摘要
Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.
摘要
Objective:To assess the clinical efficacy and infection control outcomes of two-stage revision in managing periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) utilizing either a low or high constrained prosthesis.Methods:A retrospective analysis was performed on 40 patients who underwent revision TKA in the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from February 2019 to February 2022. According to the type of prosthesis selected in primary TKA, they were divided into low constrained prosthesis group and high constrained prosthesis group. There were 28 patients (28 knees) in the low constrained group, including 12 males and 16 females, aged 69.0(63.0, 74.0) years, with a body mass index of 25.18±0.55 kg/m 2. And there were 12 patients (12 knees) in the high-constrained group, including 5 males and 7 females, aged 66.5(65.0, 71.5) years, with a body mass index of 23.94±0.51 kg/m 2. All patients underwent two-stage revision surgery, with RHK used in 1 case and LCCK in 27 cases in the low-constrained prosthesis group. In the high-constrained prosthesis group, 3 patients were treated with RHK, 1 patient with PFC Sigma MBT, and 8 patients with LCCK. The preoperative and postoperative range of motion (ROM), Knee Society score (KSS), and postoperative infection control rate were compared between the two groups. Results:All patients were followed up. The follow-up time was 22.79±8.02 months in the low-constrained prosthesis group and 23.92±7.04 months in the high-constrained prosthesis group, with no significant difference between the two groups ( t=0.426, P=0.680). At the last follow-up, the KSS and ROM in the low-constrained prosthesis group were 77.96±9.74 and 93.48°±7.45°, respectively, significantly higher than 38.93±8.01 and 68.89°±9.44° before the operation ( P<0.05). The KSS score and ROM in the high-constrained prosthesis group were 67.83±8.31 and 80.08°±5.89° at the last follow-up, which were also significantly higher than those before operation (34.25±6.31 and 66.50°±10.48°, P<0.05). There was no significant difference in KSS and ROM between the two groups before operation ( P>0.05), but the KSS score and ROM in the low-constrained prosthesis group were significantly higher than those in the high-constrained prosthesis group at the last follow-up ( P<0.05). Bacterial culture results revealed that the primary infectious agents were coagulase-negative Staphylococcus and Staphylococcus aureus, with an overall infection control rate of 80% (32/40). The infection control rate was 89% (25/28) in the low-constrained prosthesis group and 58% (7/12) in the high-constrained prosthesis group, but the difference between the two groups was not statistically significant (χ 2=3.283, P=0.070). Conclusion:Two-stage revision effectively controls PJI, and the clinical outcomes of two-stage revision for PJI after primary TKA with a high-constrained prosthesis are inferior to those with a low-constrained prosthesis. Further exploration is needed to enhance efficacy.
摘要
OBJECTIVE@#To explore the characteristics of comorbidities in patients with osteoporosis(OP) and factors associated health-related quality of life, so as to provide decision-making reference for improving the ability of disease co-prevention and co-treatment and the patient's life-cycle quality of life.@*METHODS@#From November 2017 to July 2018, clinical information and biological samples from residents in 10 communities in Chaoyang District and Fengtai Distric of Beijing were collected, and bone density testing was conducted. Based on the Charlson comorbidity index (CCI), the comorbidity of the population was quantified, and grouped according to factors such as gender, age, and the differences between the groups were explored. Combined with the clinical information of patients, the difference characteristics of comorbidity and non-comorbidity population were analyzed. Pearson/Spearman correlation analysis and binary Logistic regression analysis were used to explore the factors affecting the health-related quality of life in patients with OP.@*RESULTS@#Among the 521 OP patients, 121 patients had no comorbidities, and there were 153, 106, 65, and 30 patients with one, two, three, and four comorbidities, respectively, 46 patients with 5 or more kinds of comorbidites. Hypertension was the most common comorbidity in OP patients, accounting for 21.60%;followed by hyperlipidemia, accounting for 13.51%. The most common combination of the two diseases was hypertension plus hyperlipidemia (64 cases, 12.28%). Through the analysis of differences between age groups, it was found that the older patients, showed higher the CCI, and the difference between groups was statistically significant(Z=1.93, P=0.05). There were significant differences in the total EQ-5D score and the dimensions of anxiety and depression between patients with comorbidities (CCI≠0) and non-comorbidities (CCI=0) (Z=-2.67, P=0.01;Z=-2.44, P=0.02). Correlation analysis found that CCI, history of fracture, history of falls, hip bone mineral density T value and parathyroid hormone were all related to the health-related quality of life in OP patients (P<0.05). Binary Logistic regression analysis suggested that the right hip bone mineral density T value (P=0.02), CCI (P=0.01), fracture history (P=0.03) and fall history (P=0.01) were the risk factors that affect the health-related quality of life in OP patients.@*CONCLUSION@#The burden of comorbidities among middle-aged and elderly OP populations in Beijing is relatively heavy, and the health management of such populations should be further strengthened, specifically the combination of multiple comorbidities should be given high priority. Comorbid factors are of great importance for the diagnosis and treatment strategy of OP patients, which could further improve the quality of life.
Subject(s)
Aged , Middle Aged , Humans , Quality of Life , Osteoporosis/epidemiology , Comorbidity , Risk Factors , Fractures, Bone , Hypertension/epidemiology摘要
Oxygen is an important guarantee for the treatment of critically ill patients in public health emergencies,and its normal guarantee and supply have become the primary issue that every hospital needs to face and solve.The fundamental reasons for the shortage of oxygen supply in hospitals during the period of public health emergencies were explored by understanding the admission of critically ill patients and the supply of oxygen.Based on the actual needs of clinical medical treatment,it was found that the main reasons for insufficient oxygen supply were limited liquid oxygen storage capacity,reduced vaporization efficiency,small diameter of delivery pipe,throttling of secondary pressure reducing boxes,etc.It was recommended the limit requirement for the volume of medical liquid oxygen storage tanks be revised to 5m3.Hospitals can adjust and allocate according to actual medical needs,optimize the design and selection of vaporizers and pipeline systems,normalize and standardize the quality control and testing of medical gas systems,and when allowed by regulations and approved by clinical physicians,use oxygen-enriched air(93%oxygen)to supply oxygen to general wards,and provide more medical oxygen(≥99.5%)to critically ill patients who require life support.
摘要
Objective:To study the therapeutic effect of bone peptide combined with rifapentin and levofloxacin on bone and joint damage caused by brucellosis.Methods:A prospective study was conducted to select 64 patients with brucellosis bone and joint damage admitted to Shanxi Provincial People's Hospital from January 2017 to June 2021. They were randomly divided into a control group (32 cases) and an observation group (32 cases) using a random number table method. The control group was treated with rifapentin and levofloxacin, while the observation group was treated with bone peptide on the basis of the control group, with a treatment period of 8 weeks, and the peripheral venous blood sample was collected before and after treatment. The visual analogue scale (VAS), activity of daily living (ADL) score, serum C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and cytokines [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)] levels were compared before and after treatment.Results:The total effective rates of treatment in the observation group and the control group were 90.62% (29/32) and 65.62% (21/32), respectively, with statistically significant differences between the groups (χ 2 = 5.85, P = 0.016). After treatment, the VAS score of the observation group was lower than that of the control group ( t = 8.29, P < 0.001), and the ADL score was higher than that of the control group ( t = 6.77, P < 0.001). Both groups had lower VAS scores after treatment than before treatment in the same group ( t = 21.72, 15.09, P < 0.001), and higher ADL scores than before treatment in the same group ( t = 22.49, 12.54, P < 0.001). After treatment, the levels of CRP, PCT, ESR, TNF-α, and IL-6 of the observation group were lower than those of the control group ( t = 8.11, 10.75, 4.64, 5.11, 4.55, P < 0.001); the levels of CRP, PCT, ESR, TNF-α, and IL-6 in the two group were lower than these before treatment in the same group ( t = 14.21, 21.47, 11.21, 15.07, 9.73, 15.50, 21.30, 7.52, 6.78, 4.93, P < 0.001). Conclusion:The bone peptide combinated with rifapentin and levofloxacin has a good therapeutic effect on bone and joint damage caused by brucellosis, which can significantly reduce pain and cellular inflammatory reactions in patients, and improve their quality of life.
摘要
Objective:To construct and validate prognostic nomograms predicting overall survival (OS) and cancer-specific survival (CSS) of patients with late-stage hepatocellular carcinoma (HCC).Methods:A retrospective cohort study was used in this report. Screened 2382 late-stage HCC patients obtained from Surveillance, Epidemiology, and End Results (SEER) database (2010—2015), were randomly classified into the training cohort and the internal validation cohort by using the function in R software according to the ratio of 1∶1. Chi-square test was applied to verify the comparability of data between two groups. The external validation cohort ( n=62) were collected from the Affiliated Zhangjiagang Hospital of Soochow University. Based on univariate and multivariate COX regression analyses in the training cohort, this study constructed nomograms for 6- and 12- month OS and CSS. Concordance index (C-index), calibration plots, the receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves were applied to measure the performance of nomograms in the training cohort and to validate nomograms in two validation cohorts. The clinical utility was measured by decision curve analysis (DCA). Results:Two nomograms were constructed. The identified risk factors included sex, Edmondson-Steiner grade, T stage, N stage, M stage, tumor size, bone metastasis, Alpha-fetoprotein (AFP), surgery of primary site, radiation and chemotherapy. The C-index for OS in the training and two validation cohorts was 0.729(95% CI: 0.711-0.747), 0.721(95% CI: 0.705-0.737) and 0.860(95 CI: 0.831-0.889), respectively. The C-index for CSS in the training and two validation cohorts was 0.732(95% CI: 0.714-0.750), 0.725(95% CI: 0.707-0.743) and 0.862(95% CI: 0.829-0.895), respectively. Afterwards, for nomograms in the training and two validation cohorts, C-index and calibration plots expressed great predictive accuracy and concordance. ROC curves and Kaplan-Meier survival curves demonstrated good prognostic ability. Furthermore, nomograms performed superior to other models. DCA showed substantial clinical utility. Conclusion:This study has developed and validated nomograms predicting 6- and 12- month OS and CSS of patients with late-stage HCC, which may be useful to develop the individualized treatment.
摘要
Objective:To investigate the therapeutic effects of antibiotic articular cement spacer on shoulder joint infection in the elderly patients during stage-one operation.Methods:The data of 3 patients were analyzed retrospectively who had been treated at Department of Orthopaedics, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University for shoulder infection from May 2018 to December 2019. They were one man and 2 women with an average age of 65.3 years (from 64 to 67 years). One case of infection followed shoulder puncture, another proximal humeral fracture and another shoulder prosthesis replacement. All the 3 patients underwent radical debridement and implantation of antibiotic shoulder cement spacer in stage-one operation but no stage-two operation. The therapeutic effects were evaluated by American Shoulder and Elbow Surgeons (ASES) scoring, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scoring, Visual Analog Scale (VAS), and range of shoulder motion.Results:The 3 patients were followed up for 18 to 28 months (mean, 22.7 months). There was no recurrence of infection and the spacers were in good position. The microorganisms detected were Bifidobacterium brevis in one case and methicillin-resistant Staphylococcus aureus in 2 cases. At the final follow-up, the ASES scores averaged 54.4 (from 46.3 to 60.0), Quick-DASH scores 45.1 (from 40.8 to 50.0), VAS scores 2.3 (from 2 to 3), ranges of elevation 65.7 °, ranges of abduction 43.8° and ranges of external rotation 21.7°.Conclusion:For the elderly patients with shoulder infection, implantation of antibiotic shoulder cement spacer after radical debridement can well control infection, relieve pain and improve shoulder functions, sparing them secondary operation.
摘要
The editorial group of the clinical practice guideline for postmenopausal osteoporosis(PMOP) with traditional Chinese medicine(TCM)(hereinafter referred to as "guideline") is composed of experts specialized in TCM orthopedics, TCM gynecology, clinical epidemiology, etc. The guideline was formulated through registration, collection and selection of clinical issues/outcome indicators, evidence retrieval and screening, preparation of systematic reviews, evaluation of evidence quality, formation of recommendations, drafting, and peer review. The syndromes and treatment of PMOP are elaborated in detail. Specifically, Liuwei Dihuang Pills and Zuogui Pills are recommended for PMOP with Yin deficiency in the liver and kidney, Qing'e Pills for PMOP with kidney deficiency and blood stasis, Yougui Pills and Jingui Shenqi Pills for PMOP with Yang deficiency in the spleen and kidney, and Er'xian Decoction for PMOP with Yin and Yang deficiency in the kidney. In addition, Duhuo Jisheng Decoction can be used to relieve pain. The commonly used Chinese patent medicines include Xianling Gubao Capsules, Qianggu Capsules, Jintiange Capsules, Gushukang Capsules, Hugu Capsules, Jinwu Gutong Capsules, and Guyuling Capsules. Acupuncture and moxibustion are also effective approaches for PMOP. The rehabilitation and daily management were carried out by exercise therapies such as Baduanjin(eight-section brocade), Wuqinxi(five-animal exercises), and Taijiquan(Tai Chi), Chinese medicine diet, health education, and fall prevention. The promotion and application of this guideline will facilitate the implementation of TCM prevention and treatment of PMOP, ensure the quality of life of PMOP patients, provide effective and safe TCM treatment measures for PMOP, and reduce the risk of fracture complications.
Subject(s)
Animals , Female , Humans , Drugs, Chinese Herbal/therapeutic use , Medicine, Chinese Traditional , Osteoporosis, Postmenopausal/drug therapy , Quality of Life , Systematic Reviews as Topic , Yin Deficiency摘要
OBJECTIVE@#To explore the potential related factors of falls and provide a reference plan for preventing falls for the middle-aged and elderly people.@*METHODS@#From November 2017 to July 2018, a total of 1 642 middle-aged and elderly people from 10 communities in @*RESULTS@#A total of 1 540 subjectswere included, including, 415 men and 1 125 women. Their average age was(63.02±7.15) years. The incidence of falls in recent one year was 12.14%(187 / 1 540). According to @*CONCLUSION@#For middle aged and elderly people, avoiding heavy drinking, eating more eggs, vegetables, and active strength exercise can effectively prevent falls. And people with family history of fracture and diabetes should pay more attention to the prevention of falls.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cross-Sectional Studies , Fractures, Bone , Incidence , Risk Factors摘要
BACKGROUND@#Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy (NCRT). This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched analysis.@*METHODS@#In total, 1296 patients with NCRT or post-operative chemoradiotherapy (PCRT) were enrolled in this study between January 2008 and December 2015. Propensity score matching was used to correct for differences in baseline characteristics between the two groups. After propensity score matching, the metastasis pattern, including metastasis sites and timing, was compared and analyzed.@*RESULTS@#After propensity score matching, there were 408 patients in the PCRT group and 245 patients in the NCRT group. NCRT significantly reduced local recurrence (4.1% vs. 10.3%, P = 0.004), but not distant metastases (28.2% vs. 27.9%, P = 0.924) compared with PCRT. In both the NCRT and PCRT groups, the most common metastasis site was the lung, followed by the liver. The NCRT group developed local recurrence and distant metastases later than the PCRT group (median time: 29.2 [18.8, 52.0] months vs. 18.7 [13.3, 30.0] months, Z = -2.342, P = 0.019; and 21.2 [12.2, 33.8] vs. 16.4 [9.3, 27.9] months, Z = -1.765, P = 0.035, respectively). The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group (39/114, 34.2%) and NCRT group (21/69, 30.4%). However, 20.3% (14/69) of the distant metastases appeared in the 3rd year in the NCRT group, while this number was only 13.2% (15/114) in the PCRT group.@*CONCLUSIONS@#The predominant site of distant metastases was the lung, followed by the liver, for both the NCRT group and PCRT group. NCRT did not influence the predominant site of distant metastases, but the NCRT group developed local recurrence and distant metastases later than the PCRT group. The follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.
Subject(s)
Humans , Chemoradiotherapy , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Neoplasm Staging , Propensity Score , Rectal Neoplasms/pathology , Retrospective Studies , Treatment Outcome摘要
Objective:To investigate the risk factors for intrahepatic cholangiocarcinoma (ICC) after hepatectomy for hepatolithiasis.Methods:The retrospective case-control study was conducted.The clinico-pathological data of 1 071 patients who underwent hepatectomy for hepatolithiasis at the Eastern Hepatobiliary Surgery Hospital of Navy Medical University between January 2010 and December 2011 were collected. There were 379 males and 692 females, aged (53±12)years, with the range of 12-86 years. Patients completed preoperative examinations. For regional hepatolithiasis, the anatomical hepatectomy was performed. For diffused hepatolithiasis, regional damaged lesions which confined to liver segment or lobe were resected. Hepaticolithotomy or cholangio-lithotomy was performed if necessary. When severe stricture of hilar bile duct affects biliary drainage, cholangiojejunostomy or biliary stricture plasty was performed. Observation indicators: (1) preoperative examination, surgical and postoperative situations; (2) follow-up; (3) risk factors analysis of ICC within the 5 years after hepatectomy for hepatolithiasis. Follow-up using outpatient examination and telephone interview was performed to detect the incidence of ICC after hepatectomy up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages. Continuous variables were converted into categorical variables according to the common clinical values or the best cut-off value of receiver operating characteristic curve. Binary logistic regression model was used for risk factors analysis. The factors with P<0.10 in univariate analysis were included for the multivariate analysis. Results:(1) Preoperative examination, surgical and postoperative situations. Results of preoperative examination: duration of hepatolithiasis-related symptoms of the 1 071 patients was 8.2 years(range, 0-27.0 years), the levels of CA19-9 and CEA were (163±87)U/mL and (5.0±2.1)μg/L, and stones located at left liver, right liver, bilateral sides, common hepatic duct or common bile duct were detected in 545, 245, 228, 53 patients. There were 226 patients complicated with biliary stricture and 172 with segmental atrophy. Of the 1 071 patients, 595 underwent anatomical hepatectomy, 272 underwent regional non-anatomical hepatectomy, 143 underwent cholangiolithotomy, and 61 underwent cholangiojejunostomy. Results of postoperative imaging examination showed residual biliary stricture in 26 patients and residual biliary stones in 74 patients. (2) Follow-up: 1 071 patients were followed up for (8.6±1.5)years. Of the 1 071 patients, 92 developed ICC, with an incidence of 8.590%(92/1 071). There were 32, 66, 90 patients developing ICC within 3, 5, 8 years after hepatectomy, with the incidence of 2.988%(32/1 071), 6.162%(66/1 071), 8.403%(90/1 071). (3) Risk factors analysis of ICC within the 5 years after hepatectomy for hepatolithiasis. The receiver operating characteristic curve of duration of hepatolithiasis-related symptoms for ICC within the 5 years after hepatectomy was constructed, and duration of hepatolithiasis-related symptoms was converted into categorical variable for following analysis using 7 years as the cut-off value based on Youden index. Results of univariate analysis showed that duration of hepatolithiasis-related symptoms>7 years, complication with metabolic diseases, segmental atrophy, postoperative residual stones were related factors for ICC within the 5 years after hepatectomy ( odds ratio=2.939, 2.654, 1.903, 2.361, 95% confidence interval: 1.582-5.460, 1.145-6.154, 1.068-3.390, 1.118-4.987, P<0.05). Results of multivariate analysis based on factors with P<0.10 in the univariate analysis showed that duration of hepatolithiasis-related symptoms>7 years, complication with metabolic diseases, segmental atrophy, postoperative residual stones were independent risk factors for ICC within the 5 years after hepatectomy ( odds ratio=2.843, 2.469, 1.922, 2.202, 95% confidence interval: 1.523-5.309, 1.042-5.851, 1.064-3.472, 1.021-4.747, P<0.05). Conclusions:There was risk of developing ICC after hepatectomy for cholelithiasis. The duration of hepatolithiasis-related symptoms >7 years, complication with metabolic diseases, segmental atrophy and postoperative residual stones are independent risk factors for ICC development within 5 years after hepatectomy.
摘要
Objective:To investigate the serum level of low density lipoprotein cholesterol (sdLDL-C) in elderly patients (age≥65 years) with type 2 diabetes mellitus (T2DM) and the its predictive value in evaluatingthe risk of cardiovascular and cerebrovascularevents in elderly patients with T2DM.Methods:In this retrospective study,386 elderly patients with T2DM were collected from December 2014 to December 2016, the averageage was (72.7±5.4) years old, including 269 males and 117 females; 92 of whom had cardiovascular events during follow-up, the averageage was (72.9 ± 5.2) years old, including 65 males and 27 females, and serum sdLDL-C level was detected. Meanwhile, biomarkers such as lipoprotein (a), apolipoprotein B, apolipoprotein AI and hypersensitive c-reactive protein were analyzedin all the patients.Univariate and multivariate factors were used to analyze the relationship between each variable and the occurrence of cardiovascular and cerebrovascular events. The correlation between LDL-C, sdLDL-C of all subjects with age and other lipid indexes were analyzed. ROC curve was used to determine the predictive value of sdLDL-C elevation for cardiovascular and cerebrovascular events in elderly patients with T2DM.Results:The levels of LDL-c, sdLDL-C, non-HDL-C, GLU, HbA1c and ApoB were significantly higher in theCardio-cerebral vascular event group ( t=3.26, 3.46, 2.91, 2.47, 4.03, 3.00, P<0.05). While the levels of apolipoprotein AI was significantly lower than those in theNon-cardio-cerebral vascular event group ( t=-2.39, P<0.05). Cox regression analysis showed that sdLDL-C per 10 mg/dl was independently correlated with the risk of cardiovascular and cerebrovascular events( HR 1.281, 95 %CI 1.225-16.032, P<0.01)after adjusted for age. SdLDL-C was positively correlated with TG, non-HDL-C and ApoB ( r=0.323, 0.588, 0.623, P<0.01) and was negativelycorrelated correlation with age, HDL-C and apolipoprotein AI ( r=-0.363, -0.301, P<0.01), ROC curve analysis showed that sdLDL-C had a strong ability to predict the occurrence of cardiovascular and cerebrovascular events (AUC=0.736, 95 %CI 0.554 9-0.918 2, P=0.003), while HbA1c also had a strong ability to predict the occurrence of cardiovascular and cerebrovascular events(AUC=0.725, 95 %CI 0.524 3-0.927 3, P=0.006). Combined sdLDL-C with HbA1had the strong ability to predict the occurrence of cardiovascular and cerebrovascular events (AUC=0.837, 95 %CI 0.711 4-0.973 5, P=0.001). Conclusions:The elevation of serum sdLDL-C in elderly patients with T2DM wasa significantly independentrisk factorof cardiovascular and cerebrovascular events. Serum sdLDL-C had a higher clinical value than LDL-C, which was expected to be the most effective predictor of lipid profile in riak assessment of cardiovascular and cerebrovascular events in elderly patients with T2DM.
摘要
Objective:To investigate the levels and the clinical signficance of matrix metalloproteinase 3 (MMP-3) in different activities of rheumatoid arthritis (RA).Methods:Case-control study. A total of 130 patients [24 cases of male, 106 cases of female, age (52.98±13.24)years, the median age was 51 years] with RA diagnosed in the Department of Rheumatology from the Second Affiliated Hospital of Soochow University, Suzhou Hospital of Traditional Chinese Medicine and Suzhou Ninth People′s Hospital from 2017 to 2018, and 100 healthy controls [28 cases of male, 72 cases of female, age (45.04±11.55) years, the median age was 44 years] from the physical examination center of the Suzhou Ninth People′s Hospital. The basic clinical data was used to determine the MMP-3 on groups of RA patients and healthy controls by immunoturbidimetry. The discriminating validity of MMP-3 in disease was evaluated using receiver operating characteristic (ROC) curve analysis.Results:Compared with that in healthy controls[28.0 (21.7-36.1)ng/mL], the MMP-3 in the low groups [51.8(41.8-73.1)ng/mL] increased dramatically ( Z=2.942, P<0.01). However, there was no significant difference between the MMP-3 in remission patients [28.8 (21.9-38.7)ng/mL] compared with the healthy controls ( Z=1.09, P>0.05). The area under the curve (AUC) of MMP-3 for diagnosis of RA was 0.877. the sensitivity was 73.1%, and the specificity was 93%.The AUC of MMP-3 diagnosis of low groups was 0.906, the sensitivity was 77.8%, and the specificity was 88%. In addition, the MMP-3 level was correlated with CRP and ESR ( r=0.242, r=0.243), and it was significantly correlated with DAS 28 ( r=0.361). Conclusions:It was indicated that the level of MMP-3 increased with the severity of rheumatoid arthritis. And the clinically low level of MMP-3 in RA patients could be used to indicate the remission condition. Meanwhile, the serum MMP-3 was closely related to DAS28.
摘要
Ferroptosis is a novel form of regulated cell death which is dependent on iron and reactive oxygen species (ROS) and associated with the accumulation of lipid peroxides. It is obviously different from other cell death types in terms of morphology, biochemistry, genetics, etc. Also, it is related to the production of iron catalyzed lipid peroxides which is triggered by non-enzymatic or enzymatic reactions. Ferroptosis has been proved to be involved in hematological diseases, cardio-cerebrovascular diseases, liver and kidney diseases. This paper will review the definition, mechanism, inducers of ferroptosis, as well as the function of ferroptosis in respiratory system. We expect to present a new concept for respiratory research and suggest potential targets for clinical prevention and treatment of respiratory diseases.
Subject(s)
Humans , Cell Death , Ferroptosis , Iron , Reactive Oxygen Species , Respiration Disorders摘要
Corona virus disease 2019 (COVID-19) is a new type of coronavirus pneumonia, which is caused by infection of a novel coronavirus, SARS-CoV-2. The virus infects lung cells by binding angiotensin-converting enzyme 2 (ACE2) of cell surface, which leads to leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung, causing respiratory symptoms. The aggravation of local inflammation causes cytokine storm, resulting in systemic inflammatory response syndrome. In December 2019, a number of new pneumonia cases were reported by Wuhan Municipal Health Commission, after then a novel coronavirus was isolated and identified as SARS-CoV-2. To the date of Sep. 13th, 2020, COVID-19 is affecting 216 countries or regions, causing 28 637 952 cases, 917 417 deaths, and the mortality rate is 3.20%. This review will summarize the structure of SARS-CoV-2 and the pharmaceutical treatment of COVID-19, and their potential relationships.
Subject(s)
Humans , Betacoronavirus , COVID-19 , Coronavirus Infections/drug therapy , Pandemics , Pneumonia, Viral , Severe acute respiratory syndrome-related coronavirus , SARS-CoV-2摘要
OBJECTIVE@#To investigate the relevance ratio of osteoporosis and bone mass of middle aged and elderly people in Beijing communities, in order to understand occurrence and development trend of abnormality of bone mass in high-risk population from community.@*METHODS@#Based on the method of cross-sectional investigation, the information data of 1 540 middle-aged and elderly people from 10 communities were collected, including 415 males and 1 125 females, aged from 45 to 80 years old with the average of (63.02±7.15) years old; the height was (161.34±7.24) cm, the weight was (65.90±10.19) kg, body mass index was (25.29±3.32) kg /m2. Bone mineral density (BMD) of lumbar vertebrae (L@*RESULTS@#The level of β-CTX was(0.27±0.12) ng /ml, procollanen type 1 N-terminal propeptide(P1NP) was(51.03± 22.36) ng /ml, 25(OH) D3 was (16.68±6.24) ng /ml, serum calcium was(2.34±0.09) mmol / L, blood phosphorus was (1.43± 0.37) mmol / L, and blood magnesium was (0.94±0.07) mmol / L, alkaline phosphatase was (79.28±20.48) U/ L, parathyroid hormone was (3.09±1.60) pmol / L, osteocalcin was (13.29±6.65) ng /ml. Except for blood magnesium, the other indexes had significant differences between different sex groups(@*CONCLUSION@#There are obvious differences in relevance ratio of osteoporosis and low bone mass among different sites. It is suggested that the clinical diagnosis of osteoporosis should be combined with bone mineral density and bone metabolic markers. With the increasing prevalence of osteoporosis among middle aged and elderly people in Beijing community, continuous follow-up research based on community primary health care units could promote early examination, early diagnosis, and early treatment of middle aged and elderly people at high risk of osteoporosis in community.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Absorptiometry, Photon , Beijing/epidemiology , Bone Density , Cross-Sectional Studies , Osteoporosis/epidemiology摘要
OBJECTIVE@#To explore expression of β-catenin and NF-κB signaling pathway in synovial tissue of rats with different degrees of knee osteoarthritis (KOA).@*METHODS@#Forty-eight SPF male rats weighed (200±20) g were randomly divided into three groups, namely model group (32 rats), sham operation group (8 rats) and control group (8 rats). KOA model rats were established by Hulth method, and 8 rats were killed at 2, 4, 8, 12 weeks respectively after modeling, in order to establish KOA model rats with moderate, early, mild and severe degree. Sham operation group was only cut off capsule of knee joint and suture to exclude interference factor, control group was untreated. Behavior, synovial hyperplasia and cartilage degeneration of rats among each group were observed. Expression of NF-κB and signaling pathway and β-catenin in synovial tissue of rats were detected by real-time PCR.@*RESULTS@#KOA rat model was successfully established, and synovial hyperplasia was observed in KOA model at mild and early degree, and then gradually decreased; while cartilage degeneration in the early moderate and severe KOA model was significantly expressed, and gradually aggravated with time. The results of PCR showed that expression of β-catenin in 4-week group (8.57±0.46) and 8-week group (4.23±0.09) were higher than those in control group (<0.05); expression of TLR-2 in 2-week group (12.04±4.02) and 4-week group (8.54±2.13) were higher than those in control group(<0.05), and TLR-4 in 2-week group(5.04±0.93), 4-week group (3.29±0.58) and 8-week group (1.63±0.12) were higher than those in control group; expression of NF-κB was significantly higher in 2-week group (10.15±2.04), 4-week group (15.97±4.17), 8-week group (7.69±1.48) and 12-week group (6.70±1.58) than that in control group (<0.05), and expression of IL-1β was significantly higher in 4-week group (2.79±0.25) and 8-week group (2.46±0.32) than that of control group (<0.05).@*CONCLUSIONS@#On the RNA expression level, both of β-catenin and NF-κB signaling pathways are involved in synovial inflammation in KOA model rats, and they play a regulatory role in expression of IL-1β, degeneration of KOA.
Subject(s)
Animals , Male , Rats , Inflammation , NF-kappa B , Osteoarthritis, Knee , Signal Transduction , beta Catenin摘要
Objective :To study correlation between serum level of lipoprotein—associated phospholipase A2 (Lp—PLA2 ) and carotid atherosclerosis (AS) in patients with morning hypertension (MH ).Methods : A total of 160 MH pa—tients ,who visited or hospitalized in our department from Dec 2014 to Mar 2017 ,were selected .According to diag—nostic standard of MH ,patients were divided into MH group (n＝85) and non—MH group (n＝75).Levels of blood lipids ,fasting blood glucose (FBG ) ,serum Lp—PLA2 ,carotid intima—media thickness (IMT ) and plaque detection rate were measured and compared between two groups ,and the correlation between serum Lp—PLA2 level and carot—id AS was analyzed .Results : There were no significant difference in levels of blood lipids and FBG between two groups , P＞0.05 all.Compared with non—MH group ,there were significant rise in serum Lp—PLA2 level [ (47. 50 ± 3.15) μg／L vs.(156. 87 ± 18.56) μg／L ] ,plaque detection rate (66. 6% vs.90.6%) and carotid IMT [ (0.96 ± 0.12) mm vs.(1.26 ± 0.16) mm] in MH group , P＝0.001 all.Spearman rank correlation analysis indicated that serum Lp—PLA2 level was significant positively correlated with carotid plaque detection rate ( r＝0.532 , P＝0.003). Conclusion : Serum Lp—PLA2 level of MH patients is significantly higher than that of non—MH patients ,and it＇s sig—nificant positively correlated with carotid AS .Therefore ,the Lp—PLA2 level and atherosclerosis detections should be enhanced for early diagnosis and treatment .
摘要
Objective: To explore the clinicopathological features and the diagnostic value of the CT scan in multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and cystic nephroma (CN). Methods: The clinical data of 12 patients with CN and 20 patients with MCRNLMP, confirmed by pathology at the Renmin Hospital of Wuhan University and Jingzhou Central Hospital from Janu-ary 2000 to March 2019, were retrospectively analyzed. The receiver operating characteristic (ROC) curves were used to analyze the feature of contrast-enhanced CT images of the tumors, and the immunophenotypes of the tumors were observed by immunohisto-chemistry. Results: There were statistically significant differences between MCRNLMP and CN in terms of thickness of the cyst wall and partition, number of soft-tissue enhancing masses, peak intensity of enhancement, and the Bosniak classification (P<0.05). Based on ROC curve analyses, when the thickness of the capsule wall and partition was greater than 2.25mm, the number of enhanced high-density lesions was greater than 1, and the peaking intensity of fortification was above the moderate level in the diagnosis of CRNLMP. The areas under the curve of the three indexes were 0.879, 0.800 and 0.838, which can be used as the best diagnostic criterion for MCRNLMP. Immunophenotyping revealed that MCRNLMP characteristically expressed the renal cell carcinoma (RCC) marker, and CN characteristically expressed the estrogen receptor(ER) and progesterone receptor(PR). Conclusions: The cyst wall and septal thickness, number of soft-tissue enhancing masses, and peak intensity of enhancement show a higher diagnostic value in differentiating MCRN-LMP and CN. The precise diagnosis relies on the pathological and immunohistochemical examination.
摘要
ObjectiveTo study the relationship between tumor siza,aource intensita,arescription dose and source dwell time in the after-loading treatment plaa,and to establish a method that can be used for rapid quality control of after-loading plans.Methods The all of gynecological cancer patients treated in this hospital were selected:84 cases of all three tubes of Fletcher applicator,58 cases of uterine alone and 39 cases of vaginal applicator.Each patient was scanned with CT before treatment.Contouring the target and organs at risa,ahe treatment plan was optimized using IPSA.Record the source strengta,arescription dosa,aource dwell tima,and tumor volume of the prescribed dose for each case.Calculate CI values and Rv.The kvalue analyzes the CI distribution characteristics and the correlation with the Rv value.In addition,46 cases of gynecologic tumor patients were used to verify the method.Results The fitting index of the after-loading scheme of the three applicators showed a normal distribution.The mean value of the Fletcher applicator CI was 0.720±0.067,the k value was 1 394,Rvalue was 0.894.The mean value of the uterine alone CI was 0.697±0.076,the k value was 1 428,R=0.940,the mean value of the vaginal applicator CI was 0.742± 0.067,the k value was 1 362,and R=0.909.Conclusions Using this methoa,at can quickly assess whether the planned target voluma,aadiation source intensita,arescription dose and treatment time matca,and find the cause of deviation based on the feedback results to ensure that the after-loading treatment plan can be quickla,accuratela,and efficiently implemented according to clinical requirements.