Objective To discuss the endothelial cell which was modified by exogenous anticoagulant genes contribute to the increase of antithrombosis activity of lined vascular prosthesis and the influence to other physiological functions of endothelial cells. Methods This summarized paper was made on literature review of recent years. Results The transfection of genes, including plasminogen activator (tPA, uPA, Urokinase), thrombomoduline (TM) and hirudin, etc, to endothelial cells resulted in not only the increase of antithrombosis activity of local vascular, but also the decrease of endothelial cell function in adherence and proliferation. Conclusion The increase of antithrombosis activity of lined vascular prosthesis has been done by exogenous genes. However, this technique ought to be studied, intensively.
ObjectiveTo investigate the independent risk factors for acute biliary pancreatitis (ABP) induced by gallstones, and to develop a nomogram prediction model for the onset of ABP, thereby enabling early identification of high-risk patients and the formulation of individualized management plans, so as to provide a scientific basis for improving the clinical management of ABP. MethodsThe patients with gallstones who were admitted to the Department of Hepatobiliary and Pancreatic Surgery, Suining Central Hospital from January 2022 to January 2024 were collected. The patients were randomly divided into a training set and a validation set in a 7∶3 ratio. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors for ABP and to develop a nomogram prediction model. The discriminative ability, calibration, and clinical utility of the prediction model were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis. The accuracy and stability of the prediction model were further tested using the validation set. ResultsA total of 1 103 patients with gallstones were included, comprising 772 in the training set and 331 in the validation set. Among them, 137 (17.75%) and 60 (18.13%) patients in the training and validation sets, respectively, were complicated with ABP. Multivariate logistic regression analysis in the training set revealed that age [OR (95%CI)=1.03 (1.01, 1.04), P=0.002], normal gallbladder size [OR (95%CI)=5.36 (2.70, 10.65), P<0.001], gallstone diameter ≤1 cm [OR (95%CI)=6.26 (3.23, 12.14), P<0.001], round-shaped gallstones [OR (95%CI)=11.29 (5.42, 23.51), P<0.001], multiple gallstones [OR (95%CI)=1.37 (1.17, 1.81), P=0.013], and common bile duct diameter ≥1 cm [OR (95%CI)=4.44 (1.37, 14.41), P=0.013] were independent risk factors for ABP induced by gallstones. Based on these risk factors, a nomogram prediction model was constructed. The model demonstrated area under the ROC curve for distinguishing patients with ABP induced by gallstones were 0.873 [95%CI (0.842, 0.905)] in the training set and 0.858 [95%CI (0.810, 0.905)] in the validation set, respectively. The calibration of the model by the Hosmer-Lemeshow test indicated a good fit between predicted and actual probabilities (training set: χ2=14.061, P=0.080; validation set: χ2=7.656, P=0.468). Internal validation via the Bootstrap method (1 000 resamples) yielded calibration curves for both the training and validation sets that closely aligned with the ideal diagonal line. In both the training and validation sets, the patients with gallstone would benefit from intervention according to the nomogram at threshold probabilities of 0.03–0.88 and 0.89–0.91, respectively. ConclusionsThis study confirms that age, normal gallbladder size, gallstone characteristics (diameter ≤1 cm, round shape, and multiple stones), and common bile duct dilation (diameter ≥1 cm) are independent risk factors for ABP induced by gallstones. The nomogram prediction model constructed based on these factors demonstrates good discrimination and calibration in both the training and validation sets, and decision curve analysis confirmes its ideal clinical utility. This model provides clinicians with an intuitive and reliable quantitative tool for early identification of high-risk ABP patients and the development of individualized prevention and management strategies.
Objective To explore the feasibility of high-pressure injection to transfer human thrombomodulin (hTM) gene into arterial wall of rabbits.Methods Eighty-four healthy New Zealand rabbits were randomly divided into three groups: pcDNA3.1/hTM plasmid group (n=28), pcDNA3.1(+)/neo plasmid group (n=28) and untransfected group (n=28). After gene transfection, the model of arterial injury-blocking was established. Then, the expressions of hTM mRNA and protein in arterial wall were examined by RT-PCR and immunohistochemistry at 3 d, 7 d, 14 d and 28 d after operation. Results Seventeen rabbits died accidentally from the day of operation to 3 d after operation. The expressions of hTM mRNA of different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.01). For the expressions of hTM mRNA at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group, the difference of inter-group and intra-group was not significant (Pgt;0.05). hTM protein was expressed in every group and mainly localized in the inner lining of arterial wall. The expressions of hTM protein at different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.05). The expression of hTM protein at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group kept relative constancy, the difference of inter-group and intra-group was also not significant (Pgt;0.05). Conclusion High-pressure injection is feasible to transfer pcDNA3.1/hTM plasmid into arterial wall of live animals.
Objective To analyze the characteristics of patients transferred by ambulances to emergency department before and after coronavirus disease 2019 epidemic, in order to improve the efficiency of emergency triage, optimize the utilization of emergency resources, and provide a reference for standardized tiered medical services in different situation. Methods The patients’ information collected through Wenjuanxing questionnaire was extracted, who were transferred by ambulances to the Emergency Department of West China Hospital of Sichuan University between December 27th, 2018 and April 28th, 2019 (before epidemic), or between December 27th, 2019 and April 28th, 2020 (during epidemic), or between December 27th, 2020 and April 28th, 2021 [in regular epidemic prevention and control period (REPCP)]. The general information, sources, reasons for referral, disease spectrum and triage levels of patients in the three periods were compared. Results There were 3993, 2252 and 1851 cases before epidemic, during epidemic, and in REPCP, respectively. The differences in gender and age among the three periods were not statistically significant (P>0.05). The percentage of referrals from tertiary hospitals in each period was 74.00%, 72.65%, and 76.12%, respectively, which was higher in REPCP than that during epidemic (P<0.05). The percentage of direct referrals from emergency department in each period was 41.00%, 42.14%, and 44.46%, respectively, which was higher in REPCP than that before epidemic (P<0.05). The percentage of two-way referrals in each period was 37.79%, 36.63%, and 34.36%, respectively, which was lower in REPCP than that before epidemic (P<0.05). During epidemic and in REPCP, the proportions of referrals due to “need for surgery” (24.72%, 27.84%, and 28.74%, respectively) and “request by family members” (49.64%, 53.33%, and 56.24%, respectively) increased compared with those before epidemic (P<0.05), while the proportion of referrals due to “critical illness” decreased compared with that before epidemic (40.20%, 35.21%, and 33.17%, respectively; P<0.05); the proportion of referrals due to “diagnosis unknown” decreased in REPCP compared with that before epidemic (15.50%, 13.90%, and 11.89%, respectively; P<0.05). The proportion of acute aortic syndromes in REPCP increased compared with that during epidemic (3.46%, 2.98%, and 4.65%, respectively; P<0.05), the proportion of trauma in REPCP increased compared with that before epidemic (13.72%, 15.76%, and 17.77%, respectively; P<0.05), and the proportion of pneumonia/acute exacerbation of chronic obstructive pulmonary disease during epidemic and in REPCP decreased compared with that before epidemic (8.44%, 3.73%, and 3.84%, respectively; P<0.05). The proportion of critically ill patients referred in each period was 72.88%, 75.58%, and 79.15%, respectively, which was the highest in REPCP (P<0.05). Conclusions The epidemic has a significant impact on emergency ambulance referrals, and emergency triage needs to be continuously optimised and improved in staff, facilities, processes and management. It is necessary to further improve the implementation of hierarchical diagnosis and treatment, strengthen information communication between referral and emergency departments of receiving hospitals, and improve referral efficiency.
Objective To explore and implement a systematic, case guided online interactive training course for neurologists to improve their diagnosis and treatment of rare genetic diseases. Methods Doctors who participated in the course investigation of the neurogenetic project of the Department of Neurology of Peking Union Medical College Hospital between January and September 2021 were selected. Based on andragogy theory, a genetics training course for neurologists was developed by applying Kern’s six steps of curriculum development. According to the time of participating in the doctor’s courses, they were divided into three groups: completed all courses (10.7 h group), completed more than 1/2 courses (5.3～10.7 h group) and completed less than 1/2 courses (<5.3 h). According to the length of service, they were divided into groups of less than 10 years, 10-20 years and more than 20 years. Analyze the benefit difference of different doctors’ training time, and collect their feedback scales on the curriculum for the improvement of follow-up courses. Results A total of 54 doctors were included. Among them, 17 (31.5%) completed all courses, 29 (53.7%) completed more than 1/2 courses, and 8 (14.8%) completed less than 1/2 courses. There was a statistically significant difference among the three groups in the self-assessment improvement score (H=12.341, P=0.002). The results of pairwise comparison between groups of self-assessment improvement score showed that the <5.3 h group was lower than that of the 10.7 h group (P=0.007), and the the <5.3 h group was also lower than that of the 5.3～10.7 h group (P=0.002). 33 (61.1%) in the less than 10 years group, 16 (29.6%) in the 10-20 years group, and 5 (9.3%) in the more than 20 years group. There was no correlation between participating in work and course time (rs=0.113, P=0.418). 54 (100.0%) believed that they had more than moderate help (≥3 points). Most doctors (>90%) had a good evaluation of the curriculum. Conclusion The periodic neurogenetic re-education project is helpful for clinical diagnosis and treatment of rare neurogenetic diseases.
