Research progress on anhepatic phase in rat liver transplantation / 器官移植

With persistent advancement of surgical instruments, methods and techniques, clinical efficacy of liver transplantation has been steadily enhanced. However, the length of anhepatic phase is still an important factor affecting the efficacy of liver transplantation. Rat is one of the major animal models for liver transplantation-related basic research. In this article, multiple approaches for prolonging the anhepatic phase and shortening the operation time during anhepatic phase in rat liver transplantation were reviewed, which consisted of sevoflurane inhalation anesthesia, intravenous infusion via jugular vein indwelling needle, clamping of the abdominal aorta before anhepatic phase, injection of normal saline into portal vein before anhepatic phase, subcutaneous transposition of the spleen, electrocoagulation of hepatic esophageal artery, magnetic ring anastomosis of the superior and inferior hepatic vena cava, cannula anastomosis of the superior and inferior hepatic vena cava, stent anastomosis of the superior and inferior hepatic vena cava, rapid connection device and cannula of portal vein, and ring-shaped cannula of hepatic tissue-preserving inferior hepatic vena cava, aiming to add evidence for prolonging the duration of anhepatic phase, improving the operation efficiency during anhepatic phase and elevating the success rate of rat liver transplantation.

Unilateral secondary puncture percutaneous vertebroplasty for acute symptomatic osteoporotic thoracolumbar fractures of type ⅡA / 中华创伤骨科杂志

Objective:To explore the clinical effects of unilateral secondary puncture percutaneous vertebroplasty (PVP) in the treatment of type ⅡA acute symptomatic osteoporotic thoracolumbar fractures (ASOTLF).Methods:A retrospective case-control study was conducted to analyze the clinical data of 193 patients with type ⅡA ASOTLF who had been admitted to Department of Spine Surgery, Honghui Hospital from February 2016 to October 2018. They were 71 males and 122 females, aged from 65 to 90 years [average, (73.9±4.3) years]. The segments injured were T10 in 21 cases, T11 in 27 cases, T12 in 44 cases, L1 in 48 cases, L2 in 29 cases, L3 in 14 cases, and L4 in 10 cases. Of them, 85 received unilateral secondary puncture PVP (observation group) and 108 did not (control group). The clinical effects were evaluated by comparing between the 2 groups the operation time, bone cement injection volume, intraoperative blood loss, hospital stay, and visual analogue scale (VAS) for back pain, spinal Oswestry disability index (ODI), anterior height of the injured vertebral body (AH) and kyphosis angle (KA) of the injured vertebra before operation, at 3 days after operation and the last follow-up. The bone cement leakage and fracture of adjacent vertebral body were observed.Results:All patients were followed up for 12 to 24 months (average, 15.8 months). There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The operation time and bone cement injection volume [(36.2±1.4) min and (5.5±0.7) mL] in the observation group were significantly longer or more than those in the control group [(32.3±1.7) min and (4.0±0.7) mL] ( P<0.05). There was no significant difference in the hospital stay or intraoperative blood loss between the 2 groups ( P>0.05). The VAS, ODI, AH and KA at 3 days after operation and the last follow-up were significantly improved compared with those before operation in both groups ( P<0.05). There was no significant difference in VAS, ODI, AH or KA between the 2 groups before operation or at 3 days after operation ( P>0.05). However, the VAS, ODI, AH and KA at the last follow-up in the observation group [(2.2±0.8) points, 19.2%±5.8%, (2.90±0.21) cm, and 12.2°±1.5°] were better than those in the control group [(3.1±0.9) points, 22.8%±5.3%, (2.41±0.15) cm, and 13.3°±1.2°]. There was no significant difference between the 2 groups in the incidence of postoperative bone cement leakage or that of adjacent vertebral fracture ( P>0.05). Conclusions:In the treatment of type ⅡA ASOTLF, unilateral secondary puncture PVP can result in satisfactory clinical effects, because it effectively promotes dispersion of bone cement and prevents re-collapse of the vertebra operated but does not increase the risks of bone cement leakage and adjacent vertebral fracture.

The prospects of DNA damage repair variants guiding platinum compounds in the treatment of triple negative breast cancer / 中华肿瘤杂志

Triple negative breast cancer (TNBC) is prone to recurrence and metastasis, which is the subtype of poorest prognosis. Chemotherapy is the main treatment, although there is lack of effective adjuvant chemotherapy regimens. The unsatisfactory efficacy of chemotherapy has been a bottleneck in improving the outcome of TNBC. Platinum compounds act directly on DNA to kill tumor cells, and they have a stronger killing effect on tumor cells carrying DNA damage repair (DDR) defects, which is an important entry point to improve the efficacy of TNBC. Biomarkers for predicting the efficacy of platinum drugs in TNBC treatment have always been a hot topic. The DDR pathway contains a large number of related genes, and recent studies have shown that deficiencies in the DDR pathway may be associated with the efficacy of platinum drugs, which is expected to be a biomarker for predicting the efficacy of platinum drugs in breast cancer treatment.

Impact of prolonging dual antiplatelet therapy on long-term prognosis of elderly patients with coronary heart disease complicated with diabetes mellitus undergoing drug-eluting stent implantation / 中华心血管病杂志

Objective: To explore and compare the effect of standard or prolonged dual antiplatelet therapy (DAPT) on the long-term prognosis of elderly patients with coronary heart disease complicated with diabetes mellitus after drug-eluting stent (DES) implantation. Methods: Consecutive patients with diabetes mellitus, ≥65 years old, underwent DES implantation, and had no adverse events within 1 year after operation underwent percutaneous coronary intervention (PCI) from January to December 2013 in Fuwai Hospital were enrolled in this prospective cohort study. These patients were divided into three groups according to DAPT duration: standard DAPT duration group (11 ≤ DAPT duration≤ 13 months) and prolonged DAPT duration group (13<DAPT duration≤ 24 months; DAPT duration>24 months). All the patients were followed up at 1, 6 months, 1, 2 and 5 years in order to collect the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), and type 2 to 5 bleeding events defined by the Federation of Bleeding Academic Research (BARC). MACCE were consisted of all cause death, myocardial infarction, target vessel revascularization or stroke. The incidence of clinical adverse events were compared among 3 different DAPT duration groups, and Cox regression model were used to analyze the effect of different DAPT duration on 5-year long-term prognosis. Results: A total of 1 562 patients were enrolled, aged (70.8±4.5) years, with 398 female (25.5%). There were 467 cases in standard DAPT duration group, 684 cases in 13<DAPT duration≤ 24 months group and 411 cases in DAPT duration>24 months group. The patients in standard DAPT duration group and the prolonged DAPT duration groups accounted for 29.9% (467/1 562) and 70.1% (1 095/1 562), respectively. The 5-year follow-up results showed that the incidence of all-cause death in 13<DAPT duration≤ 24 months group (4.8%(33/684) vs. 8.6%(40/467),P=0.011) and DAPT duration>24 month group(4.1%(17/411) vs. 8.6%(40/467),P=0.008) were significantly lower than in standard DAPT group. The incidence of myocardial infarction in 13<DAPT duration≤ 24 months group was lower than in standard DAPT duration group (1.9%(13/684) vs. 5.1%(24/467),P=0.002). The incidence of MACCE in 13<DAPT duration≤ 24 months group was the lowest (standard DAPT duration group, 13<DAPT duration≤ 24 months group and DAPT duration>24 month group were 19.3% (90/467), 12.3% (84/684), 20.2% (83/411), respectively, P<0.001). There was no significant difference in the incidence of stroke and bleeding events among the three groups (all P>0.05). Multivariate Cox analysis showed that compared with the standard DAPT group, prolonged DAPT to 13-24 months was negatively correlated with MACCE (HR=0.601, 95%CI 0.446-0.811, P=0.001), all-cause death (HR=0.568, 95%CI 0.357-0.903, P=0.017) and myocardial infarction (HR=0.353, 95%CI 0.179-0.695, P=0.003). DAPT>24 months was negatively correlated with all-cause death (HR=0.687, 95%CI 0.516-0.913, P=0.010) and positively correlated with revascularization (HR=1.404, 95%CI 1.116-1.765, P=0.004). There was no correlation between prolonged DAPT and bleeding events. Conclusions: For elderly patients with coronary heart disease complicated with diabetes mellitus underwent DES implantation, and had no MACCE and bleeding events within 1 year after operation, appropriately prolonging of the DAPT duration is related to the reduction of the risk of cardiovascular adverse events. Patients may benefit the most from the DAPT between 13 to 24 months. In addition, prolonging DAPT duration does not increase the incidence of bleeding events in this patient cohort.

Application of a cream containing madecassoside and 5% panthenol in skin repairing after nonablative fractional laser resurfacing / 中华医学美学美容杂志

Objective:To evaluate the clinical efficacy and safety of a cream containing madecassoside, 5% panthenolon skin repairing after nonablative fractional 1 565 nm laser therapy.Methods:A total of 84 patients who received nonablative fractional laser surgery in our hospital from April 2017 to April 2018 were included as research objects. The patients were divided into observation group and control group by random number table method, 42 cases in each group. The control group was treated with routine facial intervention after operation, while the observation group was treated with a cream containing madecassoside, 5% panthenolon skin repairing on the basis of routine intervention. The postoperative skin barrier function of the two groups were recorded and compared through skin property system and VISIA complexion analysis system.Results:At 1 and 2 weeks after operation, the sebum content and cuticle water content in the observation group were higher than those in the control group, and the transdermal water loss in the observation group was less than that in the control group, and the differences were statistically significant ( t=4.927, 7.833, 12.430, 4.538, 10.083, 8.017, P<0.05). The erythema index (EI) and melanin index (MI) of the observation group were lower than those of the control group at 1 and 2 weeks after operation, and the incidence of complications was significantly lower than that of the control group ( t=2.392, 2.807, 3.485, 3.009, P<0.05). Conclusions:The application of a cream containing madecassoside, 5% panthenolon in skin repairing is helpful to enhance the moisturizing effect, reduce the complications and promote the early recovery of patients with skin trauma after fractional laser operation.

A case-control study of minimally invasive transforaminal interbody fusion with the assistance of robot and traditional fluoroscopy in the treatment of single-space lumbar disc herniation / 中国骨伤

OBJECTIVE@#To compare the safety and nail placement accuracy of fluoroscopy-assisted and robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-space lumbar disc herniation.@*METHODS@#The clinical data of 52 patients with single-space lumbar disc herniation treated by MIS-TLIF from March 2019 to February 2020 were retrospectively analyzed. Among them, 24 patients were treated by robot-assisted MIS-TLIF(group A) and 28 patients were treated by fluoroscopy-assisted MIS-TLIF (group B). The intraoperative blood loss, operation time, intraoperative fluoroscopy times, preoperative and postoperative visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) scores and operation-related complications were recorded in two groups. Gertzbein-Robbins grade according to CT scan was used to evaluate the nail placement after operation. Grade A and B were evaluated as satisfactory nail placement, and grade C, D, and E were evaluated as error placement. Babu's method was used to evaluate the screw's invasion to the superior articular process.@*RESULTS@#The operation time, intraoperative blood loss and intraoperative fluoroscopy times in group A were less than those in group B(P<0.05).VAS and JOA scores of all patients at the final follow-up were significantly improved compared with those before operation(P<0.05), but there was no statistically significant difference between the groups(P>0.05). There were 96 and 112 screws in group A and group B, respectively. Three days after operation, according to the Gertzbein-Robbins grade to evaluate the nail placement accuracy, there were 90 screws of grade A, 5 of grade B, 1 of grade C, no grade D and E in group A;there were 84 screws of grade A, 16 of grade B, 8 of grade C, 4 of grade D, no grade E in group B;the difference between two groups was statistically significant(Z=-3.709, P=0.000). The satisfactory rate of screw placement in group A was 98.96% (95/96), and that of group B was 89.29% (100/112), the difference between two groups was statistically significant (χ2=8.254, P=0.004). Three days after operation, the invasion of superior facet joints by pedicle screws was evaluated according to Babu's method, including 90 screws in grade 0, 4 in grade 1, 2 in grade 2, and 0 in grade 3 in group A;86 in grade 0, 12 in grade 1, 10 in grade 2 and 4 in grade 3 in group B, and the difference was statistically significant(Z=-3.433, P=0.001). There were no serious spinal cord, nerve and vascular injuries and other operation-related complications caused by screw implantation failure in both groups. All patients were followed up from 6 to 12(9.06±1.60) months. The neurological symptoms improved well after operation. During the follow-up period, there was no recurrence of symptoms, loosening or breakage of the internal fixation.@*CONCLUSION@#Compared with the traditional fluoroscopy-assisted MIS-TLIF, the spinal robot-assisted MIS-TLIF not only has more minimally invasive and safer, but also has higher accuracy in nail placement, lower incidence of upper articular process invasion, and more accurate decompression targets, which can be used for minimally invasive treatment of single-space lumbar disc herniation.

Clinical effects of botulinum toxin A intradermal injection in treatment of erythematotelangiectatic rosacea / 中华医学美学美容杂志

Objective:To evaluate the efficacy and safety of intradermal injection of botulinum toxin A (BTX-A) in the treatment of erythematotelangiectatic rosacea.Methods:From January 2019 to December 2020, 30 patients with erythematotelangiectatic rosacea were treated in the Department of Dermatology at Xijing Hospital, Fourth Military Medical University. There were 26 females and 4 males, the age range from 23 to 42 years, with the average (30.9±5.7) years. Patients were randomly divided into two groups and given intradermal injection of botulinum toxin A. In detail, 0.25 U and 0.5 U was injected at each point in the low and high concentration group of BTX-A. The clinician erythema assessment (CEA) scores were recorded before treatment and at 2, 4, 8 and 12 weeks after treatment. The standard grading system scores for rosacea were recorded before treatment and at 12 weeks after treatment.Results:Both treatments could significantly reduce CEA scores, but the declined degree was more significant ( P<0.05), the onset time was shorter and the duration of efficacy was longer in the high concentration group. The scores of flushing, persistent erythema, burning sensation, stinging sensation and the total score of the standard grading system for rosacea after treatment in both two groups were significantly lower than those before treatment (high concentration group: t=5.00, 5.93, 4.10, 2.74, 12.37; low concentration group: t=6.17, 4.12, 2.87, 2.81, 7.88; P<0.05), and the improvement in high concentration group was significantly more than that in low concentration group ( t=2.02, 2.31, 2.15, 2.56, P<0.05). There was no significant difference in the overall effective rate between the two treatments ( P>0.05). Conclusions:Intradermal injection of BTX-A is safe and effective in the treatment of rosacea. Compared with the low concentration group, the efficacy is better, the onset time is shorter and the duration of efficacy is longer in the high concentration group.

The value of CT features in predicting the invasion and invasive degree of lung pure ground-glass nodules based on the new classification of lung tumor in 2021 / 中华放射学杂志

Objective:To investigate the value of CT features in predicting the invasion and degree of invasiveness of lung pure ground-glass nodules (pGGN) in the new histological classification in 2021.Methods:A total of 281 patients (304 lesions) with pGGN confirmed by surgical pathology from December 2018 to January 2021 in Shandong Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed. According to the pathological types, the patients were divided into prodromal lesion group [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS), 129 cases], minimally invasive group [minimally invasive adenocarcinoma (MIA), 116 cases] and invasive group [invasive adenocarcinoma (IAC), 59 cases]. Clinical data (age, gender, smoking history, family history of cancer), and CT parameters [shape, boundary, lobulation, burr, vacuolar sign, bronchial abnormality sign, internal vessel sign, pleural traction sign, longest diameter, shortest diameter, unenhanced CT value, contrast-enhanced CT value in arterial phase, contrast-enhanced CT values in venous phase, the degree of enhancement (ΔCT A-N, ΔCT V-N)] were recorded and measured. The ANOVA, Kruskal-Wallis H and χ 2 test were used to compare the differences among the three groups. Binary logistic regression analysis was used to evaluate the independent risk factors of nodular invasion [prodromal lesion and invasive lesion (MIA and IAC)] and the degree of nodular invasion (MIA and IAC), and receiver operating characteristic (ROC) curve analysis was performed for each parameter. Results:There were statistically significant differences in age, pGGN morphology, lobulation, vacuolar sign, bronchial abnormality sign, internal vascular sign, pleural traction sign, longest diameter, shortest diameter, unenhanced CT value, contrast-enhanced CT value in arterial phase, contrast-enhanced CT value in venous phase among the precursor lesion group, minimally invasive group and invasive group ( P<0.05). Binary logistic regression analysis showed that vacuole sign (OR=2.832, 95%CI 1.363-5.887, P=0.005), internal vascular sign (OR=3.021, 95%CI 1.909-4.779, P<0.001) and unenhanced CT value (OR=1.003, 95%CI 1.001-1.006, P=0.019) were independent risk factors for invasion. Lobulation (OR=5.739, 95%CI 2.735-12.042, P<0.001), internal vascular sign (OR=1.968, 95%CI 1.128-3.433, P=0.017) and unenhanced CT value (OR=1.004, 95%CI 1.001-1.008, P=0.012) were independent risk factors for the degree of invasiveness. ROC curve analysis showed that the efficiency of internal vascular sign was the highest in distinguishing precursor lesion and the invasive, the area under the curve (AUC) was 0.757, the sensitivity was 50.3%, the specificity was 89.8%. The efficiency of lobulation was the highest in distinguishing MIA and IAC (AUC=0.702), with a sensitivity of 61.0% and specificity of 79.3%. Conclusions:CT features are of certain value in predicting the invasion and degree of invasiveness of lung pGGN in the new histological classification in 2021, and internal vascular sign is more effective in predicting the invasion of lung pGGN. Lobulation can predict the degree of invasiveness of pGGN better.

Risk factors for cement displacement after percutaneous vertebral augmentation for osteoporotic vertebral compression fracture / 中华创伤杂志

Objective:To explore the risk factors of cement displacement after percutaneous vertebral augmentation in patients with osteoporotic vertebral compression fracture (OVCF).Methods:A case-control analysis was made on clinical data of 1 538 patients with OVCF admitted to Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2016 to June 2021. There were 377 males and 1 161 females, aged from 45-115 years [(71.7±10.8)years]. Percutaneous vertebroplasty (PVP) or percutaneous vertebroplasty (PKP) was performed. Patients were divided into cement displacement group ( n=78) and cement non-displacement group ( n=1 460) according to the radiographic outcomes. Factors related to cement displacement were analyzed by univariate analysis, including age, gender, body mass index (BMI), preoperative bone mineral density, underlying diseases, involved vertebral segments, surgical methods, surgical approaches, cement leakage (anterior edge), viscosity of cement, dispersion ratio of cement, degree of cement interweaving, sagittal position of cement, targeted location of cement, distance from cement to upper and lower endplates and duration of brace wearing. Independent risk factors for bone cement displacement were identified by multivariate Logistic regression analysis. Results:Univariate analysis showed that bone cement displacement was significantly correlated with BMI, preoperative bone mineral density, involved vertebral segments, operation methods, cement leakage (anterior edge), viscosity of cement, dispersion ratio of cement, degree of cement interweaving, sagittal position of cement, targeted location of cement, distance from cement to upper and lower endplates and duration of brace wearing (all P<0.05), but there was no correlation with gender, age, underlying diseases or surgicales approach (all P>0.05). Multivariate Logistic analysis showed that the preoperative bone mineral density ( OR=2.45, 95% CI 1.81-7.50, P<0.01), operation methods ( OR=4.56, 95% CI 1.86-8.44, P<0.01), cement leakage (anterior edge) ( OR=5.77, 95% CI 2.85-9.20, P<0.01), viscosity of cement ( OR=7.36, 95% CI 1.01-1.77, P<0.01), dispersion ratio of cement ( OR=6.84, 95% CI 1.69-13.39, P<0.01), degree of cement interweaving ( OR=8.97, 95% CI 2.29- 14.97, P<0.01), sagittal position of cement ( OR=6.39, 95% CI 1.06-9.47, P<0.01), targeted location of cement ( OR=7.93, 95% CI 1.64-11.84, P<0.01), distance from cement to upper and lower endplates ( OR=6.78, 95% CI 1.84-6.96, P<0.01) and duration of brace wearing ( OR=9.55, 95% CI 2.26- 9.38, P<0.01) were significantly correlated with bone cement displacement after percutaneous vertebral augmentation. Conclusion:Low bone mineral density preoperatively, PKP, cement leakage into the vertebral anterior edge, low viscosity of cement, small dispersion ratio of cement, small degree of cement interweaving, cement filling in the anterior 1/3 and anterior middle 2/3 of the vertebral body in sagittal plane, non-targeted injection of cement, long distance from cement to upper and lower endplates and short duration of brace wearing are independent risk factors of cement displacement after percutaneous vertebral augmentation for OVCF.

Risk factors for proximal junctional kyphosis after posterior long-segment internal fixation of chronic symptomatic osteoporotic thoracolumbar fracture in the elderly / 中华创伤杂志

Objective:To investigate the risk factors associated with the occurrence of proximal junctional kyphosis (PJK) after posterior long-segment internal fixation for type IV chronic symptomatic osteoporotic thoracolumbar fracture (CSOTLF) in the elderly.Methods:A case-control study was used to analyze the clinical data of 95 elderly patients with type IV CSOTLF treated in Honghui Hospital affiliated to Xi′an Jiaotong University from January 2013 to June 2018, including 32 males and 63 females, aged from 60 to 85 years［(67.4±6.5) years］. Injured segments were T 11 in 17 patients, T 12 in 37, L 1 in 30 and L 2 in 11. All patients were treated with posterior long-segment internal fixation and divided into PJK group ( n=30) and non-PJK group ( n=65) according to whether PJK occurred after surgery. Univariate analysis was performed for the correlation of the following indices with the incidence of postoperative PJK, including general information such as gender, age, body mass index (BMI), bone mineral density (BMD), history of smoking, cause of injury, comorbidities, injury segments, American Spinal Injury Association (ASIA) classification and time from injury to surgery, preoperative imaging data such as posterior junctional angle (PJA), sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis difference (PI-LL), pelvic tilt (PT) and sacral slope (SS), basic surgical data such as posterior ligament complex (PLC) injury, location of upper instrumented vertebrae (UIV), location of lower instrumented vertebrae (LIV) and number of fixed segments. Multifactorial Logistic regression analysis was used to measure the independent risk factors associated with the occurrence of postoperative PJK. Results:Univariate analysis showed that the incidence of postoperative PJK was correlated with age, BMI, BMD, preoperative PJA, preoperative SVA, preoperative PI-LL, PLC injury, location of UIV, location of LIV and number of fixed segments (all P<0.05), rather than gender, history of smoking, cause of injury, comorbidities, injury segments, ASIA classification, time from injury to surgery, preoperative PT and preoperative SS (all P>0.05). Multifactorial Logistic regression analysis showed that age ≥70 years ( OR=32.28, 95% CI 3.83-272.29, P<0.01), BMI>28.0 kg/m 2 ( OR=7.88, 95% CI 1.63-37.99, P<0.01), BMD T value<-3.5 SD ( OR=20.84, 95% CI 2.36-183.93, P<0.01), preoperative PI-LL>20° ( OR=13.30, 95% CI 1.54-113.87, P<0.05) and PLC injury ( OR=13.98, 95% CI 1.37-142.34, P<0.05) were significantly associated with the occurrence of postoperative PJK. Conclusions:Age≥70 years, BMI>28 kg/m 2, BMD T value<-3.5 SD, preoperative PI-LL>20° and PLC injury are independent risk factors for the incidence of PJK after posterior long-segment internal fixation in elderly patients with type IV CSOTLF. Attention should be paid to soft tissue protection and sagittal balance restoration of the spine intraoperatively and weight control and anti-osteoporosis treatment postoperatively.

Effect of Shenmai Injection on Long-Term Prognosis of Patients with Chronic Heart Failure: A Multicenter, Large Sample Capacity, Long-Term Follow-Up Retrospective Cohort Study / 中国结合医学杂志

OBJECTIVE@#To explore the effect of Shenmai Injection (SMI) on the long-term prognosis of patients with chronic heart failure (CHF).@*METHODS@#The Hospital Information System was used to extract data of CHF patients, and the retrospective cohort study was conducted for analysis. In non-exposed group, standardized Western medicine treatment and Chinese patent medicine or decoction were applied without combination of SMI while in the exposed group, SMI were applied for more than 7 days. Evaluation indicators are followed with New York Heart Association functional classification (NYHA classification), left ventricular ejection fraction (LVEF), N-terminal brain natriuretic peptide precursor (NT-ProBNP), cardiogenic death and heart failure (HF) readmission. Statistical analysis includes Kaplan-Meier analysis and Cox regression which are used to explore the relationship between SMI and outcome events.@*RESULTS@#A total of 1,211 eligible CHF patients were involved and finally 1,047 patients were followed up successfully. After treatment, the cases of NYHA classification decline in the exposed and non-exposed groups accounted for 64.30% and 43.45%, respectively; the improvement values of LVEF were 8.89% and 7.91%, respectively; the improvement values of NT-ProBNP were 909 pg/mL and 735 pg/mL, respectively. After exposure on SMI, the rates of cardiogenic death and HF readmission reduced from 15.43% to 10.18% and 38.93% to 32.37%. According to Kaplan-Meier analysis, the log-rank P value of SMI and cardiogenic death was 0.014, while the counterpart of SMI and HF readmission was 0.025. Cox regression analysis indicated that for cardiogenic death, age, cardiomyopathy, diabetes, and NYHA classification were risk factors while β-blockers, aldosterone receptor antagonists, Chinese patent medicine/decoction and SMI were protective factors. Likewise, for HF readmission, age, cardiomyopathy, and NYHA classification were risk factors while SMI was a protective factor.@*CONCLUSION@#Combination with SMI on the standardized Western medicine treatment can effectively reduce cardiogenic mortality and readmission rate in CHF patients, and thereby improve the long-term prognosis.

Epidemiological investigation and phylogenetic analysis of Classical Swine Fever virus in Yunnan province from 2015 to 2021

Background@#Classical swine fever virus (CSFV), the causative agent of classical swine fever (CFS), is a highly contagious disease that poses a serious threat to Chinese pig populations. @*Objectives@#Many provinces of China, such as Shandong, Henan, Hebei, Heilongjiang, and Liaoning provinces, have reported epidemics of CSFV, while the references to the epidemic of CSFV in Yunnan province are rare. This study examined the epidemic characteristics of the CSFV in Yunnan province. @*Methods@#In this study, 326 tissue samples were collected from different regions in Yunnan province from 2015 to 2021. A reverse transcription-polymerase chain reaction (RT-PCR), sequences analysis, and phylogenetic analysis were performed for the pathogenic detection and analysis of these 326 clinical specimens. @*Results@#Approximately 3.37% (11/326) of specimens tested positive for the CSFV by RTPCR, which is lower than that of other regions of China. Sequence analysis of the partial E2 sequences of eleven CSFV strains showed that they shared 89.0–100.0% nucleotide (nt) and 95.0–100.0% amino acid (aa) homology, respectively. Phylogenetic analysis showed that these novel isolates belonged to the subgenotypes 2.1c and 2.1d, with subgenotype 2.1c being predominant. @*Conclusions@#The CSFV was sporadic in China’s Yunnan province from 2015 to 2021. Both 2.1c and 2.1d subgenotypes were found in this region, but 2.1c was dominant.

A short half-life of cccDNA offer or ignite hope for hepatitis B cure under nucleos(t)ide analogues treatment / 中华肝脏病杂志

Covalently closed circular DNA (cccDNA) of hepatitis B virus (HBV) is the template for HBV replication. Currently, there is a lack of therapeutic drugs that directly target cccDNA. Therefore, blocking cccDNA supplements as fast as possible and reducing the existing cccDNA is the key to achieving a complete cure of chronic hepatitis B. Previous studies have suggested that cccDNA had a long half-life, but a recent study showed that it only took a few months to update cycle of cccDNA pool, and its number was much less than previously predicted. In the future, with the advent of new antiviral drugs that can completely inhibit HBV replication, it is expected that the cccDNA pool will be completely cleared due to its supplement complete blockade, so as to achieve virological cure of chronic hepatitis B.

Research on the mechanism of bufalin inhibiting migration and invasion of human prostate cancer PC3 cells / 药学学报

In this study, we investigated the inhibitory effects of bufalin on proliferation, migration and invasion of PC3 cells in vitro, and preliminarily explored the molecular mechanism of epithelial-mesenchymal transformation (EMT) inhibited by bufalin. The viability of PC3 cells was evaluated by MTT assay, and the migration and invasion abilities of PC3 cells were detected by wound healing and Transwell assay. Western blot was used to detect the expression of EMT and integrin family proteins. The results showed that the half maximal inhibitory concentration (IC50) value of bufalin against PC3 cells was 0.26 ± 0.03 μmol·L-1. After bufalin treatment, the migration rate of PC3 cells slowed down (P < 0.05), the number of PC3 cells passing through the microporous membrane decreased (P < 0.05), which indicated that bufalin could inhibit the proliferation, migration and invasion of PC3 cells in a concentration-dependent manner. We found that bufalin could affect the expression of EMT-related proteins,including up-regulation of E-cadherin and down-regulation of N-cadherin, β-catenin, matrix metalloproteinase 9 (MMP9), matrix metalloproteinase 2 (MMP2), c-myc and Snail. Bufalin also inhibited the expression of integrin family proteins, including integrin α2 (ITGA2), integrin β1 (ITGB1), integrin β3 (ITGB3), integrin β5 (ITGB5), Yes-associated protein/transcriptional coactivator with a PDZ-binding motif (YAP/TAZ) and integrin-linked kinase (ILK). In addition, bufalin could also inhibit the protein expression level of phospho-focal adhesion kinase (p-FAK)/FAK, phospho-steroid receptor coactivator (p-Src)/Src and phospho-protein kinase B (p-Akt)/Akt. These results suggested that bufalin might inhibit the proliferation, metastasis and invasion of prostate cancer PC3 cells through the FAK/Src/phosphoinositide 3-kinase (PI3K)/Akt pathway. Therefore, bufalin provides reference value for the development of therapeutic drugs for prostate cancer.

Puncture assisted by a "TINAVI" orthopaedic robot versus freehand puncture in vertebroplaty for osteoporotic vertebral compression fracture of the upper thoracic vertebra / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between puncture assisted by a "TINAVI" orthopaedic robot versus freehand puncture in vertebroplaty for osteoporotic vertebral compression fracture(OVCF) of the upper thoracic vertebra.Methods:A retrospective study was conducted of the 19 patients (20 vertebral bodies) with OVCF of the upper thoracic vertebra who had been treated at Department of Spine Surgery, Honghui Hospital from January 2018 to March 2019 by robotic vertebroplasty (robot group) and of another 21 counterpart patients (21 vertebral bodies) who had been treated by conventional vertebroplasty from January 2016 to December 2017 (freehand group). Puncture was conducted by a "TINAVI" orthopaedic robot in the robotic vertebroplasty but freehand in the conventional vertebroplasty. The robot group had 5 males and 14 females, aged from 62 to 88 years; the freehand group had 6 males and 15 females, aged from 64 to 83 years. The 2 groups were compared in terms of operation time, bone cement volume, postoperative complications (cement leakage, infection and embolism), visual analogue scale (VAS), Oswestry disability index (ODI), anterior height (AH) and kyphosis angulation (KA) of the injured vertebra at day 1 and last follow-up after surgery.Results:The 2 groups were comparable because there were no significant differences between them in the preoperative general data ( P>0.05). Vertebroplasty via unilateral puncture approach was completed uneventfully in the 19 patients (20 vertebral bodies) in the robot group and in the 21 patients (21 vertebral bodies) in the freehand group. The 40 patients were followed up for 6 to 12 months (mean, 8.3 month). The operation time [(37.9±8.2) min], bone cement volume [(2.3±0.9) mL] and rate of cement leakage (10.0%, 2/20) in the robot group were all significantly less or lower than those in the freehand group [(46.2±9.4) min, (4.2±1.3) mL and 42.9% (9/21)] ( P<0.05). No infection or embolism was observed in either group. There were no significant differences between the 2 groups in VAS, ODI, AH or KA of the injured vertebra at day 1 or last follow-up after surgery ( P>0.05). Conclusion:In vertebroplaty for OVCF of the upper thoracic vertebra, compared with conventional freehand puncture, puncture assisted by a "TINAVI" orthopaedic robot can lead to satisfactory clinical efficacy because it reduces operation time, volume of bone cement injection, and thus incidence of bone cement leakage.

Clinical effect of 125I radioactive seed implantation combined with intermittent hormonal therapy on prostate cancer / 中国医师杂志

Objective:To explore clinical effect of 125I radioactive seed implantation combined with intermittent hormonal therapy (IHT) on prostate cancer. Methods:During the period from May 2016 to May 2017, 84 patients pathologically diagnosed with prostate cancer of T 3N 0M 0 by biopsy in Affiliated Hospital of Chifeng College were enrolled as study objects. They were divided into two groups by random number table method. 40 cases in control group were treated with intermittent hormonal therapy, while 44 cases in observation group were treated with 125I radioactive seed implantation combined with IHT. After the first IHT, time of prostate specific antigen (PSA) returning to normal and intermission time in both groups were observed. The dynamic changes of PSA level and prognosis in both groups during treatment were recorded. Results:After the first IHT, time of PSA returning to normal in observation group was shorter than that in control group, while intermission time was longer than that in control group ( P<0.05). At 3, 6, 12 and 24 months after treatment, PSA level in observation group was lower than that in control group ( P<0.05). The 2-year PSA-free progression survival (PSA-PFS) rate in observation group was higher than those in control group (77.27% vs 45.0%) ( P<0.05). There was no significant difference in 2-year total overall survival (OS) rate between the two groups ( P>0.05). There were no serious complications during treatment in observation group. Conclusions:125I radioactive seed implantation combined with IHT in treatment of prostate cancer can reduce PSA level more quickly, and increase 2-year PSA-PFS rate.

Correlation study of triglyceride-glucose index and plaque burden and characteristics of vulnerable plaque based on coronary CT angiography plaque quantitative analysis / 中华放射学杂志

Objective:To explore the relationship between triglyceride-glucose (TyG) index with plaque components, plaque burden and characteristics of vulnerable plaque using coronary plaque analysis based on coronary artery computed tomography (CCTA).Methods:A total of 498 patients(male 296, female 202), the age ranged from 33 to 87 (63±9) years who underwent CCTA from January 2020 to September in Shandong Provincial Hospital Affiliated to Shandong First Medical University were included. The enrolled patients were divided into three groups according to the tertiles of TyG index: T 1 group (the lowest one-third), T 2 group (middle one-third) and T 3 group (the highest one-third). The plaque burden, volume and ratio of calcified, lipid and fibrous components of plaques as well as the incidence of vulnerable plaques were measured based on CCTA images. Chi-square test, ANOVA and Kruskal-Wallis test were used to compare whether the differences of indexes among the three groups were statistically significant. Multiple stepwise regression was used to analyze the influencing factors of coronary atherosclerotic plaque burden and multiple logistic regression was used to analyze the risk factors of CT high-risk plaque. Finally, ROC curve was used to evaluate the value of TyG index in the diagnosis of CT high-risk plaque, and the best diagnostic threshold of TyG index was determined. Results:The plaque burden, non-calcified plaque volume and ratio had positive relationship with TyG index ( P<0.001).TyG index was significantly correlated with plaque burden according to multiple stepwise regression analysis (regression coefficient 7.267, P<0.001). The results of CT vulnerable characteristics of plaques showed that positive remodeling, low-attenuation plaque sign and the incidence of vulnerable plaque increased with TyG index ( P<0.05). Multivariate Logistic regression analysis showed that TyG index was an independent risk factor for CT vulnerable plaque(OR=2.324,95 %CI 1.533-3.523, P<0.001). The cut-off value of TyG index that can predict vulnerable plaque was 8.43(sensitivity 77.24%, specificity 45.60%, AUC 0.645, P<0.001). Conclusions:With the increase of TyG index, the burden of coronary atherosclerosis plaque and the incidence of CT vulnerable plaque increased. TyG index is expected to be a simple and effective predictor of cardiovascular disease and adverse cardiovascular events.

Comparison of curative efficacy of percutaneous vertebroplasty and non-surgical treatment of type I acute symptomatic osteoporotic thoracolumbar fracture / 中华创伤杂志

Objective:To compare the clinical efficacy of percutaneous vertebroplasty (PVP) and non-surgical treatment of patients with type I fracture according to the acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) classification.Methods:A retrospective case-control study was used to analyze the clinical data of 115 patients with ASOTLF admitted to Honghui Hospital of Xi'an Jiaotong University from January 2015 to December 2018. There were 48 males and 67 females, aged 65-92 years [(75.3±8.5)years]. According to clinical symptoms and imaging characteristics, all patients were identified with type I fracture according to the ASOTLF classification. Injury segments were at T 6 to T 10 in 10 patients, at T 11 in 15, at T 12 in 26, at L 1 in 34, ay L 2 in 18, at L 3 in 7, and at L 4 in 5. A total of 73 patients received PVP combined with anti-osteoporosis treatment (surgery group), and 42 patients received non-surgery combined anti-osteoporosis treatment (non-surgery group). Before treatment, at 1 day, 1 month, 3 months, 6 months after treatment, and at the last follow-up, the visual analogue scale (VAS) was used to assess the pain, the Roland Morris Disability (RMD) score to assess the spinal function, and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) score to evaluate the quality of life. The bone mineral density was compared between groups before treatment and at 1 year after treatment. The complications were observed as well. Results:All patients were followed up for 12-18 months [(13.2±4.6)months]. At 1 day, 1 month, and 3 months after treatment, the VAS in surgery group [(3.9±0.6)points, (3.3±0.6)points, (2.9±0.3)points] was significantly lower than that in non-surgery group [(6.0±0.7)points, (5.0±0.8)points, (4.2±1.0)points, respectively] (all P<0.05); the RMD score in surgery group [(15.2±0.7)points, (12.6±0.7)points, (10.6±0.7)points] was significantly lower than that in non-surgery group [(16.4±0.8)points, (14.6±0.8)points, (12.7±0.6)points, respectively] (all P<0.05). At 1 day and 1 month after treatment, the QUALEFFO score in surgery group [(46.0±1.1)points, (41.4±0.8)points] was lower than that in non-surgery group [(50.3±0.8)points, (44.7±1.2)points] (all P<0.05). There was no statistically significant difference between the two groups at other time points of the above indicators ( P>0.05). At 1 year after treatment, the bone mineral density in surgery group was (-3.0±0.9)SD, and was (-2.8±1.1)SD in non-surgery group ( P>0.05). There was no significant difference in the incidence of complications between surgery group [37%(27/73)] and non-surgery group [33%(14/42)] ( P>0.05). Conclusion:For patients with ASOTLF type I fracture, PVP and non-surgical treatment has similar effects in anti-osteoporosis and occurrence of complications, but the PVP is superior to non-surgical treatment in early pain relief, spinal function improvement and quality of life.

Unilateral puncture percutaneous vertebroplasty in treatment of type I chronic symptomatic osteoporotic vertebral compression fracture / 中华创伤杂志

Objective:To evaluate the efficacy of unilateral puncture techniques in high-viscosity cement percutanueous vertebroplasty (PVP) in treatment of type I chronic symptomatic osteoporotic vertebral compression fracture (CSOVCF).Methods:A retrospective case control study was conducted to analyze the clinical data of 119 patients with type I CSOVCF admitted to Honghui Hospital affiliated to Xi'an Jiaotong University School of Medicine from December 2013 to December 2016. There were 42 males and 77 females, aged 58-95 years [(79.2±15.6)years]. All patients had bone mineral density of -4.5--2.5 SD [(-3.9±0.2)SD] (T score). The fractured segments included L 1-L 2 in 56 patients and L 3-L 5 in 63. All patients were treated by high-viscosity cement PVP with the unilateral puncture of transverse process and superior articular process in unilateral group ( n=60) and by the bilateral puncture approach with the Magerl method in bilaleral group ( n=59). The operation time, cement injection volume, and intraoperative fluoroscopy frequency were recorded. The visual analogue scale (VAS), Oswestry dysfunction index (ODI), anterior height ratio of injured vertebrae and Cobb angle were measured before operation, at postoperative 1 day and at the last follow-up. The adjacent vertebral fracture, cement leakage and other complications were recorded. Results:All patients were followed up for 12-48 months [(24.1±5.6)months]. The operation time in unilateral group [(21.5±6.5)minutes] was significantly shorter than that in bilateral group [(37.8±7.4)minutes] ( P<0.05). The cement injection volume in unilateral group [(4.2±0.7)ml] was less than that in bilateral group [(6.5±1.1)ml]( P<0.05). The intraoperative fluoroscopy frequency in unilateral group [(14.2±3.0)times] was less than that in bilateral group [(31.4±6.4)times] ( P<0.05). Both groups showed significant improvements in VAS, ODI, anterior height ratio of injured vertebrae and Cobb angle at postoperative 1 day and at the last follow-up compared with these before operation ( P<0.05), but there were no significant differences after operation between the two groups ( P>0.05). The incidence of adjacent vertebral fracture was 5%(3/60) in unilateral group and 8% (5/59) in bilaleral group ( P>0.05). Four patients (7%) had cement leakage in unilateral group and 11 patients (19%) in bilateral group ( P<0.05). No complications of wound infection, nerve injury or pulmonary embolism occurred. Conclusion:Compared with Magerl bilateral puncture approach, high-viscosity cement PVP with unilateral puncture of transverse process and superior articular process in treatment of type I CSOVCF has advantages of shorter operation time, less trauma, less radiation exposure and lower cement leakage rate.

Stage I percutaneous vertebroplasty for treatment of acute multi-segment osteoporotic thoracolumbar compression fracture in the elderly / 中华创伤杂志

Objective:To explore the clinical effect of percutaneous vertebroplasty (PVP) at stage I in treatment of acute multi-segment osteoporotic vertebral compression fracture (OVCF) in the elderly with over 3 vertebrae operated.Methods:A retrospective case-control study was conducted to analyze the clinical data of 105 aged patients with acute multi-segment OVCF admitted to Honghui Hospital, Xi'an Jiaotong University from October 2015 to February 2019. There were 27 males and 78 females, aged 65-92 years [(73.0±14.5)years]. All patients received stage I multi-segmental PVP and standard anti-osteoporosis treatment. There were more than 3 operative vertebral segments in 30 patients (observation group) and less than or equal to 3 operative vertebral segments in 75 patients (control group). The operation time, intraoperative fluoroscopy frequency, cement injection volume, cement leakage rate and incidence of recurrent vertebral fractures were compared between the two groups. The visual analogue scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) score were compared before operation, 1 day, 1 month after operation and at the last follow-up.Results:All patients were followed up for 11-13 months [(12.5±1.8)months]. The observation group showed operation time of (71.2±12.2)minutes, intraoperative fluoroscopy frequency of (38.8±6.4)times and cement injection volume of (20.2±4.6)ml, more than those in control group [(52.3±10.6)minutes, (25.4±5.3)times, (12.3±4.3)ml] ( P<0.05). There was no significant difference in cement leakage rate and incidence of recurrent vertebral fractures between the two groups ( P>0.05). No complications such as infection, nerve damage or cement implantation syndrome occurred. Before operation, 1 day after operation, 1 month after operation and at the last follow-up, the VAS in observation group [(7.6±0.7)points, (3.0±0.8)points, (2.3±0.7)points, (2.2±0.6)points] showed no significant difference from those in control group [(7.4±0.5)points, (2.9±0.4)points, (2.1±0.5)points, (2.0±0.5)points], the ODI in observation group [(74.6±3.3)%, (36.8±4.6)%, (29.7±4.0)%, (24.0±3.6)%] did not differ from those in control group [(73.8±1.0)%, (35.1±0.9)%, (28.4±2.2)%, (22.8±0.9)%], the ADL score in observation group [(34.5±5.0)points, (54.5±3.8)points, (73.7±3.9)points] were similar with those in control group [(36.2±3.4)points, (56.8±4.7)points, (75.3±5.3)points, (81.3±4.5)points] (all P>0.05). The postoperative VAS, ODI and ADL score in both groups were significantly improved in comparison with preoperation ( P<0.05). Conclusion:For acute multi-segment OVCF in the elderly with over 3 or not more than 3 the vertebrae operated, PVP at stage I has the same advantages in early pain relief and improvement of motor function and quality of life.