The common morphology and clinical significance of the axillary arch / 中华外科杂志

Axillary arch is the most common type of axillary muscle fiber variation, with about 10.8% incidence in the Chinese population. Its natural forms are varied and fluid, with different starting points and terminations, and clinicians frequently lack recognition. Under commonly applicated sentinel lymph node biopsy, the axillary arch has been endowed with more clinical significance. The fabric of axillary arch will not only block lymphatic drainage in axilla and unclear anatomical level of axillary dissection, but also compress the axillary neurovascular bundle, causing upper limb venous thrombosis, lymphedema and nerve entrapment. The intumescent axillary arch may also show abnormal axillary bulge. In addition to finding axillary arch during cadaveric study and operation, several of imaging methods availably diagnose axillary arch preoperative, which can create new way for detection of axillary arch and extension of the surgical plan of sentinel lymph node biopsy. Although embryology and comparative anatomy have been used to explain the origin of the axillary arch, most of the ideas are still hypotheses and need further study.

Characteristics and related factors of plantar pressure in the chronic ankle instability individuals / 北京大学学报(医学版)

OBJECTIVE@#To analyze characteristics and related factors of the plantar pressure during the level walking and single leg standing in the chronic ankle instability (CAI) individuals.@*METHODS@#From April 2019, 75 CAI individuals and 40 healthy individuals were enrolled in this study. Both of the static and dynamic plantar pressure were measured during six times level walking and three times single leg standing testing. The data including peak force, time to peak force in various foot contact areas and the time to boundary (TTB) and velocity of center of pressure (COP) were measured and compared between the affected side and the unaffected side and between the CAI cases and the healthy individuals. The correlations between the plantar pressure and the gender, Beighton score, affected side and body mass index (BMI) were analyzed.@*RESULTS@#The characteristics of plantar pressure distribution in the CAI individuals included: (1) During the level walking, the affected side showed the similar pressure contribution as the unaffected side (P>0.05). While compared with healthy individuals, there was a significantly higher peak force in the 5th metatarsal area (t=-3.86, P=0.03) of the affected side, lower peak force in the 1st (t=2.99, P=0.02), 2nd metatarsal head areas (t=2.09, P=0.01) of the affected side, medial hindfoot areas of both sides (affected, t=2.33, P=0.01; unaffected, t=3.74, P=0.02) and toes areass of both sides (affected, t=2.23, P=0.01; unaffected, t=3.28, P=0.02) and a delay to peak force in the 4th metatarsal head area (t=3.33, P=0.01) of the affected side. (2) During the single leg standing, the CAI individuals showed significantly worse balance control in the anterior/posterior direction (P < 0.05) and lateral/medial direction (P < 0.05) compared with the healthy controls, and the affected side had more severe balance control deficit in the lateral/medial direction (P < 0.05). (3) The women (P < 0.05) and the individuals with higher Beighton scores (P < 0.05) showed worse balance control deficit in the lateral/medial direction.@*CONCLUSION@#CAI individuals showed significantly a more lateral shifted plantar distribution during the level walking compared with the healthy individuals and the tendency was worse on the affected sides, and showed worse balance control in the anterior/posterior direction and lateral/medial direction during the single leg standing. The women and those with generalized ligament laxity showed significantly worse balance control.

A family report of myoclonus-dystonia caused by epsilon-sarcoglycan gene mutation / 中华神经科杂志

Objective:To analyze the clinical phenotype and gene mutation characteristics in a family of myoclonus-dystonia caused by epsilon-sarcoglycan (SGCE) gene mutation in order to improve the understanding of the disease.Methods:The clinical data of a family with myoclonus-dystonia from the Shaanxi Provincial People′s Hospital in August 2019 were collected. The proband was confirmed by generation sequencing techniques to detect possible pathogenic mutations and the Sanger test was used in the family members, and the mutation characteristics of SGCE gene were analyzed and the clinical features were summarized.Results:The proband, a 46-year-old man, presented with spasmodic torticollis accompanied with involuntary movements of the extremities (especially on the left). A gene mutation of c.1011delA at the chr7:94229984 was identified by genetic testing in the SGCE gene, which is an unreported frameshift mutation at home and abroad. Sanger sequencing revealed the same mutation site in the proband′s eldest sister, second elder brother and his grandnephew, who pessented similar symptoms as the proband including myoclonus and dystonia. The proband′s younger niece and grandniece were a mutation carrier without obvious symptoms.Conclusions:SGCE myoclonus-dystonia is a rare autosomal dominant inherited disorder characterized by the presentation of both myoclonic jerks and dystonia, which shows clinical heterogeneity and maternal imprinting. Genetic testing confirmed the diagnosis of SGCE myoclonus-dystonia and the pathogenic mutation c.1011delA in the SGCE gene.

Patient blood management: application in complicated adult cardiothoracic surgery / 中国输血杂志

【Objective】 To evaluate the effect of multi-disciplinary patient blood management(PBM) on perioperative blood transfusion in patients with cardiothoracic surgery of gradeⅢ~Ⅳ. 【Methods】 The blood transfusion data and relevant clinical information of adult patients underwent grade Ⅲ~Ⅳ cardiothoracic surgeries before and after PBM (from January 2016 to December 2018)in our hospital were collected using Hospital Information System and Management System of Blood Transfusion Department. Patients were grouped according to three separate12-month periods: 933 cases subjected to conventional blood transfusion practice from Jan. to Dec.2016 as the control group, 1 139 cases experienced initial implement PBM(started on Jan.1, 2017)from Jan. to Dec.2017 as the early PBM group, and 1 411 cases received improved PBM from Jan. to Dec.2018 as the improved PBM group. The perioperative autotransfusion rate, allogeneic transfusion rate, length of hospital stay and hospitalization expenses of the three groups were compared by χ2 test and variance analysis. 【Results】 The comparison results among control group, early PBM group and improved PBM group were as following: 1) The proportion of patients using iron and EPO to treat preoperative anemia were 15.12%(44/291)vs 19.73%(72/365)vs 26.65%(125/469)(P<0.01) and 10.31%(30/291)vs 12.33%(40/365)vs 15.57%(73/469)(P<0.05), respectively. 2) The incidence of autotransfusion were 57.98%(541/933)vs 44.76%(544/1 139)vs 37.00%(522/1 411)(P<0.01). The allogeneic transfusion volume per capita(U) were 351.91±35.85 vs 392.76±43.33 vs 421.75±73.84(P<0.05). The incidence of allogeneic blood transfusion were 18.11%(169/933)vs 17.56%(200/1 139)vs 13.32%(188/1 411)(P<0.01). The allogeneic blood transfusion volume per capita (U) were 6.56±8.33 vs 5.52±6.28 vs 5.56±6.17(P<0.01). 3) The per capita hospital stay (d) and ICU stay (d) were19.54±16.56 vs 16.46±12.06 vs 15.11±10.18 and 4.45±9.31 vs 3.56±6.93 vs 3.26±5.29(P<0.05), respectively. The per capita hospitalization expenses (ten thousand yuan/person) were 10.76±8.39 vs 9.58±7.58 vs 9.13±5.9(P<0.05). 【Conclusion】 The application of PBM in perioperative blood transfusionfor adult cardiothoracic surgery Ⅲ ~ Ⅳcan significantly decrease the incidence of autologous and allogeneic blood transfusion, the length of hospitalstay and hospitalization expenses.

Communication in process of R&D and registration of new drugs of traditional Chinese medicine / 中国中药杂志

In recent years, the National Medical Products Administration has established a communication system for the process of drug R&D and registration. In this paper, the reform policies on establishing the communication system for drug evaluation in recent years were summarized, and the channels, processes, methods and types of communication were also collected. In addition, the communication status of new drugs of traditional Chinese medicine(TCM) was summarized according to the whole process of R&D, including summary of clinical practice, Investigational New Drug Applications, period of clinical trials, New Drug Applications, and post-marketing researches. Meanwhile, the current problems such as ineffective, inefficient, repeated or even no communication were analyzed, and relevant suggestions were proposed accordingly in order to provide reference for better communication on R&D and registration of new drugs of TCM.

The practical diagnostic approach for hereditary Epidermolysis Bullosa in the era of next generation sequencing

@#The new era of molecular diagnostics has provided new insights in both routine clinical work and research in hereditary epidermolysis bullosa (EB). Several different approaches and techniques have provided significant advantages in terms of diagnostic accuracy, predict- ing prognoses, clarifying the pathogenesis, and developing new therapies. In many developing countries, however, modern laboratory techniques remain inaccessible. Therefore, a practical diagnosticmatrix has been developed to predictthe diagnosis and subtype of EB. In thisreview,we highlight themolecular and practicaltechniquesin diagnosing hereditary EB.

Etiological factor distribution in elderly outpatients with vertigo/dizziness / 中华老年医学杂志

Objective To clarify the distribution of etiological factors in elderly versus non-elderly outpatients with vertigo/dizziness for optimizing the diagnosis and therapy. Methods We retrospectively analyzed data of outpatients with vertigo/dizziness in Shaanxi Provincial People's Hospital from April 2015 to April 2017 and conducted diagnoses in accordance with the currently wide-accepted diagnostic criteria. Results A total of 3 356 patients with chief complains of vertigo/dizziness were recruited ,and their top seven etiological factors were benign paroxysmal positional vertigo (n＝ 1 320 ,39.3%) ,chronic subjective dizziness(n＝680 ,20.3%) ,vestibular migraine(n＝386 ,11.5%) ,posterior circulation ischemia (n＝213 ,6.4%) ,Meniere's disease (n ＝ 138 ,4.1%) ,vestibular neuritis (n＝ 121 ,3.6%) ,and vestibular paroxysmia(n＝76 ,2.3%). The top four etiological factors for the elderly patients (n＝1 255)were benign paroxysmal positional vertigo (n＝ 498 ,39.7%) ,chronic subjective dizziness (n＝ 279 ,22.2%) ,posterior circulation ischemia(n＝161 ,12.8%) ,and vestibular migraine(n＝73 ,5.8%) ;while the top four etiological factors for non-elderly patients (n＝ 2 101)were benign paroxysmal positional vertigo (n＝ 822 ,39.1%) , chronic subjective dizziness(n＝401 ,19.1%) ,vestibular migraine(n＝313 ,14.9%) ,and vestibular neuritis(n＝105 ,5.0%). The detection rate in elderly patients versus non-elderly patients was significantly higher in chronic subjective dizziness (22.2% vs.19.1%,P＝ 0.032 )and in posterior circulation ischemia (12.8%vs.2.5%,P＝0.000) ,and was significantly lower in vestibular neuritis (1.3% vs.5.0%,P＝ 0.000 ) ,in vestibular migraine(5.8% vs.19.4%,P ＝ 0.000)and in other causes (1.0% vs.2.7%,P ＝ 0.002) . Conclusions The ratio of posterior circulation ischemia is markedly higher in elderly outpatients than in non-elderly outpatients ,whereas the ratios of vestibular migraine and vestibular neuritis in elderly patients are lower than in non-elderly outpatients.

Mass spectrometry combined with gene analysis for prenatal diagnosis of glutaric acidemia type Ⅰ / 中华儿科杂志

Objective@#To investigate the value of amniotic fluid metabolite detection by mass spectrometry combined with gene mutation analysis in the prenatal diagnosis of glutaric acidemia type Ⅰ (GA-Ⅰ).@*Method@#From January 2009 to December 2016, Department of Pediatric Endocrinology and Genetic, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine carried out prenatal diagnosis for 24 cases of pregnant women with GA-Ⅰproband. 24 pregnant women without organic acidemia proband for conventional prenatal diagnosis at the same period were used as the control group. The pregnant women of the two groups had the amniocentesis at 16 to 20 weeks of gestation.The levels of glutaryl carnitine (C5DC) and octanoylcarnitine (C8) in amniotic fluid were detected by tandem mass spectrometry, and the levels of glutaric acid was determined by gas chromatography-mass spectrometry. All the amniotic fluid cells underwent GCDH gene testing.@*Result@#A total of 4 cases of fetuses were diagnosed by gene mutation analysis combined with mass spectrometry detection, the levels of C5DC (1.58(0.89-2.85) μmol/L), C5DC/C8 (19.74(12.40-25.93))and glutaric acid (129.96 (90.09-66.02) mmol/mol Cr) were significantly higher than the upper limit of the reference, of which in one case with the proband only on mutation was detected, and in the amniotic fluid cells also only one mutation was detected, the diagnosis was made according to the significantly increased levels of amniotic fluid C5DC, C5DC/C8 and glutaric acid. Twenty cases of fetuses were identified as non-GA-Ⅰchildren, of whom in 2 cases of proband only one mutation was detected, and also in amniotic fluid cells one mutation was detected, in 2 cases the diagnosis was excluded because the normal levels of C5DC, C5DC/C8 and glutaric acid. There were 2 cases whose levels of C5DC or glutaric acid were slightly higher than the upper limit of the reference, but the diagnosis was excluded according to genetic testing.@*Conclusion@#Prenatal diagnosis cannot be made by gene analysis when the proband mutation is not clear, and it cannot determine whether the fetus is patient when the mass spectrometry detection of amniotic fluid metabolite is mildly abnormal, while mass spectrometry detection of amniotic fluid C5DC, C5DC/C8 and glutaric acid levels combined with GCDH gene analysis can make up the deficiencies, and make the prenatal diagnosis of GA-Ⅰ more reliably.

Nalmefene improves prognosis in patients with a large cerebral infarction: study protocol for a randomized controlled prospective trial / 中国组织工程研究

BACKGROUND:Occlusion of the middle cerebral artery trunk can cause large infarctions.Clinically,thrombolytic therapy,defibrillation,vasodilation,and surgery are often used to treat these large infarctions.However,the therapeutic efficacy of these therapeutic interventions in promoting prognosis remains controversial.Nalmefene,an opioid receptor antagonist,exhibits a neuroprotective effect.Few clinical studies are reported on the therapeutic efficacy of nalmefene in the treatment of large cerebral infarctions.OBJECTIVE:To investigate the therapeutic efficacy of nalmefene in restoring the neurologic function of patients with middle cerebral artery trunk infarction in comparison with conventional treatment as a control.METHODS:A total of 236 patients with middle cerebral artery trunk infarction who will receive treatment at the First Hospital of Jilin University,China will be randomly divided into a control group (n=116) and a nalmefene group (n=120).Patients in the control group will receive conventional treatment.Patients in the nalmefene group will receive 10 successive days of intravenous nalmefene hydrochloride injection based on conventional treatment.The primary outcome of this study is the effective rate at 20 days (10 days after treatment).The secondary outcomes of this study include (1) the National Institutes of Health Stroke Scale (NIHSS) score at 20 days,used to evaluate neurologic function deficits;(2) Glasgow Coma Scale score at 0 (before treatment) and 10 days;(3) serum level of matrix metalloproteinase 9 at 0,5 and 10 days (before treatment and 5 and 10 days of treatment);(4) MRI perfusion imaging of the head at 0 and 10 days.This trial was ragistered with the Chinese Clinical Trial Registry (registration number:ChiCTR-IOR-17013871).RESULTS AND CONCLUSION:Preliminary experiment results ravealed that compared with the control group,NIHSS score was signficiantly decreased,effective rate was increased,Glasgow Coma Scale score was significantly increased,serum level of matrix metalloproteinase 9 was significantly decreased,cerebral blood flow and cerebral blood volume on the lesion side were signficiantly increased,and the mean transit time of contrast agent on the lesion side was significantly shortened in the nalmefene group.Findings from this study will provide clinical evidence for use of nalmefene in combination with conventional treatment for large cerebral infarctions and provide data support that this combined therapy can improve the prognosis in patients with large cerebral infarctions.

Study on the Relationship between Lipoprotein-Related Phospholipase A2,Homocysteine,Beta-N-1-Deoxy Fructosyl Component of Hemoglobin and Cerebral Microbleeds / 现代检验医学杂志

Objective To investigate the relationship between lipoprotein-related phospholipase A2(Lp-PLA2),homocysteine (Hcy),beta-N-1-deoxy fructosyl component of hemoglobin(HbAlc),low density lipoprotein cholesterol(LDL-C)and cere-bral microbleeds in patients.Methods Patients with CMBs were consecutively recruited from the Department of Neurology, in Shaanxi Provincial People's Hospital by using the diagnostic criteria according to the diagnosis and treatment of cerebral cerebrovascular disease in China in 2014.In addition,volunteers were included as normal controls.The demographic charac-teristics and the history of patients were collected.The level of Lp-PLA2,Hcy,HbA1c and LDL-C in each group was ana-lyzed.Results 62 patients with CMBs were included in this study,including 48 males and 14 females.30 patients were in-cluded into the normal control group,including 20 males and 10 females.The levels of Lp-PLA2,Hcy and HbA1c in the CMBs group were significantly higher than those in the control group(t=2.67,2.97,3.24,P<0.05).The level of HbA1c levels were correlated with the number of CMBs(r=0.287,P=0.024).The level of HbA1c was correlated with the num-ber of CMBs in deep white matter(r=0.304,P=0.016),while it was not correlated with the number of CMBs in the cortex (P>0.05).Conclusion The levels of Lp-PLA2,Hcy and HbA1c in CMBs were higher than those in normal control group. HbA1c levels were associated with the number of CMBs,especially in deep white matter.

An unusual presentation of thoracic para-aortic hematoma due to blunt trauma.

An 11-yr-old boy was admitted to the hospital with gradually aggravating acute abdominal pain along with nausea, vomiting and constipation for 5 days. The pain started after blunt trauma on the superior abdomen. He had normal laboratory tests and abdominal examination, but his chest radiograph showed infiltration in the right lung and an abnormal mass on the left diaphragm. Further investigation like computed tomography (CT) and magnetic resonance MR angiography, revealed an abnormal para-aotic mass located a mass located para-aortic above posterior to the left diaphragm with a well-defined margin. The abnormal mass was finally confirmed to be a hematoma with exploratory thoracotomy. The rarity of this kind of presentation is discussed for making an early and correct diagnosis.

The effect of Baihu Decoction (白虎汤) on blood glucose levels in treating systemic inflammatory response syndrome / 中国结合医学杂志

In this paper we investigated the mechanisms of Baihu Decoction ((白虎汤, BH) and Baihu with Radix Ginseng (BHG) in treating systemic inflammatory response syndrome (SIRS) and sepsis in humans and animals. By reviewing published data on the effects of BH and BHG and the control of blood glucose in treating SIRS and sepsis, we found that (1) BH and BHG were beneficial in the treatment of SIRS and sepsis in humans and animals; (2) BH and BHG also had great effect in lowering blood glucose level; and (3) the tight control of blood glucose during critical illness substantially improved the outcome. Considering these data together, we hypothesize that one of the major mechanisms of BH and BHG in treating SIRS and sepsis is to lower the blood glucose level. The findings also suggest that the application of BH and BHG can extend to many acute illnesses and injuries, which commonly cause hyperglycemia.

Regulation of acyl-coenzyme A: cholesterol acyltransferase 2 expression by saturated fatty acids / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To verify the regulation of acyl-coenzyme A:cholesterol acyltransferase 2 (ACAT 2), which is associated with cholesterol metabolism, by saturated fatty acids (SFAs).</p><p><b>METHODS</b>Palmitic acid (PA), the most abundant saturated fatty acid in plasma, and oleic acid (OA), a widely distributed unsaturated fatty acid, were used to treat hepatic cells HepG2, HuH7, and mouse primary hepatocytes. In addition, PA at different concentrations and PA treatment at different durations were applied in HepG2 cells. In in vivo experiment, three-month male C57/BL6 mice were fed with control diet and SFA diet containing hydrogenated coconut oil rich of SFAs. The mRNA level of ACAT2 in those hepatic cells and the mouse livers was detected with real-time polymerase chain reaction (PCR).</p><p><b>RESULTS</b>In the three types of hepatic cells treated with PA, that SFA induced significant increase of ACAT2 expression (Pü0.01), whereas treatment with OA showed no significant effect. That effect of PA was noticed gradually rising along with the increase of PA concentration and the extension of PA treatment duration (both Pü0.05). SFA diet feeding in mice resulted in a short-term and transient increase of ACAT2 expression in vivo, with a peak level appearing in the mice fed with SFA diet for two days (Pü0.05).</p><p><b>CONCLUSION</b>SFA may regulate ACAT2 expression in human and mouse hepatic cells and in mouse livers.</p>