Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion / 中华劳动卫生职业病杂志

Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.

Clinical and molecular characteristics of Streptococcus pneumoniae-associated hemophagocytic lymphohistiocytosis in children / 中华儿科杂志

Objective: To summarize the clinical features of Streptococcus pneumoniae-associated hemophagocytic syndrome (SP-HLH), and the serotypes and drug-resistant characteristics of the isolated strains. Methods: There were 15 children with SP-HLH admitted to the Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital, Capital Medical University from January 2013 to December 2020 were included in this study. Clinical data including children's general characteristics, clinical features, laboratory examinations, treatments, prognosis and the outcomes of follow-up by May 2021 were analyzed retrospectively. The serotypes and drug resistance of the isolated strains were identified. All children were divided into the clinical improvement group and the death group. Mann-Whitney U test, Fisher's exact test were used to compare the data of the two groups. Results: Among the 15 children with SP-HLH, 8 were males and 7 were females. The age of these children was 1.0 (1.0, 2.5) years. Regarding the primary infection, there were 9 cases of severe pneumonia, 3 cases of meningitis and 3 cases of blood stream infection. None of these children had received pneumoniae conjugate vaccine (PCV) and all of them were admitted to the PICU. Respiratory failure was observed in 10 patients, acute renal injury in 5, and hemolytic uremic syndrome in 3 patients. All children received glucocorticoids and high-dose intravenous immunogloblin (IVIG) in addition to anti-infective treatment. Eight of the children were cured while the other 7 died. The neutrophil count in the death group was lower than that in the clinical improvement group ((5.0 (1.7, 9.3) × 109 vs. 5.2 (3.4, 10.5) ×109/L, Z =-2.43, P<0.015), and the length of hospital stay and days of PICU stay in the death group were both shorter than those in the improvement group statistically (3 (1, 11) vs. 39 (34, 48) d, 2 (1, 4) vs. 19 (12, 31) d, Z=-3.25, -3.24, both P=0.001). Ten serotypes of Streptococcus pneumoniae were identified, including 4 strains of 19F, 3 of 19A, 1 of 23F, 1 of 15A and 1 of 14, among which 9 strains (9/10) were covered by PCV13. All strains were resistant to erythromycin yet sensitive to vancomycin and linezolid. Conclusions: SP-HLH is more common in children under the age of 3, with a high mortality rate. The death cases have lower neutrophil count and rapid disease progression. The comprehensive treatment is anti-infective combined with glucocorticoids and high-dose IVIG. The predominant serotypes are 19F and 19A and all isolated strains were susceptible to vancomycin and linezolid.

Review of risk evaluation scores for benign end stage liver diseases recipients / 中华外科杂志

Liver transplant is an unreplaceable method for benign end-stage liver disease. The risk evaluation for the waiting list recipients and for post-transplant survival could provide practical indication for organ allocation. In recent years, there are two major kinds of evaluation scores. The first kind of evaluation scores is based on model for end-stage liver disease(MELD) score,including SOFT/P-SOFT score,UCLA-FRS score and BAR score. The other evaluation system is based on the concept of acute-on-chronic liver failure,including CLIF-C-ACLF score,TAM score,AARC-ACLF score and COSSH-ACLF score. The scores based on ACLF have been shown superior power in predicting waiting list survival and post-transplant prognosis than MELD. This article reviews the two kinds of evaluation scores,aiming for the better allocation policy and the better prognosis of benign end-stage liver disease.

Review of risk evaluation scores for benign end stage liver diseases recipients / 中华外科杂志

Liver transplant is an unreplaceable method for benign end-stage liver disease. The risk evaluation for the waiting list recipients and for post-transplant survival could provide practical indication for organ allocation. In recent years, there are two major kinds of evaluation scores. The first kind of evaluation scores is based on model for end-stage liver disease(MELD) score,including SOFT/P-SOFT score,UCLA-FRS score and BAR score. The other evaluation system is based on the concept of acute-on-chronic liver failure,including CLIF-C-ACLF score,TAM score,AARC-ACLF score and COSSH-ACLF score. The scores based on ACLF have been shown superior power in predicting waiting list survival and post-transplant prognosis than MELD. This article reviews the two kinds of evaluation scores,aiming for the better allocation policy and the better prognosis of benign end-stage liver disease.

Gastrointestinal reconstruction by intestinal auto-transplantation after radical resection of neoplasms involving superior mesenteric artery: a preliminary consideration / 中华外科杂志

When abdominal neoplasms originating from the pancreas or nearby organs locally involving the superior mesenteric artery (SMA), complete resection is still the only hope for cure. However, SMA resection and reconstruction is a complex surgical procedure associated with high postoperative morbidity and mortality. Intestinal autotransplantation has recently emerged in clinical practice as a treatment option for selected patients with neoplasms involving the SMA. The original procedure involved en bloc removal of a tumor together with the intestine, ex vivo resection and reconstruction of gastrointestinal tract by an intestinal autograft. To further refine this complex procedure, a modified method was developed in which a segmental bowel autograft is selected and harvested first during the initial stage of the operation, and radical resection of the neoplasm is carried out thereafter. The modification would better protect a healthy bowel autograft from potential damage due to prolonged warm ischemia and allow the subsequent lengthy process of dissection to be performed in an unrushed manner. Furthermore, this alteration would better adhere to the general principles of minimal tumor manipulation during operation and potentially decrease the risks of tumor implantation during in vitro organ perfusion. Although intestinal autotransplantation has expanded eligibility for resection of otherwise unresectable lesions involving the SMA, its operative complexity, high risks, and post-operative complications largely limit its clinical applications.

Novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint / 中国骨伤

OBJECTIVE@#To explore the efficacy of a novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint.@*METHODS@#Retrospective analysis of 13 cases of proximal clavicle fracture with dislocation of sternoclavicular joint treated with sternoclavicular hook-plate from June 2011 to January 2019 in our department. There were 9 males and 4 females, aged 26 to 78 years old, with an average age of (54.08±13.91) years old. All the patients had closed injuries without damage of blood vessels and nerves. The patient's operation time, intraoperative blood loss, hospital stay time, and postoperative complications were recorded. Fracture healing and reduction were evaluated according to X-ray and CT after operation. Constant-Murley score and Rockwood sternoclavicular joint score were used to evaluate limb function at 12 months after operation.@*RESULTS@#All the patients were treated with sternoclavicular hook-plate. The operation time ranged from 50 to 76 min, with a mean of (54.08±13.91) min. The intraoperative blood loss ranged from 20 to 56 ml, with a mean of (46.08±11.15) ml. The hospital stay time ranged from 6 to 14 d, with a mean of (8.31±2.32) d. X-ray and CT examination on the second day after operation showed that all fractures and dislocations were anatomically reduced, and shoulder joint function exercise was performed early. All patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (16.77±4.63) months. The healing time ranged from 9 to 13 d, with a mean of (11.00±1.75) d;and the bone healing time ranged from 3 to 4 months, with a mean of (3.65±0.46) months. There were no complications such as infection, internal fixation failure and nerve injury. At 12 months follow-up, the constant Murley score ranged from 78 to 100, with a mean of 87.83± 11.26; and Rockwood score ranged from 9 to 15, with a mean of 13.70±1.85. Among them, 11 cases were excellent, 1 case was good, and 1 case was general.@*CONCLUSION@#The use of the novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint is an effectively internal fixation with high safety, allowing early functional exercise for patients.

Practice of pre-hospitalization in operation department of a hospital in Guangzhou / 中华医院管理杂志

Since the performance appraisal of national tertiary public hospitals was carried out, higher requirements have been put forward for the operation and management of hospitals. Under the premise of ensuring the quality of medical service and medical safety, how to save hospital operating costs and improve the efficiency is an urgent problem for hospital managers. Supported by information upgrading, a tertiary hospital in Guangzhou reformed the treatment process and carried out pre-hospitalization in surgical departments. Data showed that pre-hospitalization can significantly shorten the length of stay, reduce hospitalization costs, and improve the operation efficiency of the hospital.

Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition

PURPOSE: The International Study Group on Pancreatic Fistula's definition of postoperative pancreatic fistula (POPF) has recently been updated. This study aimed to identify risk factors for POPF in patients having pancreaticoduodenectomy (PD) and to generate a nomogram to predict POPF.METHODS: Data on 298 patients who underwent PD from March 2012 to October 2017 was retrospectively reviewed and POPF statuses were redefined. A nomogram was constructed using data from 220 patients and validated using the remaining 78 patients. Independent risk factors for POPF were identified using univariate and multivariate analyses. A predictive nomogram was established based on the independent risk factors and was compared with existing models.RESULTS: Texture of the pancreas, size of the main pancreatic duct, portal vein invasion, and definitive pathology were the identified risk factors. The nomogram had a C-index of 0.793 and was internally validated. The nomogram performed better (C-index of 0.816) than the other most cited models (C-indexes of 0.728 and 0.735) in the validation cohort. In addition, the nomogram can assign patients into low- (less than 10%), intermediate- (10% to 30%), and high-risk (equal or higher than 30%) groups to facilitate personalized management.CONCLUSION: The nomogram accurately predicted POPF in patients having PD.

CT appearances and short-term changes of COVID-19 in subclinical period / 中华放射学杂志

Objective:To explore the characteristics and short-term changes of high resolution CT (HRCT) in subclinical stage of COVID-19.Methods:The HRCT images of 17 COVID-19 patients in subclinical stage were analyzed retrospectively in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology and Wuhan Jinyintan Hospital from January 15 to 31, 2020. There were 4 males and 13 females, age ranged from 25.0 to 51.0 (39.8±7.5) years, who were closely contacted with other COVID-19 patients. The follow-up CT examination was performed within 3 to 6 days after the initial CT examination in all patients. Six patients were treated using anti-virus, anti-inflammation and symptomatic therapy, while the other 11 patients were untreated. The subclinical CT findings and short-term follow-up were analyzed, and the CT changes of short-term follow-up were summarized.Results:The lesions of 17 COVID-19 patients were mainly located at the lower lobes of bilateral lungs (at the left lower lobe in 9 cases and at the right lower lobe in 10 cases in the subclinical stage, at the left lower lobe in 9 cases and at the right lower lobe in 11 cases in the short-term follow-up). The number of involved lung segments increased from 46 in the subclinical stage to 90 in the short-term follow-up. In the subclinical stage, the multiple lesions were found in 13 cases, while in the short-term follow-up, the number of cases with multiple lesions decreased by 7, however the cases with focal lesions increased by 6 and diffuse lesions by 4. The lesions were mainly distributed under the pleura (13 cases) or along the bronchovascular bundle(10 cases). In the short-term follow-up, the lesion in 1 case expanded from the subpleural area to neighbouring bronchovascular bundle. There were 3 main types of the lesions, including ground glass nodule, ground glass opacity and crazy-paving pattern. In the subclinical stage and short-term follow-up, the ground glass opacities were seen in all the 17 cases. In the short-term follow-up, the number of cases with ground glass nodules decreased by 4 and crazy-paving pattern increased by 4. In 6 patients after treatment, the multiple ground glass nodules became single one in 3 cases, and in other 3 cases the multiple ground glass opacities were getting smaller. However, the scope of lesions in 11 patients without treatment enlarged.Conclusion:The HRCT features of the COVID-19 in subcilincal stage have some charicteristics, such as small ground glass nodule, ground glass opacity along the subpleural area or along the bronchovascular bundle, and the great changes can be seen in the short-term follow-up.

Effects of different lymph node dissection methods in radical resection of intrahepatic cholangiocarcinoma on the number of harvested lymph nodes and prognosis of patients / 中华消化外科杂志

Objective:To investigate the effects of different lymph node dissection methods in radical resection of intrahepatic cholangiocarcinoma (ICC) on the number of harvested lymph nodes and prognosis of patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 57 patients with ICC who underwent radical resection in the Second Affiliated Hospital of Nanchang University from January 2011 to January 2016 were collected. There were 25 males and 32 females, aged from 45 to 72 years, with an average age of 59 years. Of the 57 patients, 36 undergoing en bloc fusion lymph node dissection and 21 undergoing conventional lymph node dissection were allocated into observation group and control group, respectively. Observation indicators: (1) intraoperative situations; (2) results of postoperative pathological examination; (3) postoperative complications; (4) follow-up. Follow-up using outpatient examination or telephone interview was performed once every six months after hospital discharge to detect survival of patients up to January 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. The survival curve and rate were drawn and calculated using the Kaplan-Meier method, and survival of patients was analyzed by the Log-rank test. Results:(1) Intraoperative situations: operation time, volume of intraoperative blood loss, hepatic portal occlusion time, cases with <3 segments of hepatectomy and ≥3 segments of hepatectomy for the observation group were (218±53)minutes, (266±24)mL, (21±9)minutes, 5, 31, respectively, versus (207±45)minutes, (270±23)mL, (19±8)minutes, 2, 19 for the control group, showing no significant difference in the above indicators between the two groups ( t=-0.530, 0.774, 0.590, χ2=0.004, P>0.05). (2) Results of postoperative pathological examination: the number of harvested lymph nodes and percentage of positive lymph nodes of the observation group were 11±3 and 16.58%(66/398), respectively, versus 5±2 and 6.80%(7/103) of the control group, showing significant differences in the above indicators between the two groups ( t=-9.454, 2.148, P<0.05). (3) Postoperative complications: cases with Clavien-Dindo grade Ⅰ-Ⅱ complications or Clavien-Dindo grade Ⅲ-Ⅳ complications, cases with bile leakage, cases with postoperative hemorrhage, cases with incision infection, cases with gastroparesis were respectively 35, 1, 6, 1, 8, 0 in the observation group and 19, 2, 3, 1, 1, 2 in the control group. There was no significant difference in the cases with complications of Clavien-Dindo classification, cases with bile leakage, cases with incision infection between the two groups ( χ2=0.236, 0.000, 1.870, P>0.05) and no significant difference in the cases with postoperative hemorrhage, cases with gastroparesis between the two groups ( P>0.05). (4) Follow-up: 57 patients were followed up for 5-42 months, with a median time of 36 months. The survival time and postoperative 3-year survival rate were respectively 36 months (range, 8-42 months) and 66.7% of the observation group, versus 23 months (range, 5-39 months) and 38.1% of the control group, showing significant differences in the above indicators between the two groups ( Z=-2.253, χ2=5.317, P<0.05). Conclusion:For radical resection of ICC, the en bloc fusion lymph node dissection is beneficial to increase the number of harvested lymph nodes and improve survival rate of patients.

Transcriptomic Features of Echinococcus granulosus Protoscolex during the Encystation Process

Cystic echinococcosis (CE) is a zoonotic infection caused by Echinococcus granulosus larvae. It seriously affects the development of animal husbandry and endangers human health. Due to a poor understanding of the cystic fluid formation pathway, there is currently a lack of innovative methods for the prevention and treatment of CE. In this study, the protoscoleces (PSCs) in the encystation process were analyzed by high-throughput RNA sequencing. A total of 32,401 transcripts and 14,903 cDNAs revealed numbers of new genes and transcripts, stage-specific genes, and differently expressed genes. Genes encoding proteins involved in signaling pathways, such as putative G-protein coupled receptor, tyrosine kinases, and serine/threonine protein kinase, were predominantly up-regulated during the encystation process. Antioxidant enzymes included cytochrome c oxidase, thioredoxin glutathione, and glutathione peroxidase were a high expression level. Intriguingly, KEGG enrichment suggested that differentially up-regulated genes involved in the vasopressin-regulated water reabsorption metabolic pathway may play important roles in the transport of proteins, carbohydrates, and other substances. These results provide valuable information on the mechanism of cystic fluid production during the encystation process, and provide a basis for further studies on the molecular mechanisms of growth and development of PSCs.

CT appearance of new coronavirus pneumonia in subclinical period and short-term changes / 中华放射学杂志

Objective@#To explore the characteristics and short-term changes of high resolutionCT (HRCT) in subclinical stage of new coronavirus pneumonia (NCP).@*Methods@#TheHRCT images of 17 NCP patients in subclinical stage were analyzed retrospectively in Union Hospital of Tongji Medical College, Huazhong University of science and technology and Wuhan JinyintanHospital from January 15 to January 31, 2020. There were 4 males and 13 females, aged from 25.0 to 51.0 (39.8±7.5) years, who were closely contacted with NCP patients. The follow-up CT examination was performed 3 to 6 days after the initial CT examination in all patients. Six patients were treated using anti-virus, anti-inflammation andsymptomatic therapy, while the orther 11 patients were untreated. The CT imaging signs of subclinical and short-term follow-up were analyzed, and the CT image changes of short-term follow-up was summarized.@*Results@#Thelesions of 17 NCP patients were mainly located at the lower lobes of both lungs (9 cases at the left lower lobe and 10 cases at the right lower lobe in the subclinical stage, 9 casesat the left lower lobe and 11casesat the right lower lobe in the short-term follow-up). The number of lung segments involved increased from 46 in the subclinical stage to 90 in the short-term follow-up. In the subclinical stage, most of the lesions were multiple (13 cases), while in the short-term follow-up, the number of multiple cases decreased (7 cases), focal (6 cases) and diffuse distribution(4 cases) increased. The lesions were mainly distributed under the pleura (13 cases) or along the bronchovascular bundle (10 cases). In the short-term follow-up, 1 case progressed from subpleural to subpleural and along the bronchovascular bundle. There were 3 main types of lesions, including ground glass nodule, ground glass opacity and crazy-paving pattern. In the subclinical stage and short-term follow-up, ground glass nodules were seen in all the 17 cases. In the short-termfollow-up, ground glass nodules decreased in 4 cases and crazy-paving pattern increased in 4 cases. In 6 patients after treatment, 3 cases were changed from multiple to single ground glass nodule, 3 cases showed multiple ground glass opacity reduced. Therange of lesions in 11 patients without treatment enlarged.@*Conclusion@#TheHRCT features of the NCP patients in subcilincal stagehave some charicteristics, such as small ground glass nodule, ground glass opacity along the subpleural or along the bronchovascular bundle, and the great changescan be seen in the short-term follow-up.

Effects of Zhitong Shunqi Capsule on JAK/STAT Signaling Pathway of Chronic Atrophic Gastritis Model Rats / 中国药房

OBJECTIVE：To stud y the effects of Zhitong shunqi capsule on JAK/STAT signaling pathway of chronic atrophic gastritis（CAG）model rats ，and to provide reference for clarifying its mechanism of improving CAG. METHODS ：Totally 60 SD rats were randomly divided into blank group ，model group ，positive control group [vitacoenzyme ，0.09 g/（kg·d）]，Zhitong shunqi capsule low-dose ，medium-dose and high-dose groups [ 0.75，1.5，3 g/（kg·d）]，with 10 rats in each group. Except for blank group，other groups were given N-methyl-N′-nitro-N-nitrosoguanidine freely drinking combined with abnormal ingestion method to induce CAG model. After end of modeling ，administration groups were given relevant medicine intragastrically ，blank group and model group were given constant volume of water intragastrically ，for consecutive 28 d. After end of medication ，ELISA method was used to determine the serum levels of IL- 1β and IL-6；the gastric mucosa tissue pathologic change was observed by HE staining；mRNA and protein expressions of JAK 1，STAT3，SOCS-3 and c-Myc in gastric mucosa tissue were detected by real-time PCR and Western blotting assay. RESULTS ：Compared with blank group ，the sparse and irregular glands with deep staining cell nucleus could be seen in the gastric mucosa of rats in model group ；serum levels of IL- 1 β and IL-6，mRNA and protein expressions of JAK 1，STAT3 and c-Myc in gastric mucosa tissue were increased significantly （P＜0.05），while mRNA and protein expression of SOCS- 3 in gastric mucosa tissue were decreased significantly （P＜0.05）. Compared with model group ， glandular arrangement of gastric mucosa was more orderly and the number of heavy stained cells was less in administration groups；serum level of IL- 6 and mRNA expression of c-Myc in gastric mucosa of rats was decreased significantly in Zhitong shunqi capsule low-dose group （P＜0.05），while the protein expression of SOCS- 3 was increased significantly （P＜0.05）； serum levels of IL- 1β and IL-6，mRNA expressions of JAK 1，STAT3 and c-Myc in gastric mucosa tissue ，protein expression of JAK1 were decreased significantly in Zhitong shunqi capsule medium-dose group （P＜0.05），while mRNA and protein expression of SOCS- 3 was increased significantly in gastric mucosa tissue （P＜0.05）；above indexes were improved significantly in positive control group and Zhitong shunqi capsule high-dose group （P＜0.05）. Compared with positive control group ，mRNA and protein expression of STAT 3 in gastric mucosa tissue were decreased significantly in Zhitong shunqi capsule high-dose group （P＜0.05）. CONCLUSIONS：Zhitong shunqi capsule can improve CAG model rat to certain extent ，the mechanism of which may be associated with the down-regulation of mRNA and protein of JAK 1，STAT3 and c-Myc ，and up-regulation of mRNA and protein of SOCS-3.

Risk factors concerning postoperative deep wound infection in patients with closed calcaneal fracture / 中华创伤骨科杂志

Objective To investigate the risk factors for postoperative deep wound infection after open reduction and internal fixation for closed calcaneal fractures.Methods From January 2014 to January 2017,190 patients with closed calcaneal fracture were treated at Department of Traumatic Orthopaedics,Taihe Hospital.They were 118 males and 72 females with an average of 39.8 years (range,from 18 to 73 years).They were divided into a deep infection group and a non deep infection group according to the presence or absence of deep wound infection in the follow-up period.The 2 groups were compared in the general clinical data.In statistical analysis,the related risk factors were first screened by single factor analysis and followed by multivariate logistic regression analysis to identify the independent risk factors associated with the postoperative deep wound infection in patients with closed calcaneal fracture.Results The 190 patients were followed up for an average of 21.3 months(range,from 13 to 31 months).Postoperative deep wound infection occurred in 11 patients,giving an overall incidence of 5.7％ (11 / 190).The single factor analysis showed that the deep infection group incurred significantly longer time for tourniquet and used significantly more conventional extensile lateral approach than the non deep infection group (P ＜ 0.05).There were no significant differences between the 2 groups in general data,injury cause,fracture type,drainage,or incision closure technique (P ＞ 0.05).The multivariate logistic regression analysis revealed that tourniquet time ＞ 80 min (OR=5.949,95％ CI:1.216～ 29.108,P=0.028) and conventional extensile lateral approach (OR =5.414,95％ CI:1.507 ～ 19.452,P =0.01) were independent risk factors fo r the postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Conclusions Tourniquet time and conventional extensile lateral approach may be the independent risk factors for postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Therefore,it is important to adopt the sinus tarsi approach and control tourniquet time within 80 minutes for prevention of deep wound infection as long as the surgical quality is ensured.

Arthroscopic repair and loosening of shoulder arthroscopy for patients with old supraspinatus tendon tears and dysfunction / 临床外科杂志

Objective To explore the effect of arthroscopic release combined with suture bridge treatment of old supraspinatus tendon tear with shoulder dysfunction.Methods 40 patients with old supraspinatus tendon tear were analyzed retrospectively.According to the operation method, the patients were divided into control group and experimental group with 20 cases each.Treatment of single row of loose strip anchor nails under arthroscope in control group, the experimental group was treated with the technique of loosening suture bridge under arthroscope.VAS score and ASES score were assessed before operation and after 1 month, 3 months, 6 months, and 12 months.Range of motion (ROM) was evaluated before operation and after 12 months.The analysis of complication was also preceded.Results All patients completed 12 months of follow-up.There were no difference between experimental group and control group in ASES score (27.6±5.5 vs 27.5±3.6), VAS score (7.6±0.5 vs 7.5±0.7) and shoulder bends forward[ (83.6±12.4) °vs (80.6±14.5) °], abduction[ (75.6±8.4) °vs (72.8±9.3) °], intorsion[ (20.1±3.7) °vs (21.2±2.9) °] at pre-operation (P＞0.05).At 1 month, 3 months, 6 months, and 12 months post-operation, VAS scores were 5.8±0.6, 4.2±0.5, 3.0±0.2 and 1.8±0.4 in experiment group and were 6.1±0.3, 4.4±0.6, 3.5±0.4 and 2.2±0.3 in control group, the difference was significant (P＜0.05).ASES scores were 35.8±3.6, 54.2±4.7, 73.1±3.2 and 85.8±2.6 in experiment group and were 34.1±3.3, 49.4±3.6, 69.5±2.4 and 72.2±3.1 in control group, the difference was significant (P＜0.05).After 12 months, there was a significant improvement in joint flexion, abduction, and lateral internal rotation in experimental group[ (160.4±10.2) °, (158.7±9.7) °, (48.1±5.9) °] than the control group[ (138. 4 ± 7. 2) °, (128. 7 ± 6. 5) °, (30.1 ± 4. 2) °]. No complications occurred in two groups, such as anchor loosening, pain, swelling and other complications. Conclusion Arthroscopic release combined with Suture Bridge can effectively improve the function of shoulder in patients with old supraspinatus tendon tear.

Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis / 中华医学杂志(英文版)

BACKGROUND@#Clinical outcomes of undifferentiated arthritis (UA) are diverse, and only 40% of patients with UA develop rheumatoid arthritis (RA) after 3 years. Discovering predictive markers at disease onset for further intervention is critical. Therefore, our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.@*METHODS@#We performed a prospective, multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals. Clinical and serological parameters were obtained at recruitment. Follow-up was undertaken in all patients every 12 weeks for 2 years. Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.@*RESULTS@#A total of 234 patients were recruited in this study, and 17 (7.3%) patients failed to follow up during the study. Among the 217 patients who completed the study, 83 (38.2%) patients went into remission. UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9% vs. 16.8%, χ = 8.228, P = 0.008), anti-cyclic citrullinated peptide (CCP) antibody-positivity (66.7% vs. 10.7%, χ = 43.897, P < 0.001), and double-positivity rate of RF and anti-CCP antibody (38.1% vs. 4.1%, χ = 32.131, P < 0.001) than those who did not. Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017, 95% confidence interval: 5.803-55.938; P < 0.001).@*CONCLUSION@#As an independent predictor of RA, anti-CCP antibody should be tested at disease onset in all patients with UA.

A Two-Step GRIN Lens Coating for In Vivo Brain Imaging / 神经科学通报·英文版

The complex spatial and temporal organization of neural activity in the brain is important for information-processing that guides behavior. Hence, revealing the real-time neural dynamics in freely-moving animals is fundamental to elucidating brain function. Miniature fluorescence microscopes have been developed to fulfil this requirement. With the help of GRadient INdex (GRIN) lenses that relay optical images from deep brain regions to the surface, investigators can visualize neural activity during behavioral tasks in freely-moving animals. However, the application of GRIN lenses to deep brain imaging is severely limited by their availability. Here, we describe a protocol for GRIN lens coating that ensures successful long-term intravital imaging with commercially-available GRIN lenses.

Clinical value of uncinate process resection combined with portal-superior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy / 中华消化外科杂志

Objective To explore the clinical value of uncinate process resection combined with portalsuperior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 11 patients who underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis in the Peking University Cancer Hospital (8 patients) and Jilin Guowen Hospital (3 patients) between January 2014 to April 2018 were collected.During the vascular reconstruction,uncinate process of the pancreas was first resected for reducing anastomotic tension,and then end-to-end anastomosis was done after portal-superior mesenteric vein resection.Observation indicators:(1) intraoperative situations;(2) postoperative recovery situations;(3) postoperative pathological examination situations;(4) follow-up and survival situations.Follow-up using outpatient examination and imaging examination was performed to detect patients' postoperative survival,tumor recurrence and metastasis and postoperative venous anastomotic patency up to May 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The non-recurrence and non-metastasis survival curve,overall survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.Results (1) Intraoperative situations:11 patients received uncinate process resection of the pancreas,and successfully underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis.Eight patients underwent distal pancreatectomy + Appleby combined with celiac axis resection due to pancreatic tumor involving common hepatic artery,including 2 undergoing combined total gastrectomy due to gastric ischemia;2 patients underwent distal pancreatectomy;1 patient underwent distal pancreatectomy + distal gastrectomy due to blood supply obstacle of distal stomach.Operation time and volume of intraoperative blood loss of 11 patients were (5.8± 1.1) hours and 800 mL (range,200-2 500 mL).(2) Postoperative recovery situations:there was no grade C of pancreatic fistula of 11 patients.Four patients had grade B of pancreatic fistula,including 2 were cured by drainage-tube indwelling of pancreatic wound ＞ 3 weeks,1 was cured by continous washing due to pancreatic fistula combined with infection,and 1 was cured by the second abdominal puncture drainage due to pancreatic fistula with fever;1 of 4 patients was combined with grade C of delayed gastric emptying and cured by conservative treatment,and other 3 patients didn't occur postoperative complications.Of 5 patients diagnosed as biochemical fistula,1 had esophagus-jejunum anastomotic leakage,and 1 had changes of hepatic ischemia in S2,S3 and S4b segments by CT examination and recovered normal liver function at 2 weeks postoperatively,with long-term hepatatrophia in S2 and S3 segments.There was no postoperative death and reoperation in 11 patients.Duration of postoperative hospital stay of 11 patients was (22± 5) days.(3) Postoperative pathological examination results:tumors of 11 patients were located in neck and body of the pancreas,with a maximum diameter of (4.8± 1.7)cm.Among 11 patients,10 were confirmed with moderate-or low-differentiated ductal adenocarcinoma and 1 with anaplastic carcinoma.The length of portal-superior mesenteric vein resection of 11 patients was (2.6± 0.8) cm.Seven of 11 patients occurred different degrees of tumor infiltration in the portal-superior mesenteric vein,and other 4 patients occurred inflammatory adhesion,without tumor infiltration.(4) Follow-up and survival situations:11 patients were followed up for 3.0-37.6 months,with a median time of 15.7 months.During the follow-up,8 patients died of tumor recurrence and /or metastasis,and 3 survived;the non-recurrence and non-metastais survival time and overall survival time were respectively 9.0 months (range,3.0-37.6 months) and 24.6 months (range,3.0-37.6 months).One patient was complicated with anastomotic stenosis and surrounding varices of portal-superior mesenteric vein by postoperative half-year reexamination,anastomotic vein anomalies and venous thrombosis were not found in other patients before local tumor recurrence and / or death.Conclusion The combined uncinate process resection of the pancreas cannot increase the risk of postoperative pancreatic fistula,and it could effectively reduce the anastomotic tension in the distal pancreatectomy combined with portal-superior mesenteric vein resection and reconstruction,meanwhile,it can also achieve end-to-end anastomosis after longer vein resection.

Clinical effect observation of compound glycyrrhizin on the prevention and cure of cytarabine syndromes / 白血病·淋巴瘤

Objective To evaluate the effect of compound glycyrrhizin on the prevention and cure of cytarabine syndromes. Methods A total of 130 patients with hematological malignancies treated by moderate or high dose of cytarabine in the 303th Hospital of PLA from July 2010 to July 2016 were included. Patients were randomly divided into the control group and the experiment group by using random number table method, and each group had 65 patients. In the control group, patients were treated with cytarabine alone. In the experiment group, patients were treated with cytarabine plus compound glycyrrhizin. Skin rash and fever in patients of the two groups were also recorded. Results of blood routine tests, liver and kidney function tests were monitored during the treatment. Results Sixty-one patients in the experiment group and 63 patients in the control group were enrolled finally. In experiment group and control group, the differences in the incidence of cytarabine syndromes [8.2 % (5/61) vs. 41.3 % (26/63), χ2＝ 18.1, P < 0.001], skin rash [1.6 % (1/61) vs. 12.7 % (8/63), χ2＝16.3, P <0.001], and fever [6.6 % (4/61) vs. 36.5 % (23/63), χ2＝5.63, P <0.017] were statistically significant. There was no significant difference of the incidence of liver injury and minimum blood cell count between the two groups (P＞ 0.05). Conclusion Compound glycyrrhizin can effectively reduce the incidence of cytarabine syndromes, but the larger size and multiple center studies are needed to further verify the effect.

Data analysis of non-invasive prenatal testing based on special loci in cell-free fetal DNA / 中华医学遗传学杂志

OBJECTIVE To analyze the data of non-invasive prenatal testing based on specific loci of circulating cell-free fetal DNA (cffDNA). METHODS Selected loci of target chromosomes were analyzed by sequence capture and sequencing. Meanwhile, 600 loci were selected from other chromosomes for determining the concentration of cffDNA. RESULTS A total of 768 specific loci were captured on chromosomes 21 and 18, and used to determine whether the two were abnormal. When the minimum concentration of detected cffDNA was set at 3% and the threshold of Z score was set to [-6,6], the specificity of the analysis was 99.37% and the sensitivity was 100%. CONCLUSION A reliable, convenient and low-cost analytical method has been developed. The method requires less sequencing data for non-invasive prenatal testing, and can accurately detect abnormalities of fetal chromosomes 21 and 18, and simultaneously determine the concentration of cffDNA.