Construction and verification of a nomogram prediction model of severe adult community-acquired pneumonia / 中华危重病急救医学

Objective:To construct and verify the nomogram prediction model based on inflammatory indicators, underlying diseases, etiology and the British Thoracic Society modified pneumonia score (CURB-65 score) in adults with severe community acquired pneumonia (CAP).Methods:The clinical data of 172 adult inpatients first diagnosed as CAP at Taikang Xianlin Drum Tower Hospital from January 2018 to December 2021 were divided into severe and non-severe diseases groups according to the severity of their conditions. The baseline conditions (including gender, age, past history, comorbidities and family history), clinical data (including chief symptoms, onset time, CURB-65 score), first laboratory results on admission (including whole blood cell count, liver and kidney function, blood biochemistry, coagulation function, microbiological culture results) and whether the antimicrobial therapy was adjusted according to the microbiological culture results were recorded in both groups. Univariate analysis was used to screen for differential indicators between severe and non-severe patients. After covariate analysis, multi-factor Logistic regression analysis was performed based on the Aakaike information criterion (AIC) forward stepwise regression method to rigorously search for risk factors for constructing the model. Based on the results of the multi-factor analysis, a nomogram prediction model was constructed, and the discriminatory degree and calibration degree of the model were assessed using the receiver operator characteristic curve (ROC curve) and calibration curve.Results:A total of 172 adult CAP patients were included, 48 in severe group and 124 in non-severe group. The median age was 74 (57, 83) years old, onset time was 5.0 (3.0, 10.0) days, total number of comorbidities was 3 (2, 5), including 58 cases (33.7%) with hypertension and 17 (9.9%) with heart failure, 113 (65.7%) with CURB-65 score≤1, 34 cases (19.8%) had a CURB-65 score = 2 and 25 cases (14.5%) had a CURB-65 score≥3. Univariate analysis showed that there were statistically significant differences between the two groups in age, smoking history, CURB-65 score, heart rate, onset time, total comorbidity, pathogenic microorganisms, fibrinogen (FIB), D-dimer, C-reactive protein (CRP), procalcitonin (PCT), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Multi-factor Logistic regression analysis showed that hypertension [odds ratio ( OR) = 3.749, 95% confidence interval (95% CI) 1.411 to 9.962], heart failure ( OR = 4.616, 95% CI was 1.116 to 19.093), co-infection ( OR = 2.886, 95% CI was 1.073 to 7.760), history of smoking ( OR = 8.268, 95% CI was 2.314 to 29.537), moderate to high CURB-65 score ( OR = 4.833, 95% CI was 1.892 to 12.346), CRP ( OR = 1.012, 95% CI was 1.002 to 1.022), AST ( OR = 1.015, 95% CI was 1.001 to 1.030) were risk factors for severe CAP (all P < 0.05). The filtered indicators were included in the nomogram model, and the results showed that the area under the ROC curve (AUC) for the model to identify patients with severe adult CAP was 0.896, 95% CI was 0.840 to 0.937 ( P < 0.05), and the calibration curve showed that the predicted probability of severe CAP was in good agreement with the observed probability (Hosmer-Lemeshow test: χ2 = 6.088, P = 0.665). Conclusions:The nomogram model has a good ability to identify patients with severe adult CAP and can be used as a comprehensive and reliable clinical diagnostic tool to provide a evidence for timely intervention in the treatment of adults with severe CAP.

Influence of three different nucleic acid extraction methods on 2019-nCoV / 中华检验医学杂志

Objective:To study the difference in the extraction efficiency of the novel coronavirus (2019-nCoV) nucleic acid by using magnetic beads method, centrifugal column method and one-step method.Methods:On March 5, 2021, 10 throat swabs were collected from the staff working in the nucleic acid sampling room in Department of Clinical Laboratory, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University. The positive quality control samples were mixed into the swabs and used as mock positive samples. The RNA was extracted from simulated positive samples and their diluted samples by using magnetic beads method, centrifugation column method and one-step method. The purity ( A260/ A280 ratio) and concentration of the nucleic acid obtained were measured by micro-uv photometry, and fluorescence quantitative PCR was performed to compare the CT value and extraction efficiency. The three methods were used to extract the simulated weak positive specimens and to compare the difference of CT values after amplification. The measurement data that followed normal distribution were expressed by xˉ±s, the t test was used for comparing in the same group, and single factor analysis of variance was used for comparing among multiple groups. A P value smaller than 0.05 indicated a significant difference. Results:2019-nCoV nucleic acid extracted by magnetic bead method, centrifugal column method and one-step method could amplify positive results. There was no significant difference between the CT value of RNA amplification extracted by magnetic bead method and one-step method ( t=? 0.995 , P=0.376). The CT values of orf1ab gene amplified by centrifugal column method, magnetic bead method and one-step method were 29.28±0.06, 30.82±0.14 and 29.79±0.01 respectively ( F=11.196 , P=0.041). The CT values of E gene were 28.52±0.40, 27.33±0.78 and 27.38±0.13 respectively ( F=3.407, P=0.169). The CT values of N gene were 28.61±1.02, 27.24±0.20 and 27.25±0.47, respectively ( F=2.880 , P=0.020). The CT values of human genes extracted by centrifugal column method, magnetic bead method and one-step method were 19.68±0.36, 20.14±0.06 and 20.58±0.49 respectively, which was statistically significant ( F=4.904, P=0.048). The CT value of amplified human gene was affected by the dilution of human samples twice. The CT value of undiluted samples was smaller than that of diluted samples twice, with a difference of 2.95±0.22, which was statistically significant ( t=?3.025, P=0.039). The extraction time of one-step method, magnetic bead method and centrifugal column method were (15.00±1.50), (20.00±1.50) and (40.00±5.5) min respectively, and the difference was statistically significant ( F=688 , P=0.027). Conclusions:Magnetic bead method, centrifugal column method and one-step method can be used to extract 2019-nCoV nucleic acid, for the centrifugal column method has a higher extraction efficiency than the magnetic bead method and the one-step method. The one-step method is the fastest, followed by the magnetic bead method and the centrifugal column method. A large number of clinical samples can be processed using the magnetic bead method and one-step method. One-step rapid nucleic acid test can also be performed on samples from emergency and fever clinics. It is not recommended to dilute specimens for testing. In order to improve the detection rate, extracting RNA from highly suspected samples with negative initial nucleic acid test by centrifugal column method is suggested.

Meta-analysis of inhaled nitric oxide in gestational age ≤34 weeks preterm infants / 中国新生儿科杂志

Objective:To evaluate the effect of inhaled nitric oxide (NO) in gestational age ≤34 weeks preterm infants using meta-analysis.Method:A search from PubMed, Embase, Cochrane Central library, China National Knowledge Internet, China biomedical literature database, Wanfang and VIP database from establishment to June 2020.Result:A total of 17 randomized controlled studies were included. The subjects were premature infants (gestational age ≤34 weeks) who needed respiratory support. The total sample size was 4 033.Meta-analysis showed that no significant difference was found in mortality between treatment and control groups ( RR=1.00, 95% CI 0.89~1.11, P=0.930).Risk of bronchopulmonary dysplasia (BPD) at 36 w postmenstrual age (PMA) was significantly lower in preterm infants supplemented with iNO ( RR=0.89, 95% CI 0.82~0.97, P=0.006). Subgroup analysis showed the overall risk of mortality or BPD incidence was significantly reduced for birth weight >1 000 g infants treated with iNO ( RR=0.72, 95% CI 0.58~0.89, P=0.002). Risk of BPD incidence was significantly lower when beginning iNO in the first 7 d of life ( RR=0.83, 95% CI 0.70~0.98, P=0.030). Risk of BPD incidence was significant reduced in infants treated with 5 ppm or ≥10 ppm iNO ( RR=0.89, 95% CI 0.81~0.98, P=0.020; RR=0.90, 95% CI 0.81~0.99, P=0.030). There was a decrease in BPD incidence with iNO treatment time of either ≤7 d or >7 d ( RR=0.77, 95% CI 0.60～0.99, P=0.040; RR=0.87, 95% CI 0.77~0.97, P=0.010). There were no differences concerning mechanical ventilation duration and intracranial hemorrhage incidence ( P>0.05). Significant difference was found between treatment and control group with respect to reduction of oxygenation index (OI) ( WMD=-6.32, 95% CI -12.16~-0.48, P=0.030). Conclusion:For preterm infants born at less than 34 weeks who need respiratory support, iNO treatment may improve oxygenation and reduce the risk of BPD, but not decrease mortality, mechanical ventilation duration or intracranial hemorrhage incidence. A better treatment effect may be achieved if iNO treatment began in the first 7 d of life, and if the infant had a birth weight greater than 1 000 g.

Detection of copy number variations for chromosome non-numerical abnormality with non-invasive prenatal testing: clinical analysis of 205 cases / 中华围产医学杂志

Objective:To evaluate the clinical value of non-invasive prenatal testing (NIPT) in detecting copy number variations (CNVs).Methods:There were 37 845 pregnant women undergoing NIPT in Guangdong Women and Children Hospital from January 1, 2015 to September 1, 2018, of which 205 with CNVs were detected in addition to chromosome numerical abnormality and retrospectively analyzed. Among the 205 cases, 137 received invasive prenatal diagnosis. Pregnant outcomes were followed up and the efficiency of NIPT in detecting CNVs was analyzed by descriptive statistical analysis.Results:The detection rate of NIPT for CNVs was 0.54% (205/37 845). Among the 137 cases undergoing invasive prenatal diagnosis, 110 showed normal karyotype, 27 with abnormal including two having CNVs that were inconsistent with NIPT findings and 25 with consistent results. The positive predictive value, sensitivity and specificity of NIPT for CNVs were 18.2%(25/137), 100.0%(25/25) and 99.7%(37 625/37 737), respectively. Among the 27 pregnant women with positive findings in prenatal diagnosis, five were lost to follow-up; eight terminated their pregnancies; 14 gave birth to alive baby with normal phenotype. While among the 110 pregnant women with negative results in prenatal diagnosis, 87 delivered full-term neonates including two having patent foramen ovale and 85 with normal phenotype; three gave birth prematurely; one terminated pregnancy at 28 +2 gestational weeks due to preeclampsia; two had inevitable abortion; two requested termination and 15 were lost to follow-up. Conclusions:Routine NIPT has high performance in screening CNVs but those pregnant women with positive NIPT results should be counseled after referring to their invasive prenatal diagnosis results, ultrasound scan and clinical information.

Accuracy and outcome of computer-assisted navigation system for tunnel positioning in reconstruction of anterior cruciate ligament / 中华创伤杂志

Objective:To explore the accuracy and clinical effect of computer navigation system in locating the tunnel position in anterior cruciate ligament (ACL) reconstruction.Methods:A retrospective case-control study was conducted to analyze clinical data of 60 patients with ACL rupture treated in Daping Hospital of Army Military Medical University from March 2017 to March 2018, including 44 males and 16 females, aged 15-48 years (mean, 26.3 years). Computer navigation system was used to locate the internal orifice of intra-articular femoral and tibial tunnel in 30 patients (navigation group), and artificial location of intra-articular femoral and tibial tunnel in 30 patients (control group). The operation time and complications of two groups were recorded after operation. The tunnel position was evaluated by CT three-dimensional reconstruction, and the ratio of the tunnel position on the lateral surface of the femoral condyle to the tibial platform was evaluated by the grid method. The proportion sites from the deep posterior edge of lateral intercondylar surface of the femur to the shallow anterior edge (DS) and from the upper edge to the lower edge (HL) were used to represent the position of the femoral tunnel, and the proportion sites of the line connecting the anterior and posterior edge of the tibial plateau were used to represent the tibial tunnel position. The postoperative tunnel position was compared between the two groups. The knee joint stability (Lachman test, pivot shift test) and knee joint function score (Lysholm score, Tegner score) were compared between the two groups before operation and 12 months after operation.Results:All patients were followed up for 12-24 months (mean, 15 months). The operation time was (56.1±8.1)minutes in control group versus (76.0±6.7)minutes in navigation group ( P<0.05). In navigation group, 2 patients had skin edge necrosis at the place where the navigation needle was installed. The proportion of DS in femoral tunnel was (27.2±3.7)% in navigation group versus (33.9±4.4)% in control group ( P<0.05). HL proportion site was (36.6±4.8)% in navigation group versus (38.9±4.9)% in control group ( P<0.05). Proportion of the tibial tunnel at the anterior and posterior edge of the tibial plateau was (44.9±1.8)% in navigation group and (44.7±3.0)% in control group ( P>0.05). Both groups showed significant improvements in Lysholm score, Tegner score, Lachman test and pivot shift test 12 months after operation compared to the preoperative levels ( P<0.05), but the knee joint function score and knee joint stability score had no significant difference between the two groups 12 months after operation ( P>0.05). Conclusions:No significant differences are found between computer navigated and manually navigated ACL reconstruction with regards to knee joint stability, knee joint function, and tibial tunnel localization. However, computer assisted navigation enables the location of the lateral femoral tunnel closer to the anatomical position.

Study on miR-650 for promoting proliferation of osteosarcoma cells via targeting ING4 / 重庆医学

Objective To investigate the expression of miR-650 in osteosarcoma tissue and cell lines and its action mechanism in the osteosarcoma formation.Methods The realtime fluorescence quantitative PCR was used to detect and compare the expres-sions of miR-650 between osteosarcoma tissue and normal tissue or between osteosarcoma cell lines(MG63)and normal human os-teoblast cell lines(hFOB1.19);the MTT experiment was used to investigate the proliferation situation in different groups;Western blot was used to detect the ING4 protein expression.Results The expression of miR-650 in osteosarcoma tissue and MG63 cells was higher than that in normal tissue and human osteoblast cell;after inhibiting miR-650 expression,the proliferation ability of MG63 was significantly decreased.Moreover the expression of inhibitor of growth 4(ING4)was significantly increased when miR-650 was reduced,ING4 mRNA of negative control group,scramble group and miRNA group were 1.00 ± 0.16,1.08 ± 0.14 and 5.35 ± 0.32 respectively;the ING4 protein expressions were 0.62 ± 0.06,0.59 ± 0.12 and 2.45 ± 0.20 respectively;compared with negative control group,the difference was statistically significant(P<0.05);but after suppressing this elevation,the proliferation a-bility of MG63 cells had a certain recovery.Conclusion MiR-650 promotes MG63 proliferation via reducing ING4 expression,which suggests that miR-650 could be a new target of treating osteosarcoma.

Expression and clinical significance of HMGA2 in renal carcinoma / 中华肿瘤杂志

Objective@#To detect the high mobility group A2 (HMGA2) expression in renal carcinoma, and to explore the relationship with clinicopathological features and its significance for prognosis.@*Methods@#50 renal carcinoma specimens, 50 corresponding adjacent normal kidney tissue samples, and 40 benign renal tumor specimens were used in this study. The expressions of HMGA2 mRNA and protein were detected by RT-PCR, Western blot and immunohistochemical assays, and its relationship with clinicopathological features and prognosis in the renal carcinoma patients was analyzed.@*Results@#The RT-PCR results showed that the relative expression levels of HMGA2 mRNA in the renal carcinoma, benign renal tumor tissues, and adjacent normal renal tissues were 0.84±0.23, 0.19± 0.06 and 0.08±0.04, respectively, and the expression in renal carcinoma tissue was significantly higher than those of the other 2 groups (P<0.01). The Western blot results showed that the relative expression levels of HMGA2 protein in the renal carcinoma, benign renal tumor tissues, and adjacent normal renal tissues were 0.91±0.24, 0.12±0.04 and 0.03±0.01, respectively, and the expression in renal carcinoma tissue was significantly higher than those of the other 2 groups (P<0.01). Immunohistochemical results showed that the expression of HMGA2 protein exhibited brown and tan granular, which mainly distributed in the cell nuclei. Among the 50 cases of renal carcinoma, 34 cases exhibited positive expression, with a positive rate of 68.0%. Among the 40 cases of benign tumor tissues, 3 cases had positive expression, with a positive rate of 7.5%, while among the 50 cases of adjacent normal renal tissues, there was only 1 case exhibiting positive expression of HMGA2 protein, with a positive rate of 2.0%. The protein expression of HMGA2 was significantly higher in the renal carcinoma than in the benign tumors and normal renal tissues (P=0.004). There was no statistically significant difference in the association of HMGA2 protein expressions with age, sex, tumor size and histological type (P>0.05), while significant difference did exist in the association with different statuses of TNM staging and lymph node metastasis (P<0.05). The median time to progression (TTP) in 34 HMGA2 protein-positive patients was (22.36±1.48) months and that of 16 HMGA2 protein-negative patients was (34.55±1.87) months (P<0.05).@*Conclusions@#HMGA2 plays an important role in the tumorigenesis and development of renal carcinoma, and may be used as an important predictor for estimating the prognosis of renal carcinoma. HMGA2 might become a new diagnostic and prognostic marker for renal carcinoma.

Application of minimally invasive arthroscopy in knee joint injuries caused by longitudinal impact of military training / 重庆医学

Objective To explore the applicationof minimally invasive arthroscopy in the knee joint injuries caused by longitudinal impact of military training.Methods A total of 538 consecutive soldier outpatients diagnosed as knee joint injuries caused by longitudinal impact of daily military training in our hospital from January 2006 to January 2015 were retrospectively analyzed.According to the Principles about Diagnosis and Treatment of Military Training Injury,the general condition,injuries types and injury subject were performed the statistical analysis.The grading diagnosis and treatment strategy of impact injuries was proposed at first time according to the MRI examination results,injury type and severity.The patients needing operative therapy were screened out for conducting the arthroscopic operation according to this strategy.All the patients receiving surgeries were evaluated by the Lysholm scoring before and after operation.The subjective evaluation satisfaction investigation was performed.Results Seventy six cases received the arthroscopic surgeries,and all the cases were followed up successfully.The duration of following-up ranged 12-35 months.The Lysholm scores before operation was[46.3 ± 5.3]which were lower than [83.7±3.8] after operation,the difference was statistically significant(P＜0.01).The wounds healed at the first stage,and no complications of nerve and blood vessel injury,infections,etc.occurred.The patients subjectively felt that the knee joint function was significantly improved,71 cases satisfied with the arthroscopic operation effect,the satisfactory rate was 93.4％.All the cases went back to the normal training life after surgeries.Conclusion For the knee joint injuries caused by longitudinal impact of military training,the prevention is the key role.On the basis of preliminary diagnosis by the physical examination and imaging examination,the treatment should be combined with the grading diagnosis.and treatment strategy.In the operation therapy,the minimally invasive arthroscopy as an examination and treatment means can more comprehensively evaluate the knee injury condition,timely repair injured meniscus and conduct the ligament reconstruction,which has small trauma and recovers rapidly,the patient can recover the routinemilitary training as soon as possible.The arthroscopy is the first choice of treatment scheme for the patients with grade Ⅲ or more injury.

Three cases report of ankle extension fusion / 重庆医学

Objective To observe the effect of ankle slow lengthening fusion on old ankle injury .Methods Totally 3 cases of old ankle injury ,were retrospectively analyzed .The new method of ankle slow lengthening fusion was adopted for conducting treat‐ment .Intraoperative ankle osteotomy and Orthofix external fixation were performed ,ankle slow lengthening was started on postop‐erative 7 d ,and the ankle joint gap was pulled for 1-2 cm ,the double lower limbs were basically equal length and the ankle reached completely bony fusion ,the external fixator was taken out and then weight‐bearing walking started .Results The 10 -23 months follow up was performed ,averaged 16 months .Three cases of ankle joint obtained bony fusion in postoperative 9 months and the ex‐ternal fixator was dismantled .By adopting the AOFAS foot score ,the average score in 3 feet was increased from preoperative 25 .6 points to postoperative 76 .3 points at the time of follow‐up .Conclusion Ankle slow lengthening fusion is an effective treatment method for old ankle joint injury .

Tantalum rod implantation combined with bone transplantation in the treatment of early stage osteonecrosis of the femoral head / 中华显微外科杂志

Objective To discuss the efficacy of tantalum rod implantation combined with bone transplantation in the treatment of early stage osteonecrosis of the femoral head.Methods Twenty-four male patients were re cruited.Twelve patients were allocated to the tantalum rod and bone implantation group.The mean age was 35.7 years.Twelve patients were allocated to the tantalum rod implantation group.The mean age was 33.2 years.All patients with stage Ⅱ osteonecrosis.Results All patients were followed up with an average of 42.5 ± 6.7 months.The final evaluation was made according to the last follow-up data.In the tantalum rod implantation group,the average score of pre-operation and post-operation were 65.3±6.3,82.6 ± 5.3 respectively with a statistic difference (P ＜ 0.05).Two of patients underwent total hip replacement before the end of this study,significant difference was observed in the aspect of radiographic progression (P ＜ 0.05).In the tantalum rod implantation combined with bone marrow stem cell transplantation group,the average score was 92.2 ± 1.0 with a statistic difference (P ＜ 0.05).There was no one of patients underwent total hip replacement before the end of this study.Significant difference was observed in the aspect of radiographic progression (P ＜ 0.05).Between the two groups,a significant difference was observed in clin ical symptoms in favor of the tantalum rod implantation combined with bone transplantation group(P ＜ 0.05).No significant difference was observed in the aspect of radiographic progression (P ＞ 0.05).Significant difference was observed in the aspect of survivorship of the femoral head(P ＜ 0.05).Conclusion Tantalum rod implantation combined with bone transplantation improves clinical symptoms and delay total hip arthoplasty than tantalum rod implantation.

Risk factors for venous thromboembolism in hospitalized patients undergoing total hip or knee joint replacement at the perioperative period / 重庆医学

Objective To analyze the risk factors for venous thromboembolism(VTE) in hospitalized patients undergoing to‐tal hip arthroplasty (THA) or total knee arthroplasty (TKA) at the perioperative period .Methods One hundred and seventy‐four in hospitalized patients who was given THA or TKA from October 2012 to July 2013 were enrolled in this prospective cohort stud‐y .There are a total of 205 cases of surgery ,including 132 T HAs in 122 patients and 73 TKAs in 52 patients .All patients were given Color Doppler Ultrasonography of lower limbs to detect DVT in 3 to 5 days after operation and preoperative .Then the patients were divided into two groups ,the DVT group and the non DVT group according the Ultrasonography results .More than ten factors such as age ,gender ,hypertension in DVT formation were detected .Then their correlation was analyzed .The key influencing factors for DVT were selected .Results Forty‐three patients developed DVT after operation ,the incidence of DVT was 24 .7% .Age≥ 70 years ,rheumatoid and relatively lower PT‐INR before surgery has a statistical significance (P<0 .05);elevated plasma D‐dimer val‐ue before surgery and general anesthesia has a highly statistical significance (P<0 .01) .A preoperative plasma D‐dimer cutoff value as a diagnostic test was calculated as 764 μg/L .Conclusion Age≥70 years old ,relatively lower PT INR ,preoperative elevated plasma D‐dimer value ,rheumatoid and general anesthesia were the risk factors for DVT formation after THA or TKA .A preopera‐tive plasma D‐dimer cutoff value as a diagnostic test was obtained as 764 μg/L .

Tissue-engineered neural complex seeded in modified collagen scaffold for treatment of acute spinal cord injury in adult rats / 中华创伤杂志

Objective To repair the injured spinal cord in adult rats using tissue-engineered neural complex constructed in vitro by tissue engineering techniques and discuss the treatment effect.Methods Neural stem cells (NSCs) from rats were cultured separately and modified collagen scaffold was also prepared to construct complex of NSCs /modified collagen scaffold in vitro.Embryo spine cord extract was administered to induce differentiation of NSCs,the structure of which was revealed by histochemical technique and scanning electron microscope.The rat models of hemisected spinal cord injury were built and grafted with tissue-engineered neural complex.Functional recovery of the models was evaluated every two weeks postoperatively.Effect in repair of spinal cord injury was assessed by histological method at postoperative three and eight weeks.Results After tissue-engineered neural complex planted in the modified collagen scaffold was grafted into the injured spinal cord in adult rats,the seed cells survived and further differentiated into functionally active neurons.The differentiated glia cells presented quite regular reticular structure.Motor function below the level of the injured spinal cord in adult rats obtained obvious recovery.Conclusion Tissue-engineered neural complex seeded in the modified collagen scaffold takes effect in structural reconstruction and functional recovery of the injured spinal cord in adult rats.

Prevalence of dyslipidemia in subjects with type 2 diabetes mellitus in Beijing urban communities:Beijing community diabetes study 8 / 中华全科医师杂志

Objective To investigate the prevalence of dyslipidemia in subjects with type 2 diabetes mellitus in Beijing urban communities.Methods Total 3316 subjects with type 2 diabetes (age 20-80 years) were recruited from 15 urban community health centers in Beijing using a multi-stage random sampling approach.Dyslipidemia was diagnosed according to Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults:2007 version.Results Among 3316 diabetic subjects (1329 malesand 1987 females),75.6％ (2506/3316) had dyslipidemia,the prevalence was 72.5％ (964/1329)in men and 77.6％ (1542/1987) in women.The prevalence of hypertriglyceridemia and hypercholesterolemia was 41.9％ (1388/3316) and 48.1％ (1595/3316),respectively.31.5％ (1043/3316) subjects had high levels of low-density lipoprotein cholesterol (LDL-C) and 21.2％ (703/3316) had low high-density lipoprotein cholesterol (HDL-C).Among all subjects with dyslipidemia only 22.9％ (575/2506) took hypolipid agents.The overall blood lipid control rates of triglyceride (TG),total cholesterol (TC),LDL-C and HDL-C in 1393 subjects with dyslipidemia history were 48.0％ (669/1393),17.4％ (242/1393),30.9％ (430/1393) and 75.8％ (1056/1393),respectively.Diabetics with dyslipidemia had higher body mass index,waist circumference,blood pressure,plasma glucose and hemoglobin A1c.The prevalence of dyslipidemia in the overweight and uncontrolled-glucose group were 79.0％ (1678/2125),78.9％ (1756/2227),respectively.Logistic regression analysis showed that gender,age,body mass index and hemoglobin A1c were associated with dyslipidemia.Conclusions The prevalence of dyslipidemia in diabetic subjects in Beijing urban communities is high and less than one quarter patients take hypolipid agents.Age,body mass index and hemoglobin A1c are the risk factors of dyslipidemia in type 2 diabetic patients.

Clinical research for the significance of inflammatory factors and adiponectin in type 2 diabetes complicated with non-alcohoic fatty liver disease / 中国综合临床

ObjectiveTo investigate the clinical significance of inflammatory factors and adiponectin in type 2 diabetes milletus complicated with non-alcoholic fatty liver disease.Methods Two hundred and ten subjects aging from 25.0 to 65.0 years old,including 106 men and 104 women,were recruited into this study.They were divided into four groups: Forty cases of healthy control (NC),60 cases with newly-diagnosed type 2 diabetes (T2DM),65 cases with simple non-alcoholic fatty liver disease (NAFLD) and other 45 cases with newly-diagnosed T2DM complicated with NAFLD.The physical examination was performed for each patient.Serum levels of alanine aminotransferase (ALT),gamma-glutamyl transpeptidase (GGT),fasting plasma glucose (FPG),glycation hemoglobin A 1 c ( GHbA1c ),creatinine ( Cr),uric acid ( UA ),2 hours postprandic plasma glucose (2hPG),fasting insulin (FINS),lipid profiles were measured.Insulin resistance index (HOMAIR) was calculated.Tumor necrosis factor-α (TNF-α),high sensitive C-reactive protein (hs-CRP) and adiponectin were also detected.Results The serum levels of ALT and GGT,body mass index and waist/hip ratio were higher in the NAFLD,T2DM with NAFLD patient groups than that in T2DM and NC group ( P ＜0.05or P ＜0.01 ).The serum levels of TG and LDL-C were significantly higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.And serum TG levels in T2DM with NAFLD group were higher than that of T2DM group (P ＜ 0.05).FPG and GHbAl c were higher in T2DM and T2DM with NAFLD groups than that of NAFLD and NC groups.The serum levels of TNF-α,hs-CRP and HOMA-IR were higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.T2DM with NAFLD group had higher levels of TNF-α,hs-CRP and HOMA-IR compared with T2DM group.However,serum adiponectin levels of T2DM,NAFLD and T2DM with NAFLD groups were lower than that of NC group.And it was lower in T2DM with NAFLD group when compared with NC group ( P ＜ 0.05 ).Adiponectin was negatively associated with TNF-α,hs-CRP and HOMA-IR (r =-0.635,-0.668,-0.752 respectively,P ＜ 0.0l ).But HOMA-IR was positively associated with TNF-α,hs-CRP( r =0.667,0.706 respectively,P ＜ 0.01 ).ConclusionInflammatory factors and adiponectin may play important roles in the pathophysiology and progression of T2DM and NAFLD.The protective effects of adiponectin may come from its anti-inflammatory activity to relieve insulin resistance for NAFLD.

Clinical characteristics of diabetic patients with metabolic syndrome and its components at 15 urban communities in Beijing / 中华全科医师杂志

Objective To study clinical characteristics of type 2 diabetic(T2D)patients with metabolic syndrome(MS)and its components in Beijing urban communities.Methods Totally,3295 T2D patients involved in a combined prospective diabetic management study from 15 urban communities in Beijing were classified as four groups, according to 2004 Chinese Diabetes Society's definition of MS, i. e, isolated T2D, T2D with one component of MS, T2D with two components of MS and T2D with three components of MS. Their clinical characteristics were analyzed. Results ( 1 ) Among 3295 T2D patients, 155 (4. 7% )were isolated T2D, 107 (32.6%) T2D with one component of MS, 1386 (42.1%) T2D with two components of MS and 679 (20.6%) T2D with three components of MS, with an overall 62.7% (2065/3295) of T2D patients complicated with MS. (2) In these T2D patients, the more components of MS they had, the higher body mass index (BMI), waist circumference, waist to hip circumference ratio (WHR),systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting serum levels of insulin and triglyceride (TG) and the lower level of high-density lipoprotein-cholesterol (HDL) were presented (P <0. 01 ). (3) Percentage of isolated T2D in women increased from 49. 0% (76/155) to 61.9% (420/679)of those with three components of MS ( P < 0 01 ), with increasing of components of MS. (4) Multiple logistic regression analysis showed that BMI, history of hypertension, decreased HDL, increased TG,increased blood pressure, all were risk factors for T2D patients complicated with MS. Conclusions Among T2D patients in urban communities of Beijing, 95.3% (3140/3295) of them complicated with one or more components of MS, and 61.9% (420/679) of them complicated with MS. So, community diabetic management must be implemented in an all-round way, including control of blood pressure, blood lipids,body weight and so on, in addition to control of blood sugar.

Current status of hypoglycemic drug use among 3297 adult patients with type 2 diabetes in 15 urban communities of Beijing：Beiiing Community Diabetes Study-7 / 中华全科医师杂志

Objective To investigate current status of use of oral hypoglycemic drugs and insulin among adult patients with type 2 diabetes mellitus (T2DM) in urban community of Beijing.Methods In total,3297 T2DM patients aged more than 20 years from 15 urban communities of Beijing were studied.Their body weight,height,fasting plasma glucose level and glycosylated hemoglobin Alc (HbAlc) were measured.A door-to-door questionnaire survey on use of oral hypoglycemic drugs and insulin was conducted for them.All the T2DM patients surveyed were divided into four groups based on their received intervention.Results ①Of 3279 T2DM patients,454 (13.8％) received lifestyle intervention,971 (29.5％) used only one oral hypoglycemic drug,1179 (35.7％) with combined oral hypoglycemic drugs,and 693(21.0％) with insulin.②There was significant difference in average HbAlc among the four groups of T2DM patients with lifestyle intervention,only one oral hypoglycemic drug,combined oral hypoglycemic drugs,and insulin,with HbAI c of (7.0 ± 1.9) ％,(7.1 ± 1.5) ％,(7.4 ± 1.5 ) ％,and (7.5 ± 1.5 ) ％for them,respectively ( F =15.1,P ＜ 0.01 ).Proportions of the T2DM patients with HbAlc equal to or higher than 7.0％ were 32.2％,39.4％,52.1％ and 59.5％ for the four groups,respectively ( x2 =117.7,P ＜ 0.01 ).③In the T2DM patients with lifestyle intervention,32.2％ (146/454) of them with HbA1 c equal to or higher than 7.0％ were untreated with any oral hypoglycemic drug.In those with only one oral hypoglycemic drug,39.4％ (383/971) of them with HbAlc equal to or higher than 7.0％ were not treated with combined oral hypoglycemic drugs and/or insulin.In those with combined oral hypoglycemic drugs,52.1％ (614/1079) of them with HbAlc equal to or higher than 7.0％ were not received combined insulin treatment.④ Fasting plasma glucose level,treatment strategies,postprandial 2-h blood glucose level and length of the illness were independent risk factors for HbAlc level equal to or higher than 7.0％,with odds ratio (OR) of 1.757,1.256,1.175 and 1.031,respectively.⑤ In 2843 T2DM patients with oral hypoglycemie drugs and/or insulin treatment,1494 (52.6％ ) received biguanides and 693 received (24.4％ )insulin,respectively.Conclusions More than half of adult patients with T2DM do not meet the target of glycemic control of HbAlc less than 7.0％ in urban communities of Beijing,due to not active use of oral hypoglycemic drugs,and not timely adoption of combined use of oral hypoglycemic drugs and insulin therapy.

Correlation of surgical risk score with change of T cell subsets and occurrence of postoperative complications in the elderly patients / 中华创伤杂志

ObjectiveTo discuss the correlation of the surgical risk score with the change of T cell subsets and the occurrence of postoperative complications. MethodsA total of 260 patients with hip fractures treated in our department were enrolled in this study and divided into high-risk group ( Group A) and low-risk group (Group B) based on the surgical risk score. The fasting peripheral venous blood was taken in the morning at one day before surgery and at days 1,3, 5, 7 and 14 after surgery for measuring CD3, CD4 and CD8 levels respectively in two groups.In the meantime, the correlation of level changes with risk score and postoperative complications was observed in two groups. ResultsThere were two patients with lung infection in the Group B, with no death. There were two patients with pulmonary infection, one with wound infection and two with deep vein thrombosis, with one death. The postoperative levels of CD3 and CD4 in the Group A and Group B were significantly lower than those in the control group (P ＜ 0.01 ), which reached the lowest level at day 1 after operation and recovered to normal at day 5 after operation. The postoperative levels of CD3 and CD4 in the Group A recovered near to normal at day 7 and to normal at day 14. While the postoperative levels of CD3 and CD4 in the Group B remained low level even at day 14. The level of CD8 decreased at days 1 and 5 in the Group A, then increased and remained relatively stable, while the level of CD8 increased in the Group B. The T cell subsets in both groups recovered from low to high trend at days 1-7 after surgery. The higher preoperative score had more obvious decrease and slower recovery of the T cell subsets. ConclusionsSurgical risk score has positive correlation with the change of T cell subsets and postoperative complications, which can more accurately predict the postoperative outcome of the old patients.

Controlled hypotension combined with autotransfusion in patients with idiopathic scoliosis / 中国组织工程研究

BACKGROUND: Idiopathic scoliosis is a common spinal deformity in teenagers, which is managed mainly by orthomorphia. However, due to great trauma, long operative duration and large blood loss, a great amount of blood transfusion is needed during the surgery. Allogeneic blood transfusion should be reduced in order to release blood insufficient, decline blood transfusion expense, as well as avoid transfusion diseases. OBJECTIVE: To investigate the value of controlled hypotension combined with autotransfusion in idiopathic scoliosis orthomorphia.METHODS: Intraoperative controlled hypotension was performed during posterior orthomorphia surgery on all the 46 cases of idiopathic scoliosis, 17 cases in which were served as the control group, who underwent allogeneic blood transfusion without autotransfusion, while the other 29 cases were served as the experimental group, who underwent autotransfusion that including reinfusion of preoperative deposited autologous blood and intra-operative salvaged autologous blood. The blood loss volume and transfusion status in two groups were observed. RESULTS AND CONCLUSION: Blood loss volume in the control group was 400-1 000 (867±161) mL, and that in the experimental group was 350-1400 (842±376) mL, There was no marked difference between the two groups (P > 0.05). The volume of allogeneic blood transfusion in the control group was 500-1 800 (845±332) mL, which was greater than that in the experimental group [0-1 300(423±237) mL] (P < 0.01). The results suggested that controlled hypotension reduces intraoperative bleeding, and postoperative autotransfusion minimizes the need of allogeneic blood transfusion.

Finite element analysis on point contact locking plate fixating femoral shaft fractures / 中华创伤杂志

Objective To set up a three-dimensional finite element model (FEM) to investigate biomechanics of point contact locking plate (PC-LP) fixating femoral shaft fractures. Methods One intact fresh adult cadaveric femur was scanned by CT at 1 mm interval. Then, the data of CT were utilized to establish three-dimensional FEM by using software Mimics and PRO/E and simulate the different clini-cal loading conditions. The changes of theoretical stress of femur and PC-LP were analyzed under flexion, axial compression and torsion loads. Results (1) Under four-point bending load, the distribution of femur stress was in uniformity, with the largest stress of the PC-LP focused on the edge. (2) Under axial compression load of 250 N, the largest stress of the femur was focused on the screw holes on beth distal ends, with the largest stress of the PC-LP focused on the middle screw holes. (3) Under the torsion load cused on the middlepart and the middle screw holes. Conclusions Under the four-point bending, ax-ial compression and torsion loads, the distribution of femur stress is in uniformity, when the largest stress of the PC-LP focuses on edge or the middle screw holes, while that of the PC-LP on two screw holes of proximal or distal ends.

Role of mangled extremity severity score in reservation and amputation of crush limbs in patients attributable to China Wenchuan earthquake / 中华创伤杂志

Objective To evaluate the role of mangled extremity severity score(MESS)in res-ervation and amputation of crush lower limbs in earthquake. Methods There were 122 patients with crush lower limb injuries,with MESS≥8 points in 34 patients who were primarily amputated,M ESS 5-7points in 19 who were principally preserved and MESS＜5 points in 69 who were preserved by means of debridement,external fixators,plast splints and vaeuum sealing drainage technique.Results All pa-tients were survived.with amputation rate of 29.5%. Conclusion MESS is an important reference for evaluation of reservation and amputation of crush limb injuries caused by earthquake.