Research advances in natural killer cell-based immunotherapy in liver cancer / 临床肝胆病杂志

Natural killer (NK) cells are important immune cells in the human body and are also the main lymphocytes in the liver. They are considered the first defense mechanism against tumor and have a significant impact on the development and progression of liver cancer. The characteristics of NK cells help them become a new choice for immunotherapy, and NK cell-based immunotherapy may succeed in the treatment of liver cancer. This article reviews the biological characteristics of NK cells, their role in the development and progression of liver cancer, and the research advances in related treatment.

Neuromyelitis optica presenting as neurogenic bladder

Neuromyelitis optica(NMO) is an immune mediated disease of central nervous system primarily affecting optic nerves, spinal cord and brain stem. This case report describes a 24-year-old male with no comorbidities presented with high grade fever followed by proximal lower limbweakness and bilateral hydrouretero nephrosis without any lower urinary tract obstruction. He had clinical features of conus-cauda lesion with MRI spine showing features of longitudinally extensive transverse myelitis (LETM) and brain MRI showing involvement of splenium of corpus callosum. He improved with steroid therapy with in a period of 2 weeks and oral steroid was tapered of and stopped within a period of two months. There wasno relapse of symptoms so far.

Maternal Phubbing and Mother - Child Relationship

A study was conducted among children between 10-16 years of age and their mothers attending a selected hospital in Kozhikode (Kerala) to assess the maternal phubbing of children, assess the mother-child relationship and test the association between maternal phubbing and mother-child relationship. A descriptive survey design was adopted for the study. The study was conducted among 50 mothers and children attending IPD and OPD of Paediatric Department of Baby Memorial Hospital, Kozhikode; the samples were selected using purposive sampling technique. The results of the study revealed that that majority (70%) of mothers were having mild phubbing and 88 percent of the subjects exhibited closeness in the relationship with their child. It was also revealed that there exists a negative correlation between maternal phubbing and closeness (' r' value-0.392) and a positive correlation between maternal phubbing and con ict (' r' value 0.644)

Effect of Arka Taila and Patoladi Gana Kashaya in Dooshivishajanya Vicharchika

Toxicology, is a slow acting less potent poison, which does not kill the person immediately, but gets manifested in the form of many diseases. Skin diseases (Kustha) are one among the main symptoms of Dooshivisha. Vicharchika, is one among Kshudra kustha, which is highly prevalent, common and distressing condition. Recurrence and chronicity are the main threat faced by patients suffering from Vicharchika. Most of the features of Vicharchika show similarity with symptoms of the disease entity, eczema of modern dermatology. In India, the point prevalence of dermatological cases are 9.25%, and that of eczema is 6.75%. Arkatailam is the formulation prescribed in Yogaratnakaram, which reflects the therapeutic effect of toxic plant Arka, which is directly indicated for Vicharchika. The aims and objective of the study is to evaluate the combined effect of Arkataila and Patoladi gana kashaya in Dooshivishajanya Vicharchika. The study design was an interventional pre-post study with sample size 30. Patients with signs and symptoms of Vicharchika, having history of Dooshivisha, of age group between 20-60 satisfying the diagnostic criteria selected from the OPD of Government Ayurveda College Panchakarma, Hospital, Poojappura, Thiruvananthapuram, were included in the study. The study group was given Avipathychoorna internally on first day for Virechana. On 2nd day onwards Patoladi gana Kashaya was given internally and Arkataila externally for 14 days. Symptomatic assessments were done before treatment, on 8th day, after the treatment and after the follow up period of 7 days. Results were analyzed statistically. The results show that the effect of Arkataila and Patoladiganakashaya is very effective in Dooshivishajanya vicharchika.

Arthroscopic, histological and imaging studies of rare abnormal insertion points in the anterior root of the medial meniscus / 中华骨科杂志

Objective:To investigate the characteristics of an abnormal attachment point of the anterior horn of the medial meniscus (AHMM) by methods of arthroscopy, radiological imaging, and pathology.Methods:A total of seven cases of a rare abnormal attachment (anteromedial meniscofemoral ligament, AML) connecting the AHMM and anterior cruciate ligament (ACL) were identified in the more than six thousand arthroscopic procedures from January 2018 to April 2021. During the procedures, subtotal meniscal resection or meniscal repair was performed in all cases. Tissue removed intraoperatively was used for pathologic examination. For this study, the preoperative MRI films of these patients were retrospectively examined.Results:Finally, seven cases with diagnosed meniscal tears were included in this study, including 4 males and 3 females with a mean age of 37.85±7.70 years (range, 27-50 years). The AML, which extends outward and upward and is anterior to the ACL, begins at the AHMM and ends anterior to the femoral attachment of the ACL. The histological staining showed that the AML was a bundle of collagen fibers, whereas the ACL was a bundle of dense fibrous collagen. The AML could be clearly identified in the proton-weighted image of sagittal MRI preoperatively and showed a low signaling similar to the signal intensity of the ACL. AML was easily identified on sagittal MRI but not on axial and coronal MRI. In three patients who underwent bilateral MRI, the AML structure was found in both knees.Conclusion:The incidence of rare anatomic variation between the AHMM and the lateral condyle of the femur is 0.1%, usually occurring in both knees simultaneously. In cases with this variation, there is no bony attachment in the AHMM connected to the ACL via the AML. After transection of the AML, the annular fibrous structure and mechanical properties of the meniscus are damaged, as consequently the AML should be carefully protected in clinical practice.

Analysis of factors related to postoperative functional recovery after surgery of calcaneal fracture / 中华创伤骨科杂志

Objective:To analyze the factors influencing functional recovery after surgery of calcaneal fracture.Methods:A retrospective analysis was performed in 1,080 eligible patients with calcaneal fracture who had been admitted to The Third Hospital of Hebei Medical University from January 1, 2018 to December 31, 2020. They were 931 males and 149 females with a mean age of 43.0 years. By the Sanders classification, there were 107 cases of type Ⅰ, 343 cases of type Ⅱ, 471 cases of type Ⅲ and 159 cases of type Ⅳ. Multiple linear regression model was used to screen out the main relevant factors affecting the postoperative functional recovery by analyzing the 18 factors which might influence the postoperative functional recovery like gender, age, Sanders type, occupation, body mass index, season, cause, hospital stay, operation method, internal fixation, preoperative combined injury, preoperative complication, anesthesia, attendance to rehabilitation institution, incision selection, waiting time, preoperative blister and reduction quality.Results:All the 1,080 patients were followed up for 17.5 months on average. The mean Creighton-Nebraska score at the last follow-up was 88.4. The univariate analyses showed statistically significant differences in the Creighton-Nebraska score among patients with different gender, age group, Sanders type, occupation, injury cause, surgical method, preoperative combined injury, incision selection and reduction quality ( P<0.05). Multiple linear regression model analysis resulted in the following regression equation: Y=107.408-4.013×gender-7.101×age-1.214×Sanders type-1.606×incision selection. Conclusions:The factors which influence the functional recovery after surgery of calcaneal fracture may be gender, age, fracture type and incision selection; the functional recovery score after surgery of calcaneal fracture may be low for female senior patients with type Ⅳ fracture and a large L-shaped incision.

Early clinical effect of new autologous semitendinosus ribbon-like graft in reconstruction of anterior cruciate ligament tear / 中华创伤杂志

Objective:To investigate the early curative effect of the new autologous semitendinosus ribbon-like graft in reconstruction of anterior cruciate ligament (ACL) tear.Methods:A retrospective cohort study was conducted to analyze the clinical data of 65 patients with knee ACL tear admitted to Zhengzhou Orthopedics Hospital from June 2019 to January 2021, including 52 males and 13 females, aged 16-50 years [(30.5±8.4)years]. According to the reconstruction method and graft selection, the patients were divided into ribbon-like reconstruction group ( n=31) and circular bundle reconstruction group ( n=34). All patients underwent anatomical ACL reconstruction using the new autologous semitendinosus ribbon-like graft in ribbon-like reconstruction group and the traditional circular bundle graft in circular bundle reconstruction group. The operation time, morphological difference in ACL graft immediately after surgery with original ACL, Lysholm score before and at 3 months after surgery, Lachman test and axial shift test immediately and at 3 months after surgery, and intraoperative and postoperative complications were compared between the two groups. Results:All patients were followed up for 3-15 months [(6.0±3.1)months]. The operation time was (61.6±6.7)minutes in ribbon-like reconstruction group and was (48.0±6.3)minutes in circular bundle reconstruction group ( P<0.01). Under arthroscopic observation, the original ACL was ribbon-shaped in the joint, the graft in ribbon-like reconstruction group was also ribbon-like structure, the graft in circular bundle reconstruction group was bundle structure. Therefore, the grafts in ribbon-like reconstruction group better simulated the ribbon-like structure of the original ACL than those in circular bundle reconstruction group. The ribbon-like graft mimiced the natural twisting of the ACL when the knee was bent. Lysholm score was (82.8±5.2)points in ribbon-like reconstruction group at 3 months after surgery, significantly higher than (47.5±8.7)points before surgery ( P<0.01). Lysholm score was (79.9±7.5)points in circular bundle reconstruction group at 3 months after surgery, significantly higher than (44.2±9.4)points before surgery ( P<0.01). There were no significant differences in Lysholm score between the two groups before and at 3 months after surgery (all P>0.05). Lachman and axial shift tests were negative in both groups immediately and at 3 months after surgery. The ribbon-like reconstruction group showed breakage or wear of Kirschner wires in 4 patients and hollow drill deformation in 1 intraoperatively. The circular bundle reconstruction group showed wear of Kirschner wires in 2 patients intraoperativley. There was no significant difference in intraoperative complications between the two groups ( P>0.05). One patient experienced tibial incision infection in ribbon-like reconstruction group at 3 months after surgery. All wounds were healed at stage I with no incision infection in circular bundle reconstruction group. No patients had ligament failure or function limitation. There was no significant difference in postoperative complications between the two groups ( P>0.05). Conclusions:The clinical effect of new autogenous semitendinosus ribbon-like graft in ACL reconstruction is comparable to that of traditional circular bundle graft. However, arthroscopic observation reveals that the parenchymal part of the ribbon-like graft is ribbon-shaped, which better simulates the physiological morphology of the original ACL. The natural distortion of the simulated ACL during knee bend may better simulate the physiological function of the original ACL.

Efficacy of arthroscopically-assisted modified outside-in technique for posterior cruciate ligament reconstruction / 中华创伤杂志

Objective:To compare the clinical outcome between arthroscopically-assisted modified outside-in technique and inside-out technique for reconstruction of posterior cruciate ligament (PCL).Methods:A retrospective cohort study was conducted to analyze the clinical data of 53 patients with PCL rupture treated at Zhengzhou Orthopaedics Hospital from September 2015 to March 2019. There were 36 males and 17 females, at age of 21-58 years [(37.2±12.5)years]. There were 29 patients with right knee injury and 24 patients with left knee injury. All patients underwent minimally invasive arthroscopically- assisted PCL reconstruction, including the femoral tunnel established using the modified outside-in technique in 22 patients (outside-in group) and the inside-out technique with 120° of knee flexion in 31 patients (inside-out group). The two groups were compared in terms of operation time, length of femoral tunnel intraoperatively, angle between femoral tunnel and intra-articular graft at postoperative 3 days, and posterior drawer test (PDT), International Knee Documentation Committee (IKDC) score, Lysholm knee score, knee range of motion (ROM), knee extension muscle strength at the last follow-up. The complications were recorded after operation.Results:All patients were followed up for 15-38 months [(21.4±8.7) months]. There were no significant differences between the two groups in operation time and last follow-up evaluation of PDT, IKDC score, Lysholm knee score and knee ROM (all P>0.05). The length of femoral tunnel in outside-in group [(38.6±2.9)mm] was longer than that in inside-out group [(32.4±2.5)mm] ( P<0.05). The angle between femoral tunnel and intra-articular graft in outside-in group [(147.5±3.1)°] was larger than that in inside-out group [(136.4±2.6)°] ( P<0.01). The knee extension muscle strength of all patients reached grade V at the last follow-up. There were 2 patients with 5° flexion limitation in outside-in group, comparable to 3 patients with 5° flexion limitation and 1 patient with 10° flexion limitation in inside-out group ( P>0.05). No incision infection, implant loosening or injury of the extension apparatus of the knee occurred after operation. Conclusions:In treating PCL rupture, both arthroscopically-assisted modified outside-in technique and inside-out technique can achieve satisfied stability and functional recovery. However, the length and angle of femoral tunnel is more controllable when using the the modified outside-in technique.

Efficacy and safety of programmed death-1 inhibitor combined with transcatheter arterial chemoembolization in the treatment of huge primary liver cancer / 中华放射学杂志

Objective:To investigate the efficacy and safety of programmed death-1 (PD1) inhibitor combined with transcatheter arterial chemoembolization (TACE) in the treatment of huge primary liver cancer.Methods:From June 2016 to December 2019, the clinical data of 31 patients with huge primary liver cancer enrolled in the Central Hospital of Lishui were retrospectively collected and analyzed. The tumor size ranged from 10.1 to 18.8 cm, with an average of (14.2±2.3) cm. The patients were divided into TACE group (TACE treatment, 18 cases) and combined group (one week after TACE, patients receiving a dose of 200 mg PD1 inhibitor administration every 21 days, 13 cases), according to whether patients receiving PD1 inhibitors. The patients were followed up. The disease control rate (DCR) were compared between the two groups using Mann-Whitney U test. The median overall survival (OS) and progression free survival (PFS) were calculated by Kaplan-Meier method. Results:The DCR in combined group (53.8%, 7/13) was higher than that in TACE group (22.2%, 4/18), and the difference was statistically significant ( Z=-2.13, P=0.04). The median PFS (5.0 months) in combined group was longer than that in TACE group (3.0 months), the difference was statistically significant (χ2=4.39, P=0.04). The median OS (15 months) in combined group was longer than that in control group (9 months), and the difference was statistically significant (χ2=5.51, P=0.02). Conclusion:The combine PD1 inhibitors with TACE is an effective and safe therapy for huge primary liver cancer.

The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude / 中华创伤杂志(英文版)

PURPOSE@#Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.@*METHODS@#From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests.@*RESULTS@#A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6 %); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4 %); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5 %), 4 moderate disability and 4 good recovery (good outcome 23.5 %). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z = -1.993, p = 0.046; χ@*CONCLUSION@#PD + DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.

Analysis of thyroid hormone level and its influencing factors among pubertal girls in Minhang District of Shanghai / 中国学校卫生

Objective@#To investigate thyroid hormone concentration and associated factors among pubertal girls in Minhang District of Shanghai.@*Methods@#From January to March 2019, a stratified sampling method was used to select junior high schools from the east, south, north, and middle areas in Minhang district. A total of 386 girls of grade 6 in selected schools were included in the study. Physical examination was conducted, and their urine and blood samples were collected to determine urinary iodine concentration (UIC) and thyroid function. Puberty Development Self-rating Scale (PDS) was used to define the pubertal stage. Logistic regression models were conducted to analyze the associations between pubertal stage and thyroid function.@*Results@#The median urinary iodine concentration was 163.57(106.57, 232.96) μg/L. The geometric mean values of TSH, TT3, FT3 and FT4 were 0.29 mU/L, 0.26 nmol/L, 0.68 pmol/L and 1.18 pmol/L.The mean value of TT4 was 91.64 nmol / L. The abnormal rates of TGAb and TPOAb were 6.22% and 4.15%. The rate of abnormal TGAb combined with abnormal TPOAb was 3.68%. Girls in puberty and post-puberty had the lower level of TT4 (OR=0.47,0.43) as compared with girls in pre-puberty stage. Obese girls had higher level of TT3(OR=9.08, 95%CI=1.52-54.07). With the increase of exercise time(0.5-1, >1 h/d), FT4 level was increased (OR=2.45, 2.19). TSH levels were significantly higher in girls with higher TGAb and TPOAb. Girls had higher TT4 or FT4 levels if their TGAb levels were higher and TPOAb levels were normal.@*Conclusion@#There is an association between pubertal stage, obesity, exercise and thyroid function in school-aged girls during puberty in iodine sufficient areas. TSH, FT4 and TT4 levels are correlated with TGAb and TPOAb levels.

ViVan Ratio for Maxillomandibular Tooth Material Discrepancy.

According to the guidelines of the American and Indian Boards of Orthodontics, it is essential to include second molars, while managing an orthodontic case. Therefore, the present study was planned to determine maxilla-mandibular tooth material discrepancy.METHODSThe study sample consisted of study casts of 300 subjects in the age range of 18-30 years. Samples having a full complement of teeth with Angle’s Class I molar and canine relationships, good intercuspation, normal overjet and overbite and minimal crowding and spacing were included in the study. Tooth dimensions were measured using digital vernier caliper (accurate to 0.01 mm) and overall ratio was calculated. The data was statistically analysed for range, mean, standard deviation and coefficient of variation.RESULTSViVan ratio was found to be 90.79 with standard deviation of 3.13, variance of 9.81 and range was 83.55 - 95.82.CONCLUSIONSIdeal tooth proportions play an important role in achieving good occlusion at the end of orthodontic treatment. The ViVan ratio obtained in the study included second molars and this would benefit the orthodontist in proper treatment planning. This ratio will add importance for improved results at the finish of orthodontic treatment.

Advances in Chemical Constituents and Bioactivities of Macleaya cordata / 中国实验方剂学杂志

Macleaya cordata, a perennial plant in the genus Macleaya, it mainly distributed in most provinces and regions south of the Yangtze river and north of Nanling mountains of China and has been used as a Chinese traditional medicine. It is bitter, cold, warm, poisonous. M. cordata has the functions of dispelling wind, analgesia, detoxification and detumescence. It mainly treats poisonous abscess, cachexia, ulcer, scabies, trichomonal vaginitis, etc. It also has insecticidal and anti-itching activities. The main chemical constituents of M. cordata are isoquinoline alkaloids, sanguinarine, chelerythrine, protoopioid and allocrine alkaloids are the higher ones. In addition, it also contains phenylpropanoids, steroids, organic acids, phenols and volatile oils. The pharmacological effects of M. cordata are mainly anti-bacterial, anti-inflammatory, anti-tumor and improving liver function. In agriculture, it can be used as botanical insecticides and bacteriostasis, and also as feed additives for animal husbandry. By reviewing and analyzing domestic and foreign researches that isoquinolines were the main active constituents and characteristic components of M. cordata. This paper provides theoretical basis for the development and utilization of M. cordata extract and its' monomer compounds.

Arthroscopic fixation with figure of 8 suture versus ladder mesh suture for anterior cruciate ligament tibial avulsion fracture / 中华骨科杂志

Objective To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures.Methods From August 2013 to November 2016,a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy.By the Meyers-McKeeverZaricznyj classification,10 cases were type Ⅱ,22 type Ⅲ and 5 type Ⅳ.There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels,including 17 males and 8 females with an average age of 18.91 ±9.34 years (range 14-36 years).The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases,including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years).At the latest follow-up,the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function,while the Lachman test and Pivot-shift test were used to estimate knee joint instability.The operation duration,knee range of motion (ROM) and the number of case with flexion contracture were evaluated.Results All 37 cases were followed up.The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group.In figure of 8 suture fixation group,the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61,respectively.However,they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723,P=0.462;t=l.018,P=0.279).The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92％ (23/25).There was no significant difference in the negative rate in the ladder mesh suture fixation group 100％ (12/12,x2=0.904,P=0.265).The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes,which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714,P=0.025).Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (x2=0.450,P=0.032).Conclusion In treating ACL tibial avulsion fractures,arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability.The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture.It may have more advantages in treating rotational type Ⅲ and type Ⅳ comminuted fractures.However,some disadvantages in this technique,such as high technical requirements and long operation time,have to be considered.

Efficacy and safety of short-term interval transcatheter arterial chemoembolization and radiofrequency ablation sequential therapy for advanced hepatocellular carcinoma / 中华放射学杂志

Objective:To investigate the efficacy and safety of short-term transcatheter arterial chemoembolization （TACE）-radiofrequency ablation （RFA） sequential therapy for advanced hepatocellular carcinoma (HCC).Methods:The clinical data of 117 patients with advanced HCC enrolled in the Central Hospital of Lishui from March 2010 to January 2019 were retrospectively analyzed. All patients received TACE and RFA sequential therapy. The patients were divided into 2 groups including short interval group (interval≤7 d, 61 cases) and long interval group (interval>7 d, 56 cases) according to interval between TACE and RFA. The difference of response rate was analyzed by Wilcoxon test. Kaplan-Meier survival curve was used to calculate the overall survival (OS) time and progression free survival (PFS) time.The risk factors of TACE-RFA sequential therapy were tested using Cox multivariate analysis. The complications in the two groups were compared using χ 2 test. Results:The response rate in the short interval group (72.1%, 43/61) was significantly higher than that in the long interval group (41.1%，23/56) with significant difference ( Z=-2.50, P=0.01). The median PFS in the short interval group (14.9 months) was longer than that in the long interval group (9.1 months). The difference of PFS survival curve between the 2 groups was statistically significant (χ2 =5.90, P=0.01).The median OS in the short interval group (34.7 months) was longer than that in the long interval group (20.3 months). The difference of OS survival curve between the 2 groups was statistically significant (χ2 =6.60, P=0.01). Cox multivariate analysis showed that tumor size [hazard ratio (HR)=2.42, P<0.01], cirrhosis (HR=2.04, P<0.01), interval (HR=0.44, P<0.01), aspartate aminotransferase (HR=1.71, P=0.03) were the independent risk factors for advanced HCC.There were no significant differences in the complication incidence between the 2 groups ( P>0.05). Conclusion:Short-term interval TACE-RFA sequential therapy as a protective factor is efficient and safe for advanced HCC treatment.

Clinical study of artesunate in the treatment of coronavirus disease 2019 / 中华危重病急救医学

Objective:To discuss the effective of artesunate in the treatment of coronavirus disease 2019 (COVID-19).Methods:Using prospective method, the 43 cases of confirmed COVID-19 patients in Nanning Fourth People's Hospital from January 22nd to February 15th in 2020 were enrolled and divided into routine treatment group ( n = 25) and artesunate treatment group ( n = 18) by odd-even rule after admission. According to the guidelines, the routine treatment group was recommended to receive lopinavir/ritonavir 500 mg + α-aerosolized interferon 500×10 4 U, twice daily; the artesunate treatment group was given artesunate 60 mg, twice daily besides the routine treatment, for 10 days in both groups. During the treatment period, the pharynx swab test of 2019 novel coronavirus (2019-nCoV) nucleic acid was carried out every 2 days, and the routine blood test, liver and kidney functions, blood coagulation function and myocardial enzymes were re-examined. Chest CT was checked every 3 days after the treatment, and re-examined every 5 days after the condition was improved. The routine blood test and biochemical results of two groups were observed, and the efficacy evaluation was performed by monitoring the time for significant improvement of symptoms, negative conversion time of throat swab virus nucleic acid, lung lesion absorption time, adverse drug reactions and the length of hospital stay of the two groups. Results:There were no significant differences between the two groups in terms of gender, age, body weight, routine blood test and biochemical results before treatment. In artesunate treatment group, the time for significant improvement of symptoms (days: 3.33±1.91 vs. 4.84±2.19), negative conversion time of 2019-nCoV nucleic acid (days: 4.72±2.16 vs. 6.68±3.76), lung lesion absorption starting time (days: 5.39±2.36 vs. 7.48±3.78), lung lesion absorption greater than 70% time (days: 14.11±4.16 vs. 17.04±4.42) and the length of hospital stay (days: 16.56±3.71 vs. 18.04±3.97) were significantly shorter than those in routine treatment group, with significant differences (all P < 0.05). The incidence of adverse drug reactions in two groups had no significant difference (72.2% vs. 80.0%, P > 0.05). Conclusion:Artesunate can shorten the treatment time of COVID-19, improve prognosis and eliminate pathogens, with fewer adverse reactions and a good application prospect.

Arthroscopic fixation with figure of 8 suture versus ladder mesh suture for anterior cruciate ligament tibial avulsion fracture / 中华骨科杂志

Objective@#To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures.@*Methods@#From August 2013 to November 2016, a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy. By the Meyers-McKeever-Zaricznyj classification, 10 cases were type II, 22 type III and 5 type IV. There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels, including 17 males and 8 females with an average age of 18.91±9.34 years (range 14-36 years). The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases, including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years). At the latest follow-up, the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test and Pivot-shift test were used to estimate knee joint instability. The operation duration, knee range of motion (ROM) and the number of case with flexion contracture were evaluated.@*Results@#All 37 cases were followed up. The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group. In figure of 8 suture fixation group, the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61, respectively. However, they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723, P=0.462; t=1.018, P=0.279). The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92% (23/25) . There was no significant difference in the negative rate in the ladder mesh suture fixation group 100% (12/12, χ2=0.904, P=0.265). The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes, which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714, P=0.025). Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (χ2=0.450, P=0.032).@*Conclusion@#In treating ACL tibial avulsion fractures, arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability. The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture. It may have more advantages in treating rotational type III and type IV comminuted fractures. However, some disadvantages in this technique, such as high technical requirements and long operation time, have to be considered.

A Study on the Clinical profile and the Outcome of Treatment of Congenital Hypothyroidism in Children– Early versus Late diagnosis

Hypothyroidism is one of the most common diseases in pediatric endocrinology. Congenital hypothyroidism in this vital period will result in mental retardation and other neurological sequelae and is one of the commonest causes of preventable mental retardation and hence early diagnosis and treatment is mandatory. Methods: The prospective, observational study was conducted in Department of Pediatrics, Institute of Maternal and Child Health, Calicut Medical College for a period of two years on the Clinical profile and the outcome of treatment of Congenital hypothyroidism in children based on their age at diagnosis (below one year versus above one year) . After getting informed consent, history was taken. Physical and systemic examination was done. Anthropometric measurements were taken and laboratory investigations were done. Treatment was given and followed up to see the effect. Results are expressed in terms of frequencies and means. Data is analyzed using SPSS. Results: Delayed passage of meconium, constipation, prolonged physiological jaundice, wide fontanels and umbilical hernia were the clinical features present in a statistically significant proportion in the early treated group. Microcephaly, short stature, macroglossia, dry skin, and delayed bone age was high in the late diagnosis group. Treatment outcome was comparable in both groupsexcept for improvement in coarse facies and development quotient. Conclusion: Developmental delay at diagnosis is a significant problem even in the early diagnosis group, emphasizing the need of new born screening program. Irrespective of the age at diagnosis, thyroxine replacement helps to attain a comparable intellectual and physical development.

Comparison of diagnostic and prognostic value of serum procalcitonin and serum lactate in pediatric sepsis

Background: The clinical manifestations of sepsis are highly variable. The signs of both infection and organ dysfunction may be subtle, and thus the most recent international consensus guidelines provide a long list of warning signs of incipient sepsis. Lactic acid, which is a by-product of anaerobic metabolism, can be used as a marker of tissue hypoperfusion. It is being used widely. Procalcitonin has more recently been studied in children.Methods: Totally 60 Children admitted with Septic Shock in PICU between Ages 3 Months to 12 Years were assessed for Serum Lactate & Serum Procalcitonin levels. Evaluation of the biomarkers was done on individual and combinational basis using receiver operating characteristics curve.Results: Out of 60 children, male were 40, female were 20 children. In stage-1 serum lactate' level was 47.83 (mg/dl) sensitivity is about 35.63 and specificity was 63.82' off p-value <0.065**.In stage -2 serum procalcitonin was 49.62 (mg/dl) sensitivity is about 37.77 and specificity was 69.28' off p-value <0.549**.In stage -3 serum procalcitonin was 52.89 (mg/dl) sensitivity is about 41.63 and specificity was 73.89' off p-value <0.651**Conclusions: Early recognition of risk factors will help in timely appropriate therapy and thereby will help in reducing mortality and morbidity in pediatric septic shock. The results suggest that PCT is valid for auxiliary diagnosis of septic conditions in children and used as an indicator of the severity of patients.

Evaluation of carotid plaque vulnerability by contrast-enhanced ultrasound and superb microvascular imaging / 中华老年医学杂志

Objective@#To observe the plaque surface morphology and neo-vascularization within the plaque using superb microvascular imaging(SMI)and contrast-enhanced ultrasound(CEUS), and to compare the correlation and consistency of the two technologies based on making clinical diagnosis of symptomatic carotid artery plaque as the standard.@*Methods@#A total of 92 patients undergoing carotid ultrasonography in Beijing Tiantan Hospital from August 2016 to October 2017 were recruited, including 61 males and 31 females, aged(63.5 ± 7.7)years(range, 42-80 years.A total of 105 plaques were found.According to whether or not to have plaque-induced ipsilateral ischemic symptoms, patients were divided double-blindly into the symptom group and the non-symptom group.The features of plaque(including surface morphology and neo-vascularization)were recorded.The ultrasonographic findings were chi-squarely tested.@*Results@#There were statistically significant differences in the surface morphology and enhancement degree of CEUS between carotid artery plaque-induced ischemic symptom group and the non-symptom group(χ2=6.865, P=0.032; χ2=22.494, P<0.001). The SMI-detected surface morphology and neo-vascularization had statistically significant differences between the two groups(χ2=10.367, P=0.006; χ2=8.186, P=0.041). The correlations of plaque surface morphology(r=0.856, P<0.001)and diagnostic consistency(r=0.802, P<0.001)between SMI and CEUS were higher.In the symptom group, SMI-showed plaque fissures and small surface pitting were in 33.9%(20/59)of patients, and CEUS-showed plaque fissures and small surface pitting were in 25.4%(15/59)of patients.And SMI had a better detection rate of slight and irregular appearances on plaque surface.Taking the first grade of the plaque surface as the standard, CEUS showed a sensitivity of 42.4% and specificity of 80.4% for detecting symptomatic plaques, and SMI showed a sensitivity of 54.2% and specificity of 76.1%.The two methods had similar specificity, and SMI had a slightly higher sensitivity than did CEUS.CEUS and SMI had a good correlation of plaque neo-vascularization(r=0.802, P<0.001)and a moderate diagnostic consistency(r=0.539, P<0.001). Taking the enhancement level of 2 as the standard, CEUS showed a sensitivity of 75.8% and specificity of 67.4% for detecting the symptomatic plaque, and SMI showed a sensitivity of 58.6% and specificity of 69.5%.The two methods had similar specificity, and CEUS had a higher sensitivity than did SMI.@*Conclusions@#SMI and CEUS have a good consistency for detecting plaque surface morphology.SMI and CEUS are more correlated with plaque-induced symptoms than is two-dimensional ultrasound.The SMI has a higher display rate and repeatability than does CEUS for detecting the small fissures and the surface features of plaques.Compared with SMI-detected neo-vascularization, the degree of CEUS enhancement is more correlated with the symptoms.The specificity of CEUS and SMI is similar, and the sensitivity of CEUS is higher than that of SMI.