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Objective To understand the quality status of salt iodine monitoring results at the county level and checking results at the city level from 2017 to 2021 in Suzhou，and to provide a scientific basis for the development of iodine deficiency disease（IDD）prevention and control strategies and measures. Methods During the past five years, Suzhou CDC randomly selected 15 samples of 300 monitored salt samples from each county/district CDC each year for spot checks. The data were processed by comparative analysis of relative error and grouped data t test. Results In the conformity of iodized salt and non-iodized salt, the sample monitoring results of some counties/districts were non-iodized salt, while the city-level test results were iodized salt. In the conformity of iodized salt and seaweed iodized salt (or enhanced salt), the sample monitoring results of county/district level were iodized salt, while the test results at the city level were seaweed iodized salt (or enhanced salt). The non-conformity was relatively concentrated in some county/district laboratories, and the total amount of non-conformity tended to increase year by year. The total number of samples with relative error of >20% between the county/district and city-level results was the least in 2021, with 6, and the most in 2018, with 25. The number of samples with relative error of >30% between the county/district and city-level results was the least in 2017 being 0, while there were 12 samples in 2018, fluctuating within a small range in the past three years. The t-test results of grouped data showed that the average value of the checking results at the city level was generally higher than the monitoring results at the county level. There were 21 pairs of data with no statistical significance (P>0.05) and 29 pairs of data with statistical significance (P<0.05) between the results at the county/district level and at the city level. Among them, there were 7 counties/districts whose sample monitoring results were not significantly different from the city-level test results in 2020, while there were 9 counties/districts whose monitoring results were statistically different from the city-level test results in 2021. Conclusion The data analysis results show that the monitoring data of iodized salt in Suzhou is basically reliable and accurate, but there still exist some problems. Therefore, in the future work it is necessary to strengthen the monitoring system of IDD, increase training efforts, continuously monitor and check the quality of iodized salt to provide a scientific basis for effective prevention and control of IDD.
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The autoimmune pathogenesis of chronic spontaneous urticaria was first proposed in 2013 by Konstantinou et al. In recent years, genetic, epigenetic, and immunological studies have provided supporting evidence for the autoimmune pathogenesis of chronic spontaneous urticaria, and this review summarizes relevant research progress.
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Objective:To investigate the correlation between food-specific IgG (sIgG) antibodies and phenotypes of chronic spontaneous urticaria (CSU) .Methods:Serum samples were collected from outpatients with active CSU, symptomatic dermographism (SD) , or acute urticaria (AU) , and healthy controls from 5 third-grade class-A hospitals such as the First Hospital of China Medical University between April 2014 and March 2015. Enzyme-linked immunosorbent assay was conducted to detect serum levels of 90 food-sIgG antibodies and total IgE, Western blot analysis to detect levels of 20 allergen-specific IgE antibodies, and chemiluminescent microparticle immunoassay to detect levels of anti-thyroid peroxidase IgG antibodies and anti-thyroglobulin IgG antibodies. Comparisons of normally distributed quantitative data between two groups and among several groups were performed by t test and one-way analysis of variance, respectively; comparisons of non-normally distributed quantitative data between two groups were performed by Mann-Whitney U test; for comparisons of proportions, chi-square test and Fisher′s exact test were used. Results:A total of 248 patients with CSU, 22 with SD, 15 with AU and 13 healthy controls were recruited. The cut-off level for sIgG positivity was 100 U/ml (at least 2+) , and the positive rate of food-sIgG antibodies was slightly higher in the patients with CSU (176/248, 70.97%) , SD (15/22, 68.18%) and AU (11/15) than in the healthy controls (7/13; χ2 = 1.80, P = 0.615) . Among the 248 CSU patients, the proportion of patients with family history of allergic diseases was significantly higher in the sIgG-positive group (71/176, 40.34%) than in the sIgG-negative group (19/72, 26.39%; χ2 = 4.30, P = 0.042) , while no significant difference was observed in the 1-day urticaria activity score (UASday) between the two groups ( Z = 0.18, P = 0.859) . Totally, 177 CSU patients completed 12- to 40-week treatment; their condition could be completely controlled by second-generation H1-antihistamines, and there was no significant difference in the required dosage of second-generation H1-antihistamines between the sIgG-positive group (128 cases) and sIgG-negative group (49 cases; Z = -1.06, P = 0.298) . Conclusions:The prevalence of family history of allergic diseases was relatively high in food-sIgG-positive patients with CSU. However, food-sIgG could not be used as an indicator to reflect the disease activity of CSU and treatment response.
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Objective:To compare the short- and long-term efficacy and safety of endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumor (NET) with maximum diameter ≤20 mm.Methods:From January 1, 2014 to June 30, 2022, the clinical data of 111 patients with rectal NET with maximum diameter ≤20 mm treated by ESD or TEM at Peking University People′s Hospital were retrospectively analyzed. According to the treatment of ESD or TEM, 111 patients with rectal NET were divided into ESD group (76 cases) and TEM group (35 cases). The clinicopathological characteristics (age, distance from anal margin, depth of invasion, etc.) were compared between patients with tumor maximum diameter<10 mm and 10 to 20 mm, and between ESD group patients and TEM group patients. The clinical efficacy and prognosis were also compared between ESD group and TEM group. The follow-up time was 41 months (16 months, 76 months). The propensity score matching (PSM) method was used to balance the differences of clinical characteristics between ESD and TEM groups. Independent sample t test, Wilcoxon rank-sum and chi-square test were used for statistical analysis. The risk factors of lymph node or distant metastasis were analyzed by univariate and multivariate binary logistic regression. Results:The maximum tumor diameter of 111 patients with rectal NET was (6.6±0.3) mm (ranged from 2 to 20 mm). The maximum tumor diameter of 85 cases (76.6%) was <10 mm and that of 26 cases (23.4%) was between 10 mm and 20 mm. There were statistically significant differences in age, distance from the anal margin and incidence of submucosal infiltration between patients with tumor maximum diameter<10 mm and patients with tumor maximum diameter 10 to 20 mm ((49.8±11.6 ) years old vs. (56.8±13.8) years old; 5.0 cm (4.0 cm, 8.0 cm) vs. 8.0 cm (5.0 cm, 8.0 cm); 69.4%, 59/85 vs. 96.2%, 25/26; t=2.58, Z=-2.23, χ2=6.35, P=0.011, 0.026 and 0.012). The en block resection rate of rectal NET treated with ESD or TEM was 100.0%(111/111), the complete resection rate was 93.7% (104/111), and the postoperative bleeding rate was 2.7% (3/111). There were no postoperative perforation or other major complications. During the follow-up period, there was no local recurrence. The metachronous recurrent rate was 0.9% (1/111), 3.6% (4/111) patients had lymph node or distant metastasis, and there was no death. Compared with patients with tumor maximum diameter<10 mm, more patients with tumor maximum diameter of 10 to 20 mm selected TEM (57.7%, 15/26 vs. 23.5%, 20/85), and the difference was statistically significant ( χ2=10.76, P=0.001). Before PSM, a total of 7 patients in the ESD group had positive vertical margins, and during the follow-up of 21 months (15 months, 48 months), 2 patients had lymph node or distant metastasis and received surgery. The proportion of patients with tumor maximum diameter of 10 to 20 mm and submucosal invasion in TEM group were both higher than those in ESD group (42.9%, 15/35 vs. 14.5%, 11/76; 88.6%, 31/35 vs. 69.7%, 53/76), and the differences were statistically significant( χ2=10.76 and 3.65, P=0.001 and 0.032). After PSM, there were no statistically significant differences in the complete resection rate, postoperative bleeding rate, metachronous recurrence rate, lymph node or distant metastasis rate between ESD group and TEM group (89.3%, 25/28 vs.100.0%, 28/28; 3.6%, 1/28 vs. 0, 0/28; 3.6%, 1/28 vs. 0, 0/28; 0, 0/28 vs.3.6%, 1/28; all P>0.05). However, the operation time and hospital stay of the ESD group were both shorter than those of the TEM group (27.0 min (25.0 min, 30.0 min) vs. 39.0 min (32.0 min, 45.0 min); 5.0 d (4.0 d, 5.0 d) vs. 6.0 d (3.0 d, 9.0 d)), and the differences were statistically significant ( Z=-3.38 and -2.23, P=0.001 and 0.021). Conclusion:The efficacy of ESD and TEM in rectal NET with maximum diameter ≤ 20 mm is equal, however, ESD has the advantage of shorter procedure time and hospital stay.
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Objective:To investigate the therapeutic effect of exosomes divided from bone marrow mesenchymal stem cell (BMSC) on pancreatic cancer in vivo through regulation of tumor-associated macrophages (TAM) polarization.Methods:Ten male C57BL/6 mice weighing approximately 20 g, ages 4 weeks, were used for BMSC exosomes extraction and PKH26 labelling. Thirty female SPF BALB/c-nu/nu nude mice weighing approximately (18.56±0.85) g, ages 4-6 weeks, were adopted for pancreatic carcinoma models. The models were randomly divided into 3 groups with 10 in each: control group (injected with PBS through tail vein), portal vein treatment group (injected with exosomes in PBS through portal vein), tail vein treatment group (injected with exosomes in PBS through tail vein). After the models were executive 8 weeks later, the percentage of PKH26 positive-exosomes in pancreas tissue was quantified by flow cytometry technique. The volume of the primary pancreatic tumor, the tumor volume of inhibitory rate, the number of metastatic nodule, and the ascitic fluid were assess. Also, the weight of liver and the tumor weight were evaluated. The expression of M1 and M2 macrophage-activate biomarkers and the content of pancreatic cancer marker B7-H4 tumor carbohydrate antigen 199 in peripheral blood was detected. Moreover, the expression of Survivin and matrix metalloproteinase-9 (MMP-9) in pancreatic cancer tissue cells was also detected.Results:There was no significant difference for the tumor volume of inhibitory rate between portal vein treatment group (72.4±21.6)% and tail vein treatment group (70.1±20.7)% ( t=0.24, P=0.811). Compared with control group, the volume of the primary pancreatic tumor, the weight of liver, the tumor weight, the number and rate of liver metastatic nodule, the ascitic fluid, and the number of other metastatic nodule were totally lower in the 2 treatment groups with significant difference (all P<0.05). Compared with the control group, iNOS and CD68 in portal vein treatment group and tail vein treatment group were increased, while Arginase, CD206, B7-H4, tumor carbohydrate antigen 199, Survivin and matrix metalloprotein-9 were decreased, with statistically significant differences (all P<0.05). Conclusion:Exosomes derived from BMSC can inhibit the polarization of TAM to the M2 phenotype and induce their polarization to the M1 phenotype, thereby suppressing the proliferation, invasion and migration of pancreatic cancer.
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Objective:To develop a deep convolutional neural network (CNN) to automatically detect gastric lesions in endoscopic images.Methods:A CNN-based diagnostic system was constructed based on ResNet-34 residual network structure and DeepLabv3 structure, and trained by using 17 217 routine gastroscopy images.These images were from 1 121 gastric lesions of five types acquired in Peking University People′s Hospital between 2012 and 2018, namely peptic ulcer (PU), early gastric cancer (EGC) and high-grade intraepithelial neoplasia (HGIN), advanced gastric cancer (AGC), gastric submucosal tumors (SMTs), and normal gastric mucosa without lesions. The trained CNN was evaluated through a test dataset that contained 1 091 routine gastroscopy images of 237 gastric lesions. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the CNN were calculated.Results:The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the CNN-assisted diagnosis of EGC and HGIN were 78.6% (33/42), 84.4% (27/32), 60.0% (6/10), 87.1% (27/31), and 54.5% (6/11), respectively. The accuracy, sensitivity, and specificity of CNN-assisted diagnosis of PU were 90.4% (47/52), 92.7% (38/41), and 81.8% (9/11), respectively, the outcomes of AGC were 88.1% (52/59), 91.8% (45/49), and 70.0% (7/10), respectively, and those of gastric SMTs were 86.0% (43/50), 89.7% (35/39), and 72.7% (8/11), respectively. The CNN′s recognition time for all images of the test set was 42 seconds.Conclusion:The constructed CNN system, as a rapid and accurate auxiliary diagnostic instrument, can detect not only EGC and HGIN but also other gastric lesions.
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Objective:To explore the effect of group painting art therapy on negative symptoms, the cognitive status and social function of patients with schizophrenia during rehabilitation.Methods:A total of 114 patients with schizophrenia recovered from May 2018 to May 2019 in Zhangjiakou Shalingzi Hospital. They were divided into two groups according to the random number table method with 57 case in each group, the control group was given routine nursing, and the observation group received group painting art therapy on the basis of routine nursing. The Positive And Negative Symptoms Scale (PANSS), MATRICS Consensus Cognitive Battery(MCCB), and Social Disability Screening Schedule (SDSS) were used to evaluate the symptoms, cognitive status, and social function improvement of the two groups before and after intervention.Results:There were no significant differences in the negative symptom scores and positive symptom scores of the PANSS between the two groups of patients before the intervention ( P>0.05). After the intervention, the scores of negative symptoms and general psychopathology were (11.83 ± 3.19), (17.30 ± 4.93) points in the observation group and (13.57 ± 2.85), (20.34 ± 5.12) points in the control group, the differences were significant ( t values were 2.789, 2.932, P<0.05). After the intervention, the 7-dimensional MCCB scores of the two groups of patients decreased, and the scores of the observation group were significantly lower than those of the control group ( t values were 2.046-3.238, P<0.05). After the intervention, the score of SDSS was (11.63±2.71) points in the observation group and (13.84 ±3.14) points in the control group, the differences were significant( t value was 3.653, P<0.01). Conclusions:The use of group painting art therapy in patients with schizophrenia during rehabilitation can promote the improvement of negative symptoms and improve the cognitive and social functions of patients.
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Objective To optimize the extraction process of collagen from the jellyfish (Nemopilema nomurai) and explore its characters. Methods The collagen was extracted with acetic acid and pepsin from jellyfish. The crude jellyfish collagen was purified by salting out and ultrafiltration. The purified collagen was characterized and analyzed by XRD (X-ray diffraction), UV (ultraviolet spectroscopy) and FTIR (fourier transform infrared spectroscopy). Results The purity of jellyfish collagen was 97%, the yield was 33% (dry weight). The jellyfish collagen maintained its triple helix structure during the extraction and purification process. Jellyfish collagen conformed to the characteristics of type I collagen according to amino acid composition and gel electrophoresis analysis. The jellyfish collagen exhibited a good solubility under the conditions of pH 3–5 and less than 0.9 mol/L of NaCl. Conclusion The extracted jellyfish collagen exhibited similar characteristics with bovine type I collagen and was a potential new source of collagen.
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OBJECTIVE： To establish a method for the determination of levofloxacin concentration in human pleural effusion， to study its pharmaceutical characteristics. METHODS： Totally 6 patients with infectious pleural effusion received levofloxacin 0.4 g qd intravenous drip. Pleural effusion was collected at 0.5， 1， 2， 4， 8， 12 and 24 hours after administration. After treated with methanol precipitation protein， HPLC was used to determine the concentration of levofloxacin. The determination was performed on Agilent ZORBAX SB-C18 column with mobile phase consisted of methanol-0.02 mmol/L KH2PO4 buffer （containing 0.3％ triethylamine， 70 ∶ 30， V/V at the flow rate of 1.0 mL/min. The detection wavelength was set at 294 nm， and the column temperature was 35 ℃. The sample size was 20 μL. The pharmacokinetic parameters were calculated with WinNonlin 5.2 software. RESULTS： Under this chromatogram condition， retention time of levofloxacin was about 4.9 min， the peak shape was good， the baseline was stable， and the determination of endogenous substances in pleural effusion had no interference. The linear range of levofloxacin were 0.625-20 μg/mL（R2＝0.998 9）. The relative recovery rates were （83.75±1.66）％-（87.73±2.43）％ for low， medium and high concentration samples （n＝3）； RSDs of intra-day were 2.23％-4.96％ （n＝5）； RSDs of inter-day were 4.10％-4.78％（n＝5）； the accuracy ranged （97.76±4.85）％-（100.87±2.25）％（n＝5）； RSD of concentration was no more than 5％ in stability test （n＝3） for low， medium and high quality control sample. The pharmacokinetic parameters of levofloxacin included cmax were （2.21±0.87） μg/mL； AUC0-24 h were （37.31±11.94） μg·h/mL； t1/2 were （4.50±0.21） h. CONCLUSIONS： Established method is simple， reliable and sensitive， and can be used for the determination of levofloxacin concentration in human pleural effusion and its pharmacokinetic study.
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Objective@#To explore the effects of ambient fine particulate matter（PM2.5）exposure on semen quality in healthy adult men .@*Methods@#The semen quality data were collected from the pre-pregnancy check outpatient of Taizhou Central Hospital from August 2014 to December 2017,excluding the patients with any disease of reproductive system. The data of daily pollutant concentration of this area during the same period were also collected to estimate the exposures of PM2.5,PM10,SO2,NO2,O3 and CO during 90 days before each semen examination. Logistic regression model was applied to estimate the association between PM2.5 exposure and semen quality .@*Results@#A total of 3 456 healthy adult men were included in this study. The median （interquartile range）of the total sperm count of the 3 456 subjects was 161.00（122.00）×106,and 94.40% of the subjects could reach the lower reference limit for sperm count. The median（interquartile range）of the sperm concentration was 22.20（18.80）×106/mL,and 69.50% of the subjects were qualified. The median（interquartile range）of the sperm vitality was 55.30%（23.37%）,and 44.10% of the subjects were qualified. The median（interquartile range）of daily average concentration of PM2.5 at 0-90 days before semen examination was 37.82（12.33）μg/m3. The results of multivariate logistic regression model showed that,with each 12.33 μg/m3 increase of PM2.5 exposures at 0-90 days before semen examination,the odds ratios of unqualified sperm concentration,sperm motility and sperm vitality were 1.236（95%CI：1.041-1.466）,1.493（95%CI：1.260-1.770）and 1.462（95%CI：1.246-1.715）,respectively .@*Conclusion@#The results suggested that high concentration of ambient PM2.5 exposure during the sperm development period negatively affects sperm concentration,sperm motility and sperm vitality.
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Objective Thisstudyaimedtomeasuretheatlantodentalinterval(ADI)andtherateofasymmetryoflateralatlanto-dental space(LADS)inhealthyUyghurandHanadultsbyMSCTimages.Methods CervicalspineC1~C2of404healthyvolunteers(187 Uyghurand217 Hannationalities)withoutatlanto-axialjointlesionswerescannedwithconventionalspiralMSCT.MPRtechnique wasusedtomeasuretheanteriorADIandthedifferenceinthevarianceofbilaterallateralatlantodentalspace(VBLADS).Results 92.5% ofUyghuradultsand94.0%ofHanadultsshowedasymmetryofbilateralLADS.TheratesandnumbersofasymmetryofbilateralLADS increasedwithage,thedeviationnumberandtheoffsetpercentageincreasing.TheADIdifferedindifferentagegroups,butnodifferencein themeasureofADIbetweenethnicgroupswasobserved.NosignificantdifferenceinVBLADSwasobservedindifferentagegroups. ADI≤2.7mm wasobservedin98% ofUygurandHanhealthycontrolsagedbetween18and29years.Similarly,98% ofsubjectsbetween age30-49presentedwithADI≤2.5mmand98% ofsubjectsaged50orolderpresentedwithADI≤2mm.Conclusion LADSasymmetryis commoninhealthyUyghurandHanpopulation.ThediagnosisofanteriordislocationoftheatlantoaxialjointinUyghurandHanpopulation shouldbemadecautiouslyandbebasedonADIreferencesfordifferentagegroups.
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Lung-protective ventilation (such as low tidal volume and application of positive end-expiratory pressure) is beneficial for patients with acute lung injury or acute respiratory distress syndrome (ARDS) and has become the standard treatment in intensive care unit (ICU).However,some experts now question whether the protective ventilation strategy for ARDS patients in the ICU is equally beneficial for patients after surgery,especially for most patients without any pre-existing lung lesions.This review will discuss preoperative,intraoperative,and postoperative lung protection strategies to reduce the risk of complications associated with anesthesia.
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Lung-protective ventilation (such as low tidal volume and application of positive end-expiratory pressure) is beneficial for patients with acute lung injury or acute respiratory distress syndrome (ARDS) and has become the standard treatment in intensive care unit (ICU). However, some experts now question whether the protective ventilation strategy for ARDS patients in the ICU is equally beneficial for patients after surgery, especially for most patients without any pre-existing lung lesions. This review will discuss preoperative, intraoperative, and postoperative lung protection strategies to reduce the risk of complications associated with anesthesia.
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Humans , Positive-Pressure Respiration , Respiration, Artificial , Respiratory Distress Syndrome , Tidal Volume , Ventilator-Induced Lung InjuryABSTRACT
Objective@#To measure and analyze the bone volume and thickness of mandibular angle area by computer-assisted CT.@*Methods@#From January 2010 to January 2016, 94 female patients with mandibular angle hypertrophy and bilateral mandibular angle osteotomy were selected. Twenty female patients with non-mandibular surgery were selected as control group (patient examined after nasal augmentation surgery), aged 18 to 37 years, with an average of 27.5 years. Three dimensional CT data of maxillofacial bone of patients were collected. The three dimensional reconstruction and measurement software Mimics 16.0 was used. A three-dimensional model of mandibular angle region was established. The thickness and volume of mandibular angle were measured and analyzed. The total difference between hypertrophic group and normal group was compared by two independent t-test.@*Results@#The thickness of mandibular angle area and mandibular angle area in hypertrophic group were (9.39±1.48) mm and (3 065.25±720.1) mm3 respectively, and the thickness of mandibular angle area and mandibular angle region in control group were (7.48±0.92) mm and (1 276.57±265) mm3, respectively. There was a significant difference between the two groups (P < 0.05).@*Conclusions@#Based on CT scanning data, a method of measuring the bone volume and thickness of mandibular angle region is established, which is helpful to the three-dimensional measurement and analysis of mandibular shape in patients with mandibular angle hypertrophy.
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Objective To investigate the effect of superomedial pedicle reduction mammaplasty in the treatment of severe gynecomastia.Methods 24 males with severe gynecomastia were involved in this study,who underwent superomedial pedicle reduction mammaplasty.Results All the patients were followed up for one to two years,and there were no complications such as skin necrosis,nippleareolar complex (N A C) hypaesthesia,hematoma or infection occurred.Minimal wound dehiscence occurred in two cases,and the rest cases were healed well.Conclusions Superomedial pedicle reduction mammaplasty in the treatment of severe gynecomastia could achieve satisfactory results,and good breast shapes are produced.
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Objective To analyze the role of telehealth?based dialysis registration systems in real?time and dynamic reflection of renal anemia in hemodialysis (HD) patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin (Hb) level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicians could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059(60.3％) were male.The average rate age was (60.5 ± 13.7) years old. Baseline average Hb was (108.3±16.0) g/L. Baseline detection rate and target rate were 54.2％and 47.5％, respectively. After 28 months follow?up, the detection rate of Hb increased from 54.2％ to 73.6％ (P<0.001), the target rate of Hb increased from 47.5％ to 56.1％ (P<0.001), and the level of average Hb rose from (108.3±16.0) g/L to (110.7±16.0) g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth?based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long?term way. The telehealth?based dialysis registration system, as an improved mode of dialysis registration is a promising way for long?term management of renal anemia in dialysis patients.
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Objective To report our efficacy of one-stage definite treatment of Gustilo type Ⅲ open fractures of long bone by plate osteosynthesis.Methods A retrospective case series study was conducted of the 69 cases who had undergone plate osteosynthesis for one-stage definite treatment of Gustilo type Ⅲ open fractures of long bone from January 2006 to June 2016 at Microsurgery and War Trauma Center of Chengdu Military Command,59 Hospital of Chinese PLA.They were 47 males and 22 females with an average age of 34.2 years (from 2 to 62 years).There were 27 shaft fractures of tibia or fibula (13 cases of type ⅢA,12 cases of type Ⅲ B and 2 cases of type Ⅲ C),4 fractures of distal tibia (2 cases of type Ⅲ A and 2 cases of type ⅢB),14 shaft fractures of ulna or radius (9 cases of type ⅢA,3 cases of type ⅢB and 2 cases of type Ⅲ C),12 factures of humeral shaft (7 cases of type Ⅲ A,3 cases of type Ⅲ B and 3 cases of type Ⅲ C),3 fractures of distal humerus (all type ⅢC),6 fractures of femoral shaft (5 cases of type ⅢA and one type Ⅲ C),and 3 fractures of distal femur (2 cases of type ⅢA and one type ⅢC).The intervals between injury and operation ranged from 4 to 17 hours,averaging 9.6 hours.After thorough debridement,osteosynthesis was performed with locking compression plate,limited contact dynamic compression plate or/and reconstruction locking plate,or 1/3 tubular plate.Direct closure with decreased tension or without tension was used for type Ⅲ A injury;deep open defects were repaired with perforator flaps,neurovascular axis flaps,traditional axis flaps and muscular flaps,or local flaps;limb reconstructions included neurovascular repair in 12 cases,tendon and ligament repair in 5 cases,and muscle reconstruction in 3 cases.Superficial defects were covered by skin grafts simultaneously or secondarily.Results The duration of hospitalization averaged 19 days (from 5 to 37 days).Partial necrosis occurred in one case of sural neurovascular axis flap.Superficial infection with multiple antibiotic-resistant bacteria occurred in 2 cases.Follow-up for the 69 patients ranged from 12 to 27 months (average,19.2 months).No deep bone infection occurred.Implant breaking occurred in 4 cases and implant loosening in one.The implant failures were corrected by change into intramedullary nails or plate refixation (respectively in 2 cases) in addition to bone graft.Bone union was achieved after 5 to 15 months (average,7.7 month)with satisfactory aesthetic and functional outcomes.Conclusion For patients with Gustilo type Ⅲ open fracture of long bone,especially those with metaphyseal,intraarticular or upper limb fracture and pediatric ones,plate osteosynthesis can be a satisfactory one-stage definite treatment besides intramedullar nailing and external fixation,providing that through debridement and satisfactory soft-tissue coverage can be achieved.
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Objective To investigate the clinical features of asthma at attack and chronic obstructive pulmonary disease (COPD) occurred at the same time (ACO),in elderly people for correct diagnosis and treatment of ACO.Methods A total of 102 elderly patients with either COPD or asthma who visited the Beijing Chaoyang Hospital from October 2010 to June 2016 were recruited for the study.Comparisons of clinical characteristics pulmonary function,airway inflammation and systemic inflammation,quality of life,acute aggravation,treatment and health care costs and comorbidity were carried out among the patients with COPD,asthma and ACO.Results ACO may present the features of both asthma and COPD.FEV1 and FEV1 FVC in ACO group (43.38±11.55)vs.(45.58±11.26) were significantly lower than those in asthma group(71.28±12.46) vs.(74.61±16.21) (P＜0.05),but there was no statistical difference between ACO group and COPD group (1.78±10.28)vs.(52.59±8.52)(P＞0.05).DLco in ACO group(61.86±13.53) was significantly lower than that in asthma group (86.28±16.54) (P＜0.05) and higher than that in COPD group(49.27±19.63) (P＜0.05).RV TLC in ACO group(49.85±12.59) was significantly higher than that in asthma group(29.58±1 5.43)(P＜0.05),but there was no statistical difference between ACO group and COPD group(52.65±1 1.58) (P＞＜0.05).Fractional exhaled nitric oxide(FeNO) in ACO group (29.37±10.85)was significantly lower than that in asthma group (40.18±11.86) (P＜0.05) and higher than that in COPD group(10.22±9.28) (P＜0.05).The proportion of patients with increased percentage of eosinophils in ACO group 25％ was significantly lower than that in asthma group 44.44％ (P＜0.05) and higher than that in COPD group 3.70％ (P＜0.05).The similar results were seen in IgE and C-reactive protein(CRP).There was significantly statistical difference in asthma control test(ACT) between ACO group and asthma group.There was significantly statistical difference in COPD assessment test(CAT) and the modified British Medical Research Council questionnaire (mMRC) scores between ACO group and COPD group;There was significantly statistical difference in six-minute walking distance (6MWD) among three groups(all P＜0.05).The number of acute exacerbations in ACO group (2.93±0.92) was significantly higher than that in asthma group(1.76±0.79)and COPD group(2.12±0.88) (F=14.09,P＜0.05).There was no statistical difference in treatment and health care costs among three groups(all P＞0.05).There were no statistically difference in comorbidity among three groups (all P＞0.05).Conclusions The clinical characteristics of ACO patients are different from those of COPD and asthma patients,It is necessary to understand the mechanism of ACO in order to improve the diagnosis and treatment.
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In order to provide a basic theory for the materials of repairing central nervous system injury, we have studied the growth and differentiation of neural stem cells (NSCs) on poly (L-lysine) modified silk fibroin film. First, we used poly (L-lysine) to modify silk fibroin film and confirmed by UV-vis and 1H NMR spectra. Then NSCs were isolated and seeded on the silk fibroin film (Silk group), poly (L-lysine) (PLL group) and poly (L-lysine) modified Silk fibroin film (Silk-PIL group). The proliferation of NSCs was evaluated by Cell Counting Kit-8 (CCK-8) assay on days 1, 3, 5 and 7 after seeding. Immunofluorescence was used to analyze the differentiation of NSCs at the 7th day. The levels of apoptosis were detected by Western blotting and TUNEL. The mRNA level of brain derived neurotrophic factor (BDNF) was identified by real-time PCR. UV-vis and 1H NMR spectra confirmed that poly (L-lysine) was successfully grafted onto the silk fibroin film. From the 3rd day after seeding to the 7th day, the CCK-8 test showed that proliferation rate of NSCs in the Silk-PIL was significantly higher than Silk group (P<0.05) but had no significant difference compared with PLL group (P>0.05). Immunofluorescence staining displayed that more NSCs in Silk-PIL group were differentiated into neuron compared with Silk group (P<0.05), however, there was no significant difference compared with PLL group (P>0.05). The number of NSCs differentiated into astrocytes was not significantly different between the three groups. Western blotting and TUNEL test presented that the degree of apoptosis of NSCs in the Silk-PIL group was significantly lower than Silk group (P<0.05). RT-PCR exhibited that mRNA level of brain derived neurotrophic factor (BDNF) of NSCs was higher in Silk-PIL group compared with Silk group (P<0.05) but had no significant difference compared with PLL group (P>0.05). Thus, poly (L-lysine) modified silk fibroin film could promote the proliferation of NSCs and reduce NSCs apoptosis. Furthermore, it also can enhance the differentiation of NSCs into neurons. It is expected to become a new type of tissue engineering scaffold carrying NSCs to repair central nervous system injury.
ABSTRACT
To observe the expression changes of interleukin-11 (IL-11) and its receptor in mice with pulmonary fibrosis. Methods: C57BL/6 mice were randomly divided into a control group and a bleomycin (BLM) group (6 mice per group). BLM was injected into mice to induce idiopathic pulmonary fibrosis, while 50 μL PBS was injected into the control rats. The lung tissue was collected 21 d later. HE staining was used to observe morphological changes in lung tissue. Real-time PCR was used to detect IL-11 and its receptor gene expression. Western blot and immunohistochemical staining were used to detect IL-11 receptor expression. ELISA was used to detect the content of serum IL-11 in mice. In addition, the gene and protein expression of IL-11 receptor in mouse fibroblasts were detected by real-time PCR and Western blot, respectively. Results: HE staining showed a significant change in pulmonary fibrosis in mice 21 d after BLM injection. The IL-11 mRNA expression in lung and IL-11 level in serum were up-regulated. The gene and protein expression of IL-11 receptor in mice with pulmonary fibrosis were significantly increased. The results from the cell experiments showed that the gene and protein expression of IL-11 receptor in mouse fibroblasts were significantly increased by TGF-β1. Conclusion: The expression of IL-11 and its receptor are up-regulated in mice with pulmonary fibrosis induced by BLM, which might be an important mechanism for the development of pulmonary fibrosis.