SIRT1 is transcriptionally repressed by YY1 and suppresses ferroptosis in rheumatoid arthritis

Abstract Background Sirtuin 1 (SIRT1) is reported downregulated in rheumatoid arthritis (RA), and the protective effects of SIRT1 on tissue damage and organ failure may be related to cellular ferroptosis. However, the exact mechanism by which SIRT1 regulates RA remains unclear. Methods Quantitative real-time PCR (qPCR) and western blot assays were performed to explore the expressions of SIRT1 and Yin Yang 1 (YY1). CCK-8 assay was used for cytoactive detection. The interaction between SIRT1 and YY1 was validated by dual-luciferase reporter gene assay and chromatin immunoprecipitation (ChIP). DCFH-DA assay and iron assay were applied to detect the reactive oxygen species (ROS) and iron ion levels. Results In the serum of RA patients, SIRT1 was downregulated, but YY1 was upregulated. In LPS-induced synoviocytes, SIRT1 could increase cell viability and decrease ROS and iron levels. Mechanistically, YY1 downregulated the expression of SIRT1 by inhibiting its transcription. YY1 overexpression partly revised the effects of SIRT1 on ferroptosis in synoviocytes. Conclusion SIRT1 is transcriptionally repressed by YY1 and inhibits the ferroptosis of synoviocytes induced by LPS, so as to relieve the pathological process of RA. Therefore, SIRT1 might be a new diagnosis and therapeutic target of RA. Highlights Combining SIRT1 with synoviocytes ferroptosis in rheumatoid arthritis for the first time. The transcription factor YY1 combined to the SIRT1 promoter in synovial cells and inhibited its expression and functional roles. The inhibition of SIRT1 with YY1 decreased the ferroptosis in synoviocytes.

Analysis laboratory results of three cases of COVID-19 complicated with falciparum malaria / 中国热带医学

@#Abstract: Objective　To analyze the laboratory indexes of patients infected with malaria patients and COVID-19, so as to provide reliable evidence for the diagnosis of mixed infection of both. Methods　The routine clinical laboratory items such as routine blood, biochemistry and lymphocyte subsets were tested in three cases of COVID-19 complicated with falciparum malaria who admitted to Guangzhou Eighth People's Hospital Affiliated to Guangzhou Medical University from July to December 2020 were tested. Laboratory data were stage-wise analyzed in conjunction with changes in the course of disease. Results　Three patients confirmed COVID-19 infection recruited all had malaria infection history. Fever, headache, and other symptoms emerged on the 4rd to 11th day after admission. Malaria parasite was detected by malaria parasite antigen testing and blood smear testing, and all three patients had re-ignition of malaria after being confirmed COVID-19 infection. In the early stage of malaria relapse, lymphocytes decreased, CRP and SAA increased, and gradually returned to normal level after antimalarial treatment. Interestingly, we only found one patient at the initial stage of malaria detection showed PLT decreased, no other unnormal changes in other routine blood results (WBC, ESO) and liver function results (ALT, AST, GGT, TBIL, DBIL, CG) were found from the beginning to end course of the disease. Conclusion　COVID-19 infection may promote the resurgence of malaria, so the relapse of malaria should be monitored especially for the patient with malaria infection history who begin to develop fever and other symptoms a few days after the diagnosis of COVID-19. The inflammatory indicators would be worth able as an auxiliary judgment basis for the effective treatment of the two combined infection.

Analysis of Chinese Medical Syndrome Features of Ischemic Stroke Based on Similarity of Symptoms Subgroup / 中国结合医学杂志

OBJECTIVE@#To derive the Chinese medicine (CM) syndrome classification and subgroup syndrome characteristics of ischemic stroke patients.@*METHODS@#By extracting the CM clinical electronic medical records (EMRs) of 7,170 hospitalized patients with ischemic stroke from 2016 to 2018 at Weifang Hospital of Traditional Chinese Medicine, Shandong Province, China, a patient similarity network (PSN) was constructed based on the symptomatic phenotype of the patients. Thereafter the efficient community detection method BGLL was used to identify subgroups of patients. Finally, subgroups with a large number of cases were selected to analyze the specific manifestations of clinical symptoms and CM syndromes in each subgroup.@*RESULTS@#Seven main subgroups of patients with specific symptom characteristics were identified, including M3, M2, M1, M5, M0, M29 and M4. M3 and M0 subgroups had prominent posterior circulatory symptoms, while M3 was associated with autonomic disorders, and M4 manifested as anxiety; M2 and M4 had motor and motor coordination disorders; M1 had sensory disorders; M5 had more obvious lung infections; M29 had a disorder of consciousness. The specificity of CM syndromes of each subgroup was as follows. M3, M2, M1, M0, M29 and M4 all had the same syndrome as wind phlegm pattern; M3 and M0 both showed hyperactivity of Gan (Liver) yang pattern; M2 and M29 had similar syndromes, which corresponded to intertwined phlegm and blood stasis pattern and phlegm-stasis obstructing meridians pattern, respectively. The manifestations of CM syndromes often appeared in a combination of 2 or more syndrome elements. The most common combination of these 7 subgroups was wind-phlegm. The 7 subgroups of CM syndrome elements were specifically manifested as pathogenic wind, pathogenic phlegm, and deficiency pathogens.@*CONCLUSIONS@#There were 7 main symptom similarity-based subgroups in ischemic stroke patients, and their specific characteristics were obvious. The main syndromes were wind phlegm pattern and hyperactivity of Gan yang pattern.

Expression Level and Significance of Tim-3 in CD4+ T Lymphocytes in Peripheral Blood of Patients with Coronary Heart Disease

Abstract Objective: To investigate the expression level and significance of T cell immunoglobulin and mucin-domain containing molecules-3 (Tim-3) and interleukin-7 (IL-7) in CD4+ T lymphocytes in peripheral blood of patients with coronary heart disease (CHD). Methods: 75 patients with CHD treated at our hospital were selected and classified as mild group (25 cases), moderate group (25 cases) and severe group (25 cases), according to the severity of illness. Twenty-five healthy volunteers who underwent a physical examination at our hospital during the same period were selected as the control group. The expression level of Tim-3 in CD4+ T lymphocytes in peripheral blood of patients in four groups was detected by flow cytometry and quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The expression level of IL-7 in peripheral blood serum was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analyses of Tim-3 and IL-7, Tim-3 and disease severity and IL-7 and disease severity were performed, respectively. Results: Flow cytometry and qRT-PCR demonstrated that the expression of Tim-3 in CD4+ T lymphocytes in peripheral blood of patients with CHD increased with the aggravation of the disease. ELISA showed that the tendency of IL-7 expression in peripheral blood serum was consistent with the expression of Tim-3, and the expression of Tim-3 had a positive correlation with IL-7. The expression levels of both Tim-3 and IL-7 were positively correlated with the Gensini score. Conclusion: The expression of Tim-3 and IL-7 in peripheral blood of patients with CHD was upregulated and increased with the aggravation of CHD.

Application of extended trochanter osteotomy wire fixation combined with autologous bone graft in revision of total hip arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of using lengthened trochanteric osteotomy wire fixation combined with autologous bone graft in patients undergoing revision total hip arthroplasty.@*METHODS@#From December 2010 to December 2018, 18 patients underwent revision of total hip arthroplasty with extended trochanteric osteotomy wire fixation and autogenous bone graft, including 8 males and 10 females with an average age of (78.89±3.32) years old ranging from 68 to 82 years. The time from the initial replacement to the revision was 9 to 22 (16.33±2.93) years. The patients were followed up regularly after operation. The healing time of osteotomy, the time of full weight-bearing activity, Harris score of hip joint and complications were recorded.@*RESULTS@#All 18 patients were followed up for 16 to 38 months with an average of (25.78±6.65) months. The incision length was 16 to 21 cm with an average of (18.89±1.32) cm; the operation time was 105 to 128 min with an average of (115.44±6.59) min, the bleeding volume was 240 to 285 ml with an average of (267.44±13.77) ml. The healing time of osteotomy was 12 to 18 weeks with an average of (15.61±1.75) weeks. Harris score of hip joint was (47.11±5.04) before operation, (76.39±3.85) during full weight-bearing activities, and (82.22±2.76) at the final follow-up(P<0.05). During the follow-up period, there were no complications such as limb shortening, infection, poor incision healing, prosthesis loosening and sinking, and periprosthetic fracture.@*CONCLUSION@#In revision total hip arthroplasty, the use of extended trochanteric osteotomy wire fixation combined with autologous bone graft can achieve satisfactory clinical results, but the surgeon needs to make a systematic plan for the pre-revision, intraoperative and postoperative recovery.

Expert Consensus on Otorhinolaryngology Head and Neck Diseases Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

Traditional Chinese medicine （TCM） and western medicine have their respective advantages and limitations in the diagnosis and treatment of common otorhinolaryngology head and neck diseases. Although the integrated TCM and western medicine exhibits definite curative effects， there is no consensus on the otorhinolaryngology head and neck diseases responding specifically to TCM or integrated TCM and western medicine， as well as the diagnosis and treatment schemes. The China Association of Chinese Medicine （CACM） thus organized the otorhinolaryngology head and neck specialists of both TCM and western medicine to discuss the etiology， pathogenesis， and clinical diagnosis and treatment methods of common otorhinolaryngology head and neck diseases with the results of multiple clinical trials taken into account. The acute pharyngitis， chronic pharyngolaryngitis， paraesthesia pharyngis， hysterical aphasia， allergic rhinitis， subjective tinnitus， and otogenic vertigo were confirmed to respond specifically to TCM or integrated TCM and western medicine. Then a mutually agreed diagnosis and treatment scheme and recommendation with integrated TCM and western medicine was formulated as a reference for clinical practice， thus benefiting more patients.

Effect of intranasal acupuncture on the pathology of nasal mucosa in rabbits with allergic rhinitis and related regulatory mechanism of transient receptor potential vanillic acid receptor 1-substance P axis / 解剖学报

Objective To investigate the pathological changes of nasal mucosa by intranasal acupuncture, and to explore the possible signal transduction mechanism through the distribution and expression of transient receptor potential vanillic acid receptor 1 (TRPV1)-substance P (SP) axis in nasal mucosa of experimental allergic rhinitis. Methods An animal model of allergic rhinitis was constructed by ovalbumin and aluminium hydroxide gel treatment. Twenty five New Zealand rabbits were randomly divided into normal group, model group, sham acupuncture group, acupuncture Wai Ying Xiang group and intranasal acupuncture group, with 5 rabbits in each group. To observe the effect of intranasal acupuncture on animal behavior, nasal mucosa pathology, eosinophils (EOS) count and IgE content in arterial blood. In addition, HE staining was used to determine the distribution of EOS in nasal mucosa and immunohistochemistry was used to observe the distribution and expression of TRPV1 and SP in nasal mucosa membrane. Results Compared with the model group, the behavioral score of the sham acupuncture group did not decrease significantly, while the behavioral score of the Wai Ying Xiang acupuncture group and the intranasal acupuncture group showed a downward trend, and the decrease degree of the intranasal acupuncture group was more significant. Compared with the normal group, the eosinophil count in the model group increased slightly (P0.05). HE staining found that eosinophilic distribution increased significantly in the model group and the sham acupuncture group compared with the normal group, and the difference was statistically significant (P<0.05). Compared with the model group, the distribution of eosinophil reduced in the nasal acupuncture group and the Wai Ying Xiang group. The difference was statistically significant (P<0.05 ). Immunohistochemical found that TRPV1 and SP expressed significantly in the nasal mucosa of the model group and the sham acupuncture group compared with the normal group, the difference was statistically significant (P<0.05). Compared with the model group, TRPV1 and SP expression decreased significantly in the intranasal acupuncture group and the external yingxiang group, the difference was statistically significant (P<0.05). Conclusion Intranasal acupuncture can alleviate the nasal symptoms of allergic rhinitis model by reducing the Chemotaxis of eosinophils in nasal mucosa and the content of IgE in serum.

Effect of double plate technique combined with autogenous iliac bone graft in the treatment of femoral nonunion after intramedullary nailing / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing.@*METHODS@#From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation.@*RESULTS@#All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening).@*CONCLUSION@#It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.

Research progress on ion channels and receptors in nodose ganglion neurons involved in blood pressure regulation / 药学学报

Hypertension is the most common cardiovascular disease. In recent years, reduced baroreceptor activity has been suggested as a main cause of hypertension. The cell body of the primary afferent nerve of the baroreceptor is located in the nodose ganglion (NG). The ion channels and receptors in the NG can affect baroreceptor sensitivity and neuronal excitability, thus regulating blood pressure. This review focuses on recent research progress on ion channels, receptors and other proteins in NG neurons that are involved in modulating the sensitivity of the baroreceptor reflex to regulate blood pressure.

Double plating through different approaches for periprosthetic femoral fracture following total knee arthroplasty / 中国骨伤

OBJECTIVE@#To study clinical effects of double plating through different approaches for communicated and obvious osteoporosis periprosthetic femoral fracture following total knee arthroplasty(TKA).@*METHODS@#From July 2010 to June 2017, 21 patients with periprosthetic femoral fracture following TKA were divided into two groups according to operative approach. Fifteen patients in medial and lateral double approaches group, including 5 males and 10 females aged from 63 to 79 years old with an average of (67.2±5.9) years old; 11 patients were type 33-A2 and 4 patients were type 33-A3 according to AO-OTA classification; 12 patients injured by falling down and 3 patients by traffic accident; treated with double plating. Six patients in medial parapatellar approach group, including 3 males and 3 females, aged from 61 to 74 years old with an average of (64.6±6.0) years old; 3 patients were type 33-A2 and 3 patients were type 33-A3 according to AO-OTA classification; 5 patients injured by falling down and 1 patient by traffic accident; treated with double plating. Operative time, blood loss, postoperative drainage, fracture healing time were compared between two groups; HSS score and radiology at 3 and 12 months were compared between two groups.@*RESULTS@#All patients were followed up, and the follow-up time of bilateral approaches group ranged from 12 to 18 months with an average of (14.2±2.6 ) months, while the follow-up time of single approach group ranged from 12 to 16 months with an average of (12.6±2.5) months, and there was no statistical difference between two groups. The operative time and postoperative drainage in bilateral approaches group were (107.2±10.4) min and (213.9±30.4) ml, while in sigle approach group was (95.4±12.8) min and (256.8±34.2) ml, and the differences were significant(0.05). HHS score at 3 and 12 months after operation in bilateral approach were 82.9±5.7 and 84.8±7.1, while in single approach group were 83.6±6.1 and 86.3±6.8; there was no statistical difference in HSS score between two groups(>0.05). According to HSS score at 12 months after operation, 2 cases got excellent results and 13 good in bilateral approaches group; 1 case got excellent result and 4 good and 1 moderate in single approach group; but there was no statistical difference between two groups (χ²=2.625, =0.105). There wase no significant differences in complications between bilateral approaches group(2 cases) and single approach group (1 case)(>0.05).@*CONCLUSIONS@#Double plating technique for communicated and obvious osteoporosis periprosthetic femoral fracture following TKA could obtain good function of knee joint. The medial parapatellar approach has shorter operative time, while the bilateral approaches had less drainage.

Modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with fracture / 中国骨伤

OBJECTIVE@#To study clinical effects of modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with proximal humeral fracture which area of femoral head injury less than 40%.@*METHODS@#From July 2012 to June 2017, 7 patients with posterior shoulder dislocation were treated, including 5 males and 2 females; aged from 37 to 53 years old. Three patients combined with split of humerus head and 4 patients combined with humerus surgical neck fracture. All patients treated with modified Mclaughlin procedure combined with locking plate. Motion of shoulder joint after operation was observed, postoperative UCLA score was used to evaluate clinical effects.@*RESULTS@#Seven patients were followed up from 10 to 33 months. The motion of anteflexion and up-lift ranged from 130° to 170°, the motion of extorsion ranged from 45° to 75°, the motion of abduction ranged fron 105° to 150°, and the internal rotation was between L₃ to buttock. UCLA score ranged from 29 to 34; and 1 patient reached excellent, and 6 patients good.@*CONCLUSIONS@#The modified Mclaughlin procedure combined with locking plate showed satisfying result for posterior shoulder dislocation combined with fractures. However, the internal rotation of shoulder could be compromised.

Changes of endogenous nociceptin/orphanin FQ (N/OFQ) and C-reactive protein in elderly patients with atrial fibrillation before joint replacement / 天津医药

@#Objective To investigate the serum changes of endogenous nociceptin / orphanin FQ (N / OFQ) and C reactive protein (CRP) before total knee arthroplasty in elderly patients with atrial fibrillation, and to explore its significance. Methods The patients with paroxysmal atrial fibrillation were divided into PAAFⅠ subgroup (≤75 years old, n=32) and PAAFⅡ subgroup (＞75 years old, n=31). At the same time, the patients with persistent atrial fibrillation were divided into PEAFⅠ subgroup (≤75 years old, n=27) and PEAFⅡ subgroup (＞75 years old, n=32). Forty-seven patients with non-AF sinus rhythm were used as control group. The levels of N/OFQ and CRP, left atrial dimension (LAD), ejection fraction of left ventricle (LVEF), fasting triglyceride (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein cholesterol (HDLC) were measured, and the above-mentioned indicators were analyzed. Results The LAD value was higher in PAAF group and PEAF group than that in control group. The LAD value was higher in PEAF group than that in PAAF group, and the LVEF and TG values were lower in PAAF group and PEAF group than those in control group. The values of LVEF, TG, HDL-C and LDL-C were lower in PEAF group than those of PAAF group. The values of HDL-C and LDL-C were higher in PAAF group than those of control group, and the values of HDL-C and LDL-C were lower in PEAF group than those of control group. The levels of N/OFQ and CRP were higher in PAAF group and PEAF group than those in control group, and the levels of N/OFQ and CRP were significantly higher in PEAF group than those in PAAF group (P＜0.05). The level of N/ OFQ was higher in PAAFII subgroup than that in PAAFI subgroup, and the level of N/OFQ was significant higher in PEAF Ⅱ subgroup than that in PEAFⅠ subgroup (P＜0.05). There was no significant difference in CRP level between groups (P > 0.05). Multiple Logistic regression showed that N/OFQ elevation (OR=2.911,95％CI:1.291-6.564) and CRP elevation (OR= 4.636, 95％CI:1.042-20.616) and LAD enlargement (OR=1.369,95％CI:1.000-1.875) were the risk factors of AF. LVEF elevation (OR=0.489,95％CI:0.302-0.792) was the protective factor of AF. The levels of N/OFQ and CRP were positively correlated with LAD and negatively correlated with TG, LDL-C and HDL-C in patients with atrial fibrillation. N/OFQ and CRP levels were positively correlated. The age of AF patients was positively correlated with N/OFQ level, but not with CRP level. LVEF was negatively correlated with N/OFQ level in patients with atrial fibrillation, but no correlation with CRP level. The result of ROC curve analysis showed that the area under the curve of N/OFQ for predicting atrial fibrillation was 0.949 (95％CI：0.917-0.982, P＜0.01), the area under the curve of CRP for predicting atrial fibrillation was 0.855 (95％CI: 0.775- 0.935, P＜0.01), the area under the curve of joint forecasting factor for predicting atrial fibrillation was 0.960 (95％CI: 0.933- 0.987, P＜0.01). Conclusion N/OFQ and CRP are closely related to the occurrence of atrial fibrillation in the elderly, and N/ OFQ is more advantageous in assessing cardiac function before total knee replacement in elderly patients with atrial fibrillation.

A preliminary study on prediction efficacy of multimodal MRI-based radiomics in combination with random forest model for preoperative glioma IDH1 gene type expression / 中华放射学杂志

Objective@#To preliminarily analyze the prediction efficiency of multimodal MRI-based radiomics model for preoperative glioma IDH1 gene expression type.@*Methods@#The MRI data of 108 surgery-proven glioma patients from May 2015 to January 2019 were retrospectively analyzed, and the MRI data included axial T1WI,T2WI,fluid attenuated inversion recovery (FLAIR),DWI imaging and enhanced T1WI sequence.Forty-seven cases were IDH1 mutant type, and 61 cases were IDH1 wild type. All patients were divided into training and validation groups according to the 7∶3 ratio of the random forest model. Seventy-three cases were in training group, and 35 cases were in validation group. Independent predictors of IDH1 mutation were screened by univariate analysis combined with multivariate logistic regression analysis (P<0.05) in order to construct a random forest diagnosis model of general clinical information and conventional MRI morphological features.General clinical information and conventional MRI morphological features included gender, age, umbers of cases of left and right hemispheres, location of tumors, maximum diameter of tumors, peritumoral edema, intratumoral cystic degeneration, enhancement and ADC value of tumors. The ROI was manually outlined by MaZda software in the most obvious level of 5 sequences of tumor mass and the radiomics features were extracted, including the gray-level co-occurrence matrix(GLCM), the run-length matrix(RUN), the absolute gradient(GRA),the auto-regressive model(ARM) and wavelets transform(WAV). The least absolute shrinkage and selection operator (LASSO)regression were used to select image radiomics features with a method of 10 fold cross -validation and to reduce the dimensions. The screened image radiomics labels were combined with the conventional morphological feature independent predictors to construct a multimodal MRI-based random forest model, and the validation data set was used to evaluate the accuracy and diagnostic efficiency of each model. The sensitivity and specificity of conventional MRI morphological feature model and multimodal MRI-based radiomics prediction model were evaluated dynamically by drawing ROC curves, and the prediction efficiency of the two models was quantified by using AUC statistical indicators. The model classification error rate under different outcomes and the classification error rate of out of bag(OOB)were used to evaluate the stability of the multimodal MRI-based random forest model. The contribution rate of each variable to the model was reflected by the characteristic variables importance assessment map.@*Results@#Univariate regression analysis of the conventional MRI morphological characteristics showed that peritumoral edema, cystic degeneration and enhancement were the three independent predictors of IDH1 gene expression (P<0.01). LASSO algorithm and 10-fold cross-validation identified six robust radiomic features including high frequency coefficients of wavelet transform (WavEnHH_s-4) of T2WI, S(4,4) inverse difference of gray uniformity measurement (InvDfMom),S(5,0) Entropy (entropy),WavEnHH_s-4 of T1WI enhancement, S(1,1) InvDfMom,S(1, -1) Entropy Difference (DifEntrp)of Flair.The error rate of classification for different outcomes and classification error rate of random forest OOB data of multimodal MRI radiomics diagnosis model finally stabilized at 10%. The results of Characteristic Variable Importance Assessment Map: Mean Decrease Accuracy and Mean Decrease Gini index were consistent, which showed that besides three conventional MRI morphological predictors peritumoral edema, enhancement and cystic degeneration, the radiomics labels also played a key role in the model. The results of ROC curve showed that the accuracy, specificity, sensitivity and AUC of conventional MRI morphological feature model were 82.7%, 68.4%, 90.9% and 0.835, respectively, and those of multimodal MRI-based radiomics model were 88.5%, 89.5%, 87.8% and 0.956 respectively.@*Conclusion@#Multimodal MRI-based radiomics random forest model can improve the predictive efficiency of preoperative glioma IDH1 gene expression type more quantitatively.

A preliminary study on prediction efficacy of multimodal MRI?based radiomics in combination with random forest model for preoperative glioma IDH1 gene type expression / 中华放射学杂志

Objective To preliminarily analyze the prediction efficiency of multimodal MRI?based radiomics model for preoperative glioma IDH1 gene expression type. Methods The MRI data of 108 surgery?proven glioma patients from May 2015 to January 2019 were retrospectively analyzed, and the MRI data included axial T1WI,T2WI,fluid attenuated inversion recovery (FLAIR),DWI imaging and enhanced T1WI sequence.Forty-seven cases were IDH1 mutant type, and 61 cases were IDH1 wild type. All patients were divided into training and validation groups according to the 7∶3 ratio of the random forest model. Seventy-three cases were in training group, and 35 cases were in validation group. Independent predictors of IDH1 mutation were screened by univariate analysis combined with multivariate logistic regression analysis (P<0.05) in order to construct a random forest diagnosis model of general clinical information and conventional MRI morphological features.General clinical information and conventional MRI morphological features included gender, age, umbers of cases of left and right hemispheres, location of tumors, maximum diameter of tumors, peritumoral edema, intratumoral cystic degeneration, enhancement and ADC value of tumors. The ROI was manually outlined by MaZda software in the most obvious level of 5 sequences of tumor mass and the radiomics features were extracted, including the gray?level co?occurrence matrix(GLCM), the run?length matrix(RUN), the absolute gradient(GRA),the auto?regressive model(ARM) and wavelets transform (WAV). The least absolute shrinkage and selection operator (LASSO)regression were used to select image radiomics features with a method of 10 fold cross?validation and to reduce the dimensions. The screened image radiomics labels were combined with the conventional morphological feature independent predictors to construct a multimodal MRI?based random forest model, and the validation data set was used to evaluate the accuracy and diagnostic efficiency of each model. The sensitivity and specificity of conventional MRI morphological feature model and multimodal MRI?based radiomics prediction model were evaluated dynamically by drawing ROC curves, and the prediction efficiency of the two models was quantified by using AUC statistical indicators. The model classification error rate under different outcomes and the classification error rate of out of bag(OOB)were used to evaluate the stability of the multimodal MRI?based random forest model. The contribution rate of each variable to the model was reflected by the characteristic variables importance assessment map. Results Univariate regression analysis of the conventional MRI morphological characteristics showed that peritumoral edema, cystic degeneration and enhancement were the three independent predictors of IDH1 gene expression (P<0.01). LASSO algorithm and 10?fold cross?validation identified six robust radiomic features including high frequency coefficients of wavelet transform (WavEnHH_s?4) of T2WI, S(4, 4) inverse difference of gray uniformity measurement (InvDfMom), S(5, 0) Entropy (entropy), WavEnHH_s?4 of T1WI enhancement, S(1, 1) InvDfMom, S(1, -1) Entropy Difference (DifEntrp)of Flair.The error rate of classification for different outcomes and classification error rate of random forest OOB data of multimodal MRI radiomics diagnosis model finally stabilized at 10%. The results of Characteristic Variable Importance Assessment Map: Mean Decrease Accuracy and Mean Decrease Gini index were consistent, which showed that besides three conventional MRI morphological predictors peritumoral edema, enhancement and cystic degeneration, the radiomics labels also played a key role in the model. The results of ROC curve showed that the accuracy, specificity,sensitivity and AUC of conventional MRI morphological feature model were 82.7%, 68.4%, 90.9% and 0.835, respectively, and those of multimodal MRI?based radiomics model were 88.5%, 89.5%, 87.8% and 0.956 respectively. Conclusion Multimodal MRI?based radiomics random forest model can improve the predictive efficiency of preoperative glioma IDH1 gene expression type more quantitatively.

Conventional MRI texture analysis of peritumoral edema in the differential diagnosis of glioblastoma and solitary metastatic brain tumor / 中华放射学杂志

Objective To investigate the value of conventional MR texture analysis of peritumoral edema in differentiating between glioblastoma and solitary metastatic brain tumor. Methods Forty patients with brain glioma and forty patients with brain metastases confirmed by pathology or clinic were enrolled . All patients underwent conventional MRI scan and enhanced examination, including axial T1WI, T2WI, fluid attenuated inversion recovery(FLAIR) and enhanced T1WI. The ROI was manually outlined by MaZda software in the most obvious level of 4 sequences of peritumoral edema and the texture features were extracted, including mean, variance, skewness, kurtosis, 1 percentile, 10 percentile, 50 percentile, 90 percentile, 99 percentile. Independent sample t-test (in case of normality and variance homogeneity test) or rank sum test (in case of not satisfying normality and homogeneity of variance) was used to compare the differences of the histogram parameters and to make meaningful parameters based on logistic regression modeling and drawing the receiver operating characteristic curve (ROC curve) to evaluate the differential diagnosis efficacy. Results Through the preliminary feature screening, skew of FLAIR (SkewFLAIR) for glioblastomas was -0.358±0.432, respectively,while for solitary metastatic brain tumor, the statistics was-0.648 ± 0.503. The results showed statistically significant difference(t=7.574,P=0.006). The differencesbetween the kurtosis (KurtFLAIR) were also proven to be statistically significant (Z=4.360 ,P=0.037),with-0.384 (-0.798, 0.049) for glioblastomas and-0.089 (-0.456, 0.613) for solitary metastasis brain tumor. The sensitivity of the corresponding logistic regression differential diagnosis model was 77.5％, specificity was 94.3％, and area under the curve (AUC) was 0.85. Conclusion Conventional MRI texture analysis of peritumoral edema provides reliable and quantified objective basis for the differential diagnosis of glioblastoma and solitary metastasis.

CT observation of retromaxillary posterior ethmoid / 临床耳鼻咽喉头颈外科杂志

To investigate the morphologic characteristics of the retromaxillary posterior ethmoid.A total of 103 outpatients encountered in our hospital during March 2012 and December 2012,who completed paranasal sinus CT examination,were included in this study.Patients had no sinus trauma,surgery or tumor history.Their paranasal sinus CT scans were analyzed from scheduled axial and coronal plane.The incidence and imaging features of the retromaxillary posterior ethmoid were observed.The retromaxillary posterior ethmoid(RMPE)was the posterior ethmoid cell that expanded along the lamina papyracea toward the infraorbital region.RMPE was located behind the posterior wall of the maxillary sinus and under the orbital floor.The occurrence rate of the RMPE was 74.3%.The ethmomaxillary septum is the bony septum the between the maxillary sinus and posterior ethmoid.Anatomical confirmation of RMPE is based mainly on the presence of the ethmomaxillary septum.RMPE is located at the back of ethmomaxillary septum.The sagittal angulation of the ethmomaxillary septum ranged from 22 to 87 degrees,with an average of(50.34±12.10)degrees.The ethmomaxillary septum is important for anatomic recognition of the RMPE.Accurate identification of the RMPE before ESS can help improve the removal of the posterior ethmoid sinus.

Case report: A 10 years follow-up of periprosthetic femoral fracture after total hip arthroplasty in osteopetrosis / 中华创伤杂志(英文版)

Osteopetrosis is an inherited disorder characterized by increased bone density and brittle bone quality. Degenerative changes often occur after the age of 40 in patients with osteopetrosis. Operative intervention is the primary treatment option if the clinical manifestation of secondary osteoarthritis is severe. A 44-year-old male suffering autosomal dominant osteopetrosis and progressive unilateral hip osteoarthritis required a total hip arthroplasty. However, there were several technical challenges associated with this procedure including creating a femoral medullary canal and developing a Vancouver type B2 periprosthetic femoral fracture postoperatively. To afford some experience for the management of similar cases, we here present our technical solutions to these problems.

Application of greater trochanteric slide osteotomy in total hip arthroplasty for stiff hip / 中国骨伤

<p><b>OBJECTIVE</b>To study the effect of greater trochanteric slide osteotomy(GTSO) in total hip arthroplasty (THA) for the treatment of stiff hip, as well as the potential complications.</p><p><b>METHODS</b>There were 12 cases enrolled in the study from April 2010 to December 2014, including 9 males and 3 females. The mean age was 49.9 years old (ranged, 37 to 62 years old). The clinical result was evaluated according to the Harris evaluation system, and the radiological evaluations included the healing of the osteotomy, the stability of the prosthesis, and occurrence of heterotopic ossification (HA).</p><p><b>RESULTS</b>The mean follow-up period was 17.3 months (ranged, 15 to 22 months). The mean postoperative Harris score was 88.00±6.11, which was significantly higher than the preoperative mean score which was 43.96±8.46(=-18.34,=0.00). All the osteotomy site abtained good healing without prosthesis loosening or HA. There was 1 patient with infection and 1 patient with pain in greater trochanter.</p><p><b>CONCLUSIONS</b>GTSO is an effective exposure technique in THA for stiff hip, and no marked complication associated with the osteotomy is found in the study.</p>

Long-term Trends and Predictors of Smoking Behaviors among Men Following First-ever Ischemic Stroke / 华中科技大学学报（医学）（英德文版）

Continued smoking following stroke is associated with adverse outcomes including increased risk of mortality and secondary stroke.The aim of this study was to examine the long-term trends in smoking behaviors and factors associated with smoking relapse among men who survived their first-ever stroke.Data collection for this longitudinal study was conducted at baseline through face-to-face interviews and follow-up was completed every 3 months via telephone,beginning in 2010 and continuing through 2014.Cox proportional hazard regression models were used to identify predictors of smoking relapse behavior.At baseline,372 male patients were recruited into the study.Totally,155 (41.7％) of these patients stopped smoking for stroke,and 61 (39.3％) began smoking again within 57 months after discharge with an increasing trend in the number of cigarettes smoked per day.Exposure to environmental tobacco smoke at places outside of home and work (such as bars,restaurants) (HR,2.34;95％ CI,1.04-5.29,P=0.04),not having a spouse (HR,0.12;95％ CI,0.04-0.36;P=0.0002) and smoking at least 20 cigarettes per day before stroke (HR,2.42;95％ CI,1.14-5.14,P=0.02) were predictors of smoking relapse.It was concluded that environmental tobacco smoke is an important determinant of smoking relapse among men who survive their first stroke.Environmental tobacco smoke should be addressed by smoke-free policies in public places.

Research of TCM synthetic rehabilitation on the recovery of wrist joint after distal radius fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate efficacy and advantages of the Traditional Chinese Medicine (TCM) synthetic rehabilitation therapy in the treatment of wrist dysfunction after distal radius fractures.</p><p><b>METHODS</b>From May 2014 to October 2015, 72 patients with distal radius fracture meeting standards were treated using central randomization system for clinical research. All the patients were divided into two groups: 36 patients in test group and 36 in control group. Sixty-nine cases were finished treatment and followed up in the end. The test group fell off 1 case, and the control group fell off 2 cases. The test group was given TCM synthetic rehabilitation (manipulative therapy, joint mobilization, soaking-washing with Chinese medicinal herbs, functional exercise), and the control group was given functional exercise as well as soaking-washing with Chinese medicinal herbs, 3 weeks for both. Five evaluation standards were used in this research, which were grip strength, patient-rated wrist evaluation (PRWE), Gartland and Werley wrist score, self-rating anxiety scale(SAS) and the overall curative effect evaluation. Before treatment(baseline), after 3 weeks of treatment and 3 months after fracture were the three points in time when collected the data.</p><p><b>RESULTS</b>After 3 weeks of treatment and 3 months after fracture, the test group had a significantly better results than those of control group in the PRWE, G-W wrist score and the overall curative effect evaluation(<0.05). In terms of grip strength recovery, after 3 weeks of treatment, the intergroup difference between the test group and the control group were statistically significant relative to the baseline regarding grip strength of ipsilateral wrist by group t-test(<0.05). However, the test group and the control group had no statistically significant relative to the baseline at 3 months after fracture in grip strength(<0.05). For the anxiety of patients, compared with the test group and control group at before and after rehabilitation treatment, the anxiety of both test group and control group cases was eased(<0.05). However, The degree of anxiety relief in test group and control group cases had no difference(>0.05).</p><p><b>CONCLUSIONS</b>The TCM synthetic rehabilitation therapy has better curative effects on the treatment of functional disability of wrist joints after distal radius fractures than the general therapy of soaking-washing with Chinese medicinal herbs and functional exercise.</p>