Performance of point-of-care testing for cervical cancer screening / 中华预防医学杂志

Objective: To evaluate the performance of point-of-care testing for cervical cancer and precancerous lesions screening. Methods: In September 2020, 197 and 273 women were selected by using simple random sampling method from "self-sampling" cohort and "physician-sampling" cohort established in Xiangyuan county, Shanxi Province, China, respectively. Cervical exfoliated cells were collected by women themselves or gynecologists. All samples were detected by POCT and women with positive result were directly referred for colposcopy. Subsequently, all the samples were detected by careHPV and PCR test. Colposcopy and punch biopsy were performed for women with POCT negative but careHPV or PCR test positive at another visit. Using histopathological diagnosis as the gold standard, we calculated sensitivity, specificity and drew the receiver operating characteristic (ROC) curves. The accuracy of POCT was analyzed and compared to that of careHPV and conventional PCR test in cervical cancer and precancerous lesions screening. Results: The median (Q1 , Q3) age of 470 women was 51 (45, 57) years old. Based on self-sampling, the sensitivity and specificity of POCT for CIN2+ were 100.00% (95%CI: 56.56%-100.00%) and 28.95% (95%CI: 22.97%-35.76%), respectively. Compared with POCT, POCT HPV16/18 test had similar sensitivity and higher specificity of 89.47% (95%CI: 84.30%-93.08%). Self-sampling POCT HPV16/18 test had an AUC of 0.947 (95%CI:0.910-0.985), which was higher than that of careHPV and PCR test. Physician-sampling POCT test had 100.00% sensitivity (95%CI: 64.57%-100.00%) and 55.85% specificity (95%CI: 49.83%-61.70%) for detecting CIN2+. POCT HPV16/18 test had lower sensitivity (71.43%, 95%CI: 35.90%-91.76%) and higher specificity (92.45%, 95%CI: 88.63%-95.06%). POCT HPV16/18 test generally showed similar AUC on both self-collected samples and clinician-collected samples (0.947 vs 0.819, P=0.217). Conclusion: POCT HPV16/18 test is an effective method with relatively high sensitivity and specificity for cervical cancer screening.

Clinical study of PD-1 monoclonal antibody combined with chemotherapy in the preoperative neoadjuvant treatment of stage ⅢA non-small cell lung cancer / 中华胸心血管外科杂志

Objective:To study the effectiveness and safety of programmed cell death receptor 1(PD-1) monoclonal antibody combined with chemotherapy in the preoperative neoadjuvant treatment of stage ⅢA non-small cell lung cancer(NSCLC).Methods:A total of 65 patients with stage ⅢA NSCLC who underwent preoperative neoadjuvant treatment in our hospital from January 2019 to October 2020 were selected. According to the preoperative neoadjuvant treatment plan, they were divided into control group(31 cases) and observation group(34 cases). Patients in the control group were treated with albumin-bound paclitaxel and cisplatin for injection, and the patients in the observation group were treated with immunotherapy(carrelizumab/sintilizumab) on the basis of the control group, all underwent 2 cycles of preoperative neoadjuvant treatment. Compared the clinical efficacy of imaging, T lymphocyte subsets, drug side effects, surgical resection rate, major pathological remission(MPR), complete pathological remission(pCR) and postoperative complications of the two groups of patients, and analyzed the factors those affected MPR.Results:The clinical efficacy of PR and ORR of imaging in the observation group was better than that of the control group( P<0.05). The positive rate of CD3 + cells, the positive rate of CD4 + cells, the positive rate of CD8 + cells and the ratio of CD4 + /CD8 + cells in the observation group after treatment were higher than those in the control group( P<0.05). The drug toxicity of the observation group was higher than that of the control group in RCCEP/rash, abnormal thyroid function, and abnormal myocardial enzymes( P<0.05). Compared among the observation group(carrelizumab group/sintilizumab group), the toxicity of carrelizumab group was higher than that of sintilizumab group in RCCEP/skin rash, bone marrow suppression and abnormal myocardial enzymes( P<0.05). The MPR and pCR of the observation group were higher than those of the control group( P<0.05). There was no significant difference in surgical resection rate, surgical methods and postoperative complications between the two groups( P>0.05). The results of univariate analysis showed that ECOG score, pathological type, neoadjuvant treatment plan were related to MPR( P<0.05). The results of binary logistic regression analysis showed that ECOG score and neoadjuvant treatment plan were independent risk factors affecting MPR( P<0.05). Conclusion:PD-1 monoclonal antibody combined with chemotherapy can enable patients to obtain better MPR and pCR, and can improve the immune function of patients. But the side effects caused by immunotherapy drugs are worthy of attention, and the side effects are different between different immune drugs.

Perioperative nebulization of ipratropium bromide in patients with chronic obstructive pulmonary disease under thoracic surgery: A randomized, double-blind, placebo-controlled, parallel-group, multi-centre trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effect of perioperative nebulization of ipratropium bromide on preoperative pulmonary function and incidence of postoperative pulmonary complications as well as safety in chronic obstructive pulmonary disease (COPD) patients who underwent lung resection in thoracic surgery. Methods    During November 18, 2013 to August 12, 2015, 192 COPD patients with a necessity of selective surgical procedures of lobectomy or right bilobectomy or segmentectomy under general anaesthesia in 10 centers were 1 : 1 randomized to an ipratropium bromide group (96 patients) and a placebo group (96 patients), to compare the effect on preoperative pulmonary function and incidence of postoperative pulmonary complications. The average age of treated patients was 62.90±6.50 years, with 168 male patients and 22 female patients. Results     The demographic and baseline characteristics were well-balanced between the two groups. The adjusted mean increase of forced expiratory volume in one second (FEV1) in the ipratropium bromide group was significantly higher than that in the placebo group (169.90±29.07 mL vs. 15.00±29.35 mL, P<0.05). The perioperative use of ipratropium bromide significantly decreased incidence of postoperative pneumonia (2.6% vs. 14.1%, P<0.05). There was no ipratropium bromide related adverse event (AE) observed in this trial. Conclusion    This trial indicates that perioperative nebulization of ipratropium bromide significantly improves preoperative lung function and reduces postoperative pneumonia in COPD patients undergoing lung resection in thoracic surgery, and has good safety profile.

Changes in sensitivity of bilateral medial vestibular nuclear neurons responding to input stimuli during vestibular compensation and the underlying ionic mechanism / 生理学报

Vestibular compensation is an important model for developing the prevention and intervention strategies of vestibular disorders, and investigating the plasticity of the adult central nervous system induced by peripheral injury. Medial vestibular nucleus (MVN) in brainstem is critical center for vestibular compensation. Its neuronal excitability and sensitivity have been implicated in normal function of vestibular system. Previous studies mainly focused on the changes in neuronal excitability of the MVN in lesional side of the rat model of vestibular compensation following the unilateral labyrinthectomy (UL). However, the plasticity of sensitivity of bilateral MVN neurons dynamically responding to input stimuli is still largely unknown. In the present study, by using qPCR, whole-cell patch clamp recording in acute brain slices and behavioral techniques, we observed that 6 h after UL, rats showed a significant deficit in spontaneous locomotion, and a decrease in excitability of type B neurons in the ipsilesional rather than contralesional MVN. By contrast, type B neurons in the contralesional rather than ipsilesional MVN exhibited an increase in response sensitivity to the ramp and step input current stimuli. One week after UL, both the neuronal excitability of the ipsilesional MVN and the neuronal sensitivity of the contralesional MVN recovered to the baseline, accompanied by a compensation of spontaneous locomotion. In addition, the data showed that the small conductance Ca2+-activated K+ (SK) channel involved in the regulation of type B MVN neuronal sensitivity, showed a selective decrease in expression in the contralesional MVN 6 h after UL, and returned to normal level 1 week later. Pharmacological blockage of SK channel in contralateral MVN to inhibit the UL-induced functional plasticity of SK channel significantly delayed the compensation of vestibular motor dysfunction. These results suggest that the changes in plasticity of the ipsilesional MVN neuronal excitability, together with changes in the contralesional MVN neuronal sensitivity, may both contribute to the development of vestibular symptoms as well as vestibular compensation, and SK channel may be an essential ionic mechanism responsible for the dynamic changes of MVN neuronal sensitivity during vestibular compensation.

Analysis on the construction of research ward in tertiary medical institutions in Guangzhou / 中华医院管理杂志

Objective:To investigate the construction and operation of research wards in tertiary medical institutions in Guangzhou, and to put forward suggestions for promoting the construction of research wards.Methods:From May to June 2020, an online questionnaire was distributed to tertiary medical institutions in Guangzhou to investigate the construction of research wards, and the questionnaires were collected for statistical analysis.Results:A total of 58 medical institutions completed the questionnaire survey, and 33 of them obtained GCP qualification. Eighteen medical institutions had established research ward, of which 16 were in operation, with 6-226 beds. The research wards of 14 medical institutions were used for phase I clinical trials of innovative drugs and consistency evaluation of generic drugs; 17 medical institutions were equipped with full-time research teams; 17 medical institutions had two or more basic research platforms.Conclusions:The number of medical institutions that have established research wards in Guangzhou is small, the functional positioning is limited, and the allocation of full-time researchers is insufficient. The supporting and auxiliary conditions need to be strengthened. Promoting research wards still faces some challenges.

Herbal Textual Research and Modern Research Progress of Succus Bambusae / 中国实验方剂学杂志

Succus Bambusae， regarded as the holy medicine for the treatment of phlegm by traditional Chinese medicine experts， has the functions of clearing heat and resolving phlegm， resuscitating and relieving convulsions. In clinical practice， it is mainly used to treat phlegm-heat cough， phlegm yellow and shortness of breath， stroke with exuberant phlegm and other syndromes. The research of its processing procedure and quality standard is the key issue to realize the process modernization and quality standardization of this traditional medicine resource. On the basis of literature research， this paper conducted the herbal textual research on Succus Bambusae， sorted out its medicinal history， and compared the advantages and disadvantages of its traditional and modern preparation procedure. Based on the historical records， it is pointed out that there are still many problems in the traditional and modern processing procedure of Succus Bambusae， such as low-yield processing procedure and extensive production technology that cannot meet the requirements of large-scale green manufacturing. At present， there are a lot of literature on the comparative study of the origin， variety and processing procedure of Succus Bambusae， but most of them are limited to the chemical components， and lack of in-depth study on its pharmacodynamic substance basis and mechanism. Meanwhile， the pharmacological effects of Succus Bambusae are mostly limited to antitussive and expectorant， and few other pharmacological effects have been reported. Based on the above analysis， it is suggested that the follow-up research work can be carried out from these five aspects：①Clarifying the original source， enriching and perfecting the medicinal resources. ②Standardizing the processing procedure， establishing relevant quality standards. ③Clarifying the pharmacological mechanism， strengthening the basic research on the pharmacological effect and clinical application. ④Inheriting ancient processing， researching and developing special preparation equipment and standardizing production operation rules. ⑤Comprehensive utilization of the by-products in preparation process.

The 5-year survival rate of 11 958 postoperative non-small cell lung cancer patients in stage Ⅰ-ⅢA by two different follow-up patterns: A multi-center, real-world study / 中国胸心血管外科临床杂志

@#Objective    To compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients. Methods    Pathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8 133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used. Results    The median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages. Conclusion    The proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.

Consensus on collaborative ethical review of multi-center clinical trials of new drugs of traditional Chinese medicine (version 1.0) / 中国中药杂志

At present, the issues regarding multi-center clinical trials of new drugs of traditional Chinese medicine(TCM) remain: the lack of agreement on the content and scope of the ethical review among the ethics committee members of the center and the participating units results in repeated review, which leads to a time-consuming ethical review process. Moreover, the review capabilities of the ethics committees of various research centers are uneven, which is not necessarily beneficial to the protection of subjects' rights and safety. In view of the existing problems, to improve the efficiency of ethical review of multi-center clinical trials of new drugs of TCM and avoid repeated reviews, the TCM Clinical Evaluation Professional Committee of Chinese Pharmaceutical Association organized experts to formulate the "Consensus on collaborative ethical review of multi-center clinical trials of new drugs of TCM(version 1.0)"(hereinafter referred to as "Consensus"). The "Consensus" is formulated in accordance with the requirements of relevant documents such as but not limited to "the opinions on deepening the reform of the evaluation and approval system to encourage the innovation of pharmaceutical medical devices", "the regulations of ethical review of biomedical research involving human subjects". The "Consensus" covers the scope of application, formulation principles, conditions for the ethics committee of the center, sharing of ethical review resources, scope and procedure of collaborative review, rights and obligations, etc. The aims of the "Consensus" is to preliminarily explore and establish a scientific and operable ethical review procedure. Additionally, on the basis of fully protecting the rights and interests of the subjects, a collaborative ethical review agreement needs to be signed to clarify the ethical review responsibilities of all parties, to avoid repeated review, and to improve the efficiency and quality of ethical review in multi-center clinical trials of new drugs of TCM.

PD-1 inhibitor combined with chemotherapy in preoperative neoadjuvant treatment of stage Ⅲ non-small cell lung cancer: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the efficacy and safety of programmed cell death receptor 1 (PD-1) inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ non-small cell lung cancer (NSCLC). Methods    The clinical data of 68 patients with stage Ⅲ NSCLC who underwent preoperative neoadjuvant treatment in our hospital from June 2019 to October 2020 were analyzed and divided into two groups according to a random number table. There were 34 patients in the control group including 19 males and 15 females with an average age of 59.41±4.77 years. In the observation group, there were 34 patients including 21 males and 13 females with an average age of 61.15±6.24 years. The patients in the control group were treated with albumin-bound paclitaxel and cisplatin for injection, and the patients in the observation group were treated with carrelizumab on the basis of the control group, and both groups received 2 cycles of preoperative neoadjuvant therapy. We compared the clinical efficacy of imaging, T lymphocyte subsets, drug side effects, surgical resection rate, major pathological remission (MPR), complete pathological remission (pCR) and postoperative complications of the two groups of patients, and analyzed the influencing factors for MPR. Results    The objective response rate (ORR) of imaging in the observation group (70.6%) was higher than that in the control group (38.2%, P<0.05). The positive rate of CD3+ cells, the positive rate of CD4+ cells, the positive rate of CD8+ cells and the ratio of CD4+/CD8+ cells in the observation group after treatment were higher than those in the control group (P<0.05). The drug toxicity of the observation group was higher than that of the control group in the reactive cutaneouscapillary endothelial proliferation (RCCEP)/rash, abnormal thyroid function, and abnormal myocardial enzymes (P<0.05). The MPR (66.7%) and pCR (51.9%) of the surgical observation group were higher than those of the surgical control group (MPR: 19.2%, pCR: 7.7%, P<0.05). There was no statistical difference in surgical resection rate and postoperative complications between the two groups (P>0.05). Univariate analysis showed that ECOG score, pathological type, neoadjuvant treatment plan and surgical resection were related to MPR (P<0.05). The results of binary logistic regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score and neoadjuvant treatment plan were independent risk factors for MPR (P<0.05). Conclusion    The clinical efficacy of PD-1 inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ NSCLC patients is definite, and it can significantly improve the patients' MPR, pCR and cellular immune function, but the side effects caused by immunotherapy drugs need to be concerned.

Effect of Siwu decoction on the radiation injury of Zebrafish blood system / 中华放射医学与防护杂志

Objective:To observe the effect of Chinese herbal compound Siwu decoction (SW) on radiation injury of zebra fish blood system, and to clarify whether zebra fish is a suitable model for this study. Methods:Totally 72 of 4-month-old adult male zebra fish ( Danio Rerio) with body weight ranging from 0.14 to 0.20 g were used in all the experiments, where 36 zebra fish were taken to observe the hemodynamic changes after radiation, and the other 36 zebra fish were used to study the intervention effect of Siwu decoction on the blood injury after radiation. Zebra fish was irradiated with 20 Gy of 60Co gamma-rays at a dose rate of 97.33 cGy/min. For the hemodynamic study, the peripheral blood and whole kidney marrow cells (WKMCs)of irradiated zebra fish and non irradiated control were collected on days 7, 14 and 30 after irradiation, respectively, and the cell number was detected by flow cytometry. For the Siwu decoction treatment, 36 zebra fish were randomly divided into non-irradiation group, irradiation group, SW2 000 group ( Siwu decoction was diluted by 2 000-fold) and SW5 000 group ( Siwu decoction was diluted by 5 000-fold). Siwu decoction was given on the second day after irradiation. Then the peripheral blood and WKM cells of zebra fish were collected at 7 d after irradiation for further analysis. Results:After irradiation, the dynamic of blood development of zebra fish were obviously changed with the most blood cell ablation at 7 d post-irradiation. The total number of peripheral blood cells and WKM cells decreased by 26% and 52%( t=4.535, 28.987, P<0.05), the number of myeloid monocytes, lymphocytes, and red blood cells in the WKM decreased by 46%, 79% and 33%( t=18.457, 66.900, 9.872, P<0.05), and the number of precursor cells decreased by 49% ( P>0.05). The numbers of these blood cells were partly recovered at 14 d after irradiation and returned to the normal level at 30 d after irradiation. In comparison with irradiation alone group, the numbers of WKM cells, myeloid monocytes, progenitor cells, lymphocytes and red blood cells increased by 57%, 125%, 81% and 35%, respectively ( t=12.128, 21.594, 15.473, 4.594, P<0.05), and peripheral red cells did not increase significantly in the SW5 000 group after irradiation. However, SW2 000 had no significant influence on radiation injury of zebra fish blood cells ( P>0.05). Conclusions:Radiation injury of the blood system of zebra fish could be recovered at a month after irradiation, and this radiation damage could be partly intervened by Siwu decoction at a suitable concentration, which provides a reference for the study of blood system regulation of traditional Chinese medicine.

Early outcomes of surgical treatment for patent ductus arteriosus combined with intracardiac abnormity via right vertical infra-axillary thoracotomy / 中国胸心血管外科临床杂志

@#Objective    To explore the early outcomes of the surgical treatment for patent ductus arteriosus (PDA) combined with intracardiac abnormities via right vertical infra-axillary thoracotomy (RVIAT). Methods    A total of 7 children with PDA combined with intracardiac defects underwent surgery through RVIAT at the Second Affiliated Hospital of Nanjing Medical University from 2016 to 2018. There were 4 males and 3 females, with an average age of 5.3±4.5 years and weight of 18.0±11.2 kg. Results    In all patients, PDA was ligated before the repair of intracardiac abnormities. No patient died in hospital. All patients were followed up, with a mean follow-up time of 18.0±8.0 months. No other complications such as residual shunts, arrhythmias, hemorrhaging or wound infection occurred after operations or during the follow-up period. Conclusion    RVIAT is an emerging technique used for the surgical repair of PDA combined with intracardiac defects. It yields satisfying cosmetic results, without increasing postoperative complications or mortality.

Optimization and purification of extraction of polysaccharides from Anoecto-chilus roxburghii / 药学实践杂志

Objective To optimize the process of ultrasonic extraction of polysaccharide in Anoectochilus roxburghii and to investigate the method of protein removal. Methods The extraction rate of polysaccharide was used as the detection index. On the basis of single factor investigation, Box-Behnken experimental design and response surface method were used to optimize the three factors of material-liquid ratio, ultrasonic time and ultrasonic extraction temperature. The five deproteinization methods including Sevage reagent method, TCA method, salt method (NaOH-CaCl2 and NaOH-NaCl) and hydrochloric acid method were investigated with the retention rate of polysaccharide and protein removal rate. Results The optimal extraction conditions of polysaccharide from Anoectochilus roxburghii were as follows: liquid-to-solid ratio was 10∶1, extraction temperature was 48 ℃ and extraction time was 36 min with extraction 2 times, ultrasonic power was 300 W, the extraction rate was 13.13%. NaOH-CaCl2 deproteinized methods∶ the loss rate of polysaccharide was 18.74%, and the removal rate of protein was 95.62%. Conclusion Ultrasonic extraction is easy to operate, and the optimized extraction method can achieve a high extraction rate. NaOH-CaCl2 deproteinization methods can get high protein removal rate and polysaccharide retention rate. This method is suitable for the research and development of the active components of the polysaccharides from Anoectochilus roxburghii.

Systemic Therapy for Low-grade Pulmonary Neuroendocrine Tumor / 中国肺癌杂志

The lung is the second most common site of neuroendocrine tumors (NETs). Typical and atypical carcinoids are low-grade NETs of the lung. These rare tumors have received little attention and education is needed for treating physicians. The article describes the classifcation of lung NETs, the epidemiology and pathological characteristics. When lung NETs are diagnosed at an early stage, surgical intervention is often curative. For advanced lung NETs patients, different treatment methods including chemotherapy, somatostatin analogs, m-TOR inhibition, peptide receptor radioligand therapy, and biologic systemic therapy are discussed. The conclusions are generally extrapolated from the outcome of extra-pulmonary carcinoids. Prospective randomized well-designed trials are urgently needed to inform current recommendations on systemic treatment.
.

Comparison of high-risk human papillomavirus infection rate and genotype distribution between Han and Mongolian women / 中华流行病学杂志

Objective@#To understand the infection rate and genotype distribution of high risk-human papillomavirus (HR-HPV) and the detection rate of different grades of cervical lesions in Han and Mongolian women in China and provide evidence for the development of screening and vaccination strategies for the prevention and control of cervical cancer in different ethnic groups.@*Methods@#In June 2017, a multicenter, population-based study for cervical cancer screening in low-resource settings in China was conducted in three rural areas: Xiangyuan and Yangcheng counties in Shanxi province, and Etuoke county in Inner Mongolia Autonomous Region. A total of 9 517 women aged 30-65 years were included in the study, and two cervical and vaginal secretion samples were collected from them for HPV and PCR-based HPV DNA tests. The positive samples in any of two tests were used for PCR-based HPV genotyping test by using Sansure-pioneered One-Step Fast Release technology. Women with positive results in any the HPV tests were referred for colposcopy and punch biopsy was given if cervical intraepithelial neoplasia lesion (low-grade lesion or worse) was suspected in colposcopy evaluation. Endocervical curettage was performed if women had an unsatisfactory colposcopy exam (the squamocolumnar junction was not completely visible). Pathological detection result was used as the golden standard of diagnosis.@*Results@#HR-HPV infection rates in Han and Mongolian women were 21.83% (1 842/8 438) and 24.93% (269/1 079), respectively. There were statistical differences in HPV infection rates between the two ethnic groups (χ2=5.328, P=0.021). The detection rate of cervical intraepithelial neoplasia grade 1 in Mongolian women (2.83%) was higher than that in Han women (0.87%), and the difference was statistically significant (χ2=33.509, P<0.001). There were no significant differences in cervical intraepithelial neoplasia grade 2 or worse detection rate between the two ethnic groups [Mongolian woman: 1.04% (11/1 059), Han Woman: 0.95% (80/8 378), χ2=0.069, P=0.793]. Among Han and Mongolian women with cervical intraepithelial neoplasia grade 2 or worse, the three most common HR-HPV types were HPV16, HPV52 and HPV58. There was no significant difference for multiple infection rate between Han and Mongolian women (41.37% vs. 44.35%, χ2=0.764, P=0.382).@*Conclusions@#The results show that HPV infection rate in Mongolian women was higher than that in Han women. Close attention should be paid to HPV16, 52 and 58 in the prevention and control of cervical cancer in Han and Mongolian women.

Analysis of prophylactic effect of extended-duration anticoagulant drugs in elderly patients undergoing hip fracture / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the prophylactic effect of extended-duration anticoagulant drugs on venous thromboembolism, and to explore the time of drug prevention for venous thromboembolism after hip fracture.@*METHODS@#A retrospective analysis of 143 patients undergoing hip fractures from November 2017 to October 2018 in Peking University People's Hospital was conducted to investigate the relationship between the extended-duration anticoagulant drug and the morbidity of venous thromboembolism and bleeding during the treatment. All the drug prevention programs for the patients included in the study were implemented in accordance with the 2016 edition of the Guidelines for Prevention of Venous Thrombosis in Orthopaedic Surgery by Orthopaedic Society of Chinese Medical Association. The patients in the two groups were followed up for venous thromboembolism and bleeding during the medication within 5 weeks after the fracture. Venous thromboembolism included symptomatic and asymptomatic deep venous thrombosis of the lower extremities, pulmonary thromboembolism, and all the patients with deep venous thrombosis of the lower extremities required vascular ultrasound results to obtain clear evidence. The results of vascular ultrasound were the basis for determining deep venous thrombosis. Bleeding conditions were included, but not limited to gastrointestinal bleeding, wound bleeding, intracranial hemorrhage, intraspinal hematoma, and fundus hemorrhage.@*RESULTS@#There were no pulmonary thromboembolism in both groups after surgery. The morbidity of deep venous thrombosis was 22.09% and 8.77% in the 2-week and 4-week groups (P=0.037), the time to deep venous thrombosis in the two groups was (17.32±7.75) days and (29.20±0.17) days after surgery. One case of bleeding occurred during the use of anticoagulant drugs in both groups, the morbidity of bleeding during the treatment was 1.16% and 1.75% (P=0.769), respectively.@*CONCLUSION@#Extended-duration anticoagulant drugs to 4 weeks after surgery can significantly reduce the morbidity of postoperative venous thromboembolism, and does not increase the risk of bleeding. Patients with a risk of bleeding should carefully assess the risks and benefits of drug prevention and choose the best treatment.

Proximal femoral nails antirotation and dynamic hip screws for fixation of unstable intertrochanteric fractures of femur: A meta-analysis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy and safety of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) for unstable intertrochanteric fractures using meta-analysis.@*METHODS@#The PubMed, Embase, Cocharane Central Register of Controlled Trials, Google Scholar, China Science and Technology Papers and Citation Database (CSTPCD) and China Journal Full-text Database (CNKI) were searched for published randomized controlled trials before January 1, 2019. Two researchers independently screened the literature in the light of the inclusion and exclusion criteria, evaluated the quality of the studies and extracted the data which were consisted of clinical efficacy indexes, such as incision length, operation time,intraoperative blood loss, weight-bearing time,fracture-healing time, Harris hip score and safety indicators like complications. Meta-analysis was performed with the Revman 5.3 software provided by Cochrane Community in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standard.@*RESULTS@#Nine randomized controlled trials met the requirement with a total of 779 patients, of whom 383 were fixed with PFNA and 396 with DHS. Meta-analysis demonstrated that PFNA was associated with smaller surgical incision length [MD=-7.43, 95%CI (-9.31, -5.55), P<0.05], shorter operation time [MD=-22.76, 95%CI (-29.57, -11.95), P<0.05], less intraoperative blood loss [MD=-216.34, 95%CI (-275.18, - 157.49), P<0.05], earlier weight bearing after surgery [MD=-12.34, 95%CI (-17.71, -6.97), P<0.05], shorter fracture healing time [MD=-5.00, 95%CI (-7.73, -2.26), P<0.05], higher postoperative Harris hip score [MD=12.22, 95%CI (3.88, 20.55), P<0.05], higher rate of excellent Harris hip score [OR=3.56, 95%CI (1.44, 8.81), P<0.05] and lower incidence rate of postoperative complications [OR=0.48, 95%CI (0.33, 0.70), P<0.05], such as hip varus, wound infection, urinary tract infection, pulmonary infection, pressure sore, deep vein thrombosis, pulmonary embolism, heart failure and cerebral infraction when compared with DHS. No statistical difference was shown between the groups when it came to subgroup analysis by age. However, there was no significant difference (P>0.05) in the duration of hospitalization and the complications resulting in the occurrences of internal fixation loosening, such as femoral shaft fracture (during or post operation), internal fixation fracture, cut-out, displacement or retraction.@*CONCLUSION@#Current published evidence supports the superiority of PFNA to DHS for unstable intertrochanteric fractures in terms of clinical efficacy. The conclusion was limited because of the relatively low quality of evidence with low strength of confidence. Large scale and high-quality randomized controlled trials are required to validate the safety of PFNA and DHS for unstable intertrochanteric fractures.

Comparison of the effects of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in treatment of elderly intertrochan teric fractures / 北京大学学报(医学版)

OBJECTIVE@#To explore the effect of cephalomedullary nails for elderly intertrochanteric fractures: proximal femoral nail antirotation (PFNA) versus zimmer natural nail (ZNN) to provide the data support for clinical perioperative management.@*METHODS@#A retrospective study was used to analyze the clinical data of elderly intertrochanteric fractures cases which were treated with PFNA or ZNN fixation from May 2016 to May 2017. In the study, 59 cases were followed up completely, in which 28 cases accepted PFNA, and the other 31 cases accepted ZNN. The operation time, amount of bleeding, fracture healing time, postoperative complication, postoperative radiographic measurement (tip apex distance, TAD) and the last follow-up of hip function score were analyzed.@*RESULTS@#The patients were followed up for 6 to 19 months, with an average (10.8±4.0) months. In PFNA group, the operation time was (62.7±14.2) min, the amount of bleeding was (56.8±20.6) mL, the fracture healing time was (4.6±0.8) months, the postoperative complication was 3.6%, the TAD was (17.7±5.5) mm, and the last follow-up hip function score was 91.8±3.6. In ZNN group, the operation time was (73.6±18.3) min, the amount of bleeding was (68.7±31.6) mL, the fracture healing time was (4.5±0.7) months, the postoperative complication was 3.2%, the TAD was (16.5±4.7) mm, and the last follow-up hip function score was 92.2±3.8. The two groups of comparative experiments were carried out, the operation time of the PFNA group was less than that of the ZNN group (P<0.05). There was no significant difference in the amount of bleeding, fracture healing time, postoperative complication, TAD, postoperative hip score between the two groups (P>0.05).@*CONCLUSION@#Although group ZNN had significant longer operation time than group PFNA, both implants were useful tools in the treatment of elderly intertrochanteric fractures. The operation of PFNA was simpler,while the design of the anterior bow of ZNN might be more suitable for the patients with a large femoral anterior bow.

Correlation analysis between rotator cuff tear and the superior migration of humeral head / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the association between rotator cuff tear and the proximal migration of humeral head.@*METHODS@#In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI.@*RESULTS@#In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071).@*CONCLUSION@#UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.

A study on perioperative lung protection by way of l-arginine aerosolized inhalation of pulmonary arterial hypertension patients after pulmonary lobectomy / 中华胸心血管外科杂志

Objective To study l-arginine aerosolized inhalation's protective effect on pulmonary ventilation of the pulmonary-arterial-hypertension patients during the early stage after pulmonary lobectomy,and its preventive effect on reducing postoperative complications.Methods 54 cases of pulmonary lobectomy patients with preoperative plumonary arterial hypertension were divided into two groups randomly-Group A was given L-arginine aerosolized inhalation within 4 h after the operation;Group B was given the same dose of aerosolized inhalation of physiological saline as contrast(other postoperative medication being the same with Group A).Compare the two groups of patients in terms of oxygenation index(PaO2/FiO2),alveolararterial oxygen difference(PA-aO2),nitric oxide(NO) concentration,ultrasonic cardiogram,mechanical ventilation duration,ICU duration,occurances of hemodvnamic disturbance and arrhythmia,and differences in postoperative hospital stay.Results The oxgenation index and the content of NO in plasma of Group A were higher than that of Group B(P ＜0.001);the alveolar-arterial oxygen difference and the postoperative pulmonary arterial pressure detected by UCG of Group A were lower than that of Group B(P ＜ 0.001);the postoperative mechanical ventilation duration,ICU duration,occurances of hemodynamic disturbance and arrhythmia of Group A were all lower than that of Croup B(P ＜ 0.05).Conclusion The postoperative l-arginine aerosolized inhalation during the early stage after pulmonary lobectomy has positive effect on the lung protection of the pulmonary-arterial-hypertension patients and it can reduce the perioperative complications and postoperative hospital stay of such patients.

The prognostic value of circulating microRNA-29b in left ventricular hypertrophy in patients with hypertension / 中华内科杂志

Objective To analyze the relationship between the level of microRNA-29b in circulation and left ventricular hypertrophy in hypertensive patients.Methods A total of 240 subjects from Henan Province People's Hospital from June 2015 to June 2018 were included in the present study.Among them,160 were hospitalized patients,and were divided into two groups.Patients with simple hypertension and had no left ventricular hypertrophy (80 cases) were in the simple hypertension group (HBP-NLVH),and patients with hypertension combined with left ventricular hypertrophy (80 cases) were in the high blood pressure with left ventricular hypertrophy group (HBP-LVH).Normal control subjects (80 cases) were those with no hypertension and randomly selected from the medical center of Henan Province People's Hospital.Serum microRNA-29b expressions were detected by real time fluorescence quantitative PCR.The thickness of interventricular septum (IVSD) and left ventricular posterior wall thickness (LVPWD) were measured by echocardiography.Results Compared with the normal control group (1.95±0.79),the relative expression of microRNA-29b in the patients both in the HBP-NLVH group (2.67±0.92) and the HBP-LVH group (5.12 ± 1.23) was up-regulated,and the difference between normal control and patients was statistically significant (P＜0.05).In patients,the microRNA-29b level in the HBP-LVH group was significantly higher than that in the HBP-NLVH group (P＜0.05).The expression level of microRNA-29b was positively correlated with IVSD (r=0.71,P＜0.05) and LVPWD (r=0.74,P＜0.05),respectively.The sensitivity and specificity of serum microRNA-29b levels in the diagnosis of left ventricular hypertrophy in hypertension patients were 96.8％ and 91.3％,respectively.Conclusion Serum microRNA-29b level is elevated in hypertensive patients with left ventricular hypertrophy,and is positively correlated with left ventricular hypertrophy.The circulation microRNA-29b might be a useful biomarker with prognostic value in left ventricular hypertrophy in hypertension patients.