The central nervous system involvement of patients with microscopic polyangiitis / 中华风湿病学杂志

Objective:To explore the clinical features and prognosis of central nervous system involvement in patients with microscopic polyangiitis (MPA).Methods:We retrospectively investigated the clinical data of 138 MPA patients hospitalized with MPA in Tianjin Medical University General Hospital from January 1, 2010 to November 1, 2019. Patients were divided into two groups according to whether they had the central nervous system (CNS) involvement or not and then Kaplan-Meier survival curve was used to analyze the survival rate between the two groups, Logistic regression model analysis was adopted to analyze risk factors, and P<0.05 was considered statistically significant. Results:①29 patients (21.0%)among the 138 MPA had CNS-affected, including 13(44.8%) males and 16(55.2%) females. CNS involvement was present at the diagnosis of MPA in 20 cases (69.0%) and after the diagnosis of MPA in 9 cases (31.0%). ②The clinical manifestations were motor impairment in 14 cases (48.3%), sensory impairment in 10 cases (34.5%), speech loss in 9 cases (31.0%), headache in 8 cases (27.6%), consciousness disorder in 7 cases (24.1%), dysphagia and bucking in 4 cases (13.8%), cranial nerves involvement in 3 cases (10.3%). The imaging manifestations of the head included infarction, hemorrhage, infarction with hemorrhage and linear dural thickening. Five patients received lumbar puncture. One patient showed elevation of cerebrospinal fluid pressure, 1 patient had elevated protein and 5 patients showed elevation of LDH.③Eighteen patients received glucocortoid combined with cyclophosphamide. CNS symptoms recurred in 6 patients, four patients had recurrent cerebral infarction. ④Median survival time was 55 months in the CNS affected group [95% CI=(14.215, 95.785)] and 86 months in the N-CNS group [95% CI=(24.378, 147.622)]. Kaplan-Meier survival curve showed that there was no significant difference in survival rate between the two groups ( χ2=0.07, P=0.794) . Conclusion:The central nervous system involvement of microscopic polyangiitis is not uncommon. The clinical manifestations are various, with motor impairment the most. The most common imaging manifestation is cerebral infarction and the patients mainly presenteas multiple cerebral infarction. However, the CNS involvement of microscopic polyangiitis is not associated with mortality.

Incidence and risk factors of early transient intraocular pressure elevation after canaloplasty for primary open-angle glaucoma / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Glaucoma is one of the most common optic neuropathies, featuring progressive retinal ganglion cell damage and visual field loss (Tham et al., 2014; Xu et al., 2020). Currently, the only effective treatment for this condition is the reduction of intraocular pressure (IOP) (Palmberg, 2001; Heijl et al., 2002). Canaloplasty is a proven bleb-independent surgery with good efficacy and safety profiles in primary open-angle glaucoma (POAG) (Gołaszewska et al., 2021). However, early transient postoperative IOP elevation has been reported in up to 30% of cases (Riva et al., 2019), similar to that commonly observed in other internal drainage glaucoma surgeries such as implantation using iStent (0%-21.0%), CyPass (10.8%), and Hydrus (4.8%-6.5%) (Lavia et al., 2017). This complication may be a predictor of poor reserve in the outflow system and is potentially associated with surgical failure. Nonetheless, the exact pathophysiology of glaucoma remains unknown, and studies clarifying the risk factors for postoperative IOP elevation have been scarce.

Progress of mesenchymal stem cell-derived exosomes for management of preeclampsia / 中华围产医学杂志

Pre-eclampsia is a common complication of pregnancy that can result in serious consequences for mother and child health, but there are currently no established therapeutic options. Mesenchymal stem cell-derived exosomes (MSC-exos) are nanoparticles carrying bioactive substances such as proteins, lipids, and nucleic acids, and serve as a medium of intercellular communication. MSC-exos are involved in many important physiological processes, including immunological regulation, cell proliferation and migration, and angiogenesis, thereby play an important role in tissue repair and potentially clinical treatment strategies. In recent years, the treatment strategies of MSC-exos have become an emerging hot topic in the management of ischemic diseases, immune dysfunction, inflammatory diseases, and other fields. We review the advantages and challenges of MSC-exos as a new acellular therapy strategy as well as the feasibility of MSC-exos in managing preeclampsia, from its biological role in the important pathogenesis of preeclampsia, such as trophoblastic and endothelial cell dysfunction, immune imbalance at the maternal-fetal interface, and oxidative stress, and summarize the progress of animal experimental research in this field.

Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization: a multicenter prospective study / 中国当代儿科杂志

OBJECTIVES@#To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China.@*METHODS@#A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined.@*RESULTS@#The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05).@*CONCLUSIONS@#It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.

Bone marrow mesenchymal stem cell transplantation for treating ischemic stroke / 中华物理医学与康复杂志

Objective:To observe any effect of transplanting bone marrow mesenchymal stem cells (BMSCs) after ischemic stroke, and explore its mechanism.Methods:Seventy-two spontaneous hypertensive male rats were randomly divided into a sham group, a model group and a BMSCs group, each of 24. A model of middle cerebral artery occlusion was induced in the rats of the model and BMSCs groups but not in the sham group. The BMSCs rats had 106 BMSCs injected into their tail veins 24 hours after the modeling, while the other 2 groups were injected with the same amount of phosphate buffer. Modified neurological deficit scoring and 2, 3, 5-triphenyltetrazole chloride staining were performed on the 3rd, 7th and 14th days after the operation. The mRNA and protein expressions of vascular endothelial growth factor (VEGF) and glial cell-derived neurotrophic factor (GDNF) in the rats′ brain tissues were detected by RT-PCR and western blotting.Results:On the 3rd, 7th and 14th days after the operation, the average neurological deficit score of the BMSCs group was significantly lower and the area of cerebral infarction was significantly smaller than among the model group. Moreover, the infarcted volume in the BMSCs group continued to decrease gradually as time went on. There was no significant difference between the sham and model group in the expression of VEGF or GDNF mRNA or protein 3, 7 or 14 days after the operation. They were, however, significantly higher in the ischemic brain tissue of the BMSCs group compared with the other two groups.Conclusions:BMSC transplantation has a neuroprotective effect on rats with hypertension modeling ischemic stroke. The mechanism may be that BMSCs can up-regulate the expression of VEGF and GDNF in ischemic brain tissue.

Training the skills of obstetric forceps delivery for resident doctors by using simulation teaching method / 中华医学教育探索杂志

In this study, 15 second-year resident doctors who had standardized training of OBGYN were taken as research subjects to discuss the effect of training resident doctors with obstetrics forceps by using simulation teaching method. The simulation teaching process includes theoretical study, theoretical examination, simulation teaching of forceps skills and Assessment of forceps skills. In theoretical study section: before learning to use forceps, the students acquired the theoretical knowledge by flipped teaching micro-video mode. In theoretical examination section: the mastery of basic clinical knowledge of using forceps was evaluated through online assessment. In simulation teaching of forceps skills: students who scored 8/10 points were admitted to enter the simulation teaching process, and they had practical training of scenario simulation skills in Clinical Skills Center. In assessment of forceps skills: the mastery of forceps skills was evaluated by standardized forceps delivery procedure items. The results showed that the students in the simulation teaching group had excellent teaching assessment results, and the resident doctors had more confidence in operating forceps independently, and the teaching effect was ideal, which could further promote the simulation teaching of obstetric clinical skills.

Therapeutic observation on herbal cake-partitioned moxibustion for dysmenorrhea due to deficiency cold / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of herbal cake-partitioned moxibustion for dysmenorrhea due to deficiency cold. Methods: A total of 70 patients with dysmenorrhea who met the inclusion criteria were randomized into a mild moxibustion group and a herbal cake-partitioned moxibustion group by the random number table, with 35 cases in each group. Shenque (CV 8), Zhongji (CV 3) and bilateral Zigong (EX-CA 1) were selected for both groups. The treatment continued for 3 menstrual cycles. The visual analog scale (VAS) and COX menstrual symptom scale (CMSS) were scored in both groups before treatment, after treatment and at the end of the 3rd menstrual cycle after treatment. The clinical efficacy was evaluated at the end of the 3rd menstrual cycle after treatment. Results: After treatment, the clinical efficacy of the herbal cake-partitioned moxibustion group had the tendency to be superior to that of the mild moxibustion group, while there was no statistically significant difference in the overall efficacy between the two groups (P>0.05). The VAS and CMSS scores after treatment and at the follow-up were significantly lower than those before treatment in both groups (all P<0.05). At the follow-up, the VAS scores in both groups had no significant intra-group differences from those after treatment (both P>0.05). The CMSS scores in both groups were significantly lower than those after treatment (both P<0.05). The VAS scores at the follow-up of both groups had no statistical differences from those after treatment (both P>0.05). After treatment, the CMSS score in the herbal cake-partitioned moxibustion group was significantly lower than that in the mild moxibustion group (P<0.05). At the follow-up, there were no statistical differences in the CMSS score between the two groups (P>0.05). Conclusion: The herbal cake-partitioned moxibustion has the same therapeutic efficacy for dysmenorrhea as the mild moxibustion; the two moxibustion methods can significantly improve the concomitant symptoms of dysmenorrhea, and the herbal cake-partitioned moxibustion is little better.

The value of the Pfirrmann grading standard for disc degeneration in the quantification of heterotopic ossification after artificial cervical disc replacement / 中华骨科杂志

Objective:To explore the value of the Pfirrmann grading standard for disc degeneration in the quantification of heterotopic ossification (HO) after artificial cervical disc replacement (ACDR).Methods:Data of 120 patients who underwent ACDR from January 2009 to December 2016 were retrospectively analyzed. There were 88 males and 32 females with an average age of 43.86±8.69 (range, 27-67) years old. There were 100 single-level replacements (9 Hybrid cases) and 20 double-level replacements (3 Hybrid cases). The occurrence of HO was observed by lateral radiographs of the cervical spine. The HO severity was assessed using the McAfee rating system. Degeneration degrees of cervical intervertebral discs were evaluated by the Pfirrmann grading standard based on the preoperative cervical MRI. The weighted Kappa test was used to analyze the consistency of evaluations between different observers of the Pfirrmann scoring system and the McAfee grading system. Pfirrmann scores for preoperative disc degeneration in the HO and non-HO groups were compared using the t-test. The chi-square test was used to analyze the effect of the Pfirrmann score on the incidence of postoperative segmental HO. The correlation between Pfirrmann score and McAfee grade, as well as postoperative ROM of HO group were analyzed by the Spearman rank-sum test. Quantitative indicators for risks of HO after ACDR surgery were proposed based on the incidence of segment HO in different Pfirrmann score groups. Results:One hundred and twenty patients were followed up for an average of 74.08±28.05 (range, 31-125) months. Based on statistics of cases 2 years after surgery, the overall HO incidence was 31.67% (38/120). The HO incidence was 27% (27/100) and 55% (11/20) for single-level and double-level replacements, respectively. There were 46 replacement segments in the HO group and 94 replacement segments in the non-HO group. The Pfirrmann score of HO group (3.17±1.08) was 25.80% significantly higher than that of the non-HO group (2.52±0.98) ( t=3.46, P=0.01). The incidence of HO in the replacement segment increased significantly with the preoperative Pfirrmann score ( χ2=12.44, P=0.01). The Pfirrmann score of the intervertebral disc in the HO group had a significant positive correlation with the McAfee grade ( R=0.54, P=0.01) and a significant negative correlation with the ROM ( R=-0.75, P=0.01). At 2 years after the operation, when the Pfirrmann score of the intervertebral disc was less than 3, the incidence of HO in the replacement segment was 20.55%(15/73); when the Pfirrmann score was equal to 3, the incidence of HO was 38.46% (10/26); when the Pfirrmann score was greater than 3, HO incidence was 51.22% (21/41). Conclusion:The Pfirrmann score of cervical disc degeneration was significantly related to the incidence of HO, McAfee grade, and ROM in the postoperative replacement segment. The Pfirrmann score of cervical disc degeneration can be used as a quantitativeindicator of HO risk in ACDR.

Electronic moxibustion apparatus and traditional moxibustion in treating knee osteoarthritis: a randomized controlled trial / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of DZWJY-1 type electronic moxibustion apparatus and traditional moxibustion in treating knee osteoarthritis (KOA). Methods: A total of 76 eligible patients were randomized into an electronic moxibustion apparatus group and a traditional moxibustion group, with 38 cases in each group. The electronic moxibustion apparatus group was intervened by DZWJY-1 type electronic moxibustion apparatus, and the traditional moxibustion group received moxa stick moxibustion for treatment. Neixiyan (EX-LE 4), Dubi (ST 35), Xuehai (SP 10) and Liangqiu (ST 34) were selected for both groups and the treatment was conducted 3 times a week for a total of 12 times. The visual analog scale (VAS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores were observed before treatment and after 6 and 12 sessions of treatment, respectively. Results: There were 4 dropout cases in the traditional moxibustion group. Therefore, this trial had 72 valid cases, including 38 cases in the electronic moxibustion apparatus group and 34 cases in the traditional moxibustion group, the differences in the baseline data between the two groups were statistically insignificant (P>0.05). After 6 and 12 sessions of treatment, the VAS scores decreased significantly with the increase of treatment sessions in both groups (all P<0.01), and the betweengroup differences were statistically insignificant at the same time points (both P>0.05). The pain intensity was evaluated using the weighted value of VAS score. The markedly effective rate was 47.4％ and the total effective rate was 89.5％ in the electronic moxibustion apparatus group, versus 50.0％ and 94.1％ in the traditional moxibustion group, and the betweengroup differences were statistically insignificant (both P>0.05). After 6 and 12 sessions of treatment, the total score and the component scores including pain, stiffness and difficulty moving in the WOMAC decreased significantly with the increase of treatment sessions in both groups (all P<0.01), and the between-group differences were statistically insignificant (all P>0.05). Conclusion: Electronic moxibustion apparatus and traditional moxibustion both are effective in reducing joint pain and improving joint function in KOA patients, and they are equivalent comparing the clinical efficacy.

Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases / 中华病理学杂志

Objective@#To investigate the clinical characteristics and placental pathology of 2019-nCoV infection in pregnancy, and to evaluate intrauterine vertical transmission potential of 2019-nCoV infection.@*Methods@#The placentas delivered from pregnant women with confirmed 2019-nCoV infection which were received in the Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology collected by February 4th, 2020 and retrospectively studied. Their clinical material including placental tissue and lung CT, and laboratory results were collected, meanwhile, nucleic acid detection of 2019-nCoV of the placentas were performed by RT-PCR.@*Results@#Three placentas delivered from pregnant women with confirmed 2019-nCoV infection, who were all in their third trimester with emergency caesarean section. All of the three patients presented with fever (one before caesarean and two in postpartum), and had no significant leukopenia and lymphopenia. Neonatal throat swabs from three newborns were tested for 2019-nCoV, and all samples were negative for the nucleic acid of 2019-nCoV. One premature infant was transferred to Department of Neonatology due to low birth weight. By the end of February 25, 2020, none of the three patients developed severe 2019-nCoV pneumonia or died(two patients had been cured and discharged, while another one had been transferred to a square cabin hospital for isolation treatment). There were various degrees of fibrin deposition inside and around the villi with local syncytial nodule increases in all three placentas. One case of placenta showed the concomitant morphology of chorionic hemangioma and another one with massive placental infarction. No pathological change of villitis and chorioamnionitis was observed in our observation of three cases. All samples from three placentas were negative for the nucleic acid of 2019-nCoV.@*Conclusions@#The clinical characteristics of pregnant women with 2019-nCoV infection in late pregnancy are similar to those of non-pregnant patients, and no severe adverse pregnancy outcome is found in the 3 cases of our observation. Pathological study suggests that there are no morphological changes related to infection in the three placentas. Currently no evidence for intrauterine vertical transmission of 2019-nCoV is found in the three women infected by 2019-nCoV in their late pregnancy.

Application of uterine lower part breakwater-like suture operation in placenta previa / 中华妇产科杂志

Objective To explore the efficacy and safety of uterine lower posterior wall breakwater-like suture technique in controlling the intraoperative bleeding of placenta previa. Methods From June 2016 to June 2017,47 patients were diagnosed placenta previa in Union Hospital,Tongji Medical College of Huazhong University of Science and Technology.Posterior wall breakwater-like suture technique was used preferentially,as for cases with poor myometrium layer,lower anterior wall stitch suture was used at the same time.Bilateral descending branches of uterine artery ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results Thirty cases(63.8, 30/47)were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively.Senventeen cases were diagnosed as placenta accreta(36.2%,17/47).Thirty-four cases had the previous history of cesarean section.The average cervical canal length of 47 patients was(2.8±0.9)cm. There were 19 cases(40.4%,19/47)with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47)with 2 or 3 times posterior wall breakwater-like sutured; 12 cases(25.5%,12/47)were treated with anterior wall stitch suture simultaneously.Ten cases(21.3%, 10/47)underwent uterine artery ligation, 17 cases(36.2%, 17/47)underwent COOK balloon compression on the staxis surface of lower segment. None of them had postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml,the percentiles 25 was 500 ml,and the percentiles 75 was 1 200 ml.The blood loss≥1 000 ml in 18(38.3%,18/47)patients,and the most serious one was 2 500 ml. The median blood transfusion volume(including allogenetic transfusion and autotransfusion)was 450 ml, the percentiles 25 was 228 ml,and the percentiles 75 was 675 ml.The average vaginal bleeding volume was (150 ± 63)ml first day after operation. The mean hospitalization time was(4.7 ± 1.0)days. The mean gestational weeks of pregnancy termination was(36.1±1.5)weeks,and the mean birth weight of newborns was(2 817±492)g.Apgar score:1-minute 7.8±1.1,5-minute 8.9±0.8.No neonatal death, 16 cases were transferred to neonatal ICU(34.0%, 16/47)mainly for premature delivery and low birth weight. No complication was found in 6 months post-operation. Conclusions Uterine posterior wall breakwater-like suture technique is a simple,safe and effective way in controlling intraoperative bleeding of placental previa. Lower anterior wall stitch suture could effectively stop bleeding and restore the normal uterine shape. Combined application of various methods could significantly reduce the incidence of postpartum hemorrhage and hysterectomy,and improve maternal and fetal prognosis.

Lumbar intervertebral disc degeneration assessed by the nine-point system with X-ray / 中国组织工程研究

BACKGROUND: The X-ray 9-point grading system is established based on cervical disc degeneration and its suitability for evaluation of lumbar disc degeneration has not been validated. OBJECTIVE: To investigate the feasibility of the evaluation of lumbar intervertebral disc degeneration using the 9-point grading system with X-ray, and to explore its clinical application value. METHODS: The correlation between 9-point grading system and Pfirrmann system was statistically analyzed. Magnetic resonance imaging (MRI) and X-ray images of 172 cases with lumbar disc degeneration or simple lumbago, who were treated in the Shanghai Changzheng Hospital from June 2013 to June 2016, were retrospectively analyzed. The MRI scores of lumbar disc degeneration were evaluated according to Pfirrmann standard, and the X-ray scores were evaluated according to 9-point grading system. The two groups of scores were respectively analyzed by the correlation and regression tests via Spearman rank sum test with SPSS software. RESULTS AND CONCLUSION: (1) MRI scores (the independent variable X): 2 cases scored 1; 8 cases scored 2; 55 cases scored 3; 84 cases scored 4; 23 cases scored 5. X-ray scores (the dependent variable Y): 2 cases scored 0; 6 cases scored 1; 21 cases scored 2; 43 cases scored 3; 40 cases scored 4; 26 cases scored 5; 16 cases scored 6; 8 cases scored 7; 7 cases scored 8; 3 cases scored 9. (2) The Spearman correlation test showed that significant positive correlation was found between Pfirrmann system and 9-point grading system (P <0.01). Significance test of correlation coefficient proved that there was significant linear correlation between Pfirrmann system and 9-point grading system. Further regression analysis showed the linear regression between Pfirrmann system and 9-point grading system. (3) These findings suggested that Pfirrmann system and X-ray 9-point grading system had a good consistency in evaluating lumbar disc degeneration. As a scientific, fast and effective evaluation method, the X-ray 9-point grading system has a certain reference value in the diagnoses of lumbar degenerative diseases.

Experimental study of lentiviral vector-mediated bFGF gene transfection on rabbit BMSCs / 天津医药

Objective To observe the effect of lentiviral vector-mediated basic fibroblast growth factor (bFGF) gene transfection on the biological characteristics of rabbit bone marrow stromal cells(BMSCs)under in vitro culture conditions. Methods BMSCs were obtained by density gradient centrifugation and adherence screening. The bFGF gene was transfected into BMSCs by lentiviral vector and divided into bFGF transfection group,empty virus group and untransfected group according to the transfection conditions.After transfection,the morphology,expressions of bFGF mRNA and protein, cell proliferation,cell cycle and alkaline phosphatase(ALP)activity were observed in three groups of cells. Results High density BMSCs were successfully obtained by density gradient centrifugation and adherence screening.After transfection of BMSCs with bFGF gene, the cell morphology showed no significant changes, while the expressions of bFGF mRNA and protein were significantly increased, the cell proliferation curve shifted upward, the proportion of proliferating cells increased,and the activity of ALP was significantly enhanced.There were significant differences between three groups(P<0.05).Conclusion The rabbit bFGF gene is successfully introduced into the BMSCs cultured in vitro by lentiviral vector, and the target gene is stably expressed.The expression of bFGF can promote the proliferation and osteogenic differentiation of BMSCs.

Observation on lower-reinforcing and upper-reducing acupuncture method for hyperplasia of mammary gland and its influence on estradiol and progesterone / 针灸推拿医学（英文版）

Objective:To observe the clinical effect of lower-reinforcing and upper-reducing acupuncture method for hyperplasia of mammary gland (HMG) and its influence on estradiol (E2) and progesterone (P).Methods:A randomized,single-blinded and controlled trial was conducted.A total of 124 cases conforming to the inclusion criteria were randomized by random number table into a treatment group and a control group,with 62 cases in each group.Patients in both groups received acupuncture therapy at the same acupoints,while patients in the treatment group received lower-reinforcing and upper-reducing method,and patients in the control group received even reinforcing-reducing manipulation.The treatment started around 10 d before menstruation and was conducted every other day.Patients received 5 treatments in each menstruation cycle for consecutive 3 cycles.The levels of E2,P and E2/P and clinical efficacy were measured before and after treatment.Results:After treatment,the breast lump size,pain intensity and concomitant symptoms score in both groups were substantially lower than those before treatment,showing statistical significances (all P＜0.01),and the improvement in the treatment group was higher than that in the control group,and the between-group comparisons showed statistical significances (all P＜0.01).After treatment,the overall effective rate was 91.9％ in the treatment group,higher than 72.6％ in the control group,and the between-group comparison showed a statistical significance (P＜0.01).After treatment,levels of E2,P and E2/P value showed no statistical significance when compared with those before treatment in the two groups (all P＞0.05).Conclusion:Lower-reinforcing and upper-reducing acupuncture method can effectively alleviate clinical symptoms and signs in HMG patients,and produce a better effect than even reinforcing-reducing manipulation.The majority of HMG patients' E2,P level and E2/P value were not beyond the normal ranges;therefore,acupuncture showed no substantial influence on E2 and P levels and E2/P value.

Anterior cervical ossified posterior longitudinal ligament en bloc resection for the treatment of cervical ossification of posterior longitudinal ligament / 中华骨科杂志

Objective To evaluate theclinical efficacy and safety of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE),and analyze the advantages of ACOE compared to the traditionally anterior cervical surgery.Methods The clinical datawith more than one year follow-up of 96 patients suffered from cervical ossification of the posterior longitudinal ligament(OPLL) from April 2010 to March 2017 was retrospectively analyzed,including 57 males and 39 females,aged 32-69 years,average 54.6±8.7 years.There were 29 cases of nodular type (30.2％),48 cases of segmental type (50.0％),5 cases of continuous type(5.2％),and 14 cases of mixed type (14.6％).The neurological function assessments before and after operation were performed using the Japanese Orthopaedic Association (JOA) scoring system and the visual analogue scale (VAS) scoring system.The effect of ossified mass resection was observed by three-dimensional reconstruction CT scan.The spinal cord decompression was evaluated by MRI.The cervical curvature was compared before and after surgery by cervical lateral radiograph.The operation time,intraoperative blood loss,recovery rates of the JOA scores and complication rates of this group were compared with the cases of anterior cervical ossified posterior longitudinal ligament piecemeal resection (ACOP) reported by the recent literature to analyze the clinical efficacy,safety and advantages of ACOE.Results All the surgeries of 96 cases were successfully performed,including 57 cases (59.4％) with subtotal resectionof single vertebra,31 cases (32.3％) with subtotal resectionof doublevertebras,1 case (1.0％) with expanded intervertebral decompression,4 cases (4.2％) with "vertebra + semi-vertebra" subtotal resection,1 case (1.0％) with "semi-vertebra + vertebra + semi-vertebra" subtotal resection,2 cases with "double vertebras + semi-vertebra" subtotal resection (2.1％).Ninty-six cases were followed up for 12 to 78 months,with an average of 28.0±9.3 months.The preoperative JOA score with (11.38±2.80) scores was increased to 15.32± 1.62 scores at the last follow-up,and the recovery rate of JOA score was 74.63％±13.18％.The preoperative VAS score with 6.00±1.41 scores was reduced to 2.35±1.11 scores at the last follow-up.The cervical curvature increased from 10.4°±9.0° before surgery to 15.8°±8.1° at the last follow-up.CT showed that the ossified masses of the surgical segments were completely excised without residue;MRI showed that the compressionsof spinal cords and dural sacs were completely relieved,with nice morphology recovery.There was no neurological deterioration in this group.There were 6cases of cerebrospinal fluid leakage (CSFL),3 cases of C5 nerve palsy,1 case of Hornersyndrome,2 cases of dysphagia and hoarseness,1 case of titanium mesh subsidence with screw loosing.At the final followups,except one case of occasional throat foreign body sensation,the above complications were all remittedat different followup periods.Compared with the cases of ACOP reported by the recent meta-analysis,the operation time,the intraoperative blood loss,the complication rate of dysphagia with hoarseness and neurological deterioration were lower than those reported in the literature.The recovery rate of JOA scorewas higher than which reported in the literature.Conclusion ACOE is safe and effective for the treatment of cervical OPLL,which may be superior to traditional anterior cervical surgery in terms of surgical safe-ty,controllability of cerebrospinal fluid leakage and improvement of neurological function.

Effect of imipenem and cilastatin sodium in the treatment of severe pneumonia / 新乡医学院学报

Objective To investigate the clinical effect of imipenem and cilastatin sodium in the treatment of severe pneumonia.Methods Sixty patients with severe pneumonia were selected from May 2013 to August 2016 in Wuxi People's Hospital.The patients were divided into observation group and control group according to the treatment method,30 cases in each group.The patients in the control group were treated with cefoperazone and sulbactam injection,and the patients in the observation group were treated with imipenem and cilastatin sodium.The levels of serum procalcitonin (PCT) and C-reactive protein (CRP) were measured,and the cough score was performed in the two groups before and after treatment.The clinical effect was evaluated after treatment,and the adverse reactions of the patients were recorded in the two groups.Results There were no significant difference in the levels of serum PCT and CRP between the two groups before treatment (P ＞ 0.05).The levels of serum PCT and CRP after treatment were significantly lower than those before treatment in the two groups (P ＜ 0.05).The levels of serum PCT and CRP in the observation group were significantly lower than those in the control group after treatment (P ＜ 0.05).There was no significant difference in cough score between the two groups before treatment (P ＞ 0.05).The cough score after treatment was significantly lower than that before treatment in the two groups (P ＜ 0.05).The cough score in the observation group was significantly lower than that in the control group after treatment (P ＜ 0.05).The total effective rate in the observation group and the control group was 93.33％ (14/15) and 60.00％ (9/15) respectively,the total effective rate in the observation group was significantly higher than that in the control group (x2 =4.658,P ＜ 0.05).The incidence of adverse reactions in the two groups was 6.67％,there was no significant difference in the incidence of adverse reactions between the two groups (x2 =0.000,P ＞ 0.05).Conclusion Imipenem and cilastatin sodium can significantly reduce the inflammatory response and clinical symptoms in patients with severe pneumonia,and the curative effect is remarkable.

Expression of Beclin1 and HLA Ⅰ , Ⅱ in human SKOV3 ovarian cancer cells and their correlation / 临床与实验病理学杂志

Purpose The aim of this study was to investigate the relationship between autophagy gene Beclin1 and immune response effector classical HLA Ⅰ,Ⅱ in SKOV3 cells.To explore the role of Beclin1 in immunity in ovarian cancer cells which were transfected with the vector of Beclin1.Methods RT-PCR and Western blot were used to detect the expression of Beclin1 and HLA Ⅰ,Ⅱ in SKOV3 cells.Fluorescence microscope was carried out to observe the unique autophagosome in SKOV3 cells.MTT was used to analyze the proliferation of the Beclin1 over-expressed SKOV3 cells.Results Transfection SKOV3 cells with Beclin1 vector could induce Beclin1 transcription and translation approximately 5 and 2 times compared with empty vector group respectively.The autophagosome stained by MDC was observed by fluorescence microscope.And much more green fluorescence signal was observed in Beclin1 vector group.RT-PCR and Western blot indicated that HLA Ⅰ,Ⅱ induced by transfection with extrinsic Beclin1.The allelic transcriptions of HLA Ⅰ-A,B,C and HLA Ⅱ-DP,DQ,DR in extrinsic Beclin1 group were approximately 2,1.6,3 and 2,6,3 times compared with empty vetcor group or untreated group,respectively.The results of Western blot showed that HLA Ⅰ,Ⅱ in Beclin1 vector group induced as much as 2 and 1.6 times compared with empty vetcor group or untreated group,respectively.The results of MTT showed that the proliferation of SKOV3 cells treated with Beclin1 vector was significantly suppressed.The percentage of suppression in Beclin1 vector group at 24 h,48 h,72 h and 96 his42.6％,37.8％,24.35％,14.81％ compared with untreated group or empty vector group respectively.Conclusion The enhancement of autophagy by over-expression of Beclin1 could induce HLA Ⅰ,Ⅱ transcription and translation in SKOV3 cells.The expression of HLA Ⅰ,Ⅱ may be responsible for triggering the immune response in ovarian cancer.Over-expression of Beclin1 could inhibit the proliferation of SKOV3 cells which were transfected with extrinsic Beclin1.

Comparison of safe duration of apnea and intubation time in face mask ventilation with air versus 100% oxygen during induction of general anesthesia / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the safe duration of apnea and intubation time between face mask ventilation with air and 100% oxygen during induction of general anesthesia.</p><p><b>METHODS</b>Eighty adult patients with ASA class I or II without predicted difficult airways were scheduled for elective surgery under general anesthesia. The patients were randomized to receive anesthesia induction with preoxygenation [Group 1, n=40, fraction of inspired oxygen (FiO)=1] or without preoxygenation (Group2, n=40, FiO=0.21). Two experienced anesthesiologists performed the mask ventilation and tracheal intubation during induction, and the assistants adjusted the oxygen concentration and recorded the pulse oxygen saturation (SpO) and other variables. The cases where SpOdecreased to below 90% before accomplishment of intubation were considered unsuccessful, and mask ventilation with 100% oxygen was given. After tracheal intubation, mechanical ventilation was not initiated until the SpOdecreased to 90%. The number of unsuccessful cases, the safe duration of apnea and intubation time were recorded in the two groups.</p><p><b>RESULTS</b>There was no unsuccessful case in either groups. The safe duration of apnea was 469.5∓143.0 s in Group 1 and 63.6∓20.0 s in Group 2, and the intubation time was 34.4∓12.6 s and 32.8∓9.6 s, respectively. The safe duration of apnea was significantly longer than the intubation time in both groups (P<0.01). The intubation time and the number of cases with SpO≥90% before completion of tracheal intubation were similar between the two groups. The safe duration of apnea was significantly shorter in Group 2 than in Group 1 (P<0.01) and was correlated with the body mass index of the patients (P<0.05).</p><p><b>CONCLUSION</b>Anesthesia induction without preoxygenation can provide sufficient time for experienced anesthesiologists to complete tracheal intubation.</p>

Detection of Echinoderm Microtubule Associated Protein Like 4-Anaplastic Lymphoma Kinase Fusion Genes in Non-small Cell Lung Cancer Clinical Samples by a Real-time Quantitative Reverse Transcription Polymerase Chain Reaction Method / 中国医学科学院学报

Objective To establish a real-time quantitative reverse transcription polymerase chain reaction assay (qRT-PCR) for the rapid, sensitive, and specific detection of echinoderm microtubule associated protein like 4-anaplastic lymphoma kinase (EML4-ALK) fusion genes in non-small cell lung cancer. Methods The specific primers for the four variants of EML4-ALK fusion genes (V1, V2, V3a, and V3b) and Taqman fluorescence probes for the detection of the target sequences were carefully designed by the Primer Premier 5.0 software. Then, using pseudovirus containing EML4-ALK fusion genes variants (V1, V2, V3a, and V3b) as the study objects, we further analyzed the lower limit, sensitivity, and specificity of this method. Finally, 50 clinical samples, including 3 ALK-fluorescence in situ hybridization (FISH) positive specimens, were collected and used to detect EML4-ALK fusion genes using this method. Results The lower limit of this method for the detection of EML4-ALK fusion genes was 10 copies/μl if no interference of background RNA existed. Regarding the method's sensitivity, the detection resolution was as high as 1% and 0.5% in the background of 500 and 5000 copies/μl wild-type ALK gene, respectively. Regarding the method's specificity, no non-specific amplification was found when it was used to detect EML4-ALK fusion genes in leukocyte and plasma RNA samples from healthy volunteers. Among the 50 clinical samples, 47 ALK-FISH negative samples were also negative. Among 3 ALK-FISH positive samples, 2 cases were detected positive using this method, but another was not detected because of the failure of RNA extraction. Conclusion The proposed qRT-PCR assay for the detection of EML4-ALK fusion genes is rapid, simple, sensitive, and specific, which is deserved to be validated and widely used in clinical settings.

The curative effect analysis of balloon sinuplasty and the main points of its use / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The aim of this study was to evaluate the safety and effectiveness of balloon sinuplasty, and to summarize the main points of its use.@*METHOD@#Fifteeen patients (41 sinuses) were offered treatment with a new technique of balloon sinuplasty and followed for 3 to 6 months after surgery, including "balloon-only" patients and "hybrid" patients. Effectiveness was evaluated by endoscopic examination and computed tomographic (CT) scan. The effect of the operation was tested by the Lund-Mackay CT scores, and the patient's subjective symptoms were tested by the sino-nasal outcome test-20 (SNOT-20) to evaluate postoperative condition.@*RESULT@#Fifteeen patients (41 sinuses) were followed after surgery, including 9 "balloon-only" patients and 6 "hybrid" patients. No unanticipated adverse effects were noted in any patients. Endoscopic examination showed the sinus ostium was opening well, and CT scan showed the lesions apparently disappeared. Lund-Mackay CT scores showed that all patients postoperative scores were significantly improved from baseline at 3 months and 6 months. SNOT-20 showed that all patients postoperative scores were significantly improved from baseline at 3 months and 6 months. There was no significant difference between the "balloon-only" patients and "hybrid" patients. Operation curative effect is very confirmed, and subjective symptoms improved significantly.@*CONCLUSION@#Balloon sinuplasty can not only open nasal sinus effectively, but also preserve normal tissue structure and mucous membrane of nasal cavity and nasal sinus. Balloon sinuplasty appears to be a safe, effective and minimally invasive treatment option to relieve sinus ostial obstruction. Patients who received balloon catheter sinusotomy in endoscopic sinus surgery had significant improvement after surgery. Balloon sinuplasty can also be combined with the endoscopic sinus surgery to achieve a better therapeutic effect. It is worth of clinical promotion and application.