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ObjectiveTo explore the effect and mechanism of Sishenjian on synovial lesions induced by monosodium iodoacetate (MIA) in rats with knee osteoarthritis (KOA). MethodSixty female Sprague-Dawley (SD) rats were randomly divided into the following six groups: normal group, model group, celecoxib group, and high-, medium-, and low-dose Sishenjian group. The KOA rat model was established by intra-articular injection of MIA. Celecoxib (18 mg·kg-1) and Sishenjian (14.4, 7.2, 3.6 g·kg-1) were administered by gavage according to the groups. All rats were euthanized after four weeks of continuous administration. The transverse diameter of the bilateral knee joints of rats was measured, and gross observation of the knee joint was performed. Pathological changes in knee joint synovial tissue were observed by hematoxylin-eosin (HE) staining and picrosirius red staining. Immunohistochemistry (IHC) was used to detect the expression of vascular endothelial growth factor A (VEGFA) in synovial tissue. The levels of inflammatory cytokines in the joint synovial fluid were detected by enzyme-linked immunosorbent assay (ELISA). Real-time quantitative polymerase chain reaction (Real-time PCR) and Western blot were used to detect the expression of mRNA and proteins related to the transforming growth factor-β1 (TGF-β1)/Smad2/3 pathway in knee joint synovium. ResultCompared with the normal group, the transverse diameter of the knee joint in the model group significantly increased (P<0.01). Compared with the model group, the transverse diameter of the knee joint in rats of each Sishenjian group significantly decreased (P<0.01). Compared with the normal group, the expression levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the knee joint synovial fluid of model group significantly increased (P<0.01). Compared with the model group, the expression levels of IL-1β and TNF-α in the knee joint synovial fluid of rats in each Sishenjian group significantly decreased (P<0.01). Compared with the normal group, the expression levels of TGF-β1, Smad2/3, phosphorylation(p)-Smad2/3, type Ⅰ collagen α1 (ColⅠα1), type Ⅲ collagen α1 (ColⅢα1), VEGFA proteins and TGF-β1, Smad2/3, ColⅠα1, ColⅢα1 mRNA in knee joint synovium of model group significantly increased (P<0.01). Compared with the model group, the expression levels of TGF-β1, Smad2/3, phosphorylation (p)-Smad2/3, ColⅠα1, ColⅢα1, VEGFA proteins and TGF-β1, Smad2/3, ColⅠα1, ColⅢα1 mRNA in knee joint synovium of rats in each Sishenjian group significantly decreased (P<0.05, P<0.01). ConclusionSishenjian can inhibit synovial inflammation and angiogenesis, and may become a potential drug for treating synovial lesions in KOA by regulating the TGF-β1/Smad2/3 pathway.
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Human herpes simplex virus type 1(HSV-1)infection of the upper respiratory tract is a common,mostly self-limiting disease.Reactivation of HSV-1 can sometimes cause lower respiratory tract infections.Coinfection of HSV-1 and other pathogens in the respiratory tract may cause severe diseases,resulting in HSV pneumonia and acute respiratory distress syndrome.This article reviews the symptoms and pathogenesis of HSV-1 infection or co-infections with other pathogens in the respiratory tract,as well as recent advances on drugs and vaccines for HSV-1.
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Objective To observe the value of diffusion weighted imaging intravoxel incoherent motion(IVIM)for quantitative evaluating chronic allograft dysfunction(CAD).Methods Totally 104 CAD patients were prospectively enrolled and were assigned into CAD 1,2 and 3 groups(n=11,61,32)based on impairment severity of estimated renal function,and 36 healthy volunteers were enrolled as control group.The true diffusion coefficient(D value),microcirculation perfusion diffusion coefficient(D*value)and perfusion score(f value)of renal cortex and medulla IVIM parameters were compared among groups and within groups to assess the value of IVIM parameters for diagnosing CAD.Results The D value of transplanted renal cortex in all CAD groups were lower than that in control group(all P<0.05),which decreased among CAD 1,2 and 3 groups(all P<0.05).The D value of transplanted kidney medulla in CAD 2 and 3 groups were lower than that in control group(both P<0.05).The D*values of transplanted renal cortex in all CAD groups were lower than that in control group,while of renal medulla in CAD 2 and 3 groups were lower than that in control group(both P<0.05).The f values of cortex and medulla in CAD 2 and 3 groups were lower than those in control group(all P<0.05),while of cortex in CAD 3 group was lower than that in CAD 1 and 2 groups(both P<0.05).The area under the curve(AUC)of cortical IVIM combined model for diagnosing CAD was 0.96,better than the D*value and f value(AUC=0.74,0.83,P<0.05)but not significantly different with that of the D value(AUC=0.94,P=0.32).AUC of medullary IVIM combined model for diagnosing CAD was 0.91,better than that of D,D*and f value(AUC=0.80,0.67 and 0.80,all P<0.05).Conclusion IVIM parameters could be used to quantitatively evaluate CAD.
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Objective To screen and establish a method for determining the biological activity of anfibatide.Meth-ods Three methods of light transmittance aggregometry(LTA),whole blood electrical impedance aggregometry,and continuous platelet count method were compared and studied.And the constant platelet counting method was chosen and verified to detect the biological activity of anfibatide.Results The RSD values of anfibatide biological activity detected by LTA,whole blood electri-cal impedance aggregometry,and continuous platelet count method were 10.3%,14.0%,and 3.6%,respectively.RSD of repeat-ability of 6 parallel test articles was 11.0%.The RSD of intermediate precision of 12 test articles for different personnel was 9.8%,and the inhibition rate of anfibatide was linear in the range of 0.3-0.5 U.The correlation coefficient was more than 0.990.The ac-tivity of three batches of anfibatide was determined,and the inhibition rate was 49.9%~53.6%.Conclusion The continuous platelet count method for determining anfibatide activity was established and verified,which can be used for quality control for an-fibatide activity since the precision and detection limit of the method met the requirement for activity assay of biological products.
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Objective To study the inhibitory effect of Huidu Yinhua powder from the Orthodox Manual of External Medicine on methicillin-resistant Staphylococcus aureus(MRSA),virulence factor α-hemolysin(Hla)activity,and biofilm formation,and to explore the optimal ratios of Huidu Yinhua powder and provide experimental support for its use.Methods The inhibitory effects of Huidu Yinhua powder and the herbs in the formula on USA300 were analyzed by the minimum inhibitory concentration(MIC),minimum bactericidal concentration(MBC),and disk diffusion assay(K-B method).Hemolysis,neutralization,oligomerization,and Western blot assays were used to verify in which form the drug inhibits the activity of virulence factor α-hemolysin(Hla).A biofilm assay was performed to evaluate the inhibitory effect of Huidu Yinhua powder on biofilm.Orthogonal experiments were performed to explore the optimal ratio of Huidu Yinhua powder.Results Huidu Yinhua powder inhibited the MRSA strain with a MIC90 of 64 mg/mL and an MBC of 256 mg/mL with antibacterial circle diameter of(7.50±0.50)mm.Huidu Yinhua powder inhibited Hla activity by inhibiting Hla secretion.The minimum effective concentration(MEC)was 16 mg/mL,and the MEC of biofilm was 8 mg/mL.In Huidu Yinhua powder,honeysuckle and astragalus only affected the hemolytic activity of MRSA and biofilm formation without inhibiting bacterial growth.The hemolytic activity and biofilm of MEC were both 32 mg/mL.Glycyrrhiza had a strong bacterial inhibitory capacity with a MIC90 of 8 mg/mL and biofilm MEC of 1 mg/mL without showing inhibitory hemolytic activity at subinhibitory concentrations.The orthogonal experiment showed that,at a ratio of honeysuckle,astragalus,and glycyrrhiza in Huidu Yinhua powder of 1∶2∶4,the MIC90 was 16 mg/mL,MEC of hemolytic activity was 8 mg/mL and that of biofilm was 4 mg/mL,both of which were the lowest among the nine groups.Conclusions Huidu Yinhua powder affects the hemolytic activity and biofilm formation of MRSA at subinhibitory concentrations with the optimal ratio of honeysuckle,astragalus,and glycyrrhiza being 1∶2∶4.
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Objective To explore the effect of Bajitianwan(BJTW)formula on bone formation of Aβ-injured osteoblasts and its mechanism. Methods Osteoblasts isolated from neonatal 24-hour Wistar rats were used for the study, and osteoblasts were subjected to damage with Aβ1-42 oligomers, and pharmacological intervention was performed with the aqueous extract of BJTW formula. The MTT assay, alkaline phosphatase(ALP)activity assay, catalase(CAT)activity assay, superoxide dismutase(SOD)activity assay, glutathione(GSH)activity assay and malondialdehyde(MDA)activity assay were carried out respectively. The expression levels of bone morphogenetic protein 2(BMP2), osteogenic specific transcription factor(RUNX-2)and osteoprotective protein(OPG)were detected by Western blotting. After confirming the effect of BJTW formula on Aβ-injured osteoblasts, the network pharmacology method was used to predict the potential pathways. Results The BJTW formula significantly promoted the proliferation of Aβ-injured osteoblasts, increased ALP, SOD and GSH activity, inhibited MDA activity, and promoted the expression of bone formation-related proteins BMP2, RUNX-2 and OPG. Network pharmacological analysis showed that the effect of ameliorating of Aβ-injured osteoblasts by BJTW formula was mainly mediated by AGE-RAGE, PI3K-Akt, MAPK and neuroactive ligand-receptor interaction signaling pathways. Conclusion In this study, the effect of BJTW formula on improving the osteoblasts damaged by Aβ was confirmed for the first time, and its related mechanism was explored based on network pharmacology method. The results lay a strong foundation for the clinical application of traditional formula BJTW against osteoporosis.
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Objective To investigate the change in mucosal-associated invariant T (MAIT) lymphocytes in peripheral blood of children with metabolic associated fatty liver disease (MAFLD) and its clinical significance. Methods A total of 18 children with MAFLD who attended Hunan Children's Hospital from March to May, 2022, were enrolled as MAFLD group, and 20 normal children who attended the hospital during the same period of time were enrolled as control group. Peripheral blood samples were collected, and flow cytometry was used to measure the percentages of MAIT lymphocytes (CD3 + CDl61 + TCRVα7.2 + cells), different MAIT lymphocyte subsets (CD4 + CD8 - MAIT cells, CD4 - CD8 - MAIT lymphocytes, CD4 - CD8 + MAIT lymphocytes, and CD4 + CD8 + MAIT lymphocytes), and MAIT lymphocytes expressing PD-1, CD69, perforin, CD107α, CXCR3, CXCR6, and CCR6. The correlation of MAIT lymphocyte frequency with liver inflammation, fat content, and fibrosis degree was analyzed. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Spearman correlation analysis was used for correlation analysis. Results Compared with the control group, the MAFLD group had significant increases in the percentage of MAIT lymphocytes in peripheral blood, the percentages of MAIT cells expressing PD-1, CD69, CD107α, CXCR3, CXCR6 and CCR6, and the percentages of CD4 + CD8 - MAIT cells and CD4 + CD8 + MAIT lymphocytes among MAIT cell subsets (all P < 0.05), as well as a significant reduction in the percentage of CD4 - CD8 + MAIT cells among MAIT cell subsets ( P < 0.001). The percentages of CD4 + CD8 + MAIT lymphocytes and CD107α-positive MAIT lymphocytes were negatively correlated with alanine aminotransferase ( r =-0.474 and -0.550, P =0.047 and 0.018). Conclusion The migration of peripheral blood MAIT lymphocytes to the liver plays a protective role against liver inflammation in children with MAFLD.
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BACKGROUND@#All-trans retinoic acid (ATRA) promotes the osteogenic differentiation induced by bone morphogenetic protein 9 (BMP9), but the intrinsic relationship between BMP9 and ATRA keeps unknown. Herein, we investigated the effect of Cyp26b1, a critical enzyme of ATRA degradation, on the BMP9-induced osteogenic differentiation in mesenchymal stem cells (MSCs), and unveiled possible mechanism through which BMP9 regulates the expression of Cyp26b1. @*METHODS@#ATRA content was detected with ELISA and HPLC–MS/MS. PCR, Western blot, and histochemical staining were used to assay the osteogenic markers. Fetal limbs culture, cranial defect repair model, and micro–computed tomographic were used to evaluate the quality of bone formation. IP and ChIP assay were used to explore possible mechanism. @*RESULTS@#We found that the protein level of Cyp26b1 was increased with age, whereas the ATRA content decreased. The osteogenic markers induced by BMP9 were increased by inhibiting or silencing Cyp26b1 but reduced by exogenous Cyp26b1. The BMP9-induced bone formation was enhanced by inhibiting Cyp26b1. The cranial defect repair was promoted by BMP9, which was strengthened by silencing Cyp26b1 and reduced by exogenous Cyp26b1. Mechanically, Cyp26b1 was reduced by BMP9, which was enhanced by activating Wnt/b-catenin, and reduced by inhibiting this pathway. b-catenin interacts with Smad1/5/9, and both were recruited at the promoter of Cyp26b1. @*CONCLUSIONS@#Our findings suggested the BMP9-induced osteoblastic differentiation was mediated by activating retinoic acid signalling, viadown-regulating Cyp26b1. Meanwhile, Cyp26b1 may be a novel potential therapeutic target for the treatment of bone-related diseases or accelerating bone-tissue engineering.
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With the increasing number of obese patients worldwide, metabolic and bariatric surgery (MBS) has quickly become an effective way to treat obesity and related metabolic diseases such as type 2 diabetes, hypertension, lipid abnormalities, etc. Although MBS has become an important part of general surgery, there is still controversy regarding the indications for MBS. In 1991, the National Institutes of Health (NIH) issued a statement on the surgical treatment of severe obesity and other related issues, which continues to be the standard for insurance companies, health care systems, and hospital selection of patients. The standard no longer reflects the best practice data and lacks relevance to today's modern surgeries and patient populations. After 31 years, in October 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the world's leading authorities on weight loss and metabolic surgery, jointly released new guidelines for MBS indications, based on increasing awareness of obesity and its comorbidities and the accumulation of evidence of obesity metabolic diseases. In a series of recommendations, the eligibility of patients for bariatric surgery has been expanded. Specific key updates include the following: (1) MBS is recommended for individuals with BMI≥35 kg/m2, regardless of the presence, absence, or severity of co-morbidities; (2) MBS should be considered for individuals with metabolic diseases and BMI 30.0-34.9 kg/m2; (3) the BMI threshold should be adjusted for the Asian population:: BMI≥25 kg/m2 suggest clinical obesity, and BMI ≥ 27.5 kg/m2 population should consider MBS; (4) Appropriately selected children and adolescents should be considered for MBS.
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Adolescent , Child , Humans , Diabetes Mellitus, Type 2/surgery , Bariatric Surgery , Obesity/surgery , Obesity, Morbid/surgery , Weight LossABSTRACT
In recent years, laparoscopic surgery and robotic surgery have been widely used, and various intraoperative image navigation systems have also developed rapidly. However, the liver itself has a complex vessel and duct system, which increase the difficulty of liver surgery. The augmented reality image navigation system combines the three-dimensional reconstructed image of the liver with the real liver anatomy, which presents the specific relationship between the tumor location and the surrounding vessels for the surgeon. Compared with other intraoperative image navigation methods, augmented reality has its unique advantages. This paper provides an overview of current advances in registration technology in augmented reality image navigation system, and focuses on its applications in liver surgery, including laparoscopic surgery and robotic surgery. Finally, the technological problems and difficulties still faced at present are summarized, and future directions worth studying in this field are proposed.
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Detailed characterizations of genomic alterations have not identified subtype-specific vulnerabilities in adult gliomas. Mapping gliomas into developmental programs may uncover new vulnerabilities that are not strictly related to genomic alterations. After identifying conserved gene modules co-expressed with EGFR or PDGFRA (EM or PM), we recently proposed an EM/PM classification scheme for adult gliomas in a histological subtype- and grade-independent manner. By using cohorts of bulk samples, paired primary and recurrent samples, multi-region samples from the same glioma, single-cell RNA-seq samples, and clinical samples, we here demonstrate the temporal and spatial stability of the EM and PM subtypes. The EM and PM subtypes, which progress in a subtype-specific mode, are robustly maintained in paired longitudinal samples. Elevated activities of cell proliferation, genomic instability and microenvironment, rather than subtype switching, mark recurrent gliomas. Within individual gliomas, the EM/PM subtype was preserved across regions and single cells. Malignant cells in the EM and PM gliomas were correlated to neural stem cell and oligodendrocyte progenitor cell compartment, respectively. Thus, while genetic makeup may change during progression and/or within different tumor areas, adult gliomas evolve within a neurodevelopmental framework of the EM and PM molecular subtypes. The dysregulated developmental pathways embedded in these molecular subtypes may contain subtype-specific vulnerabilities.
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Humans , Brain Neoplasms/pathology , Neoplasm Recurrence, Local/metabolism , Glioma/pathology , Neural Stem Cells/pathology , Oligodendrocyte Precursor Cells/pathology , Tumor MicroenvironmentABSTRACT
With the wide application of artemisinin and its derivatives,its safety has become particularly important.Previous studies have shown that artemisinin and its derivatives have adverse reactions such as nausea,vomiting and diarrhea in clinical use,but they are all within the controllable range.In animal experiments,it has toxic effects on kidney,liver,heart,nerve,blood,embryo and DNA at a high dose.Toxicity and adverse reactions can be alleviated or eliminated by combining medication or changing the drug administration mode,solvent and preparation type.This article mainly discusses the drug safety,toxicity mechanism and attenuation countermeasures of artemisinin and its derivatives,in order to improve the understanding of the potential toxicity of artemisinin and its derivatives and provide reference for the safe use of the drug in clinic.
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Objective This study aimed to investigate the mechanism of artesunate-induced cardiotoxicity by using network toxicology and serum untargeted metabolomics.Methods The key targets and signaling pathways of artesunate-induced cardiotoxicity were expored by network toxicology technique.The toxic effect of artesunate on Healthy C57BL/6J mice was evaluated according to the pathological morphology of the heart and the levels of serum biochemical indexes included LDH and CKMB.Serum untargeted metabolomics analysis was combined with multivariate statistical analysis to search the key endogenous metabolites of artesunate cardiotoxic injury and related metabolic pathways.Results 64 targets including AKT1,EGFR,CASP3,VEGFA and 165 signaling pathways including Apoptosis,PI3K-Akt,FoxO were screened out by network toxicology,.Serum metabolomics analysis identified the serum metabolites affected by artesunate-induced cardiotoxicity included lysophosphatidylcholine,lysophosphatidylethanolamine,indoleacetaldehyde,etc.The results of metabolic pathways enrichment analysis were glycerophosphatidylcholine metabolism and tryptophan metabolism.Conclusion Artesunate 600 mg·kg-1 can induce cardiotoxicity in C57BL/6J mice after 1-week administration,and the mechanism is related to glycerophosphatidylcholine metabolism disorder and tryptophan metabolism disorder.This study provides a reference for the early prediction and evaluation of artesunate induced drug-induced cardiotoxicity.
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Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.
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Objective:To evaluate the predictive value of prognostic nutritional index (PNI) for survival after radical resection in patients with distal cholangiocarcinoma.Methods:The clinical data of 160 patients with distal cholangiocarcinoma undergoing radical pancreatoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from September 2011 to March 2022 were retrospectively analyzed, including 97 males and 63 females, aged (65.58±9.22) years old. The optimal cut-off value of PNI for predicting postoperative survival was 42.275 determined by the receiver operating characteristic curve. Patients were divided into the low PNI group ( n=79, PNI<42.275) and high PNI group ( n=81, PNI≥42.275). The survival status of patients were followed up by outpatient clinic or telephone review. Survival analysis was performed using the Kaplan-Meier method and the log-rank test. Factors with P<0.1 in the univariate analysis were included in the Cox proportional hazards model for multivariate analysis to screen the prognostic factors. Results:There were statistically significant differences in the preoperative albumin, total bilirubin, lymphocytes counts between the two group (all P<0.05). The postoperative median survival time of the low PNI group was 17 months, with cumulative 1, 3 and 5-year survival rates of 62.0%, 25.0% and 16.2%, respectively. The postoperative median survival time of the high PNI group was 23 months, with cumulative 1, 3 and 5-year survival rates of 84.0%, 46.4% and 40.4%, respectively. There was a significant difference between the two groups ( P<0.001). PNI score<42.275 ( HR=1.040, 95% CI: 1.011-1.071, P=0.008), CA19-9>37 U/ml ( HR=1.620, 95% CI: 1.046-2.509, P=0.031), venous invasion ( HR=1.809, 95% CI: 1.013-3.230, P=0.045), lymph node metastasis ( HR=1.956, 95% CI: 1.300-2.969, P=0.001), tumor diameter >2 cm ( HR=1.534, 95% CI: 1.011-2.328, P=0.044), without postoperative adjuvant chemotherapy ( HR=2.828, 95% CI: 1.291-6.195, P=0.009) had a greater risk of poor survival after radical resection. Conclusion:PNI score could be an influencing factor and serve as a predicting tool for the survival after radical resection in patients with distal cholangiocarci-noma.
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Objective:To investigate the therapeutic effect of bidirectional-traction, Steinmann pin poking reduction,anatomic plate and raft technique in the treatment of hyperextension tibial plateau fractures.Methods:The data of 25 patients with hyperextension tibial plateau fractures admitted to Qilu Hospital of Shandong University (Qingdao) from July 2017 to June 2022 were retrospectively analyzed. According to the treatment methods, they were divided into bidirectional-traction group (treated with bidirectional-traction, Steinmann pin poking reduction, anatomic plate and raft technique) and open reduction group (treated with open reduction, bone grafting and two plates fixation). The bidirectional-traction group included 14 patients, with 8 males and 6 females; the age was 50.29±9.23 years (range, 38-61 years). The cause of the injury was a traffic accident in 4 patients, a fall from height in 7 patients and a fall from standing height in 3 patients. According to Schatzker classification, there were 5 Schatzker type V and 9 type VI fractures. The open reduction group included 11 patients (7 males and 4 females); with a mean age of 58.00±10.58 years (range, 48-69 years). 3 cases were injured by traffic accident, 6 cases by falling from height, and 2 cases by falling from standing height. According to Schatzker classification, there were 4 type V and 7 type VI. Preoperative waiting time, operative time, blood loss and percentage of blood loss, incision length, fracture healing time, tibial posterior inclination, medial proximal tibial angle, visual analogue scale (VAS) on the first day after surgery, Hospital for Special Surgery (HSS) score 6 months after surgery were compared between the two groups.Results:Patients in both groups were followed up for more than 6 months. The follow-up time was 7 to 48 months with an average of 22.76 months. There were significant differences in the preoperative waiting time [6 (4, 8) d vs. 8 (7, 11) d, W=114.00, P=0.043], the incision length [15.0 (12.5, 16.0) cm vs. 30.0 (28.0, 31.0) cm, W=154.00, P<0.001], postoperative VAS [4 (3, 4) points vs. 5 (5, 6) points, W=143.00, P<0.001], blood loss [147 (107, 206) ml vs. 267 (191, 362) ml, W=116.00, P=0.033], blood loss percentage [2.95% (2.58%, 5.20%) vs. 6.40% (4.05%, 7.00%), W=118.00, P=0.027] between the bidirectional-traction group and open reduction group. There were not significant differences in the operation time [120 (118, 120) min vs. 119 (101, 154) min, W=68.50, P=0.656], fracture healing time (8.18±1.03 weeks vs. 8.86±1.27 weeks, t=1.49, P=0.149), HSS score (8.43±3.72 vs. 85.18±7.73, t=1.28, P=0.221) and medial proximal tibial angle 6 months after surgery (87.66°±1.53° vs. 86.47°±2.24°, t=1.57, P=0.130) between the two groups. Postoperative tibial posterior inclination was improved in both groups. There was no significant difference in the tibial posterior inclination before surgery, immediately after surgery and 6 months after surgery (-14.96°±6.44°, 5.55°±1.02°, 5.61°±0.82°) in the bidirectional-traction group and -12.26°±2.93°, 7.07°±3.21° and 7.14°±3.17° in the open reduction group, P>0.05). There were no postoperative complications such as acute compartment syndrome or knee stiffness in both groups. Conclusion:The treatment of hyperextension tibial plateau fracture with bidirectional-traction, Steinmann pin poking reduction, anatomic plate and raft technique can shorten preoperative waiting time, reduce incision length, decrease blood loss and lower VAS. It is a minimally invasive, rapid and effective method, which has achieved good clinical results and is worth promoting.
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Objective:To explore the surgical procedure and clinical effect of a free transverse carpal flap based on the superficial palmar branch of radial artery in reconstruction of soft tissue defect of digits.Methods:From February 2014 to May 2022, 17 cases of soft tissue defects with tendon or phalanges in digits were treated in the Department of Hand and Foot Surgery, Hainan Zhongde Orthopaedic Hospital. All 17 cases were treated by the free transverse carpal flap based on the superficial palmar branch of radial artery. The flap size was 2.0 cm×2.0 cm-4.5 cm×2.0 cm. The anastomosed artery was digital artery or common digital artery, and the vein was the accompanying vein or superficial subcutaneous vein. All donor sites were directly sutured. Preventive measures of anti-infection, anticoagulation, anti-vasospasm and symptomatic treatment were given after surgery. After discharge of patients, scheduled follow-ups were conducted through outpatient clinic, telephone or WeChat interviews to observe the clinical effects. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, hand functional recovery was good in 14 cases and good in 1 case.Results:All 17 flaps had survived with 16 completed the postoperative follow-up. Follow-ups ranged from 6 to 18 months, with a mean of 14 months. At the last follow-up, the flaps were good in shape, soft texture, in normal flexion and extension and with good protective sensation. Two-point discrimination (TPD) was 8-12 mm, with an average of 8 mm. There was no other adverse effect in the donor sites except a linear scar.Conclusion:Application of transverse carpal flap based on the superficial palmar branch of radial artery from same limb to restore the digit function is feasible. It is an ideal surgical procedure of flap transfer.
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Objective:To analyze the results of ATP7B gene screening in neonates and explore the linkage disequilibrium between different mutation loci, providing a basis for the clinical diagnosis and genetic counseling of Wilson′s disease.Methods:A total of 12 619 newborns who were born in Women′s Hospital of Nanjing Medical University during March 18 and December 30, 2022, including 6 605 male neonates and 6 014 female neonates, with birth weight of (3.44±0.56) kg, were retrospectively collected. The results of ATP7B gene screening in all newborns were analyzed.Next-generation sequencing technology was employed to detect the pathogenic loci of ATP7B gene, and the identified loci were verified using Sanger sequencing. PLINK 1.9 software was used to analyze the linkage disequilibrium of different mutation loci.Results:Among 12 619 neonates, 22 cases were diagnosed with 2-3 pathogenic mutations in the ATP7B gene (suspected positive). Among them, 20 cases were recalled for family verification, and 2 cases refused to recall. The verification results showed that 3 newborns had mutations of two loci respectively from their parents and were preliminarily diagnosed with Wilson′s disease, the other 17 neonates were carriers of the c.3316G>A/c.588C>A or c.1708-1G>C/c.1168A>G mutation loci arranged in a cis-acting manner from the father source or maternal source. A total of 249 pathogenic mutation carriers were detected (232 cases carrying 1 pathogenic mutation, and 17 cases carrying 2 pathogenic mutations), with a carrier rate of 1/51. Among them, the mutation c.2333G>T was most frequently detected (1/207), followed by c.2975C>T (1/421), c.2621C>T (1/742), c.2755C>G (1/971) and c.2605G>A (1/971). The results of linkage disequilibrium analysis in both c.3316G>A/c.588C>A and c.1708-1G>C/c.1168A>G showed that D ′=1, which showed complete linkage disequilibrium. Conclusion:The carrier rate of pathogenic mutations in the ATP7B gene is relatively high.Moreover, the c.3316G>A/c.588C>A and c.1708-1G>C/c.1168A>G pathogenic mutation loci are likely to be arranged in a cis-acting manner, highlighting the existence of linkage disequilibrium between the two groups of mutations. This finding provides important reference value for the clinical diagnosis and genetic counseling of Wilson disease.
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Objective:To investigate the effects of femtosecond laser assistcataract extraction on the levels of inflammatory factors in aqueous humor, corneal perception and high order aberration.Methods:Forty-eight patients (56 eyes) undergoing cataract surgery in the Shouguang People′s Hospital from June 2018 to February 2020 were enrolled in this study, and they were divided into observation group (24 patients and 27 eyes, femtosecond laser cataract phacoemulsification) and control group (24 patients and 29 eyes, coaxial microincision phacoemulsification) by random number table method. The levels of prostglndin E2 (PGE2), interleukin (IL)-6 and IL-1β in aqueous humor were detected before and after operation. Upper corneal and central corneal perception thresholds were recorded before surgery, 7 d after surgery, 1 month after surgery and 3 months after surgery. High order aberrations of the whole eye and cornea at 4mm pupil diameter before and after operation were recorded.Results:After operation, the levels of PGE2, IL-6 and IL-1β in aqueous humor in the observation group were lower than those in the control group: (45.62 ± 5.71) ng/L vs. (63.65 ± 5.62) ng/L, (15.25 ± 3.21) ng/L vs. (24.59 ± 6.13) ng/L, (17.16 ± 1.28) ng/L vs. (25.74 ± 4.62) ng/L, the differences were statistically significant ( P<0.05). The upper and central corneal perception threshold of observation group after operation for 7 d were higher than those in the control group: 4.55 ± 0.50 vs. 4.20 ± 0.33, 5.68 ± 0.49 vs. 5.52 ± 0.45, the differences were statistically significant ( P<0.05). The indexes of high order aberration of the whole eye decreased in the two groups ( P<0.05), while the indexes of cornea did not change significantly. The indexes of high order aberration of the whole eye and cornea between before and after surgery between the two groups had no significant differences ( P>0.05). Conclusions:Femtosecond laser assist cataractextraction can relieve inflammation, reduce the whole eye high order aberration, but not affect the cornea, and can improve corneal perception.
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Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.