Periprosthetic gout flare after total knee arthroplasty: A misdiagnostic case report / 北京大学学报(医学版)

Periprosthetic gout flare is a rare arthritic condition after total knee arthroplasty, but the symptoms of gout may have often been mistaken as acute periprosthetic infection given their similarity. Misdiagnosis as periprosthetic infection can lead to unnecessary surgery, long-term dependence on anti-biotics, and even malfunction of the involved knee joint. Here, we report a case study of a patient with immunodeficiency condition of long-term oral glucocorticoid and diabetes mellitus, who had undergone a knee replacement 8 weeks before. The initial symptoms of fever and joint pain together with the dysfunction of her right knee with elevated inflammatory markers, such as increased serum leukocytes, erythrocyte sedimentation rate, C-reactive protein, and synovial cell counts led to a diagnosis of acute periprosthetic infection. Arthrocentesis and bacterial culture were performed preoperatively. According to the current Musculoskeletal Infection Society (MSIS) criteria for diagnosis of periprosthetic infection, the case was classified as periprosthetic infection and a prosthesis retained debridement surgery was performed. However we got negative culture results in all the pre-operative and intro-operative samples. The symptoms as well as the laboratory inflammatory markers improved shortly after the debridement surgery until the 11th day when all the similar systemic and local symptoms recurred. With a remedial crystal analysis of synovial fluid from the patient, gouty flare was found to be the cause of acute arthritis finally. Accor-dingly, after anti-gout medications were administrated, the symptoms associated with acute arthritis gra- dually subsided, and there was no recurrence during a 24-month follow-up. This article described the cli-nical manifestation, diagnosis and differential diagnosis, treatment of a case of periprosthetic gout. Although relatively rare, gout should be considered as a differential diagnosis in suspected periprosthetic infection. Current criteria for periprosthetic infection can not exclude the diagnosis of periprosthetic gout flare, it is therefore imperative that the analysis of joint aspirate for crystals be conducted to determine the correct course of treatment, or unnecessary surgical procedure may be performed in periprosthetic gout case.

Forkhead Box M1 Regulates the Proliferation,Invasion,and Drug Resistance of Gastric Cancer Cells via circ_NOTCH1 / 中国医学科学院学报

Objective To investigate the impacts of forkhead box M1(FOXM1)on the proliferation,invasion,and drug resistance of gastric cancer cells by regulating the circular RNA circ_NOTCH1.Methods Western blotting and real-time quantitative PCR were performed to determine the expression of FOXM1 protein and circ_NOTCH1,respectively,in the gastric cancer tissue,para-carcinoma tissue,human normal gastric mucosa epithelial cell line GES-1 and gastric cancer cell lines MGC-803,HGC-27,and BGC-823.BGC-823 cells were classified into the following groups:control,short hairpin RNA FOXM1(sh-FOXM1)and negative control(sh-NC),small interfering RNA circ_NOTCH1(si-circ_NOTCH1)and negative control(si-NC),and sh-FOXM1+circ_NOTCH1 overexpression plasmid(sh-FOXM1+pcDNA-circ_NOTCH1)and sh-FOXM1+negative control(sh-FOXM1+pcDNA).CCK-8 assay and clone formation assay were employed to measure the cell proliferation,and Transwell assay to measure cell invasion.After treatment with 1.0 mg/L adriamycin for 48 h,the cell resistance in each group was analyzed.Western blotting was employed to determine the expression levels of FOXM1,proliferating cell nuclear antigen(PCNA),Bax,multi-drug resistance-associated protein 1(MRP1),and multi-drug resistance gene 1(MDR1).RNA pull-down and RNA immunoprecipitation were employed to examine the binding of circ_NOTCH1 to FOXM1 protein.Results Compared with those in the para-carcinoma tissue,the expression levels of FOXM1 protein and circ_NOTCH1 in the gastric cancer tissue were up-regulated(all P<0.001).Compared with GES-1 cells,MGC-803,HGC-27,and BGC-823 cells showed up-regulated expression levels of FOXM1 protein and circ_NOTCH1(all P<0.001).Compared with the control group and sh-NC group,the sh-FOXM1 group with down-regulated expression of FOXM1 protein and circ_NOTCH1 showed decreased optical density value,clone formation rate,cell invasion number,and cell viability,down-regulated expression of PCNA,MRP1,and MDR1,and up-regulated expression of Bax protein in BGC-823 cells(all P<0.001).Compared with the control group and the si-NC group,the si-circ_NOTCH1 group with down-regulated expression of circ_NOTCH1 showed decreased optical density value,clone formation rate,cell invasion number,and cell viability,down-regulated expression of PCNA,MRP1,and MDR1,and up-regulated expression of Bax protein in BGC-823 cells(all P<0.001).Compared with sh-FOXM1 group and sh-FOXM1+pcDNA group,the sh-FOXM1+pcDNA-circ_NOTCH1 group with up-regulated expression of circ_NOTCH1 showed increased optical density value,clone formation rate,cell invasion number,and cell viability,up-regulated expression of PCNA,MRP1,and MDR1,and down-regulated expression of Bax protein(all P<0.001).FOXM1 protein was able to interact with circ_NOTCH1.Conclusion Interference with FOXM1 may inhibit the proliferation,invasion,and drug resistance of gastric cancer cells by silencing circ_NOTCH1 expression.

Clinical Efficacy of Oral Dydrogesterone Alone in Natural Cycle Frozen-thawed Embryo Transfer / 中山大学学报(医学科学版)

ObjectiveTo investigate the clinical efficacy of oral dydrogesterone alone for luteal phase support in natural cycle frozen-thawed embryo transfer （NC-FET）. MethodsThe clinical data of 1 530 NC-FET cycles enrolled in our Reproductive Center from January 2019 to September 2021 were retrospectively analyzed. According to different luteal support protocols， the patients were divided into oral dydrogesterone alone （group A， n=524）， vaginal progesterone soft capsules （group B， n=401） and vaginal progesterone soft capsules combined with dydrogesterone （group C， n=605）. The clinical outcomes and cost-effectiveness ratio were compared among the three groups. The primary outcome was live birth rate. ResultsThe live birth rate was 43.13% （226/524） in group A， 39.15% （157/401） in group B， and 42.64% （258/605） in group C. There was no statistical difference among the three groups （P > 0.05）. No statistical difference was observed in the HCG positive rate， implantation rate， biochemical pregnancy rate， clinical pregnancy rate， spontaneous miscarriage rate， ectopic pregnancy rate， twin delivery rate， premature delivery rate and newborn weight among the three groups （P>0.05）. Logistic regression analysis revealed that the three luteal support regimens did not affect live birth rate. Pharmacoeconomic analysis showed that taking group B as a reference， the cost increased by 19 227.30 yuan for every 1% increase in live birth rate in group A. ConclusionsIn NC-FET cycle， oral dydrogesterone alone can achieve the same clinical outcomes as vaginal progesterone soft capsules and vaginal progesterone soft capsules combined with dydrogesterone. Compared with that of progesterone soft capsules， the cost of oral dydrogesterone alone is increased， a large sample and multicenter prospective study is needed to further confirm our results.

Benefits of Mindfulness Training on the Mental Health of Women During Pregnancy and Early Motherhood: A Randomized Controlled Trial / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to evaluate the effects of a mindfulness-based psychosomatic intervention on depression, anxiety, fear of childbirth (FOC), and life satisfaction of pregnant women in China.@*METHODS@#Women experiencing first-time pregnancy ( n = 104) were randomly allocated to the intervention group or a parallel active control group. We collected data at baseline (T0), post-intervention (T1), 3 days after delivery (T2), and 42 days after delivery (T3). The participants completed questionnaires for the assessment of the levels of depression, anxiety, FOC, life satisfaction, and mindfulness. Differences between the two groups and changes within the same group were analyzed at four time points using repeated-measures analysis of variance.@*RESULTS@#Compared with the active control group, the intervention group reported lower depression levels at T2 ( P = 0.038) and T3 ( P = 0.013); reduced anxiety at T1 ( P = 0.001) and T2 ( P = 0.003); reduced FOC at T1 ( P < 0.001) and T2 ( P = 0.04); increased life satisfaction at T1 ( P < 0.001) and T3 ( P = 0.015); and increased mindfulness at T1 ( P = 0.01) and T2 ( P = 0.006).@*CONCLUSION@#The mindfulness-based psychosomatic intervention effectively increased life satisfaction and reduced perinatal depression, anxiety, and FOC.

Characteristics of alveolar bone loss in severe periodontitis and consideration of rehabilitation with implant / 中华口腔医学杂志

Severe periodontitis is the main cause of tooth loss in adults, with varying degrees of horizontal and vertical alveolar bone loss. In view of the complex alveolar bone defect, a suitable surgery planning should be made on the basis of fully nuderstanding the characteristics of alveolar bone defect in severe periodontitis and the key points of bone augmentation technique, so as to choose an appropriate method for reconstruction of alveolar bone and complete the implantation and restoration to ensure the integrity of dentition, which are important for the long-term stability of periodontal health. Based on clinical experiences and literature review, we summarizes the characteristics of alveolar bone loss in patients with severe periodontitis and the timing of implant placement after bone augmentation surgery, in order to provide reference for implant treatment of severe periodontitis.

Understanding the Choice of Sleep Arrangements and Soothing Methods and Their Associations with Sleep Problems among Children Under 3 Years Old: A Chinese Population-Based Study / 生物医学与环境科学（英文）

Objective@#This study aimed to examine the sleep arrangements and soothing methods and to assess their associations with sleep problems among children aged < 3 years in China.@*Methods@#A cross-sectional survey was conducted in 2019 from six provinces in China. A total of 1,195 caregivers of children aged 0-35 months were included in the study. Data on sleep arrangements, soothing methods, and sleep problems (i.e., frequent night awakenings and difficulty falling asleep) were assessed using the Brief Infant Sleep Questionnaire. The reasons for bed-sharing in sleep arrangements were recorded using a self-designed questionnaire.@*Results@#The bed-sharing practice was very prevalent at any age, which ranged from 69.9% to 78.3%. Most infants fell asleep while feeding or being rocked/held before age 12 months. By age 35 months, 62.4% of the children fell asleep in bed near parents. The most common reasons for bed-sharing were breastfeeding/feeding and convenience. Parental involvement when falling asleep was significantly related with frequent night awakenings and difficulty falling asleep. No association was found between bed-sharing and sleep.@*Conclusion@#Bed-sharing and parental involvement were very common among Chinese children aged < 3 years. Children who fall asleep with parental involvement were more likely to have sleep problems.

Effect of posterior tibial slope on the short-term outcome in mobile-bearing unicompartmental knee arthroplasty / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the relationship between postoperative knee function and the sagittal position of tibial component in unicompartmental knee arthroplasty (UKA).@*METHODS@#We retrospectively enrolled the patients who underwent UKA from January 2016 to May 2020. They were assigned into 2 groups according to postoperative posterior tibial slope (PTS): the normal PTS group (PTS≥3° and PTS < 8°) and the abnormal PTS group (PTS < 3° or ≥8°). The patients were followed up for at least 12 months. The postoperative Knee Society Clinical Score (KSS-C), Knee Society Functional Score (KSS-F) and knee range of motion (ROM) were compared between the two groups.@*RESULTS@#A total of 72 patients (82 knees) were included with 51 patients (58 knees) in PTS normal group and 21 patients (24 knees) in PTS abnormal group. All the patients were followed up with median of 23.6 months. There was no significant difference in the general data [gender, age, body mass index (BMI)], pre-operative knee range of motion, preoperative KSS-C score and KSS-F score (P > 0.01). The KSS-C score, KSS-F score, and knee range of motion significantly improved after surgery (P < 0.01) for all the patients. The postoperative KSS-C score in normal PTS group (88.76±2.79) was significantly higher than the KSS-C score in abnormal PTS group (84.42±3.35, P < 0.01), but no significant difference between the 2 groups was observed in postoperative KSS-F score and knee range of motion (P > 0.01). In addition, there was no correlation between the change of PTS and postoperative KSS-C score (r=-0.034, 95%CI: -0.247 to 0.186, P = 0.759), KSS-F score (r = -0.014, 95%CI: -0.238 to 0.198, P = 0.901) and knee range of motion (r= 0.045, 95%CI: -0.214 to 0.302, P = 0.686).@*CONCLUSION@#The posterior tibial slope between 3° and < 8° can be recommended to improve knee joint function in mobile UKA, and excessive or insufficient PTS should be avoided.

[Study on improvement and mechanism of tableting properties of porous Fagopyri Dibotryis Rhizoma powders].

At present, there are many difficulties in the development and production of traditional Chinese medicine(TCM) tablets. This work aimed to explore the feasibility of improving dissolution difficulty and large dosage of TCM tablets by co-spray drying TCM extract with a small amount of pore-foaming agent ammonium bicarbonate. A series of porous Fagopyri Dibotryis Rhizoma powders were prepared by co-spray drying Fagopyri Dibotryis Rhizoma with different amounts of ammonium bicarbonate, and their powder pro-perties and tablet properties were comparatively investigated. At the same time, Fagopyri Dibotryis Rhizoma commercial tablets and raw material tablets were used as control drugs, the improvement degree of its compressibility and dissolution rate was investigated. The results showed that there were higher porosity, specific surface area and hollow spheroidal particles structure of powders via co-spray drying Fagopyri Dibotryis Rhizoma with NH_4HCO_3. Compared to parent and commercial Fagopyri Dibotryis Rhizoma tablets, the dissolution rates and compressibility of porous Fagopyri Dibotryis Rhizoma tablets were significantly increasing. High compressibility could increase drug loading by reducing excipients in manufacturing of tablets and lower the dose of Fagopyri Dibotryis Rhizoma tablets.

Effects of Virtual Reality Balance Training on Proprioception of Knee after Anterior Cruciate Ligament Reconstruction / 中国康复理论与实践

Objective:To investigate the effect of virtual reality balance training on knee proprioception after anterior cruciate ligament reconstruction (ACLR). Methods:From January, 2016 to December, 2018, 72 patients after ACLR were randomly divided into control group (n = 36) and observation group (n = 36). On the basis of routine rehabilitation, they received routine balance training and balance training with virtual reality, respectively, for eight weeks. Before and after training, the center of pressure (COP) time stability, the COP speed (COPS) of closed eyes, the COPS of one leg, the knee joint reaction time, the center of pressure area (COPA) and the active joint angle recurrence deviation were measured. Results:After training, the COP time stability, the COPS of closed eyes, the COPS of one leg, knee joint reaction time, COPA and active joint angle recurrence deviation improved in both groups (|t|>5.611, P < 0.001); and the COP time stability, the COPS of closed eyes, the COPS of one leg, the knee joint reaction time and active joint angle recurrence deviation were better in the observation group than in the control group (|t| > 3.232, P < 0.01), however, no significant difference was found in COPA between two groups (t = 1.054, P = 0.296). Conclusion:Virtual reality balance training can improve the proprioception of knee joint after ACLR, which is better than routine balance training.

Comparison of the effects of injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty in the treatment of osteoporotic thoracolumbar burst fractures / 中国骨伤

OBJECTIVE@#To assess the curative effects of injured vertebra pedicle fixation combined with vertebroplasty and short-segment pedicle screw fixation combined with vertebroplasty in treatment of osteoporotic thoracolumbar burst fractures.@*METHODS@#Seventy patients with osteoporotic thoracolumbar burst fractures who met the inclusion criteria were collected in the study from January 2015 to December 2017. Among them, 35 patients were treated with injured vertebra pedicle fixation combined with vertebroplasty (group A), including 20 males and 15 females, aged from 55 to 74 years with an average of (64.03± 7.82) years. Twenty-six cases were type A3 and 9 cases were type A4 according to the AO typing;another 35 patients were treated with short segment pedicle screw fixation combined with vertebroplasty (group B), including 18 males and 17 females, aged from 54 to 72 years with an average of (62.78±6.40) years. Twenty-eight cases were type A3 and 7 cases were type A4 according to AO typing. Operation length, intraoperative bleeding volume, complication, imaging parameters and clinical effects were compared between the two groups.@*RESULTS@#All the patients were followed up for at least 12 months. There were no significant differences in gender, age, injury site, preoperative VAS, Cobb angle, and injured vertebral height before surgery. There were no significant differences in operation length, intraoperative bleeding volume between two groups. In terms of VAS scores before surgery, 1 week after surgery, and at the final follow up, group A was 5.5 ±2.5, 1.8 ±0.8, 0.9 ±0.4, group B was 5.4 ± 2.3, 1.7±0.6, 1.2±1.8, respectively;injured vertebral height was (40.4±8.8)%, (92.0±4.9)%, (87.1±3.8)% in group A, and (41.2±6.6)%, (93.2±4.6)%, (80.0±4.3)% in group B;Cobb angle was (18.4±6.9) °, (2.8±2.2) °, (4.2±2.6) ° in group A, and (16.8±7.2) °, (2.7±2.5) °, (6.0±2.4) ° in group B. There were significant differences in the 3 parameters above before the operation and at the final follow up in all groups (<0.05). There were significant differences in the Cobb angle and injured vertebral height between 1 week after operation and at the final follow up (<0.05). At the final follow up, injured vertebral height in group A was obviously better than that in group B (<0.05). Internal fixation failure occurred in 2 cases from the group A, and occurred in 4 cases from the group B. There were no neurological complications in both groups.@*CONCLUSION@#For osteoporotic thoracolumbar vertebral burst fractures, injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty can achieve good clinical effects. However, injured vertebra pedicle fixation combined with vertebroplasty is better at maintaining postoperative vertebral height and sagittal arrangement, and reducing internal fixation related complications. The treatment strategy is worthy of application and promotion.

Calculating the Number of Pregnant Women Receiving Standardized Services for PMTCT of HIV in Liangshan Prefecture, Based on the Equivalent Method / 生物医学与环境科学（英文）

Objective@#To calculate the number of pregnant women who receive standardized prevention of mother-to-child transmission (PMTCT) services for HIV annually.@*Methods@#HIV-positive pregnant women in six counties of Liangshan Prefecture in 2017 were selected as study subjects. The entire process, from when the subjects first received the PMTCT of HIV services to the end, was divided into four stages, which were further divided into 25 phases. The equivalent coefficient was used to indicate the weight of workload in each phase. Seven experts were invited to score the equivalent coefficient; the number of pregnant women who received standardized services to prevent the transmission of HIV was calculated.@*Results@#A total of 663 HIV-positive pregnant women were registered in six Liangshan Prefecture counties in 2017. This figure was converted into 7,780 person-months devoted to HIV-positive pregnant women, with 260 person-months (3.34%) spent on the first antenatal care, 1,510 person-months (19.41%) during pregnancy, 378 person-months (4.86%) on delivery, and 5,632 person-months (72.39%) on post-partum period. The equivalent coefficient calculation showed that 314 HIV-positive pregnant women received standardized PMTCT services.@*Conclusion@#The number of pregnant women receiving standardized services for the PMTCT of HIV can be calculated accurately using the equivalent method to identify the gap between the level of PMTCT of HIV intervention services needed and the actual workload.

Risk of low birth weight infants in women conceived through in vitro fertilization and fresh embryo transfer / 中华围产医学杂志

Objective To analyze the risk factors of low birth weight (LBW) in infants who were conceived through flesh embryo transfer after in vitro fertilization.Methods We retrospectively reviewed the medical records of 4 930 live babies born after in vitro fertilization/intra-cytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University between January 2011 to December 2016.They were 3 474 singletons and 1 456 pairs of dizygotic twins.According to their birth weight,all singletons were divided into two groups:the LBW singleton group (＜2 500 g,n=252) and the control singleton group (≥ 2 500 g,n=3 222).Two dizygotic twin groups,the LBW dizygotic twin group (＜2 500 g,n=1 014) and the control dizygntic twin group (≥ 2 500 g,n=442),were set up as well.Clinical characteristics of the infants in different groups and risk factors of LBW were analyzed.Independent samples t-test,Mann-Whitney U test,Chi-square test,and logistic regression were used for statistical analysis.Results (1) The rates of LBW were 7.25％ (252/3 474) in singletons and 69.64％ (1 014/1 456) in dizygotic twins.(2) In singleton pregnancies,the maternal body mass index (BMI) of the LBW group was lower than that of the control group [(20.9± 2.8) vs (21.3 ± 2.7) kg/m2,t=-2.162,P=0.031],while the rates of preterm delivery and blastocyst transfer were higher [61.7％ (153/252) vs 5.7％ (182/3 222),8.7％ (22/252) vs 5.1％ (163/3 222),x2=814.232 and 6.234,respectively,all P＜0.05].(3) In dizygotic twin pregnancies,maternal age,paternal age,the rate of preterm delivery and estradiol (E2) level [M(P25-P75)] at trigger were higher than those of the control group [(31.0±3.7)vs (30.5±3.9) years,(33.7±5.0) vs (32.7±4.5) years,63.0％ (631/1 014) vs 28.0％ (123/442),11 362.3 (7 549.2-16 716.1) vs 10 444.8(7 079.4-14 569.9) pmol/L;the values of t or x2 or Z were-2.498,-3.680,150.295 and-2.570,all P＜0.05].(4) Multivariate logistic regression analysis revealed that preterm delivery,maternal BMI＜18.5 kg/m2 and girl baby were independent risk factors for LBW in singleton pregnancies (adjusted OR=28.45,1.59 and 1.45,95％CI:20.87-38.80,1.06-2.41 and 1.06-1.97,all P＜0.05).Preterm delivery,high E2 level at trigger (＞10 970 pmol/L) and different gender of twins were independent risk factors for LBW in dizygotic twin pregnancies (adjusted OR=4.51,1.35 and 1.45,95％CI:3.50-5.82,1.06-1.74 and 1.09-1.93,all P＜0.05).Conclusions High maternal serum E2 level after controlled ovarian stimulation (COS) in fresh embryo transfer cycle may be one of the risk factors for LBW in twin pregnancies.

Evaluation of Predictive Value of Artificial Insemination in Anti-Mullerian Hormone in Patients with Polycystic Ovary Syndrome / 中山大学学报(医学科学版)

@#【Objective】To evaluate the role of serum antimullerian hormone （AMH） concentration in predicting clinical outcomes in controlled ovarian stimulation and intrauterine insemination （IUI）. 【Methods】 A retrospective analysis of IUI data from patients with polycystic ovary syndrome and infertility in our reproductive center from January 2014 to August 2017. According to the clinical outcomes，data was divided into three groups：clinical pregnancy group，non-pregnant group，and cancellation cycle group due to multiple follicular or no dominant follicular develop. The ovarian function evaluation indexes were compared such as serum AMH，basal FSH and basal sinus follicle（AFC）. The cutoff values of the AMH to predict multi- follicular development or no dominant follicular development which IUI cycles were cancelled，and to predict obtain cumulative clinical pregnancy outcomes were calculated according to the ROC curve to cancel the cycle. 【Results】 The clinical pregnancy rates of PCOS patients were from 15.9% to 17.1% ，while the cumulative clinical pregnancy rate increased in repeat cycles （≤3 cycles） was 21.6% ，significantly higher than the average clinical pregnancy rate（16.7%）during the first cycle. AMH levels in the cancelled cycle group were significantly higher than those in the non-cancelled cycle group［（14.1±6.5）vs（10.3±4.3）ng/mL，（14.1±6.5）vs（9.3±4.3）ng/mL， P<0.025］. Compared with the clinical pregnancy group，cancel cycle group and non- pregnant group，the mean AFC of the former two groups were significantly higher［（34.5±11.4）vs（30.7±11.3），（7.8±10.8）vs（30.7±11.3），P<0.025］. In addition，we found that women′ s age，baseline FSH were negatively correlated with the cumulative pregnancy rate of repeated IUI cycles，and women′s baseline BMI，baseline LH，AFC，and AMH were positively correlated with cumulative pregnancy rates. The number of mature follicles on the HCG triggering day，as well as the value of AMH，may be the influencing factor of IUI cumulative clinical pregnancy. By ROC curve analysis，we assume that AMH is more suitable than the AFC to predict IUI cycle cancellation rate and the cumulative pregnancy rate.【Conclusion】Repeated IUI cycles can be improved cumulative pregnancy rate of PCOS infertile couples. AMH，as an important index to measure ovarian reserve function，can be used to predict the the IUI cumulative clinical pregnancy outcomes and cancelled cycle rates：as AMH increased to more than 6.56 ng/mL，the pregnancy rate increased；but when AMH ≥14.72 ng/mL，the risk of cancelled IUI cycles was increased，becasues of multi-follicular developing and absence of dominant follicle development.

Incidence of neonatal asphyxia and contributing factors for the develpment of severe asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study / 中国当代儿科杂志

OBJECTIVE@#To investigate the incidence of neonatal asphyxia and possible contributing factors for the development of severe asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture, China.@*METHODS@#A total of 16 hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture were selected as research centers. A retrospective analysis was performed for the clinical data of 22 294 live births in these 16 hospitals from January to December, 2016 to investigate the incidence rate of neonatal asphyxia and possible contributing factors for the development of severe asphyxia.@*RESULTS@#Of the 22 294 neonates born alive, 733 (3.29%) were diagnosed with neonatal asphyxia, among whom 627 had mild asphyxia and 106 had severe asphyxia. The neonates with low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight had a higher incidence of severe asphyxia (P<0.05).@*CONCLUSIONS@#The incidence rate of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture is higher. Low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight may be related to the development of severe neonatal asphyxia.

Effects of perioperative transcutaneous electrical acupoint stimulation on postoperative analgesia in patients undergoing shoulder arthroscopic surgery / 中国针灸

OBJECTIVE@#To observe and evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) at different time points on postoperative analgesia in perioperative period in patients undergoing shoulder arthroscopic surgery, and to explore the optimal time to use TEAS for shoulder arthroscopic surgery.@*METHODS@#A total of 120 patients undergoing unilateral shoulder arthroscopy under general anesthesia, graded withⅠtoⅡaccording to ASA criteria were randomly divided into 3 groups, 40 patients in each one. The patients in the group A were treated with preoperative TEAS at sham acupoints combined with postoperative TEAS at Hegu (LI 4) and Neiguan (PC 6); the patients in the group B were treated with preoperative TEAS at Hegu (LI 4) and Neiguan (PC 6) combined with postoperative TEAS at sham acupoints; the patients in the group C were treated with TEAS at sham acupoints before and after operation. The parameters of TEAS were dilatational wave, 2 Hz/100 Hz in frequency, 30 min. When the resting-state visual analogue scale (VAS) of incision was more than 3 points, the patient-controlled intravenous analgesia (PCIA) pump of sufentanil was administered to maintain the VAS no more than 3 points. The time point when PCIA pump was firstly used, the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery were recorded. Intraoperative anesthetic doses were recorded in the three groups. The resting-state and task-state VAS were evaluated at 0, 6, 12, 24 hours after surgery; the patient's satisfaction rate and adverse effects were recorded.@*RESULTS@#The time when PCIA pump was firstly used in the group A and the group B was significantly longer than that in the group C, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A and group B were significantly less than those in the group C (all 0.05). There were no statistically significant difference in VAS score at different postoperative time points and postoperative analgesia satisfaction rate between the two groups (all >0.05).@*CONCLUSION@#Perioperative TEAS could improve the postoperative analgesia in patients undergoing arthroscopic shoulder surgery, delay the time when PCIA pump is firstly used, reduce the dosage of postoperative analgesics and adverse events. Compared before surgery, postoperative TEAS has better analgesia.

Effect of celecoxib on the expression of connexin43 in retina of diabetic rats / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the expression of connexin43(Cx43)in retina of Sprague Dawley(SD)rats with diabetes mellitus(DM), and the effects of celecoxib, inhibitor of cyclooxygenase 2(COX-2), on expression of Cx43 in retina of them. <p>METHODS: DM was induced in SD rats by the administration of streptozotocin(STZ). DM rats were divided into two groups: COX-2 treated group(CTG, <i>n</i>=15), and diabetic group(DG, <i>n</i>=15). Normal control group(NCG)consisted of 15 rats was given. Three months' treatment was given after DM development. Sample of retina were made at the end of 3mo. Expression of Cx43 in retina were investigated by immunohistochemistry. Expression of Cx43 mRNA in retina were analyzed by RT-PCR. <p>RESULTS: Cx43 was expressed in the ganglion cell layer, the nerve fiber layer, the inner plexiform layer, and the pigment epithelium layer of retina with a different degree. Computer image analysis showed that celecoxib had elevated the expression of Cx43 in experimental diabetic rats, gray values were: 0.233±0.025, 0.124±0.014, 0.197±0.021; multiple comparisons found statistically significant difference(<i>P</i><0.05). Celecoxib had raised the expression of Cx43 mRNA in diabetic rats with real time quantitative PCR. Relative value was 0.635±0.084, 0.110±0.061, 0.367±0.074, multiple comparisons found statistically significant difference(<i>P</i><0.05).<p>CONCLUSION: Expression of Cx43 decreases in retina of SD rats with DM. Celecoxib can relieve the decrease of Cx43 expression in retina of them.

Identification and preparation of a glycol-protein fraction AN from tea extracts and its and anti-hyperglycosemia activity / 中国中药杂志

The present study compared active ingredients of tea from different sources to select tea type and the fraction of tea extracts for the highest anti-hyperglycemic activity, and to verify anti-hyperglycemic activity of the selected tea extract. Tea extracts were separated and enriched by molecular weight using ultra-filtration technology. The extracts were first screened by -glucosidase inhibition assay, followed by using a rat inverted intestine sac system to measure the effect on glucose transport. Both alloxan-induced diabetic rat model and high-fat diet combined with streptozotocin-induced rat diabetes mellitus model were used to study the effects of active components on blood glucose, body weight, insulin resistance. The experimental results showed that the different kinds of tea extracts had different inhibitory effects on -glucosidase, and the inhibitory effect of tea extract E on -glucosidase was stronger. The effects of different components of tea extract E also varied greatly, of which Fraction AN protein had stronger inhibitory effect on -glucosidase than other fragments, and Fraction AN protein had a strong inhibitory effect on glucose transport, reduced blood sugar and normalized insulin secretion in diabetic rats. The results suggest that a glycol-protein fraction(AN) from the extracts might be responsible for the anti-hyperglycemic activity of tea polysaccharides. The AN glycol-protein fraction has strong inhibitory effects on both -glucosidase activity and glucose transport by the small intestine. It also reduced blood glucose level and normalized insulin secretion in diabetic rats, and has a protective effect on diabetic rats.

Study of sleep features in patients with temporal lobe epilepsy / 天津医药

Objective To study sleep characteristics in patients with temporal lobe epilepsy (TLE) through polysomnography (PSG). Methods Twenty-five TLE patients (TLE group) and eighteen healthy volunteer subjects (control group) were recruited to our study. Patients of two groups were evaluated by whole-night PSG, including total time in bed (TIB), total sleep time (TST), sleep efficiency (SE), sleep latency (SL), rapid eye movement latency (REML), wake after sleep onset (WASO), the percentages of non-REM (NREM) 1, 2 and 3 stages and the percentages of rapid eye movement (REM) occupied TST (N1％, N2％, N3％and REM％), the apnea-hypopnea index (AHI), hypopnea index, mean oxygen saturation (SpO2) and nadir SpO2, periodic leg movements (PLMs) index and PLMs index of REM sleep, sleep stage shifts (SSS) and sleep stage shifts per hour (SSS/h), NREM1, NREM2, NREM3 and REM sleep stage and wake shifts (abbreviated as N1, N2, N3, REM and W) and their proportions of SSS (abbreviated as N1/SSS, N2/SSS, N3/SSS, REM/SSS and W/SSS). Results Compared with control group, WASO, PLMs, PLMs index of REM sleep, SSS, SSS/H and N2 were significantly increased in TLE group. Moreover, compared with control group, SpO2 was decreased in TLE group (P<0.05). Conclusion Our results suggest that TLE patients have sleep disorder manifested as disorder of sleep structure, increased incidents of respiratory and motion events.

Three GnRH Agonist Prototols of Down Regulation on Pituitary Suppression and Pregnancy Outcome of In Vitro Fertilization in Women with Normal Ovarian Reserve : A Randomized-Control Clinical Trial / 中山大学学报(医学科学版)

[Objective] To investigate the effects of different doses of gonadotropin releasing hormone agonist (GnRH-α) on the down-regulation of normal ovarian reserve,and compared the down-regulation level as well as the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET) cycles.[Methods] This RCT study included 63 infertility couples of age＜35 yrs.women with normal ovarian reserve function who were intended to received GnRH-α long protocol treatment.Of the 63 women were randomly divided into three groups according to the dose of triptorelin,21 received daily 0.05 mg short-acting GnRH-α,21 received daily 0.1 mg short-acting GnRH-α,while 21 received reduced-dose depot of 1.25 mg GnRH-αt.[Results] In the three groups,the average duration of down-regulation reached after injection of GnRH-α,the level of LH and E2,the total number of antral follicles,the number of antral follicles of ＜4 mm and 8～9 mm were similar.The serum follicle-stimulating hormone level on the day of gonadotropin initiation were significantly higher in the two short-acting groups compared with the long-acting group [(3.92 ± 1.12) U vs.(3.03 ± 1.14) U vs.(2.05 ± 1.12) U,P＜ 0.001].Four hours after the GnRHa injection,the serum FSH,LH levels were higher in short-acting 0.05 mg group than the short-acting short-acting 0.1 mg group.Both number of days of gonadotropin stimulation and gonadotropin doses were similar in three groups.On the day of hCG administration,the numbers of 14-18mm diameter follicles [(3.91 ±2.12) vs.(5.81 ±3.55) vs.(6.43±3.39),P＜0.001] as well as the proportion of follicles with diameter ≥18 mm/≥10 mm [(33.1％± 13.2％) vs.(24.0％±12.4％) vs.(30.1％±12.2％),P＜0.05],were both statistically significant different in three groups.Although serum LH level on hCG day was significantly increased in 0.05 mg group [(2.47±1.33) U vs.(1.80±0.69) U vs.(1.43±0.53) U,P＜0.05].No premature LH surge and premature ovulation was observed.The number of retrieved oocyteswas significant different [(10.14±4.80) vs.(11.51±2.42) vs.(12.79±2.73),P＜0.05].However,no significant differences was found regard to the number of MII oocytes,and the serum estrogen level per egg was significant higher in 0.05 mg group [(282.33±42.13) U vs.(221.62±32.02) U vs.(200.03±37.89) U,P＜0.001].The live birth rate (LBR) of these three groups in fresh cycles were 61.9％,55.0％,and 50.0％,respectively.The cumulative LBR were 85.7％,76.2％,and 75.0％,respectively.A increased trend was observed in the clinical pregnancy rate,cumulative clinical pregnancy rate and cumulative LBR in 0.05 mg group than the other two groups.[Conclusion] For women with normal ovarian reserve,as the GnRH-α dosage decreased,the down-regulation of pituitary reduced,while serum LH levels on the day of hCG trigger increased.The number of oocytes retrieved was decreased,the proportion of cycles which retrieved ＞ 15 oocytes was also lower.However,the average estrogen level per egg was significant increased,and a better clinical outcome of IVF-ET was received.

Analysis of the characteristics and clinical diagnosis and treatment of avulsion fracture of the lateral edge of tibial plateau / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the characteristics and clinical treatment of avulsion fracture of the lateral edge of tibial plateau(segond fracture) in knee joint injuries.</p><p><b>METHODS</b>From January 2011 and December 2015, 29 patients with Segond fracture were treated with minimally invasive arthroscopy technology in intra-articular injuries combined with double anchor nail fixation in avulsion fracture of the lateral edge of tibial plateau, including 17 males and 12 females with an average age of 41 years old ranging from 27 to 62 years old. Among them, there were 20 cases of anterior cruciate ligament rupture (ACL rupture) involving the anterior cruciate ligament tibial eminence avulsion fracture included, 3 cases of posterior cruciate ligament rupture (PCL rupture), 1 case of ACL rupture combined with PCL rupture, 3 cases of medial collateral ligament tear, and 2 cases combined fractures of tibial plateau (1 case of the medial platform fractures and 1 cases of lateral fracture). All the patients were confirmed by X-rays, CT and MRI. The procedures were performed at 5 to 14 days after the injury(means 7 days). Lysholm scores were used to assess the knee function before and after the operation.</p><p><b>RESULTS</b>The operation time was 40 to 125 minutes (means 85 minutes), the intraoperative blood loss was 10 to 30 ml (means 15 ml). All paients were followed up for 12 to 18 months(means 14 months). The Lysholm scores were significantly improved from preoperative 52.0±4.2 to 91.9±1.4(=-49.24,<0.05). The results of drawer test, Lachman test and lateral stress test were negative in all 29 cases, all the fractures of 29 patients were bony union.</p><p><b>CONCLUSIONS</b>The avulsion fracture of the lateral tibial plateau suggests that there are knee joint static and stable structures(joint ligament, joint capsule, meniscus, et al) and even intra articular fractures. Therefore, besides conventional imaging examinations, arthroscopic exploration was also necessary to avoid misdiagnose and provide comprehensive assessments and treatment. This can create favorable conditions for the knee joint function restore maximum.</p>