Application of mixture analysis methods in association between metals mixture exposure and DNA oxidative damage / 中华预防医学杂志

Objectives: To study the association between metals mixture exposure and DNA oxidative damage using mixture analysis methods, and to explore the most significant exposure factors that cause DNA oxidative damage. Methods: Workers from steel enterprises were recruited in Shandong Province. Urinary metals were measured by using the inductively coupled plasma mass spectrometry method. The level of urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) was determined by using the ultra-high performance liquid chromatography-mass spectrometry method. Bayesian kernel machine regression (BKMR), elastic net regression and quantile g-computation regression were used to analyze the association between urinary metals and urinary 8-OHdG. Results: A total of 768 subjects aged (36.15±7.40) years old were included in the study. BKMR, elastic net regression and quantile g-computation all revealed an overall positive association between the mixture concentration and increased urinary 8-OHdG. The quantile g-computation results showed that with a 25% increase in metal mixtures, the urinary 8-OHdG level increased by 77.60%. The elastic net regression showed that with a 25% increase in exposure risk score, the urinary 8-OHdG level increased by 26%. The BKMR summarized the contribution of individual exposures to the response, and selenium, zinc, and nickel were significant contributors to the urinary 8-OHdG elevation. Conclusion: Exposure to mixed metals causes elevated levels of DNA oxidative damage, and selenium, zinc, and nickel are significant exposure factors.

Quality evaluation of infectious disease surveillance data in Lianyungang City in 2017 - 2021 / 公共卫生与预防医学

Objective To evaluate the quality of infectious disease surveillance data and provide scientific basis for improving data quality and health decision-making. Methods The comprehensive index of infectious disease monitoring system evaluation and the integrity, accuracy and reliability of infectious disease report data were used to evaluate the quality of infectious disease monitoring data in multiple dimensions. Results In 2021, The comprehensive evaluation index of infectious disease surveillance system was 98.40%. In terms of data integrity, 1 105 data were missing, and the incomplete rate was 1.46%; In terms of data accuracy, 1978 cases were not accurately, rate of accuracy was 26.72%; In terms of data reliability, the card reporting rate of tertiary medical institutions accounted for 67.05%, the diagnosis rate of confirmed cases was 27.74%, and the correction rate of report card was 28.48%. Conclusion The accuracy and reliability of infectious disease data are insufficient, and new methods for infectious disease monitoring data quality are expanded to make up for the lack of data quality evaluation of the current national epidemic system.

Analysis of the causes and clinical results of vertebral fracture during oblique lateral lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To analyze the causes of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy, summarize the clinical results, and propose preventive measures.@*METHODS@#Retrospective analysis was made on the data of 8 cases of lumbar spondylopathy and vertebral fracture treated by oblique lateral interbody fusion in three medical centers from October 2014 to December 2018. All were female, aged from 50 to 81 years with an average of 66.4 years. Disease types included 1 case of lumbar degenerative disease, 3 cases of lumbar spinal stenosis, 2 cases of lumbar degenerative spondylolisthesis and 2 cases of lumbar degenerative scoliosis. Preoperative dual energy X-ray bone mineral density test showed that 2 cases had T-value >-1 SD, 2 cases had T-value -1 to -2.5 SD, and 4 cases had T-value <-2.5 SD. Single segment fusion was in 5 cases, two segment fusion in 1 case and three segment fusion in 2 cases. Four cases were treated with OLIF Stand-alone and 4 cases were treated with OLIF combined with posterior pedicle screw fixation. Postoperative imaging examination showed vertebral fracture, and all of them were single vertebral fracture. There were 2 cases of right lower edge fracture of upper vertebral body at fusion segment, 6 cases of lower vertebral body fracture at fusion segment, and 6 cases with endplate injury and fusion cage partially embedded in vertebral body. Three cases of OLIF Stand-alone were treated with pedicle screw fixation via posterior intermuscular approach, while one case of OLIF Stand-alone and four cases of OLIF combined with posterior pedicle screw fixation were not treated specially.@*RESULTS@#The 5 cases of initial operation and 3 cases of reoperation did not show wound skin necrosis or wound infection. The follow-up time was from 12 to 48 months with an average of 22.8 months. Visual analogue scale (VAS) of low back pain was preoperative decreased from 4 to 8 points (averagely 6.3 points) and postoperative 1 to 3 points (averagely 1.7 points) at the final follow-up. Oswestry disability index (ODI) was preoperative 39.7% to 52.4% (averagely 40.2%), and postoperative 7.9% to 11.2% (averagely 9.5%) at the final follow-up. During the follow-up, there was no loosening or fracture of the pedicle screw system, and no lateral displacement of the fusion cage;however, the fusion cage at the vertebral fracture segment had obvious subsidence. The intervertebral space height of vertebral fracture segment was preoperaive 6.7 to 9.2 mm (averagely 8.1 mm), and postoperative 10.5 to 12.8 mm (averagely 11.2 mm). The improvement rate after operation was 37.98% compared to preoperative. The intervertebral space height at final follow-up was 8.4 to 10.9 mm (averagely 9.3 mm), and the loss rate was 16.71% compared with that after operation. At the final follow-up, interbody fusion was achieved in all cases except for one that could not be identified.@*CONCLUSION@#The incidence of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy is lower, and there are many reasons for fracture, including preoperative bone loss or osteoporosis, endplate injury, irregular shape of endplate, excessive selection of fusion cage, and osteophyte hyperplasia at the affected segment. As long as vertebral fracture is found in time and handled properly, the prognosis is well. However, it still needs to strengthen prevention.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Quantitative analysis of macular microcirculation changes in diabetic retinopathy patients by optical coherence tomography angiography / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the macular microcirculation changes in patients with diabetic retinopathy(DR)by optical coherence tomography angiography(OCTA), and correlate the risk factors that may affect the macular microcirculation, so as to provide a clinical basis for early screening, diagnosis and therapeutic intervention for DR.METHODS: Retrospective study. A total of 75 patients(75 eyes)with type 2 diabetes mellitus(DM)who came to the ophthalmology outpatient clinic and ward of Xi'an Central Hospital from May to October 2022 were collected, and the DM patients were further divided into non-DR(NDR)group, non-proliferative DR(NPDR)group and proliferative DR(PDR)group, with 28 eyes, 25 eyes and 22 eyes in each group respectively. OCTA was applied to perform a 3mm×3mm blood flow imaging scan of the macular retina to automatically obtain the vascular density(VD)of the superficial retinal macular foveal, the parafoveal(1～3mm), as well as the macular 3mm×3mm and the area of macular foveal avascular zone(FAZ). Furthermore, the alteration of these parameters in patients with different degrees of DR was analyzed.RESULTS: Compared with the NDR group, the VD of the 3mm×3mm superficial retinal capillary(SCP)in the macular region was decreased in both PDR and NPDR group(all P&#x003C;0.017), and the VD of the parafoveal was decreased in each quadrant(P&#x003C;0.017), with the most significant decrease in the PDR group. The FAZ area of patients in the PDR and NPDR groups was significantly larger than that in the NDR group(P&#x003C;0.017). Age, homocysteine, best corrected visual acuity(LogMAR), axial length and glycosylated hemoglobin(HbA1c)of patients with DR were negatively correlated with VD in the macular foveal(P&#x003C;0.05), while homocysteine, best corrected visual acuity(LogMAR), axial length, and the duration of diabetes were negatively correlated with VD in the macular 3mm×3mm(P&#x003C;0.05). Triglycerides, best corrected visual acuity(LogMAR), and HbA1c were negatively correlated with VD in the parafoveal(P&#x003C;0.05), while total cholesterol and central macular thickness had no significant correlation with VD(P&#x003E;0.05).CONCLUSION: The microcirculation changes in the macular area of DR patients can be monitored by OCTA, and the systemic condition of DR patients is closely related to their macular microcirculation.

Effect of transcatheter aortic valve replacement on postoperative left ventricular reverse remodeling in patients with aortic regurgitation / 中国胸心血管外科临床杂志

@#Objective     To investigate the left ventricular reverse remodeling (LVRR) in patients with aortic valve insufficiency with reduced ejection fraction (AIrEF) and aortic valve insufficiency with preserved ejection fraction (AIpEF) after transcatheter aortic valve replacement (TAVR). Methods    The clinical and follow-up data of patients who underwent TAVR in the Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2018 to 2021 were retrospectively analyzed. According to the guideline, the patients with left ventricular ejection fraction<55% were allocated to an AIrEF group, and the patients with left ventricular ejection fraction≥55% were allocated to an AIpEF group. Results    A total of 50 patients were enrolled. There were 19 patients in the AIrEF group, including 15 males and 4 females with a mean age of 74.5±7.1 years. There were 31 patients in the AIpEF group, including 19 males and 12 females with a mean age of 72.0±4.8 years. All patients underwent TAVR successfully. Echocardiographic results showed that TAVR significantly promoted LVRR in the patients. Significant LVRR occurred in the early postoperative period (the first day after the surgery) in both groups. It remained relatively stable after the LVRR in the early postoperative period (the first day after surgery) in the AIpEF patients, while it continued to occur in the early postoperative period (the first day after surgery) to three months after the surgery in the AIrEF patients, and then remained relatively stable. Compared to preoperative values, AIrEF patients had a reduction in the average left ventricular end-diastolic volume index and left ventricular end-systolic volume index by 16.8 mL/m2 (P=0.003) and 8.6 mL/m2 (P=0.005), respectively, and the average left ventricular end-diastolic diameter index and end-systolic diameter index decreased by 2.5 mm/m2 (P=0.003) and 1.9 mm/m2 (P=0.003), respectively on the first day after the surgery. In comparison to the first day after the surgery, AIrEF patients experienced an average increase of 12.1% in the left ventricular ejection fraction three months after the surgery (P<0.001). Conclusion    TAVR has achieved good therapeutic effects in patients with aortic valve insufficiency, significantly promoting the LVRR in patients, and has better curative effects in AIrEF patients.

Diagnostic value of the fat deposition between the base of spinous process and dura mater for occult pars interarticularis defect / 中华骨科杂志

Objective:To observe the diagnostic value of the fat deposition between the base of spinous process and dura mater in the mid-sagittal T1WI image of lumbar spine MRI for occult pars interarticularis defect, and to discuss the its mechanism.Methods:From January 2015 to December 2019, 32 cases with low back and leg pain were confirmed by MR scanning that the fat deposition between the dura mater and the base of spinous process with or without fat deposition in the rest of the spinal canal, including 20 males and 12 females were included. The age was 28.5±6.2 years (range, 18-57 years). Spiral CT scanning and multiplanar reconstruction were used to judge the integrity of the isthmus, levels of defect, and unilateral or bilateral defect. The observation of the above imaging data were independently completed by two orthopaedic doctors.Results:In 32 patients with epidural fat deposition, there were 24 patients with occult isthmus and 8 patients with simple epidural lipomatosis, confirmed by spiral CT multiplanar reconstruction. In 24 cases of isthmus, there were 18 males and 6 females. The age was 27.3±5.3 years (range, 18-45 years). There were 2 cases between the base of L 4 spinous process and dura mater, and 22 cases between the base of L 5 spinous process and dura mater, without fat deposition in the rest of the spinal canal. All 24 cases were bilateral isthmus, and the anterior and lateral X-ray could not be diagnosed. All patients complained of different degrees of mechanical low back pain. 6 cases with disc herniation, and no case with intermittent claudication. In 8 patients with simple epidural lipomatosis, there were 2 males and 6 females. The age ranged from 32 to 55 years, with an average of 38.4±6.7 years. There were 4 cases between the base of L 3 spinous process and dura mater, 3 cases between the base of L 4 spinous process and dura mater, and 1 case between the base of L 5 spinous process and dura mater. All 8 patients had fat deposition between the lamina and dura mater in the upper and/or the same level, and the dura mater was compressed by the fat. 8 patients complained of different degrees of low back pain without tenderness. 2 cases with disc herniation, and one case with intermittent claudication. Conclusion:The fat deposition sign between the base of spinous process and dura mater has certain specificity for occult lumbar spondylolysis. As an effective supplement to the discontinuous bone signal of spondylolysis, it is helpful to the early diagnosis of spondylolysis.

Differentiating imaging features of pyogenic and tuberculous spondylodiscitis / 中华骨科杂志

Spinal infection was a common disease. It was very important to clarify the type of infection when deciding treatment. After following up of imaging data of spinal infection cases and reviewing the literature reports, some characteristic imaging manifestations were found and summarized, which were very helpful for the differential diagnosis of pyogenic and tuberculous spondylodiscitis. MR features of tuberculous spondylodiscitis were thoracic spine involvement, obvious bone destruction, larger kyphosis angle, vertebral intraosseous abscess, thin and smooth abscess walls, heterogeneous and focal enhancement of vertebral body, 3 vertebrals or more involvement. MR features of pyogenic spondylodiscitis were lumbar spine involvement, a diskitis pattern (disc destruction) with peridiscal bone destruction, homogeneous enhancement of vertebral body, and abnormal signal around the facet joint.

The role of miR-21 in Endostar combined with X-ray irradiation of cardiac fibroblasts / 中华放射肿瘤学杂志

Objective:To investigate the implication of micro RNA-21(miR-21) in Endostar combined with X-ray irradiation of cardiac fibroblasts (CF).Methods:Rat CFs were used in this experiment and been divided into the blank control group, 10 Gy X-ray irradiation group, Endostar group, 10 Gy X-ray+ Endostar group, 10 Gy X-ray+ Endostar+ NC mimic group (negative control 1), 10 Gy X-ray+ Endostar+ miR-21 mimic group, 10 Gy X-ray+ Endostar+ NC inhibitor group (negative control 2) and 10 Gy X-ray+ Endostar+ miR-21 inhibitor group. The proliferation of CF was determined by Methyl thiazolyl tetrazolium (MTT) assay. The expression level of Collagen Ⅰ protein was analyzed by Western blot. The expression levels of Collagen Ⅰ and miR-21 mRNA were assayed by real-time quantitative polymerase chain reaction (q-PCR).Results:In the 10 Gy X-ray+ Endostar+ miR-21 mimic group, the CF proliferation, Collagen Ⅰ and miR-21 mRNA were increased significantly compared with those in the blank control group, 10 Gy X-ray+ Endostar group, and negative control group 1 (all P<0.05). In the 10 Gy X-ray+ Endostar+ miR-21 inhibitor group, the CF proliferation and expression levels of Collagen Ⅰ mRNA were decreased significantly compared with those in the blank control group, 10 Gy X-ray+ Endostar group and negative control group 2(all P<0.05). Conclusions:The CF proliferation and Collagen Ⅰ expression are increased when the expression level of miR-21 gene is simulated. When inhibiting the expression of miR-21 gene, the CF proliferation and Collagen Ⅰ expression are reduced.

Differences and causes of myopia among students in different stages in the same region in Xi'an / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To gather baseline data on visual acuity by screening students from different stages in the same administrative district of Xi'an, as well as to analyze and investigate disparities in myopia rates among students from different stages in this area.METHODS: A total of 13 707 students from 21 elementary schools, 3 middle schools, 3 general high schools and 1 vocational high school were randomly selected for uncorrected distance visual acuity and computerized refraction testing in 28 schools with a random sampling approach.RESULTS: The detection rate of myopia in elementary, middle, high and vocational high schools in the same region of Xi'an were 32.27%, 72.07%, 81.22% and 65.12%, respectively; The total myopia rate of students was 47.81%; The myopia rate of girls was higher than that of boys in all grades; The myopia rates of elementary and middle schools increased with the growth of grades; The percentage of high myopia increased from 2.40% in elementary schools to 16.51% in high schools with the growth of grades.CONCLUSION: The myopia rate in different stages of the same region is different, and it tends to rise with the gronth of grades; Girls have a higher myopia rate than boys; Compared to the results of the national survey on myopia in different grades of children and adolescents in 2018, the myopia rate in the same region has decreased significantly in 2021 of the elementary school level, although myopia rate of middle school and high school stage do not rise, the decline is not obvious.

Oblique lateral interbody fusion treats adjacent segment diseases after lumbar spinal fusion / 中华骨科杂志

Objective:To explore the feasibility and clinical efficacy of oblique lateral interbody fusion (OLIF) in the treatment of adjacent segment disease (ASDis).Methods:Retrospective analysis was conducted on the data of 31 patients with ASDis treated by OLIF in four medical centers from June 2015 to December 2018. There were 17 males and 14 females. The average age was (65.7±3.4) years (range, 59 to 75 years). 19 cases received single-segment fixed fusion, 11 cases received double-segment fixed fusion and 1 case received three-segment fixed fusion. Original fixed fusion site: 1 case of L 1, 2, 3 cases of L 3, 4, 11 cases of L 4, 5, 4 cases of L 5S 1, 6 cases of L 3-L 5, 5 cases of L 4-S 1, and 1 case of L 3-S 1. The time from the initial fixation and fusion to this admission was 82.5±45.5 months (rang, 24 to 180 months). ASDis occurred at the proximal end of the fixed fusion segment in 28 cases and at the distal end in 3 cases. The types of ASDis: degenerative disc disease in 11 cases, lumbar spinal stenosis in 15 cases, degenerative spondylolisthesis in 2 cases, and degenerative scoliosis in 3 cases. The location of ASDis: 6 cases of L 2, 3, 12 cases of L 3, 4, 6 cases of L 4, 5, 3 cases of L 1-L 3, 1 case of L 2-L 4, and 3 cases of L 1-L 4. At admission, 3 cases of lumbar internal fixation had been removed and 28 cases of internal fixation remained. Stand-alone OLIF was performed in 19 cases, OLIF combined with pedicle screw fixation in 8 cases, and OLIF combined with cortical screw fixation in 4 cases. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the low back pain and lumbar function before operation and at the last follow-up, and the imaging results and complications were observed. Results:All patients were followed up. The follow-up time was 23.6±9.6 months (range, 12 to 60 months). The operation time was 73.8±25.3 mins (range, 40 to 180 min), and the intraoperative blood loss was 86.2±67.4 ml (range, 20 to 310 ml). The average blood loss in each segment was 24.8 ml. During the operation, there were 1 case of segmental vein injury, 7 cases of endplate injury, 2 cases of transient iliopsoas muscle weakness, 1 case of thigh pain and numbness, and 1 case of incomplete intestinal obstruction. There was no incision necrosis and infection. The VAS score of low back pain decreased from 5.9±1.9 before operation to 1.4±0.6 at the last follow-up, with a statistically significant difference ( t=8.47, P<0.001). The ODI index recovered from 45.2%±5.7% before operation to 13.8%±4.7% at the last follow-up, with a statistically significant difference ( t=7.92, P<0.001). The height of intervertebral space increased from 8.7±1.6 mm before operation to 11.4±1.9 mm after operation and 9.9±1.8 mm at the last follow-up. There was a statistically significant difference between postoperative and preoperative height of intervertebral space ( F=4.15, P=0.007). There was a statistically significant difference between the last follow-up and postoperative height of intervertebral space ( P=0.011). During the follow-up, there were 13 cases of fusion cage subsidence, 1 case of fusion cage displacement, and no case of internal fixation loosening or fracture. The intervertebral fusion rate was 94%(29/31) and the complication rate was 42%(13/31). Conclusion:ASDis is a common complication after lumbar fixation and fusion, and requires surgical treatment. OLIF is a reliable method to treat ASDis as it has advantages of small trauma, high fusion rate and low complication rate.

Diagnosis and treatment of Charcot spinal arthropathy / 中华骨科杂志

Charcot Spinal Arthropathy (CSA) is a rare and progressive serious degenerative spinal disease. The clinical manifestations of CSA are concealed and atypical, which could lead to missed misdiagnosis, disease prognosis, and a huge burden on patients. However, there is no systematic review of CSA in China. The causes of CSA are mainly divided into spinal cord injury and non-injury neuropathy. The risk factors for CSA caused by spinal cord injury include long-segment fixation, scoliosis, laminectomy, overload spinal exercise and obesity. CSA usually occurs in the lower thoracic or lumbar spine. The symptoms of CSA include spinal deformity, unbalanced sitting posture and local pain. The CSA can be diagnosed after excluding non-specific chronic inflammation in histology and other inflammatory diseases or tumor based on the following items, damage to proprioception, pain and temperature perception, bone destruction, absorption and new bone formation on imaging. Conservative treatment can be considered for patients with CSA who have good stability without infections, stable nerve function, skin fistulas, balanced sitting posture, and autonomic dysfunction. Surgery is recommended for patients with symptoms lasting for more than 6 months with spinal instability, skin fistulas or complicated infections. Before surgery, it is recommended to evaluate the heterotopic ossification or rigidity of both hip joints. During operation, more attention should be paid to the adequate removal of necrotic tissue and inflammatory tissue in the lesion and sufficient bone grafting. Spinal fusion is recommended at the sacrum or pelvis. Postoperative complications include failure of internal fixation, new Charcot joint formation, difficulty in wound healing and infection. The authors emphasize that the overall thoracolumbar spine should be followed up for patients with spinal cord injury and paraplegia for the long-term. The typical symptoms of CSA are helpful for early diagnosis and selection of appropriate interventions.

Echocardiographic study of operation-related aorto-cardiac fistula / 中华超声影像学杂志

Objective:To analyze the echocardiographic features of operation-related aorto-cardiac fistula(ACF) after surgery or transcatheter procedure, to explore the value of echocardiography on diagnosis of operation-related ACF, and summarize the key points of its diagnosis.Methods:Eight patients with operation-related ACF who were admitted to Fuwai Hospital were collected from July 2002 to December 2020. Echocardiographic features of the 8 patients with operation-related ACF were reviewed and analyzed. The diagnosis methodology was summarized.Results:Of the 8 patients with operation-related ACF, 3 had aortic right atrial fistula and 5 had aortic right ventricular fistula. The fistula was single, which can be located but not limited to the aortic sinus. The median size of the fistula was 4 mm (range: 3-5 mm). There was no aneurysmal dilation of the aortic sinus where the fistula was located. The fractured end of the fistula did not thin, and the fistula had a regular shape. Six of the 8 patients undertook cardiac catheterization and occlusion. One patient received surgical repairment. One patient was treated conservatively.Conclusions:Echocardiography can help diagnose operation-related ACF and provide valuable information for further clinical diagnosis and treatment. Sonographers should avoid missed diagnosis and pay attention to distinguishing from other causes of aortic-cardiac shunt disease.

Regional-level risk factors for severe hand-foot-and-mouth disease: an ecological study from mainland China

BACKGROUND@#Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective.@*METHODS@#We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations.@*RESULTS@#We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations.@*CONCLUSION@#Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD.

Study on chemical constituents from fruiting bodies of Ganoderma calidophilum / 中国中药杂志

Chemical constituents were isolated and purified from fruiting bodies of Ganoderma calidophilum by various column chromatographic techniques, and their chemical structures were identified through combined analysis of physicochemical properties and spectral data. As a result, 11 compounds were isolated and identified as(24E)-lanosta-8,24-dien-3,11-dione-26-al(1), ganoderone A(2), 3-oxo-15α-acetoxy-lanosta-7,9(11), 24-trien-26-oleic acid(3),(23E)-27-nor-lanosta-8,23-diene-3,7,25-trione(4), ganodecanone B(5), ganoderic aldehyde A(6), 11β-hydroxy-lucidadiol(7), 3,4-dihydroxyacetophenone(8), methyl gentiate(9), ganoleucin C(10), ganotheaecolumol H(11). Among them, compound 1 is a new triterpenoid. The cytotoxic activities of all of the compounds against tumor cell lines were evaluated. The results showed that compounds 1, 3, 4 and 6 showed cytotoxic activity against BEL-7402, with IC_(50) values of 26.55, 11.35, 23.23, 18.66 μmol·L~(-1); compounds 1 and 3-6 showed cytotoxic activity against K562, with IC_(50) values of 5.79, 22.16, 12.16, 35.32, and 5.59 μmol·L~(-1), and compound 4 showed cytotoxic activity against A549, with IC_(50) value of 42.50 μmol·L~(-1).

Clinical value of the emergency department in screening and diagnosis of COVID-19 in China / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Since the global outbreak of severe acute respiratory syndrome (SARS) in 2003, China has gradually built a robust prevention and control system for sudden infectious diseases. All large hospitals have a fever clinic that isolates patients with all kinds of acute communicable diseases as the first line of medical defense. The emergency department, as the second line of medical defense in hospitals, is constantly shouldering the heavy responsibility of screening communicable diseases while also treating all kinds of other non-communicable acute and critical diseases (Zhang et al., 2012; Zhu et al., 2015; Wang et al., 2017; Feng et al., 2018; Lu, 2018; Xu and Lu, 2019). An outbreak of pneumonia of unknown etiology that began in Wuhan city (China) has spread rapidly in China since December 2019 (Huang et al., 2020; WHO, 2020; Zhu et al., 2020). In February 2020, the National Health Commission of China named the disease a novel coronavirus pneumonia (NCP); then, it was formally named the coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) on Feb. 11, 2020. The Coronavirus Study Group of the International Committee on Taxonomy of Viruses designated this causative virus as SARS coronavirus 2 (SARS-CoV-2). SARS-CoV-2 belongs to the β coronavirus genus, and its pathogenic mechanism has not been clarified, which requires further study. To better understand the clinical characteristics of COVID-19 and more effectively prevent and control this disease, we retrospectively analyzed four representative cases of COVID-19 that had recently been screened and diagnosed in our emergency department.

Analysis on the causes and prevention strategies of the vascular injury caused by the oblique lateral lumbar fusion / 中国骨伤

OBJECTIVE@#To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures.@*METHODS@#There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury.@*RESULTS@#The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(@*CONCLUSION@#Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.

A case report of primary leiomyosarcoma of the spermatic cord / 中华泌尿外科杂志

This study retrospectively analyzed the clinical data of 1 case of spermatic cord leiomyosarcoma admitted to the urology department of the Affiliated Hospital of Chengde Medical College. The clinical characteristics, diagnosis, treatment and prognosis was discussed with the literature review. Radical resection of the left testicle and high ligation of the left spermatic cord were performed. Postoperative pathology was spermatic cord leiomyosarcoma. Its clinical manifestations are painless masses, which are mainly confirmed by pathological examination. The treatment is mainly radical resection, and postoperative radiotherapy can improve the prognosis and reduce recurrence.

Application of oblique lumbar interbody fusion for lumbar intervertebral pyogenic infection / 中华骨科杂志

Objective:To investigate the safety, key techniques and clinical efficacy of OLIF (oblique lumbar interbody fusion) corridor combined with lumbar intervertebral debridement, fusion with two interbody and internal fixation for the treatment of single-level lumbar pyogenic spondylodiscitis.Methods:From February 2016 to March 2017, data of 12 patients with single-level lumbar intervertebral pyogenic infection diagnosed in our hospital who had undergone oblique lumbar interbody fusion with two interbody and posterior pedicle screw fixation via Wiltse approach were retrospectively analyzed. Among them, there were 10 males and 2 females, aged from 49 to 79 years, with an average age of 65.4±9.5 years. The white blood cells (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded and analyzed before operation and at the last follow-up. Lumbar pain was assessed by visual analogue acale (VAS), Oswestry disability index (ODI), and clinical efficacy was assessed by the MOS 36-item short-form health survey (SF-36) and Kirkaldy-Willis criteria. The hospitalization time, operation time, intraoperative blood loss, pathological reports, etiological results and complications were recorded. Disc height (DH), segmental angle (SA) and Lumbar Lordosis (LL) were measured before operation and at the last follow-up. The fusion time was recorded. Paired t-test and ANOVA was used for data analysis. Results:All patients underwent surgery successfully, including 6 cases using two titanium meshes and 6 cases using two autologous tricortical iliac bones. Pathogenic culture was positive in 10 cases, with a positive rate of 83.3%, including 4 cases of streptococcus, 4 cases of Staphylococcus aureus, 1 case of Escherichia coli, and 1 case of Klebsiella pneumoniae. All patients were followed up for 16.1±5.1 months. At the last follow-up, WBC ([6.25±2.02] ×10 9/L) was lower than that before operation ([4.89±1.28] ×10 9/L), CRP (preoperation 58.73±52.56 mg/L vs postoperation 8.48±8.79 mg/L) and ESR (preoperation 51.88±19.04 mm/1 h vs postoperation 9.25±5.50 mm/1 h) were significantly lower ( P< 0.01). The VAS score was preoperation 6.67±1.63 and postoperation 1.50±0.55, ODI score was preoperation 72.57%±3.41% and postoperation 18.00%±2.31%, and both were significantly lower postoperatively ( P < 0.01). SF-36 score (preoperation 56.33±4.93 vs postoperation 73.73±5.86) was significantly higher ( P< 0.01) respectively. The postoperative height of intervertebral space ([11.68±2.64] mm) was significantly higher than that before operation ([5.18±1.58] mm). The disc height at the last follow-up was (11.22±2.25) mm, and the loss rate was 1.89% compared with that of the immediate postoperatively; The postoperative lumbar lordosis angle (32.89°±14.52°) was significantly increased compared with that of the preoperative (24.16°±13.49°), and maintained well at the last follow-up (32.27°± 14.21°); The postoperative segmental angle (10.8°±8.51°) was significantly increased compared with that of the preoperative (5.81°±7.44°), and maintained well at the last follow-up (9.94°±7.87°). The fusion time ranged from 6 to 16 months, with an average of 9.2±3.5 months. The clinical efficacy was excellent in 10 cases (83.3%) and good in 2 cases (16.7%). The excellent and good rate was 100%. One case of pulmonary infection and pulmonary embolism occurred 2 days after operation, and recovered after use of antibiotics and anticoagulation treatment in ICU; one case of intramuscular venous thrombosis was found 1 day after operation, and recovered after anticoagulation treatment; no loosening of internal fixation was found, and no complications related to OLIF corridor occurred. Conclusion:The treatment of single-level lumbar intervertebral pyogenic infection with OLIF corridor combined with lumbar intervertebral debridement, fusion with two interbody and internal fixation has the advantages of less blood loss, shorter operation time, more direct clearance of intervertebral space and left paravertebral focus, no disturbance of intraspinal canal and posterior structure, higher positive rate of etiology detection, shorter bedrest time and better restore of disc height and lumbar lordosis after operation. What’s more, the fusion rate is high and the clinical efficacy is satisfactory.

Role of Regional Network Management System in Disability Prevention for Newborn High-risk Infants / 中国康复理论与实践

Objective:To explore the feasibility of establishing a regional network management system to prevent and control the disability in high-risk infants. Methods:From July, 2015 to June, 2016, 1252 type B high-risk infants who born alive and registered in Lianyungang were divided into control group and experimental group by receiving network management system or not. The network high-risk infants management system was used to monitor the growth, diagnosis and early intervention of high-risk infants in the experimental group, while the control group was managed in the conventional way. A comprehensive physical examination and systematic assessment of 940 high-risk infants finally were conducted after two years. Their parents' compliance, developmental state, degree of dysplasia and function of dysplastic child were compared. Results:The compliance of parents was higher in the experimental group than in the control group (χ2 = 44.161,P < 0.001), as well as the outcome when the infants were two years old (χ2 = 204.340,P < 0.001). The younger they were found deviated and intervened, the better the outcome was (χ2 = 42.038,P < 0.001), and the less degree of dysplasia when they were two years old (χ2 = 10.508,P < 0.01). The deviation/abnormality condition was less in the experimental group than in the control group (χ2 = 17.446,P < 0.01). The development of functional area was better in the experimental group than in the control group (|t| > 2.206,P < 0.05), expect body structure (P > 0.05), in the infants with developmental deviation/abnormality. Conclusion:The establishment of network management system for high-risk infants can significantly improve the management compliance of parents and outcome of development of high-risk infants, to prevent disability.