最新刊期
卷 44 ， 期 2 ， 2023
- 摘要：Periprosthetic joint infection （PJI） following joint arthroplasty is devastating and technique-demanding. At present， the surgical treatment for PJI includes debridement， antibiotics， and implant retention （DAIR）， single- or two-stage revision， arthrodesis， and amputation. DAIR is appealing to both surgeons and patients as it can avoid unnecessary implants removal， making it less time-consuming and less invasive. In this article， we review the current knowledge in surgical timing， intraoperative details and antibiotics strategy of DAIR.关键词：periprosthetic joint infection;artificial joint;implant retention;debridement
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发布时间：2024-02-19 - 摘要：ObjectivePeriprosthetic joint infections （PJI） are currently the most calamitous complication after arthroplasty. Although achievements have been made in many markers for the diagnosis of PJI， the lack of a gold standard remains a great obstacle for early diagnosis. This study aimed to investigate the association between coagulation markers and the development of PJI in patients undergoing revision total joint arthroplasty （TJA）.MethodsWe conducted a retrospective cohort study with a total of 2 517 patients who underwent hip or knee arthroplasties from January 2011 to January 2022 （2 394 with primary TJA， 87 with aseptic revision and 36 with PJI）. We applied univariate analysis and multivariate logistic regression to analyze differences of coagulation factors between primary TJA and aseptic revision or PJI group. Receiver operating characteristic （ROC） curve and area under the curve （AUC） were used to measure the diagnostic value of coagulation factors in predicting PJI.ResultsCoagulation factors and their ratios including plasma fibrinogen （FBG）， prothrombin time （PT）， thrombin time （TT）， activated partial thromboplastin time （APTT）， platelet （PLT）， mean platelet volume （MPV）， platelet distribution width （PDW）， plateletcrit （PCT）， PLT / MPV， PLT / PDW and PLT / PCT were included in this study. High FGB level was strongly correlated with the risk of PJI compared to other coagulation factors. The optimal threshold value of FBG was 4.53 g/L with a sensitivity of 47.22%， a specificity of 93.07% （Primary TJA group vs. PJI group）. Similarly， the optimal threshold value of FBG was 4.44 g/L with a sensitivity of 47.22%， a specificity of 95.40% between the other two groups （Aseptic revision group vs. PJI group）. ROC curve analysis demonstrated moderate diagnostic performance of FBG （AUC value）， indicating a potential to be a diagnostic marker for PJI.ConclusionsFBG is significantly correlated with PJI and it can be used as a potential non-invasive marker for early detection. It may serve as a safe and cost-effective tool for assessing PJI in clinical work.关键词：periprosthetic joint infection;plasma fibrinogen;coagulation-related indicators;diagnosis
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发布时间：2024-02-19 - 摘要：ObjectiveThe purpose of this study was to evaluate the functional outcomes and satisfaction in periprosthetic knee infection patients after above-the-knee amputation （AKA）.MethodsA review was performed in 13 patients who underwent AKA due to periprosthetic knee infection from October 2010 to August 2022， there were 7 females and 6 males with the median age of 69 （45~ 73） years. The mean number of surgical procedures between primary total knee arthroplasty and AKA was 2.9 times （range： 1 ~ 6）. Patients were segregated into non-elderly group （including patients <65 years old） and elderly group （involving patients ≥65 years old）. Functional outcomes were evaluated by SF-12 and Barthel activities daily living index （Barthel ADL index）. Patient satisfaction was accomplished through a questionnaire.ResultsFour patients died within 6 months after the amputation. Three patients received surgical procedures for recurrent infections after AKA. In the remaining 9 patients，the median time from AKA to the final follow-up was 4.2 （1.9~8.2） years， three patients received surgical procedures for recurrent infections after AKA. Patients in non-elderly group showed better functional outcomes than elderly patients after AKA （both P<0.05）. All patients in non-elderly group were fitted with a prosthesis. Whereas， elderly patients reported a better satisfaction after AKA than young patients.ConclusionYoung PJI patients seemed to have better function and ambulatory ability with high expectation and demand， which made them feel less satisfied about AKA. Meanwhile，despite poor function outcomes due to the less healthy physical condition， the alleviation of financial and psychological burdens resulting from reinfections and multiple surgeries and the less demand in function and daily activities made elderly patients have a good satisfaction after AKA.关键词：PJI;satisfaction;function;above-the-knee amputation
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发布时间：2024-02-19
Topics on PeriprostheticJointInfection
- 摘要：The new variant B.1.1.529 of COVID-19 was reported to the WHO for the first time by South Africa on November 24， 2021. At present， Omicron has become the dominant strain in the world and is spreading rapidly. Although Omicron infected during pregnancy shows the lower risk of serious maternal and fetal complications than the previous variants and Delta variant， the rapid increase in the number of cases and the wide range of patients still worth attention of obstetricians. This article reviews the prevalence of Omicron variant infection， the clinical characteristics ， the prevention and the treatment of pregnant women infected with Omicron， as well as the breastfeeding of newborns. It is believed that Omicron infection will not increase the rate of early spontaneous abortion and the infant congenital malformations， but it may increase the risk of gestational hypertensive disorders， premature delivery， cesarean section， and postpartum hemorrhage in the third trimester of pregnancy.We put forward corresponding management strategies and suggestions to provide references for the diagnosis and treatment of novel coronavirus infection in pregnant women in China.关键词：SARS-COV-2;Omicron;pregnancy;clinical manifestation;treatment
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发布时间：2024-02-19
Invited Review
- 摘要：ObjectiveTo explore the clinical application of molecular classification in endometrial cancers with the next generation sequencing （NGS）.MethodsTotally 112 cases of endometrial carcinoma diagnosed by pathology in The Sun Yat-sen University Cancer Center were collected. All of them were tested by hybridized-capture second-generation sequencing based on 1，021 gene panel. The molecular variation spectrum of each subtype and its relationship between the clinicopathological features were analyzed.ResultsThe cases were distributed as follows： 8 （7.1%） POLE mutation， 34 （30.4%） mismatch repair deficient， 26 （23.2%） TP53 mutation， 44 （39.3%） non-specific molecular profile. The median tumor mutation burden was respectively 252.0， 38.4， 5.8 and 5.4 Muts/Mb. There were no significantly differences among four subtypes in clinicopathological features such as age， histological grade， lymph node metastasis and clinical stage. PTEN （75.5%）， PIK3CA （66.7%）， ARID1A （55.9%）， TP53 （40.2%）， NF1 （29.4%） were the most common mutations in endometrial cancers.ConclusionsThe utilization of NGS in endometrial cancers can simultaneously identify molecular subgroups， screen Lynch syndrome and obtain molecular variation spectrum， which can provide guidance for immunotherapy and targeted therapy， contribute to further accumulation and exploration of molecular genetic characteristics.关键词：the next generation sequencing;endometrial carcinomas;molecular classification;clinical application
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发布时间：2024-02-19 - 摘要：ObjectiveTo understand the composition of related characteristics of HIV/AIDS cases in Lanzhou and analyze the influencing factors of AIDS-related deaths.MethodsThe information of HIV/AIDS cases reported in Lanzhou from 2011 to 2019 was collected， the method of survival was used analysis and Bayesian Cox Proportional Hazard Regression Model was constructed to analyze the related factors of death.ResultsA total of 2 312 HIV/AIDS patients were selected in this study， including 45 AIDS-related deaths. The results of multivariate regression showed that the older the patients were， the higher the risk of death was； the risk of death of AIDS patients at the time of diagnosis was 13.91 times higher than that of HIV-infected patients； Patients who received CD4 testing had a lower risk of death than those who did not； The risk of death was 0.22 times higher among those who received antiretroviral therapy than those who did not receive antiretroviral therapy.ConclusionsAge at diagnosis， course of disease， antiviral therapy were the influencing factors of AIDS-related death in HIV/AIDS patients in Lanzhou. Therefore， it is necessary to strengthen health education for AIDS-related groups， advocate early detection， early diagnosis， and early treatment， expand the coverage of AIDS testing and treatment， prolong the survival time of AIDS patients.关键词：Cox proportional hazard regression model;AIDS;death;influencing factors
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发布时间：2024-02-19 - 摘要：ObjectiveUsing multi-omics technology， we conducted the present study to determine whether dexamethasone has therapeutic effect on pneumonia rats through the regulation of intestinal flora and metabolites.MethodsTotally 18 Sprague-Dawley rats were randomly divided into 3 groups （n = 6 each）： Control group， Model group and Dexamethasone （Dex） group. Lipopolysaccharide （LPS） was continuously injected intraperitoneally into rats at a dose of 4 mg/kg for 7 days to induce pneumonia except the Control group. Then the Dex group was given Dex at a dose of 2 mg/kg via oral gavage for 12 days， and both the other two groups received continuously equal volume of sterile PBS buffer for 12 days. On the 19th day， lung， plasma， feces and intestinal contents of rat were collected. Hematoxylin-eosin （H&E） staining and Bio-plex suspension chip system were applied to evaluate the effect of Dex on pneumonia. Furthermore， metagenomic sequencing and UPLC-Q-TOF-MS/MS technology were employed to determine the intestinal flora and metabolites of rats， respectively.ResultsH&E staining results showed that the lung tissue of the Model group was infiltrated with inflammatory cells， the alveolar septum was increased， alveolar hemorrhage， and histological lesions were less severe in Dex group than in the model group. The levels of 3 inflammatory cytokines including TNF-α （P < 0.000 1）， IL-1α （P = 0.009 6） and IL-6 （P < 0.000 1） in the Model group were increased compared with the Control group， while Dex treatment reduced the levels of the three inflammatory factors. Taken together， Dex treatment effectively reversed the features of pneumonia in rats. Metagenomic analysis revealed that the intestinal flora structure of the three groups of rats was changed. In contrast with the Model group， an increasing level of the Firmicutes and an elevated proportion of Firmicutes/Bacteroidetes were observed after Dex treatment. Dex-treated rats possessed notably enrichment of Bifidobacterium， Lachnospiraceae and Lactobacillus. Multivariate statistical analysis showed a great separation between Model group and Dex group， indicating metabolic profile changes. In addition， 69 metabolites （P < 0.05） were screened， including 38 up-regulated in the Model group and 31 elevated in the Dex group， all of which were mainly involved in 3 metabolic pathways： linoleic acid metabolism， tryptophan metabolism and primary bile acid biosynthesis.ConclusionsIn summary， we demonstrate the beneficial effects of Dex on the symptoms of pneumonia. Meanwhile， integrated microbiome-metabolome analysis reveals that Dex improves LPS-induced pneumonia in rats through regulating intestinal flora and host metabolites. This study may provide new insights into the mechanism of Dex treatment of pneumonia in rats.关键词：pneumonia;dexamethasone;intestinal flora;metabolomics;UPLC-Q-TOF-MS/MS
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发布时间：2024-02-19 - 摘要：ObjectiveTo observe the effects of fire-needle of Lingnan on the vitiligo model after hydroquinone-induced oxidative stress based on the Hippo-YAP signaling pathway.MethodsC57BL/6 mice were randomly divided into normal group （Control）， model group （HQ）， HQ+fire-needle group （FA）， and positive control group （Halometasone）， with 8 mice in each group. The vitiligo model was prepared by hydroquinone （HQ）. The skin pathological changes were observed by depigmentation score， HE staining and Masson-Fontana. Elisa was used to detect the levels of tyrosinase （TYR）， malondialdehyde （MDA） and monoamine oxidase （MAO）.Western-blot and PCR were used to detect the expression of Yap1 and Tp73 among the groups.ResultsCompared with the control group， the epidermis and dermis were significantly thicker. The number of melanocyte hair follicles， basal melanocytes， epidermal cells containing melanin granules were significantly decreased， and the depigmentation score was significantly reduced（P＜0.01）. The level of TYR decreased， and the levels of MDA and MAO increased after modeling（P＜0.01）. The expression of Yap1 and Tp73 were significantly reduced （P<0.01）. The dermis became thinner in the halometasone and FA group after treatment of 4 weeks. The number of melanocyte hair follicles， basal melanocytes， epidermal cells containing melanin granules increased （P<0.05）. Compared with that of the HQ group， the level of TYR in the halometasone group and FA group was significantly increased （P<0.01）. The levels of MDA and MAO in the FA group were decreased （P<0.05）. The expressions of Yap1 and Tp73 in the FA group were significantly increased （P<0.01）， and their effects were better than those in the Halometasone group （P<0.05）.ConclusionsFire-needle of Lingnan protects melanocytes from oxidative stress by activating the Hippo-YAP pathway. It enhances the synthesis and function of melanocytes and promotes repigmentation by reducing the content and activity of oxidative stress products.关键词：fire-needle of lingnan;Hippo-YAP signaling pathway;oxidative stress;vitiligo;melanocytes
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发布时间：2024-02-19 - 摘要：ObjectiveThis study aims to investigate the role of suPAR in the pathogenesis of podocyte injury in FSGS.Methods① The sera of primary FSGS patients （17 cases） were collected. Healthy volunteers （10 cases） and patients with other types of primary nephrotic syndrome （10 cases） were set as normal and disease controls. SuPAR levels were detected by ELISA； ② Podocytes were stimulated by suPAR in vitro， and cells were collected to analyze apoptosis by flow cytometry and for RNAseq analysis； ③ Differentially expressed genes （DEGs） were screened from RNAseq data. Both up-regulated and down-regulated genes were analyzed by KEGG and GO enrichment analysis. Heat map was used to show expression of genes related to podocyte focal adhesion， slit diaphragm and actin dynamics and endocytosis. Differentially expressed genes were verified by qPCR.Results① The level of suPAR in FSGS patients was significantly increased， and that in other nephrotic syndrome（NS） patients was also significantly increased； ② suPAR stimulation significantly altered the transcriptome pattern of human podocytes. A total of 272 up-regulated genes and 288 down-regulated genes were screened； ③ KEGG and GO enrichment analysis of up-regulated and down-regulated genes showed that Focal adhesion and DNA replication and DNA repair related pathways were significantly down-regulated； ④ suPAR did not increase podocyte apoptosis.ConclusionThe level of suPAR is significantly increased in patients with primary FSGS. SuPAR may promote podocyte injury by interfering with genomic homeostasis and disrupting focal adhesion， slit diaphragm， actin dynamics and endocytosis-related functional molecules of podocytes.关键词：suPAR;focal segmental glomerulosclerosis;podocyte
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发布时间：2024-02-19
Basic Research
- 摘要：ObjectiveTo assess the prognostic value of 18F-FDG PET/CT parameters for predicting therapeutic response in diffuse large B-cell lymphoma （DLBCL）.MethodsWe retrospectively analyzed the clinical data and 18F-FDG PET/CT radiomics features of 81 DLBCL patients enrolled between June 2015 and October 2020. Multivariate logistic regression analysis was used to identify the predictive factors for therapeutic response of DLBCL， based on which a predictive model was developed accordingly. The performance of the model was evaluated by receiver operating characteristic （ROC） curves and calibration plots.ResultsDuring the two years after first chemotherapy， 23 patients （28.3%） developed relapse and 58 patients （71.7%） had progression-free survival （PFS）. The analysis for the predictive capability of the binary logistic regression model incorporating the PET/CT features revealed that the imaging features of 18F-FDG PET/CT after chemotherapy were independent prognostic factors for PFS. Among them， SUVTHR-mean2 was the most important factor for predicting therapeutic response in DLBCL patients after chemotherapy， with a cutoff value of 2.00 （AUC=0.81）.Conclusions18F-FDG PET/CT showed a valuable prognostic performance for PFS in DLBCL patients after chemotherapy， with the imaging feature after chemotherapy SUVTLR-mean2 being the optimal independent predictor. Our predictive model of imaging features might have an important prognostic value in assessing the risk of disease progression， guiding the treatment and follow-up protocol， improving therapeutic efficiency and cutting down the medical cost.关键词：diffuse large B-cell lymphoma（DLBCL）;PET/CT;therapeutic response;predictive model
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发布时间：2024-02-19 - 摘要：ObjectiveCentral nervous system （CNS） infiltration commonly occurs in children with acute lymphoblastic leukemia （ALL）. Early subclinical CNS infiltration in pediatric ALL is hard to detect with conventional methods. This study aimed to investigate the changes of brain structure volume parameters based on Synthetic MRI （SyMRI） in pediatric ALL without clinically diagnosed CNS infiltration.MethodsThirty-six ALL and twenty-nine typically developing （TD） children were prospectively collected and all underwent SyMRI. The Synthetic MR software was used to obtain brain volumetric parameters including total white matter volume （WMV）， gray matter volume （GMV）， cerebrospinal fluid （CSF） volume， etc. and their within-group differences were assessed by analysis of covariance. The Spearman correlation analysis was used to examine the correlation between biological characteristics and statistically significant brain volume parameters.ResultsALL children showed increased CSF volume （PFDR-corrected = 0.009） and decreased GMV （PFDR-corrected = 0.027） when compared to TD children. We also found a moderately negative association between GMV/intracranial volume and risk classification in pediatric ALL （rs = -0.380， P = 0.022）.ConclusionsPediatric ALL without clinically diagnosed CNS infiltration presented with accumulation of CSF and reduction of gray matter. The brain volumetric changes in subclinical CNS infiltration of pediatric ALL provides a new attempt for exploring the underlying mechanism and early detection of CNS infiltration in pediatric ALL.关键词：MRI;acute lymphoblastic leukemia （ALL）;children;gray matter;cerebrospinal fluid （CSF）
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发布时间：2024-02-19 - 摘要：ObjectiveTo investigate the expression of RNA binding motif single stranded interacting protein 3 （RBMS3） in epithelial ovarian cancer （EOC） tissues and its relationship with the clinicopathological features and prognosis of EOC.MethodsThe study enrolled the paraffin-embedded tissues from 110 EOC cases and 73 benign epithelial ovarian tumor cases pathologically diagnosed in the first affiliated Hospital of Bengbu Medical College from January 2015 to December 2019. By using anti-RBMS3 polyclonal antibody， the immunohistochemical staining was employed to detect RBMS3 expression in the tissues and then its correlation with the clinicopathological parameters and prognosis of EOC was analyzed.ResultsRBMS3 was expressed in both EOC and benign epithelial ovarian tumor tissues. RBMS3 expression in EOC tissues， significantly related with International Federation of Gynecology and Obstetrics （FIGO） stage， histological grade， CEA levels and survival status， was significantly lower than that in benign epithelial ovarian tumor tissues （P<0.05）. Kaplan–Meier survival curve showed that low RBMS3 expression in EOC patients was correlated with decreased progression-free survival （PFS） and overall survival （OS） （P<0.05）. Univariate analysis showed that RBMS3 expression， FIGO stage， residual lesion size， intestinal metastasis and intraperitoneal implantation were associated with OS of EOC patients （P<0.05）； multivariate analysis showed that low RBMS3 expression and intestinal metastasis were independent risk factors for poor prognosis in EOC patients （P<0.05）.ConclusionsRBMS3 is expressed at low levels in EOC tissues， which is closely related to poor prognosis of EOC patients. RBMS3 may function as a tumor suppressor gene in EOC tissues and can be used as an EOC-independent prognostic marker for targeted therapy against EOC.关键词：epithelial ovarian cancer （EOC）;RNA binding motif single stranded interacting protein 3 （RBMS3）;clinicopathological features;prognosis
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发布时间：2024-02-19 - 摘要：ObjectivesBased on the changes of lung lesions in patients with COVID-19 at different stages， a nomogram model describing CT image features was established by radiomics method to explore its efficacy in predicting the progression of the disease.MethodsThis retrospective study enrolled 136 patients with COVID-19 pneumonia who received at least two CTs including three cohorts （training cohort and validation cohort 1 and 2）. Patients in the training cohort were divided into three groups according to time between onset of fever symptoms and the first CT. The clinical manifestations and CT features of each group were analyzed and compared. A nomogram to predict disease progression was constructed according to the CT features of the patients， and its performance was evaluated.ResultsThe training cohort consisted of 41 patients.A nomogram was generated to predict disease progression based on three CT features： irregular strip shadow， air bronchial sign， and the proportion of lesions with irregular shape ≥50%. AUC（95%CI）=0.906（0.817，0.995）.The C index of the training cohort was 0.906， and the C index of the internal verification was 0.892. AUC（95%CI）of the validation cohort 1 （34 cases） =0.889（0.793，0.984）；AUC（95%CI）of the validation cohort 2 （61 cases）=0.876（0.706，1.000）.The calibration curves show that the predicted values of the nomogram are in good agreement with the observed values.ConclusionThe nomogram model based on CT radiomics can predict the outcome of lung lesions in patients with high sensitivity and specificity.According to the changes of CT image characteristics of patients with COVID-19， lung lesions will be improved when the proportion of irregular cable shadow， air bronchogram and irregular lesions is greater than 50%.关键词：COVID-19;computed tomography;disease progression;nomogram
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发布时间：2024-02-19 - 摘要：ObjectiveThe study aims to determine whether the horizontal posterior displacement of the distal clavicle in patients with acromioclavicular joint dislocation can be corrected via the application of modified intraoperative axillary fluoroscopy.MethodsFrom February 2019 to April 2021， 50 patients with Rockwood type Ⅲ acromioclavicular joint dislocation eligible for inclusion were randomly divided into two groups： the normal （32 cases） and the experimental （18 cases）. The conventional anteroposterior position radiographs were obtained to detect the surgery effect on the patients in the normal group. In experimental group， modified intraoperative axillary radiographs were obtained， with the concept of polar coordinates introduced to reduce the horizontal posterior translation of the clavicle. Then we compared the perioperative parameters， such as average operative time， intraoperative blood loss between the two groups. The Constant score was used for assessing the postoperative function of the shoulder joint in the follow-up visits.ResultsNo statistically significant difference was found in gender， age， duration of injury， underlying diseases， intraoperative blood loss and operative time between the two groups. The postoperative shoulder function score of the experimental group was higher than that of the normal group.ConclusionsThe application of modified intraoperative axillary fluoroscopy is recommendable for accurately reducing posterior translation of the distal clavicle， and meanwhile helpful for the precise placement of the clavicular plate.关键词：acromioclavicular joint dislocation;posterior translation;modified axillary radiograph;polar coordinates
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发布时间：2024-02-19 - 摘要：ObjectiveTo investigate the clinical efficacy of oral dydrogesterone alone for luteal phase support in natural cycle frozen-thawed embryo transfer （NC-FET）.MethodsThe clinical data of 1 530 NC-FET cycles enrolled in our Reproductive Center from January 2019 to September 2021 were retrospectively analyzed. According to different luteal support protocols， the patients were divided into oral dydrogesterone alone （group A， n=524）， vaginal progesterone soft capsules （group B， n=401） and vaginal progesterone soft capsules combined with dydrogesterone （group C， n=605）. The clinical outcomes and cost-effectiveness ratio were compared among the three groups. The primary outcome was live birth rate.ResultsThe live birth rate was 43.13% （226/524） in group A， 39.15% （157/401） in group B， and 42.64% （258/605） in group C. There was no statistical difference among the three groups （P > 0.05）. No statistical difference was observed in the HCG positive rate， implantation rate， biochemical pregnancy rate， clinical pregnancy rate， spontaneous miscarriage rate， ectopic pregnancy rate， twin delivery rate， premature delivery rate and newborn weight among the three groups （P>0.05）. Logistic regression analysis revealed that the three luteal support regimens did not affect live birth rate. Pharmacoeconomic analysis showed that taking group B as a reference， the cost increased by 19 227.30 yuan for every 1% increase in live birth rate in group A.ConclusionsIn NC-FET cycle， oral dydrogesterone alone can achieve the same clinical outcomes as vaginal progesterone soft capsules and vaginal progesterone soft capsules combined with dydrogesterone. Compared with that of progesterone soft capsules， the cost of oral dydrogesterone alone is increased， a large sample and multicenter prospective study is needed to further confirm our results.关键词：frozen-thawed embryo transfer （FET）;natural cycle;luteal phase support;pregnancy outcomes;cost-effectiveness ratio
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发布时间：2024-02-19 - 摘要：ObjectiveTo investigate the prevention strategy of bilateral vocal cord adhesion after simultaneous Renke space edema resection under CO2 laser.MethodsSeventy patients who underwent CO2 laser resection of bilateral Renke space edema of vocal cords from June 2018 to June 2021 in our hospital were retrospectively selected for this study. According to their postoperative vocal cord adhesion， patients were divided into vocal cord adhesion group （35 cases） and silent band adhesion group （35 cases）， and the general data of the two groups were compared. Multivariate logistic regression analysis was used to evaluate the risk factors for postoperative vocal cord adhesion. The prediction model of postoperative morbidity risk of vocal cord adhesion was established by using chisquared automatic interaction detection （CHAID） classification tree algorithm， and the application value of the model was evaluated by benefit graph and index graph.ResultsMultivariate analysis showed that surgical range and depth of Ⅱ， laser power≥5 W and anterior connection involvement were the risk factors for postoperative vocal cord adhesion ［OR 95%CI： 6.113 （2.346， 17.451）； 5.214 （1.469， 15.263）； 18.651 （1.689， 36.203）］. The classification tree model showed that anterior articulation involvement was an important predictor of postoperative vocal cord adhesion （76.92%； χ2=11.993， P=0.001）， and the benefit graph and index graph showed good models.ConclusionClinical attention should be paid to surgical scope and depth， laser power and anterior union involvement， and timely prevention strategies should be formulated to reduce the risk of vocal cord adhesion in patients.关键词：CO2 laser;edema in the Renke space of bilateral vocal cords;vocal cord adhesion;classification tree algorithm;prediction model
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发布时间：2024-02-19 - 摘要：ObjectiveTo investigate the clinical appropriateness and application value of the peroxidase （POD） method for the detection of unbound bilirubin （UB） in neonatal serum.MethodsHydrogen peroxide （0.33 mol/L） and three different final concentrations （0.019， 0.038， 0.075 μg/mL） of horseradish peroxidase （HRP） were added to standard bilirubin solution （1， 2， 3 μmol/L） to obtain a standardized HRP primary rate constant Kp. Then 25 μL of neonatal serum was diluted by 41.6 fold， and measured with 2.4 and 4.8 μg/mL HRP at 37 ℃ under the dark， to determine the UB concentration. The accuracy， precision， and stability of the methodology were validated. The clinical characteristics of 33 jaundiced neonates were collected， including total serum bilirubin （TSB）， indirect bilirubin （IDB）， albumin （ALB）， bilirubin to albumin molar ratio （BAMR）， etc. The experimental data were analyzed by Graphpad Prism 8.0.ResultsA standardized Kp of （7.20±1.08） mL·μg-1·min-1 was determined at pH 7.4±0.2， 37 ℃ in the dark. The HRP activity and UB concentrations remained stable at -20 ℃ for 3 weeks and a week， respectively. The mean intra-day and inter-day coefficients of variation of the serum samples with different UB concentrations were less than 10%. In this study， the UB concentrations in 33 jaundiced neonates （gestational age ≥35 weeks） were measured by the POD method in the range of （0.32～1.20） μg/dL， which was positively correlated with TSB， IDB and BAMR. Of the five infants whose UB concentrations measured more than 1 μg/dL， three received intensive phototherapy （60%）.ConclusionsThe POD method combined with a standard equipment spectrophotometer to detect serum UB concentrations in neonates is easy to operate， rapid to detect， and low cost. This method has good accuracy and precision， which is convenient for clinical implementation. Moreover， the measurement of serum UB may assist us in better management of neonatal jaundice in clinical practice.关键词：neonatal jaundice;unbound bilirubin;peroxidase test
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发布时间：2024-02-19 - 摘要：ObjectiveTo investigate the value of reduced field-of-view DWI （r-FOV DWI） in quantitative assessment of axial spondyloarthritis.MethodsA total of 112 patients with chronic back pain or suspected axial spondyloarthritis receiving full field-of-view DWI （f-FOV DWI） and reduced field-of-view DWI （r-FOV DWI） from December 2019 to December 2021 were enrolled. Next， subjective image quality assessment （anatomical detail， artifacts， distortion， overall image quality） and objective image quality assessment including （signal to noise ratio and contrast to noise ratio） were conducted by two experienced radiologists. In addition， the Apparent Diffusion Coefficient （ADC） values of three groups （active group， inactive group， and control group） on the two DWI sequences were measured by the two radiologists， respectively. Finally， the consistency of measurement between the two researchers was evaluated and the differences in ADC values was compared.Results102 patients were included and were divided into three groups， including the active group （n=32）， inactive group （n=29）， and control group （n=41） according to ASAS diagnostic criteria. All subjective and objective image quality metrics were rated in favor of r-FOV DWI images compared with f-FOV DWI images ［overall image quality： DWI 4（3~4） vs. 3（3~3） and SNR： 6.58（5.05~10.38） vs. 4.46（2.37~10.04）， CNR： 2.04（-1.14~8.29） vs. 0.97（-8.19~7.12）；P＜0.05］. Inter-rater consistency of the two researchers were 0.60~0.74. According to the AUC curve， group inactive vs. control showed r-FOV DWI was better than f-FOV DWI. In other groups （lesion vs. control， active vs. inactive）， there were no differences between both sequences（P＜0.05）.ConclusionThe subjective image quality score and signal to noise ratio of r-FOV DWI were higher than those of f-FOV DWI， which could be used for quantitative assessment of axial spondyloarthritis.关键词：reduced field-of-view DWI;ankylosing spondylitis;magnetic resonance imaging;apparent diffusion coefficient
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发布时间：2024-02-19 - 摘要：ObjectiveTo discuss the correlation between young patients’ adverse transfusion reaction and pre-transfusion C reactive protein （CRP） level and EO% （percentage of eosinophils） .MethodsThe observation group was chosen from among sixty-six young patients who experienced transfusion-related adverse events between January 2019 and December 2020. For each patient chosen to be included in the observation group， another patient from the same department， with the same disease and gender， who had been hospitalized in the same month and received the same type of blood product transfusion， but had not experienced any transfusion-related adverse effects， was chosen to be in the control group. We examined and compared their ages， transfusion experiences， allergy backgrounds， EO%， and CRP levels in peripheral blood prior to transfusion. A receiver operating characteristic （ROC） curve was used to examine the diagnostic value of EO% and CRP for transfusion-related adverse events. Simultaneously， a logistic analysis was performed on the risk factors for transfusion-related adverse events.ResultsPre-transfusion CRP was higher in patients with FNHTR in the observation group than it was in patients in the control group； pre-transfusion CRP was also higher in patients with ATR in the observation group than it was in patients in the control group. There were also statistically significant differences between these variables in the percentage of patients with transfusion history and pre-transfusion EO% （ P＜0.05）. For the transfusion of different blood types， there was statistical significance in the occurrence of ATR and FNHTR （ P＜0.05）. For the diagnosis of FNHTR， the CRP area under the ROC curve was 0.889， and the best cut-off value was 18.05 mg/L. For the diagnosis of ATR， the area under the ROC curve was 0.749， and the best cut-off values were 17.60 mg/L.ConclusionPre-transfusion C-reactive protein level is an independent risk factor for FNHTR and ATR in young patients； the predictive value of EO% for adverse blood transfusion reactions is insufficient.关键词：young people;adverse transfusion reaction;EO%;C reactive protein;risk factors
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发布时间：2024-02-19 - 摘要：ObjectiveTo explore the clinical efficacy of percutaneous transforaminal endoscopic spine system （TESSYS） in the treatment of lumbar disc herniation （LDH） complicated with nerve root canal stenosis.MethodsA retrospective study was done on 40 LDH patients complicated with nerve root canal stenosis who underwent TESSYS in our hospital from April 2019 to April 2021. The clinical efficacy of the patients was evaluated by the modified Mac Nab criteria 12 months after the surgery. We also measured and analyzed the scores of visual analogue scale （VAS）， Oswestry disability index （ODI） and Japanese orthopaedic association （JOA）， the changes of structural parameters of lumbar spine and inflammatory factor levels preoperatively， 6 and 12 months after the surgery.ResultsAll the 40 cases successfully underwent the surgery and follow-ups， with a 12-month post-operative clinical excellent and good rate of 90%. The preoperative， 6-month and 12-month post-operative VAS scores were （7.38±2.06）， （2.36±0.87） and （1.62±0.82）， respectively. The respective ODI scores were （55.54±11.19）， （26.52±7.61） and （18.14±4.36）； JOA scores （13.93±2.10）， （20.26±1.35） and （22.34±1.88）. The post-operative scores of VAS， ODI and JOA were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative lumbosacral angles were （37.23±6.84）° and （27.37±4.31）°， respectively， with the respective lumbar curvatures of （13.48±3.06） mm and （22.36±4.51） mm. The post-operative lumbosacral angle and lumbar curvature were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative high-sensitivity C-reactive protein （hs-CRP） levels were （3.43±0.61） mg/L and （5.18±0.70） mg/L， respectively， with the respective tumor necrosis factor alpha （TNF-α） levels of （1.44±0.27） mg/L and （2.07±0.44） mg/L. The post-operative levels of hs-CRP and TNF-α were significantly higher than those before the surgery （P<0.05）.ConclusionIn the treatment of LDH complicated with nerve root canal stenosis， TESSYS achieves a good clinical effect， improves the structure and function of the lumbar spine， reduces the degree of lumbar spine pain， and has a mild post-operative inflammatory reaction.关键词：lumbar disc herniation （LDH）;percutaneous transforaminal endoscopic spine system （TESSYS）;lumbar spine function;inflammatory factors
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发布时间：2024-02-19 - 摘要：ObjectiveTo discuss the diagnostic methods of global developmental delay caused by 10q24.3 heterozygous loss.MethodsA retrospective analysis was conducted on the clinical data of one child with global developmental delay， and the results of low depth whole-genome copy number variation sequencing （CNVseq） and family whole exome sequencing （WES） of the child and his parents.ResultsThe patient was a 10-month-old male with developmental retardation in four areas， with some special features （ocular hypertelorism， strabismus， flat nose bridge， protruding forehead， cleft palate， high palatal arch， etc.） and hypotonia of limbs. The CNVseq and WES test showed that the patient had new 10q24.3 heterozygosis loss. Because this region contains the gene SUFU associated with basal cell nevus syndrome and the gene CNNM2 associated with hypomagnesemia， seizures， and mental retardation， and the gene TRIM8 associated of Focal segmental glomerulosclerosis with neurodevelopmental syndrome， we speculated that the cause of the disease in the child was highly related to the heterozygosity deletion of SUFU gene and CNNM2 gene and TRIM8 gene.ConclusionGenetic testing should be improved as soon as possible for children with global developmental delay and special facial manifestations， so as to make clear diagnosis and to judge prognosis.关键词：10q24.3 heterozygous loss;global developmental delay;SUFU gene;CNNM2 gene;TRIM8 gene
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发布时间：2024-02-19
Clinical Research
- 摘要：With the deepening of the aging of society， there are more and more patients with motor dysfunction of lower limb，and rehabilitation therapy for these patients is becoming more and more important. Since the 1980s， exoskeleton robots for lower-limb rehabilitation have been applied to the rehabilitation for patient with dyskinesia， especially those with dyskinesia caused by neurological diseases such as stroke. These exoskeleton robots are wearable， nonlinear and complex mechanical devices， which deserve to be studied and widely applied. In this review， the research status， clinical application and challenges of exoskeleton robots for lower-limb rehabilitation are described in three aspects according to the difference of the therapeutic sites of exoskeleton rehabilitation robots， and on the basis， the development trend of exoskeleton robots for lower-limb rehabilitation is prospected.关键词：lower limb;exoskeleton robot;rehabilitation;application
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发布时间：2024-02-19
Review
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