Repair of Rabbit Knee Cartilage by Bipolar Radiofrequency with Different Energy Settings and Recovery Periods.

BACKGROUND: Arthroscopic bipolar radiofrequency energy (bRFE) is a common method for minimally invasive treatment of cartilage injuries. The benefits of bRFE are still controversial, and its safety has become the focus of attention. OBJECTIVE: This study aimed to reveal the effects of energy setting and recovery period on the efficacy and safety of bRFE. METHODS: The New Zealand white rabbit knee cartilage injury model was established, and bRFE was used to treat the cartilage with different energy settings, including 20 W and 40 W, and recovery periods of 0 and 1 month. By observing the immediate and late results on damaged cartilage, along with chondrocyte apoptosis, the effects of energy setting and recovery period on the efficacy and safety of bRFE were accessed. RESULTS: The pathological conditions, surface profile and chondrocyte viability in the bRFE treatment group produced greater late effects and were significantly better than those in the model group. Nevertheless, bRFE produced a timely injury that resulted in an increased rate of apoptosis (p < 0.05), which was alleviated in subsequent recovery (p < 0.05). CONCLUSIONS: bRFE can effectively trim and improve the cartilage lesion area, and reduce cracks. Although bRFE produced timely chondrocyte damage, this was alleviated on subsequent recovery. Therefore, bRFE with appropriate energy is beneficial to the recovery of cartilage damage, proper attention should be paid to the recovery period.

Candida parapsilosis infection after double-lung transplantation in a patient with pulmonary fibrosis caused by COVID-19.

Pulmonary fibrosis is a complication in patients with coronavirus disease 2019 (COVID-19). Extensive pulmonary fibrosis is a severe threat to patients' life and lung transplantation is last resort to prolong the life of patients. We reported a case of critical type COVID-19 patient, though various treatment measures were used, including anti-virus, anti-infection, improving immunity, convalescent plasma, prone position ventilation, and airway cleaning by fiber-optic bronchoscope, although his COVID-19 nucleic acid test turned negative, the patient still developed irreversible extensive pulmonary fibrosis, and respiratory mechanics suggested that lung compliance could not be effectively recovered. After being assisted by ventilator and extracorporeal membrane oxygenation for 73 days, he finally underwent double-lung transplantation. On the 2nd day after the operation, the alveolar lavage fluid of transplanted lung was examined by cytomorphology, and the morphology of alveolar epithelial cells was intact and normal. On the 20th day post-transplantation, the chest radiograph showed a large dense shadow in the middle of the right lung. On the 21st day, the patient underwent fiber-optic bronchoscopy, yeast-like fungal spores were found by cytomorphological examination from a brush smear of the right bronchus, which was confirmed as Candida parapsilosis infection by fungal culture. He recovered well due to the careful treatment and nursing in our hospital. Until July 29, 96 days after transplantation, the patient was recovery and discharged from hospital.

Analysis of the Curative Effect of Curved Angle Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fracture.

Objective: To evaluate the clinical efficacy of Percutaneous curved vertebroplasty (PCVP) for osteoporotic vertebral compression fracture of the thoracolumbar spine. Methods: Retrospective analysis of 113 patients with osteoporotic vertebral compressive fractures (OVCFs) in our hospital from January 2017 to January 2020, a total of 120 diseased vertebrae, were divided into PCVP group (35 cases, 37 sections) and bilateral PVP(BVP) group (78 cases, 83 sections). To compare the distribution of baseline clinical data, pain relief (Visual Analog Scale, VAS), ODI (Oswestry Dability Index, ODI), operation time, intraoperative fluoroscopy, postoperative vertebral body re-fracture, and comparison of bone, and to compare the volume of cement penetration and the leakage rate of bone cement, etc. Results: There was no significant difference in VAS and ODI before operation between the two groups (P > 0.05), and the VAS score and ODI after operation were significantly improved (P < 0.001). Compared with the bilateral PVP group, the operation time, the number of fluoroscopy, and the leakage rate of each layer of bone cement in the PCVP group were significantly reduced (P < 0.05); however, the amount of cement used in the two groups was similar (P > 0.05). There were no serious complications in both groups. In the bilateral PVP group, a total of seven patients had adjacent vertebral fractures or re-fractures of the original vertebral body. However, no patients in the PCVP group had re-fractures in any vertebral body segment. Conclusion: Both PCVP and bilateral PVP are safe and effective methods for the treatment of osteoporotic vertebral compression fractures, but PCVP has a short operation time, fewer fluoroscopy times, and a low bone cement leakage rate.

Overexpression of Karyopherin α2 in small cell carcinoma of the cervix correlates with poor prognosis.

BACKGROUND: Cervical small cell carcinoma (SCCC) is uncommon and little is known about its molecular markers. Karyopherin α2 (KPNA2) has been demonstrated in a variety of malignancies. Our objective was to determine whether the KPNA2 level is predictive of clinical outcome in patients with SCCC. METHODS: We detected KPNA2 expression by immunohistochemistry in SCCC tumors from 62 patients. The staining results were evaluated by H-score. The correlation among KPNA2 expression level, clinical characteristics, and prognosis was analyzed. RESULTS: KPNA2 expression was detected in tumor tissue from 55 patients with SCCC (55/62, 89%). High KPNA2 expression correlated significantly with International Federation of Gynecology and Obstetrics staging (P=0.035), tumor size (P=0.019), poorer overall survival (OS) (P=0.008), and poorer disease-free survival (P=0.004) compared to low KPNA2 expression. Multivariate analysis showed that KPNA2 expression level (P=0.037) and tumor size (P=0.046) were independent prognostic factors of OS. CONCLUSIONS: KPNA2 may be a molecular marker and indicator of prognosis in SCCC.

Differences between Chinese men and women with adult-onset non-radiographic axial spondyloarthritis / 中华风湿病学杂志

Objective:To explore the clinical characteristics of adult-onset non-radiographic axial spondyloarthritis (nr-axSpA) in different genders.Methods:A total of 662 patients with adult-onset nr-axSpA (age at disease onset ≥16 years) who visited the Rheumatology Department of the First Affiliated Hospital of Shantou University Medical College from 1999 to 2020 were included in the study. Comparisons of baseline demographic and clinical characteristics between different genders were performed.Results:Overall, the male-to-female ratio was 1.17∶1, and the prevalence of human leukocyte antigen-B27 (HLA-B27) positivity was 71.8%(475/662). The median baseline disease duration and age at diagnosis was 1.6 (0.5, 4.0) years and 25.0 (21.0, 33.0) years respectively. The males had a significantly earlier age at disease onset and diagnosis [21.0 (18.0, 28.0) vs 25.0 (21.0, 30.0), Z=5.63, P<0.001; 24.0 (19.0, 32.0) vs 27.0 (23.0, 34.5), Z=4.90, P<0.001, respectively] than females. HLA-B27 positivity was more frequent in males than in females [78.4% (280/357) vs 63.9%(195/305), χ2=17.06, P<0.001]. The prevalence of inflammatory back pain (IBP), morning stiffness, nocturnal pain, enthesitis, hip and groin pain were higher in males, whereas females showed a higher prevalence of small joint involvement of the hands. At baseline, males had higher median ankylosing spondylitis disease activity score (ASDAS)-C-reaction protein (CRP) [3.0(2.3, 3.8) vs 2.4(2.0, 3.0), Z=5.59, P<0.001] and a greater prevalence of high disease activity ASDAS-CRP>2.1 [81.9%(185/227) vs 67.9%(133/195), χ2=11.08, P=0.001] than females. The proportions of male patients with elevated CRP levels and erythrocyte sedimentation rate (ESR) were also higher than those of female patients [49.0%(175/357) vs 27.9%(85/305), χ2=30.85, P<0.001; 49.3%(176/357) vs 33.4%(102/305), χ2=16.98, P<0.001, respectively]. Conclusion:The adult-onset nr-axSpA in China is characterized by a comparable sex ratio. Males have an earlier age at disease onset and are higher HLA-B27 positivity with higher prevalence of IBP, enthesitis, hip and groin pain, as well as high disease activity.

[Biomechanical effects of different bone cement diffusion patterns after vertebroplasty:finite element analysis].

OBJECTIVE: To investigate the biomechanical effects of different bone cement diffusion patterns in the treatment of osteoporotic vertebral compression fractures. METHODS: One volunteer with L1 osteoporotic vertebral compression fracture was selected, male, aged 68 years old, heighed 172 cm, weighted 60 kg, and healthy before. CT scans were used from T10-L5, CT data was extracted with Mimics software, and Geomagic wrap and Solidworks were used to model, and the three-dimensional finite element model (T12-L2) of preoperative osteoporotic vertebral compression fractures in the thoracolumbar segment was established. Similarly, the situations of bone cement dispersion in vertebroplasty were simulated (the situations of bone cement dispersion had the three kinds, including the bone cement not contacts with upper and lower endplates, the bone cement only contacts with upper endplates, and the bone cement contacts with upper and lower endplates). According to different diffusion situations, five types of loads were applied to the model:upright, upright plus forward flexion, upright plus backward extension, upright plus left bending, upright plus right rotation. Meanwhile, the model was compared with the cementless lumbar spine model, and the deformation and stress distribution of each model under load were recorded and compared. RESULTS: After the establishing the finite element model of osteoporotic vertebral compression fracture in the thoracolumbar segment, it was found that the deformation of three different bone cement distribution models above was not significantly different. In L1 cancellous bone, the Von Mises stress of the cementless lumbar spine group was significantly higher than that of the cemented group. Among the three groups of different bone cement injection situations, the Von Mises stress in the group of bone cement contacts with upper and lower endplates was the lowest, followed by the group of bone cement only contacts with upper endplates, and the highest Von Mises stress was the group that bone cement contacts neither the upper or lower endplates. In the comparison of bone cement stress, the Von Mises stress in the group of bone cement contacts with upper and lower endplates was significantly higher than the other two groups (upright 12.375 MPa, upright plus forward flexion 16.411 MPa, upright plus backward extension 16.801 MPa, upright plus left bending 13.425 MPa, upright plus right rotation 13.014 MPa), and the Von Mises stress in the group of bone cement does not contact with upper and lower endplates was the lowest. CONCLUSION: The bone cement contact with both upper and lower endplates can effectively absorb and transfer the stress level brought by the load, reduce the stress level of cancellous bone, and reduce the possibility of refracture of the operative vertebral body.

Patient with EGFR-mutant lung cancer harboring de novo MET amplification successfully treated with gefitinib combined with crizotinib.

While 50% of lung adenocarcinoma patients in Asia have mutations in the epidermal growth factor receptor (EGFR) site, there are few patients with the EGFR mutation accompanied by de novo mesenchymal-epithelial transition (MET) amplification. Due to the low incidence rate, there is no consensus regarding treatment. Here, a case of a 62-year-old never smoker presented with EGFR Exon19del and de novo MET amplification. A radiographic examination and computed tomography (CT) imaging were conducted on the chest and middle abdomen. A pulmonary puncture was performed and a sample of the lung tissue was used for pathologic diagnosis. Immunohistochemistry was performed for the expression of CK, P40, P63, ttf-1, NapsinA, alk-d5f3, and ki-67 on the cancer cells. Craniocerebral magnetic resonance and whole body bone imaging were completed. Second-generation gene sequencing (next-generation sequencing [NGS]) and fluorescence in situ hybridization examination were also performed to further characterize the cancer cells. A radiographic examination was performed and revealed space-occupying lesions in the lungs. CT results revealed a mass in the upper lobe of the left lung. The pathologic diagnosis was non-small cell carcinoma T3N2M1a. Second-generation gene sequencing (NGS) indicated EGFR Exon 19del (p.E746_A750del, mutant abundance: 13.99%) with de novo MET amplification (CHR: q31.2, CN = 4.0). Fluorescence in situ hybridization examination confirmed MET amplification. Targeted therapy with gefitinib combined with crizotinib was administered as treatment. Four weeks later, the CT results revealed a substantial reduction in the lesion size. The patient was followed up with favorable complete recovery and no tumor-related symptoms. Although crizotinib is efficacious when used alone in follow-up treatment; however, these results of this case and others indicate that it is likely safe to use both drugs together in the case of drug resistance.

Cerebral regional and network characteristics in asthma patients: a resting-state fMRI study / 医学前沿

Asthma is a serious health problem that involves not only the respiratory system but also the central nervous system. Previous studies identified either regional or network alterations in patients with asthma, but inconsistent results were obtained. A key question remains unclear: are the regional and neural network deficits related or are they two independent characteristics in asthma? Answering this question is the aim of this study. By collecting resting-state functional magnetic resonance imaging from 39 patients with asthma and 40 matched health controls, brain functional measures including regional activity (amplitude of low-frequency fluctuations) and neural network function (degree centrality (DC) and functional connectivity) were calculated to systematically characterize the functional alterations. Patients exhibited regional abnormities in the left angular gyrus, right precuneus, and inferior temporal gyrus within the default mode network. Network abnormalities involved both the sensorimotor network and visual network with key regions including the superior frontal gyrus and occipital lobes. Altered DC in the lingual gyrus was correlated with the degree of airway obstruction. This study elucidated different patterns of regional and network changes, thereby suggesting that the two parameters reflect different brain characteristics of asthma. These findings provide evidence for further understanding the potential cerebral alterations in the pathophysiology of asthma.

Laparoendoscopic single-site surgery using a homemade glove port in the treatment of 60 benign gynecologic cases / 中国实用妇科与产科杂志

OBJECTIVE:To investigate the safety and clinical value of laparoendoscopic single-site surgery(LESS)using a homemade glove port in benign gynecologic diseases.METHODS:From December 2017 to May 2018,60 LESSs were performed in the First Affiliated Hospital of Chongqing Medical University,including hysterectomy,myomectomy,etc.The operations were performed using a patented homemade glove port with conventional laparoscopic instruments.The clinical data were recorded and analyzed retrospectively.RESULTS:All surgeries were successfully completed,including1 case of conversion to laparotomy and 4 cases of an additional site.The mean operation time was 104.4 min.The mean blood loss was 57.8 mL.The average hemoglobin decrease was 16.3 g/L 24 h after surgery.The pain score was 2.8 24 h af⁃ter surgery.No fever happened postoperatively.The average hospital stay was 2.9 days after surgery.One case of navel wound was poorly healed.No poor wound healing or umbilical hernia occurred at the 1-month follow-up. The main medi⁃cal cost of LESS was from the wound retractor,which cost around 700 RMB.CONCLUSION:LESS using a homemade glove port has the advantage of high safety and low cost in gynecological benign diseases,which is suitable for wide application.

Evaluation of innovative teaching mode on obstetrics and gynecology for clinical interns / 中华医学教育探索杂志

Objective@#To evaluate an innovative teaching mode on obstetrics and gynecology for clinical interns.@*Methods@#A total of 195 students from Grade 2015 of Clinical Medicine (Group 2018) were enrolled to receive the innovative teaching mode. This mode was based on organ integration medicine,focused on solving problems and improving teacher-student interaction, and provided creative homework and more clinical practice for students. The teaching results were evaluated objective and structured clinical examinations and questionnaire, and by comparing their scores with those of the former two grades (Grade 2013 and 2014). The statistical analysis was performed with SPSS 21.0.@*Results@#Scores of objective and structured clinical test in Group 2018 was higher than those in the two groups former of the same period, and the difference was statistically significant (P<0.05). Satisfaction in Group 2018 was higher than that in the former two groups (P<0.05).@*Conclusion@#The their innovative teaching mode can help students to integrate theories with practice and cultivate ability of clinical thinking.

Evaluation of innovative teaching mode on obstetrics and gynecology for clinical interns / 中华医学教育探索杂志

Objective To evaluate an innovative teaching mode on obstetrics and gynecology for clinical interns. Methods A total of 195 students from Grade 2015 of Clinical Medicine (Group 2018) were enrolled to receive the innovative teaching mode. This mode was based on organ integration medicine, focused on solving problems and improving teacher-student interaction, and provided creative homework and more clinical practice for students. The teaching results were evaluated objective and structured clinical examinations and questionnaire, and by comparing their scores with those of the former two grades (Grade 2013 and 2014). The statistical analysis was performed with SPSS 21.0. Results Scores of objective and structured clinical test in Group 2018 was higher than those in the two groups former of the same period, and the difference was statistically significant (P<0.05). Satisfaction in Group 2018 was higher than that in the former two groups (P<0.05). Conclusion The their innovative teaching mode can help students to integrate theories with practice and cultivate ability of clinical thinking.

Role of Long Noncoding RNA 799 in the Metastasis of Cervical Cancer through Upregulation of TBL1XR1 Expression.

Long noncoding RNAs (lncRNAs) are closely associated with the molecular mechanisms underlying cancer development, and it would be highly useful to study their expression and mechanisms in cervical cancer too. The current study investigated lncRNA799 expression in cervical cancer in order to determine its clinical importance in the progression of cervical cancer. lncRNA799 expression was studied in 218 cervical cancer samples. Expression of lncRNA799 was significantly higher in the cervical cancer tissue than in the adjacent normal tissue. Overexpression of lncRNA799 was found to have a significant correlation with FIGO stage, SCC-Ag level, and lymphatic metastasis, and it was also associated with poor survival. Ectopic expression of lncRNA799 promoted the metastasis of SiHa cells, whereas lncRNA799 knockdown had an inhibitory effect on metastasis. Western blot analysis demonstrated that lncRNA799 promotes the expression of transducing ß-like protein 1-related protein (TBL1XR1), and that lncRNA799 and TBL1XR1 expression show strong correlation in cervical cancer. Moreover, lncRNA799 modulated the expression of TBL1XR1 by acting as a competitive endogenous RNA (ceRNA) for miR-454-3P. The results indicate that lncRNA799 could be used as a novel marker of cervical cancer prognosis. Thus, targeting the ceRNA network involving lncRNA799 could be a potential treatment strategy against cervical cancer.

The effect of clamping the urinary catheter before removal in cervical cancer patients / 中国实用护理杂志

Objective To investigate the necessity of clamping the indwelling catheters before removal in patients with cervical cancer postoperatively. Methods A total of 198 cases of patients with cervical cancer after radical hysterectomy were divided into the study group (70 cases) and the control group (128 cases) randomly according to operation time. In the study group the catheters were clamped intermittently by patients 2 days before removal, while in the control group the catheters were removed without clamping. The rate of recatheterization, urinary tract infection, as well as the residual urinary volume were compared between groups. Results There were no significant differences in the rate of urinary tract infection and recatheterization between the two groups (P>0.05). The residual urinary volume was significantly higher in the study group than that in the control group ( χ2=10.293, P=0.016). Conclusions There may be no positive effect of training the bladder function by clamping the indwelling catheters before its removal in patients after radical hysterectomy, besides, it can not change the risk of recatheterization and can increase the residual urine in the bladder 24 hours after removal of the catheter.

[Effect of Jingang Jiangu pill (see text) on expression of integrin beta1 and alphavbeta3 in ovariectomized osteoporosis model rats].

OBJECTIVE: To investigate the regulatory effect of Jingang Jiangu pill (see text, JGJG) on expression of integrin in ovariectomized rats. METHODS: Fifty ovariectomized 10 months old female rats were randomly divided into 5 groups: Fushanmei group (FSM), Jingang Jiangu pill (see text) group (JGJG), Gusongbao granule group (GSB), Model group (OVX), Sham group. After ovariectomized,the rats were raised in the same environment for 13 weeks. The rats in JGJG group took 0.13 g JGJG pill orally each day for each rat; the rats in GSB group took 0.86 g GSB granule orally each day for each rat; the rats in FSM group took 0.28 mg FSM orally each day for each rat; and the rats in OVX and sham groups took sodium. The treatment duration of rats in above 5 groups was 13 weeks. Bone mineral density (BMD) and the expression of integrin beta1 and alphavbeta3 were detected in each group after the treatment. RESYKTS: The BMD and the expression of integrin beta1 in FSM group, JGJG group and GSB group improved obviously than that of OVX group. There were statistical difference between these groups (P<0.05). The expression of integrin alphavbeta3 of the three treating groups significantly depressed. CONCLUSION: The JGJG pill improves BMD and express of integrin beta1, in ovariectomized rats and reduces express of integrin alphavbeta3 through the regulation of the coupling of osteoblasts and osteoclasts.

[Clinical research of modified taohe chengqi granule combined mannitol for treating complicated edema in affected limbs of patients after tibiofibulas double fracture operation].

OBJECTIVE: To observe the therapeutic efficacy of Modified Taohe Chengqi Granule (MTCG) combined mannitol for treating complicated edema in affected limbs of patients after tibiofibulas double fracture operation (TDFO). METHODS: Totally 64 TDFO patients complicated edema were randomly assigned to the treated group and the control group, 32 in each group. Those in the treated group took MTCG combined intravenous dripping of mannitol, while those in the control group received intravenous dripping of mannitol alone. The treatment course was 1 week. The clinical efficacy, the onset time, the swelling degree, and the pain index were observed and compared between the two groups. RESULTS: One week after operation, the effective rate was 98.0% and the markedly effective rate was 87.5% in the treated group, while they were 78.0% and 56.9% respectively in the control group. Better results were obtained in the treated group, showing statistical difference when compared with the control group (P < 0.05). As for the onset time for swelling subsiding, it was (2.4 +/- 1.3) days in the treated group and (3.8 +/- 2.9) days in the control group. There was statistical difference between the two groups (P < 0.05). Better effects on the swelling subsiding degree and the pain index were obtained in the treated group, showing statistical difference when compared with the control group (P < 0.05). CONCLUSIONS: MTCG combined mannitol could obviously abate the edema in affected limbs of patients after TDFO. It was a better treatment method for managing edema in the peri-operative period of orthopedics.

[Retrospective analysis on total hip arthroplasty for the treatment of developmental dysplasia of the hip in 29 adults].

OBJECTIVE: To study the results of the total hip arthroplasty (THA) in the treatment of developmental dysplasia of the hip (DDH) with severe osteoarthritis in adults. METHODS: From March 2004 to February 2011, 29 patients (32 hips) with DDH were treated by THA with an cementless cup. There were 11 males and 18 females,with an average age of 52.6 years (ranging from 37 to 73 years). Unilateral DDH occurred in 26 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 18 hips in 17 patients of type I ,7 hips in 6 patients of type II, 4 hips in 3 patients of type III, 3 hips in 3 patients of type IV. Except for 3 patients with bilateral DDH, the other patients' ill lower limbs were 1 to 6 cm shorter than the healthy lower ones. RESULTS: All the patients were followed up,and the duration ranged from 8 months to 5.3 years(averaged 3.7 years) without infection, dislocation, and sciatic nerves injury after the operation. One patient with proximal femoral fracture, intraoperation used wire binding, after 4 years of follow-up, fracture healed without evidence of prosthesis loosening. All grafts and subtrochanteric osteotomy healing were achieved. In 21 patients, the pain was completely relieved and the function of the hip joints was good. Five patients still had mild limping, but reduced significantly than preoperation. In 3 patients, the ill lower limbs were more than 1 cm shorter than the healthy lower ones and the other patients' ill lower limbs were less than 1 cm shorter than the healthy lower ones. Two patients' lower limbs were lengthened 4 to 5 cm. The Harris scores were 43.6 +/- 7.1 preoperatively and 86.7 +/- 5.3 postoperatively (P < 0.05). CONCLUSION: THA with deepening the medial wall of the acetabulum at the true acetabulum, according to different characteristics of Crowe classification, using different operation program, cementless cup in adult could obtain favorable results.

Correction of Angle class Ⅱ division 1 malocclusion by means of segmental approach / 实用口腔医学杂志

Objective:To evaluate the effect of segmental approach in the treatment of Angle class Ⅱ division 1 malocclusion.Methods:7 cases of classⅡ,division 1 maloclusion were treated.Upper first premolar and lower second premolars were extracted in all cases.Lower first molars were mesially moved by means of segmental arch. Cephalometric analysis was used to evaluate the effects of the treatment.Results:Facial profile improvement and lower anterior facial height maintenance were achieved.The occlusion plane angle,mandibular plane angle were well controlled with lower anterior teeth upright on the lower basal bone.All patients represented good mandible response.Conclusion:Segmental technique is a simple and effective approach in correcting class Ⅱ,division 1 maloclusion