Treatment Retention Rates of 3-monthly Paliperidone Palmitate and Risk Factors Associated with Discontinuation: A Population-based Cohort Study

Objective@#Limited evidence exists regarding real-world 3-monthly paliperidone palmitate (PP3M) treatment retention and associated factors. @*Methods@#We conducted a retrospective, nationwide cohort study using the Taiwan National Health Insurance Research Database between October 2017 and December 2019. Adult patients with schizophrenia initiated on PP3M were enrolled. The primary outcomes were time to PP3M discontinuation, time to psychiatric hospitalization, and the proportions of patients receiving the next PP3M dose within 120 days among first-, second-, and third-dose completers. Key covariates included prior PP1M duration and adequate PP3M initiation. @*Results@#The PP3M treatment retention rates were 79.7%, 66.3%, and 52.5% after 6, 12, and 24 months, respectively, with 86.4%, 90.6%, and 90.0% of respective first-, second-, and third-dose completers receiving the next PP3M dose. Adequate PP3M initiation and prior PP1M treatment duration ＞ 180 days were associated with favorable PP3M treatment retention. In multivariate analyses, PP1M durations of 180−360 days (adjusted relative risk [aRR], 1.76) or ＜ 180 days (aRR, 2.79) were associated with PP3M discontinuation at the second dose. Inadequate PP3M initiation was associated with discontinuation at the third dose (aRR, 2.18). Patients fully adherent to PP3M treatment in the first year had a higher probability of being free from psychiatric hospitalization (86.7% at 2 years), compared with those partially adherent or non-adherent to PP3M in the first year. @*Conclusion@#Prior PP1M duration and adequate PP3M initiation are major factors affecting PP3M treatment retention. Higher PP3M treatment retention is associated with a lower risk of psychiatric hospitalization.

Efficacy of percutaneous short segment fixation in the treatment of Magerl A3 thoracolumbar fractures with low bone mineral density:a retrospective study / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of percutaneous pedicle screw short segment internal fixation with or without the intermediate screw in the treatment of Magerl A3 thoracolumbar fractures with low bone mineral density.@*METHODS@#Patients with Magerl A3 thoracolumbar fracture underwent percutaneous pedicle screw short segment internal fixation from January 2017 to July 2020 were retrospectively analyzed, 93 cases met the diagnosis and inclusion criteria, 9 cases were excluded according to the exclusion criteria, and the remaining 84 cases obtained complete imaging follow-up data. There were 38 males and 46 females, the age ranged from 56 to 73 years old with an average of (64.78±7.12) years old, bone mineral density (BMD) ranged from 0.61 to 0.89 g/cm3 with an average of (0.73±0.14) g/cm3, the follow-up time was 11 to 25 months with an average of (17.58±6.12) months. There were 45 cases in group A with intermediate screw and 39 cases in group B without intermediate screw. The operation time and intraoperative blood loss were recorded, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used for clinical evaluation. The Cobb angle, vertebral wedge angle (VWA) and anterior vertebral body height (AVBH) were measured by X-ray after the operation. The corrected loss of the above parameters was calculated.@*RESULTS@#There were 5 cases of screw loosening in 84 patients (2 cases in group A and 3 cases in group B, P>0.05). There were significant differences in operation time and intraoperative blood loss between two groups(P<0.01). Clinical effects of two groups were good, postoperative VAS and ODI after operation obviously improved, there was no significant difference between two groups during all follow-up periods (3 days, 1 month after operation and the final follow-up) (P>0.05). Three days after the operation, the image evaluations (Cobb angle, VWA and AVBH) were significantly improved (P<0.05), but significant reduction loss was observed in both groups at 1 month after the operation and at the final follow-up (P<0.05). At the final follow-up, the loss of Cobb angle, VWA and AVBH in group A were (5.26±4.18) °, (4.63±3.80) ° and (9.54±8.71)%, respectively;group B was (6.01±4.34) °, (6.55±6.21) ° and (11.67± 9.95)%, respectively;however, there was no significant difference in reduction loss between the two groups(P>0.05).@*CONCLUSION@#Although the curative effect of the patients is satisfactory, the stability of the patients can not be improved by increasing the middle injured vertebra screw placement, the two groups of percutaneous short segment internal fixation can not resist the reduction loss of Magerl-A3 thoracolumbar fracture with low bone mineral density. Because the injured vertebra screw increases the operation time and intraoperative blood loss, it is not significant to use the intermediate screw for the elderly Magerl A3 thoracolumbar fractures with low bone mineral density.

Schisandrae Fructus oil-induced elevation in serum triglyceride and lipoprotein concentrations associated with physiologic hepatomegaly in mice

Objective: To investigate hypertriglyceridemia and hepatomegaly caused by Schisandrae Sphenantherae Fructus (FSS) and Schisandra chinensis Fructus (FSC) oils in mice. Methods: Mice were orally administered a single dose of Schisandrae Fructus oils. Serum and hepatic triglyceride (TG), triglyceride transfer protein (TTP), apolipoprotein B48 (Apo B48), very-low-density lipoprotein (VLDL), hepatocyte growth factor (HGF), alanine aminotransfease (ALT) and liver index were measured at 6-120 h post-dosing. Results: FSS and FSC oil caused time and dose-dependent increases in serum and hepatic TG levels, with maximum increases in the liver (by 297% and 340%) at 12 h post-dosing and serum (244% and 439%) at 24-h post-dosing, respectively. Schisandrae Fructus oil treatments also elevated the levels of serum TTP by 51% and 63%, Apo B48 by 152% and 425%, and VLDL by 67% and 38% in mice, respectively. FSS and FSC oil treatments also increased liver mass by 53% and 55% and HGF by 106% and 174%, but lowered serum ALT activity by 38% and 22%, respectively. Fenofibrate pre/ co-treatment attenuated the FSS and FSC oil-induced elevation in serum TG levels by 41% and 49% at 48 h post-dosing, respectively, but increased hepatic TG contents (by 38% and 33%, respectively) at 12 h post-dosing. Conclusions: Our findings provide evidence to support the establishment of a novel mouse model of hypertriglyceridemia by oral administration of FSS oil (mainly increasing endogenous TG) and FSC oil (mainly elevating exogenous TG).

Tactile vibration feedback training can improve the balance and walking of stroke survivors / 中华物理医学与康复杂志

Objective:To observe any effect of tactile vibration feedback training on the balance and wal-king ability of stroke survivors.Methods:Fifty stroke survivors who met the selection criteria were randomly divided into a control group ( n=25) and an observation group ( n=25). In addition to conventional exercise training, neuromuscular electrical stimulation and biofeedback therapy, the control group underwent one hour of walking training daily, 5 days a week for 6 weeks, while the observation group received tactile vibration feedback training with the same timetable. Before and after the treatment, lower limb motor function was evaluated using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test and the Fugl-Meyer lower extremity assessment (FMA-LE). A Gaitrite analyzer recorded the gait parameters of the two groups. The step length on the unaffected side was recorded and the duration of the single support phase was compared between the affected and healthy sides. Results:Before the treatment, there was no significant difference between the two groups in average step length on the unaffected side or in the difference in duration of the single support phase between the affected and healthy sides. The average BBS scores, TUG test times and FMA-LE scores also were not significantly different. After the treatment all of those indicators were significantly better in the treatment group, on average.Conclusions:Tactile vibration feedback training can significantly improve the balance and walking ability of stroke survivors during the recovery period, and lower their risks of falling.

Schisandrae Fructus oil-induced elevation in serum triglyceride and lipoprotein concentrations associated with physiologic hepatomegaly in mice

Objective: To investigate hypertriglyceridemia and hepatomegaly caused by Schisandrae Sphenantherae Fructus (FSS) and Schisandra chinensis Fructus (FSC) oils in mice. Methods: Mice were orally administered a single dose of Schisandrae Fructus oils. Serum and hepatic triglyceride (TG), triglyceride transfer protein (TTP), apolipoprotein B48 (Apo B48), very-low-density lipoprotein (VLDL), hepatocyte growth factor (HGF), alanine aminotransfease (ALT) and liver index were measured at 6-120 h post-dosing. Results: FSS and FSC oil caused time and dose-dependent increases in serum and hepatic TG levels, with maximum increases in the liver (by 297% and 340%) at 12 h post-dosing and serum (244% and 439%) at 24-h post-dosing, respectively. Schisandrae Fructus oil treatments also elevated the levels of serum TTP by 51% and 63%, Apo B48 by 152% and 425%, and VLDL by 67% and 38% in mice, respectively. FSS and FSC oil treatments also increased liver mass by 53% and 55% and HGF by 106% and 174%, but lowered serum ALT activity by 38% and 22%, respectively. Fenofibrate pre/ co-treatment attenuated the FSS and FSC oil-induced elevation in serum TG levels by 41% and 49% at 48 h post-dosing, respectively, but increased hepatic TG contents (by 38% and 33%, respectively) at 12 h post-dosing. Conclusions: Our findings provide evidence to support the establishment of a novel mouse model of hypertriglyceridemia by oral administration of FSS oil (mainly increasing endogenous TG) and FSC oil (mainly elevating exogenous TG).

Identification of Cordyceps cicadae and Tolypocladium dujiaolongae based on ITS sequences and chemical pattern recognition method / 中国中药杂志

Based on ITS sequences, the molecular identification of Cordyceps cicadae and Tolypocladium dujiaolongae was carried out, and high-performance liquid chromatography(HPLC) fingerprint combined with chemical pattern recognition method was established to differentiate C. cicadae from its adulterant T. dujiaolongae. The genomic DNA from 10 batches of C. cicadae and five batches of T. dujiaolongae was extracted, and ITS sequences were amplified by PCR and sequenced. The stable differential sites of these two species were compared and the phylogenetic tree was constructed via MEGA 7.0. HPLC was used to establish the fingerprints of C. cicadae and T. dujiaolongae, and similarity evaluation, cluster analysis(CA), principal component analysis(PCA), and partial least squares discriminant analysis(PLS-DA) were applied to investigate the chemical pattern recognition. The result showed that the sources of these two species were different, and there were 115 stable differential sites in ITS sequences of C. cicadae and T. dujiao-longae. The phylogenetic tree could distinguish them effectively. HPLC fingerprints of 18 batches of C. cicadae and 5 batches of T. dujiaolongae were established. The results of CA, PCA, and PLS-DA were consistent, which could distinguish them well, indicating that there were great differences in chemical components between C. cicadae and T. dujiaolongae. The results of PLS-DA showed that six components such as uridine, guanosine, adenosine, and N~6-(2-hydroxyethyl) adenosine were the main differential markers of the two species. ITS sequences and HPLC fingerprint combined with the chemical pattern recognition method can serve as the identification and differentiation methods for C. cicadae and T. dujiaolongae.

Pull-Through Buddy Wire Technique for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: Technical Note / 신경중재치료의학

Excessive tortuosity is a notable cause of failed endovascular thrombectomy for acute large-vessel occlusion stroke. Transcervical access (TCA) is a commonly proposed solution for overcoming this difficulty. However, the large-bore catheter usually used in TCA increases the risk of serious local complications. This paper presents a modified technique for TCA that uses a pull-through buddy wire (PTBW) to track a large-bore femoral guiding sheath (GS) into the carotid artery via a small carotid puncture site. The carotid puncture site can be easily managed through gentle manual compression. Two illustrative cases using this technique to deal with a large aortic arch and tortuous left common carotid artery are reported. In both cases, recanalization was achieved after successful GS placement. Using a PTBW is feasible in TCA.

Effects of Tactile Vibration Feedback System on Balance Function and Walking Ability of Unilateral Transtibial Amputees with Prostheses / 中国康复理论与实践

Objective:To observe the effect of the tactile vibration feedback system on the balance and walking function of the unilateral transitional amputees with prostheses. Methods:From October, 2019 to November 2020, eleven unilateral transtibial amputees with prostheses were selected from our hospital. They performed daily activities for three hours wearing tactile vibration feedback system designed by our department. The patients were evaluated by Performance Oriented Mobility Assessment (POMA), gait analysis and outdoor 1000 meters complex road walking test before and after treatment. Results:The balance score of the POMA improved (Z = -2.264, P < 0.05), the gait score and total score of the POMA increased significantly (|t| > 6.249, P < 0.001) after treatment. Gait analysis showed that the step length of the affected side improved, the bilateral step time and double support phase shortened, and the walking speed increased (|t| > 2.250, |Z| > 2.756, P < 0.05) after installation. The outdoor 1000 meters complex road walking test showed that the total steps, energy consumption and time decreased (|t| > 2.412, |Z| > 2.045, P < 0.05). All the patients finished the trail, and no discomfort appeared. Conclusion:The tactile vibration feedback system could safely and effectively improve the balance and walking function of the unilateral transtibial amputees with prostheses.

Antipsychotic Medication in Schizophrenic Patients is Associated with Higher Risks of Developing Bone Fractures and Refractures

Objective@#The relationship of antipsychotics and the risk of refracture in treated patients is unclear. The aim of this study is to evaluate the association between prolonged antipsychotic and the incidences of bone fractures and refractures in schizophrenia. @*Methods@#This is a retrospective nested case-control study using Taiwan National Health Insurance Research Database recorded from 2000 to 2005, with cases followed up to end of 2011. Total of 7,842 schizophrenic patients, 3,955 had developed bone fractures were compared with 3,887 control subjects matched in age, sex, and index date.Antipsychotic drug exposure was classified based on the drug type and medication duration. Conditional logistic regression analyses were performed. Odds ratio (OR) and confidence interval (CI) were calculated. @*Results@#We found (after adjustments) higher risks of developing fractures under continued use of typical (OR = 1.70; 95% CI, 1.51−1.91) or atypical antipsychotics (OR = 1.43; 95% CI, 1.28−1.60) were found. Additionally, continued use typical (OR = 1.84; 95% CI, 1.35−2.50) or atypical antipsychotics (OR = 1.44; 95% CI, 1.06−1.95) was positively associated with refracture risks. Moreover, refractures were associated with continuous use of chlorpromazine (one typical antipsychotics, OR = 2.45; 95% CI, 1.14−5.25), and risperidone (OR = 1.48; 95% CI, 1.01−2.16) or zotepine (OR = 2.15; 95% CI, 1.06−4.36) (two atypical antipsychotics). @*Conclusion@#Higher risks of bone fracture and refracture were found in schizophrenia under prolonged medication with typical or atypical antipsychotics. We therefore recommend that clinicians should pay more attention on bone density monitoring for patients using long-term antipsychotics.

Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome / 신경중재치료의학

Carotid blowout syndrome (CBS) is a fatal complication of head and neck cancer. Endovascular treatment, particularly deconstructive embolization, is effective for CBS, but it might result in thromboembolic events. We report the case of a 57-year-old man with underlying recurrent head and neck cancer who had CBS. The patient received endovascular embolization of the right internal, external, and common carotid arteries. Right internal carotid artery to middle cerebral artery embolic occlusion was noted immediately after the procedure, and left-sided weakness and facial palsy were found. Ipsilateral suprabulbar cervical internal carotid artery puncture was performed under fluoroscopic guidance, and rescue suction thrombectomy was successful. The patient had no significant neurological sequela. Transcarotid intraarterial thrombectomy is a reasonable method for managing postembolization large vessel occlusion, even in the neck, after irradiation.

Prior uterine myoma and risk of ovarian cancer: a population-based case-control study / 부인종양

OBJECTIVE: Uterine myoma which results in the magnitude of ovarian cancer remains uncertain. This study aimed to assess the association between women with previous uterine myoma and the risk of ovarian cancer. METHODS: This population-based case-control study was conducted using the Taiwan National Health Insurance Research Database between 2006 and 2010. We identified 4,088 adult women with newly diagnosed ovarian cancer with 16,348 women without ovarian cancer matched for age, urbanization level, income and initial diagnosis date. Logistic regression analyses were used to evaluate the variables associated with ovarian cancer. In addition, the effect of surgical interventions on the risk of ovarian cancer was also evaluated. RESULTS: Women with previous uterine myoma were more likely than those who did not to have ovarian cancer (adjusted odds ratio [aOR]=2.26; 95% confidence interval [CI]=2.06−2.49). Patients with uterine myoma who either received (aOR=1.79; 95% CI=1.51−2.13) or did not receive hormone replacement therapy (aOR=2.51; 95% CI=2.24−2.82) experienced a significantly higher risk of ovarian cancer than those without uterine myoma, respectively. However, patients with uterine myoma who underwent either myomectomy (aOR=0.55; 95% CI=0.39−0.77) or hysterectomy (aOR=0.33; 95% CI=0.26−0.42) had a significantly lower risk of ovarian cancer. CONCLUSION: The results revealed that a significantly higher risk of ovarian cancer in women with previous uterine myoma, through an indirect mechanism. Furthermore, a lower risk of ovarian cancer was observed in women who underwent surgical removal of the uterine myoma.

Response to comment on: prior uterine myoma and risk of ovarian cancer: a population-based case-control study / 부인종양

No abstract available.

Improvement in affinity and thermostability of a fully human antibody against interleukin-17A by yeast-display technology and CDR grafting

Monoclonal antibodies (mAbs) are widely used in many fields due to their high specificity and ability to recognize a broad range of antigens. IL-17A can induce a rapid inflammatory response both alone and synergistically with other proinflammatory cytokines. Accumulating evidence suggests that therapeutic intervention of IL-17A signaling offers an attractive treatment option for autoimmune diseases and cancer. Here, we present a combinatorial approach for optimizing the affinity and thermostability of a novel anti-hIL-17A antibody. From a large naïve phage-displayed library, we isolated the anti-IL-17A mAb 7H9 that can neutralize the effects of recombinant human IL-17A. However, the modest neutralization potency and poor thermostability limit its therapeutic applications. affinity optimization was then used to generate 8D3 by using yeast-displayed random mutagenesis libraries. This resulted in four key amino acid changes and provided an approximately 15-fold potency increase in a cell-based neutralization assay. Complementarity-determining regions (CDRs) of 8D3 were further grafted onto the stable framework of the huFv 4D5 to improve thermostability. The resulting hybrid antibody 9NT/S has superior stabilization and affinities beyond its original antibody. Human fibrosarcoma cell-based assays and analyses in mice indicated that the anti-IL-17A antibody 9NT/S efficiently inhibited the secretion of IL-17A-induced proinflammatory cytokines. Therefore, this lead anti-IL-17A mAb might be used as a potential best-in-class candidate for treating IL-17A related diseases.

Biomechanics of osteonecrosis of femoral head after tantalum rod implantation: a three-dimensional finite element analysis / 中国组织工程研究

BACKGROUND: The femoral anterolateral column plays a key role in hip preservation surgery, and the China-Japan Friendship Hospital (CJFH) type stresses the anterolateral column, but there is little information available in three-dimensional (3D) finite element analysis of the L-type tantalum rod implantation.OBJECTIVE: To establish a 3D finite element model of L-type tantalum rod implantation into the normal, necrotic and L-type necrotic areas, followed by a finite element analysis, and to explore the importance of the integrity of the anterolateral column for hip preservation surgery, thus providing biomechanical evidence for the treatment of CJFH type.METHODS: Based on the prepared 3D models of CJFH L1, L2 and L3 osteonecrosis of the femoral head (ONFH) and normal hip, the 3D finite element model of tantalum rod implantation of femoral head necrosis was established, and finite element analysis was conducted. The stress distribution and the maximum Mises stress value of cortical shell of normal femoral head, necrotic femoral head and tantalum rod implanted ONFH were observed and compared.RESULTS AND CONCLUSION: (1) The maximum Mises of the weight-bearing area of cortical bone shell of L-type ONGH was higher than that of normal femoral, L1. L2 and L3 increased by 21.76%, 31.02%, and 42.79%, respectively. (2) The maximum Mises of weight-bearing area of cortical bone shell was decreased after tantalum rod implantation, L1 L2 and L3 decreased by 13.38%, 8.81%, and 11.45%, respectively. (3) In necrotic femoral head, the decreased bearing stress, leads to stress concentration on the femoral head bone shell, so the maximum is higher than that of the normal condition. The higher classification is, the greater the stress concentration of the cortical bone shell is. Tantalum rod implantation share certain stress. (4) Tantalum rod implantation corrects some stresses of the bone shell of ONFH, and can prevent collapse and exert the biomechanical effect of supporting subchondral bone. Furthermore, the integrity of the lateral column of the necrotic femoral head affects the efficacy of hip preservation, and more lateral column preserved always accompanied with better hip preservation. The higher CJFH classification exhibits a higher risk of collapse, and poorer hip preservation.

Anti-post-traumatic-stress-disorder effects of YL-IPA08, a selective 18kDa translocator protein ligand / 国际药学研究杂志

Objective To explore the anti-post-traumatic-stress-disorder(anti-PTSD)effects of YL-IPA08,a selective 18kDa translocator protein(TSPO)ligand.Methods The time-dependent stress sensitization(TDS)method was used to establish a rat mod?el of PTSD.The open field test(OFT)was used to evaluate the locomotor activity in rats.The contextual freezing(CF)measurement, elevated plus maze(EPM)test and novel objective recognition(NOR)test were used to evaluate the PTSD-like behaviors in rats.The concentration of allopregnanolone in rat hippocampus was detected by ELISA. Results Compared with the control group,neither TDS nor drug treatment affected the locomotor activity in rats(P>0.05).However,PTSD rats showed significant PTSD-like behaviors with enhanced CF time in CF mearsurement,decreased open arm time and open arm entries in EPM test,and dropped object recogni?tion index in NOR test(P<0.05 or 0.01).Moreover,the concentration of hippocampus allopregnanolone was decreased in PTSD rats (P<0.05).YL-IPA08(0.05-0.1mg/kg)or positive drug sertraline(15 mg/kg),administered intragastrically after establishment of PTSD model,significantly reversed the above PTSD-like behavioral changes(P<0.05 or 0.01)and increased the concentration of hip?pocampus allopregnanolone in PTSD rats.Conclusion YL-IPA08 could improve the PTSD-like behavior in rats,and the mechanism may be related to the increased allopregnanolone level in hippocampus.

Increased risk of breast cancer in women with uterine myoma: a nationwide, population-based, case-control study / 부인종양

OBJECTIVE: To evaluate if uterine myoma is associated with breast cancer. METHODS: This case-control study used a nationwide database in Taiwan. We identified 24,315 patients with newly diagnosed breast cancer as cases and matched them with 24,281 patients without breast cancer on age, sex, urbanization, income, and initial diagnosis date. Patients with prior mastectomy were excluded. We used logistic regression analysis to assess the association between uterine myoma and breast cancer while adjusting for confounders. We evaluated the impact of surgical removal of uterine myoma on subsequent breast cancer among patients with uterine myoma. RESULTS: We found that 2,892 (11.9%) patients with newly diagnosed breast cancer and 2,541 (10.5%) patients without breast cancer had a history of uterine myoma. The association between breast cancer and uterine myoma was significant (adjusted odds ratio [aOR]=1.14; 95% confidence interval [CI]=1.07–1.21; p<0.001). This association remained in patients who used hormone (aOR=1.20; 95% CI=1.08–1.33; p=0.001) or who did not use hormone (aOR=1.11; 95% CI=1.03–1.19; p=0.005) within 5 years prior to the index date. Surgical removal of uterine myoma was not associated with a decreased risk of breast cancer (aOR=0.99; 95% CI=0.88–1.10; p=0.795). CONCLUSION: A minor increased risk of breast cancer was found in women with a history of uterine myoma. This association remained in patients with recent hormone use. Removal of uterine myoma was not associated with decreased risk of breast cancer.

Statin Therapy for Primary Prevention of Atrial Fibrillation: Guided by CHADS2/CHA2DS2VASc Score

Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased cardiovascular morbidity and mortality. The anti-arrhythmic effect of statins on AF prevention appears to be highly significant in most clinical studies. However, some discrepancies do exist among different clinical studies. Different clinical settings and types of stains used may explain these differences between trials. The CHADS2 and CHA2DS2VASc scoring systems have been used for stroke risk stratification in AF patients. The recent study suggested that these scores can also be used to guide statin therapy for AF prevention. Patients with higher scores had a higher risk of developing AF and gained more benefits from statins therapy than those with lower scores. This review article focused on the ability of these scores to predict AF prevention by statins.

Re-appraising the role of sonography in pediatric acute abdominal pain

Most pediatric emergency department [ED] visits are due to acute abdominal pain. Sonography is a reliable technique for differential diagnosis. The objective of this study was to re-appraise the role of sonography in evaluating acute abdominal pain in children. Retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent sonography between December 2004 and June 2006 was conducted. Patients with trauma were excluded. 775 patients [478 males and 297 females, age 1-17 years; mean age 6 +/- 5.8 years] enrolled the study. Among 284 children with suspected appendicitis, 118 were diagnosed with appendicitis using sonography. Of 663 children without appendicitis, majority had gastrointestinal tract infection or non-specific abdominal pain. Other specific diagnoses were established by clinical, laboratory, and radiologic finings in 51 patients [including renal diseases in 20, intussusceptions in 15, gynecologic diseases in six, extra-abdominal disease in 4, and gastrointestinal tract abnormalities in 2]. The sensitivity and specificity of sonography was 96.4% and 76.7%, respectively, for diagnosing appendicitis and 100% and 100%, respectively, for intussusception. Sonography remains a very effective, complementary, non-invasive method for evaluating children with acute abdominal pain, especially those with suspected appendicitis or intussusception

Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the donor area after harvesting of relatively large flaps carries a risk of postoperative dehiscence. This research was to investigate a modified superior gluteal artery perforator flap for repairing sacrococcygeal soft tissue defects.</p><p><b>METHODS</b>From June 2003 to April 2010, we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients (study group). The wound and donor areas were measured, and the flaps were designed accordingly. Wound healing was assessed over a follow-up period of 6 - 38 months. From January 1998 to February 2003, twelve patients with sacrococcygeal pressure sores were treated with traditional methods, VY advancement flaps or oblong flaps, as control group.</p><p><b>RESULTS</b>After debridement, the soft tissue defects ranged from 12 cm × 10 cm to 26 cm × 22 cm (mean 16.3 cm × 13.5 cm). Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm (mean 18.2 cm × 14 cm). Four patients were treated using left-sided flaps, and two were treated using both right- and left-sided flaps. Suction drains were removed on postoperative Days 3 - 21 (mean 5.9) and sutures were removed on postoperative Days 12 - 14. Each flap included 1 - 2 perforators for each of the donor and recipient sites. Donor sites were closed directly. All flaps survived. In eight patients, the wounds healed after single-stage surgery. After further debridement, the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33, respectively. The rate of first intention in the study group (80%, 8/10) significantly increased than that of control group ((25%, 3/12), χ(2) = 4.583, P = 0.032). Follow-up examinations found that the flaps had a soft texture without ulceration. In the two patients without paraplegia, the range of motion of the hip joints was not affected.</p><p><b>CONCLUSION</b>The use of the quadrilobed superior gluteal artery perforator flap can overcome the disadvantages of traditional perforator flaps and represents an improved approach for repairing soft tissue defects in the sacrococcygeal region.</p>

Expression and identification of recombinant human C-reactive protein in Pichia pastoris / 重庆医学

Objective To construct the secretory expression vector of recombinant human C-reactive protein(rhCRP) for its se-cretory expression in Pichia pastoris ,rhCRP was expressed as a secretory protein and purified ,and the immunity reactivity of the purified protein was identified .Methods The DNA fragment of rhCRP which was designed and synthesized was cloned into pPICZαA vector .Recombinant plasmid pPICZαA/rhCRP was linearized by SacⅠand transformed into Pichia pastoris X-33 by elec-trotransformation .The rhCRP was secreted into the medium under the methanol induction .RhCRP was purified by Histamine affin-ity chromatography .The purified rhCRP was identified by SDS-PAGE and Western blotting ,and its immunity reactivity and stabili-ty was identified by indirect ELISA .Results The pPICZαA/rhCRP expression vector was successfully constructed .The rhCRP of 23 × 103 was inducted and successfully expressed as a secretory protein by the recombinant Pichia pastoris strains .The rhCRP was purified by one step up to 90 .42% purity ,and it was showed good immunity and stability by indirect ELISA .Conclusion The rh-CRP with higher purity and immunoreactivity was successfully obtained by using the Pichia pastoris expression system ,which pro-vided an important experimental basis for producing anti-human CRP antibodies and developing testing CRP reagent .