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BACKGROUND We performed a systematic review and meta-analysis of studies investigating the end-expiratory occlusion (EEO) test induced changes in cardiac index (CI) and in arterial pressure as predictors of fluid responsiveness in adults receiving mechanical ventilation. METHODS MEDLINE, EMBASE, Cochrane Database, and Chinese database were screened for relevant original and review articles. The meta-analysis determined the pooled sensitivity, specificity, diagnostic odds ratio, area under the receiver operating characteristic curve (AUROC), and threshold for the EEO test assessed with CI and arterial pressure. In addition, heterogeneity and subgroup analyses were performed. RESULTS We included 13 studies involving 479 adult patients and 523 volume expansion. Statistically significant heterogeneity was identified, and meta-regression indicated that prone position was the major sources of heterogeneity. After removal of the study performed in prone position, heterogeneity became nonsignificant. EEO-induced changes in CI (or surrogate) are accurate for predicting fluid responsiveness in semirecumbent or supine patients, with excellent pooled sensitivity of 92% (95% CI, 0.88-0.95, I = 0.00%), specificity of 89% (95% CI, 0.83-0.93, I = 34.34%), and a summary AUROC of 0.95 (95% CI, 0.93-0.97). The mean threshold was an EEO-induced increase in CI (or surrogate) of more than 4.9 ± 1.5%. EEO test exhibited better diagnostic performance in semirecumbent or supine patients than prone patients, with higher AUROC (0.95 vs. 0.65; P

This study investigated the sex-specific differences in the correlation between intestinal microbiota and end-stage renal disease. Here, we compared the differences in the gut microbiota of male and female healthy controls (HC) and patients with end-stage renal disease (ESRD) caused by immunoglobulin A (IgA) nephropathy (ESRD-IgAN) or type-2 diabetes mellitus (ESRD-T2DM) using high-throughput sequencing of the 16S rRNA gene. We also analyzed the correlation between gut microbiota and clinical immune indicators. We assigned 8, 10, 5, 7, 11, and 20 volunteers to female HC, ESRD-IgAN, and ESRD-T2DM, and male HC, ESRD-IgAN, and ESRD-T2DM, respectively. The results showed sex-specific differences in both physiological and biochemical indices and intestinal microbiota composition, as well as the correlation between them. The correlations between physiological and biochemical indices in men were significantly lower than those in women, especially for indices related to immunity, blood glucose, and cardiac color sonography. Urine output, lymphocyte ratio, serum albumin, blood calcium, dialysis status, serum urea nitrogen, urine protein, and diabetes significantly correlated with male fecal microbiota composition, whereas only creatinine and 2-h post-prandial blood glucose significantly correlated with female fecal microbiota composition. The top 50 dominant operational taxonomic units showed a stronger correlation with physiological and biochemical indices in samples obtained from females than from males. These differences highlight sex-specific differences in the effectiveness of ESRD prevention and treatments via regulating intestinal microbiota.

BACKGROUND Synovial sarcoma (SS), a rare malignant soft tissue tumor whose histological origin is still unknown, often occurs in limbs in young people and is easily misdiagnosed. CASE SUMMARY We report a 24-year-old man who sought treatment for plantar pain thought to be caused by a foot injury that occurred 4 years prior. Currently, he had been seen at another hospital for a 1-wk history of unexplained pain in the left plantar region and was treated with acupuncture, a kind of therapy of Chinese medicine, which partly relieved the pain. Because of this, the final diagnosis of biphasic SS was made after two subsequent treatments by pathological evaluation after the last operation. SS is rarely seen in the plantar area, and his history of a left plantar injury confused the original diagnosis. CONCLUSION This study shows that pathological and imaging examinations may play a vital role in the early diagnosis and treatment of SS.

This study designed a new type of double-pin external fixator for temporary fixation of unstable ankle fractures, and the safety and effectiveness of this fixation method were explored. Cases were included in patients with ankle fractures treated in the Department of Traumatology and Orthopedics at Peking University People's Hospital from February 2016 to February 2020. Two groups of cases were obtained (cast group, n=19; double-pin external fixator group, n=21). All cases received the same postoperative care, and the VAS score before and after temporary fixation, the maintenance of fracture reduction, the complications of temporary fixation and the interval time were recorded. All patients completed follow-ups. There were 4 cases and 0 cases of complications in the cast and double-pin external fixator groups respectively. 6 cases and 1 case each had a loss of reduction in the cast and double-pin external fixator groups respectively. There was no difference in interval time for final open reduction with internal fixation between the two groups. The post-fixation VAS score of the double-pin external fixator group was significantly lower than that of the cast group. This technique is a simple, safe, and effective treatment for the temporary reduction of unstable ankle fractures with double-pin external fixator which can relieve patients' pain, effectively maintain the length of the lateral malleolus, and create good soft tissue conditions for elective surgery under the state of grasping the indications strictly.

Background To investigate the application of the superior mesenteric artery (SMA) for the in vitro reconstruction of the hepatic artery for liver transplantation, and to improve the success rate and safety of donor liver transplantation. Methods The donor liver and the pancreas were obtained, and the SMA and its branches were used to reconstruct the hepatic artery. Liver transplantation was performed after reconstruction to understand the intraoperative situation after donor liver opening, as well as postoperative liver function. Color Doppler ultrasound of the transplanted liver was also performed. Results During the period from September 2016 to March 2020, a total of 98 pancreases were obtained. The common hepatic artery and gastroduodenal artery loop (CHA-GDA) were preserved to the donor pancreas, and only the proper hepatic artery (PHA) or left/right hepatic artery (LHA/RHA) were preserved to the donor liver. If the PHA of the donor liver was short or absent, the SMA was used for lengthening the PHA or in vitro reconstruction of the LHA/RHA, followed by implantation of the donor liver after reconstruction. A total of 17 cases of this type of donor liver required mesenteric artery lengthening or reconstruction. After opening, the donor liver was well-filled, bile secretion was normal, and liver function recovered as scheduled after surgery. Color Doppler ultrasound and CT angiography (CTA) of the transplanted liver revealed that hepatic arteries were normal without complications such as hepatic artery embolism. Conclusions In vitro reconstruction of the hepatic artery with the SMA is an effective new method of vascular reconstruction, which ensures the blood flow of the hepatic artery, reduces the anastomosis difficulty of the arteries of the donor liver, and reduces the occurrence of vascular complications.

BACKGROUND: To explore the impact of the use of vasoactive drugs in donation after cardiac death (DCD) donors on graft function, with an attempt to guide the clinical practices of organ preservation and DCD kidney transplantation. METHODS: The clinical data of 187 DCD donors and 304 recipients who were operated on in our center from February 2018 to May 2019 were retrospectively analyzed. Based on whether vasoactive drugs were used for maintaining blood pressure in DCD donors, the renal donors and recipients were divided into a high-dose group (norepinephrine ≥1.3 µg/kg/min or in combination with dopamine), a low-dose group (norepinephrine 0.05). Blood urea nitrogen (BUN) on the 1st postoperative days was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P0.05). The incidence of delayed graft function (DGF) after renal transplantation was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P0.05). CONCLUSIONS: The use of vasoactive drugs in DCD donors can affect the early recovery of renal function in renal transplant recipients, particularly for those donors who are administered a high dose of vasoactive drugs. Therefore, donor maintenance should be performed cautiously with vasoactive drugs.

First metatarsophalangeal (MTP) arthrodesis is commonly used to treat many end-stage first MTP diseases. The most widely used scale for measuring the clinical outcomes after this procedure, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal scale, has not been adequately validated and does not measure specific foot functions. Another outcome measure, the patient-reported Foot and Ankle Outcome Score (FAOS) has acceptable construct validity but poor content validity. The FAOS scale has 42 questions, many of which are unrelated to the hallux. We designed a short-form FAOS (sf-FAOS) consisting of 11 questions that are more relevant to first MTP arthrodesis. The sf-FAOS includes a pain subscale and a function subscale, and the score of each subscale ranges from 0 (worst outcome) to 100 (best outcome). Our study has shown that the sf-FAOS scale has acceptable validity, reliability, and responsiveness. In 21 feet (16 patients) with hallux valgus after1 year of follow-up, the mean sf-FAOS pain score had improved by 44.9 points after surgery (from 51.2 to 96.0; p .001), and the mean sf-FAOS function score had improved by 22.5 points (from 47.3 to 69.8; p .001). The improvement in the function score for running and jumping was limited.

Background: In this paper, the regular flow of ultrasound-guided renal allograft biopsies was established by analyzing complications and clinical management principle of ultrasound-guided renal allograft biopsies, to increase the safety of ultrasound-guided renal allograft biopsies. Methods: The purpose of this study was to analyze the cases of ultrasound-guided renal allograft biopsies in our hospital from January 2006 to October 2018 because of abnormal renal function (including symptoms of albuminuria and elevated serum creatinine). The type of puncture needle used in renal allograft biopsies, the number of puncture needle and the relationship between puncture needle and complication were counted, and the treatment measures were analyzed. Results: From January 2006 to October 2018, a total of 487 patients underwent ultrasound-guided renal allograft biopsies in our hospital. Among them, the successful sampling rate was 98.8%, and the average number of glomeruli per specimen was 15.24±2.26. The complications of the patient after puncture included: perirenal hematomas, subcapsular hematomas, acute ureter obstruction caused by hematuria, gross hematuria, and microscopic hematuria. Among them, two patients were treated with open surgery to save the function of renal transplantation, and the primary treatment measures were to increase the absolute bed rest time. The symptoms of the patients were relieved after treatment. Conclusions: The analysis showed that ultrasound-guided renal allograft biopsies are safe and feasible, and the analysis of the biopsies of patients can provide meaningful pathological information for the clinic.

BACKGROUND: Transesophageal echocardiography (TEE) performed by intensivists is increasingly used in critically ill patients. However, TEE is usually not the preferred monitoring tool, especially when transthoracic echocardiography (TTE) appears to have addressed the clinical problems. As a result, it remains largely unknown whether TEE is a clinically valuable replacement or supplement for TTE as a primary tool in evaluating haemodynamic problems in critically ill surgical patients. The purpose of this study was to assess the diagnostic and therapeutic value of TEE instead or in addition to TTE in critically ill surgical patients with hemodynamic instability. METHODS: A prospective observational study was conducted. A total of 68 consecutive patients were enrolled from December 2016 to February 2018. TEE was routinely performed in addition to TTE, and the imaging data from TTE and TEE were successively disclosed to two different primary physicians, who reported any resulting changes in management. The two physicians were required to reach a consensus if there was any disagreement. The results of the additional TEE examination were compared with the clinical findings and TTE information. The image quality of TTE views was classified as a good (score 2), suboptimal (score 1) or poor view (score 0). According to the scores of TTE images, the patients were divided into two groups: patients with adequate TTE views (score ≥6) and inadequate TTE views (score

Icariin is the major active ingredient of Herba Epimedii. Icaritin (ICT) is a hydrolytic product of Icariin. In the present study, we investigated the protective role of ICT against cigarette smoke extract (CSE)-mediated oxidative stress in human lung epithelial A549 cells. As demonstrated by the WST-8 assay, exposure to CSE (2.5%, 5%, and 10%) reduced the cell viability of A549 cells (84%, 64% and 53%) in a dose-dependent manner and treatment with ICT 10 μM dramatically attenuated CSE induced cytotoxicity (73% and 64%). The MFI data suggested that CSE induced oxidative stress by generating ROS (230) and 10 μM ICT treatment attenuated CSE-induced ROS production (90). 10 μM ICT treatment resulted in significant AKT activation, Nrf2 nuclear translocation, increased GCL transcription and GSH levels, as compared with CSE exposure alone. However, ICT-mediated upregulation of GCL transcription in CSE-treated cells were lost in Nrf2 siRNA-transfected cells. Furthermore, inhibition of PI3K/AKT signaling by LY294002 partially prevents ICT-induced nuclear translocation of Nrf2 and GCL transcription. These findings suggest that ICT attenuates CS-induced oxidative stress by quenching ROS and also by upregulating GSH via a PI3K-AKT-Nrf2-dependent mechanism. Further studies are required to confirm that a similar protective effect of ICT occurs in the lungs in vivo in response to CS exposure.

Numerous epidemiological and experimental animal studies have indicated that chronic psychological stress may promote tumor development. However, the underlying molecular mechanisms by which chronic stress promotes tumorigenesis remain to be fully elucidated and animal models have not yet been well established. In the present study, an established mouse model of repeated social defeat stress (RSDS), was generated and used to investigate the effect of stress on tumor growth and metastasis. C57BL/6 mice were exposed to RSDS for 10 days, followed by subcutaneousl inoculation with Lewis lung carcinoma cells for seven days. The tumor weight and volume as well as the number of the lung metastatic nodules were then determined. Vascular endothelial growth factor (VEGF) serum levels were measured using ELISAs. In addition, expression levels of VEGF receptor (VEGFR) and L1 cell adhesion molecule (L1CAM) messenger (m)RNA were confirmed using reverse transcription quantitative polymerase chain reaction. Furthermore, protein expression levels of phosphorlyated extracellular signal-regulated kinase (pERK), matrix metalloproteinase (MMP)-2 and MMP-9 were examined using western blot analysis. The results showed that RSDS significantly increased the weight and the volume of the primary tumor as well as the number of the lung metastatic nodules. Serum VEGF levels were significantly higher in the tumor-stress group compared with those of the unstressed tumor mice. In addition, tumors in stressed animals demonstrated markedly enhanced expression of VEGFR-2 and L1CAM mRNA as well as pERK, MMP-2 and MMP-9 protein expression. In conclusion, these results suggested that RSDS contributed to lung cancer progression, angiogenesis and metastasis, which was partially associated with increased VEGF secretion and therefore the activation of the ERK signaling pathway, resulting in the induction of MMP-2 and MMP-9 protein expression.