Systemic lupus erythematosus associated macrophage activation syndrome with neuropsychiatric symptoms: A report of 2 cases / 北京大学学报(医学版)

Systemic lupus erythematosus (SLE) associated macrophage activation syndrome (MAS) is clinically severe, with a high mortality rate and rare neuropsychiatric symptoms. In the course of diagnosis and treatment, it is necessary to actively determine whether the neuropsychiatric symptoms in patients are caused by neuropsychiatric systemic lupus erythematosus (NPSLE) or macrophage activation syndrome. This paper retrospectively analyzed the clinical data of 2 cases of SLE associated MAS with neuropsychiatric lesions, Case 1: A 30-year-old female had obvious alopecia in 2019, accompanied by emaciation, fatigue and dry mouth. In March 2021, she felt weak legs and fell down, followed by fever and chills without obvious causes. After completing relevant examinations, she was diagnosed with SLE and given symptomatic treatments such as hormones and anti-infection, but the patient still had fever. The relevant examinations showed moderate anemia, elevated ferritin, elevated triglycerides, decreased NK cell activity, and a perforin positivity rate of 4.27%, which led to the diagnosis of "pre-hemophagocytic syndrome (HPS)". In May 2021, the patient showed mental trance and babble, and was diagnosed with "SLE-associated MAS"after completing relevant examinations. After treatment with methylprednisolone, anti-infection and psychotropic drugs, the patient's temperature was normal and mental symptoms improved. Case 2: A 30-year-old female patient developed butterfly erythema on both sides of the nose on her face and several erythema on her neck in June 2019, accompanied by alopecia, oral ulcers, and fever. She was diagnosed with "SLE" after completing relevant examinations, and her condition was relieved after treatment with methylprednisolone and human immunoglobulin. In October 2019, the patient showed apathy, no lethargy, and fever again, accompanied by dizziness and vomiting. The relevant examination indicated moderate anemia, decreased NK cell activity, elevated triglycerides, and elevated ferritin. The patient was considered to be diagnosed with "SLE, NPSLE, and SLE-associated MAS". After treatment with hormones, human immunoglobulin, anti-infection, rituximab (Mabthera), the patient's condition improved and was discharged from the hospital. After discharge, the patient regularly took methylprednisolone tablets (Medrol), and her psychiatric symptoms were still intermittent. In November 2019, she developed symptoms of fever, mania, and delirium, and later turned to an apathetic state, and was given methylprednisolone intravenous drip and olanzapine tablets (Zyprexa) orally. After the mental symptoms improved, she was treated with rituximab (Mabthera). Later, due to repeated infections, she was replaced with Belizumab (Benlysta), and she was recovered from her psychiatric anomalies in March 2021. Through the analysis of clinical symptoms, imaging examination, laboratory examination, treatment course and effect, it is speculated that the neuropsychiatric symptoms of case 1 are more likely to be caused by MAS, and that of case 2 is more likely to be caused by SLE. At present, there is no direct laboratory basis for the identification of the two neuropsychiatric symptoms. The etiology of neuropsychiatric symptoms can be determined by clinical manifestations, imaging manifestations, cerebrospinal fluid detection, and the patient's response to treatment. Early diagnosis is of great significance for guiding clinical treatment, monitoring the condition and judging the prognosis. The good prognosis of the two cases in this paper is closely related to the early diagnosis, treatment and intervention of the disease.

Case-control study on calcaneal locking plates and tension band with Kirschner's nail for the treatment of patellar fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical effect between calcaneal locking plates and tension band with Kirschner's nail for the treatment of patellar fracture.</p><p><b>METHODS</b>From December 2009 to December 2017, 58 patients with patellar fracture were divided into plate group(calcaneal locking plate) and tension band(tension band with Kirschner's nail) by surgical method. There were 29 patients in plate group, including 14 males and 15 females, aged from 18 to 72 years old with an average of (36.9±11.5) years old; while there were 29 patients in tension band group, including 17 males and 12 females, aged from 20 to 70 years old with an average of (37.7±14.4) years old. Operative time, blood loss, fracture healing time, follow-up time and postoperative complications were compared between two groups. Böstman score was applied to compared therapeutic effects at 12 months after operation.</p><p><b>RESULTS</b>There was no significant differences in following-up time between plate group(18.4±2.6) months and tension band group(17.8±3.6) months. According to Böstman score at 12 months after operation, plate group was (28.5±4.6) and (25.7±4.3) in tension band group, and had statistical difference between two group(=2.395, =0.020). Twenty-six patients got excellent results, 3 moderate in plate group; while 14 patients got excellent results, 11 moderate and 4 poor in tension band group, and had obviously meaning between two groups(χ²=12.17 =0.02). There were no significant differences in operative time(=1.978, =0.53), blood loss(=1.740, =0.87), fracture healing time(=0.65, =0.517) and postoperative complications(χ²=0.268, =0.604) between two groups.</p><p><b>CONCLUSIONS</b>Calcaneal locking plates for patellar fracture has advantages of more wide range of clinical application, more reliable fixation, and more satisfactory surgical curative method, its clinical effects is better than that of tension band with kirschner nail.</p>

An experiment study and clinical observation of the influence of free-skin-grafted scrotal avulsion injuries on spermatogenesis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the influence of Free-skin-grafted penoscrotal avulsion injuries on spermatogenesis.</p><p><b>METHODS</b>Forty-two male New Zealand albino rabbits during child-bearing period were divided into the experimental group (n = 24) and the control group (n = 18) using random digits table, and 24 female rabbits with reproductive history were used for mating experiment. The experimental group animal's scrotum skin were excised, and the split skin from abdominal region was used to repair the skin defect of scrotum. The control group did not any processing. Six rabbits were randomly chosen respectively in control group and on the 3rd and 8th weekend after the model was successfully established in experimental group. The testicular surface temperature was measured in the eighteen rabbits using the method of burying thermometer, then the testicular biopsy were performed for hematoxylin-eosin (HE) staining. On the 8(th) weekend after the model was successfully established in experimental group, matched-pair feed was performed in the other 12 rabbits respectively in experimental group and in control group. Observation of corresponding mother rabbit fertility. Three patients of penoscrotal avulsion injuries were treated using split skin grafts, and the information of sex life and the quality of sperm were obtained by follow up.</p><p><b>RESULTS</b>The testicular surface temperature was similar on the 3rd and 8th weekend after the model was successfully established in experimental group [(36.15 ± 0.24)°C, (36.77 ± 0.42)°C] with that of the control group. Testis tissue (HE) staining showed the tier of spermatogenic cells was rule arrangement and lot of mature sperms were found in the convoluted seminiferous tubules in control group. The tier of spermatogenic cells was diminished and disposed derangement, the spermatozoa were not seen on the 3(th) weekend of the experiment group. The tier of spermatogenic cells was increased and some spermatozoa were seen on the 8th weekend of the experiment group. Male and female matched-pair feed showed the experimental group conception rate 8/12, and 4.1 ± 3.2 rabbit babies were born averagely, while that of was 12/12 and 6.0 ± 1.3 in control group (P > 0.05). The skin grafts there were some contracture in early stage (1 - 2 months) when the skin grafts applied to repair the avulsing scrotum in three patients. But the skin grafts became loose with downward sagging and there were the good cosmetic result in one year, and without any contracture. The sperm quality was normal after the skin grafts applied to repair the avulsing scrotum in the late stage.</p><p><b>CONCLUSIONS</b>The skin grafting is little arrest the testicle spermatogenesis in the three methods (skin flap reconstruction scrotum, testicle buried, split skin grafting) that have usually been used to repair scrotum skin lose. For a young male, the best treatment for penoscrotal avulsion injuries is free skin grafting, while skin flaps are not recommended for reconstructing the scrotum.</p>

Minimally invasive percutaneous plate osteosynthesis for the treatment of intertrochanteric femoral fractures of Evans IlI and IV in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To study therapeutic effects of minimally invasive percutaneous plate osteosynthesis for the treatment of intertrochanteric femoral fractures of Evans III, IV in elderly patients.</p><p><b>METHODS</b>From December 2007 to April 2010, 23 patients with intertrochanteric femoral fractures were reviewed. Among the patients, 11 patients were male and 12 patients were female,ranging in age from 62 to 90 years, with a mean of 72.8 years. According to Evans classification, 13 patients were type III and 10 patients were type IV. All the patients were treated with proximal femoral locking plate (minimally invasive percutaneous plate osteosynthesis, MIPPO) surgery.</p><p><b>RESULTS</b>The operative time ranged from 45 to 60 min, with an average of 50 min. The blood loss ranged from 60 to 100 ml, averaged 80 ml. All the patients were followed up,and the duration ranged from 9 to 18 months, with an average of 11 months. The healing time based X-ray ranged from 3 to 6 months, with an average of 4 months. According to hip scoring criteria evaluation: 18 patients got an excellent results, 5 good.</p><p><b>CONCLUSION</b>For the treatment of intertrochanteric femoral fractures of Evans III, IV in elderly patients, MIPPO has advantages such as small trauma, reliable fixation, which has good clinical application.</p>

Repair of high-voltage electrical burn in the neck / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore methods of repair of high-voltage electrical burn in the neck.</p><p><b>METHODS</b>Thirty-seven patients with high-voltage electrical burn in neck hospitalized since 1985 were enrolled in this study. After debridement, the wounds were repaired with latissimus dorsi myocutaneous flap, trapezius myocutaneous flap, platysma myocutaneous flaps, pectoralis major myocutaneous flap, or latissimus dorsi myocutaneous flap combined with pectoralis major myocutaneous flap.</p><p><b>RESULTS</b>Necrosis occurred at edge of flap (about 1 - 2 cm in breadth) in 3 patients, and the other flaps survived well with perfect appearance and local function.</p><p><b>CONCLUSION</b>To repair with pedicled myocutaneous flaps and combined flaps after early debridement can be safe, effective and reliable in the management of patients with high-voltage electrical burn in the neck.</p>