Prediabetes Progression and Regression on Objectively- Measured Physical Function: A Prospective Cohort Study

Background@#Prediabetes leads to declines in physical function in older adults, but the impact of prediabetes progression or regression on physical function is unknown. This study assessed this longitudinal association, with physical function objectivelymeasured by grip strength, walking speed, and standing balance, based on the Health and Retirement Study enrolling United States adults aged >50 years. @*Methods@#Participants with prediabetes were followed-up for 4-year to ascertain prediabetes status alteration (maintained, regressed, or progressed), and another 4-year to assess their impacts on physical function. Weak grip strength was defined as <26 kg for men and <16 kg for women, slow walking speed was as <0.8 m/sec, and poor standing balance was as an uncompleted fulltandem standing testing. Logistic and linear regression analyses were performed. @*Results@#Of the included 1,511 participants with prediabetes, 700 maintained as prediabetes, 306 progressed to diabetes, and 505 regressed to normoglycemia over 4 years. Grip strength and walking speed were declined from baseline during the 4-year followup, regardless of prediabetes status alteration. Compared with prediabetes maintenance, prediabetes progression increased the odds of developing weak grip strength by 89% (95% confidence interval [CI], 0.04 to 2.44) and exhibited larger declines in grip strength by 0.85 kg (95% CI, –1.65 to –0.04). However, prediabetes progression was not related to impairments in walking speed or standing balance. Prediabetes regression also did not affect any measures of physical function. @*Conclusion@#Prediabetes progression accelerates grip strength decline in aging population, while prediabetes regression may not prevent physical function decline due to aging.

Risk factors of extrauterine growth retardation in very preterm infants with birth weight less than 1 500 g / 中国新生儿科杂志

Objective:To study the risk factors of extrauterine growth retardation (EUGR) during hospitalization in very preterm infants (VPIs) with birth weight (BW) <1 500 g.Methods:From Jan 2015 to Dec 2020, clinical data of VPIs admitted to neonatal department our hospital were retrospectively studied. The infants were assigned into EUGR group and non-EUGR group according to their weight at discharge. Multivariate logistic regression analysis was used to analyze the risk factors of EUGR in VPIs.Results:A total of 969 VPIs were enrolled, including 400 cases of EUGR (41.3%). Multivariate logistic regression analysis showed that Z-score of BW ( OR=0.057, 95% CI 0.037-0.088, P<0.001) was closely correlated with the occurrence of EUGR and growth velocity (GV) after regain BW ( OR=0.537, 95% CI 0.479-0.602, P<0.001) was a protective factor for EUGR. Maternal hypertension during pregnancy ( OR=1.895, 95% CI 1.059-3.394, P=0.031), asphyxia at birth ( OR=2.508, 95% CI 1.265-3.347, P=0.004) and moderate to severe bronchopulmonary dysplasia (BPD) ( OR=2.660, 95% CI 1.503-4.708, P=0.001) were risk factors for EUGR at discharge. Conclusions:EUGR is still common in VPIs. Increased GV after regain BW, prevention and treatment of moderate to severe BPD may reduce the incidence of EUGR at discharge in VPIs.

Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT).@*METHODS@#The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared.@*RESULTS@#All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation ( P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation ( P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group ( P<0.05). There was no significant difference in other baseline data between the two groups ( P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group ( P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups ( P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B ( P>0.05).@*CONCLUSION@#Tendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.

Long-term effectiveness of arthroscopic partial repair for massive irreparable rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives.@*METHODS@#A retrospective analysis was conducted on the clinical data of 24 patients (25 sides) with massive irreparable rotator cuff tears who met the inclusion criteria between May 2006 and September 2014. Among them, there were 17 males (18 sides) and 7 females (7 sides) with an age range of 43-67 years (mean, 55.0 years). There were 23 cases of unilateral injury and 1 case of bilateral injuries. All patients were treated with the arthroscopic partial repair. The active range of motion of forward elevation and abduction, external rotation, and internal rotation, as well as the muscle strength for forward flexion and external rotation, were recorded before operation, at the first postoperative follow-up, and at last follow-up. The American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, and Constant score were used to evaluate shoulder joint function. And the visual analogue scale (VAS) score was used to evaluate shoulder joint pain. MRI examination was performed. The signal-to-noise quotient (SNQ) was measured above the anchor point near the footprint area (m area) and above the glenoid (g area) in the oblique coronal T2 fat suppression sequence. The atrophy of the supraspinatus muscle was evaluated using the tangent sign. The global fatty degeneration index (GFDI) was measured to assess fat infiltration in the supraspinatus muscle, infraspinatus muscle, teres minor muscle, upper and lower parts of the subscapularis muscle. The mean GFDI (GFDI-5) of 5 muscles was calculated.@*RESULTS@#The incisions healed by first intention. All patients were followed up with the first follow-up time of 1.0-1.7 years (mean, 1.3 years) and the last follow-up time of 7-11 years (mean, 8.4 years). At last follow-up, the range of motion and muscle strength of forward elevation and abduction, ASES score, Constant score, UCLA score, and VAS score of the patients significantly improved when compared with those before operation ( P<0.05). Compared with the first follow-up, except for a significant increase in ASES score ( P<0.05), there was no significant difference in the other indicators ( P>0.05). Compared with those before operation, the degree of supraspinatus muscle infiltration worsened at last follow-up ( P<0.05), GFDI-5 increased significantly ( P<0.05), and there was significant difference in the tangent sign ( P<0.05); while there was no significant difference in the infiltration degree of infraspinatus muscle, teres minor muscle, and subscapularis muscle, upper and lower parts of the subscapularis muscle ( P>0.05). Compared with the first follow-up, the SNQm and SNQg decreased significantly at last follow-up ( P<0.05). At the first and last follow-up, there was no correlation between the SNQm and SNQg and the ASES score, Constant score, UCLA score, and VAS score of the shoulder ( P>0.05).@*CONCLUSION@#Arthroscopic partial repair is effective in treating massive irreparable rotator cuff tear and significantly improves long-term shoulder joint function. For patients with severe preoperative fat infiltration involving a large number of tendons and poor quality of repairable tendons, it is suggested to consider other treatment methods.

Maternal lactation initiation behavior / 中华围产医学杂志

The initiation of lactation is the critical initial event contributing to breastfeeding. It is of great significance for maternal lactation and neonatal access to breast milk. However, various factors limit the successful initiation of lactation and increase the risk of poor neonatal prognosis. We provide an overview of the mechanism, significance, method, time, and factors that influence lactation initiation behavior, and summarize related guidelines aiming to gain more insight into the lactation initiation behavior to promote maternal lactation and improve neonatal prognosis.

Primary research of early oral feeding after total laryngectomy / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore whether early oral feeding after total laryngectomy is safe and effective by evaluating the incidence of pharyngocutaneous fistula (PCF) and the hospital duration. @*Methods@#A retrospective cohort study was conducted, including 52 patients underwent total laryngectomy, plus partial tongue base resection (n=2), partial pharyngectomy (n=1), or pedicle flap (n=2) between January 2012 and October 2017. Patients who had a history of preoperative radiotherapy, chemotherapy or chemoradiotherapy, previous surgery for larynx or pharynx and who had severe complications were excluded. Early oral feeding started between 48 h and 72 h postoperatively, while delayed oral feeding started within postoperative day 8-10. The incidences of PCF in two groups were compared to evaluate whether PCF and early oral feeding was related. Multi-variables analysis was conducted to evaluate risk factors for PCF. @*Results@#PCF rate was 19.2% among all patients, 11.1% in patients with early oral feeding and 23.5% in patients with delayed oral feeding. No significant statistically difference in PCF rate was found between two groups (χ2=0.506, P=0.477). Multi-variables analysis showed that oral feeding time (early or delayed) was not a independent risk factor of PCF (Two classification response variable Logistic regression, P=0.200, OR=0.242, 95%CI[0.028-2.118]). But low preoperative albumin level was observed as an independent risk factor for PCF (P=0.039, OR=0.848, 95% CI [0.726-0.992]). A negative correlation was observed between preoperative albumin level and PCF. And also there was not a significant difference in hospital duration between patients with early oral feeding and delayed oral feeding(U=268, P=0.464). @*Conclusion@#For patients total laryngectomy with no previous history of radiotherapy, chemotherapy, chemoradiotherapy, early oral feeding after surgery is safe and effective.

Clinical and MRI results of arthroscopic repair for massive rotator cuff tear / 中华骨科杂志

Objective To investigate the clinical and MRI outcomes of the arthroscopic rotator cuff repair for massive ro tator cuff tear at minimum 2 years after surgery.Methods From October,2010 to March,2013,data of 79 shoulders in 77 patients with massive rotator cuff tear who were treated with arthroscopic rotator cuff repair were retrospectively analyzed.There were 42 male (44 shoulders) and 35 female (35 shoulders).The average age before surgery was 57.4 years (43.1-80.4 years).There were 64 right shoulders and 15 left shoulders.The dominate side were involved in 70 cases.A trauma history was documented in 52 shoulders.The symptoms persisted less than 3 months in 42 shoulders,between 3 and 6 months in 11 shoulders,between 6 and 12 months in 11 shoulders and more than 1 year in 15 shoulders.No revision case was included.The clinical results (range of motion,forward elevation strength,external rotation strength and American Shoulder & Elbow Surgeons (ASES) score and MRI results were collected.Results All 77 cases were followed up more than 2 years.The forward elevation (156.9°±20.0° to 103.2°± 54.5°),external rotation (40.6°±15.5° to 32.0°±21.4°),internal rotation (L1 to ~),forward elevation strength (9.7±4.7 lb to 4.6±4.9 lb),external rotation strength (11.1±5.1 lb to 8.3±5.4 lb) and ASES score (82.7±14.6 to 45.2± 17.4) were all improved significantly at the latest follow-up.During the surgery,complete repair were achieved in 68 shoulders.The forward elevation (146.4°±31.4° to 110.0°±56.7°),external rotation (45.0°± 14.8° to 34.1°±20.8°) and ASES score (78.6± 14.9 to 54.5± 13.9) were all improved signifi cantly at the latest follow-up in patients with partial repair during the surgery.But the forward elevation strength (10.5±4.9 lb to 6.2±3.2 lb) and external rotation strength (11.5±5.1 lb to 8.3±3.8 lb) were significantly better improved in patients who had complete repair.In 68 shoulders with complete repair during the surgery,20 shoulders were found to have rotator cuff re-tear.The retear rate was 29.4％.But none of the patient with postoperative re-tear received revision surgery.The forward elevation (152.0± 23.3 to 103.5±60.5),forward elevation strength (8.5±4.7 lb to 5.0±4.7 lb) and ASES score (76.9±16.5 to 40.8±18.6) were all improved significantly at the latest follow-up in patients with postoperative re-tear of the rotator cuff tendon.But the forward elevation (161.4°± 13.4° to 152.0°±23.3°),forward elevation strength (11.3±4.7 lb to 8.5±4.7 lb),external rotation strength (12.4±4.8 lb to 9.6±5.3 lb) and ASES score (86.0±13.0 to 76.9±16.5) were significantly better in patients with complete healed rotator cuff tendon comparing with the re-tear group.Conclusion The rotator cuff repair can significantly improve the shoulder function of massive rotator cuff tear even when the rotator cuff tendon can only be partially repaired or re-tear after the surgery.The shoulder function is significantly better in patients with complete healed rotator cuff tendon comparing with the partial repair group and the re-tear group.

Clinical analysis of secondary cervical lymph node dissection in papillary thyroid carcinoma / 中华肿瘤杂志

Objective@#To investigate the value of secondary cervical lymph node dissection in papillary thyroid carcinoma (PTC).@*Methods@#PTC patients with recurrence re-operated in a previously dissected area at our hospital during 2000-2016 were included in this analysis. Patients were divided according to the operative interval of 6 months. The level and number of lymph node metastasis and the number of lymph node dissection were analyzed to calculate the ratio of lymph node metastasis.@*Results@#A total of 336 PTC patients received 360 side lateral cervical lymph nodes dissection. The ratio of recurrence in unilateral lateral neck is 92.9%(312/336). The ratio of recurrence in multiple levels (more than two regions) were 47.5% (171/360). The recurrence ratio of level Ⅱ, Ⅲ, Ⅳ and Ⅴ were 55.6%(200/360), 44.2%(159/360), 59.7%(215/360) and 10.3%(37/360), respectively. Lymph node metastases were inclined to level Ⅱ (33.6%) and Ⅳ (35.8%). The mean number of lymph node dissection and metastasis in the group of operative interval ≤ 6 months was 26.56 per case and 4.37 per case, respectively. The mean number of lymph node dissection and metastasis in the group of operative interval >6 months was 16.80 per case and 3.20 per case, respectively. The number of lymph node dissection and metastasis between these two groups were significantly different (P=0.001, P<0.001).@*Conclusions@#Lymph node metastasis of PTC patients with secondary cervical lymph node dissection are inclined to level Ⅱ and level Ⅳ. Moreover, multi-level metastasis is not rare. Level Ⅱ and level Ⅳ require more attention in the first operation. Most of the patients undergo reoperation because of residual lymph nodes from the previous treatment. Normalization and completeness of the initial dissection are particularly important to PTC patients.

A Comparative Study of SNPscan and Sanger Sequencefor Common Deafness Gene / 听力学及言语疾病杂志

Objective To compare the advantages and disadvantages of SNPscan and Sanger sequence which are both used to detect the common deafness gene mutations in non-syndromic hearing loss (NSHL) in Gansu Province.Methods Peripheral blood samples were obtained from Dongxiang, Yugu and Baoan people with moderately severe to profound sensorineural hearing loss in Gansu province to extract genomic DNA.SNPscan was used to detect the 115 mutations in the common pathogenic GJB2 gene, SLC26A4 gene and mtDNA gene.Results We used the SNPscan to screen the mutation of GJB2 gene,mtDNA A1555G and mtDNA C1494T, SLC26A4 gene of sensorinural deafness patients from Gansu Province.The mutation rate of these three genes was 23.18% (35/151), and the mutation rate of Dongxiang, Yugu, Baoan was 21.31% (26/122), 54.54% (6/11), 16.67% (3/18), respectively.Compared with the Sanger sequence, the results were statistically insignificant(P>0.05).The detection rates in the three genes of SNPscan were 11.26% (17/151), 1.32% (2/151) and 0.66% (1/151),respectively , and the detection rates of Sanger sequence were 9.93% (15/151), 1.32% (2/151) and 0.66% (1/151) ,respectively.The results of the two methods were compared.The results were statistically insignificant (P>0.05).Time, cost and flux, SNPscan method is superior to Sanger sequencing.Conclusion Compared with the Sanger sequence, SNPscan is more lighter in workload, less time-consuming, higher-throughput, lower cost, and can get more meaningful mutations and reduce the false negative rates.

Clinical efficacy and safety of bevacizumab combined with TP chemotherapy in platinum recurrent ovarian cancer / 中国生化药物杂志

Objective To study the clinical efficacy and safety of bevacizumab combined with TP chemotherapy in platinum recurrent ovarian cancer.Methods34 patients with platinum sensitive recurrent ovarian cancer were seleted as the objects.All patients were treated with bevacizumab plus paclitaxel and cisplatin.The short-term effects, overall survival(OS), progression free survival(PFS) and incidence of adverse reaction during chemotherapy were observed.ResultsThe patients with CR, PR, SD and PD were 3 cases, 24 cases, 5 cases and 2 cases, respectively.The median PFS and median OS of patiens were 12.7months and 26.2 months, respectively.The incidence of decrease in leukocytes, thrombocytopenia, neutrophils, gastrointestinal reactions, elevated levels of transaminase, hypertension, epistaxis, proteinuria, peripheral neuropathy, mucositis were 73.53%, 20.59%, 67.65%, 82.35%, 47.06%, 14.71%, 5.88%, 17.65%, 29.41% and 17.65%, respectively.ConclusionThe bevacizumab combined with TP chemotherapy in treatment of platinum sensitive recurrent ovarian cancer can better relieve the disease, improve the survival time of the patient, the adverse reaction is controllable, and the safety is good, which has the clinical popularization value.

Research progress of PARP inhibitors in ovarian cancer / 中国生化药物杂志

Ovarian cancer is one of the highest mortality rate of gynecologic malignant tumors. Chemotherapy can improve the survival rate of the traditional ovary. In recent years, PARP [poly(ADP-ribose)polymerase]inhibitors in breast cancer susceptibility gene (breast cancer susceptibility gene, BRCA) mutations in patients with ovarian cancer can significantly improve the disease-free survival, may change the prognosis of patients with ovarian cancer. This part of PARP [poly(ADP-ribose)polymerase] inhibitors, inhibiting the repairment of DNA damage in tumor cell, causing DNA damage accumulation, eventually killing tumor cells.In breast cancer susceptibility gene 1 (breast cancer susceptibility gene1, BRCA1)/BRCA2 mutation patients with ovarian cancer, PARP inhibitors and BRCA mutation of the synthetic lethal effect provides a new direction for the development of anti-cancer drugs. Now, many highly selective and sensitive PARP inhibitors have been developed and applied in clinical trials.Although PARP inhibitor monotherapy can produce a therapeutic effect in BRCA mutation in patients with ovarian cancer, but the clinical application is still used in combination with other chemotherapy or radiotherapy. This review is focused on the recent progress in clinical trials of PARP inhibitors in combination with common chemotherapeutic agents.

Short-term complications in reconstruction of the postoperative defects with free jejunum graft in patients with pharyngeal, laryngeal or cervical esophageal cancers / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical effects and short-term complications of using free jejunum graft (FJG) to reconstruct the defects by resections of pharyngeal, laryngeal or cervical esophageal cancers.@*METHOD@#Fifty-eight cases of pharyngeal, laryngeal or cervical esophageal cancers were reconstructed with FJG. All cases were analyzed retrospectively.@*RESULT@#The success rate of FJG transplantations was 91.4% (53/58). The incidence of post-operative short-term complication was 43.1% (25/58), which was not related to age or BMI. The most common complication was anastomotic leakage (18.9%), which was not related to per-operative radiation therapy. However, BMI > 25 cases had significantly higher incidence of anastomotic leakage than BMI ≤ 25 cases (P = 0.009). The second and third most common complications were respiratory system complications (10. 3%) and FJG necrosis (8. 6%). Para-operative death rate was 3.4% (2/58). Two-year overall survival rates of hypopharyngeal cancer and cervical esophageal cancer were 49% and 67% respectively. The group with no short-term complications had a slightly better survival rate than the group with short-term complications from the Kaplan-Meier curve, but there was no significant difference (P = 0.103).@*CONCLUSION@#FJG is ideal to reconstruct cervical digestive tract circumferential defects with a high success rate and a low mortality. However, the post-operative complication rate is high. Intensive observation, early detection and timely treatment of complications are crucial.

Metamemory monitoring ability in patients with idiopathic generalized epilepsy / 中华行为医学与脑科学杂志

Objective To investigate the memory monitoring ability in patients with idiopathic generalized epilepsy (IGE) and explore the mechanism of the memory impairment.Methods The feeling of knowing (FOK) paradigm of episodic memory (EM) and semantic memory (SM) were established and subsequently administered in 31 patients with IGE (IGE group) and 30 healthy controls (HC group) participants who were matched in age,sex and educational level.Results Compared with HC group (feeling of knowing of episodic memory (FOK-EM) FOK accuracy (85.29± 16.84) ％;feeling of knowing of sematic memory (FOK-SM) recall (76.61± 18.66) ％),the FOK-EM FOK accuracy ((64.03± 22.10) ％) and FOK-SM recall ((53.27±26.91) ％) in IGE group were significantly decreased(t=-4.215,P＜0.01;t=-3.677,P＜0.01).The correct judgment and correct recognition of FOK-EM ((51.16±32.93) ％) and the false judgment and correct recognition ((21.07±24.38) ％) of FOK-EM in the IGE group were significantly different with the HC group (the correct judgment and correct recognition of FOK-EM:(79.34±27.26)％ and the false judgment and correct recognition of FOK-EM:(2.45±5.38) ％;t=-3.634,P＜0.01;t=4.149,P＜0.01).Most importantly,the false judgment and correct recognition of FOK-EM were correlated with the Digital Span Test,Vocabulary Fluency Test and the Stroop effect in IGE group (r=-0.309,P＜0.05;r=-0.355,P＜0.01;r=-0.354,P＜0.05;r=0.602,P＜0.01).Conclusion The results show that the IGE group made less accurate metamemory monitoring than the HC group by underestimating their memoU performance on FOK-EM,whereas the semantic metamemory monitoring is not impaired in IGE group.More importantly,the impairment of memory monitoring was correlated with the deficit of executive function,indicating that this mechanism can be an influential factor of memory disorder in IGE.It also indicates that the episodic and semantic metamemory monitoring depend on different neural networks.

Safety and effectiveness of laparoscopic surgery for early ovarian cancer / 中国内镜杂志

Objective To investigate the safety and effectiveness of laparoscopic surgery for early ovarian cancer. Methods Selected 90 early-stage ovarian cancer patients from January 2010 to December 2014 in Zhejiang Cancer Hospital as research subjects, and randomly divided into laparoscopic surgery group and laparotomy group. Then compared the age, BMI, ovarian cancer diameter, ovarian cancer staging, blood loss, operative time, surrounding or﹣gan damage, albumin difference before and after surgery, postoperative ventilation time, postoperative hospital stay, interval of postoperative to the first chemotherapy, postoperative fever cases, follow-up time, postoperative complica﹣tions, postoperative recurrence and postoperative death in two groups. Results Blood loss and operative time of la﹣paroscopic surgery group was less than that of laparotomy group (P 0.05). Conclusion Laparoscopic surgery for early-stage ovarian cancer has a relatively good safety and efficacy. Laparoscopic surgery has advantages over open surgery in improving early ovarian cancer intra﹣operative situation and postoperative situation.

Efficacy analysis of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures / 北京大学学报(医学版)

Objective:To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures.Methods:From January 2013 to December 2014,8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were ret-rospectively reviewed after the final follow-up.There were 1 man and 7 women with a mean age of (58.5 ±6.4)years,of whom 3 left shoulders and 5 right shoulders were involved.There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures,and 6 patients with hu-meral head necrosis as well as implant-associated infection after open reduction internal fixation for proxi-mal humeral fractures with the locking plate.The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery.At the first-stage surgery,all the patients underwent a thorough debridement,and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate.During the second-stage surgery,the cement spacer was removed,and then a revision shoulder arthroplasty with the reverse shoul-der prosthesis was performed in all the patients who were routinely followed up after the second-stage sur-gery.The visual analogue score (VAS ),Constant score and University of California Los Angeles (UCLA)score were employed to evaluate the postoperative shoulder function.Results:The mean follow-up time was (19.9 ±8.0)months (range 12 to 35 months).At the end of the follow-up,the median forward elevation [100°(60°,140°)vs.25°(0°,90°),P=0.011],the median external rotation [15°(0°,50°)vs.5°(0°,20°),P=0.048],and the median internal rotation [L4 (buttock,T12) vs.buttock (buttock,L3 ),P =0.041 ]were all significantly improved postoperatively.The median Constant score [53.5 (32,74)vs.29.0 (10,57),P=0.012],the median UCLA score [20.5 (9, 26)vs.9.5 (5,15),P=0.012],and the median VAS score [1.5 (0,5)vs.5.0 (0,8),P=0.018]were all significantly improved after the surgery.No recurrence of infection,prosthetic loosening or neurovascular injury was noted by the last follow-up.Conclusion:Two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures.The shoulder function was postoperatively improved to a certain degree.

Analysis of the diagnosis and treatment of myoepithelial carcinoma of the parotid gland: report of 17 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Myoepithelial carcinoma (MC) is a rare malignant neoplasm of the salivary gland. The aim of this study was to analyze the diagnosis, treatment and prognosis of MC of the parotid gland.</p><p><b>METHODS</b>The clinicopathological data of 17 cases of MC of the parotid gland treated in our hospital from 1999 to 2013 were analyzed retrospectively. Of all the 17 patients, 9 cases received radical surgery only, 5 cases received postoperative radiotherapy, 2 cases received preoperative radiotherapy, and one case received chemotherapy. The survival rate was calculated by Kaplan-Meier analysis.</p><p><b>RESULTS</b>Among the 17 patients, 11 patients had post-operative recurrence (11/17, 64.7%), Of these 11 cases, 5 cases (45.5%) had recurrence within one year after the first operation. During the follow-up for 12-180 months (median 50 months), six cases died (two patients died of distant metastases and 4 cases died of local recurrence). The overall 1-year, 2-year and 5-year survival rates were 94.1%, 74.2% and 64.9%, and the overall 1-year, 2-year and 5-year recurrence-free survival rates were 70.6%, 48.1% and 40.1%, respectively.</p><p><b>CONCLUSIONS</b>Radical surgery is the main treatment modality for myoepithelial carcinoma of the parotid gland. For the patients with extensive lesions or after palliative surgery, adjuvant radiotherapy or chemotherapy might be helpful. However, its therapeutic efficacy remains to be proved.</p>

Effect of 3% hypertonic saline as early fluid resuscitation in pediatric septic shock / 中华儿科杂志

<p><b>OBJECTIVE</b>The mainstay of therapy in patients with septic shock is early and aggressive intravenous fluid resuscitation. However the type of intravenous fluid that would be ideal for managing septic shock has been intensely debated. In this study, the authors observed the effects of 3% hypertonic saline solution compared with normal saline solution as early fluid resuscitation in children with septic shock.</p><p><b>METHOD</b>In this prospective study, 44 septic shock children seen in the intensive care unit (ICU) of the Children's Hospital Affiliated to Capital Institute of Pediatrics were enrolled from January 2012 to January 2014, of whom 33 were male and 11 were female. Patients were randomly divided into two groups: normal saline group (NS group, 24 patients) and 3% hypertonic saline group (HS group,20 patients). There were no significant differences between the 2 groups of patients in age, gender, pediatric critical illness score (PCIS), oxygenation index (OI = PaO2/FiO2), arterial lactate, initial hemodynamic parameters, serum sodium and treatment at time of admission. Patients in NS group received normal saline guided by standard therapy. Those in HS group received 6 ml/kg 3% hypertonic saline as a single bolus over 10 min to 15 min with a maximum of 2 boluses and other standard therapy. Heart rate (HR), mean arterial blood pressure (MAP), arterial lactate, oxygenation index, urine output, serum sodium, lactate clearance rate, PCIS, fluid infusion volume, vasoactive - inotropic score, mechanical ventilation time , as well as incidence of multiple organ dysfunction syndrome (MODS), and 28 days in - hospital mortality were recorded for all patients.</p><p><b>RESULT</b>(1) HR, MAP in both groups were significantly higher after infusion than those on admission. There were no significant difference in HR and MAP at 1h, 3h, 6h and 24h after infusion between NS group and HS group. (2) OI in HS group was significantly higher than that on admission at 3 hours after infusion [(321. 8 ± 50. 7) vs. (296. 5 ± 58. 2) mmHg, t = -2. 50, P = 0. 018 ]), and it was significantly higher at 24 hours after infusion in NS group (325. 7 ± 62. 6) vs. (304. 2 ± 70. 4) mmHg, t = -2.60, P=0.016]. There were no significant differences in OI at 1h, 3h, 6h and 24h after infusion between NS group and HS group. (3) At 1 hour after infusion, serum sodium in HS group was significantly higherthan that in NS group [(138.3 ± 3.8)vs. (135.0 ± 3.5) mmol/L, t=8.77, P=0.005], and then no significant difference at 3h, 6h and 24h after infusion between two groups. (4) At 6 hours and 24 hours after treatment, fluid infusion volume in HS group was markedly less than that in NS group [6 h: (39. 2 13. 9) vs. (60. 8 ± 22. 4) ml/kg, t = 14. 21, P =0. 000; 24 h: (102. 9 ± 27. 7) vs. (130. 6 ± 33. 2 ) ml/kg, t= 8. 85, P = 0. 005]. Urine output had not significant different between the two groups. (5) There were no significant differences in 24h PCIS, 24h lactate clearance rate, vasoactive - inotropic score and mechanical ventilation time between the two groups. The incidence of MODS (80. 0% in HS group, 70. 0% in NS group) and mortality rate(5. 0% in HS group, 8. 3% in NS group) were similar in both groups.</p><p><b>CONCLUSION</b>The 3% hypertonic saline was effective as resuscitation fluid in pediatric septic shock with respect to restoration of hemodynamic stability without obvious side effects. Hypertonic saline could more rapidly improve oxygenation and need less fluid infusion volume compared with normal saline.</p>

Management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To discuss the management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection.</p><p><b>METHODS</b>A total of 259 cases of free flap reconstruction performed in the Cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2013 were retrospectively analyzed, including 89 cases of anterolateral thigh flaps, 48 cases of radial forearm flaps, 46 free fibula flaps, 5 cases of inferior epigastric artery perforator flaps, 5 cases of free latissimus dorsi flaps, one case of lateral arm flap, and one case of medial femoral flap. The surveillance frequency of free flaps was q1h on post-operative day (POD) 1, q2h on POD 2 and 3, and q4h after POD 3. Vascular crises were reviewed for analysis.</p><p><b>RESULTS</b>The incidence rate of vascular crisis was 8.1% (21/259), with 15 males and 6 females. The average age was 54.8 years old (17-68), and the average time of vascular crisis was 100.8 h post-operation (3-432). There were 7 cases of free jejunum flaps and 14 dermal free flaps. Seven of these 21 cases with vascular crisis were rescued by surgery. The success rate of salvage surgery within 72 hours from the primary operation was 54.5% (6/11), significantly higher than that of salvage surgery performed later than 72 hours from primary operation (10.0%, 1/10, P=0.043). There were 14 cases of flap necrosis, two of which died of local infection.</p><p><b>CONCLUSION</b>Early detection of vascular crisis can effectively improve the success rate of salvage, so as to avoid the serious consequences caused by free flap necrosis.</p>

Arthroscopic coracoclavicular ligament reconstruction versus open modified Weaver-Dunn procedure for acromioclavicular joint dislocations:comparison of curative effect / 北京大学学报(医学版)

Objective:To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dis-locations.Methods:From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up.There were 49 men and 14 women with a mean age of (40.3 ±10.6) years.The mean time from injury to surgery was (10.3 ±5.3) d.According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with typeⅢinjury.All the patients with typeⅢinjury claimed high level of sport activi-ty.The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken.All the patients were rou-tinely followed up after the surgery.The visual analogue score ( VAS ) , American shoulder and elbow surgeons( ASES) score and University of California Los Angeles( UCLA) score were employed to evaluate the postoperative shoulder function.The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Re sults:The mean follow-up time was (29.6 ±6.0) months ( range:24 to 43 months) .No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient’ s age [(41.0 ±10.5) years vs.(38.0 ±10.8) years], gender (male/female,24/8 vs.25/6), classification (Ⅴ/Ⅲ,22/10 vs. 23/8), time from injury to surgery [(10.6 ±4.9) d vs.(10.1 ±5.7) d], dominant involvement (19/32 vs.17/31)and mean follow-up time [(29.8 ±6.4) months vs.(29.5 ±5.5) months], P>0.05.At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward elevation [(164.4 ±17.2) degrees vs.(162.6 ±12.9) degrees], mean external rotation [(60.9 ±17.0) degrees vs.(57.3 ±15.8) degrees], mean internal rotation [(T12 ±3 vertebrae) vs. (T12 ±3 vertebrae)], mean ASES scores (96.0 ±5.1 vs.94.5 ±3.8)and UCLA scores (34.2 ±1.5 vs. 33.7 ±1.4), P>0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group (1/32) compared with the open surgery group (7/31, P=0.026).Conclusion:Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function.The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.