Moderate and severe valgus knee by total knee arthroplasty through medial and lateral parapatellar approach / 中国组织工程研究

BACKGROUND:Prosthesis restricted selection,soft tissue release,patellar trajectory recovery,and bone defect reconstruction were need to be optimized in total knee arthroplasty for moderate and severe valgus knee.The medial parapatellar approach has disadvantages in the treatment of valgus knee,such as aggravating the medial soft tissue relaxation.In recent years,it has been found that the lateral parapatellar approach has advantages in the treatment of valgus knee,such as exposure and release. OBJECTIVE:To observe the efficacy of the lateral and medial parapatellar approach in total knee arthroplasty for moderate and severe valgus knee,and to explore a more suitable surgical approach for moderate and severe valgus knee. METHODS:Totally 56 patients with moderate and severe valgus knee underwent total knee arthroplasty and would take turns performing surgery through the medial and lateral parapatellar approach according to the order of admission.The lateral group(n=28)underwent total knee arthroplasty through lateral parapatellar approach,and the medial group(n=28)through medial parapatellar approach.Posterior stablized knee prosthesis was used in all patients.The restricted types of prosthesis,thickness of polyethylene,operation time,amount of blood loss,femoro-tibia angle,patellar tilt angle,range of motion,Hospital for Special Surgery score,Western Ontario and McMaster Universities Arthritis Index(WOMAC)score,and complications were collected as observation indexes for statistical analysis. RESULTS AND CONCLUSION:(1)The utilization rate of condyle-restricted prosthesis in the lateral group was significantly lower than that in the medial group.The average thickness of polyethylene liner was lower,and the operation time was shorter in the lateral group compared with the medial group.There were significant differences between the two groups(P<0.05),and there was no significant difference in the amount of surgical bleeding.(2)56 patients were followed up for an average of 2-5 years.There were no signs of prosthesis loosening or bone resorption in all patients.The average patellar tilt angle and femoral tibial angle of the lateral group were lower than those of the medial group,and the average Hospital for Special Surgery score and WOMAC score of the lateral group were higher than those of the medial group,with significant differences(P<0.05).There was no significant difference in the range of motion of the knees between the two groups.(3)Incision fat liquefaction and calf intermuscular venous thrombosis occurred in one case in each group.No infection,poor incision healing,incisional hematoma,prosthesis dislocation,iatrogenic nerve injury,ectopic ossification,or periprosthesis fracture occurred during follow-up.(4)In conclusion,the treatment of moderate and severe valgus knee by lateral parapatellar approach can better protect the tension of the medial soft tissue of the knee,use less condylar restrictive prostheses,and have a more friendly patellar trajectory and higher postoperative function score.

The application value of multimodal MRI imaging in early neurological deterioration and clinical prognosis prediction of acute ischemic stroke / 中国医师杂志

Objective:To explore the application value of multimodal MRI imaging in early neurological deterioration (END) and clinical prognosis prediction of acute ischemic stroke (AIS).Methods:A total of 200 AIS patients admitted to the Chengde Central Hospital from October 2019 to October 2022 were selected as the study subjects. Based on whether END occurred within 7 days of enrollment, there were 40 cases in the occurrence group and 160 cases in the non occurrence group. The influencing factors of END occurrence in AIS patients and the predictive value of multimodal magnetic resonance imaging (MRI) parameters on END were analyzed; According to the modified Rankin (mRS) score, patients were divided into good prognosis and poor prognosis groups, and the impact of multimodal MRI imaging parameters on the risk of poor prognosis in AIS patients was analyzed.Results:There were statistically significant differences in the apparent diffusion coefficient (ADC), cerebral blood flow (CBF), and their differences before and after thrombolysis in multimodal MRI imaging parameters between the END group and the non END group, as well as in the National Institutes of Health Stroke Scale (NIHSS) score at admission, age, and time from onset to admission (all P<0.05). The difference between ADC and CBF before and after thrombolysis, time from onset to admission, NIHSS score at admission, and age were all independent influencing factors for the occurrence of END in AIS patients (all P<0.05). The area under the curve (AUC) of the combined prediction of the difference between ADC and CBF before and after thrombolysis for the occurrence of END in AIS patients was 0.924, which was higher than that predicted by a single indicator ( P<0.05). The incidence of poor prognosis in patients with END was significantly higher than that in patients without END ( P<0.05). The risk of poor prognosis in AIS patients with a difference of less than <45.83×10 -9 mm 2/s before and after ADC thrombolysis was 3.136 times higher than that in patients with ≥45.83×10 -6 mm 2/s. The risk of poor prognosis in AIS patients with a difference of less than 10.52 ml/(min·100 g) before and after ADC thrombolysis was 2.640 times higher than that in patients with ≥10.52 ml/(min·100 g). Conclusions:Multimodal MRI imaging can be used for END evaluation in AIS patients and can provide reference for clinical prognosis evaluation.

Optimization of biopsy strategies for risk related staging of gastric cancer / 中华消化内镜杂志

Objective:To investigate the correlation of atrophy and intestinal metaplasia (IM) stage with gastric cancer and to optimize biopsy strategy.Methods:Data of patients who underwent endoscopy and five-point biopsy at Shandong Provincial Hospital between November 2020 and October 2022 were collected. The baseline characteristics of gastric cancer and non-gastric cancer patients, as well as the occurrence and severity of atrophy and IM in different areas were compared. Logistic regression analysis was used to evaluate the correlation of operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) staging with gastric cancer. The Kendall tau correlation coefficient was used to compare the consistency of different biopsy strategies (two-point, three-point, and four-point) with the standard five-point biopsy in OLGA and OLGIM staging. Receiver operating characteristic (ROC) curve analysis was further performed to compare the diagnostic performance of different biopsy strategies in identifying the OLGA and OLGIM Ⅲ-Ⅳ stage.Results:A total of 122 patients were included in the analysis, with age of 61.0±10.0 years. Multivariate analysis showed that OLGA staging was not associated with gastric cancer ( P=0.788), while OLGIM Ⅲ-Ⅳ staging was significantly correlated with gastric cancer ( P=0.006, OR=3.39, 95% CI: 1.41-8.17). The occurrence of atrophy and IM were higher in lesser curvature of the antrum [56.6% (69/122) and 66.4% (81/122)] and incisura angularis [57.4% (70/122) and 52.5% (64/122)], with higher severity, while lower in greater curvature of the corpus [2.5% (3/122) and 5.7% (7/122)], with lower severity. The consistency of four-point and three-point biopsies with standard five-point biopsy in OLGA and OLGIM staging was high. The consistency of three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus was exceptionally high among them, with correlation coefficients of 0.969 and 0.987, respectively. Conclusion:OLGIM Ⅲ-Ⅳ stages increase the risk of gastric cancer. Three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus are recommended for the screening and monitoring of atrophy or IM.

Effects of X-ray volume imaging registration methods on position verification for radiotherapy in treatment of middle/lower-segment esophageal cancer / 中国辐射卫生

@#<b>Objective</b> To compare the set up errors derived from different registration methods of the X-ray volume imaging (XVI) system for radiotherapy in the treatment of middle/lower-segment esophageal cancer, and to provide a reference for radiation treatment of esophageal cancer. <b>Methods</b> We randomly selected 63 patients with middle/lower-segment esophageal cancer, and obtained their reconstructed XVI images at the first therapy to perform automatic registration with gray-value and bone registration methods. We acquired and compared the three translation errors (along <i>x</i> [left to right], <i>y</i> [head to feet], and <i>z</i> [front to back] axes) and three rotation errors (around the <i>x</i>, <i>y</i>, and <i>z</i> axes) derived from the two registration methods. <b>Results</b> Gray-value registration had significantly smaller translation errors along the <i>x</i> and <i>z</i> axes than bone registration (<i>x</i> azes <i>t</i> = −2.78, <i>z</i> azes <i>t</i> = −2.15, <i>P</i> < 0.05), but there was no significant difference along the <i>y</i> axes (<i>P</i> > 0.05). The rotation errors around the three axes were all smaller than 1°, and were smaller with gray-value registration than with bone registration, but without significant differences (<i>P</i> > 0.05). <b>Conclusion</b> We recommend gray-value registration for radiotherapy in the treatment of middle/lower-segment esophageal cancer. Manual verification or fine-tuning is recommended after automatic registration in clinical practice. Besides translation errors, rotation errors should also be paid attention to.

Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.@*METHODS@#Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).@*RESULTS@#We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.@*CONCLUSION@#The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01597232.

Clinical features and CACNA1A gene mutation in a family with episodic ataxia type 2 / 中南大学学报(医学版)

Episodic ataxia (EA) is a group of disorders characterized by recurrent spells of vertigo, truncal ataxia, and dysarthria. Episodic ataxia type 2 (EA2), the most common subtype of EA, is an autosomal dominant disease caused by mutation of the CACNA1A gene. EA2 has been rarely reported in the Chinese population. Here we present an EA2 family admitted to Xiangya Hospital in October 2018. The proband was a 22-year-old male who complained of recurrent spells of vertigo, slurred speech, and incoordination for 4 years. Brain magnetic resonance imaging (MRI) showed cerebellar atrophy. He had neuropsychological development disorder in childhood, and cognitive assessment in adulthood showed cognitive impairment. The proband's mother and grandmother had a similar history. Peripheral blood samples from the proband and family members were collected, and genomic DNA was isolated. Whole exome sequencing of the proband detected a heterozygous frameshift mutation c.2042_2043del (p.Q681Rfs*100) of CACNA1A gene. This mutation was verified in the proband and 2 family members using Sanger sequencing. One family member carrying this mutation was free of symptoms and signs, suggesting an incomplete penetrance of the mutation. We reported a variant c.2042_2043del of CACNA1A gene as the pathogenic mutation in a Chinese EA2 family for the first time. This case enriched the clinical spectrum of CACNA1A related EA2, and contributed to the understanding of clinical and genetic characteristics of EA2 to reduce misdiagnosis.

Expression of Rad51 and the histo-morphological evaluation of testis of the sterile male cattle-yak.

Meiotic recombination is key to the repair of DNA double-strand break damage, provide a link between homologs for proper chromosome segregation as well as ensure genetic diversity in organisms. Defects in recombination often lead to sterility. The ubiquitously expressed Rad51 and the meiosis-specific DMC1 are two closely related recombinases that catalyze the key strand invasion and exchange step of meiotic recombination. This study cloned and sequenced the coding region of cattle-yak Rad51 and determined its mRNA and protein expression levels, evaluated its molecular and evolutionary relationship as well as evaluated the histo-morphological structure of testes in the yellow cattle, yak and the sterile cattle-yak hybrid. The Rad51 gene was amplified using PCR, cloned and sequenced using testicular cDNA from yak and cattle-yak. Real-time PCR was used to examine the expression levels of Rad51/DMC1 mRNA in the cattle, yak and cattle-yak testis while western blotting, immunofluorescence and immunohistochemistry were used to assess the protein expression and localization of Rad51/DMC1 protein in the testicular tissue sections. The results revealed that the mRNA and protein expression of Rad51 and DMC1 are extremely low in the male cattle-yak testis with a corresponding higher incidence of germ cell apoptosis. There was also thinning of the germinal epithelium possibly due to the depletion of the germ cells leading to the widening of the lumen area of the cattle-yak seminiferous tubule. Our findings provide support for the hypothesis that the low expression of Rad51 and DMC1 may contribute to the male hybrid sterility in the cattle-yak.

Clinical effect of argon-helium knife cryoablation combined with radioactive particle implantation in the treatment of non-small cell lung cancer / 中华老年医学杂志

Objective:To investigate the clinical application value of argon-helium knife cryoablation combined with radioactive seed implantation in the treatment of non-small cell lung cancer(NSCLC).Methods:A total of 117 patients with NSCLC admitted to Oncology Department of Fifth Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 were included in our study.And they were divided into the combination group(n=63)treated with CT guided argon-helium knife cryoablation combined with radioactive 125I seeds implantation and the control group(n=54)treated only with argon-helium knife ablation.The changes of blood routine indexes, tumor markers, tumor ablation target volume and CT value were observed before and 1, 3, 6 months after treatment.Adverse reactions during treatment and the evaluation results of efficacy were compared between the two groups.Patients were followed up for 24 months to observe the recurrence and survival rates between the two groups. Results:In the combination group, seeds of(12.49±4.91)were implanted, and the X-ray exposure was(123.16±42.75)Gy.There was no significant difference in general clinical data between the two groups before treatment( P>0.05). At 1, 3 and 6 months after treatment, as compared with control group the combination group showed the significantly decreased platelet count( t=3.154, 3.586, 2.233, P=0.027、0.019、0.034), while, there was no significant difference in white blood cell count, red blood cell count and hemoglobin level between the two groups(all P>0.05). The levels of carcinoembryonic antigen(CEA), neuron-specific enolase(NSE)and tumor volume were significantly lower in combination group than in control group at 3 and 6 months after treatment( t3=3.142, 2.926 and 4.281, t6=4.094, 5.382 and 4.535, all P<0.05), showing significant improvements of illness.While, the above levels showed no significant differences at 1 month after treatment between two groups( t=1.065, 1.037, P=0.197, 0.255). At each monitoring time, the CT value of tumor target area showed a steady downward trend( P<0.05). During the treatment, the incidence of thrombocytopenia was higher in the combination group than in the control group(47.6% or 30/63 vs.24.1% or 13/54, χ2=6.935, P=0.008), while there were no significant differences in the incidence of postoperative fever, pneumothorax, myoglobinuria, pain, bleeding and nausea and vomiting between the two groups(all P>0.05). After 6 months of treatment, the remission rate was higher in the combination group(73.0% or 46/63)than in the control group(48.1% or 26/54). The survival time and relapse-free time of the combination group were longer than those of the control group[(21.81±4.31)months vs.(18.93±5.94)months, (20.48±5.76)months vs.(16.93±7.14)months, Log Rank χ2=8.229 and 9.656, P=0.004 and 0.002)]. Conclusions:Argon-helium knife Cryoablation combined with radioactive seed implantation can effectively control the local progression of NSCLC, reduce the risk of tumor recurrence, and has high safety.

Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices / 临床肝胆病杂志

ObjectiveTo investigate the risk factors for portal vein thrombosis (PVT) in cirrhotic patients with esophageal varices, and to establish a nomogram for predicting the risk of PVT. MethodsA retrospective analysis was performed for the clinical data of 283 cirrhotic patients with esophageal varices who attended Shandong Provincial Hospital Affiliated to Shandong University from December 2013 to December 2018, and according to imaging findings, the patients were divided into PVT group with 119 patients and non-PVT group with 164 patients. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was used to screen out independent risk factors; a nomogram was established and validated based on the results of the multivariate logistic regression analysis, and C-index and calibration curve were used to evaluate its performance. ResultsThe univariate analysis showed that compared with the non-PVT group, the PVT group had significantly higher Child-Pugh class (χ2=9.388, P=0.009), proportion of patients with a history of splenectomy (χ2=26.805, P＜0.001), white blood cell count (Z=-2.248, P=0.025), platelet count (Z=-3.323, P=0.001), D-dimer(Z=-6.236, P＜0.001), and spleen thickness (Z=-2.432, P=0.015) and a significantly lower level of triglyceride (TG) (Z=-4.150, P＜0.001). The multivariate logistic regression analysis showed that a reduction in TG (odds ratio ［OR］=0.441, 95% confidence interval ［CI］: 0.190-0.889), an increase in D-dimer (OR=1.151, 95%CI: 1.041-1.272), prolonged prothrombin time (PT) (OR=1160, 95%CI: 1.025-1.313), and a history of splenectomy (OR=2.933, 95%CI: 1.164-7.389) were independent risk factors for PVT in cirrhotic patients with esophageal varices. In addition, a nomogram was established based on the results of the multivariate regression analysis, with a C-index of 0.745, and the calibration curve showed good consistency between the observed and predicted values for the development of PVT. ConclusionA reduction in TG, an increase in D-dimer, prolonged PT, and a history of splenectomy are independent risk factors for PVT in cirrhotic patients with esophageal varices, and the nomogram developed based on these results can provide a quantitative and intuitive tool for clinicians to assess the risk of PVT.

Clinical and imaging features of idiopathic intracranial hypertension / 中南大学学报(医学版)

OBJECTIVES@#Idiopathic intracranial hypertension (IIH) is a syndrome that excludes secondary causes such as intracranial space-occupying lesion, hydrocephalus, cerebrovascular disease, and hypoxic ischemic encephalopathy. If not be treated promptly and effectively, IIH can cause severe, permanent vision disability and intractable, disabling headache. This study aims to explore the clinical and image features for IIH, to help clinicians to understand this disease, increase the diagnose rate, and improve the outcomes of patients.@*METHODS@#We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital, Central South University, during January 2015 to September 2020. The diagnosis of IIH was based on the updated modified Dandy criteria. We analyzed clinical data of patients and did statistical analysis, including age, gender, height, weight, medical history, physical examination, auxiliary examination, treatment and outcome.@*RESULTS@#There were 10 females and 5 males. Female patients were 22 to 42 years old with median age of 39.5. Male patients were 27 to 52 years old with the median age of 44.0. The BMI was 24.14-34.17 (28.71±2.97) kg/m@*CONCLUSIONS@#IIH primarily affects women of childbearing age who are overweight. The major hazard of IIH is the severe and permanent visual loss. Typical image signs have high specificity in IIH diagnosis. Prompt diagnosis and effective treatment are significantly important to improve the outcomes of patients.

Prevalence of depression and its influencing factors among middle school students in Liaoning Province / 中国学校卫生

Objective@#To investigate the prevalence of depression of middle school students in Liaoning Province in 2019 and analyze its influencing factors, to provide corresponding strategies and measures for depression prevention and control.@*Methods@#By using the method of multi-stage stratified random cluster sampling, the 32 909 students of grade 1-3 of junior middle school, senior high school and vocational high school were selected from 14 cities in Liaoning province, and were investigated with Center for Epidermiologic Studies Depression Scale (CES-D) psychological scale.@*Results@#The depression score of middle school students in Liaoning Province was (12.66±9.53), and the incidence of depression was 19.5%. Analysis of variance and multiple regression analysis showed that the main factors influencing the occurrence of depression were grade, bullying on campus, internet addiction, being beaten and scolded by parents, drinking, gender, Leave of absence from school, smoking, serious injury and economic classification (P<0.05).@*Conclusion@#Depression of middle school students in Liaoning Province is not optimistic. Effective prevention and control measures should be developed and implemented to the occurrence of adverse factors, so as to reduce the occurrence of depression symptoms.

The latest research progress: Exosomal microRNAs as biomarkers for diagnostic and therapeutic application in Alzheimer’s disease / 中华老年医学杂志

Exosomes are spherical microvesicles(30-100 nm)secreted by a variety of cells and contain a variety of proteins, lipids, mRNAs, and microRNAs.These molecules into exosomes can be transferred to adjacent cells and distant tissues or cells by exosomes to develop full effects.Exosomes-released microRNAs are involved in the pathogenesis of Alzheimer's disease(AD)by regulating the abnormal expression of amyloid β-protein(Aβ)and p-Tau protein, initiating the inflammatory response by interacting with toll-like receptors.In addition, exosomal microRNAs can be used as a potential therapeutic target for AD.Exosomes as good carriers have great research values.This review summarized the literatures related to the role of exosomal microRNAs in the development of AD and the potential therapeutic effect on AD.A large amount of evidence indicates that expression disorder of exosomal microRNA plays an important role in the pathogenesis of AD and can be used as a new potential biomarker and therapeutic target for the diagnosis and treatment of AD.

Status of general practice residency training and career choice of trainees in Henan Province / 中华全科医师杂志

Objective:To survey the status general practice residency training and career choice of trainees in Henan Province.Methods:From December 2017 to February 2018, 332 trainees from the first general practice residency training program (2014-2017) were enrolled in the study. The self- administered questionnaire included the demographic information and the current career status. The logistic regression model was used to analyze the influencing factors of the career choice when their completed the training.Results:Of 332 participants, there were 167 participants designated by the institutions and the others were directly enrolled by the program. The designated participants were from the 56 medical institutions in Henan. The percentage of participants from the tertiary hospitals was 75.5% (126/167), which was much higher than that from the secondary hospitals (24.5%,41/167). There were 24 participants who did not have a work six months after graduation. Of the 308 employed participants, there were only 111 (36.0%, 111/308) working in the department of general practice, and 197 (64.0%, 197/308) working in other departments. The participants designated by the institutions and with the post-graduate degrees preferred to choose other specialties, instead of the general practice. The reasons were that there was no department of general practice in their institutions or the participants had been designated to the other departments (57.9%, 114/197).Conclusion:The survey suggests that the general practice residency training program should enroll trainees mainly from the medical graduates in order to improve the effectiveness of general practitioner residency training and the allocation of health resources in Henan Province.

Cryptococcal Encephalitis Complicating Anti-N-methyl-D-aspartate Receptor Encephalitis in an Immunosuppressed Patient / 中国医学科学院学报

Cryptococcal encephalitis is a fatal central nervous system infectious disease,whereas anti-N-methyl-D-aspartate(NMDA)receptor encephalitis(NMDARE)is an autoimmune syndrome associated with psychological symptoms,behavioural abnormalities,seizures,and dyskinesias.Despite their distinct pathologies and pathogenic mechanisms,both of them can lead to cognitive dysfunction and abnormal behaviors,although anti-NMDARE can also have mood and mental disorders as its core manifestations.A patient with nephrotic syndrome accompanied by both cryptococcal encephalitis and anti-NMDARE was treated in our center,which for the first confirmed that these two conditions could coexist in one patient.The underlying mechanism may be similar to that of anti-NMDARE after other infections.

Ankle distraction arthroplasty with platelet-rich plasma injection for post-traumatic ankle arthritis / 中华创伤骨科杂志

Objective To evaluate the surgical techniques and clinical outcomes of ankle distraction arthroplasty with platelet-rich plasma(PRP) injection for post-traumatic ankle arthritis.Methods From May 2012 to May 2017,32 patients with post-traumatic ankle arthritis were treated at Department of Orthopaedic Surgery,Shanghai Sixth Peopled Hospital.They were 22 males and 10 females,with an age of 32.6±5.8 years(from 18 to 40 years).Their course of disease was 14.0±2.8 months(from 6 to 24 months).After failure of the conservative management for at least 6 months,they received ankle distraction arthroplasty with PRP injection.American Orthopaedic Foot&Ankle Society(AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were used to evaluate the final overall outcomes.Range of motion(ROM) of the ankle joint and complications were also recorded postoperatively.Results Pin tract infection occurred in 12 patients but responded to alcohol care.All the patients were followed up for an average of 36 months(from 18 to 60 months).The VAS score decreased significantly from preoperative 6.8±1.2 to postoperative 8±1.4;the AOFAS ankle-hindfoot score increased significantly from preoperative 38.5±6.2 to 80.3±8.1 at the final follow-up;dorsal expansion and plantar flexion of the ankle increased significantly from preoperative 8.3°±7.0° and 24.7°±6.4° to 12.8°±6.5° and 31.4°±5.3° at the final follow-up,respectively(all P<0.05).Two patients had to receive salvage arthrodesis after conservative management failed to relieve their symptoms or delay the progression of their post-traumatic arthritis.Conclusion Ankle distraction arthroplasty with PRP injection is an effective ankle preserving surgery which can relieve symptoms,improve functions and delay progression of post-traumatic ankle arthritis.

Clinical and image features for 12 cases of cerebral autosomal dominant arteriopathy with the subcortical infarcts and leukoencephalopathy / 中南大学学报(医学版)

To analyze the clinical and image features for 12 patients of cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy (CADASIL).
 Methods: A total of 12 CADASIL patients were collected in Xiangya Hospital of Central South University from January 2013 to December 2018. The clinical manifestation, risk factors, MRI imaging data and NOTCH3 mutations were analyzed retrospectively.
 Results: The mean age of 12 patients was (47.25±9.49) years. The clinical manifestation was most common in cognitive impairment (75%) and stroke events (58.3%), and 2 cases showed cerebral hemorrhage. Migraine was only seen in 25% patients. All MRI showed white matter hyperintensity (WMH), lacune and enlarged perivascular space (PVS). WMH mainly occurred in the frontal parietal lobe (100%), temporal lobe (83.3%), external capsule (66.7%), occipital lobe (41.6%), callosum 41.6% and the temporal pole (33.3%), while lacune mainly appeared in frontal lobe (91.6%), parietal lobe(83.3%), temporal lobe(66.7%), basal ganglia (66.7%), brain stem (41.6%), occipital lobe (33.3%), cerebellum (8.3%). Enlarged PVS located in the basal ganglia (100%), partly under the cortex (45.4%). WMH of the patient with intracerebral hemorrhage was mild (Fezakas score 1-2), which was not found in external capsule. 16.7% of the patients had intracranial arterial stenosis. In 12 patients, 8 different Notch3 mutations were detected. The c1013G>c p.(Cys338Ser) located in exon 6, which was a new pathogenic mutation of CADASIL.
 Conclusion: The patients with cerebral hemorrhage have mild WMH and specific genotype, indicating that the clinical characteristics of CADASIL with cerebral hemorrhage may be related to image features and genotype.

Myopathy associated with anti-signal recognition peptide antibodies: Five case reports / 中南大学学报(医学版)

Five patients with myopathy associated with anti-signal recognition peptide antibodies, admitted to our hospital from December 2015 to June 2018, were chosen in our study, and their clinical and pathological manifestations and treatments were retrospectively analyzed. Five patients showed subacute or chronic onset and proximal limb muscle weakness. Serum creatine kinase level was significantly elevated. Immunoblotting assay confirmed the positive anti-signal recognition particle antibody. EMG prompted myogenic damage. Pathological features included muscle degeneration, necrosis with regeneration, visible atrophy and hypertrophic of muscle fiber, connective tissue hyperplasia and a small amount of inflammatory cell infiltration. Immunohistochemical staining showed necrotizing muscle fiber infiltrated with CD4-positive and CD8-positive lymphocytes and CD68-positive macrophages, and no CD20-positive lymphocytes and CD303-positive dendritic cells were observed. Two patients had expressed a bit of c5b-9 positive capillary. Anti-sarcoglycans staining, anti-dysferlin staining and dystrophin staining showed continuous strong positive expression. Follow-up study found that all patients were response to glucocorticoid, and a combination therapy of immunoglobulin and immunosuppression were necessary for some patients.

Treatment of Maisonneuve fracturewitharthroscopic-assistant plate-screw fixation of the syndesmosis / 国际外科学杂志

Objective To investigate the effect of the treatment for Maisonneuve fracture with arthroscopicassistant plate-screw fixation ofsyndesmosis.Methods From January 2015 to December 2016,totally 22 patients with Maisonneuve fracture were treated in Shanghai Jiao Tong University Affiliated Six People's Hospital.Eleven patients in minimal invasive surgery (MIS)group were treated by the arthroscopic-assistant plate-screw fixation ofthe syndesmotic injury.Another 11 patients in the control group were performed a classic syndesmosis screw fixation.Plain radiographic examination was carried out during the follow-up.Functional evaluation was measured according to the American Orthopedic Foot Ankle Society (AOFAS) ankle hindfoot score and the Visual analogue scale(VAS).A t test was applied for the statistic analysis of post-operative outcome between the two groups at 6th and 12th month.Results The patients were followed for an average 18 months (range from 12 to 24 months)except one of MIS group.The X-ray demonstrated the solid bone union occurred on the 12th week in MIS group and 12.5th week in the control group.The implants of syndesmosis were removed at 12th week post-operatively.No cases of re-diastasis occurred during the follow-up.There was significant difference with in the groups.In the MIS group,the AOFAS ankle hindfoot score was (85.9 ±4.1) points at 6th month post-operatively,and increased to (90.8 ± 3.7) at 12th month (P ＜ 0.05).VAS score was (2.4 ± 1.2) at 6th month and (1.1 ± 0.7) at 12th month after the operation(P ＜0.05).In the control group,the AOFAS ankle hindfoot score was (81.1 ±4.7) points at 6th month after operation,and increased to (89.1 ± 3.4) at 12th month after operation (P ＜ 0.05).VAS score was (3.2 ± 1.3) at the 6th month and (1.0 ± 1.0) at the 12th month after operation (P ＜ 0.05).However,for the outcome comparison between the two groups,only the AOFAS ankle hindfoot score of 6th month post-operatively in MIS group was better than the control group (P ＜ 0.05),other results,had no significant difference.Nocomplications of implant failure,nonunion,malunion or post-traumatic arthritis were occurred during the followup.Conclusion The treatment of Maisonneuve fracture by arthroscopic-assistant plate-screw fixation proved to have an advantage of minimal invasion and accurate reduction and fixation,which is a safe and effective surgical method.

CT manifestations of non-epithelial malignant tumors of bladder / 实用放射学杂志

Objective To investigate the clinical and CT features of non-epithelial malignant tumors of bladder to improve the understanding.Methods Clinical and CT data of 1 1 patients with non-epithelial malignant tumors of bladder were analyzed retrospectively. All patients underwent plain and contrast enhanced CT scan,and confirmed by surgery and pathology.Results Of 1 1 patients,there were 4 rhabdomyosarcomas,3 cancerous sarcomas,2 leiomyosarcomas and 2 small cell carcinomas.The CT performance were mostly cauliflower like or papillary,with wide basis and thickening of adjacent bladder wall.Diffuse thickening of the bladder wall was detected in all rhabdomyosarcoma lesions.The lesions were homogeneous or heterogeneous soft tissue-like density.CT showed calcification in 1 cancerous sarcoma,necrosis in 1 leiomyosarcoma and 1 rhabdomyosarcoma.Contrast enhanced scan showed mild to moderate or significant enhancement.Conclusion Besides the age of rhabdomyosarcoma,other non-epithelial malignant tumors of bladder have no special clinical and CT characteristics.CT examination can provide the information about location,size,surrounding tissue change,which is helpful to make the treatment plan.

The effects of different dose of nonionic iodine contrast agent on the renal function of dogs / 实用放射学杂志

Objective To evaluate the change of serum creatinine (Scr) before and after administration of contrast agent in different dose,to observe the difference of dog's kidney tissue with electron microscopy and investigate the effect of contrast agent on renal function.Methods Twelve dogs were divided into four groups randomly:the control group,the low dose group,the moderate dose group and high dose group.After the administration of different doses of iodine contrast agent at the same rate,the changes of Scr and microscopic structure were compared before administration and 48 hours later.Results The differences of Scr before and 48 hours after administration were (4.6±1.6) μmol/L,(6.7±2.5) μmol/L,(6.9±4.5) μmol/L,(5.1± 1.9) μmol/L for control group,low dose group,moderate dose group and high dose group,respectively.There was no statistically significant difference among the groups (P ＞0.05).In high dose group,the mitochondria of tubular epithelial cells were swelling and obvious vacuoles were observed.Only a small amount of vacuoles existed in the renal tubular epithelial cells in low dose group.Conclusion Compared with the moderate and high dose group,the low-dose iodine contrast agent have less damage to the kidney cells of the dogs.