-1.659, p=0.023).

CONCLUSIONS

NWU based on Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) could be used to predict the occurrence of futile recanalisation in patients with acute anterior circulation LVO ischaemic stroke.

[The expression of Cath-D, c-erbB-2 and EGFR in breast cancer and its correlation to lymphatic metastasis]

The expression of Cath-D c-erbB-2 and EGFR in breast cancer and its correlation of lymphatic metastases were studied in 277 cases by immunohistochemical technique. Positive staining of Cath-D was detected in 107 cases (38.62%), of which, 89 cases (83.17%) had documented metastasis in the lymph nodes. One hundred and seventy cases (61.38%) stained negative for Cath-D, of which 64 cases (37.64%) had detectable lymphatic metastases. There was a significant difference in the rate of the lymphatic metastases between the Cath-D positive and Cath-D negative groups (P < 0.0001). Fifty-six out of 107 Cath-D positive cases (52.34%) were c-erbB-2 positive as well. However, only 27 out of 170 Cath-D negative cases (15.88%) were c-erbB-2 positive. The positive rate of c-erbB-2 in Cath-D positive group was significantly different from that of Cath-D negative group (P < 0.0001). Among those 107 Cath-D positive cases, 49 cases (45.79%) were EGFR positive. Only 24 cases (14.12%) were EGFR positive among the 170 Cath-D negative cases. The positive rate of EGFR between these two groups was also significantly different (P < 0.0001). The results suggest that Cath-D status can be used as an indicator of the aggressiveness of the breast cancer. Breast cancer cases with a positive Cath-D staining are more likely to have lymphatic metastases and a poor prognosis. Therefore, alternative therapeutic strategies and close follow-ups are needed for these patients.

[Transposition of flexor pollicis brevis muscle for reconstruction of opposition function of the thumb: anatomical study and clinical application]

Anatomical study was performed on 20 cadaveric hands and the results showed that M. flexor pollicis brevis overlap the M. abductor pollicis brevis for about half of its width at their origins and the overlapping reduced to about 1/3 of the width at the muscle belly level. The M. flexor pollicis brevis chiefly inserts on the palmar aspect of the base of proximal phalanges. The M. abductor pollicis brevis primarily inserts to the radial side of MP joints, the M. flexor pollicis brevis is entirely innervated by the deep branch of the ulnar nerve. In order to increase the angle bettween longitudinal force lines of these two muscles for 7-9 degrees, the authors transfered the insertion of the M. flexor pollicis brevis to the radial side of the metacarpal-phalangeal joint, so that it gives this muscle the function of opposition. Eight patients had been treated and followed up on average for 12 months. All had fine functional results. This new methodis effective, least traumatizing and does not need transposition of another tendon.

[Analysis of anxiety, depression and related factors in patients with chronic lumbocrural pain before minimally invasive surgery]

OBJECTIVE

To investigate anxiety and/or depression status of patients with chronic lumbocrural pain, and to further analyze related risk factors of anxiety and/or depression .

METHODS

Retrospective analysis of the medical data of patients who suffered from chronic lumbocrural pain caused by lumbar disc herniation and/or lumbar spinal stenosis and received minimally invasive surgery from March 2018 to April 2018. General data (including age, gender, education levels, past history, sleep order and medical insurance), numeric rating scale(NRS), Japanese Orthopedic Association(JOA) back pain scale and hospital anxiety and depression scale(HADS) were collected for analysis. The basic demographic data and clinic data were analyzed, possible related risk factors associated were analyzed by univariate analysis, and multivariate Logistic regression analysis was further used to find the relative independent risk factors and included all the predictive variables with P values less than 0.05 as covariates.

RESULTS

A total of 91 patients met the inclusion criteria and finished this study, the mean HADS score for anxiety was 8.1±4.2, 48(52.7%) respondents were screened positive for anxiety, while the rest 43(47.3%) patients had negative anxiety state, the mean HDDS score for depression was 6.9±4.9, 38(41.8%) respondents were screened positive for depression, and the rest 53(58.2%) patients were not depressed, and 56(61.5%) patients experienced anxiety or depression. There were significant difference in sleep disorder, JOA score and leg NRS score between the patients with and without anxiety(P<0.05), and the significant differences were also found in age, sleep disorder and JOA score between the patients with and without depression(P<0.05), Logistic regression analysis further showed that the JOA score and sleep disorder were risk factors for anxiety, and the JOA score was risk factor for depression.

CONCLUSION

Patients with chronic lumbocrural pain are often accompanied by anxiety and/or depression before minimally surgery, the low JOA score and sleep disturbance increased the risk of presenting anxiety, and the low JOA score increased the risk of developing depression. It is necessary to evaluate mental status and related risk factors before surgery.

[Rehabilitation therapy for short bowel syndrome]

OBJECTIVE

To investigate the effect of rehabilitation therapy for short bowel syndrome on patients' nutritional status and intestinal adaptation.

METHODS

Twenty seven patients with short bowel syndrome with the average age of 38.5 +/- 19.3 years, the residual small intestine of the length of 15 to 80 cm, ileocecal valve being preserved in 15 cases, and an average time between the onset of short bowel syndrome and rehabilitation therapy of 86 +/- 105 d received 29 courses of rehabilitation therapy including enteral or parenteral nutrition, glutamine, recombinant human growth hormone and rehabilitation diet from January 1997 to July 2000.

RESULTS

After the treatment, the patients' nutritional status improved markedly, their intestinal absorptive capacity improved too. Eight patients were followed up for more than 2 y, 4 of them (50%) had weaned from total parenteral nutrition. Thirteen patients were followed up for more than 1 y, 10 of them (76.9%) had weaned from total parenteral nutrition.

CONCLUSION

Rehabilitation therapy for short bowel syndrome improves patients' nutritional status effectively and promote intestinal adaptation. Early initiation of rehabilitation therapy promotes intestinal adaptation, and increases patients' liability to wean from total parenteral nutrition.

[Etiological study on patients with seronegative viral hepatitis]

OBJECTIVE

To investigate the etiology of hepatitis patients who were seronegative for viral hepatitis A through E.

METHODS

By using PCR, HBV DNA, HCV RNA, HEV RNA and HGV RNA were detected in sera of 104 patients with seronegative viral hepatitis. The partial nucleotide sequences of 2 HCV and 17 HEV isolates were analysed by direct sequencing.

RESULTS

Among the 104 patients with seronegative viral hepatitis, the positive rates of HBV DNA, HCV RNA, HEV RNA and HGV RNA were 29.8%, 3.8%, 22.1% and 7.7%, respectively, with only 38 cases (36.6%) negative for the genome of all known hepatitis viruses.

CONCLUSION

In addition to serological tests, the polymerase chain reaction of all known hepatitis viruses should be used to make the diagnosis of non-A - E hepatitis.

[Kinetics of the Ca(2+)-activated K+ channel in Ca2+ induced cortex neurons damage]

Ca(2+)-activated K+ channels were studied by using the patch clamp technique of single channel recordings from the primary culture fetal SD rat cortex neurons. Besides their physiologic characters, the effects of increasing cytosolic and cytoplasmic Ca2+ triggered neuronal damage were also studied. The results showed that Kca with conductance around 170PS was predominant in the rat cortex neurons. These channels almost did not open at physiologic intracellular free Ca2+ concentration (10(-8) mol/L), but was extremely activated at intracellular free Ca2+ concentration (10(-6) mol/L). So the open probabilities of the KCa in the cortex neurons obviously depended on the concentration of cytoplasmic Ca2+ and membrane potential. The KCa activated by increasing of intracellular Ca2+ during the early stage of anoxia may be a protective reaction of ischemic neurons.

Single-cell transcriptome analysis yields new insights into the pathogenic mechanisms and possible genetic etiology of cardiomyopathies

Background

Inherited cardiomyopathies (CM) represent a clinically heterogeneous group of primary cardiac muscle disorders with a strong genetic underpinning. Recent rapid genomic advances have led to the identification of numerous disease-causing genes for both non-syndromic (nsCM) and syndromic (sCM) cardiomyopathies. This has greatly facilitated molecular genetic testing, thus enabling accurate disease diagnosis needed for the practice of precision medicine and the optimization of patient outcome. However, many cardiomyopathies remain unexplained with the known genes and dominant genetic model of disease.

Purpose

To reassess the genetic features of known CM genes as a strategy to recover novel candidate CM genes.

Methods

Known hypertrophic CM (HCM), dilated CM (DCM) and pediatric CM genes were curated from the literature and from 23 commercial CM diagnostic panels. They were classified as non-syndromic and syndromic, and further annotated using two constraint metrics, the missense Z score and pLI score obtained from the GnomAD database. Publicly available mouse (n=6) and human (n=3) single-cell RNA (scRNA) datasets were downloaded and cardiomyocyte specific differentially expressed genes (DEGs) (fold change &gt;0.1; adjusted P&lt;0.0001) were recovered. Genes identified as DEGs in at least 4 mouse or 3 human scRNA datasets were recovered as nsCM candidate genes.

Results

Analyses of 9 scRNA datasets showed the majority of known nsCM genes are cardiomyocyte specific (Fig. 1a-b). nsCM and sCM genes have distinct expression and genetic profile. nsCM genes are associated with higher heart expression and lower loss intolerance (Fig. 1c). In contrast, syndromic CM genes mostly showed lower expression with high loss intolerance, consistent with their higher clinical impact. However, interestingly some of the nsCM genes (MYLK2, TMPO and KLF10) show low or even no detectable expression in mouse and human cardiac cells. Using the scRNA data, we assessed cellular expression of genes in the 23 commercial CM diagnostic panels. This analysis showed some of the CM genes with high cardiomyocytes expression have low coverage on the current commercial CM panels (Fig. 1d). Using human and mouse scRNA data, we recovered 224 mouse and 157 human nsCM candidate genes. MTUS2 (microtubule-associated tumor suppressor candidate 2) was identified as a strong nsCM candidate gene supported by evidence from both mouse and human studies (Fig. 1e-f).

Conclusions

Our analysis showed many of the nsCM genes have differential cardiomyocyte expression with low loss intolerance, while the reverse was observed for many sCM genes. We propose increasing commercial panel coverage of cardiomyocytes-specific expressed genes may help increase disease diagnostic yield. Additionally, novel candidate genes uncovered trained on cardiomyocyte expression profile may help accelerate elucidation of unsolved cardiomyopathy cases.

Funding Acknowledgement

Type of funding sources: None.