Bioinformatics screening and analysis of key differentially expressed genes characteristics in nonalcoholic fatty liver disease / 中华肝脏病杂志

Objective: To screen and analyze the key differentially expressed genes characteristics in nonalcoholic fatty liver disease (NAFLD) with bioinformatics method. Methods: NAFLD-related expression matrix GSE89632 was downloaded from the GEO database. Limma package was used to screen differentially expressed genes (DEGs) in healthy, steatosis (SS), and nonalcoholic steatohepatitis (NASH) samples. WGCNA was used to analyze the output gene module. The intersection of module genes and differential genes was used to determine the differential genes characteristic, and then GO function and KEGG signaling pathway enrichment analysis were performed. The protein-protein interaction network (PPI) was constructed using the online website STRING and Cytoscape software, and the key (Hub) genes were screened. Finally, R software was used to analyze the receiver operating characteristic curve (ROC) of the Hub gene. Results: 92 differentially expressed genes characteristic were obtained through screening, which were mainly enriched in inflammatory response-related functions of "lipopolysaccharide response and molecular response of bacterial origin", as well as cancer signaling pathways of "proteoglycan in cancer" and "T-cell leukemia virus infection-related". 10 hub genes (FOS, CXCL8, SERPINE1, CYR61, THBS1, FOSL1, CCL2, MYC, SOCS3 and ATF3) had good diagnostic value. Conclusion: The differentially expressed hub genes among the 10 NAFLD disease-related characteristics obtained with bioinformatics analysis may become a diagnostic and prognostic marker and potential therapeutic target for NAFLD. However, further basic and clinical studies are needed to validate.

Clinical comprehensive evaluation of Mudan Granules in treatment of diabetic peripheral neuropathy with Qi-deficiency and collateral stagnation syndrome / 中国中药杂志

This study explored the clinical comprehensive evaluation of Mudan Granules, aiming to promote the safe, effective and rational use of Mudan Granules, reflect its clinical value and provide a basis for medical decision-making. The safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine of Mudan Granules were combed, and the multi-criteria decision analysis(MCDA) model was used to carry out comprehensive evaluation on each dimension. In terms of safety, multiple sources of evidence showed that the adverse reactions of Mudan Granules mainly involved gastrointestinal system, with controllable safety risk rated as grade B. In terms of effectiveness, Mudan Granules can significantly alleviate the diabetic peripheral neuropathy(Qi-deficiency and collateral stagnation syndrome), limb and trunk numbness, pain and sensory abnormalities and other clinical symptoms, exhibiting positive curative effect rated as grade A. In terms of economy, Mudan Granules combined with Mecobalamin and other conventional western medicines is economical compared with the western medicine alone group, which is supported by sufficient evidence and clear results, rated as grade B. In terms of innovation, Mudan Granules is the only Chinese patent medicine with the indication of benefiting Qi for activating blood circulation and dredging collaterals in the Medicine Catalogue for National Basic Medical Insurance, Industrial Injury Insurance, and Maternity Insurance. It has important clinical innovation and is evaluated as grade A. In the aspect of suitability, Mudan Granules has good suitability in ADR treatment, drug characteristics and usage, and is rated as grade B. In terms of accessibility, Mudan Granules has the price level comparable to that of similar drugs, with good affordability. The resources of medicinal materials for the preparation of Mudan Granules are abundant and available, which is rated grade B. Moreover, Mudan Granules, as a hospital preparation with both functions of tonification and purgation, reflects the combination between syndrome differentiation and disease differentiation as well as the combination between overall and local characteristics, and has prominent Chinese medicine features. According to the above dimensions, we suggest to classify Mudan Granules as a class A preparation which can be directly included the policy results of basic clinical drug administration.

Report standards for clinical comprehensive evaluation of Chinese patent medicine / 中国中药杂志

The clinical comprehensive evaluation of drugs is an important basis for the return of clinical value, decision-making of medical and health authorities, and allocation of medical resources. In July 2021, the National Health Commission issued the Guidelines for the Management of Clinical Comprehensive Evaluation of Drugs(trial version 2021), which required the evaluation to be implemented from the six dimensions(safety, effectiveness, economy, innovation, suitability, and accessibility), and made detailed arrangements for the clinical comprehensive evaluation of drugs. As Chinese patent medicine differs from chemical medicines in terms of effective components and action modes, the clinical comprehensive evaluation of Chinese patent medicine should highlight the characteristics and advantages of traditional Chinese medicine(TCM) on the basis of general requirements of comprehensive clinical evaluation of drugs. At present, in the clinical comprehensive evaluation of Chinese patent medicine, unified report standards have not yet been generated, resulting in the uneven quality of existing reports. To standardize the clinical comprehensive evaluation report of Chinese patent medicine and improve its quality, the editorial team, based on the relevant policy documents of clinical comprehensive evaluation of drugs, formulated the clinical comprehensive evaluation report standards for Chinese patent medicine in combination with the previous practice and expert opinions. The report standards, containing seven sections with 15 items determined, focus on data source, evaluation content, evidence synthesis, quality control, and evaluation results supported with detailed interpretations to help researchers better understand and apply the report standards for clinical comprehensive evaluation of Chinese patent medicine, improve the report quality, and provide references for the decision-making by the national medical management authorities.

Pregnancy outcomes among women with high and low risk in first and second trimester prenatal screening analysis / 预防医学

Objective To analyze adverse pregnancy outcomes among women with high risk and low risk during prenatal screening. Methods Clinical data of 180006 pregnancies in 5 prenatal screening center in Hangzhou were collected. We compared the adverse pregnancy outcomes of high and low risk pregnancies. Results Among 180006 pregnancies (age<35 years old), there were 10296 high-risk cases and 169710 low-risk cases, with 168654 cases followed. There were 9406 high-risk cases of Down's syndrome (DS) (5.23％), 273 high-risk cases of Edwards' syndrome (ES) (0.15％) and 617 high-risk cases of open neural tube defect (ONTD) (0.34％) . The detection rate of pregnancy outcome of premature birth, spontaneous abortion, termination of pregnancy, stillbirth in the high risk was 5.46％, 0.80％, 1.80％, 0.37％, respectively, and that rate in low risk results was 3.50％, 0.21％, 0.38％, 0.18％, respectively. Adverse pregnancy outcomes in high-risk group were significantly higher than that in low-risk group (all P<0.001) . The actual incidence rate of DS, ES or ONTD in high-risk group (4.56‰, 1.65‰, 0.97‰, respectively) were significantly higher than that in low-risk group (0.12‰, 0.04‰, 0.09‰, respectively, all P<0.001) . The detection rates of prenatal screening were 70.15％, 68.00％ and 38.46％, and false positive rates were 5.23％ , 0.14％ and 0.34％ . Conclusion High risk of serum prenatal screening analysis is associated with adverse pregnancy outcomes. The number of pregnancies experienced invasive prenatal diagnosis can be reduced by routine serum prenatal screening. That is an Effective method to reduce the birth defects.

Correlation analysis between plasma D-dimer levels and orthopedic trauma severity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The correlation between the plasma D-dimer level and deep vein thrombosis has not been conclusive in various studies. The aim of this research was to study the relationship between plasma D-dimer levels and the severity of orthopedic trauma by retrospective examination of orthopedic trauma cases.</p><p><b>METHODS</b>Clinically acute trauma and non-acute trauma patients were selected and their plasma D-dimer levels were measured. Plasma D-dimer levels in patients of these two groups were compared. The relationship between the plasma D-dimer level and the severity of the trauma was also studied.</p><p><b>RESULTS</b>There were 548 cases in the acute trauma group and 501 cases in the non-acute trauma group. The levels of plasma D-dimer were significantly higher in the acute trauma group than in the non-acute trauma group (P < 0.01). In the acute trauma group, the correlation between the D-dimer level and the number of fractures was a positive linear correlation (r = 0.9532).</p><p><b>CONCLUSIONS</b>Elevated plasma D-dimer is common in trauma patients. The D-dimer level and the number of fractures in the trauma patients are closely correlated. D-dimer is not only an indicator for the diagnosis of deep vein thrombosis and pulmonary embolus, but also an indicator of the severity of trauma in acute trauma patients.</p>

microRNA expression in childhood acute granulocytic leukemia and its subtypes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Recent studies have suggested that there is a close relation between microRNA and acute leukemia (AL). The aim of this study was to investigate and better understand the classification and diagnosis of AL as well as pathogenesis and prognosis of this disease.</p><p><b>METHODS</b>A total of 93 children with AL and and 12 cases of idiopathic thrombocytopenic purpura (as control group) were enrolled in this study. Microarray chip analysis of their bone marrow samples was conducted to evaluate the microRNA profiles. Quantitative real-time PCR was performed for validating the abnormal expression of microRNA.</p><p><b>RESULTS</b>The microRNA expression profiles were different between acute granulocytic leukemia and acute lymphoblastic leukemia and also between the three subtypes (M1, M2 and M3) of acute granulocytic leukemia according to FAB classification based on leukemic cell differentiation. These three subtypes of leukemia could be identified by unsupervised hierarchical cluster analysis of microRNA expression and had specific up-regulation of miR-335, miR-126 and miR-125b, respectively. However, in the M2 and M3 subtypes with positive AML1-ETO and PML-RARα, respectively, which have a better prognosis, the expressions of miR-126 and miR-125b were significantly higher than those with negative AML1-ETO and PML-RARα. Further more, miR-335 and miR-146 were up-regulated in acute granulocytic leukemia observed in this study, which are different from those reported for adult patients.</p><p><b>CONCLUSIONS</b>microRNA cascade may serve as new biomarkers for the classification and diagnosis of pediatric AL. It is also suggested that there might be different pathogenesis and prognosis between AL types related to specific expression and regulation of microRNA.</p>

Semi-constrained total elbow arthroplasty for the treatment of the elbow disorders / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively review the results of Coonrad-Morrey semi-constrained total elbow arthroplasty (TEA) for the treatment of different elbow disorders.</p><p><b>METHODS</b>Between December 2003 and April 2008, 30 patients with different kinds of elbow disorders including elbow fracture, non-healing elbow fracture, rheumatoid arthritis and osteoarthritis were treated with TEA using the semi-constrained Coonrad-Morrey elbow replacement prostheses. One patient had bilateral total elbow replacements. There were 22 females and 8 males, with a mean age of 66 years (47 to 78).</p><p><b>RESULTS</b>Twenty patients (21 elbows) were available for review. The average length of follow-up was 35 months (from 12 to 52 months). The mean Mayo elbow performance score was 84 points. Excellent results were achieved in 6 elbows (28%), 11 elbows had good outcome (52%), 2 elbows had improvement (10%), while the other 2 elbows had no improvement (10%). The 2 elbows with distal humeral fractures, had no pain after treatment but developed heterotopic ossification, which caused stiffness and lower the Mayo elbow performance score. One delayed healing of the wound, one patient experienced temporary radial nerve hypesthesia and one elbow showed transparent region around the implant without radiological sign of loosening in the implanted prostheses.</p><p><b>CONCLUSIONS</b>This study reveals good to excellent outcome with the use of semi-constrained TEA for the treatment of rheumatoid arthritis, elbow fracture, osteoarthritis and non-healing elbow fractures in elder patients. The non-healing elbow fractures in elder patients would accompany with severe osteoporosis and comminuted fracture, which would affect the result of open reduction internal fixation. So TEA may be one optimal treatment for these patients.</p>

Posterior monteggia fracture-dislocations of proximal ulna / 中华外科杂志

<p><b>OBJECTIVES</b>To discuss the diagnosis and differential diagnosis, and to establish an effective protocol to treat the posterior Monteggia fracture-dislocations of proximal ulna in adult according to our experience.</p><p><b>METHODS</b>Between April 2004 and December 2007, 16 patients with posterior Monteggia fracture-dislocations were treated surgically, 13 were followed up at a mean of 28 months (range, 12 - 58 months). All the operations were through the posterior midline approach. The fractures of radial head and coronoid process were reduced and fixed, if possible. The proximal ulna fractures were fixed with a single plate in 7 cases, plate combined with K-wires in 2, plate combined with K-wires tension band in 3, and K-wires tension band combined with screws in 1.</p><p><b>RESULTS</b>No elbow was painful or unstable at the last follow up examination. They had an average of 100 degrees (range, 0 degrees to 145 degrees ) of flexion-extension of elbow. The average motion of forearm rotation was 119 degrees (range, 0 degrees to 170 degrees ). The mean Mayo Elbow Performance Score (MEPS) was 93.1 points (67 - 100 points), excellent and good results were achieved in 92.3%. The mean system of Broberg and Morrey score was 88.8 points (53 - 100 points), excellent and good results were achieved in 76.9%.</p><p><b>CONCLUSIONS</b>Attention should be paid to the diagnosis and differential diagnosis of the posterior Monteggia fracture-dislocation of proximal ulna. Anatomically reduction and stable fixation of proximal ulna is the keystone for the surgical treatment.</p>

Preliminary report of surgical treatment of post-traumatic stiff elbow / 中华外科杂志

<p><b>OBJECTIVE</b>To report the method and result of open arthrolysis of patients who suffered from severe post-traumatic elbow stiffness.</p><p><b>METHODS</b>Of the 12 patients, there were 9 male and 3 female, average age of 32 years old (16 - 47 years). Primary injury included 7 simple fractures, 1 simple dislocation, 2 fracture dislocations and 2 soft tissue injury. The averaged time of immobilization after injury was 3.3 weeks (0 - 8 weeks). The averaged time between injury and open arthrolysis was 6.4 months (1 - 14 months). Before open arthrolysis, the mean arc of total motion was 33.8 degrees (0 degrees - 80 degrees ). Three patients suffered from forearm rotation deficiency. Posterior approach was used for 4 patients, medial approach for 2 patients and both medial and lateral approach for 6 patients. tissues were resected, which hindered the motion of the elbow and perform proximal radioulnar joint arthrolysis for some patients. After arthrolysis, the arc of elbow motion could reach 0 degrees - 140 degrees , and for the patients who suffered from forearm rotation deficiency, pronation 80 degrees and supination 90 degrees were gotten. Ulnar nerve transposition was not a routine. The patients began active and active-assisted elbow and forearm movement the first day after operation. Indomethacin was taken the first day after open arthrolysis routinely.</p><p><b>RESULTS</b>Twelve patients were followed up for 14 - 18 months (averaged 15.8 months). At the latest follow-up, the mean arc of total motion was 120.8 degrees (100 degrees - 140 degrees ). Nine patients recovered the functional arc of 30 degrees - 130 degrees , and 10 patients extended to less than 10 degrees , and 4 patients could extend to 0 degrees . As for the 3 patients who suffered forearm rotation deficiency, the forearm rotation improved. The mean Mayo elbow performance score was 70.4 (50 - 90) before open arthrolysis, and 98.8 (85 - 100) after open arthrolysis. No patient was found to have signs of heterotopic ossification.</p><p><b>CONCLUSIONS</b>For the treatment of post-traumatic stiff elbow, with careful open arthrolysis and early active and active-assisted exercise we can get good results.</p>

Computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails: a preliminary report on clinical application / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails.</p><p><b>METHODS</b>The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical localization cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330.</p><p><b>RESULTS</b>All distal holes except 1 were locked successfully. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23+/-0.31 s.</p><p><b>CONCLUSIONS</b>The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of X-ray exposure per procedure can be significantly reduced.</p>

Hinged external fixator in elbow trauma management / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce a new way of treatment for elbow stiffness and instability.</p><p><b>METHODS</b>30 cases of elbow trauma were treated with mobile hinged Orthofix elbow fixator, 26 of them were followed up. There are 15 male patients and 11 female patients. The average age is 32.6 years old. The 26 injured elbows involved 12 cases on left side and 14 cases on right side; Sixteen cases on the dominant side and 10 cases on the non-dominant side. Sixteen cases had elbow stiffness, 5 cases had acute radial head fracture and posterior dislocation of the elbow, 3 of cases had Monteggia's fracture dislocation, and 2 cases had neglected posterior dislocation of the elbow.</p><p><b>RESULTS</b>The average follow up time was 6 months (3 - 12 month). The mean time of fixation with fixator was 8.5 weeks (6 - 11 weeks). The mean ROM of the 16 cases of elbow stiffness was (37.5 +/- 0.8) degrees before operation, and (96.5 +/- 0.6) degrees operation, with a significant difference (P < 0.05). The mean Mayo elbow score was (69.5 +/- 1.7) before operation, compared with (82.8 +/- 1.6) after operation, with a significant difference (< 0.05). For the other 10 cases (5 cases with acute radial head fracture and posterior dislocation of the elbow, 3 cases with Monteggia's fracture dislocation, 2 cases with neglected posterior dislocation of the elbow), the average ROM of the elbow flexion-extension was 95 degrees (65 degrees - 150 degrees ); The average range of flexion was 117 degrees; the average loss of extension was 22 degrees; the average pronation was 76 degrees (20 degrees - 90 degrees ), the average supination was 75 degrees (15 degrees - 90 degrees ). Nine of the cases achieved anatomic reduction and proved by X-ray. The mean Mayo elbow score was 84 (49 - 96). Three cases were rated excellent, 4 good, 2 fair and 1 poor. The rate of excellent and good was 70% (7/10). Nine cases had no pain or mild pain, and did not need analgesic. Eight cases returned to their former work, 5 of the cases had complications.</p><p><b>CONCLUSIONS</b>The mobile hinged elbow external fixator have following advantages: (1) distraction of the articular space and enhance fracture healing; (2) allow early movement of the elbow during healing; (3) provide stable environment for the healing after arthrolysis and reconstruction. Mobile hinged elbow external fixator can achieve successful result in the treatment of elbow stiffness or unstable fracture dislocation of elbow.</p>

Design and experimental study of computer-assisted orthopaedic system for distal locking of intramedullary nails / 中华外科杂志

<p><b>OBJECTIVE</b>To test the safety and accuracy of the computer-assisted orthopaedic system for distal locking of intramedullary nails and apply it to internal fixation with intramedullary nails in the lower limb.</p><p><b>METHODS</b>According to the theory of mechanical arms stereotactic localization in computer-assisted orthopaedic surgery (CAOS), we design a CAOS system for distal locking of intramedullary nails. The system comprised 2 independent modules: computer-assisted imaging and registration workstation; mechanical stereotactic framework. Ten plastic tibia models, 20 plastic femur models (Synbone AG, Malans, Switzerland) and 6 human cadaver lower limbs were randomly divided into 2 groups undergoing internal fixation with intramedullary nails (Orthofix, Germany). The first group (CAOS group with 5 plastic tibia models, 10 plastic femur models, 6 human cadaver tibia, 6 human cadaver femur; each nail had 2 holes, and 2 distal locking screws were inserted in each bone, which gave a total number of 54 holes) used a computer-assisted orthopaedic system, the second group (CONTROL GROUP is the same as CAOS group) used Orthofix mechanical targeting device for distal locking. Comparison between 2 groups was made in radiation exposure time, operating time, percentage of correctly placed screws.</p><p><b>RESULTS</b>CAOS group: operating time was (4.44 +/- 2.99) min; radiation exposure time was (1.16 +/- 0.38) min; correctly placed screws rate was (100 +/- 0)%.</p><p><b>CONTROL GROUP</b>operating time was (10.42 +/- 4.18) min; radiation exposure time was (4.71 +/- 3.86) min; correctly placed screws rate was (94.44 +/- 0.36)%. Operating time and radiation exposure time in CAOS group were significantly shorter than those in control group (P < 0.05), no differences were found between 2 groups in relation to the percentage of correctly placed screws.</p><p><b>CONCLUSIONS</b>By using CAOS system for distal locking of intramedullary nails, the locking holes can be drilled accurately and safely. Radiation exposure significantly reduced.</p>