Compound anisodine combined with retinal laser photocoagulation for the treatment of severe non-proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of the compound anisodine combined with retinal laser photocoagulation in the treatment of severe non-proliferative diabetic retinopathy(NPDR). METHODS: According to the retrospective study, totally 120 eyes of patients with severe NPDR who admitted to Daxing Teaching Hospital Affiliated to Capital Medical University from May 2023 to July 2023 were selected. The patients were divided into the observation group and the control group according to treatment methods, with 60 eyes in each group. The observation group was treated with panretinal photocoagulation combined with the compound anisodine injection. The control group was only treated with panretinal photocoagulation. The optical coherence tomography angiography(OCTA)and optical coherence tomography(OCT)were used to quantitatively analyze the fundus retinal structure and blood flow. Furthermore, the best corrected visual acuity(BCVA), superficial vascular density(SVD), deep vascular density(DVD), choroidal blood flow density and central macular foveal retinal thickness(CMT)were compared before treatment and at 1 d, 1 and 2 mo after treatment.RESULTS:At 2 mo postoperatively, the rate of visual improvement and the BCVA in the observation group of patients were significantly better than those of the control group, and the incidence of macular edema in the observation group was significantly lower than the control group(P<0.05). The BCVA at 1 and 2 mo after treatment were significantly higher than those before treatment in both groups(P<0.05). The SVD in the observation group was better than the control group at 1 d, 1 and 2 mo after treatment(all P<0.05). The DVD and choroidal flow density in the observation group were better than those of the control group at 1 d after treatment(all P<0.05). The CMT of the observation group was smaller than that of the control group at 1 d after treatment(P<0.05).CONCLUSION:Compound anisodine can effectively improve the fundus microcirculation after panretinal photocoagulation and reduce the incidence of macular edema, thus promoting the visual function.

Clinical treatment options oriented to the endotype of chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

Chronic rhinosinusitis（CRS） is an inflammatory disease involving the mucosa of the nasal and paranasal sinuses for more than 12 weeks and can be classified as CRS with nasal polyp（CRSwNP） and CRS without nasal polyp（CRSsNP） depending on the phenotype. Clinical treatments reveal significant differences in disease prognosis and improvement in quality of life in patients with the same clinical phenotype. Inflammatory cells infiltration and inflammatory mediators are important factors driving CRS endotypes. In particular, CRS with predominantly eosinophilic infiltration and type 2 CRS present severe clinical symptoms, comorbidities, and high recurrence rates. CRS endotype-oriented treatment methods may better contribute to improving patient prognosis and quality of life. This article summarizes the current progress of CRS endotype research and reviews the endotype-oriented treatment options.

Predictive value of left ventricular ejection fraction reserve assessed by SPECT G-MPI for major adverse cardiovascular event in patients with coronary artery disease / 中华心血管病杂志

Objective: To evaluate the prognostic value of left ventricular ejection fraction (LVEF) reserve assessed by gated SPECT myocardial perfusion imaging (SPECT G-MPI) for major adverse cardiovascular event (MACE) in patients with coronary artery disease. Methods: This is a retrospective cohort study. From January 2017 to December 2019, patients with coronary artery disease and confirmed myocardial ischemia by stress and rest SPECT G-MPI, and underwent coronary angiography within 3 months were enrolled. The sum stress score (SSS) and sum resting score (SRS) were analyzed by the standard 17-segment model, and the sum difference score (SDS, SDS=SSS-SRS) was calculated. The LVEF at stress and rest were analyzed by 4DM software. The LVEF reserve (ΔLVEF) was calculated (ΔLVEF=stress LVEF-rest LVEF). The primary endpoint was MACE, which was obtained by reviewing the medical record system or by telephone follow-up once every twelve months. Patients were divided into MACE-free and MACE groups. Spearman correlation analysis was used to analyze the correlation between ΔLVEF and all MPI parameters. Cox regression analysis was used to analyze the independent factors of MACE, and the optimal SDS cutoff value for predicting MACE was determined by receiver operating characteristic curve (ROC). Kaplan-Meier survival curves were plotted to compare the difference in the incidence of MACE between different SDS groups and different ΔLVEF groups. Results: A total of 164 patients with coronary artery disease [120 male; age (58.6±10.7) years] were included. The average follow-up time was (26.5±10.4) months, and a total of 30 MACE were recorded during follow-up. Multivariate Cox regression analysis showed that SDS (HR=1.069, 95%CI: 1.005-1.137, P=0.035) and ΔLVEF (HR=0.935, 95%CI: 0.878-0.995, P=0.034) were independent predictors of MACE. According to ROC curve analysis, the optimal cut-off to predict MACE was a SDS of 5.5 with an area under the curve of 0.63 (P=0.022). Survival analysis showed that the incidence of MACE was significantly higher in the SDS≥5.5 group than in the SDS<5.5 group (27.6% vs. 13.2%, P=0.019), but the incidence of MACE was significantly lower in the ΔLVEF≥0 group than in theΔLVEF<0 group (11.0% vs. 25.6%, P=0.022). Conclusions: LVEF reserve (ΔLVEF) assessed by SPECT G-MPI serves as an independent protective factor for MACE, while SDS is an independent risk predictor in patients with coronary artery disease. SPECT G-MPI is valuable for risk stratification by assessing myocardial ischemia and LVEF.

Establishment of the normal reference values of left ventricular function parameters evaluated by CZT SPECT stress gated myocardial perfusion imaging in low-likelihood of stable coronary artery disease / 中华核医学与分子影像杂志

Objective:To establish the normal reference value of left ventricular function parameters by cadmium-zinc-tellurium (CZT) SPECT stress gated myocardial perfusion imaging (G-MPI) in low-likelihood of stable coronary artery disease (SCAD).Methods:From March 2022 to August 2022, 348 consecutive SCAD patients (146 males, 202 females, age (58±10) years) who underwent exercise or pharmacological stress G-MPI (CZT SPECT) in Beijing Anzhen Hospital, Capital Medical University were retrospectively recruited. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) were acquired using quantitative gated SPECT (QGS) analysis. EDV and ESV were corrected by body surface area (BSA) to obtain EDV index (EDVI) and ESV index (ESVI), respectively. Independent-sample t test, one-way analysis of variance and Mann-Whitney U test were used for data analysis. The influences of EDV, ESV, EDVI, ESVI and LVEF were analyzed by multiple regressions for linear models. Results:There were 314 patients with low-likelihood of SCAD (128 males, 186 females, age (58±10) years) and 34 normal controls (18 males, 16 females, age (55±10) years). There were no significant differences of basic clinical characteristics and left ventricular function parameters in different genders between 2 groups ( z values: from -1.74 to -0.02, t values: from -1.16 to 1.17, all P>0.05). Using the 95% CI as the cut-off value for left ventricular function parameters in patients with a low-likelihood of SCAD, the upper limits of EDV, ESV, EDVI and ESVI in females and males were 84 and 111 ml, 30 and 44 ml, 47 and 54 ml/m 2, 17 and 21 ml/m 2, respectively, and the lower limit of LVEF in females and males were 58% and 55%, respectively. In the low-likelihood of SCAD group, the EDV ((58±13) vs (77±17) ml) and ESV ((16±7) vs (26±9) ml) of females were smaller than those of males ( t values: 10.65, 10.35, both P<0.001), while LVEF of females was higher than that of males ((72±7)% vs (67±6)%; t=-6.23, P<0.001). However, there were no significant differences in left ventricular function parameters among different age groups with the same gender ( F values: 0.12-2.19, all P>0.05). Based on multiple regression for linear models, the primary predictors of EDV, ESV and LVEF were gender and weight ( β values: from -0.380 to 0.358, all P<0.05). Conclusions:Normal reference values of left ventricular function parameters are established by CZT SPECT stress G-MPI in low-likelihood of SCAD patients. Left ventricular EDV and ESV of females are smaller than those of males, while LVEF of females is higher than that of males. The influence of gender on left ventricular function parameters should be considered in clinical practice.

Whole exome sequencing analysis of a patient with 45,X/46,XY mosaicism and autism spectrum disorder / 中华医学遗传学杂志

OBJECTIVE@#To carry out genetic testing for a patient with 45,X/46,XY mosaicism and autism spectrum disorder (ASD).@*METHODS@#Peripheral blood samples of the patient and his parents were collected for the extraction of genomic DNA. Trio-based whole exome sequencing and Sanger sequencing were carried out thereafter.@*RESULTS@#The proband and his father were found to harbor a heterozygous c.4781G>A (p.Arg1594Gln) variant of the CACNA1I gene. In addition, the proband was also found to harbor a de novo c.268C>T (p.Arg90Trp) missense variant of the MTRR gene. Based on guidelines of the American College of Medical Genetics and Genomics (ACMG), the c.4781G>A (p.Arg1594Gln) variant of the CACNA1I gene was predicted to be pathogenic (PVS1, PM1, PM2, PP3), while the c.268C>T (p.Arg90Trp) variant of the MTRR gene was predicted to be of uncertain significance.@*CONCLUSION@#Variants of the CACNA1I and MTRR genes, together with the chromosomal mosaicism, may have predisposed to the susceptibility to the ASD in this patient.

The clinical value of 18F-FDG PET/CT dual-time-point imaging in diagnosing aortic graft infection / 中华胸心血管外科杂志

Objective:To explore the diagnostic value of 18F-deoxyglucose (FDG) PET/CT dual-time-point imaging (DTPI) in the diagnosis of aortic grafts infection (AGI). Methods:Forty-two patients with suspected AGI were prospectively recruited in this DTPI study from October 2014 to October 2021. There were 35(83%) males and 7 females, mean age (54±15) years old, range 22-79 years old. PET/CT image quality was scored as 5 grading scale. Semi-quantitative analysis of DTPI data was performed using maximum standardized uptake value (SUVmax) of suspected AGI lesions. The percentage of SUVmax change between initial and delayed images were recorded as retention index (RI). Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used as the diagnostic reference criteria for AGI.Results:According to the MAGIC criteria, 27 patients (64%) were positive for AGI, and 15 patients (36%) were negative. The mean RI of AGI was higher than that of non-AGI ones[(26.7±18.9)% vs. (6.4 ±18.8)%, P<0.01]. The sensitivity, specificity, and accuracy of initial SUVmax ≥6 with the presence of AGI was 88.9%, 73.3%, and 83.3%, respectively. Delayed SUVmax ≥6 improved the sensitivity (96.3%) and accuracy (88.1%) for diagnosing AGI. DTPI with 15% increment as the optimal cut-off value of RI improved the specificity (93.3%) and accuracy (90.5%) for diagnosing AGI. Fifteen (56%, 15/27) AGI patients had improved image quality grading on the delayed images, leading to more accurately delineating the detailed extent of the infected aortic graft. Conclusion:18F-FDG PET/CT DTPI has better diagnostic performance for AGI than conventional Single-time-point PET/CT imaging by improving image quality as well as enhancing delineation of infected aortic graft extent.

Gracilis musculocutaneous flap in repair of perineal soft tissue defect with open pelvic fracture / 中华显微外科杂志

Objective:To investigate the clinical effect of gracilis musculocutaneous flap in repair of perineal soft defect with open pelvic fracture.Methods:From June 2009 to June 2019, 11 cases of open pelvic fracture associated with perineal injury were treated in the Department of Trauma and Orthopaedic of 521 Hospital of Norinco Group. There were 4 males and 7 females aged 16-56 (33 in average) years old. Cause of injuries: 6 cases by traffic accident, 4 by falling from height, and 1 by crushing. All the patients had open pelvic fractures. According to Tile classification, 1 case was rated as type A, 7 as type B and 3 as type C. All the patients were accompanied with perineal injury and soft tissue defect. The wound sizes ranged from 5 cm×5 cm to 8 cm×12 cm. The defects were repaired with gracilis musculocutaneous flap. The size of gracilis myocutaneous flaps was 6 cm×5 cm to 9 cm×13 cm. All donor areas of the flap were sutured directly. After surgery, 11 patients treated with strengthened nutritional support, keep supine position to avoid abduction, and appropriately raise the lower limbs. Follow-ups were conducted regularly after surgery.Results:All patients entered 6 to 30 (22 in average) months of follow-up. All of 11 myocutaneous flaps survived, besides 1 had a few necrosis at the distal surface of the myocutaneous flap, and healed after change of dressing. All the incisions at donor site had stage I healing. The colour, texture and flexibility of the gracilis myocutaneous flap were good. There was a scar at the donor sites without causing obvious dysfunction. Over the follow-up period, there was no failure of flap in either the recipient and donor sites. The patients were satisfied with the appearance and function.Conclusion:Gracilis musculocutaneous flap is one of the ideal methods in repair of perineal soft tissue defect with open pelvic fracture.

A study on KIF1A gene missense variant analysis and its protein expression and structure profiles of an autism spectrum disorder family trio / 中华医学遗传学杂志

OBJECTIVE@#To analyze the pathogenic variants of the KIF1A gene and its corresponding protein structure in an autism spectrum disorder (ASD) family trio carrying harmful missense variants in the KIF1A gene.@*METHODS@#The peripheral blood DNA of the patient and his parents was extracted and sequenced using whole exome sequencing (WES) technology and verified by Sanger sequencing. Bioinformatics software SIFT, PolyPhen-2, Mutation Taster, and CADD software were used to analyze the harmfulness and conservation of variants. The Human Brain Transcriptome (HBT) database was used to analyze the expression of the KIF1A gene in the brain. PredictProtein and SWISS-MODEL were further used to predict the secondary structure and tertiary structure of KIF1A wild-type protein and variant protein. PyMOL V2.4 was utilized to investigate the change of hydrogen bond connection after protein variant.@*RESULTS@#The WES sequencing revealed a missense variant c.664A>C (p.Asn222His) in the child's KIF1A gene, and this variant was a de novo variant. The harmfulness prediction results suggest that this variant is harmful. By analyzing expression level of KIF1A gene in the brain. It is found that KIF1A gene widely expressed in various brain regions during embryonic development. By analyzing the variant protein structure, the missense variant of KIF1A will cause many changes in the secondary structure of protein, such as alpha-helix, beta-strand, and protein binding domain. The connection of hydrogen bond and spatial structure will also change, thereby changing the original biological function.@*CONCLUSION@#The KIF1A gene may be a risk gene for ASD.

Associations of impaired glucose metabolism with chronic peridontitis in pre-diabetes patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the associations of impaired glucose metabolism and insulin resistance with chronic periodontitis in pre-diabetes patients.@*METHODS@#A cross-sectional analysis was conducted and we included a total of 171 pre-diabetes patients aged 30-65 years, free of diabetes. pre-diabetes was defined as impaired fasting glucose (IFG) [fasting glucose (FG): 6.1-7.0 mmol/L] and/or impaired glucose tolerance (IGT) [oral glucose tolerance test (OGTT): 7.8-11.0 mmol/L]. Chronic periodontitis was defined according to Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) definition and the patients were divided into mild, moderate, and severe chronic periodontitis groups [mild: at least two interproximal sites with clinical attachment loss (CAL) ≥3 mm and at least two interproxima sites with probing depth (PD) ≥4 mm or 1 site with PD≥5 mm; moderate: at least two interproximal sites with CAL ≥4 mm and at least two interproxima sites with at least two interproximal sites with PD ≥5 mm; severe: at least two interproximal sites with CAL ≥6 mm and at least one interproxima site with at least two interproximal sites with PD≥5 mm]. A periodontal examination indexes [plaque index (PLI), PD, CAL, and bleeding on probing (BOP)] and glucose metabolism indexes [FG, OGTT, hemoglobinA1c (HbA1c), fasting insulin and homeostasis model assessments of insulin resistance (HOMA-IR)] were measured. The association of glucose metabolism and chronic periodontitis was investigated by multivariable logistic regression analysis.@*RESULTS@#FG in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, HOMA-IR in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, OGTT in the severe chronic periodntitis group was significantly higher compared with mild chronic peridontitis group and moderate chronic periodontitis groups, and there was no significant difference between moderate and mild chronic periodontitis groups. For the insulin and HbA1c, there was no significant difference among mild, moderate and severe chronic periodontitis groups. After multivariable adjustment of age, gender, smoking status, hypertension and body mass index, IFG (OR=1.39, 95%CI: 1.01-1.98) and HOMA-IR (OR=1.36, 95%CI: 1.04-1.76) were associated with moderate periodontitis; IFG (OR=1.64, 95%CI: 1.17-2.40), IGT (OR=1.65, 95%CI: 1.21-2.26), and HOMA-IR (OR=1.72, 95%CI: 1.23-2.41) were significantly associated with severe periodontitis.@*CONCLUSION@#Our data provided evidences that impaired glucose metabolism were associated with chronic periodontitis among pre-diabetes patients.

Case control study on micro external fixator in treating supracondylar fracture of humerus in children / 中国骨伤

OBJECTIVE@#To explore clinical effects of micro external fixator for the treatment of supracondylar fracture of humerus in children.@*METHODS@#From October 2017 to December 2018, 20 children with supracondylar fracture of humerus (treatment group) were admitted and treated with micro-external fixation after closed reduction, including 14 males and 6 females, aged from 6 to 14 years old with an average of (7.9±2.4) years old, classified to Gartland Ⅲ. Thirty nine children with supracondylar fracture of humerus were admitted as control group from January 2015 to September 2017, and treated with closed reduction Kirschner wire fixation. Among them, including 24 males and 15 females, aged from 6 to 14 years old with an average of (8.1±1.9) years old, classified to GartlandⅢ. Operation time, times of intraoperative fluoroscopy, and complications between two groups were observed and compared, Mayo scoring system at the latest follow up was used to evaluate clinical effect.@*RESULTS@#Twenty children in treatment group were followed up from 6 to 12 months with an average of (8.0±2.5) months, operation time was(30.10±12.50) min, times of intraoperative fluoroscopy was(10.00±2.50). Fifteen patients got excellent results, 3 good, 2 fair according to Mayo elbow joint scoring. No ulnar nerve injury moderate or severe elbow varus occurred in treatment group. Thirty-nine children in control group were followed up from 5 to 13 months with an average of (9.0±3.1) months, operation time was(45.60±18.90) min, times of intraoperative fluoroscopy was(19.00±5.60). Twenty-three patients got excellent results, 12 good, 3 fair and 1 poor according to Mayo elbow joint scoring. One child occurred ulnar nerve injury and recovered at the final follow-up, 1 child occurred severe cubitus varus and 2 children occurred moderate cubitus varus. There was no statistical difference in clinical effect between two groups (@*CONCLUSION@#Treated with closedreduction and mini external fixator fixed on children humerus condyle fracture could receive the same clinical result as closed as reduction gram needle fixation, which has advantages of shorter operation time, less times of intraoperative fluoroscopy, not esay to damage ulnar nerve during operation, less incidence of moderate and severe cubitus varus deformity after operation, and the permeation was simple.

Influence of local anesthesia on the outcomes of non-surgical periodontal treatment / 中华医学杂志(英文版)

BACKGROUND@#There is limited evidence of the effects of local anesthesia (LA) on outcomes of non-surgical periodontal treatment (NSPT), in particular among the Chinese. This retrospective cohort study aimed to evaluate the effects of LA on short-term treatment outcomes of NSPT and to determine under what circumstances LA should be prescribed to improve these outcomes.@*METHODS@#Data from periodontal examinations of 3980 patients were used. The data were from 3-month re-evaluation records of an electronic periodontal charting record system in the Department of Periodontology of Peking University School and Hospital of Stomatology from June 2008 to January 2015. Descriptive analyses included changes in probing depth (PD) and the Mazza bleeding index (BI). Two-level (patient and tooth) logistic regression models and three-level (patient, tooth, and site) linear regression models were constructed to analyze the influence of LA on PD for all teeth/sites and teeth/sites with an initial PD ≥ 5 mm. Decreases in PD and BI at sites under LA using the initial PD were also compared.@*RESULTS@#A significantly higher mean decrease in PD after NSPT was found in the LA group than in the no local anesthesia (NLA) group (0.98 vs. 0.54 mm, t = 24.12, P  1 and BI > 2) for all teeth (16.7% vs. 13.8%, t = 3.75, P < 0.001; 34.7% vs. 28.1%, t = 6.73, P < 0.001) and PD for teeth with PD ≥ 5 mm (32.3% vs. 17.3%, t = 28.48, P < 0.001). The difference in PD between the LA and NLA groups increased as the initial PD increased. The difference between the two groups was 0.12 to 0.22 mm for sites with a baseline PD < 7 mm; however, it increased to 0.41 to 1.37 mm for sites with a baseline PD ≥ 7 mm.@*CONCLUSIONS@#LA improved the decrease in PD after NSPT. Root debridement at sites with initial PD ≥ 7 mm should be performed under routine LA.

Comparisons of clinical effects between hollow screw tension band internal fixation and Kirschner wire tension band internal fixation for patellar fracture / 中国综合临床

Objective:To compare the clinical effect of hollow screw tension band internal fixation and Kirschner wire tension band internal fixation for patellar fracture, so as to provide reference for clinical operation.Methods:A retrospective case-control study was conducted to analyze the clinical data of 82 patients with transverse patellar fracture admitted to the Department of Orthopedics of Linxi Hospital of Kailuan general hospital and the Department of orthopedics of Tangshan Central Hospital from May 2016 to October 2018.According to different operation methods, they were divided into Kirschner wire group (44 cases) and cannulated screw group (38 cases). The Kirschner wire group was treated with Kirschner wire tension band internal fixation, and the hollow screw group was treated with cannulated screw tension band internal fixation. The operation conditions, postoperative complications and postoperative knee function recovery of the two groups were compared.Results:The operation time of hollow screw group was significantly longer than that of Kirschner wire group((68.25±10.81) min vs.(59.72±12.32) min, t=3.31, P<0.05). Fracture healing time of hollow screw group was significantly shorter than that of Kirschner wire group((3.12±0.40) month vs.(3.68±0.45) month, t=5.91, P<0.05). B?stmanscores of the two groups increased significantly with time( Fintra-group=74.69, P<0.05). The B?stmanscore of cannulated screw group was significantly higher than that of Kirschner wire group ( Finteraction=4.87, P<0.05). The B?stmanscore of hollow screw group was significantly higher than that of Kirschner wire group( Finter-group=7.52, P<0.05). VAS scores in both decreased significantly with time( Finter-group=86.24, P<0.05). The decreasing of visual analogue scale (VAS) score in hollow screw group was significantly higher than that in Kirschner wire group( Finteraction=6.62, P<0.05). The VAS score in hollow screw group was significantly lower than that in Kirschner wire group ( Finter-group=7.74, P<0.05). The postoperative complications were 20.5% (9/44) in Kirschner wire group and 5.3% (2/38) in hollow screw group.The incidence of adverse reactions in hollow screw group was lower than that in Kirschner wire group (χ 2=4.05, P<0.05). The excellent and good rates of Kirschner wire group and cannulated screw group were 86.4% (38/44) and 94.7% (36/38), respectively, with no significant difference (χ 2=0.51, P>0.05). Conclusion:The results show that the two methods have the same effect on patella fracture, but the hollow screw tension band internal fixation has less trauma and less complications, which is conducive to the recovery of knee joint function.

Clinical analysis of arthroscopic minimally invasive Kirschner wire tension band internal fixation for transverse patellar fracture / 中国综合临床

Objective:To investigate the clinical effect of arthroscopic minimally invasive Kirschner wire tension band internal fixation in the treatment of transverse patellar fracture.Methods:From March 2016 to March 2018, 108 patients with transverse patellar fracture admitted to the Department of orthopedics, Linxi hospital, Kailuan general hospital, Hebei Province were analyzed retrospectively.According to the different operation methods, the patients were divided into arthroscopic group (68 cases) and control group (40 cases). The patients in the arthroscopic group were treated with arthroscopic minimally invasive Kirschner wire tension band internal fixation, and the patients in control group were treated with open reduction and Kirschner wire tension band internal fixation.The operation condition, clinical efficacy, Lysholm score and visual analogue scale(VAS) score were compared between the two groups.Results:The incision length((3.5±0.8) cm) of arthroscopic group was shorter than that of control group((13.7±2.2) cm), the amount of intraoperative bleeding ((47.4±12.5) ml) was significantly less than that of control group ((86.9±14.7) ml), and the length of hospitalization((11.8±2.6) d) and fracture healing time ((11.5±2.4) weeks)were significantly less than those in control group ((15.8±3.0) d, (15.7±2.8) weeks), the difference was statistically significant( t value were 34.63, 14.85, 7.29, 8.25; all P<0.05). The Lysholm score of two groups increased significantly with time( Fintra-group=87.53, P<0.05). The increasing of Lysholm score in arthroscopic group was significantly higher than that in control group( Finteraction=7.64, P<0.05). The overall level of Lysholm in arthroscopic group was significantly higher than that of control group( Finter-group=11.42, P<0.05). The VAS score of two groups decreased significantly with time( Fintra-group=76.47, P<0.05). The decreased of VAS score in arthroscopic group was significantly higher than that in control group( Finteraction=9.96, P<0.05). The overall level of VASin arthroscopic group was significantly lower than that of control group( Finter-group=10.38, P<0.05). Conclusion:Arthroscopic minimally invasive Kirschner wire tension band internal fixation for the treatment of transverse patellar fracture has better efficacy and safety, less injury, less pain after operation.

Clinical value of 18F-FDG PET/CT in distinguishing benign from malignant cardiac tumors / 中华核医学与分子影像杂志

Objective:To evaluate the clinical value of 18F-fluorodexoyglucose (FDG) PET/CT in distinguishing benign from malignant tumors in patients with cardiac tumors. Methods:Between January 2015 and September 2018, 18F-FDG PET/CT was performed in 3 678 patents in Beijing Anzhen Hospital, and 51 of them (51/3 678, 1.39%) were diagnosed as cardiac tumors. Finally, 28 patients (10 males, 18 females; mean age (52±14) years, age range: 18-84 years) with pathological results were included. According to pathological results, patients were divided into 4 groups: group 1 with primary benign cardiac tumor ( n=9), group 2 with primary malignant cardiac tumor ( n=9), group 3 with lymphoma ( n=6) and group 4 with secondary malignant cardiac tumor ( n=4). All patients underwent early (60 min) 18F-FDG PET/CT imaging and 22 patients (6, 7, 6, 3 patients in group 1, group 2, group 3, group 4 respectively) underwent delayed (120 min) imaging. The maximum standardized uptake value (SUV max) and target/backgroud ratio (TBR) of 4 groups in early imaging and delayed imaging were calculated and compared with one-way analysis of viariace and Scheffe Post-hoc test. TBR were calcualted as SUV max/mean standardized uptake value (SUV mean) in the liver. Receiver operating characteristic (ROC) curve analysis was also performed. Results:SUV max during early imaging, defined SUV max(early), was 2.6±1.5, 9.9±4.0, 20.5±6.1, 9.2±5.8 in group 1-4 respectively ( F=21.39, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). TBR early was 1.1±0.6, 4.1±1.6, 9.4±2.6, 3.7±2.0 in the 4 groups ( F=29.15, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). SUV max in delayed imaging (SUV max(delay)) was 2.4±1.2, 11.0±5.9, 25.8±7.7, 13.7±7.7 respectively in the 4 groups ( F=16.01, P<0.01). TBR delay was also significantly different among the 4 groups (1.3±0.7, 5.5±2.9, 14.4±4.9, 7.9±5.0; F=14.78, P<0.01), the value of group 3 was higher than that of group 1 and 2 (all P<0.05). ROC curve analysis showed optimal cut-off values for indicating malignancy were: SUV max(early)=4.2, TBR early=1.6, SUV max(delay)=4.6, TBR delay=1.9. The corresponding sensitivities, specificities, accuracies were 19/19, 8/9, 96.4%(27/28); 19/19, 7/9, 92.9%(26/28); 16/16, 6/6, 100%(22/22); 16/16, 5/6, 95.5%(21/22), respectively. Conclusions:18F-FDG PET/CT imaging can accurately diagnose malignant cardiac tumors. Delayed imaging can further improve the accuracy for diagnosis of malignant cardiac tumors.

18F-FDG PET/CT images quality and its impact factors in diabetic and non-diabetic patients with coronary artery disease / 中华核医学与分子影像杂志

Objective:To evaluate the image quality (IQ) of 18F-fluorodeoxyglucose (FDG) PET/CT imaging and identify its influenfial factors in diabetes mellitus (DM) and non-DM patients with coronary artery disease (CAD). Methods:A total of 196 consecutive CAD patients (174 males, 22 females, 68 DM; age: (57±10) years) in Beijing Anzhen Hospital between June 2016 and February 2018 were retrospectively analyzed. All patients underwent 18F-FDG myocardial PET/CT imaging. The standardized fasting+ oral glucose loading (OGL) and intravenously injection of insulin protocol was performed. According to the FDG uptake by myocardium, background activity in blood and other visceral organ nearby the heart, the IQ was visually evaluated and scored by 0-4. Zero-two was considered as good IQ, 3-4 was regarded as poor IQ. Patients were divided into three groups: group 1 (non-DM+ good IQ), group 2 (DM+ good IQ), group 3 (DM+ poor IQ). Factors which may affect IQ were analyzed, which including OGL, the injection dose of insulin, fasting blood glucose (FBG), peak blood glucose (PBG), blood glucose (BG) level at 18F-FDG injection (BG injnection), BG increasing rate ((PBG-FBG)/FBG, %), and BG decreasing rate ((PBG-BG injection)/PBG, %). One-way analysis of variance, Spearman correlation analysis and logistic regression analysis were used for data analysis. Results:There were significant differences ( F values: 13.074-38.371, all P<0.05) of FBG, PBG, OGL, BG decreasing rate and the injection dose of insulin among group 1 ( n=132, 67.3%), group 2 ( n=53, 27.1%), group 3 ( n=11, 5.6%). All those parameters, except for OGL, were positively correlated with FDG PET/CT IQ ( r s values: 0.142-0.262, all P<0.05). OGL was negatively correlated with IQ ( r s=-0.324, P<0.05). Logistic regression analysis showed that FBG (odds ratio ( OR)=0.687, 95% CI: 0.633-0.746), PBG( OR=0.786, 95% CI: 0.746~0.829), BG injection( OR=0.631, 95% CI: 0.595-0.716), OGL( OR=0.897, 95% CI: 0.873-0.922), the injection dose of insulin( OR=0.680, 95% CI: 0.618-0.748) were predictive factors (all P<0.01) for good IQ in all patients. For DM patients, OGL was the only predictive factor for good IQ( OR =0.940, 95% CI: 0.904-0.960; P<0.01). Conclusions:FBG, PBG, BG injection, OGL, the injection dose of insulin can predict IQ for all patients with CAD. For DM patients with CAD, OGL is the only predictive factor for good IQ. A good IQ of 18F-FDG PET/CT could be obtained in majority of CAD patients, with the standardized fasting + OGL and intravenously injection of insulin protocol and adjust according to the personal status, and prevent the hypoglycemia from happening.

A surgical classification system for the management of axial primary malignant and aggressive benign tumors and its application in multiple tertiary centers / 中华骨科杂志

Objective:To propose and verify a surgical classification system for the axial primary malignant and aggressive benign tumor.Methods:The CZH surgical classification system was originally developed for the axial primary malignant and aggressive benign tumor. The CZH surgical classification system includes seven types, according to the anatomic features and the extension of tumor violation. A total of 136 patients (79 males and 57 females) with axial primary malignant and aggressive benign tumor from multiple tertiary centers who received surgery from July 2006 to July 2019 were included. The average age was 44.40±17.55 years (8-83 years) old. There were 99 malignant tumors and 37 aggressive benign tumors included. The number of patients with each classification was presented as followed, Type I 13, Type II 15, Type IIIa 3, Type IIIb 20, Type IVa 43, Type IVb 12, Type Va 21, Type Vb 3, Type VI 2, Type VIIa 3 and Type VIIb 1. Surgical procedures were selected according to different types in classification. The inter- and intra-observer consistencies were evaluated by the Kendall's W test. The VAS, Frankel score, overall survival and recurrence free survival were recorded during the follow-up. Results:The inter- and intra-observer consistent coefficient was 0.973 and 0.996, respectively ( P<0.05). The single posterior approach was adopted for the Type II tumors. Other patients underwent surgery by the combined antero-posterior approach. The majority in anterior approach (113 cases) was the modified submandibular approach. The reconstruction modes included anterior "T" shape titanium mesh (112 cases) or the 3D printed prothesis (7 cases) combined with the posterior occipto-cervical fusion (92 cases) or the pedicle screw system (44 cases). The average surgical duration and the volume of intraoperative bleeding was 348.40±136.14 min (60-760 min) and 1 225.69±859.40 ml (80-4 000 ml), respectively. The operation duration and volume of intraoperative bleeding among each type were with statistical difference. The patients with Type IV, V tumors had longer operation duration than those with Type II tumors. Those with Type V and VII tumors had longer operation duration than those with Type I tumors. The patients with Type V tumors had more intraoperative bleeding than those with Type I-IV tumors. The average preoperative VAS score was 4.15±2.25 and then was reduced significantly to 0.62±0.71 and 0.38±0.59 at one and three months after operation, respectively. The Frankel score was also significantly ameliorated at one and three months postoperatively. There were 22 postoperative complications (16.2%). The complications included cerebral spinal fluid leak (12.5%), dysphagia and/or dysphonia (7.4%), dyspnea (5.1%), wound infection (3.7%), wound hemorrhage (2.2%) and pharyngeal dehiscence (1.5%). The incidence of postoperative complication was 25.9% in Type IV-VII tumors, while 11.8% in Type I-III tumors. Conclusion:CZH surgical classification system was verified with high observer consistency. This classification system could assist surgeons to select proper surgical approaches, resection modes and reconstruction modes, and thus ensure the safety of surgery and reduce the recurrence. The tumors in Type IV, V and VII may be with more challenging for surgeons. The incidence of postoperative complication in Type IV-VII tumors may be higher than that in Type I-III tumors.

Analysis of common genetic variants associated with neuro-synapse development among 60 family trios affected with sporadic autism spectrum disorders / 中华医学遗传学杂志

Objective@#To explore susceptibility genes for autism spectrum disorders (ASD).@*Methods@#Whole-exome sequencing was carried out for 60 family trios affected with sporadic ASD. Genetic variants discovered in over 10% of the patients were selected for genotype-phenotype correlation and pathway enrichment analysis using Phenolyzer software and metascape database. Combining gene-phenotypic scores, pathway-related genes associated with neural and neurite triggering were screened for the candidates.@*Results@#A total of 170 common variants were found to be associated with the ASD phenotype. Among these, there was only one high-confidence gene [SHANK2 (0.8146)] and four medium-confidence genes [ERBB2 (0.1322), LAMC3 (0.1117), PPFIA4 (0.1059), DISC1 (0.1002)]. Twenty-pathways and four biological processes were found to be statistically significant by pathway enrichment analysis, which included neuron projection morphogenesis (GO: 0048812), regulation of neuroblast proliferation (GO: 1902692), modulation of excitatory postsynaptic potential (GO: 0098815), and dendrite morphogenesis (GO: 0048813). Twenty-one genes were found to be closely associated with neurological and neurite triggering, among which only SHANK2, ERBB2, and DISC1 had above-medium confidence correlation scores with the ASD phenotypes.@*Conclusion@#Abnormal neuron projection morphogenesis (GO: 0048812) may be closely related to the occurrence of ASD. SHANK2, ERBB2, and DISC1 are susceptibility genes for ASD.

Analysis of common genetic variants associated with neuro-synapse development among 60 family trios affected with sporadic autism spectrum disorders / 中华医学遗传学杂志

OBJECTIVE@#To explore susceptibility genes for autism spectrum disorders (ASD).@*METHODS@#Whole-exome sequencing was carried out for 60 family trios affected with sporadic ASD. Genetic variants discovered in over 10% of the patients were selected for genotype-phenotype correlation and pathway enrichment analysis using Phenolyzer software and metascape database. Combining gene-phenotypic scores, pathway-related genes associated with neural and neurite triggering were screened for the candidates.@*RESULTS@#A total of 170 common variants were found to be associated with the ASD phenotype. Among these, there was only one high-confidence gene [SHANK2(0.8146)] and four medium-confidence genes [ERBB2(0.1322), LAMC3(0.1117), PPFIA4(0.1059), DISC1(0.1002)]. Twenty-pathways and four biological processes were found to be statistically significant by pathway enrichment analysis, which included neuron projection morphogenesis (GO: 0048812), regulation of neuroblast proliferation (GO: 1902692), modulation of excitatory postsynaptic potential (GO: 0098815), and dendrite morphogenesis (GO: 0048813). Twenty-one genes were found to be closely associated with neurological and neurite triggering, among which only SHANK2, ERBB2, and DISC1 had above-medium confidence correlation scores with the ASD phenotypes.@*CONCLUSION@#Abnormal neuron projection morphogenesis (GO: 0048812) may be closely related to the occurrence of ASD. SHANK2, ERBB2, and DISC1 are susceptibility genes for ASD.

Effect of orthodontic tooth movement on keratinized gingival width / 北京大学学报(医学版)

OBJECTIVE@#The relationship between the orthodontic tooth movement and the change of keratinized gingival width was analyzed by measuring the keratinized gingival width and position of the teeth before and after 28 orthodontic treatments.@*METHODS@#The photos were matched to the model and the width of the keratinized gingival was obtained by measuring the length of the crown, and the keratinized gingiva. The pre- and post-treatment models were overlapped on rapidform 2006 and the change of tooth position before and after orthodontic movement could be accurately measured, and the relationship between tooth intrusion and extrusion, retraction and forward movement, torque variation and keratinized gingival width was statistically investigated.@*RESULTS@#Analysis of the correlation between data before and after treatments for 213 teeth in 28 patients revealed a strong correlation between changes in tooth torque angle and changes in keratinized gingiva width (r=-0.47, P<0.001). In the multi-level linear regression analysis, the correlation between them was verified (regression coefficient<0, P<0.001), and there was no significant correlation between the intrusion and retraction of the teeth and the change of the width of keratinized gingiva (P>0.05). Regression coefficient was negatively relative to the reference incisor between the teeth for the canines and premolars (canine regression coefficient=-0.35, premolar regression coefficient=-0.38, P<0.05). Therefore, the study found that there was a strong negative correlation between the changes in tooth torque angle and width of keratinized gingival (r=-0.41, P<0.001), that is, an increase in positive torque led to the reduction of width of keratinized gingiva, and on the contrary the increase of negative torque would cause the width of keratinized gingiva increase. There was no significant correlation between the intrusion and extrusion of the teeth for the width of keratinized gingiva. The sensitivity of different teeth for the width of keratinized gingiva differed, with incisor compared with canines and premolars that were more prone to keratinized gingiva width changes.@*CONCLUSION@#Tooth movement during orthodontics affected the width of the keratinized gingiva width, and the increase in positive torque was more likely to cause a reduction in the width of keratinized gingiva. There was no significant correlation between the intrusion and retraction of the teeth and the change in the width of keratinized gingiva. Incisors were more prone to changes in the width of keratinized gingiva relative to the cuspids and premolars during tooth movement. In the orthodontic process, it is possible to predict the effect of changes in the position of the teeth on the keratinized gingiva width, and attention shoud be to the changes in the keratinized gingiva width.

Occlusal changes before and after orthodontic treatment in patients with aggressive periodontitis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of occlusal improvement in the labial fixed orthodontic treatment in aggressive periodontitis patients and to explore the relationship between occlusal improvement and inflammation control.@*METHODS@#Twenty-two aggressive periodontitis patients who underwent combined periodontal-orthodontic treatment were included in this study. The patient's photos were matched to the dental models and digital three dimentional models were acquired using 3Shape R700 laser scanner. The occlusal force distribution maps were generated in the OrthoAnalyzer software. The newly established occlusal force distribution score (OFDS) and proximal contact score (PCS) were used to evaluate the occlusal distribution changes before and after labial fixed orthodontic treatment for assessing the effectiveness of orthodontic treatment. The multi-level linear regression analysis was used to explore the relationship between the probing depth changes and OFDS or PCS changes to screen out the favorable orthodontic strategy for inflammation control, which would provide clinical strategy for combined periodontal-orthodontic treatment in aggressive periodontitis patients.@*RESULTS@#At the patient level, OFDS was improved significantly after orthodontic treatment compared with the score before orthodontic treatment (84.5±20.9 vs.105.3±22.6, P <0.001) and PCS was improved significantly after orthodontic treatment compared with the score before orthodontic treatment (68.9±9.1 vs. 83.7±6.3, P <0.001).At the tooth level, the OFDS was significantly increased in the maxillary anterior teeth (P <0.001) while the PCS of the anterior teeth in both maxillary and mandible arches were significantly increased significantly (P <0.01). No significant changes were found in other tooth positions. The multilevel linear regression model showed that no significant correlation was found between age and gender and probing depth decrease (P >0.05). The baseline probing depth,OFDS improvements and PCS improvements (P <0.001) were positively correlated with probing depth decrease.@*CONCLUSION@#This study showed that the distribution of occlusal force was more reasonable and the proximal contacts were more ideal in aggressive periodontitis patients. Orthodontic treatment was effective in improving occlusal force distribution by the above two ways. Especially, the OFDS and PCS improvements were both positively correlated with probing depth decrease, indicating that in the combined periodontal-orthodontic treatment for aggressive periodontitis patients, occlusal force distribution and proximal contact should be improved in order to facilitate periodontal improvement.