Classification Tree Model Analysis on Risk Factors of Diabetic Kidney Disease to Progress to ESRD for CKD3-4 Stages Patients / 中山大学学报(医学科学版)

@#【Objective】To analyze the risk factors of progression to end-stage renal disease（ESRD）in patients with diabetic kidney disease（DKD），and screen the high-risk population for early prevention.【Methods】The clinical data of 231 patients with diabetic nephropathy in our hospital were collected and followed up for 3 years. According to whether ESRD occurred，they were divided into non-progressing ESRD group（133 cases）and ESRD group（98 cases）. Classification tree model was used to analyze the risk factors related to ESRD，and the high-risk population was screened by node gain analysis.【Results】Four important explanatory variables were screened out by the classification tree model from the candi⁃ date variables related to early renal damage，including apolipoprotein B（ApoB），gender，diabetic retinopathy，systemic blood pressure（SBP）. ApoB level was an important factor for DKD progression. For DKD patients with the chronic kidney disease （CKD）3~4 stageswith ApoB> 1.14 mmol/L，theprobabilityofprogression toESRDfor 3 yearswas 75.0 %，and ifat the same time with diabetic retinopathy，the probability was 79.7 %.【Conclusion】The classification tree model can analyze the risk factors of progression to ESRD in DKD patients effectively，to identify the characteristics of high-risk populations.

Indoor air quality monitoring and management in primary and secondary schools in China / 中国学校卫生

Objective@#To investigate indoor air quality monitoring and management in primary and secondary schools, so as to provide scientific basis for health protection of students and healthy school environment.@*Methods@#Stratified sampling method was adopted to select schools for investigation. Data of daily ventilation and ventilation was collected from relevant principals of schools through questionnaire survey. Chi-square test was used to analyze the difference of ventilation and ventilation among different types of schools.@*Results@#Daily indoor air quality testing indicators: 317 schools (13.2%) have tested the concentration of CO2 in the air environment. Daily detection of CO2 in urban schools was significantly better than that in township schools, and the difference is statistically significant(χ2=72.06, P<0.01); Non-boarding schools were superior than boarding schools(χ2=21.89, P<0.01). The proportion of schools that routinely tested for carbon monoxide, particulate matter and volatile pollutants was 6.5%, 7.5% and 9.3%, respectively. Of the schools that participated in the survey, 80.8% had a daily ventilation system. Among them, 925 schools (38.5%) had a cumulative daily ventilation time of more than 90 minutes in cold season, and 331 schools (13.8%) had a daily ventilation time of less than 30 minutes.@*Conclusion@#Regulations and standards for school air quality monitoring needs to be improved. The Center for Disease Control and Prevention or other qualified institutions are suggested to lead air quality monitoring in schools testing, creating a healthy learning and living environment for primary and secondary school students.

Remote Ischemic Postconditioning for Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials / 中华医学杂志(英文版)

<p><b>Background</b>Remote ischemic postconditioning (RIPostC) appears to protect distant organs from ischemia-reperfusion injury (IRI). However, cerebral protection results have remained inconclusive. In the present study, a meta-analysis was performed to compare stroke patients with and without RIPostC.</p><p><b>Methods</b>CNKI, WanFang, VIP, CBM, PubMed, and Cochrane Library databases were searched up to July 2016. Data were analyzed using both fixed-effects and random-effects models by Review Manager. For each outcome, risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated.</p><p><b>Results</b>A total of 13 randomized controlled trials that enrolled a total of 794 study participants who suffered from or are at risk for brain IRI were selected. Compared with controls, RIPostC significantly reduced the recurrence of stroke or transient ischemic attacks (RR = 0.37; 95% CI: 0.26-0.55; P < 0.00001). Moreover, it can reduce the levels of the National Institutes of Health Stroke Scale score (MD: 1.96; 95% CI: 2.18-1.75; P < 0.00001), modified Rankin Scale score (MD: 0.73; 95% CI: 1.20-0.25; P = 0.00300), and high-sensitivity C-reactive protein (MD: 4.17; 95% CI: 4.71-3.62; P < 0.00001) between the two groups. There was no side effect of RIPostC using tourniquet cuff around the limb on ischemic stroke treating based on different intervention duration.</p><p><b>Conclusion</b>The present meta-analysis suggests that RIPostC might offer cerebral protection for stroke patients suffering from or are at risk of brain IRI.</p>

Heart Rate Variability in Patients with Acute Ischemic Stroke at Different Stages of Renal Dysfunction: A Cross-sectional Observational Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction.</p><p><b>METHODS</b>This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography (ECG). Autonomic function was measured based on the heart rate variability (HRV) using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate (eGFR), and stroke severity was rated according to the National Institutes of Health Stroke Scale (NIHSS). The Barthel index and modified Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression.</p><p><b>RESULTS</b>In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval (SDANN) index (P = 0.022), very low frequency (VLF) (P = 0.043), low frequency (LF) (P = 0.023), and ratio of low-to-high frequency power (LF/HF) (P = 0.001) were significantly lower than those in the patients with a normal eGFR. A multinomial linear regression indicated that eGFR (t = 2.47, P = 0.014), gender (t = -3.60, P < 0.001), and a history of hypertension (t = -2.65, P = 0.008) were the risk factors of LF/HF; the NIHSS score (SDANN index: t = -3.83, P < 0.001; VLF: t = -3.07, P = 0.002; LF: t = -2.79, P = 0.006) and a history of diabetes (SDANN index: t = -3.58, P < 0.001; VLF: t = -2.54, P = 0.012; LF: t = -2.87, P = 0.004) were independent factors for the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project (t = -2.38, P = 0.018) was related to the SDANN index.</p><p><b>CONCLUSIONS</b>Autonomic dysfunction is aggravated with the progression of eGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfunction.</p>

Treatment of osteoporotic intertrochanteric fractures by zoledronic acid injection combined with proximal femoral nail anti-rotation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the clinical results of proximal femoral nail anti-rotation (PFNA) combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly.</p><p><b>METHODS</b>60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument. Patients were randomly divided into treatment or control groups (30 cases in each group). Patients in both groups were treated by closed/open reduction and internal fixation using PFNA. In the treatment group, patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip, in addition to 600 mg of Caltrate D (qd) and 0.25 mg of alpha ossification alcohol (qd). The control group received 600 mg of Caltrate D (qd) and 0.25 mg of alpha ossification alcohol (qd). The oral drugs were administered for 12 months. Bone pain relief was observed, and changes in the bone mineral density (BMD) of the lumbar and health-side hip were recorded. Clinical results were evaluated using the Visual Analogue Scale (VAS), Harris joint function score, and Osteo- porosis Quality of Life Scale (OQOLS).</p><p><b>RESULTS</b>Compared with the control group, bone pain symptoms were significantly alleviated (p < 0.05) in the treatment group. In the treatment and control groups, both between-group and within-group differences in BMD were significantly increased in L1e4, femoral neck and trochanter (p < 0.05). No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period, although cases in the treatment group had higher OQOLS scores than those of the controls (p = 0.04). Cases in the treatment group healed more quickly than those in the control group [(13 ± 3.2) weeks vs (15 ± 4.6) weeks, p = 0.02]. During the follow-up period, cases in the treatment group had no new fractures, whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed among the controls.</p><p><b>CONCLUSION</b>Zoledronic acid injection combined with PFNA is a favorable treatment option for the elderly patients with osteoporotic intertrochanteric fracture. It can effectively relieve bone pain, increase bone density, improve quality of life, reduce the occurrence of new fractures and promote fracture healing.</p>

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury.</p><p><b>METHODS</b>Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years). Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents (3 cases), fall from height (5 cases) and hit by heavy object (2 cases). All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days (average 6.6 days). Postoperatively, the foot function was assessed using Visual Analogue Scales (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Scales. Healing time and complications were observed.</p><p><b>RESULTS</b>All patients were followed up for 18-24 months (average 20 months). Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score (7.89 ± 0.34) and score at postoperative 8 weeks (0.67 ± 0.13). According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months.</p><p><b>CONCLUSION</b>Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.</p>

Bottleneck and development trend of bone xenograft for the treatment of bone defect / 中国骨伤

Bone xenograft bone for the treatment of bone defect is one of the current research focus, which has advantages of extensive sources, low cost, simple preparation method. While the process of single bone xenograft bone in repairing bone defect is very long, and the clinical outcome is not satisfactory. The main problems focus on formation of bone and vascularization. Reconstituted bone xenograft combined with cells and xenogenic bone material could promote vascularization and bone fusion in vivo, thus achieve a clinical effect of autogenous bone in repairing bone defect.

Locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical outcomes of locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture.</p><p><b>METHODS</b>From January 2009 to December 2012, Pilon fracture patients treated by LCP with MIPPO were retrospectively analyzed. All open fractures, pathologic fractures and those who had limb vascular disease or nerve injury were excluded. Thirty-eight patients were enrolled, including 29 males and 9 females aged from 21 to 78 years old with an average of 48 years old. According to AO classification, 20 cases were type B, 18 cases were type C. Operative time, blood loss, reduction quality, time of fracture healing complications and postoperative ankle joint function were applied for evaluating clinical outcomes, AOFAS scoring were used for assessing postoperative clinical effects.</p><p><b>RESULTS</b>All patients were followed up from 13 to 24 months (averaged 18 months). All patients obtained bone union without any plate failures or loss of fixation/reduction. One patient occurred superficial wound infection, and resolved with antibiotics and local wound care. Postoperative average AOFAS score was 81 (ranged 65 to 97).</p><p><b>CONCLUSION</b>LCP with MIPPO for Pilon fratcure has advantages of less invasion, fewer complications and satisfactory ankle function.</p>

Expression of ESM-1 in hepatocellular carcinoma is associated with angiogenesis and tumor invasion / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the expression and significance of endothelial cell specific molecule-1 (ESM-1) in hepatocellular carcinoma (HCC) tissue and serum from HCC patients.</p><p><b>METHODS</b>The ESM-1 expression was evaluated by immunohistochemistry staining and quantitative real-time PCR in 30 tumor tissues from HCC patients, 15 surrounding non-cancerous hepatic parenchyma, and 15 normal controls. Serum levels of ESM-1 were also measured in the HCC patients and healthy controls by Enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>ESM-1 was expressed in endothelium of 24 HCC tissues and 6 pericarcinomatous tissues, however, it was not expressed in normal liver tissues. The mRNA level of ESM-1 was 0.064 +/- 0.018, 0.383 +/- 0.103, 0.528 +/- 0.148 in the corresponding tissues, respectively. The mRNA level of ESM-1 in tissues was correlated with the TNM phase of HCC patients, tumor vascular invasion as well as metastasis. The serum ESM-1 was (12.643 +/- 2.280) ng/ml and (4.660 +/- 1.172) ng/ml in hepatic cell carcinoma and normal controls, respectively.</p><p><b>CONCLUSION</b>The expression of ESM-1 is significantly up-regulated in HCC, suggesting that ESM-1 may play an important role in the pathoigenesis of HCC.</p>

Involvement of CD4+CD25+ regulatory T cells in the pathogenesis of polycythaemia vera / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Regulatory T cells (T(reg)) have been shown to play an important role in the regulation of hematopoietic activity. However, there is no information about the effect of T(reg) cells in the pathogenesis of polycythaemia vera (PV).</p><p><b>METHODS</b>In this study, we investigated the percentage and function of T(reg) cells in the peripheral blood of 21 PV patients and 25 healthy donors. T(reg) cells were identified and characterized as CD4+CD25+ FOXP3+ by flow cytometry. The suppressive activity of CD4+CD25+ T(reg) cells was assessed by the proliferation and cytokine secretion of the co-cultured CD4+CD25- fractions.</p><p><b>RESULTS</b>The results showed that the percentage of T(reg) cells in the peripheral blood of PV patients significantly increased compared to healthy controls ((10.93 +/- 4.02)% vs (5.86 +/- 1.99)%, P < 0.05). Moreover, the mRNA and protein expression of FOXP3 was higher in CD4+CD25+ T(reg) cells. Coordinately, when co-cultured with the activated CD4+CD25- cells, the CD4+CD25+ T(reg) cells showed enhanced suppressive function in PV. Yet, the underlying mechanism for the increased frequency and function of CD4+CD25+ T(reg) cells is still to be clarified.</p><p><b>CONCLUSION</b>T(reg) cells expansion might account for the abnormal T cell immunity in PV patients and thus contribute to the pathogenesis of PV.</p>