Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.

Domains of Adherence and Non-Adherence to Anti-Hypertensive Medications in Hypertensive Patients from Kuala Lumpur: A Qualitative Study

@#Introduction: Previous medication adherence studies primarily focused on the domains of non-adherence in hypertension treatment and less attention has been given on domains that encourage adherence to anti-hypertensive medications. The current study is aimed to identify the domains of adherence and non-adherence to anti-hypertensive medications among hypertensive patients in Kuala Lumpur, Malaysia. Methods: Hypertensive patients from two public health clinics in Kuala Lumpur were invited for in-depth interviews until thematic saturation. Audio recordings from these interviews were transcribed verbatim. Transcripts were then analysed deductively with the guidance of the World Health Organization Medication Adherence Framework to extract the domains of adherence and non-adherence to anti-hypertensive medications. Results: Ten patients who were predominantly Malays and aged 34-73 years old participated the study. Patient-related (encompassing knowledge, attitude, belief and culture, lifestyle, personal barriers, self-efficacy, and cue to action), socioeconomic (encompassing social support), condition-related (encompassing nature of illness and presence of multiple co-morbidities), therapy-related (encompassing experience of receiving treatment, barrier in treatment, and side effects of treatment), and healthcare system (encompassing access to healthcare and healthcare center experience) domains were identified as central to the medication-taking behaviour of hypertensive patients. Conclusion: Sixteen codes of adherence and 22 codes of non-adherence to anti-hypertensive medications were identified, which were distributed across five domains (patient-related, socioeconomic, condition-related, therapy related, and healthcare system domains). These findings can help to inform future development of medication adherence questionnaires, individualised interventions for patients with adherence problems, and targeted health promotion programmes to reduce uncontrolled hypertension.

Prevalence of depressive symptoms among community-dwelling elderly with mild cognitive impairment in China: a Meta-analysis / 中华全科医师杂志

Objective:To estimate the prevalence of depressive symptoms in community-dwelling elderly with mild cognitive impairment(MCI) in China by systemic review.Methods:PubMed, Web of Science, CNKI, VIP database and other databases were searched for cross-sectional studies on the prevalence of depressive symptoms in the elderly with MCI in China. The search period was from January 1, 2011 to October 1, 2021. The studies were screened according to predefined inclusion and exclusion criteria. Stata 12.0 software was used for statistical analysis, and finally the prevalence rate of depressive symptoms in the elderly with MCI in China was calculated.Results:A total of 2 036 relevant studies were retrieved, among which 14 met the inclusion criteria, involving 3 819 cases. Meta-analysis showed that 32.3%(30.9%-33.7%) of community-dwelling elderly with MCI had depressive symptoms. Subgroup analysis showed that the detection rate of depressive symptoms in studies published during 2016—2021 was higher than that during 2011—2015 (34.6% vs. 23.5%, χ2=11.64, P<0.001).However there were no significant differences in detection rate between genders, among studies using different depression assessment and MCI assessment tools, and among different geographic regions (all P>0.05). Conclusion:The study shows that the prevalence of depressive symptoms in community-dwelling elderly with MCI in China is high and it presents a rising trend, suggesting that attention should be paid to mental health of elderly in the community and the screening of depressive symptoms should be strengthened for those with MCI.

Study Protocol of a Mixed-Methods Study to Develop and Validate the Malaysian Anti-Hypertensive Agents Non-Adherence Scale in Hypertensive Patients

@#Introduction: Domains of adherence and non-adherence to hypertensive medications have not been extensively documented in Malaysia due to the absence of theoretically driven and culturally appropriate measurement tools, leading to a poor understanding of the adherence and underlying factors. We aim to identify these domains in Malaysian hypertensive patients and subsequently apply the findings to develop and validate the Malaysian Anti-Hypertensive Agents Non-Adherence Scale (MAANS). Methods: This study has an exploratory mixed-methods design. In Phase 1, we will recruit hypertensive patients from two health clinics to participate in a semi-structured interview. Recruitment of participants will terminate once thematic saturation is achieved. Coding and thematic analyses will be performed to identify the domains of adherence and non-adherence to anti-hypertensive medications. In Phase 2, based on the domains generated from Phase 1, we will develop the Malaysian Anti-Hypertensive Agents Non-Adherence Scale (MAANS). Four hundred hypertensive patients will be randomly selected. Data from 200 participants (serving as the calibration sample) will be subjected to exploratory factor analysis while data from additional 200 participants (serving as the validation sample) will be subjected to confirmatory factor analysis. Factor structure, predictive validity, and reliability of the MAANS will be statistically tested. Discussion: With the presence of the MAANS, health care providers can gather crucial information regarding barriers and facilitators to hypertensive treatment adherence and design effective health promotion programmes to reduce complications of uncontrolled hypertension. Trial registration: Ethical approval is granted by the Medical Research Ethics Committee, Ministry of Health, Malaysia (NMRR-18-3251-44694).

Sequential Changes of Total Adenine Nucleotide and Adenylic-Acid Energy Charge in Muscles of Rats after Death / 法医学杂志

Objective To determine the purine adenylate [adenosine triphosphate （ATP）, adenosine diphosphate （ADP）, adenosine monophosphate （AMP）] content in the muscles of both hind limbs of rats at different postmortem interval （PMI）, calculate the changes in the total adenine nucleotide （TAN） content and the adenylic-acid energy charge （AEC）, and explore their relationship with PMI. Methods Healthy rats were sacrificed by cervical dislocation and kept at 20 ℃. The muscles of their hind limbs were extracted at 0, 24, 48, 72, 96, 120, 144, and 168 h after death. Reversed-phase high performance liquid chromatography was used to determine the content of purine adenylates, the TAN and AEC of the muscles of the both hind limbs were calculated, and the related regression equations of their relationship with PMI were established. Results Within 168 h of death of rats, the trend of ATP change was different from ADP, and the content of AMP continuously increased. The TAN value gradually increased with the extension of PMI, and the AEC showed a downward trend within 168 h after death. Among them, the patterns of AEC changes with PMI were obvious, the correlation coefficient was high （ R2=0.903）, and the curve fitting relationship was good; the fitting relationship between ATP, ADP, AMP, TAN and PMI was poor （ R2=0.198-0.754）. Conclusion The postmortem change patterns of AEC provide new research ideas for PMI estimation in the forensic field.

A Review of the Effectiveness of Interventions on Medication Adherence Among Hypertension Patients

@#A majority of hypertensive patients will end up suffering uncontrolled hypertension, which is partly due to poor medication adherence. This paper aimed to review a range of interventions that could improve anti-hypertensive medication adherence. Literature search was conducted using PubMed, Scopus, Medline, and Science Direct databases, with publication dates confined to between October 2009 and October 2019. Eventually, only 11 studies were used for this study. It was found that interventions that are based on or include patient education, patient interviews, patient reminders, self-management and behavioural modifications have the potential to improve patients’ adherence to anti-hypertensive therapy. Most successful interventions involve patient reminder, self-management and behavioural intervention.

Short-Term Efficacy of Two Different Access Site Ultrasound-Guided Radiofrequency Ablation for Saphenous Varicose Veins at Two Different Access Sites / 中山大学学报(医学科学版)

@#【Objective】 To investigate the efficacy and safety of ultrasound- guided above- knee and below- knee radiofrequency ablation for the treatment of saphenous varicose veins.【Methods】Patients who underwent ultrasound-guided radiofrequency ablation closure in our department from July 2019 to November 2019 were compared in operation time ， recovery time，volume of sclerosant foam，pain score，venous clinical severity score（VCSS），Aberdeen Varicose Veins Questionnaire （AVVQ）， and complications. 【Results】 Fifty- nine patients underwent above- knee radiofrequency ablation and 19 patients underwent below-knee radiofrequency ablation. The average operation time（69.75 vs. 78.95）min， time return to normal activity（2.93 vs. 3.58）min or the volume of foam（28.3 vs. 24.2）mL were similar in both groups. The pain score，VCSS，and AVVQ scores 24 h，1 week，or 4 w postoperative decreased significantly in the two groups. No deep vein thrombosis，pulmonary embolism，or infection occurred in the two groups after surgery. Other complications including phlebitis，pigmentation，bleeding，rash，or paresthesia，showed no difference in rates. And overall incidence of complications were similar between the two groups. 【Conclusions】 Both above-knee and below-knee radiofrequency ablation are safe and effective treatments for great saphenous varicose veins.

Predicting the Risk of Chronic Kidney Disease Among Type 2 Diabetes Mellitus Patients in a Primary Care Setting: An Evaluation of the QKidney Model

Abstract@#Introduction: Diabetes mellitus is a major risk factor for chronic kidney disease (CKD). Thus, making routine screening among the diabetic group is necessary in order to reduce the burden of the disease. As such, various risk prediction models including QKidney model have been developed for early detection of CKD. However, the Qkidney model has not been validated in Malaysia. This study aimed to evaluate the performance of QKidney model in predicting a 5-year risk of developing CKD in a cohort of type 2 diabetes mellitus (T2DM) patients in the primary care setting. Methods: A total of 377 T2DM patients attended the primary care clinic at the town of Rawang, aged 30-74 years old, and free of CKD outcomes at baseline were recruited and followed-up for 5 years. Their CKD risk was calculated using the QKidney model. The predictive performance of QKidney model was assessed through discrimination and calibration analyses. Results: At the end of the 5-year follow-up, a total median QKidney score was 3.9% (IQR: 5.9). The median QKidney score of male participants (7.3%) was significantly higher than that of the females (3.0%) (p < 0.001). The QKidney model has a moderate discrimination in which the area under the receiver operating characteristic curve was 0.748, with good calibration (χ2 = 13.039, p = 0.111). Conclusion: It was found that the QKidney model had a moderate discriminative ability with good calibration. When taken together, it was suggested that the QKidney model could be utilized to predict a moderate-to-severe CKD risk in Malaysians with T2DM.

Surgical technique and effect of proximal femoral nail anti-rotation internal fixation assisted with large retractor for the treatment of femoral intertrochanteric fractures / 中国骨伤

OBJECTIVE@#To investigate the surgical technique and efficacy of large retractor assisted maintenance of proximal femoral nail antirotation(PFNA) in the treatment of femoral intertrochanteric fracture in the absence of a retractor.@*METHODS@#A total of 55 patients with intertrochanteric fractures treated with PFNA internal fixation were selected from April 2012 to December 2016 with a large retractor assisted in maintaining reduction, including 18 males and 37 females with an average age of 75.65 years old ranging from 47 to 90 years old; 31 cases were on the left side and 24 on the right side. All patients had preoperative ipsilateral hip pain, limited mobility, ipsilateral lower extremity extreme external rotation malformation or accompanied by shortening, and preoperative radiographs were clearly diagnosed intertrochanteric fractures. The operative time, intraoperative blood loss, and intraoperative fluoroscopy time were recorded. Postoperative hip function were evaluated.@*RESULTS@#The average operation time was 45.35 min, the average intraoperative blood loss was 117.64 ml and the mean intraoperative fluoroscopic time was 3.42 min. All the fractures were well restored. All patients were followed up from 12 to 24 months with an average of 16.43 months. All the intertrochanteric fractures were bone healed without hip varus deformity, and there were no complications such as internal fixation loosening and fracture. According to Harris hip function score criteria, the results were excellent in 40 cases, good in 8 cases, fair in 5 cases, poor in 2 cases.@*CONCLUSIONS@#Large retractor assisted in maintaining the use of PFNA under reposition can fix various types of femoral intertrochanteric fractures. It has simple requirements for surgical position, low equipment requirements, short operation time, less trauma, reliable fixation, and good postoperative recovery. The surgical procedure can be carried out in a primary hospital without a traction bed.

Diagnosis of acute posteromedial corner injury of knee joint under arthroscope / 中国内镜杂志

Objective To study the performance of knee arthroscopy in patients with acute posteromedial corner injury and to explore the use of arthroscopy to help diagnosis. Methods From April to August 2017, the arthroscopic posteromedial corner after operation of 7 cases of acute knee joint injury patients data were retrospectively studied, treatment are in the same group. They were two man and three women, 37 ~ 59 years of old (average 49.6 years). All patients were selected for preoperative MRI to indicate medial collateral ligament damage. The VAS score was evaluated preoperative. When check-up knee flexion and 30° valgus stress test positive and 0° valgus stress test positive. Intraoperative arthroscopy was performed to confirm the injury of the Posteromedial corner. The medial meniscus was formed or stitched. The medial collateral ligament and Posteromedial corner were repaired. The knee X-ray examination were measured preoperative and in 2 months after surgery, Evaluation of the knee VAS score in 2 months after surgery. Results All patients were followed up for 2 months. The medial meniscus were easily observed and raise easily 5 cases undergoing arthroscopic surgery. All 7 patiens were showed the injury of the joint capsule ligament complex. All of the 7 cases showed the injury of the joint capsule ligament complex. Preoperative and postoperative knee medial clearance for 2 months in knee valgus stress buckling 30° [(9.2 ± 1.3) vs (3.0 ± 1.0) mm]. Preoperative and postoperative knee medial clearance for 2 months in knee valgus stress 0° [(8.8 ± 1.1) vs (2.9 ± 1.0) mm]. There were statistically significant differences (P < 0.05). After 2 months in knee valgus stress buckling is compared with the normal control group 30° [(3.0 ± 1.0) vs (2.9 ± 1.2) mm]. After 2 months in 0° knee valgus stress compared with normal control group [(2.9 ± 1.0) vs (2.8 ± 1.2) mm]. There was no statistical difference (P > 0.05). Preoperative and postoperative knee joint pain VAS score [(5.4 ± 0.3) vs (2.3 ± 1.1)]. There were statistically significant differences (P < 0.05). Conclusion Under arthroscopy detection in patients with acute Posteromedial corner injury. If it is easy to observe posterior horn of medial meniscus and the medial meniscus angle is easy to raise; The medial meniscus posterior horn joint capsule and ligament damage. They were indicated acute Posteromedial corner injury. Timely deal with medial meniscus and repair Posteromedial corner, the stability of the knee joint can be satisfactory.

The effect of thermal damage on the cell proliferation and invasive metastasis of HCC: an experimental study in vitro / 介入放射学杂志

Objective To evaluate the influence of thermal damage on the cell proliferation,invasive metastasis and epithelial-mesenchymal transition of hepatocellular carcinoma (HCC) through experiments in vitro,and to explore the relationship between thermal ablation and the recurrence,metastasis of HCC.Methods The McA-RH7777 HCC cell thermal damage model was established by using external heating method.The effect of thermal damage on the proliferation of HCC cells was detected by Kit-8 assay (CCK-8),and the cell cycle changes were studied by flow cytometry.The effect of thermal damage on the invasion potential of HCC cells was assessed by using Transwell assay.Fluorescence quantitative polymerase chain reaction (RT-PCR) and Western blot were used to evaluate the influence of thermal damage on HCC cell invasion potential,and on the mRNA and protein expression levels of EMT-related molecular markers,including VEGF,MMP-9,Nm23,E-cadherinand vimentin.Results Heating treatment of McA-RH7777HCC cells was performed by putting the cells in 43.5℃ water basin for 30 min.Two to five days after heating treatment the cell proliferative ability was significantly higher than that of control group (P＜0.05).At 48-72hours after heating treatment the proportion of HCC cells in G1 phase was obviously reduced and the proportion of HCC cells in S+G2 phase was significantly increased,the differences were statistically significant (P＜0.05).Compared with the control group,the difference in HCC cell invasion potential determined at 24 h after heating treatment was not significant,while the HCC cell invasion potential determined at 72 h after heating treatment was strikingly increased (22.3±2.46 vs.14.2±l.82,P＜0.001).Real-time PCR and Western blotting results indicated that at 72 h after heating treatment the expression levels of VEGF,MMP-9 and vimentin were significantly increased,while the expression level of E-cadherin was remarkably decreased,the differences were statistically significant (P＜0.05).Conclusion Thermal damage with sub-lethal heating dose can induce McA-RH7777 HCC cell to develop epithelial-mesenchymal transition and to enhance its proliferation and invasive metastasis potential,and HCC cells show higher malignant potential.

Interventional therapy for acute hepatic artery thrombosis after liver transplantation / 复旦学报（医学版）

Objective To evaluate the short-term and long-term efficacy of interventional therapy for acute hepatic artery thrombosis.Methods We analyzed retrospectively the interventional treatment and long-term follow-up data of 34 patients with acute hepatic artery thrombosis in Zhongshan hospital of Fudan University from March 2003 to October 2015.Results Thirty-four patients with acute hepatic artery thrombosis were performed with urokinase thrombolytic therapy.Twenty-one patients were implanted stents in the thrombolytic therapy.Splenic artery embolization were performed in 3 patient with splenic artery steal syndrome.Technical and clinical success rates were 91％ (31/34).The complication associated with interventional procedures were observed in 2 patients.The patency rates of hepatic artery in 1,2,3 and 5 years were 82％,73％,57％ and 57％ respectively.The median obstruction free time was 94 months.Conclusions Good short-term and long-term effect have been obtained in interventional treatment for acute hepatic artery thrombosis,which can be used as the first treatment for acute hepatic artery thrombosis after liver transplantation.

Effect of Shensong Yangxin on the Progression of Paroxysmal Atrial Fibrillation is Correlated with Regulation of Autonomic Nerve Activity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Shensong Yangxin (SSYX), a traditional Chinese herbal medicine, has long been used clinically to treat arrhythmias in China. However, the mechanism of SSYX on atrial fibrillation (AF) is unknown. In this study, we tested the hypothesis that the effect of SSYX on the progression of paroxysmal AF is correlated with the regulation of autonomic nerve activity.</p><p><b>METHODS</b>Eighteen mongrel dogs were randomly divided into control group (n = 6), pacing group (n = 6), and pacing + SSYX group (n = 6). The control group was implanted with pacemakers without pacing; the pacing group was implanted with pacemakers with long-term intermittent atrial pacing; the pacing + SSYX group underwent long-term intermittent atrial pacing and SSYX oral administration.</p><p><b>RESULTS</b>Compared to the pacing group, the parameters of heart rate variability were lower after 8 weeks in the pacing + SSYX group (low-frequency [LF] component: 20.85 ± 3.14 vs. 15.3 ± 1.89 ms 2 , P = 0.004; LF component/high-frequency component: 1.34 ± 0.33 vs. 0.77 ± 0.15, P < 0.001). The atrial effective refractory period (AERP) was shorter and the dispersion of the AERP was higher after 8 weeks in the pacing group, while the changes were suppressed by SSYX intake. The dogs in the pacing group had more episodes and longer durations of AF than that in the pacing + SSYX group. SSYX markedly inhibited the increase in sympathetic nerves and upregulation of tumor necrosis factor-alpha and interleukin-6 expression in the pacing + SSYX group. Furthermore, SSYX suppressed the decrease of acetylcholine and α7 nicotinic acetylcholine receptor protein induced by long-term intermittent atrial pacing.</p><p><b>CONCLUSIONS</b>SSYX substantially prevents atrial electrical remodeling and the progression of AF. These effects of SSYX may have association with regulating the imbalance of autonomic nerve activity and the cholinergic anti-inflammatory pathway.</p>

Embolization of hepatic arterio-portal shunt in patients with HCC complicated by portal vein tumor ;thrombus treated with TACE combined with portal vein stenting：its clinical significance / 介入放射学杂志

Objective To evaluated the clinical significance of embolization of arterio-portal venous shunt (APVS) in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) treated by transcatheter arterial chemoembolization (TACE) and portal vein stenting. Methods Twenty-six HCC patients with MPVTT and marked APVS, who were treated with TACE and portal vein stenting, were enrolled in this study. Portal vein stenting was performed via percutaneous transhepatic approach, which was followed by the embolization of the feeding arteries of APVS by using suitable embolic agents. The portal vein pressure levels were separately measured before, after portal vein stenting and after APVS embolization. The results were statistically analyzed. Results Both the portal vein stenting and APVS embolization were successfully accomplished in all the 26 patients. Hepatic angiography and portal venography performed before portal vein stenting revealed bidirectional portal flow in 16 cases and hepatofugal portal flow in 10 cases. Among the 16 patients with bidirectional portal flow, remarkable improvement of portal vein to liver blood flow after portal vein stenting was seen in 14, and obvious recovery of main portal vein to liver blood flow after APVS embolization in 2. Obvious recovery of main portal vein to liver blood flow after APVS embolization was also demonstrated in 10 cases with hepatofugal portal flow. The portal vein pressure determined before, after portal vein stenting and after APVS embolization was (50.1±6.3) cmH2O,(43.5± 7.5) cmH2O and (36.9 ±8.2) cmH2O respectively. After portal vein stenting the portal vein pressure was significantly decreased when compared with the preoperative pressure, and the difference was statistically significant (P<0.05); after APVS embolization the portal vein pressure was further decreased (P<0.05). Conclusion For HCC patients with MPVTT and marked APVS, portal vein stenting can effectively restore the portal blood flow and reduce the portal vein pressure; and embolization of APVS can further reduce the pressure of portal vein, thus the bidirectional portal flow or hepatofugal portal flow will return to normal hepatopetal flow.

Super-selective catheterization for “one-way valve occlusion” of the common hepatic artery during transcatheter arterial chemoembolization：discussion on the catheterization skill / 介入放射学杂志

Objective To discuss the technical skill of super-selective catheterization for “one-way valve occlusion” of the common hepatic artery during transcatheter arterial chemoembolization (TACE). Methods A total of 128 patients with “one-way valve occlusion”of the common hepatic artery were enrolled in this study, who were admitted to authors’ department to receive TACE during the period from 2000 to 2011. The lesions included hepatocellular carcinoma (n = 110), cholangiocellular carcinoma (n = 3) and hepatic metastasis (n=15). “One-way valve occlusion”of the common hepatic artery occurred in 90 patients (70.3%, 90/128) after 2-5 times of TACE had been carried out, and in the other 38 patients (29.7%, 39/128) the “one- way valve occlusion” of the common hepatic artery was recognized at the initial TACE procedure. Super-selective hepatic catheterization was performed via the superior mesenteric artery (SMA) approach or celiac artery (CA) approach using coaxial micro-catheter catheterization technique. The success rate and fluoroscopy time of super-selective catheterization were recorded, and the results were compared between the two approaches. Results A total of 337 times of hepatic super-selection catheterization were performed in 128 patients, with a mean of 2.6 times for each case. The success rate was 100%. Of the 337 procedures, the catheterization was via CA approach in 148 (43.9%, 148/337) and via SMA approach in 189 (56.1%, 189/337). The mean fluoroscopy time in CA approach group was 3.2 minutes(ranged 1-6 minutes), and in SMA group was 15.3 minutes(ranged 5-40 minutes). The difference between the two groups was statistically significant (P < 0.05). Conclusion Super- selective hepatic catheterization for “one-way valve occlusion” of the common hepatic artery can be achieved through SMA approach or CA approach by using coaxial micro-catheter catheterization. Compared with SMA approach, the technique of hepatic catheterization through CA approach is much simpler and the fluoroscopy time is significantly shorter.

The clinical significance of evolution of paroxysmal nocturnal haemoglobinuria clones in aplastic anemia patients / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the clinical significance of evolution of paroxysmal nocturnal hemoglobinuria (PNH) clones in aplastic anemia (AA) patients.</p><p><b>METHODS</b>The positive rate of PNH clones in 678 AA cases at first diagnosis from January 2002 to December 2009 were analyzed, and to compare the response rate and overall survival (OS) between AA patients with or without PNH clones. All patients were sequentially followed-up to assess the incidence rate and risk factors for AA evolving to overt PNH.</p><p><b>RESULTS</b>(1) Of 119/678 (17.6%) AA patients at initial diagnosis presented with PNH clones,the positive rates of PNH clones among non-severe AA (NSAA), severe AA (SAA) and very severe AA (VSAA) were 16.7% (37/ 222), 17.3% (45/260) and 18.9% (37/196), respectively. There was no statistical difference among the three groups. (Chi2 = 0.369; P = 0.832); (2) 678 newly diagnosed AA cases were divided into 5 subgroups according to PNH clones, severity of disease and treatment regimens. There was no statistical difference among the five subgroups regarding 6m-response rate (RR) and OS. (3) Serial follow-up revealed that persistent PNH negative clones were found in 516 (76.1%) cases, and evolved to PNH positive clones after therapy in 43 (6.3%) cases. Persistent PNH positive clones were found in 72 (10.6%) cases, and disappeared the clones after treatment in 47 (6.9%) cases. There was no statistical difference among the four subgroups in terms of the 6m RR (Chi2 = 2.489,P = 0.426) and OS (P = 0.477); (4) 17 out of 678 AA cases (2.5%) evolved to overt PNH and the estimated incidence of evolution to overt PNH was (3.7 +/- 0.9)% at 10 years. The incidences of AA patients with or without PNH clones at initial diagnosis evolved to overt PNH were 3.4% and 2.3%, respectively. There was no statistical difference between the two groups, (Chi2 = 0.111; P = 0.739); and so was found in OS by Kaplan-Meier analysis (P = 0.868). Cox regression model analysis showed that none of the severity of AA, with or without PNH clone at initial diagnosis, treatment regimen and 6m RR was the risk factor for evolution to overt PNH.</p><p><b>CONCLUSION</b>There is no difference between AA patients presented with or without PNH clones at initial diagnosis regarding the RR and prognosis. The appearance of PNH clones in AA is not identified as a risk factor for developing into overt PNH.</p>

Mutation of drug resistant gene in HIV/AIDS patients with antiretroviral therapy in Shandong province in 2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate drug resistance status in patients with highly active antiretroviral therapy (HAART) in Shandong province.</p><p><b>METHODS</b>A total of 758 patients were separated from the anticoagulatory whole blood during May and October in 2011. The entire protease gene and part of the reverse transcriptase gene were amplified by RT-PCR and nest-PCR in the samples with viral load larger than 1000 copies/ml, then sequenced the gene fragments. Mutation of drug resistant gene and drug susceptibility was analyzed by the online tool HIV db program developed by Stanford University.</p><p><b>RESULTS</b>The rate of virologic failure in patients was 9.1% (69/758). A total of 53 gene sequences that acquired were used for genotypic resistance analysis. A total of 23 patients were indicated drug resistance with the total of 3.1% (23/742). Drug resistance rates of nucleotide reverse transcriptase inhibitor (NRTI) and non-NRTI(NNRTI) were 2.4% (18/742) and 3.0% (22/742), respectively, and the primary mutation types of drug resistance were M184V and Y181C for NRTI and NNRTI, with no resistance to protease inhibitor (PI). In the 23 patients indicated drug resistance, 78.3% (18/23) were NRTI resistance, 95.7% (22/23) were NNRTI resistance and 73.9% (17/23) dual NRTI and NNRTI resistance.</p><p><b>CONCLUSION</b>The presence of drug resistant gene in HIV strains among AIDS patients with HAART in Shandong province was at low level, but mutation diversity was found in drug resistant gene.</p>

The prevalence and evolution of HIV drug-resistant strains in people who live with HIV/AIDS during HIV antiretroviral therapy in Shandong province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the prevalence and evolution of HIV drug-resistant strains in people who live with HIV/AIDS (PLWHA) during HIV antiretroviral therapy in Shandong province.</p><p><b>METHODS</b>Viral load testing was performed by using fluorescence real-time quantitative PCR (NucliSens EasyQ system) on 324 patients who were under HIV antiretroviral therapy (ART) over 1 year in Shandong province. HIV resistance testing was conducted on the samples with more than 1000 copies/ml by using genotypic resistance testing method established in our lab. We tested the samples from drug-resistant patients before and after treatment to analyze the evolution of HIV resistant strains.</p><p><b>RESULTS</b>The resistance rate for the patients under HIV ART over 1 year was 6.2% (20/324). The rate of drug-resistant mutation, but not resistant to ART was 0.6% (5/324). Nucleoside reverse transcriptase inhibitor (NRTIs) and non-NRTIs (NNRTIs) accounted for 93.1% (94/101) and protein inhibitors (PIs) accounted only 6.9% (7/101) of all mutations. M184V (48.0%, 12/25) and Y181C (32.0%, 8/25) were the most frequent mutations among 25 samples. Our research showed 20.0% (2/10) patients were resistant to primary ART and 1 patient was detected drug resistance in 6 months after ART treatment. HIV evolved from wild type to drug resistant virus, from low level to high level drug resistance, and from resistance to few to multiple drugs. In addition, interactions between mutations may influence the sensitivity of patients to other drug treatment.</p><p><b>CONCLUSION</b>The prevalence of HIV drug-resistant strains in Shandong province is still at a low level, but its evolution is complex.</p>

Long-term follow-up of malignant clonal evolution in patients with acquired aplastic anemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To assess the incidence and risk factors for evolution of acquired aplastic anemia (AA) into myelodysplastic syndrome/acute myeloid leukemia (MDS/AML).</p><p><b>METHOD</b>A total of 1003 AA patients hospitalized in our institute hospital between January 1991 and December 2009 enrolled into this study. The incidence and risk factors for AA developing MDS/AML by the Kaplan-Meier method and Cox proportional hazards models, respectively.</p><p><b>RESULTS</b>The median follow-up was 62 (2 - 423) months and the projected 5-year survival rate was (78.0 +/- 1.0)%. Twenty-seven patients evolved to MDS/AML, of whom 11, 6 and 10 were from NSAA, SAA and VSAA subgroups, respectively. The estimated cumulative incidence of MDS/AML transformation for these 1003 patients after diagnosis was (4.5 +/- 1.0)% at 10 year. The incidence of MDS/AML transformation in VSAA subgroup [(12.8 +/- 3.5)%] was significantly higher than in NSAA subgroup [(4.1 +/- 1.9)%] (P < 0.001) and SAA subgroup [(3.5 +/- 1.4)% ] (P = 0.008), but no difference between the latter two subgroups (P = 0.616). Age [RR = 3.527 (95% CI: 1.598 - 7.784), P = 0.002], severity of disease [RR = 5.122 (95% CI: 2.214 - 11.853), P < 0.001], the duration (days) of rhuG-CSF therapy [RR = 10.782 (95% CI: 4.600 - 25.269), P < 0.001] and exposure to ray, chemicals or drugs [RR = 3.401 (95% CI: 1.535 - 7.534), P = 0.003] were risk factors for the transformation in both univariate and multivariate analyses.</p><p><b>CONCLUSION</b>Long-term follow-up is essential to assess the incidence and risk factors for evolutions of acquired AA into MDS/AML, and to administer salvage therapy for transformation in time during follow-up.</p>

Study on the change of urinary iodine of different salt concentrations among the target population in an intervention trial / 中华流行病学杂志

Objective To analyze the change of urinary iodine in a cohort of intervention trial and to observe the role of different doses on salt iodization and related impact factors on nutritional condition of iodine. Methods Multistage cluster sampling was used to sample three townships in two counties for community intervention with different doses (15 ± 5, 25 ± 5, 35 ± 5)mg/kg. Results Compared to the (35 ± 5)mg/kg group, the urine iodine levels of three experimental townships were gradually declining in county B when time went on, and the (15 ± 5) mg/kg group showed anobvious results, at 6,12,18 and 24 months, with the urine iodine level as 180.00,186.10,150.04,191.28 μg/L respectively, which were in accordance with the WHO standard and reached to appropriate range (187.96μg/L) at the 18 month. The townships at county Y under intervention had declined slightly, but the urine iodine levels did not reach the WHO standard. The thyroid volume declined from 3.65 ml to 3.40 ml in two counties and the difference between them was statistically significant. Conclusion To some extent, reducing the iodine concentration in salt, had a role of lowering the urine iodine level and reducing the strumous rate.