Repair of soft tissue defect at flap donor site with keystone flap in 12 cases / 中华显微外科杂志

Objective:To explore the clinical effect of keystone flap (KF) on repair of soft tissue defects at the donor site after flap transfer.Methods:From October 2020 to December 2022, in the Department of Microsurgical Rapair of First Affiliated Hospital of Xinjiang Medical University, 12 patients were repaired with KF after transfer of flaps. There were 3 donor sites for lateral thigh myocutaneous flap, 3 for sural nerve nutrient vascular flap, 4 for latissimus dorsi myocutaneous flap and 2 for medial supramalleolar island flap. Size of the KF was 15.0 cm × 12.0 cm-30.0 cm × 20.0 cm. Types of KF were: 3 of type I, 5 of type IIA, 2 of type IIB and 2 of type Sydney Melanoma Unit (SMU) modification KF design. Four patients were reviewed by telephone follow-up, 5 by WeChat and 3 with outpatient clinic visits to observe the appearance of the transferred KF and postoperative complications. Appearance of flaps was scored and analysed using Vancouver Scar Scale (VSS) and Scar Cosmesis Assessment and Rating (SCAR) .Results:The average follow-up period was 15.9 (2-27) months. The colour and texture of the transferred KF were similar to that of the surrounding skin, together with good sensation recovery. No complication such as osteofascial compartment syndrome, necrosis, wound dehiscence and venous congestion occurred in all patients. At the final follow-up, the scores for VSS was 2.17±0.58 and the score for SCAR was 5.33±1.23, with satisfactory repairing outcomes.Conclusion:As a relay flap, the KF is a simple and effective flap for reconstruction of the defects at the donor site and it can avoid complications that can be caused by direct closure of the soft tissue defect or a wound dehiscence after skin grafting.

Value of number of negative lymph nodes in predicting the prognosis of patients with esophageal cancer after neoadjuvant therapy and the construction of nomogram prodiction model / 中华消化外科杂志

Objective:To investigate the value of number of negative lymph nodes (NLNs) in predicting the prognosis of patients with esophageal cancer after neoadjuvant therapy and the construction of nomogram prodiction model.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 924 patients with esophageal cancer after neoadjuvant therapy uploaded to the Surveillance, Epidemiology, and End Results Database of the National Cancer Institute from 2004 to 2015 were collected. There were 1 624 males and 300 females, aged 63 (range, 23?85)years. All 1 924 patients were randomly divided into the training dataset of 1 348 cases and the validation dataset of 576 cases with a ratio of 7:3 based on random number method in the R software (3.6.2 version). The training dataset was used to constructed the nomogram predic-tion model, and the validation dataset was used to validate the performance of the nomogrram prediction model. The optimal cutoff values of number of NLNs and number of examined lymph nodes (ELNs) were 8, 14 and 10, 14, respectively, determined by the X-tile software (3.6.1 version), and then data of NLNs and ELNs were converted into classification variables. Observation indicators: (1) clinicopathological characteristics of patients in the training dataset and the validation dataset; (2) survival of patients in the training dataset and the validation dataset; (3) prognostic factors analysis of patients in the training dataset; (4) survival of patients in subgroup of the training dataset; (5) prognostic factors analysis in subgroup of the training dataset; (6) construction of nomogram prediction model and calibration curve. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curve and Log-Rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Based on the results of multivariate analysis, the nomogram prediction model was constructed. The prediction efficacy of nomogram prediction model was evaluated using the area under curve (AUC) of the receiver operating characteristic curve and the Harrell′s c index. Errors of the nomogram prediction model in predicting survival of patients for the training dataset and the validation dataset were evaluated using the calibration curve. Results:(1) Clinicopathological characteristics of patients in the training dataset and the validation dataset. There was no significant difference in clinicopatholo-gical characteristics between the 1 348 patients of the training dataset and the 576 patients of the validation dataset ( P>0.05). (2) Survival of patients in the training dataset and the validation dataset. All 1 924 patients were followed up for 50(range, 3?140)months, with 3-year and 5-year cumulative survival rate as 59.4% and 49.5%, respectively. The 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 in the training dataset was 46.7%, 62.0% and 66.0%, respectively, and the 5-year cumulative survival rate was 38.1%, 52.1% and 59.7%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=33.70, P<0.05). The 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 in the validation dataset was 51.1%, 54.9% and 71.2%, respectively, and the 5-year cumulative survival rate was 39.3%, 42.5% and 55.7%, respectively. There was a significant difference in the survival of these patients in the validation dataset ( χ2=14.49, P<0.05). The 3-year cumulative survival rate of patients with number of ELNs as <10, 10?14 and >14 in the training dataset was 53.9%, 60.0% and 62.7%, respectively, and the 5-year cumulative survival rate was 44.7%, 49.1% and 56.9%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=9.88, P<0.05). The 3-year cumulative survival rate of patients with number of ELNs as <10, 10?14 and >14 in the validation dataset was 56.2%, 47.9% and 69.3%, respectively, and the 5-year cumula-tive survival rate was 44.9%, 38.4% and 51.9%, respectively. There was a significant difference in the survival of these patients in the validation dataset ( χ2=9.30, P<0.05). (3) Prognostic factors analysis of patients in the training dataset. Results of multivariate analysis showed that gender, neoadjuvant pathological (yp) T staging, ypN staging (stage N1, stage N2, stage N3) and number of NLNs (8?14, >14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadjuvant therapy ( hazard ratio=0.65, 1.44, 1.96, 2.41, 4.12, 0.69, 0.56, 95% confidence interval as 0.49?0.87, 1.17?1.78, 1.59?2.42, 1.84?3.14, 2.89?5.88, 0.56?0.86, 0.45?0.70, P<0.05). (4) Survival of patients in subgroup of the training dataset. Of the patients with NLNs in the training dataset, the 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 was 61.1%, 71.6% and 76.8%, respectively, and the 5-year cumulative survival rate was 50.7%, 59.9% and 70.1%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=12.66, P<0.05). Of the patients with positive lymph nodes in the training dataset, the 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 was 26.1%, 42.9% and 44.7%, respectively, and the 5-year cumulative survival rate was 20.0%, 36.5% and 39.3%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=20.39, P<0.05). (5) Prognostic factors analysis in subgroup of the training dataset. Results of multivariate analysis in patients with NLNs in the training dataset showed that gender, ypT staging and number of NLNs (>14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadju-vant therapy ( hazard ratio=0.67, 1.44, 0.56, 95% confidence interval as 0.47?0.96, 1.09?1.90, 0.41?0.77, P<0.05). Results of multi-variate analysis in patients with positive lymph nodes in the training dataset showed that race as others, histological grade as G2, ypN staging as stage N3 and number of NLNs (8?14, >14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadjuvant therapy ( hazard ratio=2.73, 0.70, 2.08, 0.63, 0.59, 95% confidence interval as 1.43?5.21, 0.54?0.91, 1.44?3.02, 0.46?0.87, 0.44?0.78, P<0.05). (6) Construction of nomogram prediction model and calibration curve. Based on the multivariate analysis of prognosis in patients of the training dataset ,the nomogram prediction model for the prognosis of patients with esophageal cancer after neoadju-vant treatment was constructed based on the indicators of gender, ypT staging, ypN staging and number of NLNs. The AUC of nomogram prediction model in predicting the 3-, 5-year cumulative survival rate of patients in the training dataset and the validation dataset was 0.70, 0. 70 and 0.71, 0.71, respectively. The Harrell′s c index of nomogram prediction model of patients in the training dataset and the validation dataset was 0.66 and 0.63, respectively. Results of calibration curve showed that the predicted value of the nomogram prediction model of patients in the training dataset and the validation dataset was in good agreement with the actual observed value. Conclusion:The number of NLNs is an independent influencing factor for the prognosis of esophageal cancer patients after neoadjuvant therapy, and the nomogram prediction model based on number of NLNs can predict the prognosis of esophageal cancer patients after neoadjuvant therapy.

Network Meta-analysis of Chinese medicine injection combined with conventional western medicine in treatment of stable angina pectoris / 中国中药杂志

This study aimed to systematically evaluate the efficacy and safety of different Chinese medicine injections combined with conventional western medicine for stable angina pectoris. PubMed, Cochrane Library, EMbase, Web of Science, CNKI, Wanfang, VIP, and SinoMed were searched to collect randomized controlled trial(RCT) of Chinese medicine injection combined with conventio-nal western medicine in the treatment of stable angina pectoris from the inception of the databases to July 8, 2022. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Stata 15.1 was used for network Meta-analysis. A total of 52 RCTs were included, involving 4 828 patients treated by 9 Chinese medicine injections(Danhong Injection, Salvia Miltiorrhiza Polyphenol Hydrochloride Injection, Tanshinone Sodium Ⅱ_A Sulfonate Injection, Salvia Miltiorrhiza Ligustrazine Injection, Dazhu Hongjingtian Injection, Puerarin Injection, Safflower Yellow Pigment Injection, Shenmai Injection and Xuesaitong Injection). The network Meta-analysis showed that:(1)in terms of improving the efficacy of angina pectoris, the surface under the cumulative ranking curve(SUCRA) followed the order of conventional western medicine combined with Salvia Miltiorrhiza Ligustrazine Injection>Tanshinone Sodium Ⅱ_A Sulfonate Injection>Danhong Injection>Salvia Miltiorrhiza Polyphenol Hydrochloride Injection>Xuesaitong Injection>Shenmai Injection>Puerarin Injection>Safflower Yellow Pigment Injection>Dazhu Hongjingtian Injection;(2)in terms of improving the efficacy of electrocardiogram(ECG), SUCRA followed the order of conventional western medicine combined with Salvia Miltiorrhiza Ligustrazine Injection>Puerarin Injection>Danhong Injection>Salvia Miltiorrhiza Polyphenol Hydrochloride Injection>Shenmai Injection>Xuesaitong Injection>Safflower Yellow Pigment Injection>Tanshinone Sodium Ⅱ_A Sulfonate Injection>Dazhu Hongjingtian Injection;(3)in terms of increasing high-density lipoprotein cholesterol(HDL-C), SUCRA followed the order of conventional western medicine combined with Danhong Injection>Shenmai Injection>Safflower Yellow Pigment Injection>Xuesaitong Injection>Tanshinone Sodium Ⅱ_A Sulfonate Injection>Dazhu Hongjingtian Injection;(4)in terms of lowering low-density lipoprotein cholesterol(LDL-C), SUCRA followed the order of conventional western medicine combined with Safflower Yellow Pigment Injection>Danhong Injection>Shenmai Injection>Tanshinone Sodium Ⅱ_A Sulfonate Injection>Dazhu Hongjingtian Injection>Xuesaitong Injection;(5)in terms of safety, the overall adverse reactions of Chinese medicine injection combined with conventional western medicine were less than those of the control group. Current evidence indicated that Chinese medicine injection combined with conventional western medicine could improve the curative effect of stable angina pectoris with higher safety. Limited by the number and quality of included studies, the above conclusion needed to be verified by more high-quality studies.

Forensic Analysis of 9 Cases of Sudden Unexpected Death in Epilepsy / 法医学杂志

OBJECTIVES@#To analyze the case, scene and forensic pathological characteristics of sudden unexpected death in epilepsy (SUDEP), to provide a practical basis for forensic identification.@*METHODS@#A total of 9 autopsy cases of SUDEP were collected. The basic information of the cases, the scene characteristics, the forensic pathological changes, the common drugs and antiepileptic drug test results, and pericardial fluid biochemical test results were analyzed.@*RESULTS@#All of the 9 cases were male epilepsy patients died during sleep at night, the age of death was (37.1±8.6) years, and the course of epilepsy was (21.3±5.6) years. Six corpses were in prone position and three in left lateral position. The hemorrhage of the sternocleidomastoid muscle, sternal thyroid muscle and sternohyoid muscle were found with 8 cases, 5 cases and 4 cases, respectively, all of them were unilateral. Six cases had bilateral hemorrhage of pectoralis minor muscle. Brain edema, phagocytosis of frontotemporal neurons and gliosis, cardiac fibers bend in wavy patterns and eosinophilic staining enhancement, pulmonary edema, pulmonary congestion, alveolar hemorrhage, pulmonary small bronchiole wall shrinking, tubular proteinuria and pancreatic parenchymal hemorrhage were the common histopathological changes. The biochemical test results of pericardial fluid indicated that there were myocardial ischemic damage.@*CONCLUSIONS@#Young male, early onset, long course of disease, sleep in the prone position, poor drug compliance or combination, epileptic seizure may be the risk factors of SUDEP. Cardiac dysfunction and respiratory depression might be the main death mechanism of SUDEP.

Investigation on occupational hazards of non-coal mines in Hunan Province in 2021 / 中国职业医学

@#Abstract: Objective - To understand the status of occupational hazards in non coal mine mountains in Hunan Province. Methods - - A cross sectional survey was conducted on 432 non coal mining enterprises in Hunan Province in 2021. The field ， occupational health survey occupational disease hazard factors detection and occupational health monitoring data analysis were Results - carried out. Limited liability companies and private enterprises were the main economic types of non coal mining ， ， mountains in Hunan Province accounting for 55.3% and 32.4% respectively. The size of enterprises was mainly small and ， ； - micro enterprises accounting for 59.3% and 35.2% respectively 78.0% of the enterprises were in non metallic mining. The - ， over standard rates of silica dust and noise in workplaces were 17.1% and 29.4% respectively. The exposure rate of ， （P ） occupational hazard factor was 47.3%. The smaller the enterprise scale the higher the exposure rate <0.01 . The number of ， ， people exposed to silica dust and noise was the largest with the exposure rate of 29.4% and 31.0% respectively. The rates of ， occupational health training for persons in charge of enterprises occupational health management personnel and workers were ， ， ， 73.8% 73.4% and 85.0% respectively. The smaller the enterprise scale the lower the occupational health training rates of ， ， enterprise leaders occupational health management personnel and workers and the lower the implementation rates of （ P ） - - enterprise occupational health examination all <0.05 . The fully installed rate and effective rate of occupational disease ； prevention facilities were 6.9% and 1.6% respectively and the fully deployed rate and effective wearing rate of personal ， protective equipment were 11.1% and 6.2% respectively. The detection rates of occupational contraindications and suspected ， Conclusion occupational diseases in workers exposed to silica dust and noise were 2.0% and 2.9% respectively. The - ， occupational risks such as silica dust and noise are serious in non coal mine mountains of Hunan Province and the foundation of occupational health management is weak in small and micro enterprises.

Sciatic nerve injury and its effect on bone regeneration in distraction osteogenesis zone in rat / 中华显微外科杂志

Objective:To evaluate the effect and mechanism of bone regeneration in distraction osteogenesis zone after the repair of sciatic nerve in rats.Methods:Between January 2021 and August 2021, 60 healthy adult male Sprague-Dawley rats were divided randomly into 3 groups: Group A, B, and C. In groups B and C, right sciatic nerve transection and anastomosis were performed. Then after 8 and 12 weeks, the 3 groups were treated with extension external fixation (Ilizarov technique) of right femur osteotomy to make distraction osteogenesis model. Electrophysiological changes of peripheral nerves were monitored by electromyography (EMG) pre-and postoperatively in all the femoral lengthening rats. The formation of callus was examined by X-ray every week after operation. The rats were sacrificed on 2nd, 4th, 6th weeks after the bone transport operation. Four-point bending test and histological staining examination were carried out to determine the osteogenesis in the distracted area. SPSS 21.0 was used for statistical analysis. Data of measurement were expressed as (Mean±SD). A non-parametric test was used to assess the statistical difference between groups. Graphs were plotted by GraphPad Prism 8.0 and considered statistically significant when P<0.05. Results:The results of Sciatic nerve function index (SFI), Compound muscle action potential (CMAP) and Motor nerve conduction velocity (MNCV) in group A were better than the group B and group C in both of before and after the surgery. At the 2nd and 4th weeks of the consolidation stage, X-ray showed that bone formation in group B was superior to groups A and C; HE and Safranin O staining showed that local capillary and cartilage formation in group B was significantly more than in groups A and C; Immunohistochemical staining showed that the expression levels of Osteopontin(Opn) and Osteocalcin(Ocn) in the distraction area of group B were higher than that of groups A and C. At the 6th week of the consolidation stage, the four-point bending test showed that the bone quality of group B was better than groups A and C. The differences of the results between groups shown above had statistical significance ( P<0.05). Conclusion:Bone regeneration in the distraction area of the bone lengthening group with sciatic nerve injury was better than that of the bone lengthening group without a never injury. This might be in relation to the fact that a distractive osteogenesis caused the secondary injury to the repaired nerve. The electrophysiological results showed that periodic changes took place in the repaired sciatic nerve caused by the stretch of femoral lengthening, and the injurious changes of sciatic nerve would be gradually relieved in 6th week after surgery.

Reconstruction of soft tissue defects of extremities with polyfoliate anterolateral thigh perforator flap / 中华显微外科杂志

Objective:To report the clinical effect of using polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects of extremities.Methods:From April 2017 to January 2020, 21 cases of soft tissue defect in extremities were repaired by polyfoliate ALTPF, including 11 cases of traffic accident trauma, 8 of machine crush injury, and 2 of iatrogenic complications. There were 14 cases in calf and ankle, and 7 in hand and wrist. The area of defect was 17.0 cm×12.0 cm-20.0 cm×14.0 cm. Eight cases were complicated with fracture and bone exposure, 13 with tendon and nerve exposure. Thirteen cases had 2 adjacent wounds and 8 had large wound. The polyfoliate ALTPF was designed for wound repair. The patients entered follow-up regularly. The last follow-up included the colour, texture, shape, sensation of the flap and the scar of the donor area.Results:There was no infection in the recipient site of all 21 patients after operation, and all flaps survived. Two cases had venous crisis, with 1 was found in 5 hours after operation. Emergency exploration found that there were thrombosis in anastomosed veins. The flap survived completely after the thrombus removed and the embolized vein was anastomosed again. Another case was found with venous crisis at 1 lobe of flap in 2 hours after operation. Emergency exploration found that the anastomotic site between the superficial vein from the medial edge of the flap to the great saphenous vein and the superficial vein of the recipient area was embolised. The flap survived completely after the thrombus removed and the embolized veins was anastomosed again. The wounds of all donor sites healed in the first stage. All patients were followed-up for 6-30 (mean 12.3) months. All flaps had good colour and texture, with slightly bloated appearance and dull sensation. There was only a linear scar in the donor area, and the appearance evaluation was good.Conclusion:Polyfoliate ALTPF can be used to repair 2 large or adjacent wounds in 1 stage, reduce the damage of donor site. It is an ideal method to repair large or adjacent wounds of limb.

Bone tunnel positions in anterior cruciate ligament reconstruction evaluated by three-dimensional CT reconstruction based on Mimics software:modified transtibial versus anteromedial portal technique / 中国骨伤

OBJECTIVE@#To compare the femoral and tibial tunnel positions of anterior cruciate ligament reconstruction using the modified transtibial (MTT) technique and anteromedial (AM) portal technique.@*METHODS@#Between January 2017 and September 2020, 78 patients with anterior cruciate ligament rupture underwent single-bundle reconstruction with the modified transtibial technique in 39 cases (group MTT) and through anteromedial approach in 39 cases (group AM). There were 25 males and 14 females in group MTT, with an average age of (37.0±2.3) years old; 27 males and 12 females in group AM, with an average age of (37.5±2.2) years old. CT scan of the affected knee was conducted one week after the surgery to measure and compare the femoral tunnels positioning (Fx, Fy), tibial tunnels positioning in the frontal plane(Tx1), tibial tunnels positioning in the sagittal plane (Ty1), and tibial tunnels positioning in the axial plane (Tx2, Ty2) in patients undergoing anterior cruciate ligament reconstruction through Mimics software.@*RESULTS@#Three-dimensional CT reconstruction after the surgery showed that the average Fx and Fy were(25.2±2.1)% and (34.9±3.0)% respectively and the Tx1 and Ty1 were (45.5±3.3)% and (44.7± 3.0)% respectively, while the Tx2 and Ty2 were (47.0±3.0)% and (39.9±4.2)% respectively in group MTT. In group AM, the average Fx and Fy were (26.0±2.0)% and (36.1±3.9)% respectively and the Tx1 and Ty1 were (46.5±3.1)% and (45.6± 3.1)% respectively, while the Tx2 and Ty2 were (47.4±2.5)% and (39.6±3.9)% respectively. There were no statistically significant differences in the femoral and tibial tunnels between the two groups (@*CONCLUSION@#Both the MTT and AM technique can achieve good anatomical positioning of the femoral and tibial tunnels, without significant differences in the positioning of the bone tunnels.

Chronic stress increases dopamine levels in hippocampal dentate gyrus and impairs spatial learning and memory in rats / 生理学报

The objective of this study was to elucidate the effect of chronic stress (CS) on dopamine (DA) level and synaptic efficiency in the hippocampal dentate gyrus (DG) during spatial learning and memory. Sprague Dawley (SD) male rats were randomly divided into control group and CS group (n = 10). CS group was treated with chronic mild unpredictable stress, and control group did not receive any treatments. The levels of epinephrine and corticosterone (CORT) in serum were measured by using enzyme-linked immunosorbent assay (ELISA); the spatial learning and memory abilities of rats were measured by Morris water maze (MWM) test. Meanwhile, the amplitude of field excitatory postsynaptic potential (fEPSP) and concentration of DA in the DG region were determined by in vivo electrophysiology, microdialysis and HPLC techniques during MWM test in rats. After that, the DA D1 receptor (D1R) and its key downstream members in DG were examined by immunohistochemistry or Western blot assay. The results showed that the levels of epinephrine and CORT in the serum of the rats in CS group were significantly increased compared with those in the control group (P < 0.05). In CS group rats, the escape latency was significantly prolonged and the number of platform crossing was markedly decreased during MWM test, compared with those in control group (P < 0.05). Furthermore, the amplitude of fEPSP in the DG was not changed during MWM test in CS rats, while it was significantly increased on the 3rd day of MWM test in control group (P < 0.05). Compared with baseline or control group, CS group showed significantly increased DA level from the 1st to 3rd days of MWM test in the DG (P < 0.05). In addition, the protein expression of D1R was markedly up-regulated in the DG in CS group, while the protein expression levels of p-PKA, p-CREB and BDNF were significantly reduced, compared with those in control group. These results suggest that CS may impair spatial learning and memory abilities in rats through the enhancement of the DA levels in the hippocampal DG.

Preliminary establishment of reference interval for non-fasting serum triglycerides among healthy middle-aged and elderly people in some communities Beijing / 中华检验医学杂志

Objective:To establish the reference interval of serum triglyceride (TG) for 4 hours after meal in healthy middle and old people of Beijing community, and to provide the diagnostic basis for the judgment of dyslipidemia after meal.Methods:Selected 369 elderly people from January to October 2018 in the health examination of Guang′anmen Hospital of the Chinese Academy of Traditional Chinese Medicine. The subjects collected fasting venous blood samples in the morning the next day after fasting for 12 hours, then ate a standard breakfast that conformed to the local dietary habits, and collected venous blood samples again 4 hours after eating. Serum TG levels were measured 4 h after meal using AU5822 fully automatic biochemical analyzer and matching reagents. The comparison of postprandial TG between different age and sex groups was statistically significant using the nonparametric test of two independent samples, and the comparison between postprandial and fasting TG using the nonparametric test of two paired samples with P<0.05 as the difference. The 95% confidence interval was calculated using a nonparametric method according to the relevant requirements of the CLSI EP28-A3c file, and the reference interval was expressed as P2.5, P97.5. Results:The median 4-hour post-prandial TG of the middle-aged and elderly aged 45-59 years and those aged ≥ 60 years at health checkups were 1.65 (1.25, 2.13) mmol/L and 1.58 (1.25, 2.00) mmol/L, there was no significant difference between the two groups ( Z=-1.040, P>0.05). There was no statistical difference between males 1.69 (1.22, 2.31) mmol/L and females 1.63 (1.26, 2.12) mmol/L at 4 hours postprandial TG levels in the 45-59 year-old group ( Z=-0.179, P>0.05),there was also no statistical difference between 1.64 (1.22, 2.06) mmol/L for men and 1.53 (1.28, 1.99) mmol/L for women aged 60 years or older ( Z=-0.256, P>0.05).Compared with the median fasting TG of 1.05 (0.87, 1.29) mmol/L, the median serum TG of 1.61 (1.25, 2.09) mmol/L at 4 hours after meal was significantly increased ( Z=-16.449, P<0.01). The difference between postprandial and fasting was 0.52 (0.30, 0.85) mmol/L.The reference range of serum TG at 4 hours after meal was 0.82 to 3.02 mmol/L. Conclusion:In this study, the reference range of serum triglycerides for 4 hours after meal was established in some healthy elderly population groups in Beijing.

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region / 中华显微外科杂志

Objective To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014.Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases.The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recov鄄ered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the muscu鄄locutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3.In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively. Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region / 中华显微外科杂志

Objective@#To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation.@*Methods@#A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014. Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery.@*Results@#All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recovered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3. In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively.@*Conclusion@#Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Effect of Translocator Protein Ligand YL-IPA08 on Anxiety-Depressive-Like Behavior in Postpartum Depression Rats / 中国药学杂志

OBJECTIVE: To study the effect of Mr1.8×104 translocator protein (TSPO) selective ligand compound YL-IPA08 on postpartum anxiety-depressive behavior. METHODS: The model of postpartum depression in rats was established by classical hormone simulating postpregnancy (HSP) hormone withdrawal induced, and the effect of YL-IPA08 on spontaneous activity in rats was evaluated by the open field test(OFT), and the effect of YL-IPA08 on anxiety and depressive-like behavior in rats was evaluated by the elevated plus maze test (EPM) and forced swimming test (FST). The changes of TSPO expression in hippocampuls and prefrontal cortex of rats were detected by RT-PCR and Western blot. RESULTS: Compared with control group, the hormones of pregnancy hormones withdraw stimulating and drug treatment do not affect the spontaneous activity of rats (P>0.05), but the model group rats showed significant anxiety and depressive symptoms, which is characterized by elevated plus maze test (P<0.05, P<0.01),and forced swimming test (P<0.05).After the establishment of the model, three weeks of intragastric administration were started, YL-IPA08 (0.1 and 0.3 mg•kg-1, po) or positive control drug sertraline (10 mg•kg-1, po) can significantly reverse the above series of changes of postpartum anxiety and depressive behavior (P<0.05 or 0.01), and significantly increase the TSPO level in the hippocampus and prefrontal cortex of the model rats. CONCLUSION: YL-IPA08 shows anti-postpartum anxiety-depressive behavior in a series of rat behavior models, and the mechanism may be closely related to its enhancing central TSPO expression and promoting biosynthesis of following neurosteroids.

Effect of body mass fluctuation on the prognosis of atrial fibrillation / 中国综合临床

Objective To investigate the effect of body mass fluctuation on the prognosis of patients with atrial fibrillation.Methods The patients diagnosed with atrial fibrillation in the People′s Hospital of Xinjiang Uygur Autonomous Region from 2012 to 2014 were selected.Among the 540 patients,the patients were divided into normal body( BMI ≤ 25 kg／m2 ),overweight (25 kg／m2＜BMI＜30 kg／m2 ) and obesity (BMI ≥30 kg／m2) according to the baseline body mass.The median body mass fluctuation of the three groups was 2.40 kg,and according to the median body mass fluctuations,the patients were divided into two groups:the high body mass fluctuation group and the low body mass fluctuation group.Changes of body mass were observed and the incidence of cardiac death,acute coronary syndrome,chronic heart failure,cerebral embolism and peripheral vascular embolization were monitored.Results During the follow?up period,as the increased of body mass fluctuation,the incidence rate of end point events also increasing continuously.The main end point event was used as the composite end point (HR(95%CI): 1.03 (1.06～1.15); P＝0.02), including the cardiogenic death ( HR( 95%CI): 1.04 ( 1.09～1.12); P＝0.03),the incidence of acute coronary syndrome (HR(95%CI): 1.04 (0.96～1.08); P＝0.06) and the heart failure incidence ( HR (95%CI): 95%CI: 1.04 (1.01～1.09),P＝0.04).The secondary endpoint as composite endpoint ( HR (95%CI): 1.16 (1.15～1.31); P＝0.01),including the cerebral embolism (HR(95%CI): 1.21 (1.23～1.54); P＝0.01) and the peripheral vascular embolism (HR(95%CI): 1.03 (0.91～1.03); P＝0.01) .After adjusting for all confounding factors,the quartile group with the highest body mass fluctuations was 6.2% higher in the main endpoint event than the lowest body quartile and 14.2% higher in the secondary endpoint.The occurrence of major endpoint events and secondary endpoint events in the quadruple group with high body mass fluctuation was significantly higher than that in the quadruple group with the lowest body mass fluctuation(main endpoint: 4.4% vs 10.6%; ( HR ( 95%CI): 1.86 ( 1.53 ～ 2.41); P＜0.01;secondary endpoints: 15.6% vs 29.8%; ( HR ( 95%CI) 2.12 ( 1.56 ～ 3.58); P＜0.01).The main endpoint events were cardiogenic death (HR(95%CI): 1.85 (1.73～2.3); P＜0.01); incidence of acute coronary syndrome (HR(95%CI): 1.02 (0.94～1.35); P＝0.08); incidence of heart failure (HR(95%CI): 1.48 (1.28～1.62); P＜0.01); secondary endpoint events were cerebral embolism (HR(95%CI):2.23 (1.93～3.91).( P＜0.01),peripheral vascular embolism ( HR( 95%CI): 1.05 (0.96～1.42); P＝0.13).For patients with normal body mass,body mass fluctuations had no significant effect on prognosis (main endpoints: 6.1% vs 5.3%; (HR(95%CI): 1.04 (0.94 ～ 1.43); P＝0.064; secondary endpoint: 16.7% vs 17.4%; ( HR ( 95%CI): 1.12 ( 0.84～ 1.09); P＝0.072), but for overweight and obese patients,the greater the fluctuation of body mass,the higher the incidence of adverse events (main endpoint:super?recombination: 5.8% vs 11.2%; ( HR ( 95%CI): 1.532 ( 1.135 ～ 3.156); P＜0.001; obese group: 8.3% vs 15.1%; (HR(95%CI): 1.584 (1.258～3.489); P＜0.001; secondary end points: super recombination: 17.1% and 21.3%; (HR(95%CI): 341.00 ( 1.132～ 1.984); P＝0.013; obese group:19.4% and 25.2%; ( HR ( 95%CI): 1.315 ( 1.128～2.123); P＝ 0.018).Conclusion Body mass fluctuations can significantly affect the prognosis of patients with atrial fibrillation and has a greater impact on patients with overweight and obesity.

The pattern of lymph node metastasis and prognostic factors analysis of Siewert type Ⅱ adenocarcinoma of esophagogastric junction / 中华消化外科杂志

Objective To investigate the pattern of lymph node metastasis and analyze prognostic factors of Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG).Methods The retrospective case-control study was conducted.The clinicopathological data of 368 patients with Siewert type Ⅱ AEG who were admitted to Tianjin Medical University Cancer Institute and Hospital from June 2010 and November 2015 were collected.There were 323 males and 45 females,aged from 35 to 80 years,with an average age of 64 years.Of 368 patients,209 underwent left transthoracic surgery,1 12 underwent thoracoabdominal surgery,and 47 underwent Ivor-Lewis surgery.Observation indicators:(1) total lymph node metastasis and metastasis of various lymph node stations;(2) follow-up and survival;(3) prognostic factors analysis;(4) influencing factors affecting thoracic lymph node metastasis.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients up to November 2018.Measurement data with skewed distribution were represented as M (range).Count data were represented as absolute number or percentage.The survival time and rate were calculated using the Kaplan-Meier method.The univariate and multivariate analyses were done by the COX proportional hazard model.Results (1) Total lymph node metastasis and metastasis of various lymph node stations:the total lymph node metastasis rate was 66.58％ (245/368) in 368 patients.The metastasis rates of abdominal lymph nodes,thoracic lymph nodes,lower mediastinal lymph nodes,and upper mediastinal lymph nodes were 65.49％ (241/368),12.77％ (47/368),12.23％ (45/368),and 1.09％ (4/368),respectively.The order of metastasis rate of various lymph node stations from high to low was 51.99％(170/237) of No.7 left gastric artery,34.23％(89/260) of No.1 right paracardial region,33.88％ (83/245) of No.2 left paracardial region,28.91％ (85/294) of No.3 lesser curvature,27.10％(29/107) of No.1 1 splenic artery,19.75％(16/81) of No.9 celiac trunk,15.25％(36/236) of No.E8Lo lower paraesophageal region,11.94％ (16/134) of No.4 greater curvature,11.76％ (6/51) of No.E8M middle paraesophageal region,11.1 1％(10/90) of No.8 common hepatic artery,4.65％(4/86) of No.E9L left inferior pulmonary ligament and 3.39％ (2/59) of No.E7 subcarinal region.(2) Follow-up and survival:of the 368 patients,309 were followed up for 1-103 months,with a median follow-up time of 38 months.The survival time of 309 patients was 0.7-101.9 months,and the median survival time was 35.9 months.During the followup,the postoperative l-,2-,3-year overall survival rates were 85.9％,68.6％,and 58.7％,respectively.(3) Prognostic factors analysis.Results of univariate analysis showed that tumor differentiation degree,presence of thoracic lymph node metastasis,number of metastatic lymph nodes,T staging,tumor diameter,and length of esophageal invasion were associated factors affecting prognosis of patients (x2 =8.776,26.582,46.057,18.679,22.460,9.158,P＜0.05).Results of multivariate analysis showed that presence of thoracic lymph node metastasis,number of metastatic lymph nodes,T staging,and tumor diameter were independent influencing factors for prognosis of patients [odds ratio (OR) =1.699,1.271,1.422,1.238,95％ confidence interval:1.102-2.621,1.019-1.481,1.090-1.856,0.971-1.481,P＜0.05].(4) Influencing factors affecting thoracic lymph node metastasis:results of univariate analysis showed that tumor diameter,length of esophageal invasion,number of lymph lodes harvested in thorax were related factors for thoracic lymph node metastasis (x2 =5.129,43.140,10.605,P＜0.05).Results of multivariate analysis showed that length of esophageal invasion ≥2 cm,number of lymph lodes harvested in thorax ≥ 4 were independent risk factors for thoracic lymph node metastasis (OR =6.321,1.097,95％ confidence interval:2.982-13.398,1.026-1.173,P＜0.05).Conclusion Lymph node metastasis of Siewert type Ⅱ AEG spreads two regions,mainly at abdominal lymph nodes,followed by the thoracic lymph nodes.Presence of thoracic lymph node metastasis,number of metastatic lymph nodes,T staging,and tumor diameter are independent influencing factors for prognosis of patients.Presence of thoracic lymph node metastasis indicates poor prognosis of patients.Length of esophageal invasion ≥ 2 cm and number of lymph lodes harvested in thorax ≥4 are independent risk factors for thoracic lymph node metastasis.

Diagnostic value of magnetic resonance multimode functional imaging in small hepatocellular carcinoma / 新乡医学院学报

Objective To investigate the magnetic resonance multimodal function imaging characteristics of small hepa-tocellular carcinoma and evaluate its diagnostic value in small liver cancer. Methods Thirty-nine patients with small hepato-cellular carcinoma were selected in the First Affiliated Hospital of Xinxiang Medical University from January 2016 to January 2018. The magnetic resonance plain scan data,dynamic enhance data and diffusion imaging data of all patients were analyzed. Results Forty-five lesions were found by plain scan,and 48 lesions(37 lesions were rapid rise and rapid descent type,6 le-sions were flatbed type,3 lesions were slow ascent and rapid descent type,2 lesions were not obvious strengthening type)were found by dynamic enhancement. The lesions were hyperintense or slightly hyperintense on the diffusion weighted imaging (DWI)image. The lesions were hyperintense or slightly hyperintense on the DWI. The main shape of lesions was round,irregu-lar ring and nodositas. The apparent diffusion coefficient(ADC)value of cancer tissue and normal liver tissue gradually de-creased with the increase of b value. Under the same b value,the ADC values of small hepatocellular carcinoma was significant-ly lower than that in the normal liver tissue(P < 0. 05). Conclusion Magnetic resonance multimodality functional imaging (magnetic resonance imaging dynamic enhanced combine with multi-b value DWI)can effectively improve the diagnostic effi-cacy of small hepatocellular carcinoma.

The influence of fear of hypoglycemia on the treatment compliance of diabetes patients / 中国实用护理杂志

Objective To investigate the influence of fear of hypoglycemia on the compliance of diabetes patients.Methods A total of 201 diabetes inpatients with hypoglycemia in four first-class hospital of grade three in Ji'nan were selected by convenience sampling method and investigated by General Information Questionnaire,Chinese version of Hypoglycemia Fear Survey Ⅱ-Worry Scale and Diabetes Treatment Compliance Scale.And carrid on the correlation analysis and the multiple linear regression analysis.Results The scores of fear of hypoglycemia was 3-33 points,the median score was 12 points(interquartile range,10-15 points).The score of treatment compliance was 23-55(35.90±5.84)points.Spearman correlation analysis showed that fear of hypoglycemia score were negative correlated with treatment compliance score,drug,diet,exercise dimensions(r=-0.467-0.288),and it was positively correlated with self monitoring dimension(r=0.259),the difference was statistically significant(P＜0.01),it was not associated with periodic inspection dimension.Multiple linear regression analysis showed that the economic income,occupation,whether to participate in health education of diabetes mellitus,glycosylated hemoglobin,fear of hypoglycemia were the influence factors of treatment compliance.Conclusions Diabetes patients'fear of hypoglycemia can influence treatment compliance.medical staff should pay attention to and take effective measures to reduce their fear of hypoglycemia and improve treatment compliance.

The effects of circadian typology on glycemic control in patients with type 2 diabetes / 中国实用护理杂志

Objective To investigate the distribution of circadian typology of patients with type 2 diabetes mellitus (T2DM) and to analyze its consequent impact on glycemic control. Methods From January 2016 to June 2016, a total of 283 T2DM patients were interviewed in this study. Self designed questionnaire, Morningness-Eveningness Questionnaire (MEQ), Pittsburg Sleep Quality Index (PSQI) and Center for Epidemiological Survey-Depression Scale (CES-D) were used to collect information on diabetes history, circadian typology, sleep quality and depression. HbA1c and other biochemical indicators were determined. The glycemic control target was<7%. The 283 T2DM patients were divided into three groups:morning type group, evening type group and neither type group according to MEQ score. Results Of the 283 subjects, 97 (34.3%) were classified as morning type, 42 (14.8%) as evening type, and 144 (50.9%) as neither. Participants with evening type were younger, shorter diabetes duration, more depressive symptoms, higher perceived sleep debt, higher FBG and higher HbA1c than those with morning type. The binary Logistic regression analysis showed that HbAlc≥7%was associated with higher FBG, higher PSQI score, higher sleep debt, lower HDL-C, and lower MEQ scores (OR=0.189-2.904, all P<0.05). Conclusions Evening type was associated with higher HbA1c and poorer glycemic control in T2DM patients compared with morning type and may be one of the risk factors affecting glycemic control.

Comparison of the prognostic value of the seventh and eighth edition of The AJCC Esophageal Cancer Staging System for the patients with stage Ⅱ and Ⅲesophageal squamous cell carcinoma / 中华外科杂志

Objective@#To compare and evaluate the prognostic value of the 7th and 8th edition of The AJCC Esophageal Cancer Staging System for patients with stage Ⅱ and Ⅲ esophageal squamous cell carcinoma.@*Methods@#The clinical data of 328 esophageal cancer patients who received operation at Department of Esophageal Cancer, Tianjin Tumour Hospital from January 2006 to December 2010 were restrospectively analyzed. There were 63 female and 265 male patients. The mean age was 65 (range: 33 to 87) years. Univariate and multivariate analysis were performed to identify the prognosis factors.@*Results@#The five years overall survival rates among patients with stage Ⅱ and Ⅲ were both significantly different (χ2=87.035, 84.730, all P=0.000) according to the 7th and 8th editions of the TNM staging systems. The five years overall survival rate among patients with stage ⅡB and ⅢA were significantly different (39.6% vs 23.4%, P=0.001) according to the 7th edition of the esophageal cancer staging systems.According to the 8th edition of the esophageal cancer staging system, the 5 years survival rate of patients with stage ⅡA and ⅡB, ⅢB and Ⅳ was statistically significant (58.5% vs. 35.5%, P=0.040; 18.9% vs. 0, P=0.000). In multivariate analysis, tumor size, T staging, N staging and tumor differentiation (HR=1.592, 95%CI: 1.185 to 2.139, P=0.002; HR=1.519, 95% CI: 1.236 to 1.867, P=0.000; HR=1.647, 95% CI: 1.448 to 1.874, P=0.000; HR=1.404, 95% CI: 1.059 to 1.861, P=0.018) were the main independent prognosis factors affecting the prognosis of esophageal squamous cell carcinoma patients.@*Conclusions@#Both the 7th and the 8th editions of TNM staging systems are able to reflect the clinical prognosis of patients receiving radical resection of esophageal cancer, and the factors of tumor size, differentiaton, invasion depth and lymph node metastases are the independent predictors of prognosis. The 8th edition provides a more detailed and more reasonable for the staging of stage Ⅱ and Ⅲ for esophageal cancer patients than the 7th edition, and it is more accurate for the prognosis of patients with esophageal cancer after surgery.

Progress of biological characteristics and clinical signifiance of common heart failure markers / 中国综合临床

Heart failure is a serious and terminal stage of various cardiovascular diseases,is one of the most important heart diseases,and it also the most common reason for hospitalization.In recent years,studies on new markers in the diagnosis,treatment and prognosis of heart failure have made great progress,such as B-type brain natriuretic peptide can partially reflect hemodynamic imbalance,troponin can indicate cardiomyocyte injury,soluble ST2 and galectin-3 indicate myocardium remodeling and fibrosis,C-reactive protein,cystatin C and procalcitonin,and copeptin have significant prognostic value for outcomes,microRNA in the regulation of gene expression influence heart failure.