Experimental study and clinical significance of intravascular angiography in vivo / 中华骨科杂志

Objective:To study the method of intravascular angiography in vivo, analyze the clinical significance, and supply the basis of diagnosis and treatment of related orthopaedic diseases.Methods:The development was realized by improving the developer to increase the local concentration. Based on the study of Lijianmin-Chengkun Complexes and using the theory of magnetic microspheres, Fe 3O 4 magnetic microspheres with amino (negatively charged) shell are used to adsorb the aggregated ionic developer meglumine diatrizoate (positively charged diatrizoate). That is, by improving the method of developer, the magnetic microspheres can carry the developer to make new nanoparticles magnetic imaging composite particles. Under the action of external magnetic field, the magnetic imaging composite particles brought by blood circulation continue to stay and gather in the blood vessels in the magnetic field area, and the developer carried by the magnetic microspheres in the blood vessels in the magnetic field area is concentrated to reach the imaging concentration, so as to realize in vivo intravascular vascular imaging. By adjusting the ratio of the two reagents, the charge can be neutralized and condensed into small groups to improve the development efficiency. Thus, the electron microscope experiment, CT in vivo experiment, rabbit imaging experiment, experimental rabbit tissue picture confirmation, CT in vivo human body (the author is a volunteer) imaging experiment were carried out step by step. Results:Electron microscope experiment: meglumine diatrizoate, scanning electron microscope, the particle diameter is about 20 nm. Scanning electron microscope showed that the diameter of the magnetic microspheres was about 100 nm and the distribution was uniform. After the two reagents are mixed in a certain proportion, the neutralizing charge condenses into small groups, but it still has magnetohydrodynamic properties and strong paramagnetism. In vivo rabbit imaging experiment: the ideal intraosseous vascular imaging of the proximal tibia was captured. The tissue pictures of experimental rabbits confirmed that the distribution of Fe 3O 4 was obviously visible in the blood vessels in the proximal tibia on the side with magnetic field, but not on the side without magnetic field. In vivo human imaging experiment: the ideal intraosseous vascular imaging of the proximal fibula was captured. Conclusion:Through the preparation of new reagent of magnetic imaging composite particles (magnetic microspheres + meglumine diatrizoate), the concentration of in vivo bone developer can be achieved under the action of external magnetic field, and the in vivo external diameter ≥ 0.5mm can be achieved under CT thin-layer scanning.

Preliminary investigation on the dissected methods of intraosseous vasculature and the clinical significances of intraosse-ous vascularity / 中华骨科杂志

Objective:The vasculature and canal were located using radiography after the fresh osseous specimens were decalcified, after which the anatomic investigation of intraosseous vasculature was conducted based on the orientation of the canals.Methods:To investigate the basic dissected methods for intraosseous vasculature and the related clinical significance. Methods The materials were obtained from seven fresh knee joint specimens from patients with amputation due to car accidents, nine fresh knee joint specimens from patients with amputation due to oncological radical surgery, and 44 knee joint specimens from 24 cadavers. Among them, 22 were males (55%) and 18 were females (45%), 28 were left knees (46.7%) and 32 were right knees (53.3%). 10 were aged from 16-90 years old (from 8 donors) and 50 were aged from 15-85 years old (from 32 donors). The tributaries of middle genicular vein which penetrate into the proximal tibial epiphysis and metaphysis via our previously discovered and denominated "foramen of tibial intercondylar eminence (FTIE)" were dissected as an example. After obtaining the fresh knee joint specimen, angiography was performed to observe the continuous extraosseous and intraosseous blood vessels. The first group of specimens with the removal of cortical bone was reserved in formalin solution at 4 °C for 7 d, sequentially immersed in Ethylene Diamine Tetraacetic Acid (EDTA), the decalcification agent, for 30 d with replacement for each two days. Based on the CT scanning and three-dimensional reconstruction, the orientation of bony canal which enclosed the vasculature was exposed to guide the anatomic incision. The exquisite dissection was achieved with the help of ophthalmological microsurgical instruments. The anatomical dissection were intuitively observed, compared with the angiographic images, and verified by histological examinations. The second group of samples was decalcified with strong acid as another strategy, and the comparison between different groups was conducted. To estimate the advantages and disadvantages of the two decalcification and dissection methods, and the distribution and universality of specific intraosseous vasculatures and canals, the methods can be utilized to dissect the diameter of the intraosseous vessels. Based on the anatomical study of intraosseous vasculature, the mechanisms including etiology, recurrence and spread of bone tumors and epiphyseal injuries were analyzed to improve the therapeutic regimen.Results:The intraosseous tributaries of middle genicular vein which penetrate into the tibial intercondylar eminence from the articular cavity were dissected, these vessels extended to the tibial metaphysis from epiphysis through the epiphyseal line or senescent physes. The diameter of the vessel entering the FTIE was 1.2 mm, and the intraosseous vessels divided into several tinier tributaries with the diameter of 0.3 mm to cross the epiphyseal line or closed physeal plate and differentiated into capillaries in the distal regions, therefore was difficult to dissect directly. The histological examinations confirmed the authenticity of intraosseous vessels. Compared with the samples decalcified with strong acid, the blood vessels were obviously dissolved, and only a few residual epithelial cells were observed under the light microscope. Based on the anatomical study of intraosseous vessels, the treatment protocols for some related bone tumors and epiphyseal injuries were modified and satisfactory results were achieved.Conclusion:The methods can realize the ideal direct dissection for the intraosseous blood vessels with the outer diameter greater than or equal to 0.3 mm.

Application effects of unprotected perineal delivery technique in low-risk nulliparous women during natural delivery / 中国基层医药

Objective:To investigate the application effects of unprotected perineal delivery technique in low-risk nulliparous women during natural delivery.Methods:Seventy low-risk nulliparous women who delivered in January to December 2017 in Huaibei People's Hospital were included in this study. They were randomly assigned to undergo delivery with either conventional technology (control group, n = 35) or unprotected perineal delivery technique (observation group, n = 35). Lateral episiotomy rate, incidence of perineal tears, labor process time and Visual Analogue Scale score as well as the degree of postpartum perineal pain were compared between two groups. Results:Lateral episiotomy rate in the observation group was significantly lower than that in the control group [8.57% (3/35) vs. (45.71% (16/35), χ2 = 10.402, P < 0.001). The incidence rates of complete perineum, grade I perineal injury and grade II perineal injury in the observation group were 34.29% (12/35), 57.14% (20/35) and 8.57% (3/35), respectively, and those in the control group were 11.43% (4/35), 28.57% (10/35) and 60.00% (21/35) respectively ( χ2 = 4.732, 4.725, 18.324, all P < 0.05). The Visual Analogue Scale score in the observation group was significantly lower than that in the control group [(3.08 ± 0.42) points vs. (5.13 ± 0.58) points, t = 16.936, P < 0.001]. There were no significant differences in the time of first-stage, second-stage and third-stage labors between the two groups (all P > 0.05). Conclusion:Application of unprotected perineal delivery technique for low-risk primipara delivery can reduce maternal injury during delivery, which is worthy of application.

The relationship between the recurrence rate of aggressive tumors and the foramina around the knee joint / 中华骨科杂志

Objective:To introduce the discovery and nomenclature of the intercondylar foramen of femur (IFF) and foramen of tibial intercondylar eminence (FTIE) and research the close relationship between the high recurrence rate of aggressive tumors around the knee joint and the foramina around the knee joint.Methods:①Radiographic observation and measurement: 3D reconstruction of CT scan of 200 patients in our hospital were used to obverse the common feature、position and measure of Inter-condylar foramen of femur and Foramen of tibial intercondylar eminence. ②Anatomical and histological observation: To proof the existence of IFF and FTIE through the anatomy of 15 cases of car accidents or tumor amputations and 60 cases of autopsy. Then the specific location, the surrounding structure, the proximal coverage, the contents, the apical construction, the wall and the bottom tissues of the IFF and FTIE were studied and analyzed. ③Histological and pathological observation of tumor anatomy: Through the study of the distal femur and tibia malignant tumor tissues(including primary bone tumors and metastatic tumors), we observed the relationship between the foraminal structures and the tumor, judged the situation of concealed transmission and two-way spread through the foramina, and analyzed the relationship between tumor recurrence and foraminal structures. ④The synovial membrane of foramina, especially in cases where the synovium was suspected to be involved by the lesions judged by the radiography was analyzed to observe whether the synovium was infiltrated by the tumor.Results:IFF and FTIE were the inherent physical structure of the human. Their physiological function was the vascular foramina that lead the branches of arteria media genus into the Intercondylar fossa of femur and tibial intercondylar eminence. Their opening was separated with the joint cavity by the synovial tissues, so IFF and FTIE were isolated with joint cavity by the synovial tissues、meniscus and cruciate ligaments. After invading the IFF and FTIE, the aggressive tumors did not break into the joint cavity immediately, but conceal in the foramina and invade the synovium with specific biological behavior with the sequence: reactive edema, hyperplasia, degeneration, calcification, hyaline degeneration (infiltration in some cases), synovial rupture, and then tumor invasion of the articular cavity. Usually, tumors or recurrence has been observed before synovial rupture. We also observed the tendency of tumors to spread along the arteria media genus to the popliteal vessels, peripheral soft tissues and lymphatic vessels with typical radiographic performance like popliteal lymphadenectasis. Color nodules and tumors in other parts could also invade or metastasize into bone through these foramina.Conclusions:IFF and FTIE are foramina nutricium of arteria media genus. They are the inherent physical structure of the human. The foramina play an important role in the spread, concealment and recurrence of peripheralkneeaggressive tumor.

Association of perceived organizational support,job burnout and depression tendency of nurses in Zhengzhou City / 中国职业医学

OBJECTIVE: To explore the relationship among perceived organizational support,job burnout and depressive tendency in nursing staffs. METHODS: A total of 807 nurses from 7 municipal hospitals in Zhengzhou City,Henan Province were selected as the study subjects by multi-stage cluster random sampling method. The questionnaires of Perceived Organizational Support,Maslach Burnout Inventory-General Survey and Center for Epidemiological Survey-Depression Scale were used to conduct the survey. RESULTS: The total scores of perceived organizational support and job burnout were( 69. 3 ± 18. 5) and( 36. 3 ± 13. 7) respectively. The median of the total score of depression tendency was 17. 00. The total score of nurses' perceived organizational support was negatively correlated with the total scores of job burnout and depression tendency( P < 0. 01). The total score of job burnout was positively correlated with the total score of depression tendency( P < 0. 01). The degree of explanations for the change of perceived organizational support and job burnout on depression tendency were 9. 1% and 13. 1%,respectively. CONCLUSION: Perceived organizational support and job burnout play important roles in predicting depression tendency. Job burnout plays a mediating role in the relationship between perceived organizational support and depression tendency.

Effect of spontaneous urination training on postoperative urine retention and catheteration duration of cervical cancer patients / 现代临床护理

Objective To investigate the effect of spontaneous urination training on postoperative urine retention and catheteration duration of cervical cancer patients. Methods Seventy patients were divided into the control group (n=34) and control group(n=36). according to the admission time Both groups received bladder function training. Besides this, the control group also received intermittent clamping of urine catheter while the observation group received spontaneous urination training . The two groups were compared in terms of incidence of urinary retention and catheteration duration. Result The incidence of urinary retention in the observation group was lower than that of the control group, there was significant difference between the this groups (P<0.05). Conclusion For the patients after cervical cancer operation , both bladder function training and urination training can reduce the incidence of urine retention .

Evaluation of community health service institutions responsiveness in Henan Province:Key in-formant survey / 中国卫生政策研究

Objective:To understand the responsiveness of community health service institutions in Henan Province. Methods:This research collected information through questionnaire investigations. The object of the investigations is key informants familiar with community health service institutions. Various dimensions of responsiveness within Henan province community health service institutions are determined through a multiple-input pecking order graph. The fuzzy comprehen-sive evaluation method is used to evaluate the level of responsiveness. Responsiveness inequality index is used to measure the distribution of reactions. Results:A total of 431 valid key informants were surveyed. The various dimensions of the questionnaire of Cronbach alpha coefficient was greater than 0. 623;the total scale of the Cronbach alpha coefficient was 0. 850;the correlation coefficient of each dimension of test-retest reliability were greater than 0. 907. The levels of responsive-ness and distribution index were 8. 33 and 0. 2744, respectively;each dimension by order of importance:timely attention>dignity>infrastructure>communication>confidentiality >social support >selective >autonomy. Approximately 50% of key informants considered that vulnerable groups in community health service institutions were sometimes or often treated unfairly. Conclusion:Key informants considered the responsiveness level of overall higher community health service institu-tions in Henan Province was high, and the distribution of responsiveness was relative equilibrium. However, there is a large shortage of infrastructure, privacy protection, doctor-patient communication, etc.

Study on the polymorphism in circumsporozoite protein of Plasmodium vivax before the completion on elimination program of malaria, in Hainan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the polymorphism in circumsporozoite protein of Plasmodium vivax before malaria was eliminated in Hainan island.</p><p><b>METHODS</b>PCR amplification, sequencing, and alignment methodologies were conducted and phylogenetic tree constructed.</p><p><b>RESULTS</b>From all the cases, 19 of them belonged to two types, with 18 as VK210 type and 1 as VK247 type. VK210 type could be divided into seven kinds of subtypes but VK247 had only one type. Ratio of tropical strain with temperate stain in VK210 type was explored between the two stages:control or elimination. Phylogenetic tree was constructed by amino acid sequencing which clearly manifested that VK210 type and VK247 type belonged to different clusters.</p><p><b>CONCLUSION</b>Compared the proportion of two types in the control stage, there was no significant difference seen in the stage of elimination.</p>

Effect of surgical resection on the prognosis if children patients with advanced neuroblastoma / 中国综合临床

Objective To investigate the effect of the extent of surgical resection on the prognosis of children patients with advanced neuroblastoma. Methods Thirty-seven children patients with advanced neuroblastoma were selected as our subjects,who underwent surgical treatment in the People's Hospital Binzhou from Jan. 2001to Dec. 2006. All the patients were treated with surgical operation or surgical operation combined with chemotherapy,among them 24 cases were completely removal,and 13 cases were partially removal. All patients were followed-up for more than 5 years. Log rank test and multivariate COX regression analysis were used to explore the effect of surgery resection on prognosis. Results The influencing factors of the complete resection group included lymphatic metastasis,clinical stage,combined with chemotherapy,tumor markers neuronspecific enolase(P = 0. 002,0. 000,0. 019,0. 015 respectively). COX regression analysis showed that the independent factors included chemotherapy( OR = 1. 952,95% CI = 1. 258 - 2. 759,P = 0. 000),lymph node metastasis(OR = 2. 856,95% CI = 1. 356 - 3. 859,P = 0. 019),and extent of surgical resection(OR = 3. 069, 95% CI = 1. 585 - 4. 685,P = 0. 005). The shortest survival period of patients in this study was a month,and the median survival period was 33. 96 months. One year survival rate was 62. 21% and 2-year survival rate was 41. 09% as well as 3-year survival rate was 23. 59% . The average survival period between total and partial of surgical resection was significant((56. 96 ± 13. 22)months,(19. 63 ± 10. 20)months;P = 0. 019). Conclusion Surgical resection is an important factor of the prognosis of patients with NB. If the patient's own conditions permit,it can be appropriate to expand the scope of surgical resection in order to reduce the risk of tumor recurrence.

Analysis of the short-and mid-term curative effect and influence factors of hepaticojejunostomy for biliary atresia / 中国基层医药

Objective To explore the short-and mid-term curative effect and influence factors of hepaticojejunostomy(Kasai operation) for biliary atresia.Methods The clinical data of 66 children with biliary atresia treated with Kasai operation were analyzed retrospectively.The jaundice fading rate,2-year survival rate and influence factors of prognostic were analyzed.Results The jaundice fading rate of 62 cases was 58.1％ after Kasai operatiou.The patients also had a 2-year native liver survival rate of 53.2％.The jaundice fading rate,2-year survival rate of type Ⅰ,Ⅱ and Ⅲ had no significant differences (χ2 =1.91,0.76,all P ＞ 0.05).The 2-year survival rate of children underwent Kasai operation as younger than 60 days was higher rate than that of the children as 61 to 90 days and older than 90 days(χ2 =4.72,P ＜ 0.05).The 2-year survival rate of children with cytoinegalovirus infection and postoperative cholangitis were 43.6％,39.5％,respectively,which were lower than those of children without cytomegalovirus infection and postoperative cholangitis (69.6％.75.0％) (χ2 =3.92,7.46,all P ＜ 0.05).Conclusion Kasai operation is still the preferred method for the treatinent of biliary atresia.Type of the disease was not related with the short-and mid-term effects of Kasai operation.Age at operation was the main factor affecting the prognosis.Therefore,it is very important to make early surgery,enhance the anti-viral treatment and prevent postoperative cholangitis.

A Case of Plasmodium ovale wallikeri Infection in a Chinese Worker Returning from West Africa

In contrast to the gradual reduction in the number of locally transmitted malaria cases in China, the number of imported malaria cases has been increasing since 2008. Here, we report a case of a 39-year-old Chinese man who acquired Plasmodium ovale wallikeri infection while staying in Ghana, West Africa for 6 months in 2012. Microscopic examinations of Giemsa-stained thin and thick blood smears indicated Plasmodium vivax infection. However, the results of rapid diagnostic tests, which were conducted 3 times, were not in agreement with P. vivax. To further check the diagnosis, standard PCR analysis of the small-subunit rRNA gene was conducted, based on which a phylogeny tree was constructed. The results of gene sequencing indicated that this malaria is a variant of P. ovale (P. ovale wallikeri). The infection in this patient was not a new infection, but a relapse of the infection from the one that he had contracted in West Africa.

Epidemic status of Angiostrongylus cantonensis in Hainan island, China

OBJECTIVE@#To understand the current epidemiological status of Angiostrongylus cantonensis in Hainan island and provide the scientific evidences for prevention and control of the disease.@*METHODS@#The investigation on nature infection condition of intermediate hosts and final hosts of Angiostrongylus cantonensis were carried out in five counties, Hainan Province, and enzyme linked immunosorbent assay (ELISA) was employed to detect antibodies of Angiostrongylus cantonensis in human hosts.@*RESULTS@#A total of 1612 molluscs were examined, 21.3% of which harbored L3 of Angiostrongylus cantonensis. Among them, the infection rates of Pomacea canaliculata, Achatina fulica, Cepaea and Phlegm bilineatus were 12.36%(64/518), 22.66%(121/534), 20.93%(9/43), and 28.24%(146/517), respectively. Of the 118 rats trapped, 13 Rattus norvegicus were found to be infected with Angiostrongylus cantonensis. A total of 459 serum samples were collected and tested. 92 serum samples were Angiostrongylus cantonensis antibody-positive.@*CONCLUSIONS@#The survey revealed a wide distribution of Angiostrongylus cantonensis in Hainan island. Pomacea canaliculata and Achatina fulica are main intermediate hosts of Angiostrongylus cantonensis. Rattus novegicus is a nature definitive host, indicating that a considerable number of people are at risk of angiostrongyliasis. Health education, rigorous food inspection and surveillance are all needed to prevent angiostrongyliasis outbreaks in future.

Change of ACTH and cortisol in patients with obstructive sleep apnea hypopnea syndrome after the operation of uvulopalatopharyngoplasty / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the change of hypothalamus-pituitary-adrenal hormone in patients with Obstructive sleep apnea hypopnea syndrome (OSAHS) by observing the change of Corticotropin (ACTH) and cortisol after Uvulopalatopharyngoplasty (UPPP).@*METHOD@#OSAHS patients were monitored by polysomnography (PSG). The ACTH and cortisol levels in plasma were measured by radioimmunoassay before, during and after sleep in pre-operation and six months post-operation. Their correlation were analyzed.@*RESULT@#The cortisol concentration [ (170.4+/-56.5) microg/L, (252.2+/-62.3) microg/L, (276.9+/-70.4) microg/L, (2859.0+/-63.2) microg/L, (395.1+/-85.2) microg/L before, during and after sleep] in the before UPPP group were significantly higher than those of the after UPPP group [(133.5+/-24.8) microg/L, (99.9+/-9.2) microg/L, (103.8+/-13.2) microg/L, (146.2+/-22.5) microg/L, (199.6+/-20.9) microg/L before, during and after sleep, respectively, all P <0. 05]; but there was no difference in corticotropin(ACTH). The average blood oxygen concentration was negatively correlated with average awareness duration (r = -0.713).@*CONCLUSION@#There are abnormal change of HPA axis in OSAHS patients, and the feedback regulation is disordered. These abnormalities are related to sleep awareness and hypoxia during sleep.