ObjectiveTo analyze the characteristics of platelet changes and their influencing factors during postoperative hospitalization in patients who underwent transcatheter aortic valve implantation (TAVI). MethodsThe patients who underwent TAVI at Beijing Anzhen Hospital Valve Surgery Center between March 2017 and October 2021 were retrospectively selected. The patients were divided into a self-limiting group and a non-self-limiting group according to the characteristics of postoperative platelet decline. In addition, the general preoperative data, preoperative and postoperative ultrasound data, intraoperative data, and the use of anticoagulant drugs during the postoperative stay in the hospital were compared between the two groups. ResultsA total of 249 patients were enrolled in this study. There were 175 (70.3%) patients in the self-limiting group, including 100 males and 75 females, and there were 74 (29.7%) patients in the non-self-limiting group, including 43 males and 31 females, with no statistical difference between the two groups (P=0.863). The mean age of patients was 73.11±8.88 years in the self-limiting group and 71.54±10.39 years in the non-self-limiting group (P=0.231). The decline of platelets in the self-limiting group generally occurred on the postoperative day 2 and reached the lowest count on the postoperative day 4, and returned to the baseline level on the postoperative day 5-7, while the platelets in the non-self-limiting group changed by simple rise, fall or irregular fluctuation. Patients in the self-limiting group had severer preoperative aortic stenosis (P<0.001) and used more extracorporeal circulation assistance during surgery (P<0.001). Postoperatively, patients in the self-limiting group were more likely to have periaortic valve leakage than those in the non-self-limiting group (P=0.013). ConclusionPlatelet changes in most patients after TAVI show a self-limiting decline, which may be related to the severity of patients’ preoperative aortic stenosis, intraoperative extracorporeal circulation device use, and postoperative perivalvular leakage.
ObjectiveTo investigate the early effects of acellular xenogeneic nerve combined with adipose-derived stem cells (ADSCs) and platelet rich plasma (PRP) in repairing facial nerve injury in rabbits.MethodsThe bilateral sciatic nerves of 15 3-month-old male Sprague-Dawley rats were harvested and decellularized as xenografts. The allogeneic ADSCs were extracted from the neck and back fat pad of healthy adult New Zealand rabbits with a method of digestion by collagenase type Ⅰ and the autologous PRP was prepared by two step centrifugation. The 3rd generation ADSCs with good growth were labelled with CM-Dil living cell stain, and the labelling and fluorescence attenuation of the cells were observed by fluorescence microscope. Another 32 New Zealand rabbits were randomly divided into 4 groups and established the left facial nerve defect in length of 1 cm (n=8). The nerve defects of groups A, B, C, and D were repaired with CM-Dil-ADSCs composite xenogeneic nerve+autologous PRP, CM-Dil-ADSCs composite xenogeneic nerve, xenogeneic nerve, and autologous nerve, respectively. At 1 and 8 weeks after operation, the angle between the upper lip and the median line of the face (angle θ) was measured. At 4 and 8 weeks after operation, the nerve conduction velocity was recorded by electrophysiological examination. At 8 weeks after operation, the CM-Dil-ADSCs at the distal and proximal ends of regenerative nerve graft segment in groups A and B were observed by fluorescence microscopy; after toluidine blue staining, the number of myelinated nerve fibers in regenerated nerve was calculated; the structure of regenerated nerve fibers was observed by transmission electron microscope.ResultsADSCs labelled by CM-Dil showed that the labelling rate of cells was more than 90% under fluorescence microscope, and the labelled cells proliferated well, and the fluorescence attenuated slightly after passage. All the animals survived after operation, the incision healed well and no infection occurred. At 1 week after operation, all the animals in each group had different degrees of dysfunction. The angle θ of the left side in groups A, B, C, and D were (53.4±2.5), (54.0±2.6), (53.7±2.4), and (53.0±2.1)°, respectively; showing significant differences when compared with the healthy sides (P<0.05). At 8 weeks after operation, the angle θ of the left side in groups A, B, C, and D were (61.9±4.7), (56.8±4.2), (54.6±3.8), and (63.8±5.8)°, respectively; showing significant differences when compared with the healthy sides and with the values at 1 week (P<0.05). Gross observation showed that the integrity and continuity of regenerated nerve in 4 groups were good, and no neuroma and obvious enlargement was found. At 4 and 8 weeks after operation, the electrophysiological examination results showed that the nerve conduction velocity was significantly faster in groups A and D than in groups B and C (P<0.05), and in group B than in group C (P<0.05); no significant difference was found between groups A and D (P>0.05). At 8 weeks after operation, the fluorescence microscopy observation showed a large number of CM-Dil-ADSCs passing through the distal and proximal transplants in group A, and relatively few cells passing in group B. Toluidine blue staining showed that the density of myelinated nerve fibers in groups A and D were significantly higher than those in groups B and C (P<0.05), and in group B than in group C (P<0.05); no significant difference was found between groups A and D (P>0.05). Transmission electron microscope observation showed that the myelinated nerve sheath in group D was large in diameter and thickness in wall. The morphology of myelin sheath in group A was irregular and smaller than that in group D, and there was no significant difference between groups B and C.ConclusionADSCs can survive as a seed cell in vivo, and can be differentiated into Schwann-like cells under PRP induction. It can achieve better results when combined with acellular xenogeneic nerve to repair peripheral nerve injury in rabbits.
ObjectiveTo prepare platelet-derived growth factor receptor β (PDGFRβ)-targeted near-infrared molecular probe and evaluate its potential in optical molecular imaging of lung cancer.MethodsPDGFRβ-specific affibody Z-tri was recombinantly expressed in Escherichia coli (E. coli) and purified using affinity chromatography. In vitro cell-binding of Z-tri was analyzed by flow cytometry. Cellular distribution of Z-tri in tumor grafts was determined by protein-tracing. The molecular probe CF750-Z-tri was prepared by conjugating near-infrared fluorescent dye CF750 to Z-tri. The optical images of xenografts of lung cancer were obtained by using CF750-Z-tri combined with optical imaging system.ResultsPDGFRβ-specific affibody Z-tri was highly expressed in E. coli and purified to homogeneity. Z-tri could bind PDGFRβ-positive cells but not PDGFRβ-negative cells cultured in vitro. In the tumor xenografts of human lung cancer, intravenously injected Z-tri was predominantly distributed on cells overexpressing PDGFRβ. The near infrared fluorescent dye CF750 was efficiently conjugated to Z-tri. Optical images with high contrast of lung cancer xenografts were produced by using the near-infrared fluorescent probe CF750-Z-tri combined with optical imaging system.ConclusionThe near-infrared fluorescent probe CF750-Z-tri can be used for optical imaging of human lung cancer, which takes great potential in optical imaging-guided surgery of lung cancer.
Objective The use of autologous platelet-rich gel (APG) is a relatively new technology and a promising treatment method for infections, which is currently being used by a variety of surgical specialties. The mechanism of antibacterialeffect of APG is not yet fully discovered. Subsequent evidence suggests that platelets have multi ple functional attributes inantimicrobial host defense (including the capacity to generate antimicrobial oxygen metabol ites and the antimicrobial peptides) and interact directly with microorganisms, contribute to clearance of pathogens from the blood. To investigate the bacteriostasis of APG against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa in vitro. Methods Platelet-rich plasma (PRP) and platelet-poor plasma (PPP) were obtained from whole blood of 17 healthy donors. APG was prepared by mixing PRP with bovine thrombin in a 10% calcium gluconate solution or bovine thrombin in a 10% calcium gluconate solution and apocynin (APG-APO). Antibacterial effects of APG, PRP, and APG-APO on Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were evaluated by bacteriostasis assay. Results The culture results showed apparent decrease in the number of Staphylococcus aureus for both APG and APG-APO, which was maximal at first 4 hours and lasted to 24 hours and 8 hours, respectively; showing significant difference (P lt; 0.05) when compared APG with PRP and PPP, however no significant difference at first 8 hours (P gt; 0.05) and significant difference at 12 and 24 hours (P lt; 0.05) when compared APG with APG-APO; showing significant difference at first 4 hours (P lt; 0.05), no significant difference at 6, 8, 12, and 24 hours when compared APG-APO with PRP and PPP (P gt; 0.05). The bacteriostasis rates of APG and APG-APO were 27.36%-52.97% and 18.82%-51.52% against Escherichia coli, respectively; showing no significant difference (P gt; 0.05) when compared with PRP. The bacteriostasis rates of APG and APG-APO were less than 35% against Pseudomonas aeruginosa, showing no significant difference (P gt; 0.05) when compared with PRP; the bacteriostasis rates of PRP were less than 15% against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Conclusion APG may have potential bacteriostatic effect against Staphylococcus aureus by platelet mediating. Either APG or APG-APO has no obvious bacteriostatic effect against Escherichia coli or Pseudomonas aeruginosa. PRP has no antibacterial activity against Staphylococcus aureus, Escherichia coli or Pseudomonas aeruginosa.
The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.
Objective To determine the effectiveness and safety of autologous platelet-rich gel in the management of diabetic foot ulcer. Methods We searched Cochrane Central Register of Controlled Trails (CENTRAL), MEDLINE or PubMed, EMbase, OVID Database, Chinese Biological Medicine Database (CBMDisc), CNKI, Chinese VIP Database and WANFANG Database. We also handsearched the bibliographies of retrieved articles and correlated proceedings. The systematic review was conducted using the method recommended by the Cochrane Collaboration. Results Four trials involving 216 patients were included. Meta-analyses showed (1) Diabetic foot ulcer healing rate: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (2) Diabetic foot ulcer reduction rate: Autologous platelet-rich gel was superior to the standard care (P=0.000 3); (3) Diabetic foot ulcer healing time: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (4) Complications: No patient in these trials had complications. Conclusions The limited current evidence shows that autologous platelet-rich gel is safe and effective in the short-term treatment for diabetic foot ulcer.
Objective To observe the serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), platelet 5-HT and blood platelet count, emotion and burn injury healing of patients with moderate and severe burn injury and anxiety-depression symptoms. Methods In-patients with moderate and severe burn injury were selected from 2003.4 to 2005.2 and then divided into anxiety-depression group and control group according to their anxiety-depression scores by Hamilton Rating Scale for Depression (HAMD ) and Hamilton Rating Scale for Anxiety (HAMA) 3 days after being burnt. Routine therapy was given to two groups, which lasted 1 month. Their scores of anxiety and depression and the degree of injury healing were observed, and the serum levels of TNF-α and IL-6, platelet 5-HT and blood platelet count were measured in the two groups. Results Fifty-one in-patients with moderate and severe burn injury were divided into the anxiety-depression group (24 cases) and the control group (27 cases). After 30-day treatment, the depression scores did not decrease in the anxiety-depression group (P=0.12), but the anxiety scores decreased (P=0.00). In the anxiety-depression group, the burn injury healing time was postponed (P=0.00), the serum levels of TNF-α increased (P=0.00), and the platelet 5-HT levels decreased (P=0.04) before and after treatment. Conclusion Depressive reaction occurs in patients with moderate and severe burn injury, which is a continuously negative emotion. It can lead to high levels of serum TNF-α, reduction in platelet 5-HT, and delayed burn injury healing time. Due to the limited sample size and different location of patients, there may be some bias in this conclusion. We are prepared to increase the sample size and select patients in the same region in further relevant studies.
ObjectiveTo investigate the prognostic value of platelet volume indices ［mean platelet volume (MPV) and platelet distribution width (PDW)］ in early period for patients with sepsis .MethodsThis retrospective study was conducted in a general ICU at a University Hospital from January 2015 to January 2017. Patients with sepsis were divided into a survival group and a death group according to 28-day prognosis. The demographic and clinical data were recorded and analyzed, including platelet indices, Charlson comorbidity index, Glasgow Coma Scale (GCS) score and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score. Multivariable COX proportional hazard ratio model was used to evaluate the 28-day mortality risk, and receiver operating characteristic (ROC) curve were used to evaluate the value of platelet volume indices.ResultsA total of 209 patients were enrolled in this study. Mean arterial pressure, pH, platelet count, serum creatinine, bilirubin, troponin I, prothrombin time, GCS score and platelet volume indices showed significant differences between the survival group (n=137) and the death group (n=72) (all P<0.05). Multivariable COX regression analysis revealed that the PDW was independently associated with 28-day mortality in sepsis (HR=1.068, 95%CI 1.002-1.139, P=0.043). The area under the ROC curve of PDW was 0.762 (95%CI 0.694 - 0.831), with a sensitivity of 86% and a specificity of 63% at a cut-off value of 18.65%.ConclusionPDW can be used as a powerful prognostic indicator in patients with sepsis following 28-day.
Objective To investigate the clinical characteristics and pathogen distribution of community-acquired pneumonia (CAP) combined with type 2 diabetes mellitus (T2DM), based on bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) test. Methods In this cross-sectional study, CAP patients with BALF mNGS test were screened from April 2023 to April 2024. The patients were divided into a single CAP group (CAP group) and a CAP combine with T2DM group (CAP+T2DM group). The data of demographics, underlying diseases, complications, and laboratory tests including blood routine, inflammatory parameters, liver and renal functions, random blood glucose (RGB), hemoglobin A1C (HbA1c), and BALF mNGS tests were collected and compared between the two groups. Results Ultimately, 86 patients were included, with 45 in the CAP group and 41 in the CAP+T2DM group. Compared with the CAP group, the CAP+T2DM group had higher platelet count [(272.44±128.57)×109/L vs. (215.00±100.06)×109/L], erythrocyte sedimentation rate [(75.63±35.19) vs. (59.69±34.47) mm/h], RGB [10.8 (9.1, 13.5) vs. 6.5 (5.8, 7.8) mmol/L], HbA1c [8.2% (7.3%, 8.5%) vs. 5.7% (5.5%, 6.1%)], and fungi infection rate (65.9% vs. 40.0%), and the differences were statistically significant between the two groups (P<0.05). Conclusion CAP patients with T2DM have increased levels of platelet and erythrocyte sedimentation rate, and are at higher risk for fungi infection, which potentially leads to worse outcome.
Objective To investigate the relationship between preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) score, and clinicopathologic features of colon cancer, and to analyze the predictive value of HALP score for postoperative liver metastasis. Methods The clinical data of 163 patients with colon cancer admitted to the 909th Hospital of Joint Logistic Support Force (Dongnan Hospital of Xiamen University) from January 2018 to December 2019 were retrospectively analyzed. According to the occurrence of postoperative liver metastasis, the patients were divided into metastatic group (n=35) and non-metastatic group (n=128). The correlation between preoperative HAPL score and clinicopathologic features of colon cancer was analyzed. The predictive value of HALP score for postoperative liver metastasis of colon cancer was analyzed by using receiver operating characteristic (ROC) curve. The risk factors of liver metastasis after colon cancer surgery were analyzed by using univariate and multivariate logistic analysis. Kaplan-Meier risk curve was drawn, and log-rank test was used to analyze the predictive value of different HALP score for postoperative liver metastasis. Results HALP score were decreased in patients with maximum tumor diameter ≥5 cm, preoperative carcinoembryonic antigen (CEA) ≥5 μg/L, serous membrane and extrasserous infiltration, lymph node metastasis and vascular invasion, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that HALP score [OR=1.467, 95%CI (1.253, 1.718), P<0.001], maximum tumor diameter [OR=3.476, 95%CI (1.475, 5.358), P=0.013], preoperative CEA level [OR= 6.197, 95%CI (2.436, 6.248), P=0.005], and lymph node metastasis [OR=2.593, 95%CI (1.667, 6.759) , P=0.003] were risk factors for postoperative liver metastasis of colon cancer. ROC curve analysis showed that the area under the curve of HALP score for predicting liver metastasis after colon cancer surgery was 0.908 (0.841, 0.974), the maximum value of the Youden index was 0.738, the optimal cut-off value of the HALP score was 35.5, the sensitivity was 0.852, the specificity was 0.886. Kaplan-Meier risk curve showed that the risk of early postoperative liver metastasis in the low HALP score group was higher than that in the high HALP score group (χ2=8.126, P=0.004). Conclusion Low HALP score in patients with colon cancer is associated with adverse prognosisi related pathological features, and is an influential factor for postoperative liver metastasis of colon cancer, and has predictive value for patients with postoperative liver metastasis of colon cancer.