Hospitalization costs of pediatric community-acquired pneumonia in Shanghai / 中华儿科杂志

Objective: To investigate the epidemiology and hospitalization costs of pediatric community-acquired pneumonia (CAP) in Shanghai. Methods: A retrospective case summary was conducted on 63 614 hospitalized children with CAP in 59 public hospitals in Shanghai from January 2018 to December 2020. These children's medical records, including their basic information, diagnosis, procedures, and costs, were extracted. According to the medical institutions they were admitted, the patients were divided into the children's hospital group, the tertiary general hospital group and the secondary hospital group; according to the age, they were divided into <1 year old group, 1-<3 years old group, 3-<6 years old group, 6-<12 years old group and 12-18 years old group; according to the CAP severity, they were divided into severe pneumonia group and non-severe pneumonia group; according to whether an operation was conducted, the patients were divided into the operation group and the non-operation group. The epidemiological characteristics and hospitalization costs were compared among the groups. The χ2 test or Wilcoxon rank sum test was used for the comparisons between two groups as appropriate, and the Kruskal-Wallis H test was conducted for comparisons among multiple groups. Results: A total of 63 614 hospitalized children with CAP were enrolled, including 34 243 males and 29 371 females. Their visiting age was 4 (2, 6) years. The length of stay was 6 (5, 8) days. There were 17 974 cases(28.3%) in the secondary hospital group, 35 331 cases (55.5%) in the tertiary general hospital group and 10 309 cases (16.2%) in the children's hospital group. Compared with the hospitalizations cases in 2018 (27 943), the cases in 2019 (29 009) increased by 3.8% (1 066/27 943), while sharply declined by 76.2% (21 281/27 943) in 2020 (6 662). There were significant differences in the proportion of patients from other provinces and severe pneumonia cases, and the hospitalization costs among the children's hospital, secondary hospital and tertiary general hospital (7 146 cases(69.3%) vs. 2 202 cases (12.3%) vs. 9 598 cases (27.2%), 6 929 cases (67.2%) vs. 2 270 cases (12.6%) vs. 9 397 cases (26.6%), 8 304 (6 261, 11 219) vs. 1 882 (1 304, 2 796) vs. 3 195 (2 364, 4 352) CNY, χ2=10 462.50, 9 702.26, 28 037.23, all P<0.001). The annual total hospitalization costs of pediatric CAP from 2018 to 2020 were 110 million CNY, 130 million CNY and 40 million CNY, respectively. And the cost for each hospitalization increased year by year, which was 2 940 (1 939, 4 438), 3 215 (2 126, 5 011) and 3 673 (2 274, 6 975) CNY, respectively. There were also significant differences in the hospitalization expenses in the different age groups of <1 year old, 1-<3 years old, 3-<6 years old, 6-<12 years old and 12-18 years old (5 941 (2 787, 9 247) vs. 2 793 (1 803, 4 336) vs. 3 013 (2 070, 4 329) vs. 3 473 (2 400, 5 097) vs. 4 290 (2 837, 7 314) CNY, χ2=3 462.39, P<0.001). The hospitalization cost of severe pneumonia was significantly higher than that of non-severe cases (5 076 (3 250, 8 364) vs. 2 685 (1 780, 3 843) CNY, Z=109.77, P<0.001). The cost of patients who received operation was significantly higher than that of whom did not (10 040 (4 583, 14 308) vs. 3 083 (2 025, 4 747) CNY, Z=44.46, P<0.001). Conclusions: The number of children hospitalized with CAP in Shanghai decreased significantly in 2020 was significantly lower than that in 2018 and 2019.The proportion of patients from other provinces and with severe pneumonia are mainly admitted in children's hospitals. Hospitalization costs are higher in children's hospitals, and also for children younger than 1 year old, severe cases and patients undergoing operations.

Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore

INTRODUCTION@#Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients.@*METHODS@#This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore.@*RESULTS@#560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required.@*CONCLUSION@#Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.

Trends in cardiovascular death related to mechanical complications of cardiac electronic devices in the United States from 1999 to 2020

Background@#While cardiac implantable electronic devices (CIED) are increasingly used, real-world data on the mortality rate due to mechanical complications of CIED is scarce. @*Objective@#This study aimed to determine longitudinal trends in mortality attributed to mechanical complications of CIED. @*Methods@#We queried the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research and performed serial cross-sectional analyses of national death certificate data for mechanical complications of CIED-related mortality among the United States population aged ≥ 35 years from 1999 to 2020. Cardiovascular disease (ICD-10: I00–I99) was listed as the underlying cause of death, and mechanical complication of the cardiac electronic device (ICD-10: T82.1) was stated as the contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals. Linear regression was used to calculate for the significance of the annual percent of changes in AAMRs. @*Results@#1237 cardiovascular deaths related to mechanical complications of CIED were identified between 1999 and 2020. The AAMR dropped significantly from 0.45 per 1,000,000 individuals in 1999 to 0.21 per 1,000,000 individuals in 2020 (p < 0.01). Cumulative AAMRs were higher in males than females (0.39 per 1,000,000 individuals vs. 0.26 per 1,000,000 individuals, p < 0.01), higher in White populations than African American populations (0.32 per 1,000,000 individuals vs. 0.30 per 1,000,000 individuals, p < 0.01), and higher in the rural areas than in the urban areas (0.50 per 1,000,000 individuals vs. 0.27 per 1,000,000 individuals, p < 0.01). @*Conclusion@#While the cardiovascular deaths related to mechanical complications of CIED were decreasing over the past decades, disparities in the AAMRs across sex, races and geographical region still present.

Thoracolumbar Injury Classification and Severity Score Is Predictive of Perioperative Adverse Events in Operatively Treated Thoracic and Lumbar Fractures

Methods@#We performed a retrospective review of 199 patients with surgically treated thoracolumbar fractures operated between January 2007 and January 2018. The potential risk factors for the development of AEs as well as the development of common complications were evaluated by univariate analysis, and a multivariate logistic regression analysis was performed to identify independent risk factors predictive of the above. @*Results@#The overall rate of AEs was 46.7%; 83 patients (41.7%) had nonsurgical AEs, whereas 24 (12.1%) had surgical adverse events. The most common AEs were urinary tract infections in 43 patients (21.6%), and hospital-acquired pneumonia in 21 patients (10.6%). On multivariate logistic regression, a Thoracolumbar Injury Classification and Severity (TLICS) score of 8–10 (odds ratio [OR], 6.39; 95% confidence interval [CI], 2.33–17.51), the presence of polytrauma (OR, 2.64; 95% CI, 1.17–5.99), and undergoing open surgery (OR, 2.31; 95% CI, 1.09–4.88) were significant risk factors for AEs. The absence of neurological deficit was associated with a lower rate of AEs (OR, 0.47; 95% CI, 0.31–0.70). @*Conclusions@#This study suggests the presence of polytrauma, preoperative American Spinal Injury Association score, and TLICS score are predictive of AEs in patients with surgically treated thoracolumbar fractures. The results might also suggest a role for minimally invasive surgical methods in reducing AEs in these patients.

Identification of Hypertension Subgroups through Topological Analysis of Symptom-Based Patient Similarity / 中国结合医学杂志

OBJECTIVE@#To obtain the subtypes of the clinical hypertension population based on symptoms and to explore the relationship between hypertension and comorbidities.@*METHODS@#The data set was collected from the Chinese medicine (CM) electronic medical records of 33,458 hypertension inpatients in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine between July 2014 and May 2017. Then, a hypertension disease comorbidity network (HDCN) was built to investigate the complicated associations between hypertension and their comorbidities. Moreover, a hypertension patient similarity network (HPSN) was constructed with patients' shared symptoms, and 7 main hypertension patient subgroups were identified from HPSN with a community detection method to exhibit the characteristics of clinical phenotypes and molecular mechanisms. In addition, the significant symptoms, diseases, CM syndromes and pathways of each main patient subgroup were obtained by enrichment analysis.@*RESULTS@#The significant symptoms and diseases of these patient subgroups were associated with different damaged target organs of hypertension. Additionally, the specific phenotypic features (symptoms, diseases, and CM syndromes) were consistent with specific molecular features (pathways) in the same patient subgroup.@*CONCLUSION@#The utility and comprehensiveness of disease classification based on community detection of patient networks using shared CM symptom phenotypes showed the importance of hypertension patient subgroups.

Percutaneous sacroiliac screw fixation assisted by O-arm navigation in treatment of sacroiliac joint complex injury / 中华创伤杂志

Objective:To compare the clinical effect of percutaneous sacroiliac screw fixation assisted by O-arm navigation or C-arm X-ray fluoroscopy in the treatment of sacroiliac joint complex injury.Methods:A retrospective case-control study was conducted on 32 patients with sacroiliac joint complex injury admitted to Second Affiliated Hospital of Army Medical University from July 2016 to January 2019.There were 21 males and 11 females, aged from 20 to 59 years (mean, 41.3 years). According to Tile classification, there were 7 patients with type B1 fracturs, 13 with type B2, 5 with type B3, 5 with type C1, and 2 with type C1. Group A ( n=17) had percutaneous sacroiliac screw fixation assisted by O-arm navigation, while Group B ( n=15) had percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy. Time of single screw placement, time of intraoperative fluoroscopy, intraoperative bleeding volume and bone union time were measured. Reduction quality was evaluated by Matta standard score. Majeed function score was assessed 6 months at the latest follow-up. Complications were also observed. Results:All patients were followed up for 6-37 months (mean, 18.6 months). The time of sacroiliac joint screw placement [(27.3±5.1)minutes] and time of intraoperative fluoroscopy [(43.3±3.2)s] in Group A were significantly less than those in Group B [(52.3±5.9)minutes, (64.6±5.4)s] ( P<0.05). There were no significant differences between Group A and Group B in intraoperative bleeding [(17.8±2.6)ml vs. (20.7±3.1)ml] and bone union time [(13.4±1.4)weeks vs. (14.1±1.9)weeks] ( P>0.05). According to the reduction quality evaluated by Matta standard score, the good and excellent rate was 88% (15/17) in Group A and 87% (13/15) in Group B ( P>0.05). The good and excellent rate of the Majeed function score was 94% (16/17) in Group A and 87% (13/15) in Group B at the latest follow-up ( P>0.05). One patient in Group B demonstrated one screw slightly penetrating the anterior cortex of vertebral body. No neurovascular injury, wound infection, or screw loosening occurred. Conclusion:For sacroiliac joint complex injury, percutaneous sacroiliac screw fixation assisted by O-arm navigation has advantages in the duration of screw placement and intraoperative fluoroscopy over percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy.

Different distributions of nerve demyelination in chronic acquired multifocal polyneuropathies / 中华医学杂志(英文版)

BACKGROUND@#Multifocal motor neuropathy (MMN), Lewis-Sumner syndrome (LSS), and many chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs) are representative of acquired multifocal polyneuropathy and are characterized by conduction block (CB). This retrospective study aimed to investigate the demyelinating distribution and the selective vulnerability of MMN, LSS, and CIDP with CB (CIDP-CB) in nerves.@*METHODS@#Fifteen LSS subjects (107 nerves), 24 MMN subjects (176 nerves), and 17 CIDP-CB subjects (110 nerves) were included. Their clinical information was recorded, blood and cerebrospinal fluid tests were conducted, and nerve conductions of the median, ulnar, radial, peroneal, and tibial nerves were evaluated. CB, temporal dispersion, distal motor latency (DML), and F-wave latency were recorded, and nerve conduction velocity, terminal latency index, and modified F-wave ratio were calculated.@*RESULTS@#CB was more likely to occur around the elbow in CIDP-CB than in MMN (78.6% vs. 6.8%, P < 0.01) but less likely to occur between the wrist and the elbow than in LSS (10.7% vs. 39.3%, P < 0.05). Tibial nerve CB was most frequently observed in MMN (47.4%, P < 0.05). CIDP-CB was characterized by a prolonged DML in all nerves, and slow motor nerve velocity of the upper limb was significant when CB nerves were excluded (P < 0.05).@*CONCLUSIONS@#We report the different distributions of segmental and diffuse demyelination of the ulnar and tibial nerves in LSS, MMN, and CIDP-CB. These distinct distributions could help in differentiating among these conditions.

Effect of dhfr gene overexpression on ethanol-induced abnormal cardiovascular development in zebrafish embryos / 中国当代儿科杂志

OBJECTIVE@#To study the effect of dhfr gene overexpression on ethanol-induced abnormal cardiac and vascular development in zebrafish embryos and underlying mechanisms.@*METHODS@#dhfr mRNA was transcribed in vitro and microinjected into zebrafish fertilized eggs to induce the overexpression of dhfr gene, and the efficiency of overexpression was verified. Wild-type zebrafish were divided into a control group, an ethanol group, and an ethanol+dhfr overexpression group (microinjection of 6 nL dhfr mRNA). The embryonic development was observed for each group. The transgenic zebrafish Tg (cmlc2:mcherry) with heart-specific red fluorescence was used to observe atrial and ventricular development. Fluorescence microscopy was performed to observe the development of cardiac outflow tract and blood vessels. Heart rate and ventricular shortening fraction were used to assess cardiac function. Gene probes were constructed, and embryo in situ hybridization and real-time PCR were used to measure the expression of nkx2.5, tbx1, and flk-1 in the embryo.@*RESULTS@#Compared with the ethanol group, the ethanol+dhfr overexpression group had a significant reduction in the percentage of abnormal embryonic development and a significant increase in the percentage of embryonic survival (P<0.05), with significant improvements in the abnormalities of the atrium, ventricle, outflow tract, and blood vessels and cardiac function. Compared with the control group, the ethanol group had significant reductions in the expression of nkx2.5, tbx1, and flk-1 (P<0.05), and compared with the ethanol group, the ethanol+dhfr overexpression group had significant increases in the expression of nkx2.5, tbx1, and flk-1 (P<0.05), which were still lower than their expression in the control group.@*CONCLUSIONS@#The overexpression of the dhfr gene can partially improve the abnormal development of embryonic heart and blood vessels induced by ethanol, possibly by upregulating the decreased expression of nkx2.5, tbx1, and flk-1 caused by ethanol.

Clinical application of dynamic locking screw in treating humeral shaft fracture / 中国骨伤

OBJECTIVE@#To compare clinical effect of dynamic locking screws and common screws in treating humeral shaft fractures.@*METHODS@#From January 2016 to October 2018, clinical data of 46 patients with humeral shaft fracture were retrospectively analyzed, which were divided into dynamic locking screw internal fixation group (treatment group) and ordinary screw internal fixation group (control group). In treatment group, there were 14 males and 10 females, aged from 20 to 61 years old with an average of (36.8±10.9) years old;22 patients in control group, there were 13 males and 9 females, aged from 19 to 60 years old with an average of (35.9±12.8) years old. Length of incision, operation time, amount of bleeding, fracture healing time and complications were compared between two groups, Constant-Murley score of shoulder joint and Mayo score of elbow joint at 3 and 9 months after operation were compared to evaluate clinical effect.@*RESULTS@#Forty six patients were followed up from 9 to 43 months with an average of (18.6±7.9) months. There were no statistical differences in length of incision, operation time, amount of bleeding between two groups (>0.05);fracture healing time in treatment group was (12.2±3.2) weeks, and (15.6±4.7) weeks in control group;there was difference between two groups (0.05);One patient occurred neural paralysis in treatment group;1 patient occurred delayedunion, 2 patients occurred bone nonunion and 1 patient occurred broken nail in control group;while there was no statistical difference between two groups in complication.@*CONCLUSION@#Both of dynamic locking screws and ordinary screws could effectively treat humeral shaft fractures. dynamic locking screws has an advantage in fracture healing time, and recovery of early shoulder and elbow function. However, the active time of this technology is not too long in China, further study on long-term efficacy of large samples is needed.

Anti-tumor activity of a recombinant endoglin-MIP3α Fc-fusion protein in mice with hepatocellular carcinoma

Objective: To investigate the effects of a recombinant endoglin-macrophage inflammatory protein 3α Fc-fusion protein (EM) vaccine on tumor angiogenesis and growth in mice with H22 hepatocellular carcinoma. Methods: An in vivo hepatoma mouse model was established. Seven days after subcutaneous inoculation of H22 tumor cells, mice were randomly divided into four groups: EM, endoglin Fc-fusion protein, macrophage inflammatory protein 3α Fc-fusion protein, and normal saline groups. Tumor volume and survival rate of mice were studied at 3-day intervals. Microvessel density of the tumors and tumor cell proliferation were detected by immunohistochemistry, and tumor cell apoptosis was detected by TdT-mediated biotinylated-dUTP nick-end label staining. The number of CD11c and CD86 positive dendritic cells were detected by flow cytometry. Results: Compared with the other groups, the tumor volume became smaller, and the survival time was longer in the EM-treated group. Besides, microvessel density and cell proliferation index were significantly lower, while the tumor cell apoptosis index was significantly higher in the EM-treated group. Besides the number of CD11c and CD86 positive dendritic cells in EM-treated mice was larger than that in other groups. Conclusions: EM Fc-fusion protein could effectively inhibit tumor growth through inhibiting endoglin-related tumor angiogenesis and cell proliferation, promoting tumor cell apoptosis, and could induce a certain degree of antitumor immune responses.

Efficacy of dynamic locking screw combined with plate internal fixation for tibial fractures / 中华创伤杂志

Objective@#To evaluate the efficacy of dynamic locking screw combined with plate internal fixation for tibial fractures.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 36 patients with tibial fractures (AO 4A-C) admitted to the Second Affiliated Hospital of Army Medical University from March 2017 to March 2018. There were 27 males and nine females, aged 26-71 years [(51.6±14.3)years]. A total of 18 patients were treated with dynamic locking screw combined with locking plate internal fixation (Group A), and another 18 patients received common locking screw combined with locking plate internal fixation (Group B). The operation time, intraoperative bleeding, hospital stay, visual analogue score (VAS), callus growth and fracture healing rate at 4, 8, 12 and 24 weeks after operation were compared between the two groups. At the same time, the complications of internal fixation were evaluated, including screw loosening, screw fracture and steel plate fracture.@*Results@#All the patients were followed up for 8-18 months [(12.2±2.7)months]. There was no significant difference in operation time, intraoperative bleeding, postoperative hospital stay and postoperative VAS between the two groups (P>0.05). At 8 and 12 weeks after operation, the callus growth rate of Group A was 61% and 83% respectively, significantly higher than those of Group B (28% and 50%) (P<0.05). At 8, 12, and 24 weeks after operation, the fracture healing rate of Group A was 17%, 50% and 100% respectively, and those of Group B was 6%, 28% and 89%, showing no significant difference between the two groups (P>0.05). No complications or failure of internal fixation were found during the follow-up.@*Conclusion@#For tibial fractures, the locking plate internal fixation can achieve satisfactory clinical outcome, but the dynamic locking screw system can promote the growth of callus at early stage.

Meta-analysis of Efficacy and Safety of Yinxie Capsules Combined with Acitretin Capsules in the Treatment of Psoriasis Vulgaris / 中国药房

OBJECTIVE： To evaluate the efficacy and safety of Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris in order to provide reference for clinical drug use. METHODS： Retrieved from PubMed， Embase， Cochrane Library， CBM， CNKI， VIP， Wanfang database， randomized controlled trials （RCTs） about Yinxie capsules combined with Acitretin capsules （trial group） vs. Acitretin capsules （control group） in the treatment of psoriasis vulgaris were collected. After literature screening， data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool， Meta-analysis was performed by using Rev Man 5.3 software， and trial sequence analysis （TSA） was conducted with TSA 0.9 software. RESULTS： A total of 7 RCTs with 660 patients were included. Results of Meta-analysis showed that the total response rate [RR＝1.15，95％CI（1.04， 1.28）， P＝0.007]， the levels of IL-4 [SMD＝0.85，95％CI（0.02， 1.68），P＝0.04] and IL-10 [SMD＝0.56，95％CI（0.28， 0.83）， P＜0.000 1] in trial group were significantly higher than control group. The psoriasis area and severity index score [MD＝－2.34，95％CI（－2.77，  －1.91），P＜0.000 01]， incidence of dry eye [RR＝0.32，95％CI（0.23， 0.45），P＜0.001]， dry skin [RR＝0.47，95％CI（0.32， 0.71），P＜0.001]， folliculitis [RR＝0.42，95％CI（0.30， 0.59），P＜0.001]， the elevation of ALT [RR＝0.18，95％CI（0.05， 0.61），P＝0.005] and hyperlipidemia [RR＝0.48，95％CI（0.35， 0.65），P＜0.001] in trial group were significantly lower than control group. There was no statistical significance in nose bleeding between 2 groups [RR＝0.46，95％CI（0.16， 0.37），P＝0.16]. TSA showed that the evidence of enhancing total response rate by Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris was reliable. CONCLUSIONS： Yinxie capsules combined with Acitretin capsules show good efficacy and safety for psoriasis vulgaris.

Efficacy of dynamic locking screw combined with plate internal fixation for tibial fractures / 中华创伤杂志

Objective To evaluate the efficacy of dynamic locking screw combined with plate internal fixation for tibial fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 36 patients with tibial fractures(AO 4A-C)admitted to the Second Affiliated Hospital of Army Medical University from March 2017 to March 2018.There were 27 males and nine females,aged 26-71 years [(51.6±14.3)years].A total of 18 patients were treated with dynamic locking screw combined with locking plate internal fixation(Group A),and another 18 patients received common locking screw combined with locking plate internal fixation(Group B).The operation time,intraoperative bleeding,hospital stay,visual analogue score(VAS),callus growth and fracture healing rate at 4,8,12 and 24 weeks after operation were compared between the two groups.At the same time,the complications of internal fixation were evaluated,including screw loosening,screw fracture and steel plate fracture.Results All the patients were followed up for 8-18 months [(12.2±2.7)months].There was no significant difference in operation time,intraoperative bleeding,postoperative hospital stay and postoperative V AS between the two groups(P＞0.05).At 8 and 12 weeks after operation,the callus growth rate of Group A was 61％and 83％respectively,significantly higher than those of Group B(28％and 50％)(P＜0.05).At 8,12,and 24 weeks after operation,the fracture healing rate of Group A was 17％,50％and 100％respectively,and those of Group B was 6％,28％and 89％,showing no significant difference between the two groups(P＞0.05).No complications or failure of internal fixation were found during the follow-up.Conclusion For tibial fractures,the locking plate internal fixation can achieve satisfactory,clinical outcome,but the dynamic locking screw system can promote the growth of callus at early stage.

Effect of nano-scaled surface roughness on the biological properties of hydroxyapatite ceramics / 中国组织工程研究

BACKGROUND: Hydroxyapatite ceramic is one of the bioactive ceramics commonly used in clinic. Accurate regulation of the surface microstructure of hydroxyapatite ceramics is favorable for improving its biological performance, which is needed to be investigated thoroughly. OBJECTIVE: To investigate the effect of surface roughness on the wettability and protein adsorption ability of hydroxyapatite ceramic as well as mesenchymal stem cell proliferation on its surface. METHODS: Hydroxyapatite powders were synthesized by chemical precipitation method. Hydroxyapatite ceramics were produced by cold isostatic pressing of the powders and then high-temperature sintering of the obtained green compacts. After the different grinding and polishing processes, the hydroxyapatite ceramics with three distinct surface roughness were fabricated. The phase composition, microstructure, surface roughness and water contact angle of the hydroxyapatite ceramics were evaluated. Bovine serum albumin was used as the protein model to study the effect of surface roughness on protein adsorption. The in vitro cell culture was carried out to investigate the effect of surface roughness of hydroxyapatite ceramics on the growth and proliferation of rat bone marrow mesenchymal stem cells. RESULTS AND CONCLUSION: The hydroxyapatite ceramics with no surface treatment had higher surface roughness, presenting with marked undulating surface; the hydroxyapatite ceramics with surface grinding had a reduction in the surface roughness, but still had an undulating surface; and the hydroxyapatite ceramics with polishing treatment had a smooth surface. The surface roughness of the three hydroxyapatite ceramics with different surface treatment as mentioned above was 448.4, 229.9 and 18.6 nm, respectively, and there was a significant difference between them. The results of contact angle tests indicated that water contact angle of the hydroxyapatite ceramic was influenced by its surface roughness. Lower surface roughness meant larger contact angle, leading to the decreased hydrophilicity of the hydroxyapatite ceramics. The protein adsorption experiment showed that the hydroxyapatite ceramics were favorable for bovine serum albumin adsorption, and the amount of the adsorbed bovine serum albumin was dependent on the surface roughness of the ceramic as well as the initial concentration of the protein solution. The hydroxyapatite ceramics with higher surface roughness would absorb more bovine serum albumin, and the bovine serum albumin adsorption increased with the increasing initial concentration of the protein solution. The in vitro cell culture confirmed that surface roughness impacted the proliferation of rat bone marrow mesenchymal stem cells. Although the good attachment and growth of bone marrow mesenchymal stem cells were observed on the three hydroxyapatite ceramics, faster proliferation of mesenchymal stem cells occurred on the hydroxyapatite ceramics with lower and nano-scaled surface roughness was observed. Therefore, the surface roughness of hydroxyapatite ceramics exerts great effects on hydrophobicity, protein adsorption, and cell proliferation and growth.

Assessment of neonatal brain development by 2D1H-MRS at 3.0T / 西安交通大学学报(医学版)

Objective To compare metabolite ratios in the basal ganglia regions between preterm and term neonates and analyze the correlation between metabolite ratio and postmenstrual age(PMA)using 2D magnetic resonance spectroscopy(MRS)at 3.0T,so as to explore the value of MRS in evaluating neonatal brain development.Methods Normal neonates who underwent 3.0T MRS exam ination were recruited.Axial 2D MRS was performed with the point-resolved spectroscopy sequence(PRESS)(echo time/repetition time,144 ms/1 000 ms) through the basal ganglia covering three regions of interest(ROI)(i.e.bilateral lenticular nucleus,thalamus and white matter beside the anterior horn of lateral ventricle).The peak areas ratios of Cho/Cr,NAA/Cho and NAA/Cr were calculated.Metabolite ratios were compared between preterm and term neonates,and between three ROIs. Correlation between metabolite ratio and PMA was further analyzed.Results Totally 54 neonates were included(preterm/term,27/27).In all the three ROIs,preterm neonates presented significantly higher Cho/Cr(P＜0.05) and significantly lower NAA/Cho ratios(P＜0.001)than those of term neonates;higher NAA/Cr ratio was only observed in the lenticular nucleus of preterm neonates(P＜0.001).Significant differences in metabolite ratios were detected among the three ROIs in preterm group(P＜0.05).For term group,metabolite ratios differed between lenticular nucleus and white matter beside the anterior horn of the lateral ventricle(P＜0.01),while no difference between lenticular nucleus and thalamus was found(P＞0.05).Significant correlation between metabolite ratio and PMA was found in all the three ROIs except NAA/Cr ratio in the white matter beside the anterior horn of the lateral ventricle.To be specific,we found linear negative correlation of Cho/Cr ratio(r= -0.325,-0.633,-0.438) and positive correlation of NAA/Cho ratio(r = 0.604,0.773,0.483)in all the three ROIs,but negative correlations of NAA/Cr ratio(r=0.487,0.367)in lenticular nucleus and thalamus with PMA.Conclusion Our findings suggest the tempo-spatial pattern of neonatal brain metabolite development in terms of anatomic location and PMA.Besides,the multi-voxel MRS presents potentials in establishing the normal topologic and age-matched reference in neonates and thus making brain maturation assessment and detection of early abnormal metabolism.

Research advances in the pathogenesis of familial Kawasaki disease / 中国当代儿科杂志

Kawasaki disease has become the leading cause of acquired heart disease in children in North America and Japan. The incidence rate of Kawasaki disease varies significantly across regions and races. The first-degree relatives of patients with Kawasaki disease have a significantly higher risk of this disease than the general population. This article reviews the onset of familial Kawasaki disease and possible pathogenesis.

Magnetic Resonance Venography Findings of Obstructed Hepatic Veins and the Inferior Vena Cava in Patients with Budd-Chiari Syndrome

OBJECTIVE: This study aimed to illustrate the magnetic resonance venography (MRV) manifestations of obstructed hepatic veins (HVs), the inferior vena cava (IVC), and accessory hepatic veins (AHVs) in patients with Budd-Chiari syndrome (BCS) and to evaluate the visualization capacity of MRV in the diagnosis of BCS. MATERIALS AND METHODS: Fifty-two patients with chronic BCS were included in this study. All patients were examined via MRV performed with a 3T system following injections of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) or Gd-ethoxibenzyl-DTPA. HV and IVC lesions were classified, and their characteristics were described. HV cord-like occlusions detected via MRV were compared using ultrasonography (US). Digital subtraction angiography (DSA) was performed as a contrast in the MRV detection of IVC lesions. The HVs draining collaterals, mainly AHVs, were carefully observed. HV lesions were classified as segmental stenosis, segmental occlusion, membranous stenosis, membranous occlusion, cord-like occlusion, or non-visualized. Except for patent IVCs, IVC lesions were classified as segmental occlusion, segmental stenosis, membranous occlusion, membranous stenosis, and hepatomegaly-induced stenosis. RESULTS: All patients (52/52, 100%) showed HV lesions of different degrees. MRV was inferior to US in detecting cord-like occlusions (6 vs. 19, χ2 = 11.077, p < 0.001). Dilated AHVs, including 50 (50/52, 96.2%) caudate lobe veins and 37 (37/52, 71.2%) inferior HV and AHV lesions, were well-detected. There were no significant differences in detecting segmental lesions and thrombosis between MRV and DSA (χ2 = 0.000, p1 = 1.000, p2 = 1.000). The capacity of MRV to detect membranous lesions was inferior to that of DSA (7 vs. 15, χ2 = 6.125, p = 0.013). CONCLUSION: In patients with BCS, MRV can clearly display the lesions in HVs and the IVC, as well as in AHVs, and it has diagnostic and therapeutic value.

Effects of Nrf2-autophagy pathway in rats of the incisional pain-remifentanil-induced hyperalgesia / 天津医药

Objective To investigate the effect of nuclear factor erythroid 2-related factor 2(Nrf2)-autophagy pathway on the incisional pain-remifentanil-induced hyperalgesia of rat model. Methods Twenty-four male Sprague-Dawley rats were randomly allocated into three groups:saline+incisional pain group(group I),remifentanil+incisional pain group(group RI)and Nrf2 agonist t-BHQ group(group tBHQ),with 8 rats in each group.In group I and RI,normal saline at 0.1 mL/(kg· min) and remifentanilat 1 μg/(kg·min) were respectively infused into caudal vein for 60 min. Rats in group t-BHQ were injected intraperitoneally with Nrf2 agonist t-BHQ(15 mg/kg),the first time at 0.5 h before remifentanil infusion,per 12 h once,4 times in a row,the rest management was the same as group RI.Brennan incision pain model rats were constructed along with the infusions in the three groups. The thermal paw withdraw latency (PWL) and mechanical paw withdraw threshold(PWT)were measured at 24 h before the infusion(T0)and at 2 h(T1),6 h(T2),24 h(T3),48 h(T4)after the infusion. Rats were sacrificed after the tests, then the L4-6segments of signal cord were removed and the expression levels of autophagy-related proteins,microtubule associated protein 1 light chain 3Ⅱ(LC3Ⅱ),Beclin 1,Nrf2 and Nrf2 downstream molecular hemeoxygenase-1 (HO-1) were detected by Western blot assay. Results The PWT and PWL values were decreased significantly with the prolongation of the processing time in the three groups. Compared with group I, PWL and PWT values were decreased at T1-4,the expression levels of LC3Ⅱand Beclin-1 were increased while Nrf2 and HO-1 were decreased at T4in group RI (P<0.05). While compared with group RI, PWL and PWT values were increased, and the expressions of Nrf2 and HO-1 were increased, LC3Ⅱ and Beclin-1 protein were upregulated in group tBHQ (P<0.05).Conclusion The activation of Nrf2-autophagy pathway can improve the incisional pain-remifentanil induced hyperalgesia.

Clinical observation of closed reduction and compression cannulated screw fixation for the treatment of femoral neck fracture in young and middle-aged patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of internal fixation with closed reduction and hollow compression screws for the treatment of femoral neck fracture in young and middle-aged patients.</p><p><b>METHODS</b>From June 2013 to December 2016, 33 young and middle-aged patients with femoral neck fractures were treated with hollow compression screws fixation including 17 males and 16 females with an average age of 38.5 years old ranged from 19 to 59 years old; 20 cases were on the left side and 13 cases on the right side;the time from injury to operation ranged from 2 to 5 days with an average of 3 days. According to Garden classification, 1 case were type I, 11 cases were type II, 18 cases were type III, 3 cases were type IV. During regular follow-up after operation, through the hip joint X-ray, the healing situation of bone and osteonecrosis were observed. The Harris score was used to evaluate the hip function of the final follow-up.</p><p><b>RESULTS</b>The operation time was from 30 to 50 minutes, the blood loss during operation was 20 to 70 ml. All patients were followed up for 8 to 42 months with an average of 24 months. At the final follow-up, the Harris score of hip joint was excellent in 18 cases, good in 10 cases, fair in 2 cases and poor in 3 cases. Among them, the pain scores were 40.61±5.08, function scores were 38.94±6.78, malformation scores were 3.88±0.69, motion range scores were 3.70±0.64 and the total scores were 87.12±11.98. Thirty cases achieved bone healing, the healing time was 4 to 12 months with an average of 7.5 months, 2 patients occurred with nonunion (Garden type IV), 1 patient with femoral head necrosis (Garden type IV). All patients had no postoperative infection, internal fixation loosening, refracture and other complications.</p><p><b>CONCLUSIONS</b>In treating the young and middle-aged patients with femoral neck fracture, closed reduction and hollow compression screw fixation has advantages of simple, stable fixation, less trauma, high rate of fracture healing, osteonecrosis of the femoral head with low risk and satisfactory clinical effect.</p>

Application of CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors / 上海交通大学学报（医学版）

Objective·To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors. Methods·A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgical procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique. Results·A total of 13 cases with refractory pelvic tumors were included in this study (8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma) with an average age of (50.0±8.5) years. According to the Enneking classification,there were 2 cases in zone Ⅰ , 2 in zones Ⅰ + Ⅱ , 1 in zones Ⅱ + Ⅲ , 3 in zones Ⅰ + Ⅱ + Ⅲ , 1 in zones Ⅰ + Ⅱ + Ⅳ , 1 in zonesⅠ + Ⅱ + Ⅲ + Ⅳ , 1 in zones Ⅰ + Ⅳ , 1 in zones Ⅱ + Ⅳ , and 1 in zone Ⅳ. The mean maximal tumor diameter was (15.15±4.81) cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique. Conclusion·CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-surgical planning and clinical treatment of refractory pelvic tumors.