Role of complement dysregulation in age-related macular degeneration / 中华实验眼科杂志

Age-related macular degeneration (AMD) is a common cause of blindness, which is still short of effective therapies.As a complex disease affected by genetical, metabolic and nutritional factors, a key factor to promote the occurrence and development of AMD is chronic inflammation.In recent years, the etiological role of abnormal complement activation in AMD has attracted lots of attention.Genetic analysis has identified a number of complement-related genes, especially CFH, affecting the susceptibility of AMD.Moreover, in vitro and in vivo studies have found that abnormal ocular and systemic complement activations are closely related to the pathological alterations of AMD, including Bruch membrane changes, drusen formation, chronic retinal inflammation and choroidal neovascularization.The dysregulation of complement activation cascades causes the damage of retinal cells, which eventually leads to the pathological changes of AMD.Accordingly, complement system has become a target for new anti-AMD therapy development.This review summarized the pathological characteristics of AMD, complement-related risk genes for AMD, and the role of abnormal complement activation in promoting the progression of AMD, so as to find new targets for AMD treatment.

Effects of GSK3β/eEF2K signaling pathway on pulmonary fibrosis in mice / 中国应用生理学杂志

Objective: To investigate the effects of glycogen synthase kinase-3β (GSK3β)/eukaryotic extension factor kinase 2 (eEF2K) signaling pathway on the process of pulmonary fibrosis through in vivo experiments, and find new ideas for clinical treatment of pulmonary fibrosis. Methods: The pulmonary fibrosis model of C57BL/6 male mice was induced by bleomycin with intratracheal injection at the dose of 2 mg/kg. After 14 days of modeling, animals were divided into model group, negative inhibition group and inhibition group (n=5 for each group), and control group was not processed. The inhibition group was treated with TDZD-8 (4 mg/kg) after modeling, the negative inhibition group was given DMSO solution after modeling, and the samples were collected after 28 days. Hematoxylin-eosin staining method was used to detect lung fibrosis in mice and scored according to Ashcroft scale. Expression levels of GSK3β, p-GSK3β, eEF2K, p-eEF2K (Ser70, Ser392, Ser470), precursor protein of matrix metalloproteinase-2 (pro-MMP-2), matrix metalloproteinase-2 (MMP-2), collagen I (Col I), collagen Ⅲ (Col Ⅲ) and α-smooth muscle actin (α-SMA) were detected by Western blot. Results: Compared with control group, the fibrosis score was up-regulated, the expression levels of GSK3β, p-GSK3β, p-eEF2K (Ser70, Ser392, Ser470), pro-MMP-2, MMP-2, Col I, Col Ⅲ and α-SMA were increased, while that of eEF2K was decreased in model group (P＜0.05). Compared with model group, the fibrosis score, expression levels of GSK3β, p-GSK3β, p-eEF2K (Ser70, Ser392, Ser470), pro-MMP-2, MMP-2, Col I, Col Ⅲ and α-SMA were decreased, but the expression level of eEF2K was increased in inhibition group (P＜0.05). Conclusion: GSK3β can activate eEF2K by phosphorylation at the sites of Ser70, Ser392 and Ser470, increase the contents of fibrosis indicators, promote the formation of pulmonary fibrosis, and aggravate lung tissue lesions.

Avascular necrosis of the metacarpal head: a case report and literature review / 中华骨科杂志

Osteonecrosis is the most common disorder in femoral head and scaphoid. However, avascular necrosis (AVN) in metacarpal head is a rare disease. In the present study, a 14-year-old male patient complained of right-hand pain with a limited range of motion for one month. Physical examination showed that the active flexion was 70° and the extension was limited to 30° of the metacarpophalangeal (MCP) joints. The grip strength decreased to 60% of the contralateral hand. X-rays demonstrated flattening and sclerotic changes in the long finger and ring finger of metacarpal head. CT scanning indicated cystic, osteochondral defects and sclerotic changes in metacarpal head. Imaging examination further confirmed the diagnosis of AVN in the long metacarpal finger and ring finger. After conservative treatments including splint immobilization, non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy, the local pain symptoms of the MCP joint gradually disappeared. The range of motion of MCP joint returned to normal with the grip strength score as 105% of the contralateral hand. MRI confirmed excellent remodeling and regeneration in the metacarpal head at two years later. The clinical characteristics, diagnosis and treatments of AVN of metacarpal head were reviewed. Although radiograph examination is commonly used, early-stage osteonecrosis of the metacarpal head should be confirmed by MRI. Given the rarity of this disorder, there is no consensus on the treatments. Metacarpal necrosis is the more common disorder in adolescent patients with a history of trauma. Considering the potential of bone remodeling, juveniles with metacarpal head necrosis could recover by conservative treatments.

Analysis and prenatal diagnosis of FMR1 gene mutations among patients with unexplained mental retardation / 中华医学遗传学杂志

OBJECTIVE@#To analyze the (CGG)n repeats of FMR1 gene among patients with unexplained mental retardation.@*METHODS@#For 201 patients with unexplained mental retardation, the (CGG)n repeats of the FMR1 gene were analyzed by PCR and FragilEase@*RESULTS@#For the 201 patients with unexplained mental retardation, 15 were identified with full mutations of the FMR1 gene. The prevalence of fragile X syndrome (FXS) in patients with unexplained mental retardation was determined as 7.5% (15/201). Prenatal diagnosis was provided for 6 pregnant women with pre- or full mutations. Analysis revealed that women with mental retardation and full FMR1 mutations exhibited a skewed XCI pattern with primary expression of the X chromosome carrying the mutant allele.@*CONCLUSION@#FXS has a high incidence among patients with unexplained mental retardation. Analysis of FMR1 gene (CGG)n repeats in patients with unexplained mental retardation can facilitate genetic counseling and prenatal diagnosis for their families. FMR1 gene (CGG)n repeats screening should be recommended for patients with unexplained mental retardation.

Analysis of FMR1 gene CGG repeats among patients with diminished ovarian reserve / 中华医学遗传学杂志

OBJECTIVE@#To explore the correlation between Fragile X mental retardation gene-1 (FMR1) gene CGG repeats with diminished ovarian reserve (DOR).@*METHODS@#For 214 females diagnosed with DOR, DNA was extracted from peripheral blood samples. FMR1 gene CGG repeats were determined by PCR and capillary electrophoresis.@*RESULTS@#Three DOR patients were found to carry FMR1 premutations, and one patient was found to carry gray zone FMR1 repeats. After genetic counseling, one patient and the sister of another patient, both carrying FMR1 permutations, conceived naturally. Prenatal diagnosis showed that both fetuses have carried FMR1 permutations.@*CONCLUSION@#FMR1 gene permutation may be associated with DOR. Determination of FMR1 gene CGG repeats in DOR patients can provide a basis for genetic counseling and guidance for reproduction.

Mechanism of inhibiting proliferation of tumor cells by a new tetrahydroisoquinoline compound SYT-1 / 药学学报

In this study, we investigated the inhibitory effect of SYT-1, a new compound of tetrahydroisoquino-line, on tumor cell proliferation and underlying mechanisms. Cell counting kit-8 (CCK-8) method was used to detect cell proliferation; clone formation experiment was used to detect cell clone formation ability; JC-1 probe was used to detect cell mitochondrial membrane potential; 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) probe was used to detect intracellular reactive oxygen species; Annexin V-FITC/PI (fluorescein isothiocyanate/propidium) counterstaining method was used to detect apoptosis; Western blot assay was used to detect the expression level of related proteins. The experimental results show that SYT-1 has a significant inhibitory effect on the proliferation of six human-derived cancer cells. Among them, the inhibitory effect on breast cancer MCF-7 cells is the strongest, the half maximal inhibitory concentration (IC50) of SYT-1 of 48 h administration on MCF-7 cells is 5.87 μmol·L-1, which is better than that of cisplatin (8.92 μmol·L-1). Further studies have shown that SYT-1 can dose-dependently inhibit the monoclonal formation ability of MCF-7 cells, and can cause the mitochondrial membrane potential of the cells to decrease and the level of reactive oxygen species to increase. In addition, SYT-1 can significantly inhibit the activation of PI3K-Akt (phosphatidylinositol 3-kinase/protein kinase B) signaling pathway and induce apoptosis of MCF-7 cells. The above research results show that, as a new type of tetrahydroisoquinoline compound, SYT-1 has the potential to inhibit tumor cell proliferation.

The fifth metacarpal neck fracture treated by closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique / 中华创伤骨科杂志

Objective:To assess the clinical effects of closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique in the treatment of the fifth metacarpal neck fracture.Methods:In this retrospective study, 26 patients with the fifth metacarpal neck fracture were treated by closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique at Department of Orthopaedics, Central Hospital of Karamay from August 2015 to October 2017. They were 23 males and 3 females, aged from 12 to 53 years with an average age of 25.2 years. In the intramedullary nailing, a Kirschner wire pre-bent by 10° to 15° was inserted from the base of the fifth metacarpal into the medullary canal before closed reduction. After satisfactory reduction was achieved, the Kirschner wire was inserted across the fracture site into the metacarpal head for further reduction and fixation using rod rotation technique. After operation, a plaster was applied to protect the fixation for 2 weeks. Functional exercise was started after removal of the plaster. The Kirschner wire was not removed under local anaesthesia at the outpatient department until about 10 to 16 weeks postoperation when X-ray showed fracture healing. Records of their operation time, head/shaft angle of the fifth affected metacarpal, active range of motion of the metacarpophalangeal joints and Total Active Movement (TAM) of hand function at the last follow-up were collected.Results:Their operation time averaged 21 minutes (from 12 to 35 minutes). Anatomical reduction was achieved in 23 cases but not in 3 ones whose metacarpal head/shaft angle and alignment were obviously improved. Follow-ups for 6 to 29 months (average, 15.8 months) showed all the patients obtained solid fracture healing with no infection or delayed fracture healing. The head/shaft angle was improved significantly from preoperative 61.2°±11.2° to postoperative 14.7°±3.5° ( P<0.05) which was not significantly different from that of the healthy side (14.6°±1.7°)( P>0.05). The active range of motion of the metacarpophalangeal joint was 89.3°±4.2° after fixation removal, not significantly different from that of the healthy side (90.7°±1.5°) ( P>0.05). According to TAM scores at the last follow-up, 22 cases were rated as excellent, 3 as good and one as fair. Conclusion:In the treatment of the fifth metacarpal neck fracture, closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique is effective, because it is simple and limitedly invasive, and leads to limited complications, low costs and secondary reduction.

Efficacy and safety of bone-filling mesh container in treatment of osteoporotic vertebral compression fractures: a meta-analysis / 中华创伤杂志

Objective:To assess the effect and safety of bone-filling mesh container (BFC) and percutaneous kyphoplasty (PKP) in treatment of osteoporotic vertebral compression fractures (OVCF).Methods:PubMed, Web of Science, Cochrane Library, CNKI, VIP, CBM and Wanfang database were searched by computer from inception to September 2019, for the randomized controlled trial (RCT) or case-control trial (CCT) that compared the treatment of OVCF using BFC and PKP. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.3. The literature search results, basic characteristics of the included studies, operation time, postoperative visual analogue score (VAS), Oswestry disability index (ODI), Cobb's angle, leakage rate of the bone cement and publication bias were evaluated.Results:Only 5 RCTs and 5 CCTs involving 668 patients were included. Compared with the PKP group, the BFC group showed no significant difference in postoperative VAS ( MD=-0.06, 95% CI -0.24-0.37), ODI ( MD=-0.20, 95% CI-1.13-0.73) and Cobb's angle ( MD=0.18, 95% CI-0.05-0.91), while there were significant differences in operation time ( MD=-3.07, 95% CI-5.53--0.60) and leakage rate ( OR=0.21, 95% CI 0.12-0.36). Funnel plots showed that there was no significant asymmetry among the above indicators, suggesting that publication bias had little effect on the results. Conclusion:BFC is as effective as PKP in the postoperative efficacy of OVCF, but is superior in operation time and leakage rate of bone cement.

Effects of complement dysfunction on diabetic retinopathy / 中华实验眼科杂志

Diabetic retinopathy (DR) is one of the common neuronal and microvascular complications of diabetes,and it is the key cause of blindness in the populations aged from 20 to 74.The pathogenesis of DR remains elusive,and the role of complement in DR has attracted intensive attentions in recent years.The dysregulation of complement factors and regulatory proteins could affect the fate and functions of pericytes,endothelial cells,neuronal cells and glia cells in retina,which may be novel targets for anti-DR therapy.Advances regarding the characteristics of complement in the eye,the relationship between complement dysfunction and DR,complement gene polymorphism in DR and recent therapy explorations targeting complement pathways were reviewed,so as to providing new clues for the related research in the future.

Effects of complement dysfunction on diabetic retinopathy / 中华实验眼科杂志

Diabetic retinopathy (DR) is one of the common neuronal and microvascular complications of diabetes, and it is the key cause of blindness in the populations aged from 20 to 74.The pathogenesis of DR remains elusive, and the role of complement in DR has attracted intensive attentions in recent years.The dysregulation of complement factors and regulatory proteins could affect the fate and functions of pericytes, endothelial cells, neuronal cells and glia cells in retina, which may be novel targets for anti-DR therapy.Advances regarding the characteristics of complement in the eye, the relationship between complement dysfunction and DR, complement gene polymorphism in DR and recent therapy explorations targeting complement pathways were reviewed, so as to providing new clues for the related research in the future.

Drug resistance and pathogenic spectrum of patients coinfected with nontuberculous mycobacteria and human-immunodeficiency virus in Chengdu, China / 中华医学杂志(英文版)

BACKGROUND@#Human-immunodeficiency virus (HIV) infection is increasing worldwide and nontuberculous mycobacteria (NTM) is an established microbiologic cause of pulmonary disease, lymphadenitis, and disseminated disease in cases of advanced immune suppression. Data on patients coinfected with HIV and NTM are limited. Thus, this study aimed to analyze the clinical characteristics, drug resistance, and pathogen spectrum of patients coinfected with both HIV and NTM in the Chengdu area of China.@*METHODS@#Data of 59 patients coinfected with both HIV and NTM collected from the Public Health Clinical Center of Chengdu, between January 2014 and December 2018, were analyzed. NTM drug sensitivity testing was performed using the microporous plate ratio method. Data were analyzed using SPSS 19.0, and the change in drug resistance rate was analyzed using the chi-square (χ) test.@*RESULTS@#Seven species/complex of NTM were identified from patients coinfected with HIV and NTM in this study, with Mycobacterium avium-intracellulare complex (52.5%) and M. kansasii (27.1%) as the predominant species. Male patients were more affected 50/59 (84.7%); the mean age of the 59 cases was 45 years. The clinical characteristics mainly included anemia (86.4%), cough and expectoration (79.7%). The baseline CD4 count was 0.05).@*CONCLUSIONS@#The immune level of patients coinfected with HIV and NTM is low in advanced AIDS stage; more male are affected in patients who are mainly infected with MAC and M. kansasii and with serious drug resistance. The drug resistance rate of ethambutol and clarithromycin is relatively low.

Advance in Diffusion Tensor Imaging for Predicting Motor Function Outcome after Stroke / 中国康复理论与实践

Diffusion tensor imaging (DTI) can be used to characterize the orientation of water diffusion, and track white matter fiber bundles. The decrease of fractional anisotropy after stroke indicates impairment of structural integrity of fibers, even Wallerian degeneration if serious; in another hand, the increase of fractional anisotropy relates to the more recovery of motor function. The affected/unaffected ratios of fractional anisotropy are more suitable for predicting motor function recovery after stroke. The changes of corticospinal tract in diffusion tensor tractography can also predict the motor outcome in stroke patients.

Advance in Diffusion Tensor Imaging for Predicting Motor Function Outcome after Stroke / 中国康复理论与实践

Diffusion tensor imaging (DTI) can be used to characterize the orientation of water diffusion, and track white matter fiber bundles. The decrease of fractional anisotropy after stroke indicates impairment of structural integrity of fibers, even Wallerian degeneration if serious; in another hand, the increase of fractional anisotropy relates to the more recovery of motor function. The affected/unaffected ratios of fractional anisotropy are more suitable for predicting motor function recovery after stroke. The changes of corticospinal tract in diffusion tensor tractography can also predict the motor outcome in stroke patients.

Update on thyroid ultrasound: a narrative review from diagnostic criteria to artificial intelligence techniques / 中华医学杂志(英文版)

Objective@#Ultrasound imaging is well known to play an important role in the detection of thyroid disease, but the management of thyroid ultrasound remains inconsistent. Both standardized diagnostic criteria and new ultrasound technologies are essential for improving the accuracy of thyroid ultrasound. This study reviewed the global guidelines of thyroid ultrasound and analyzed their common characteristics for basic clinical screening. Advances in the application of a combination of thyroid ultrasound and artificial intelligence (AI) were also presented.@*Data sources@#An extensive search of the PubMed database was undertaken, focusing on research published after 2001 with keywords including thyroid ultrasound, guideline, AI, segmentation, image classification, and deep learning.@*Study selection@#Several types of articles, including original studies and literature reviews, were identified and reviewed to summarize the importance of standardization and new technology in thyroid ultrasound diagnosis.@*Results@#Ultrasound has become an important diagnostic technique in thyroid nodules. Both standardized diagnostic criteria and new ultrasound technologies are essential for improving the accuracy of thyroid ultrasound. In the standardization, since there are no global consensus exists, common characteristics such as a multi-feature diagnosis, the performance of lymph nodes, explicit indications of fine needle aspiration, and the diagnosis of special populations should be focused on. Besides, evidence suggests that AI technique has a good effect on the unavoidable limitations of traditional ultrasound, and the combination of diagnostic criteria and AI may lead to a great promotion in thyroid diagnosis.@*Conclusion@#Standardization and development of novel techniques are key factors to improving thyroid ultrasound, and both should be considered in normal clinical use.

Drug resistance and pathogenic spectrum of patients coinfected with nontuberculous mycobacteria and human-immunodeficiency virus in Chengdu, China / 中华医学杂志(英文版)

Background@#Human-immunodeficiency virus (HIV) infection is increasing worldwide and nontuberculous mycobacteria (NTM) is an established microbiologic cause of pulmonary disease, lymphadenitis, and disseminated disease in cases of advanced immune suppression. Data on patients coinfected with HIV and NTM are limited. Thus, this study aimed to analyze the clinical characteristics, drug resistance, and pathogen spectrum of patients coinfected with both HIV and NTM in the Chengdu area of China.@*Methods@#Data of 59 patients coinfected with both HIV and NTM collected from the Public Health Clinical Center of Chengdu, between January 2014 and December 2018, were analyzed. NTM drug sensitivity testing was performed using the microporous plate ratio method. Data were analyzed using SPSS 19.0, and the change in drug resistance rate was analyzed using the chi-square (χ2) test.@*Results@#Seven species/complex of NTM were identified from patients coinfected with HIV and NTM in this study, with Mycobacterium avium–intracellulare complex (52.5%) and M. kansasii (27.1%) as the predominant species. Male patients were more affected 50/59 (84.7%); the mean age of the 59 cases was 45 years. The clinical characteristics mainly included anemia (86.4%), cough and expectoration (79.7%). The baseline CD4 count was <50 cells/μL (84.7%). Patients were mainly in advanced acquired immunodeficiency syndrome (AIDS) stage. Chest imaging mainly showed patchy shadows (42.4%) and nodules (32.2%), with various degrees of AIDS-defining diseases. The drug resistance of NTM was severe, and the rate of isoniazid resistance (100.0%) was the highest, followed by rifampicin (94.9%), streptomycin (94.9%), ofloxacin (93.2%), and others. Ethambutol (52.5%) and clarithromycin (33.9%) were relatively low. No significant difference was found in the drug resistance rate of NTM strain against nine antituberculosis drugs in 5 years (P > 0.05).@*Conclusions@#The immune level of patients coinfected with HIV and NTM is low in advanced AIDS stage; more male are affected in patients who are mainly infected with MAC and M. kansasii and with serious drug resistance. The drug resistance rate of ethambutol and clarithromycin is relatively low.

Efficacy comparison between minimally invasive fixation and routine fixation of tracer in robot-assisted pedicle screw placement / 中华创伤杂志

Objective@#To investigate the clinical efficacy of modified tracer minimally invasive fixation in robot-assisted pedicle screw placement.@*Methods@#A prospective randomized controlled study was conducted to analyze the clinical data of 41 patients with thoracolumbar fresh fracture at the orthopaedics department of Karamay Central Hospital from July 2017 to December 2017. There were 20 males and 21 females, aged 25-55 years, with an average of 40.6 years. According to AO fracture typing, there were 28 patients with type A and 13 patients with type B. The patients underwent robot-assisted pedicle screw placement. Random number table method was used to divide the patients into the conventional group (20 patients) and modified group (21 patients). The conventional group was treated with conventional tracer fixation, and the modified group modified tracer minimally invasive fixation. A total of 92 pedicle screws were implanted in the conventional group and 96 pedicle screws were implanted in the modified group. The size of wound, wound bleeding, time of fixing the tracer, complications (spinal cord injury and nerve root injury when fixing the tracer), development of the tracer fixator and artifacts were recorded. The accuracy of nail placement was evaluated by 320-slice CT scan and Gertzbein-Robbins criteria.@*Results@#There was no significant difference in age, sex, diagnosis, transverse diameter of pedicle and e angle between the two groups (P>0.05). The wound size, wound bleeding, and time of fixing the tracer in the modified group were (6.00±1.26)mm, (1.38±0.22)ml and (1.42±0.17)minutes, respectively, while those of the conventional group were (40.16±5.71)mm, (11.61±1.15)ml, and (5.12±0.64)minutes respectively (P<0.05). No spinal cord or nerve root injury occurred in either group when the tracer was fixed. In the process of three-dimensional image acquisition and automatic registration, the tracer fixator in the modified group developed with Kirschner needle without artifacts, and the tracer in minimally invasive fixator had good fluoroscopy effect. The modified group included 94 pedicle screws of type A and two of type B according to Gertzbein-Robbins criteria. The conventional group included 89 pedicle screws of type A and three of type B according to Gertzbein-Robbins criteria. There was no significant difference in the screw placement accuracy between the two groups (P>0.05).@*Conclusion@#In the robot-assisted pedicle screw placement, the modified tracer minimally invasive fixation method is safe and less traumatic, with no side effect on the accuracy of pedicle screw placement.

Update on thyroid ultrasound: a narrative review from diagnostic criteria to artificial intelligence techniques / 中华医学杂志(英文版)

OBJECTIVE@#Ultrasound imaging is well known to play an important role in the detection of thyroid disease, but the management of thyroid ultrasound remains inconsistent. Both standardized diagnostic criteria and new ultrasound technologies are essential for improving the accuracy of thyroid ultrasound. This study reviewed the global guidelines of thyroid ultrasound and analyzed their common characteristics for basic clinical screening. Advances in the application of a combination of thyroid ultrasound and artificial intelligence (AI) were also presented.@*DATA SOURCES@#An extensive search of the PubMed database was undertaken, focusing on research published after 2001 with keywords including thyroid ultrasound, guideline, AI, segmentation, image classification, and deep learning.@*STUDY SELECTION@#Several types of articles, including original studies and literature reviews, were identified and reviewed to summarize the importance of standardization and new technology in thyroid ultrasound diagnosis.@*RESULTS@#Ultrasound has become an important diagnostic technique in thyroid nodules. Both standardized diagnostic criteria and new ultrasound technologies are essential for improving the accuracy of thyroid ultrasound. In the standardization, since there are no global consensus exists, common characteristics such as a multi-feature diagnosis, the performance of lymph nodes, explicit indications of fine needle aspiration, and the diagnosis of special populations should be focused on. Besides, evidence suggests that AI technique has a good effect on the unavoidable limitations of traditional ultrasound, and the combination of diagnostic criteria and AI may lead to a great promotion in thyroid diagnosis.@*CONCLUSION@#Standardization and development of novel techniques are key factors to improving thyroid ultrasound, and both should be considered in normal clinical use.

Efficacy comparison between minimally invasive fixation and routine fixation of tracer in robot-assisted pedicle screw placement / 中华创伤杂志

Objective To investigate the clinical efficacy of modified tracer minimally invasive fixation in robot-assisted pedicle screw placement. Methods A prospective randomized controlled study was conducted to analyze the clinical data of 41 patients with thoracolumbar fresh fracture at the orthopaedics department of Karamay Central Hospital from July 2017 to December 2017. There were 20 males and 21 females, aged 25-55 years, with an average of 40. 6 years. According to AO fracture typing, there were 28 patients with type A and 13 patients with type B. The patients underwent robot-assisted pedicle screw placement. Random number table method was used to divide the patients into the conventional group (20 patients) and modified group (21 patients). The conventional group was treated with conventional tracer fixation, and the modified group modified tracer minimally invasive fixation. A total of 92 pedicle screws were implanted in the conventional group and 96 pedicle screws were implanted in the modified group. The size of wound, wound bleeding, time of fixing the tracer, complications (spinal cord injury and nerve root injury when fixing the tracer), development of the tracer fixator and artifacts were recorded. The accuracy of nail placement was evaluated by 320-slice CT scan and Gertzbein-Robbins criteria. Results There was no significant difference in age, sex, diagnosis, transverse diameter of pedicle and e angle between the two groups (P>0. 05). The wound size, wound bleeding, and time of fixing the tracer in the modified group were (6. 00 ± 1. 26)mm,(1. 38 ± 0. 22)ml and (1.42 ±0.17)minutes, respectively, while those of the conventional group were (40. 16 ± 5. 71)mm, (11.61 ±1.15)ml, and (5.12 ±0.64)minutes respectively (P<0.05). No spinal cord or nerve root injury occurred in either group when the tracer was fixed. In the process of three-dimensional image acquisition and automatic registration, the tracer fixator in the modified group developed with Kirschner needle without artifacts, and the tracer in minimally invasive fixator had good fluoroscopy effect. The modified group included 94 pedicle screws of type A and two of type B according to Gertzbein-Robbins criteria. The conventional group included 89 pedicle screws of type A and three of type B according to Gertzbein-Robbins criteria. There was no significant difference in the screw placement accuracy between the two groups (P>0. 05). Conclusion In the robot-assisted pedicle screw placement, the modified tracer minimally invasive fixation method is safe and less traumatic, with no side effect on the accuracy of pedicle screw placement.

Effects of montelukast sodium and bacterial lysates on airway remodeling and expression of transforming growth factor-β1 and Smad7 in guinea pigs with bronchial asthma / 中国当代儿科杂志

OBJECTIVE@#To study the effect of montelukast sodium (MK), a leukotriene receptor antagonist, and bacterial lysates (OM-85BV), used alone or in combination, on airway remodeling and the expression of transforming growth factor-β1 (TGF-β1) and Smad7 in guinea pigs with bronchial asthma and their correlation.@*METHODS@#A total of 40 male Hartley guinea pigs were randomly divided into normal control group, asthma group, MK group, OM-85BV group, and MK+OM-85BV group, with 8 guinea pigs in each group. Intraperitoneal injection of 10% ovalbumin (OVA) for sensitization and aerosol inhalation of 1% OVA for challenge were performed to establish a model of airway remodeling of asthma in all of the groups apart from the normal control group, which were treated with normal saline. In the stage of challenge by aerosol inhalation, the guinea pigs in the MK, OM-85BV, and MK+OM-85BV groups were given corresponding suspension by gavage, and those in the normal control and asthma groups were given an equal volume of normal saline by gavage. Bronchoalveolar lavage fluid (BALF) of the guinea pigs was collected within 24 hours after challenge, and ELISA was used to measure the levels of TGF-β1 and Smad7 in BALF. The guinea pigs were sacrificed and the pathological section of lung tissue was prepared to observe the degree of airway remodeling. An image analysis technique was used to measure perimeter of the basement membrane (Pbm), total bronchial wall area (Wat), and airway bronchial smooth muscle area (Wam). Pearson linear regression was used to investigate the correlation between two variables.@*RESULTS@#According to the lung pathological section, compared with the normal control group, the asthma, MK, OM-85BV, and MK+OM-85BV groups had significant thickening of bronchial smooth muscle and alveolar wall, significantly higher Wat/Pbm and Wam/Pbm, a significantly higher level of TGF-β1, and a significantly lower level of Smad7 (P<0.05). Compared with the asthma group, the MK, OM-85BV, and MK+OM-85BV groups had a significant improvement in pathological injury, significantly lower Wat/Pbm and Wam/Pbm, a significantly lower level of TGF-β1, and a significantly higher level of Smad7 (P<0.05). The MK+OM-85BV group had significantly greater improvements than the MK group and the OM-85BV group (P<0.05). The expression of TGF-β1 was negatively correlated with that of Smad7 and positively correlated with Wat/Pbm and Wam/Pbm, and the expression of Smad7 was negatively correlated with Wat/Pbm and Wam/Pbm (P<0.01).@*CONCLUSIONS@#MK and OM-85BV, used alone or in combination, can reduce airway remodeling in guinea pigs with asthma, and MK combined with OM-85BV has the best effect, possibly by reducing TGF-β1 expression, increasing Smad7 expression, and improving the TGF-β1/Smad7 imbalance.

Treatment of Maisonneuve fracturewitharthroscopic-assistant plate-screw fixation of the syndesmosis / 国际外科学杂志

Objective To investigate the effect of the treatment for Maisonneuve fracture with arthroscopicassistant plate-screw fixation ofsyndesmosis.Methods From January 2015 to December 2016,totally 22 patients with Maisonneuve fracture were treated in Shanghai Jiao Tong University Affiliated Six People's Hospital.Eleven patients in minimal invasive surgery (MIS)group were treated by the arthroscopic-assistant plate-screw fixation ofthe syndesmotic injury.Another 11 patients in the control group were performed a classic syndesmosis screw fixation.Plain radiographic examination was carried out during the follow-up.Functional evaluation was measured according to the American Orthopedic Foot Ankle Society (AOFAS) ankle hindfoot score and the Visual analogue scale(VAS).A t test was applied for the statistic analysis of post-operative outcome between the two groups at 6th and 12th month.Results The patients were followed for an average 18 months (range from 12 to 24 months)except one of MIS group.The X-ray demonstrated the solid bone union occurred on the 12th week in MIS group and 12.5th week in the control group.The implants of syndesmosis were removed at 12th week post-operatively.No cases of re-diastasis occurred during the follow-up.There was significant difference with in the groups.In the MIS group,the AOFAS ankle hindfoot score was (85.9 ±4.1) points at 6th month post-operatively,and increased to (90.8 ± 3.7) at 12th month (P ＜ 0.05).VAS score was (2.4 ± 1.2) at 6th month and (1.1 ± 0.7) at 12th month after the operation(P ＜0.05).In the control group,the AOFAS ankle hindfoot score was (81.1 ±4.7) points at 6th month after operation,and increased to (89.1 ± 3.4) at 12th month after operation (P ＜ 0.05).VAS score was (3.2 ± 1.3) at the 6th month and (1.0 ± 1.0) at the 12th month after operation (P ＜ 0.05).However,for the outcome comparison between the two groups,only the AOFAS ankle hindfoot score of 6th month post-operatively in MIS group was better than the control group (P ＜ 0.05),other results,had no significant difference.Nocomplications of implant failure,nonunion,malunion or post-traumatic arthritis were occurred during the followup.Conclusion The treatment of Maisonneuve fracture by arthroscopic-assistant plate-screw fixation proved to have an advantage of minimal invasion and accurate reduction and fixation,which is a safe and effective surgical method.