Cldn4 overexpression promotes penile cavernous smooth muscle cell fibrotic response via the JNK signaling pathway.

BACKGROUND: Erectile dysfunction (ED), defined as the inability to achieve or maintain a penile erection sufficient to satisfy sexual behavior, is prevalent worldwide. AIM: Using previous research, bioinformatics, and experimental confirmation, we aimed to discover genes that contribute to ED through regulating hypoxia in corpus cavernosum smooth muscle cells (CCSMCs). METHODS: We used the Gene Expression Omnibus to acquire the sequencing data of the corpus cavernosum transcriptome for diabetic ED and nerve injury type ED rats. We intersected the common differentially expressed genes. Further verification was performed using single cell sequencing. Real-time quantitative polymerase chain reaction and immunofluorescence were used to investigate whether the differentially expressed genes are found in the corpus cavernosum. We used induced hypoxia to assess cell viability changes, and we developed a lentivirus overexpressing Cldn4 for in vitro and in vivo experiments to measure changes in JNK signaling, fibrosis, hypoxia, and erectile function. OUTCOMES: Our results indicate that targeting the JNK pathway and decreasing local hypoxia may be better options for therapeutic intervention to improve erectile function. RESULTS: We identified Cldn4 and found its expression increased in the corpora cavernosa of the 2 datasets. In addition, we found that hypoxia can increase the expression of Cldn4, activate the JNK signaling pathway, and exacerbate fibrosis in CCSMCs. Cldn4 overexpression in CCSMCs activated the JNK signaling pathway and increased fibrotic protein expression. Last, rat corpus cavernosum overexpressing Cldn4 activated the JNK signaling pathway, increased local fibrosis, and impaired erectile function. CLINICAL IMPLICATIONS: Through bioinformatics and in vitro and in vivo experiments, we found that Cldn4 has a negative effect on ED, and targeting Cldn4 may provide new ideas for ED treatment. STRENGTHS AND LIMITATIONS: Although we have identified Cldn4 as a potential target for ED treatment, we have only conducted preliminary validation on CCMSCs, and we still need to further validate in other cell lines. CONCLUSION: CCSMC hypoxia leads to increased Cldn4, in both nerve injury and diabetic ED rat models, and promotes fibrosis by activating the JNK signaling pathway.

Cigarette Smoke or Motor Vehicle Exhaust Exposure Induces PD-L1 Upregulation in Lung Epithelial Cells in COPD Model Rats.

A high smoking-independent chronic obstructive pulmonary disease (COPD) prevalence is observed in lung cancer patients. However, the underlying connection between these two diseases still remains unclear. Cigarette smoking and ambient air pollution are common risk factors for COPD and lung cancer. In this study, we established rat COPD model through exposure to cigarette smoke (CS) or motor vehicle exhaust (MVE). The model rats developed COPD-like phenotypes, manifested as lung functions decline, lung inflammation, emphysema-like alveolar enlargement and airway remodeling. The programmed death-ligand 1 (PD-L1), a factor contributing to immune escape of tumor cells, was overexpressed in lungs from COPD model rats, though more severe COPD phenotypes did not bring with further PD-L1 overexpression in lung. The upregulations of proinflammatory cytokines and PD-L1 were also observed in cultured human bronchial epithelial cells BEAS-2B upon treatment with cigarette smoke extract (CSE) or diesel-related particulate matter 2.5 (PM2.5, SEM1650b). The inflammatory cytokines produced in BEAS-2B cells reflected the PD-L1 levels. Furthermore, ERK1/2, a kinase mediating PD-L1 upregulation in premalignant bronchial cells or NSCLC cells, and STAT1/3, which was reportedly associated with PD-L1 expression in lung tumors, were activated in COPD rats' lungs or in BEAS-2B cells treated with CSE or PM2.5. Therefore, we proposed that inflammation associated PD-L1 overexpression in airway epithelial cells could be the underlying factor facilitating lung cancer incidence in COPD.

Association between testosterone levels and RigiScan parameters of patients with erectile dysfunction.

Background: It is difficult to diagnose hypogonadism because of the lack of objective assessments of erectile dysfunction (ED), which is caused by hypogonadism. Aim: To provide a new approach for diagnosing hypogonadism, this study evaluated the efficacy of nocturnal penile tumescence and rigidity (NPTR) testing with RigiScan for patients with ED with and without hypogonadism. Methods: From June 2021 to February 2023, 133 patients with ED (62 with hypogonadism and 71 without) underwent NPTR testing at the Department of Andrology. A detailed history of all participants was obtained. All participants also underwent a physical examination, sex hormone testing, and ultrasound examination of the cavernous vessels of the penis. Outcomes: Patient characteristics, sex hormone serum levels, and RigiScan Plus data of NPTR testing of patients with ED were obtained and evaluated. Results: Between the groups, there were no significant differences in age, body mass index, or erectile function score or in the prevalence of smoking, drinking, diabetes, hypertension, and hyperlipidemia. RigiScan data revealed differences in erection episodes per night, average event rigidity, erection durations, and percentage of tumescence greater than baseline, which were significantly lower in the testosterone-deficient group than in the normal testosterone group. The average event rigidity of the tip displayed the largest area under the curve value, with a sensitivity of 67.6%, a specificity of 85.5%, and a cutoff value of 52.50. Clinical Implications: Our findings may allow appropriate patients to receive testosterone replacement therapy, which has been shown to be an effective treatment for hypogonadism. Strengths and Limitations: This is the first study of its kind to perform a comprehensive review of the association between hypogonadism and RigiScan parameters. This study was limited by its small sample size. Conclusion: RigiScan parameters of patients with ED and testosterone deficiency were significantly lower than those of patients with normal testosterone; therefore, RigiScan is useful for the differential diagnosis of patients with ED caused by hypogonadism.

Clinical efficacy and outcome analysis of early abdominal paracentesis drainage for treating patients with severe acute pancreatitis / 中华胰腺病杂志

Objective:To analyse the clinical efficacy and outcome of early abdominal paracentesis drainage (APD) in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 107 SAP patients with massive abdominal fluid in Shanghai General People Hospital from May 2017 to December 2021 were collected and analyzed. Patients were divided into APD group ( n=56) and NO-APD group ( n=51) according to whether they underwent APD or not within 3 days after admission. The APD group was then divided into abdominal compartment syndrome (ACS) subgroup ( n=29) and NO-ACS subgroup ( n=27) according to whether ACS had occurred or not at the time of puncture. Patients' general data, the duration of systemic inflammatory response (SIRS), length of ICU stay, the trends of intra-abdominal pressure and inflammatory indicators (white blood cell count and the content of C-reactive protein) within 1-3 days after admission, incidence of infection complication, step-up therapy, discharge or death were recorded. Results:The intra-abdominal pressure were 18.6±5.6mmHg , 13.7±4.2mmHg (1 mmHg=0.133 kpa) in APD group and NO-APD group, respectively. The intra-abdominal pressure of APD group was significantly higher than that of NO-APD group, and the difference was statistically significant ( P=0.000). Compared with NO-APD group, the duration of SIRS was significantly shortened in APD group [3(2, 4) days vs 4(3, 6) days, P=0.029]. On day 1, 2 and 3 after admission, the intra-abdominal pressure was 18.6±5.6 mmHg, 16.4±4.7 mmHg and 13.5±3.9 mmHg in APD group, and was 13.7±4.2 mmHg, 12.3±3.6 mmHg and 11.0±2.6 mmHg in NO-APD group, respectively. The intra-abdominal pressure of the APD group dropped faster than the NO-APD group ( P=0.004). The white blood cell count was (14.8±4.8), (10.5±4.5) and (9.0±3.8)×10 9/L in APD group, and was (14.2±5.4), (12.3±7.3), (11.7±5.3)×10 9/L in NO-APD group, respectively. Compared with the NO-APD group, the decrease rate of white blood cell count was faster in APD group ( P=0.006). The C-reactive protein content was (153.6±47.1), (150.4±10.5) and (108.8±49.4)mg/L in APD group, and were (174.8±31.1), (191.6±29.4) and (186.8±45.5)mg/L in NO-APD group . The content of C-reactive protein in APD group decreased significantly, while that in NO-APD group did not decrease. There was a significant difference between the two groups ( P=0.009). In the subgroup comparisons, the duration of SIRS in the ACS subgroup was significant longer than that in the NO-ACS subgroup [4(3, 5) days vs 2(1, 3)days, P=0.000]. Compared between the two groups and two subgroups respectively, there were no statistically significant differences on length of ICU stay, infection complication rate, advanced treatment rate and mortality. Conclusions:For SAP patients with abdominal fluid, APD in the early stage could shorten the duration of SIRS, decrease intra-abdominal pressure rapidly, improve inflammatory indicators, but could not improve the clinical outcome.

Is subfibular ossicle excision necessary in the modified Brostr?m procedure for chronic lateral ankle instability? / 中华创伤骨科杂志

Objective:To investigate the effect of subfibular ossicle excision on the clinical efficacy of Brostr?m procedure for chronic lateral ankle instability (CLAI).Methods:From March 2014 to December 2018, 76 patients were treated by the modified Brostr?m procedure using the suture anchor technique for CLAI at Department of Foot & Ankle Surgery, Wuhan Fourth Hospital. Of them, 33 had subfibular ossicles (SFO group) and 43 did not (NSFO group). In the SFO group, there were 19 males and 14 females, aged (28.4±8.6) years; in the NSFO group, there were 21 males and 22 females, aged (27.8±7.4) years. Subfibular ossicles were excised in the SFO group. The 2 groups were compared in terms of American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analogue scale (VAS) pain scores at preoperation and the final follow-up.Results:The 2 groups were comparable due to insignificant differences between them in their preoperative general data ( P>0.05). All the patients were followed up for 24 to 72 months (average, 28 months). The AOFAS ankle-hindfoot scores improved significantly from 54.5±3.4 to 95.7±2.1 in the SFO group and significantly from 56.2±2.7 to 95.2±2.4 in the NSFO group at the final follow-up; the VAS scores reduced significantly from 5.7±1.8 to 1.6±1.4 in the SFO group and significantly from 5.7±1.6 to 1.7±1.2 in the NSFO group at the final follow-up (all P<0.05). No significant differences were found between the 2 groups in terms of AOFAS or VAS scores at the final follow-up ( P>0.05). Conclusion:Since the modified Brostr?m procedure plus subfibular ossicle excision may result in similar good clinical efficacy as merely the modified Brostr?m procedure may for the CLAI patients without subfibular ossicle, subfibular ossicle excision should be suggested for the CLAI patients with subfibular ossicle.

Annual financial expenditure in 24 domestic blood stations: a comparative analysis / 中国输血杂志

【Objective】 To study the annual financial expenditure in blood stations with different scales, and to establish the regression equation between blood collection units and total expenditure. 【Methods】 The annual total expenditure, the per capita cost of serving population, as well as the collection units of whole blood and apheresis platelet of 24 blood stations were collected. The financial expenditure required for collecting 10 000U blood was calculated.The statistical analysis was carried out with SPSS statistical software. 【Results】 From 2017 to 2020, the total annual financial expenditure of 24 blood stations showed an upward trend. The total expenditure among blood stations was different. The per capita cost of servicing population in the areas where the 24 blood stations were located had been increasing year by year. The 24 blood stations were divided into two grades according to the blood collection volume as 50 000 U, and the relationship equation between the blood collection volume and the annual total expenditure had been established. After testing, each equation was effective(P<0.05); There was no difference in the financial expenditure required for collecting 10 000U blood among blood stations with different scales. 【Conclusion】 From 2017 to 2020, the blood stations with an annual collection volume more than 50 000 U demonstrated a higher financial expenditure and the per capita cost of serving population than those <50 000 U. The blood collection volume of blood stations is significantly correlated with the annual total expenditure and the per capita cost of serving population.

Inhibition of Acute Lung Injury by TNFR-Fc through Regulation of an Inflammation-Oxidative Stress Pathway.

BACKGROUND: Acute lung injury (ALI), characterized by disruption of the lung alveolar-capillary membrane barrier and resultant pulmonary edema, and associated with a proteinaceous alveolar exudate, is a leading cause of morbidity and mortality. Currently, inflammation-oxidative stress interaction between TNF-α and NF-κB was identified as a key pathway of ALI. We hypothesized that a TNFR-Fc fusion protein would have beneficial effects in experimental ALI, and sought to test this idea in mice by blocking TNF-α. METHODS AND RESULTS: Intratracheal instillation of lipopolysaccharide (LPS) into the lungs of ALI mice led to histiocyte apoptosis, and detection of serum and bronchoalveolar lavage fluid (BALF) cytokines, feedback between NF-κB and TNF-α, lung albumin leakage, lung damage, IκB kinase (IKK) and NF-κB activation, I-κB degradation, and oxidative injury. LPS administration raised pulmonary inflammation as reflected by increased inflammatory cytokines, alveoli protein concentration, and ALI scores. IKK is phosphorylated following LPS challenge, leading to I-κB degradation and NF-κB p65 phosphorylation. Furthermore, NF-κB is translocated into the nucleus and up-regulates TNF-α gene transcription. Infusion of TNFR-Fc 24h before LPS challenge significantly abrogated the increase of inflammatory cytokines, especially serum TNF-α concentration, as well as pulmonary alveoli protein levels, and diminished IKK and NF-κB activation and I-κB degradation. The nuclear translocation of NF-κB was inhibited, following by down-regulation of TNF-α gene transcription. In addition, LPS intratracheal instillation induced marked oxidative damage, such as a decrease in total anti-oxidation products and an increase in malondialdehyde (MDA), as well as up-regulation of oxidation enzymes. Histologic analysis and apoptosis scores revealed that the extent of tissue lesions was significantly reduced, but not abrogated, by TNF-α blockade. CONCLUSION: Treatment with LPS alone increased inflammation and oxidative stress in ALI mice, while administration of TNFR-Fc 24h before LPS challenge broke the feedback between NF-κB and TNF-α, resulting in decreased pulmonary inflammation/oxidative damage and tissue destruction. These results suggest a potential role for TNF-α therapy to treat clinical ALI.

Optimization of an unpowered energy-stored exoskeleton for patients with spinal cord injury.

The paper describes a novel unpowered energy-stored exoskeleton (ES-EXO) for spinal cord injured patients in consideration of patients' characteristics and injured levels. It proposed a method to optimize the energy-stored element to decrease the hip joint moment in walking. EMG patterns, ground reaction force and motion data from one participant with complete spinal cord injury at T10 were recorded. A combined human-ES-EXO model was built and the stored-energy element including locations and stiffness of springs were optimized in AnyBody Modeling System. Significant correlations between experimental and simulated muscle activations in without springs condition proved that the model was feasible. With optimized energy-stored elements, the hip flexion moment decreased by 37.2%, activations in abdominal muscles decreased and low back muscles slightly increased. The results suggest that ES-EXO could provide specific walking assistance for SCI patients through adjusting energy-stored elements according to patients' characteristics.

ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series

Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thromboembolic events in the acute setting. However, the abnormal thrombotic diathesis is not known to persist into the recovery phase of COVID-19 infection. We described 3 cases of ST-segment elevation myocardial infarction in healthy male patients who recovered from COVID-19 with no prior cardiovascular risk factors. They shared features of elevated von Willebrand factor antigen, factor VIII and D-dimer level. One patient had a borderline positive lupus anticoagulant. Intravascular ultrasound of culprit vessels revealed predominantly fibrotic plaque with minimal necrotic core. Clot waveform analysis showed parameters of hypercoagulability. They were treated with dual antiplatelet therapy, angiotensin-converting-enzyme inhibitor, beta blocker and statin. These cases highlight the strong thrombogenic nature of COVID-19 that persisted among patients who recovered from infection. Several suspected mechanisms could explain the association between vascular thrombosis in the convalescent period (endothelial dysfunction, hypercoagulability, systemic inflammatory response and vasculopathy). Additional studies on "long COVID" are essential for identifying endotheliopathy and thrombotic sequalae.

3D printed individualized osteotomy template for treatment of painful talocalcaneal coalition of Rozansky types Ⅲ-Ⅳ / 中华创伤骨科杂志

Objective:To explore the effectiveness of 3D printed individualized osteotomy template for the treatment of painful talocalcaneal coalition of Rozansky types Ⅲ-Ⅳ.Methods:From January 2016 to August 2018, a 3D printed individualized osteotomy template was used in 14 patients with painful talocalcaneal coalition at Department of Foot and Ankle Surgery, Wuhan Fourth Hospital. They were 8 males and 6 females, aged from 19 to 42 years (mean, 30.2 years). CT scan of full bilateral feet was conducted. The bone bridge to be resected was marked and an individualized template designed taking the CT scans of the healthy foot as mirror images. The 3D individualized templates were used to assist resection of talocalcaneal coalitions. Scores of visual analogue scale(VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) and complications were recorded at the final follow-up.Results:The 14 patients obtained an average follow-up of 21.6 months. Their VAS and AOFAS ankle and hindfoot scores (2.3±0.7 and 86.5±4.5) at the final follow-up were significantly improved compared with their preoperative values (7.0±1.9 and 37.1±6.0) ( P<0.05). Their follow-up X-ray films showed no recurrence of talocalcaneal coalition or traumatic arthritis. Conclusion:A 3D printed individualized osteotomy template is an effective assistance in the treatment of talocalcaneal coalition because it can lead to accurate location of the talocalcaneal bridge and full osteotomy.

Anatomical reconstruction of the lateral ankle ligament with an individualized 3D printed drill template / 中华创伤骨科杂志

Objective:To evaluate the clinical application of an individualized 3D printed drill template to create a fibular channel in the anatomical reconstruction of the lateral ankle ligament for chronic lateral ankle instability.Methods:From October 2012 to June 2015, 15 patients with lateral ankle in-stability underwent surgery at Department of Foot and Ankle Surgery, The Fourth Hospital of Wuhan.They were 4 men and 11 women, with a mean age of 26.3 years (range, from 18 to 42 years).For each of them, anatomical reconstruction of the lateral ankle ligament was performed through a fibular channel which was created with the aid of an individualized 3D printed drill template.The American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores were used to assess the patients preoperation and at the last follow-up.Results:The 15 patients obtained a mean follow-up of 15.2 months (range, from 12 to 18 months).Their preoperative AOFAS scores (47.1±3.8) were increased to 88.3±4.7 at the last fol-low-up, and their preoperative VAS scores (5.8±1.8) decreased to 1.55±1.35 at the last follow-up, showing significant differences ( P<0.05).There were 11 excellent and 4 good cases by the AOFAS ankle-hindfoot scale.No significant complications were found. Conclusion:In the anatomical reconstruction of the lateral ankle ligament for chronic lateral ankle instability, an individualized 3D printed drill template can help create a fibular channel which exactly fits each individual, leading to positive therapeutic effects.

Finite Element Study of Lumbar Disc Herniation Loaded with Muscle Force / 医用生物力学

Objective To investigate the effect of muscle function on structural stress in patient with lumbar disc herniation (LDH), by observing the stress changes in LDH lumbar-pelvis finite element model loaded with muscle force. Methods One normal healthy volunteer and one LDH patient were selected. Their CT data were collected to establish two corresponding normal and LDH lumbar-pelvis finite element models, and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model. The muscle force around the lumbar and pelvis as well as the hip-joint force were obtained as the loading condition. Self-loading of the normal and LDH model as well as the normal model loaded with LDH muscle forces were conducted seperately. Then the stress changes in L4 and L5 intervertebral discs and sacroiliac joints under two above loading conditions were compared. Results The stress curve of normal model loaded with LDH muscle force showed a unimodal stress curve, instead of a bimodal curve, and such trend of stress-time curve was as same as the trend of the LDH model during self-loading. But the stress difference in L4 and L5 intervertebral discs and sacroiliac joint of the normal model loaded with LDH muscle force was smaller than that in the LDH model during self-loading. Conclusions Abnormal muscle function of LDH could lead to abnormal joint stress of the intervertebral discs and sacroiliac joint. Structural imbalance itself could lead to stress imbalance, and muscle as a driving factor was an important cause of anomaly structural dynamic stress, thus leading to abnormal joint motion patterns. Therefore, attention should be paid to assessment of the imbalance of peripheral muscle function in clinical treatment of LDH.

Study of Therapeutic Bandage Type Contact Lens in the Treatment of 27 Cases of Severe Tear and Evaporative Dry Eye / 现代医院

Objective To investigate the value of therapeutic bandage type contact lens in the treatment of severe dry tear with dry eye. Methods 54 cases of severe tear evaporative dry eye patients from January 2016 to April 2017 were randomly divided into observation group (27 cases) and control group (27 cases). The observation group received the treatment of artificial tears combined with bandage contact lens treatment, the control group only received the treatment of artificial tears. Continuous treatment trials compared two groups of symptoms score, tear secretion after 1 months (SⅠt, SⅡt), tear break-up time (break up, time, BUT) and tear ferning test (tear ferning, test, TFT). Results After treatment, the scores of the two groups were decreased, and the observation group was lower than the control group. The difference was statistically significant (P＜0. 05); the levels of SⅠt, SⅡt and BUT were improved in both groups, and the improvement effect was better in the observation group (P＜0. 05); The detection level of TFT in the observation group was better than that in the control group, the difference was statistically significant (P＜0. 05). Conclusion The treatment of bandage contact lens in severe tear evaporation effect in treatment of patients with dry eye in strong type is effective and able to significantly improve their symptoms score and SⅠt, BUT and TFT index.

Effect of immune function on prognosis of patients with sepsis / 中华危重病急救医学

Objective To investigate the influence of immune function and its changes on the prognosis of patients with sepsis. Methods 393 patients who met the diagnostic criteria of Sepsis-3 admitted to General Hospital of Southern War Zone of PLA from April 2003 to April 2017 were enrolled. Clinical data were collected and analyzed retrospectively. According to the initial immune status, patients with more than 4 days course of disease were divided into the initial immune suppression group (219 cases) and the initial immune function normal group (174 cases). According to the changes of immune function, patients with more than 7 days course of disease were divided into persistent inhibition group (113 cases), persistent normal group (96 cases), first normal inhibition group (22 cases) and first inhibited normal group (59 cases). In addition, the patients were divided into the elderly group (≥ 65 years old) and the young group (< 65 years old). Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment (SOFA), procalcitonin (PCT), C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine (SCr) within 24 hours after diagnosis of sepsis, whether respiratory failure and circulatory failure occur, hormone, immunomodulatory drugs and high-volume hemofiltration treatment within 28 days, the absolute value of lymphocyte counts for 4 consecutive days after diagnosis and 4 consecutive days before the end point event (death or survival within 28 days or more than 28 days) were collected and compared between each group. Results Among 393 sepsis patients, 174 cases had normal initial immune function, of whom 85 cases were older than 65 years old;219 cases had depression of initial immune function, of whom 118 cases were older than 65 years old. Compared with the initial immune function normal group, the levels of PCT, CRP, ALT, AST and SCr in the initial immunosuppressive group were significantly increased [PCT (μg/L): 9.32 (2.13, 34.01) vs. 4.28 (1.02, 19.02), CRP (mg/L): 89.00 (26.00, 142.00) vs. 65.25 (19.88, 119.04), ALT (mmol/L): 39.0 (39.0, 99.0) vs. 27.0 (16.2, 73.0), AST (mmol/L): 55.0 (31.0, 148.0) vs. 39.0 (23.0, 100.8), SCr (μmol/L): 132.00 (74.75, 245.00) vs. 100.25 (61.00, 182.54)], the mean absolute value of lymphocyte counts for 4 consecutive days was significantly decreased [0.615 (0.380, 0.810) vs. 1.442 (1.217, 1.742)], SOFA and APACHEⅡ were significantly increased (SOFA: 9.25±4.19 vs. 6.87±4.66, APACHEⅡ:22.27±8.96 vs. 18.25±9.47), the incidence of circulatory failure (66.2% vs. 50.0%), the incidence of respiratory failure (87.7% vs. 69.0%) and 28-day mortality (65.3% vs. 33.9%) were significantly increased, with statistically significant differences (all P < 0.05). When combined with immunosuppression, there was no significant difference in 28-day mortality between the elderly group and the young group (26.3% vs. 15.8%, P > 0.05); when the immune function was normal, the 28-day mortality of the elderly group was significantly higher than that of the young group (48.2% vs. 20.2%, P < 0.01). The 28-day mortality of the persistent inhibition group and the first normal inhibition group were significantly higher than those of the persistent normal group and the first inhibition normal group [83.2% (94/113), 81.8% (18/22) vs. 26.0% (25/96), 40.7% (24/59), all P < 0.05]. The incidence of immunosuppression in elderly patients [33.3% (14/42) vs. 10.5% (8/76)] and the incidence of persistent immunosuppression [77.0% (67/87) vs. 54.1% (46/85)] were higher than those in young patients (all P < 0.01). Conclusions Immune function is closely related to the prognosis of sepsis patients. Elderly patients with sepsis are more likely to have immunosuppression or persistent immunosuppression than young patients, and the prognosis is worse.

Biomechanical properties of cervical traction under neck muscle force / 医用生物力学

Objective To establish a three-dimensional(3D) finite element model of cervical vertebrae (C1-7),and study its biomechanical properties under muscle force by cervical traction,so as to provide references for clinical treatment.Methods On the basis of nonlinear finite element model of normal cervical vertebrae and combined with clinical traction methods,cervical traction at the extension angle of 0°,10°,20°,30°,40° under the same traction weight,was simulated by finite element analysis (FEA) software to obtain and select the joint force and muscle force that were appropriate for FEA on the model.Results In the process of cervical extension by traction,under the muscle force,the average maximum equivalent stress of cervical vertebrae,intervertebral disc and uncovertebral joints increased by 4.86,1.79,0.69 MPa,respectively,and the average maximum relative displacement of cervical vertebrae in sagittal and vertical axis direction increased by 1 1.1,1.26 mm,respectively.The biomechanical properties of cervical traction were similar to the FEA results reported in the literature.Conclusions Neck muscles play an active role in promoting the stress and displacement of cervical vertebrae,intervertebral discs and uncovertebral joints and it should be taken into consideration when performing cervical traction in clinic.In addition,the traction angle should not be too large:0.-20. is generally recommended as a relatively safe angle range at the initial stage.

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

Biomechanical analysis of a finite element model of rotator cuff / 中华创伤骨科杂志

Objective To establish a finite element model of rotator cuff which can be used to simulate the rotator cuff injury and to evaluate the biomechanical effects of rotator cuff surgery.Methods The Dicom CT images of the right shoulder of a Chinese healthy volunteer were used to establish models of the scapula,humerus and clavicle.The rotator cuff structures were separated and modeled based on the MRI images and anatomical knowledge.After the rotator cuff model was introduced into the finite element analysis software Abaqus 6.12,the anatomical positions were simulated when the shoulder was at 30° internal rotation,30° external rotation,30° abduction,30° adduction,30° flexion and 30° extension.Results When the shoulder was in 30° flexion,the average stress was 52.2 kPa on the supraspinatus,223.0 kPa on the inffaspinatus and the teres minor,and 90.4 kPa on the subscapularis.When the shoulder was in 30° extension,the average stress was 105.0 kPa on the supraspinatus,78.2 kPa on the infraspinatus and the teres minor,and 55.7 kPa on the subscapularis,indicating that the muscle and tendon of the supraspinatus was subjected to greater stress and the humerus and the scapula produced less stress compared with the shoulder in 30° flexion.Conclusion Since our finite element model of the rotator cuff can simulate common activities of the shoulder joint and obtain stress values of the corresponding rotator cuff muscles,it can be used in simulation of rotator cuff injury and its surgery.

Quality of Life in Obstructive Sleep Apnoea: A Role for Oxygen Desaturation Indices?

<p><b>INTRODUCTION</b>This study aimed to determine the impact of obstructive sleep apnoea (OSA) on quality of life (QOL) and evaluate the utility of polysomnographic parameters in reflecting QOL.</p><p><b>MATERIALS AND METHODS</b>Eighty-eight patients who underwent polysomnography (PSG) between December 2010 and November 2012 consecutively were recruited and they completed the 36-Item Short-Form Health Survey (SF-36) and Epworth Sleepiness Scale (ESS) questionnaires. Based on the apnoea-hypopnoea index (AHI), patients were classified as primary snorers (AHI <5), suffering from mild (5 ≤15), moderate (15 ≤30) or severe OSA (≥30).</p><p><b>RESULTS</b>Seventy-nine male and 9 female patients with a mean age of 41 years were recruited. OSA patients scored significantly lower on 7 domains of SF-36 compared to the population. As AHI increased, only Physical Function (PF) and Physical Component Summary (PCS) but not ESS scores significantly worsened. PSG parameters correlated poorly with all QOL measures except PF, PCS and ESS. After adjusting for age, sex and body mass index (BMI), multiple linear regression revealed that only the oxygen desaturation parameters, but not sleep architecture indices or AHI were significant predictors of PF and ESS. For every fall in the lowest oxygen saturation (LSAT) by 1%, there was a decrease in PF by 0.59 points, and an increase in ESS by 0.13 points.</p><p><b>CONCLUSION</b>OSA patients have a poor QOL compared to the population. The amount of physical impairment and daytime sleepiness they experience is better predicted by severity and duration of hypoxia and not AHI.</p>

Application of three-dimensional laparoscopic cholecystectomy for complicated gallstone disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical value of three-dimensional (3D) laparoscopic cholecystectomy in the treatment of complicated gallstone disease.</p><p><b>METHODS</b>From March 2014 to March 2015, 46 patients underwent cholecystectomy for complicated gallstone disease under 3D laparoscopy (3D group) and 43 received 2D laparoscopic cholecystectomy (2D group). The surgical data including the operative time, intraoperative blood loss, the rate of conversion to open laparotomy, recovery time of postoperative bowel motion and hospital stay were compared between the 2 groups.</p><p><b>RESULTS</b>Laparoscopic cholecystectomy was successfully completed in 43 patients in 3D group and in 39 patients in 2D group, and the rates of conversion to open laparotomy were similar between the two groups (P>0.05). The median operation time was significantly shorter in 3D group than in 2D group (50.5∓15.2 vs 65.4∓18.1 min, P<0.05), and the median volume of intraoperative blood loss was significantly smaller in 3D group (34.1∓13.6 vs 44.5∓22.3 mL, P>0.05). No significant differences were found in the recovery time of postoperative bowel motion and postoperative hospital stays between the two groups (P>0.05).</p><p><b>CONCLUSION</b>3D laparoscopy, which provides three-dimensional vision with a good sense of depth to allow precise surgical manipulation, can shorten the operation time and reduce the rate of conversion to open laparotomy for patients undergoing 3D laparoscopic cholecystectomy for complicated gallstone disease.</p>

Investigation on Cognition of the Clinical Pharmacists on the Clinical Pharmacy Practice and Their Profes-sion in the Medical and Health Institutions in Shanghai / 中国药房

OBJECTIVE:To investigate the cognition of clinical pharmacists on the clinical pharmacy practice and their profes-sion,and provide reference for further developing clinical pharmacy practice. METHODS:A questionnaire was designed,and ran-dom sample was conducted for the clinical pharmacists from 30 secondary and tertiary hospitals in Shanghai,and the investigation results were analyzed statistically. RESULTS:Totally 130 questionnaires were sent out,and 102 were effectively received with valid response rate of 78.46%. 94.11% of the investigated subjects were willing to be a clinical pharmacist,but 17.65% of them consid-ered that they were incompetent for their work;29.41% of them thought the current situation of clinical pharmacy practice was not ideal;all the respondents considered that the clinical pharmacist system should be implemented in medical and health institu-tions;the cognition and evaluation of investigated subjects in tertiary hospitals on clinical pharmacy practice and their profession was generally higher than those in secondary hospitals(P<0.05). CONCLUSIONS:The clinical pharmacists in medical and health institutions in Shanghai showed high cognition on their profession,and the clinical pharmacy practice has already made some achievements,but many work still need to be improved. Therefore,clinical pharmacists should continuously study their profession-al knowledge and improve their professional skills and quality;hospitals and universities should strengthen the subject construction and personnel training of clinical pharmacy and deeply carry out the clinical pharmacist system;health administration departments should strengthen the related laws and regulations of clinical pharmacy;colleges and universities should strengthen the discipline construction and personnel training.