Consensus of experts on the medical risk prevention for the patients with cardiovascular diseases during dental treatment (2022 edition) / 中华口腔医学杂志

With the aging process of population in the society, the prevalence of cardiovascular diseases (CVD) in China is increasing continuously and the number of dental patients with CVD is increasing gradually too. Due to the lack of guidelines for dental patients with CVD in our country, how to implement standardized preoperative evaluation and perioperative risk prevention remains a problem to be solved for dentists at present. The present expert consensus was reached by combining the clinical experiences of the expert group of the Fifth General Dentistry Special Committee, Chinese Stomatological Association and respiratory and cardiology experts in diagnosis and treatment for CVD patients, and by systematically summarizing the relevant international guidelines and literature regarding the relationship between CVD and oral diseases and the diagnosis and treatment of dental patients with heart failure, hypertension and antithrombotic therapy. The consensus aims to provide, for the dental clinicians, the criteria on diagnosis and treatment of CVD in dental patients in China so as to reduce the risk and complications, and finally to improve the treatment levels of dental patients with CVD in China.

Consensus of experts on the oral health management and medical risk prevention for the patients with chronic airway diseases (2022 edition) / 中华口腔医学杂志

Today, there is greater awareness on the association between oral diseases and respiration diseases after the outbreak of COVID-19. However, confusion regarding the oral health management and medical risk prevention for patients with chronic airway diseases has been remained among dental clinicians. Therefore, the dental experts of the Fifth General Dentistry Special Committee, Chinese Stomatological Association, combined with the experts of respiratory and critical care medicine, undertook the formation of consensus on the oral health management of patients with chronic airway diseases in order to help dental clinicians to evaluate medical risks and make better treatment decision in clinical practice. In the present consensus report, the relationship of oral diseases and chronic airway diseases, the oral health management and the treatment recommendations of patients with chronic airway diseases are provided.

Renormalization of Thalamic Sub-Regional Functional Connectivity Contributes to Improvement of Cognitive Function after Liver Transplantation in Cirrhotic Patients with Overt Hepatic Encephalopathy

Objective@#The role of preoperative overt hepatic encephalopathy (OHE) in the neurophysiological mechanism of cognitive improvement after liver transplantation (LT) remains elusive. This study aimed to explore changes in sub-regional thalamic functional connectivity (FC) after LT and their relationship with neuropsychological improvement using resting-state functional MRI (rs-fMRI) data in cirrhotic patients with and without a history of OHE. @*Materials and Methods@#A total of 51 cirrhotic patients, divided into the OHE group (n = 21) and no-OHE group (n = 30), and 30 healthy controls were enrolled in this prospective study. Each patient underwent rs-fMRI before and 1 month after LT. Using 16 bilateral thalamic subregions as seeds, we conducted a seed-to-voxel FC analysis to compare the thalamic FC alterations before and after LT between the OHE and no-OHE groups, as well as differences in FC between the two groups of cirrhotic patients and the control group. Correction for multiple comparisons was conducted using the false discovery rate (p < 0.05). @*Results@#We found abnormally increased FC between the thalamic sub-region and prefrontal cortex, as well as an abnormally decreased FC between the bilateral thalamus in both OHE and no-OHE cirrhotic patients before LT, which returned to normal levels after LT. Compared with the no-OHE group, the OHE group exhibited more extensive abnormalities prior to LT, and the increased FC between the right thalamic subregions and right inferior parietal lobe was markedly reduced to normal levels after LT. @*Conclusion@#The renormalization of FC in the cortico-thalamic loop might be a neuro-substrate for the recovery of cognitive function after LT in cirrhotic patients. In addition, hyperconnectivity between thalamic subregions and the inferior parietal lobe might be an important feature of OHE. Changes in FC in the thalamus might be used as potential biomarkers for recovery of cognitive function after LT in cirrhotic patients.

Enteral nutrition support reduces toxicity of chemotherapy in patients with advanced or metastatic esophageal cancer / 北京大学学报(医学版)

OBJECTIVE@#To assess the impact of enteral nutrition support on response and toxicity of the first-line chemotherapy in those patients with advanced or metastatic esophageal cancer.@*METHODS@#We collected the clinical data of 118 patients with unresectable advanced or metastatic esophageal cancer who received the first-line chemotherapy in our center from July 2014 to December 2016. All these 118 esophageal cancer patients were then divided into two groups: the nutrition group (received enteral nutrition support in addition to chemotherapy) and the control group (received chemotherapy only). Differences were analyzed before and after chemotherapy in each of the nutritional indicators including Karnofsky performance status (KPS), weight, body mass index (BMI), hemoglobin (Hb), number of lymphocytes (Lymph), total protein (TP), albumin (Alb), triglycerides (TG), total cholesterol (TC) in both groups. And differences of the efficacy and toxicities of the first-line chemotherapy between the two groups were also analyzed.@*RESULTS@#(1) Weight, BMI and Hb were all significantly decreased after chemotherapy in the control group (P<0.001), while there was no significant change of weight and BMI in the nutrition group, just with Hb decrease only. However, there was no significant change of all the other nutrition indicators after chemotherapy in both groups. (2) Compared with the control group, the nutrition group had significantly lower incidence of grade 3 to 4 hematologic toxicities after chemotherapy (15.4% vs. 42.1%, P=0.004). In addition, the incidence of grade 3 to 4 nonhematologic toxicities after chemotherapy was also lower in the nutrition group but without statistical significance (0 vs. 9.2%, P=0.123). Logistic regression model was then used for multivariate analysis to identify the factors that affected the toxicity of chemotherapy in these patients, and the results showed that nutrition therapy was an independent influencing factor of grade 3 or higher hematological toxicity after chemotherapy in the patients with esophageal cancer (P=0.008, RR=6.048, 95%CI: 1.589-23.027). (3) The response rate of chemotherapy between the control group and the nutrition group had not significant difference.@*CONCLUSION@#Enteral nutrition support in addition to chemotherapy could improve nutrition status and reduce toxicity of chemotherapy in advanced or metastatic esophageal cancer patients.

Automatic extraction of imaging observation and assessment categories from breast magnetic resonance imaging reports with natural language processing / 中华医学杂志(英文版)

BACKGROUND@#Structured reports are not widely used and thus most reports exist in the form of free text. The process of data extraction by experts is time-consuming and error-prone, whereas data extraction by natural language processing (NLP) is a potential solution that could improve diagnosis efficiency and accuracy. The purpose of this study was to evaluate an NLP program that determines American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) descriptors and final assessment categories from breast magnetic resonance imaging (MRI) reports.@*METHODS@#This cross-sectional study involved 2330 breast MRI reports in the electronic medical record from 2009 to 2017. We used 1635 reports for the creation of a revised BI-RADS MRI lexicon and synonyms lists as well as the iterative development of an NLP system. The remaining 695 reports that were not used for developing the system were used as an independent test set for the final evaluation of the NLP system. The recall and precision of an NLP algorithm to detect the revised BI-RADS MRI descriptors and BI-RADS categories from the free-text reports were evaluated against a standard reference of manual human review.@*RESULTS@#There was a high level of agreement between two manual reviewers, with a κ value of 0.95. For all breast imaging reports, the NLP algorithm demonstrated a recall of 78.5% and a precision of 86.1% for correct identification of the revised BI-RADS MRI descriptors and the BI-RADS categories. NLP generated the total results in <1 s, whereas the manual reviewers averaged 3.38 and 3.23 min per report, respectively.@*CONCLUSIONS@#The NLP algorithm demonstrates high recall and precision for information extraction from free-text reports. This approach will help to narrow the gap between unstructured report text and structured data, which is needed in decision support and other applications.

Automatic extraction of imaging observation and assessment categories from breast magnetic resonance imaging reports with natural language processing / 中华医学杂志(英文版)

Background@#Structured reports are not widely used and thus most reports exist in the form of free text. The process of data extraction by experts is time-consuming and error-prone, whereas data extraction by natural language processing (NLP) is a potential solution that could improve diagnosis efficiency and accuracy. The purpose of this study was to evaluate an NLP program that determines American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) descriptors and final assessment categories from breast magnetic resonance imaging (MRI) reports.@*Methods@#This cross-sectional study involved 2330 breast MRI reports in the electronic medical record from 2009 to 2017. We used 1635 reports for the creation of a revised BI-RADS MRI lexicon and synonyms lists as well as the iterative development of an NLP system. The remaining 695 reports that were not used for developing the system were used as an independent test set for the final evaluation of the NLP system. The recall and precision of an NLP algorithm to detect the revised BI-RADS MRI descriptors and BI-RADS categories from the free-text reports were evaluated against a standard reference of manual human review.@*Results@#There was a high level of agreement between two manual reviewers, with a κ value of 0.95. For all breast imaging reports, the NLP algorithm demonstrated a recall of 78.5% and a precision of 86.1% for correct identification of the revised BI-RADS MRI descriptors and the BI-RADS categories. NLP generated the total results in <1 s, whereas the manual reviewers averaged 3.38 and 3.23 min per report, respectively.@*Conclusions@#The NLP algorithm demonstrates high recall and precision for information extraction from free-text reports. This approach will help to narrow the gap between unstructured report text and structured data, which is needed in decision support and other applications.

Rapid Identification of Calamina Based on Near-infrared Diffuse Reflectance Spectroscopy and PCA-SVM Algorithm / 中国实验方剂学杂志

Objective: To establish a near-infrared diffuse reflectance spectroscopy(NIRS) identification model for crude products,counterfeit products and processed products of Calamina by principal component analysis(PCA) and support vector machine(SVM) algorithm. Method: NIRS of crude products,counterfeit products and processed products of Calamina were collected,the characteristic spectrum segments were selected,the preprocessing method and the optimum principal component number were optimized,and the PCA-SVM qualitative model was established. Result: The characteristic spectrum segment of analysis model was 7 500-4 000 cm-1.Spectra were preprocessed by the first-order derivative method(FD).The optimum principal component number was 5. And the optimum internal parameters of SVM[penalty factor(c)=0.25 and kernel function parameter(g)=8] were screened by applying the grid search algorithm.In the PCA-SVM qualitative model,the prediction accuracy rate was 100%for the 5-fold cross validation,and the prediction accuracy rates also were 100%both for training set and test set. Conclusion: PCA-SVM analysis model of NIRS for Calamina samples has a high prediction accuracy rate,and it can be used for the rapid and nondestructive identification of crude products,counterfeit products and processed products of Calamina by combining the diffuse reflection technique on solid powder.

Correlation between the new lung adenocarcinoma classification and epidermal growth factor receptor mutation / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the association of the histological subtype of lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutation.@*METHODS@#A total of 94 patients with resected lung adenocarcinoma in the Department of Thoracic Surgery of China-Japan Friendship Hospital from January 2010 to December 2014 were enrolled in the study. All specimens were tested for EGFR mutation by a company. In the 94 patients, histological subtypes were classified according to the 2011 International Association for the Study of Lung Cancer and American Thoracic Society and European Respiratory Society classification. We compared the association with the histological subtype of lung adenocarcinoma with EGFR mutation frequency by the χ2 test, with SPSS 20.0.@*RESULTS@#The 94 patients of surgically resected lung adenocarcinomas were included in this analysis, of whom, 47 were male and 47 female (male:female=1:1). The median age was 61 (range: 24-79) years, and 48 of the 94 patients were 60 years and above. Regarding the pathological staging, 34 patients were diagnosed as Stage I of the disease, 17 as Stage II,24 as Stage III, and 19 as Stage IV. Among the 51 patients with EGFR mutation, exon 19 mutation was 22, exon 20 mutation was 2, exon 21 mutation was 26, exon 20 and 21 mutation were 1, and the total EGFR mutation rate was 54.3% (51/94). The cases of EGFR gene mutation of acinar predominant lung adenocarcinoma, lepidic predominant lung adenocarcinoma, papillary predominant lung adenocarcinoma, solid predominant lung adenocarcinoma, micropapillary predominant lung adenocarcinoma and mucious adenocarcinoma were 24, 14, 5, 5, 3, and 0, respectively. The rate of EGFR gene mutation of acinar predominant lung adenocarcinoma was higher than that of non-acinar predominant lung adenocarcinom, but there was not statistically significant (66.7% vs. 46.6%, P=0.057). The rate of EGFR gene mutation of solid predominant lung adenocarcinoma was lower than that of non-solid predominant lung adenocarcinom (26.3% vs. 61.3%, P=0.005). The rate of EGFR gene mutation of mucious adenocarcinoma was lower than that of non-mucious adenocarcinom (0 vs. 57.3%, P=0.018).@*CONCLUSION@#There is heterogeneity of EGFR mutation in lung adenocarcinoma. The presence of lung adenocarcinoma with acinar indicates a higher EGFR mutation rate, while the solid and mucinous component indicates a lower EGFR mutation rate.

Analysis on the correlation between chalcone synthase gene polymorphism and content of liquiritin in licorice / 药学学报

Chinese pharmacopoeia stipulates that the content of liquiritin in licorice slices should be no less than 0.5%. However, there are lots of unqualified licorice slices in the herbal medicine markets. Due to the important role of functional gene polymorphism in secondary metabolism, this study attempts to analyze the influence of chalcone synthase (CHS) gene polymorphism on liquiritin biosynthesis and find out the unique haplotypes in licorice samples with high or low content of liquiritin, and to provide a basis for further analysis of molecular mechanism in flavonoid biosynthetic pathway. The contents of the 4 main flavonoids (liquiritin, isoliquiritin, liquiritigenin, isoliquiritigenin) in 60 licorice samples were assayed by HPLC and the results were analyzed by Spearman and χ2 tests. The contents of the 4 main flavonoids were related to each other and obviously different in different original plants. They were highest in Glycyrrhiza uralensis samples and lowest in Glycyrriza inflate samples. Five G. uralensis samples with the highest liquiritin contents and five G. inflate samples with the lowest liquiritin contents were selected to clone the CHS cDNA sequences. 336 CHS cDNA sequences with a full length of 1 175 bp were obtained, 249 variable sites (141 missense mutation sites) were found, and 137 haplotypes were determined. 130 variable sites were found in the 336 CHS amino acid sequences and 102 types were determined. AA-3 is the major type of CHS in licorice, AA-35 is the special major type of CHS in the group with high flavonoids contents and AA-36 is the special major type of CHS in the group with low flavonoids contents. The mutation sites between AA-35 and AA-36 are I/V at 193 and V/T at 229. Discovery Studio 2.5 analysis of the three-dimensional structure of the CHS protein shows that the valine at site 229 of AA-35 is combined with malonyl-CoA. Homology analysis indicates that the homology of CHS among different species is low. This study is significant for identification of the unique haplotypes in licorices with high or low content of liquiritin and guiding the further molecular breeding of high-quantity licorice.

C-MYC Gene and Protein Expression in Paraffin Wax of T Lymphoblastic Lymphoma and Leukemia Patients and Its Effect on the Prognosis / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the relevance between the expression of C-MYC gene and protein of patients with T lymphoblastic lymphoma and leukemia(T-LBL/ALL) and its effect on the prognosis.</p><p><b>METHODS</b>Paraffin specimens from 60 cases of T-LBL/ALL with detailed follow-up during May 2005 to May 2016 were selected as study group; at same time 20 cases of reactive hyperplasia (RH) of lymphonuedes were selected as control group. The immunohistochemical EnVision method was used to mark the terminal deoxynucleotidyl transferase (TDT), myeloperoxidase (MPO), Ki-67 and C-MYC immune tissue.</p><p><b>RESULTS</b>C-MYC gene rupture and copy number increase did not occur in 20 cases of RH.The expression of C-MYC protein did not correlate with C-MYC gene copy number increase. The expression rate of C-MYC protein was 66.7% (40/60), and 20 cases of lymph node RH was all negative (0/20), as compared with the positive expression rate of protein C-MYC, the difference was statistically significant (P<0.05). The Ki-67 positive index and mediastinal bloadening had influence on the expression of C-MYC protein (P<0.05), the sex, primary site, symptoms, age, AnnArbor stage and lactate dehydrogenase (LDH) level and bone marrow involvement have no influence on it, there was no statistically significant difference (P>0.05). The 8q24 chromosome breakage occurred in 6 cases (10%), and the number of copies increased in 11 cases (18.3%). C-MYC gene copy number increase and C-MYC gene rupture in a total 20 cases of reactive hyperplasia of lymph nodes did not occur.</p><p><b>CONCLUSION</b>C-MYC gene may play an important role on the development of T-LBL/ALL. It can be an independent prognosis factor.</p>

A patent anaIysis of biodegradabIe vascuIar scaffoIds / 中国组织工程研究

BACKGROUND: Biodegradable vascular stents show great commercial potential as the third generation of stents in the treatment of vascular stenosis, and there is naturally an intense competition in patents. OBJECTIVE: To analyze the patent information of biodegradable vascular scaffolds, which is helpful for better understanding of the development of biodegradable vascular scaffold technology, and provides reference for patent early warning. METHODS: Based on the Orbit patent database, through the manual screening, we conducted an analysis with FAMPAT patent family as analysis object from three aspects—the application trend, patent layout and competitor analysis. In combination with the development of technology and industrialization, important Chinese patent list was also screened.RESULTS AND CONCLUSION: USA is in a leading position in this field, and China develops quickly. There are still a lot of research and patent layout space in the improvement of stent materials. Although some of basic patents have expired, patent infringement risks in China still needs to be investigated due to the intensive patent layout when Chinese enterprises develop their industrialization.

Cloning and bioinformatics analysis of iridoid oxidase gene in Gentiana rigescens / 中草药

Objective To obtain the key enzyme gene involving in the monoterpenoid biosynthesis pathway, an iridoid oxidase gene (GrIDO) and its promoter were cloned from the leaves of Gentiana rigescens, and its bioinformatics analysis were also performed. Methods The gene specific primers were designed according to the GrIDO gene of transcriptome in G. rigescens. The open reading frame (ORF) of GrIDO gene was cloned by RT-PCR method. The bioinformation of GrIDO gene was analyzed by online softwares. Meanwhile, the gene specific primers were designed according to the cloned GrIDO gene, and the promoter of GrIDO gene was amplified by PCR method. Its sequence analysis was also performed. Results The length of GrIDO gene ORF (GenBank accession number KP722034) was 1 557 bp, which encoded a protein with 518 amino acids. Its relative molecular weight was 58 920 with the theoretical isoelectric point of 8.40. GrIDO was the member of cytochrome P450 superfamily and may localize in chloroplast. GrIDO was a hydrophilic stable protein without signal peptide and composed of mainly α-helix (51.07%) and loops (42.69%). GrIDO protein had a high similarity with CrIDO of Catharanthus roseus (85.83%) and their genetic relationship was close. The cloned GrIDO promoter had a length of 720 bp (GenBank accession number KT428570), which possessed cis-regulatory elements TATA-box and CAAT-box, and had cis-acting elements involved in the abscisic acid and MeJA responsiveness, part of a light responsive element and MYB transcription factor binding site. Conclusion The expression of GrIDO gene were regulated by multifactors. The GrIDO gene and its promoter were cloned from G. rigescens. This study will lay foundations for the functional research of GrIDO gene in monoterpenoid biosynthesis pathway.

Longitudinal Intrinsic Brain Activity Changes in Cirrhotic Patients before and One Month after Liver Transplantation

OBJECTIVE: To evaluate the spontaneous brain activity alterations in liver transplantation (LT) recipients using resting-state functional MRI. MATERIALS AND METHODS: Twenty cirrhotic patients as transplant candidates and 25 healthy controls (HCs) were included in this study. All patients repeated the MRI study one month after LT. Amplitude of low-frequency fluctuation (ALFF) values were compared between cirrhotic patients (both pre- and post-LT) and HCs as well as between the pre- and post-LT groups. The relationship between ALFF changes and venous blood ammonia levels and neuropsychological tests were investigated using Pearson's correlation analysis. RESULTS: In the cirrhotic patients, decreased ALFF in the vision-related regions (left lingual gyrus and calcarine), sensorimotor-related regions (left postcentral gyrus and middle cingulate cortex), and the default-mode network (bilateral precuneus and left inferior parietal lobule) were restored, and the increased ALFF in the temporal and frontal lobe improved in the early period after LT. The ALFF decreases persisted in the right supplementary motor area, inferior parietal lobule, and calcarine. The ALFF changes in the right precuneus were negatively correlated with changes in number connection test-A scores (r = 0.507, p < 0.05). CONCLUSION: LT improved spontaneous brain activity and the results for associated cognition tests. However, decreased ALFF in some areas persisted, and new-onset abnormal ALFF were possible, indicating that complete cognitive function recovery may need more time.

Focuses and difficulties in clinical study of botanical drugs based on revised guidance for Industry by FDA / 药学学报

This paper was prepared to analyze and discuss the main content of the Botanical Drug Development Guidance for Industry by United States FDA's (the draft version of the 2015), especially focused on the guidelines for clinical research (mainly in late-stage clinical studies) recommendations and requirements sectiones. The key and difficult issues in the late clinic study were analyzed and discussed, and a series of countermeasures were proposed in this paper. At the same time, combined with the case of approved botanical drug products, analysis of the guidelines for the development of plant drug regulations, the enlightenment were presented in the last part, to guide the research and development of traditional Chinese medicine and the internationalization of Chinese medicine.

Effects of Appropriate Prolonged Sacral Neuromodulation Testing in Improving Implantation Rate of a Permanent Implantable Pulse Generator in Patients with Refractory Lower Urinary Tract Dysfunctions in Mainland China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sacral neuromodulation (SNM) has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator (IPG) implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms (LUTS) in mainland China.</p><p><b>METHODS</b>From January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy. In this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications (such as pain, infection, and electrode displacement) and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness.</p><p><b>RESULTS</b>Among 51 patients receiving SNM therapy, 19 patients (mean age 45.0 ± 16.9 years) had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients (mean age 46.7 ± 15.3 years) received Stage II permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage I-II conversion was 62.7% (32/51) in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% (8/51), which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% (27/32) of the patients received Stage II implantation within 4 weeks. None of the patients had incision infections. In one patient, the entire system was removed 1 month after Stage II implantation due to pain in the implantation site.</p><p><b>CONCLUSIONS</b>Appropriate extension of the Stage I testing time of an SNM-barbed electrode could significantly improve the Stage II permanent implantation rate in Chinese refractory LUTS patients; there were no wound infections, and the postoperative complication rate was low. This study recommended that Stage I period of SNM therapy should be 4 weeks according to safety and successful conversion rate.</p>

Correlation between vertebral bone marrow fat and abdomen fat: a prospective study / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the correlation between the lumbar bone marrow fat and abdominal fat.</p><p><b>METHODS</b>A total of 68 individuals (32 men and 36 women, aged 21-74 years with a median of 49.5 years) were included in this study. All the subjects underwent spectroscopic examination of the third lumber vertebra with the single voxel method on a 1.5T MR scanner to measure the fat fraction (FF%). Quantitative CT was also performed for measurement of the abdomen subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). The measurements were compared between subjects aged ≥50 years and those below 50 years, respectively,in male or female subjects.</p><p><b>RESULTS</b>In male subjects, BMI, FF%, VAT or SAT showed no significant differences between the two age groups (P>0.05), and FF% was not correlated with BMI, VAT or SAT (r=0.109, 0.034, 0.066, respectively; P>0.05). In the female subjects, BMI, FF%, VAT and SAT differed significantly between the two age groups (P<0.05), and in ≥50 years group, FF% showed a positive correlation with VAT (r=0.499, P<0.05) but was not correlated with SAT (r=0.221, P>0.05); in<50 years group, FF% was not correlated with VAT or SAT (r=0.076, -0.067, respectively; P>0.05).</p><p><b>CONCLUSION</b>FF% is positively correlated with VAT in female subjects aged beyond 50 years, but is not correlated with VAT or SAT in male subjects or in younger female subjects.</p>

Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Percutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy (FURS) is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy (UFURS) identifying diverticulum and the management of calyceal diverticular calculi.</p><p><b>METHODS</b>A retrospective analysis was conducted on 24 patients who had calyceal diverticular calculi. In all 12 patients in the UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the diverticular walls.</p><p><b>RESULTS</b>Puncture of calyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed fever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time (UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min), stone-free rate (UFURS vs. PCNL, 9/12 vs. 10/12), and rate of successful lithotripsy (UFURS vs. PCNL, 10/12 vs. 11/12) between the two groups (all P> 0.05). Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group (2.7 ± 1.2 vs. 6.2 ± 1.5, P< 0.05). Hospital stay in the UFURS group was significantly shorter than that in the PCNL group (3.4 ± 0.8 vs. 5.4 ± 1.0 days, P< 0.05). All patients were symptom-free following surgery (UFURS vs. PCNL, 10/10 vs. 12/12).</p><p><b>CONCLUSION</b>Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.</p>

Application of minimally invasive, decompression bone graft implantation combined with metal trabecular bone reconstruction system for early stage osteonecrosis of femoral head / 中国骨伤

<p><b>OBJECTIVE</b>To observe the application effect of minimally invasive decompression, bone graft implantation and metal trabecular bone reconstruction system for early stage osteonecrosis of femoral head and discuss the treatment of hip-salvage operation in early stage osteonecrosis of femoral head;</p><p><b>METHODS</b>From January 2010 to June 2011, 50 patients (62 hips) Which were osteonecrosis of femoral head of early stake,were treated with minimally invasive decompression, bone graft implantation and metal trabecular bone reconstruction system, including 31 males (40 hips), 19 females (22 hip) with an average age of 36.2 years old ranging from 22 to 54 years old. The course of disease was from 6 to 15 months (averaged 10.5 months). Among them, 19 cases (23 hips) were steroid-induced, 25 cases (33 hips) were alcohol-induced, 6 cases (6 hips) were idiopathic; According to ARCO stage, 28 hips were at stage I, 34 hips were at stage II. All of them were diagnosed as femoral head necrosis by imaging examination before operation. Then each patient was followed to assess by Harris hip score, curative effect, and conduct the femoral head survival analysis during the postoperation.</p><p><b>RESULTS</b>All patients had finished operation, the operation time was between 30 and 85 min, intraoperative blood loss was 50 to 220 ml, and 47 cases (58 hips) were follow-up from 24 to 46 months with an average of 34.05 months. As compared with preoperative, the Harris hip score at the last follow-up was improved, the difference was statistically significant (P<0.01). The Harris hip score, curative effect and survival time of femoral head in ARCO stage I was superior to these in ARCO Stage II, the difference was statistically significant (P< 0.05).</p><p><b>CONCLUSION</b>Effect of minimally invasive decompression,bone graft implantation combine with the metal trabecular bone reconstruction system for early stage osteonecrosis of femoral head was good,it could significantly improve the Harris hip score, increase the femoral head survival time, delay the hip replacement, and performance better in ARCO stage I.</p>

Serum hepcidin predicts uremic accelerated atherosclerosis in chronic hemodialysis patients with diabetic nephropathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hepcidin, as a regulator of body iron stores, has been recently discovered to play a critical role in the pathogenesis of anemia of chronic disease. Atherosclerotic cardiovascular disease is the most common complication and the leading cause of death in chronic hemodialysis (CHD) patients. In the current study, we aimed to explore the relationship between serum hepcidin and uremic accelerated atherosclerosis (UAAS) in CHD patients with diabetic nephropathy (CHD/DN).</p><p><b>METHODS</b>A total of 78 CHD/DN and 86 chronic hemodialyzed nondiabetic patients with chronic glomerulonephritis (CHD/non-DN) were recruited in this study. The level of serum hepcidin-25 was specifically measured by liquid chromatography-tandem mass spectrometry. Serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>High serum level of hepcidin-25 was seen in CHD patients. Serum hepcidin-25 in CHD/DN was significantly higher than that in CHD/non-DN patients. Serum hepcidin-25 was positively correlated with ferritin, high-sensitivity C-reactive protein (hs-CRP), TNF-α, and IL-6 in CHD/DN patients. CHD/DN patients exhibited higher common carotid artery intima media thickness (CCA-IMT), hs-CRP, and hepcidin-25 levels than that in CHD/non-DN patients. Moreover, in CHD/DN patients, CCA-IMT was positively correlated with serum hepcidin, hs-CRP, and low-density lipoprotein-cholesterol. On multiple regression analysis, serum hepcidin and hs-CRP level exhibited independent association with IMT in CHD/DN patients.</p><p><b>CONCLUSIONS</b>These findings suggest possible linkage between iron metabolism and hepcidin modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients.</p>

Correlation of Lower Concentrations of Hydrogen Sulfide with Activation of Protein Kinase CβII in Uremic Accelerated Atherosclerosis Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hydrogen sulfide (H 2 S) plays a protective role in chronic hemodialysis (CHD) patients. In this study, we further investigate the relationship between H 2 S and conventional protein kinase CβII (cPKCβII) in CHD patients with uremic accelerated atherosclerosis (UAAS).</p><p><b>METHODS</b>A total of 30 healthy people, 30 CHD patients without AS and 30 CHD patients with AS (CHD + AS) were studied. Plasma H 2 S was measured with a sulfide sensitive electrode, and cPKCβII membrane translocation was detected by Western blotting.</p><p><b>RESULTS</b>Plasma H 2 S in CHD + AS group was significantly lower than that in CHD patients. cPKCβII membrane translocation in CHD + AS group increased significantly compared with CHD group. Plasma H 2 S concentration was negatively correlated with cPKCβII membrane translocation in CHD + AS patients.</p><p><b>CONCLUSIONS</b>These findings suggest a possible linkage between H 2 S metabolism and cPKCβII activation, which may contribute to the development of UAAS in CHD patients.</p>