Association of greenness, nitrogen dioxide with the prevalence of hypertension among the elderly over 65 years old in China / 中华预防医学杂志

Objective: To investigate the association of mixed exposure to greenness and nitrogen dioxide(NO2) and hypertension among the older adults aged 65 years and over in China. Methods: The study subjects were from the Chinese Longitudinal Healthy Longevity Survey from 2017 to 2018. A total of 15 423 older adults aged 65 years and over meeting the criteria were finally included in the study. A questionnaire survey was used to collect information on demographic characteristics, lifestyle habits and self-reported prevalence of hypertension. Blood pressure values were obtained through physical examination. The level of normalized difference vegetation index(NDVI) was measured by the Medium-resolution Imaging Spectral Radiator(MODIS) of the National Aeronautics and Space Administration(NASA). The concentration of NO2 was from China's surface air pollutant data set. Meteorological data was from NASA MERRA-2. The exposure to NDVI and NO2 for each study subject was calculated based on the area within a 1 km radius around their residence. The association between mixed exposure of NDVI and NO2 as well as their interaction and hypertension in older adults was analyzed by using the multivariate logistic regression model. The restrictive cubic spline(RCS) function was used to explore the exposure-response relationship between greenness and NO2 and the risk of hypertension in study subjects. Results: The mean age of 15 423 older adults were (85.6±11.6). Women accounted for 56.3%(8 685/15 423) and 55.6%(8 578/15 423) lived in urban areas. The mean time of residence was (60.9±28.5) years. 59.8% of participants were with hypertension. The mean NDVI level was 0.41±0.13, and the mean NO2 concentration was (32.18±10.36) μg/cm3. The results of multivariate logistic regression analysis showed that NDVI was inversely and linearly associated with the hypertension in older adults, with the OR(95%CI) value of 0.959(0.928-0.992). Compared with the T1 group of NDVI, the risk of hypertension was lower in the T3 group, with the OR(95%CI) value of 0.852(0.769-0.944), and the trend test was statistically significant(P<0.05). Compared with the T1 group of NO2, the risk of hypertension was higher in the T2 and T3 groups, with OR(95%CI) values of 1.160(1.055-1.275) and 1.244(1.111-1.393), and the trend test was statistically significant (P<0.05). The result of the RCS showed that NDVI was inversely and linearly associated with hypertension in older adults. NO2 was nonlinearly associated with hypertension in older adults. The interaction analysis showed that NDVI and NO2 had a negative multiplicative interaction on the risk of hypertension, with OR(95%CI) value of 0.995(0.992-0.997). Conclusion: Exposure to greenness and NO2 are associated with hypertension in older adults.

Association of hs-CRP with frailty and its components among the elderly over 65 years old in 9 longevity areas of China / 中华预防医学杂志

Objective: To investigate the association of the levels of high sensitivity C-reactive protein (hs-CRP) with frailty and its components among the elderly over 65 years old in 9 longevity areas of China. Methods: Cross-sectional data from the Health Ageing and Biomarkers Cohort Study (HABCS, 2017-2018) were used and the elderly over 65 years old were included in this study. Through questionnaire interview and physical examination, the information including demographic characteristics, behavior, diet, daily activity, cognitive function, and health status was collected. The association between hs-CRP and frailty and its components in the participants was analyzed by multivariate logistic regression model and restrictive cubic spline. Results: A total of 2 453 participants were finally included, the age was (84.8±19.8) years old. The median hs-CRP level was 1.13 mg/L and the prevalence of frailty was 24.4%. Compared with the low-level group (hs-CRP<1.0 mg/L), the OR (95%CI) value of the high-level group (hs-CRP>3.0 mg/L) was 1.79 (1.35-2.36) mg/L. As for the components, the hs-CRP level was also positively associated with ADL disability, IADL disability, functional limitation and multimorbidity. After adjusting for confounding factors, compared with the low-level group, the OR (95%CI) values of the high-level group for the four components were 1.68 (1.25-2.27), 1.88 (1.42-2.50), 1.68 (1.31-2.14) and 1.39 (1.12-1.72), respectively. Conclusion: There is a positive association between the levels of hs-CRP and the risk of frailty among the elderly over 65 years old in 9 longevity areas of China. The higher hs-CRP level may increase the risk of frailty by elevating the risk of four physical functional disabilities, namely ADL disability, IADL disability, functional limitation and multimorbidity.

Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults (version 2023) / 中华创伤杂志

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Certain issues requiring urgent attentions in the clinical diagnosis and treatment of chronic injury of lumbar back muscles / 中华创伤杂志

Chronic injury of lumbar back muscles characterized by a high incidence, insidious onset, recurrence and continuous progression is mostly due to unreasonable physical exercise, excessive professional training and unhealthy lifestyle. Persistent or recurrent back pain is the primary clinical manifestations in the early stage. With the prolongation of the injury, the accelerated degeneration of the lumbar back muscle impairs the function and leads to the deterioration of the local and overall mechanical environment of the spine, followed by a series of degenerative spinal diseases such as lumbar disc herniation, lumbar spondylolisthesis, lumbar segmental instability and spinal deformity, which seriously affects the motor function, work and quality of life. However, there is an urgent need to improve the level of awareness and attention to chronic injury and degenerative changes of lumbar back muscles in clinical practice, so as to achieve accurate diagnosis and early intervention of chronic injury of lumbar back muscles. Therefore, the author reviews the etiology, clinical manifestation, diagnosis and treatment of chronic injury of low back muscles to discuss the current problems and summarize the cutting-edge technology, hoping to provide a reference for improving the diagnosis and treatment level of clinicians.

An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique (version 2023) / 中华创伤杂志

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair (version 2023) / 中华创伤杂志

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Pre-attentive processing in autism spectrum disorder / 中华行为医学与脑科学杂志

Autism spectrum disorder (ASD) is a neurodevelopmental disorder.Its typical symptoms include social disorder, stereotyped behavior and restrictive interest.In addition, sensory abnormality is also a common symptom of ASD individuals.Pre-attentive processing is an automatic cognitive process that takes place before attention and is independent of consciousness, which reflects the ability to automatically detect changes in the environment of brain.Many researches show that the sensory abnormality and social ability disorder in ASD patients may be related to the defects in the pre-attentive processing stage.Mismatch negativity (MMN) is the most commonly used indicator of pre-attentive processing.ASD individuals show abnormal MMN in response to both social and non-social stimulus.Among them, the pre-attentive processing defect of non-social stimuli in ASD individuals is manifested as the amplitude or latency of MMN induced by single tones, voice or visual stimuli, which is different from that of normal people.The pre-attentive processing defect of social stimuli in ASD individuals is manifested as the amplitude or latency of MMN induced by emotional voice and emotional face, which is different from that of normal people.This result not only helps to find the physiological mechanism of sensory and social disorders in ASD individuals, but also provides theoretical support for MMN as an auxiliary diagnostic index of ASD.Future research on the pre-attentive processing of ASD individuals should pay more attention to enriching the research paradigms of MMN and adopting more kinds of social stimuli.At the same time, the influence of ASD genetic factors on MMN can also be one of the concerns of future research.

Analysis on off-label use of drugs in pediatric guidelines and consensus published by Chinese authors / 中华儿科杂志

Objective: To understand the current situation regarding pediatric off-label use of drugs recommendations in Chinese clinical practice guidelines and to make recommendations for standardized reporting format regarding off-label use of drugs for children. Methods: This cross-sectional study was carried out by systematically searching the databases for Chinese guideline consensus articles published in journals between 2018 and 2020 and extracting recommendations regarding off-label use of drugs from those articles. The essential characteristics of the included guidelines, the ranking of off-label drug types, the order of drug information, the type of off-label drug use, and the percentage of citation studies on which the recommendations were based were analyzed. Results: Among 108 studies that included Chinese off-label guidelines and consensus, 364 recommendations on pediatric off-label use of drugs were included. The Chinese Medical Association published the most, 48 out of the 108 studies (44.4%), and of those 14 studies (13.0%) were on infectious and parasitic diseases. Of the 364 recommendations on off-label use of drugs, the most commonly addressed drugs were 16 recommendations (4.4%) for cyclosporine A, 11 recommendations (3.0%) for methotrexate , and 11 recommendations (3.0%) for fentanyl. The most commonly addressed drug categories were as follows: 68 recommendations (18.6%) were immune system drugs, 66 recommendations (18.1%) were anti-infectives, and 56 recommendations (15.4%) were oncology drugs. The most commonly addressed drug information accounts were as follows: 364 recommendations (100.0%) were indications, 204 recommendations (56.0%) were dosages, and 198 recommendations (54.4%) were the route of administration. Based on the instructions approved by the Chinese Food and Drug Administration, the main forms of the off-label drug were as follows: 175 recommendations (48.1%) were unapproved indications, 127 recommendations (34.9%) were unapproved populations, and 72 recommendations (19.8%) were unapproved ages. Only 129 recommendations (35.4%) were cited, mainly including clinical guidelines (48 studies, 23.4%), reviews (22 studies, 10.7%), and pediatric randomized controlled trials (22 studies, 10.7%). Conclusions: Off-label use of drugs is commonly recommended in pediatric guidelines and consensus documents written by Chinese authors. However, the reporting of the recommendations varies widely, and the quality of the supporting evidence is poor.

Relationship between body mass index and clinical characteristics, imaging characteristics and prognosis of patients with primary brainstem hemorrhage / 中国医师进修杂志

Objective:To explore the relationship between body mass index (BMI) and clinical characteristics, imaging characteristics and prognosis of patients with primary brainstem hemorrhage (PBH).Methods:The clinical data of 114 PBH patients admitted in 909th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) from February 2016 to October 2019 were retrospectively analyzed. According to the BMI, the patients were divided into the normal group (BMI<24 kg/m 2, 71 cases) and the overweight/obese group (BMI≥24 kg/m 2, 43 cases). The clinical and imaging characteristics of the two groups were compared, and the factors affecting the prognosis of the PBH patients were analyzed by univariate analysis and Cox multivariate regression model. Results:More patients in the overweight/obese group had histories of hypertension (86.05% vs. 69.01%, P = 0.041), diabetes (37.21% vs. 9.86%, P<0.01), and heart disease (20.93% vs. 5.63%, P = 0.013) than the normal group. The systolic blood pressure, diastolic blood pressure, blood glucose, LDL, TG, WHR, and the incidences of coma, convulsions, central fever in overweight/obese group were significantly higher than those in normal group: (172.83±26.15) mmHg (1 mmHg = 0.133 kPa) vs. (159.28±31.67) mmHg, (98.36±15.57) mmHg vs. (89.52±13.26) mmHg, (8.64±1.53) mmol/L vs. (7.95±1.28) mmol/L, (3.51±1.29) mmol/L vs. (2.95±1.04) mmol/L, (5.94±2.27) mmol/L vs. (2.19±0.86) mmol/L, 1.29±0.21 vs. 2.19±0.86, 48.84% vs. 25.35%, 30.23% vs. 14.08%, and 44.19% vs. 23.94%, the GCS score was significantly lower than that in the normal group: (4.69±1.87) scores vs. (6.37±1.52) scores, and there was statistical difference ( P<0.05 or<0.01). Compared with the normal group, there were significant differences in the bleeding site ( χ2 = 5.64, P = 0.010), bleeding volume ( χ2 = 5.35, P = 0.013), combined ventricular hemorrhage ( χ2 = 9.21, P = 0.002) and hydrocephalus ( χ2 = 4.79, P = 0.029). Multivariate analysis showed that BMI ( OR = 4.11, 95% CI 3.84 to 4.64, P = 0.039), history of hypertension ( OR = 8.71, 95% CI 6.28 to 9.52, P = 0.021), GCS score ( OR = 0.05, 95% CI 0.03 to 0.12, P = 0.012), bleeding volume ( OR = 3.09, 95% CI 2.16 to 4.03, P = 0.041), combined ventricular hemorrhage ( OR = 4.34, 95% CI 2.96 to 5.12, P = 0.023) and hydrocephalus ( OR = 6.40, 95% CI 5.63 to 6.89, P = 0.027) were all independent risk factors affecting the prognosis of PBH patients. Conclusions:BMI has a greater impact on the prognosis of PBH. Overweight/obese PBH patients also have hypertension history, low GCS score, large amount of bleeding, ventricular hemorrhage, hydrocephalus, etc., which should be paid more attention to by clinicians, positively control the progress of the disease and improve the prognosis of patients.

Relationship Between Intestinal Flora and Bone and Joint Diseases and Regulation of Traditional Chinese Medicine： A Review / 中国实验方剂学杂志

Intestinal flora is the largest microbial community in human body， which consists of more than 1 000 species. Its structure and metabolites change dynamically with the age， diet and intestinal environment of the host. Study shows that the intestinal microbes play a pivotal role in regulating human physiological and pathological processes， and intestinal flora imbalance may be the key factors affecting the occurrence and development of bone and joint diseases， including osteoporosis， osteoarthritis， rheumatoid arthritis and gouty arthritis. At present， calcitonin， estrogen， nonsteroidal anti-inflammatory drugs， immunosuppressants， xanthine oxidase inhibitors and other western drugs are mostly used to treat the above diseases. However， long-term use of western drugs leads to poor compliance and obvious gastrointestinal adverse reactions among patients. Traditional Chinese medicine （TCM） predominates in the treatment of bone and joint diseases due to its low price， high efficacy and slight side effects， with the advantages of multi-targets， multi-mechanism and multi-levels. In recent years， many scholars have carried out experiments and clinical studies on the treatment of bone and joint diseases by TCMs on the basis of the liver and kidney theory such as "tonifying liver and kidney and strengthening muscles and bones". Gratifying results have been achieved. However， the mechanism of action has not been fully clarified. Intestinal flora becomes a hot spot in medical research， and a close relationship between intestinal flora and bone and joint diseases has been unveiled. Relevant literature in China and abroad showed that TCM has a significant effect on the treatment of bone and joint diseases by regulating intestinal flora. In this paper， the relationship between intestinal flora and bone and joint diseases was summarized and the intervention of TCM active ingredients and compounds on intestinal flora was reviewed to facilitate the prevention and treatment of bone and joint diseases by TCM.

Prevalence of diabetes mellitus among Uygur children in Hotan Prefecture of Xinjiang, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the prevalence of diabetes mellitus (DM) among Uygur children in Hotan Prefecture of Xinjiang, China, as well as the factors influencing the development of DM.@*METHODS@#The cluster random sampling method was used to select 5 308 children, aged 4-18 years, from the middle and primary schools and kindergartens in Hotan Prefecture of Xinjiang. The survey methods included questionnaire survey and the measurement of height and weight. All subjects were tested for fasting fingertip blood glucose to investigate the prevalence of DM and impaired fasting glucose (IFG).@*RESULTS@#A total of 5 184 valid questionnaires were collected. Fourteen children (0.27%) were found to have DM, among whom 8 had type 1 DM, 2 had type 2 DM, and 4 had unclassified DM. Twenty-nine children (0.56%) were found to have IFG. There was no significant difference in the prevalence rate of DM and IFG between boys and girls (P>0.05). The prevalence rate of DM was 0.18% in the 4-<10 years group, 0.47% in the 10-<15 years group, and 0.07% in the 15-18 years group (P=0.072).The prevalence rate of IFG in the above three age groups was 0.18%, 0.94%, and 0.42%, respectively, with a significant difference among groups (P=0.007). The proportion of family history of DM and the proportion of overweight/obesity in children with DM were significantly higher than those in children without DM (P<0.05), while the proportion of children with DM who preferred coarse grains was significantly lower than that in children without DM (P<0.05).@*CONCLUSIONS@#The prevalence of DM and IFG in Uyghur children in Hotan Prefecture of Xinjiang is relatively low. There is no significant difference in the prevalence of DM among children of different genders or age groups, but the prevalence of IFG in children of different age groups is different. A family history of DM, overweight or obesity, and low intake of coarse grains might be associated with the development of DM.

Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients (version 2022) / 中华创伤杂志

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Dyskinesia is Closely Associated with Synchronization of Theta Oscillatory Activity Between the Substantia Nigra Pars Reticulata and Motor Cortex in the Off L-dopa State in Rats / 神经科学通报·英文版

Excessive theta (θ) frequency oscillation and synchronization in the basal ganglia (BG) has been reported in elderly parkinsonian patients and animal models of levodopa (L-dopa)-induced dyskinesia (LID), particularly the θ oscillation recorded during periods when L-dopa is withdrawn (the off L-dopa state). To gain insight into processes underlying this activity, we explored the relationship between primary motor cortex (M1) oscillatory activity and BG output in LID. We recorded local field potentials in the substantia nigra pars reticulata (SNr) and M1 of awake, inattentive resting rats before and after L-dopa priming in Sham control, Parkinson disease model, and LID model groups. We found that chronic L-dopa increased θ synchronization and information flow between the SNr and M1 in off L-dopa state LID rats, with a SNr-to-M1 flow directionality. Compared with the on state, θ oscillational activity (θ synchronization and information flow) during the off state were more closely associated with abnormal involuntary movements. Our findings indicate that θ oscillation in M1 may be consequent to abnormal synchronous discharges in the BG and support the notion that M1 θ oscillation may participate in the induction of dyskinesia.

The role and thinking of expert preliminary counselling in improving the funding rate of National Natural Science Fund / 中华医学科研管理杂志

Objective:In this study, we compared the funding rates of applicants who participated in the expert preliminary counseling with those who did not, to explore the role of the expert preliminary counseling in improving the funding rate of the National Natural Science Fund, so as to provide further reference for the management of scientific research.Methods:Statistical methods was used to analyze relevant data from 2012 to 2019 to compare the approval and funding rate of the applicants that participated in and did not participate in the expert preliminary counseling using.Results:From 2012 to 2019, the proportion of funded applicants in the expert preliminary counselling group was 30.45%, and the overall funding rate was 18.51%. Under the same research basis, the funding rate of the group was 29.91%, which was significantly higher than the group did not participate in the expert preliminary counselling (funding rare: 13.59%, P<0.001). Conclusions:We should pay more attention to and participate actively in the expert preliminary counselling, which can increase the quality of the projects and improve their funding rate significantly.

Cytomegalovirus infection in preterm infants of gestational age <32 weeks or birth weight <1 500 g fed by their own mother's frozen breast milk / 中华围产医学杂志

Objective:To understand cytomegalovirus (CMV) infection status in hospitalized preterm infants who were fed by their own mother's frozen breast milk.Methods:This retrospective study enrolled breastfed neonates with gestational age less than 32 weeks or birth weight less than 1 500 g who were born and admitted to Gynecology and Obstetrics Hospital of Fudan University from January 2018 to December 2020. Clinical data of the babies and their mothers were collected and analyzed, including CMV DNA results of breast milk and urine samples of the subjects by fluorescence quantitative polymerase chain reaction. Chi-square test (or Fisher's exact probability test), two independent samples t test, and Mann-Whitney U test were used for the statistical analysis. Results:A total of 94 parturients and their 103 premature infants (including nine pairs of twins) were included. CMV DNA of breast milk was noted for positive in 75 cases (including eight pairs of twins) and for negative in 28 cases (including one pair of twins). Out of the 75 preterm infants born to mothers with positive CMV DNA breast milk, 67 (including eight pairs of twins) were switched to frozen breast milk (－20 ℃ for 72 h), and six of them were infected by CMV(9.0%) without any treatment. All of the 103 infants were divided into two groups: the frozen milk fed group ( n=67) or fresh milk fed group ( n=36). In the frozen milk fed group, the CMV DNA was mainly detected during 2-8 weeks postpartum with copy number reaching the peak at 8th week. And those infants in the frozen milk fed group, whose mother's breast milk CMV DNA was positive, was further divided into CMV infected ( n=6) or CMV non-infected groups ( n=61) according to the urine test results. Moreover, compared with the non-infected group, the average [22.7(3.0-95.7)×10 3 copies/ml vs 5.0(0.5-89.5)×10 3 copies/ml, Z=－2.218) and the highest[45.9(5.9-261.0)×10 3 copies/ml vs 9.8(1.2-766.0)×10 3 copies/ml, Z=－2.218] copy number of CMV DNA in the breast milk were higher in the CMV infected group (both P<0.05). The incidence of feeding intolerance[37.3% (25/67) vs 50.0% (18/36), χ2=1.550], neonatal necrotizing enterocolitis [0.7% (1/67) vs 0.0% (0/36)], bronchopulmonary dysplasia [28.4% (19/67) vs 27.8% (10/36), χ2=0.004], retinopathy of prematurity [20.9% (14/67) vs 8.3%(3/36), χ2=2.682], and late-onset sepsis [22.4% (15/67) and 30.6% (11/36), χ2=0.828] did not differ significantly between the frozen or fresh milk fed groups (all P>0.05). Conclusions:The incidence of breast milk-related CMV infection in those fed with frozen breast milk was low and does not increase the without increasing risks of related complications or leading to obvious clinical manifestations after infection. For preterm infants with gestational age <32 weeks or birth weight <1 500 g, frozen breast milk can be an alternative for mothers with CMV DNA positive breast milk.

The clinical research of five-step 180W XPS greenlight photoselective vaporization of the prostate for large volume benign prostatic hyperplasia / 中华泌尿外科杂志

Objective:To explore the efficacy and safety of five-step 180W XPS greenlight photoselective vaporization of prostate (PVP)for large volume (≥80ml) benign prostatic hyperplasia.Methods:A total of 240 BPH patients (PV≥ 80 ml), treated with five-step 180W XPS PVP from June 2017 to May 2019 in our center, were reviewed retrospectively. The average age was (70.18±7.71) years old, and 129 cases were over 70 years old. The average body mass index was (24.91±2.98 )kg/m 2. The median international prostate symptom score (IPSS) was 23 (20, 26) and the quality of life (QOL) score was 5 (4, 5) points. Besides, the preoperative median prostate volume (PV) was 98.29 (86.49, 116.32) ml, the median maximum urinary flow rate (Q max)was 6 (4, 8) ml/s and postvoid residual urine volume (PVR) was 120 (30, 200) ml. All patients underwent 180W XPS five-step method PVP operation according to the following method. The first step is vaporization of 1-2 o′clock (left lobe) and 10-11 o′clock (right lobe) in order to establish operating channel. The second step is vaporization of the lateral lobe layer by layer from the ventral side to the dorsal side. The third step is channel establishment of 5/7 o′clock mid lobe parasulcus. The forth step is ablation of the middle lobe laterally. The fifth step is vaporization of the apex of the prostate and trimming. The IPSS score, QOL score, Q max and PVR were evaluated 12 months later after the PVP operation. Results:All the 240 cases were treated by five-step 180W XPS PVP operation successfully. The median operation time and laser time were 83 (73, 98.75) min and 66 (60, 76) min. Capsular perforation was found in 3 cases, which occurred in the trimming stage. There were 9 cases treated with TURP to stop bleeding, and no cases suffered blood transfusion. Twenty-two patients underwent bladder irrigation for 6 to 24 hours after the operation, and the median catheter indwelling time and post-operative hospital stay were 3 (3, 4) days and 4 (3, 5) days respectively. Twenty-six patients suffered urinary incontinence, including 22 cases of urinary incontinence and 4 cases of stress urinary incontinence. In addition, there was no severe hematuria, severe bladder irritation or urinary retention among the patients. The postoperative IPSS score was 5(4, 7), QOL score 1(1, 2), Q max 18(15, 20)ml/s and PVR 10(0, 30)ml, which were all significantly improved compared with those before surgery ( P<0.01). None second PVP surgery was performed. Conclusions:The five-step 180W XPS PVP operation has the advantages of improving lower urinary tract symptoms, less blood loss and low incidence of perioperative adverse events. It is easy to use, which is a reliable minimally surgery.

Comparison between discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion in the treatment of single-level lumbar disc herniation / 中华骨科杂志

Objective:To compare the clinical effects of discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion (TLIF) in treating single-level lumbar disc herniation.Methods:From November 2012 to November 2015, a total of 96 patients with single-level lumbar disc herniation (disc height decreased more than 1/3, the width of the basilar part of the herniated disc >6 mm, massive disc herniation or Modic type I endplate changes) treated by discectomy combined with Dynesys dynamic stabilization (Dynesys group, n=48) or TLIF (fusion group, n=48) were enrolled. Clinical assessments included operation duration, intraoperative blood loss, MacNab score, visual analogue scale (VAS), Oswestry disability index (ODI) and rate of complications. Radiographs were evaluated for lumbar mobility, intervertebral height, etc. Results:A total of 86 patients were included in the final analysis (44 in Dynesys group and 42 in fusion group) and were evaluated after 5 years follow-up. The operation duration of Dynesys group (159.61±37.29 min) was less than that of the fusion group (177.42±39.90 min) significantly ( t=2.140, P=0.035). Intraoperative blood loss in Dynesys group (151.78±50.88 ml) was less than that in fusion group (197.74±76.55 ml) with significant difference ( t=3.293, P=0.001). At 5 years follow-up, there were 2 cases with screw loosening and 5 cases with adjacent segmental degeneration in Dynesys group without symptom. In fusion group, there were 12 cases with adjacent segmental degeneration and two of them with symptom. There were significant differences in the incidence of adjacent segment degeneration between the two groups ( χ2=4.012, P=0.045). According to the MacNab criteria, excellent or good cases accounted for 95% in Dynesys group and 93% in fusion group without significant differences ( Z=0.425, P=0.671). VAS back, VAS leg and ODI scores were improved significantly in both groups after 2 years and 5 years ( P<0.05). However, there were no significant differences between the two groups ( P<0.05). The activity of the surgical segment was 4.59°±0.48° in Dynesys group and 1.00°±0.42° in fusion group at 5 years after surgery. The height of intervertebral space in Dynesys group decreased from 11.19±2.07 mm before surgery to 9.98±2.02 mm at 2 years after surgery and to 9.86±1.64 mm at 5 years after surgery ( F=6.462, P=0.002). However, there was no statistically significant difference between the 2 and 5 years follow-up ( q=0.415, P>0.05). At 5 years after surgery, the activity of the first proximal segment in the two groups was 9.74°±3.29° and 11.69°±3.89°, respectively ( t=2.514, P=0.014). Conclusion:Both discectomy combined with dynamic stabilization and TLIF can achieve satisfied clinical effects in treating single-level lumbar disc herniation. Dynamic stabilization preserves the intervertebral activity of surgical segments and results in a lower incidence of adjacent segment degeneration compared with that in fusion surgery. Furthermore, discectomy combined with dynamic stabilization is a less invasive intervention with shorter operation duration and less blood loss compared with TLIF.

The effect and mechanism of circSIPA1L1 on the proliferation, migration, invasion of renal cancer cells / 中华泌尿外科杂志

Objective:To investigate the functional mechanism of circular RNA signal-induced proliferation-associated gene 1(circSIPA1L1) on proliferation, migration and invasion of renal cell carcinoma cells, as well as to explore its mechanism.Methods:The study was completed between January 2019 and December 2019. Bioinformatics was used to analyze the expression of circular RNA(circRNA), circSIPA1L1 in renal cancer tissue and the information of circSIPA1L1. The expression of circSIPA1L1 mRNA, miR-22-3p in renal cancer tissues and renal cancer cells was detected by RT-qPCR. The circSIPA1L1 interference vector negative control (si-NC group), circSIPA1L1 interference vector (si-circSIPA1L1 group), si-circSIPA1L1+ miR-22-3p suppression vector plasmid negative control (anti-miR-NC group), si-circSIPA1L1 + miR-22-3p inhibition vector plasmid (anti-miR-22-3p group) were transfected into A498 and OSRC2 cells respectively. Dual luciferase reporter gene experiment was used to verify the targeting relationship. Clone formation experiment and Transwell chamber were used to detect cell proliferation, migration and invasion. The xenograft model was established by subcutaneous injection of A498/sh-circSIPA1L1 or A498/sh-NC (2×10 6 in 0.2 ml PBS/mice) on the right back of nude mice, and nude mice were divided into sh-circSIPA1L1 group and sh-NC group. Nude mice tumor formation experiments were used to detect tumor formation ability. Results:The expression of circSIPA1L1 mRNA in adjacent tissues and renal cancer tissues were (1.09±0.44) and (3.89±1.35) respectively. The expression of miR-22-3p were (1.02±0.30) and (0.44±0.19)respectively. The difference of the expression of circSIPA1L1 mRNA and miR-22-3p in kidney cancer tissue and adjacent tissues were statistically significant ( P<0.05). Compared with normal kidney cell KiMA, the expression of circSIPA1L1 mRNA in renal cancer cells A498 and OSRC2 was increased, and the expression of miR-22-3p was decreased ( P<0.05). The cell clone number of A498 and OSRC2 in the si-circSIPA1L1 group (130.67±15.04, 99.00±14.80) was lower than that in the si-NC group (314.33±29.57, 234.67±21.50), the number of cell migration (108.33±17.01, 85.67±11.93) was lower than si-NC group (265.00±20.00, 210.33±18.58), cell invasion number (84.00±12.00, 66.00±10.15) was lower than si-NC group (210.33±18.58, 173.00±17.52), and the differences were all statistically significant ( P< 0.05). CircSIPA1L1 targets and negatively regulates miR-22-3p expression. The cell clone number of A498 and OSRC2 in the si-circSIPA1L1+ anti-miR-22-3p group (234.20±21.90, 185.06±20.72) was higher than that in the si-circSIPA1L1+ anti-miR-NC group (134.65±26.55, 106.14±16.38), the migration cell number (187.02±23.54, 117.86 ±15.09) was higher than that of the si-circSIPA1L1+ anti-miR-NC group (110.59±12.12, 91.70±14.83), and the number of cell invasion (168.23±11.69, 103.70±9.23) was higher than that of the si-circSIPA1L1+ anti-miR-NC group (90.46±11.53, 61.35±9.10). The differences were all statistically significant ( P<0.05). The tumor volumes of nude mice in the sh-NC group and sh-circSIPA1L1 group on day 35 were (578.65±68.67) mm 3 and (242.56±42.35) mm 3 respectively, the tumor weights of nude mice were (0.68±0.06) g and (0.38±0.04) g respectively, the differences were statistically significant ( P<0.05). Conclusions:CircSIPA1L1 can promote the deterioration of renal cancer, promote the proliferation, migration, invasion of cancer cells and tumor growth. The mechanism of action is related to the direct targeting of miR-22-3p.

Titanium cable binding plate combined with proximal femoral nail antirotation for recurrent fractures after treatment of unstable intertrochanteric fractures / 中华创伤杂志

Objective:To investigate the clinical effect of titanium cable binding plate combined with lengthened proximal femoral nail antirotation (PFNA) for fixation of recurrent fracture after treatment of unstable intertrochanteric fractures.Methods:A retrospective case series study was conducted for analyzing the clinical data of 17 patients with recurrent fracture of unstable intertrochanteric fractures admitted to Southwest Hospital of Army Medical University from January 2010 to January 2018. There were 7 males and 10 females, aged from 65 to 94 years [(75.7±13.2)years]. The patients were treated using titanium cable binding plate combined with PFNA. Anti-osteoporosis therapy was applied as well. X-ray images were performed at postoperative 3 days, 3, 6 and 12 months. The healing and complications of the patients were recorded. The Harris hip score, visual analogue score (VAS), physical health score (PCS), mental health score (MCS) and 36-item short form health survey questionnaire (SF-36) were evaluated before operation and at postoperative 6 and 12 months.Results:All patients were followed up for 12-18 months [(15.3±2.8)months]. Bone healing was achieved in all patients, and the postoperative bone healing time was 3-6 months [(3.6±1.1)months]. One patient developed lumbosacral pressure sores and recovered after dressing change. Two patients developed drooping pneumonia, which was completely relieved after symptomatic treatment including nebulized inhalation of antibiotics and sputum aspiration. At postoperative 6 and 12 months, Harris hip score was (76.5±5.2)points and (85.5±5.7)points, significantly higher than (32.8±5.1)points before operation ( P<0.05); VAS was (3.3±0.5)points and (1.2±0.7)points, significantly lower than (8.5±0.7)points before operation ( P<0.05); PCS was (44.2±4.9)points and (56.9±5.8)points, significantly higher than (29.3±4.7)points before operation ( P<0.05); MCS was (47.9±6.8)points and (58.4±7.9)points, significantly higher than (39.7±5.9) points before operation ( P<0.05); SF-36 was (493.9±85.7)points and (603.4±76.8)points, significantly higher than (415.9±88.2)points before operation ( P<0.05). Conclusions:Titanium cable binding plate combined with lengthening PFNA can provide stability of fracture end, promote fracture healing, reduce complications, relieve pain and improve patients' quality of life for recurrence of unstable intertrochanteric fracture.

Application of CBL teaching based on digital orthopedic technology in clinical teaching of kyphosis / 中华医学教育探索杂志

Objective:To explore the feasibility and superiority of applying digital orthopedic technology of virtual human reconstruction and 3D printing to CBL teaching of kyphosis for clinical postgraduates.Methods:Thirty postgraduates of professional degree participated in the standardized training of resident doctors in our department were randomized into the experimental group (New CBL teaching mode group) and the control group (traditional teaching mode group) with 15 students in each group, and the two groups were taught differently (the teaching content was two typical cases of kyphosis). Among them, the experimental group adopted the new CBL teaching mode, and successively conducted small class theory teaching, model explanation, group discussion, preoperative design, surgery observation and specific questions and answers, etc. The control group only used the traditional method to teach theory in a large class. The teaching effect of the two groups was evaluated in t test by SPSS 25.0.Results:For the teaching of patients with ankylosing spondylitis and kyphosis, scores of the satisfaction with class interest, mastery of theoretical knowledge and understanding of operation plan in the experimental group were (9.4±0.2), (91.1±3.8), and (91.5±3.5) respectively, and those in the control group were (8.2±0.4), (82.1±3.5) and (83.1±4.7) respectively, with statistical significance ( P<0.05). Conclusion:In the teaching of kyphosis, the CBL teaching mode based on digital orthopedic technology is superior to the traditional teaching mode, which is conducive to improving clinical skills for students.