BACKGROUND:Traumatic aortic dissection(TAD)has a low incidence but extremely high mortality.It always presents atypical clinical manifestations that are easily missed or misdiagnosed.This study mainly aims to describe the imaging characteristics and management of TAD patients.METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020.Demographic features,imaging characteristics,and management were analyzed.RESULTS:Twenty-seven patients with type B aortic dissection(age 56.04±16.07 years,20 men)were included.Aortic intimal tears were mostly initiated from the aortic isthmus.The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature(1.78±0.56 cm vs.1.24±0.52 cm,P=0.031).Compared with those in the control group,the maximum diameters of the aortic arch,thoracic aorta,and abdominal aorta in the TAD patients were all significantly widened(all P<0.050).Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD,with a predictive value with an area under the receiver operating characteristic curve(AUC)of 0.673.Finally,26 patients successfully underwent delayed thoracic endovascular aortic repair(TEVAR),and the remaining one patient was treated conservatively.No progression of aortic dissection or death occurred during the six-month follow-up period.CONCLUSIONS:In blunt trauma,the aortic isthmus is the most common site of proximal intimal tears.An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics.Delayed TEVAR might be an eff ective therapeutic option for TAD.
Objective： To investigate the effects of resuscitation with normal saline（NS）, hypertonic saline（HTS）, and hydroxyethyl starch（HES） on regulatory T cells（Tregs）, helper T 1（Th1）/Th2 and cytotoxic T 1（Tc1）/Tc2 profiles in the treatment of hemorrhagic shock. Methods： Rats subjected to severe hemorrhagic shock were resuscitated for 30 min with NS（n=8）, HTS（n=8）, or HES（n=8）; sham（n=8） and naive control（n=8） groups were used for comparison. Following fluid resuscitation, the whole shed blood was reinfused for 30 min, and the rats were observed with continuous hemodynamic monitoring for 120 min. CD4^＋CD25^＋Foxp3^＋ Treg proportions, Th1/Th2 and Tc1/Tc2 profiles in spleen were analyzed by three-color flow cytometry. Results： The proportion of CD4^＋CD25^＋Foxp3^＋ Tregs and ratios of Th1/Th2 and Tc1/Tc2 did not differ among control, sham, and HTS groups, but were significantly lower in NS and HES groups（both P0.05 vs. sham）; NS and HES levels were similar. The level of Tc1 was significantly increased in HTS（P0.05 vs. sham）, and levels of Tc2 were increased in NS, HES, and HTS groups compared to sham（all P0.05）, but did not differ from each other. Conclusions： HTS resuscitation has a greater impact on immune system recovery than NS or HES by preserving the proportion of Tregs and maintaining the balance between Th1/Th2 and Tc1/Tc2 cells in the spleen. Thus, HTS resuscitation provides potential immunomodulatory activity in the early stage after hemorrhagic shock.
Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and hydroxyethyl starch （HES）. Methods： BALB/c mice were randomly divided into control, NS, HTS, and HES resuscitation groups. Three subgroups （n=8） in each resuscitation group were marked as 2, 24, and 72 h. Flow cytometry was used to detect the MDSCs, monocytic MDSCs （M-MDSCs）, and granulocytic/neutrophilic MDSCs （G-MDSCs） in peripheral blood nucleated cells （PBNCs）, spleen single-cell suspension, and bone marrow nucleated cells （BMNCs）. Results： The MDSCs in BMNCs among three resuscitation groups were lower 2 h after shock, in PBNCs of the HTS group were higher, and in spleen of the NS group were lower （all P〈0.05 vs. control）. The M-MDSC/G-MDSC ratios in PBNCs of the HTS and HES groups were lower （both ,P〈0.05 vs. control）. At 24 h, the MDSCs in PBNCs of the NS and HTS groups were higher, while the spleen MDSCs in the HTS group were higher （all P〈0.05 vs. control）. The M-MDSC/ G-MDSC ratios were all less in PBNCs, spleen, and BMNCs of the NS and HTS groups, and were lower in BMNCs of the HES group （all P〈0.05 vs. control）. At 72 h, the elevated MDSCs in PBNCs were presented in the HTS and HES groups, and in spleen the augment turned up in three resuscitation groups （all P〈0.05 vs. control）. The inclined ratios to M-MDSC were exhibited in spleen of the NS and HTS groups, and in PBNCs of the NS group; the inclination to G-MDSC in BMNCs was shown in the HES group （all P〈0.05 vs. control）. Conclusions： HTS induces the earlier ele- vation of MDSCs in peripheral blood and spleen, and influences its distribution and differentiation, while HES has a less effect on the distribution but a stronger impact on the differentiation of MDSCs, especially in bone marrow.
Background Hemorrhagic shock is usually associated with complicated immune and inflammatory responses, which are sometimes crucial for the prognosis. As regulators of the immune and inflammatory system; proliferation, migration, distribution and activation of myeloid-derived suppressor cells （MDSCs） are intimately linked to the inflammation cascade. Methods In a model of severe hemorrhagic shock, thirty-five rats were randomly divided into control, sham, normal saline resuscitation （NS）, hypertonic saline resuscitation （HTS）, and hydroxyethyl starch resuscitation （HES）, with seven in each group. MDSCs were analyzed by flow cytometric staining of CD11b/c＊Gra~ in peripheral blood mononuclear cells （PBMC）, spleen cell suspensions, and bone marrow nucleated cells （BMNC）. Simultaneously, the expressions of arginase-1 （ARG-1） and inducible nitric oxide synthase （iNOS） mRNA in MDSCs were evaluated by quantitative reverse transcription-polymerase chain reaction （qRT-PCR）. Results In the early stage after hemorrhagic shock, fluid resuscitation and emergency treatment, the MDSCs in the PBMC of NS, HTS and HES groups markedly increased, and MDSCs in BMNC of these groups decreased accordingly, significantly different to the control group. In hemorrhagic shock rats infused with HTS at the early resuscitation stage, MDSCs in PBMC increased about 2 and 4 folds, and MDSCs in BMNC decreased about 1.3 and 1.6 folds, as compared to the sham group respectively, with statistically significant difference. Furthermore, compared to the NS and HES groups, the MDSCs in PBMC of HTS group increased 1.6 and 1.8 folds with statistically significant differences; the MDSCs decrease in BMNC was not significant. However, there was no statistically significant difference in MDSCs of spleen among the five groups. In addition, compared to the control, sham, NS and HES groups, the ARG-1 and iNOS mRNA of MDSCs in PBMC, spleen and BMNC in the HTS group had the highest level of expression, but no statistically signi
LU Yuan-qiangGU Lin-huiZHANG QinJIANG Jiu-kunMOU Han-zhou
Objective: To provide comprehensive data to understand mechanisms of vascular endothelial cell(VEC) response to hypoxia/re-oxygenation. Methods: Human umbilical vein endothelial cells(HUVECs) were employed to construct hypoxia/re-oxygenation-induced VEC transcriptome profiling. Cells incubated under 5% O2, 5% CO2, and 90% N2 for 3 h followed by 95% air and 5% CO2 for 1 h were used in the hypoxia/re-oxygenation group. Those incubated only under 95% air and 5% CO2 were used in the normoxia control group. Results: By using a well-established microarray chip consisting of 58 339 probes, the study identified 372 differentially expressed genes. While part of the genes are known to be VEC hypoxia/re-oxygenation-related, serving as a good control, a large number of genes related to VEC hypoxia/re-oxygenation were identified for the first time. Through bioinformatic analysis of these genes, we identified that multiple pathways were involved in the reaction. Subsequently, we applied real-time polymerase chain reaction(PCR) and western blot techniques to validate the microarray data. It was found that the expression of apoptosis-related proteins, like pleckstrin homology-like domain family A member 1(PHLDA1), was also consistently up-regulated in the hypoxia/re-oxygenation group. STRING analysis found that significantly differentially expressed genes SLC38A3, SLC5A5, Lnc-SLC36 A4-1, and Lnc-PLEKHJ1-1 may have physical or/and functional protein–protein interactions with PHLDA1. Conclusions: The data from this study have built a foundation to develop many hypotheses to further explore the hypoxia/re-oxygenation mechanisms, an area with great clinical significance for multiple diseases.
Jia XUJiu-kun JIANGXiao-lin LIXiao-peng YUYing-ge XUYuan-qiang LU
Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.Methods:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected.Patients were divided into two groups depending on how their disease was detected.Group A(n=85):Patients were diagnosed with pancreatic cancer in clinic visits.Group B(n=72):Patients were diagnosed with pancreatic cancer in routine check-ups.We compared their prognosis.Results:The tumor stage in group B was earlier than that in group A.The 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P<0.001),while the 3-and 5-year survival rates of the two groups showed no significant difference(P>0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival rate.However,early intervention did not improve overall survival in the long-term.
