Efficacy of transcatheter pulmonary valve perforation in neonates with pulmonary atresia with intact ventricular septum / 中华儿科杂志

Objective: To explore the efficacy and safety of transcatheter pulmonary valve perforation in the treatment of neonatal pulmonary atresia with intact ventricular septum (PA-IVS). Methods: The clinical data on surgical treatment and follow-up in 16 patients with PA-IVS who underwent transcatheter pulmonary valve perforation in Women and Children's Hospital, Qingdao University from October 2018 to October 2021 were analyzed retrospectively. The right ventricular systolic pressure and percutaneous oxygen saturation (SpO2) were compared before and after operation. In addition, the SpO2 and echocardiographic data at preoperative and the last follow-up were compared. Comparisons between groups were performed using paired-samples t test. Results: Among the 16 patients (10 males and 6 females) with the age at operation of 19 (14, 26) days, 12 cases underwent transcatheter pulmonary valve perforation successfully, 2 cases were transferred to surgery department for open-heart pulmonary valvulotomy, and the remaining 2 cases were transmitted to surgery department for transthoracic pulmonary valve perforation. The age at operation of the 12 patients who underwent transcatheter pulmonary valve perforation was 18 (14, 27) days, and the weight was (3.6±0.4) kg. The immediate postoperative right ventricular systolic pressure decreased significantly ((57±16) vs. (95±19) mmHg (1 mmHg=0.133 kPa), t=7.49, P<0.001), and the postoperative SpO2 was improved effectively (0.90±0.48 vs.0.75±0.09, t=-5.61, P<0.001). The follow-up time was 22 (7, 33) months for 12 patients who underwent transcatheter pulmonary valve perforation successfully. At the last follow-up, the ratio of right to left ventricular transverse diameter was significantly higher than that before operative (0.55±0.05 vs. 0.45±0.05, t=-3.27,P=0.007). Furthermore, the Z-scores of pulmonary valvular diameter (-0.78±0.23 vs. -1.73±0.56, t=-8.52, P<0.001) and the tricuspid valvular diameter (-0.52±0.12 vs. -1.46±0.38, t=-10.40, P<0.001) were all significantly higher than preoperative data. At last, all the patients achieved biventricular circulation without death or major complications. Conclusion: Transcatheter pulmonary valve perforation is a safe and effective therapy for neonatal PA-IVS, and its curative effect has been confirmed by the medium follow-up data.

Integrated management during the perinatal period for total anomalous pulmonary venous connection / 中国当代儿科杂志

OBJECTIVES@#To evaluate the clinical effectiveness of integrated management during the perinatal period for fetuses diagnosed with total anomalous pulmonary venous connection (TAPVC) by prenatal echocardiography.@*METHODS@#Clinical data of 64 cases of TAPVC fetuses diagnosed by prenatal echocardiography and managed with integrated perinatal care in Qingdao Women and Children's Hospital from January 2017 to December 2021 were retrospectively analyzed. Integrated perinatal care included multidisciplinary collaboration among obstetrics, fetal medicine, ultrasound, pediatric cardiology, pediatric anesthesia, and neonatology.@*RESULTS@#Among the 64 TAPVC fetuses, there were 29 cases of supracardiac type, 27 cases of intracardiac type, 2 cases of infracardiac type, and 6 cases of mixed type. Chromosomal analysis was performed in 42 cases, and no obvious abnormalities were found. Among the 64 TAPVC fetuses, 37 were induced labor, and 27 were followed up until term birth. Among the 27 TAPVC cases, 2 cases accepted palliative care, 2 cases were referred to another hospital for treatment and lost to follow-up, while the remaining 23 cases underwent primary repair surgery. One case died within 6 months after the operation due to low cardiac output syndrome, while the other 22 cases were followed up for (2.1±0.3) years with good outcomes (2 cases underwent a second surgery within 1 year after the first operation due to anastomotic stenosis or pulmonary vein stenosis).@*CONCLUSIONS@#TAPVC fetuses can achieve good outcomes with integrated management during the perinatal period.

Changes in early postoperative outcomes and complications observed in a single center during the 2022 COVID-19 pandemic wave in China: A single-center ambispective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Currently, the effect of the 2022 nationwide coronavirus disease 2019 (COVID-19) wave on the perioperative prognosis of surgical patients in China is unclear. Thus, we aimed to explore its influence on postoperative morbidity and mortality in surgical patients.@*METHODS@#An ambispective cohort study was conducted at Xijing Hospital, China. We collected 10-day time-series data from December 29 until January 7 for the 2018-2022 period. The primary outcome was major postoperative complications (Clavien-Dindo class III-V). The association between COVID-19 exposure and postoperative prognosis was explored by comparing consecutive 5-year data at the population level and by comparing patients with and without COVID-19 exposure at the patient level.@*RESULTS@#The entire cohort consisted of 3350 patients (age: 48.5 ± 19.2 years), including 1759 females (52.5%). Overall, 961 (28.7%) underwent emergency surgery, and 553 (16.5%) had COVID-19 exposure (from the 2022 cohort). At the population level, major postoperative complications occurred in 5.9% (42/707), 5.7% (53/935), 5.1% (46/901), 9.4% (11/117), and 22.0% (152/690) patients in the 2018-2022 cohorts, respectively. After adjusting for potential confounding factors, the 2022 cohort (80% patients with COVID-19 history) had a significantly higher postoperative major complication risk than did the 2018 cohort (adjusted risk difference [aRD], 14.9% (95% confidence interval [CI], 11.5-18.4%); adjusted odds ratio [aOR], 8.19 (95% CI, 5.24-12.81)). At the patient level, the incidence of major postoperative complications was significantly greater in patients with (24.6%, 136/553) than that in patients without COVID-19 history (6.0% [168/2797]; aRD, 17.8% [95% CI, 13.6-22.1%]; aOR, 7.89 [95% CI, 5.76-10.83]). Secondary outcomes of postoperative pulmonary complications were consistent with primary findings. These findings were verified through sensitivity analyses using time-series data projections and propensity score matching.@*CONCLUSION@#Based on a single-center observation, patients with recent COVID-19 exposure were likely to have a high incidence of major postoperative complications.@*REGISTRATION@#NCT05677815 at https://clinicaltrials.gov/ .

Prevalence and influencing factors of work-related musculoskeletal disorders among clinical nurses in China: A meta-analysis / 环境与职业医学

Background Work-related musculoskeletal disorders (WMSDs) seriously affect work efficiency and quality of life of nurses. Currently, there are significant differences in the published studies on WMSDs in nurses. Objective To systematically evaluate the prevalence of WMSDs among nurses in the mainland of China and analyze its main influencing factors. Methods Eight databases (CNKI, Wanfang data, VIP, SinoMed, PubMed, Cochrane Library, Web of Science, and Embase) were selected for searching literature reporting prevalence and influencing factors of WMSDs among clinical nurses in China from inception to December 31, 2022. The literature was included according to a pre-set criteria of inclusion and exclusion. The quality of cross-sectional studies was assessed using the criteria recommended by the Agency for Healthcare Research and Quality (AHRQ), and the extracted data were analyzed by Stata 15.0 software. A random effect model or a fixed effect model was selected to calculate combined effects based on heterogeneity of included studies. Results A total of 19 studies were included in this meta-analysis, including 14 studies published in Chinese and 5 in English, involving 17852 nurses in total. The estimated prevalence rate of WMSDs since work among clinical nurses in China was 85.5% (95%CI: 79.8%, 91.1%), the estimated annual prevalence rate was 81.0% (95%CI: 75.2%, 86.8%), and the estimated weekly prevalence rate was 65.0% (95%CI: 48.5%, 81.5%). The results of subgroup analysis showed that the prevalence rate of WMSDs among nurses in specific departments of emergency, ICU, and midwifery was 88.6% (95%CI: 82.6%, 94.6%), higher than that among nurses in general departments [79.0% (95%CI: 72.5%, 85.5%)]. The reported prevalence of WMSDs from 2018 to 2022 was 82.2% (95%CI: 75.0%, 89.4%), which was higher than that from 2004 to 2017 [76.8% (95%CI: 67.2%, 86.4%)]. Age >40 years (OR=2.34, 95%CI: 1.69, 3.24), length of service >10 years (OR=2.12, 95%CI: 1.43, 3.15), obesity (OR=2.73, 95%CI: 1.56, 4.77), night shift (OR=2.03, 95%CI: 1.81, 2.28), lifting heavy objects (OR=3.80, 95%CI: 1.79, 8.07), rest during work (OR=0.49, 95%CI: 0.30, 0.83), and bending (OR=3.47, 95%CI: 2.37, 5.08) were influencing factors of WMSDs in nurses. Conclusion The prevalence rate of WMSDs among Chinese nurses is high, and it is increasing year by year. Nurses in specific departments such as emergency, ICU, and midwifery show higher prevalence rates than those in general departments. Age > 40 years, length of service >10 years, obesity, night shifts, lifting heavy objects, and bending are risk factors for WMSDs among nurses, while rest during work is a protective factor. Therefore, early prevention actions should be taken targeting the above factors, such as increasing auxiliary assistance facilities and improving work patterns, so as to reduce the risk of WMSDs.

Effect of miR-7159-5p on the proliferation and invasion of gastric cancer cells by regulating the expression of TRIM26 / 中国医师杂志

Objective:To observe the expression of microRNA (miRNA)-7159-5p in gastric cancer tissues, and explore its effect on the proliferation and invasion of gastric cancer cells and its molecular mechanism.Methods:The cancer tissues and adjacent tissues of 29 patients with gastric cancer who underwent surgical resection in Hubei 672 Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine from March 2018 to November 2019 were collected. Fluorescence real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of miR-7159-5p in gastric cancer tissues and adjacent tissues, gastric cancer cell lines and normal gastric epithelial cell lines. Select the cell line with the lowest expression of miR-7159-5p, set the control group and the experimental group, and be transfected with control and miR-7159-5p mimics respectively. qRT-PCR was used to detect the expression of miR-7159-5p in transfected cells. The lymphocyte proliferation test (MTS method) was used to detect the proliferation of transfected cells, and the Transwell chamber method was used to detect the invasion activity of transfected cells. The miRNAMap database and dual luciferase reporter gene experiment were used to predict and verify the target genes of miR-7159-5p. qRT-PCR and Western blot were used to detect the expression of target genes in transfected cells.Results:The expression of miR-7159-5p in gastric cancer tissues was lower than that in adjacent tissues ( P<0.01), the expression of miR-7159-5p in gastric cancer cell lines was lower than that of normal gastric epithelial cells (all P<0.01), and the expression of miR-7159-5p was the lowest in SGC7901 cells ( P<0.01). After transfection, the expression of miR-7159-5p in SGC7901 cells of the experimental group was significantly higher than that in the control group ( P<0.01). After transfection, the proliferation activity and the cell invasion activity of the experimental group was significantly lower than that of the control group (all P<0.01). The target gene of miR-7159-5p was tripartite motif 26 (TRIM26). After transfection, the expression of TRIM26 mRNA in SGC7901 cells of the experimental group was significantly lower than that in the control group ( P<0.01). Western blot showed that after transfection, the expression of TRIM26, c-Myc, cyclin D1, β-catenin protein were lower than those in the control group (all P<0.05). Conclusions:The expression of miR-7159-5p is low in gastric cancer tissues, and miR-7159-5p can inhibit the proliferation and invasion of SGC7901 cells by down-regulating the expression of TRIM26.

Association between duration of fever before treatment and intravenous immunoglobulin resistance in Kawasaki disease / 中国当代儿科杂志

OBJECTIVES@#To examine the association between duration of fever before intravenous immunoglobulin (IVIG) treatment and IVIG resistance in children with Kawasaki disease (KD).@*METHODS@#A retrospective analysis was performed on the medical data of 317 children with KD who were admitted from January 2018 to December 2020. According to the duration of fever before IVIG treatment, they were divided into two groups: short fever duration group (≤4 days) with 92 children and long fever duration group (>4 days) with 225 children. According to the presence or absence of IVIG resistance, each group was further divided into a drug-resistance group and a non-drug-resistance group. Baseline data and laboratory results were compared between groups. A multivariate logistic regression analysis was used to identify the influencing factors for IVIG resistance.@*RESULTS@#In the short fever duration group, 19 children (20.7%) had IVIG resistance and 5 children (5.4%) had coronary artery aneurysm, and in the long fever duration group, 22 children (9.8%) had IVIG resistance and 19 children (8.4%) had coronary artery aneurysm, suggesting that the short fever duration group had a significantly higher rate of IVIG resistance than the long fever duration group (P<0.05), while there was no significant difference in the incidence rate of coronary artery aneurysm between the two groups (P>0.05). In the short fever duration group, compared with the children without drug resistance, the children with drug resistance had a significantly lower level of blood sodium and significantly higher levels of procalcitonin, C-reactive protein, and N-terminal B-type natriuretic peptide before treatment (P<0.05). In the long fever duration group, the children with drug resistance had significantly lower levels of blood sodium and creatine kinase before treatment than those without drug resistance (P<0.05). The multivariate logistic regression analysis showed that a reduction in blood sodium level was associated with IVIG resistance in the long fever duration group (P<0.05).@*CONCLUSIONS@#IVIG resistance in children with KD varies with the duration of fever before treatment. A reduction in blood sodium is associated with IVIG resistance in KD children with a duration of fever of >4 days before treatment.

Postnatal management and follow-up of six fetuses affected by pulmonary atresia with intact ventricular septum and right ventricular hypoplasia without intrauterine intervention / 中华围产医学杂志

Objective:To explore the value of current indications for fetal pulmonary valvuloplasty (FPV) by summarizing the postnatal diagnosis, treatment, and prognosis of fetuses with pulmonary atresia with intact ventricular septum (PA/IVS) and right ventricular hypoplasia (RVH).Methods:This prospective study was conducted at the Heart Center of Women and Children's Hospital, Qingdao University from September 2018 to March 2021, which included pregnant women who were (1) with fetal PA/IVS and RVH; (2) unable to receive FPV due to fetal position or gestational age despite the indications; (3) given integrated pre- and postnatal management. Prenatal fetal echocardiography assessment, postnatal diagnosis, treatment, and follow-up were summarized using Wilcoxon matched-pair signed-rank test.Results:A total of 35 singleton pregnant women were diagnosed with fetal PA/IVS and RVH by ultrasonic cardiogram and admitted during the study period. Among the 28 fetuses meeting the FPV indications, 18 underwent FPV, while the other 10 did not due to inappropriate fetal position or gestational age. After excluding four terminated pregnancies, the rest six cases were enrolled. The median gestational age at the initial prenatal fetal echocardiography diagnosis was 28.9 weeks (28.3-30.4 weeks). Compared with the initial evaluation, the fetal right ventricular to left ventricular length/diameter ratio [0.8 (0.6-0.9) vs 0.6 (0.5-0.8)] and tricuspid regurgitation velocity [4.7 m/s (3.2-5.1 m/s) vs 4.1 m/s (3.3-4.8 m/s)] were increased, while tricuspid valve Z value [－0.8(－1.6-0.8) vs 0.4 (－0.3-1.9)] and single-ventricular predictive score [0.5 (0.0-2.0) vs 2.0 (1.0-3.0)] were decreased when re-evaluated six weeks later ( T were－2.21, 2.00,－2.20, and 2.00; all P<0.05). All of the six fetuses were born alive with a median gestational age of 38.9 weeks (37.3-40.1 weeks). The median weight was 3 425 g (3 100-4 160) g after being transferred to cardiac intensive care unit. The median age was 12.5 d (0.0-20.0 d) at the first surgical intervention. The median follow-up duration was 15 months (11.8-18.5 months). At initial diagnosis, the single-ventricular predictive score was 1-2 points in four fetuses, and =3 points in two fetuses. There was no death during follow-up. Four patients achieved anatomical biventricular circulation, one achieved clinical biventricular circulation, and one still needed further follow-up, with single-ventricular predictive score at initial diagnosis of 1-3, 3, and 2 points, respectively. Conclusions:The prognosis is good in fetuses with PA/IVS and RVH who have FPV indications but do not receive intrauterine intervention, which suggests that the current FPV indications may be too broad, and a more suitable FPV indication need to be further explored given the difficulty of implementing FPV.

Perinatal multidisciplinary diagnosis and treatment of fetal D-transposition of great arteries: analysis of 37 cases / 中华围产医学杂志

Objective:To review the clinical outcomes following perinatal multidisciplinary diagnosis and treatment of fetal D-transposition of great arteries (D-TGA).Methods:This retrospective analysis involved 37 fetuses (two fetuses were one of the twins) with D-TGA that were diagnosed by prenatal ultrasound at the Women and Children's Hospital, Qingdao University from January 2016 to December 2020. All the subjects received perinatal multidisciplinary diagnosis and treatment, from the Departments of Fetal Medicine, Genetics, Obstetrics, Ultrasonography, Pediatric Cardiology, Neonatology, etc., and the outcomes were described and summarized.Results:The detection rate of D-TGA was 0.059% (37/62 413), among which intact ventricular septum with D-TGA accounted for 56.8% (21/37) and ventricular septal defect with D-TGA for 43.2% (16/37). All the 37 cases were observed with normal nuchal translucency and four of them were at high risk in fetal Down syndrome screening. All the 31 cases who received non-invasive cell-free fetal DNA screening had normal results and two of 26 cases who received amniocentesis for karyotype analysis and chromosome microarray analysis were abnormal. In terms of pregnancy outcome, 19 pregnancies (51.4%) were terminated, of which 10 cases were terminated for medical reasons and others for non-medical reasons, and 18 cases gave birth to alive body (48.6%, 18/37). Postnatal ultrasound re-examination of one neonate revealed D-TGA with ventricular septal defect, patent ductus arteriosus, and bicuspid pulmonary valve malformation and severe hypoxia and acidosis occured. The patient was discharged after withdrawing treatment and was lost to follow-up. The other 17 neonates all underwent successful surgical treatment with a mean age of (10.2±6.0) d and length of hospital stay of (26.3±9.3) d. Postoperative follow-up (3.3±1.2) years showed all with good cardiac function.Conclusion:Perinatal multidisciplinary diagnosis and treatment of D-TGA can improve the success rate of postnatal treatment and prognosis.

Analysis of pathogenic bacteria and influencing factors of death in patients with severe neurological pulmonary infection / 中国医师杂志

Objective:To investigate the distribution of respiratory pathogens and risk factors of death in patients with pulmonary infection in neurosurgical intensive care unit (NICU).Methods:A total of 87 patients with pulmonary infection in the NICU of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2018 to December 2019 were collected, and the pathogens of their respiratory tract were analyzed to understand the types and distribution of bacteria in the lung infection. Univariate statistical analysis was used to analyze the relationship between the patient′s clinical outcome with age, diabetes, hypertension, renal insufficiency, hypoproteinemia, anemia, chronic respiratory disease, surgery, tracheotomy, and bacterial multi-resistance. Binary logistic regression analysis was used to analyze the influencing factors of death in NICU patients with pulmonary infection.Results:A total of 112 pathogenic bacteria were isolated in this research group, including 83 Gram-negative bacteria (74.11%), 22 Gram-positive bacteria (19.64%), and 7 Fungi (5.25%). Imipenem was highly sensitive to Gram-negative bacteria, vancomycin was highly sensitive to Gram-positive bacteria, and other drugs were highly resistant. 41 patients died (47.13%). Age≥60 ( OR=3.501, 95% CI: 1.152-10.638), renal insufficiency ( OR=3.872, 95% CI: 1.336-11.224), tracheotomy ( OR=0.317, 95% CI: 0.114-0.882), bacteria multi-drug resistance ( OR=3.480, 95% CI: 1.162-10.422) were independent risk factors for death in NICU patients with pulmonary infection. Conclusions:Patients with severe neurological diseases are in critical condition, and there are many patients with pulmonary infection, with poor prognosis and high mortality. Gram-negative bacteria are the most common respiratory pathogens. Carbapenems account for the highest proportion of antibiotics in clinic. Advanced age, renal insufficiency and bacterial multidrug resistance increase the mortality of patients, while early tracheotomy can reduce the mortality of patients.

Application of a self-made distraction reductor in percutaneous minimally invasive treatment of calcaneal fractures / 中华创伤骨科杂志

Objective:To evaluate our self-made distraction reductor used in the percutaneous minimally invasive treatment of calcaneal fractures.Methods:A retrospective study was conducted of the 32 patients (37 feet) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Chongqing Medical University from January 2017 to December 2019 for calcaneal fractures. They were 26 males and 6 females, aged from 20 to 67 years (average, 46.5 years). The height and length of the calcaneus were restored by our self-made tri-plane distraction reductor in all patients; the displaced fracture blocks were reset in a minimally invasive manner in patients with intra-articular fracture; final fixation was performed with a minimally invasive plate and screws. Time for reductor installation, operation time and intraoperative blood loss were recorded; complications, fracture union and reduction were observed; height, length and width of the calcaneus, ankle-hindfoot scores of American Society of Foot and Ankle Surgery (AOFAS), Maryland scores, and visual analogue scale (VAS) were recorded at the last follow-up; B?hler and Gissane angles were compared between pre- and post-operation.Results:All patients were followed up for 12 to 36 months (average, 17.2 months). Time for reductor installation averaged 5.0 min (from 3 to 8 min), operation time 91.5 min(from 70 to 110 min), and intraoperative blood loss 25.2 mL (15 to 50 mL). Superficial infection of traction track occurred in one patient and sural nerve injury in one patient. All fractures united without any reduction loss by the last follow-up. On average, the last follow-up observed a calcaneal height of 39.3 mm, a calcaneal length of 70.6 mm, a calcaneal width of 32.7 mm, an AOFAS score of 87.8, a Maryland score of 86.7 and a VAS score of 2.2. The calcaneal B?hler angle was recovered significantly from 3.7°±13.7° preoperatively to 25.8°±6.4° at the last follow-up, and the calcaneal Gissane angle from 112.2°±21.3° preoperatively to 125.8°±5.7° at the last follow-up ( P< 0.05). Conclusion:In percutaneous minimally invasive treatment of calcaneal fractures, application of our self-made tri-plane distraction reductor can lead to fine clinical efficacy.

Progress of midkine in kidney disease / 国际儿科学杂志

As a heparin-binding growth factor, midkine plays an important role in the nervous system, cancer, and inflammatory response.Midkine is involved in the occurrence and development of many autoimmune diseases.This article reviews the role of midkine in renal ischemia reperfusion injury, crescentic glomerulonephritis, lupus nephritis, diabetic nephropathy, and Henoch-Schonlein Purpura nephritis.

Combined Effect of Smoking and Obesity on Coronary Heart Disease Mortality in Male Veterans: A 30-year Cohort Study / 生物医学与环境科学（英文）

Objective@#Evidence is lacking regarding the combined effects of smoking and obesity on mortality from coronary heart disease in male veterans. This study aimed to explore the combined effect of smoking and obesity on coronary heart disease mortality in male veterans in China.@*Methods@#A cohort of 1,268 male veterans from 22 veteran centers in Xi'an (Shaanxi Province, China) were followed up once every 2 years from February 1, 1987 to October 30, 2016. The endpoint was death from any cause. The hazard ratio ( @*Results@#The total follow-up was 24394.21 person-years; each subject was followed up for a mean duration of 19.24 years. By the end of the study, of the 1,268 veterans, 889 had died, 363 were alive, and 16 were lost to follow-up. Cox regression analysis results revealed that current smoking ( @*Conclusion@#Our results suggest that obese veterans who smoke might be an important target population for coronary heart disease mortality control.

Influence of metabolic syndrome and its components on the prognosis of patients with pancreatic cancer / 临床肝胆病杂志

ObjectiveTo investigate the association of metabolic syndrome (MS) and its components with the overall survival of pancreatic cancer (PC) patients who do not receive antitumor therapy. MethodsA retrospective analysis was performed for the data of patients who were diagnosed with PC in The Affiliated Hospital of Southwest Medical University from August 2013 to November 2018. Related data were collected, including age, sex, body weight, body height, body mass index (BMI), smoking, drinking, medical history of chronic pancreatitis, medical history of biliary tract diseases and gastritis, medical history of chronic hepatitis B/C, medical history of other tumors, presence or absence of PC in first-grade relatives, blood glucose, blood pressure, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), MS, and TNM stage. The log-rank test was used for comparison of survival curves between groups, and the univariate and multivariate Cox regression analyses were used to investigate the influencing factors for survival. ResultsA total 269 PC patients were enrolled in this study, with an average survival time of 3 months. The survival analysis showed no significant difference in survival time between the patients with MS and those without MS (P=0.754). There was no significant difference in median survival time between the patients with hypertension, high TG, high HDL-C, or abnormal BMI and those without such abnormality (all P＞0.05). There was a significant difference in median survival time between the patients with hyperglycemia and those without hyperglycemia (hazard ratio ［HR］=1.322, 95% confidence interval ［CI］: 0.985-1.775, P=0.028), and the multivariate Cox regression analysis achieved consistent results (HR=1481, 95% CI: 1.043-2.104, P=0.028). The analysis of the influencing factors for survival time in patients with stage Ⅳ PC showed that the patients with hyperglycemia had a significant reduction in median survival time (HR=1.524, 95%CI: 1.046-2.218, P=0004). ConclusionMS is not an influencing factor for the survival of PC patients, but hyperglycemia is an independent risk factor for poor prognosis in PC patients, especially in those with advanced PC.

Risk factors for new-onset diabetes after incipient acute pancreatitis / 临床肝胆病杂志

ObjectiveTo investigate the risk factors for new-onset diabetes after incipient acute pancreatitis (AP). MethodsA retrospective analysis was performed for 95 patients with post-acute pancreatitis diabetes mellitus (PPDM-A) after incipient AP who were admitted to The Affiliated Hospital of Southwest Medical University from June 2013 to January 2020 (PPDM-A group), and 190 patients without diabetes after incipient AP during the same period of time were selected at a ratio of 2∶1 and were enrolled as non-PPDM-A group. Baseline data and clinical data were collected. The t-test or the U test was used for comparison of continuous data, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data; a logistic regression analysis was used for multivariate analysis. Results There were significant differences between the two groups in body mass index (BMI), body weight, and proportion of patients with a drinking history, hyperuricemia, or fatty liver disease (all P＜0.05), while there were no significant differences between the two groups in age, male sex, and proportion of patients with a smoking history, a family history of diabetes, or hypertension (all P＞0.05). There were also significant differences in etiologies (biliary, hyperlipidemic, and alcoholic AP) between the two groups (P＜0.05). Compared with the non-PPDM-A group, the PPDM-A group had significantly higher triglyceride, blood glucose, white blood cell count (WBC), C-reactive protein, and proportion of patients with blood glucose ＞11.1 mmol/L on admission (all P＜0.05), while there were no significant differences in Ca2+, blood amylase, and blood lipase between the two groups (all P＞0.05). Compared with the non-PPDM-A group, the PPDM-A group had significantly higher incidence rates of acute peripancreatic necrotic collections and acute peripancreatic fluid collections, proportion of patients with multiple onset of AP, and proportion of patients with CTSI score ＞4 (all P＜0.05), while there were no significant differences in the proportion of patients with systemic inflammatory response syndrome and disease severity between the two groups (both P＞0.05). The multivariate analysis showed that the outcome of PPDM-A in alcoholic AP patients was 5.868 times that in biliary AP patients (95% confidence interval ［CI］: 1.607-21.418, P=0.007), and the outcome of PPDM-A in hyperlipidemic AP patients was 3.312 time that in biliary AP patients (95%CI: 1.593-6.887, P=0.001). The outcome of PPDM-A in overweight patients was 3.694 times that in patients with normal BMI (95%CI: 1.575-8.667, P=0.003), and the outcome of PPDM-A in obese patients was 5.964 times that in patients with normal BMI (95%CI: 2.516-14.139, P＜0.001). Multiple onset of AP (OR=4.522,95%CI: 2.298-8.900, P＜0.001), blood glucose on admission ＞11.1 mmol/L (OR=6.749,95% CI: 3.381-13.469, P＜0.001), CTSI score ＞4 (OR=1.176,95%CI: 1008-1.371, P=0.039), and WBC (OR=1.082,95%CI: 1.009-1.160, P=0.026) were independent risk factors for PPDM-A. ConclusionMultiple onset of AP, alcoholic AP, hyperlipidemic AP, blood glucose on admission ＞11.1 mmol/L, overweight or obesity, CTSI score ＞4, and WBC are independent risk factors for PPDM-A, which can provide a reference for formulating strategies to prevent or reduce the onset of PPDM-A.

Effectiveness of repairing the deep layer of deltoid ligament by suture anchor repair method in treatment of mixed medial injury associated with ankle fractures / 中国修复重建外科杂志

Objective: To explore the necessity of repairing the deep layer of deltoid ligament in the treatment of mixed medial injury associated with ankle fractures. Methods: Between January 2016 and December 2018, 12 patients with mixed medial injury associated with ankle fractures were treated with the fixation of the lateral malleolus by bone plates, the fixation of the anterior colliculus of medial malleolus by cannulated screws, and the repair of the deltoid ligament by suture anchors. There were 8 males and 4 females, with an average age of 42 years (range, 18-56 years). According to the Lauge-Hansen classification criteria, there were 11 cases of supination-external rotation type and 1 case of pronation-external rotation type. According to the Weber classification criteria, all cases were type B. The time from injury to operation was 3-6 days, with an average of 4.7 days. In each patient, X-ray films of anteroposterior and lateral views and mortise view of ankle were taken postoperatively. The motion range of ankle joints was observed. The function of the ankle and the outcome of the treatment were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, Olerud-Molander scoring system, and the visual analogue scale (VAS) score. Results: All cases were followed up 12-42 months (mean, 28 months). The 12 patients returned to their pre-injury jobs. Five patients with sports injury completely recovered to their pre-injury motor function. No patient experienced persistent medial ankle pain or ankle instability. At last follow-up, the ankle range of motion in dorsiflexion was 9°-25° (mean, 17.96°), which was 0°-11° (mean, 4.02°) less than that in normal side; the range of motion in plantar flexion was 38°-50° (mean, 43.90°), which was 0°-7° (mean, 2.53°) less than that in normal side. The AOFAS score was 88-100 (mean, 96.7); the Olerud-Molander score was 90-100 (mean, 96.5); the VAS score was 0-3 (mean, 1.1). Conclusion: It is necessary to repair the deep layer of deltoid ligament in the mixed medial injuries associated with ankle fracture, which include anterior colliculus fracture and deep deltoid ligament injury. A better outcome can be achieved by employing the suture anchor repair method.

Progress of pulmonary artery denervation in treatment of pulmonary arterial hypertension / 中华实用儿科临床杂志

Pulmonary artery denervation (PADN) can block local sympathetic nerve of pulmonary artery, reduce the hemodynamic parameters of pulmonary arterial hypertension(PAH), attenuate pulmonary vascular remodeling, right ventricular hypertrophy and fibrosis, thus improving cardiac function.Early basic experiment has determined the position of sympathetic nerve of pulmonary artery in pulmonary endarterium and confirmed the safety and effectiveness of PADN in the animal model of PAH.PADN may play a role by inhibiting execssive activation of the sympathetic nervous system and renin-angiotension-aldosterone system.PADN has been applied to adult clinical research, and has achieved a good clinical effect.On this basis, the possibility of applying PADN to children′s PAH is being explored preliminarily.

Clinical application of dynamic locking screw in treating humeral shaft fracture / 中国骨伤

OBJECTIVE@#To compare clinical effect of dynamic locking screws and common screws in treating humeral shaft fractures.@*METHODS@#From January 2016 to October 2018, clinical data of 46 patients with humeral shaft fracture were retrospectively analyzed, which were divided into dynamic locking screw internal fixation group (treatment group) and ordinary screw internal fixation group (control group). In treatment group, there were 14 males and 10 females, aged from 20 to 61 years old with an average of (36.8±10.9) years old;22 patients in control group, there were 13 males and 9 females, aged from 19 to 60 years old with an average of (35.9±12.8) years old. Length of incision, operation time, amount of bleeding, fracture healing time and complications were compared between two groups, Constant-Murley score of shoulder joint and Mayo score of elbow joint at 3 and 9 months after operation were compared to evaluate clinical effect.@*RESULTS@#Forty six patients were followed up from 9 to 43 months with an average of (18.6±7.9) months. There were no statistical differences in length of incision, operation time, amount of bleeding between two groups (>0.05);fracture healing time in treatment group was (12.2±3.2) weeks, and (15.6±4.7) weeks in control group;there was difference between two groups (0.05);One patient occurred neural paralysis in treatment group;1 patient occurred delayedunion, 2 patients occurred bone nonunion and 1 patient occurred broken nail in control group;while there was no statistical difference between two groups in complication.@*CONCLUSION@#Both of dynamic locking screws and ordinary screws could effectively treat humeral shaft fractures. dynamic locking screws has an advantage in fracture healing time, and recovery of early shoulder and elbow function. However, the active time of this technology is not too long in China, further study on long-term efficacy of large samples is needed.

The optimization and assessment of the method for inducing hyperuricemia in rats / 中国应用生理学杂志

To explore an effective method for inducing a rat model with hyperuricemia in a short period and assess the effects of the model. Methods: Sprague-Dawley rats were adopted as donors and randomly divided into control group (CT group, n=6) and 5 model groups (M1-M5 groups, n=8 in each group). M1 group (gavage with 10 g/kg yeast extracts and 100 mg/kg adenine, twice per day, 300 mg/kg oxonic acid potassium by intraperitoneal injection, in the 7 day of model inducing), M2 group (gavage with 10 g/kg yeast extracts and 100 mg/kg adenine, twice per day, 300 mg/kg oxonic acid potassium by intraperitoneal injection, in the 1, 3 and 7 day of model inducing),M3 group (gavage with 10 g/kg yeast extracts and 100 mg/kg adenine, twice per day, 300 mg/kg oxonic acid potassium by intraperitoneal injection, once per day during the model inducing), M4 group (gavage with 20 g/kg yeast extracts and 100 mg/kg adenine, twice per day, 300 mg/kg oxonic acid potassium by intraperitoneal injection, once per day during the model inducing), M5 group (gavage with 30 g/kg yeast extracts and 100 mg/kg adenine, twice per day, 300 mg/kg oxonic acid potassium by intraperitoneal injection, once per day during the model inducing), and group CT (gavaged with equal volume sterilized water and intraperitoneal injected with normal saline according to the weight and at the same frequency as the model groups). The model inducing lasted for 7 days. After the inducing was finished, blood and 24-hour urine were sampled for uric acid and creatinine determination. Then rats were maintained for 2 weeks and blood and 24-hour urine samples were collected, the concentration of uric acid and creatinine were detected. The kidney and stomach were weighed,morphological changes in kidney were observed. After model inducing, the body weight of rats in all model groups was lower than that of the control group (P＜0.01). Deaths occurred in all the rats with model treatments except M2. M4 and M5 groups were failed to be analyzed because of the high mortality, model 1 and 3 groups had 4 and 2 deaths, respectively. The uric acid levels in blood and urine of the model groups were significantly elevated (P＜ 0.01) at the end of model inducing. The model 2 group's blood uric acid was highest among the model groups (P＜0.05). It sustained a higher concentration than CT group in the three model groups after 2 weeks feeding (P＜0.05). The kidneys in model groups obviously swelling and were heavier than CT group (P＜0.01). The inflammation and structural damages were observed in kidneys of all model groups. The yeast extract (10 g/kg), adenine (100 mg/kg) gavage combined with intraperitoneal injections(the 1, 3, 7 day during inducing) of potassium oxonate can be an rapid and effective method for inducing the rat model with hyperuricemia, which can be suggested to the related research.

Self-made calcaneal distraction device and percutaneous screw fixation at the key points for treatment of displaced intra-articular calcaneal fractures / 中华创伤杂志

Objective:To compare the clinical outcomes of percutaneous screw fixation at the key points using a self-made calcaneal distraction device with traditional open reduction plate internal fixation for the treatment of patients with displaced intra-articular calcaneal fractures (DIACFs).Methods:A retrospective case-control study was made on clinical data of 60 patients (69 feet) with DIACFs admitted to First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2019. There were 51 males and 9 females, with an average age of 47.2 years [(47.2±8.7)years]. According to the Sanders classification, there were 42 feet of type II, 15 feet of type III and 12 feet of type IV. According to the Essex-Lopresti classification, there were 43 feet of tongue type fractures and 23 feet of joint depression fractures. Another 3 feet were not applicable to this classification system. In Group A, 30 patients (35 feet) were treated by percutaneous reduction or reduction using tarsal sinus approach with the self-made calcaneal distraction device followed by percutaneous screw fixation. In Group B, 30 patients (34 feet) were treated by open reduction and internal fixation with plates using the traditional extended lateral approach. Waiting time for surgery, operation time, length of hospital stay, efficacy of reduction and fracture healing, American Orthopedic Foot and Ankle Society (AOFAS) score, Maryland score, visual analog scale (VAS), and incidence of surgical site related complications were compared between groups. The efficacy of reduction was evaluated by measuring the height, length and width as well as the B?hler angle of the calcaneus.Results:All patients were followed up for an average of 28.2 months [(28.2±11.3)months]. The waiting time for surgery in Group A was (3.4±1.3)days, significantly shorter than that in Group B [(6.9±1.9)days] ( P<0.05). The operation time was (91.7±10.3)minutes in Group A and (92.8±11.5)minutes in Group B ( P>0.05). The length of hospital stay in Group A was (7.0±1.4)days, significantly shorter than that in Group B [(12.7±1.7)days] ( P<0.05). At the final follow-up, all fractures were healed, with no reduction loss of fixation observed. The height of the calcaneus was (48.9±2.0)mm in Group A and (49.3±2.6)mm in Group B ( P>0.05). The length of the calcaneus was (83.2±2.9)mm in Group A and (83.5±2.7)mm in Group B ( P>0.05). The width of the calcaneus was (35.8±2.3)mm in Group A and (35.1±1.3)mm in Group B ( P>0.05). The B?hler angle of the calcaneus was (24.7±6.4)° in Group A and (25.9±5.8)° in Group B ( P>0.05). At the final follow-up, the AOFAS score was (87.1±8.5)points in Group A and (86.7±7.8)points in Group B, with the good and excellent rate of 89% (31/35) and 88% (30/34) respectively ( P>0.05). The Maryland score was (85.3±9.5)points in Group A and (84.9±9.5)points in Group B, with the good and excellent rate of 86% (30/35) and 85% (29/34), respectively ( P>0.05). The VAS was (2.3±1.5)points in Group A and (2.5±1.5)points in Group B ( P>0.05). No surgical site related complication was observed in Group A. While in Group B, there was one foot of superficial incision infection, three necrosis of the skin at the edge of the incision, and one deep infection ( P<0.05). Conclusions:For the treatment of DIACFs, percutaneous screw fixation at the key point using the self-made calcaneal distraction device can achieve the same clinical outcome as traditional open reduction plate internal fixation, but it has advantages like significant shorter waiting time for surgery, less invasiveness, faster recovery and lower incidence of incision-related complications. This method is especially suitable for patients with contraindications of open reduction and internal fixation.

Percutaneous sacroiliac screw fixation assisted by O-arm navigation in treatment of sacroiliac joint complex injury / 中华创伤杂志

Objective:To compare the clinical effect of percutaneous sacroiliac screw fixation assisted by O-arm navigation or C-arm X-ray fluoroscopy in the treatment of sacroiliac joint complex injury.Methods:A retrospective case-control study was conducted on 32 patients with sacroiliac joint complex injury admitted to Second Affiliated Hospital of Army Medical University from July 2016 to January 2019.There were 21 males and 11 females, aged from 20 to 59 years (mean, 41.3 years). According to Tile classification, there were 7 patients with type B1 fracturs, 13 with type B2, 5 with type B3, 5 with type C1, and 2 with type C1. Group A ( n=17) had percutaneous sacroiliac screw fixation assisted by O-arm navigation, while Group B ( n=15) had percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy. Time of single screw placement, time of intraoperative fluoroscopy, intraoperative bleeding volume and bone union time were measured. Reduction quality was evaluated by Matta standard score. Majeed function score was assessed 6 months at the latest follow-up. Complications were also observed. Results:All patients were followed up for 6-37 months (mean, 18.6 months). The time of sacroiliac joint screw placement [(27.3±5.1)minutes] and time of intraoperative fluoroscopy [(43.3±3.2)s] in Group A were significantly less than those in Group B [(52.3±5.9)minutes, (64.6±5.4)s] ( P<0.05). There were no significant differences between Group A and Group B in intraoperative bleeding [(17.8±2.6)ml vs. (20.7±3.1)ml] and bone union time [(13.4±1.4)weeks vs. (14.1±1.9)weeks] ( P>0.05). According to the reduction quality evaluated by Matta standard score, the good and excellent rate was 88% (15/17) in Group A and 87% (13/15) in Group B ( P>0.05). The good and excellent rate of the Majeed function score was 94% (16/17) in Group A and 87% (13/15) in Group B at the latest follow-up ( P>0.05). One patient in Group B demonstrated one screw slightly penetrating the anterior cortex of vertebral body. No neurovascular injury, wound infection, or screw loosening occurred. Conclusion:For sacroiliac joint complex injury, percutaneous sacroiliac screw fixation assisted by O-arm navigation has advantages in the duration of screw placement and intraoperative fluoroscopy over percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy.