Comparison of deltoid split versus deltopectoral approaches in locking plate fixation for proximal humerus fracture / 中华创伤骨科杂志

Objective:To compare the medium and long-term efficacy between the deltoid split approach and the conventional deltopectoral approach in locking plate fixation for proximal humerus fractures.Methods:A retrospective study was performed in the 65 patients with proximal humerus fracture who had been operatively treated at Department of Orthopedics, The Third People's Hospital of Nantong from January 2018 to December 2020. They were 20 males and 45 females with an age of (64.6±9.2) years. Of them, 34 were assigned to fixation with proximal humerus internal locking system (PHILOS) through the deltoid split approach (minimally invasive group), and 31 to PHILOS fixation through the deltopectoral approach (conventional group). The 2 groups were compared in terms of general data, operation time, intraoperative blood loss, hospital stay, fracture union time, intraoperative fluoroscopy, postoperative 2-year imaging scores, and Constant-Murley shoulder score at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). In the minimally invasive group and the conventional group, respectively, the intraoperative blood loss was (97.9±16.6) mL and (155.8±27.4) mL, and the frequency of intraoperative fluoroscopy (12.0±1.8) times and (6.7±1.8) times, both showing a statistically significant difference ( P<0.05). There was no significant difference in operation time, hospital stay, or fracture union time ( P>0.05). All patients were followed up for (43.9±5.5) months. There was no statistically significant difference between the 2 groups in postoperative 2-year imaging scores ( P>0.05). Compared with the conventional group, patients in the minimally invasive group had significantly lower Constant-Murley strength scores and significantly lower Constant-Murley scores for the Neer four-part fractures ( P<0.05). Postoperatively, one case of screw protrusion and one case of complete ischemic necrosis occurred in both groups while one case of partial ischemic necrosis was observed in the minimally invasive group and 3 cases of partial ischemic necrosis were observed in the conventional group. Conclusions:In locking plate fixation for proximal humerus fractures, compared with the deltopectoral approach, the deltoid split approach shows advantages of less soft tissue damage, less intraoperative bleeding, and less destruction of the blood supply to the humeral head. However, the deltopectoral approach may be more appropriate for the Neer four-part fractures.

Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR) / 中华医学杂志(英文版)

BACKGROUND@#The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.@*METHODS@#Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.@*RESULTS@#In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use.@*CONCLUSIONS@#Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.

Nephrostomy catheter following percutaneous nephrostolithotomy entering the inferior vena cava / 现代泌尿外科杂志

【Objective】 To explore the causes and management of nephrostomy catheter following percutaneous nephrostolithotomy (PCNL) entering the inferior vena cava. 【Methods】 A retrospective analysis was performed on the management of two cases of nephrostomy catheter entering the inferior vena cava. The causes, changes of minimally invasive treatment and prevention plans were discussed. 【Results】 Two patients underwent digital subtraction angiography (DSA) to restore the nephrostomy tube to the renal pelvis collecting system. No renal vein rupture or bleeding occurred during the operation, and the patients’ vital signs were stable. Nephrostomy tube was removed successfully after operation. The wound healing was good, and there was no secondary hemorrhage such as perirenal hematoma. The prognosis was good. 【Conclusion】 Although intravenous nephrostomy tube misplacement is an uncommon PCNL complication, the consequences are serous. One-step retraction displacement of nephrostomy tube to the renal collecting system can effectively manage nephrostomy catheter entering the inferior vena cava.

Clinical characteristics of patients with rheumatic diseases and abnormal liver function / 中华内科杂志

Objective:To investigate the clinical characteristics of patients with rheumatic diseases and abnormal liver function, as well as determine the proportion and severity of liver function abnormalities.Methods:Cross-sectional study. Data were collected from patients registered in the Chinese Rheumatism Date Center from 2011 to 2021. The rheumatic diseases analyzed in this study were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome (SS), ankylosing spondylitis (AS), and gout. Patient data, including demographic characteristics [ such as age, sex, body mass index,(BMI), and smoking history], liver function test results [including alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase(ALP), and total bilirubin], and use of anti-rheumatic immune drugs and liver-protective drugs, were collected and compared between groups with normal and abnormal liver functions. In addition, the proportions of abnormal liver function were compared between sex and age groups.Results:A total of 116 308 patients were included in this study, including 49 659 with RA, 17 597 with SLE, 9 039 with SS, 11 321 with AS, and 28 692 with gout. The lowest proportion of liver function abnormalities was observed in patients with RA[11.02% (5 470/49 659)], followed by those with SS[17.97% (1 624/9 039)] and AS [18.22% (2 063/11 321) ], whereas patients with SLE [21.14% (3 720/17 597) ] and gout [28.73% (8 242/28 692)] exhibited the highest proportion of these abnormalities. Elevated ALT, mostly classified as grade 1, was the most commonly noted liver function abnormality, whereas elevated ALP was the least common. Some patients who took liver-protective drugs had normal liver function, with the lowest percentage observed in patients with gout [7.45% (36/483) ] and ranging from 21.7% to 30.34% in patients with RA, SLE, SS, and AS. The proportion of liver function abnormalities was higher in males than in females for all disease types [RA: 13.8%(1 368/9 906) vs. 10.3%(4 102/39 753); SLE: 33.6% (479/1 424) vs. 20.0% (3 241/16 173); SS: 25.4%(111/437) vs. 17.6%(1 513/8 602); AS: 20.1%(1 629/8 119) vs. 13.6% (434/3 202); and gout: 29.3% (8 033/27 394) vs. 16.1% (209/1 298)]. In RA, SLE, and AS, the proportions of liver function abnormalities were similar across all age groups. In SS, the proportion of liver function abnormalities increased with age [<40 years: 14.9%(294/1 979); 40-59 years: 18.1%(858/4 741); ≥60 years: 20.4%(472/2 319)], whereas a reversal of this trend was observed in gout [<40 years: 34.9%(4 294/12 320); 40-59 years: 25.5%(2 905/11 398);≥60 years: 21.0%(1 042/4 971)].Conclusions:The proportions of combined liver function abnormalities in patients with rheumatologic diseases were high, and the utilization rates of liver-protective drugs were low. It is necessary to pay more attention to monitoring patients′ liver function, timely administer liver-protective drugs, and optimize liver-protective regimens during the treatment of rheumatic diseases.

Effect of concentrated growth factors and lower-level laser therapy on alveolar bone atrophy after tooth extraction site in orthodontic patients / 国际生物医学工程杂志

Objective:To compare the effects of concentrated growth factors (CGF) and lower-level laser therapy (LLLT) on alveolar bone changes at the extraction site in orthodontic patients.Methods:Twenty-one patients who underwent orthodontic treatment at the Department of Stomatology, Tianjin Beichen Hospital, from June 2020 to May 2022 were enrolled and randomly divided into the control group, LLLT group, and CGF group, with 7 patients in each group and 28 extraction sites. The control group received natural healing with tooth extraction (minimally invasive healing with tooth extraction). The LLLT group received diode laser treatment on the 1st, 2nd, and 7th days after minimally invasive tooth extraction (wavelength 808 nm, average output power 0.25 W, energy density 4 J/cm 2, spot area 0.28 cm 2), with each site irradiated for 20 seconds. After minimally invasive tooth extraction in the CGF group, immediately place the CGF membrane in the extraction socket. The changes in alveolar bone height and width before and after tooth extraction and bone density and bone contour after alveolar bone healing were measured. Meanwhile, the concentration changes of growth factors osteopontin (OPN) and transforming growth factor-β1 (TGF-β1) in gingival crevicular fluid at tooth extraction were measured and statistically analyzed. Results:Compared with the control group, the height and width of the alveolar bone at the tooth extraction wound in the LLLT group and CGF group decreased significantly (all P < 0.05). Compared with the LLLT group, the height and width of the alveolar bone at the tooth extraction wound in the CGF group decreased, and the differences were statistically significant (all P < 0.05). The bone contour score and bone density grading of the LLLT and CGF groups after tooth extraction wound healing were better than those of the control group (all P < 0.05). There was no statistically significant difference in bone contour score and bone density grading between the LLLT group and the CGF group after tooth extraction wound healing ( P > 0.05). At 1 and 6 months after tooth extraction, there was no statistically significant difference in the concentration of OPN in the gingival crevicular fluid at the extraction site among the control group, LLLT group, and CGF group (all P > 0.05). One month after tooth extraction, compared with the control group, the concentration of TGF-β1 in the gingival crevicular fluid of the tooth extraction wound increased in the LLLT group and the CGF group, and the differences were statistically significant (all P < 0.05). Six months after tooth extraction, there was no statistically significant difference in TGF-β1 concentration among the three groups (all P > 0.05). Conclusions:Both LLLT and CGF treatments can effectively reduce the height and width of alveolar bone in tooth extraction wounds, promote the recovery of alveolar bone contour and bone density in tooth extraction wounds and provide clinical data support for how to delay the atrophy of alveolar bone in tooth extraction wounds.

Cognitive and Brain Gray Matter Changes in Children with Obstructive Sleep Apnea: A Voxel-Based Morphological Study.

BACKGROUND: To explore the neural difference between children with obstructive sleep apnea (OSA) and healthy controls, together with the relation between this difference and clinical severity indicator of children with OSA. METHODS: Twenty-seven children with OSA (7.6 ± 2.5 years, apnea hypopnea index [AHI]: 9.7 ± 5.3 events/h) and 30 healthy controls (7.8 ± 2.6 years, AHI: 1.7 ± 1.2 events/h) were recruited and matched with age, gender, and handedness. All children underwent 3.0 T magnetic resonance imaging of the brain and cognitive testing evaluating. Volumetric segmentation of cortical and subcortical structures and voxel-based morphometry were performed. Pearson's correlation analysis was performed between these features of gray matter volume (GMV) and obstructive apnea index (OAI) among children with OSA. RESULTS: In the comparison of children's Wechsler test scores of full-scale intelligence quotient and verbal intelligence quotient, the OSA group was significantly lower than the control group (p < 0.05). Compared with the control group, the GMV of many brain regions in the OSA group was significantly decreased (p < 0.05). In the correlation analysis of GMV and OAI in OSA group, right inferior frontal gyrus volume was significantly negatively correlated with OAI (r = - 0.49, p = 0.02). CONCLUSION: Children with OSA presented abnormal neural activities in some brain regions and impaired cognitive functions. This finding suggests an association between the OSA and decreased GMV in children.

Analysis of the real situation of medication in the population with gout achieving T2T indicators: a multicentre real-world study / 中华风湿病学杂志

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Sex disparities in clinical characteristics of Chinese patients with systemic sclerosis / 中华内科杂志

Objective:To evaluate the differences in clinical characteristics between different genders of Chinese patients with systemic sclerosis(SSc).Methods:The data of SSc patients registered in Chinese Rheumatism Data Center between August 2008 and June 2020 were retrospectively analyzed.Results:A total of 1 844 patients with SSc were enrolled in the study. The ratio of males to females was 289 to 1 555. The onset age was (48.6±13.7) years in males and (45.5±13.1) years in females( P<0.001). Male patients represented shorter disease duration [2.0(0.0, 4.0)years vs.3.0(1.0, 7.0) years, P<0.001],higher proportion of diffuse cutaneous SSc (dcSSc) [63.0% (182/289)vs.44.2%(688/1 555), P<0.001]. Although more man patients experienced smoking [47.4%(137/289) vs. 1.7%(27/1 555), P<0.001] and exposure to harmful environments [7.6%(22/289) vs. 2.1%(33/1 555), P<0.001], there was no statistically significant difference in interstitial lung disease between male and female patients [69.3%(181/261) vs. 74.5%(1 085/1 457), P=0.084].Otherwise, Raynaud′s phenomenon [87.7% (1 364/1 555) vs.75.4%(218/289), P<0.001], arthritis [11.1%(173/1 555) vs.6.9%(20/289), P=0.032], gastroesophageal reflux disease [22.0%(342/ 1 555) vs.13.1%(38/289), P=0.001], and leucopoenia [10.7(161/1 511)% vs. 6.1%(17/279), P=0.019] were more common in female patients, but finger ulcer was less common [22.5%(350/1 555) vs. 30.4%(88/289), P=0.004]. Antinuclear antibody(ANA) positivity rate [85.6%(1 310/1 531) vs. 78.6%(221/281), P=0.003], anti-RNP antibody positivity rate [23.1%(342/1 479) vs.14.0%(38/271), P=0.001], anti-SSA antibody positivity rate [28.2%(419/1 487) vs.13.9%(38/274), P<0.001] were higher in female patients. Physician′s global assessment(PGA) scores [1.4 (1.0, 2.0) vs. 1.0 (0.3, 1.6), P<0.001] and modified Rodnan Skin Score(mRSS) [18.0 (9.5, 28.0) vs. 14.0 (5.0, 28.0), P=0.003] were higher in males. Conclusion:Even though male SSc patients account for a small proportion, more extensive skin involvement, finger ulcers and higher PGA are manifested in males. Physicians need pay attention to these clinical disparities between different genders in SSc.

Two cases report of long segment ureteral avulsion caused by ureteroscopy / 中华泌尿外科杂志

With the popularization of ureteroscopy, ureteral avulsion has become a common complication of urological surgery in recent years. In the study, we reviewed the clinical management of 2 patients who underwent emergency ureterostomy and selective operation of ileoureteral substitution, emergency repair and selective operation of Boari-flap ureteroneocystostomy respectively. After 22 and 17 months of follow-up, no ureter stricture were found, and hydronephrosis were relieved compared with preoperative in both.

The correlation between serum krebs von den lungen-6 level and immune function in rheumatoid arthritis patients with interstitial lung disease / 中华风湿病学杂志

Objective:To explore the correlation between serum krebs von den lungen-6 (KL-6) level and immune function in rheumatoid arthritis (RA) patients with interstitial lung disease (ILD), and provide theoretical basis for clinical diagnosis and treatment.Methods:Eighty-six RA patients were divided into Non-RA-ILD group and RA-ILD group. The serum KL-6 level and immune function (the number of CD3 +, CD4 +, CD8 + and CD4 +/CD8 + ratio) of all subjects were detected. The correlation between serum KL-6) level and immune function was analyzed. The correlation analysis was performed by Pearson or Spearman rank correlation analysis. Results:There were 54 cases of Non-RA-ILD patients and 32 cases of RA-ILD patients in this study. The clinical data showed that RA-ILD patients were mainly male, and the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) were significantly increased( t=6.382, 7.243 and 7.748, P<0.05). The KL-6 level of RA-ILD patients [(835±72) U/ml] was significantly higher than that of Non-RA-ILD patients [(434±45) U/ml]. And the difference was statistically significant( t=31.670, P<0.05). Meanwhile, the number of CD8 + lymphocyte and CD4 +/CD8 + ratio of RA-ILD patients were significantly increased ( t=3.456 and 4.993, P<0.05). The results of correlation analysis showed that the level of KL-6 in serum was negatively correlated with the level of Ts cells CD8 + ( r=-3.563, P=0.031), and positively correlated with the ratio of CD4 +/CD8 + ( r=4.879, P=0.011). Conclusion:The level of serum KL-6 level is closely related to the abnormal immune function of RA-ILD patients. The serum KL-6 level can be used as an important index to evaluate the immune status of RA-ILD patients.

Associations of Changes in Serum Inflammatory Factors, MMP-3, 25(OH)D and Intestinal Flora with Osteoporosis and Disease Activity in Rheumatoid Arthritis Patients.

BACKGROUND: To explore the associations of changes in serum inflammatory factors, matrix metalloproteinase-3 (MMP-3), 25-hydroxy vitamin D [25(OH)D], and intestinal flora with osteoporosis and disease activity in rheumatoid arthritis (RA) patients, so as to provide references for clinical diagnosis and treatment. METHODS: A total of 98 RA patients were selected as the objects of study (RA group), and divided into active-stage group (n = 56) and remission-stage group (n = 42) according to the disease activity score (DAS28). Another 50 healthy people receiving physical examination in our hospital during the same period were selected as the control group. The changes in serum inflammatory factors, MMP-3, 25(OH)D, and intestinal flora were compared among the three groups, and the osteoporosis of the subjects was analyzed in each group. Moreover, the associations of changes in serum inflammatory factors, MMP-3, 25(OH)D, and intestinal flora with osteoporosis and disease activity in RA patients were analyzed using the Pearson's method. RESULTS: Compared with those in the control group, the levels of serum MMP-3, interleukin-6 (IL-6), IL-10, and C-reactive protein (CRP). The Escherichia coli count were significantly increased, while the level of serum 25(OH)D, bone mineral density (BMD), and Lactobacillus and Bifidobacterium counts were significantly decreased in the active-stage group and remission-stage group, more obviously in active-stage group (p < 0.05). The osteoporosis and disease activity in RA patients were positively correlated with serum IL-6, IL-10, CRP, MMP-3, Escherichia coli and BMD, but negatively correlated with 25(OH)D, Lactobacillus and Bifidobacterium (p < 0.05), and not correlated with the sharp score (p > 0.05). CONCLUSIONS: There are certain associations of changes in serum inflammatory factors, MMP-3, 25(OH)D, and in-testinal flora with osteoporosis and disease activity in RA patients, showing certain value in clinical application.

Problems and thoughts in the application of neonatal resuscitation technology in rural primary hospitals / 中国实用护理杂志

Neonatal resuscitation project to rural grass-roots development is different from urban promotion and application, need to adjust appropriate strategies and measures. Correct understanding of the effectiveness of resuscitation technology can improve the compliance of rural grass-roots promotion and application. According to "Renewal of International Neonatal Resuscitation Course and China′s Implementation Opinions", we should make the training of recovery teams as an important goal of long-term management, And adhere to "one case one preparation, one monitoring, one week one review". Rural grass-roots units should innovate and popularize application methods according to local conditions. It is suggested that the training system for neonatal resuscitation and post-resuscitation treatment should be gradually established in county (city) areas.

Clinical effect of low-level laser on severe periodontitis / 国际生物医学工程杂志

Objective:To evaluate the clinical effect of basic periodontal therapy combined with low-level laser irradiation on patients with severe periodontitis.Methods:18 patients with severe periodontitis (a total of 43 teeth samples) were enrolled from the Dental Department of Tianjin First Central Hospital from June 2018 to May 2019. The patients were averagely divided into the control group (20 teeth) and the experimental group (23 teeth) according to the random number table method. All the teeth were firstly received basic periodontal treatment. In the experimental group, the gingival pouch of the teeth was irradiated with low energy laser for 15 s on the 1st, 2nd, and 7th days after the basic periodontal treatment, in which the output power is 80 mw, the energy density is 4 J/cm 2, and irradiated area is 0.28 cm 2. Before the treatment and 1 week and 4 weeks after the treatment, the periodontal probing depth (PD), clinical attachment level (CAL), gingival sulcus bleeding index (SBI) of the teeth of the control group and the experimental group were detected, and the gingival sulcus of the two groups were collected at the same time. The level of basic fibroblast growth factor (b-FGF) in gingival crevicular fluid was detected by enzyme-linked immunosorbent assay (ELISA), and the level of serum hypersensitive C-reactive protein (hs-CRP) was detected by immunoturbidimetry. Results:Before the treatment, there were no significant differences in the age, PD, CAL, SBI, hs-CRP and b-FGF levels of patients with severe periodontitis between the two groups (all P>0.05). One week after the treatment, there was no statistically significant difference in PD, CAL, hs-CRP and b-FGF levels between the two groups (all P>0.05), and the SBI of the experimental group (2.43±0.97) was lower than that of the control group (4.13±0.78), and the difference was statistically significant ( P<0.05). Four weeks after the treatment, the SBI of the experimental group (2.26±0.96) was lower than that of the control group (3.75±0.72) ( P<0.01), there was no statistical difference between the two groups in PD and CAL (all P>0.05), the b-FGF level of the experimental group [(35.28±5.41) pg/30 s] was higher than that of the control group [(33.45±2.37) pg/30 s] ( P<0.05), and the serum hs-CRP level of the experimental group [(3.23±1.73) mg/L] was significantly lower than that of the control group [(5.79±0.63) mg/L] ( P<0.05). Conclusions:Low-level laser therapy can effectively reduce the SBI of severe periodontitis patients in the short term, but it has little significance for reducing PD and improving CAL. At the same time, low-level laser therapy can reduce the serum hs-CRP level of patients and increase the level of b-FGF in gingival sulcus fluid, which is beneficial to the control of severe periodontal inflammation.

Effect of low-level laser therapy on cytokines in gingival crevicular fluid of patients with severe periodontitis / 国际生物医学工程杂志

Objective:To study the effect of low-level laser therapy (LLLT) on cytokines in gingival crevicular fluid of patients with severe periodontitis, and to analyze the effect of LLLT on periodontal inflammation control and bone healing.Methods:A total of 43 teeth from 18 patients with severe periodontitis were selected. There were no differences in age, gender, and periodontal status of all patients enrolled. 20 teeth in the control group received basic periodontal treatment, and 23 teeth in the experimental group were received combination of basic periodontal treatment and LLLT. During the LLLT treatment, the gingival pocket was irradiated by low-level laser for 15 s on days 1, 2, and 7. One and four weeks after treatment, the gingival crevicular fluid the patients in the control group and the experimental group was collected, and the interleukin-1β (IL-1β), transforming growth factor-β (TGF), tumor necrosis factor-α (TNF-α), metal matrix protease-8 (MMP-8), soluble intercellular adhesion molecule-1 (sICAM-1) and periosteal protein levels were determined by enzyme-linked immunosorbent assay (ELISA).Results:After treatments, the levels of IL-1β, TNF-α, MMP-8 and sICAM-1 in the control group and the experimental group decreased, and the levels of TGF-β and periosteal protein increased. The basic periodontal treatment combined with LLLT had better therapeutic effect. One week after treatments, the differences in the levels of IL-1β and TNF-α between the two groups were statistically significant (all P<0.05). Four weeks after treatments, the differences in the levels of IL-1β, TNF-α, TGF-β, MMP-8 and sICAM-1 between the two groups were statistically significant (all P<0.05). Conclusions:LLLT treatment can effectively reduce the levels of IL-1β, TNF-α and MMP-8 in the gingival crevicular fluid of patients with severe periodontitis in a short period of time. LLLT has a certain effect on the recovery of periodontal tissue, including controlling periodontal inflammation, reducing the expression of sICAM-1 in gingival crevicular fluid, alleviating the symptoms of gum bleeding, promoting the secretion of TGF-β, increasing the level of periosteal protein, and inhibiting the destruction of periodontal tissue.

Problems and thoughts in the application of neonatal resuscitation technology in rural primary hospitals / 中国实用护理杂志

Neonatal resuscitation project to rural grass-roots development is different from urban promotion and application, need to adjust appropriate strategies and measures. Correct understanding of the effectiveness of resuscitation technology can improve the compliance of rural grass-roots promotion and application. According to "Renewal of International Neonatal Resuscitation Course and China ′s Implementation Opinions", we should make the training of recovery teams as an important goal of long-term management, And adhere to "one case one preparation, one monitoring, one week one review". Rural grass-roots units should innovate and popularize application methods according to local conditions. It is suggested that the training system for neonatal resuscitation and post-resuscitation treatment should be gradually established in county (city) areas.

Patterns of tocilizumab use in clinical practice of rheumatoid arthritis: a multi-center, non-interventional study in China / 中华风湿病学杂志

Objective:To study the patterns of tocilizumab (TCZ) use, its efficacy and safety in patients with rheumatoid arthritis (RA) in routine clinical practice.Methods:A total of 407 patients with RA were enrolled from 23 centers and treated with TCZ within 8 weeks prior to the enrollment visit, and were followed for 6-month. The patterns of TCZ treatment at 6 months, the effectiveness and safety outcomes were recorded. Statistical analysis was performed using SAS version 9.4.Results:A total of 396 patients were included for analysis, in which 330 (83.3%) patients received TCZ combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and 16.7%(66/396) received TCZ monotherapy. At baseline, TCZ was initiated in 56.6%(224/396) and 9.6%(38/396) of patients after failure of DMARDs and other biological agents (bDMARDs) respectively. During the 6-month follow-up period, the mean frequency of TCZ administration was (3.7±1.6), the mean TCZ dosage was (7.4±1.2) mg/kg, and the mean interval between doses was (40±13) days. 120(25.8%) patients were on TCZ treatment at the end of the study. Improvements in disease activity, systemic symptoms and patient report outcomes were observed at the end of the study. 22.7%(90/396) patients experienced at least one treatment related adverse event, and 8 patients experienced at least one serious adverse event.Conclusion:This study demonstrates that TCZ treatment is effective in patients with RA when being treated for 6 months with an acceptable safety profile. The duration of TCZ treatment needs to be extended.

A case report of double percutaneous nephrostomy combined with ureter occlusion stent in treating bladder rectal residual fistula / 中华泌尿外科杂志

This report is about the application of interventional therapy for bladder rectal residual fistula in a patient whose postoperative rectal stump tumor invaded the bladder and underwent radiotherapy and chemotherapy,resulting in urinary fistula,which seriously affected the quality of life.Referring to the treatment experience of visicovaginal fistula,the patient successfully adopted double percutaneous nephrostomy combined with ureter occlusion stent and achieved good palliative treatment effect.

Urethra rerouted under corpora cavernosus anastomotic urethroplasty for treatment of complex posterior urethral strictures / 中华泌尿外科杂志

Objective:To explore the outcomes of urethra around corpora cavernosus anastomotic urethroplasty for the treatment of complex posterior urethral strictures.Methods:Between June 2008 and June 2020, 35 patients with complex posterior urethral strictures were treated using urethra rerouted under one corpora cavernosus anastomotic urethroplasty. The patients’ age was 3-54 years(mean 23.2 years), the urethral stricture or loss length was 4-7 cm(mean 5.2 cm), and 6 patients associated with urethrorectal fistula. The technique involved: ①The anterior urethra is dissected long more than 5 cm, separation of the proximal corporeal bodies, inferior pubectomy and the dissected proximal urethra.②A channel around the left crus of the penis through the inferior pubectomy is separated and urethra rerouted under left corpora cavernosus to allow a tension-free anastomosis to the proximal urethra.Results:Two patients lost follow-up; the remainder 33 patients were followed-up for 3 to 144 months(mean 37 months). Thirty-two patients could void normally(97%), The examination of maximal urinary flow rates(Q max) were taken in 21 patients, of whom Q max was 13.6-35.5 ml/s (mean 17.5 ml/s) in 7 children and 16.3-77.6 ml/s(mean 27.9 ml/s) in 14 adult patients. All 6 patients associated with urethrorectal fistula successful repaired, of these patients 1 had died of hemorrhage of brain 6 years postop. One patient developed urethral stenosis postoperatively. Continence was achieved in 29 patients, the remaining 3 patients had incontinence from mild to moderate. Conclusions:Urethra rerouted under left corpora cavernosus anastomotic urethroplasty is not only an effective surgical salvage option, with low recurrent rate for patients with complex posterior urethral strictures, but also do not cause curve and affect growth of corpora cavernosus.

A case report of double percutaneous nephrostomy combined with ureter occlusion stent in treating bladder rectal residual fistula / 中华泌尿外科杂志

This report is about the application of interventional therapy for bladder rectal residual fistula in a patient whose postoperative rectal stump tumor invaded the bladder and underwent radiotherapy and chemotherapy, resulting in urinary fistula, which seriously affected the quality of life. Referring to the treatment experience of visicovaginal fistula, the patient successfully adopted double percutaneous nephrostomy combined with ureter occlusion stent and achieved good palliative treatment effect.

Correlation between microRNA and rheumatoid arthritis activity / 中华风湿病学杂志

Objective To investigate the correlation between miRNAs and clinical manifestations, laboratory examinations, serum cytokines and disease activity scores in rheumatoid arthritis (RA). Methods Thirty-eightnewly diagnosed RA patients who visited the department of Rheumatology of Inner Mongolia Medical Affiliated Hospital from October 2015 to December 2015 were enrolled in the study. Thirty-eight age and sex matched healthy volunteers were enrolled as the control group. MiR-125b, miR-21, miR-155, miR-346, miR-223, miR-146a were tested by real-time fluorescence quantitative polymerase chain reaction (real-time PCR). Datawere collected at the baseline and 3 weeks after the study. Solutions statistical package for the social sciences (SPSS) 20.0 version was usedfor statistical analysis. Data were analyzed using t test or χ2 test and Pearson test was used for correlation analysis.Levene method was used to test homogeneity of variance. Results MiR-125b (1.55±0.24), miR-155 (3.1±0.5), miR-346 (650±51), miR-223-3p (1.26±0.18), miR-146a-5p (2.39±0.25) levels in the RA group were significantly higher than those in the healthy control group at the baseline (0.84±0.16, 1.4±0.5, 304±101, 0.58±0.11, 1.09±0.27; t=15.36, 18.60, 18.77, 19.67, 21.66; P<0.05). MiR-21-5p (0.91±0.09) was lower than the control group (1.51±0.21; t=-16.029, P<0.05), while miR-146a-3p, miR-21-3p, miR-223-5p showed no difference between the two groups. MiR-155 and miR-146a was positively correlated with RA disease activity scores (P<0.05). MiR-21 was negatively correlated with disease activity scores and serum cytokines including IL-1β, IL-6, IL-17a, IL-23 and Tumor necrosis factor (TNF)-α. After 3 months treatment, tenderness joint count, swelling joint count, laboratory tests and imaging examination were improved (P<0.05), while miRNAslevels in RA were decreased significantly respectively (P<0.05), mir-21 was increased significantly. Conclusion MiR-125b, miR-21, miR-155, miR-346, miR-223, miR-146a in RA are characteristically expressed in RA and related with the disease activity and treatment response. MiRNAs may hold a great promise as the diagnostic and prognostic biomarkers in RA.