[Imaging classification and analysis of the diagnosis and treatment of infected pancreatic necrosis:a report of 126 cases].

Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ2 test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ2=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ2=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.

[A study about the epidemiological characteristics of rabies of the cases of medical treatment from a certain hospital in Beijing from 2011 to 2020].

From 2011 to 2020, there were 111 213 cases of rabies exposed people recruited from the rabies immunization clinic of a hospital in Beijing. The monthly distribution of patients in each year was not statistically significant (P>0.05). The distribution of patients showed remarkable seasonality, with the exposure peak from May to October. The ratio of male to female was 1∶1.3. The majority of patients were aged 20-29 years old (39.1%) and in-service personnel (56.5%). Level-Ⅱ wounds (84.2%) were more common than level-Ⅲ wounds (14.9%). The number of visits to level-Ⅲwounds increased rapidly since 2017. The most common injured body part was hand (60.7%). Dogs were the most common animal for injuries (60.6%), followed by cats (32.3%), of which most were host animals (75.5%). The vaccination rate from 2016 to 2020 [49.8% (24 276/48 703)] was significantly higher than that from 2011 to 2015[18.6% (6 559/35 272)](χ²=8597.18, P<0.001).

Stomatal conductance, not biochemistry, drives low temperature acclimation of photosynthesis in Populus balsamifera, regardless of nitrogen availability.

Low-temperature thermal acclimation may require adjustments to N and water use to sustain photosynthesis because of slow enzyme functioning and high water viscosity. However, understanding of photosynthetic acclimation to temperatures below 11 °C is limited. We acclimated Populus balsamifera to 6 °C and 10 °C (6A and 10A, respectively) and provided the trees with either high or low N fertilizer. We measured net CO2 assimilation (Anet ), stomatal conductance (gs ), maximum rates of Rubisco carboxylation (Vcmax ), electron transport (Jmax ) and dark respiration (Rd ) at leaf temperatures of 2, 6, 10, 14 and 18 °C, along with leaf N concentrations. The 10A trees had higher Anet than the 6A trees at warmer leaf temperatures, which was correlated with higher gs in the 10A trees. The instantaneous temperature responses of Vcmax , Jmax and Rd were similar for trees from both acclimation temperatures. While soil N availability increased leaf N concentrations, this had no effect on acclimation of photosynthesis or respiration. Our results indicate that acclimation below 11 °C occurred primarily through changes in stomatal conductance, not photosynthetic biochemistry, and was unaffected by short-term N supply. Thermal acclimation of stomatal conductance should therefore be a priority for future carbon cycle model development.

Enhancement effect of nanoscale zero-valent iron addition on microbial degradation of BDE-209 in contaminated mangrove sediment.

Chemical and biological methods have been employed to remedy polybrominated diphenyl ether contamination, but the removal of decabromodiphenyl ether (BDE-209) by either method still has limitations. The present study aims to evaluate the combined effect of nanoscale zero-valent iron (nZVI) (from 0.1 to 10%) reduction and microbial debromination on BDE-209 removal in mangrove sediments under an anaerobic condition. During the 12-months incubation, nZVI significantly enhanced BDE-209 removal, with 17.03% to 41.99% reduction in sterilized sediments. The reduction was even higher in non-sterilized sediments with living indigenous microorganisms, achieving 15.80%, 33.50%, 55.83% and 66.95% removal of BDE-209 at 0 (control without nZVI), 0.1%, 1% and 10% nZVI, respectively. In control sterilized sediments, no debromination was found, and debromination occurred according to spiked levels of nZVI, with BDE-153 being the dominant congener. The concentrations of debrominated congeners in non-sterilized sediments also increased with nZVI levels, but were significantly higher than the respective sterilized sediment. The relative proportions of different debrominated congeners in non-sterilized sediments depended on nZVI levels, with BDE-99 being the dominant congener in low nZVI amended sediments but shifted to BDE-153 under high nZVI. Higher concentrations of ferrous iron (Fe2+) were detected in both sterilized and non-sterilized sediments spiked with more nZVI, and their concentrations significantly correlated with BDE-209 removal. Growth of total bacteria in sediments with 1% and 10% nZVI was inhibited within first two months, but their numbers resumed to that in the control at the end of 12 months. The present study demonstrates the synergy between chemical and microbiological methods, and a combination of nZVI and indigenous microorganisms could be an efficient and feasible mean to remedy BDE-209 in contaminated sediments.

Enhanced remediation of BDE-209 in contaminated mangrove sediment by planting and aquaculture effluent.

Toxic and persistent flame retardant (BDE-209) and aquaculture effluent (AE) are ubiquitous in coastal environments, but how their co-existence influences their fate is not yet investigated. This study investigated AE effects on remediation and uptake of BDE-209 by Kandelia obovata (Ko) and Avicennia marina (Am), true and dominant mangrove species. After 12-months, a significant removal of BDE-209 was achieved in planted mangrove sediment and the removal was significantly enhanced by AE addition, possibly due to the enhancement of nitrogen (N) and phosphorous (P) content in sediment. Residual percentages of parent BDE-209 in Ko and Am planted sediments without AE were 61.4% and 70.9%, respectively, but decreased to 46.9% and 48.0% with AE addition after 12-months. A similar trend was found in unplanted sediment, with 86.5% and 65.3% of BDE-209 retained in sediments without and with AE addition, respectively. The results demonstrated that AE addition not only increased the debromination of BDE-209 in all treated sediments with the production of debrominated congeners (de-PBDEs) like di- to nona-BDEs in unplanted and planted sediments, but also enhanced the take up of BDE-209 in Ko root, and de-PBDEs in both Ko and Am, thus enhancing the phytoremediation of BDE-209 in contaminated sediments.

[Four-steps surgery for infected pancreatic necrosis based on "Step-up" strategy: a retrospective study].

Objective: To examine the effect of the "four-steps" treatment on infectious pancreatic necrosis(IPN). Methods: The data of 207 patients who were diagnosed with IPN from January 2013 to December 2017 at Department of Pancreaticobiliary Surgery, the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Among 207 patients, 132(63.8%) were males and 75(36.2%) were females. The median age was 45 years old (range: 19 to 80 years old). One hundred and fifty-eight patients(76.3%) suffered severe acute pancreatitis and 49 patients(23.7%) suffered moderately severe acute pancreatitis. Percutaneous catheter drainage(PCD) was performed on all the patients(Step 1). Patients received "four-steps" minimally invasive treatment strategy in step-up group(173 patients). The following steps after PCD were mini-incision access pancreatic necrosectomy(MIAPN) (Step 2), sinus tract endoscopic debridement and(or) PCD for residual infections(Step 3) and finally conventional open pancreatic necrosectomy(OPN) (Step 4). Patients(34 cases) received conventional open pancreatic necrosectomy after invalided PCD in OPN group. The perioperative parameters and prognosis were compared between Step-up group and OPN group. Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ(2) test or Fisher exact test, respectively. Results: The basic characteristics of the two groups of patients were similar, but the referral rate of patients and the rate of preoperative 3 days organ failure in the OPN group were significantly higher than those of step-up group patients(47.1% vs. 28.9%, χ(2)=4.313, P=0.038; 26.5% vs. 9.2%, χ(2)=2.819, P=0.011). The frequency of PCD and the number of PCD tube (root) were less than those in the step-up group(1(1) vs. 2(1), Z=-3.373, P=0.018; 2(1) vs. 3(2), Z=-2.208, P=0.027). Compared with the OPN group, the interval time from onset to surgery and the MIAPN operation time were significantly shorter in the step-up group(29(15) days vs. 36(17)days, Z=-0.567, P=0.008; 58(27)minutes vs. 90(56)minutes, Z=-3.908, P<0.01); postoperative mortality was lower(5.8% vs.17.6%, χ(2)=4.070, P=0.044); the overall incidence of postoperative complications was reduced(23.1% vs. 55.9%, χ(2)=14.960, P<0.01) and the incidence of new-onset organ failure was decreased after operation in the step-up group(37.5% vs.47.4%, χ(2)=7.133, P=0.007). The incidence of local abdominal complications (pancreatic fistula, intra-abdominal hemorrhage, gastrointestinal fistula) showed no significant difference between the two groups (P>0.05). Fewer patients required ICU treatment after operation in the step-up group compared with OPN group(22.0% vs. 44.1%, χ(2)=6.204, P=0.013). Patients in the Step-up group has shorter hospital stay than patients in OPN group (46(13) days vs. 52(13)days, Z=-1.993, P=0.046). Conclusions: The clinical effects of "four-steps" exhibited the superiority of minimally invasive treatment of IPN.And MIAPN is a simple, safe and effective procedure to remove pancreatic necrotic tissue and decrease complications.

[Prognostic factors of multi-drug resistant organism infection in infected pancreatic necrosis patients].

Objective: To investigate the prognostic factors of multi-drug resistant organism (MDRO) infection in patients with infected pancreatic necrosis(IPN). Methods: A retrospective study was performed to assess the MDRO in IPN patients. The clinical data of 104 IPN patients admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from June 2013 to January 2019 were analyzed. Fifty-six patients were allocated in the MDRO group and 48 patients in the non-MDRO group depended on drug sensitivity test. There were 37 males and 19 females in the MDRO group with age of 40 (23) years. The duration time was 3(5) days between onset and admission. In the non-MDRO group,34 males and 14 females were included with age of (42±14)years. The duration time was 3(4) days between onset and admission. Normally distributed quantitative variables was represented by x±s, non-normally distributed quantitative variables was represented by M(Q(R)). Wilcoxon rank-sum test and χ(2) test were used to analyze the data. Univariate and multivariable Logistic regression analytic model were used to figure out the risk factors associated with MDRO infection. Results: The mean duration of hospital stay was 29.5(31.8) days and hospitalization expenses were CNY 166 991(270 692), which were much higher than those in non-MDRO group (16.5(15.7) days, 56 789(62 354) yuan) (W=1 889, 2 019, both P<0.01). Gram-negative isolates(67.2%, 80 /119) were commonly detected in IPN patients. Acinetobacter baumannii was the most common MDRO(27.0%,20/74). Initial use of carbapenem(OR=2.22, 95%CI: 1.02-4.96, P=0.047) and open necrosectomy(OR=10.00, 95%CI: 3.14-44.77, P<0.01) were the potential risk factors for MDRO-induced infections in IPN. Furthermore, the Logistic regression analysis revealed that open necrosectomy is the independent variable for MDRO infections (OR=9.42, 95%CI: 2.92-42.42, P<0.01). Conclusion: Open necrosectomy was the independent risk factor for the infection of MDRO.

[The therapeutic experience of blunt pancreatic trauma].

Objective: To summarize the experience of treatment for blunt pancreatic trauma. Methods: The clinical data of 52 patients with blunt pancreatic trauma admitted to the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2018 were analyzed retrospectively.There were 40 male and 12 female patients, aging from 12 to 112 years with a median age of 35.5 years.According to the organ injury scale by American Association for the Surgery of Trauma(AAST) for pancreatic injury severity, 15 cases were in grade Ⅰ(28.8%), 20 cases were in grade Ⅱ(38.5%), 10 cases were in grade Ⅲ(19.2%),5 cases were in grade Ⅳ(9.6%) and 2 cases were in grade Ⅴ(3.8%). Isolated blunt pancreatic trauma occurred in 11(21.2%) patients including 5 cases of grade Ⅰ,5 cases of grade Ⅱ and 1 case of grade Ⅲ, and associated injuries existed in 41 patients(78.8%). Results: Among 52 patients, 36 patients(69.2%) were transferred from other hospitals and 16(30.8%) patients were admitted through the emergency department. Finally, 49 patients(94.2%) were cured and 3 patients (5.8%) died.For the 15 cases of grade Ⅰ,9 patients were managed non-operatively, 5 cases underwent peritoneal lavage and drainage after surgery for the other injured abdominal organs, and 1 patient received percutaneous catheter drainage(PCD) with non-operative treatment. For the 20 cases of grade Ⅱ,4 cases only received non-operative treatment and 2 cases also received PCD. Besides, 2 cases underwent debridement and drainage for peripancreatic necrotic tissue and external drainage for pancreatic pseudocyst retrospectively after about 25 days of getting injured. As for patients who received exploratory laparotomy, 5 patients underwent suture repair associated with external drainage, and 7 patients were managed only with external drainage. For the 10 cases of grade Ⅲ,6 patients were cured through distal pancreatectomy and splenectomy with external drainage, while 2 patients underwent endoscopic retrograde cholangiopancreatography and ductal stenting, and the other 2 patients just received debridement and drainage for peripancreatic necrotic tissue.For the 5 cases of grade Ⅳ,2 patients underwent jejunostomy and abdominal cavity drainage, 1 patient had a pancreaticoduodenectomy with drainage,1 patient received suture repair of the pancreas and pancreaticojejunostomy, and 1 patient was managed with suture repair of the head of pancreas and external drainage.For the 2 patients of grade Ⅴ,1 patient received exploratory laparotomy and gauze compression packing hemostasis, and the other patient underwent pancreaticoduodenal repair, gastrointestinal anastomosis, duodenal exclusion surgery and external drainage. Conclusion: According to the AAST classifications, associated injuries, physiological status and intraoperative situation, it could be better to make a comprehensive judgment, achieve early diagnosis and take appropriate individualized treatment strategy, and to improve the overall therapeutic effect for blunt pancreatic trauma.

Age, lifestyle and self-perceptions of hair: Is there an association with hair diameter and tensile properties?

OBJECTIVE: To determine the association of age, lifestyle habits and the self-perception of hair condition with the objectively measured physical properties of hair in Caucasian females with brown hair. METHODS: Hair biophysical properties, lifestyle habits data and self-perceptions of hair condition were collected on 110 Caucasian females with brown hair ranging in age from 17 to 78. Hair diameter (cross-sectional area) and tensile properties (elastic modulus, break strength and break extension) were measured at the root end of individual fibres (n = 100/subject) from the crown and frontal regions using objective instrumental methods. Other measures included body mass index (BMI) and Savin female pattern hair loss grades based on judging of standardized front, top and side view head images. Lifestyle habits and practices and self-perceived hair condition were obtained via a standardized self-assessment questionnaire. RESULTS: Hair fibre diameter and break extension decreased significantly with age. Hair fibre elastic modulus and Savin hair loss scores increased significantly with age. No age-related change in hair fibre break stress was observed. A history of smoking or being overweight was significantly associated with having lower hair fibre cross-sectional area but was not associated with any of the measured tensile properties. Subjects who perceived their hair as fine, thinning or weak had significantly lower cross-sectional areas than subjects who did not. Subjects who perceived their hair to be healthy or strong had significantly higher cross-sectional areas than subjects who did not. CONCLUSION: The biophysical properties of hair change significantly with age. A history of smoking or being overweight was significantly associated with having smaller hair cross-sectional area but was not associated with differences in hair tensile properties. The self-perception of having strong or healthy hair seems more associated with having a larger cross-sectional area than any real differences in hair strength.Abstrait.

OBJECTIF: Déterminer l'association entre l'âge, les habitudes de vie et la perception de l'état des cheveux avec les propriétés physiques mesurées de manière objective chez les femmes de race blanche à cheveux bruns. MÉTHODES: Les propriétés biophysiques des cheveux, les données sur les habitudes de vie et la perception de leur état de santé ont été recueillies chez 110 femmes de race blanche aux cheveux bruns âgés de 17 à 78 ans. Le diamètre des cheveux (surface transversale), résistance à la rupture et extension à la rupture) ont été mesurés à la racine des fibres individuelles (n = 100 / sujet) à partir des régions de la couronne et de la partie frontale en utilisant des méthodes instrumentales objectives. Parmi les autres mesures, citons l'indice de masse corporelle (IMC) et les degrés de perte de cheveux selon le modèle féminin de Savin, fondés sur l'évaluation d'images de tête normalisées de face, de dessus et de côté. Les habitudes et pratiques de mode de vie et l'état de poil auto-perçu ont été obtenues à l'aide d'un questionnaire d'autoévaluation standardisé. RÉSULTATS: Le diamètre de la fibre capillaire et l'extension de la rupture ont diminué de manière significative avec l'âge. Le module d'élasticité de la fibre capillaire et les scores de perte de cheveux de Savin augmentaient considérablement avec l'âge. Aucun changement lié au vieillissement du stress lié à la rupture de la fibre capillaire n'a été observé. Des antécédents de tabagisme ou d'embonpoint étaient significativement associés à une section inférieure de la fibre capillaire mais n'étaient associés à aucune des propriétés de traction mesurées. Les sujets qui percevaient leurs cheveux fins, fins ou clairsemés avaient une section transversale significativement plus basse que les autres. Les sujets qui percevaient que leurs cheveux étaient en bonne santé ou forts avaient des zones transversales significativement plus élevées que les sujets qui n'en avaient pas. CONCLUSION: Les propriétés biophysiques des cheveux changent de manière significative avec l'âge. Les antécédents de tabagisme ou d'embonpoint étaient significativement associés à une plus petite section transversale des cheveux mais n'étaient pas associés à des différences de propriétés de tension des cheveux. La perception de soi d'avoir des cheveux forts ou en bonne santé semble plus associée à une plus grande surface transversale que toute différence réelle dans la résistance des cheveux.

[The sensitization feature of artemisia allergy and the diagnosis value of skin prick test].

Objective:The purpose of this study was to explore the sensitization feature of artemisia allergy and to assess the diagnostic value of skin prick test(SPT) compared with specific IgE(sIgE) test. Method:One hundred and fifty-one patients with typical rhino-conjunctivitis symptoms during pollen season were enrolled and general information was recorded in this study. All subjects received SPT and sIgE test of artemisia allergen. The accuracy rate, sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), Kappa index and Youden index of SPT for diagnosing artemisia allergy was analyzed. Receiver operating characteristic curve(ROC curve) and the area under the curve was calculated. Result:Among 151 patients, 89(58.9%) was sIgE positive while severe type was 59.6% in positive group. 106(70.2%) was SPT positive while 84.0% was SPT level 3. SPT level was positively associated with sIgE level(r=0.714, P<0.01). While considering SPT level 1 as positive, the sensitivity of SPT diagnosing artemisia allergy was 98.9% and the NPV was 97.8%. While considering SPT level 2 as positive, the accuracy rate of SPT was highest(89.4%) with sensitivity of 97.8%, specificity of 77.4% and NPV of 96.0%. The Kappa index and Youden index was the highest at SPT level 2 compared with other SPT level. The area under the curve was 0.886(95%CI 0.822-0.949, P<0.01). Conclusion:Artemisia allergy tends to be severe type. Strong correlation exists between SPT and sIgE tests of artemisia. SPT level 1 has the highest sensitivity while SPT level 2 has the strongest screening ability of artemisia allergy.

[Clinical analysis of small incision minimally invasive approach in treatment of infected pancreatic necrosis].

Objective: To investigate the safety and efficiency of small incision minimally invasive approach pancreatic necrosectomy in the treatment of infected pancreatic necrosis. Methods: The data of 164 patients who underwent small incision minimally invasive approach pancreatic necrosectomy for infected pancreatic necrosis at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were analyzed retrospectively.Among 164 patients, there were 102 male and 62 female patients.The median age was 46 years(ranging from 19 to 79 years). One hundred and one patients(61.6%) suffered from severe acute pancreatitis and 63 patients(38.4%) suffered from moderately severe acute pancreatitis.Following step-up approach principle, the surgical procedures were performed for 131 patients(79.9%) who suffered from sepsis which could not be alleviated via percutaneous catheter drainage(PCD). The other 33 patients(20.1%) who did not undergo PCD directly took small incision minimally invasive approach pancreatic necrosectomy.Preoperative CT images were used to determine the location of the lesion.The PCD puncture points or the points where the abscess was closest to the skin were chosen as the incision.Gradually, the small incision minimally invasive approach pancreatic necrosectomy were performed via cutting all layers into the abscess. Results: The median time from the onset of symptom to first operation was 32 days(ranging from 23 to 45 days). The average hospital stay was 46 days(ranging from 29 to 103 days). The average number of drainage tubes placed was 4 pieces(ranging from 2 to 8 pieces). Ninety-two patients(56.0%) underwent minimal access retroperitoneal pancreatic necrosectomy. Thirty-six patients(22.0%) underwent minimal invasive approach lesser omentum sac pancreatic necrosectomy.Thirty-six patients(22.0%) underwent minimal invasive approach lesser omentum sac pancreatic necrosectomy combined with minimal access retroperitoneal pancreatic necrosectomy.A total of 148 cases(90.2%) were cured via minimally invasive approach pancreatic necrosectomy, 8 cases(4.9%) were cured after transfering to open pancreatic necrosectomy.The cure rate was 95.1%(156/164). The mainly postoperative complications included pancreatic fistula(25 cases), intra-abdominal hemorrhage(10 cases), gastric fistula (2 cases), duodenal fistula(4 cases) and colonic fistula(3 cases). The overall incidence rate of complications was 26.8%(44/164). Eight cases were dead after surgery and the in-hospital mortality was 4.9%(8/164). Conclusion: In summary, small incision minimally invasive approach pancreatic necrosectomy is an effective way to clean up necrotic tissue, improve the drainage, reduce complications in dealing with infected pancreatic necrosis.

[Advances in diagnosis and treatment of undifferentiated pancreatic carcinoma with osteoclast-like giant cells].

Undifferentiated pancreatic carcinoma with osteoclast-like giant cell(UOC) published to date, and most have been in Asia, is a rare occurrence making up 1% of all pancreatic malignancies.With the increasing number of reported cases of the disease, the degree of awareness of the disease also gradually deepened, but there are few summary articles for the clinical features, imaging features, pathological features, treatment programs, prognosis and other aspects of UOC.Hence, this article is going to introduce pathological features, clinical manifestations, diagnosis and treatment of adjuvant advances of UOC in detail.

[Minimally invasive small incision direct anterior total hip arthroplasty in the lateral decubitus position: complications and early outcome].

Objective: To analyze the feasibility, perioperative complications and early outcomes of minimally invasive small incision in direct anterior approach total hip arthroplasty in lateral decubitus position. Methods: From January 2015 to January 2017, 212 patients (228 hips) received minimally invasive small incision (approximately 8 cm in length) direct anterior approach total hip arthroplasty in modified lateral decubitus position and approach. Sixteen cases underwent bilateral hip arthroplasty separately. All procedures were performed by the same surgeon in the Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital. Twenty-eight patients (28 hips) were set as the complicated case group. The rest 184 patients (200 hips) had no previous hip surgeries, severe deformity and limited motion of the hip, were set as the standard group, and were divided into the first 100 cases group and the second 100 cases group in sequence. The difference between the standard group and complicated case group were analyzed. Also we compared the difference between the first 100 cases and the second 100 cases. Perioperative complications, postoperative function and radiological evaluation were recorded and statistically analyzed. The t test was applied to compare the data between groups. Results: All the patients were followed-up for 13 to 25 months[(18±5) months]. Intraoperative complications and postoperative complications happened in 9 and 34 patients respectively. The anterior dislocation occurred in 2 cases. The standard group showed significant superior outcomes when compared with complicated case group in the surgical time[(42±19) vs (67±16) min, t=-2.628, P=0.027], blood loss[(222±94) vs (579±120) ml, t=-8.371, P=0.000], postoperative Harris hip score[90±5 vs 83±7, t=2.390, P=0.024]and the rate of surgical complication (15.0% vs 46.4%, χ(2)=15.854, P=0.000). The complication rate tended to decrease in the second 100 cases when compared with that in the first 100 cases (11.0% vs 19.0%, χ(2)=3.922, P=0.037). Meanwhile, the second 100 cases showed significant excellent outcomes when compared with the first 100 cases in the mean surgical time[(34±15) vs (48±10) min, t=4.217, P=0.002]and blood loss[(182±52) vs (254±40) ml, t=2.889, P=0.018]. Conclusions: It suggests that there is a learning curve with the minimally invasive small incision direct anterior approach total hip arthroplasty in lateral decubitus position. The risk of intraoperative femoral fractures is slightly high, especially for cases with osteoporosis, stiffness and limited range of movement. Surgeons in early learning curve period should grasp the surgical indications and master the technical points.

Hesperetin Mitigates Bile Duct Ligation-Induced Liver Fibrosis by Inhibiting Extracellular Matrix and Cell Apoptosis via the TGF-ß1/Smad Pathway.

BACKGROUND: Hesperetin, a natural component of citrus fruits, is indicated to have beneficial anti-inflammatory effects on injury and various cancers as a transforming growth factor beta (TGF-ß) inhibitor. However, little evidence associates hesperetin with liver fibrosis. OBJECTIVE: Work from our laboratory aims at finding the mechanism by which hesperetin attenuates liver fibrosis. METHODS: Bile duct ligation (BDL) was used to induce liver fibrosis in mice and the findings were determined using enzyme-linked immunosorbent assay, quantitative realtime polymerase chain reaction, western blotting and immunohistochemical staining. RESULTS: Data from Immunohistochemical staining and injury score indicated that pathological lesions were reduced by hesperetin treatment. Decreasing levels of several serum parameters including cytokines tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6), liver enzyme alanine aminotransferase (ALT) and aspartate aminotransferase (AST), fibrosis indicators laminin (LN), hyaluronic acid (HA) and hydroxylproline (Hyp) suggested similar results to the immunohistochemical. In addition, our data verified hesperetin could suppress the formation of extracellular matrix and hepatocyte apoptosis in vitro, together with promoting hepatic stellate cell death in vivo, which was considered to be associated with the inhibition of TGF-ß1/Smad pathways. CONCLUSION: In the present study, the favorable role of hesperetin extracted from citrus peels was verified to prevent the progression of BDL-induced liver fibrosis via inhibiting TGF-ß1/Smad pathway-mediated extracellular matrix progression and apoptosis.

[Research advances in anatomical study on the diffusion routs of acute pancreatitis].

The retroperitoneum space comprises anterior pararenal space, perirenal space and posterior pararenal space. Pancreas is a retroperitoneal organ and located in the anterior pararenal space of the retroperitoneum. Left and right sides anterior pararenal space are potentially communicated, which contains many adipose tissues and a little connective tissues. The exacerbation of acute pancreatitis results in the lesion spreading into adjacent area of pancreas in the retroperitoneal space. In addition, the lesion could spread into bare area of stomach, posterior colonic region, subperitoneal space and pelvic retroperitoneal space through the same anatomical space or communicating space. Due to the fascia destruction by pancreatic enzymes or the lesion directly diffuse through the weak fascia, the lesion could also diffuse across fascia to perirenal space, posterior pararenal space, the peritoneal cavity and abdominal wall. Finally, a series of complications are developed. The diffusion paths of acute pancreatitis are complex and diverse. Familiarity with these diffusion paths is useful for determining the severity and guiding therapy.

Continued EGFR-TKI with concurrent radiotherapy to improve time to progression (TTP) in patients with locally progressive non-small cell lung cancer (NSCLC) after front-line EGFR-TKI treatment

Background. Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is the optimal treatment for EGFR-mutant advanced non-small cell lung cancer (NSCLC). However, most patients developed systemic or local progression due to acquired EGFR-TKI resistance. This retrospective study aimed to evaluate the feasibility of continued EGFR-TKI with concurrent radiotherapy (CTCRT) in patients with local progression after front-line EGFR-TKI treatment. Methods. Advanced NSCLC patients with active EGFR mutation who received EGFR-TKI were treated with CTCRT after local progression. Medical data were analyzed for time to progression (TTP), progression-free survival (PFS), tumor response rate, overall survival (OS) and adverse events. Results. A total of 50 irradiated lesions from 44 patients were included. Median TTP and PFS of measurable lesions (n = 31) were both significantly prolonged after local radiotherapy (TTP1 + TTP2 vs. TTP1: 21.7 vs. 16.0 months, P = 0.010; PFS1 + PFS2 vs. PFS1: 21.3 vs. 16.0 months, P = 0.027). For all lesions (n = 50), objective response rate (ORR) and local tumor control rate (LCR) were 54.0 and 84.0%, respectively. Median OS was 26.6 months. There were no serious adverse events before or after radiotherapy. Conclusions. The treatment modality of CTCRT is considerable and effective for EGFR-mutant NSCLC patients even with local failure from front-line EGFR-TKI treatment (AU)

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Continued EGFR-TKI with concurrent radiotherapy to improve time to progression (TTP) in patients with locally progressive non-small cell lung cancer (NSCLC) after front-line EGFR-TKI treatment.

BACKGROUND: Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is the optimal treatment for EGFR-mutant advanced non-small cell lung cancer (NSCLC). However, most patients developed systemic or local progression due to acquired EGFR-TKI resistance. This retrospective study aimed to evaluate the feasibility of continued EGFR-TKI with concurrent radiotherapy (CTCRT) in patients with local progression after front-line EGFR-TKI treatment. METHODS: Advanced NSCLC patients with active EGFR mutation who received EGFR-TKI were treated with CTCRT after local progression. Medical data were analyzed for time to progression (TTP), progression-free survival (PFS), tumor response rate, overall survival (OS) and adverse events. RESULTS: A total of 50 irradiated lesions from 44 patients were included. Median TTP and PFS of measurable lesions (n = 31) were both significantly prolonged after local radiotherapy (TTP1 + TTP2 vs. TTP1: 21.7 vs. 16.0 months, P = 0.010; PFS1 + PFS2 vs. PFS1: 21.3 vs. 16.0 months, P = 0.027). For all lesions (n = 50), objective response rate (ORR) and local tumor control rate (LCR) were 54.0 and 84.0%, respectively. Median OS was 26.6 months. There were no serious adverse events before or after radiotherapy. CONCLUSIONS: The treatment modality of CTCRT is considerable and effective for EGFR-mutant NSCLC patients even with local failure from front-line EGFR-TKI treatment.

Does cross-acclimation between drought and freezing stress persist over ecologically relevant time spans? A test using the grass Poa pratensis.

Despite evidence that prior exposure to drought can increase subsequent plant freezing tolerance, few studies have explored such interactions over ecologically relevant time spans. We examined the combined effects of drought and subsequent freezing on tiller growth and leaf sugar concentrations in the grass, Poa pratensis. We exposed tillers to no drought (-0.04 MPa), moderate drought (-0.19 MPa) or severe drought (-0.42 MPa) for 3 weeks in summer. Tillers were then frozen in autumn or spring at -5 °C (frost damage) or at 0 °C (control) for 3 days and harvested after a re-growth period. For shoot growth, there was a significant interaction between drought and autumn freezing, whereby the relative effect of freezing on growth was least for the plants previously exposed to severe drought; however, there was no significant interaction between drought and spring freezing. For root growth, there were no significant interactions between drought and freezing in either season. Leaf sugar concentrations increased significantly with drought intensity, but these effects dissipated within a month, prior to the onset of the autumn freezing treatment. Overall, our results suggest that interactions between prior drought and subsequent freezing in P. pratensis may be most relevant in the context of autumn freezing, and despite the important role of soluble sugars in increasing both drought and freezing tolerance in this species, the retention of these compounds after drought stress does not appear to explain the occurrence of drought-frost interactions at ecologically relevant time scales.

The significance of HBD-3 and fluorescent composite carriers in the processof bone formation in rats infected with Staphylococcus aureus.

OBJECTIVE: The objective of the present study was to explore the significance of human ß-defensin 3 (HBD-3) through establishment and evaluation of the model of implant-related biofilm infection of the femoral condyle of the outer knee using Sprague-Dawley (SD) rats. MATERIALS AND METHODS: Age-matched SD rats were divided into three groups, the HBD-3 group, HBD-3 fluorescent liposome group, and the HBD-3 liposome-microbubble fluorescent composite carrier group. After biofilm infection for 24 h, the fluorescent composite vector was injected intraperitoneally 2 times/day. After the first injection, rats in each group were sacrificed on the 7th, 14th, and 28th day. The lower end of the femur bone was harvested after removing the surrounding soft tissue. H&E and immunohistochemical staining were applied and light microscopy was used for observation. Fluorescent markers including tetracycline and calcein were used to follow the formation of new bone in vivo. Undecalcified specimens were embedded in epoxy resin (thickness of roughly 150 m), and confocal microscopy was used for observation. RESULTS: By assessing cell proliferation with cell counting kit-8, the proliferation ability of cells in the HBD-3 liposome-microbubble fluorescent composite carrier group was significantly increased compared with the other groups (p<0.05). qPCR was used to measure the levels of alkaline phosphatase (ALP), type I collagen, osteocalcin (OCN), osteopontin (OPN), and bone sialoprotein (BSP) in each group. The levels of these genes in the HBD-3 liposome-microbubble fluorescent composite carrier group were significantly higher than those in other groups (p<0.05). CONCLUSIONS: The application of the HBD-3 liposome-microbubble fluorescent composite carrier can significantly promote osteogenesis in rats infected with Staphylococcus aureus, and increase the expression levels of ALP, type I collagen, OCN, OPN, and BSP.

[Clinical experience on the employment of the staged step-up approach in the treatment of local complications secondary to severe acute pancreatitis].

Objective: To explore the experience and prognostic factors associated with the employment of the step-up approach in the treatment of local complications secondary to severe acute pancreatitis (SAP). Methods: The clinical data of 279 patients admitted to the Department of Pancreatic and Biliary Surgery, First Affiliated Hospital of Harbin Medical University from January 2011 to December 2015, whose local complications secondary to SAP were treated in a staged step-up framework, were retrospectively analyzed.For patients with documented or suspected infected pancreatic necrosis or gastrointestinal tract obstruction, some non-surgical interventions were initialed with the aim of postponing the timing of surgery to the forth week from the onset of SAP.The first-step intervention was a percutaneous catheter drainage (PCD) under the guidance of ultrasound. A minimal access retroperitoneal pancreatic necrosectomy, representing the second-step intervention, was conducted when PCD had failed. Finally, an open necrosectomy (the third-step intervention) was immediately resorted to when all of previous minimal invasive interventions had failed.Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ2 test or Fisher's exact test.A multivariable Logistic regression analytic model was established to figure out the prognostic factors that were independently associated with the requirement of debridement in addition to drainage procedure during the staged step-up framework of patients with local complications secondary to SAP. Results: The initial interventions in this series were performed at 12 d (9-22 d) from the on-set of SAP and 104 cases (37.3%) were cured with ultrasound guided PCD alone.There were 152 cases (54.5%) cured by debridement in addition to PCD with the time interval of 30 d (25 to 44 d) since the on-set of the disease.The overall incidence of postoperative complications was 22.6% (63 cases) and in-hospital mortality was 8.2% (23 cases) in the present series.Multiple organ failures(MOF)(P<0.01, OR=3.15), heterogeneous collections (P<0.01, OR=2.40) and tertiary transfer (P=0.03, OR=1.80) were verified as the prognostic factors that were independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP. Conclusions: The staged step-up framework is a promising innovation that complies well with the era of minimal invasive surgery and is optimally suitable for the surgical interventions against SAP.MOF, heterogeneous collections and tertiary transfer are the prognostic factors that are independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP.