Performance of PRECISE-DAPT and Age-Bleeding-Organ Dysfunction Score for Predicting Bleeding Complication During Dual Antiplatelet Therapy in Chinese Elderly Patients.

Background: Recently, the Age-Bleeding-Organ Dysfunction (ABO) algorithm was recommended by the Asian Pacific Society of Cardiology Consensus as a binary approach to evaluate bleeding risk. This analysis made comparison of the predictive performances between the PRECISE-DAPT and ABO bleeding score in identifying the risk of 12-months major bleeding in Chinese elderly patients over 65 years old patients who underwent percutaneous coronary intervention (PCI) during dual-antiplatelet therapy period. Methods: A total of 2,037 elderly coronary artery disease (CAD) patients (≥65 years) receiving dual antiplatelet therapy (DAPT) after PCI were enrolled in the study. The predictive accuracy of the two bleeding risk scores (PRECISE-DAPT and ABO) was compared for identifying the risk of bleeding during the dual-antiplatelet therapy in patients who underwent PCI. Major clinically relevant bleeding events were defined according to the Bleeding Academic Research Consortium (BARC) criteria. Results: The PRECISE-DAPT score in the no bleeding, BARC = 1 bleeding, BARC ≥ 2 bleeding patients was 23.55 ± 10.46, 23.23 ± 10.03, and 33.54 ± 14.33 (p < 0.001), respectively. Meanwhile, the ABO score in the three groups was 0.72 ± 0.80, 0.69 ± 0.81, and 1.49 ± 0.99 (p < 0.001), respectively. The C-statistic of the PRECISE-DAPT model for prediction of BARC ≥ 2 bleeding in overall patients was 0.717 (95% CI, 0.656-0.777) and 0.720 (95% CI, 0.656-0.784) in acute coronary syndrome (ACS) patients. Similar discriminatory capacity was demonstrated in the ABO risk score [overall, patients, AUC: 0.712 (95% CI, 0.650-0.774); ACS patients, AUC: 0.703 (95% CI, 0.634-0.772)]. No differences were observed when the ABO model was in comparison with the PRECISE-DAPT model, regardless in overall patients (z = -0.199, p = 0.842) or ACS patients (z = -0.605, p = 0.545). The calibration for BARC ≥ 2 bleeding of the PRECISE-DAPT and ABO score were acceptable, regardless in overall patients [goodness-of-fit (GOF) Chi-square = 0.432 and 0.001, respectively; p-value = 0.806 and 0.999, respectively] or ACS patients (GOF Chi-square = 0.008 and 0.580, respectively; p-value = 0.996 and 0.748, respectively). Conclusion: No matter of clinical presentation in Asian 65-years older patients with DAPT, the PRECISE-DAPT, and ABO scores had the similar discriminative ability for 12-months BARC ≥ 2 bleeding. Considering the simplicity and reliability, the PRECISE-DAPT score might be more clinically applicable in the overall population and ACS patients in bleeding prediction.

Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis.

BACKGROUND: Many previous studies lack sufficient quantitative evidences about changes in biomechanical properties of the knee in response to proximal fibular osteotomy (PFO). Therefore, the aim of this study was to compare the preoperative and postoperative effects of PFO on mechanical stresses in the knee joint and provide with a biomechanical basis for PFO in the treatment of mild knee osteoarthritis (KOA) with varus deformity. METHODS: A total of 10 patients suffering mild KOA with varus deformity were enrolled in this study. Their image data from computerized tomography (CT) and magnetic resonance imaging (MRI) were used for finite element models, and PFO models were established. Static structural analysis was carried out using ABAQUS to compare the von Mises stress distribution and values of the maximal von Mises stress of femoral cartilage, meniscuses, tibial cartilages, and tibial plateau before and after surgery. RESULTS: The stress distribution in the cortical bone of the tibial plateau showed that stresses were transferred from the anterior medial area to the posterior medial area after PFO. Values of the maximal von Mises stress in femoral cartilage, medial meniscus, medial tibial cartilage, and tibial plateau after surgery were significantly lower than the preoperative values, with statistically significant differences (P < 0.05). Postoperative values of the maximal von Mises stress of lateral meniscus and lateral tibial cartilage were significantly higher than the preoperative ones, with statistically significant differences (P < 0.05). CONCLUSION: PFO could reduce the stresses in the medial compartment of the knee joint with stress pathways transferring from the anterior medial area to the posterior medial area of the tibial plateau. Therefore, PFO is recommended for the treatment of mild KOA with varus deformity featuring favorably pain-relieving effects.

Based on the entropy weight method of Urumqi municipal CDC in 2008-2017 comprehensive evaluation on the scientific research capability / 中华医学科研管理杂志

Objective Through the analysis of the data such as the publication of the paper and the scientific research project of urumqi disease prevention and control center from 2008 to 2017,the research ability level of the center is comprehensively evaluated.Methods In this paper,the entropy weight method is used to process and analyze the data.According to the results of information entropy and weight,the comprehensive scores of each index project are obtained and sorted.Results The information entropy of the paper is the smallest,the weight is the largest,the information entropy of the scientific progress award and the result identification is the largest,and the weight is the smallest.The top four years in the comprehensive score are:2016,2017,2014 and 2015;The ranking year is 2012,2010,2013 and 2011 respectively.The last two years are 2008 and 2009.Conclusions Urumqi center for disease control and prevention,2008-2017,scientific research and comprehensive ability level,although each year a little ups and downs,but overall present a curve upward trend,have a qualitative leap in the area of scientific research,achieved the zero breakthrough,and formed a "scientific promoting business,business support scientific research "as the new situation.

Efficacy of dexmedetomidine mixed with ropivacaine for transversus abdominis plane block (TAPB) combined with general anesthesia in patients undergoing laparoscopic colorectal surgery / 中国医师杂志

Objective To evaluate the efficacy of dexmedetomidine (DEX) mixed with ropivacaine for transversus abdominis plane block (TAPB) combined with general anesthesia in the patients undergoing laparoscopic colorectal surgery.Methods 58 patients scheduled for laparoscopic colorectal surgery under general anesthesia were randomly divided into 3 groups using a random number table:general anesthesia group (group A n =19),ropivacaine for TAPB group (group B n =20),and Dex mixed ropivacaine for TAPB group(group C n =19).After the end of anesthesia induction,ultrasound-guided bilateral TAPB was performed in B and C groups.20 ml of 0.25％ ropivacaine and 0.5 μg/kg DEX mixed with 0.25％ ropivacaine were injected into each side in groups B and C respectively.Patient controlled intravenous analgesia (PCIA) with sufentanil 100 μg and tropisetron 5 mg in 100 ml of normal saline was provided to all patients after surgery.When the visual analogue scale (VAS) score ≥ 4,tramadol 50-100 mg was intravenously injected as remedial analgesic.VAS scores were measured respectively after extubation and 6,12,24 h after surgery.The consumption of remifentanil during the operation and sufentanil during PCIA,and the number of successfully delivered doses and patients requiring rescue analgesic were recorded within 24 hrs after surgery.The occurrence of TAPB-related adverse events were also recorded.Results Compared with group A,the consumption of reminfentanil during the operation and sufentanil during PCIA,and the amount of successfully delivered doses and patients requiring rescue analgsia within 24hrs after surgery,were decreased in B and C groups (P ＜ 0.05).Furthermore,those numbers in group C are more less than group B in 12-24 hrs after the surgery.There were no significant difference among the three groups in the incidence of adverse reactions (P ＞0.05).TAPB-related complication were not found in B and C groups.Conclusions 0.5 μg/kg DEX mixed with 0.25％ ropivacaine for TAPB combined with general anesthesia can play a better analgesic effect in the patiens urdergoing laparoscopic colorectal surgery.

Impact factors and clinical outcomes of the treatment for osteonecrosis of femoral head by using impacting bone graft: a long and mid-term study / 中华骨科杂志

Objective To investigate the long and mid-term clinical outcomes of the impacting bone graft and impact factors in treating osteonecrosis of femoral head (ONFH).Methods Impacting bone graft was utilized to treat 54 patients (64 hips)with ONFH.There were 44 cases male and 10 female with an average age of 35.44±8.86 (range,20-55) years.There were 5 hips caused by trauma,23 hips by glucocorticoid administration,28 hips by intake of alcohol,4 hips by alcohol and glucocorticoid induced,and 4 hips by idiopathic factors.There were 14 hips at ARCO (Association Research Circulation Osseous) stage Ⅱ,50 hips at stage Ⅲ and 6 hips at JIC (Japanese Osteonecrosis Investigation Committee) type B,23 hips at type C1,35 hips at C2 type.Harris hip score (HHS) was used to evaluate the clinical effects.Potential factors,including age,etiologies,pain duration,ARCO stage and JIC type,were evaluated to investigate their impacts on clinical outcomes.Surgery failure was defined as diverting to other surgeries,or poor HHS score evaluation (＜70 points).The survival time of femoral head was defined as the interval between time of impacting bone graft and the failure of surgery.Results The mean follow-up duration was 8.61 ± 1.45 (range,5.13-10.84) years.The proportion of patients with excellent or good Harris score was 81.3％ (52/64).The excellent or good rate was 76.0％ (38/50) at 8 years follow-up.Furthermore,the total survival rate of femoral head was 92％ at 8 years follow-up.The number of surgical failure was 10 (12 hips) and the failure rate was 18.8％ (12/64).There were no significant differences in ages,etiologies,pain duration,ARCO stage and JIC type among these patients before surgery (P ＜ 0.05).There were significant differences in the post-operational Harris score and excellent or good rate among the 20-30 years group,31-40 years group and over 40 years group (P ＜ 0.05).No significant difference for both two indexes was observed among different etiologies (P ＞ 0.05).When considering the duration after the initial pain,there were significant differences among 6 months group,7-12 months group and over 12 months group (P ＜0.05).There were significant differences between the Ⅲa stage and Ⅲc stage (P＜ 0.05),and between the C1 type and C2 type (P ＜ 0.05).Multifactor Logistic regression showed that there was closely relationship between the Harris score (excellent or good rate) after surgery and pain duration,ARCO stage,JIC type (P ＜ 0.05).Conclusion Impacting bone graft for ONFH is satisfy in the long and mid-term follow up duration.Impacting bone graft would be more suitable for patients with the collapse less than 2 mm,the lateral wall preservation and interval after the initial pain less than 12 months.

Microneedle radiofrequency for minimally invasive interventional treatment of bromhidrosis for 31 patients / 中华整形外科杂志

Objective@#To evaluate the safety and efficacy of microneedle radiofrequency for minimally invasive interventional treatment of bromhidrosis.@*Methods@#From March 2016 to June 2017, Thirty-one bromhidrosis patients were treated with microneedle radiofrequency equipment (Bodytite armpits). Clinical follow up was then evaluated with Park standard.@*Results@#Six to twelve months after surgery (average 8.58 months), malodor were totally eliminated in thirty patients. One patient with residual malodor was cured by second operation. There were no significant scars in all patients. Five patients were observed with mild pigmentation.@*Conclusions@#The microneedle radiofrequency treatment is a simple, efficient and safe method for minimally invasive interventional treatment of bromhidrosi.

Finite element analysis applied to the diagnosis and treatment of osteonecrosis of femoral head:latest progress / 中国组织工程研究

BACKGROUND:At present, finite element analysis technology can set up the model, predict diagnosis, treatment design, as wel as surgical plan, and can be used in the treatment of necrosis of femoral head. OBJECTIVE:To sum and discuss recent progress in clinical and experimental research regarding biomechanical study in osteonecrosis of femoral head by using finite element analysis. METHODS:A computer-based retrieval was performed by the authors (Hong Guo-ju and Zhou Guang-quan) in PubMed, Google, SpringerLink, ChinaNational Knowledge Infrastructure databases for literatures published from January 2010 to December 2015. The key words were“(finite element analysis OR finite element) AND (osteonecrosis OR osteonecrosis of femoral head)”. Inclusive criteria:studies with contents closely related to this paper;original papers with reliable topics and evidence;or papers with clear points and al-round analysis and both studies in vitro and in vivo. RESULTS AND CONCLUSION:A total of 27 studies were included. The articles in the latest five years related to femoral head osteonecrosis and finite element analysis application were concentrated on. We summarized the latest research progress and problems, including the applied research carried out in the femoral head osteonecrosis clinical cases, innovational skil s, so as to point out the direction of future research in the finite element analysis.

Research progress of the osteonecrosis of the femoral head after internal fixation for femoral neck fractures / 中国组织工程研究

BACKGROUND: Osteonecrosis of the femoral head (ONFH) following internal fixation of femoral neck fractures is difficult to be cured in clinic.OBJECTIVE: To analyze the literatures concerning ONFH in patients with femoral neck fractures treated with screw internal fixation in recent 15 years, and to summarize the research progress in views of epidemiology, etiology, diagnosis,treatment and rehabilitation.METHODS: Databases of CNKI, WanFang, CqVip, PubMed, Medline, Web of Science were searched with the keywords of femoral neck fracture, osteonecrosis of femoral head, osteonecrosis, internal fixation, internal fixation with screw in English and Chinese, respectively. Afterwards, the reviews and case reports were excluded. RESULTS AND CONCLUSION: (1) A total of 54 eligible articles addressing the ONFH following internal fixation for femoral neck fractures were included, and the incidence of ONFH varied from 8.1% to 37.2%, which was found at an average of 17 months after injury. (2) ONFH was found to be related to age, preoperative fracture displacement, preoperative traction,reduction condition, time from injury to operation, elderly patients companied with other diseases, older patients undergoing removal of the screws, closed or open internal fixation, restored time postoperatively, high body mass index, hyperlipidemia, season, and depression. (3) Early prevention and remedial surgery were used to treat ONFH. (4) The patients without weight-bearing activities at 3-6 months postoperatively could be beneficial for functional recovery. (5) These results suggest that choosing appropriate surgical programs and rehabilitation plan can reduce the incidence of ONFH and achieve good treatment outcomes, such as reasonable preoperative planning, standardized operation skills, correct diagnosis and treatment, proper postoperative rehabilitation and good doctor-patient cooperation.

Hypokalemia after TACE for hepatic cancer: risk assessment and nursing countermeasure / 介入放射学杂志

Objective To assess the risk factors for the occurrence of hypokalemia in patients with hepatic cancer after transcatheter arterial chemoembolizaion (TACE) therapy,and to discuss the corresponding nursing countermeasures.Methods The clinical data of 214 patients with hepatic cancer,who received TACE during the period from August 2014 to February 2015,were retrospectively analyzed.The risk factors causing hypokalemia were analyzed.Results Among the 214 patients,post-TACE hypokalemia occurred in 23 (10.7％).The main risk factors that could cause hypokalemia included anorexia,hydration,vomiting,ascites drainage,sweating.After actively symptomatic treatment,the serum potassium level returned to normal in 22 patients.One patient developed hepatic encephalopathy coma complicated by hepatorenal syndrome,the patient's family members gave up treatment and,according to family members' will the patient left hospital.Conclusion anorexia,vomiting,hydration,ascites drainage,sweating are the risk factors that can cause hypokalemia in patients with hepatic cancer after TACE therapy.The use of low potassium risk scale is helpful for the formulation of nursing countermeasures.

“Removing Blood Stasis” Method for bone repair in steroid-induced osteonecrosis of the femoral heads / 中国组织工程研究

BACKGROUND:The pathogenesis of steroid-induced osteonecrosis of the femoral head remains unclear. Femoral head reconstruction after colapse is related to the bone remodeling due to disorder of the bone formation-absorption coupling. “Removing Blood Stasis” Method has been shown to have a positive effect on the disease in clinics. However, the mechanisms by which the “Removing Blood Stasis” Method confers bone repair after osteonecrosis remain poorly understood. OBJECTIVE:To explore the effect of “Removing Blood Stasis” Method on bone repair in rabbits with steroid-induced femoral head osteonecrosis. METHODS: Fifty New Zealand rabbits were randomly assigned into three groups: normal control (n=10), model (n=20) andTaohong Siwu Decoction (n=20) groups, respectively. The steroid-induced osteonecrosis of the femoral head animal models were established by intramuscular injection of endotoxin combined with methylprednisolone (MPS). Rabbits inTaohong Siwu Decoction group were intragastricaly administered with 0.3 g/kg ofTaohong Siwu Decoction suspension after the last injection of methylprednisolone. The control and model groups were administrated by equal volume of ultrapure water for 8 consecutive weeks. High-resolution MRI and pathological determinations were used to assess the successful models. Protein expression levels of ABCB1, RUNX2, OPN, RANK, RANKL, PPAR, osteoprotegerin (OPG), vascular endothelial growth factor (VEGF) in rabbit femoral heads were detected by western blot assay. RESULTS AND CONCLUSION:(1) Hematoxylin-eosin staining showed that trabecular bone fracture, karyopyknosis, empty lacunae, necrotic bone marrow cels were seen in the model group. Empty lacunae rate in the model group was significantly different from that in the normal control group (P < 0.05). Bone formation was active and kept better trabecular morphology in theTaohong Siwu Decoction group. It suggested that “Removing Blood Stasis” Method can improve repair of necrotic area. (2) In the model group, femoral head with a wide range of low-density areas in high-resolution MRI;Taohong Siwu Decoction group showed the relatively normal shape of the femoral head with smal areas of low density. It suggested that “Removing Blood Stasis” Method can improve image changes in the necrotic area. (3) Protein expression levels of RUNX2, RANK, RANKL were significantly up-regulated but protein expression levels of ABCB1, OPG, VEGF were significantly down-regulated in the model group compared with the normal control group; whereas, they were al significantly up-regulated in theTaohong Siwu Decoction group compared with the model group, except for RANK and RANKL (P < 0.05). These results suggest that the “Removing Blood Stasis” Method can promote bone repair in steroid-induced femoral head osteonecrosis rabbits by regulating protein expressions of ABCB1, RUNX2, RANK, RANKL, OPG, and VEGF.

Angiogenic factors in osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND: A variety of angiogenic factors are involved in bone healing after osteonecrosis of the femoral head. OBJECTIVE:To explore the role and mechanism of angiogenic factors in osteonecrosis of the femoral head. METHODS: A computed-based online search of PubMed, Google and SpringerLink databases was performed using the key words of “angiogenic factors, osteonecrosis of the femoral head, vascular endothelial growth factor, angiopoietin-1, fibroblast growth factor-2, hypoxia inducible factor-1, calcitonin gene related peptide and hypoxia inducible factor-1α” for literatures published from December 1980 to May 2015. RESULTS AND CONCLUSION:Finaly, 68 articles were included. Bone angiogenesis which is dependent on special signaling factors in the microenvironment is closely linked with bone repair. A variety of cytokines, such as vascular endothelial growth factor, angiopoietin-1, fibroblast growth factor-2, platelet-derived growth factor, calcitonin gene-related peptide, and hypoxia inducible factor-1α, have been identifiedto control angiogenesis in different ways and be involved in the repair of necrotic femoral head.

A meta-analysis of arthroplastyversus internal fixation in treatment of intertrochanteric fracture in the elderly / 中国组织工程研究

BACKGROUND:Intertrochanteric fracture is one of the most common fractures in older adults. The surgical treatment methods include artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw), but there is no clear evidence to evaluate the effect of them. OBJECTIVE: To compare the effect difference of arthroplasty and internal fixation in the treatment of intertrochanteric fracture in the elderly people. METHODS:We retrieved randomized controled studies on artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw) in the treatment of intertrochanteric fracture from 1990 to 2015. Meta-analysis was used to compare operation time, intraoperative bleeding volume, one-year postoperative Harris hip scores, and one-year postoperative complication between the arthroplasty and internal fixation. RESULTS AND CONCLUSION:(1) Twenty-one studies were included. (2) Intraoperative bleeding volume and one-year postoperative Harris hip scores were higher in the arthroplasty group than in the internal fixation group. (3) Operation time was similar between the arthroplasty and internal fixation groups. (4) Complication rate was lower in the arthroplasty group than in the internal fixation group. Incidence of complications was closed between the arthroplasty and internal fixation groups. (5) Results suggested that the effect of arthroplasty was better than internal fixation for treating intertrochanteric fracture in the elderly. However, prospective large-sample long-term randomized controled trials are needed for verification.

The impact of dietary methionine-restriction on tight junction expression and function in a rat colonitis model / 中华内科杂志

Objective To study the impact of methionine restriction (MetR) on mucosal histopathology,permeability and tight junction composition in a dextran sulfate sodium (DSS)-induced colitis model,and to explore its underlying mechanism.Methods SD rats were randomly divided into 4 groups:normal rats fed by a complete amino acid (AA group) diet,normal rats fed by MetR diet (MetR group),DSS treated rats fed by a complete amino acid (DSS + AA group) and DSS treated rats fed by MetR diet (DSS + MetR group),each group had 15 rats.Abdominal aorta blood sampling was taken at day 21 after DSS model been established to analyze blood routine examination,liver and kidney function and level of electrolyte.Morphological changes in colonic mucosa were evaluated and scored by light microscopy.Myeloperoxidase (MPO) activity was measured.The effect of MetR on mucosal permeability of colon strips was detected by Ussing chamber.Claudin2,occludin,claudin3,ZO-1 expression were quantified by Western blot.Results The early clinical manifestation in the DSS treated rats were loose stool or diarrhea,hematochezia positive and bleeding,and weight losing.HE observation showed prominent colitis in distal colon with manifestations of crypt abscess and infiltration of inflammatory cells.Although MPO activity and WBC account between the DSS + MetR and DSS + AA group did not significantly changed,treatment with MetR diet significantly decreased the extent and severity of epithelial injury of DSS + MetR group (10.55 ± 3.62 vs 15.00 ± 4.89,P =0.003).There were no significant difference in PCNA immunohistochemical result between the DSS + MetR group and DSS + AA group.Compared to the rats on AA diet,transepithelial electrical resistance(TEER) in DSS + AA group was obvious lower [(28.40 ± 6.78) Ω · cm2 vs (46.53 ± 4.03)Ω · cm2,P ＜0.05],and TEER in MetR group were obviously higher[(60.64 ± 8.40)Ω · cm2 vs (46.53 ±4.03)Ω · cm2,P ＜0.05].However,short-circuit current (Isc) in DSS + MetR group was obviously higher that of DSS + AA group [(35.01 ± 2.19) μA/cm2 vs (29.61 ± 1.19) μA/cm2,P ＜0.05].Western blot suggested that colon claudin2 expression was not found in colon epithelium of normal rats,and an obviously increase expression of claudin3 protein was found in the MetR group,compared to AA group; and an significantly increase in the abundance of claudin3 was found in the DSS + MetR group,but amount of claudin2 was decreased,compared with the DSS + MetR group.Conclusion The MetR diet has obvious therapeutic effect on ulcerative colitis model rats induced by DSS,and its mechanism may not by regnlating inflammatory cell infiltration and the way of promoting intestinal cell growth to alleviate inflammatory injury,but probably by changing the structure and function of tight junction protein and improve the intestinal mucosal barrier function,and promote the repair of damaged intestinal mucosa.