Satisfaction of Patients with Above-the-knee Amputation following Periprosthetic Joint Infection / 中山大学学报(医学科学版)

ObjectiveThe purpose of this study was to evaluate the functional outcomes and satisfaction in periprosthetic knee infection patients after above-the-knee amputation （AKA）. MethodsA review was performed in 13 patients who underwent AKA due to periprosthetic knee infection from October 2010 to August 2022， there were 7 females and 6 males with the median age of 69 （45~ 73） years. The mean number of surgical procedures between primary total knee arthroplasty and AKA was 2.9 times （range： 1 ~ 6）. Patients were segregated into non-elderly group （including patients <65 years old） and elderly group （involving patients ≥65 years old）. Functional outcomes were evaluated by SF-12 and Barthel activities daily living index （Barthel ADL index）. Patient satisfaction was accomplished through a questionnaire. ResultsFour patients died within 6 months after the amputation. Three patients received surgical procedures for recurrent infections after AKA. In the remaining 9 patients，the median time from AKA to the final follow-up was 4.2 （1.9~8.2） years， three patients received surgical procedures for recurrent infections after AKA. Patients in non-elderly group showed better functional outcomes than elderly patients after AKA （both P<0.05）. All patients in non-elderly group were fitted with a prosthesis. Whereas， elderly patients reported a better satisfaction after AKA than young patients. ConclusionYoung PJI patients seemed to have better function and ambulatory ability with high expectation and demand， which made them feel less satisfied about AKA. Meanwhile，despite poor function outcomes due to the less healthy physical condition， the alleviation of financial and psychological burdens resulting from reinfections and multiple surgeries and the less demand in function and daily activities made elderly patients have a good satisfaction after AKA.

Correlation analysis of asthma and prognosis in 148 children with low immune function / 公共卫生与预防医学

Objective To analyze the effect of immune function on the condition and prognosis of asthma in children with asthma. Methods A total of 148 children with asthma diagnosed in Qinghai women and children's Hospital from January 2018 to January 2021 were included in the analysis, the immune function of the children was determined, and the information of all children was followed up for 6 months after treatment; compared The condition and follow-up prognosis of children with immunocompromised and normal immune function were analyzed and discussed, and the correlation between the expression levels of immunoglobulins (IgG, IgA, IgM) and the condition and short-term recurrence prognosis (6 months) of children was analyzed and discussed, so as to guide Prevention and clinical work. Statistical analysis was done using SPSS19.0. Results The average age of 148 children with recurrent respiratory tract infection in the study was (8.94±3.65) years old, including 70 male children. The condition of the children was evaluated and classified into mild/severe cases: 148 children in this study included mild cases. There were 98 cases and 50 severe cases. There were more males and lower BMI levels in severe children (P<0.05) . The levels of IgG, IgA and IgM in children were all lower in severe children (P<0.05) . The follow-up found that the proportion of relapses in critically ill children was higher (P<0.05). Comparing the levels of IgG, IgA, and IgM in mild and severe children, the average levels of IgG, IgA, and IgM in severe children were lower than those in the mild group, and the difference was statistically significant (P<0.05); recurrence within 6 months of follow-up Prognostic evaluation showed that 19 of the 148 children had relapse, and the levels of IgG, IgA, and IgM in severe relapsed children were significantly lower than those without relapse (P<0.05). Analysis of the relevant factors potentially affecting the prognosis of recurrence showed that gender (female) (OR=1.726) , BMI level (weight loss) (OR=1.613) , IgG expression level factor (low expression) (OR=1.898) , IgA expression Level factor (low expression) (OR=3.509) , IgM expression level factor (low expression) (OR=3.217) and disease factor (severe) (OR=3.619) were potential risk factors, which would increase the risk of poor prognosis. Conclusion The asthma attack in children with immunocompromised immune function is relatively severe, and the short-term recurrence probability is higher, which deserves clinical attention and preventive intervention.

Study on the molecular mechanism of Cinnamomi Cortex-Rehmanniae Radix in preventing and treating osteoporosis based on multi-directional regulation of inflammatory factors, estrogen and bone homeostasis / 药学学报

In this study, the molecular mechanism of Cinnamomi Cortex-Rehmanniae Radix (CR) in the prevention and treatment of osteoporosis (OP) was investigated by integrating compatibility analysis of compound, bioinformatics and metabolomics. The rat OP models were established, and the Micro-CT indexes and pathological sections were comprehensively evaluated. The results showed that compared with the model group, the indexes such as bone mineral density (BMD) and bone volume/tissue volume (BV/TV) were significantly increased after CR treatment (P < 0.05), and the bone trabeculae were arranged into mesh. The results of UHPLC-Q-TOF/MS mainly involved amino acid metabolism, lipid metabolism and estrogen metabolism pathways. Integrating bioinformatics and metabolomics analysis, it was finally found that: ① cinnamic acid and ethylcinnamate inhibit inflammatory factors such as TNF, IL-1β, and IL-13, thereby preventing and treating OP; ② multiple active ingredients of CR target ESR2, PPARG, and CYP19A1, GABRA1 and other targets, regulate cAMP synthesis, AMPK signaling pathway and lipid metabolism, thereby regulating estrogen levels to prevent and treat OP; ③ oleic acid, arachic acid, etc. act on AR, VDR and other targets, and regulate HIF-1 signaling pathway and AGE-RAGE signaling pathway, thereby regulating osteoblasts and osteoclasts, and affecting calcium and phosphorus absorption to maintain bone homeostasis. This study clarified the molecular mechanism of CR in preventing and treating OP from the perspective of multi-directional regulation of inflammatory factors, estrogen and bone homeostasis, and provided theoretical basis for the clinical application of CR and the development of compound. This experiment complied with the ethical standards of animal experiments and was approved by the Animal Ethics Committee of Shaanxi University of Chinese Medicine (No. SUCMDL20210309002).

Clinical study on quantitative evaluation of proton radiotherapy by off-line PET-CT in vivo biological validation / 中华放射肿瘤学杂志

Objective:Patients are breathing freely during adjuvant proton pencil beam radiotherapy after breast conserving surgery. Fluctuation of the thorax may affect the position of the end of the proton beam flow, which needs to be precisely evaluated on a millimeter scale.Methods:For 20 patients with breast cancer treated with proton radiotherapy after breast conserving surgery, PET-CT scan was performed approximately 10 min after the end of proton radiotherapy. The images of PET-CT were processed for ROI determination and sampling line (profile) extraction on a Raystation RV workstation to calculate the actual difference between the predicted and real radioactivity from the same spatial location as obtained by PET acquisition R50. Then, the differences in the spatial location between the actual process of proton irradiation and the planned process were obtained. Depth difference values for each pair of sampling lines were presented. Results:For 20 patients with breast cancer with a median follow-up of 22 months (range 12 - 46 months), all patients survived at the last follow-up, and no radiation pneumonitis was observed during the follow-up period. Among the verification results of 21 cases, the depth difference of evenly distributed was (-0.75±1.89) mm in the primary field and (-0.82±2.06) mm in the secondary field; The depth difference of sequential treatment was (1.81±1.87) mm in the primary field and (1.32±1.74) mm in the secondary field; The depth difference of synchronous addition in the primary field was (-1.47±1.44) mm, and the depth difference in the secondary field was (-1.48±2.11) mm.Conclusion:The results of off-line PET-CT in vivo biological verification show that the accuracy of the dose boundary cut-off was within 3 mm in breast cancer patients, which meets the clinical and physician requirement for the precision in breast cancer treatment.

Comparison of efficacy of femoral tunnel creation with figure-of-four position and traditional knee hyperflexed position for arthroscopic anterior cruciate ligament reconstruction using tendon autograft / 中华创伤杂志

Objective:To compare the efficacy of arthroscopic anterior cruciate ligament reconstruction using tendon autograft with figure-of-four position and traditional knee hyperflexed position for femoral tunnel creation.Methods:A retrospective case series study was conducted to analyze the clinical data of 46 patients with ACL injury admitted to Second Affiliated Hospital of Harbin Medical University from August 2019 to October 2019, including 26 males and 20 females; aged 24-40 years [(31.1±7.5)years]. All patients underwent arthroscopic ACL reconstruction using tendon autograft. The femoral tunnel was created with figure-of-four position in 21 patients (figure-of-four position group) and with traditional knee hyperflexed position in 25 patients (knee hyperflexed position group). The operation time was compared between the two groups. The center position, length and angle of femoral tunnel were evaluated and measured by three dimensional CT reconstruction and Bernard quadrant method at 8 weeks postoperatively. The knee function was assessed by knee Lysholm score preoperatively, at 8 weeks and at 1 year postoperatively. Complications were observed as well.Results:All patients were followed up for 2-20 months [(15.3±2.1)months]. The operation time was (28.5±2.6)minutes in figure-of-four position group, significantly less than (39.5±2.4)minutes in knee hyperflexed position group ( P<0.05). The tunnel center position was located at (27.1±1.4)% and (25.1±2.6)% within the Bernard quadrant in figure-of-four position group, similar with (28.1±2.8)% and (26.1±3.1)% in knee hyperflexed position group (all P>0.05). Total tunnel length and thick tunnel length were (42.1±2.4)mm and (34.1±2.4)mm in figure-of-four position group, significantly longer than (38.2±2.5)mm and (31.1±2.7)mm in knee hyperflexed position group (all P<0.05). The coronal plane angle of the tunnel was (41.1±2.4)° in figure-of-four position group, significantly smaller than (47.5±2.6)° in knee hyperflexed position group ( P<0.05). The sagittal plane angle of the tunnel was (42.1±1.4)° in figure-of-four position group, significantly greater than (37.1±1.8)° in knee hyperflexed position group ( P<0.05). Figure-of-four position group showed the knee Lysholm score of (53.4±5.2)points preoperatively, (97.1±1.4)points at 8 weeks postoperatively and (98.3±2.3)points at 1 year postoperatively. Knee hyperflexed position group showed the knee Lysholm score of (54.3±7.4)points preoperatively, (97.1±1.6)points at 8 weeks postoperatively and (98.1±1.3)points at 1 year postoperatively. The knee Lysholm score did not differ significantly between the two groups (all P>0.05), but the knee function was significantly improved in both groups when compared with that before the operation (all P<0.05). There were 1 patient with femoral tunnel fracture, one with injury to the medial condylar cartilage and one with injury to the posterior root of lateral meniscus in knee hyperflexed position group, while no above-mentioned complications occurred in figure-of-four position group ( P<0.05). Conclusion:Arthroscopic ACL reconstruction using tendon autograft with femoral tunnel creation through figure-of-four position and traditional knee hyperflexed position can both contribute knee functional recovery, but the figure-of-four position has the advantages of short operation time, accurate tunnel positioning, favorable length and angle of the tunnel and less complications.

Step treatment of Kashin-Beck disease arthritis of the knee / 中华地方病学杂志

Kashin-Beck disease (KBD) is a disabling osteoarthropathy of unknown cause, which occurs most frequently in children and adolescents and affects many regions in China. In adults KBD patients, the degeneration of weight-bearing joints is the most serious, especially the knee joint. Up to now, there are still a large number of adult patients with KBD arthritis of the knee, and they have not been systematically and effectively treated. The main manifestations are knee joint pain, thickening, deformation and restricted movement. In severe cases, it can lead to knee joint varus, valgus, flexion contracture, and rotational deformity, which seriously affects the quality of life and work ability of the patients. Early diagnosis of KBD arthritis of the knee is difficult and there is no effective treatment, so it needs to be differentiated from knee osteoarthritis (OA). KBD and OA have common pathological characteristics. According to the "Consensus of Four-stepladder Program of Knee 0steoarthritis" (2018), OA treatment is divided into four levels: basic treatment, drug treatment, restorative treatment and reconstruction treatment. In this paper, the treatment of KBD arthritis of adult knee joint is summarized, which is also divided into four steps. It is necessary to make stepwise treatments according to the severity of KBD arthritis of the knee and the differences of patient's own condition, so that the limited medical resources can be efficiently used. At the same time, this paper also systematically summarizes the epidemiological characteristics, pathological features and diagnostic criteria of KBD arthritis of the knee, aiming to provide effective reference and guidance for the treatment of KBD arthritis of the knee.

Otologic disorders and management strategies in Turner syndrome / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the incidence and risk factors of otologic disorders in patients with Turner syndrome (TS), so as to provide management strategies for ear health. Methods: This study is a prospective study based on questionnaires and a cross-sectional study. The TS patients who visited our hospital from 2010 January to 2021 March were included (A total of 71 patients with TS were included in this study. the age of TS diagnosed was 3- to 11-year-old, age of visiting ENT department was 4- to 27-year-old) and the incidence of otologic diseases in different age groups was investigated by questionnaires. The cross-sectional study included ear morphology and auditory function assessment, and further analysis of the risk factors that related to ear disease. Prism was used for data analysis. Results: The investigation found that the incidence of acute otitis media in patients aged 3-6 and 7-12 years was higher than that of patients over 12 years old, which was 33.8%(24/71), 42.9%(30/70)and 23.5%(8/34), respectively; 21.1% (15/71) of patients were recurrent acute otitis media in patients aged 3-6 years, and about 46.6% (7/15)of them persisted beyond 6-year. The prevalence of otitis media with effusion in the three groups was 32.4%(23/71), 34.3%(24/70)and 38.2%(13/34), respectively; the recurrence rate of tympanocentesis was 100%(7/7), 42.9%(3/7)and 50.0%(1/2), which was significantly higher than that of grommet insertion. For age groups of 3-6 and 7-12 years, the prevalence of acute otitis media and secretory otitis media was lower in the X chromosome structure abnormal patients; while for patients older than 12 years, otitis media with effusion was the highest prevalence in Y-chromosome-containing karyotypes. In addition, the prevalence of acute otitis media and otitis media with effusion in patients with other system diseases were increased significantly. A cross-sectional study found that 7.0% (5/71)of the lower auricular, 4.2% (3/71)of the external auditory canal narrow, and 38.0% (27/71)of the tympanic membrane abnormality. 35.2%(25/71) had abnormal hearing, including 17 cases of conductive deafness, 6 cases of sensorineural hearing loss, and 2 cases of mixed deafness. The rest of the patients had normal hearing, but 6 of them had abnormalities in otoacoustic emission. Eustachian tube function assessment found that the eustachian tube dysfunction accounted for 38%(27/71). Hearing loss and abnormal Eustachian tube function were not significantly related to karyotype(Chi-square 2.83 and 2.84,P value 0.418 and 0.417), but significantly related to other system diseases(Chi-square 13.43 and 7.53,P value<0.001). Conclusions: The incidence of TS-related otitis media and auditory dysfunction is significantly higher than that of the general population. It not only occurs in preschool girls, but also persists or develops after school age. Accompanied by other system diseases are risk factors for ear diseases. Clinicians should raise their awareness of TS-related ear diseases and incorporate ear health monitoring into routine diagnosis and treatment.

Safety and efficacy of left atrial appendage closure combined with patent foramen ovale closure for atrial fibrillation patients with patent foramen ovale / 中华心血管病杂志

Objective: To analyze the safety and efficacy of combined left atrial appendage (LAA) and patent foramen ovale (PFO) closure in adult atrial fibrillation (AF) patients complicating with PFO. Methods: This study is a retrospective and cross-sectional study. Seven patients with AF complicated with PFO diagnosed by transesophageal echocardiography (TEE) in Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences from June 2017 to October 2020 were selected. Basic data such as age, gender and medical history were collected. The atrial septal defect or PFO occluder and LAA occluder were selected according to the size of PFO, the ostia width and depth of LAA. Four patients underwent left atrial appendage closure(LAAC) and PFO closure at the same time. PFO closure was performed during a one-stop procedure of cryoablation combined with LAAC in 2 patients. One patient underwent PFO closure at 10 weeks after one-stop procedure because of recurrent transient ischemic attack (TIA). All patients continued to take oral anticoagulants. TEE was repeated 8-12 weeks after intervention. In case of device related thrombus(DRT), TEE shall be rechecked 6 months after adjusting anticoagulant and antiplatelet drug treatment. Patients were follow-up at 1, 3, 6, 12, 24 months by telephone call, and the occurrence of cardio-cerebrovascular events was recorded. Results: Among the 7 patients with AF, 2 were male, aged (68.0±9.4) years, and 3 had a history of recurrent cerebral infarction and TIA. Average PFO diameter was (3.5±0.8)mm. Three patients were implanted with Watchman LAA occluder (30, 30, 33 mm) and atrial septal defect occluder (8, 9, 16 mm). 2 patients were implanted with LAmbre LAA occluder (34/38, 18/32 mm) and PFO occluder (PF1825, PF2525). 2 patients were implanted with LACbes LAA occluder (24, 28 mm) and PFO occluder (PF2525, PF1825) respectively. The patients were followed up for 12 (11, 24) months after operation. TEE reexamination showed that the position of LAA occluder and atrial septal defect occluder or PFO occluder was normal in all patients. DRT was detected in 1 patient, and anticoagulant therapy was adjusted in this patient. 6 months later, TEE showed that DRT disappeared. No cardiovascular and cerebrovascular events occurred in all patients with AF during follow-up. Conclusions: In AF patients complicated with PFO, LAAC combined with PFO closure may have good safety and effectiveness.

Minimally invasive treatment with anterograde multiple endoscopes for upper urinary tract stones in allograft kidney / 中华泌尿外科杂志

Objective:To discuss the clinical experience and efficacy of minimally invasive anterograde multiple endoscopic treatment of upper urinary tract stones in allograft kidney.Methods:We retrospectively analyzed 14 patients with upper urinary tract stones in allograft kidney admitted to our hospital from June 2018 to August 2020. 8 cases were female and 6 cases were male, with an average age of 47.3±11.1 years. 3 patients had hyperuricemia and four had hypertension and diabetes. The history of renal transplantation was over ten years in 3 cases, three to five years in 4 cases, two years in 3 cases, 1 year in 3 cases, and 4 months in 1 case. 3 patients had a history of RIRS, and the operation was terminated due to severe ureteral tortuosity resulting in failure of sheathing or ureteroscopy. Ureteral stent was performed in 2 cases due to stone obstruction and hydronephrosis. Serum creatinine was normal in 7 patients before operation, and serum creatinine was 91-139μmol/L in 4 patients in the compensatory stage of chronic renal insufficiency. The serum creatinine was 292, 544 and 708μmol/L respectively in 3 patients in the decompensated stage of chronic renal insufficiency or renal failure stage. The preoperative average hemoglobin was 117.5g/L. 3 cases were partial staghorn calculi, 4 cases were single caliceal or renal pelvis calculi, 2 cases were renal pelvis or caliceal calculi with upper ureteral calculi, and 5 cases were renal pelvis or renal caliceal calculi with multiple calculi. Stone size were 1 case of single upper caliceal stone of 0.7cm, 3 cases of lower caliceal stones of 1.5, 1.6 and 2.0cm, 1 case of renal pelvic stone of 1.5cm, 2 cases of middle and upper caliceal stones of 2.8 and 3.1cm, 2 cases of middle and lower caliceal stones of 1.5 and 3.2cm, respectively. 3 cases of middle upper caliceal and renal pelvic stones were 2.2, 2.5 and 2.6cm. 2 cases of renal pelvis with upper ureteral stones were 1.3 and 1.7cm, 0.7 and 0.5cm respectively. Preoperative routine urine examination showed that 9 cases had urinary tract infection, among which 5 cases had positive urine culture. Surgery was performed after therapeutic improvement with sensitive antibiotics. According to the size and distribution of stone, the combination of single access or multi-access PCNL in different diameters was adopted, supplemented by FURS. Surgical methods selection and performance: 2 cases performed in single S-PCNL with stone size were 2.2cm and 2.6cm, 2 cases performed in single M-PCNL with stone size were 1.5cm and 1.5cm, 1 case performed in Needle-perc with stone size was 0.7cm, 2 cases performed in S-PCNL combined M-PCNL with stone size were 2.8cm and 3.1cm, 3 cases performed in S-PCNL combined Needle-perc with stone size were 2.0cm, 2.5cm and 3.2cm, 2 cases performed in M-PCNL combined Needle-perc with stone size were 1.5cm and 1.6cm, 2 cases performed in S-PCNL combined anterograde FURS with stones size were 1.3cm and 1.7cm in allograft kidney and ureter stone were 0.7cm and 0.5cm, a total of 7 kinds of way, and postoperative stone free rate, laboratory indexes (serum creatinine, blood hemoglobin), surgical complications, postoperative hospital stay were analyzed.Results:All 14 patients (mean age was 47.3±11.1 years) were successfully operated. Postoperative examination revealed 1 case had 0.6cm residual stone and it was cleared at the second stage anterograde FURS through the original access. The mean operative time and postoperative hospital stay were 68.2±21.6min and 6.2±1.3 days. Compared with preoperative serum creatinine changes, 2 cases showed slight increase (mean 12.6±0.3μmol/L), 3 cases showed significant decrease (mean 329.6±216.6μmol/L), and the other 9 cases showed no significant change (range<10μmol/L), among which 5 cases showed an increase (mean 5.4±0.7 μmol/L) and 4 cases showed a decrease (mean 3.7±0.4 μmol/L). The mean decrease of hemoglobin was 9.3±4.1g/L. Two patients had fever and their body temperature returned to normal after anti-inflammatory treatment. No blood transfusion, abdominal organ injury or urogenic sepsis occurred.Conclusions:Invasive anterograde multiple endoscopic treatment of upper urinary tract stones in allograft kidney is a single or combined operation using single-channel PCNL, multi-channel PCNL of different sizes and diameters and anterograde FURS according to individual differences, which can effectively reduce renal function injury is safe, efficient and feasible.

Molecular Mechanism of "Transmission Between Lung and Brain" of Influenza and Intervention Effect of Maxing Shigantang Based on JAK1/STAT1 Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo explore the molecular mechanism of "transmission between the lung and brain" of influenza based on Janus kinase 1/signal transducer and activator of transcription 1（JAK1/STAT1） signaling pathway and further investigate the intervention effect of Maxing Shigantang （MXSGT）. MethodA total of 100 SPF BALB/c mice were randomly divided into a normal group，a model group，an oseltamivir group （21.63 mg·kg-1·d-1），an antiviral granules group（3.9 g·kg-1·d-1）， and an MXSGT group（6.05 g·kg-1·d-1）， with 20 mice in each group. The pneumonia model was induced in mice except for those in the normal group by intranasal infection of influenza A virus（IAV）. Twenty-four hours after modeling，mice were treated with corresponding drugs， while those in the normal group and the model group received the same amount of normal saline by gavage， once a day for 3 and 7 days. The pathological changes in the lung and brain were observed by hematoxylin-eosin（HE）staining. The mRNA expression of IAV nucleoprotein（NP），JAK1， and STAT1 in the lung and brain was detected by real-time quantitative polymerase chain reaction（Real-time PCR）， and the protein expression of JAK1 and STAT1 in the lung and brain was detected by Western blot. Immunohistochemical method was used to detect the expression of phosphorylated（p）-STAT1 in the lung and brain tissues， and enzyme-linked immunosorbent assay（ELISA） was used to detect the serum levels of interleukin-1β（IL-1β） and interleukin-10（IL-10）. ResultCompared with the normal group， the model group showed obvious pathological changes in the lung tissues and cerebral cortex， increased relative mRNA expression of IAV NP in the lung （P<0.01）， elevated mRNA and protein expression of JAK1 and STAT1 in the lung and brain tissues （P<0.05，P<0.01），up-regulated expression level of p-STAT1 in lung tissues and cerebral cortex （P<0.05，P<0.01）， and increased serum level of IL-1β （P<0.05）. Compared with the model group， the MXSGT group showed alleviated pathological damage to lung tissues and cerebral cortex， decreased relative mRNA expression of IAV NP in lung tissues（P<0.01），reduced mRNA and protein expression levels of JAK1 and STAT1 in lung tissues and brain tissues（P<0.05，P<0.01）， and increased serum level of IL-10（P<0.01）. ConclusionThe abnormal activation of the JAK1-STAT1 signaling pathway may be one of the molecular mechanisms of "transmission between the lung and brain" of influenza. As an effective compound prescription against the influenza virus，MXSGT can alleviate the pathological damage of brain tissues in mice infected with IAV by regulating the level of cytokines mediated by this pathway.

Progress in the research of medial column reconstruction of proximal humerus fractures in the elderly / 中国骨伤

The proximal medial column of the humerus is a continuous cortical region in the inner and lower part of the humerus head, which has attracted more and more attention in clinical and scientific research since it was proposed. It has been shown to increase the stability of internal fixation, maintain the height of the humeral head to prevent varus, and reduce the risk of screw penetration. Biomechanical studies have also shown that the medial column has an outstanding performance in increasing the stiffness, torsion resistance, and shear resistance of the locking plate. Although it has many benefits, there is no unified definition of its concept and specific region, and the existing classification does not include the medial column, therefore more researches are required to provide supporting information. The methods of medial column reconstruction mainly include locking plate combined with talus screw, locking plate combined with bone grafting, internal and external double plate combined support, locking plate combined with bone cement, and humeral cage. These methods have their own characteristics, however they will increase the cost of surgery and bring new complications. How to determine the best way of reconstruction is one of the focuses of future research. In this review, the concept of the proximal medial humerus column, the role of maintaining internal fixation, the role of biomechanics and the reconstruction methods are reviewed.

Exploration on the training model of applied undergraduate pharmacy talents under the perspective of industry education integration / 中华医学教育探索杂志

This research analyzes and explores the elements of the industry education integration in the process of pharmacy talent training from two aspects: collaborative education (professional construction, curriculum co-construction, skill deepening and talent transfer) and collaborative innovation (base expansion, technological research and completion innovation). Besides, this research also explores the outstanding performance of School of Pharmacy of Xiamen Medical College in talent training of the industry education integration. The results show that through the construction of collaborative education and collaborative innovation, the elements of the industry education integration in the cultivation of pharmacy talents in the school have become increasingly prominent, and the forms have been gradually diversified, which have promotion and guiding significance for other majors in our school to develop the industry education integration.

A case of congenital myopathy caused by the SPEG gene mutation / 中华实用儿科临床杂志

Clinical data of a child with congenital myopathy caused by the SPEG gene mutation diagnosed in the Children′s Hospital of Nanjing Medical University in March 2020 were retrospectively analyzed, and the relevant literature was reviewed.A 13-year-old female child with lagged motor development since childhood, weakness of both lower extremities for 10 years, and slow progression of disease.Physical examinations showed gait swinging, mild hypertrophy of gastrocnemius, positive Gower sign, grade Ⅴ distal muscle strength of both lower extremities, and grade Ⅳ proximal muscle strength.The electromyography showed myogenic damage changes.Her 11-year-old sister presented similar symptoms of muscle weakness.Gene sequencing revealed compound heterozygous mutations in the SPEG gene, with the newly reported mutation sites at c. 3715+ 4C>T and c. 3588delC, which had not been reported at home and abroad.This study for the first time reported a case of congenital myopathy caused by the SPEG gene mutation in China, which differed from previous cases accompanied cardiomyopathy.This case report expanded the mutation spectrum of the SPEG gene.

Effect of small-dose furosemide on tissue edema after shoulder arthroscopy / 中华麻醉学杂志

Objective:To evaluate the effect of small-dose furosemide on tissue edema after shoulder arthroscopy.Methods:A total of 368 patients of either sex, aged 18-65 yr, of American Society of Anesthesiology physical status Ⅰ orⅡ, were divided into 2 groups ( n=184 each) by a random number table method: control group (group C) and small-dose furosemide group (group F). A posterior approach to interscalene brachial plexus block was selected, tracheal intubation was performed under general anesthesia, and all the patients were placed in the lateral position.At 20-30 min before the end of surgery, patients in group F received intravenous injection of furosemide 2 mg (diluted to 2 ml in normal saline) and patients in group C received intravenous injection of normal saline 2 ml.The tissue thickness from the surface of the second rib of the middle clavicular line to the skin (CR2) was measured by ultrasound immediately after nerve block (T 0), immediately after tracheal intubation (T 1), immediately after the end of operation (T 2), and at 30 min and 1, 4 and 8 h after operation (T 3-6). Arterial blood gas analysis was performed at T 1-3, Hct and blood glucose concentration were measured simultaneously, and relative blood volume was calculated.Tube malposition at T 2 and hypoxemia within 30 min after operation were recorded. Results:Compared with the baseline at T 0, CR2 on the affected side was significantly increased at T 2-5 in group F, and CR2 on the affected side was significantly increased at T 2-6 in group C ( P<0.05). CR2 at T 2-5 was significantly higher on the affected side than on the healthy side ( P<0.05). Compared with group C, intraoperative urine volume was significantly increased, CR2 was decreased at T 2-5, the incidence of tube malposition and hypoxemia was decreased ( P<0.05), and no significant changes were found in pH value, PaO 2, PaCO 2, Na + , K + , Ca 2+ , Cl -, blood glucose concentration or relative blood volume at each time point in group F ( P>0.05). Conclusion:Small-dose furosemide can reduce tissue edema after shoulder arthroscopy and decrease the occurrence of postoperative tube malposition and hypoxemia, without causing disturbances in the internal environment.

Risk factors for urinary tract infection in kidney transplantation from brain death donor and its role in graft function / 中南大学学报(医学版)

OBJECTIVES@#Urinary tract infection (UTI) is the most common infection complication after kidney transplantation, and the reports of the incidence vary greatly among different centers. This study aims to explore the risk factors for UTI after kidney transplantation with the donation from brain death (DBD) and the impact on graft function, thus to provide theoretical basis for comprehensive prevention and treatment of UTI after kidney transplantation.@*METHODS@#The clinical and laboratory data of DBD kidney transplantation from January 2017 to December 2018 in Xiangya Hospital, Central South University were collected and retrospectively analyzed. Patients were assigned into an UTI group and a non-UTI group. The base line characteristics, post-transplant complications, and graft function were compared between the 2 groups. Multivariate logistic regression was used to analyze the risk factors for UTI.@*RESULTS@#A total of 212 DBD kidney transplant recipients were enrolled in this study. UTI occurred in 44 (20.75%) patients after transplantation. The female, the time of indwelling catheter, and postoperative urinary fistula were independent risk factors for UTI after DBD kidney transplantation. A total of 19 strains of gram-positive bacteria, 12 strains of gram-negative bacteria , and 10 strains of fungi were isolated from the urine of 44 UTI patients. The UTI after kidney transplantation significantly increased time of hospital stay (@*CONCLUSIONS@#UTI after DBD kidney transplantation transplantation affects the renal function at 3 months and increases the patient's economic burden.

Molecular identification and efficacy analysis of herbs at Orussey Herbal Market, Phnom Penh, Cambodia / 中国中药杂志

Cambodia is rich in medicinal plant resources. One hundred and thirty-three medicinal material samples, including the hole herb, root, stem/branch, leaf, flower, fruit, seed, and resin, were collected from the Orussey Herbal Market in Phnom Penh, Cambodia, and then authenticated by ITS and psbA-trnH. A total of 46 samples were identified based on ITS sequences, belonging to 24 families, 40 genera, and 42 species. A total of 100 samples were identified by psbA-trnH sequences to belong to 42 families, 77 genera, and 84 species. A total of 103 samples were identified by two DNA barcodes. According to the morphological characteristics of the medicinal materials, 120 samples classified into 50 species, 86 genera, and 86 families were identified, and the majority of them were from Zingiberaceae, Fabaceae, and Acanthaceae. Such samples have been commonly used in traditional Cambodian medicine, Ayurvedic medicine, Unani medicine, traditional Chinese medicine, and ethnomedicine, but different medical systems focus on different functional aspects of the same medicinal material. The results of this study have demonstrated that DNA barcoding has a significant advantage in identifying herbal products, and this study has provided basic data for understanding the traditional medicinal materials used in Cambodia.

Identification and characterization of DIR gene family in Schisandra chinensis / 中国中药杂志

Dirigent(DIR) proteins are involved in the biosynthesis of lignin, lignans, and gossypol in plants and respond to biotic and abiotic stresses. Based on the full-length transcriptome of Schisandra chinensis, bioinformatics methods were used to preliminarily identify the DIR gene family and analyze the physico-chemical properties, subcellular localization, conserved motifs, phylogeny, and expression patterns of the proteins. The results showed that a total of 34 DIR genes were screened and the encoded proteins were 156-387 aa. The physico-chemical properties of the proteins were different and the secondary structure was mainly random coil. Half of the DIR proteins were located in chloroplast, while the others in extracellular region, endoplasmic reticulum, cytoplasm, etc. Phylogenetic analysis of DIR proteins from S. chinensis and the other 8 species such as Arabidopsis thaliana, Oryza sativa, and Glycine max demonstrated that all DIR proteins were clustered into 5 subfamilies and that DIR proteins from S. chinensis were in 4 subfamilies. DIR-a subfamily has the unique structure of 8 β-sheets, as verified by multiple sequence alignment. Finally, through the analysis of the transcriptome of S. chinensis fruit at different development stages, the expression pattern of DIR was clarified. Combined with the accumulation of lignans in fruits at different stages, DIR might be related to the synthesis of lignans in S. chinensis. This study lays a theoretical basis for exploring the biological functions of DIR genes and elucidating the biosynthesis pathway of lignans in S. chinensis.

Prevalence of Clonorchis sinensis infections in freshwater fish in mainland China: A meta-analysis / 中国血吸虫病防治杂志

Objective To understand the real prevalence of Clonorchis sinensis infections in the freshwater fish in mainland China, so as to provide insights into clonorchiasis control and detection of freshwater fish. Methods All literatures reporting the prevalence of C. sinensis infections in the freshwater fish, the second intermediate host of the parasite, were jointly retrieved in Chinese and English electronic databases from January 1, 2010 to December 31, 2020, including Wanfang Data, CNKI, PubMed, Web of Science, Embase and Cochrane Library. All studies were screened based on inclusion and exclusion criteria, and the quality of all enrolled literatures was evaluated. The pooled prevalence of C. sinensis infections in freshwater fish and its 95% confidence interval (CI) were estimated using the software Stata version 15.0, and subgroup analyses were performed to investigate the region-, season- and sample source-specific pooled prevalence of C. sinensis infections in freshwater fish. In addition, the sensitivity and publication bias of all included studies were analyzed. Results A total of 40 eligible literatures were included in this study, including 37 Chinese literatures and 3 English literatures, and there were 10 high-quality literatures, 27 moderate-quality literatures and 3 low-quality literatures. A total of 53 species containing 37 959 freshwater fish were reported in these 40 studies, and 73.58% (39/53) of freshwater fish species were identified with C. sinensis infections. Meta-analysis showed 23.5% [95% CI: (0.19, 0.28)] pooled prevalence of C. sinensis infections in freshwater fish in mainland China, and subgroup analyses higher prevalence of C. sinensis infections in freshwater fish in northeastern China [35.7%, 95% CI: (0.22, 0.50)] than in central [25.9%, 95% CI: (0.04, 0.48)] and southern China [20.6%, 95% CI: (0.09, 0.32)], higher prevalence of C. sinensis infections in freshwater fish sampled in spring [44.1%, 95% CI: (0.35, 0.53)] than in autumn [6.7%, 95% CI: (0.05, 0.08)] and summer [3.3%, 95% CI: (−0.01, 0.07)], and higher prevalence of C. sinensis infections in freshwater fish sampled from natural water [25.2%, 95% CI: (0.17, 0.33)] than from retail trades [22.2%, 95% CI: (0.17, 0.28)] and breeding chain [12.3%, 95% CI: (0.03, 0.22)]. However, all included studies had a publication bias with a low sensitivity. Conclusions The prevalence of C. sinensis infections is high in freshwater fish in mainland China, and there are still challenges for clonorchiasis control. Reinforcement of health education, diagnostics development and food safety supervision is recommended in future clonorchiasis control programs.

Analysis of comprehensive intervention measures on reducing the mortality rate of infants born to human immunodeficiency virus-infected pregnant women / 中华传染病杂志

Objective:To evaluate the effect of comprehensive intervention measures on reducing the mortality rate of infants born to human immunodeficiency virus (HIV)-infected pregnant women.Methods:A total of 9 773 infants born to pregnant women with positive HIV antibody and confirmed HIV infection in Sichuan Province from 2005 to 2019 were included. The changes of infant mortality, death composition, time of death, and main causes of death in the whole province and different regions at baseline (2005 to 2016) and after comprehensive intervention measures (from 2017 to 2019) were analyzed. Statistical analysis was conducted by chi-square test and trend chi-square test.Results:After the intervention, the infant mortality rate born to HIV-infected mothers was 49.6‰ (221/4 455), which dropped 40.6% compared to the baseline (83.5‰ (444/5 318)), and that in Liangshan Yi Autonomous Prefecture was 53.3‰ (186/3 491), which dropped 48.3% compared to the baseline (103.1‰ (379/3 676)). Furthermore, the infant mortality rate in Sichuan Province and Liangshan Yi Autonomous Prefecture decreased with time (trend χ2=42.058 and 60.041, respectively, both P<0.01). The proportions of infant death of HIV-infected mothers among the total infant death in Sichuan Province and Liangshan Yi Autonomous Prefecture decreased from 29.3% (130/444) and 25.9% (98/379) to 13.6%(30/221) and 9.7%(18/186), respectively, and the differences were statistically significant ( χ2=19.918 and 20.020, respectively, both P<0.01). The infant death time was mainly delayed from less than one month (31.5%(140/444) and 28.5%(108/379), respectively) to 2-3 months (27.6%(61/221) and 28.5%(53/186), respectively) in Sichuan Province and Liangshan Yi Autonomous Prefecture, and the differences were statistically significant ( χ2=24.642 and 26.009, respectively, both P<0.01). The infant mortality rates due to pneumonia, diarrhea, suspected HIV infection, premature delivery or low birth weight decreased from 44.4‰ (236/5 318), 12.0‰ (64/5 318), 4.9‰ (26/5 318) and 4.3‰ (23/5 318) at baseline to 26.9‰ (120/4 455), 7.6‰ (34/4 455), 1.8‰ (8/4 455) and 0.7‰ (3/4 455), respectively, and the differences were statistically significant ( χ2=21.010, 4.734, 6.691 and 12.182, respectively, all P<0.05). Conclusions:Through the implementation of comprehensive intervention measures, the infant mortality rates of HIV-infected mothers in Sichuan Province and the high endemic areas decrease significantly. However, it is necessary to pay more attention to the high death risk and the infant death in the middle or low endemic areas. The infant health care of HIV-infected mothers within six months should be strengthened. The quality of follow-up and health care services targeted to the main cause of death should be improved.

The significance of skin and facial behaviors characteristics in identifying the etiology of childhood epilepsy / 中华实用儿科临床杂志

Objective:To explore the significance of skin and facial behaviors characteristics identifying the etiology of childhood epilepsy.Methods:Clinical data of 53 epilepsy children with skin and facial behaviors treated in the inpatient/outpatient of Children′s Hospital of Nanjing Medical University from August 2013 to August 2019 were retrospectively analyzed.Relevant case reports were reviewed through literature review.Results:All 53 children were diagnosed with epilepsy, including 28 cases diagnosed as tuberous sclerosis with the clinical clue of depigmentation spots, 5 cases diagnosed as cerebrovascular hemangioma with the clinical clue of crimson nevus, 5 cases diagnosed as mitochondrial brain disease combined with lactic acidosis and stroke like attack with the clinical clue of hairy and thin body, 5 cases diagnosed with Menkes disease with the clinical clue of sparse and curling hair and white skin, 1 case diagnosed as Alexandria disease with the clinical clue of large head circumference, 1 case diagnosed as giant cerebral leukodystrophy combined with subcortical cysts with the clinical clue of large head circumference, 1 diagnosed as type Ⅰ glutaric acidemia with the clinical clue of large head circumference, 2 cases diagnosed as Angelman syndrome with the clinical clue of happy face and mental retardation, 2 cases diagnosed as Rett syndrome with the clinical clue of stereotyped hand behavior, 1 case diagnosed as Aicardi-Goutières syndrome with the clinical clue of skin pigmentation and loss of spots, 1 case diagnosed as microdeletion of chromosome 1 with the clinical clue of wide eye distance and tooth loss, and 1 case diagnosed as neurofibromatosis with the clinical clue of café-au-lait-spots.Supported by the above characteristics, all cases had a clear diagnosis by imaging or genetic testing.Conclusions:characteristics of skin and facial behaviors is of great significance in the diagnosis of epilepsy etiology, and proficiency in the skin and facial behavior characteristics of childhood neurological diseases is conducive to the etiological diagnosis of epilepsy.