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This paper summarized Professor ZHOU Zhongying's experience in differentiating and treating hepatitis and liver cirrhosis from deficiency and excess. It is considered that the pathogenesis of hepatitis and liver cirrhosis belongs to deficiency in root and excess in branch， with depletion of liver， spleen and kidney as the root， and constraint and bind of damp-heat and stasis toxin as the branch. Moreover， mutual cause and promotion between deficiency and excess leads to the disease. For general principle of treatment， it is recommended to clear and transform pathogenic excess， supplement deficiency and rectify the healthy qi. In the early stage of hepatitis and cirrhosis， excess pathogen hyperactivity is the main manifestation， which can be treated by clearing and transforming damp-heat and stasis toxin， supplemented by regulating spleen and stomach， with modified Yinchenhao Decoction （茵陈蒿汤） and Biejiajian Pill （鳖甲煎丸）. In the middle and late stages， cases with deficiency-excess complex were more common， which should be treated by clearing damp-heat and stasis toxin， regulating and supplementing liver-spleen-kidney， using medicinals with the function of clearing heat and dispelling damp， dissolving stasis and resolving toxins to treat the branch. Moreover， Liujunzi Decoction （六君子汤）， Yiguan Decoction （一贯煎）plus Erzhi Pill （二至丸） and Buzhong Yiqi Decoction （补中益气汤） modifications are suggested respectively in correspondence to the different kinds of root deficiency including irregular liver and spleen， liver and kidney yin deficiency， and liver-spleen-kidney deficiency.
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Objective: To investigate surgical strategies and the corresponding benefits for patients with perihilar cholangiocarcinoma(pCCA). Methods: A total of 81 patients with pCCA who underwent radical excision in the Department of Biliary and Pancreatic Surgery of Sun Yat-Sen Memorial Hospital between January 2014 and December 2021 were retrospectively collected.The cohort consisted of 50 male and 31 female patients,with an age of (62.5±11.5)years(range:26 to 83 years).Seventy-five cases were diagnosed with jaundice,60 of whom received preoperative biliary drainage,while 20 patients received portal vein embolization.Their serum bilirubin level within one week before the operation(M(IQR)) was 44.3 (41.9) μmol/L(range:8.0 to 344.2 μmol/L).Preoperative imaging examinations were performed to evaluate the Bismuth-Corlette type of pCCA,showing 3,6,21,27,and 24 cases of Bismuth-Corlette type Ⅰ,Ⅱ,Ⅲa,Ⅲb,and Ⅳ,respectively.The primary outcome was overall survival (OS),and the secondary outcomes were relapse-free survival (RFS),90-day postoperative morbidity and 90-day postoperative mortality.OS and RFS were estimated using the Kaplan-Meier method and compared by the Log-rank test.Significant prognostic factors were determined using univariate and multivariable Cox proportional hazard regression analyses. Results: In the cohort of 81 pCCA patients,67 cases(82.7%) underwent major hepatectomy while 3 cases received major hepatectomy combined with pancreaticoduodenectomy.Thirty-four patients underwent hepatectomy combined with vascular resection and reconstruction(18 cases of portal vein resection and reconstruction alone;9 cases of hepatic artery resection and reconstruction alone;7 cases of combination of portal vein and hepatic artery resection and reconstruction).Margin negative(R0 excision) were achieved in 53.1%(43/81) of these patients.The operation duration was (627±136)minutes(range:565 to 940 minutes),and the intraoperative blood loss was 400(455)ml(range:200 to 2 800 ml).The 90-day postoperative mortality was 3.7%(3/81).Grade 3-4 postoperative morbidity was 23.4% (19/81) according to the Clavien-Dindo classification of surgical complications.Up to the last follow-up at September 2022,the follow-up time was 34.0(24.2)months (range:0.4 to 103.6 months).Three patients who died within 90 days after surgery were excluded from the survival analysis.The median OS was 36.10 months (95%CI:18.23 to 42.97 months) and the 1-,3-and 5-year OS rates were 85.3%,46.8% and 27.3%,respectively.The median OS of 41 patients with negative margins was 47.83 months(95%CI:36.90 to 58.80 months) and that of 37 patients with positive margins was 20.47 months(95%CI:10.52 to 30.58 months).The median RFS of 70 patients with R0 and R1 resection was 24.50 months(95%CI:12.15 to 31.85 months)and the 1-,3-and 5-year RFS rates were 65.2%,45.7% and 29.9%,respectively.The median RFS of 41 patients with R0 resection was 38.57 months(95%CI:21.50 to 55.63 months) and that of 29 patients with R1 resection was 10.83 months(95%CI:2.82 to 19.86 months). Conclusions: The primary therapy for pCCA is radical surgical resection.A precise preoperative evaluation and sufficient preparation can reduce postoperative morbidity.Surgical treatment can achieve a better survival outcome by increasing the radical resection rate.
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PURPOSE@#Static progressive stretch (SPS) can be applied to treat chronic joint stiffness. However, the impacts of subacute application of SPS to the distal lower limbs, where deep vein thrombosis (DVT) is common, on venous thromboembolism remain unclear. This study aims to explore the risk of venous thromboembolism events following subacute application of SPS.@*METHODS@#A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022. Patients with unilateral lower limb comminuted para-articular fractures, transferred to rehabilitation ward for further treatment within 3 weeks after operation, followed up more than 12 weeks since initial manual physiotherapy, and diagnosed DVT by ultrasound before rehabilitation course were included in the study. Patients with polytrauma, without evidence of previous peripheral vascular disease or incompetence, had medication for thrombosis treatment or prophylaxis before the operation, detected with paralysis due to nervous system impairment, infected after operation during the regime, or with acute progression of DVT were excluded. The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation. Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups. SSPS 28.0 and GraphPad Prism 9 were used for data processing. A p < 0.05 was set significant difference.@*RESULTS@#In total of 154 patients with DVT participating in this study, 75 of them were treated with additional SPS for postoperative rehabilitation. The participants in the SPS group showed improved range of motion (12.3° ± 6.7°). However, in the SPS group, there was no difference in thrombosis volume between the start and termination (p = 0.106, p = 0.787, respectively), although difference was seen intra-therapy (p < 0.001). Contingency analysis revealed the pulmonary embolism incidence (OR = 0.703) in the SPS group compared to the mean physiotherapy.@*CONCLUSION@#The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.
Subject(s)
Humans , Venous Thromboembolism/prevention & control , Venous Thrombosis/etiology , Retrospective Studies , Pulmonary Embolism/complications , Lower Extremity , Risk Factors摘要
Objective To explore the protective mechanism of RNA binding protein LIN28 on diabetic nephropathy(DN).Methods LIN28 was overexpressed or knocked down by adenovirus in HEK 293T cells.The gene and functional signaling pathway significantly changed after overexpression of LIN28 were obtained through RNA Seq transcriptome sequencing and bioinformatics analysis.HEK 293T cells were divided into the Control group,the Treatment group,the Adv-LIN28-OE+D-ribose group and the Adv-LIN28-NC+D-ribose group in in vitro LIN28 overexpression studies.And HEK 293T cells were divided into the Control group,the Treatment group,the Adv-shRNA LIN28+D-ribose group and the Adv-shRNA NT+D-ribose group in in vitro LIN28 knockdown studies.ELISA was used to detect the levels of human advanced glycation end products(AGEs)of cells supernatants in the above groups.Western blot was used to detect the expression levels of RAGE,NF-κB and MMP-2 of cells in the above groups.Results The results of RNA-Seq transcriptome sequencing,GO analysis and KEGG analysis showed that overexpression of LIN28 resulted in a significant down-regulation of AGE-RAGE signaling pathway in HEK 293T cells(P<0.05).The results of ELISA showed that compared with the Control group,the cell in the Treatment group produced a large amount of AGEs(P<0.05);compared with the Treatment group,the AGEs level of cells in the Adv-LIN28-OE+D-ribose group was significantly decreased(P<0.05),while the AGEs level of cells in the Adv-shRNA LIN28+D-ribose group was increased(P>0.05).The results of Western blot showed that compared with the Control group,the expression levels of RAGE,NF-κB and MMP-2 of cells in the Treatment group were significantly increased(P<0.05);compared with the Treatment group,the expression levels of RAGE,NF-κB and MMP-2 of cells in the Adv-LIN28-OE+D-ribose group were significantly decreased(P<0.05),while the expression levels of RAGE,NF-κB and MMP-2 of cells in the Adv-shRNA LIN28+D-ribose group were significantly increased(P>0.05).Conclusion Overexpression of LIN28 by adenovirus at the cellular level in vitro can lead to significant differential expression of thousands of genes.In particular,it can inhibit the diabetes and complications-related AGE-RAGE signaling pathway,which is critical in the progression of DN disease,and play a role in protecting DN.
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Long non coding RNA(lncRNA)LINC01296 plays a carcinogenic role in different tumor growth,apoptosis,and metastasis,but its mechanism in nasopharyngeal carcinoma is still unclear.The aim of this study is to study the mechanism of knockdown of long non-coding RNA(lncRNA)LINC01296 in inhibiting immune escape of nasopharyngeal carcinoma cells by regulating programmed death ligand-1(PD-L1).In this study,human peripheral blood lymphocytes were isolated and cultured,and then co-cultured with human nasopharyngeal carcinoma cells CNE-2Z,meantime,C57BL/6 mice were injected subcutaneously with CNE-2Z cells to establish a nasopharyngeal carcinoma xenograft model(24 mice).All of them were randomly grouped into control group,lncRNA LINC01296 knockdown group(transfected with lncRNA LINC01296 small interfering RNA(siRNA)),negative control group(transfected with lncRNA LINC01296 siRNA negative control and empty plasmid),and lncRNA LINC01296 knockdown + PD-L1 overexpression group(transfected with lncRNA LINC01296 siRNA and PD-L1 overexpression plasmid).After grouping and transfection,the proportion of activated CD8+ T cells in human peripheral blood lymphocytes was detected by flow cytometry;the killing rate of human peripheral blood lymphocytes to CNE-2Z cells was detected by cell count kit-8 method;the tumor volume of tumor-bearing mice was measured;the CD8 and PD-L1 positive expression in tumor tissue of tumor-bearing mice was measured by immunofluorescence staining;the expression of lncRNA LINC01296 and PD-L1 messenger RNA(mRNA)in CNE-2Z cells and tumor tissues were detected by real-time PCR assay;the expression of PD-L1 protein in CNE-2Z cells and tumor tissues was detected by Western blotting.The results showed that compared with control group,the proportion of activated CD8+ T cells in human peripheral blood lymphocytes,the killing rate of CNE-2Z cells,and the positive proportion of CD8 in tumor tissue of the lncRNA LINC01296 knockdown group increased(P<0.05),the tumor volume and the expression of positive proportion of PD-L1,double positive proportion of CD8 and PD-L1,lncRNA LINC01296,PD-L1 mRNA and protein in CNE-2Z cells and tumor tissue decreased(P<0.05);there was no obvious change in each index of the mice in the negative control group(P>0.05);overexpression of PD-L1 can weaken the effects of lncRNA LINC01296 knocking down on various indicators in CNE-2Z cells and mice.In summary,knockdown of lncRNA LINC01296 can promote the activation and infiltration of CD8+ T cells by down-regulating PD-L1,attenuate the immune escape of nasopharyngeal carcinoma cells,and enhance the lethality of CD8+ T cells.
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Dysmenorrhea is a common gynecological disease in clinic， with primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea is usually not accompanied by organic lesions in genital organs， which is mainly related to the increase of prostaglandin content in endometrium during menstruation. Secondary dysmenorrhea is accompanied by organic lesions of reproductive organs， often associated with local lesions of reproductive organs， but also with patients' mental factors and neuroendocrine factors.The incidence of dysmenorrhea is as high as 73.8%， and there is no radical cure method， which has a great impact on the life， work and learning of patients. Chinese medicine essential oil widely exists in aromatic Chinese medicine， with antibacterial， antioxidant and anticancer activities. It can regulate neuroendocrine function， anti-inflammatory and analgesic effects， and improve mood by regulating the levels of prostaglandins， oxytocin and other hormones in the body and regulating the emotions of patients， there by alleviating dysmenorrhea to a certain extent. In recent years， many scholars have made more in-depth research on Chinese medicine essential oil in alleviating dysmenorrhea， but there is a lack of comprehensive collation of such studies. In this regard， the author has systematically sorted out the generation and classification of dysmenorrhea， the mechanism of action of essential oil of traditional Chinese medicine to alleviate dysmenorrhea and the application of essential oil of traditional Chinese medicine in the field of dysmenorrhea by consulting relevant literature in Chinese and foreign languages in recent years， so as to provide reference for the treatment of dysmenorrhea.
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OBJECTIVE@#To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP).@*METHODS@#A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females, aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb, 7 cases of type Ⅱc, 8 cases of type Ⅲa, 2 cases of type Ⅲb, 2 cases of type Ⅲc, 1 case of type Ⅳb, and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation, FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis, superior ramus of pubis or acetabular anterior column in the screw group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, length of hospital stay, cost of internal fixation, pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function was evaluated by the Majeed functional scoring system respectively.@*RESULTS@#All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of hospital stay between the two groups(P>0.05). As for the cost of internal fixation, the cost of internal fixation in the screw group [2 914 (2 914, 4 371) yuan] was significantly lower than that of the INFIX group [6 205 (6 205, 6 205) yuan] (P<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in VAS assessment at admission, 1 week, and 3 months after surgery between the two groups(P>0.05). However, the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(P<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(P>0.05).@*CONCLUSION@#For the treatment of fragility fractures, minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive, less bleeding, relieving the pain. It deserves clinical application.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Blood Loss, Surgical , Case-Control Studies , Fractures, Bone/surgery , Pelvic Bones/surgery , Retrospective Studies摘要
Objective To evaluate the impact of Toxoplasma gondii human infections on blood lipid levels. Methods A total of 1 000 healthy volunteers that were randomly sampled from a tertiary hospital during the period from December 2017 through December 2019 were enrolled, and assigned into the infection group and the control group according to the detection of serum anti-T. gondii antibody using enzyme-linked immunosorbent assay (ELISA). The serum levels of total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglyceride (TG) were detected and compared between the two groups. Results The seroprevalence of anti-T. gondii antibody was 8.40% in the study subjects, and there were no significant differences between the infection and control groups in terms of gender (χ2 = 1.29, P > 0.05) or age (χ2 = 1.41, P > 0.05). The mean serum LDL (t = 3.89, P < 0.05) and TC levels (t = 3.81, P < 0.05) were significantly higher in the infection group than in the control group, while no significant differences were seen between the two groups in terms of mean serum TG (t = 0.97, P > 0.05) or HDL levels (t = 0.75, P > 0.05). In addition, the proportions of abnormal LDL (χ2 = 9.69, P < 0.01) and TC levels (χ2 = 10.39, P < 0.01) were significantly greater in the infection group than in the control group, while no significant differences were found in the proportion of abnormal TG (χ2 = 0.02, P > 0.05) or HDL level (χ2 = 0.11, P > 0.05) between the two groups. Conclusion T. gondii human infections affect blood lipid levels, and the individuals sero-positive for anti-T. gondii antibody have higher mean serum LDL and TC, as well as higher proportions of abnormal TC and LDL than sero-negative individuals.
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OBJECTIVE@#To evaluate the efficacy of iliolumbar fixation in the treatment of U-shaped sacral fractures.@*METHODS@#A retrospective study was conducted on the 14 complex U-shaped sacral fractures which had been treated from January 2014 to December 2019, involved 10 males and 4 females, aged 24 to 48 (35.4±6.5) years. Fracture healing time, nerve function, clinical function and complications were observed in the patients.@*RESULTS@#All patients were followed up for 9 to 16(26.0±5.9) months. The complete weight-bearing time for bone healing was(12.4±2.0) weeks. One case of surgical incision infection occurred after operation, and one case of sacrum nailspenetrated to the outer plate of sacrum. No complications such as pressure ulcers, loosening or rupture of internal fixation occurred. According to Gibbons scoring, the neurological function recovered from preoperative 2.9±0.9 to postoperative 2.1±1.1, there were statistically significant differences between preoperative and postoperative (@*CONCLUSION@#Sacral lumbar fixation is an effective method for the treatment of U-shaped sacrum fractures. It has the advantages of strong internal fixation and satisfactory functional recovery.
Subject(s)
Female , Humans , Male , Bone Screws , Fracture Fixation, Internal , Retrospective Studies , Sacrum/surgery , Spinal Fractures/surgery , Treatment Outcome摘要
Liangmianzhen(Zanthoxyli Radix) has long been used as medicine. The current medicinal parts are different from those in the ancient. As recorded in the Chinese Pharmacopeia, the medicinal part is root. However, in ancient works, the medicinal parts include root, stem, leaf, and fruit. In an attempt to find the historical basis that stem is a reasonable medicinal part, the herbalogical study was carried out on this medicinal based on the formal names, synonyms, original plant, medicinal parts, habitat of the medicinal plant, producing area, processing and preparation methods, efficacy, and indications recorded in ancient Chinese materia medica and local gazetteers. The results showed that Liangmianzhen was firstly recorded as a medicinal in Shennong's Classic of Materia Medica with the formal name of "Manjiao". "Manjiao" was adopted from the Han Dynasty to the Qing Dynasty when it was changed to "Rudijinniu", the name originating from the folk in the south of the Five Ridges. Now, the formal name is "Liangmianzhen", which was firstly recorded in Wuxuan County Gazetteer in 1914 and then as a synonym in the Updated Records of Picking Herbs in the South of the Five Ridges. According to the formal names, synonyms, and the descriptions of the original plant, the medicinal plants of Liang-mianzhen have the characteristics of shrub-like young seedlings, vine adult seedlings, corymbiform thyrsus, stems with thorns, amphitropous golden-yellow roots with horn-like branches, and thorns on both sides of the leaves. Thus, "Manjiao", "Rudijinniu", and "Liangmianzhen" were from the same species of Zanthoxylum nitidum(Rutaceae), which was also verified based on the growth environment, habitat, processing and preparation methods, efficacy, and indications. In ancient times, the stem and root were the main medicinal parts and leaves and fruits were also used. However, in the Chinese Pharmacopeia, root is recorded as the only medicinal part, which is obviously inconsistent with the records in the ancient classics. In light of the limited medicinal resources for Liang-mianzhen, other medicinal parts of Z. nitidum is recommended. This study clarified the medicinal parts of Z. nitidum in history. It is recommended that the stem be added to the medicinal parts of Z. nitidum in the next edition of Chinese Pharmacopeia.
Subject(s)
China , Drugs, Chinese Herbal , Fruit , Materia Medica , Medicine, Chinese Traditional , Plants, Medicinal摘要
OBJECTIVE@#To investigate the efficacy of high-risk myelodysplastic syndrome (MDS) patients treated by different doses of decitabine (DAC) and its safety.@*METHODS@#Thirty patients with high-risk MDS were all treated by demethylation drug DAC. According to the doses of DAC, 30 patients were divided into 10-day regimen [6 mg/(m@*RESULTS@#The patients were followed up to May 2020, in the 10-day regimen group, 10 cases achieved complete remission (CR), 3 cases achieved partial remission (PR), and 2 cases were progressive disease (PD). Four cases died, including 1 case for heart failure, 2 cases for respiratory failure and 1 case for serious infection. In the 5-day regimen group, 11 cases achieved CR, 1 case achieved PR, 3 cases were PD. Five cases died, including 2 cases for heart failure and 3 for serious infection. The CR rate and ORR of the patients in the two groups were 66.67% vs 73.33%, 86.67% vs 80.00%, respectively, which showed no significant differences, and the efficacy also showed no significant difference. After treatment, the levels of WBC, NE, Hb and PLT of the patients in 10-day regimen group were higher than those in 5-day regimen. In the 10-day regimen group, there were 11 cases of pneumonia, 2 cases of bacteremia, 1 case of skin infection and 1 case of urinary tract infection. While in the 5-day regimen group, 13 cases of pneumonia, 5 cases bacteremia, 1 case of skin infection and 3 cases of urinary tract infection. There were 2 cases with mild gastrointestinal response in the 10-day regimen group, and 7 cases with obvious nausea and anorexia in the 5-day regimen group. The symptoms were relieved after the treatment of acid suppression, stomach protection and antiemetic. The liver, kidney and heart function were monitored. One case liver function damage and 2 cases cardiac insufficiency were observed in the 10-day regimen group. Seven cases regimen cardiac insufficiency and 4 cases regimen liver function damage were observed in the 5-day regimen group.@*CONCLUSION@#10-day regimen and 5-day regimen are equally effective, but 10-day regimen is less myelosuppressive and more safer, which can be applied in clinical.
Subject(s)
Humans , Antineoplastic Combined Chemotherapy Protocols , Azacitidine/therapeutic use , Cytarabine/therapeutic use , Decitabine/therapeutic use , Myelodysplastic Syndromes/drug therapy , Treatment Outcome摘要
Objective To understand the seroprevalence of Toxoplasma gondii infections among patients with autoimmune diseases, so as to provide the scientific evidence for the management of toxoplasmosis in patients with autoimmune diseases. Methods A total of 237 patients with definitive diagnosis of autoimmune disease were selected as the study subjects, including 79 cases with systemic lupus erythematosus, 71 cases with rheumatoid arthritis and 87 cases with inflammatory bowel disease, while 237 healthy volunteers served as controls. The serum anti-T. gondii IgG antibody was detected using enzyme-linked immunosorbent assay (ELISA) in patients with autoimmune diseases and healthy controls, and the detection of serum IgG antibody against T. gondii was compared between the autoimmune disease patients and healthy controls. Results The seroprevalence of serum IgG antibody against T. gondii was significantly greater in patients with autoimmune diseases than in healthy controls (29.96% vs. 4.22%; χ2 = 55.41, P < 0.01), and the seroprevalence of T. gondii infection was all significantly higher in patients with systemic lupus erythematosus (31.65%), rheumatoid arthritis (23.94%) and inflammatory bowel disease (33.33%) than in healthy controls (χ2 = 45.25, 26.58 and 50.95; all P values < 0.01). Conclusion The seroprevalence of anti-T. gondii IgG antibody is significantly higher in patients with autoimmune diseases than in healthy controls, and T. gondii infection may be a potential risk factor for the development of systemic lupus erythematosus, rheumatoid arthritis and inflammatory bowel disease.
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Hypoxic-ischemic encephalopathy is a leading cause of acquired neonatal brain injury and may lead to long-term neurological sequelae or death. Early and professional assessment of neurobehavior with appropriate tools facilitates identifying critical influencing factors within the neonatal period and providing specific guidance and determining management and prognosis. This review summarized the neurobehavior assessment tools at home and abroad within the neonatal period, aiming to provide a reference for clinical practice and research.
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OBJECTIVE@#To compare the clinical efficacy of three minimally invasive methods of anterior column screw, plate and screw rod system in the treatment of anterior pelvic ring fracture.@*METHODS@#From December 2015 to September 2018, 77 patients with pelvic anterior ring fracture were treated and followed up, including 45 males and 32 females, aged 19 to 73 years. According to AO / OTA classification, there were 26 cases of type B1, 20 cases of type B2, 17 cases of type B3 and 14 cases of type C. According to the different internal fixation methods, they were divided into three groups:anterior column screw group(35 cases), plate group(20 cases), and screw rod system group(22 cases). The operation time, intraoperative fluoroscopy times, blood loss, fracture reduction quality, complications and curative effect of the three groups were compared.@*RESULTS@#All 77 patients were followed up for 12 to 33 (16.5±5.7) months. The operation time, intraoperative blood loss and incision length of anterior column screw group were significantly shorter than those of plate group and screw rod system group, and intraoperative fluoroscopy times of plate group were significantly less than those of anterior column screw group and screw rod system group (@*CONCLUSION@#Minimally invasive internal fixation with anterior column screw, plate and screw rod system can obtain good clinical effect, but anterior column screw fixation has less trauma and lower incidence of surgicalcomplications.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Plates , Bone Screws , Fracture Fixation, Internal , Fractures, Bone/surgery , Minimally Invasive Surgical Procedures , Pelvic Bones/surgery , Retrospective Studies , Treatment Outcome摘要
Objective To evaluate the efficacy and accuracy of hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery.Methods From September 2015 to March 2018,46 patients with pelvic or/and acetabular fracture involving the anterior column were treated with hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw at Department of Orthopaedics,Lishui Municipal Central Hospital.They were 28 men and 18 women,aged from 21 to 85 years (mean,55.6 years).There were 34 pelvic ring fractures,9 acetabular fractures and 3 combined pelvic ring and acetabular fractures.After the anterior lateral spine of pubic tuberosity was drilled by a guide pin and drill bit as the entry point,a reverse guide wire was knocked into the bone lightly by a hammer.For each retrograde intramedullary screwing into the acetabular anterior column,we recorded operation time,fluoroscopic frequency,and attempts to establish an acceptable screw pathway by the guide pin.The accuracy of screwing and the quality of fracture reduction were evaluated by imaging examination.For each patient,we recorded fracture union time and complications.Functional recovery of the pelvis and acetabulum was assessed by postoperative physical examination at the last follow-ups.Results The operation time of retrograde intramedullary screwing for the 46 patients averaged 28.9 minutes (from 16 to 55 minutes);the fluoroscopy frequency averaged 16.3 times (from 9 to 35 times);an acceptable screw pathway was established by the first attempt in 43 of the 46 patients (93.5％) and re-established after adjustment of the guide pin in the other 3.Forty patients were followed up for an average of 15.2 months(from 6 to 36 months).Postoperative CT scan and three-dimensional reconstruction showed that all the screws had been placed safely and accurately in the acetabular anterior column.Implant loosening and fracture displacement occurred in one case and lower limb thrombosis in another.No nail breakage,fracture nonunion,incision necrosis or infection,neurovascular injury or femoral head necrosis was observed.All fractures united after an average of 14.7 weeks (from 12 to 18 weeks).According to the Majeed scoring at the last follow-ups,the pelvic and acetabular function was evaluated as excellent in 29 cases,as good in 9,and as fair in 2,giving an excellent and good rate of 95.0％.Conclusion Hammering reverse guide wire technique is an effective method for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery,because it can increase accuracy of screwing and reduce intraoperative radiation,operation time and incidence of complications though it is simple.
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Myelodysplastic syndrome (MDS) is a kind of clone diseases originating from hematopoietic stem/progenitor cells, and it has a high risk of transforming into acute myeloid leukemia (AML). The incidence of childhood MDS is low, which shows a big difference between pediatric MDS and adult MDS in morphology, immunology, cytogenetics and molecular biology. Childhood MDS has some unique biological characteristics, and thus, it is very difficult to diagnose and treat. This article reviews the progress of pediatric MDS.
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Objective@#To study the protective effect of melatonin (MT) against lead-induced neurotoxicity.@*Methods@#PC12 cells were divided in four groups (control, 25 μmol/L PbAc, 50 μmol/L MT and 25 μmol/L PbAc+50 μmol/L MT) . After treatment, cell viability was detected by cell counting kit-8 (CCK-8) assay and cytotoxicity LDH assay were used to evaluate cell damage rate. The expression of Cleaved-Caspase-3 and cytochrome C (cyto C) was detected by immunofluorescence (IF) . ROS levels were measured by DCFH method. GSH contents and SOD activities were detected after whole cell protein was extracted.@*Results@#Compared with control group, 25 μmol/L PbAc caused significantly decreased cell viability, GSH contents and SOD activities, while increased cell damage rate and ROS level significantly (P<0.05) . 25 μmol/L PbAc could also increase the protein level of cleaved-caspase-3 and cyto C in cytoplasm. Compared with 25 μmol/L PbAc group, 50 μmol/L MT+25 μmol/L PbAc caused significantly increased cell viability, GSH contents and SOD activities, while decreased cell damage rate and ROS level significantly (P<0.05) . Compared with 25 μmol/L PbAc group, 50 μmol/L MT+25 μmol/L PbAc decreased the protein level of cleaved-caspase-3 and cyto C.@*Conclusion@#Melatonin could attenuate PbAc-induced oxidative stress and cell death and promote cell survival.
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OBJECTIVE@#This study aimed to investigate the gene mutational characteristics of cathepsin C (CTSC) gene in a Chinese patient with Papillon-Lefèvre syndrome (PLS) and further confirm the genetic basis for the phenotype of PLS.@*METHODS@#Peripheral blood samples were obtained from the PLS proband and his family members (his parents and younger brother) for genomic DNA extraction. The coding region and exon boundaries of the CTSC gene were amplified and sequenced by polymerase chain reaction and direct sequencing of DNA.@*RESULTS@#Compound heterozygous mutations of CTSC gene were identified in the patient. A heterozygous missense mutation occurred in the 800th base of exon 6, and the base T in the base pair was replaced by C (c.800T>C). The encoded amino acid leucine changed to proline (p. L267P). A heterozygous missense mutation occurred in the 1015th base of exon 7, and base C in the base pair was replaced by T (c.1015C>T). The encoded amino acid arginine changed to cysteine (p.R339C). Among the mutations, c.800T>C originated from the mother, c.1015C>T was identified from the father. No mutations were detected in the younger brother.@*CONCLUSIONS@#Mutations of CTSC gene are responsible for the phenotype of PLS.
Subject(s)
Humans , Male , Cathepsin C , Genetics , DNA Mutational Analysis , Exons , Mutation , Papillon-Lefevre Disease , Genetics , Pedigree , Phenotype摘要
Breastfeeding, as the optimal feeding pattern, ensures the physical, neurological and psychological growth and development of infants. Professional evaluation of breastfeeding with assessment tools facilitates identifying critical influencing factors and providing specific guidance and health education. This review summarized the breastfeeding assessment tools at home and abroad to provide reference for clinical practice and research.
摘要
Objective To explore RIZ1 mRNA expression level in different subtypes and risk classification groups of the patients with myelodysplastic syndromes (MDS) and to analyze the correlation between the clinical features and RIZ1 mRNA expression. Methods A total of 46 newly diagnosed as MDS patients and 10 healthy controls who were the donors of hematopoietic stem cell transplantation from Chuiyangliu Hospital Affiliated to Tsinghua University and the Second Hospital of Shanxi Medical University between January 2014 and December 2017 were collected. The real time fluorescence quantitative polymerase chain reaction (RT-PCR) was used to detect the expression level of RIZ1 mRNA in bone marrow cells from MDS patients and the healthy controls. Results Compared with the healthy control group, the relative expression level of RIZ1 mRNA in MDS patients was decreased [the median (P25, P75):1.003 (0.895, 1.812) vs. 0.557 (0.333, 0.815)], and the difference was statistically significant (Z= -2.991, P= 0.0003). According tothe World Health Organization (WHO) classification criteria, compared with the healthy control group, the relative expression of RIZ1 mRNA in refractory anemia/refractory anemia with ring sideroblasts/refractory cytopenia with multiple dysplasia (RA/RAS/RCMD), refractory anemia with excess blasts Ⅰ (RAEB-Ⅰ), RAEB-Ⅱand MDS transformed into acute myeloid leukemia (MDS/AML) groups had statistically significant differences (χ2= 19.500, P< 0.01). Further pairwise comparison showed that the relative expression level of RIZ1 mRNA in RAEB-Ⅰ, RAEB-Ⅱand MDS/AML groups was lower than that in the healthy control group, and the differences were statistically significant (all P < 0.05). According to the international prognostic scoring system (IPSS), compared with the healthy control group, the expression of RIZ1 mRNA in low-risk, inter-risk-1, inter-risk-2 and high-risk group had statistical differences (χ2= 19.214, P= 0.001). Further pairwise comparison showed that the relative expression of RIZ1 mRNA in inter-risk-1, inter-risk-2 and high risk group was lower than that in the healthy control group, and the differences were statistically significant (all P<0.05). And RIZ1 mRNA expression showed a decreasing trend with the increase of disease risk grade. RIZ1 mRNA expression level had no relationship with age, gender, peripheral blood white cell count, the hemoglobin, platelet count and karyotype (all P> 0.05). Conclusion RIZ1 mRNA expression level is decreased in MDS patients, and it is different in various subtypes and risk classification. RIZ1 may involve in the pathogenesis of MDS and play an important role in the progression of MDS.