Iliac ecchymosis, a valuable sign for hollow viscus injuries in blunt pelvic trauma patients / 中华创伤杂志(英文版)

PURPOSE@#Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury. CT has been applied for several decades to evaluate blunt pelvic trauma patients. However, it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury (HVI), especially in the early stage after injury. The delayed diagnosis of HVI could result in a high morbidity and mortality. The bowel injury prediction score (BIPS) applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary. We recently found another clinical variable (iliac ecchymosis, IE) which appeared at the early stage of injury, could be predicted for HVI. The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI, and thus reduce complications and mortalities.@*METHODS@#We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital. The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention. The exclusion criteria were abdominal CT insufficiency before operation, abdominal surgery before CT scan, and CT mesenteric injury grade being 5. The MBIPS was defined as BIPS plus IE, which was calculated according to 4 variables: white blood cell counts of 17.0 or greater, abdominal tenderness, CT scan grade for mesenteric injury of 4 or higher, and the location of IE. Each clinical variable counted 1 score, totally 4 scores. The location and severity of IE was also noted.@*RESULTS@#In total, 635 cases were hospitalized and 62 patients were enrolled in this study. Of these included patients, 77.4% (40 males and 8 females) were operated by exploratory laparotomy and 22.6% (8 males and 6 females) were treated conservatively. In the 48 patients underwent surgical intervention, 46 were confirmed with HVI (45 with IE and 1 without IE). In 46 patients confirmed without HVI, only 3 patients had IE and the rest had no IE. The sensitivity and specificity of IE in predicting HVI was calculated as 97.8% (45/46) and 81.3% (13/16), respectively. The median MBIPS score for surgery group was 2, while 0 for the conservative treatment group. The incidence of HVI in patients with MBIPS score ≥ 2 was significantly higher than that in patients with MBIPS score less than ≤ 2 (OR = 17.3, p < 0.001).@*CONCLUSION@#IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity, which is a valuable sign for HVI in blunt pelvic trauma patients. MBIPS can be used to predict HVI in blunt pelvic trauma patients. When the MBIPS score is ≥ 2, HVI is strongly suggested.

Tumor-suppressor microRNA-139-5p restrains bladder cancer cell line ECV-304 properties via targeting Connexin 43 / 中华医学杂志(英文版)

BACKGROUND@#In our previous paper, we demonstrated that Connexin 43 (CX43) was highly expressed in bladder cancer (BC) tissues. But the molecular mechanism about microRNAs (miRNAs) regulation upstream of CX43 in BC has not been well elucidated and remains to be further studied. MicroRNA-139-5p (miR-139-5p) is a tumor suppressor in progression of multifarious cancers including BC. Nevertheless, the underlying mechanisms of CX43/miR-139-5p in tumorigenesis of BC are still not well illustrated. The specific objective of our study was to inquiry the effect of CX43/miR-139-5p on BC progression and its underlying mechanism.@*METHODS@#The bioinformatics analysis softwares were applied to predict the miRNAs in the upstream of CX43. First, the expression levels of miR-139-5p in BC tissues (tumor) and paracancer tissues (normal) were investigated using the data from The Cancer Genome Atlas database. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression level of miR-139-5p in three human BC cell lines 5637, T24, ECV-304 and a human bladder epithelial immortalized cell line SV-HUC-1 (normal control). Then si-CX43, si-control, miR-139-5p mimic, and its negative control (NC) were transfected into BC cell line ECV-304. The relationship of miR-139-5p and CX43 was analyzed by dual-luciferase reporter assay. The qRT-PCR and Western blotting were used to test the mRNA and protein expression level of CX43. The proliferation of ECV-304 and T24 cells were examined by cell counting kit-8. The migration and invasion of ECV-304 cells were tested by transwell assay. To determine whether miR-139-5p would affect cell proliferation, migration and invasion by targeting CX43, we executed the rescue assay. The comparison between two groups was analyzed by Student's t test, and comparisons among multiple samples were performed by one-way analysis of variance and a Bonferroni post hoc test.@*RESULTS@#The expression of miR-139-5p was remarkably down-regulated in BC tissues (tumor vs. normal, 2.286 ± 0.017 vs. 3.211 ± 0.034, t = 11.540, P < 0.0001) and cell lines (P < 0.01 in all BC cell lines). Besides, we also indicated that over-expression of miR-139-5p reduced the proliferation of ECV-304 (P = 0.001) and T24 cells (P = 0.005). Moreover, miR-139-5p over-expression weakened the invasion (P = 0.001) and migration (P = 0.001) of ECV-304 cells. Furthermore, the relative luciferase activity of CX43-wild type construct was distinctly lessened by up-regulation of miR-139-5p (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.916 ± 0.063 vs. 0.356 ± 0.048, t = 7.085, P = 0.002), nevertheless the activity of CX43-mutant type construct was untouched (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.918 ± 0.057 vs. 0.878 ± 0.039, t = 0.577, P = 0.595). Finally, the rescue assay revealed that CX43 deletion enhanced the depressor effect of miR-139-5p on ECV-304 cell proliferation (P < 0.01), invasion (P = 0.028), and migration (P = 0.014).@*CONCLUSION@#MiR-139-5p, as a tumor-suppressor, repressed cell proliferation, invasion, and migration in BC, which might be achieved by regulating CX43.

Association between physical activity and glycemic control among type 2 diabetic patients with a good compliance level / 中华疾病控制杂志

Objective To examine the relationship between physical activity and glycemic control among type 2 diabetic patients with a good compliance level in China. Methods A total of 1 272 patients diagnosed with type 2 diabetes with a good compliance level were recruited from five community health centers in Nanjing Chemical Industry Administrative Zone from 2014 to 2016. Logistic regression models were used to examine the relationship between physical activity and glycemic control. Results In this cross-sectional study, 1 272 type 2 diabetic patients (596 men and 676 women) were recruited. The participants’ mean (standard deviation, SD) age was (64.63±9.04) years old. Male participants who achieved sufficient physical activity had the odds ratio (OR) of 2.11 (95%CI:1.17-3.18, P=0.013) for a tight glycemic control compared to their counterparts who had sufficient physical activity, after controling for the potential confounders, no significant association between physical activity and glycemic control status existed in women. Conclusions Physical activity is positively associated with glycemic control among male type 2 diabetic patients who had a good compliance level in Nanjing. Specific physical activity interventions should be implemented to type 2 diabetic patients

Evaluation of an item-specific physical activity scale for Chinese children and adolescents(I-PASCA) / 中华疾病控制杂志

Objective To evaluate the validity and reliability of an item-specific physical activity scale for Chinese children and adolescents(I-PASCA). Methods Students from Grade 4-12 in Nanjing were randomly selected using a multi-stage sampling approach, 7-days physical activity (PA) level was recorded by self-reported I-PASCA and PA log and were objectively measured with accelerometers. The total moderate and vigorous PA (MVPA) time was calculated. Cronbach α was calculated to estimate the reliability of I-PASCA. Pearson correlation coefficient and Bland-Altman were used to examine I-PASCA's validity. Results There were 815 students recruited in 2013 to evaluate the reliability and validity of I-PASCA using PA log. Cronbach α for I-PASCA was 0.73 regarding moderate and vigorous PA (MVPA). The Spearman correlation coefficients of the values of PA recorded by I-PASCA and PA log were 0.59 for MVPA, and the Bland-Altman coefficient was 95.8% for MVPA. 624 students were involved to examine the reliability and validity of I-PASCA using accelerometers. Cronbach α for I-PASCA was 0.72 regarding MVPA. The Spearman correlation coefficient was 0.36 for MVPA, while the Bland-Altman coefficient was 95.5% for MVPA. Conclusions The I-PASCA, the first physical activity questionnaire specific to Chinese children and adolescents, shows acceptable reliability and validity and can be used to evaluate Chinese students' physical activity level in population-based studies.

Tumor-suppressor microRNA-139-5p restrains bladder cancer cell line ECV-304 properties via targeting Connexin 43 / 中华医学杂志(英文版)

Background@#In our previous paper, we demonstrated that Connexin 43 (CX43) was highly expressed in bladder cancer (BC) tissues. But the molecular mechanism about microRNAs (miRNAs) regulation upstream of CX43 in BC has not been well elucidated and remains to be further studied. MicroRNA-139-5p (miR-139-5p) is a tumor suppressor in progression of multifarious cancers including BC. Nevertheless, the underlying mechanisms of CX43/miR-139-5p in tumorigenesis of BC are still not well illustrated. The specific objective of our study was to inquiry the effect of CX43/miR-139-5p on BC progression and its underlying mechanism.@*Methods@#The bioinformatics analysis softwares were applied to predict the miRNAs in the upstream of CX43. First, the expression levels of miR-139-5p in BC tissues (tumor) and paracancer tissues (normal) were investigated using the data from The Cancer Genome Atlas database. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression level of miR-139-5p in three human BC cell lines 5637, T24, ECV-304 and a human bladder epithelial immortalized cell line SV-HUC-1 (normal control). Then si-CX43, si-control, miR-139-5p mimic, and its negative control (NC) were transfected into BC cell line ECV-304. The relationship of miR-139-5p and CX43 was analyzed by dual-luciferase reporter assay. The qRT-PCR and Western blotting were used to test the mRNA and protein expression level of CX43. The proliferation of ECV-304 and T24 cells were examined by cell counting kit-8. The migration and invasion of ECV-304 cells were tested by transwell assay. To determine whether miR-139-5p would affect cell proliferation, migration and invasion by targeting CX43, we executed the rescue assay. The comparison between two groups was analyzed by Student’s t test, and comparisons among multiple samples were performed by oneway analysis of variance and a Bonferroni post hoc test.@*Results@#The expression of miR-139-5p was remarkably down-regulated in BC tissues (tumor vs. normal, 2.286 ± 0.017 vs. 3.211 ± 0.034, t= 11.540, P < 0.0001) and cell lines (P < 0.01 in all BC cell lines). Besides, we also indicated that over-expression of miR-139-5p reduced the proliferation of ECV-304 (P = 0.001) and T24 cells (P = 0.005). Moreover, miR-139-5p over-expression weakened the invasion (P = 0.001) and migration (P = 0.001) of ECV-304 cells. Furthermore, the relative luciferase activity of CX43-wild type construct was distinctly lessened by up-regulation of miR-139-5p (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.916 ± 0.063 vs. 0.356 ± 0.048, t = 7.085, P = 0.002), nevertheless the activity of CX43-mutant type construct was untouched (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.918 ± 0.057 vs. 0.878 ± 0.039, t= 0.577, P = 0.595). Finally, the rescue assay revealed that CX43 deletion enhanced the depressor effect of miR-139-5p on ECV-304 cell proliferation (P < 0.01), invasion (P = 0.028), and migration (P = 0.014).@*Conclusion@#MiR-139-5p, as a tumor-suppressor, repressed cell proliferation, invasion, and migration in BC, which might be achieved by regulating CX43.

Changes of skin mechanical properties and reuse of denatured dermis after deep second-degree burn in rats / 上海交通大学学报（医学版）

Objective • To investigate the changes of skin mechanical properties after deep second-degree burn, and study the feasibility of composite transplantation by using denatured dermal acellular matrix. Methods • The deep second-degree burn models in SD rats were constructed, and then the full skins were harvested after 3 h and 3 d, respectively, to compare the skin modulus of elasticity and ultimate load with normal skins. In addition, the structural differences of the dermal matrix were also compared. The composite transplantations were conducted by using the normal or denatured dermal acellular matrix, and then the general and histological structures of living skin grafts were observed. Results • The moduli of elasticity of the normal skins and the skins 3 h and 3 d after burn in SD rats were (8.7±6.4) MPa, (7.2±2.7) MPa and (2.7±0.3) MPa, respectively. The ultimate loads were (107.1±41.7) N, (81.5±10.8) N and (42.2±7.0) N, respectively. Both indexes were significantly reduced in the skins 3 d after burn compared to the normal ones (P<0.05). In the acellular matrix of denatured dermis 3 h after burn, the pore structure was still similar to that of normal one, and the appearance and histological structure after healing from composite transplantation were similar to those of the control group. Conclusion • The early denatured skin tissue after deep second-degree burn maintains the similar mechanical properties and histological structure to the normal skin, which is a potential source of acellular dermal matrix for composite transplantation.

Long-term quality of life after sepsis and predictors of quality of life in survivors with sepsis / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To evaluate the quality of life among survivors after sepsis in 2 years, comparing with critical patients without sepsis and the general people, analyze the changes and the predictors of quality of life among septic survivors.</p><p><b>METHODS</b>This prospective case-control study screened the intensive care unit (ICU) patients in Tianjin Third Central Hospital from January 2014 to October 2017, and the Chinese general population in the previous studies was also included. According to inclusion criteria and exclusion criteria, 306 patients with sepsis were enrolled as the observation group, and another 306 patients without sepsis in ICU during the same period, whose ages, gender and Charlson Comorbidity Index matched with observation group, were enrolled as the control group. At 3 mo, 12 mo, and 24 mo after discharge, the Mos 36-item Short Form Health Survey (SF-36), the Euroqol-5 dimension (EQ-5D), and the activities of daily living (ADL) were evaluated in face-to-face for the quality of life among survivors.</p><p><b>RESULTS</b>There were 210 (68.6%) septic patients and 236 (77.1%) non-septic critically ill patients surviving. At 3 months after discharge, the observation and control groups had the similar demographic characteristics (age: 58.8 ± 18.1years vs. 57.5 ± 17.6 years, p = 0.542; male: 52.0% vs. 51.4%, p = 0.926). However, the observation group had higher acute physiology and chronic health evaluation II (APACHEII) scores, higher sequential organ failure assessment (SOFA) scores, longer hospital stay, and longer ICU stay than the control group did (p < 0.05). There were no significant differences in the eight dimensions of the SF36 scale, the EQ-5D health utility scores, and the activities of daily life scores between septic survivors and non-septic survivors (p > 0.05). In addition, compared with the quality of life of the Chinese general population (aged 55-64 years), the quality of life of septic patients were significantly lower at 3 months after discharge (p < 0.05). Comparing the quality of life of the ill patients who had been discharged at 3 mo and 24 mo, the general health improved statistically (p = 0.000) and clinically (score improvement > 5 points). Older age (OR, 1.050; 95% CI, 1.022-1.078, p = 0.000), female (OR, 3.375; 95% CI, 1.434-7.941, p = 0.005) and longer mechanical ventilation time (OR, 3.412; 95% CI, 1.413, 8.244, p = 0.006) were the risk factors for the quality of life of septic survivors.</p><p><b>CONCLUSION</b>The long-term quality of life of septic survivors was similar to that of non-sepsis critically ill survivors. After discharge, the general health of sepsis improved overtime. Age, female and mechanical ventilation time (>5 days) were the predictors of the quality of life after sepsis.</p>

Clinicopathologic study of adenosarcoma with sarcomatous overgrowth of the uterine / 临床与实验病理学杂志

Purpose To investigate the clinicopathologic characteristtics, immunophenotype and differential diagnosis of uterine adenosarcoma with sarcomatous overgrowth. Metheds The clinicopathological data of 4 cases of uterine adenosarcoma with sarcomatous overgrowth were collected, the histopathologic and immunohistochemical features were investigated, and the rele-vant literatures were also reviewed. Results All of tumors were arised from the endometrium with complains of postmenopausal vaginal bleeding or prolonged menstrual period. There is a poly-poid nodular in the uterine cavity with a pedicle or no pedicel, or rough endometrium. On the cut surface, the tumor was fish-like without distinct from the surrounding tissue. Light microsco-py show the tumors were composed of benign glands and malignant mesenchymal components, the sarcomatouscomponents ac-counted for over 25％. In 4 cases, 2 cases had heterologous com-ponent of rhabdomyosarcoma. The component of sarcomatous were positive for vimentin and CD10. The heterologous component of rhabdomyosarcoma were positive for desmin, MyoDl, and Myogenin.3 cases were died at in 5, 10, and 19 months after operation, 1 patient was disease free survival for 3 months. Conclusion Uterine adenosarcoma with sarcomatous overgrowth has a bad prognosis.

The variation of renal pelvic pressure and the influence on renal glomerular filtration rate during percutaneous nephrolithotomy via standard- tract / 中国内镜杂志

Objective To investigate the variation of renal pelvic pressure during percutaneous nephrolithotomy (PCNL) via standard nephrostomy tract and explore its influence on renal function. Methods 156 patients with renal calculi were selected for PCNL in standard-tract. The patients were divided into normal, mild hydronephrosis, moderate hydronephrosis groups according to the image by color Doppler ultrasonograph. A transurethral 6F ureteral catheter was inserted into renal pelvis and connected to the pressure monitering system before PCNL. During the operations, all the nephrostomy tracts were dilated to F24 size after successful puncture. Energy used was pneumatic and ultrasound lithotripsy. Renal function of the patients was evaluated with glomerular filtration rate (GFR) determined by 99mTc-DTPA dynamic renal imaging before and one week after PCNL. Data were analyzed by SPSS 19.0 software. Results The stone clearance rate was 75.0％ in one-session procedure. Severe complications did not occur during the operation, such as hemorrhage needing nephrectomy and abdominal organ injury or pneumothorax. There were no statistically significant differences between normal and mild hydronephrosis groups for the variation of renal pelvic pressure during preoperative versus intraoperative PCNL (P > 0.05). The renal pelvic pressure was significantly higher during operation than those of preoperation in moderate hydronephrosis group (P < 0.05), and it was greater than those of normal and mild hydronephrosis groups during operation (P < 0.05). Renal pelvic pressure generally remained lower than a level to 30.00 mmHg. There were no significant differences of preoperative and postoperative glomerular filtration rate in all the groups (P > 0.05). Conclusions There were no significant differences on the renal pelvic pressure in normal group and mild hydronephrosis group during operation via standard nephrostomy tract. It should be careful to maintain the lower intrapelvic pressure in order to avoid reflux and infection in moderate hydronephrosis group. Percutaneous nephrolithotomy via standard- tract does not cause significant effects on glomerular filtration rate during the perioperative period of PCNL .

The progress of long-term outcomes in survivors of acute respiratory distress syndrome / 天津医药

Along with the development of critical care medicine and the advances in respiratory support,the short-term mortality of acute respiratory distress syndrome (ARDS) has significantly decreased, and many patients have survived. Then the long-term outcomes of survivors of ARDS is getting more and more attention. ARDS survivors can have complete recovery of pulmonary function, but they might continue to present sequelae including physical impairment (muscle weakness and limited activities), cognitive impairment and psychologic problem (anxiety, depression, post-traumatic stress disorder) over five years, called as post intensive care syndrome, resulting in a decline in quality of life and increasing the burden of family and medical resource consumption. For ARDS patients, some factors have a significant impact on the long-term outcomes of survivors, including pre-ARDS health status (such as comorbidity, obesity, functional independence, mental health status), lifestyle (such as smoking) and the relevant variables during their stay in ICU (such as delirium, corticosteroids, opioids, acquired muscle weakness, hypoxemia). Identifying the modifiable risk factors for long-term outcomes of ARDS patients, and taking timely intervention measures have important significance for decline of post-ARDS dysfunction. It is unclear whether interventions in ICU or post-ICU can effectively improve long-term outcomes in ARDS survivors, and further investigation and validation are required.

Expression changes and clinical significances of Gas6, SDF-1α and SDF-1β in serum in patients with diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the expression changes and clinical significances of Gas6, SDF-1α and SDF-1β in serum in patients with diabetic retinopathy(DR). <p>METHODS: Totally 113 patients with DR were divided into proliferative group(<i>n</i>=45)and nonproliferative group(<i>n</i>=68). In the same period, 49 cases of patients with non-contracted DR diabetes were selected as the diabetic group and 42 cases of healthy subjects were selected. The indexes of blood glucose, blood lipids and hs-CRP were detected. The expressions of Gas6, SDF-1α and SDF-1β genes in serum were detected by using real-time PCR technology. <p>RESULTS: The HOMA-IR, TG and hs-CRP in the diabetic group, nonproliferative group and proliferative group gradually increased, the differences were statistically significant(<i>F</i>=39.672, 81.625, 99.872, all <i>P</i><0.05). The LDL-C in the nonproliferative group and proliferative group were higher than the diabetic group and healthy subjects, while the HDL-C were lower than the diabetic group and the healthy subjects, the differences were statistically significant(<i>F</i>=51.974, 43.824, all <i>P</i><0.05). The relative expression levels of Gas6 mRNA in proliferative group, nonproliferative group and diabetic group were higher than the healthy subjects; the relative expression levels of SDF-1α mRNA in proliferative group were higher than the nonproliferative group, diabetic group and healthy subjects. The relative expression levels of SDF-1β mRNA in proliferative group and nonproliferative group were higher than the diabetic group and healthy subjects, and the proliferative group were higher than the nonproliferative group, the differences were statistically significant(<i>F</i>=15.381, 21.589, 38.942, all <i>P</i><0.05). Pearson correlation analysis showed that the relative expression levels of Gas6 mRNA in serum in patients with DR were positively correlated with TG, TC and LDL-C(<i>r</i>=0.228, 0.241, 0.209, all <i>P</i><0.05), and the relative expression levels of SDF-1α mRNA and SDF-1β mRNA in serum were positively correlated with hs-CRP(<i>r</i>=0.297 and 0.325, all <i>P</i><0.05). <p>CONCLUSION: The expression levels of Gas6, SDF-1α and SDF-1β genes in serum in patients with DR are elevated. They might be related to abnormal blood lipid metabolism and inflammatory response.

Huannao Yicong Formula () regulates γ-secretase activity through APH-1 and PEN-2 gene ragulation pathways in hippocampus of APP/PS1 double transgenic mice / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the effects of Huannao Yicong Formula (, HYF) on learning and memory and it's regulating effect on γ-secretase related anterior pharynx defective 1 (APH-1), presenilin enhancer-2 (PEN-2) signaling pathway, so as to discuss and further clarify the mechanism of HYF on Alzheimer's disease.</p><p><b>METHODS</b>Sixty APP/PS1 transgenic mice, randomly allocated into 4 groups, the model group, the donepezil group (0.65 mg/kg), HYF low-dose group (HYF-L, 5.46 g/kg) and HYF high-dose group (HYF-H, 10.92 g/kg), 15 for each group. Another 15 C57BL/6J mice with the same age and same genetic background were allocated into the control group, proper dosage of drugs or distilled water were given by intragastric administration once daily for 12 weeks. After 12 weeks of administration, the learning and memory abilities of mice in each group was evaluated by the morris water maze test, amyloid precursor protein (APP), Aβand Aβlevels in hippocampus were detected by enzyme-linked immunosorbent assay, γ-secretase was detected by dual luciferase assaying, the levels of APH-1a, hypoxia-inducible factor 1α (HIF-1α), cAMP response element-binding protein (CREB) and PEN-2 and their mRNA expression was measured by Western blot and real-time polymerase chain reaction.</p><p><b>RESULTS</b>HYF can ameliorate learning and memory deficits in APP/PS1 transgenic mice by decreasing the escape latency, improving the number of platform crossing and swimming speed (P<0.01, P<0.05). HYF can decrease the levels of APP, Aβ, Aβand the activity of γ-secretase in hippocampus of Alzheimer's disease model mice. HYF can down-regulate the levels of CREB and PEN-2 and the expression of their mRNA.</p><p><b>CONCLUSION</b>HYF can improve the learning and memory ability by inhibiting the activity of γ-secretase through the CREB/PEN-2 signaling pathway, and this may be one of the therapeutic mechanisms of HYF in Alzheimer's disease.</p>

Meta-analysis of the efficacy and safety of PFNA and InterTAN for the treatment of intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To system evaluate the clinical effect and safety of PFNA and InterTAN internal fixation methods for femoral intertrochanteric fracture.</p><p><b>METHODS</b>According to the Cochrane systemic analysis method, randomized controlled trials and quasi-randomized controlled trials which were about the comparison of PFNA and InterTAN for intertrochanteric fracture were collected from Cochrane Library(2017, issue 4), PubMed (January, 2003-May, 2017), Wanfang Med Online (January, 2003-May, 2017) and China Academic Journals Full-text Database(January, 2003-May, 2017) by computer searching. Cross-checking was done after assessing the quality of the included trials and extracting the data by two reviewers independently. Data analysis were performed with RevMan 5.3.</p><p><b>RESULTS</b>Two randomized controlled trials and five quasi-randomized controlled trials involving 611 cases met the inclusion criteria. The meta-analyses showed no significant differences between the two methods on Harris scores[MD=-1.00, 95%CI(-2.29, 0.28),=0.13], union time[MD=0.04, 95%CI (-0.70, 0.77),=0.92], full weight-bearing time[MD=1.06, 95%CI(-0.29, 2.42),=0.13], hospital stay[MD=-0.04, 95%CI (-0.52, 0.45),=0.89] and length of incision[MD=-1.00, 95%CI (-2.64, 0.65),=0.23]. There were significant differences between the two methods on operative time[MD=-25.75, 95%CI (-37.47, -14.03),<0.000 1], intraoperative blood loss[MD=-55.67, 95%CI(-108.07, -3.27),=0.04] and the internal fixation complication rate[MD=4.17, 95%CI (1.33, 13.08),=0.01].</p><p><b>CONCLUSIONS</b>Both PFNA and InterTAN could provide good effect for intertrochanteric fracture. The operation time of PFNA is shorter than that of InterTAN, and there is less blood loss during operation. PFNA may be the first choice for the treatment of patients who have many complications and can't endure long-time operation. The complications of PFNA are more than those of InterTAN. In patients with long life expectancy and high requirements, InterTAN may be preferentially selected to reduce complications. According to the patient's situation, after a comprehensive consideration, appropriate treatment can be selected.</p>

Assessment of 1-year Outcomes in Survivors of Severe Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation or Mechanical Ventilation: A Prospective Observational Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Little is known about the long-term outcomes of severe acute respiratory distress syndrome (ARDS) patients requiring extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the 1-year outcomes of these patients or patients receiving mechanical ventilation (MV) and compare their health-related quality of life (HRQoL) to the general population.</p><p><b>METHODS</b>Severe ARDS survivors admitted to two ICUs in China between January 2012 and January 2014 were enrolled. Of the severe ARDS survivors enrolled, 1-year postdischarge, HRQoL assessment using the Short-Form 36 (SF-36) and EuroQol questionnaire dimensions, 6-min walking distance, chest computed tomography scan, pulmonary function, and arterial blood gas analysis were compared for ARDS patients with or without ECMO.</p><p><b>RESULTS</b>ARDS patients receiving ECMO had a significantly higher Acute Physiology and Chronic Health Evaluation II score (30.3 ± 6.7 vs. 26.5 ± 7.3, P= 0.036), lung injury score (3.3 ± 0.4 vs. 2.8 ± 0.5, P= 0.000), Sequential Organ Failure Assessment score (10.8 ± 3.5 vs. 7.9 ± 3.1, P= 0.000), lower PaO2/FiO2ratio ([mmHg, 1 mmHg = 0.133 kPa], 68.3 ± 16.1 vs. 84.8 ± 16.5, P= 0.000), and increased extrapulmonary organ failure (2 [1, 3] vs. 1 [1, 1], P= 0.025) compared with patients not receiving ECMO. ECMO and non-ECMO survivors showed similar pulmonary function, morphological abnormalities, resting arterial blood gas values, and 6-min walking distance. Mild pulmonary dysfunction and abnormal morphology were observed in a few survivors. In addition, ECMO and non-ECMO survivors showed a similar quality of life. ECMO survivors showed lower SF-36 physical functioning and role-physical domain scores (minimum clinically significant difference at least 5 points), and non-ECMO survivors had similar outcome.</p><p><b>CONCLUSIONS</b>One-year posthospital discharge, severe ARDS survivors receiving ECMO or MV demonstrated comparable outcomes. Compared with the general population, ARDS survivors showed reduced HRQoL. Pulmonary function and lung morphology revealed sufficient recovery with minor lung impairment.</p>

Comparison of the pulmonary dead-space fraction derived from ventilator volumetric capnography and a validated equation in the survival prediction of patients with acute respiratory distress syndrome / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>This prospective observational study aims to evaluate the accuracy of dead-space fraction derived from the ventilator volumetric capnography (volumetric CO₂) or a prediction equation to predict the survival of mechanically ventilated patients with acute respiratory distress syndrome (ARDS).</p><p><b>METHODS</b>Consecutive VD/VT measurements were obtained based upon a prediction equation validated by Frankenfield et al for dead-space ventilation fraction: VD/VT = 0.320 + 0.0106 (PaCO₂-ETCO₂)⁺ 0.003 (RR)⁺0.0015 (age) in adult patients who had infection-related severe pneumonia and were confirmed as having ARDS. Here PaCO₂ is the arterial partial pressure of carbon dioxide in mmHg; ETCO₂, the end- tidal carbon dioxide measurement in mmHg; RR, respiratory rate per minute; and age in years. Once the patient had intubation, positive end expiratory pressure was adjusted and after Phigh reached a steady state, VD/VT was measured and recorded as the data for the first day. VD/VT measurement was repeated on days 2, 3, 4, 5 and 6. Meanwhile we collected dead-space fraction directly from the ventilator volu- metric CO₂ and recorded it as Vd/Vt. We analyzed the changes in VD/VT and Vd/Vt over the 6-day period to determine their accuracy in predicting the survival of ARDS patients.</p><p><b>RESULTS</b>Overall, 46 patients with ARDS met the inclusion criteria and 24 of them died. During the first 6 days of intubation, VD/VT was significantly higher in nonsurvivors on day 4 (0.70 ± 0.01 vs 0.57 ± 0.01), day 5 (0.73 ± 0.01 vs. 0.54 ± 0.01), and day 6 (0.73 ± 0.02 vs. 0.54 ± 0.01) (all p =0.000). Vd/Vt showed no significant difference on days 1e4 but it was much higher in nonsurvivors on day 5 (0.45 ± 0.04 vs. 0.41 ± 0.06) and day 6 (0.47 ± 0.05 vs. 0.40 ± 0.03) (both p=0.008). VD/VT on the fourth day was more accurate to predict survival than Vd/Vt. The area under the receiver-operating characteristic curve for VD/VT and Vd/Vt in evaluating ARDS patients survival was day 4 (0.974 ± 0.093 vs. 0.701 ± 0.023, p = 0.0024) with the 95% confidence interval being 0.857-0.999 vs. 0.525-0.841.</p><p><b>CONCLUSION</b>Compared with Vd/Vt derived from ventilator volumetric CO₂, VD/VT on day 4 calculated by Frankenfield et al's equation can more accurately predict the survival of ARDS patients.</p>

Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults.</p><p><b>METHODS</b>Reports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis.</p><p><b>RESULTS</b>Seven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P < 0.000 01], hospital stays time [WMD = -4.72, 95% CI (-5.18, -4.25), P < 0.000 01], bearing load time [WMD = -29.54, 95% CI (-30.77, -28.31), P < 0.000 01], total complications rate [WMD = 0.15, 95% CI (0.11, 0.22), P < 0.000 01], the good rate of Harris scores [WMD = 1.09, 95% CI (0.54,1.32), P < 0.05]. However, there were no statistical significance in the rate of deep venous thrombosis [WMD = 1.09, 95% CI (0.47, 2.55), P > 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.</p>

Relationship between dietary pattern and excess body weight among urban residents: a three-year follow-up study in Nanjing / 中华流行病学杂志

Objective To examine the relationship between the duration of diet and the risk related to excess body weight in residents of Nanjing city.Methods With multi-stage cluster random sampling method,a total number of 3376 local residents aged 30 and over in 7 communities from 2 urban districts were involved in this survey.Through diet balance index (DBI),nine dietary patterns were identified.Subjects with normal BMI in the baseline survey were selected to participate in the follow-up survey.Multiple linear regression and multivariate logistic regression analysis were used to estimate the incidence risks on overweight and obesity.Results Of 1898 eligible subjects with normal BMI in the baseline survey,1347 of them completed the 3-year follow-up survey,with a follow-up rate of 71.0％.By multiple linear regression method,on average,an increase in DBI_DQD of 1 unit was seen and associated with a 0.028 increase in BMI.DBI_DQD were also associated with BMI (β=0.022,P＜0.001)after adjusted for the covariates.By logistic regression,when compared with the group of healthy dietary pattern,the relative risk for excessive body weight was 1.37 for those with unhealthy dietary patterns.After adjusting the possible confounding factors,the excessive body weight was also associated with significantly increased risk (RR=1.51,95％ CI:1.09-2.09).Conclusion Results from this study provided evidence,showing that unhealthy dietary patterns could predict the increase risk of excessive body weight,suggesting that healthy dietary pattern was important in controlling the excessive body weight.

Clinical application of free thin anterolateral thigh flap in the reconstruction of intraoral defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the clinical features and therapeutic effect of free thin anterolateral thigh flap for the reconstruction of intraoral defects.</p><p><b>METHODS</b>The clinicopathologic data of 34 cases with oral carcinoma were obtained from Institute and Hospital of Stomatology, Nanjing University Medical School, from December 2008 to December 2011. These 34 patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free thin anterolateral thigh flaps. The defects were located at tongue, buccal, mouth floor, and so on. The subcutaneous fat thickness of the flap at the site of the perforator is usually measured by ultrasound before the operation. If the thickness of the subcutaneous fat at the site of the perforator exceeded 1.5 cm, the patient was excluded from the study.</p><p><b>RESULTS</b>There were 16 male and 18 female patients. The mean age was 55.4 years. Among the 34 patients, 26 flaps with musculocutaneous perforators and 8 flaps with septo-cutaneous perforators were used. Partial flap necrosis occurred in 2 patients.</p><p><b>CONCLUSIONS</b>The free thin anterolateral thigh flap is the ideal soft tissue flap for the intraoral defects reconstruction. Satisfactory functional results can he achieved at recipient area with minimal morbidity at the donor site area.</p>

Treating oligospermia patients of Shen-essence deficiency syndrome by 3 different treatment programs: a clinical observation / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To compare the clinical efficacy of 3 different treatment programs for oligospermia patients of Shen-essence deficiency syndrome (SEDS).</p><p><b>METHODS</b>Totally 450 male patients were randomly assigned to 3 groups, i.e., the treatment group, the control group 1, and the control group 2, 150 in each group. Patients in the treatment group were treated by Bushen Yijing Decoction (BYD), tamoxifen tablet (TT), Licorzine Capsule (LC), and Vitamin E Soft Capsule (VESC). Those in the control group 1 were treated by BYD, LC, and VESC. Those in the control group 2 were treated by TT, LC, and VESC. All patients were treated for 3 months. Their pregnant rates were compared. Clinical efficacies of each Chinese medical symptom and sperm parameters [sperm density, grade a sperm motility rate, grade (a + b) sperm motility rate, grade (a + b + c) sperm motility rate, and normal sperm morphology rate] were compared before and after treatment.</p><p><b>RESULTS</b>At 3 months after treatment 61 patients were pregnant in the treatment group, 36 patients were pregnant in the control group 1, and 30 patients were pregnant in the control group 2. The differences in the sperm density, grade a sperm motility rate, and grade (a + b) sperm motility rate, and grade (a + b + c) sperm motility rate between before and after treatment were significantly higher in the treatment group than in the control group 1 and the control group 2 (P < 0.01). The difference in the normal sperm morphology rate between before and after treatment was obviously higher in the treatment group and the control group 1 than in the control group 2 (P < 0.01). Better results were obtained in the treatment group and the control group 1 in improving the sexual apathy, soreness and weakness of waist and knees, impotence, premature ejaculation, seminal emission, dizziness, tinnitus, forgetfulness, alopecia, when compared with the control group 2 (P < 0.01, P < 0.05). There was no statistical difference in the total effective rate of improving Chinese medical symptoms between the treatment group and the control group 1 (P > 0.05).</p><p><b>CONCLUSION</b>BYD combined with TT, LC, and VESC could significantly improve sperm qualities and clinical Chinese medical symptoms of oligospermia patients of SEDS.</p>

Dietary patterns and hyperglycemia in a follow-up study in Nanjing city / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the association between dietary patterns and the risk of developing hyperglycemia in Nanjing.</p><p><b>METHODS</b>Using multi-stage stratified random cluster sampling, the baseline survey was conducted on local residents older than 30 years in 7 communities from 2 urban districts from June to September 2007 in Nanjing. The total eligible subjects were 3376. Excluding the 476 previously diagnosed hyperglycemia patients, 2900 non-hyperglycemia subjects were used as the baseline sample for the follow-up survey from June to September 2010. Using specially designed food frequency questionnaire (FFQ), factor analysis was applied to identify food patterns. Multivariable linear and Cox regression models were used to analyze the association between different dietary patterns and risk of hyperglycemia.</p><p><b>RESULTS</b>The follow-up rate was 72.2%, with 2093 subjects participated the follow-up survey in 3 years. Three-year cumulative incidence of hyperglycemia was 7.5% (158/2093). The incidence rate was 7.1% (62/873) for males and 7.9% (96/1220) for females, but the differences were not statistically significant (χ(2) = 0.43, P = 0.513). Five dietary patterns were identified by factor analysis: condiment, animal and plant protein, traditional healthy, sweet food and alcohol drinking. By multivariable linear regression, on average, an increase in traditional healthy pattern and sweet food pattern of 1 unit was associated with a -0.054, 0.050 mmol/L increase in fasting blood glucose, respectively, and the differences were both statistically significant (t = -2.38, 2.27, respectively, P values were both less than 0.05). By multivariable Cox regression, the pattern sweet food was positively significantly associated with hyperglycemia risk in men. The incidence of hyperglycemia was 4.7% (14/295) for the lowest tertile of the factor score (T1), and 9.7% (26/269) for the highest tertile of the factor score (T3) (T3:T1: RR = 1.88, 95%CI: 1.04 - 3.54). The pattern traditional healthy was inversely associated with hyperglycemia risk in women. The incidence of hyperglycemia was 10.7% (45/421) for T1 and 6.3% (21/335) for T3 (T3:T1: RR = 0.59, 95% CI: 0.35 - 0.99). Conversely, a statistically significant positively association was observed for the pattern alcohol drinking in women. The incidence of hyperglycemia was 8.1% (38/472) for T1 and 11.1% (33/297) for T3 (T3:T1: RR = 1.35, 95%CI: 0.84 - 2.16).</p><p><b>CONCLUSION</b>Dietary patterns are associated with hyperglycemia. The sweet food pattern is a risk factor for hyperglycemia in men. In women, healthy dietary pattern is healthy and the alcohol drinking pattern is a risk factor for hyperglycemia.</p>