Evaluation of red blood cell distribution width and platelet distribution width in combination with Glasgow Coma Score for the prognosis of patients with severe traumatic brain injury / 医学研究生学报

ObjectiveAt present, there are few studies on prognostic indicators for patients with severe traumatic brain injury (STBI). This paper aims to explore its significance by analyzing the demographic characteristics of patients with STBI, as well as parameters such as clinical laboratory test indicators.MethodsA retrospective analysis was performed on 139 STBI patients admitted to the Department of Emergency Medicine, General Hospital of Eastern Theater Command from January 2017 to December 2018. According to the 28-day death event, the participants were divided into the survival group (n=108) and the death group (n=31). Indicators such as Glasgow Coma Score (GCS), red blood cell distribution width (RDW), platelet distribution width (PDW) and clot-related indicators were collected. Univariate and multivariate logistic regression were used to analyze the risk factors related to death, and receiver operating characteristic (ROC) curve was adopted to determine their prognostic values.ResultsThere were significant differences in GCS, RDW and PDW between the two groups. RDW (OR=4.577, 95% CI: 1.704-12.291), PDW (OR=1.346, 95% CI: 1.093-1.657) and GCS (OR=0.469, 95% CI: 0.301-0.730) were risk factors for death of STBI patients. The area under the curve (AUC) of RDW, PDW and GCS scores were 0.735 (0.640-0.840), 0.675 (0.553-0.796) and 0.737 (0.638-0.837), respectively, and the AUC of the combination of the three was 0.840 (0.748-0.932), which was significantly better than that of single diagnosis.ConclusionRDW, PDW combined with GCS can effectively evaluate the prognosis of patients with STBI, which has important guiding value for clinicians′ diagnosis and treatment.

A review of gene therapy for Duchenne muscular dystrophy / 中国当代儿科杂志

Duchenne muscular dystrophy (DMD) is an X-linked recessive hereditary disease caused by mutations in the DMD gene that encodes dystrophin. It is characterized by progressive muscle weakness and degeneration of skeletal muscle and myocardium due to the absence of dystrophin. The disease often occurs at the age of 2-5 years, and most children may die of heart failure or respiratory insufficiency at the age of around 20 years. At present, supportive therapy is often used in clinical practice to improve symptoms, but this cannot improve the outcome of this disease. The development of gene therapy brings new hope to the cure of this disease. This article summarizes gene replacement therapy for DMD, including the research advances in DMD gene transduction technology mediated by adeno-associated virus, utrophin protein upregulation technology, and clustered regularly interspaced short palindromic repeat gene editing technology, and reviews the recommendations to solve the issues of adeno-associated viral load, long-term effective expression of transgenic products, and utrophin protein expression, in order to provide a reference for further research.

Implantation of beta-tricalcium phosphate combined with osteoblast-specific peptides for alveolar bone preservation in extraction sockets / 中国组织工程研究

BACKGROUND: Previous findings show that osteoblast-specific peptides can promote the repair and regeneration of skull defects in rabbits, and β-tricalcium phosphate (β-TCP) is used as a scaffold to carry osteoblast-specific polypeptides. Both of them not only complement each other, but also fully exert dual effects of osteoinduction and bone conduction. OBJECTIVE: To investigate the effect of osteoblast-specific peptide on the preservation of the anterior tooth extraction site in rabbits, and to study the effect on the alveolar bone remodeling. METHODS: Twenty-seven New Zealand white rabbits were randomly divided into three groups (n=9 per group), and the right mandibular incisors were removed to establish the animal models of tooth extraction. β-TCP/osteoblast-specific peptide compounds were implanted in the experimental group, and pure β-TCP meal was implanted into the material group. The blank control group had no implantation. Three rabbits from each group were scarified at 4, 8 and 12 postoperative weeks, and tissue samples were prepared for gross observation, histomorphology measurements, and radiographic measurements of extraction socket healing. RESULTS AND CONCLUSION: (1) Imaging results showed that the relative length of residual alveolar bone after modeling was ranked as follows: the experimental group > the material group > the blank control group, and the difference was statistically significant among groups (P < 0.05). Cone-beam CT findings in the three groups changed as time went on. At 4 and 8 postoperative weeks, the implanted materials in the experimental and material groups gradually degraded; the bone mass in the experimental group was significantly higher than that in the material and blank control groups. At 12 postoperative weeks, the experimental group had basically completed the reconstruction of tooth socket, but there were still some bone defects in the material and blank control groups. (2) Histomorphological findings showed that at 4 postoperative weeks, the experimental group exhibited obvious bone deposition lines, and the bone trabecula was widened; in the material and blank control groups, the new bone was less. At 8 postoperative weeks, a small amount of undegraded scaffold was found in the experimental group, with mature lamellar bone, the amount of new bone tissues in the material group increased and osteoblasts were obviously detected in the blank control group. At 12 postoperative weeks, the bone remodeling in the extraction socket of the experimental group was basically completed; in the material group, there were still a small amount of scaffold materials and dense plate-like new bone; and in the blank control group, the new bone tended to be mature, and there was obvious lamellar structure. To conclude, osteoblast-specific peptides can effectively preserve the length of the residual alveolar bone after tooth extraction, promote the formation of new bone, and have the function of preserving the tooth extraction site.

Evaluation of renal parenchymal damage in children with primary vesicoureteral reflux / 中华实用儿科临床杂志

Objective To evaluate the clinical features of primary vesicoureteral reflux(VUR) in children and to investigate the association of sex,age,reflux grade and renal parenchymal damage (RPD) in VUR.Methods Medical records of 85 patients in Department of Pediatric Nephrology,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine diagnosis as VUR from Jan.2000 to May 2012 were reviewed.VUR was diagnosed by voiding cystourethrogram(VCUG).According to the results of VCUG,patients were divided into groups of low-grade(Ⅰ-Ⅱ)VUR and high-grade (Ⅲ-Ⅴ) VUR.All cases underwent Tc-dimercaptosuccimc acid (DMSA) renal scan,RPD was defined by image appearance and relative kidney uptake.The impact of patient's gender and age as well as VUR grade on RPD were compared.Results A total of 85 patients (33 boys,52 girls) were included,of whom 59 cases (69.4％)were under 2 years old,26 cases(30.6％) were older than 2 years.VUR was unilateral in 45 patients(52.9％) and bilateral in 40 patients(47.1％),total of 125 renal units.The high-grade VUR was 93 renal units(74.4％),the incidence of high-grade VUR was significantly higher in patients who under 2 years old,but the reflux grade showed no association with gender.RPD was found in 89 renal units(71.2％).RPD rate was associated with high-grade reflux (P =0.030),male gender (P=0.021)and age(P =0.005).Conclusions The high-grade VUR is common seen in patients under 2 years old.The risk of RPD in patients were under 2 years old and in boys.High-grade VUR is a critical risk factor of RPD in children.

Chronic atrophic gastritis is a progressive disease: analysis of medical reports from Shanghai (1985-2009)

<p><b>INTRODUCTION</b>We aimed to examine the turnover of chronic atrophic gastritis (CAG) pathologically and endoscopically and explore its potential causes.</p><p><b>METHODS</b>A retrospective analysis was conducted of prospective data collected from 1,592 patients who underwent gastroscopy three times or more during the period 1985-2009 at Renji Hospital, Shanghai, China. Pathological and endoscopic findings were analysed. Data collected included gender, age, length of follow-up period, family history, past medical history, history of Helicobacter (H.) pylori infection, drug history for the use of proton pump inhibitors (PPIs), antacids and non-steroidal anti-inflammatory drugs [NSAIDs], and lifestyle history, including the patients' eating habits.</p><p><b>RESULTS</b>23 (1.44%) patients presented with gastric cancers resulting from CAG and 349 (21.92%) patients had dysplasia. Pathological and endoscopic findings suggested that the proportion of patients with worsening gastric mucosa during the atrophic and intestinal metaplasia (IM) phases was over 35% with increasing age. Gastric mucosa was found to be pathologically aggravated by carbonated drinks and fast food, and pathologically degenerated by H. pylori infection. Smoking deteriorated the gastric mucosa. Side dishes of vegetables may benefit the gastric mucosa even in the atrophic and IM phases.</p><p><b>CONCLUSION</b>Our findings support the consensus that CAG is a progressive disease. Potential factors that were found to affect the state of the gastric mucosa in our patient group were gender, H. pylori infection, use of PPIs or NSAIDs, and intake of vegetable side dishes, spicy food, carbonated drinks and fast food.</p>

Clinical natural course of temporomandibular joint intermittent closed lock / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the clinical natural course of temporomandibular joint (TMJ) intermittent closed lock (ICL) through 24 months follow-up.</p><p><b>METHODS</b>Sixty-eight patients with ICL were included, and 54 patients finished 24 months follow-up. The disease duration, frequency of joint lock and joint pain were recorded at the patient's first visit. Telephone interviews were taken for every month, and the frequency of joint lock and joint pain were recorded. According to the development of ICL, the patients were divided into 3 groups: symptom-worsened group, symptom-disappeared group, symptom-persisted group.</p><p><b>RESULTS</b>There were 16 patients (30%) whose symptoms worsened into closed lock (disk displacement without reduction), 32 patients (59%) whose symptoms persisted during the 24 months follow-up, and 6 patients' (11%) symptoms disappeared. In symptom-persisted group, the frequency of joint lock decreased in 11/32 (34%), increased in 4/32 (13%), did not change in 17/32 (53%). There was no significant difference in gender, age, frequency of joint lock and joint pain recorded at the first visit among these 3 groups (P > 0.05). The disease duration in the symptom-disappeared group was much shorter than the other 2 groups (P < 0.05).</p><p><b>CONCLUSIONS</b>ICL of TMJ was more likely to get worse into closed lock. There seemed no significant relation between the sequelaes of ICL and patients' gender, age, disease duration, frequency of joint lock and joint pain, and larger sample studies were necessary.</p>

Influence of intra-articular corticosteroid on the efficacy of arthrocentesis in treatment of temporomandibular joint anterior disc displacement without reduction / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare the efficacy and radiographic changes after arthrocentesis followed or not followed by intra-articular corticosteroid injection in patients with temporomandibular disc displacement without reduction.</p><p><b>METHODS</b>Ninty patients were enrolled in the randomized clinical trial. After receiving arthrocentesis, either 0.5 mL triamcinolone acetonide plus 0.5 mL saline (experimental group, n = 46) or 1 mL saline solution as control (control group, n = 44) was injected. Patients were assessed by visual analogue scale (VAS) pain scores and Fricton temporomandihular joint (TMJ) index at first visit before treatment, 3-4 weeks and 6 months after treatment respectively. Transpharyngeal and lateral transcranial projections for temporomandibular joints were taken for imaging evaluation. The pain score of patients with pain complaint were recorded everyday for 1 week after treatment.</p><p><b>RESULTS</b>Glucocorticoid injection showed more effective pain control over the first week (P < 0.05), and both groups reported symptom and clinical sign relief significantly after treatment (P< 0.001). However, quantitative evaluation for pain reduction, maximal mouth opening improvement and Friction TMJ index showed no significant difference between two groups at 3-4 weeks and 6 months after the treatment. Also there was no significant difference for condylar bone changes radiographically between the two groups.</p><p><b>CONCLUSION</b>Arthrocentesis is an effective treatment for temporomandibular joint disc displacement without reduction, but it is not necessary to inject corticosteroid after arthrocentesis. Intra-articular corticosteroid injection after arthrocentesis is indicated for only those patients with severe pain.</p>

Positional changes of temporomandibular joint disk and condyle with insertion of anterior repositioning splint / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To measure the positional changes of temporomandibular joint (TMJ) disk and condyle with insertion of anterior repositioning splint (ARS) using magnetic resonance imaging (MRI) for further understanding of the splint therapy mechanisms.</p><p><b>METHODS</b>Twenty-two patients with temporomandibular joint clicks were included. 31 TMJs were diagnosed as anterior disk displacement with reduction (disk-displaced group), and the other 13 TMJs were normal (normal group). All joints were scanned oblique-sagittally by MRI before splint treatment in three positions including closed-mouth position of centric occlusion (the position before insertion of ARS), incisors' edge to edge position, and mandibular least forward protrusion position (the position after insertion of ARS).</p><p><b>RESULTS</b>1) Disk-condyle angle: In closed-mouth position, the average angle was 54.23 degrees in the disk-displaced group, while it was 9.80 degrees in the normal group; in incisors' edge to edge position and mandibular least forward protrusion position, the angle was reduced to normal in most of the disk-displaced cases. 2) Disk position: From closed-mouth position to incisors' edge to edge position or mandibular least forward protrusion position, the forward displaced disk moved backward significantly, while the disk with normal position did not change significantly in the three positions. 3) Condyle position: From closed-mouth position to incisors' edge to edge position or mandibular least forward protrusion position, the condyle moved forward and downward significantly both in the disk-displaced group and in the normal group.</p><p><b>CONCLUSION</b>With insertion of the splint, the condyle moved anteriorly and inferiorly and the disk moved posteriorly, most of the anterior displaced disks could be reduced to normal positions in the joint fossa. The result indicated that the splint protruded condyle forward and prevented the backward reduced disk from displacing forward again during mouth closing.</p>

Investigation on clinical pain features in temporomandibular disorders / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the pain features of temporomandibular disorders (TMD) by qualitatively and quantitatively analyzing patient multi-dimension sensations.</p><p><b>METHODS</b>Two hundred and fifty patients with painful TMD from January to December 2005 were included, short-form mcgill pain questionnaire (SF-MPQ) and visual analog scale (VAS) were administered to assess patients' sensation, affection and intensity of pain. The data were analyzed by SAS 8.0 software.</p><p><b>RESULTS</b>All patients were assigned to three groups including 139 joint pain, 47 muscle pain and 64 both joint and muscle pain group. In joint pain group, the total number of descriptors was 250, 1.80 in average; in muscle pain group, the total number was 99, 2.11 in average; in both joint and muscle pain group, the total number was 107, 1.64 in average. The sensitive descriptors most frequently chosen in all three groups were "aching", "heavy", and "tender". "Tiring-exhausting" and "sickening" were high frequency descriptors in affective items. There were higher affective scores in the muscle pain group than in others. Muscle pain group had a higher VAS score at rest than the other two (P < 0.05), but had a lower VAS score during function than the other two (P < 0.001). All three groups usually had no pain at rest, and complained a slight to moderate pain during function.</p><p><b>CONCLUSIONS</b>TMD pain was generally slight to moderate; "aching", "heavy", and "tender" were the most frequently sensitive descriptors, while unpleasant feelings were described as "tiring-exhausting" and "sickening"; pain generally occurred or exacerbated during mandibular function; compared to joint pain, muscle pain had its own features.</p>

Management of sinonasal inverted papilloma: endoscopic approach and lateral rhinotomy / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To compare endoscopic approach with lateral rhinotomy for treatment of the sinonasal inverted papilloma in terms of advantage, indications and limitations of the procedures.</p><p><b>METHODS</b>Eighty-six cases with inverted papilloma were reviewed retrospectively, among which 23 cases underwent transnasal endoscopic procedures including 10 combined with Caldwell-Luc intervention, and 63 cases underwent lateral rhinotomy. The follow-up period ranged from 11 - 36 m (mean 23 m). The data were processed statistically by SPSS 10.0 software.</p><p><b>RESULT</b>Both procedures permitted removal of most sinonasal inverted papilloma. The endoscopic surgery provided an excellent visualization, and preserved a vital anatomic structure and left no facial scar. Lateral rhinotomy was associated with postoperative facial scar or deformity. The recurrence rate in lateral rhinotomy group was 9.5% and in endoscopic approach was 13% (P >0.05).</p><p><b>CONCLUSION</b>Endoscopic approach is favored for the treatment of non-massively extending sinonasal inverted papilloma because of an acceptable recurrence and a better cosmetic results.</p>

The relationship between symptoms and signs of temporomandibular disorders and the patients' quality of life / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To analyze the relationship between symptoms and signs of temporomandibular disorders (TMD) and the patients' quality of life (QOL).</p><p><b>METHODS</b>A total of 492 TMD patients were included in this study. The clinical examination results were recorded using Fricton index of temporomandibular joint function. "Visual analog scale (VAS) evaluation of QOL disturbance" was designed to quantitate patients' QOL, to evaluate the degree that the patients QOL was affected.</p><p><b>RESULTS</b>Chewing, daily life and emotion among all 8 items of QOL were frequently affected by TMD, and joint clicking had the least influence on QOL. Intermittent closed lock had more severe interference with QOL than joint clicking only. Severe and moderate pain or limited mouth opening affected the QOL more severely than mild pain or mild limited mouth opening. The simple linear relationship between Fricton index and patients' QOL was poor (r < 0.4).</p><p><b>CONCLUSIONS</b>Pain is the most frequently seen symptom in TMD. TMD could affect patients' QOL, including both physical and social-psychological functions. The results suggest that the patients' QOL as well as TMD symptoms and signs should be considered in the management of TMD.</p>

Cone beam computed tomography in the diagnosis of temporomandibular joint osteoarthrosis / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical use of cone beam dental CT in the diagnosis of temporomandibular joint osteoarthrosis.</p><p><b>METHODS</b>Forty-eight cases diagnosed as temporomandibular joint osteoarthrosis (OA) and disk displacement with or without reduction accompanied by OA changes were included, and a total of 96 joints received both trans-pharyngeal radiography and cone beam CT (CBCT) examination. The detectable rate for OA radiographic changes was compared between the two examinations.</p><p><b>RESULTS</b>The radiographic appearances of osteoarthrotic condyle included six types: loss of the lamina dura density of condyle surface (type I), destructive and erosive bone changes (type II), flattening of the articular surface (type III), sclerosis (type IV), osteophytes (type V), and false cyst change (type VI). The detectable ratio of CBCT for all types of osteoarthrosis was 65.63%, 37.50%, 27.08%, 31.25%, 28.13%, 1.04%, respectively, and the detectable ratio of trans-pharyngeal radiographs was 52.08%, 19.79%, 32.29%, 23.96%, 12.50%, 2.08% respectively. Intraobserver and interobserver reproducibility for type I and type II was in good agreement with both the trans-pharyngeal radiographs and CBCT, Kappa > 0.60.</p><p><b>CONCLUSIONS</b>CBCT had higher detectable rates for pathological changes of osteoarthrosis, and could show the exact location, size, and the types of pathological changes. CBCT may be used as a measure in evaluating disease severity and progression, and in clinical trials of disease treatment.</p>

Clinical and Pathological Analysis of Complement 1q Nephropathy in 10 Cases of Children / 实用儿科临床杂志

Objective To explore the relationship between clinical and pathological changes of complement 1q(C1q) nephropathy. Methods Clinical manifestation, pathologic features including glomerulus change, renal tubule - interstitial change and im-munopathology were compared between 10 cases of C1q nephropathy in children, who were diagnosed by renal biopsy. Results Presentation included idiopathic nephritic syndrome(6 cases), simple hematuria(2 cases), nephritic syndrome(1 case), rapidly progressive glomerulonephritis( 1 case); Renal biopsy revealed focal segmental glomerulosclerosis( FSGS) in 5, minimal-change disease( MCD) and mesangial proliferative glomerulonephritis (MsPGN) respectively in two and crescentic glomerulonephritis in one. In addition, there were renal - tubule interstitial changes with 3 cases of grade I and grade II each other, 2 of grade III , 1 of grade IV . The prominent immunofluorescent features was the presence of bright mesangial deposition of C1q. The average follow - up time was 25.7 months. Six cases presenting nephrotic syndrome were resistant to steroid, but 5 were released after immunosuppressive therapy, the other had progressive renal insufficiency. Conclusions C1q nephropathy falls with the clinical - pathologic spectrum of FSGS generally. It is also presented as steroid - resistant nephritic syndrome. Moreover, the prognosis of C1q nephropathy is related to renal tubulointerstitial pathologic lesions not to C1q deposition.

NEW TYPE EXTERNAL IMMOBILIZATION MATERIAL—THE THRMOPLASTIC SPILINT / 医疗卫生装备

The plastic splint PCL,which is introduced in this article,is a new type of medical exter- nal immobilization material.During the course of its development,the burden has been optimality seeked with regressive orthogonality after screening of the material.Its function has attained the international levels during the eighties.This splint may be used not only in the treatment of burns and various orthopedic conditions,but also in the immobilization of fracture and rehabilation treatment of orthopedic patients etc.

Clinical and pathological analysis of hepatitis B virus-associated glomerulonephritis in 20 cases / 实用儿科临床杂志

Objective To understand the clinical and pathological features of hepatitis B virus-associated glomerulonephritis(HBV-GN).Methods Twenty children with HBV-GN were analysed including 17 cases of nephritic syndrome (4 cases of simple nephrosis, 13 cases of nephritic nephrosis),2 cases of isolated proteinuria, 1 case of nephritic syndrome according to the clinical classification.Results On the basis of pathology of kidney biopsy, there were 15 cases of membranous glomerulonephritis(MN),3 cases of manbranoproliferative glomerulonephritis(MPGN),2 cases of mesangial proliferative glomerulonephritis(MsPGN).Eight of 20 cases were treated with recombinated human alpha-interfeon. The average follow-up time was 5.7 years. As the result, complete remission clinically was on 5 cases,partial remission on 2 cases and ineffectiveness on one case. Besides, serum HBsAg, HBeAg were converted to negative on 3 cases , HBeAg disappeared and anti-HBe appeared on one case.Conclusion MN is common in childhood with HBV-GN.It also indicates the prognosis of the associated nephropathies is quite favorable.