ABO-incompatible living-related kidney transplantation: report of 23 cases / 器官移植

Objective To evaluate clinical efficacy and safety of ABO-incompatible (ABOi) living-related kidney transplantation. Methods Clinical data of 23 recipients undergoing ABOi living-related kidney transplantation were retrospectively analyzed. According to the initial blood group antibody titers in the recipients before surgery, different individualized pretreatment regimens were adopted, including oral intake of immunosuppressive drugs plus rituximab, or oral intake of immunosuppressive drugs plus plasma exchange and/or double filtration plasmapheresis plus rituximab. The blood group antibody titers before and after pretreatment, before and after kidney transplantation, and perioperative renal function and related complications were monitored. Renal allograft function and related complications were observed during postoperative follow-up. Results Among 23 recipients undergoing ABOi living-related kidney transplantation, except for one case presenting with hyperacute rejection during operation, the serum creatinine levels of the remaining 22 recipients were restored normal. Perioperative complications included lymphatic fistula in 4 cases, 1 case of urinary fistula, 1 case of perirenal hematoma complicated with T cell-mediated rejection, 6 cases of urinary system infection, 1 case of acute tubular necrosis, 1 case of acute pancreatitis, 1 case of blood group antibody titer rebound, and 1 case of primary disease recurrence, and all of these complications were cured after corresponding treatment. During postoperative follow-up, the graft and recipient survival rates of 22 recipients were 100%, and renal allograft function was normal. The blood group antibody titer were all ≤1:8 during follow-up. Complications during follow-up included 2 cases of severe lung infection, 1 case of antibody-mediated rejection, 2 cases of primary disease recurrence, 1 case of lymphocyst, 1 case of urinary system infection, 1 case of herpes zoster, 1 case of BK viruria and 2 cases of abnormal blood glucose levels. Conclusions ABOi living-related kidney transplantation may be safely performed by selecting individualized pretreatment regimens according to antibody titers by different blood groups. However, high-dose rituximab or combined use of rabbit anti-human thymocyte immunoglobulin may cause severe infectious complications in highly sensitized recipients.

Efficacy of hardware maintenance after fracture-related infection / 中华创伤骨科杂志

Objective:To investigate the efficacy of internal fixation maintenance after fracture-related infection (FRI).Methods:Retrospectively analyzed were the data of 81 patients with deep FRI after 6 weeks of internal fixation who had been treated with hardware maintenance at Department of Orthopedics, The Second Hospital Affiliated to School of Medicine, Zhejiang University between 2013 and 2021. They were 61 males and 20 females, aged from 11 to 73 years (average, 11 years). After admission, the patients received bacterial culture, thorough debridement, negative pressure suction, soft tissue repair, and local and intravenous antibiotics. If a joint was affected by FRI, its cavity was cleaned and drained. Infection control and fracture healing were regularly observed in all patients. A treatment was considered successful when the internal fixation was maintained until fracture union, and considered as unsuccessful when the internal fixation was removed before fracture union. Risk factors associated with treatment failure were identified from gender, age, smoking, diabetes, fracture type, methicillin-resistant Staphylococcus aureus (MRSA) infection, methicillin-susceptible staphylococcus (MSSA) infection, Pseudomonas aeruginosa infection, Escherichia coli infection, infection by two kinds of bacteria, negative bacterial culture, early infection (within 2 weeks) and local use of antibiotics.Results:All patients were followed up for an average of 30 months (from 6 to 84 months). Fracture union was achieved in 62 (76.5%) patients with infection control and internal fixation retained. Masquelet technique was used to treat bone defects in 2 patients; a muscle flap or skin flap was used to reconstruct soft tissue coverage in 11 cases; fracture union was achieved by antibiotics and dressing changes in 2 patients with sinus tract. Amputation was performed in one unsuccessful case due to uncontrollable infection, and internal fixation was changed to external fixation in the other 18 unsuccessful cases, of which 3 achieved final bone union after application of Masquelet technique, 7 achieved final bone union after application of bone transfer technique, and 3 achieved soft tissue coverage after reconstruction with flap technique. Pseudomonas aeruginosa infection, open fractures and FRI for more than 2 weeks were high risk factors for failure in internal fixation maintenance ( P<0.05). Conclusions:If internal fixation is still stable and effective, hardware maintenance should be tried first in the patients with FRI within 6 weeks after fracture internal fixation. Muscle flap or skin flap surgery should be performed as soon as possible to effectively control infection and promote fracture union in the patients with soft tissue defects after thorough and effective debridement. History of open fracture, Pseudomonas aeruginosa infection, and FRI for over 2 weeks may be risk factors for failure in internal fixation maintenance.

Analysis of unknown-origin fever after simultaneous pancreas-kidney transplantation / 中华器官移植杂志

Objective:To explore the clinical features, etiologies and outcomes of unknown origin fever after simultaneous pancreas-kidney transplantation(SPK).Methods:From March 2015 to January 2020, clinical data were retrospectively reviewed for 120 SPK recipients.According to the definite evidence of fever, such as microbial culture, imaging findings or rejection, they were divided into three groups of free-fever(FF, n=41)and defined-fever(DF, n=47)and fever of unknown origin(FUO, n=32). The differences in general clinical features, surgical complications, laboratory tests and prognoses were compared.Logistic regression was employed for analyzing the risk factors of FUO and Kapla-Meier for survival analysis.And P<0.05 was deemed as statistically significant. Results:Multivariate analysis revealed that preoperative diabetic gastroenteropathy was an independent risk factor for unexplained fever.Significant differences existed between FUO and DF groups in leucocyte count[6.50(5.13, 7.36)vs.10.36(6.11, 12.97)×10 9/L], C-reactive protein(CRP)[11.75(6.25, 16.85)vs.35.00(16.30, 75.00)μg/ml], procalcitonin[0.13(0.06, 0.18)vs.0.19(0.11, 1.05)ng/ml]( P<0.001, P<0.001, P=0.025). As compared with DF group, 19 recipients in FUO group only received 1-2 antibiotics and there was a shorter course of treatment[13(40.6%)vs.32(68.1%), P=0.016]. For 6(18.7%)recipients after a diagnosis of FUO, clinical outcome was achieved with only NSAIDs.Length of stay was(48.72±19.51)days in FUO group versus(57.36±27.46)days in DF group and the difference was statistically significant( P<0.001). Hospitalization expenses of two groups were 253 463.25 and 334 605.96 yuan respectively and the difference was also statistically significant( P=0.002). Conclusions:Diabetic gastroenteropathy is an independent risk factor for early FUO after SPK transplantation.Inflammatory markers of leukocytes, CRP and procalcitonin in FUO patients are significantly lower than DF group.And these clinical features can help diagnose FUO in an early stage.

Tissue-engineered cartilage nanoscaffolds prepared with collagen, hyaluronic acid and chondroitin sulfate / 中华医学美学美容杂志

Objective:To explore the possibility of constructing tissue-engineered cartilage three-dimensional nanoscaffolds with collagen Ⅱ (COLⅡ), hyaluronic acid (HA) and chondroitin sulfate (CS).Methods:The tissue-engineered cartilage scaffolds were prepared by electrospinning techniques with the mixture COLⅡ-HA-CS solvent, which dissolved by 3-trifluoroethanol-water. The surface topography was observed under electron microscope (SEM). And the diameter of nanofibers, the water absorption rate, contact angle and degradation rate were also detected. Generation 2 rabbit chondrocytes were seeded into the scaffold. The cell survival rate and proliferation were evaluated by Cell Counting Kit-8.Results:When the concentration range of electrospinning was 80-120 mg/ml and the mixing ratio of Col, HA and CS was 6-8∶1∶1-2, the tissue engineered cartilage nanoscaffolds could be successfully prepared. Their diameters were mainly distributed between 126.5±23.3 nm and 374.7±14.1 nm. The scaffolds had satisfactory hydrophilicity and degradability. The chondrocytes could well adhere and proliferate on the scaffold.Conclusions:The COLⅡ-HA-CS tissue-engineered cartilage nanoscaffolds have good physical and biological properties, which suggests its promising application in tissue-engineered cartilage.

Risk factors of paralyticileus after simultaneous pancreas-kidney transplantation / 中华器官移植杂志

Objective:To explore the risk factors of paralytic ileus (PI) after simultaneous pancreas-kidney (SPK) transplantation.Methods:From January 2017 to December 2019, clinical data were reviewed retrospectively for 115 cases of SPK transplantation. The risk factors of PI after SPK were analyzed. According to the occurrence of PI, they were divided into two groups of occurrence and non-occurrence. One-way analysis of variance was utilized for analyzing such influencing factors as gender, age, body mass index (BMI), diabetic type, duration of diabetes, mode of dialysis, duration of dialysis, diabetic gastroenterology, history of open surgery, bowel preparation, operative duration, hemorrhagic volume, immunosuppressant and hypoproteinemia. Multivariate Logistic regression analysis was performed for screening the suspected risk factors.Results:Among them, 19 patients (16.5%) had PI. Univariate analysis showed that PI was associated with diabetic gastroenterology, operative duration, history of open surgery, no bowel preparation and hypoproteinemia ( P<0.05). Multivariate Logistic regression analysis revealed that the risk factors of PI after SPK included diabetic gastroenterology, operative duration time, history of open surgery and no bowel preparation ( P<0.05). Conclusions:Diabetic gastroenterology, operative duration, history of open surgery and no bowel preparation are risk factors for PI after SPK. Clinical interventions for the above factors are necessary.

Efficacy and safety of simultaneous pancreas-kidney transplantation in patients aged over 60 years / 中华器官移植杂志

Objective:To explore the efficacy and safety of simultaneous pancreas-kidney (SPK) transplantation in patients aged over 60 years.Methods:A retrospective analysis was performed for 150 SPK patients from January 1, 2013 to June 30, 2019. Based upon age, they were divided into three groups of ≥60 years ( n=21), 50-60 years ( n=44) and <50 years ( n=85). Clinical data of three groups were compared, including postoperative rejection, perioperative graft thrombosis, reoperative frequency, average hospitalization time and readmission ratio. And cardiocerebrovascular complications before/after-SPK, CMV viremia within 1 year post-SPK, fasting blood glucose, fasting C-peptide, fasting insulin level, HbA1c at 1 year post-SPK, glomerular filtration rate (eGFR) at 1 year post-SPK and survival rate of patient/graft were compared. Results:There were 21 cases in ≥60 years group, accounting for 14% of the total number of cases and the maximal age was 67 years. The proportion of preoperative cardiovascular events was 14.3%(3/21) in ≥60 years group, 34.1%(15/44) in 50-60 years group and 7.1%(6/85) in <50 years group. Statistical difference existed among three groups ( P=0.001). A pairwise comparison indicated that preoperative cardiovascular event in 50-60 years group was higher than that in <50-years group ( P=0.0006). The postoperative cardiovascular events in three groups were 4.8%, 4.5% and 2.4% respectively and there was no statistical difference ( P=0.537). The incidence of graft thrombosis in three groups was 2 cases (9.5%) in ≥60 years group, 1 case (2.3%) in 50-60 years group and 7 cases (8.2%) in <50 years group ( P=0.384). The proportion of reoperation in three groups was 14.3%, 18.3% and 18.8% respectively and there was no statistical difference ( P=0.889). The causes of death were cerebral hemorrhage ( n=2), myocardial infarction ( n=2) and tumor ( n=1); ≥ 60 years group ( n=1), 50-60 years group ( n=1) and <50 years group ( n=3). No significant difference existed among three groups ( P=0.842). There was no significant difference in average postoperative hospitalization time, readmission rate, postoperative rejection, postoperative 1-year CMV viremia, postoperative cerebrovascular events, postoperative 1-year fasting blood glucose, fasting C-peptide, fasting insulin level, HbA1c, postoperative 1-year eGFR or patient/graft survival rate among three groups. Conclusions:Through strict preoperative evaluations, SPK for patients aged over 60 years increases no operative risk and achieves the same outcome.

Discussion on primary public health service and rural doctors' team construction / 上海预防医学

In China, rural doctors and primary health institutions take important responsibilities as the basic of public health system.They play the fundamental role in the construction of public health system in the rural area. However, primary public health is facing the challenge of poor infrastructure, weak human resources, and inefficient services in most areas. We employed field investigation and literature review to identify major problems on the implementation of primary health service and the development of rural doctors' team. The recommendation in this study might provide scientific evidence to improve the construction of public health system and policy-making in rural area in China.

Effects on Elbow Stability of the Terrible Triad Using Medial Collateral Ligament Repair and Ulnar Coronoid Process Fixation / 医用生物力学

Objective To investigate the effect of medial collateral ligament (MCL) repair and coronoid process fracture fixation on stability of the Terrible Triad of the elbow. Methods CT and MRI scan images of elbow joints from one healthy 28-year-old male volunteer were used to establish three elbow models. Model A: normal model. Model B: repair of coronoid process fractures, without MCL repair. Model C: repair of MCL, without repair of ulnar coronoid processes. Longitudinal loads were applied on the three models to analyze the displacement and stress distributions of the elbow joint under different working conditions and compare the stability of the elbow joint. Results The displacement and stress distributions of the three models were similar. The maximum displacement and maximum stress of the articular surface were located at the ulna pulley notch, while the minimum displacement was located at the coronoid process and its medial side. The minimum stress was located at the lower lateral side of the coronoid process. There were no statistical differences in the maximum displacement and stress among the three models (P>0.05). Conclusions When the lateral column is stable, the effect of repairing the MCL and fixing the fracture block of ulnar coronoid process is similar.

Several suggestions on the classification management process and countermeasures of pulmonary surgery during the COVID-19 / 中华胸心血管外科杂志

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

Video essentials of thoracolaparoscopy combined with esophagectomy / 中国胸心血管外科临床杂志

@#（正）Luketich 等[1]2000 年首次报道了胸腹腔镜联合食管癌微创手术（minimally invasive esophagectomy， MIE）病例。随着近 10 多年的发展，食管癌微创外科已经进入一个技术成熟的阶段，能使广大食管癌患者受益。2009 年美国国立综合癌症网络（NCCN）临床指南[2]已将 MIE 列为标准食管癌术式之一。

Reoperation strategy of malunited tibial plateau fracture / 中华骨科杂志

Objective@#To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect.@*Methods@#From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were collected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and internal fixation. If the patient was older (>65 years old) or with severe local bone defect, total knee arthroplasty should be performed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the original fracture line osteotomy; 2. the tibial tubercle + original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy.@*Results@#All patients were followed up for 12-30 months (average 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the original internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 patients underwent fibular head osteotomy+ original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow-up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (average 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post-operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm collapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infection of the wound surface after operation.@*Conclusion@#It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different characteristics of the tibial plateau fracture malunion of the patients.

Expression of cystatin A in esophageal squamous cell carcinoma and its clinical significance / 国际生物医学工程杂志

Objective To investigate the expression and clinical significance of cysteine protease inhibitor A(CSTA) in esophageal squamous cell carcinoma. Methods A total of 59 patients with esophageal cancer who underwent esophagectomy or endoscopic submucosal tumor dissection were enrolled. The esophageal squamous cell carcinoma and normal esophageal tissues were collected and clinical pathological data were collected. The expression of CSTA mRNA and protein in cancer tissues and normal tissues was determined by real-time quantitative fluorescent polymerase chain reaction (RTFQ-PCR) and immunohistochemistry. The expressions of CSTA and Ki-67 mRNA and protein in cancer tissues and normal tissues were determined by RTFQ-PCR and Western Blot. Results Compared with normal, the expression of CSTA mRNA and protein in esophageal squamous cell carcinoma tissues was significantly lower, and the difference was statistically significant (all P<0.05). In squamous cell carcinoma, the CSTA-positive expression is often associated with Ki-67 expression, whereas normal esophageal tissue has CSTA expression but no Ki-67 expression. Squamous cell carcinoma with CSTA-positive expression had higher tumor pT stage and tumor grade (all P<0.05). Conclusions The expression of CSTA in cancer tissues of patients with esophageal squamous cell carcinoma is significantly lower than that in normal tissues. The CSTA-positive expression in esophageal squamous cell carcinoma is related to the pT clasification and tumor grade. The CSTA test for esophageal squamous cell carcinoma can provide a basis for clinical treatment.

Modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with fracture / 中国骨伤

OBJECTIVE@#To study clinical effects of modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with proximal humeral fracture which area of femoral head injury less than 40%.@*METHODS@#From July 2012 to June 2017, 7 patients with posterior shoulder dislocation were treated, including 5 males and 2 females; aged from 37 to 53 years old. Three patients combined with split of humerus head and 4 patients combined with humerus surgical neck fracture. All patients treated with modified Mclaughlin procedure combined with locking plate. Motion of shoulder joint after operation was observed, postoperative UCLA score was used to evaluate clinical effects.@*RESULTS@#Seven patients were followed up from 10 to 33 months. The motion of anteflexion and up-lift ranged from 130° to 170°, the motion of extorsion ranged from 45° to 75°, the motion of abduction ranged fron 105° to 150°, and the internal rotation was between L₃ to buttock. UCLA score ranged from 29 to 34; and 1 patient reached excellent, and 6 patients good.@*CONCLUSIONS@#The modified Mclaughlin procedure combined with locking plate showed satisfying result for posterior shoulder dislocation combined with fractures. However, the internal rotation of shoulder could be compromised.

MRTF-A Regulates the Proliferation and Migration of Non-small Cell Lung Cancer Cells of A549 through HOTAIR / 中国肺癌杂志

BACKGROUND@#Non-small cell lung cancer (NSCLC) is a kind of lung cancer, because its high incidence has been concerned. Therefore, it has great significance to reveal the pathogenesis of NSCLC. As a transcriptional regulatory factor, MATF-A plays an important role in the development of multiple tumors, can regulate the migration process of a variety of tumor cells. HOTAIR is a long non-coding RNA (LncRNA) found in recent years, which expresses abnormally in multiple tumors and is involved in the proliferation and migration of multiple tumors. The aim of this study is to explore the role of MRTF-A through HOTAIR to regulate the proliferation and migration of NSCLC cell A549 cell.@*METHODS@#We constructed the overexpression plasmid and interfering plasmid of MRTF-A, and detected the effect of MRTF-A on the proliferation and migration of A549 cells by CCK8 and wound healing methods respectively. Then, we designed the siRNA of HOTAIR to detect its effect on the proliferation and migration of A549 cells. Through qRT-PCR, we detected the effect of MRTF-A on HOTAIR expression. Finally, we constructed HOTAIR's promoter, and detect the effect of MRTF-A on HOTAIR promoter activity by luciferase reporter gene test.@*RESULTS@#Overexpression of MRTF-A promotes the proliferation and migration of A549 cells, while silent MRTF-A inhibits its proliferation and migration. Next, we found that interfered HOTAIR expression inhibited the proliferation of A549 cells. We found that MRTF-A could influence the expression of HOTAIR and regulate the activity of HOTAIR promoter.@*CONCLUSIONS@#MRTF-A regulates the proliferation and migration of A549 cell through HOTAIR.

A retrospective study ofsimultaneous pancreas-kidney transplantation from a single-center experience / 中华器官移植杂志

Objective To explore the surgical indications for pancreas-kidney surgery and summarize the experiences of ,selecting surgical approaches ,formulating immunosuppressive regimens and preventing complications .Methods A total of 145 donor simultaneous pancreas-kidney transplants in uremic patients with T1DM/T2DM between 2002 and 2018 were retrospectively analyzed .Based upon surgical approaches and immunosuppressive agents ,they were divided into three eras of 2002-2010 ,2011-2014 and 2015-2018 respectively .Patient profiles ,survival outcomes of patient and graft , surgical techniques ,immunosuppressive agents and incidence of common complications were compared among different groups .Results The overall 1/3/5-year patient and graft survival rates of three groups were above 75％ and the survival rates of group Ⅰ were inferior to those of groups Ⅱ and Ⅲ(P<0 .001) .The overall 1/3/5-year pancreas graft survival rates were the highest in group Ⅲ and the lowest in group Ⅱ (P=0 .004) .In the 2015-2018 group ,ipsilateral pancreas-kidney transplantation and SE-ED surgery were more preferred .Regarding the incidence of complications ,graft thrombosis frequently occurred from 2011 to 2014 and intestinal obstruction was more common from 2002 to 2010 .For univariable analysis of graft loss ,anticoagulation programme with argatroban monohydrate were 0 .28 times likely to lose pancreas graft (OR= 0 .28 ,95％ CI:0 .09-0 .86) and T1DM patients were 4 times likely to have kidney graft loss (OR=4 .08 ,95％ CI:1 .37-12 .15) .Conclusions SPK is an effective treatment for uremic diabetics . Effective perioperative management and preventing complications are crucial for prolonging patient and graft survivals .

Value of cell-bound complement activation products in the diagnosis of systemic lupus erythematosus / 临床检验杂志

Objective@#To investigate the values of T lymphocyte-bound complement activation products such as T-C3d and T-C4d, B lymphocyte-bound complement activation products such as B-C3d and B-C4d and erythrocyte-bound complement activation products such as E-C3d and E-C4d in the diagnosis of systemic lupus erythematosus (SLE). @*Methods@#Peripheral blood samples from 68 SLE patients, 70 patients with non-SLE autoimmune diseases and 68 healthy controls were collected randomly, and the expression levels of T-C4d, B-C4d, E-C4d, T-C3d, B-C3d and E-C3d in these samples were detected by flow cytometry. Meanwhile, antinuclear antibodies (ANA), anti-double stranded DNA antibodies (anti-dsDNA), peripheral blood cell count and other markers were also detected. The differences of cell-bound complement activation products in three groups were analyzed with the area under the receiver operating characteristic curve (AUC), nonparametric test, sensitivity and specificity. @*Results@#The specific median fluorescence intensity (SMFI) of T-C4d, B-C4d, E-C4d, T-C3d, B-C3d and E-C3d in SLE patients were significantly higher than those in the patients with non-SLE autoimmune diseases and healthy controls (all P＜0.05). The SMFI (median \[P 25, P 75\]) of T-C4d, B-C4d and E-C4d in SLE patients were 3.8(1.2, 13.1), 22.1(6.2, 67.9) and 19.6(1.8, 52.4), respectively. The SMFI of T-C4d, B-C4d and E-C4d in SLE patients with reduced red blood cells and/or lymphocytes were significantly higher than that with normal red blood cell and lymphocyte count (all P＜0.05). The AUCs of T-C4d, B-C4d, E-C4d, T-C3d, B-C3d and E-C3d were 0.711, 0.763, 0.663, 0.631, 0.611 and 0.615, respectively (all P＜0.05). The sensitivity of the combination of T-C4d with B-C4d (73.5%) in the diagnosis of SLE was superior to that of anti-dsDNA (36.8%). @*Conclusion@#The cell-bound complement activation products (CB-CAPs) are specifically expressed in SLE patients, and their combination detection is helpful for the diagnosis of SLE.

Reoperation strategy of malunited tibial plateau fracture / 中华骨科杂志

Objective To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect. Methods From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were col?lected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and in?ternal fixation. If the patient was older (＞65 years old) or with severe local bone defect, total knee arthroplasty should be per?formed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the origi?nal fracture line osteotomy; 2. the tibial tubercle+original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy. Results All patients were followed up for 12-30 months (aver?age 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the origi?nal internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 pa?tients underwent fibular head osteotomy+original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow?up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (aver?age 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post?operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm col?lapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infec?tion of the wound surface after operation. Conclusion It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different charac?teristics of the tibial plateau fracture malunion of the patients.

Effect of RNA interference on WD101 gene of Schistosoma japonicum

Objective:To study the effect of RNA interference (RNAi) on WD101 gene and its effect on the expression of WD101 mRNA and protein in Schistosoma japonicum.Methods:Double-stranded RNA (dsRNA) WD101 gene and control gene (lacZ) were generated by in vitro transcription and transfected into mechanically transformed schistosomula. The total RNA and protein were isolated simultaneously using TRIzol reagent. The expression levels of mRNA and the protein were determined by quantitative real-time PCR (qPCR) and Western blotting, respectively. After injected dsRNA-electroporated schistosomula into BALB/c mouse six weeks, the male and female reproductive organs were observed and measured under the confocal laser scanning microscope.Results:After 1, 3 and 5 d of RNAi, WD101 mRNA level was decreased by 15%, 39%, and 58% in experiment group compared to that in control group; meanwhile, WD101 protein level was decreased by 11%, 28%, and 43% in experiment group compared to that in control group. There were significantly more sperms in testicular lobes in experiment group than that in control group, while there were no significant differences in terms of ovary and vitelline glands between two groups.Conclusions:The dsWD101-RNAi can effectively induce suppression of WD101 gene expression at both mRNA and protein levels. WD101 gene might be a reproduction-related gene in Schistosoma japonicum.

Risk factors of new-onset diabetes among senior public officials in Chengdu / 中华全科医师杂志

The consecutive data of 822 senior public officials in Chengdu undergoing health checkup from 2011 to 2016 were retrospectively reviewed.Among them,56 new cases of diabetes was diagnosed with a cumulative incidence of 6.81％.Fifty six age-and sex-matched healthy subjects served as controls,the risk factors of new-onset diabetes were analyzed with multivariate logistic regression.The results showed that BMI (OR =1.82,95％ CI:1.27-2.59,P =0.00) and fasting plasma glucose (OR =13.63,95％ CI:2.71-68.43,P =0.00) were independent risk factors of new-onset diabetes in senior public officials.

Extended anterolateral approach for thetreatment of tibial plateau fractures with posterolateral bone fragment / 中华骨科杂志

Objective To investigate the differences and clinical effects of extended anterolateral approach in the treatment of simple/complex tibial plateau fractures with posterolateral bone fragment.Methods From January 2013 to December 2015,forty-six patients with posterolateral tibial plateau fractures treated in our hospital were included in our research.The posterolateral plateau fractures were reduced and fixed by the extended anterolateral approach.According to Schatzker fracture classification,patients with type Ⅱ fractures were treated as simple group and patients with type Ⅴ and type Ⅵ fractures were treated as complex group.According to tibial plateau three column classification,patients were divided into single column group,double column group and three column group.The operative time,bleeding volume,fracture healing time,postoperative Rasmussen score,knee mobility,reduction and fixation of fractures and postoperative complications were compared among the groups.Results All 46 patients were followed up for 23-45 months,with an average of 31.9 months.There were 24 cases in simple fracture group and 22 cases in complex fracture group.The mean operation time of simple group was 124±33.8 min,and that of complex group was 175±65.5 min,with significant difference (t=2.302,P=0.025);the mean bleeding volume of simple group was 118±93.5 ml,and that of complex group was 190± 149.4 ml,with significant difference (t=1.905,P=0.028).12 cases were treated with arthroscopy.Bone union was achieved in all patients at the last follow-up,and daily activities were not limited.The average healing time was 4.58 months in simple group and 5.54 months in complex group.The excellent rate of fracture reduction was 83.3％ in simple group and 27.3％ in complex group (x2=14.679,P=0.000).Posterolateral bone fragment was not completely fixed in 4 cases (16.7％) in simple group and 8 cases (36.4％) in complex group.The average Rasmussen function score was 26.8±2.1 and the range of motion of knee joint was 100°-120° (average 115.5°±6.2°) in simple group;The average Rasmussen function score was 23.5±3.4 points and the range of motion of knee joint was 95°-115° (average 106.3°±7.4°) in complex group,neither with no significant differences.According to the three-column fracture classification system,there were 6 cases in the single-column group,24 cases in the double-column group and 16 cases in the three-column group.There were significant differences in the operative time (F=5.039,P=0.000),bleeding volume (F=5.215,P=0.000) and the excellent rate of fracture reduction (x2=7.003,P=0.030) between these three groups.But there was no significant difference in the time of fracture healing,un-fixation rate of posterolateral bone fragment,knee joint Rasmussen score and knee jointactivity.The excellent rate of fracture reduction was 83.3％ in arthroscopy assisted cases and 47.1％ in arthroscopy un-assisted cases respectively (x2=4.749,P=0.002).Postoperative wound infection occurred in 1 patient.Conclusion Extended anterolateral approach could provide good reduction and fixation of tibial plateau fractures with posterolateral bone fragment with satisfactory clinical outcomes obtained in both simple and complex fractures.The operation was relatively simple and posterolateral bone fracture could get better reduction and fixation in simple tibial plateau fractures,and arthroscopy treatment was helpful to improve fracture reduction.