Surgical site infections (SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.We retrospectively analysed the inpatient records of Shaanxi Provincial People's Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002 (NRS 2002) scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance (NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus (42.2%), the liver (27.6%), the gastrointestinal tract (19.1%), the appendix (5.9%), the kidney (3.7%), and the groin area (1.4%). SSI occurred in 5% of the patients (n = 150). The risk factors associated with SSI were as follows: Age; gender; marital status; place of residence; history of diabetes; surgical season; surgical site; NRS 2002 score; preoperative white blood cell, procalcitonin (PCT), albumin, and low-density lipoprotein cholesterol (LDL) levels; preoperative antibiotic use; anaesthesia method; incision grade; NNIS score; intraoperative blood loss; intraoperative drainage tube placement; surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio (OR) = 5.698, 95% confidence interval (CI): 3.305-9.825, P = 0.001], antibiotic use (OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3 (OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia (OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2 (OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L (OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L (OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL (OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season (P < 0.05), surgical site (P < 0.05), and incision grade I or III (P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score (0.662).The patient's condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.
Malignant tumors pose a major problem in the medical field. Millimeter wave (MMW) exposure have potential apoptosis-promoting effects on several types of tumors. Considering that the penetration depth of millimeter wave is usually several millimeters, we study the apoptosis-promoting effects of millimeter wave exposure on A375 human melanoma tumor cells in vitro, and this topic has not been explored in the previous literature. In this study, we use the A375 human melanoma cell line as an experimental model exposed to 35.2 GHz millimeter wave in vitro to determine any positive effect and further explore the underlying mechanisms. In this study, 2 groups namely, exposed and sham groups, were set. The exposed groups included 4 exposure time periods of 15, 30, 60, and 90 minutes. The cells in the sham group did not receive millimeter wave exposure. After millimeter wave exposure, the A375 cells in the exposed and sham groups were collected for further experimental procedures. The cell viability after exposure was determined using a cell counting kit, and the apoptosis of A375 cells was assessed by Annexin V/propidium iodide. Changes in the expression of apoptosis-related proteins, including cleaved-caspase-3, and -8, were examined by Western blot. We observed that the millimeter wave exposure could inhibit the viability and induce apoptosis in A375 cells, and the expression of cleaved caspase-3 and -8 were upregulated ( P < .05). The results indicated that the millimeter wave at 35.2 GHz exerted apoptosis-promoting effects on the A375 cells via a pathway by activating of caspase-8 and -3.
Accumulating studies confirmed that luteolin, a common dietary flavonoid which is widely distributed in plants and has diverse beneficial biological function, including anti-oxidant, anti-inflammation and anticancer properties.However, the detail mechanisms of luteolin on GC are poorly understood.Here, we investigated the anticancer effect of luteolin in GC cells in vitro and in vivo.Luteolin reduced the cell viability in a time and dose-dependent manner.Luteolin significantly inhibited cell cycle progress, colony formation, proliferation, migration, invasion and promoted apoptosis in vitro and in vivo.Luteolin also regulated these biological effects associated regulators.Mechanically, luteolin treatment regulated Notch1, PI3K, AKT, mTOR, ERK, STAT3 and P38 signaling pathways and modulated a series of miRNAs expression.These findings provide novel insight into the molecular function of luteolin which suggest its potential as a therapeutic agent for human GC.
The stomach is the main digestive organ in humans. Patients with gastric cancer often develop digestive problems, which result in poor nutrition. Nutritional status is closely related to postoperative complications and quality of life (QoL) in patients with gastric cancer. The controlling nutritional status (CONUT) score is a novel tool to evaluate the nutritional status of patients. However, the relationship of the CONUT score with postoperative complications, QoL, and psychological status in patients with gastric cancer has not been investigated. The present follow-up study was conducted in 106 patients who underwent radical gastrectomy in our hospital between 2014 and 2019. The CONUT score, postoperative complications, psychological status, postoperative QoL scores, and overall survival (OS) of patients with gastric cancer were collected, and the relationship between them was analyzed. A significant correlation was observed between the CONUT score and postoperative complications of gastric cancer (P < 0.001), especially anastomotic leakage (P = 0.037). The multivariate regression analysis exhibited that the CONUT score (P = 0.002) is an independent risk factor for postoperative complications. The CONUT score was correlated with the state anxiety questionnaire (S-AI) for evaluating psychological status (P = 0.032). However, further regression analysis exhibited that the CONUT score was not an independent risk factor for psychological status. Additionally, the CONUT score was associated with postoperative QoL. The multivariate regression analysis exhibited that the CONUT score was an independent risk factor for the global QoL (P = 0.048). Moreover, the efficiency of CONUT score, prognostic nutrition index, and serum albumin in evaluating complications, psychological status, and QoL was compared, and CONUT score was found to outperform the other measures (Area Under Curve, AUC = 0.7368). Furthermore, patients with high CONUT scores exhibited shorter OS than patients with low CONUT scores (P = 0.005). Additionally, the postoperative complications (HR 0.43, 95% CI 0.21-0.92, P = 0.028), pathological stage (HR 2.26, 95% CI 1.26-4.06, P = 0.006), and global QoL (HR 15.24, 95% CI 3.22-72.06, P = 0.001) were associated with OS. The CONUT score can be used to assess the nutritional status of patients undergoing gastric cancer surgery and is associated with the incidence of postoperative complications and QoL.
Ataxia‑telangiectasia (A‑T) syndrome is a rare autosomal recessive disorder mainly caused by mutations in the A‑T mutated (ATM) gene. However, the genomic abnormalities and their consequences associated with the pathogenesis of A‑T syndrome remain to be fully elucidated. In the present study, a whole‑exome sequencing analysis of a family with A‑T syndrome was performed, revealing a novel homozygous deletion mutation [namely, NM_000051.3:c.50_72+7del,p.Asp18_Lys24delins(23)] in ATM in three affected siblings, which was inherited from their carrier parents who exhibited a normal phenotype in this pedigree. The identified mutation spans the exon 2 and intron 2 regions of the ATM gene, causing a splicing aberration that resulted in a 30‑bp deletion in exon 2 and intron 2, as well as a 71‑bp insertion in intron 2 in the splicing process, which was confirmed by reverse transcription‑polymerase chain reaction and sequencing analysis. The change in the three‑dimensional structure of the protein caused by the mutation in ATM may affect the functions associated with telomere length maintenance and DNA damage repair. Taken together, the present study reported a novel homozygous deletion mutation in the ATM gene resulting in A‑T syndrome in a Chinese pedigree and expanded on the spectrum of known causative mutations of the ATM gene.
To investigate the effects of millimeter wave (MMW) exposure on apoptosis of human melanoma A375 cells and explore the mechanisms.Through electromagnetic field calculation we simulated MMW exposure in cells and calculated the specific absorption rate (SAR). The optimal irradiation parameters were determined according to the uniformity and intensity of the SAR. A375 cells were then exposed to MMV for 15, 30, 60, or 90 min, with or without pretreatment with the caspase-3 inhibitor AC-DEVD-fmk (10 μmol/L) for 1 h at 90 min before the exposure. CCK-8 assay was used to assess the changes in the viability and Annexin-V/ PI staining was used to detect the apoptosis of the cells following the exposures; Western blotting was used to detect the expression of caspase-3 in the cells.The results of electromagnetic field calculation showed that for optimal MMV exposure, the incident field needed to be perpendicular to the bottom of the plastic Petri dish with the antenna placed below the dish. CCk-8 assay showed that MMW exposure significantly inhibited the cell viability in a time-dependent manner (P < 0.05); exposures for 15, 30, 60, and 90 min all resulted in significantly increased apoptosis of the cells (P < 0.05). The cells with MMW exposure showed significantly increased expression of caspase-3. The inhibitory effect of MMW on the cell viability was antagonized significantly by pretreatment of the cells with AC-DEVD-fmk (P < 0.05), which increased the cell viability rate from (36.7±0.09)% to (59.8±0.06)% (P < 0.05).35.2 GHz millimeter wave irradiation induces apoptosis in A375 cells by activating the caspase-3 protein.
Lung cancer remains the leading cause of cancer-associated mortality in China and worldwide. Increasing numbers of studies have demonstrated that microRNAs (miRNAs/miRs) have vital functions in numerous developmental processes and tumorigenesis. The aim of the present study was to investigate miR-154 expression in non-small cell lung cancer (NSCLC), and to explore the roles of miR-154 in the carcinogenesis and progression of this cancer. Reverse transcription-polymerase chain reaction (RT-qPCR) was performed to detect miR-154 expression in NSCLC tissues and cell lines. In addition, cell proliferation assay, migration and invasion assays were adopted to investigate the functional roles of miR-154 in NSCLC. Bioinformatics analysis, luciferase reporter assay, RT-qPCR and western blot analysis were used to explore the potential targets of miR-154 in NSCLC. According to the results, miR-154 was significantly downregulated in NSCLC tissues and cell lines. Restoration of miR-154 expression inhibited proliferation, migration and invasion of NSCLC cells. In addition, B-cell-specific Moloney murine leukemia virus insertion site 1 (BMI-1) was identified as a direct target gene of miR-154 in NSCLC. In conclusion, miR-154 may function as a tumor suppressor in NSCLC, partly by regulating BMI-1, and the modulation of miR-154 expression represents a potential strategy for the treatment of NSCLC patients.
BACKGROUND Prolonged postoperative ileus (PPOI) delays the postoperative recovery of gastrointestinal function in patients with gastric cancer (GC), leading to longer hospitalization and higher healthcare expenditure. However, effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of the lack of noninvasive methods. AIM To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice. METHODS This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021. Among them, PPOI was reported in 33 cases. The patients were randomly divided into the training and validation cohorts. Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model. RESULTS The analysis identified six potential variables associated with PPOI among the included participants. The incidence rate of PPOI was 27.5%. Age ≥ 70 years, cTNM stage (I and IV), preoperative hypoproteinemia, recovery time of bowel sounds (RTBS), number of bowel sounds (NBS), and frequency of bowel sounds (FBS) were independent risk factors for PPOI. The Bayesian model demonstrated good performance with internal validation: Training cohort [area under the curve (AUC) = 0.880, accuracy = 0.823, Brier score = 0.139] and validation cohort (AUC = 0.747, accuracy = 0.690, Brier score = 0.215). The model showed a good fit and calibration in the decision curve analysis, indicating a significant net benefit. CONCLUSION PPOI is a common complication following gastrectomy in patients with GC and is associated with age, cTNM stage, preoperative hypoproteinemia, and specific bowel sound-related indices (RTBS, NBS, and FBS). To facilitate early intervention and improve patient outcomes, clinicians should consider these factors, optimize preoperative nutritional status, and implement routine postoperative bowel sound monitoring. This study introduces an accessible machine learning model for predicting PPOI in patients with GC.
Background
Accounting for 6% of all fractures, clavicle fractures are common in clinic with the middle 1/3 fracture as the most common type. The options for treatment include conservative and surgical strategies. The effect of conservative treatment via manipulative reduction is often unsatisfactory (especially for comminuted fractures) . For the middle 1/3 clavicle fractures, the displacement of proximal end caused by the upward and posterior tractions of sternocleidomastoid muscle may result in instability and nonunion of fracture. These risk factors increase the chance of redisplacement, which restrict early activity and affect joint function simultaneously. With in-depth study of the injury and therapeutic effect of clavicle fractures and patients' improved expectation for life quality, more patients require surgical treatment. Those with comminuted and shortened fractures are often treated with plate fixation. The surgical treatment reduces complications including nonunion, shoulder deformity, pain, functional impairment and neurovascular injury, et al., and greatly improves the clinical therapeutic effect of clavicular fracture. However, the excessive dissection of surrounding tissue required by conventional plate fixation increases the chance of nonunion. Moreover, the large incision on skin not only leads to the formation of large scar but also causes supraclavicular nerve damage and numbness in the corresponding area. The minimally invasive percutaneous plate osteosynthesis (MIPPO) technique can nicely solve some of the common drawbacks of traditional surgery.
Methord
Ⅰ. General information: From January 2012 to December 2014, 86 patients (52 males and 34 females) with mid-shaft clavicle fractures were treated in the first affiliated hospital of dalian medical university. The age ranged from 14 to 70 years old with an average of 40 years. All cases were closed fractures, which included 48 cases of traffic accident and 38 cases of fall injury. 36 cases were affected by left side, and 50 cases were affect by right side. Among the patients, there were 14 cases of combined rib fractures and 3 cases of scapular fractures (minor fractures) . The time from injury to admission ranged from 1 to 10 days with an average of 5 days. The operation indications: fractures of total displacement, comminuted fractures and clavicle shortening of over 2 cm. Locking compression plate was used in all patients who were randomly divided into Conventional ORIF group (Group A, 41 cases) and MIPPO group (group B, 45 cases) based on the different placements of internal fixators. Ⅱ.Inclusive and exclusive criteria: Inclusive criteria: (1) Unilateral displaced mid-shaft clavicle fractures of adult (Robison type II) ; (2) Combined rib or scapular fractures without the affection of shoulder function assessment. Exclusive criteria: (1) Open fractures; (2) Combination of other severe fractures that affect shoulder function assessment; (3) Combined brachial plexus injury or other disease that affects upper extremity function; (4) Pathological fractures; (5) Patients who are lost for follow-up. Ⅲ. Surgical methods: (1) Conventional ORIF group (group A) : After general anesthesia, the patient was placed in semi-sitting position (beach chair position) . The fracture ends and acromion were both marked. The incision was made along the surface of clavicle and was extended toward acromion. The soft tissue was separated and exposed to reveal periosteum and fracture fragments with particular attention to comminuted or displaced disc-shaped fractures. Comminuted fractures were treated with lag screw for fixation. The fracture fragments were converted into 3-part or 2-part fractures. Finally, anatomical locking compression plate was used for fixation with 3 screws on each side. (2) MIPPO technique group (group B) : After general anesthesia, the patient was placed in semi-sitting position (beach chair position) . The situation of fracture was confirmed, and the fracture ends and acromion were both marked to design minimally invasive incisions on the distal and proximal clavicle. 2-3 cm arc incisions were made from the center of fracture toward both sides along the longitudinal axis of clavicle. The skin, subcutaneous tissue and deep fascia were cut open, and the subperiosteum was slightly dissected for fracture reduction. The periosteum at fracture ends was preserved to the greatest extent, and the hematoma was removed to expose the fracture ends. Crossing clavicle downward from superomedial to inferolateral, the supraclavicular nerve should be identified and protected during operation. The fractures were reduced by manipulation or percutaneous poking with Kirschner wire under fluoroscopy. With satisfactory linear and positional alignments, the small fragments were fixed with lag screw. If necessary, Kirschner wire should be adopted for temporarily fixation and maintenance of the position of clavicle. A subcutaneous tunnel was established along the incision edge, through which the appropriate anatomical locking compression plate was selected and inserted towards the distal end of clavicle. With the position of distal incision determined, A 1-2 cm of distal incision was made. Then, the plate was removed and inserted again through the distal incision to the proximal end. With the position of proximal incision determined, a 1-2 cm proximal incision was made as well. As the plate was fully inserted, both the proximal and distal ends were checked to make sure their attachment with clavicle. The plate position was properly adjusted as needed, and 3 screws were placed through each of the two small incisions. The reduction was further observed under fluoroscopy.Ⅳ. Postoperative treatment: Postoperative antibiotic was given to prevent infection within 24 hours. After adequate drainage, the stiches were taken out 7-10 days later. The affected arm was suspended for 2 weeks with triangular bandage, and passive training was initiated on the 2nd postoperative day. Passive should joint exercise was carried out within 2 weeks, and no-weight bearing active exercise started 2 weeks later. The callus was observed during regular reexamination, and normal activities were gradually restored based on the growth.Ⅴ. Outcome Measurements: (1) Surgical situations and postoperative follow-up scores: the operative time and hospital stay of both groups were recorded, and the wound healing was observed as well. After discharge, the patients were required to be followed up every two weeks till fracture healing. The condition of affected limb was observed under fluoroscopy, and the patients were followed up every 3 months after fracture healing. The criteria of fracture healing include continuous callus formation and the disappearance of fracture line revealed by radiographic examination, no tenderness in the clinical examination of fracture ends, and pain free in active movement and weight-bearing activities. The shoulder joint functions including pain, anatomical location and activity were assessed by Neer score. The criteria of Neer score: 90-100 points as excellent; 80-89 points as good; 70-79 points as moderate; less than 70 points as poor. (2) Complication rate and patients’ subjective satisfaction: the common postoperative complications were compared using statistics, including infection, delayed union, hypertrophic scar, supraclavicular nerve damage, et al., and in the meanwhile, the subjective satisfaction (satisfaction or dissatisfaction) with the operation of patients was asked as well. Ⅵ. Statistical analysis: The SPSS 23.0 software was used for data processing. According to the data distribution characteristics, the enumeration data were analyzed using the t test and the measurement data were analyzed using the χ2 test. A P value <0.05 was regarded as statistically significant.
Results
(1) Comparison of surgical situations and postoperative follow-up scores: The surgical situations were compared between the two groups, including operation time (min) , hospital stay (d) , fracture healing time (w) and Neer score. The operation time (approximately 1 hour) , the hospital stays (5-7 days) and the fracture healing time (11-14 weeks) were the same for both groups. Also, the Neer scores for both groups were excellent without significant statistical difference (P>0.05) . The patients' shoulder joint functions including abduction, internal rotation and external rotation were all well performed. (2) Comparison of complication rate and patients’ subjective satisfaction: Both groups have no infection or delayed union occurred, and the comparison was not statistically significant. However, there were differences in the comparison of hypertrophic scar, supraclavicular nerve damage and subjective satisfaction. There were 12 cases of hypertrophic scar in group A and 0 case in group B, and the comparison had statistical significance (χ2 =15.307, P<0.001) . There were 20 cases of numbness in the dominated region of supraclavicular nerve in group A and only 4 cases in group B, and the comparison had statistical significance (χ2 16.969, P<0.001) . There were 26 cases of subjective incision satisfaction in group A and 39 cases in group B, and the comparison had statistical significance (χ2 =6.285, P<0.012) .
Conclusion
MIPPO technique has been used for the treatment of mid-shaft clavicle fractures. The surgical incision is small, and the internal fixation is reliable. These not only embody the advantage of plate fixation but also minimize the complications of hypertrophic scar and supraclavicular nerve injury. Thus, it provides good conditions for early functional exercise and is worth of clinical application.
Key words:
Mid-shaft clavicle fracture; Minimal invasion; Reduction; Internal fixation
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