Otologic disorders and management strategies in Turner syndrome / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the incidence and risk factors of otologic disorders in patients with Turner syndrome (TS), so as to provide management strategies for ear health. Methods: This study is a prospective study based on questionnaires and a cross-sectional study. The TS patients who visited our hospital from 2010 January to 2021 March were included (A total of 71 patients with TS were included in this study. the age of TS diagnosed was 3- to 11-year-old, age of visiting ENT department was 4- to 27-year-old) and the incidence of otologic diseases in different age groups was investigated by questionnaires. The cross-sectional study included ear morphology and auditory function assessment, and further analysis of the risk factors that related to ear disease. Prism was used for data analysis. Results: The investigation found that the incidence of acute otitis media in patients aged 3-6 and 7-12 years was higher than that of patients over 12 years old, which was 33.8%(24/71), 42.9%(30/70)and 23.5%(8/34), respectively; 21.1% (15/71) of patients were recurrent acute otitis media in patients aged 3-6 years, and about 46.6% (7/15)of them persisted beyond 6-year. The prevalence of otitis media with effusion in the three groups was 32.4%(23/71), 34.3%(24/70)and 38.2%(13/34), respectively; the recurrence rate of tympanocentesis was 100%(7/7), 42.9%(3/7)and 50.0%(1/2), which was significantly higher than that of grommet insertion. For age groups of 3-6 and 7-12 years, the prevalence of acute otitis media and secretory otitis media was lower in the X chromosome structure abnormal patients; while for patients older than 12 years, otitis media with effusion was the highest prevalence in Y-chromosome-containing karyotypes. In addition, the prevalence of acute otitis media and otitis media with effusion in patients with other system diseases were increased significantly. A cross-sectional study found that 7.0% (5/71)of the lower auricular, 4.2% (3/71)of the external auditory canal narrow, and 38.0% (27/71)of the tympanic membrane abnormality. 35.2%(25/71) had abnormal hearing, including 17 cases of conductive deafness, 6 cases of sensorineural hearing loss, and 2 cases of mixed deafness. The rest of the patients had normal hearing, but 6 of them had abnormalities in otoacoustic emission. Eustachian tube function assessment found that the eustachian tube dysfunction accounted for 38%(27/71). Hearing loss and abnormal Eustachian tube function were not significantly related to karyotype(Chi-square 2.83 and 2.84,P value 0.418 and 0.417), but significantly related to other system diseases(Chi-square 13.43 and 7.53,P value<0.001). Conclusions: The incidence of TS-related otitis media and auditory dysfunction is significantly higher than that of the general population. It not only occurs in preschool girls, but also persists or develops after school age. Accompanied by other system diseases are risk factors for ear diseases. Clinicians should raise their awareness of TS-related ear diseases and incorporate ear health monitoring into routine diagnosis and treatment.

Clinical diagnosis and treatment features of Maisonneuve fracture and analysis of clinical outcome of 15 patients / 中国骨伤

OBJECTIVE@#To explore clinical diagnosis and treatment features of Maisonneuve fractures (maisonneuve fractures of the fibula, MFF), and evaluate its clinical effects.@*METHODS@#From March 2017 to June 2018, 15 patients with MFF were treated with operation, including 9 males and 6 females, aged from 27 to 54 years old with an average of (35.00±7.46) years old, the time from injury to operation ranged from 5 to 8 days with an average of (6.33±1.04) days. All the fractures were fresh and closed injury. The time of bone union and postoperative complications were observed, and AOFAS score was used to evaluate recovery of ankle joint function at 12 months after operation.@*RESULTS@#All patients were followed up from12 to 28 months with an average of (17.00±3.79) months. Four patients were misdiagnosed. All fractures were obtained bone union from 4 to 6 months with an average of (4.80±0.94) months. No postoperative complications such as infection, delayed union or nonunion occurred. Postoperative AOFAS score at 12 months was 90.23±7.27, among which 9 patients got excellent result, 3 good, and 3 fair.@*CONCLUSION@#Maisonneuve fracture is an unstable fracture. High fibular fracture and the separation of the lower tibia and fibula could be easily neglected, which could lead to misdiagnosis and missed care. Surgical treatment could recover anatomical relation of the lower tibia and fibula and ankle mortise, and obtain satisfying clinical effect.

Clinical characteristics of patients with acute renal infarction: an analysis of 52 patients in a single center / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical characteristics of patients with acute renal infarction (ARI) and explore the possible clinical and/or laboratory parameters relative to hematuria.@*METHODS@#Medical records of 52 patients hospitalized with radiologic proven ARI were retrospectively reviewed. Clinical characteristics, including demographic data, risk factors for thromboembolism, initial clinical presentations, laboratory data, diagnosis, treatment programs and outcomes were evaluated and compared between hematuria(+) and hematuria(-) patients.@*RESULTS@#The mean age of the patients (34 men and 18 women) was (56.3±14.8) years. The left, right, and bilateral kidneys were involved in 44.2%, 34.6% and 21.2% of the patients, respectively. Focal, multiple and massive infarctions were involved in 36.5%, 50.0% and 13.5% of the patients. The prevalence of concurrent thromboembolic events was 38.5%. Atrial fibrillation was complicated in 44.2% of the patients. ARI often presented with nonspecific symptoms, including abdominal/flank pain (71.2%), nausea (55.8%), lumbar pain (53.9%), vomiting (48.1%), fever (48.1%), and diarrhea (21.2%). Percussion tenderness over kidney region was the most common sign (40.4%). The levels of serum lactate dehydrogenase, white blood cell count and C-reactive protein were elevated in 86.5%, 67.3%, and 54.5% of cases, respectively. Hematuria was detected in only 38.5% of the cases on admission. Elevation of serum D-dimer was only noted in 56.5% of the patients. The median duration from hospital presentation to diagnosis was 41.5 h (range: 2-552 h). Contrast-enhanced computed tomography was diagnostic in 47 (90.4%) cases. Angiography was positive in the other 5 (9.6%) cases. Anticoagulation was the most common therapy. During a mean follow-up of (39.4±35.8) months, renal functions of most patients were stable. Four patients needed permanent dialysis and one patient died of heart failure. There was no statistical significance between hematuria (+) group and hematuria (-) group for all the parameters except the level of serum lactate dehydrogenase, which was higher in hematuria(+) group [773.5 IU/L (range: 153.0-3 159.0 IU/L) vs. 488.0 IU/L (range: 137.0-3 370.0 IU/L), P=0.041].@*CONCLUSION@#Thromboembolism due to heart disease is the main etiology of ARI. Early contrastenhanced computed tomography scan should be considered for high-risk patients with persisting abdominal or lumbar pain and elevated serum level of lactate dehydrogenase. Hematuria is not a sensitive clue for diagnosis and is not relative to prognosis. Whether it is present may be determined by the severity of infarction.

Effect of Threshold Inspiratory Muscle Training on Respiratory Muscle Function: A Meta-analysis / 中国康复理论与实践

Objective:To evaluate the effect of threshold inspiratory muscle training (TIMT) on respiratory muscle strength and clinical outcomes for machinery ventilates patients. Methods:The Cochrane Library, PubMed, Embase, Web of Science, CBM, Wanfang Database, CNKI and VIP were searched for the randomized controlled trials (RCT) about the effect of TIMT on respiratory muscle strength and clinical outcomes from establishment to July 1st, 2018. Two researchers strictly evaluated literature quality and extracted information, and then a Meta-analysis was carried out. Results:A total of 14 literatures were included with 650 patients, 323 cases in the experimental group and 327 cases in the control group. Compared with the control group, the massive inspiratory pressure (MIP) increased (MD = -6.65, 95%CI -8.27~-5.03, P < 0.001), the respiratory muscle strength increased (MD = -5.04, 95%CI -7.68~-2.04, P = 0.0002), the weaning time reduced (MD = -1.01, 95%CI -1.65~-0.37, P = 0.002), the mechanical ventilation time shortened (MD= -2.24, 95%CI -4.33~-0.15, P = 0.04), as well as the intensive care unit (ICU) length of stay (MD= -3.41, 95%CI -6.06~-0.76, P= 0.01). There was no significant difference in maximum expiratory pressure (MEP) (MD= 1.22, 95%CI -6.55~9.00, P = 0.76), the rate of reintubation/tracheotomy (RR = 0.99, 95%CI 0.56~1.73, P = 0.96) and mortality (RR= 1.05, 95%CI 0.53~2.06, P = 0.89) between two groups. Conclusion:TIMP could improve MIP and respiratory muscle strength of patients with mechanical ventilation, shorten the weaning time, the mechanical ventilation time and the ICU length of stay, and then reduce the incidence of weaning failure.

Clinical analysis of pulmonary cryptococcosis in non-human immunodeficiency virus infection patients / 北京大学学报(医学版)

OBJECTIVE@#To improve the understanding of the clinical features of pulmonary cryptococcosis in non-human immunodeficiency virus (non-HIV) infection patients and reduce delay in diagnosis, or misdiagnosis.@*METHODS@#The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 34 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Peking University First Hospital from June 1997 to June 2016.@*RESULTS@#There were 34 cases diagnosed with pulmonary cryptococcosis, including 22 males and 12 females, aged from 20 to 75 years [average: (50.1±15.0) years]. There were 16 cases with host factors and (or) underlying diseases named immunocompromised group. In the study, 67.6% patients had clinical symptoms while 32.4% patients had no symptoms. The most common symptoms included cough, fever, chest pain, shortness of breath, and hemoptysis in sequence. Common chest imaging findings were patchy infiltrates, consolidation, single or multiple nodular or masses shadows. Among the 20 cases with cryptococcal capsular polysaccharide antigen detection, 19 were positive. Eleven cases underwent routine cerebrospinal fluid examination, and 3 cases complicated with central nervous system cryptococcal infection. At first visit, 24 cases were misdiagnosed, among which, 11 cases were misdiagnosed as lung cancer. The diagnosis of 15 cases was proved by percutaneous lung biopsy and 11 were confirmed by surgery, while 8 were diagnosed clinically. Then 11 cases were treated by surgical resection, and in median 4 years' followp, there was 1 case of recurrence. And 23 cases were treated with antifungal therapy, and in median 8 years' follow-up, 3 cases lost to the follow-up and 1 case of recurrence. Compared with normal immune group, immunocompromised patients had higher ages (P=0.017), more crackles (P=0.006) and more percentage of increase of peripheral white blood cells or neutrophils (P=0.003), but no significant difference in symptoms, imaging characteristics or hospitalization time.@*CONCLUSION@#There were no specific clinical symptoms and signs for pulmonary cryptococcosis in non-HIV patients. Diagnosis of pulmonary cryptococcosis depends on pathology. Percutaneous lung biopsy was mostly recommended for clinical highly suspected patients. Cryptoeoccal capsular polysaccharide antigen detection had a high sensitivity for the clinical diagnosis. Antifungal drug therapy was the major treatment, and the prognosis of the most patients was good.

SCCmec resistant mechanism, toxicity and prevalence in livestock-associate methicillin-resistant Staphylococcus aureus / 中国人兽共患病学报

Staphylococcus aureus is one of the most frequently encountered zoonotic pathogens.This bacterium produces the notable virulence factors such as hemolysin,panton-valentine leucocidin,exfoliative toxins and enterotoxin,which can cause invasive disease in humans and animals.Methicillin-resistant S.aureus (MRSA) is a multidrug-resistant bacterium which acquired the staphylococcal chromosome cassette mec (SCCmec).SCCmec is one of the key reasons for the antibiotic resistance of MRSA.As for MRSA resistance,the β-1actam resistance is mediated by mecA gene,and the drug-resistance genes inserted in the variable area of the SCCmec element play an important role in the multidrug resistance of MRSA.In recent years,it has been reported in Europe,North America and other countries that the multidrug resistance MRSA was detected in aquaculture environment and livestock.Besides,MRSA poses a serious threat to public health,and it can colonize and cause invasive disease in humans through aquaculture environment or other ways.This review summarizes drug resistance change of S.aureus and analysis of SCCmec resistance elements,toxicity and prevalence of livestock-associate MRSA,which would have theoretical and practical significance to understand S.aureus drug resistance,SCCmec typing,as well as control and prevent LA-MRSA transmission and infection between animals and humans.

Treatment of thoracolumbar fractures with three-dimensional reduction method and external fixation devices under analgesia / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects between open reduction internal fixation and three-dimensional reduction with external fixation under analgesia in treating fresh thoracolumbar fractures, and explore the simple and effective method for thoracolumbar fractures.</p><p><b>METHODS</b>The clinical data of 40 patients with thoracolumbar fractures who met the inclusion and exclusion criteria in the department of orthopaedics affiliated to Suzhou Hospital of Nanjing University of Chinese Medicine from February 2013 to August 2017 were retrospectively analyzed. According to therapeutic methods, the patients were devided into treatment group and control group, 20 cases in each group. Treatment group was treated by three-dimensional reduction method and external fixation devices under analgesia, and control group was treated by open reduction and common spinal fixation system. In treatment group, there were 9 males and 11 females, aged from 26 to 68 years old with an average of (52.8±11.3) years; and in control group, there were 10 males and 10 females, aged from 26 to 64 years old with an average of(50.6±8.8) years. Anterior vertebral body compression(AVBC), Cobb angle and visual analogue scale(VAS) were measured and compared in two group.</p><p><b>RESULTS</b>All 40 patients finished follow-up. The follow-up time in treatment group was 5 to 37 months with average of (16.1±8.8) months, in control group was 5 to 29 months with an average of(17.3±6.0) months. There was no significant difference between two groups(>0.05). AVBC, Cobb angle, VAS score were obviously improved in all patients after treatment(<0.05), but there were no significant difference between two groups(>0.05).</p><p><b>CONCLUSIONS</b>Clinical effect of two methods was similar in treating thoracolumbar fractures, but three-dimensional reduction and external fixation devices under analgesia has advantage of easy operation, smaller trauma and no need secondary surgery for removed internal fixation.</p>

Acetylation of decorin can enhance the stability and function of decorin protein in renal mesangial cells of rats / 复旦学报（医学版）

Objective To detect the acetylation of decorin (DCN) and its influence on DCN ubiquitination in mesangial cells in rats.Methods Mesangial cells of rats were cultured in vitro.The immunoprecipitation,Western blot assay and RT-PCR were used to determine the acetylation of DCN.Results DCN was acetylated in renal mesangial cells in rats.The acetylated DCN promoted its stability via inhibiting of its degradation through polyubiquitination.Moreover,transforming growth factor-β1 (TGF-β1) and type Ⅳ collagen expression of mesangial cells decreased,and cell growth was inhibited when acetylation of DCN was enhanced in mesangial cells.Conclusions Acetylation of DCN inhibited DCN ubiquitination degradation,which enhances DCN's antagonistic effect against nephritis.These results may provide a potential target for further study of prevention and treatment of mesangial cell proliferative glomerulonephritis.

Development of new-type landmine sweeping protective outfit / 医疗卫生装备

Objective To optimize GGF110 landmine sweeping protective outfit to improve its wearing comfort and environmental adaptability.Methods With considerations on protection performances the outfit was improved from its size, structure,humanization design and manufacturing technique,which was composed of helmet and mask,protective clothing, mine boots and protective gloves. The protective clothing was made up of an upper piece, a vest, a jockstrap and a lower piece.Results The mine boots with the existed protection performances was optimized in increased walking stability while decreased possibilities to trigger GLD111 antipersonnel mine; the protective clothing was improved in comfort and convenience with the protection performance kept the same;the helmet and mask had the problems of giddiness or dizziness due to light reflecting as well as forward head gravity center resulting from unbalanced weight;the protective gloves met the tactical and technical requirements and ensured the flexibility when mine detection and sweeping were carried out. Conclusion The outfit with high protecting performances is enhanced in comfort, safety and adaptability, and thus can be used for mine sweeping by military forces.

Feasibility study of the use of left atrial appendage occluder LACBES with animal experiment / 介入放射学杂志

Objective To introduce a self-developed left atrial appendage occluder,LACBES,and to explore the clinical feasibility of using it for the occlusion of left atrial appendage (LAA).Methods Eight healthy canines were used in this experimental study.The LAA of each canine was occluded with LACBES occluder through trans-femoral vein approach.After the procedure of occlusion,the compression ratio of the occluder was calculated,the residual shunt was assessed by left atrial angiography.The left atrium pressure was monitored before and after the procedure,and the immediate effect of LAA occlusion on the left atrium pressure was statistically analyzed.Results Implantation of LACBES occluder was successfully accomplished in all the eight canines.The compression ratio of the occluders ranged from 10％ to 15％.Small amount of postoperative residual shunt was detected in one canine.After occlusion two canines died of procedure-related complications,including shifting of occluder and formation of hematoma at puncturing site.No device-associated death occurred.After occlusion,the left atrial systolic pressure increased instantly,which went up from preoperative (25.4±2.8) mmHg to postoperative (27.5±3.4) mmHg (P＜0.05),but it returned to the baseline of (25.4±2.8) mmHg within 15 minutes.Conclusion For the occlusion of LAA,the use of LACBES occluder carries higher instant success rate and lower residual shunt rate with less device-associated complications,although the left atrial systolic pressure has a transient rising immediately after the occlusion.Therefore,it is expected that LACBES will be able to be applied in clinical practice.