Patient Cranial Angle and Intrafractional Stability in CyberKnife Robotic Radiosurgery: A Retrospective Analysis.

Purpose: The aim of this study was to investigate whether variations in cranial angles and treatment accuracy during CyberKnife robotic radiosurgery necessitate adjustment of the margins of the planning target volume. Patients and Methods: Data from 66 patients receiving CyberKnife treatment for brain tumors were retrospectively analyzed. Patients were immobilized using a thermoplastic mask and headrest. The cranial angle was measured on planning CT and patients were divided into 2 groups: ≤10° (Group A) and >10° (Group B). Intrafractional motion was recorded using the CyberKnife tracking system over 50 min. Translational and rotational errors were compared between groups, and planning target volume margins were calculated. Results: In Group A, significant translational error differences were found along with the X-axis over time (P < .02). In Group B, significant differences occurred along with the Z-axis (P < .03). No significant rotational or 3-dimensional vector differences were found in either group. Group A had significantly lower Y-axis (P < .045) and roll axis (P < .005) errors compared to Group B. Estimated planning target volume margins in Group A were 0.56 mm (X), 0.46 mm (Y), and 0.47 mm (Z). In Group B, margins were 0.62 mm (X), 0.48 mm (Y), and 0.46 mm (Z). Margins covering 95% of intrafraction motion were 0.49 to 0.50 mm (X, Y, Z) and 0.69 mm (3-dimensional vector) for Group A, and 0.48 to 0.60 mm and 0.79 mm for Group B. With a 1-mm margin, complete coverage was achieved in Group A while 2.1% of vectors in Group B exceeded 1 mm. Conclusion: Adjusting cranial angle to ≤10° during thermoplastic mask molding provided better or similar intrafractional stability compared to >10°.

Direct C(sp3)-H Arylation of Unprotected Benzyl Anilines and Alkylarenes by Organocatalysis under Visible Light.

Reported herein is direct C(sp3)-H arylation of unprotected benzyl anilines and alkylarenes via consecutive photoinduced electron transfer by visible light irradiation. Reductive quenching cycles and radical-radical cross-coupling were involved, and electron paramagnetic resonance experiments provide evidence for the formation of radical intermediates formed in situ. The protocol highlights transition metal free, external oxidant free, broad substrate scope, and high efficiency (>60 examples, up to 96%).

Simultaneous determination of five compounds of fried Radix Paeoniae Alba extract in beagle dogs plasma by Ultra Performance Liquid Chromatography Tandem Mass Spectrometry and its application in a pharmacokinetic study.

In this present study, we developed a reliable and simple ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) assay for the simultaneous quantification of paeoniflorin, albiflorin, oxypaeoniflorin, benzoylpaeoniflorin and isomaltopaeoniflorin in beagle dog plasma. We also analyzed the pharmacokinetics of those components after oral administration of fried Radix Paeoniae Alba (FRPA) in beagle dogs. Plasma samples were processed by protein precipitation with methanol. Chromatographic separation was performed with a Waters HSS-T3 C18 column (100 × 2.1 mm, 1.8 µm, kept at 40°C) using multiple reaction monitoring mode. A gradient elution procedure was used with solvent A (0.02% formic acid-water) and solvent B (0.02% formic acid-acetonitrile) as mobile phases. Method validation was performed as US Food and Drug Administration guidelines, and the results met the acceptance criteria. The method we establish in this experiment was successfully applied to the pharmacokinetic study after oral administration of FRPA extract to beagle dogs.

Electrochemical N-Acylation of Sulfoximine with Hydroxamic Acid.

Despite the widespread applications of sulfoximines, green and efficient access to functionalized sulfoximines remains a challenge. By employing an electrochemical strategy, we describe an approach for the construction of N-aroylsulfoximines, which features a broad substrate scope, mild reaction conditions, safety on a gram scale, and no need for an external oxidant and transition metal catalysts.

Investigation of the sodium-ion transport mechanism and elastic properties of double anti-perovskite Na3S0.5O0.5I.

Sodium-rich anti-perovskites have unique advantages in terms of composition tuning and electrochemical stability when used as solid-state electrolytes in sodium-ion batteries. However, their Na+ transport mechanism is not clear and Na+ conductivity needs to be improved. In this paper, we investigate the stability, elastic properties and Na+ transport mechanisms of both the double anti-perovskite Na3S0.5O0.5I and anti-perovskite Na3OI. The results indicate that the NaI Schottky defect is the most favorable intrinsic defect for Na+ transport and due to the substitution of S2- for O2-, Na3S0.5O0.5I has stronger ductility and higher Na+ conductivity compared to Na3OI, despite the electrochemical window being slightly narrower. Divalent alkaline earth metal dopants can increase the Na+ vacancy concentration, while impeding Na+ migration. Among the dopants, Sr2+ and Ca2+ are the optimal dopants for Na3S0.5O0.5I and Na3OI, respectively. Notably, the Na+ conductivity of the non-stoichiometric Na3S0.5O0.5I at room temperature is 1.2 × 10-3 S cm-1, indicating its great potential as a solid-state electrolyte. Moreover, strain effect calculations show that biaxial tensile strain is beneficial for Na+ transport. Our work reveals the sodium-ion transport mechanism and elastic properties of double anti-perovskites, which is of great significance for the development of solid-state electrolytes.

Electrochemical Oxidative Carbonylation of NH-Sulfoximines.

The electrochemical synthesis of N-aroylsulfoximines features the use of tetra-n-butylammonium iodide (TBAI) as the medium and a broad substrate scope, thus affording a wide range of N-aroylated sulfoximines in moderate to good yields. The advantages of this electrochemical strategy are augmented by mild reaction conditions that are external oxidant-free, ligand-free, and easy to scale up to gram scale. Both the control experiments and the mechanistic studies revealed that the whole electrochemical process proceeded through a palladium (II/IV/II) catalytic cycle.

Comparative genomics hints at dispensability of multiple essential genes in two Escherichia coli L-form strains.

Despite the critical role of bacterial cell walls in maintaining cell shapes, certain environmental stressors can induce the transition of many bacterial species into a wall-deficient state called L-form. Long-term induced Escherichia coli L-forms lose their rod shape and usually hold significant mutations that affect cell division and growth. Besides this, the genetic background of L-form bacteria is still poorly understood. In the present study, the genomes of two stable L-form strains of E. coli (NC-7 and LWF+) were sequenced and their gene mutation status was determined and compared with their parental strains. Comparative genomic analysis between two L-forms reveals both unique adaptions and common mutated genes, many of which belong to essential gene categories not involved in cell wall biosynthesis, indicating that L-form genetic adaptation impacts crucial metabolic pathways. Missense variants from L-forms and Lenski's long-term evolution experiment (LTEE) were analyzed in parallel using an optimized DeepSequence pipeline to investigate predicted mutation effects (α) on protein functions. We report that the two L-form strains analyzed display a frequency of 6-10% (0% for LTEE) in mutated essential genes where the missense variants have substantial impact on protein functions (α<0.5). This indicates the emergence of different survival strategies in L-forms through changes in essential genes during adaptions to cell wall deficiency. Collectively, our results shed light on the detailed genetic background of two E. coli L-forms and pave the way for further investigations of the gene functions in L-form bacterial models.

Revealing Tissue Heterogeneity and Spatial Dark Genes from Spatially Resolved Transcriptomics by Multiview Graph Networks.

Spatially resolved transcriptomics (SRT) is capable of comprehensively characterizing gene expression patterns and providing an unbiased image of spatial composition. To fully understand the organizational complexity and tumor immune escape mechanism, we propose stMGATF, a multiview graph attention fusion model that integrates gene expression, histological images, spatial location, and gene association. To better extract information, stMGATF exploits SimCLRv2 for visual feature exaction and employs edge feature enhanced graph attention networks for the learning potential embedding of each view. A global attention mechanism is used to adaptively integrate 3 views to obtain low-dimensional representation. Applied to diverse SRT datasets, stMGATF is robust and outperforms other methods in detecting spatial domains and denoising data even with different resolutions and platforms. In particular, stMGATF contributes to the elucidation of tissue heterogeneity and extraction of 3-dimensional expression domains. Importantly, considering the associations between genes in tumors, stMGATF can identify the spatial dark genes ignored by traditional methods, which can be used to predict tumor-driving transcription factors and reveal tumor immune escape mechanisms, providing theoretical evidence for the development of new immunotherapeutic strategies.

Factors associated with depression among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis.

The COVID-19 pandemic has had a profound impact on the mental health of healthcare workers (HCWs). We aimed to identify the factors associated with depression among HCWs during the pandemic. We conducted literature search using eight electronic databases up to July 27 2022. Observational studies with more than 200 participants investigating correlates of depression in HCWs after COVID-19 outbreak were included. We used fixed- and random-effects models to pool odds ratios (ORs) across studies, and Cochran's chi-squared test and I 2 statistics to assess study heterogeneity. Publication bias was evaluated by funnel plots. Thirty-five studies involving 44,362 HCWs met the inclusion criteria. Female (OR=1.50, 95% CI [1.23,1.84]), single (OR=1.36, 95% CI [1.21,1.54]), nurse (OR=1.69, 95% CI [1.28,2.25]), history of mental diseases (OR=2.53, 95% CI [1.78,3.58]), frontline (OR=1.79, 95% CI [1.38,2.32]), health anxiety due to COVID-19 (OR=1.88, 95% CI [1.29,2.76]), working in isolation wards (OR=1.98, 95% CI [1.38,2.84]), and insufficient personal protective equipment (OR=1.49, 95% CI [1.33,1.67]) were associated with increased risk of depression. Instead, HCWs with a positive professional prospect (OR=0.34, 95% CI [0.24,0.49]) were less likely to be depressed. This meta-analysis provides up-to-date evidence on the factors linked to depression among HCWs during the COVID-19 pandemic. Given the persistent threats posed by COVID-19, early screening is crucial for the intervention and prevention of depression in HCWs.

Insights on transport performance, thermodynamic properties, and mechanical properties of Ruddlesden-Popper antiperovskite LiBr(Li2OHBr)2 and LiBr(Li3OBr)2.

Due to high ion conductivity, low cost, and adjustable composition, antiperovskite has attracted much attention as a potentially useful material in solid-state batteries. Compared with simple antiperovskite, Ruddlesden-Popper (R-P) antiperovskite is an updated material, which is not only more stable but also reported to significantly enhance conductivity when added to simple antiperovskite. However, systematic theoretical research on R-P antiperovskite is scarce, hindering its further development. In this study, the recently reported easily synthesized R-P antiperovskite LiBr(Li2OHBr)2 is calculated for the first time. Comparative calculations were conducted on the transport performance, thermodynamic properties, and mechanical properties of H-rich LiBr(Li2OHBr)2 and H-free LiBr(Li3OBr)2. Our results indicate that due to the presence of protons, LiBr(Li2OHBr)2 is more prone to defects, and synthesizing more LiBr Schottky defects can improve its Li-ion conductivity. Young's modulus of the LiBr(Li2OHBr)2 is as low as 30.61 GPa, which is beneficial for its application as a sintering aid. However, the calculated Pugh's ratio (B/G) of 1.28 and 1.50, respectively, indicates that R-P antiperovskites LiBr(Li2OHBr)2 and LiBr(Li3OBr)2 exhibit mechanical brittleness, which is not conducive to its application as solid electrolytes. Through quasi-harmonic approximation, we found that the linear thermal expansion coefficient of LiBr(Li2OHBr)2 is 2.07 × 10-5 K-1, which is more advantageous in matching electrodes than LiBr(Li3OBr)2 and even simple antiperovskites. Overall, our research provides comprehensive insights into the practical application of R-P antiperovskite in solid-state batteries.

Altered gut microbiota in older adults with mild cognitive impairment: a case-control study.

Introduction: The microbiota-gut-brain axis is implicated in Alzheimer's disease. Gut microbiota alterations in mild cognitive impairment (MCI) are inconsistent and remain to be understood. This study aims to investigate the gut microbial composition associated with MCI, cognitive functions, and structural brain differences. Methods: A nested case-control study was conducted in a community-based prospective cohort where detailed cognitive functions and structural brain images were collected. Thirty-one individuals with MCI were matched to sixty-five cognitively normal controls by age strata, gender, and urban/rural area. Fecal samples were examined using 16S ribosomal RNA (rRNA) V3-V4 sequencing. Compositional differences between the two groups were identified and correlated with the cognitive functions and volumes/thickness of brain structures. Results: There was no significant difference in alpha and beta diversity between MCIs and cognitively normal older adults. However, the abundance of the genus Ruminococcus, Butyricimonas, and Oxalobacter decreased in MCI patients, while an increased abundance of nine other genera, such as Flavonifractor, were found in MCIs. Altered genera discriminated MCI patients well from controls (AUC = 84.0%) and were associated with attention and executive function. Conclusion: This study provides insights into the role of gut microbiota in the neurodegenerative process.

Clinical Features and Genetic Analysis of Taiwanese Primary Immunodeficiency Patients with Prolonged Diarrhea and Monogenetic Inflammatory Bowel Disease.

PURPOSE: Diarrhea lasting longer than 14 days which fails to respond to conventional management is defined as severe and protracted diarrhea and might overlap with inflammatory bowel disease (IBD). METHODS: The prevalence, associated pathogens, and prognosis of severe and protracted diarrhea without IBD (SD) and with monogenetic IBD (mono-IBD) in primary immunodeficiency patients (PID) were investigated in Taiwan. RESULTS: A total of 301 patients were enrolled between 2003 and 2022, with predominantly pediatric-onset PID. Of these, 24 PID patients developed the SD phenotype before prophylactic treatment, including Btk (six), IL2RG (four), WASP, CD40L, gp91 (three each), gp47, RAG1 (one each), CVID (two), and SCID (one) without identified mutations. The most detectable pathogens were pseudomonas and salmonella (six each), and all patients improved after approximately 2 weeks of antibiotic and/or IVIG treatments. Six (25.0%) mortalities without HSCT implementation were due to respiratory failure from interstitial pneumonia (3 SCID and 1 CGD), intracranial hemorrhage (WAS), and lymphoma (HIGM). In the mono-IBD group, seventeen patients with mutant TTC7A (2), FOXP3 (2), NEMO (2), XIAP (2), LRBA (1), TTC37 (3), IL10RA (1), STAT1 (1), ZAP70 (1), PIK3CD (1), and PIK3R1 (1) genes failed to respond to aggressive treatments. Nine mono-IBD patients with TTC7A (2), FOXP3 (2), NEMO (2), XIAP (2), and LRBA (1) mutations were fatal in the absence of HSCT. The mono-IBD group had a significantly earlier age of diarrhea onset (1.7 vs 33.3 months, p = 0.0056), a longer TPN duration (34.2 vs 7.0 months, p < 0.0001), a shorter follow-up period (41.6 vs 132.6 months, p = 0.007), and a higher mortality rate (58.9 vs 25.0%, p = 0.012) compared with the SD group. CONCLUSION: When compared to those with the SD phenotype, the mono-IBD patients had significant early-onset and poor responses to empiric antibiotics, IVIG, and steroids. Anti-inflammatory biologics and suitable HSCT still have the potential to control or even cure the mono-IBD phenotype.

A Palladium-Catalyzed Carbonylative Acetylation of N-Phenylpyridin-2-amine Using DMF and CO as the Acetyl Source.

This study reports a carbonylative acetylation for the synthesis of N-phenyl-N-(pyridin-2-yl)acetamides using N,N-dimethylformamide (DMF) as a methyl source and CO as a carbonyl source. Interestingly, dimethyl sulfoxide (DMSO) can be also used as a methyl source when using only DMSO as the solvent. Mechanistic studies using DMSO-d6 revealed that the methyl group was derived from the methyl group of DMF instead of DMSO when using DMF and DMSO as a mixed solvent. These results indicated that DMF was a preferential methyl source.

Study on insulin resistance and ischemic cerebrovascular disease: A bibliometric analysis via CiteSpace.

Background: It is reported that insulin resistance widely exists in non-diabetic patients with a recent history of transient ischemic attack (TIA) or ischemic stroke. There is currently strong evidence to prove the bidirectional effect of glucose metabolism disorders and stroke events. Therefore, it is necessary to retrospectively tease out the current status, hotspots, and frontiers of insulin resistance and ischemic cerebrovascular disease through CiteSpace. Materials and methods: We searched the Web of Science (WOS) for studies related to insulin resistance and ischemic cerebrovascular disease from 1999 to April 2022, then downloaded the data into CiteSpace to generate a knowledge visualization map. Results: A total of 1,500 publications relevant to insulin resistance and ischemic cerebrovascular disease were retrieved. The USA had the most articles on this topic, followed by PEOPLES R CHINA and JAPAN. WALTER N KERNAN was the most prolific author, whose research mainly focused on insulin resistance intervention after stroke (IRIS) trial. The most common keywords were myocardial ischemia, metabolic syndrome, ischemic stroke, cerebral ischemia, association, oxidative stress, inflammation, and adipose tissue. Major ongoing research trends include three aspects: (1) the association between insulin resistance and ischemic cerebrovascular disease in non-diabetic patients, (2) the intrinsic pathological mechanism between insulin resistance and ischemic cerebrovascular disease, and (3) early intervention of insulin resistance to improve the prognosis of stroke. Conclusion: The results of this bibliometric study provide the current status and trends of clinical research publications in the field of insulin resistance and ischemic cerebrovascular disease. Insulin resistance is strongly associated with the occurrence of ischemic stroke, early neurological deterioration in stroke patients, post-stroke depression, and cerebral small vessel disease. Early treatment of insulin resistance can be an effective way to prevent the onset of ischemic stroke and improve stroke prognosis. This study may help researchers to identify hot topics and explore new research directions.

The first complete mitochondrial genome sequences for Ulidiidae and phylogenetic analysis of Diptera.

BACKGROUND: Tetanops sintenisi is a pest that mainly damages the root of quinoa (Chenopodium quinoa) and it is first discovered in China in 2018. METHODS AND RESULTS: Here, the complete mitochondrial genome (mitogenome) of T. sintenisi was sequenced and compared with the mitogenomes of other Diptera species. The results revealed that the mitogenome of T. sintenisi is 15,763 bp in length (GenBank accession number: MT795181) and is comprised of 13 protein-coding genes (PCGs), 22 transfer RNA (tRNA) genes, 2 ribosomal RNA genes, and a non-coding A + T-rich region (959 bp). The highly conserved gene arrangement of the mitogenome of T. sintenisi was identical to that of other Diptera insects. Twelve PCGs contained the typical insect start codon ATN, while cox1 had CGA as the start codon. The genes cox2, nad4, and nad1 contained an incomplete termination codon T; nad3, nad5, and cob contained the complete termination codon TAG; and the remaining seven PCGs contained the termination codon TAA. All tRNA genes were predicted to fold into the typical cloverleaf secondary structure. Phylogenetic analysis of 48 species based on the mitogenome sequence revealed that T. sintenisi clustered with the Tephritidae family, indicating that T. sintenisi and Tephritidae have a close phylogenetic relationship. CONCLUSIONS: The phylogenetic relationship of T. sintenisi based on the mitogenome is consistent with the traditional morphological taxonomy, according to which T. sintenisi belongs to the family Otitidae, which is closely related to the family Muscidae.

Distinct Lymphocyte Immunophenotyping and Quantitative Anti-Interferon Gamma Autoantibodies in Taiwanese HIV-Negative Patients with Non-Tuberculous Mycobacterial Infections.

PURPOSE: The presence of anti-interferon-γ autoantibodies (AutoAbs-IFN-γ) is not rare in patients suffering from persistent non-tuberculous mycobacterial (NTM) infections that are characteristic of adult-onset immunodeficiency syndrome. The immune disturbances in this distinct disorder remain to be elucidated. METHODS: Patients with NTM infections but without effective response over 3 months' treatment were referred to our institute to quantify their level of AutoAbs-IFN-γ after excluding defective IL12/23-IFN-γ circuit and reactive oxygen species production. The AutoAbs-IFN-γ and percentage of lymphocyte subpopulations most relevant to T and B cell pools were assessed and compared with age-matched healthy controls. RESULTS: A total of 31 patients were enrolled during the 15-year study period (2008-2022), 20 patients with > 50% suppression of IFN-γ detection at 1:100 serum dilution were classified into the Auto-NTM group. The remaining 11 with negligible suppression were assigned to the No Auto-NTM group. Mycobacterium chimaera-intracellulare group (MAC), M. kansasii, and M. abscessus were the most common pathogens. Pneumonia (19 vs 7), lymphadenitis (11 vs 5), Salmonella sepsis (6 vs 2), osteomyelitis (5 vs 1), and cutaneous herpes zoster (4 vs 4) were the main manifestations in both the Auto-NTM and No Auto-NTM groups who had similar onset-age (55.3 vs 53.6 years; p = 0.73) and follow-up duration (71.9 vs 54.6 months; p = 0.45). The Auto-NTM group had significantly higher transitional (IgM + + CD38 + +), CD19 + CD21-low, and plasmablast (IgM-CD38 + +) in the B cell pool, with higher effector memory (CD4 + /CD8 + CD45RO + CCR7 -), senescent CD8 + CD57 + , and Th17 cells, but lower naïve (CD4 + /CD8 + CD45RO - CCR7 +) and Treg cells in the T cell pool when compared to the No Auto-NTM and healthy groups. NTM patients with/without AutoAbs-IFN-γ had lower Th1-like Tfh (CD4 + CXCR5 + CXCR3 + CCR6 -) cells. All Auto-NTM patients still had non-remitted mycobacterial infections and higher AutoAbs-IFN-γ despite anti-CD20 therapy in 3 patients. CONCLUSION: In patients with suspected adult-onset immunodeficiency syndrome, two thirds (20/31) were recognized as having significantly inhibitory AutoAbs-IFN-γ with higher antibody-enhancing transitional, CD19 + CD21-low and plasmablast B cells; as well as higher effector memory, senescent CD8 + CD57 + and Th17 cells, but lower naïve T and Treg cells in contrast to those with negligible AutoAbs-IFN-γ. Such immunophenotyping disturbances might correlate with the presence of AutoAbs-IFN-γ. However, the mutual mechanisms need to be further clarified.

Prognostic implication of early posttransplant hypercholesterolemia in liver transplantation for patients with hepatocellular carcinoma.

BACKGROUND: Hyperlipidemia is a common complication after liver transplantation (LT) and develops mostly in the early posttransplant period. Recently, some studies have reported a positive correlation between hyperlipidemia and favorable prognosis in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. This study aimed to evaluate the possibility of predicting prognosis in HCC patients receiving LT by early posttransplant dyslipidemia. METHODS: From January 2015 to December 2017, a total of 806 HCC patients from China Liver Transplant Registry database were retrospectively enrolled. The prognostic relevance of early posttransplant hypertriglyceridemia or hypercholesterolemia was examined using survival analysis, and subgroup analysis was implemented based on LT criteria. RESULTS: Early posttransplant hypercholesterolemia (EPHC) was independently inversely associated with the risk of recurrence [hazard ratio (HR) = 0.630; P = 0.022], but was not significantly correlated with the mortality. However, early posttransplant hypertriglyceridemia was not related to prognosis. Intriguingly, with further classification, we found that borderline EPHC (B-EPHC), instead of significant EPHC, was a predictor of lower risk for both recurrence (HR = 0.504; P = 0.006) and mortality (HR = 0.511; P = 0.023). Compared with non-EPHC patients, B-EPHC patients achieved significantly superior 1-year and 3-year tumor-free survival (89.6% and 83.7% vs. 83.8% and 72.7% respectively; P = 0.023), and 1-year and 3-year overall survival (95.8% and 84.8% vs. 94.6% and 77.6% respectively; P = 0.039). In the subgroup analysis, B-EPHC remained an independent predictor of better prognosis in patients beyond Milan criteria and those within Hangzhou criteria; whereas there was no significant relationship between B-EPHC and prognosis in patients within Milan criteria and those beyond Hangzhou criteria. More interestingly, patients beyond Milan criteria but within Hangzhou criteria were identified as the crucial subpopulation who benefited from B-EPHC (recurrence HR = 0.306, P = 0.011; mortality HR = 0.325, P = 0.031). CONCLUSIONS: B-EPHC could assist transplant teams in dynamically evaluating prognosis after LT for HCC as a postoperative non-oncological biomarker, especially in patients beyond Milan criteria but within Hangzhou criteria.

Modified all-arthroscopic reconstruction of medial patellofemoral ligament for the treatment of recurrent patellar dislocation / 中华创伤杂志

Objective:To evaluate the clinical efficacy of modified all-arthroscopic reconstruction of medial patella femoral ligament (MPFL) for the treatment of recurrent patellar dislocation.Methods:A retrospective case series study was conducted to analyze the clinical data of 38 patients (46 knees) with recurrent patellar dislocation, who were treated at First Affiliated Hospital of Shenzhen University from January 2017 to January 2020. The patients included 12 males (12 knees) and 26 females (34 knees), aged 14-40 years [(24.6±5.4)years]. All patients underwent the modified all-arthroscopic MPFL reconstruction procedure. The femoral tunnel locations were assessed by 3D-CT immediately after surgery. The MRI was performed at 6 and 12 months after operation to assess the healing morphology of the reconstructed MPFL. The Lysholm score and Kujala score were used to assess the knee function before operation, at 6 months after operation, at 12 months after operation and at the last follow-up. The time to return to sports as well as complications were observed.Results:All patients were followed up for 26-48 months [(32.4±8.6)months]. Postoperative 3D-CT examination showed that the femoral tunnels were located in the groove area of the medial epicondyle of the femur and the adductor tubercle. At 6 and 12 months after operation, MRI T2 images showed that the reconstructed MPFL had a low signal and well tensioned ligament tissue, indicating that the MPFL was healed well. The Lysholm scores at 6 and 12 months postoperatively and at the last follow-up were (81.1±12.0)points, (91.2±3.8)points, and (92.2±9.8)points, respectively, being significantly higher than the preoperative (52.4±10.6)points (all P<0.01). The Kujala scores at 6 and 12 months postoperatively and at the last follow-up were (85.4±3.9)points, (91.4±3.6)points, and (93.1±8.5)points, respectively, being significantly higher than the preoperative (55.2±6.8)points (all P<0.01). Compared with 6 months postoperatively, the Lysholm score and Kujala score were significantly improved at 12 months postoperatively and at the last follow-up (all P<0.05). All patients returned to sports, with the time to return to sports for 3-12 months [(8.7±2.3)months] after operation. One patient had poor wound healing but was healed after dressing changes. No wound infection, nerve injury, joint stiffness, patella re-dislocation or other complications occurred. Conclusion:For recurrent patellar dislocation, the modified all-arthroscopic MPFL reconstruction has advantages of accurate bone tunnel positioning, good ligament healing, good function recovery, early return to sports, and less postoperative complications.

Diagnosis and treatment of 15 cases with hepatic cystic echinococcosis / 中华传染病杂志

Objective:To provide reference for clinical diagnosis and treatment of hepatic cystic echinococcosis by analyzing the clinical characteristics of these patients.Methods:Clinical data of 15 patients with hepatic cystic echinococcosis hospitalized in the Second Hospital of Lanzhou University from April 22, 2019 to March 5, 2022 were collected. The general data, clinical manifestations, abdominal imaging results, treatment and outcome of the included patients were retrospectively analyzed.Results:The age of 15 patients with hepatic cystic echinococcosis ranged from 39 to 78 years, with a median age of 51 years. Among the 15 patients, 12 were farmers, two were freelance workers, and one was unknown. Eleven patients presented with abdominal pain and fatigue, one patient presented with obstructive jaundice, and three patients whom were found by physical examination did not complain of obvious discomfort. Echinococcoid cysts were located at the right lobe of the liver in eight patients, at the left lobe of the liver in five patients, and with multiple lesions in the left and right lobes of the liver in two patients. Two patients received conservative therapy. All the 13 patients who received surgical treatment recovered without complications, such as biliary fistula and subphrenic infection. The clinical symptoms including abdominal pain and fatigue were relieved significantly after surgery. The hospital stay were four to 23 days. All patients were administrated with albendazole (400 mg once daily).Conclusions:Hepatic cystic echinococcosis is more common in the right lobe of the liver, with atypical clinical symptoms. Preoperative imaging diagnosis and postoperative pathological examination are necessary for diagnosis. Surgery is the most effective treatment at present, and albendazole should be taken regularly in all patients.

Correlation analysis of anterior pituitary hormone and tumor size in patients with pituitary adenomas / 中华内科杂志

Objective:To summarize the correlation between anterior pituitary function and tumor size in patients with different hormone-secreting pituitary adenomas.Methods:This was a retrospective case series study. The clinical data of 1 946 patients with pituitary adenoma hospitalized in the First Medical Center of Chinese PLA General Hospital from January 1, 2005, to December 31, 2020, were collected. The correlation between tumor size and anterior pituitary hormone levels was analyzed using Spearman rank correlation analysis in different types of pituitary adenomas.Results:The median age of the 1 946 patients was 45.1 years, of which 857 (44.0%) were men. The maximum tumor diameter of the patients [ M ( Q1, Q3)] was 22 (14, 30) mm. Tumor size in nonfunctioning adenomas ( n=1 191) was negatively correlated with adrenocorticotropic hormone (ACTH) ( r=-0.11, P<0.001), growth hormone ( r=-0.13, P<0.001), and luteinizing hormone (men: r=-0.26, P<0.001, women: r=-0.31, all P<0.001). The tumor size of somatotropic adenomas ( n=297) was positively correlated with growth hormone ( r=0.46, P<0.001), but negatively correlated with male testosterone ( r=-0.41, P<0.001). The tumor size of ACTH-secreting pituitary adenomas ( n=155) was positively correlated with the ACTH level at 8∶00 AM ( r=0.25, P<0.001); however, no correlation was found with cortisol at 8∶00 AM ( P>0.05). The tumor size of prolactinomas ( n=303) was positively correlated with the prolactin level (men: r=0.34, P=0.001; women: r=0.13, P=0.070). Conclusions:The correlation between the function of the anterior pituitary and size of the tumor depends on the cellular origin of the pituitary adenoma and specific type of hormone secretion. In somatotroph adenomas, ACTH-secreting pituitary adenomas, and prolactinomas, there is a positive correlation between tumor size and level of hormones secreted by the corresponding tumors. In patients with nonfunctioning adenomas, the tumor size was negatively correlated with the hormone levels of the pituitary-adrenal and pituitary-growth hormone axes.