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Objective:To explore the significance of four-dimensional CT angiography(4D CTA) and CT perfusion (CTP) imaging in evaluating collateral circulation grades in patients with moyamoya disease and moyamoya syndrome and their relationship with cerebral hemodynamics.Methods:The clinical and imaging data of 32 patients with moyamoya disease and moyamoya syndrome in Beijing Hospital from January 2017 to January 2022 were retrospectively analyzed. All patients underwent 4D CTA-CTP imaging. Collateral circulation was scored on CTA images by using Alberta stroke program early CT score system, and on digital subtraction angiography (DSA) images by using American society of interventional and therapeutic neuroradiology/Society of interventional radiology score system, respectively. The patients were divided into Ⅰ-Ⅲ circulation compensation grades based on collateral circulation score. Regions of interest were delineated at basal ganglia on perfusion maps and the perfusion parameters were obtained including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), mean transit time (TTP) and delay time (DLY). The Kruskal-Wallis test was used to compare the perfusion parameters in different collateral circulation grades, and pairwise comparison was performed with Bonferroni correction. Kappa and Spearman tests were used to analyze the consistency and correlation of 4D CTA and DSA in the classification of collateral circulation.Results:4D CTA and DSA had a moderate consistency (Kappa=0.693, P<0.001) and a strong correlation ( r=0.805, P<0.001) in evaluating collateral grades. There were statistically significant differences in CBF, MTT and TTP among collateral compensation grade Ⅰ, grade Ⅱ and grade Ⅲ ( H values were 7.91, 11.69, 8.93; P values were 0.019, 0.003 and 0.012, respectively). Further pairwise comparison showed that the CBF of collateral compensation grade Ⅰ was lower than that of grade Ⅲ ( P=0.015), MTT of grade Ⅱ was higher than that of grade Ⅲ ( P=0.005), and TTP of grade Ⅰ was higher than that of grade Ⅲ ( P=0.015). There was no statistical significance of other indicators in pairwise comparison. There were no significant differences in CBV and DLY among collateral compensation grade Ⅰ, grade Ⅱ and grade Ⅲ ( P>0.05). Conclusions:4D CTA-CTP is equivalent to DSA in evaluating collateral circulation in patients with moyamoya disease and moyamoya syndrome. It can also evaluate the cerebral hemodynamics comprehensively, which has high clinical significance for disease monitoring.
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Objective:To explore the distribution characteristics of memory B cells and its relationship with bone erosion in patients with rheumatoid arthritis (RA), and to further understand the mechanism of B cells in the pathogenesis of RA.Methods:B cell subsets in peripheral blood of 200 RA patients and 50 healthy individuals were detected by flow cytometry. According to the surface markers CD19, CD27 and lgD, B cells were divided into CD19 +CD27 +lgD - switched memory B cells, CD19 +CD27 +lgD + non-switched memory B cells, CD19 +CD27 -lgD - double-negative memory B cells and CD19 +CD27 -lgD + naive B cells. B cells in RA patients with various disease activity score, course of disease and treatment were analyzed. Patients were divided into four groups according to the results of joint ultrasonography, including patients without bone erosion, patients with hand bone erosion, patients with knee bone erosion and patients with hand and knee bone erosion. The relationship between the distribution of B cell subsets, autoantibodies and RA bone erosion were analyzed. Differences between the groups were analyzed by independent-samples t test, Mann-Whitney U test and χ2 test. The analysis of variance, Kruskal-Wallis analysis were used for multi-group comparison, Spearman correlation analysis was also used for correlation analysis. Results:①RA patients showed significantly decreased non-switched memory B cells [(9.5±6.7)% vs (12.1±4.7)%, t=2.46, P=0.015] and increased double negative memory B cells [(3.8±2.5)% vs(2.7±1.3)%, t=-4.74, P<0.001] in comparison to healthy individuals. The percentage of non-switched memory B cells were decreased in RA patients with moderate disease activity [(8.4±4.7 )% vs (12.4±7.5)%, t=3.13, P=0.001] and high disease activity [(7.8±7.6)% vs (12.4±7.5)%, t=3.00, P=0.003] in comparison to those in RA patients who achieved remission. Meanwhile, the na?ve B cells [(70.3±15.0)% vs (63.9±14.6)%, t=-2.15, P=0.034] were increased in RA patients with moderate disease activity. No difference was found in RA patients with different disease courses. Total B cells [(4.8±2.9)% vs (7.2±4.1)%, t=-3.24, P=0.001], non-switched memory B cells (7.6±4.3)% vs (10.0±7.1)%, t=-2.63, P=0.010) in RA patients who received prednisone treatment were decreased, while double-negative memory B cells (4.9±3.0)% vs (3.6±2.3)%, t=-2.79, P=0.006] were increased compared with those in RA patients without prednisone treatment. Non-switched memory B cells was decreased in RA patients with hand and knee erosion compared with RA patients without erosion [6.8%(2.5%, 9.5%) vs 9.7%(5.5%, 17.5%), Z=-2.12, P=0.034]. Double negative memory B cells in subgroup with keen erosion [3.3%(2.7%, 5.0%) vs 2.6%(1.9%, 3.8%), Z=-2.09, P=0.036]as well as with hand and knee erosion [3.9%(2.3%, 5.6%) vs 2.6%(1.9%, 3.8%), Z=-2.41, P=0.016] were higher than those in patients without erosion. In addition, higher serum RF level was found in subgroup RA patients with hand and knee erosion compared with subgroup of RA patients without erosion [141.0 (38.0, 874.0) U/ml vs 53.5 (10.0, 106.0)U/ml, Z=-2.07, P=0.039]. Meanwhile, the positive rate of ACPA in RA patients with bone erosion of hand was significantly higher than that of RA patients without bone erosion [81%(52/64) vs 64%(38/59), χ2=4.44, P=0.043). Conclusions:The results suggest that the increase of double negative memory B cells, the decrease of non-switched memory B cells and higher level of autoantibodies may closely relate to bone erosion of RA, which may be one of the pathogenesis of disability in RA.
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Objective:To explore the staged treatment of keloid scars and to optimise treatment options.Methods:From June 2005 to June 2019, 629 keloid patients, 253 males and 376 females, aged 9 to 78 years, with a mean age of 31.3±16.8 years, were admitted to the Department of Aesthetic Plastic Surgery of Weifang People＇s Hospital. Three-stage comprehensive treatment was administered according to the stage of the disease from low to high, and the treatment effect was observed regularly, and the recurrence rate was counted.Results:In stage Ⅰ, 251 patients had local recurrence in 14 cases (5.5%) and 4 cases (1.6%) at 2 years 6 months after treatment, all of whom were cured after re-injection; in stage Ⅱ, 302 patients had local recurrence in 56 cases (18.6%) at 6 months after treatment, 49 patients (87.5%) were cured after re-treatment and 35 patients (11.6%) at 2 years; in stage Ⅲ, at 6 months after treatment, 36 patients (47.3%) had recurrence and 19 patients (25%) had recurrence at 2 years after re-treatment.Conclusions:The results and recurrence rate of keloids after comprehensive treatment are related to their severity, and a more satisfactory outcome can be achieved by staging the treatment according to the stage of the disease.
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Objective:To investigate the screening values of immunocytochemical P16/Ki-67 double staining, P16 INK4α single staining and high-risk human papillomavirus (HR-HPV) testing for high-grade cervical lesions. Methods:The clinical data of 622 patients who underwent cervical thin-layer liquid-based cytology (TCT) and HR-HPV testing in General Hospital of Taiyuan Iron and Steel (Group) Co., Ltd. from March 2019 to July 2021 were retrospectively analyzed. The remaining cytological specimens were detected by P16/Ki-67 double staining and P16 INK4α single staining. Among them, 334 patients with TCT results suggesting atypical squamous cell of undetermined significance (ASCUS) and above and HPV-positive underwent colposcopy pathological biopsy. Using pathological results as reference, the positive predictive value, sensitivity, specificity and accuracy of P16/Ki-67 double staining, P16 INK4α single staining and HR-HPV testing for screening of high-grade squamous intraepithelial neoplasia (HSIL) and cervical cancer were compared. Results:Taking the results of histopathology as references, combined with the results of TCT, 31 of 622 patients were HSIL, of which 22 (71.0%) were positive for P16/Ki-67 double staining, 23 (74.2%) were positive for P16 INK4α single staining, and 25 (80.6%) were positive for HR-HPV testing; 4 cases were cervical cancer, and the positive rates of the three detection methods were all 100.0% (4/4). Among 622 patients, the positive rates of P16/Ki-67 double staining, P16 INK4α single staining and HR-HPV testing for screening of HSIL and cervical cancer were 13.99% (87/622), 25.40% (158/622) and 21.38% (133/622); the positive predictive values were 29.89%, 17.09% and 21.08%; the accuracies were 91.19%, 78.94% and 83.28%; the specificities were 89.77%, 77.98% and 82.46%; the sensitivities were 74.29%, 77.14% and 82.86%. The positive rate, positive predictive value, specificity and accuracy of P16/Ki-67 double staining were higher than those of P16 INK4α single staining and HR-HPV testing, and the differences were statistically significant ( z values were -5.062 and -3.418, 2.328 and 2.450, 5.436 and 3.570, 6.043 and 4.161, all P < 0.05); the sensitivity of HR-HPV testing was higher than that of P16/Ki-67 double staining and P16 INK4α single staining, but the differences were not statistically significant ( z values were -0.890 and 1.017, both P > 0.05). Conclusions:HR-HPV testing is more suitable for primary cervical lesion screening; P16/Ki-67 double staining can be used as a potential combined cell screening tool or an effective triage tool; P16 INK4α single staining has certain limitations.
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Objective:To investigate the effect of systemic lupus erythematosus (SLE) on the status of hepatitis B virus (HBV) infection, and provide data for clarifying the relationship between autoimmunity and infection.Methods:SLE patients in the department of rheumatology and immunology of the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to December 2019 were screened. A retrospective case-control study was carried out. SLE patients with positive hepatitis B surface antigen (HBsAg) were gender and age matched with chronic hepatitis B (CHB) in a 1∶4 ratio. Chi-square test was used to compared the positive rates of hepatitis B e antigen (HBeAg) and Paired-Samples t test or Signed rank Wilcoxon test was used to compare the HBV DNA load and HBsAg titer. Results:The positive rate of HBsAg in SLE patients was lower than the prevalence rate of HBsAg in general population in the second Chinese National Hepatitis Seroepidemiological Survey in 2006 [2.2%(27/1 227) vs 7.2%], but the positive rate of HBcAb was not obviously different from that in general population in China [33.9%(416/1 227) vs 34.1%]. Compared with matched CHB patients, the positive rate of HBeAg [37.0%(10/27) vs 58.3%(63/108), χ2=3.94, P=0.047], the HBV DNA load [0(0, 3.7) lg U/ml vs 4.8(2.2, 3.7) lg U/ml, Z=-5.37, P<0.001] and HBsAg titer [(2.0±1.5) lg U/ml vs (3.3±1.1) lg U/ml, t=-4.26, P<0.001] in SLE patients were lower. Conclusion:The HBV infection status of SLE patients is different from that of patients with chronic hepatitis B and the HBV infection is more likely to be controlled.
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Objective:To understand the epidemiological and clinical characteristics of patients with tsutsugamushi disease in Zaozhuang City, Shandong Province, and to provide a basis for formulating effective diagnosis and treatment plan of tsutsugamushi disease. Methods:Retrospective analysis was carried out to collect clinical data of 38 patients with tsutsugamushi disease admitted to Zaozhuang Municipal Hospital of Shandong Province from 2018 to 2020. The epidemiological characteristics, clinical manifestations, laboratory examination results and drug treatment of patients with tsutsugamushi disease were analyzed. Results:Among the 38 patients with tsutsugamushi disease, 15 were males and 23 were females, aged (58.58 ± 14.47) years old; the occupation distribution was mainly farmers, accounting for 92.11% (35/38); the onset time was concentrated in October and November, accounting for 100.00% (38/38); the regional distribution was mainly in Yicheng District, accounting for 34.21% (13/38); 38 patients had a history of grassland/forest contact. All patients had fever, and other main symptoms were eschar (97.37%, 37/38), headache (68.42%, 26/38), fatigue (42.11%, 16/38), and whole body aches (36.84%, 14/38), etc. The results of laboratory examination mainly showed that C-reactive protein increased (89.47%, 34/38), procalcitonin increased (81.58%, 31/38), abnormal liver function (78.95%, 30/38), D-dimer increased (71.05%, 27/38), eosinophils decreased (60.53%, 23/38), and erythrocyte sedimentation rate increased (57.89%, 22/38). All 38 patients were cured after treated with doxycycline or azithromycin. Conclusions:The high incidence time of tsutsugamushi disease in Zaozhuang City is autumn. The clinical symptoms are mainly fever, eschar and headache. Doxycycline and azithromycin are the first choices for treatment of the disease.
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Objective:To study the reason for failed fixation with dynamic hip screws (DHS) and the indications for DHS fixation in the treatment of intertrochanteric fracture based on the lever-balance-reconstruction theory.Methods:A retrospective analysis was performed of the data of 32 patients with intertrochanteric fracture who had been treated by DHS fixation at Department of Orthopaedic Trauma, Peking University People's Hospital from January 1999 to December 2019. There were 22 males and 10 females, aged from 34 to 91 years (average, 67.7 years). By the AO classification, 15 fractures were type 31-A1, 13 ones type 31-A2, and 4 ones type 31-A3. According to the lever-balance-reconstruction theory, after the position of postoperative fulcrum was determined depending on the relationship between fracture line and internal fixation, the medial and lateral force arms were measured after internal fixation. The 32 patients were divided into 2 groups according to the position of fulcrum after internal fixation. In group A of 13 patients, the fulcrum was located in or within the center of the medullary cavity; in group B of 19 patients, the fulcrum was located outside the center of the medullary cavity. The incidence of internal fixation failure was compared between the 2 groups.Results:Internal fixation failure occurred in 15 of the 32 patients: cutting out of the head and neck screws without penetration in 2 cases, screw withdrawal in 8 cases, hip varus deformity in 10 cases, and femoral neck shortening in 15 cases. The 2 groups were comparable because there were no statistically significant differences in their preoperative general data or types of internal fixation between them except AO classification ( P>0.05). The length of medial force arm (power arm) averaged 51.12 mm (from 39.4 to 57.9 mm) and the length of lateral force arm (resistance arm) 23.37 mm (from 15.1 to 31.0 mm) in group A where 3 patients experienced internal fixation failure after operation; the length of medial force arm (power arm) averaged 63.71 mm (from 52.3 to 74.5 mm) and the length of lateral force arm (resistance arm) 9.94 mm (from 3.1 to 18.3 mm) in group B where 12 patients experienced internal fixation failure after operation. There was a significant difference between the 2 groups in internal fixation failure ( P=0.036). Conclusions:In the DHS fixation of intertrochanteric fracture, the postoperative fixation failure is associated with the fulcrum position after reconstruction. DHS is only indicated for intertrochanteric fractures whose fracture line (post-reconstruction fulcrum) is near and inside the center of the medullary cavity, but not for those whose fracture line (post-reconstruction fulcrum) is outside the medullary cavity.
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Objective:To study the differentially expressed genes in chronic periodontitis (CP) and to explore the correlation with disease severity.Methods:Gene expression profile data associated with CP were screened in the Gene Expression Omnibus (GEO) database and analyzed with GEO2R online software to create volcano maps. Kyoto Encyclopedia of Genes and Genomes (KEEG) and Gene Ontology (GO) analyses were performed on the screened CP-associated differentially expressed genes to predict their possible functions and signaling pathways. The protein-protein interaction database (STRING) was used to analyze the interaction relationships between the encoded proteins of the screened CP-related differentially expressed genes. Cytohubba software was used to identify key genes in the signaling pathway. One120 CP patients and 40 healthy controls were selected. The screened CP-related genes were validated by the real-time polymerase chain reaction (q-PCR) method.Results:A total of 1 151 CP differentially expressed genes that met the requirements were screened. These genes were mainly enriched in the GO pathway for positive regulation of granulocyte differentiation, helper T-cell differentiation, leukocyte aggregation, regulation of acute inflammatory response, chemokine-mediated and endoplasmic reticulum unfolded protein response, as well as in the KEGG pathway for NFB pathway, chemokine pathway, cytokine receptor interaction, leukocyte transendothelial migration pathway, B-cell receptor pathway, Toll-like receptor pathway, etc. The protein-protein interaction network was constructed using the screened CP-related differentially expressed genes, which included 78 nodes and 496 links, with a mean aggregation coefficient and mean connectivity of 0.69 and 12.7, respectively. Cytohubba analysis showed that Sell was a key gene in the signaling pathway, and its relative expression levels in the gingival fluids of the three CP groups with different degrees(1.14±0.46, 0.86±0.41, 0.52±0.46) was significantly lower than that of the control group (1.50±0.65) (all P<0.05). The area under the ROC curve (AUC) of subjects diagnosed with CP using Sell expression levels in gingival fluid was 0.79 (95% CI: 0.71 to 0.86). The AUC values were greater than 0.65 at 95% CI when Sell was used as a biological marker to evaluate the severity of CP. Conclusions:CP-related differentially expressed genes are mainly enriched in the number of pathways associated with the inflammatory response of periodontitis. The expression levels of Sell genes were significantly reduced in the gingival sulcus fluid of CP patients and correlated with the severity of the disease. The Sell genes are expected to be a biomarker for CP grading.
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OBJECTIVE@#To perform prenatal diagnosis for a woman carrying a balanced translocation.@*METHODS@#Clinical phenotype of the woman and her first child was analyzed. Peripheral blood sample of the woman and amniotic fluid sample from two subsequent pregnancies were subjected to chromosomal karyotyping and copy number variation analysis through next-generation sequencing (NGS).@*RESULTS@#The karyotypes of the woman and her first child were determined as 46,XX,t(5;6)(p15:p23) and 46,XX,?der(5),t(5;6)(p15.32;p22.3), respectively. The karyotype of the amniocyte from her second pregnancy was 46,XN,t(5;6)(p15:p23). No pathogenic copy number variation was detected. The karyotype of her third pregnancy was 46,XN,?der(5),t(5;6)(p15.32;p22. 3), in addition with a 6.04 Mb deletion at 5p15.33p15.32 (20 000 - 6 060 000) and a 18.50 Mb duplication at 6p25.3p22.3 (160 000 - 18 660 000).@*CONCLUSION@#Combined karyotyping analysis and NGS has enabled detection of fetal copy number variations for a woman carrying a balanced chromosomal translocation.
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Child , Female , Humans , Pregnancy , DNA Copy Number Variations , Fetus , High-Throughput Nucleotide Sequencing , Karyotype , Karyotyping , Prenatal DiagnosisABSTRACT
Objective:To compare the biomechanical properties of traditional surface hip prosthesis and bionic surface hip prosthesis.Methods:The Sawbone digital model (#3908, Left, Medium) was selected as the research object. Mimics 21.0 software was used to reconstruct the physical model of femur. Solidworks 16.0 software was used to build the model of prostheses, including the traditional and bionic (type 1-4) protheses and their assembly. The distances from the screw cross position to the top of pressure screw of type 1 to type 4 protheses were 20.22 mm, 30.12 mm, 32.17 mm and 37.76 mm, respectively. The mechanical distribution characteristics of the whole model were measured and the stress distribution cloud map was obtained.Results:The peak stresses at bone-stem junction of traditional prosthesis and type 1-4 hip prostheses were 32.18 MPa, 13.80 MPa, 15.01 MPa, 23.46 MPa and 34.51 MPa, respectively. With the fulcrums away from the top of the femur, the peak stresses at the fulcrums of type 1-4 hip protheses were 37.98 MPa, 48.60 MPa, 54.80 MPa, and 53.87 MPa, respectively. The maximum stress above femoral neck of traditional prosthesis and type 1-4 hip prostheses were 8.00 MPa, 7.80 MPa, 7.04 MPa, 7.03 MPa and 7.51 MPa, respectively. The maximum stresses under femoral neck was 15.38 MPa, 14.20 MPa, 11.11 MPa, 13.10 MPa and 12.18 MPa, respectively. The maximum stresses in the greater trochanter region of femur were 13.08 MPa, 11.61 MPa, 13.09 MPa, 11.02 MPa and 39.51 MPa, respectively.Conclusion:Compared with the traditional surface hip prosthesis, the type I bionic surface hip prosthesis is designed based on the lever balance reconstruction theory. With the bionic reconstruction of the tension trabeculae and compression trabeculae through reasonable screw placement angles and the inward movement of the fulcrum closer to the center of the femoral head, the new type prothesis make up for the design defects of the traditional surface hip prosthesis, optimize the stress distribution in the proximal femur, and improve the stability of the prosthesis after replacement, which help reduce the risk of femoral neck fracture and prosthesis loosening, and extend the service life of the prosthesis.
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Objective:To analyze the influence of comprehensive rehabilitation on postoperative functions in the elderly patients with femoral intertrochanteric fracture.Methods:From June 2015 to June 2019, 144 elderly patients were treated at Department of Orthopedics, China-Japan Friendship Hospital for femoral intertrochanteric fractures by internal fixation with proximal femoral nail anti-rotation (PFNA). Of them, 65 received comprehensive rehabilitation, including intervention measures for details, prevention and management of comorbidities and complications and active exercise of the injured limb, while 79 conventional rehabilitation. In the comprehensive rehabilitation group, there were 22 males and 43 females with an age of (76.6±6.7) years, and 18 cases of type 31-A1, 35 cases of type 31-A2 and 12 cases of type 31-A3 by the AO type. In the control group, there were 23 males and 56 females with an age of (75.2±7.0) years, and 25 cases of type 31-A1, 39 cases of type 31-A2 and 15 cases of type 31-A3 by the AO type. The 2 groups were compared in terms of visual analog scale (VAS), Harris hip score, Barthel index, postoperative ambulation time and complications at 6 months after operation.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative or intraoperative general data ( P>0.05). The comprehensive rehabilitation group had a significantly lower VAS score (1.5±1.0), a significantly higher Harris hip score(83.9±5.4), a significantly higher Barthel index (81.6±5.4), significantly shorter postoperative ambulation time [(2.6±1.0) d], and a significantly lower incidence of complications [4.6% (3/65)] than the control group did [1.9±1.2, 80.2±7.9, 78.2±7.9, (3.2±1.4) d, 16.5%(13/79), respectively] (all P< 0.05). Conclusion:For elderly patients with femoral intertrochanteric fracture, comprehensive rehabilitation can significantly reduce complications, promote functional recovery of the hip, and speed up recovery of capabilities of daily living compared with conventional rehabilitation.
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Objective:To investigate the characteristics of postoperative internal fixation failures of femoral intertrochanteric fractures and analyze the related reasons using the leverage-balance-reconstruction theory.Methods:A retrospective case series study was performed for 40 patients suffering from implant failure after internal fixation of femoral intertrochanteric fractures admitted to Peking University People's Hospital from January 1999 to December 2019. There were 20 males and 20 females, aged from 43 to 92 years [(74.1±11.5)years]. The patients were assigned to extramedullary fixation (extramedullary fixation group, 17 patients) and intramedullary fixation (intramedullary fixation group, 23 patients). Complications associated with internal fixation were recorded, including internal fixation cutout, coxa vara deformity of hip joint, internal fixation withdrawal, femoral heck shortening and internal fixation breakage. Based on the lever-balance-reconstruction theory, the failure reasons of internal fixation were analyzed in combination with the change of arm length and outward shift of fulcrum measured before operation, after internal fixation and after fixation failure.Results:Among 40 patients, internal fixation cutout occurred in 18 patients, coxa vara deformity of hip joint in 37, internal fixation withdrawal in 29, femoral neck shortening in 37 and internal fixation breakage in 3. In extramedullary fixation group, the lengths of primary power arm and resistance arm were (8.0±1.0)mm and (59.4±10.9)mm, the lengths of power arm and resistance arm after fixation were (72.7±21.7)mm and (8.9±7.4)mm, the lengths of power arm and resistance arm after fixation failure were (50.3±14.9)mm and (33.6±17.6)mm. In intramedullary fixation group, the lengths of primary power arm and resistance arm were (6.7±0.6)mm and (49.8±9.9)mm, the lengths of power arm and resistance arm after fixation were (51.5±7.0)mm and (19.8±5.9)mm, the lengths of power arm and resistance arm after fixation failure were (41.6±9.6)mm and (32.4±7.7)mm. In each group, the lengths of power arm and resistance arm after internal fixation showed significant differences from that of normal ones and from that after fixation failure ( P<0.05). The length of power arm in extramedullary fixation group was larger than that in intramedullary fixation group ( P<0.05). The shortening of power arm in extramedullary fixation group was larger than that in intramedullary fixation group after fixation failure ( P<0.05). Conclusions:The extramedullary and intramedullary fixation of femoral intertrochanteric fractures result in the displacement of reconstruction fulcrum. The shortening of power arm is observed after fixation failure. The leverage-balance-reconstruction theory is helpful to analyze the cause of complications. The power arm after extramedullary fixation is longer than that after intramedullary fixation and is therefore more prone to fixation failure. The primary cause of postoperative internal fixation complications is to achieve a new balance of leverage.
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Objective:To investigate the frequency of myeloid dendritic cells (mDC) and plasmacytoid dendritic cells (pDC) in peripheral blood of patients with systemic lupus erythematosus (SLE) and their relationship with renal injury.Methods:The frequency of peripheral mDC and pDC in 102 SLE patients and 10 healthy controls were detected by flow cytometry. The quantitative data were expressed by [ M( P25, P75)]. The measurement data of the two groups with non-normal distribution was analyzed by Mann Whitney U test. The correlation between the two groups was analyzed by Spearman rank correlation analysis and multiple linear regression. Results:The frequency of pDC [14.00%(7.92%, 19.65%) vs 24.55%(19.68%, 32.90%), Z=-3.163, P<0.01] and mDC [21.25%(13.28%, 32.83%) vs 34.85%(24.58%, 41.93%), Z=-2.607, P<0.01] in the peripheral blood of 102 patients with SLE were significantly lower than those of healthy controls. The frequency of pDC [9.09%(7.31%, 17.38%) vs 24.55%(19.68%, 32.90%), Z=-3.033, P=<0.01] and mDC [9.40%(7.88%, 21.60%) vs 34.85%(24.58%, 41.93%), Z=-3.231, P<0.01] in 12 patients with newly diagnosed SLE were also significantly lower than those in healthy controls. After adjustedfor confounding factors, multivariate analysis showed that SLEDAI level was the main factor influencing the frequency of pDC ( P=0.019) and mDC ( P<0.01). In addition, pDC[8.02%(2.25%, 9.97%) vs 16.70%(11.80%, 24.60%), Z=-2.490, P=0.015] and mDC[8.80%(5.99%, 12.80%) vs 20.20%(11.20%, 42.80%), Z=-2.226, P=0.029] in patients with active LN were also significantly lower than that of patients with stable LN. The mDC frequency was positively correlated with the levels of complement C3 ( r=0.455, P<0.01) and C4 ( r= 0.289, P, P<0.01). Conclusion:The frequency of mDC and pDC in SLE patients is significantly abnormal, which is closely related to disease activity. In addition, pDC and mDC may be involved in the occurrence and development of LN.
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Objective:To detect the levels of cytokines in peripheral blood of patients with chronic immune thrombocytopenia (ITP) and analyze their significance in the clinical prognosis of children with chronic ITP.Methods:Thirty patients with chronic ITP who were treated in the Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical Univercity from October 2015 to October 2018 were followed and enrolled in the experimental group and 40 healthy children in the same hospital were enrolled in the healthy control group.The levels of interleukin-2(IL-2), interferon-γ(IFN-γ), tumor necrosis factor(TNF), interleukin-4(IL-4), interleukin-6(IL-6), interleukin-10(IL-10) and interleukin-17A(IL-17A) in the experimental group and the healthy control group were detected by flow cytometry (CBA). The relationship between cytokines and prognosis of children with chronic ITP were analyzed.Results:Thirty patients with ITP were enrolled. The expressions of IL-2 and IL-17A in the experimental group before treatment were (7.86±3.90) ng/L and (10.45±12.35) ng/L, while those of IL-2 and IL-17A in the healthy control group were (3.11±2.41) ng/L and (2.97±7.04) ng/L. The levels of IL-2 and IL-17A in the experimental group were significantly higher than those in the healthy control group, and the differences were statistically significant ( t=-7.123, -5.582, all P<0.01). The expressions of IL-4 and IL-10 in the experimental group before treatment were (0.38±0.25) ng/L and (1.80±1.25) ng/L, while those of IL-4 and IL-10 in the healthy control group were (3.08±0.26) ng/L and (4.55±3.44) ng/L. The levels of IL-4 and IL-10 in the experimental group were significantly lower than those in the healthy control group, and the differences were statistically significant ( t=8.400, 5.653, all P<0.01). The expressions of IL-6, TNF and IFN-γ in the experimental group before treatment were (7.30±9.16) ng/L, (4.85±7.60) ng/L and (7.68±20.41) ng/L, while those of IL-6, TNF and IFN-γ in the healthy control group were (5.44±4.18) ng/L, (1.97±0.37) ng/L, (4.81±17.71) ng/L. There was no significant difference between the two groups ( P>0.05), and no significant difference in the levels of cytokines between the patients with chronic ITP before and 12 months after treatment ( P>0.05). Conclusions:The changes of T lymphocyte related cytokines are closely related to the pathogenesis and development of chronic ITP in children. There may be persistent immune dysfunction in children with chronic ITP. Dynamic monitoring of cytokines IL-2, IL-4, IL-10, IL-17A, especially IL-17A, is helpful to judge the prognosis of ITP in children, and may be of guiding significance in evaluating clinical prognosis.
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Objective:To compare the effect of intranasal dexmedetomidine and oral chloral hydrate in deep sedation of children.Methods:The Pubmed, EMBase, CENTRAL (Issue 4, 2018), Web of science, CBM, Wanfang Data, CNKI and VIP databases from the inception to January 2019 were searched. Randomized controlled trials (RCTs) with dexmedetomidine and chloral hydrate as interventions were included and the data were analyzed by RevMam 5.3 and Stata 12.0 software. The success rate of deep sedation, the indicator of sedation onset time, the recovery time, the incidence of vomiting and bradycardia were compared.Results:A total of 7 RCTs involving 1 007 patients were included for analysis. The results showed that the success rate of deep sedation ( OR=2.55, 95 %CI:1.46-4.44, P<0.01) and the incidence of bradycardia ( OR=4.42, 95 %CI:1.82-10.74, P<0.01) in the dexmedetomidine nasal group were significantly higher than those in the chloral hydrate oral group. The recovery time was significantly shorter ( MD=-16.41, 95 %CI:-21.54-11.28, P<0.01) and the incidence rate of vomiting ( OR=0.04, 95 %CI:0.01-0.17, P<0.01) in dexmedetomidine nasal group was significantly lower than those in the chloral hydrate oral group. There was no significant difference in the indicator of sedation onset time ( MD=-0.47, 95 %CI:-2.71-1.22, P=0.46). Conclusion:Compared with the traditional oral chloral hydrate, intranasal dexmedetomidine has a higher sedation success rate and shorter recovery time after sedation with a lower incidence of nausea and vomiting.
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Intertrochanteric femoral fractures are common in clinical practice and the key to treatment is timely stable fixation and early rehabilitation to prevent bedridden complications. At present, the failure of common internal fixation system in the treatment of unstable intertrochanteric femoral fractures is not rare. The authors think that for the normal anatomical type of leverage structure of human proximal femur, pivot can bear weight and complete multidirectional activities because its pivot is close to the center of the body. The intertrochanteric femoral fractures destroyed the trabecular structure on the tension side and pressure side. At the same time, the physiological lever of the proximal femur was destroyed. The cause for the failure of the existing internal fixation is the inability to reconstruct the physiological pivot. Based on the anatomical and biomechanical characteristics of the proximal femur, the author reviewed the previous literatures and analyzed the problems in the treatment of intertrochanteric femoral fractures, and for the first time raised the " lever-pivot balance" theory for the treatment of intertrochanteric femoral fractures. This theory opens a new way for solving the problems in treatment of intertrochanteric femoral fractures.
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Objective:To investigate the differential expression of cyclooxygenase (COX) gene between familial aggregated atherosclerotic large-artery atherosclerosis(LAA) cerebral infarction patients and sporadic LAA cerebral infarction patients.Methods:Twenty-five patients with familial aggregation LAA cerebral infarction (familial aggregation LAA group) and 25 sporadic LAA cerebral infarction patients (sporadic LAA group) were collected.Another 25 patients with non-cardiovascular and cerebrovascular diseases were selected as control group.Real-time quantitative PCR and ELISA were used to detect COX-1 and COX-2 protein in the supernatant of samples.Results:The expression level of COX-1 gene was 0.5436±0.2737, 0.2400±0.1656 and 0.8340±0.3799 in the familial aggregation, sporadic LAA cerebral infarction and control groups.Compared with control group, COX-1 gene expression in sporadic LAA cerebral infarction group and familial aggregation LAA cerebral infarction group was significantly down-regulated, the differences were significant( P<0.05). The expression level of COX-2 gene was 1.3672±0.8249, 1.3932±0.7158 and 0.7212±0.9623 in the familial aggregation, sporadic LAA cerebral infarction and control groups.Compared with the normal control group, the expression of COX-2 gene in familial aggregation LAA cerebral infarction group and sporadic LAA cerebral infarction group increased significantly( P<0.05). The expression of COX-1 protein was 2.9956±0.5672, 2.5572±1.0289 and 2.6721±0.7944 in the familial aggregation, sporadic cerebral infarction and control groups.The expression of COX-2 protein was 16.63±4.06, 16.86±7.93 and 15.94±5.94 in the familial aggregation, sporadic cerebral infarction and control groups.There was no significant difference in the relative expression of COX-1 and COX-2 proteins among familial aggregation LAA cerebral infarction group, sporadic LAA cerebral infarction group and control group(all P>0.05). Conclusion:There is significant difference in COX-1 gene expression between patients with familial LAA and sporadic LAA cerebral infarction.
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Objective@#To compare the effect of intranasal dexmedetomidine and oral chloral hydrate in deep sedation of children.@*Methods@#The Pubmed, EMBase, CENTRAL (Issue 4, 2018), Web of science, CBM, Wanfang Data, CNKI and VIP databases from the inception to January 2019 were searched. Randomized controlled trials (RCTs) with dexmedetomidine and chloral hydrate as interventions were included and the data were analyzed by RevMam 5.3 and Stata 12.0 software. The success rate of deep sedation, the indicator of sedation onset time, the recovery time, the incidence of vomiting and bradycardia were compared.@*Results@#A total of 7 RCTs involving 1 007 patients were included for analysis. The results showed that the success rate of deep sedation (OR=2.55, 95%CI:1.46-4.44, P<0.01) and the incidence of bradycardia (OR=4.42, 95%CI:1.82-10.74, P<0.01) in the dexmedetomidine nasal group were significantly higher than those in the chloral hydrate oral group. The recovery time was significantly shorter (MD=-16.41, 95%CI:-21.54-11.28, P<0.01) and the incidence rate of vomiting (OR=0.04, 95%CI:0.01-0.17, P<0.01) in dexmedetomidine nasal group was significantly lower than those in the chloral hydrate oral group. There was no significant difference in the indicator of sedation onset time (MD=-0.47, 95%CI:-2.71-1.22, P=0.46).@*Conclusion@#Compared with the traditional oral chloral hydrate, intranasal dexmedetomidine has a higher sedation success rate and shorter recovery time after sedation with a lower incidence of nausea and vomiting.
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The National Health Commission recently has released a notice about further promoting the trauma rescue and treatment in China, which includes four main contents as follows: ( 1 ) to strengthen the establishment of regional trauma rescue and treatment system based on trauma center;(2) to lift the specialized medical service ability related to trauma rescue and treatment; ( 3 ) to further develop the radiant and stimulating role of National Trauma Medical Centre and National Regional Trauma Medical Center;(4) to enhance the trauma-related professional training and public health education. In this article, we interpret the third aspect regarding medical quality control and maintenance of trauma treatment, providing reference for better understanding the specific requirements of the document.
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Objective To investigate the expression of FBP1 in human renal clear cell carcinoma and paracancerous tissue and its effect and clinical significance in the carcinogenesis,progression and prognosis of renal cancer.Methods The paraffin sections from 118 patients with renal clear cell carcinoma treated by surgical resection and fresh specimens from 40 patients with renal clear cell carcinoma were selected.The expressions of FBP1 protein and mRNA in renal cancer and paracancerous tissues(negative incisal edge) were detected by adopting the immunohistochemistry(IHC),Western blot and RT-PCR.Its correlation with clinicopathologic characteristics and prognosis of the patients was analyzed.Results The IHC result,found that strong positive expression of FBP1 protein could be seen in 78.81％ (93/118) of cancer-adjacent tissues,while only 39.83％ (47/118) of renal cancer tissues had positive expression.Western blot found that the expression positive rate of FBP1 in renal cancer tissue was significantly decreased compared with corresponding cancer-adjacent tissues (P＜0.01).RT-PCR found that the FBP1mRAN expression level in cancer-adjacent tissues was also significantly higher than that in renal cancer tissue(P＜0.05).The FBP1 low expression was significantly correlated with the clinical stage,pathologic grade,UISS risk coefficient and recurrence(P＜0.05),and had no relation with the age,gender,symptoms,tumor size,location,tumor necrosis,vascular invasion and adrenal involvement(P＞0.05).The 5-year survival rate in renal cancer patients with FBP1 positive expression was higher than that in the patients with FBP1 negative expression(P＜0.05).Conclusion FBP1 and protein are lowly expressed in renal cancer tissue,are correlated with occurrence and development of renal cancer,and may become one of candidate markers of renal cancer prognosis.