Common types and treatment of elbow injuries in skiing or snowboarding / 中华创伤骨科杂志

Objective:To investigate the common types of elbow joint injuries in skiing or snowboarding and their treatment.Methods:A retrospective study was conducted to analyze the data of 90 patients with elbow injury caused by skiing or snowboarding who had been admitted to Department of Upper Limbs, Sichuan Orthopaedic Hospital from February, 2015 to February, 2022. There were 53 males and 37 females with an age of (31.8±8.4) years. The types of elbow injury, visual analogue scale (VAS), range of motion (ROM) of the elbow and Mayo elbow performance score (MEPS) of the patients were recorded before treatment and at the last follow-up.Results:Of the patients, 18 were treated conservatively (3 simple Mason type I radial head fractures and 15 O'Driscoll type I coronal process fractures) and 72 surgically. Their follow-up time was (31.3±18.7) months. The fractures all healed by the time of the last follow-up. Simple elbow fracture was observed in 63 patients, simple elbow dislocation in 2 patients, fracture plus dislocation in 25 patients. The posterior dislocation was the most common (22 cases). Among the elbow fractures, radial head fracture occurred in 27 patients, ulnar coronoid process fracture in 41 patients, proximal ulnar fracture in 13 patients, and distal humeral fracture in 28 patients. Collateral ligament injuries were complicated in 65 cases. In the patients undergoing conservative treatment, their VAS, elbow ROM, and MEPS were all improved significantly from 4.7±1.4, 92.2°±14.4° and 63.9±6.5 before treatment to 0.4 (0,1.0), 110.6°±0.6°, and 92.2±3.9 at the last follow-up ( P<0.05); in the patients undergoing surgical treatment, their VAS, elbow ROM, and MEPS were also all improved significantly from 5.6±1.7, 24.3°±18.4°, and 26.9±12.2 before surgery to 0.6 (0,1.0), 97.4°±14.0° and 86.6±7.1 at the last follow-up ( P<0.05). After surgery, 8 patients presented with neurological symptoms and 7 patients developed heterotopic ossification. Conclusions:In skiing or snowboarding, the coronoid process of the ulna is the most vulnerable to fracture. In the elbow injuries due to skiing or snowboarding, posterior dislocation is the most common type which is often accompanied by injuries to the medial and lateral collateral ligaments. For simple Mason type Ⅰ radial head fractures and O'-Driscoll type Ⅰ coronoid process fractures in which the elbow is stable, conservative treatment can be adopted; surgical treatment is indicated for the other injuries.

Comparison of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part fractures of proximal humeral in the elderly / 中华骨科杂志

Objective:To compare the clinical effects of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part proximal humeral fractures in the elderly.Methods:The clinical data of 58 elderly patients with three- or four-part proximal humeral fractures treated with hemiarthroplasty or reverse shoulder arthroplasty from June 2014 to June 2020 were retrospectively analyzed. Among them, 46 cases were from Sichuan Provincial Orthopaedic Hospital (22 cases of hemiarthroplasty and 24 cases of reverse shoulder arthroplasty), and 12 cases were from Tianjin Hospital (5 cases of hemiarthroplasty and 7 cases of reverse shoulder arthroplasty). In the hemiarthroplasty group, there were 27 patients, including 7 males and 20 females, with an average age of 70.29±6.81 years (range, 61-87 years), and there were 10 cases of 3-part fractures and 17 cases of 4-part fractures. In the reverse shoulder arthroplasty group, including 9 males and 22 females, with an average age of 75.06 ±4.25 years (range, 67-86 years), and there were 9 cases of 3-part fractures and 22 cases of 4-part fractures. The postoperative efficacy evaluation indexes included visual analogue scale (VAS), range of motion (ROM), prosthesis upward displacement, healing of greater tuberosity, scapular glenoid notch, American Shoulder and Elbow Surgeons (ASES) and Constant-Murley score.Results:The average follow-up was 50.63±16.02 months (range, 24-75 months) in the hemiarthroplasty group and 28.32±11.93 months (range, 14-56 months) in the reverse shoulder arthroplasty group. The anterior elevation in the reverse shoulder arthroplasty group was 118.22°±27.22°, and those in the hemiarthroplasty group was 102.77°±25.88°, which was significant difference ( t=2.21, P=0.032); the results of external rotation (ER) and internal rotation (IR) in two groups were similar, and no significant difference (ER: t=0.57, P=0.616; IR: χ 2=2.61, P=0.273); the average Constant-Murley and ASES in the reverse shoulder arthroplasty group were significantly better than those in the hemiarthroplasty group ( P=0.019 and 0.018); the complication rates of hemiarthroplasty group and reverse shoulder arthroplasty group were 37% (10/27) and 13% (4/31), respectively (χ 2=4.59, P=0.032). In the hemiarthroplasty group, 6 patients had upward movements of the prosthesis and 2 patients had wear of the glenoid side; notching (sirveaux grade 1) was noted in 1 patient in the reverse shoulder arthroplasty group. Conclusion:In the treatment of three- or four-part proximal humeral fractures in the elderly, reverse shoulder arthroplasty achieves significantly better functional results compared to hemiarthroplasty.

Association study of single nucleotide polymorphisms of AQP7 and AQP9 genes with type 2 diabetes mellitus among ethnic Han Chinese population / 中华医学遗传学杂志

OBJECTIVE@#To assess the association of single nucleotide polymorphisms (SNP) of aquaporin 7 ( AQP7) and aquaporin 9 ( AQP9) genes and type 2 diabetes mellitus (T2DM) among ethnic Han Chinese population.@*METHODS@#A case-control study involving 1194 subjects with T2DM and 1274 non-diabetic mellitus (NDM) subjects were enrolled. Genotypes of three SNPs (rs3758269 of AQP7 gene, rs16939881 and rs57139208 of AQP9 gene) were determined by using a MassArray method. The association of the three SNPs with T2DM was assess, and the correlation of glucose and lipid metabolism parameters with various SNP genotypes in the NDM group was analyzed.@*RESULTS@#The allelic and genotypic frequencies of the three SNPs did not differ significantly between the two groups (P>0.05). Nor was there significant difference between the two groups with different genetic models (P>0.05). No significant association of genotypes of AQP7 gene rs3758269, AQP9 gene rs16939881 and rs57139208 with glucose and lipid metabolism parameters were observed in the NDM group (P>0.05).@*CONCLUSION@#The rs3758269 in AQP7 gene and rs16939881 and rs57139208 in AQP9 gene are not associated with the genetic susceptibility of T2DM among ethnic Han Chinese population.

Effect of dexmedetomidine on pyroptosis in mice with acute renal injury induced by endotoxin and the relationship with miRNA-223-3p / 中华麻醉学杂志

Objective:To evaluate the effect of dexmedetomidine on pyroptosis in mice with acute renal injury induced by endotoxin and the relationship with miRNA-223-3p.Methods:Thirty-two clean-grade healthy male ICR mice, aged 8-12 weeks, weighing 20-25 g, were divided into 4 groups ( n=8 each) using the random number table method: control group (group C), lipopolysaccharide (LPS) group (group L), LPS plus dexmedetomidine group (group LD), and LPS plus dexmedetomidine plus atipamezole group (group LDT). The model of acute renal injury induced by endotoxin was established by intraperitoneal injection of LPS 400 μg/kg, followed by intraperitoneal injection of LPS 10 mg/kg 8 h later.Dexmedetomidine 40 μg/kg was intraperitoneally injected once every 2 h for 3 times in total starting from 30 min after establishing the model in group LD.Atipamezole 750 μg/kg was intraperitoneally injected immediately after establishing the model, and 30 min later dexmedetomidine 40 μg/kg was intraperitoneally injected once every 2 h for 3 times in total in group LDT.The equal volume of normal saline was intraperitoneally injected in group C. Blood samples were collected from the heart at 24 h after establishing the model, and serum creatinine (Cr) and blood urea nitrogen (BUN) concentrations were measured with an automatic biochemical analyzer.The animals were sacrificed and the left kidney tissues were obtained for microscopic examination of pathological changes after HE staining (with a light microscope) and for determination of the expression of caspase-1 p20, NOD-like receptor thermoprotein structural domain-related protein 3 (NLRP3) and ASC protein and mRNA (by quantitative real-time polymerase chain reaction and Western blot), contents of interleukin-1beta (IL-1β) and IL-18 (by enzyme-linked immunosorbent assay), and rate of pyroptosis in renal cortical cells (by TUNEL). Results:Compared with group C, the concentrations of serum Cr and BUN were significantly increased, the expression of NLRP3, caspase-1 p20 and ASC protein and mRNA in the renal tissues was up-regulated, the contents of IL-1β and IL-18 were increased, the rate of pyroptosis in renal cortical cells was increased ( P<0.05), no significant change was found in the expression of miRNA-223-3p ( P>0.05), and pathological changes of kidney were accentuated in group L. Compared with group L, the concentrations of serum Cr and BUN were significantly decreased, the expression of NLRP3, caspase-1 p20 and ASC protein and mRNA in the renal tissues was down-regulated, the contents of IL-1β and IL-18 were decreased, the rate of pyroptosis in renal cortical cells was decreased, the expression of miRNA-223-3p was up-regulated ( P<0.05), and pathological changes of kidney were attenuated in group LD.Compared with group LD, the concentrations of serum Cr and BUN were significantly increased, the contents of IL-1β and IL-18 were increased, the expression of NLRP3, caspase-1 p20 and ASC protein and mRNA in the renal tissues was up-regulated, the rate of pyroptosis in renal cortical cells was increased, the expression of miRNA-223-3p was down-regulated ( P<0.05), and the pathological changes of kidney were accentuated in group LDT. Conclusion:The mechanism by which dexmedetomidine reduces acute renal injury may be related to up-regulating the expression of miRNA-223-3p and inhibiting pyroptosis in mice.

Clinical features and treatment of anterior shoulder dislocation complicated with fractures of glenoid and greater tuberosity / 中华创伤骨科杂志

Objective:To explore the clinical features and treatment of anterior shoulder dislocation complicated with fractures of glenoid and greater tuberosity (GT).Methods:From December 2013 to October 2019, 26 patients (27 shoulders) were treated at Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital by arthroscopy or open reduction and internal fixation (ORIF). They were 13 males and 13 females with a mean age of 49.1 years (range, from 22 to 71 years). By the Goss-Ideberg classification for glenoid fractures, there were 21 cases of type Ⅰa and 6 cases of type Ⅱ; by the Mutch classification for GT fractures, there were 3 cases of depression type, 6 cases of avulsion type and 18 cases of split type. At the last follow-up, visual analogue scale (VAS), Constant-Murley and American Shoulder & Elbow Surgeons (ASES) scores were used to evaluate the pain and function of the shoulder and the Rowe scores to assess shoulder stability.Results:In this cohort, the avulsion type accounted for 66.7% (18/27) of the GT fractures and the type of anterior glenoid rim for 77.8% (21/27) of the glenoid fractures. All the 26 patients (27 shoulders) were followed up for a mean period of 18.3 months (range, from 12 to 47 months). All fractures united after 6 to 17 weeks (mean, 11.6 weeks). At the last follow-up, anterior flexion and lifting averaged 155.6°, lateral external rotation 43.6°, and the internal rotation thumb touching the spinous process levels from L4 to T8. At the last follow-up, the Constant-Murley scores averaged 89.2, the ASES scores 88.9, the Rowe scores 94.5, and the VAS scores 0.3.Conclusions:In anterior shoulder dislocation complicated with fractures of glenoid and GT, the GT fractures are mainly the split type and the glenoid fractures mainly the type of anterior glenoid rim. Arthroscopy or ORIF can be used to repair rotator cuff tears and restore shoulder stability, leading to significantly improved shoulder function and satisfactory therapeutic outcomes.

Arthroscopic autologous scapular spine bone graft transplant for shoulder recurrent instability / 中华骨科杂志

Objective@#To investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability.@*Methods@#Data of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10%-15% from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed. There were 20 males and 7 females with an average age of 30.8 years old (range, 19-50). The bone loss of the glenoid was 10%-15%. The time between the first dislocation and the surgery was 24.1±15.8 months. The patients were treated with arthroscopic autologous scapular spine bone graft transplant. Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks, after that the passive motion was applied. Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months. Constant-Murley score and the Disabilities of Arm, Shoulder and Hand (DASH) score were used to evaluate the shoulder function, and visual analogue score (VAS) score was used to evaluate the degree of pain. Computed tomography scans were obtained one week post-operation and at the latest follow-up, from which the length, width, height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated. The subjective satisfaction degree of patients at the latest follow-up was also recorded.@*Results@#All 27 patients were followed up for 19.8 months (range, 13-39 months). No infection or neurovascular injury was identified. At the latest follow-up, the Constant-Murley score was 85.15±5.62 (range, 76-94), the DASH score 13.39±5.51 (range, 3.19-21.95) and the VAS score 1.29±0.45 (range, 1-2), thus all of those were improved significantly compared to those of pre-operation. At the latest follow-up, the anterior flexion was 153°±24°, lateral rotation by side 38°±21°, internal rotation 70°±21°, and abduction was 139°±18°. At the latest follow-up, the absorption rate of the bone graft was 46.1%±20.6% (range, 24.0%-71.7%). Among all the 27 patients, 19 patients considered the outcome as very good, and 6 patients considered as good, 2 patients fair.@*Conclusion@#Arthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10%-15%. This technique could achieve satisfactory clinical results, improve glenohumeral stability, decrease the re-dislocation rate.

Arthroscopic simplified double-pulley double row suture technique to fix the bigger glenoid anterior edge fracture / 中华骨科杂志

Objective@#To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture.@*Methods@#From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded.@*Results@#Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L3-T10 level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion.@*Conclusion@#The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results.

Arthroscopic autologous scapular spine bone graft transplant for shoulder recurrent instability / 中华骨科杂志

Objective To investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability.Methods Data of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10％-15％ from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed.There were 20 males and 7 females with an average age of 30.8 years old (range,19-50).The bone loss of the glenoid was 10％-15％.The time between the first dislocation and the surgery was 24.1±15.8 months.The patients were treated with arthroscopic autologous scapular spine bone graft transplant.Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks,after that the passive motion was applied.Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months.Constant-Murley score and the Disabilities of Arm,Shoulder and Hand (DASH) score were used to evaluate the shoulder function,and visual analogue score (VAS) score was used to evaluate the degree of pain.Computed tomography scans were obtained one week post-operation and at the latest follow-up,from which the length,width,height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated.The subjective satisfaction degree of patients at the latest follow-up was also recorded.Results All 27 patients were followed up for 19.8 months (range,13-39 months).No infection or neurovascular injury was identified.At the latest follow-up,the Constant-Murley score was 85.15±5.62 (range,76-94),the DASH score 13.39±5.51 (range,3.19-21.95) and the VAS score 1.29±0.45 (range,1-2),thus all of those were improved significantly compared to those of pre-operation.At the latest follow-up,the anterior flexion was 153°±24°,lateral rotation by side 38°±21°,internal rotation 70°±21°,and abduction was 139°± 18°.At the latest follow-up,the absorption rate of the bone graft was 46.1％±20.6％ (range,24.0％-71.7％).Among all the 27 patients,19 patients considered the outcome as very good,and 6 patients considered as good,2 patients fair.Conclusion Arthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10％-15％.This technique could achieve satisfactory clinical results,improve glenohumeral stability,decrease the re-dislocation rate.

Arthroscopic simplified double-pulley double row suture technique to fix the bigger glenoid anterior edge fracture / 中华骨科杂志

Objective To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ⅰa glenoid fracture.Methods From January 2014 to July 2017,data of patients with Ideberg Ⅰa glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed.Totally 24 patients were enrolled of whom 13 were males and 11 were females.The mean age was 50.14±10.60 years (range,34-67).In those patients,there were 8 cases of glenoid fracture alone,4 cases of glenoid fracture associated with greater tuberosity fracture,5 cases of glenoid fracture with rotator cuff tear,4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture,2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear,and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture.The fragment accounts for 28.91±5.35％ (range,25.1％-38.5％) of the glenoid articular surface.According to the size of the fragment,one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid;two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level,and simplified double-pulley technique was finally used to fix the fragment.The situation of fracture reduction and healing and the post-operative complications were evaluated.The Constant-Murley,DASH and VAS were also recorded.Results Satisfactory fracture reduction and fixation were achieved in all 24 patients.The mean followup time was 19.5 months (range,12-36).Mean VAS was 0.8±0.8 (range,0-2).The range of motion at the latest follow-up was:anterior flexion 145°-180° (mean,161.00°±5.77°),external rotation at the side 35°-60° (mean,46.43°±6.63°),internal rotation L3-T10 level.The mean Constant-Murley score was 88.1±3.7 (range,81-93),and mean DASH score was 8.4±4.7 (range,0-40.4).All cases except one showed no dislocation or disability of the shoulder.The CT scans showed:19 cases of which the step-off of articular surface was less than 2 mm;4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm.No severe osteoarthritis was identified at the latest follow-up,and only 1 patient at the age of 67 showed slight osteoarthritis.Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion.Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe,effective and reliable for treating the bigger Ideberg Ⅰa glenoid fracture.The technique is able to provide clear visulization of the fracture and achieve excellent clinical results.

Effect of early enteral nutrition and parenteral nutrition on the postoperative outcomes of patients with gastric cancer and nutritional riskin enhanced recovery after surgery / 中华临床营养杂志

Objective@#To explore the effect of early enteral nutrition(EEN) and parenteral nutrition(PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery.@*Methods@#A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen.The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups.@*Results@#The incidence of nutrition-related complications was 10 cases (15.38%) and 4 cases (6.15%)in EEN group and PN group, that was not statistically different (P=0.157). The incidence of infection-related complications was 3 cases (4.61%) and 5 cases (7.69%) in EEN group and PN group, that was not statistically different (P=0.715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13)in EEN group and PN group, that was not statistically different (P=0.233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours(range, 60-86) and 96 hours(range, 86-120) in PN group, that was statistically different(P=0.001, P=0.034).@*Conclusion@#Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.

Effect of standardized process management of early enteral nutrition after operation on rapid recovery of elderly patients with gastric cancer / 中华临床营养杂志

Objective To explore the clinical effect of applying standard process management in early enteral nutrition support for elderly patients with gastric cancer after operation. Methods A total of142 elderly patients with gastric cancer in our hospital were randomly divided into control group ( n=71) treated with the traditional nursing of enteral nutrition and intervention group ( n=71) adopting the standardized process man-agement, and then enteral nutrition tolerance, complications, nutritional status and recovery of gastrointestinal function were compared between the two groups. Results There was no significant difference in age, sex and preoperative nutritional condition and operation situation between the two groups ( P>0. 05) . The incidence of nutritional intolerance and the cost of nutritional support were lower than those in the control group ( P<0. 05) . The completion rate of enteral nutrition target in the intervention group was significantly higher than that in the control group ( P<0. 05) . The anal exsufflation time and defecation time of patients in the intervention group were shorter than those in the control group ( P<0. 05) . There was no significant difference in pulmonary infec-tion, incision infection and postoperative hospital stay between the two groups ( P>0. 05 ) . Conclusions Standardized process management of early enteral nutrition after operation could significantly improve the toler-ance of enteral nutrition, meanwhile, it has positive significance in promoting rapid recovery of elderly patients with gastric cancer.

Effect of early enteral nutrition and parenteral nutrition on the postoperative outcomes of patients with gastric cancer and nutritional riskin enhanced recovery after surgery / 中华临床营养杂志

Objective To explore the effect of early enteral nutrition (EEN) and parenteral nutrition (PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery. Methods A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen. The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups. Results The incidence of nutrition-related complications was 10 cases (15. 38％) and 4 cases (6. 15％) in EEN group and PN group, that was not statistically different (P = 0. 157). The incidence of infection-related complications was 3 cases (4. 61％) and 5 cases (7. 69％) in EEN group and PN group, that was not statistically different (P = 0. 715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13) in EEN group and PN group, that was not statistically different (P = 0. 233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours (range, 60-86) and 96 hours (range, 86-120) in PN group, that was statistically different (P=0. 001, P=0. 034). Conclusion Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.

Mid-term results of fixation of coronoid fractures via modified anterior elbow neurovascular interval approach / 中华骨科杂志

Objective To explore the efficacy and complication prevention of operative fixation of coronoid fractures via neurovascular interval of anterior elbow approach.Methods From March 2006 to September 2009,data of 21 patients with coronoid process fractures associated with complex elbow dislocation who were treated via neurovascular interval of anterior elbow approach in my ward were retrospectively analyzed.There were 14 males and 7 females.The mean age of the patients was 31.6 years (range,18-52 years).Injury was caused by walk falling in 10 cases,falling from standing-height in 3 cases and sports events in 8 cases;7 patients were left side and 14 patients were right side,including 16 prominent sides and 5 non-prominent sides.There were 3 type Ⅰa,3 type Ⅱa,8 type Ⅱb,4 type Ⅱc,3 type Ⅲa coronoid process fractures according to the O'Driscoll's classification.Pre-operative 3D-CT scans were conducted to clarify if there were subluxations or sign of instabilities in elbows.Operative fixation of coronoid process fractures with cannulated screws and/or mini plates and/or suture anchors were carried out via the anterior interval between humeral vessels and median nerve,and then lateral collateral ligaments were repaired if instability still existed.Results The average operation time was 72 min,and the follow-up time was 52-74 months.Only 1 case of type Ⅰa fracture got nonunion because of early postoperative activities from the first day after the operation and the elbow was fixed at 0 degree of extension with brace.At the latest follow-up,in suture anchor fixation group (3 cases),the average VAS was 1.8±0.5,Broberg-Morrey score 90.2±6.6,extension deficiency 11.2°±3.6°,flexion 133.4°±8.8°,and the excellent-good-rate was 66.7％ (2 cases excellent and 1 fair).In the screw-fixation group (10 cases),the average VAS was 1.6±0.8,Broberg-Morrey score 89.2±6.6,extension deficiency 15.2°±4.6°,flexion 130.8°±10.8°,and the excellent-good-rate was 90％ (6 cases excellent,3 good,and 1 fair).In the mini plate fixation group (8 cases),the average VAS score was 1.6±0.7,Broberg-Morrey score 88.6±6.7,extension deficiency 11.8°±5.6°,flexion 134.2°±8.6°,and the excellent-good-rate was 87.5％ (4 cases excellent,3 good,and 1 fair).In the lateral ligament repaired group (14 cases),the average VAS was 1.3±0.9,Broberg-Morrey score 91.5±6.3,extension deficiency 10.2°±3.4°,flexion 135.2°±4.2°,and the excellent-good-rate was 100％ (8 cases excellent,6 good).In the lateral ligament non-repaired group (7 cases),the average VAS was 2.2± 1.6,Broberg-Morrey score 80.2± 13.8,extension deficiency 13.6°±4.4°,flexion 126.6°±4.0°,and the excellent-good-rate was 71.4％ (3 cases excellent,2 good,1 fair).There were 5 cases which had early osteoarthritis changes in the elbow joint in 3 years' follow-up,with the incidence rate 23.8％ (5/21),and the incidence of mid-term osteoarthritis in the 5 and 7 years after operation was 4.8％ (1/21).Conclusion Operative fixation of coronoid fractures with suture anchor and/or cannulated screw and/or mini plate via neurovascular interval of anterior elbow approach was confirmed to be efficient and safe.Lateral collateral ligaments should be repaired if the elbow is unstable.

Meta analysis of left ventricular normal reference value in echocardiographic measurements for racial heterogeneity / 中华超声影像学杂志

Objective To investigate the heterogeneity of the left ventricular reference value in echocardiography mesurements by Meta analysis. Methods A literature retrieval in PubMed,Embase, Medline and other databases from January 2005 to September 2017 related to left ventricular normal reference value in healthy adults was performed. Cohrane′s Q test was used to test the heterogeneity,and I2 was used as a statistic for the description of heterogeneity. Subgroup analysis,sensitivity analysis and Meta regression were used to analyze the sources of heterogeneity. Results The Meta analysis enrolled 9 studies including 5 933 normal cases. The heterogeneity test showed that the left ventricular normal reference value of echocardiography was highly heterogeneous among the studies. In subgroup analysis, some measurements′ heterogeneity were significantly reduced. Meta regression analysis showed that the contribution of racial specificity to heterogeneity was relatively high in some measurements. Conclusions The heterogeneity of left ventricle is mainly related to racial specificity,but it cannot fully explain the heterogeneity between studies. Further studies are needed to demonstrate the involved factors of heterogeneity of left ventricular normal reference values.

Identification of intracellular host factors essential for hepatitis C virus infection with CRISPR-Cas9 method / 国际生物医学工程杂志

Objective To identify the intracellular host factors necessary for the hepatitis C virus (HCV) infection process so as to provide a scientific basis for the discovery of new antiviral targets.Methods In total 1×108 human liver cancer cells Huh7.5 were infected with a CRISPR Cas9 lentiviral small guide RNA (sgRNA) library which covers 19 050 human genes.Cell clonal populations with genes knockout were screened using blasticidin and puromycin resistance markers,and then were infected with HCV JFH1 strain (multiplicity of infection of 0.30).By comparing the infection levels with the unknocked Huh7.5 cells (control group),the cell populations with significantly reduced infection levels were screened and obtained.Finally,the cloned gene sequence of cell clonal populations was obtained by Illumina sequencing,and the single gene was separately verified by short hairpin RNA (shRNA) technology to identify the intracellular host factor necessary for HCV infection.Results The gene knockout cell populations by CRISPR-Cas9 library were successfully screened by blasticidin and puromycin resistance markers.Cell populations with significantly decreased HCV infection levels compared with the control group were obtained by immunofluorescence assay.These populations were sequenced by Illumina and the results suggest that there are at least 10 genes that may be associated with a reduction in HCV infection.The shRNA knockdown single gene verification results showed that compared with the unknocked Huh7.5 cells,the HCV infection rates were decreased in MTCP1 or RPS14 genes knockout Huh7.5 cells,and the differences were statistically significant (all P＜0.05).That indicates that MTCP1 and RPS14 are two intracellular host factors essential for HCV infection.Conclusion A new method for identifying intracellular host factors essential for HCV infection was established.The two intracellular host factors essential for HCV infection,MTCP1 and RPS14,were screened.This study lays a foundation for further studies on related action mechanism,and also provides a scientific basis for discovering new antiviral targets.

Efficacy comparison of Philos plate and Multiloc intramedullary nail for 3-or 4-part proximal humeral fractures in middle-aged and elderly patients / 中华创伤杂志

Objective To compare the clinical efficacy of Philos plate and Multiloc intramedullary nail for 3-or 4-part proximal humeral fractures in the middle-aged and elderly patients.Methods A retrospective case control study was conducted to analyze the clinical data of 52 middle-aged and elderly patients with 3-or 4-part proximal humeral fractures admitted to Sichuan Orthopedic Hospital from January 2014 to January 2016.The patients were divided into Philos plate group (27 patients) and Multilloc intramedullary nail group (25 patients) according to different treatment methods.In the Philos plate group,there were 11 males and 16 females,aged (59.3 ± 4.5) years.Based on the Neer classification,there were 16 patients with 3-part fracture,11 patients with 4-part fracture including two patients with 4-part fracture dislocation.There were eight patients with varus fracture and 19 patients with valgus fracture.In the Multiloc intramedullary nail group,there were 10 males and 15 females,aged (62.2 ± 7.4) years.Based on the Neer classification,there were 18 patients with 3-part fracture,seven patients with 4-part fracture including one with 3-part fracture dislocation and one with 4-part fracture dislocation.There were 12 patients with varus fracture and 13 with valgus fracture.The operation time,intraoperative bleeding volume,fracture healing time,neck-shaft angle changes and complications of humeral head ischemic necrosis were compared between the two groups.At the last follow-up,the motion range of affected shoulder joint,American Shoulder and Elbow Surgeons (ASES) scale,Constant-Murley score and visual analogue score (VAS) were compared between the two groups.Results There was no significant difference in the operation time between the two groups (P ＞ 0.05).The intraoperative bleeding volumes were 170-350 ml [(260.1 ± 110.3) ml] in the Philos plate group and 70-250 ml [(172.2 ± 100.3)ml] in the Multiloc intramedullary nail group,with statistically significant difference (P ＜ 0.05).All incisions were healed by first intention,and no infection was found.The patients in the Philos plate group were followed up for 12-36 months [(17.2 ±6.5)months],and patients in the Multiloc intramedullary nail group for 12-36 months [(14.5 ± 4.7) months] (P ＞ 0.05).All fractures were healed,with the healing time for 2.5-4 months [(3.5 ± 0.5)months] in the Philos plate group and for 2-3.3 months [(3.0 ± 0.5) months] in the Multiloc intramedullary nail group.The neck-shaft angle was lost to some degree in both groups at the last follow-up compared with the first day after operation,but the differences were not statistically significant (P ＞ 0.05).The Philos plate group had a higher incidence rate of complication [22％ (6/27)] than the Multiloc intramedullary nail group [12％ (3/25)] (P ＜ 0.05).Three patients in the Philos plate group had partial ischemic necrosis of the humeral head,while none was found in the Multiloc intramedullary nail group.There were no significant differences in active shoulder joint ante-flexion and uplift,lateral intorsion and extorsion,ASES score,Constant-Murley score and VAS between the two groups (P ＞ 0.05).Conclusions For 3-or 4-part proximal humeral fractures in middle-aged and elderly patients,both Philos plate and Multiloc nail can obtain stable and reliable fixation and achieve satisfactory results of shoulder joint function.However,the Philos plate fixation has more intraoperative bleeding,longer fracture healing time,and higher incidence rate of humeral head ischemic necrosis than the intramedullary nail.

Association of single nucleotide polymorphisms of CDH13 gene with metabolic syndrome among ethnic Han Chinese / 中华医学遗传学杂志

OBJECTIVE To assess the association of single nucleotide polymorphisms (SNPs) of the T-cadherin (CDH13) gene with metabolic syndrome (MS) among ethnic Han Chinese.METHODS Genotypes of 6 SNPs(rs11646213, rs12596316, rs3865188, rs12444338, rs12051272, and rs7195409) of the CDH13 gene among 453 patients with MS and 526 controls were determined with a TaqMan method, and their association with MS was assessed. RESULTS For 5 SNPs (rs11646213, rs3865188, rs12444338, rs12051272, and rs7195409), no difference was found in allelic and genotypic frequencies of the CDH13 gene between the two groups. Comparing with rs12596316 (AA+GG) genotype, rs12596316 AG genotype has significantly increased the risk of MS(P = 0.01,OR = 1.38,95%CI: 1.07-1.78), though no association was found between particular alleles of the rs12596316 with MS.There was no difference in the frequencies of rs11646213-rs12596316-rs3865188-rs12444338-rs12051272 haplotype between the two groups(P > 0.05). CONCLUSION No association was found between the five SNPs (rs11646213, rs3865188, rs12444338, rs12051272 and rs7195409) of the CDH13 gene with the MS, while the rs12596316AG genotype of the CDH13 gene is associated with the susceptibility to MS among ethnic Han Chinese.

Bioinformatics analysis on differentially expressed TGF-β1-induced trans-differentiation genes in human embryonic lung fibroblast / 中国职业医学

OBJECTIVE: To analyze transforming growth factor-β1( TGF-β1)-induced differentially expressed genes( DEGs) in human embryonic lung fibroblast( IMR-90) using microarray,and to screen the key genes and signaling pathways related to trans-differentiation of fibroblast.METHODS: The gene chip GSE17518,attained from TGF-β1 stimulated IMR-90 cells,was downloaded from the Gene Expression Omnibus database.The DEGs were screened by GENE-E software.Then,the DEGs were imported into the DAVID online database for Gene Ontology( GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes( KEGG) pathway enrichment analysis.The proteinprotein interaction( PPI) network was constructed and the hub genes were screened using STRING database and Cytoscape software.RESULTS: A total of 394 DEGs related to TGF-β1 stimulation were identified,including 171 down-regulated genes and 223 up-regulated genes.The results of GO analysis showed that the DEGs were widely distributed in cytoplasm,cell membrane,extracellular matrix( ECM) and exosomes,regulating biological functions such as ECM organization,cell migration and adhesion,cell proliferation and apoptosis.The results of the KEGG pathway analysis indicated that most of DEGs were enriched in cell focal adhesion,ECM-receptor interaction and phosphoinositide 3 kinase-Protein kinase B( PI3K-Akt) signaling pathways.The PPI network screened 10 core genes,included nucleolar protein 2( NOP2),succinate dehydrogenase B,glutamyl-prolyl-tRNA synthetase( EPRS),FtsJ homolog 3( FTSJ3),prefoldin subunit 4,Ras-related C3 botulinum toxin substrate 2,signal recognition particle receptor subunit beta,succinate-Co A ligase GDPforming beta subunit,pumilio RNA binding family member 3( KIAA0020),and general vesicular transport factor p115.NOP2,EPRS,FTSJ3,KIAA0020 were mainly distributed in M1 module.The NOP2 is the core gene with the highest number of nodes in M1 module.CONCLUSION: A total of 10 core differential genes and 7 signaling pathways related to TGF-β1 stimulation were screened.Among them,focal adhesion,ECM-receptor interaction,PI3K-Akt and NOP2,EPRS,FTSJ3,KIAA0020 may provide new direction for research of mechanisms of abnormal activation of fibrotic diseases including silicosis in incidence and development of multiple lung fibrotic diseases.

Therapeutic effects of anti-B7-H3 monoclonal antibody in a murine model of neutrophilic asthma / 中华微生物学和免疫学杂志

Objective To investigate the therapeutic effects of anti-B7-H3 blocking monoclonal antibody(McAb) in a murine model of neutrophilic asthma. Methods Twenty-four female BALB/c mice were randomly divided into four groups: PBS control group (group A), neutrophilic asthma group (group B),anti-B7-H3 McAb group (group C) and IgG isotype control group (group D). Those in group A were sensitized by injection of PBS and challenged with PBS through inhalation,while the other mice were sensi-tized by injection of ovalbumin (OVA) plus airway instillation of lipopolysaccharide(LPS),and then chal-lenged with OVA. Moreover,mice in group C and group D were respectively injected with anti-B7-H3 McAb and IgG isotype control in the induction period. Each mouse′s performance was observed. Samples of bron-choalveolar lavage fluid (BALF) and lung tissues were collected. Total and differential cell counts in BALF were determined by using microscope. Levels of cytokines including IFN-γ,IL-4,IL-6,IL-17,tumor nec-rosis factor-α (TNF-α) and granulocyte colony stimulating factor (G-CSF) in BALF were measured by ELISA. Lung sections were stained with hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) to identify tissue inflammation and mucus production,respectively. Immunohistochemistry was used to measure the expression of B7-H3 in frozen mouse lung sections. Results Mice in group B and group D showed asth-matic symptoms such as breathlessness,dysphoria and incontinence after nebulization,while these symptoms in group C were alleviated due to anti-B7-H3 McAb treatment. No abnormalities were observed in group A. Compared with group A,the other three groups showed increased total cell count in BALF and higher per-centages of neutrophil and eosinophil(P<0.05). These three indicators in group C were lower than those in group B and group D (P<0.05). With regard to lung infiltration by Th1,Th2 and Th17 cells,the levels of IFN-γ,IL-4,IL-6,IL-17,TNF-α and G-CSF in BALF were increased in group B,group C and group D as compared with those in group A. Compared with group C,group B and group D showed higher levels of IL-6, TNF-α,IL-17 and G-CSF(P<0.05),but lower level of IL-4(P<0.05). No statistical difference in the level of IFN-γ was observed among group B, group C and group D. Histological staining of lung sections showed that no obvious inflammatory cells and mucus secretion was observed in group A. Massive infiltration of inflammatory cells and neutrophils and mucus hypersecretion were detected in group B and group D. Treatment with anti-B7-H3 McAb inhibited the accumulation of neutrophils and mucus hypersecretion in lung tissues of group C. Compared with group A, levels of B7-H3-positive cells were significantly increased in group B and group D. Anti-B7-H3-treated mice showed reduced levels of B7-H3-positive cells in lung tissues as compared with those in group B and group D(P<0.05). Conclusion Treatment with anti-B7-H3 bloc-king McAb in an early stage can relieve the asthmatic syndrome, reduce airway inflammatory cells, inhibit mucus production and down-regulate Th17 cell-related cytokine secretion,which helps to alleviate airway and systematic inflammation in mice with NA,and partially inhibit the development of NA.

LRIG1 expression and its possible suppressor role in oral verrucous carcinoma / 实用口腔医学杂志

Objective:To explore leuncine-rich repeats and immunoglobulin-like domains protein 1 (LRIG1) expression in oral verrucous carcinoma(OVC) and its possible mechanism of tumor suppression.Methods:Paraffin specimens of OVC (n =15) and oral squamous cell carcinoma(OSCC,n =30) and corresponding adjacent normal tissues,and 15 normal mucosa tissues(NM) as control from injured patients were collected.The expression levels of LRIG1 and Bcl-2 were examined using immunohistochemical SP method.The correlation between the expression levels of LRIG1 and Bcl-2 was determined using two tailed Pearson's correlation.Results:LRIG1 was significantly lower in OVC tissue than that in NM tissue,but higher than in OSCC tissue.The expression levels of Bcl-2 in OVC were significantly higher than that in NM,but lower than in OSCC.The expression level of LRIG1 was negatively correlated with expression level of Bcl-2 in NM,OVC and OSCC tissue.Conclusion:LRIG1 may inhibit the expression of Bcl-2 and the development of OVC.