[Clinical analysis of posterior axillary approach internal fixation for Idebergâ a andâ ¡glenoid fractures].

OBJECTIVE: To investigate the efficacy of posterior axillary approach internal fixation for Ideberg Ⅰa andⅡ glenoid fractures. METHODS: From December 2018 to September 2021, 9 patients with lower part of glenoid fractures were treated by posterior axillary approach, including 3 males and 6 females, aged from 50 to 78 years old. All the fractures were closed fractures. According to Ideberg type of scapular glenoid fracture was type Ⅰa in 6 cases and type Ⅱ in 3 cases. AP and lateral X-ray films of scapula were taken at 6, 12 weeks and 6 and 12 months postoperatively. Constant-Murley and disabilities of the arm shoulder and hand (DASH), and other complications were recorded at the latest follow-up. RESULTS: Nine patients were followed up, ranged from 6 to 15 months. And bone healing was achieved in all 9 patients at the final follow-up, the healing time 3 to 6 months, Constant-Murley score at the final follow-up ranged from 55 to 96, and DASH score ranged from 3.33 to 33.33. Both of them were better than preoperative. CONCLUSION: The posterior axillary approach internal fixation for Ideberg Ⅰa and Ideberg Ⅱ Glenoid fractures scapular fracture is satisfactory and worthy of clinical application.

Carcinoembryonic antigen, carbohydrate antigen 199 and carbohydrate antigen 724 in gastric cancer and their relationship with clinical prognosis.

BACKGROUND: Gastric cancer (GC) is a common malignant tumor of the digestive system with a high degree of malignancy. It usually develops insidiously without any specific symptoms in the early stages. As one of the diseases caused by abnormal gene changes, GC has abnormal expression of various oncogenes and products during its development. Tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199) and carbohydrate antigen 724 (CA724) are not expressed or lowly expressed in normal people, but significantly increased after carcinogenesis. Monitoring the changes in the levels of tumor markers such as CEA, CA199 and CA724 is conducive to early diagnosis and evaluation of the occurrence of some solid tumors. AIM: To investigate the expression of CEA, CA199 and CA724 in GC and their correlation with clinical features, hoping to provide more effective markers for the early preventive diagnosis of GC. METHODS: Of 87 patients with GC admitted to our hospital from September 2020 to December 2021 were included in the GC group, and another 80 healthy people who came to our hospital for physical examination with normal results during the same period were selected as the control group. The serum CEA, CA199, and CA724 levels were compared between the two groups, and the serum CEA, CA199, and CA724 levels were compared in patients with GC at different TNM stages, and the differences in the positive rates of CEA, CA199, and CA724 alone and in combination in detecting TNM stages of GC and GC were compared. In addition, the relationship between the levels of tumor markers CEA, CA199 and CA724 and the clinicopathological characteristics of GC patients was also analyzed. The relationship between the serum levels of CEA, CA199 and CA724 and the survival period of GC patients was analyzed by Pearson. RESULTS: The serum levels of CEA, CA199 and CA724 in GC group were significantly higher than those in control group (P < 0.05). With the increase of TNM stage, the serum CEA, CA199 and CA724 expression levels in GC patients increased significantly, and the differences between groups were statistically significant (P < 0.05). The positive rate of the CA724 single test was higher than that of CEA and CA199 single test (P < 0.05). The positive rate of the three combined tests was 95.40% (83/87), which was higher than that of CEA, CA199 and CA724 single tests. The difference was statistically significant (P < 0.05). The combined detection positive rates of CEA, CA199, and CA724 in stages I, II, III, and IV of GC were 89.66%, 93.10%, 98.85%, and 100.00% respectively, all of which were higher than the individual detection rates of CEA, CA199, and CA724. The differences were statistically significant (P < 0.05). There was no significant difference in serum CEA, CA199 and CA724 levels between GC patients with different genders, smoking history and alcohol history (P > 0.05). However, the serum CEA, CA199 and CA724 levels were significantly higher in GC patients aged ≥ 45 years, TNM stage III-IV, with lymph node metastasis and tumor diameter ≥ 5 cm than in GC patients aged < 45 years, TNM stage I-II, without lymph node metastasis and tumor diameter < 5 cm (P < 0.05). CONCLUSION: The expression levels of serum tumor markers CEA, CA199 and CA724 in patients with GC are high and rise with the increase of TNM stage. The levels of CEA, CA199 and CA724 are related to age, TNM stage, lymph node metastasis and tumor diameter. The combined detection of CEA, CA199 and CA724 is helpful to improve the diagnostic accuracy of GC with high clinical guidance value.

Impact of oral care modalities on the incidence of ventilator-associated pneumonia in the intensive care unit: A meta-analysis.

BACKGROUND: At present, evidence of the role of oral hygiene in ICU-related pneumonia is rare. The study aimed to evaluate the effectiveness of toothbrush-based oral care in preventing ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in the ICU. METHODS: Ten databases were searched for randomized controlled trials (RCTs) evaluating toothbrush-based oral care for preventing VAP in patients with mechanical ventilation in ICU. Quality assessment and data extraction were independently performed by 2 researchers. The meta-analysis was performed using RevMan 5.3 software. RESULTS: Thirteen RCTs with 657 patients were included. Tooth brushing + 0.2%/0.12% chlorhexidine was associated with reduced incidence of VAP compared to chlorhexidine (OR = 0.63, 95% confidence interval [CI]: 0.43-0.91, P = .01) or tooth brushing + placebo (OR = 0.47, 95% CI: 0.25-0.86, P = .02) in patients with mechanical ventilation in ICU, but was similar to cotton wipe with 0.2% or 0.12% chlorhexidine (OR = 1.33, 95% CI: 0.77-2.29, P = .31). CONCLUSIONS: Tooth brushing combined with chlorhexidine mouthwash can prevent VAP in patients with mechanical ventilation in ICU. There is no advantage of tooth brushing combined with chlorhexidine mouthwash over cotton wipe with chlorhexidine mouthwash for preventing VAP in these patients.

Totally laparoscopic total gastrectomy using the "enjoyable space" approach coupled with self-pulling and latter transection reconstruction versus laparoscopic-assisted total gastrectomy for upper gastric cancer: short-term outcomes.

Introduction: With the development of minimally invasive surgery in recent years, totally laparoscopic total gastrectomy (TLTG) has attracted more attention. Aim: To introduce the more comprehensive "enjoyable space" approach coupled with the self-pulling and latter transaction (SPLT) reconstruction technique to perform TLTG and investigate its safety and feasibility. Material and methods: Ninety-seven patients with primary upper gastric cancer underwent laparoscopic radical total gastrectomy between January 2020 and December 2020. Among these patients, 46 underwent laparoscopic-assisted total gastrectomy (LATG), and 51 underwent TLTG. We compared the clinicopathological characteristics, surgical outcomes and postoperative complications between the two groups. Results: There were no significant differences in the clinicopathological characteristics between the two groups (p > 0.05). However, the TLTG group had a slightly lower mean operative time and mean blood loss than the LATG group (p < 0.05 each). Although there were similarities in the mean times to first flatus, liquid diet, and soft diet, the duration of hospital stay was significantly reduced in the TLTG group (p < 0.05). No significant differences in overall complications and E-J-related complications were found between the two groups (15.2% vs. 25.4%, p > 0.05). Conclusions: TLTG is a safe and feasible procedure for treating upper gastric cancer. The enjoyable space approach in conjunction with SPLT reconstruction is an appropriate comprehensive technique with several advantages over LATG.

Impact of multiple policy interventions on the screening and diagnosis of drug-resistant tuberculosis patients: a cascade analysis on six prefectures in China.

BACKGROUND: The detection of drug-resistant tuberculosis (DR-TB) is a major health concern in China. We aim to summarize interventions related to the screening and detection of DR-TB in Jiangsu Province, analyse their impact, and highlight policy implications for improving the prevention and control of DR-TB. METHODS: We selected six prefectures from south, central and north Jiangsu Province. We reviewed policy documents between 2008 and 2019, and extracted routine TB patient registration data from the TB Information Management System (TBIMS) between 2013 and 2019. We used the High-quality Health System Framework to structure the analysis. We performed statistical analysis and logistic regression to assess the impact of different policy interventions on DR-TB detection. RESULTS: Three prefectures in Jiangsu introduced DR-TB related interventions between 2008 and 2010 in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the Bill & Melinda Gates Foundation (Gates Foundation). By 2017, all prefectures in Jiangsu had implemented provincial level DR-TB policies, such as use of rapid molecular tests (RMT), and expanded drug susceptibility testing (DST) for populations at risk of DR-TB. The percentage of pulmonary TB cases confirmed by bacteriology increased from 30.0% in 2013 to over 50.0% in all prefectures by 2019, indicating that the implementation of new diagnostics has provided more sensitive testing results than the traditional smear microscopy. At the same time, the proportion of bacteriologically confirmed cases tested for drug resistance has increased substantially, indicating that the intervention of expanding the coverage of DST has reached more of the population at risk of DR-TB. Prefectures that implemented interventions with support from the Global Fund and the Gates Foundation had better detection performance of DR-TB patiens compared to those did not receive external support. However, the disparities in DR-TB detection across prefectures significantly narrowed after the implementation of provincial DR-TB polices. CONCLUSIONS: The introduction of new diagnostics, including RMT, have improved the detection of DR-TB. Prefectures that received support from the Global Fund and the Gates Foundation had better detection of DR-TB. Additionally, the implementation of provincial DR-TB polices led to improvements in the detection of DR-TB across all prefectures.

Developmental toxicity of copper in marine medaka (Oryzias melastigma) embryos and larvae.

Copper as developmental toxicants have been reported extensively in freshwater fish, however, the sublethal and chronic toxic effects of Cu to the early life stages of marine fish are not clear. Embryo (3-5 hpf) and newly hatched larvae of marine medaka (Oryzias melastigma) were exposed to 0.01-1.28 mg L-1 waterborne Cu to investigate the developmental toxic effects. The results showed that Cu accumulation in the whole embryos presented a dose- and time-response increase while it decreased dramatically once hatching. Most of Cu accumulated in the chorion suggests that chorion is an effective barrier to Cu absorption. However, Cu that penetrated chorion and entered embryo still caused significant lethal and sublethal effects. Cu concentrations at ≥0.16 mg L-1 led to low hatchability, delayed hatching, high mortality, morphological abnormalities and increased egg size in the embryos. Heart beats and the total body length of the newly hatched larvae were significantly increased when exposed to ≥0.02 mg L-1. Cu exposure accelerated early development and promoted or delayed hatching of embryo. High Cu concentration (≥0.16 mg L-1) exposure induced morphological abnormalities of embryo and larvae, particularly skeletal and vascular system abnormalities and reduction of pigmentation. The 30 d-LC50 for embryo development was 0.138 mg L-1 and 7d LC50 for larvae survival was 10.15 mg L-1, demonstrating that embryos were more sensitive to Cu than larvae. In summary, O. melastigma embryos development is highly sensitive to Cu exposure, and the sublethal effects occurred at low Cu concentration might be as potential biomarkers in marine fish.

High admission rates and heavy inpatient service costs of urban tuberculosis patients in eastern China.

BACKGROUND: Tuberculosis patients often experience hospitalization. Inpatient services may result in high medical expenditures. It is important to explore the hospitalization rates of tuberculosis patients and the potential factors that are associated with admission rates and inpatient service expenditures. METHODS: Data from patients diagnosed and treated at the No.3 hospital of Zhenjiang City from Apr. 2014 to Mar. 2015 were obtained. Univariate and multivariate statistical analyses were applied for the analysis of potential factors associated with admission rates, average length of stay and cost. RESULTS: A total of 356 tuberculosis patients were treated at the No.3 hospital of Zhenjiang City. A total of 221 of the 356 patients were hospitalized. Sputum smear test results and type of health insurance were the potential factors associated with hospitalization rates. The average admission was (1.26 ± 0.64) per patient. The average length of stay of inpatients was 29.99 ± 25.83 days. Age, occupation, and sputum smear test were related to the average length of stay. The average total cost to inpatients was 13007.91 ± 5205.58 CNY. The sputum smear test results, type of health insurance, occupation and age were the main potential factors associated with TB inpatient expenditures. CONCLUSIONS: The admission rate of tuberculosis patients was high. Despite advances in TB insurance policies, there were substantial costs associated with TB diagnosis and treatment. TB patients still face a heavy financial burden. Health care providers should revise the service package and reform the health insurance regulations to ensure that TB patients receive appropriate care.

Diagnostic Performance of the GenoType MTBDRplus and MTBDRsl Assays to Identify Tuberculosis Drug Resistance in Eastern China.

BACKGROUND: The WHO recently has recommended the GenoType MTBDRplus version 1.0 and MTBDRsl version 1.0 assays for widespread use in countries endemic with drug-resistant tuberculosis. Despite this, these assays have rarely been evaluated in China, where the burden of drug-resistant tuberculosis is among the highest globally. METHODS: Mycobacterium tuberculosis clinical isolates were obtained between January 2008 and December 2008. Isolates were tested for drug resistance against rifampicin (RFP) and isoniazid (INH) using the GenoType MTBDRplus assay and drug resistance against ethambutol (EMB), ofloxacin (OFX), and kanamycin (KM) using the Genotype MTBDRsl assay. These results were compared with conventional drug-susceptibility testing (DST). RESULTS: Readable results were obtained from 235 strains by GenoType MTBDRplus assay. Compared to DST, the sensitivity of GenoType MTBDRplus assay to detect RFP, INH, and multidrug resistance was 97.7%, 69.9%, and 69.8%, respectively, whereas the specificity for detecting RFP, INH, and multidrug resistance was 66.7%, 69.2%, and 76.8%, respectively. The sensitivity and specificity of the GenoType MTBDRsl assay were 90.9% and 95.2% for OFX, 77.8% and 99.5% for KM, 63.7% and 86.4% for EMB, respectively. Mutations in codon S531L of the rpoB gene and codon S315T1 of KatG gene were dominated in multidrug-resistant tuberculosis (MDR-TB) strains. CONCLUSIONS: In combination with DST, application of the GenoType MTBDRplus and MTBDRsl assays may be a useful supplementary tool to allow a rapid and safe diagnosis of multidrug resistance and extensively drug-resistant tuberculosis.

Dickkopf-1 has an Inhibitory Effect on Mesenchymal Stem Cells to Fibroblast Differentiation.

BACKGROUND: Mesenchymal stem cells (MSCs) are bone marrow stem cells which play an important role in tissue repair. The treatment with MSCs will be likely to aggravate the degree of fibrosis. The Wnt/ß-catenin signaling pathway is involved in developmental and physiological processes, such as fibrosis. Dickkopfs (DKKs) are considered as an antagonist to block Wnt/ß-catenin signaling pathway by binding the receptor of receptor-related protein (LRP5/6). DKK1 was chosen in attempt to inhibit fibrosis of MSCs by lowering activity of Wnt/ß-catenin signaling pathway. METHODS: Stable MSCs were randomly divided into four groups: MSCs control, MSCs + transforming growth factor-ß (TGF-ß), MSCs + DKK1, and MSCs + TGF-ß + DKK1. Flow cytometry was used to identify MSCs. Cell viability was evaluated by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide test. Immunofluorescence was used to detect protein expression in the Wnt/ß-catenin signaling pathways. Western blotting analysis was employed to test expression of fibroblast surface markers and, finally, real-time reverse transcription polymerase chain reaction was employed to test mRNA expression of fibroblast surface markers and Wnt/ß-catenin signaling proteins. RESULTS: Cultivated MSCs were found to conform to the characteristics of standard MSCs: expression of cluster of differentiation (CD) 73, 90, and 105, not expression of 34, 45, and 79. We found that DKK1 could maintain the normal cell morphology of MSCs. Western blotting analysis showed that fibroblast surface markers were expressed in high quantities in the group MSCs + TGF-ß. However, the expression was lower in the MSCs + TGF-ß + DKK1. Immunofluorescence showed high expression of all Wnt/ß-catnin molecules in the MSCs + TGF-ß group but expressed in lower quantities in MSCs + TGF-ß + DKK1 group. Finally, mRNA expression of fibroblast markers vimentin, α-smooth muscle actin and Wnt/ß-catenin signaling proteins ß-catenin, T-cell factor, and glycogen synthase kinase-3ß was significantly increased in MSCs + TGF-ß group compared to control (P < 0.05). Expression of the same fibroblast markers and Wnt/ß-catenin was decreased to regular quantities in the MSCs + TGF-ß + DKK1 group. CONCLUSIONS: DKK1, Wnt/ß-catenin inhibitors, blocks the Wnt/ß-catenin signaling pathway to inhibit the process of MSCs fibrosis. It might provide some new ways for clinical treatment of certain diseases.

Distal tibial fracture: An ideal indication for external fixation using locking plate.

OBJECTIVE: To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures. METHODS: In this non-control prospective study, 28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate. There were 21 males and 7 females, with a mean age of 43 years (19-63). According to AO/OTA fracture classification, there were 9 cases of Type A1, 9 of Type A2, 10 of Type A3 fractures. There were 21 close and 7 open fractures. The locking plate was placed on the anteromedial aspect of the tibia with 4-5 bicortical screws inserted in both distal met- aphysis and diaphysis. The radiographic and clinic results were evaluated. RESULTS: All patients were followed up for the average of 16 months (ranging from 12 to 21 months). The average surgery duration was 38 (25-60) minutes. The mean time to fracture healing were 14.6 ± 2.67, 17.5 ± 3.66, and 18.4 ± 3.37 (p < 0.05) weeks in type A1, A2, and A3 fractures respectively. By the end of the follow-ups, the mean AOFAS score were 96.11 ± 2.32, 92.67 ± 1.80 and 92.00 ± 2.06 (p > 0.05) in type A1, A2, and A3 fractures respectively. None of nonunion, deep infection, or breakage of screw or plate were observed. CONCLUSIONS: Distal tibial fracture was the ideal indication for external fixation using locking plate. The external plating is characterized by ease of performance, less invasive, fewer soft tissue impingement, improved cosmesis, and convenient for removal.

Interferon-Gamma Release Assays for the Diagnosis of Tuberculosis: A Systematic Review and Meta-analysis.

BACKGROUND AND OBJECTIVE: We conducted a systematic review and meta-analysis to compare the accuracy of the interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for the diagnosis of Mycobacterium tuberculosis infection. METHODS: We systematically searched PubMed, Embase, Cochrane library, and Web of Science databases for relevant published studies in recent decades and calculated pooled estimated sensitivities, specificities, DOR, and SROC curve of the QFT-IT, T-SPOT and TST. Random-effects models were used to assess estimates from studies with significant heterogeneity. Moreover, area under the curve was used to evaluate the accuracy of the tests. RESULTS: Overall, 9 studies for QFT-IT, 12 studies for T-SPOT, and 16 studies for TST involving 3586 participants were included in this analysis. We found that sensitivities of the QFT-IT, T-SPOT, and TST were respectively 0.842 (95 % CI 0.811-0.870), 0.840 (95 % CI 0.814-0.864), and 0.665 (CI 0.635-0.693); specificities were respectively 0.745 (95 % CI 0.715-0.775), 0.658 (95 % CI 0.621-0.693), and 0.633 (CI 0.605-0.661); positive likelihood ratios were respectively 3.652 (95 % CI 2.180-6.117), 2.196 (95 % CI 1.727-2.794), and 1.825 (95 % CI 1.351-2.464); negative likelihood ratios were respectively 0.212 (95 % CI 0.109-0.414), 0.246 (95 % CI 0.161-0.377), and 0.556 (95 % CI 0.385-0.804); the SROC curves were 19.205, 10.397, and 3.810. CONCLUSIONS: The two IGRAs showed better performance than TST for the diagnosis of the tuberculosis. However, neither of them showed stability in the diagnosis of TB.

Origin of neurotoxins from defensins.

There are at least three conserved protein folds shared by ion channel-targeted neurotoxins and antimicrobial defensins, including cysteine-stabilized α-helix and ß-sheet fold (CSαß), inhibitor cystine knot fold (ICK) and ß-defensin fold (BDF). Based on a combined data of sequences, structures and functions, it has been proposed that these neurotoxins could originate from related ancient antimicrobial defensins by neofunctionalization. This provides an ideal system to study how a novel function emerged from a conserved structural scaffold during evolution. The elucidation of functional novelty of proteins not only has great significance in evolutionary biology but also will be helpful in guiding rational molecular design. This review describes recent progresses in origin of neurotoxins, focusing on the three conserved protein scaffolds.

Comparing risk factors for primary multidrug-resistant tuberculosis and primary drug-susceptible tuberculosis in Jiangsu province, China: a matched-pairs case-control study.

To find out the reason why some people get infected directly with multidrug-resistant tuberculosis (MDR-TB), whereas some get infected with drug-susceptible tuberculosis (DS-TB), a 1:1:1 matched-pairs case-control study was conducted to identify predictors associated with primary MDR-TB and primary DS-TB against the control in Jiangsu Province, China. All three groups were geographically matched (by neighborhood) and matched on sex and age (±5 years). In total, 110 participants were enrolled in each of three matched groups. Conditional logistic regression analysis showed that predictors independently associated with primary MDR-TB were illiteracy or primary school education, annual per capita income ≤ US$2,000, per capita living space < 40 m(2), and interval ≥ 7 days of eating fruits; predictors with primary DS-TB were body mass index ≤ 20 and feeling higher life pressure. This indicates that there are different predictors impacting the transmission range of primary MDR-TB and primary DS-TB in the general population.

Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors.

OBJECTIVE: To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation. METHODS: Twenty-eight patients with acute traumatic Rockwood III, IV and V dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors. Function was evaluated using the Constant- Murley shoulder score. Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3, 6 and 12 months. RESULTS: Two cases with fixation loosening were not included in final statistical analysis. Other patients obtained full joint reposition on immediate postoperative radiographs. Follow-up was performed with an average of 15.6 months (range, 12-19). After early range of motion exercises, 96.2% of the patients (25/26) could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months. There was no infection. Average Constant-Murley score was 96.3 points (range, 94-100) and mean Taft shoulder rating was 10.7 points (range, 8-12) at 12 months. CONCLUSION: The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.