Finite element analyses of retention of removable partial denture circumferential clasps manufactured by selective laser melting / 北京大学学报(医学版)

OBJECTIVE@#To compare the retentions of different designs of cobalt-chromium (Co-Cr), pure titanium (CP Ti), and titanium alloy (Ti-6Al-4V) removable partial denture (RPD) circumferential clasps manufactured by selective laser melting (SLM) and to analyze the stress distribution of these clasps during the removal from abutment teeth.@*METHODS@#Clasps with clasp arm size A (1.9 mm width/1.1 mm thickness at the body and 0.8-taper) or B (1.2 times A) and 0.25 mm or 0.50 mm undercut engagement were modeled on a prepared first premolar die, named as designs A1, A2, A3, and A4, respectively. The density and elastic modulus of SLM-built Co-Cr, CP Ti, and Ti-6Al-4V were measured and given to different groups of clasps. The density, elastic modulus, and Poisson ' s ratio of enamel were given to the die. The control group was the cast Co-Cr clasp with design A1, to which the density and elastic modulus of cast Co-Cr alloy were given. The Poisson's ratio of all metals was 0.33. The initial 5 N dislodging force was applied, and the maximum displacement of the clasp along the insertion path was computed. The load was reapplied with an increment of 5 N than in the last simulation until the clasp was completely dislodged. The retentive force range of different groups of clasps was obtained. The retentive forces of the SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with equivalent computed retentive force range to the control group were validated through the insertion/removal experiment. The von Mises stress distributions of these three groups of SLM-built clasps under 15 N loads were analyzed.@*RESULTS@#SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with designs B1 or B2, and Co-Cr clasps with design A2 had higher retentive forces than those of the control group. SLM-built CP Ti and Ti-6Al-4V clasps with design A1 had lower retentive forces than those of the control group. SLM-built Co-Cr clasp with design A1 and SLM-built CP Ti and Ti-6Al-4V clasps with design A2 had equivalent retentive forces to those of the control group. The insertion/removal experiment showed that the measured retentive forces of these three groups of SLM-built clasps were (21.57±5.41) N, (19.75±4.47) N, and (19.32±2.04) N, respectively. No statistically significant measured retentive force difference was found among these three groups of SLM-built clasps (P>0.05). The maximum von Mises stress of these three groups of SLM-built clasps exceeded their responding yield strength except for the Ti-6Al-4V one.@*CONCLUSION@#SLM-built Co-Cr circumferential clasps had higher retention than CP Ti and Ti-6Al-4V ones with the same clasp arm size and undercut engagement. The retention of SLM-built circumferential clasps could be adjusted by changing the undercut engagement and clasp arm size. If SLM-built circumferential clasps are used in clinical practice, the Ti-6Al-4V clasp with clasp arm size A and 0.50 mm undercut engagement is recommended considering the long-term use of RPD in the patient's mouth.

Research progress on chemical composition and pharmacological effects of Periplocae Cortex and predictive analysis on Q-marker / 中国中药杂志

Periplocae Cortex is a traditional Chinese medicine in China, which is mainly produced in northeast China, north China, northwest China, southwest China. In recent years, the increasing in-depth research resulted in the discovery of anti-tumor and cardiac pharmacological activities of Periplocae Cortex, which has broad application prospects. On the basis of summarizing chemical components and pharmacological effects, combined with the theoretical system of Q-marker, the quality control components of Periplocae Cortex were predicted from the aspects of the correlation between chemical composition and traditional medicinal properties, traditional efficacy, and new clinical use, plasma composition, measurable composition, storage time by analyzing literature. Among the components, periplocoside, periplocin, periplogenin, 4-methoxy salicylaldehyde showed significant activity, which provides a scientific basis for quality evaluation of Periplocae Cortex.

Effect of Sijunzi Decoction on regulation of Aβ-related proteins across blood-brain barrier / 中国中药杂志

According to traditional Chinese medicine, "spleen transport" is closely related to the metabolism of substance and energy. Studies have shown that Alzheimer's disease(AD) is a disease related to glucose and lipid metabolism and energy metabolism. The traditional Chinese medicine Jiangpi Recipe can improve the learning ability and memory of AD animal model. Sijunzi Decoction originated from Taiping Huimin Hefang Prescription is the basic prescription for strengthening and nourishing the spleen, with the effects of nourishing Qi and strengthening the spleen. In this experiment, human brain microvascular endothelial cells(HBMEC) and Sijunzi Decoction water extract(0.25, 0.5, 1 mg·L~(-1)) were pre-incubated for 2 h, and then Aβ_(25-35) oligomers(final concentration 40 μmol·L~(-1)) was added for co-culture for 22 hours. The effect of Sijunzi Decoction on the activity of Aβ_(25-35) oligomer injured cells and the expression of related proteins were investigated. Q-TOF-LC-MS was used first for principal component analysis of Sijunzi Decoction water extract. Then MTT assay was used to investigate the effect of Sijunzi Decoction water extract on the proliferation of HBMEC cells. Real-time fluorescence quantitative PCR(RT-qPCR) was employed to detect the mRNA expression of GLUT1, RAGE, and LRP1. The expression of Aβ-related proteins across blood-brain barrier(RAGE, LRP1) was detected by Western blot. The results showed that 40 μmol·L~(-1) Aβ_(25-35) oligomers could induce endothelial cell damage, reduce cell survival, increase expression of RAGE mRNA and RAGE protein, and reduce expression of GLUT1 mRNA, LRP1 mRNA, and LRP1 protein. Sijunzi Decoction water extract could reduce the Aβ_(25-35) oligomer-induced cytotoxicity of HBMEC, decrease the expression of RAGE mRNA and RAGE protein, and increase the expression of GLUT1 mRNA, LRP1 mRNA and LRP1 protein. The results indicated that Sijunzi Decoction could reduce the injury of HBMEC cells induced by Aβ_(25-35) oligomer, and regulate the transport-related proteins GLUT1, RAGE and LRP1, which might be the mechanism of regulating Aβ_(25-35) transport across the blood-brain barrier.

Effect of Zhenxin Shengshui Yizhi Fang on Damage of Human Brain Microvascular Endothelial Cells Induced by Aβ25-35 / 中国实验方剂学杂志

Objective::To observe the neuroprotective effect and potential mechanism of Zhenxin Shengshui Yizhi Fang(XSF) aqueous extract on human brain microvascular endothelial cells (HBMEC) injury induced by amyloid-β protein(Aβ)25-35. Method::HBMEC cells damage induced by Aβ25-35 was used as Alzheimer' s disease(AD) cell model. The study included control group, Aβ25-35 group, and low, medium and high-dose XSF aqueous extract groups (125, 250, 500 mg·L-1). After treatment, the cytotoxicity of different concentrations of drugs and Aβ25-35 was determined by methyl thiazolyl tetrazolium(MTT) colorimetry. Apoptosis was observed by Hoechst-33258 staining. The activity of Caspase-3 was detected by colorimetry. Western blot was used to detect the expression levels of the receptor of advanced glycation end products (RAGE) and low-density lipoprotein receptor-related protein (LRP1). Result::Compared with the control group, the cell viability of Aβ25-35 group was significantly decreased (P<0.01). Hoechst-33258 staining showed bright blue fluorescence, chromatin condensation, dense staining or fragmentation dense staining, whitening in color, and significant increase of the percentage of apoptotic cells (P<0.01). Caspase-3 activity increased significantly (P<0.01). Western blot showed that RAGE protein expression increased significantly (P<0.01), while low-density lipoprotein receptor-related protein(LRP1), glucose transporter 1(GLUT1) and GLUT3 protein expressions decreased significantly (P<0.01). Compared with the Aβ25-35 group, the cell viability of XSF aqueous extract groups was significantly increased in a dose-dependent manner. The XSF aqueous extract had a more significant protective effect of than the other groups (P<0.05). The XSF aqueous extract group (500 mg·L-1) significantly inhibited the number of apoptotic cells (P<0.01), but significantly reduced the Caspase-3 activity (P<0.01). RAGE protein expression was not significantly decreased in XSF aqueous extract group (125 mg·L-1), but significantly decreased in XSF aqueous extract group (250, 500 mg·L-1, P<0.01), while LRP1, GLUT1 and GLUT3 protein expression significantly increased (P<0.05, P<0.01) in a dose-dependent manner. Conclusion::XSF aqueous extract can attenuate the cytotoxicity of HBMEC induced by Aβ25-35 oligomer, inhibit apoptosis, decrease caspase-3 activity and RAGE protein expression, increase LRP1, GLUT1 and GLUT3 protein expressions, and reduce the abnormal accumulation and deposition of Aβ in the brain, which may be its mechanisms for prevention and treatment of AD.

Cardiac magnetic resonance for assessment of cardiac structure and function after renal transplantation in patients with end-stage renal disease / 医学研究生学报

Objective Few clinical studies have been reported on the reversibility of uremic cardiomyopathy (UC) after renal transplantation. This article aimed to investigate the cardiac structure and function of end-stage renal disease (ESRD) patients undergoing renal transplantation using cardiac magnetic resonance (CMR). Methods This study included 38 ESRD patients undergoing renal transplantation in the National Clinical Research Center for Kidney Diseases, General Hospital of Eastern Theater Command, from September 2015 to February 2017. All the patients received initial CMR examination at 1－2 days before renal transplantation and during the postoperative follow-up. At the median follow-up time of 3.5 (3.4-3.7), 7.0 (3.7-9.5) and 8.4 (7.1-12.7) months, we recorded the CMR parameters, including the left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), end-diastolic mass (LVEDM), end-systolic mass (LVESM), ejection fraction (LVEF), and native myocardial T1 relaxation time, and compared the parameters obtained before and after surgery. Results Twenty-five of the patients completed the postoperative follow-up, who averaged 27.5 years of age, with no history of diabetes mellitus or ischemic heart disease, and treated by dialysis for 1.7 (1.5-2.2) years. At 7.0 months after renal transplantation, as compared with the baseline, the patients showed significant decreases in the LVEDV ([96.7 ± 22.8] vs [83.4 ± 17.4] mL/m², P < 0.05), LVESV ([44.3 ± 14.8] vs [33.0 ± 10.9] mL/m², P < 0.05) and LVEDM ([67.1 ± 24.2] vs [59.0 ± 17.0] mL/m², P < 0.05), but an increase in the LVEF ([54.1 ± 10.6] % vs [60.9 ± 9.6] %, P < 0.01). The LVEDV and LVESV were also remarkably lower at 3.5 and 8.4 months than the baseline (P < 0.001), and so were the left ventricular at basal, mid, apical and global native T1 relaxation times at 3.5, 7.0 and 8.4 months (P < 0.05). Conclusion For young ESRD patients with no history of diabetes mellitus or ischemic heart disease and on short-term dialysis, left ventricular dilatation, systolic dysfunction and diffuse myocardial fibrosis are reversible after renal transplantation. Native T1 relaxation time can be used as a sensitive indicator to evaluate the degree of diffuse myocardial fibrosis in ESRD patients.

Correlation between Mycoplasma pneumoniae DNA replication level and disease severity in children with severe Mycoplasma pneumoniae pneumonia / 中国当代儿科杂志

OBJECTIVE@#To study the correlation of Mycoplasma pneumoniae DNA (MP-DNA) replication level in throat swab and bronchoalveolar lavage fluid (BALF) with disease severity in children with severe Mycoplasma pneumoniae pneumonia (SMPP).@*METHODS@#A total of 44 children with SMPP who underwent bronchoalveolar lavage were enrolled as subjects. The serum levels of cytokines and MP-DNA replication times in throat swab were measured in the acute stage and the recovery stage, and the levels of interleukin (IL)-8 and MP-DNA replication times in BALF were measured in the acute stage. According to whether mechanical ventilation was needed for respiratory failure, the children were divided into a mechanical ventilation group (n=19) and a non-mechanical ventilation group (n=25), and the two groups were compared in MP-DNA replication times in BALF.@*RESULTS@#For the children with SMPP, serum levels of C-reactive protein, erythrocyte sedimentation rate, lactate dehydrogenase, IL-1, IL-6, IL-8, and IL-18 in the acute stage were significantly higher than those in the recovery stage (P<0.05). In the acute stage, MP-DNA replication times in throat swab were positively correlated with those in BALF (r=0.613, P<0.05), and MP-DNA replication times in BALF were positively correlated with IL-18 levels in peripheral blood and BALF (r=0.613 and 0.41 respectively, P<0.05). Compared with the non-mechanical ventilation group, the mechanical ventilation group had significantly higher MP-DNA replication times in BALF, a significantly longer duration of systemic hormone treatment, significantly higher serum levels of lactate dehydrogenase and IL-18, and significantly higher white blood cell count and IL-18 level in BALF (P<0.05).@*CONCLUSIONS@#In children with SMPP, MP-DNA replication level in throat swab and BALF can be used as a reference index for the assessment of disease severity.

Effect of Zhenxin Xingshui Yizhi Fang and Its Essential Oil Extract on Ability of Learning and Memory in Alzheimer's Disease Model Mice / 中国实验方剂学杂志

Objective: The present study was designed to investigate the modulating effect of Zhenxin Xingshui Yizhi Fang and its essential oil extract on cognitive deficits in mice.Method: For the purpose of this study 5 months old APP/PS1 double transgenic mice and wild-type C57BL/6JNju were selected as experimental animals.Then APP/PS1 double transgenic mice were randomly divided into model group,essential oil low and high-dose groups (12.13,48.50 mg·L-1),Zhenxin Xingshui Yizhi Fang group (0.46 g·kg-1).Meanwhile,wild-type C57BL/6JNju mice were used as a normal group.APP/PS1 double transgenic mice were treated with Zhenxin Xingshui Yizhi Fang and its essential oil extract for 22 consecutive days.Mice were subjected to a Morris water maze test and a platform test in order to determine their cognitive effect.Nissl's staining was used to observe pathological changes in brain tissue.Meanwhile,senile plaques (SP) were observed by employing Thioflavin-S staining.The expression of glucose transporter 1(GLUT1) and insulin receptor substrate-1(IRS-1) were analyzed using immunohistochemistry techniques.The levels of neurotransmitters such as acetylcholine (ACH),glutamate (GLU) and γ-aminobutyric acid (GABA) in the hippocampus were quantified by enzyme-linked immunosorbent assay (ELISA).Result: The memory function was significantly reduced in model group,and severe brain injury and neuronal apoptosis were also observed in comparison to normal group (PPPPPPPConclusion: These results indicate that Zhenxin Xingshui Yizhi Fang and its essential oil extract could ameliorate cognitive deficits and GLUT1 and IRS-1 could be a possible therapeutic target for AD.It may be an interesting approach to the treatment of Alzheimer's disease.

The application value of time-zero renal biopsy in living donor kidney transplantation / 医学研究生学报

Objective Few studies have paid attention to time-zero renal biopsy in living kidney transplantation so far. This article aimed to investigate the risk factors of latent pathologic changes in living donors by time-zero renal biopsy (TO-RBx) and the predictive value in the allograft function of recipients early after living kidney transplantation.Methods We retrospectively analysed the clinical data of 89 renal transplant recipients and living donors who received TO-RBx at Nanjing General Hospital from January 2008 to December 2016. According to the 2007 Banff criteria, the common pathologic changes in living donors such as latent glomeruloscerosis (GS), tubular atrophy (CT), interstitial fibrosis (CI), arteriolar hyaline thickening (AH) and vascular fibrous intimal thickening (CV) were scored. To analyze the influencing factors for different pathological changes and evaluate its predictive value in the allograft function of recipients in 1, 3, 6 months after living renal transplantation.Results Of all the TO-RBx specimens, 23 cases (25.84%) with GS (21 were mild change, 1 was moderate change and 1 was severe change), 33 cases (37.08%) with CT/CI changes (30 were mild change and 3 were moderate change) and 37 cases (41.57%) with AH/CV changes (36 were mild change and 1 was moderate change). GS was related to the donor age (P=0.042); CT/CI changes were related to donor age, gender and systolic pressure (P=0.019；0.006；0.01); arterial changes were related to donor gender and blood triglyceride level (P=0.029；0.049). Within 3 and 6 months after living donor renal transplantation, the eGFR of renal transplant recipients with GS lesions \[(65.96±17.17), (69.52±19.1)mL/min·1.73m2\] were significantly lower than the groups without lesions \[(76.91±18.98), (79.52±18.91)mL/min·1.73m2\] (P＜0.05).Conclusion Time-zero renal biopsy has significance in terms of predicting the allograft function in 6 months after transplantation. It can guide the formulation and adjustment of postoperative immunosuppressive regimens for recipients. Besides, it can also detect the latent pathologic changes in living donors and is one of the important evidence for establishing a personalized follow-up plan for donors after surgery. This method is practical in clinical.

Risk factors for postoperative hyperactive-type delirium in elderly patients undergoing orthopedic surgery / 中华麻醉学杂志

Objective To determine the risk factors for postoperative hyperactive-type delirium (PHTD) in elderly patients undergoing orthopedic surgery.Methods A total of 7 171 elderly patients of both sexes,aged more than or equal to 65 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅳ,who underwent orthopedic surgery from January 2008 to December 2012 in Second Affiliated Hospital of Wenzhou Medical University,were retrospectively analyzed.Data such as gender,age,preoperative electrolytes,blood glucose,hemoglobin,albumin,senile dementia and use of benzodiazepines,type of operation,anesthesia methods,operation time,intraoperative use of anticholinergic agents and benzodiazepines and hypotension (decrease more than 20％ of the baseline),and postoperative electrolyte,hemoglobin,albumin and hypotension were collected.The patients were divided into postoperative PHTD group (group PHTD) and postoperative non-PHTD group (group non-PHTD) according to whether PHTD developed within 7 days after operation.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression to stratify the risk factors for postoperative PHTD.Results Ninety-nine patients developed PHTD,and the incidence was 1.38％.The results of logistic regression analysis showed that age more than or equal to 80 yr,hip surgery and preoperative anemia were independent risk factors for postoperative PHTD (P＜0.05).Conclusion Age more than or equal to 80 yr,hip surgery and preoperative anemia are independent risk factors for postoperative PHTD in elderly patients undergoing orthopedic surgery.

Expressions of JNK and p-JNK in advanced prostate cancer and their clinical implications / 中华男科学杂志

Objective@#To investigate the expressions of JNK and p-JNK in advanced prostate cancer (PCa) and benign prostatic hyperplasia (BPH) and their implications.@*METHODS@#Using immunohistochemistry, we detected the expressions of JNK and p-JNK proteins in 40 cases of paraffin wax-embedded PCa and 21 cases of BPH tissues and analyzed their relationships with advanced PCa and BPH as well as with the pathologic features of advanced PCa.@*RESULTS@#Statistically significant differences were not found in the positive expression rate of the JNK protein between BPH and PCa (42.86% vs 52.50%, P>0.05), non-metastatic and metastatic PCa (53.85% vs 51.85%, P >0.05), Gleason ≤7 and Gleason >7 (58.82% vs 47.82%, P >0.05), PSA ≤20 μg/L and PSA >20 μg/L (57.14% vs 51.52%, P >0.05), or survival >5 yr and survival ≤5 yr (60.00% vs 45.00%, P >0.05), nor in the expression level of p-JNK between BPH and PCa (33.33% vs 35.00%, P >0.05), non-metastatic and metastatic PCa (30.77% vs 37.03%, P >0.05), Gleason ≤7 and Gleason >7 (35.29% vs 34.78%, P >0.05), or PSA ≤20 μg/L and PSA >20 μg/L (43.75% vs 10.93%, P >0.05). However, the expression of p-JNK was significantly higher in the survival >5 yr than in the survival ≤5 yr group of the PCa patients (50.00% vs 20.00%, P <0.05).@*CONCLUSIONS@#PCa patients with highly expressed p-JNK have a longer survival time and the high positive rate of p-JNK is associated with the prognosis of PCa.

Expressions of ERK and p-ERK in advanced prostate cancer / 中华男科学杂志

Objective@#To investigate the expressions of extracellular signal-regulated kinase (ERK) and p-ERK in benign and malignant prostate tissues, and whether it can be used as a marker for the prognosis of advanced prostate cancer (PCa).@*METHODS@#Using immunohistochemical Envision, we detected the expressions of ERK1/2 and p-ERK1/2 in 20 cases of benign prostatic hyperplasia (BPH) and 40 cases of advanced PCa and analyzed their correlation with PCa metastasis, Gleason score, PSA level, and prognosis.@*RESULTS@#The expression of ERK1/2 was remarkably higher in the advanced PCa than in the BPH cases (82.5% vs 55%, P5 yr, and survival ≤ 5 yr groups were 61.9%, 89.5%, 57.9%, and 90.5%, respectively, with statistically significant differences among these groups (P<0.05).@*CONCLUSIONS@#ERK1/2 and p-ERK1/2 proteins are highly expressed in advanced PCa and p-ERK1/2 is associated with the metastasis and prognosis of advanced PCa.

Eeffect of HMGB1 on expression of NF-κB in BV-2 cells stimulated with Aβ25-35 / 中国病理生理杂志

AIM:To investigate the effect of high mobility group box-1 protein (HMGB1) on the expression of nuclear factor-κB ( NF-κB) in BV-2 cells stimulated with amyloid β-protein ( Aβ) 25-35 .METHODS:Cultured BV-2 cells in logarithmic growth phase were divided into 4 groups:normal cell group ( without any treatment ) , model group ( treated with Aβ25-35 at 40 μmol/L) , RNA interference ( RNAi) group ( conducted with HMGB1-siRNA followed by Aβ25-35 stimula-tion) and solvent control group (treated with 0.1% DMSO).After treatment with Aβ25-35 for 24 h, the protein levels of HMGB1 and NF-κB in BV-2 cells were determined by Western blot .RESULTS:Aβ25-35 at 40μmol/L was used to stimu-late BV-2 cells.The GFP fluorescence-tagged HMGB1-siRNA (30 nmol/L) was used to transfect BV-2 cells and its trans-fection efficiency was about 80%~90%.The results of Western blot showed that the protein level of HMGB 1 was signifi-cantly decreased after the interference of siRNA fragment (P<0.05).The protein levels of HMGB1 and nucleic NF-κB p65 were dramatically increased in BV-2 cells stimulated with Aβ25-35(P<0.05).After RNA interference with HMGB1, the expression of HMGB1 and nucleic NF-κB p65 were significantly decreased in BV-2 cells stimulated with Aβ25-35 ( P<0. 05).CONCLUSION:RNA interference with HMGB1 reduces the expression of nucleic NF-κB in BV-2 cells stimulated with Aβ25-35 .

Recurrent IgA nephropathy after renal transplantation:not always a benign prognosis / 器官移植

Objective To discuss the clinicopathological characteristics and prognosis of the recurrence of IgA nephropathy (IgAN)after renal transplantation.Methods A total of 1 48 patients,pathologically diagnosed with IgAN which progressed into end-stage renal failure,undergoing renal transplantation in National Clinical Medical Research Center of Kidney Diseases,Nanjing General Hospital of Nanjing Military Command from January 1 996 to April 2009,were included in this study.According to whether IgAN recurred,all patients were assigned into recurrence (n =46)and non-recurrence groups (n =1 02).Urinary red blood cell (U-RBC)count,24 h urinary protein level,renal function including serum creatinine (Scr)and glomerular filtration rate (GFR)at 0,1 ,2,3 and 5 years after renal transplantation were statistically compared between two groups.The incidence of histopathological renal injury and survival rate of transplant kidneys was compared between two groups.Results In recurrence group,U-RBC count and 24 h urinary protein level were gradually elevated and renal function steadily declined.Compared with non-recurrence group,U-RBC count at 2-,3-and 5-year after renal transplantation significantly increased,and renal function was significantly aggravated at postoperative 5 years (all in P<0.01 -0.001 )in recurrence group.Renal pathological findings revealed that compared with non-recurrence group,the incidence of cellular crescent formation,glomerulus adhesion,mesangial cell proliferation,increased mesentery matrix, glomerulosclerosis,segmental glomerulosclerosis,glomerular dysfunction and tubulointerstitial fibrosis was significantly higher in recurrence group (all in P <0.001 ).After renal transplantation,chronic kidney injury index in recurrence group was 7.7 ±2.3,which was significantly higher than 4.6 ±1 .4 in non-recurrence group (P <0.01 ).Compared with non-recurrence group,the incidence of chronic rejection,glomerulopathy of transplant kidney (without IgAN)and positive C4d deposition was significantly higher in recurrence group (P <0.01 -0.001 ).At 1 -and 3-year after renal transplantation, survival rates of transplant kidney did not significantly differ between recurrence and non-recurrence groups (93.8% vs.86.7%,95.6% vs.88.3%,both in P >0.05).However,the survival rate at 5 years after transplantation was 51 .4% in recurrence group,significantly lower compared with 83.8% in non-recurrence group (P <0.001 ).In recurrence group,1 0 patients (22%)presented with renal failure after renal transplantation,and 9 patients (9%)in non-recurrence group.Conclusions After renal transplantation,the recurrence of IgAN characterized by asymptomatic microscopic hematuria, albuminuria and progressive aggravation of renal function reduce long-term survival rate of renal graft and indicate poor prognosis.

Analysis of human papillomavirus infection in 16 320 patients from gynecologic clinic / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the genital human papillomavirus (HPV) infection in patients from gynecology clinic, and to investigate the association of persistent HPV infection with cervical lesions.@*METHODS@#From January, 2009 to December, 2013, clinical data of 16 320 patients in Third Xiangya Hospital were collected. A retrospective analysis was carried out to evaluate the overall prevalence of HPV infection. The prevalence of HPV infection in different ages and subtypes were compared. The prevalence of persistent HPV infection and results of cervical cytology were analyzed.@*RESULTS@#The overall HPV prevalence was 26.54%. The lowest overall and high-risk HPV prevalence were found in women at the age of 30-39 years old (P<0.05); the highest ones were found at the age of over 60 years old, with significant difference among the aged groups (P<0.05). There was no significant difference in low-risk HPV prevalence among the aged groups (P=0.693). The clearance rate of HPV was 87.65% one year later. There was no significant difference in high-risk and low-risk HPV infection between the non-persistent positive group and the persistent positive group (P=0.545), but the difference in single and multiple subtypes infection between these 2 groups was significant (P<0.05). In the persistent positive group, the most common genotypes were HPV 16, 52, 58, CP8304, and 33. The incidence of ASC-US, HSIL or SCC was significantly increased in the persistent positive group.@*CONCLUSION@#Persistent HPV infection mainly consists of multiple and high-risk HPV infection. It is necessary to focus on the prevention of HPV 16, 52 and 58 persistent infection in our region.

Presetting negative pressure drainage for anastomotic leakage after esophageal cancer surgery: A clinical comparative analysis / 第二军医大学学报

Objective To evaluate the efficacy and safety of presetting negative pressure drainage for anastomotic leakage after esophageal cancer surgery. Methods The clinical data of 68 patients with intrathoracic anastomotic leakage following surgery of esophageal and cardial carcinoma from January 2008 and January 2014 were retrospectively analyzed The patients were divided into 3 groups, including presetting negative pressure drainage group (Group A), endoscopy drainage placement group (Group B) and traditional treatment group (Group C). Results A total of 1 251 patients underwent intrathoracic anastomosis were analyzed and anastomotic leakage occurred in 68 cases (5. 4%), with 14(20. 6%) died after operation. The mortality rates of Group A and Group B were significantly lower than that in Group C (14. 3%, 0 vs 39. 1%, P<0. 05). The repeated drainage times in Group A and Group B were signficantly less than that in Group C (P<0. 05). Compared with Group B and Group C, Group A had the advantage of shorter manipulation time (P<0. 05). Drainage lavaging time, recovery time and retaining time of gastric tube in Group A and Group B were significantly shorter than those in Group C(P<0. 05). Patients in Group A and Group C had significantly less discomfort in nasopharynx and significantly lower obstruction incidence compared with those in Group B (P<0. 05). Except for death, all patients with anastomotic leakage had normal diet and safe discharge after prompt treatment. Conclusion Presetting negative pressure drainage after esophageal cancer surgery has a better effect for anastomotic leakage by reducing recovery time, lowering mortality rate and alleviating the suffering of patients.

Effects of intrathecal injection of methylprednisolone sodium succinate in acute spinal cord injury rabbits / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects and apoptosis of intrathecal injection of Methylprednisolone Sodium Succinate (MPss) for acute spinal cord injury (SCI) in New Zealand rabbits.</p><p><b>METHODS</b>Seventy-two healthy New Zealand rabbits were used for the procedure and were randomly divided into two groups: SCI group and SHAM group, which was both divided into 6 subgroups, such as the vehicle group, the MPss intrathecal injection groups (1.5 mg/kg, 3.0 mg/kg, 6.0 mg/kg group), the MPss intravenous injection group and the combined injection group. TARLOV score was tested daily to evaluate the motor function. The rabbits were sacrificed 7 days after the surgery and the thoracic spinal cord sections and the sacral sections where MPss was injected were harvested for HE and TUNEL staining. Two-Factors Repeated Measures analysis of variance for TARLOV scores tested at various times and One-Way ANOVA analysis of variance for data between groups were used.</p><p><b>RESULT</b>Seven days after surgery in SCI group, there was no statistical difference between the TARLOV scores of intrathecal injection of MPss 3.0 mg/kg group, 6.0 mg/kg group and MPss intravenous injection group (P > 0.05), which were all better than the vehicle group (F = 4.762, P < 0.05). Referring to the lymphocyte infiltration at the injury site in SCI group, there was statistical difference between MPss intrathecal injection 6.0 mg/kg group (1.33 ± 0.21) and the vehicle group (2.67 ± 0.21) (F = 5.793, P < 0.05) and no statistical difference between intrathecal injection of MPss 6.0 mg/kg group and MPss intravenous injection group (P > 0.05). As for the lymphocyte infiltration at the intrathecal injection site in SHAM group, there was statistical difference between MPss intrathecal injection 6.0 mg/kg group (2.50 ± 0.55) and the vehicle group (0.50 ± 0.55) (F = 17.333, P < 0.05). TUNEL staining in SCI group showed statistical difference between MPss intrathecal injection 6.0 mg/kg group (6.3 ± 1.5) and the vehicle group (20.3 ± 2.2) (F = 71.279, P < 0.05).</p><p><b>CONCLUSIONS</b>Intrathecal injection of MPss can improve the functional recovery of lower limb and decrease apoptosis of neuron cells,which can provide same effects as the traditional intravenous injection of MPss in New Zealand rabbits.</p>

The effect of Topping-off surgery on preventing adjacent segment degeneration, a retrospective study / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the early-middle stage clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration exists before surgery.</p><p><b>METHODS</b>All the cases that received L(5)-S(1) posterior lumbar interbody fusion (PLIF)+L(4)-L(5) interspinous process (ISP) surgeries between April 2008 and March 2010 (Topping-off group) were analyzed retrospectively. The cases received L(5)-S(1) PLIF surgery and whose intervertebral disc degeneration using modified Pfirrmann's grading system were grade 4 - 6 were analyzed retrospectively at the same time (PLIF group). Both groups matched in gender, age, body mass index and Pfirrmann's grading of disc. All the patients were evaluated with visual analogue scale (VAS) and Japanese orthopaedic association (JOA) scores before the surgery and in the last follow-up. The X-ray films before and after surgery were measured.</p><p><b>RESULTS</b>There were 25 patients in Topping-off group and 42 patients in PLIF group were included in the final analysis. The follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. The average surgery time was (120 ± 24) min and (106 ± 21) min. There was no significant difference in the blood loss during surgery or post-operation drainage (P > 0.05). VAS and lumbar JOA score improved in both groups (P < 0.01). In the lateral view of lumbar spine, neither of anterior or posterior disk height was significantly changed (P > 0.05), segmental lordosis of L(4)-L(5), total lordosis were all increased (Topping-off group: t = -2.30 and -2.24, P < 0.05; PLIF group: t = -2.76 and -1.83, P < 0.05). In the hyperextension and hyperflexion view, Topping-off group's range of motion (ROM) and olisthesis in the L(4-5) segment did not significantly change in flexion (P > 0.05), but decreased in extension (t = 5.83 and 4.92, P < 0.01). In PLIF group, the ROM (t = -7.82 and -4.90, P < 0.01) and olisthesis (t = -15.67 and -18.58, P < 0.01) both significantly increased in extension and flection.</p><p><b>CONCLUSIONS</b>Compared with single segmental PLIF surgery, Topping-off surgery can achieve similar symptomatic improvement in cases with pre-existing mild or moderate adjacent segment degeneration, restrict the adjacent segment's range of motion in extension and prevent excessive olisthesis of adjacent segment in both extension and flexion. Topping-off surgery has a potential effect of preventing adjacent segmental degeneration.</p>

Clinical outcomes of Hybrid-surgery to treat the two-level cervical disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical and radiologic outcomes of the Hybrid surgery (cervical artificial disc replacement combined with anterior cervical discectomy and fusion (ACDF)) and the effective of the adjacent segment.</p><p><b>METHODS</b>Between December 2007 to June 2010, 34 patients underwent 2-level cervical disc surgery. There were 17 patients underwent Hybrid surgery (Hybrid group), 17 patients underwent 2-level ACDF (ACDF group). Japanese orthopaedic association (JOA), neck disability index (NDI), and Odom's standards were evaluated. Dynamic flexion and extension lateral cervical radiographs were obtained in the standing position before surgery and at routine postoperative intervals of 1, 3, 6 months.</p><p><b>RESULTS</b>Both of the two groups had significantly improvement than preoperative in JOA (t = -8.790 - -5.803, P < 0.05) and NDI scores (t = 10.717 - 13.514, P < 0.05), but no significantly difference between the two groups (P > 0.05). Both of the two groups had significantly decreased in the mean C(2-7) range of motion (ROM). The Hybrid group decreased from 46° ± 11° preoperative to 41° ± 8° at the 6 mouths after surgery (t = 3.170, P < 0.05). The ACDF group decreased from 45° ± 13° preoperative to 38° ± 15° at the 6 mouths after surgery (t = 6.709, P < 0.05). But there were no significantly difference between the two groups (P > 0.05). In the Hybrid group, both the superior adjacent segment ROM and the inferior adjacent segment ROM were decreased in the follow-up, there had significantly difference at the 1 and 3 months after surgery (superior adjacent segment: t = 5.622 and 4.032, P < 0.05; inferior adjacent segment: t = 2.879 and 2.207, P < 0.05), but no significantly difference after 6 months (P > 0.05). In the ACDF group, the ROM of the inferior adjacent segment was significantly increased at 3 and 6 months after surgery (t = -7.038 and -13.540, P < 0.05), the ROM of the superior adjacent segment was significantly increased at 6 months after surgery (t = -2.453, P < 0.05).</p><p><b>CONCLUSIONS</b>Hybrid surgery has excellent clinical results and decreases the ROM of the adjacent segment in the following 6 months, meanwhile 2-level ACDF increases the ROM of the adjacent segment. The long-term clinical outcomes of the Hybrid surgery need more study.</p>

Comparison of Topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease: a retrospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few reports on Topping-off surgery and its rationality and indications remains highly controversial. Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery.</p><p><b>METHODS</b>The 25 cases that underwent L5-S1 posterior lumbar interbody fusion (PLIF) + L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group. The 42 cases undergoing L5-S1 PLIF surgery formed PLIF group. Both groups matched in gender, age, body mass index and Pfirrmann grading (4 to 6). The patients were evaluated with visual analogue scale (VAS) and Japanese orthopaedic association (JOA) scores before surgery and in the last follow-up. Modic changes of endplates were recorded.</p><p><b>RESULTS</b>The follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. There was no significant difference in intraoperative blood loss or postoperative drainage. VAS and lumbar JOA scores improved significantly in both groups (t = 12.1 and 13.5, P < 0.05). Neither anterior nor posterior disc height was significantly changed. Segmental lordosis of L4-L5 and total lordosis were all increased significantly (Topping-off group: t = -2.30 and -2.24,P < 0.05; PLIF group: t = -2.76 and -1.83, P < 0.01). In the hyperextension and hyperflexion view, Topping-off group's range of motion (ROM) and olisthesis in the L4-L5 segment did not significantly change in flexion, but decreased in extension. In PLIF group, ROM (t = -7.82 and -4.90, P < 0.01) and olisthesis (t = -15.67 and -18.58, P < 0.01) both significantly increased in extension and flexion.</p><p><b>CONCLUSIONS</b>Compared with single segment PLIF surgery, Topping-off surgery can achieve similar symptomatic improvement in cases with pre-existing mild or moderate adjacent segment degeneration, restrict the adjacent segment's ROM in extension and prevent excessive olisthesis of adjacent segment in both extension and flexion.</p>

Pathogenesis analysis of proximal junctional lordosis after short-level posterior pedicle screw fixation in lumbar spine / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the possible reasons for proximal junctional lordosis (PJL) after short-segment posterior pedicle screw fixation in lumbar spine and discuss its proper management.</p><p><b>METHODS</b>From December 2001 to August 2005, 345 patients were treated by short-segment pedicle screw fixation and these patients were reviewed. Clinical outcome was evaluated according to Oswestry Disability Index (ODI). Proximal junctional lordosis was assessed evaluated on radiographs, by measuring lumbar lordosis angle, segmental angle at proximal level and lumbar-sacral angle. Risk factors of proximal junctional lordosis were analyzed.</p><p><b>RESULTS</b>All patients were followed-up for 2 to 6 years (average 3.8 years). ODI after lumbar surgery was 9.7-46.2 ( average 19.6 +/- 10.7). PJL was noted in 78 patients (22.6%), 37 (10.7%) of whom were symptomatic and 21 (6.1%) received revision surgery. PJL was more commonly occurred in patients over 60 years old, with reduced lumbar lordosis or vertical sacrum. The number of fusion-segment was not correlated to the occurrence of PJL.</p><p><b>CONCLUSIONS</b>Short-segment posterior pedicle screw fixation can not improve lumbar sagittal alignment. Age over of 60 years, reduced lumbar lordosis and vertical sacrum are possible risk factors of PJL sacrum.</p>