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Objective:To investigate the expression of high mobility group protein 1 (HMGB1) and interleukin-17 (IL-17) in peripheral blood and membrane tissues of pregnant women with premature rupture of membranes (PROM) and its relationship with intrauterine infection.Methods:Seventy-four pregnant women with PROM from January 2019 to June 2021 were selected as the study group, and 58 healthy pregnant women at the corresponding period were selected as the healthy control group. The levels of HMGB1 and IL-17 in peripheral blood and membrane tissues and serum CD 8+ were compared between the two groups. The pregnant women with PROM were divided into the chorioamnionitis group, subclinical chorioamnionitis group and normal group according to their intrauterine infection, the expression levels of HMGB1 and IL-17 in peripheral blood and membrane tissues of patients with different infection degrees were compared, and the correlation with the severity of intrauterine infection were analyzed. Results:The levels of peripheral blood HMGB1, membrane tissues HMGB1, peripheral blood IL-17, membrane tissues IL-17 and serum CD 8+ in the study group were higher than those in the control group: (28.34 ± 5.16) μg/L vs. (22.51 ± 4.09) μg/L, 0.79 ± 0.12 vs. 0.34 ± 0.05, (13.05 ± 2.57) ng/L vs. (8.16 ± 1.38) ng/L, 0.37 ± 0.06 vs. 0.12 ± 0.02, 0.386 ± 0.052 vs. 0.252 ± 0.044, there were statistical differences ( P<0.05). The levels of HMGB1 and IL-17 in peripheral blood and membrane tissues and serum CD 8+ were increased with the severity of severity of intrauterine infection ( P<0.05). The results of Spearman correlation analysis showed that the level of peripheral blood HMGB1, membrane tissues HMGB1 and IL-17 had positively correlated with the severity of intrauterine infection ( r = 0.336, 0.316, 0.311, P<0.05). The results of receiver operating characteristic curve analysis showed that combined detection of HMGB1 and IL-17 levels in peripheral blood and membrane tissues and serum CD 8+ levels in evaluating the severity of intrauterine infection had higher area under the curve than that of each index alone ( P<0.05). Conclusions:Pregnant women with PROM have abnormal HMGB1 and IL-17 levels in peripheral blood and membrane tissues, and HMGB1 levels in peripheral blood and mRNA expressions of HMGB1 and IL-17 in membrane tissues are positively correlated with the severity of intrauterine infection, which has evaluation value for the severity of the disease.
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Objective:To observe the clinical effect of the cannula under laparoscopy, percutaneous puncture cannula, and conventional surgery cannula for peritoneal dialysis.Methods:From May 3, 2015 to February 14, 2020, 87 patients with end-stage renal disease needing peritoneal dialysis in Ningbo Zhenhai People's Hospital were enrolled. These patients were divided into three groups including cannula under laparoscopy (23 cases), percutaneous puncture cannula (29 cases), and conventional surgery cannula (35 cases). The baseline characteristics, perioperative conditions (surgical time, post-surgical hospitalization time), the incidence of recent complications (abdominal hemorrhage, direct abdominal hemorrhage, incision pain, leakage, catheter shift, peritonitis), and long-term complications (catheter shift, peritonitis, hernia, thoracic and abdominal fistula, abdominal tube obstruction) among the three groups were compared.Results:Compared with the group of conventional surgery cannula, the operation time in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly shorter (minutes: 32.5±12.3, 28.9±11.8 vs. 61.3±15.4, both P < 0.05), the in-hospital stay in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were reduced (days: 9.8±3.4, 9.2±2.6 vs. 10.7±3.2), but there was no statistical significance among the three groups ( P > 0.05). The incidence of abdominal bleeding, rectus abdominis bleeding, and incision pain in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly lower than those in the group of conventional surgery cannula [incidence of abdominal bleeding: 4.3% (1/23), 3.4% (1/29) vs. 22.9% (8/35), incidence of rectus abdominis bleeding: 4.3% (1/23), 3.4% (1/29) vs. 22.9% (8/35), incidence of incision pain: 8.7% (2/23), 10.3% (3/29) vs. 42.9% (15/35), all P < 0.01]. The difference between the group of cannula under laparoscopy and the group of percutaneous puncture cannula had no statistical significance. Compared with the group of conventional surgery cannula and the group of percutaneous puncture cannula, the incidence of catheter displacement in the group of cannula under laparoscopy was significantly reduced [4.3% (1/23) vs. 27.6% (8/29), 31.4% (11/35), both P < 0.05]. Compared with the group of conventional surgery cannula and the group of percutaneous puncture cannula, the incidence of catheter displacement in long-term complications in the group of cannula under laparoscopy was significantly reduced [4.3% (1/23) vs. 24.1% (7/29), 31.4% (11/35), both P < 0.05], however, the difference of that between the group of conventional surgery cannula and the group of percutaneous puncture cannula was not statistically significant. The incidence of hernia in the group of cannula under laparoscopy was significantly higher than that in the group of percutaneous puncture cannula or in the group of conventional surgery cannula [21.7% (5/23) vs. 3.4% (1/29), 2.8% (1/35), both P < 0.05], and all of that were umbilical hernia, however, the difference of that between the group of percutaneous puncture cannula and the group of conventional surgery cannula was not statistically significant. Conclusion:Compared with the traditional conventional surgical cannula placement methods, percutaneous puncture has the advantages of simple operation, short operation time, small trauma, but still cannot reduce the incidence of drift tube; laparoscopic peritoneal dialysis tube has the advantages of short operation time, small trauma and low catheter displacement rate, but increases the risk of umbilical hernia.
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Objective:To investigate the effect of CD 8+ CD 25+ FoxP3 + regulatory T cell (Treg) expression levels in peripheral blood of pregnant women with premature rupture of fetal membranes(PROM) on immune function of helper T cells (Th) 1/Th2. Methods:Thirty cases of pregnant women with PROM (PROM group), 30 cases of normal pregnant women (normal pregnancy group) and 30 cases of normal non-pregnant women (non-pregnancy group) who treated in Binhai County People′s Hospital from September 2019 to May 2020 were collected. Peripheral blood of each group was collected and the proportion of CD 8+ CD 25+ FoxP3 + Treg was determined by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were extracted and FoxP3 mRNA was determined by polymerase chain reaction (PCR). The levels of Th1-related cytokines interferon-γ (IFN-γ), interleukin (IL)-2, and Th2-related cytokines IL-10 and IL-4 were measured by Luminex liquid phase microarray. The effects of CD 8+ CD 25+ FoxP3 + Tregexpression on Th1/Th2 balance were analyzed. Results:The proportion of CD 8+ CD 25+ FoxP3 + Tregand the expression of FoxP3 mRNA in PROM groupand normal pregnancy group were lower than those in non-pregnancy group: (0.15 ± 0.03) %, (0.35 ± 0.09) % vs. (0.47 ± 0.11) %; 0.89 ± 0.11, 3.15 ± 0.67 vs. 3.75 ± 0.23 , the proportion of CD 8+ CD 25+ FoxP3 + Treg and the expression of FoxP3 mRNA in PROM groupwere lower than those in the normal pregnancy group , and the differences were statistically significant ( P<0.05). The levels of Th1-related cytokines IFN-γ and IL-2 in PROM group and normal pregnancy group were higher than those in non-pregnancy group, the level of Th2-related cytokines IL-4 was lower than that in non-pregnancy group , the levels of IFN-γ and IL-2 in PROM group were higher than those in normal pregnancy group, the level of IL-4 was lower than that in normal pregnancy group , and the differences were statistically significant ( P<0.05). In PROM group, the proportion of CD 8+ CD 25+ FoxP3 + Treg and the expression of FoxP3 mRNA in peripheral blood were negatively correlated with Th1-related cytokines IFN-γ ( r = - 0.413, -0.451, P<0.05) and IL-22 ( r = -0.645, -0.535, P<0.05), and were positively correlated with Th2-related cytokines IL-4 ( r = 0.558, 0.469, P<0.05). Conclusions:The proportion of CD 8+ CD 25+ FoxP3 + Treg in peripheral blood of pregnant women with PROM is lower, and the expression level of related FoxP3 mRNA is lower, which all affecte the Th1/Th2 immune balance and cause Th1 immune drift, which may be the related immune mechanism of PROM.
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Objective:To investigate the clinical significance of the expression of oxidized α1-antitrypsin (ox-AAT) and neutrophil elastase (NE) in the peripheral blood and fetal membrane tissues of pregnant women with premature rupture of membranes (PROM).Methods:The clinical data of 95 cases of PROM pregnant women admitted to Binhai County People′s Hospital from April 2019 to April 2020 were analyzed. According to combination of histological chorioamnionitis (HCA), they were divided into PROM combined with HCA group ( 31 patients) and PROM without HCA group (64 patients). Besides, 50 normal pregnant women were collected during the same period as a healthy control group. The expression levels of ox-AAT and NE in the peripheral blood and fetal membrane tissues of the three groups were compared and analyzed.Results:The levels of peripheral blood ox-AAT and NE in the PROM combined with HCA group were higher than those in PROM without HCA group and healthy control group: (2.34 ± 0.02) ng/L vs. (1.50 ± 0.12), (0.32 ± 0.04) ng/L; (0.48 ± 0.08) ng/L vs. (0.13 ± 0.06), (0.11 ± 0.05) ng/L;the level of peripheral blood ox-AAT in PROM without HCA group was higher than that in healthy control group: (1.50 ± 0.12) ng/L vs. (0.32 ± 0.04) ng/L, and the differences were statistically significant ( P<0.05). The levels of fetal membrane tissues ox-AAT and NE in the PROM combined with HCA group were higher than those in PROM without HCA group and healthy control group: (0.031 ± 0.005) ng/L vs. (0.015 ± 0.002), (0.009 ± 0.003) ng/L; (0.020 ± 0.002) ng/L vs. (0.003 ± 0.001), (0.002 ± 0.001) ng/L; the level of fetal membrane tissues ox-AAT in PROM without HCA group was higher than that in the healthy control group: (0.015 ± 0.002) ng/L vs. (0.009 ± 0.003) ng/L, and the differences were statistically significant ( P<0.05). There was a positive correlation between ox-AAT and NE in peripheral blood and fetal membrane tissues ( r = 0.879, 0.875, P<0.05). The incidence of placental abruption in the PROM combined with HCA group and PROM without HCA group was higher than that in the healthy control group: 32.26%(10/31), 20.31%(13/64) vs. 4.00%(2/50), the incidence of neonatal pneumonia in the PROM combined with HCA group was higher than that in the PROM without HCA group and healthy control group: 25.81%(8/31) vs. 9.38%(6/64), 2.00%(1/50), and the differences were statistically significant ( P<0.05). Conclusions:The level of ox-AAT is overexpressed in peripheral blood and fetal membrane tissues of pregnant women with PROM, the level of NE is overexpressed in peripheral blood and fetal membrane tissues of PROM combined with HCA, and the increase of ox-AAT and NE expression is closely related to adverse perinatal outcomes.
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Objective To investigate the clinical effect of minimally invasive single locking plate combined with multiplanar screw internal fixation on pilon fracture of distal tibia. Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with pilon fracture involving distal tibial articular surface admitted to 81th Group Military Hospital of the Army from January 2013 to August 2017. Among the patients, 20 patients including 15 males and five females, aged (37. 5 ± 9. 9)years were treated with closed traction reduction or open joint reduction through minimally invasive incision and single main locking plate combined with multiplanar screw placement ( study group) . There were 13 patients with type II and seven patients with type III according to Ru edi-Allgwer classification of fracture. In addition, 31 patients were treated with open reduction and multi-plate internal fixation (control group), including 25 males and six females, aged (43. 4 ± 11. 3) years. There were 20 patients with type II and 11 with type III according to Ru edi-Allgwer classification. The operation time, fracture healing time, postoperative complications were compared between the two groups. Burwell-Charnley imaging evaluation criteria were used to assess the quality of fracture reduction. At the last follow-up, ankle function was assessed by the American Orthopedic Foot and Ankle Society ( AOFAS) ankle-hind foot functional score. Results All 51 patients were followed up for 6-24 months, with an average of 16 months. The operation time was (82. 5 ± 19. 2)minutes in the study group and (127. 7 ± 40. 8)minutes in the control group (P<0. 05). The fracture healing time was (10. 8 ± 1. 6)weeks in the study group and (11.0 ±1.5) weeks in the control group (P>0.05). Local skin necrosis (not above the plate) occurred in two patients in the study group and in three patients in the control group, with the wounds being healed within 3 months after dressing change and vacuum sealing drainage ( VSD) . In the control group, one patient had severe infection and recovered after treatment of steel plate removal, debridement and irrigation, and external fixator fixation. Three patients in the control group had skin necrosis resulting in plate exposure, who received transferred skin flaps to cover the wound. The incidence of postoperative complications were 10％ (2/20) and 23％ in the study group and the control group, respectively (7/31) (P >0. 05), with the incidence of severe complications for 0 and 13％(4/31)(P<0. 05), respectively. According to Burwell-Charnley imaging evaluation criteria, 18 patients obtained anatomical reduction in the study group, one had unsatisfactory reduction and one had poor reduction, with satisfaction rate of 90％. In the control group, 29 patients obtained anatomical reduction and two had unsatisfactory reduction, with satisfaction rate of 94％ (P>0. 05). At the last follow-up, AOFAS ankle-hind foot function scores were excellent in 12 patients, good in five patients, fair in two patients and poor in one patient in the study group with excellence rate of 85％, while the scores were excellent in 20 patients, good in six patients, fair in three patients and poor in two patients in the control group, with excellence rate of 84％ (P>0. 05). Conclusion For pilon fracture of distal tibia, both minimally invasive single locking plate combined with multi-plate screw internal fixation and open reduction combined with multi-plate internal fixation have good reduction effect and satisfactory recovery of ankle function, but the former can significantly shorten the operation time and reduce the incidence of serious complications after operation.
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Objective@#To analysis the status of HIV infection and the related factors among students of men who have sex with men (MSM) from voluntary counseling and testing (VCT) clinics in Changzhoucity Jiangsu province.@*Methods@#A total of 236 subjects with previous male sexual history, 16-25 years of age and less than 3 months of confirmation time of HIV positive infection were recruited in Changzhou from January 2014 to December 2017. Questionnaires were conducted and plasma samples were collected for selenium and HIV antibody testing. The relevant factors of HIV infection among MSM were screened by classification tree model. The model was evaluated using cross validation and receiver operating characteristic (ROC) curve.@*Results@#The age of subjects was (20.76±1.97) years old. The age of the first sex with men was (19.14±1.85) years old and the plasma selenium content was (82.59±11.99) ng/ml. Of the 236 subjects, 74.58% (176 cases) were college students or undergraduates; 8.90% (21 cases) were diagnosed with venereal diseases in the last year; 80.93% (191 cases) received health services in the last year, and the positive rate of HIV antibody was 25.00% (59 cases). Four relevant factors were screened by the classification tree model, including the diagnosis of sexual transmitted diseases (STDs) in the last year, health services in the last year, plasma selenium level and education level. The most important factor was whether STDs were diagnosed in the last year. The estimate of re-substitution and cross-validation of the classification tree model was 0.186 and 0.195, and the standard error was 0.025 and 0.026, respectively. The area under the ROC was 0.706 (P<0.001).@*Conclusion@#The MSM HIV antibody positive rate of VCT students in Changzhou City, Jiangsu Province was 25.0%. The diagnosis of STDs in the last year, receiving health services in the last year, plasma selenium level and education level were relevant factors of HIV infection.
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Objective To set up a computer-assisted polyp detection system under colonoscopy,and to preliminarily verify its effectiveness.Methods Based on Faster R-CNN algorithm and the open source implementation of the open source framework tensorflow and Faster R-CNN,a computer-assisted polyp detection system under colonoscopy was constructed.According to the size and difficulty of the training set,five test groups were set up:test group one,two,three and four contained 1 000,2 000,4 000 and 6 000 training samples,respectively.Test group five increased the probability of selecting the difficult samples based on 6 000 training samples.In different training sets,the sensitivity,specificity,other classification evaluation parameters,and the evaluation parameters of target detection such as recall and precision of this polyps detection system were calculated.Results Classification evaluation parameters showed that the sensitivities of test group one,two,three,four and five were 90.1％,93.3％,93.3％,93.3 ％ and 93.5 ％,respectively,and the difference was statistically significant (x2 =25.324,P＜0.01).The sensitivities of test group two,three,four and five were all higher than that of test group one,and the differences were statistically significant (x2 =13.964,13.508,13.508 and 13.386,all P＜ 0.006 25).There were no significant differences in specificity and positive predictive value among test groups (both P＞0.05).The negative predictive values of test group one,two,three,four and five were 90.4％,93.3％,93.3％,93.3％ and 93.5％,respectively,and the differences were statistically significant (x2 =21.862,P＜0.01).The negative predictive values of test group two,three,four and five were higher than that of test group one,and the differences were statistically significant (x2=11.447,11.564,11.755,13.760;all P＜0.006 25).As the training sample size increased from 1 000 to 2 000,the area under curve (AUC) increased by 2％,and further increased the sample size to 6 000,AUC increased by less than 1 ％.At this point maintaining the same sample size while increasing the proportion of difficult samples,AUC increased by 0.4％.The results of evaluation parameters of target detection showed that the recall rate of each test group was 73.6％,79.8％,79.5％,79.8％ and 83.3％,respectively,and the differences were statistically significant (x2 =71.936,P＜0.01).Among them,the recall rates of test group two,three and four were higher than that of test group one,and the differences were statistically significant (x2 =25.960,23.492 and 25.960,all P＜0.006 25),and the recall rate of test group five was higher than those of test group one,two,three and four,and the differences were statistically significant (x2=67.361,9.899,11.527 and 9.899;all P＜0.006 25).In addition,the precision rates of test group one,two,three,four and five were 87.9％,85.3％,90.2％,91.4％ and 89.2％,respectively,and the difference was statistically significant (x2=48.194,P＜0.01).The precision rates of test group three and five were higher than that of test group two,and the differences were statistically significant (x2 =24.508 and 15.223,both P＜0.006 25),and the precision rate of test group four was higher than those of test group one and two,and the differences were statistically significant (x2=13.524 and 39.120,both P＜0.006 25).As samples size and training difficulty increased,the values of F1-score and mean average precision increased steadily.Conclusions This study initially constructed a computer-assisted polyp detection system under colonoscopy.Currently the maximum sensitivity reached 93.5％,and the maximum recall rate reached 83.3％.Increasing the training set size may improve the polyp detection result to a certain degree,however it will reach a bottleneck.At this time,increasing the training difficulty can further improve the detection scores,especially the recall rate.
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Objective To develop a time-resolved fluorescent microspheres immunochromatographic assay (TRFMIA) for detection of alphafetoprotein (AFP) and carcinoembryonic antigen (CEA) in human serum and to evaluate its performance.Methods The Eu-time-resolved fluorescent polystyrene particles conjugated with monoclonal antibody AC18# for AFP and AE03# for CEA were used as fluorescent labels.The monoclonal antibody AC17# for AFP,AE05# for CEA and goat anti-rabbit antibody were immobilized on the nitrocellulose membrane as the test lines and control line.Several performances indicators were measured,including linear range,detection limit,and specificity.AFP and CEA were measured by the new method and the results were compared with those obtained by time-resolved fluoroimmunoassay (TRFIA) and electro-chemiluminescence immunoassay (ECLIA) using linear correlation analysis.Results The measurement ranges of AFP were 0.07-1 000.00 kU/L with the intra-and inter-assay CV of 5.93％ and 11.07％,and those of CEA were 0.12-500.O0 μg/L with the intra-and inter-assay CV of 7.53％ and 12.13％ respectively.The average recovery rate of AFP and CEA was 92.77％ and 94.73％,respectively.Measurements obtained by TRFMIA had strong correlation coefficients ranging from 0.93 to 0.97 when compared with those obtained by TRFIA and ECLIA.Conclusion TRFMIA,which can simultaneously detect AFP and CEA,has been successfully established.
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Objective To explore the efficacy of sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy and the factors associated with the prognosis.Methods 106 cases with esophageal varices in control group was treated with drugs alone;study group had 113 cases, was given endoscopic therapy add drugs, The study group randomly divided into two groups, one was treated with endoscopic variceal ligation all the time (EVL group), another was treated with sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy (sequential group). After the treatment, the rate of removal of varicose veins, the rate of rebleeding, the number of total treatment,mortality and intra-operative complications and postoperative complications were compared. And compared rebleeding rate and mortality with the control group and study groups with different CTP and MELD, analyze the factors of prognosis, and evaluate their prognostic value.Results Rebleeding, rate in control group, EVL group and sequential group were 41.51%,10.53% and 10.64%,sequential group was significantly better than control group (P = 0.000); mortality in control group, EVL group and sequential group were 15.09%, 5.26% and 2.13%, sequential group was also significantly better than control group (P = 0.001); rate of recurrence in EVL group and sequential group within half a year were 73.68% and 44.68%, sequential group was significantly better than EVL group (P = 0.021). In all control group and EVL group and the sequential group, rebleeding rate and mortality of the liver function Child-Turcotte-Pugh (CTP) class C was significantly higher than that of calss A; In MELD model, AUC area under the ROC curve of rebleeding rate in control group and sequential group were 0.944 and 0.851, mortality of the two groups were 0.881 and 0.984, while the rate of recurrence in the EVL group and sequential group were respectively 0.914 and 0.765, the MELD score has the important value to the prediction of rebleeding and death.Conclusion The rebleeding rate and mortality in cirrhotic patients with esophageal varices treated with sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy were significantly decreased and the recurrence rate was lower than that of the patients with endoscopic variceal ligation all the time. Liver function Child-Turcotte-Pugh (CTP) score and the MELD score have important value in prediction of rebleeding and death, ligation and sclerosing sequential therapy can significantly reduced rebleeding and mortality in CTP class B and C, and improve the MELD threshold of rebleeding and death.
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Objective To investigate the correlation of plasma brain natriuretic peptide (BNP) level with serum albumin, serum total bilirubin and thrombin time in patients with liver cirrhosis.Methods RandomLy selected from January 2014 to June 2016 to our hospital diagnosis and hospitalization of 200 cases of cirrhosis patients, according to the standard of Child-Pugh classification provided by Chinese Medical Hepatology Division in 2006, 48 cases were Child A group, 96 cases were Child B group and 56 cases were Child C group.The plasma BNP, serum albumin, serum total bilirubin, prothrombin time and QTc interval of electrocardiogram were analyzed in the clinical data of each group of patients and the correlation between plasma BNP and their correlation.Results The levels of plasma BNP in Child A, B and C groups were higher than those in B group and B group.The correlation between plasma BNP and Child's grade showed a positive correlation, and the results of each group were statistically different (P<0.05).The plasma BNP level was negatively correlated with ALB ( P<0.05 ) .The level of plasma BNP was positively correlated with ALB ( P <0.05 ) .The correlation between plasma BNP and PTIL was correlated with TBIL.The correlation between plasma BNP and TBIL was significantly correlated with TBIL ( P <0.05), The higher the plasma BNP, the regression analysis showed that plasma BNP and TBIL were positively correlated, the difference was statistically significant (P<0.05).The correlation between plasma BNP level and QTc was analyzed.The QTc interval of plasma BNP level was higher than that of the control group ( P<0.01 ) , and the difference was statistically significant ( P <0.01 ) .Conclusion The plasma BNP level in patients with liver function is closely related to ALB, TBIL, PT, QTc interval, and has the value of evaluating and predicting liver function.
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Objective To observe and study the therapeutic effect of ctreotide combined with omeprazole in the treatment of liver cirrhosis with upper gastrointestinal bleeding.Methods 76 cases of patients with upper gastrointestinal bleeding caused by liver cirrhosis were selected in our hospital from January 2013 to December 2014 to be separated into the observation group and control group randomly, with each group having 38 patients.Patients in two groups were all given symptomatic treatment first.Patients in control group were given 0.1 mg octreotide dissolved 20 mL 0.9% sodium chloride solution by intravenous injection in the first administration.And the rest octreotide was given by intravenous drip at the speed of 25μg/h.The treatment lasted for 72 h.On the base of control group, patients in observation group were given 40 mg omeprazole dissolved 100 mL 0.9%sodium chloride solution additionally, twice daily, for 3 d.Then the therapeutic effect, hemostatic time, blood transfusion, rebleeding rate and adverse reactions of patients in two groups were observed.Results The total effective rate of observation group 89.47%was much more than control group 63.16% (P<0.05).And the apparent rate of observation group 55.26%was also more than control group 31.58% ( P <0.05 ) .Both the hemostatic time and blood transfusion of observation group is less than control group ( P <0.05 ) .Besides, the rebleeding rate of observation group 5.26% is much less than control group 21.05% ( P<0.05 ) ., Incidence rates of adverse reactions in two groups were 10.53% and 7.89%, with no statistically significant difference. Conclusions Treatment of octreotide combined with omeprazole on patients with upper gastrointestinal bleeding caused by liver cirrhosis can improve the therapeutic effect, shorten the hemostatic time and decrease the blood transfusion with low rebleeding rate and few adverse reaction.
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Objective To investigate the efficacy of foramen magnum decompression alone and foramen magnum decompression + Syrinx-shunt in the treatment of Chiari anomalies with syringomyelia.Methods Forty-nine Chiari anomalies with syringomyelia patients were selected,28 patients performed foramen magnum decompression alone (surgical method Ⅰ group),21 patients performed foramen magnum decompression + Syrinx-shunt (surgical method Ⅱ group).The treatment efficacy was evaluated by postoperative clinical effect and MRI review.Results In surgical method Ⅰ group,effective in 18 cases,invalid in 10 cases,the effective rate was 64.3％ (18/28).In surgical method Ⅱ group,effective in 19 cases,invalid in 2 cases,the effective rate was 90.5％(19/21).There was statistical difference (x2 =4.45,P =0.034).Conclusion Foramen magnum decompression + Syrinx-shunt is effective in the treatment of Chiari anomalies with syringomyelia,which is applicable for these patients and has a more precise consequence than foramen magnum decompression alone.
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Purpose To explore the relationship between the change of space anterior to right portal vein and the pathological staging in liver ifbrosis/cirrhosis. Materials and Methods Plain and contrast enhanced CT scan were performed in patients with biopsy proven liver ifbrosis/cirrhosis including S1 in 17 patients, S2 in 13 patients, S3 in 15 patients, S4 in 21 patients and cirrhosis in 22 patients. Twenty subjects were included as control group. The width of anterior space of right portal vein was measured on contrast enhanced CT and correlated with ifbrosis staging. The receiver operating characteristic curve was created for cirrhosis diagnosis. Results The width of anterior space of right portal vein enlarged in patients with S3 ifbrosis to cirrhosis (P<0.05 or P<0.01). It was signiifcantly bigger in group S4 compared to other groups (P<0.01). Spearman rank correlation analysis showed significant positive correlation between the width of anterior space and liver fibrosis staging (r=0.704, P<0.01). ROC curve analysis showed the area under curve (AUC) of 0.897 with the optimum width of ≥10 mm. Conclusion The change in the space anterior to the right portal vein is positively correlated with live ifbrosis staging. CT measurement helps early diagnose and assess the severity of liver ifbrosis and cirrhosis.
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<p><b>OBJECTIVE</b>To study the effects of educational background of men who have sex with men (MSM) on their high risk sexual behaviors and the HIV/STI infection rates.</p><p><b>METHODS</b>During July to November of 2009 and March to October of 2010, snowball and convenience sampling methods were adopted to recruit MSM from MSM venues and via the internet in Changzhou city of Jiangsu province, and finally 659 MSM were conducted a questionnaire survey and serological testing. According to the educational background of MSM, they were divided into 3 groups, that is, junior high school group (206 cases), high school group (254 cases), and university group (199 cases). The questionnaire mainly includes information on social demography, sexual behaviors, condom use, etc. Blood samples were collected for HIV and syphilis spirochete detection, and urine samples were also collected in 291 MSM who were recruited during July to November of 2009 for neisseria gonorrhoeae and chlamydia trachomatis nucleic acid detection. χ(2) test and other statistical analysis methods were used to compare the characteristics of sexual behaviors and HIV/STI infections in 3 groups.</p><p><b>RESULTS</b>Of the 659 valid questionnaires returned, junior high school group, high school group, and university group accounted for 31.3% (206 cases), 38.5% (254 cases) and 30.2% (199 cases). Places where MSM of different education levels most often to seek sexual partners, were significantly different. Junior high school group and high school group mostly went to bath house/sauna club (56.3%, 116 cases) and bar (34.8%, 88 cases) for partners, respectively, while the university group sought partners mainly through the internet (41.1%, 81 cases) (χ(2) = 99.35, P < 0.05). 53.4% (109/204) of the junior high school group had anal sex with men in the last 6 months, which was higher than that of high school group (67.7%, 172/254) (χ(2) = 9.74, P < 0.05) and university group (72.7%, 144/198) (χ(2) = 16.04, P < 0.05) . A total of 54.4% (111/204) of the junior high school group had sex with women in the last 6 months, which was higher than that of university group (38.6%, 76/197) (χ(2) = 10.10, P < 0.05) , but was not statistically significantly different from that of high school group (46.9%, 119/254) (χ(2) = 2.59, P = 0.11) . The rates of condom use with men at the last anal sex in junior high school group (73.4%, 80/109) , high school group (78.0%, 131/168) and university group (73.9%, 105/142) were similar. The rates of condom use with women in the last intercourse in junior high school group, high school group and university group were 51.8% (57/110), 54.6% (65/119) and 61.8% (47/76), respectively(χ(2) = 1.88, P = 0.39) . In junior high school group, high school group and university group, the infection rates of HIV were 9.2% (19/206), 10.6% (27/254) and 5.6% (11/197) (χ(2) = 3.68, P = 0.16), the positive rates of neisseria gonorrhoeae were 3.8% (3/79), 3.4% (4/117) and 0.0% (0/95) (χ(2) = 3.85, P = 0.14), the positive rates of chlamydia trachomatis were 5.1% (4/79), 9.4% (11/117) and 4.2% (4/95) (χ(2) = 2.70, P = 0.26). The infection rate of syphilis in junior high school group was 19.9% (41/206), which was higher than high school group (12.2%, 31/254) (χ(2) = 5.11, P < 0.05) and university group (10.2%, 20/197) (χ(2) = 7.45, P < 0.05 ).</p><p><b>CONCLUSION</b>There was no obvious correlation between education level and high risk sexual behaviors;MSM with lower education level were at higher risk of infection of syphilis.</p>
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Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estudos Transversais , Características Culturais , Escolaridade , Infecções por HIV , Epidemiologia , Homossexualidade Masculina , Instituições Acadêmicas , Inquéritos e Questionários , Sífilis , Epidemiologia , Universidades , Sexo sem ProteçãoRESUMO
Objective To analyze the complications ofventriculoperitoneal shunt in the treatment of pediatric hydrocephalus,and improve operative method,in order to reduce postoperative complications and improve the clinical curative effect.Methods A total of 39 infants with hydrocephalus who underwent adjustable shunt were retrospectively analyzed,including surgical methods,results,and complications,and put forward counter measures.Results Thirty cases of postoperative clinical symptoms obviously improved compared with preoperative,head CT review were clearly seen with ventricle retraction.Nine cases suffered with complications after operation.Obstruction of shunt tube was found in 4 cases,shunt exposed in 3 cases,and postoperative infection in 2 cases.Conclusions Ventriculoperitoneal shunt complications related to surgery itself.Improved surgical techniques,and taking appropriate treatment measures can effectively reduce the incidence of complications.
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ObjectiveTo evaluate the clinical results of minimally invasive ankle arthrodesis with percutaneous cannulated screws.MethodsBetween April 2005 and October 2010, 12 patients with the ankle arthrodesis for unilateral severe arthritis (Kellgren-Lawrence class Ⅲ) were prospectively analyzed, including 2 cases of rheumatoid arthritis, 8 cases of post-traumatic arthritis, and 2 cases of osteoarthritis. There were 7 males and 5 females with an average age of 42.0 years(range, 25-7 1). The average disease duration was 7.3 years (range, 1-21). The anterior median incision of 3.0-5.0 cm was made to explore the ankle joint.The cartilage of tibial-talus joint was completely debrided. Two guide pins were inserted from posterosuperior to anteroinferior, and cannulated screws were implanted to fix ankle joint. All patients were physically examined with an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Scales. Ankle fusion in all patients was evaluated by clinical examination, and conventional radiography including anterior-posterior, lateral and mortise views of the ankle. ResultsAll 12 patients were followed up postoperatively for an average of 21.5 months(range, 6-55), and were proved be bone union by clinical examination and radiology with a mean of 13.5 weeks (range, 9-21). The AOFAS rating scale improved from a mean of 42.8±8.6 points at pre-operation to a mean of 66.6±5.4 points at post-operation 6 months,showing significant difference(t=-3.075, P=O.012), and to a mean of 72.3±4.6 at the final follow-up, also showing significant difference with pre-operation (t=-8.595, P=-0.006). There was no infection,local skin necrosis, screw loosing, and so on. ConclusionThe minimally invasive ankle arthrodesis with percutaneous cannulated scews is a recommend procedure, with mini-invasion, short surgery time, high fusion rate, good clinical outcomes, few complications.
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ObjectiveTo investigate the effect of different cyclic strengths on expressions of phospholipase A2 (PLA2) and cyclooxygenase (COX) in human tenocytes.MethodsHuman tenocytes were uniaxially stretched with different stretching intensity (4％, 8％ and 12％) under 0.5 Hz for four hours.Non-stretched tenocytes were applied to the control group.The expressions of cytosolic PLA2(cPLA2), COX1 and COX2 were measured by Western blot and RT-PCR.The secretion of secretory PLA2 (sPLA2) was measured by ELISA.Results The mRNA expressions of cPLA2, COX1 and COX2 in control group, 4％, 8％ and 12％ stretch groups showed an increase trend.But protein expressions of cPLA2 and COX1 in 4％ stretch group were increased insignificantly compared with the control group (P ＞ 0.05).Protein expressions of cPLA2 and COX1 in 8％ and 12％ stretch groups were increased more significantly compared with the control group (P ＜ 0.01).The COX2 expression in 4％,8％ and 12％ stretch groups showed statistical difference compared with that in the control group (P ＜0.01) and the difference increased with stretch intensity.There was no different expression of sPLA2 between 4％ stretch group and control group (P = 0.260).However, expression of sPLA2 was increased markedly in 8％ and 12％ stretch groups (P ＜ 0.01).ConclusionsThe expressions of human tendnocytes PLA2, COX1 and COX2 in vitro are positively correlated with stretch intensity.PLA2/COX system may be a new molecule target in clinical treatment of tendinopathy.
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Objective To observe the lung protection of Astragalus membranaceus against radiotherapy to intermediate-stage and terminal thoracic neoplasm, and its influence on TNF-α and ET expression.Methods The patients with intermediate-stage and terminal thoracic neoplasm under radiotherapy were divided into a treatment group and a control group.Patients in the treatment group took 10 ml of Asragalus membranaceus twice a day.for consecutive 6 months from the beginning of radio therapy.TNF-α and ET in the plasma were measured before and after the radiotherapy.The clinical symptom,iconographic changes and lung diffusion were observed from the 15th day of radiotherapy.Results The TNF-α and ET in plasma afterthe radiotherapy were(2.48±0.75)as/ml and(69.32±23.03)pg/ml for the treatment group,and(5.12±1.01)ns/ml and(97.87±37.83)pg/ml for the control group with the statistial difference(x2=7.49,6.57,P<0.001).The decrease of CO diffusion 5 and 10 months after the radiotherapy in the treatment group was statistically different compared with that in the control group(x2=3.98,3.78,P<0.05).There was a statistical difference of the incidence of acute radiation pneumonitis and pulmonary fibrosis between these two groups(P<0.05).Conclusions Astragalus membranaceus could inhibit the excess expression of TNF-α and ET in plasma and reduce the deterioration of diffusion after radiotherapy,so that it can be used for intervention of lung injuries from radiotherapy.
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Objective To investigate the clinical outcome of arthroscopic percutaneous cannulated screw fixation with subtalar fusion in the treatment of post-traumatic subtalar arthritis. Methods The study involved 12 patients (five males and seven females) with severe post-traumatic subtalar arthritis admitted to our hospital from April 2006 to December 2009. The patients were at age range of 28-68 years ( mean 45.6 years). All patients had the history of conservative treatment but failed in pain alleviation.Then, the percutaneous cannulated screw fixation plus subtalar fusion was selected. The ande and hind foot of all patients were evaluated preoperatively and postoperatively by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Imaging assessment was carried out by X-ray examination.Results The patients were followed up for mean 21.2 months (range 6-48 months), which showed thatthe mean AOFAS ankle-hindfoot scale was increased from (54.67 ± 5.28 ) points (range 43-61 points)preoperatively to (89.17 ±3.56) points (range 78-95 points) at final follow-up, with excellence rate of 93%. Eleven patients got good fusion with the mean time of 12.4 weeks (range 9-15 weeks). Only one patient had nonunion, with the pain in the lateral malleolus. The subtalar joint of the patient got union after plaster immobilization for three months, which was proved by X-ray examination. Conclusions The arthroscopic percutaneous cannulated screw fixation and subtalar fusion can acquire good clinical outcomes and hence is a recommended procedure for post-traumatic subtalar arthritis.
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Objective To retrospectively analyze the clinical results of peroneal tendon insertion and reconstruction with suture anchors in the treatment of avulsion fractures of the fifth metatarsal base.Methods Five patients (three males and two females) with the fifth metatarsal base fractures were in zone 1, with average seven days of duration before surgery. The result of radiological examination confirmed that all fractures were in zone 1 of the fifth metatarsal base, with some small, comminuted and obviously displaced pieces. After removal of the small comminuted fracture pieces, the peroneal tendon insertion was dissociated and sutured to the fifth metatarsal base by suture anchors (5 mm in diameter) with line. The feet were immobilized by plaster in the vagus position. The patients began to walk with weightbearing six weeks after operation. Results All patients were followed up for at least six months, which showed no deformity of the feet. The function of forefoot valgus and abduction restored to normal. There was no any loss in muscle force compared with the normal side. Conclusions Peroneal tendon insertion and reconstruction by suture anchors is very helpful to solve the problem in the fixation of the small fracture fragments. The function of the peroneal tendon recovers very well. The surgery has the advantages of easy manipulation and small area of dissection, without requirement of secondary surgery.