Olecranon osteotomy vs. triceps-sparing for open reduction and internal fixation in treatment of distal humerus intercondylar fracture: a systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture.@*METHODS@#The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications.@*RESULTS@#Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: -2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach.@*CONCLUSIONS@#This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Research progress in revision surgery after total elbow arthroplasty / 中华创伤杂志

Total elbow arthroplasty (TEA) is an effective surgical method for treatment of end-stage elbow arthritis. However, compared with hip and knee arthroplasties, the implant survival rate of TEA remains low, with a high postoperative complications rate and a high revision rate. The main reasons for revision include aseptic loosening, periprosthetic infection, periprosthetic fracture, component failure, and postoperative instability, of which the most common cause is aseptic loosening. Unlike the initial TEA, revision surgery usually needs to deal with complicated conditions such as infection, scars, bone defects, prosthetic stem extraction and cement removal, making the operation more difficult. There are few clinical studies related to TEA revision in China. Therefore, the authors review the reasons for postoperative revision, the management of key intraoperative issues, and the outcomes of treatment to provide the basis for future clinical application and academic research of TEA revision surgery in China.

Treatment progress on proximal humerus fracture with proximal humerus cage / 中国骨伤

Proximal humerus fracture is one of the common shoulder fractures. With the increase in incidence, the proportion of surgical intervention is increasing. This paper explores the traditional and new treatment methods for proximal humerus fracture. Locking plate technology is the most commonly used method in the clinic, but its complication rate of intra-articular screw penetration and reoperation is too high.Fibular strut allografts can provide adequate support, but it is a significant trauma surgery and has a high incidence of potential disruption to necessary vascular.Arthroplasty is one of the treatments for complex proximal humerus fractures, but it has a long learning curve and high cost.In recent years, the proximal humerus cage's intervention model has emerged, which has the inherent advantagesof a three dimensional structure, which can provide adequate load bearing support for the humeral head and provide flexible screw placement Angle. The cage offers a new technical option to reduce postoperative complications and improve patients' rehabilitation safety. A comprehensive grasp of the treatments of proximal humerus fracture and rational choice of intervention measures will benefit patients.

Epidemiological status of metabolic syndrome and its correlation with renal damage in Shanghai Chongming rural areas / 中华内分泌代谢杂志

Objective To investigate the prevalence of metabolic syndrome in adults in Shanghai Chongming area and to analyze the relationship between metabolic syndrome and chronic kidney disease. Methods A total of 7679 residents aged 30 years and over in Chongming District of Shanghai were randomly sampled and investigated by questionnaires, physical examinations, and laboratory examinations. The metabolic syndrome was diagnosed by the diagnostic criteria of metabolic syndrome according to the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes in 2017. According to the criteria of the International Society of Nephrology Working Group on Improving the Overall Prognosis of Kidney Diseases, estimated glomerular filration rate (eGFR)<60 ml?min-1?(1.73 m2)-1 was diagnosed as chronic kidney disease. Results The prevalence of metabolic syndrome was 38. 61％ in the total population. The prevalence of metabolic syndrome was 47. 06％ in males and 34. 71％ in females. Urinary albumin-creatinine ratio (ACR), eGFR, age, smoking, waist circumference, blood glucose, blood pressure, high density lipoprotein-cholesterol and triglyceride in metabolic syndrome group were significantly higher than those in non-metabolic syndrome group. With the increase of metabolic components, eGFR decreased, and ACR increased. According to logistic regression analysis, age, male, hyperglycemia, hypertension, hypertriglyceride were risk factors for eGFR. Male, hypertension, hyperglycemia, hypertriglyceride, central obesity, smoking history, lower education level were risk factors for ACR. Conclusion The number of metabolic components is related to renal damage. Male, hypertension, hyperglycemia, hypertriglyceride are risk factors for early renal damage.

Progress on diagnosis and treatment of low transcondylar fractures of distal humerus / 中国骨伤

Low transcondylar fractures of the distal humerus in adults is rarely seen and reported in literatures. It has a bimodal distribution in terms of age, affecting the elderly and younger patients. The fracture is characterized by a very low transverse intra-capsular and extra-articular fracture lines extending from the level of lateral epicondyle to medial epicondyle. Standard elbow plain films and CT scans are crucial and indispensable for diagnosis. Conservative treatment is suitable for undisplaced fractures, patients who are intolerant of anesthesia, or people with advanced dementia. Open reduction and internal fixation (ORIF) is preferred. Parallel and orthogonal plate fixation are widely adopted while some researchers preferred crisscross-type screw fixation or bicolumnar 90-90 plating. In addition, some customized posterolateral plates are specially designed to be able to insert a transverse screw, functioning as lateral support. However, most of the recent researches conducted on low transcondylar fractures of the distal humerus are retrospective studies with relatively lower level of evidence compared to prospective and randomized controlled ones which remain a vacancy in this field. Therefore, further studies comparing the biomechanical properties and clinical prognosis of different configurations of internal fixation or total elbow arthroplasty for the treatment of low transcondylar fractures are needed in the future.

Risk factors for elbow stiffness after open reduction and internal fixation for intercondylar fractures of the distal humerus / 中华创伤骨科杂志

Objective@#To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.@*Methods@#From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.@*Results@#The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.@*Conclusion@#The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Risk factors for elbow stiffness after open reduction and internal fixation for intercondylar fractures of the distal humerus / 中华创伤骨科杂志

Objective To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.Methods From January 2013 to May 2017,159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating.They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years).They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not.The stiffness group had extension-flexion and/or pronation-supination ＜ 100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥ 100° and no secondary elbow arthrolysis.Age,gender,fracture side,mechanism of injury,AO fracture classification,open/close fracture,additional fracture,preoperative nerve injury,time from injury to surgery,surgical approach,configuration of plating,medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.Results The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months).The latest follow-up showed fracture union in all the patients.The stiffness group had 38 patients and the non-stiffness group 121.Multivariate regression analysis showed that high energy trauma (OR =3.141,95％ CI 1.396 ～ 7.070,P =0.006) and time from injury to surgery ＞ one week (OR =2.596,95％ CI 1.123 ～ 6.000,P =0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.Conclusion The patients with high energy trauma and time from injury to surgery ＞ one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Beta-tricalcium phosphate combined with advanced platelet-rich fibrin contributes to bone regeneration: X-ray and immunohistochemical analysis / 中国组织工程研究

BACKGROUND: It has been proved that various bone substitute materials combined with blood derivatives contribute to osteogenesis. At present, no relevant reports have been reported on the combination of β-tricalcium phosphate (β-TCP) combined with advanced platelet-rich fibrin (A-PRF) in the repair of bone defects. OBJECTIVE: To observe the characteristics and effects of β-TCP combined with A-PRF for repair of bone defects. METHODS: Thirty-nine Japanese big ear rabbits (provided by the Chengdu Dashuo Experimental Animal Center in China) were randomly divided into A-PRF group (n=12), β-TCP group (n=12), composite group (n=12), and blank control group (n=3). A 6.0 mm× 8.0 mm cylindrical critical bone defect was made on the lateral femoral condyle of each side of hind legs of each rabbit and filled in with different materials in corresponding groups, respectively. No implantation was done in the blank control group. The whole femur of each rat was taken at 1, 2 and 3 months after implantation, and X-ray films were taken as well as receptor activator nuclear factor kappa B ligand and osteoprotegerin immunohistochemical analysis. RESULTS AND CONCLUSION: (1) Over time, X-ray films showed high-density shadow in the bone defect area in the A-PRF group, and there was a centripetal growth trend from the edge of bone defect to the center, while in the β-TCP group and composite group, there was a centripetal decrease trend from the edge to the center of the bone defect, and finally the density was close to natural bone or consistent to the surrounding bone tissues. (2) Receptor activator nuclear factor kappa B ligand and osteoprotegerin immunohistochemical analysis showed a positive expression in all the groups. The order of the mean absorbance value in the four groups was as follows: the composite group> β-TCP group> A-PRF group> blank group, all of which were statistically significant (P < 0.05). To conclude, β-TCP combined with A-PRF has a better osteogenic effect than individual use.

Effects of phlegm-resolving and stasis-removing herbal drugs on PGC-1α mRNA expressions and insulin resistance in NAFLD rats / 国际中医中药杂志

Objective To explore the mechanism of phlegm-resolving and stasis- removing herbals on NAFLD by observing expressions of PGC1α mRNA and insulin resistance. Methods A total of 60 male SD rats were randomly divided into the normal group, model group, positive medication control group, high-dose, middle-dose and low-dose group. The rats were fed with high-fat forage for 8 weeks. The positive medication control group were gavaged with Dongbao-Gantai liquid (0.9 g/kg/day), the high-dose, middle-dose and low-dose group were gavaged with Xiaotan-Huayu liquid (43.34、32.50、21.67 g/kg/day), and normal group, model group were gavaged with equal volume of distilled water. The drugs were given by 1 ml/100 g and last for 8 weeks. The levels of TC, TG, FFA, ALT, AST, FBG, FINS, and HOMA-IR in serum, and levels of TC, TG, and PGC-1α mRNA and pathological morphological changes in hepatic tissue were observed after 8 weeks. Results The levels of TG (0.55 ± 0.10 mmol/L, 0.58 ± 0.09 mmol/L, 0.67 ± 0.11 mmol/L vs. 1.18 ± 0.15 mmol/L), TC (1.48 ± 0.24 mmol/L, 1.69 ± 0.27 mmol/L, 1.74 ± 0.27 mmol/L vs. 3.29 ± 0.26 mmol/L), FFA (251.08 ± 48.18 μmol/L, 277.53 ± 56.73 μmol/L, 291.82 ± 48.67 μmol/L vs. 432.19 ± 67.83 μmol/L), ALT (29.32 ± 4.17 U/L, 31.26 ± 4.74 U/L, 33.56 ± 5.18 U/L vs. 47.21 ± 8.67 U/L), AST (11.05 ± 2.18 U/L, 12.15 ± 2.67 U/L, 12.96 ± 2.93 U/L vs. 19.43 ± 3.68 U/L), FBG (5.68 ± 1.22 mmol/L, 6.86 ± 1.36 mmol/L, 7.94 ± 1.82 mmol/L vs. 11.88 ± 2.54 mmol/L), FINS (8.48 ± 1.22 mmol/L, 9.55 ± 1.95 mmol/L, 9.96 ± 1.74 mmol/L vs. 12.96 ± 2.67 mmol/L), HOMA-IR (1.91 ± 0.26, 2.91 ± 0.65, 3.52 ± 0.58 vs. 6.89 ± 1.21) in serum of high-dose, middle-dose and low-dose groups were decreased than model group. Levels of FFA (242.19 ± 35.13 μmol/L, 259.78 ± 29.33 μmol/L, 277.62 ± 34.29 μmol/L vs. 436.48 ± 52.15 μmol/L), TG (23.65 ± 3.28 mmol/L, 24.41 ± 3.15 mmol/L, 25.37 ± 3.59 mmol/L vs. 15.98 ± 2.37 mmol/L), TC (7.15 ± 0.82 mmol/L, 8.60 ± 0.95 mmol/L, 8.86 ± 1.04 mmol/L vs. 36.98 ± 4.28 mmol/L) were in hepatic tissue of high-dose, middle-dose and low-dose groups were significantly lower than the model group. The levels of PGC-1α mRNA (1.24 ± 0.06, 1.02 ± 0.07, 0.99 ± 0.08 vs. 0.43 ± 0.06) in hepatic tissue of high-dose, middle-dose and low-dose groups were significantly higher than model group. Conclusions The phlegm-resolving and stasis-removing herbals may improve lipid metabolism by regulating the expression of PGC-1α mRNA, inhibiting gluconeogenesis and liver sugar output, correcting disturbance of lipid metabolism and improving insulin resistance.

Recent progress in diagnosis and treatment of hyperparathyroidism / 国际外科学杂志

Hyperparathyroidism is a secondary or primary endocrine disorder.In recent years,the incidence of hyperparathyroidism in China is increasing.Clinical manifestations tend to be multi-systemic injuries,which poses challenges for patients and clinicians.At the same time,with the advancement of medical science and technology,new detection means and innovative therapies are emerging.In this paper,recent progress of diagnosis and treatments is reviewed to provide basis for clinical work.

Comparison of clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by either parallel or orthogonal double plating / 中华创伤骨科杂志

Objective@#To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.@*Methods@#From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery.@*Results@#The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05).@*Conclusions@#In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

Epidemiological status of metabolic syndrome and its correlation with renal damage in Shanghai Chongming rural areas / 中华内分泌代谢杂志

Objective@#To investigate the prevalence of metabolic syndrome in adults in Shanghai Chongming area and to analyze the relationship between metabolic syndrome and chronic kidney disease.@*Methods@#A total of 7 679 residents aged 30 years and over in Chongming District of Shanghai were randomly sampled and investigated by questionnaires, physical examinations, and laboratory examinations. The metabolic syndrome was diagnosed by the diagnostic criteria of metabolic syndrome according to the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes in 2017. According to the criteria of the International Society of Nephrology Working Group on Improving the Overall Prognosis of Kidney Diseases, estimated glomerular filration rate (eGFR)<60 ml·min-1·(1.73 m2)-1 was diagnosed as chronic kidney disease.@*Results@#The prevalence of metabolic syndrome was 38.61% in the total population. The prevalence of metabolic syndrome was 47.06% in males and 34.71% in females. Urinary albumin-creatinine ratio (ACR), eGFR, age, smoking, waist circumference, blood glucose, blood pressure, high density lipoprotein-cholesterol and triglyceride in metabolic syndrome group were significantly higher than those in non- metabolic syndrome group. With the increase of metabolic components, eGFR decreased, and ACR increased. According to logistic regression analysis, age, male, hyperglycemia, hypertension, hypertriglyceride were risk factors for eGFR. Male, hypertension, hyperglycemia, hypertriglyceride, central obesity, smoking history, lower education level were risk factors for ACR.@*Conclusion@#The number of metabolic components is related to renal damage. Male, hypertension, hyperglycemia, hypertriglyceride are risk factors for early renal damage.

Comparison of clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by either parallel or orthogonal double plating / 中华创伤骨科杂志

Objective To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.Methods From January 2013 to December 2017,54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma,Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration).According to their age,the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5 ± 3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1 ± 5.8 years.The 2 groups were compared in terms of perioperative data,ranges of motion (flextion,extension and rotation),numeric rating scale for pain (NRS),Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm,Shoulder and Hand (Quick-DASH) at the last follow-up,complications and secondary surgery.Results The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy,combined injury and gender between them (P ＞ 0.05).The young group had significantly more cases of high-energy injury and combined injuries than the elderly group (P ＜ 0.05).All patients were followed up for 33.6 ± 15.0 months (from 12 to 63 months).The total blood loss in the elderly group (643.9 ± 298.7 mL)was significantly less than that in the young group (953.9 ± 554.6 mL) (P ＜ 0.05).At the last follow-up,there were no significant differences between the 2 groups in ranges of motion,NRS or MEPS (P ＞ 0.05),but the elderly group had significantly higher Quick-DASH scores (13.9 ± 14.4 points) than the young group (5.7 ± 8.9 points) (P ＜ 0.05).There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P ＞ 0.05),but the rate of secondary surgery in the young group (37.9％,11/29) was significantly higher than that in the elderly group (4.0％,1/25)(P ＜ 0.05).Conclusions In the treatment of humeral intercondylar fractures,ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

Selection of clinical diagnosic cut point of HbA1Cin Chongming rural areas of Shanghai / 中华内分泌代谢杂志

Objective To investigate the optimal HbA1Cthreshold to be used for the diagnosis of diabetes mellitus in Chongming rural area,and further to evaluate the optimal HbA1Ccutoff values in different age stratifications and body mass index classifications.Methods Data from 9,981 individuals aged greater than 40 years who participated in a population-based cross-sectional survey in Shanghai,China,were analyzed.A 2 h 75 g oral glucose tolerance test(OGTT)value was used to diagnose diabetes.The performance of HbA1Cwas evaluated against the results of the OGTTs by using receiver operating characteristic(ROC)curve analysis.Results At the optimal HbA1C cutoff point of 6.15%for newly diagnosed diabetes, sensitivity was 69.73%, and specificity was 89.71%.The optimal HbA1Ccutoff points for diabetes were 6.05%in subject with age less than 60 years(sensitivity was 72.88%, and specificity was 90.25%),and 6.25%in subjects with age≥60 years(sensitivity was 70.89%,and specificity was 92.34%).The optimal HbA1Ccutoff points for diabetes were 6.05% in normal-weight(with sensitivity 70.94%,and specificity 89.93%),6.25%in overweight(with sensitivity 70.21%,and specificity 90.32%), and 6.35% in obese population(with sensitivity 72.33%, and specificity 92.75%).Conclusion An HbA1C threshold of 6.15%was highly specific for detecting undiagnosed diabetes.The HbA1Cdiagnosis cutoff point can be affected by age and overweight/obesity status.

Analysis of clinical features and inflammatory factors in induced sputum in common phenotypes of COPD with frequent exacerbations / 中国综合临床

Objective To compare the clinical characteristics of chronic bronchitis ( CB),emphysema (EM ), asthma - chronic obstructive pulmonary disease overlapping syndrome ( ACOS ) with frequent exacerbations ( FE ) or infrequent exacerbations ( iFE ) and induced sputum inflammatory cells and the heterogeneity of the transmitter. Methods Ninety-one cases of chronic obstructive pulmonary disease( COPD) with acute exacerbation were divided into CB,EM or ACOS phenotype,among which 44 were frequent,and 47 were non frequent. The clinical data,induced sputum inflammatory cells,interferon-γ(IFN-γ),tumor necrosis factor-α ( TNF-α ), interleukin ( IL )-4, IL-13 were analyzed. Results The FEV1% was ( 47 ± 13. 1 )%, significantly lower than that of non frequent episodes (( 56. 2 ± 10. 2)%),and the difference was statistically significant(P＝0.049).The FEV1/FVC% was (54.3±9.3)%,significantly lower than that of non frequent episodes (60. 1±7. 3)%,and there was a significant difference between them ( P＝0. 001) . The proportion of patients with GOLD III and IV,the percentage of neutrophils in induced sputum,tumor necrosis factor -α(TNF-α) and interferon-γin the patients with frequent episodes were significantly higher than those with non frequent episodes (P＜0. 05). Among them,FEV1/FVC% and TNF-αwere independent risk factors for COPD patients (P＝0. 032, 0. 021) . The FEV1% of patients with CB phenotypic frequent episodes were ( 47. 9 ± 14. 9 )%, significantly lower than that of non frequent episodes ((57. 2±10. 9)%)(P＝0. 000),and FEV1/FVC% was (53. 4± 9. 5)% in patients with CB frequent episodes,significantly lower than that of non frequent episodes ((60. 3±6. 9)%),and the difference was statistically significant (P＝0. 022),while the level of N%,TNF-α in induced sputum were significantly higher in CB phenotype subjects with FE than those in subjects with iFE(P＜0. 01). Patients with frequent episodes of emphysema had longer duration of disease (P＜0. 05),lower FEV1%and FEV1/FVC%(P＜0. 05),the proportion of GOLD III patients and the induced sputum TNF-αwere higher, but there was no significant difference in the number and proportion of phlegm inflammatory cells,interferon-γ, interleukin 4 and interleukin 3. The level of GOLD III and the IL-13 level of induced sputum in patients with frequent ACOS phenotype were significantly higher than those in patients with non frequent episodes (P＜0. 05) . Conclusion The lung function,the severity of the disease,the course of the disease,and the percentage of sputum neutrophils,tumor necrosis factor-α,or interleukin 13 are helpful in diagnosing patients with high risk of frequent episodes.

Wiltse approach versus conventional posterior midline approach for single thoracolumbar fracture:A Me-ta-analysis / 实用医学杂志

Objective To systematically evaluate the efficacy and safety of Wiltse approach and conven-tional posterior midline approach for single thoracolumbar fracture. Methods Databases including Embase, PubMed,cnki,WanFang Data were searched to collect the related literatures for single thoracolumbar fracture treated with surgery of Wiltse approach and conventional posterior midline approach. The data were collected and evaluated by different reviewers independently and the Meta analysis was conducted by using the RevMan 5.3. Results A total of 6 literatures involving 351 patients were included. The results of Meta-analysis showed that there were significant differences in surgical duration,intraoperative bleeding,postoperative discharge volume, and visual analog score(VAS)(P < 0.000 01). There was no significant difference between the Cobb angle(P =0.69)and the fanterior edge convex height(P=0.46).Conclusions Wiltse approach is superior to conventional posterior midline approach for single thoracolumbar fracture with shorter surgical duration,less intraoperative blood loss,less postoperative discharge and lower incidence of postoperative backache. It reduces spine malformation, maintains height of the fanterior edge convex.Wiltse approach is a safe and feasible surgical technique for treating single thoracolumbar fracture.

Effect of cumin total flavonoids on experimental gastric ulcer and its mechanism / 中国病理生理杂志

AIM: To discuss the effects of cumin total flavonoids on experimental gastric ulcer and the mechanisms.METHODS: Three rat gastric ulcer models induced by pylorus ligation, ethanol or reserpine were selected.Based on these models, the gastric juice, pH value, ulcer index and suppressive rate were recorded to determine the inhibitory effects of cumin flavonoids on rat gastric ulcers.In addition, the concentrations of gastrin (GAS), prostaglandin E2 (PGE2) and epidermal growth factor (EGF) were detected to further uncover the mechanisms of these effects.RESULTS: Cumin flavonoids exhibited significant anti-gastric ulcer effects on the three models.Low-dose treatment group (P<0.01) demonstrated higher inhibitory effects than high-dose group (P<0.01), and both low-and high-dose groups had lower effects than cimetidine treatment.Furthermore, cumin flavonoids were able to profoundly decrease the amount of gastric juice, free acidity, total acidity and output of total acid, and enhance the expression of PGE2 and EGF, but down-regulate the level of GAS in rat serum in a dose-dependent manner.CONCLUSION: Cumin flavonoids might inhibit experimental gastric ulcers by affecting and regulating the gastric juice, PEG2, EGF and GAS.

Effect of dentin proteoglycans on the stability of resin-dentin bonds against artificial saliva storage / 中华口腔医学杂志

Objective@#To investigate the potential effect of proteoglycans (PG) and glycosaminoglycans (GAG) on the stability of resin-dentin bonds against artificial saliva storage.@*Methods@#Seventy-two extracted molars were used to obtain standard dentin bonding surface, and the specimens were etched for 15 s with 37% phosphoric acid and divided into three groups using a table of random number. Then the three groups undergone different incubating procedures as follow: specimens in chondroitinase ABC (C-ABC) group were incubated with C-ABC, specimens in trypsin (TRY) group were incubated with trypsin, and specimens in the control group were incubated with deionized water. All specimens were incubated at 37 ℃ for 48 h in the oscillators. Then specimens in each group were randomly assigned into three subgroups (n=8) as follows: immediate control subgroup, aging subgroups with artificial saliva storage for 6 months and 12 months. Microtensile bond strength (μTBS), fracture mode, bonding interface morphology and nanoleakage were evaluated.@*Results@#Immediately and with artificial saliva storage for 6 months and 12 mouths, the μTBS of TRY group ([49.04±3.57], [37.01±3.21] and [35.27±3.56] MPa) were significantly higher than those in the control group ([40.71±3.32], [28.87±2.34] and [24.20±2.07] MPa) (P<0.05). The immediate μTBS of C-ABC group ([32.94±2.45] MPa) was significantly lower than that of the control group (P<0.05). While with artificial saliva storage for 6 months and 12 mouths, the μTBS of C-ABC group ([26.46±2.45] and [22.50±2.58] MPa) were no differences with those of the control group (P>0.05). The ratio of cohesive fracture increased with the extension of aging time. Some narrow gaps were found in hybrid layer of the control group with artificial saliva storage for 6 months and 12 mouths.@*Conclusions@#Removal of PG increased the μTBS and durable bonds to dentin, while removal of GAG decreased the μTBS, however, it can be of help to create more durable bonds to dentin.

Analysis of the clinical characteristics and treatment of 494 cases of esophageal adeno-squamous carcinoma / 中国肿瘤临床

Objective:To investigate the clinicopathological characteristics, treatments, and survival of patients with esophageal adeno-squamous carcinoma (EASC). Methods:A total of 494 patients with EASC were selected from the clinical information databases of 500, 000 cases with esophageal and gastric cardiac carcinomas in the Henan Key Laboratory for Esophageal Cancer Research. Among the 494 EASC cases, 361 were males with an average age of 61.47 ± 8.32 years, and 133 were females with an average age of 65.56 ± 8.06 years. SPSS 21.0 software was applied to determine the statistical differences among the different groups. A life-table method was also used to calculate the five-year survival rate. A linear regression model was used to analyze the correlation of changes at different peri-ods. Results:The incidence of EASC in our database was 0.196%(494/251707). EASC occurred predominantly in male patients (male:female=2.71:1.00). The peak age was within 60-69 years in both males and females (39.6%vs. 40.6%). Notably, the incidence of male patients showed a downward trend (R2=0.063), whereas that of female patients showed an upward trend (R2=0.004). The prevalence of EASC was obviously higher in low-incidence areas for esophageal cancer than in high-incidence areas (53.1%vs. 46.9%, P<0.001). Ac-cording to the TNM staging criteria for esophageal cancer, phases II and III patients comprised the majority of cases, which accounted for 40.8%(173/424). The positive lymph node metastasis rate was 47.0%(206/438), and the number of positive lymph node metasta-ses ranged within 1-2 (48.5%, 100/206). In addition, preoperative biopsy was performed in 467 cases, and more than half of the pa-tients (53.96%, 252/467) were diagnosed before the operation. Surgical resection was the predominant treatment method for EASC (88.8%, 419/472). Only 1.9%patients (9/472) underwent radiotherapy and chemotherapy. The five-year survival rate of male patients who were neither smoking nor drinking of alcohol was higher than that of male smokers (26.5%vs. 12.1%). In patients with stagesⅠ,Ⅱ, andⅢ+Ⅳcarcinomas with surgery as lone treatment, the three-year survival rates were 64.7%, 50.9%, and 48.5%, respectively. Correspondingly, these rates were 51.7%, 47.8%, and 33.1%after adjuvant radiotherapy and chemotherapy. Conclusion:EASC is a rare type of esophageal malignant tumor. The preoperative biopsy pathological diagnosis has high misdiagnosis rate. Smoking and drinking of alcohol can influence the prognosis of patients. In EASC patients, lymph node metastasis easily occurs, and a simple surgery is bet-ter than other cancer treatments.

Prokaryotic expression and characterization of receptor binding domain protein of the Middle East respiratory syndrome coronavirus / 中华微生物学和免疫学杂志

Objective To express the receptor binding domain (RBD) protein of the Middle East respiratory syndrome coronavirus (MERS-CoV) and to characterize the antigenicity of the purified recombi-nant protein. Methods The codon-optimized gene encoding the RBD protein of MERS-CoV was synthesized and then cloned into the pET30a ( +) vector to construct the recombinant expression plasmid. The trans-formed E. coli BL21 (DE3) strains carrying expression plasmid were induced by IPTG under different condi-tions. The expressed products were purified by using nickel affinity chromatography and further analyzed by SDS-PAGE and Western blot assay. Indirect ELISA was performed to analyze the antigenicity and specificity of RBD proteins expressed in prokaryotic expression systems in human serological test. Results The recom-binant RBD proteins were mainly expressed as conclusion body in an optimal induction condition of 37℃ and 0. 5 mmol/ L IPTG for 4 h. The high purified recombinant RBD proteins were obtained through denaturation and renaturation with a relative molecular mass of about 29×103 . Results of the Western blot assay showed that the recombinant RBD proteins could have specific reaction with the serum samples collected form mice with MERS-CoV infection. Indirect ELISA revealed that the RBD proteins expressed in the prokaryotic ex-pression system showed better sensitivity and specificity in the detection of antibodies against MERS-CoV in human serum samples. Conclusion This study reported the prokaryotic expression and purification of RBD protein of MERS-CoV for the first time, which might pave the way for further investigation on immunological detection of MERS-CoV and development of vaccines against MERS-CoV infection.