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BACKGROUND:Currently,there is a lack of large sample studies to analyze the bone metabolism level of patients with femoral head necrosis of different etiologies and stages,which is not conducive to the development of better necrosis-promoting repair strategies. OBJECTIVE:To study the bone metabolism of patients with osteonecrosis of the femoral head with different etiologies and Association Research Circulation Osseous(ARCO)stages. METHODS:A retrospective study was performed on 401 patients diagnosed with osteonecrosis of the femoral head as the trial group,and 81 healthy subjects as the control group.The trial group could be divided into three groups according to different etiologies:steroid-induced osteonecrosis of the femoral head,alcoholic osteonecrosis of the femoral head and traumatic osteonecrosis of the femoral head,and were divided into stages Ⅱ/Ⅲ/Ⅳ according to different ARCO stages.Seven bone metabolism-related indicators of all subjects were collected,including bone metabolism-regulating hormone 25-hydroxyvitamin D and bone conversion markers:N-terminal propeptide of type Ⅰ procollagen,degradation product of type Ⅰ collagen,n-terminal middle molecular fragment of osteocalcin,general biochemical markers of bone metabolism:serum calcium,serum phosphorus,serum alkaline phosphatase.The bone metabolism levels of each group were compared and the independent factors associated with osteonecrosis of the femoral head were determined by binary Logistic regression analysis. RESULTS AND CONCLUSION:Compared with the control group,levels of degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen,n-terminal middle molecular fragment of osteocalcin,serum phosphorus and alkaline phosphatase in the trial group were significantly increased(all P＜0.05).Based on the presence or absence of the disease,according to binary Logistic regression analysis,degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen,and n-terminal middle molecular fragment of osteocalcin were independent factors associated with osteonecrosis of the femoral head.The levels of degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen in three groups of patients with different etiologies were higher than normal reference values.The bone metabolism-regulating hormone 25-hydroxyvitamin D and serum calcium in the alcoholic osteonecrosis of the femoral head group were higher than those in the other two groups(P＜0.05).The level of bone metabolism-regulating hormone 25-hydroxyvitamin D in steroid-induced and traumatic osteonecrosis of the femoral head groups was lower than the normal value.There were no significant differences in seven bone metabolism-related indicators in patients with ARCO stages Ⅱ,Ⅲ and Ⅳ osteonecrosis of the femoral head(all P＞0.05),but degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen in these three groups were higher than normal reference values.Bone metabolism-regulating hormone 25-hydroxyvitamin D in patients with ARCO stage Ⅱ and ARCO stage Ⅳ was lower than the normal reference value.It is concluded that the bone metabolism level of osteonecrosis of the femoral head patients was abnormal.The degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen of osteonecrosis of the femoral head patients with different etiologies and ARCO stages were all higher than the normal reference value,and they were in a state of high bone turnover.Degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen and n-terminal middle molecular fragment of osteocalcin may be risk factors for the pathogenesis of osteonecrosis of the femoral head.
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Background: Gastric cancer is one of the common gastrointestinal malignancies. Early diagnosis can reduce the mortality rate significantly. In the Chinese consensus published in 2017, the New Gastric Cancer Screening Scoring System was recommended to be used for risk stratification of gastric cancer. Aims: To preliminarily explore the value of the New Gastric Cancer Screening Scoring System in early gastric cancer screening in asymptomatic community population. Methods: At several communities in Suzhou City Xiangcheng District, a questionnaire survey was conducted in asymptomatic community residents willing to accept voluntary serum tests to collect information on high risk factors of gastric cancer. Serum pepsinogen (PG), PGⅡ, gastrin 17 (G-17) and Helicobacter pylori (Hp) IgG were tested simultaneously. Risk stratification of gastric cancer was carried out in accordance with the New Gastric Cancer Screening Scoring System. Gastroscopy was recommended for moderate to high risk individuals. Results: A total of 540 asymptomatic individuals completed the study, of which 11 were categorized as high risk (2.0%), 168 as moderate risk (31.1%), and 361 as low risk (66.9%). Sixty-four moderate to high risk individuals completed the gastroscopy with a response rate of 35.8%. Four precancerous lesions were detected (6.2%), including 3 gastric low-grade intraepithelial neoplasia and 1 duodenal adenoma. No gastric cancer was detected. Conclusions: The New Gastric Cancer Screening Scoring System is useful for risk stratification of gastric cancer in asymptomatic population and may provide a basis for further endoscopic examination. However, the value of this scoring system in low risk areas of gastric cancer needs to be further verified.
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Objective To investigate the clinical effect of percutaneous hollow screw combined with tension band internal fixation for comminuted patellar fracture after arthroscopic reduction.Methods 105 patients with comminuted patellar fracture in our hospital from April 2013 to September 2017 were selected and divided into observation group (n =53) and control group (n =52) according to different treatment schemes.The control group was treated with conventional open reduction and Kirschner wire combined with tension band internal fixation,while the observation group was treated with arthroscopic assisted reduction and percutaneous cannulated screw combined with wire tension band internal fixation.The operation status and postoperative fracture healing time of the two groups were compared.One-year follow-up was performed after operation.The incidence of complications,the excellent and good rate of operation,and the preoperative and postoperative pain scores (VAS) and knee were compared.Hospital for special surgery knee score (HSS),Activity of Daily Life Scale (ADL),quality of life score (the Mos 36-item Short Form Health Survey,SF-36) were compared.Results The observation group had fewer fluoroscopy times during operation,shorter incision length and shorter healing time after operation than the control group (P ＜ 0.05);the incidence of complications in the observation group was 3.85％,lower than 20.00％ in the control group,and the excellent and good rate of operation was 96.15％,higher than 82.00％ in the control group (P ＜ 0.05);the VAS scores of the two groups were lower than those of the control group one year after operation,and the scores of HSS,ADL and SF-36 were lower than those of the control group.The preoperative improvement was higher in the observation group than in the control group (P ＜ 0.05).Conclusions Arthroscopic reduction combined with percutaneous hollow screw and tension band internal fixation for patellar comminuted fracture can reduce surgical trauma and accelerate the rehabilitation of patients.It can reduce the incidence of complications,relieve pain,improve knee function,daily living ability and quality of life,and the effect is remarkable.
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Background: Colorectal cancer (CRC) is a commonly seen cancer, and is a heterogeneous disease entity with a diverse biological pathogenesis. Aims: To investigate the expressions of mismatch repair protein (MMRP) and Ki-67 in CRC, and analyze the correlations of microsatellite instability (MSI), Ki-67 with clinicopathological features of CRC. Methods: Clinicopathological data of 90 CRC patients from Jan. 2014 to Dec. 2016 at the First Affiliated Hospital of Soochow University were retrospectively analyzed. Immunohistochemical staining was used to detect the protein expressions of 4 MMRP (MLH1, PMS2, MSH2 and MSH6) and Ki-67 in CRC patients. Correlations of MSI, Ki-67 with clinicopathological features of CRC patients were analyzed. Correlation of MSI with Ki-67 was also analyzed. Results: The loss expression rate of MMRP was 16.7%, and that of MLH1, PMS2, MSH2 and MSH6 were 11.1%, 11.1%, 6.7% and 4.4%, respectively. Positivity rate of Ki-67 was 90.0%. MSI was correlated with tumor location (P0.05). Expression of MLH1 was positively correlated with expression of PMS2 (r=0.577, P<0.05), and expression of MSH2 was positively correlated with expression of MSH6 (r=0.739, P<0.05). Conclusions: The loss expressions of MLH1, PMS2 are more common than those of MSH2, MSH6 in CRC. MSI is correlated with tumor location and Ki-67 is correlated with tumor location and gross type; they may be of some significance for the diagnosis and prediction of prognosis of CRC. However, MSI is not correlated with Ki-67, and joint detection of MMRP and Ki-67 could not improve the diagnostic accuracy of CRC.
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Objective To explore the expressions and significance of P-cadherin(P-ca),E-cadherin(E-ca), and β-catenin(β-ca)in colon polyps.Methods A total of 120 patients with colon polyps were selected and di-vided into the hyperplastic polyp group(40 cases),the tubular adenoma group(40 cases)and the villous adeno-ma group(40 cases).Other 20 healthy normal persons in the same period were selected as the control group. Immunohistochemistry(S-P)method was used to detect the expressions of P-ca,E-ca,and β-ca of subjects in paraffin sections of colonic polyp tissue and normal colonic mucosa.Western blotting semiquantitative method was used to detect the expression levels of P-ca,E-ca,and β-ca protein.Results P-ca was almost not express-ing in normal colonic mucosa,and positive signals in colon polyps tissue located in the cytoplasm and cell mem-brane,with the progression of the positive expression rate,it gradually increased(P<0.05).Positive-expres-sion of E-ca was in the cell membrane,with the progress of the disease,the positive-expression rate significant-ly decreased(P<0.05),β-ca expressed on the cell membrane in normal colonic mucosa tissue,with cytoplasmic of nuclear ectopic expression in the colon polyps group,with the progress of the disease,the positive rate of cytoplasm of nucleus gradually increased(P<0.05).Conclusion P-ca and β-ca show up-regulated expression in colon polyps,and E-ca show down-regulate expression,these three indicators were related closely to the oc-currence and development of colon polyps.
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Objective To evaluate the expression of mucin(MUC1,MUC2,MUC5AC and MUC6)in the pathological tissues of different colonic polyps,and to analyze the clinical value of mucin expression in colonic polyp transformation.Methods 120 cases of colonic polyps were selected treated from the First Hospital of Shijiazhuang in Hebeiin hospital from January 2013 to January 2015.According to histopathological diagnosis, there were 3 groups,40 patients with hyperplastic polyps,40 patients with tubular adenoma,40 patients with villous adenoma.The expression of MUC1,MUC2,MUC5AC and MUC6 in the pathogens were detected by immunohistochemistry.Results In normal colonic mucosa,MUC1,MUC5AC,MUC6 were not expressed,and MUC2 positive expression was detected.The positive expression rates of high expression of MUC1 and MUC6 were observed in tubular adenoma and villous adenoma,while the positive expression of MUC1 and MUC6 was not detected in proliferative polyps.MUC2 showed a high positive expression rate in hyperplastic polyps and adenomatous polyps,and the positive expression rate in proliferative polyps and adenomatous polypshyperplas-tic polyps and adenomatous polyps decreased gradually.MUC5AC was expressed in proliferative polyps and adenomatous polyps,and the expression of MUC5AC in proliferative polyps was significantly lower than that ofin adenomatous polyps.Conclusion The difference in the positive expression of MUC1,MUC2,MUC5AC and MUC6 in hyperplastic polyps and adenomatous polyps MUC1,MUC2,MUC5AC,MUC6 in hyperplastic polyps and adenomatous polyps is associated with the increased risk of mucosal or muscularis mucosa invasion in colonic polyps,w hich can be used as a biomarker for the clinical diagnosis of the development of colonic pol-yps.
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Objective To evaluate the expression of trefoil peptides (TFF1 ,TFF3) in colonic polyps and its relationship with clinicopathological parameters.Methods 120 cases of colon polyps were selected as the colon polyps group ,including 40 cases of hyperplastic polyps and 80 cases of adenomatous polyps ,and 30 cases of co-lon cancer (colon cancer group) and 20 cases of normal colonic mucosa (normal colon mucosa group) were se-lected as controls.The expression of TFF1 and TFF3 in various tissues were detected by q-RT-PCR ,Western Blot and immunohistochemistry ,and their relationship with clinicopathological parameters was analyzed.Re-sults The positive rates of TFF1 in normal colon mucosa ,hyperplastic polyp tissue ,adenomatous polyp and colon cancer were 0 ,0 ,53.8% and 80.0%,respectively and the differences were statistically significant (χ2=66.614 ,P＜0.05).The positive rates of TFF3 in normal colon mucosa ,hyperplastic polyp tissue ,adenomatous polyp and colon cancer were 90.0%,77.5%,55.0% and 30.0%,respectively.and the differences were statisti-cally significant (χ2=24.688 ,P＜0.05).The differences of TFF1 mRNA ,TFF3 mRNA ,TFF1 protein ,TFF3 protein expressions in the four groups were statistically significant.TFF1 protein expression in moderate and severe dysplasia polyp tissues increased significantly compared with those in mild dysplasia polyp tissues (t=2.760 ,P=0.009) ,while the expression of TFF3 significantly decreased (t=2.556 ,P=0.015) ;the expression of TFF1 protein in villous adenomatous polyp tissues increased significantly compared with that in tubular ad-enoma tissues (t=2.549 ,P=0.013) ,while the expression of TFF3 protein decreased significantly (t=2.108 , P=0.038).Conclusion The expression of TFF1 and TFF3 is closely related to the process of malignant co-lonic cancinogenesis ,and can be used as a biomarker for the differential diagnosis of colon benign diseases and early diagnosis of colon cancer.
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Objective To evaluate the feasibility and safety of endoscopic treatment for gastric stromal tumors with maximum diameter of 3 to 5 cm. Methods From April 2010 to April 2016, a retrospective analysis was performed on the data of patients with gastric stromal tumors undergoing endoscopic (29 cases)or laparoscopic(26 cases)resection in the First Affiliated Hospital of Soochow University. Baseline data, perioperative data and follow-up data were collected and analyzed. Results There was significant difference on tumor location between the two groups(χ2=12.173, P=0.007). Tumors mainly located at gastric fundus in the endoscopic group(65.5%,19/29),while at gastric body in the laparoscopic group(61.5%, 16/26). Compared with the laparoscopic group, patients in the endoscopic group had shorter operation time[45(35, 60)min VS 70(60, 85)min, U = 686.000, P<0.05], lesser intraoperative blood loss[15(10,15)mL VS 20(10, 20)mL, U=513.000, P=0.017], and earlier recovery time of gastrointestinal function[12(6, 24)h VS 20(18, 24)h, U=585.500, P<0.001]. Compared with the laparoscopic group, the patients in the endoscopic group had a higher complication rate[55.2%(16/29)VS 11.5%(3/26), χ2=11.543, P<0.001]and a lower intact tumor removal rate [89.7%(26/29)VS 100.0%(26/26),χ2=23.989,P<0.001]. The other perioperative parameters such as the incidence of intraoperative major bleeding, postoperative peritonitis, postoperative fasting time, hospitalization time and total hospitalization expenses showed no statistical different(all P>0.05). The postoperative follow-up time was 30.0(17.5,50.0)and 38.5(26.0,49.8)months in the endoscopic and laparoscopic group,respectively. There was no significant difference in the recurrence rate between the two group[3.4%(1/29)VS 7.7%(2/26),χ2=0.009,P=0.922]. Conclusion Endoscopic resection may be an alternative therapeutic approach for large gastric stromal tumors with shorter operation time, less intraoperative blood loss,and earlier recovery time of gastrointestinal function.
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Objective To investigate the impact of covariates on diagnostic test and assess the correlation between re-peated measurement data,this paper explores innovative modeling techniques of ROC curve.Methods We introduce the new ROC curve method based on generalized linear mixed effects model and apply Bayesian techniques to parameters estimation with Winbugs Software.Further,areas under the ROC curve(AUC)with different values of covariates could be calculated in terms of assessment.Results Cases analysis results indicate the proposed method efficiently explores the repeated measurement data and provides parameters with practical significance,serving as a golden reference.Conclusion The ROC curve based on generalized linear mixed effects models can be effectively used to solve the test accuracy evaluation problem of the repeated diagnostic trials.