bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of superior retinacular artery damage on osteonecrosis of the femoral head
Authors: LIU Bao-yi , ZHAO De-wei , YU Xiao-bing , YANG Lei , GUO Lin , WANG Ben-jie
Published: January 2024

Background

Osteonecrosis of the femoral head (ONFH) is the result of dysfunctional blood supply, but associations between specific damaged arteries, imaging changes and clinical sign require more understanding. We investigated characteristics of ONFH that pertain to blood supply, imaging appearance, and clinical feature to judge the prognosis of ONFH.

Methods

Clinical data were collected for 92 patients (118 hips) with ONFH, including gender, age, duration of pain (from initial clinical presentation to arthroplasty), cause, stage, and classification. Magmatic resonance imaging and X-rays were obtained of all patients to diagnose ONFH. The sizes of lesions were classified by necrotic index. The location of necrosis was classified as Type A, B, or C using the grading system by magmatic resonance imaging and X-rays. All hips were imaged with digital subtraction angiography to visualize their blood-supply characteristics. Hips were divided into groups based on the source artery for femoral head damage: superior retinacular artery (S), inferior retinacular artery (I), and combined superior and inferior retinacular arteries (S+I). Via digital subtraction angiography, imaging appearances and clinical data in three groups were compared.

Results

ONFH was caused by damage in either the superior or inferior retinacular artery, or both, in all of 118 hips. The group with only inferior retinacular artery damage reported longer hip pain duration than the other groups. The probability of the lesion extending laterally to the acetabular edge in group S was much more than it in group I. Necrosis indices of the patients in S and S+I were higher than those in group I.

Conclusions

ONFH associated with interruption of the superior and inferior retinacular arteries in this study. When the former alone was damaged, the necrosis of the volume was larger, the risk of femoral head collapse was higher and the time from initial clinical presentation to arthroplasty was shorter.
Management of postoperative instrumented spinal wound infection
Authors: FANG Xiu-tong , Wood Kirkham B.
Published: January 2024

Background

Wound infection following spinal instrumented surgery is a frequent complication. The optimal treatment of acute deep wound infection following spinal instrumentation fusion remains controversial because of variability in cohort identification, definition of an infection, and the instrument used to measure outcomes. This retrospective study evaluated the clinical curative effect for postoperative spinal infection after instrumented spine fusion with extensive debridement, or implant removal.

Methods

From January 2004 to October 2009, 851 patients were identified who underwent surgical treatment of spinal diseases. The medical records of patients who developed infections were reviewed in detail.

Results

Of 851 patients, 41 (4.9%) developed an infection. Thirty-three were acute, and eight were delayed. Acute infected cases were managed with antibiotic therapy, and aggressive debridement of the wound and soft tissues leaving all instrumentation in situ in all but one patient. The most common symptoms of acute infection included: posterior incisional drainage (26 of 33 patients), back pain (22 of 33 patients) and fever (13 of 33 patients). Among patients with delayed onset infection, five of eight patients had local pain, four of eight patients had incision drainage, and one patient had a prolonged period of intermittent fever. The most frequent causative organism for postoperative spinal infection following spine surgery is Staphylococcus aureus. Pseudarthrosis was noted in long-term follow-up in four of 41 patients.

Conclusions

We recommend irrigation and debridement, no instrumentation removal, and, if necessary, repeat debridement followed by delayed primary closure for the treatment of acute deep infection with instrumentation.
Combined action of C-reactive protein and lipid profiles on risk of hypertension and prehypertension in Mongolian adults in Inner Mongolia, China
Authors: Zhang Shihui , Xu Tian , Peng Yanbo , Peng Hao , Wang Aili , Wang Guiyan , Wang Dali , Zhang Yonghong
Published: January 2024

Background

Many studies have suggested that C-reactive protein (CRP) and blood lipids are associated with hypertension and cardiovascular disease (CVD). However, few studies discussed the combined action of CRP and blood lipids on the risk of hypertension and prehypertension. This study aimed to investigate the combined action of CRP and lipid profiles on the risk of hypertension and prehypertension in Mongolian adults from Inner Mongolia, China.

Methods

The systolic and diastolic blood pressure, height, weight and waist circumference were measured and factors such as smoking, alcohol intake, family history of hypertension, etc., were investigated and CRP, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) were tested for 2 534 Mongolian adults aged ≥20 years. The subjects were divided into four subgroups, namely CRP <median and LDL-C (TG) <median subgroup, CRP median subgroup, CRP >median and LDL-C (TG) median and LDL-C (TG) >median subgroup. The ORs (95% CIs) of hypertension and prehypertension for the subgroups were calculated by univariate and multivariate analysis.

Results

The multivariate adjusted ORs (95%CIs) of hypertension/prehypertension were 1.389 (0.979–1.970)/1.151(0.865–1.531), 1.666 (1.159–2.394)/1.431 (1.060–1.930), 1.756 (1.242–2.484)/1.770 (1.321–2.372), for CRP median subgroup, CRP >median and LDL-C median and LDL-C >median subgroup, respectively, compared with CRP <median and LDL-C <median subgroup. Similarly, the multivariate adjusted ORs (95% CIs) of hypertension/prehypertension were 2.032 (1.394–2.963)/1.442 (1.047–1.988), 1.412 (0.960–2.079)/1.596 (1.166–2.184), and 2.197 (1.595–3.027)/1.730 (1.321–2.266) for CRP median subgroup, CRP >median and TG median and TG >median subgroup, respectively, compared with CRP <median and TG median and LDL-C (TG) >median subgroup among the four subgroups.

Conclusions

Subjects with both CRP >median and LDL-C (TG) >median had highest risks of hypertension and prehypertension among all subjects. This study appeared to indicate that the combined action of elevated CRP and elevated LDL-C (TG) further increase the risks of hypertension and prehypertension among Mongolian population.
Diagnosis of Fanconi anemia in children with atypical clinical features: a primary study
Authors: LIU Rong , HU Tao , LI Jun-hui , LIANG Chao , GU Wei-yue , SHI Xiao-dong , WANG Hong-xing
Published: January 2024

Background

Fanconi anemia is a severe congenital disorder associated with mutations in a cluster of genes responsible for DNA repair. Arriving at an accurate and timely diagnosis can be difficult in cases of Fanconi anemia with atypical clinical features. It is very important to increase the rate of accurate diagnosis for such cases in a clinical setting. The purpose of this study is to explore the clinical diagnosis of Fanconi anemia in children with atypical clinical features.

Methods

Six cases of Fanconi anemia with atypical clinical features were enrolled in the study, and their clinical features were recorded, their FANCA gene transcription was assessed by RT-PCR, and FANCA mutations and the ubiquitination of FANCD2 protein were analyzed using DNA sequencing and western blotting respectively.

Results

All six cases showed atypical clinical features including no apparent deformities, lack of response to immune therapy, and progressively increasing bone marrow failure. They also have significantly increased fetal hemoglobin, negative mitomycin-induced fracture test results, and carry a FANCA gene missense mutation. Single protein ubiquitination of FANCD2 was not observed in those patients.

Conclusion

The combination of clinical features, FANCA pathogenic gene mutation genotype and the absence of FANCD2 protein ubiquitination are helpful in the accurate and timely diagnosis of Fanconi anemia in children.
Advances and disputes of posterior malleolus fracture
Authors: FU Su , ZOU Zhen-yu , MEI Gang , JIN Dan
Published: January 2024

Objective

The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture (PMF).

Data sources

Data used in this review were mainly from English literature of PubMed data base.

Study selection

Articles were included in this review if they were related to the PMF or trimalleolar fracture.

Results

No consensus was found regarding what sizes of posterior malleolus fragments would lead to ankle instability thus affecting prognosis and should be fixed. X-ray measurement is unreliable, while CT scan is widely recommended and it can recognize the occult posterior malleolus fractures associated with tibia shaft fractures, which are always undetected previously. Direct posterior malleolus fixation is suitable to stabilize syndesmotic injury. The basic and clinical researches support direct reduction and buttress plate fixation of posterior malleolus fracture through the posterolateral approach. Operative indications and timing of weight bearing are still in discussion.

Conclusions

Knowing whether ankle instability occurs and the proper methods to diagnose, evaluate, and operate can help manage the fracture. Further biomechanical research on ankle stability and clinical study to compare various treatment methods are required.
Efficacy of radical cystectomy plus adjuvant intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced bladder cancer
Authors: Jiang Lijuan , Zhang Zhiling , Dong Pei , Li Yonghong , Yao Kai , Liu Zhuowei , Han Hui , Qin Zike , Yao Min , Zhou Fangjian
Published: January 2024

Background

Bladder cancer is the ninth most common cancer in the world; fewer than 15% of transitional-cell carcinoma patients survive 2 years if left untreated. Although radical cystectomy is the standard treatment of choice, much of them relapse and the necessity of adjuvant chemotherapy is still under debate. The aim of the study was to evaluate the efficacy of adjuvant intraarterial chemotherapy (IAC) with gemcitabine and cisplatin (GC) on locally advanced bladder cancer.

Methods

This is a retrospective study on 60 patients with locally advanced bladder carcinoma who underwent radical cystectomy between May 2000 and June 2011. Patients were studied in two groups based on IAC and followed up for up to 5 years.

Results

Among 60 patients, there were 25 patients who underwent IAC (GC) after radical cystectomy (the IAC group) and 35 patients who underwent radical cystectomy alone (the control group). Although not significant, the relapse rates were slightly reduced in the IAC group than in the control group. Patients with IAC had a reduction in mortality compared with patients without IAC over 5 years. Specifically, IAC significantly reduced about 82% of mortality within the first year (hazard ratio=0.18, 95% CI 0.03–0.97, P=0.04). Additionally, IAC was well tolerated and safe. The most common adverse effect was transient myelosuppression (10/25, 40%), which was resolved by various medical treatments.

Conclusions

Compared with radical cystectomy alone, radical cystectomy in combination with adjuvant IAC moderately but significantly reduces 1-year mortality. Our preliminary data showed only marginal benefit for the early survival. However, a randomized clinical study is needed to determine the long-term survival benefit.
Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery
Authors: YE Xun , LIU Xing-Ju , MA Li , LIU Ling-Tong , WANG Wen-Lei , WANG Shuo , CAO Yong , ZHANG Dong , WANG Rong , ZHAO Ji-Zong , ZHAO Yuan-Li
Published: January 2024

Background

Microscope-integrated near-infrared indocyanine green video angiography (ICG-VA) has been used in neurosurgery for a decade. This study aimed to assess the value of intraoperative indocyanine green (ICG) video angiography with Flow 800 software in cerebrovascular surgery and to discover its hemodynamic features and changes of cerebrovascular diseases during surgery.

Methods

A total of 87 patients who received ICG-VA during various surgical procedures were enrolled in this study. Among them, 45 cases were cerebral aneurysms, 25 were cerebral arteriovenous malformations (AVMs), and 17 were moyamoya disease (MMD). A surgical microscope integrating an infrared fluorescence module was used to confirm the residual aneurysms and blocking of perforating arteries in aneurysms. Feeder arteries, draining veins, and normal cortical vessels were identified by the time delay color mode of Flow 800 software. Hemodynamic parameters were recorded. All data were analyzed by SPSS version 18.0 (SPSS Inc., USA). T-test was used to analyze the hemodynamic features of AVMs and MMDs, the influence on peripheral cortex after resection in AVMs, and superficial temporal artery to middle cerebral artery (STA-MCA) bypass in MMDs.

Results

The visual delay map obtained by Flow 800 software had more advantages than the traditional playback mode in identifying the feeder arteries, draining veins, and their relations to normal cortex vessels. The maximum fluorescence intensity (MFI) and the slope of ICG fluorescence curve of feeder arteries and draining veins were higher than normal peripheral vessels (MFI: 584.24±85.86 vs. 382.94±91.50, slope: 144.95±38.08 vs. 69.20±13.08, P <0.05). The arteriovenous transit time in AVM was significantly shorter than in normal cortical vessels ((0.60±0.27) vs. (2.08±1.42) seconds, P <0.05). After resection of AVM, the slope of artery in the cortex increased, which reflected the increased cerebral flow. In patients with MMD, after STA-MCA bypass, cortex perfusion of corresponding branches region increased and local cycle time became shorter.

Conclusion

Intraoperative ICG video angiography combined with hemodynamic parameter analysis obtained by Flow 800 software appears to be useful for intraoperative monitoring of regional cerebral blood flow in cerebrovascular disease.
Prognostic value of serum galactomannan index in critically ill patients with chronic obstructive pulmonary disease at risk of invasive pulmonary aspergillosis
Authors: He Hangyong , Li Qian , Chang Shuo , Ding Lin , Sun Bing , Li Fang , Zhan Qingyuan
Published: January 2024

Background

Critically ill chronic obstructive pulmonary disease (COPD) patients admitted to an intensive care unit (ICU) due to respiratory failure are at particularly high risk of Aspergillus infection. The serum galactomannan index (GMI) has proven to be one of the prognostic criteria for invasive pulmonary aspergillosis (IPA) in classical immunocompromised patients. However, the prognostic value of serum GMI in critically ill COPD patients needs evaluation. The purpose of this study is to investigate the prognostic value of serum GMI in patients with severe COPD.

Methods

In this single-center prospective cohort study, serum samples for GMI assay were collected twice a week from the first day of ICU admission to the day of the patients’ discharge or death. Patients were divided into two groups according to their clinical outcome on the 28th day of their ICU admission. Univariate analysis and survival analysis were tested in these two groups.

Results

One hundred and fifty-three critically ill COPD patients were included and were divided into survival group (106 cases) and non-survival group (47 cases) according to their outcome. Univariate analysis showed that the highest GMI level during the first week after admission (GMI-high 1st week) was statistically different between the two groups. Independent prognostic factors for poor outcome in severe COPD patients were: GMI-high 1st week >0.5 (RR: 4.04, 95% CI: 2.17–7.51) combined with accumulative dosage of corticosteroids >216 mg before the RICU admission (RR: 2.25, 95% CI: 1.11–4.56) and clearance of creatinine (Ccr) ≤64.31 ml/min (RR: 2.48, 95% CI: 1.22–5.07).

Conclusions

The positive GMI-high 1st week (>0.5) combined with an accumulative dosage of corticosteroids >216 mg before the ICU admission and a low Ccr may predicate a poor outcome of critically ill COPD patients.
Adiponectin protects the genioglossus of rats against chronic intermittent hypoxia-induced injury via inhibition of endoplasmic reticulum stress
Authors: ZHANG Xiao-feng , HUANG Han-peng , DING Wen-xiao , DING Ning , LU Gan , LIU Jian-nan , ZHANG Xi-long
Published: January 2024

Background

Obstructive sleep apnea hypopnea syndrome, characterized by chronic intermittent hypoxia (CIH), is closely correlated with genioglossus dysfunction. CIH has been identified to mediate mitochondrial damage in genioglossus. It has been reported that endoplasmic reticulum stress (ERS) could be induced by mitochondrial dysfunction. This study aimed to investigate the role of ERS in CIH-induced genioglossus injury, as well as the possible intervention effect of adiponectin (Ad) supplement in rats.

Methods

Forty-five male Wistar rats were randomly divided into three groups and submitted to room air (group A, n=15) as a control or CIH (groups B and C, n=15, respectively). Throughout the exposure period, intravenous Ad was given in group C; while intravenous normal saline was simultaneously given in groups A and B. After 35-day exposure, genioglossus samples were obtained from the pentobarbital-anaesthetized rats via surgical dissection, following blood sampling. Western blotting was applied to detect expressions of ERS signals and associated apoptotic pathways in genioglossus. Serum adiponectin levels were assessed via enzyme-linked immunosorbent assay (ELISA).

Results

Significant hypoadiponectinemia was revealed in group B only (P <0.05). Compared to those in groups A and C, expressions of markers involved in ERS, such as glucose regulated protein 78 (GRP78), p-PERK, phosphorylated eukaryotic initiation factor 2α (p-eIF2α), phosphorylated inositol-requiring transmembrane kinase/endoribonuclease 1α (p-IRE1α), spliced X-Box binding protein 1 (XBP1s) and activating transcription factor 6 (ATF6), were significantly enhanced in group B (all P <0.01); while no significant difference was shown between groups A and C (all P >0.05). ERS-associated apoptotic pathways were remarkably activated in group B. The involved markers detected as the expression of CCAAT/enhancer binding protein homologous protein (CHOP), B-cell lymphoma/leukemia associatied X protein (BAX) and caspase-12 were significantly elevated (all P <0.01). Transvenous adiponectin supplement improved the above CIH-induced pathological changes in group C.

Conclusion

Beyond hypoadiponectinemia, CIH could enhance ERS and induce activation of ERS-associated apoptotic pathways in genioglossus, which could be significantly improved by adiponectin supplement.
Inhibition of central Na+/H+ exchanger type 3 can alleviate sleep apnea in Sprague-Dawley rats
Authors: Wang Qimin , Zhou Rong , Zhang Cheng , Dong Hui , Ma Jing , Wang Guangfa
Published: January 2024

Background

Recent studies showed the central Na+/H+ exchanger type 3 (NHE3) has a close relationship with ventilation control. The objective of the study is to investigate the role of NHE3 in sleep apnea in Sprague-Dawley (SD) rats.

Methods

A sleep study was performed on 20 male SD rats to analyze the correlation between the sleep apneic events and total NHE3 protein content and inactive NHE3(pS552) in the brainstem measured by Western blotting. Another 20 adult male SD rats received 3 days of sleep and respiration monitoring for 6 hours a day, with adaption on the first day, 0.5% DMSO microinjection into the fourth ventricle on the second day, and AVE0657 (specific inhibitor of NHE3) microinjection on the third day. Rats were divided into two groups with injection of 5 μmol/L or 8 μmol/L AVE0657 before the sleep study. The effects of AVE0657 on sleep apnea and sleep structure of rats were analyzed through self-control.

Results

The total post-sigh apnea index (TPSAI) and post-sigh apnea index in non-rapid eye movement (NREM) sleep (NPSAI) and total apnea index (AI) in NREM sleep (NAI) were negatively correlated with NHE3(pS552) protein contents in the brainstem (r=-0.534, -0.547 and -0.505, respectively, P<0.05). The spontaneous apnea index in REM sleep (RSPAI) was positively correlated with the level of NHE3(pS552) protein expression in the brainstem (r=0.556, P<0.05). However, the sleep AI had no relationship with total NHE3 protein. Compared with the blank control and microinjection of 0.5% DMSO, 5 μmol/L AVE0657 significantly reduced the total AI and NPSAI (both P<0.05) without a significant effect on sleep architecture. In contrast to blank control and microinjection of 0.5% DMSO, injection of 8 μmol/L AVE0657 significantly reduced the AI and PSAI in NREM and REM sleep (all P<0.05).

Conclusions

The severity of sleep apnea was negatively correlated with central inactive NHE3. A specific inhibitor of NHE3 decreased the sleep AI. Thus, our results indicate that central NHE3 might be a molecular target for sleep apnea treatment, whose inhibitors may be potential therapeutic drugs for sleep apnea.
Augmentation plating in hypertrophic non-union after nail fixation of femoral shaft fracture compared with exchange plating
Authors: Liangjun Jiang , Zhijun Pan , Qiang Zheng
Published: January 2024

Background

Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation. This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.

Methods

A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union. The procedures were conducted at our medical centre between January 2005 and January 2012. Clinical follow-up was conducted at 2 weeks, 1 month and then monthly until union was achieved to compare union time, operation time, bleeding and complications between the two groups.

Results

All patients underwent follow-up examinations until fracture union was achieved. The average length of followup time after the second treatment was (18.37±3.28) months. The time needed for union was (4.17±0.94) months in the augmentation plating group and (5.33±1.72) months in the exchange plating group. The operation time was (90.00±17.58) minutes in the augmentation plating group and (160.00±25.35) minutes in the exchange plating group. The amount of blood loss during the operation was (270.00±43.32) ml in the augmentation plating group and (530.00±103.65) ml in the exchange plating group. Both groups showed significant difference (P<0.05) in their results. No complications were reported after the second operation.

Conclusions

Augmentation plating after nail fixation could remove local rotation instability, facilitate simple operation, create minimal damage and enable exercise for early functional recovery. Therefore, augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.
What is the real practice of exercise echocardiographic testing in asymptomatic patients with severe aortic stenosis?
Authors: Cho Eun Jeong , Park Sung-Ji , Song Jung-Eun , Kim Seol-Hwa , Lee Yung-Joo , Gak Ji-Hye , Chang Sung-A , Lee Sang-Chol , Park Seung Woo
Published: January 2024

Background

Although exercise testing has been suggested to help predict clinical outcome, limited data are available to guide how exercise Doppler echocardiography (ECG) can be used clinically in asymptomatic patients with aortic stenosis (AS). The aim of this study was to assess the clinical value of exercise echocardiographic testing in asymptomatic patients with severe AS.

Methods

Symptom-limited treadmill exercise testing using the modified Bruce protocol was performed in 31 asymptomatic patients (mean age (62±11) years) with severe AS (aortic valve area <1 cm2, peak aortic velocity (AV Vmax) >4 m/sec, or a mean transaortic pressure gradient (AV mean PG) >40 mmHg (1 mmHg=0.133 kPa)) with normal left ventricular (LV) systolic function (LV ejection fraction (EF) >50%). Clinical symptoms, vital signs, ECG, and Doppler hemodynamics were obtained during and/or immediately after exercise.

Results

Aortic valve replacement (AVR) was performed in 18 patients during follow-up. The patients who had AVR exhibited higher baseline AV mean PG (51 (35-84) vs. 44 (25.2-57.0) mmHg; P=0.031). There were no significant differences between the AVR group and non-AVR group including exercise duration (7.47 (2.32-11.59) vs. 7.25 (4.06-10.52) minutes, P=0.917), exercise capacity (10.1 (4.6-12.8) vs. 10.1 (7.0-12.8) metabolic equivalents, P=0.675), and an increment in AV mean PG by exercise (18.5 (3.2-48.0) vs. 12.6 (4.4-32.1) mmHg, P=0.366). Univariate regression analysis revealed that independent determinant of AVR was the baseline AV mean PG (P=0.031).

Conclusions

Although additional value of exercise ECG was demonstrated, baseline transaortic mean pressure gradient is the major determinant of AVR. Further large-scale prospective studies are required to determine whether surgery should be recommended in the presence of an abnormal exercise ECG in asymptomatic severe AS.
Association between clinical features and prognosis of patients with limb-shaking transient ischemic attack
Authors: MA Qing-Feng , HUANG Qiang , ZHANG Qian , FAN Chun-Qiu , GUO Xiu-Hai , WU Jian
Published: January 2024

Objective

This review aims to illustrate the relationship between clinical features and the prognosis of patients with limb-shaking transient ischemic attack (LS-TIA).

Data sources

Relevant articles published in two main Chinese medical periodical databases (China National Knowledge Infrastructure and China Science Periodical Database) from 1986 to June 2013 were identified with keywords “limb shaking” and “transient ischemic attack”.

Study selection

Original articles and case reports about LS-TIA were selected.

Results

A total of 63 cases collected from 19 articles were included in the pooled analysis. LS-TIA presented in two cerebrovascular diseases, of which atherosclerotic high-grade stenosis or occlusion in carotid artery system and moyamoya disease formed 95.2% and 4.8%, respectively. Of 63 patients, 11 (17.5%) were once misdiagnosed as epileptic and prescribed useless antiepilepsy drugs. The multivariable Logistic regression model showed a significant protective effect of patients with revascularization therapy on prognosis, compared with patients treated with drugs (odds ratio 0.20, 95% CI 0.05-0.74, P=0.016).

Conclusions

Chronic carotid artery system hypoperfusion can induce limb(s) shaking, followed by high possibility of ischemic stroke in the same brain territorial. Revascularization of the responsible artery may work better than conservative drug-based therapy.
Advancement of maxillary anterior segment by distraction osteogenesis for severe maxillary retrusion in cleft lip and palate
Authors: Feng Gao , Minlie Yang , Zhenmin Zhao , Xiaomei Sun , Ningbei Yin , Yongqian Wang , Tao Song , Haidong Li , Di Wu , Jiapeng Yin , Yimei Cao , Haizhou Tong
Published: January 2024

Background

Maxillary anterior segmental distraction osteogenesis (MASDO) is a recently used method for correction of severe maxillary retrusion in cleft lip and palate (CLP) patients. In this article, we evaluated the feasibility of MASDO using rigid external distraction (RED) and rapid orthodontic tooth movement to correct severe maxillary retrusion in CLP patients.

Methods

Fourteen male and five female complete CLP patients between the ages of 18 and 22 years (mean age 19.7 years) at the time of distraction, with severe maxillary retrusion, were treated with the rigid external distraction (RED) device after maxillary anterior osteotomy. Rapid orthodontic tooth movement was started one week after the MASDO. Standard profile photographic, cephalometric films were obtained preoperatively and after therapy. Sella-nasion-point A (SNA) and Sella-nasion-point B (SNB) angles were measured to reflect changes in maxillary and mandibular position, and the distance between anterior nasal spine and posterior nasal spine (ANS-PNS) was measured to represent the maxillary dental arch length.

Results

The SNA angle increased from an average of 74.6° (range 73.0°-78.0°), preoperatively, to 83.4° (range 78.6°-88.0°) after the RED was removed (P <0.01). All cases of severe maxillary retrusion were improved. Nine patients' profiles became harmonious after therapy. One patient had a bimaxillary protrusion deformity and needed further surgery. The regenerate alveolar crest and edentulous space on both segments was almost completely eliminated after rapid orthodontic tooth movement.

Conclusion

MASDO with the RED system and rapid orthodontic tooth movement is a successful way of correcting severe maxillary retrusion in CLP patients.
Application of the multi-planar reconstruction in endovascular treatment of type B aortic dissection
Authors: LI Yong-sheng , HOU Kai , XU Xin , YANG Jue , ZHU Ting , DONG Zhi-hui , YUE Jia-ning , WANG Yu-qi , FU Wei-guo
Published: January 2024

Background

Although Multi-planar reconstruction (MPR) has been considered a diagnostic imaging technique that observes more perspectives for diseases, few people have applied it surgically. In fact, MPR is also very useful to clinical operation, especially for patients with type B aortic dissection. It helps the surgeon to locate accurately with more information about aortic dissection, so that the safety and effectiveness of operation can be improved. This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection, a spin angle of the coronal plane, and a tilt angle of the sagittal plane in treatment of type B aortic dissection.

Methods

The conventional and the MPR approaches were compared on positioning the aortic arch for surgery. A group of 40 patients (group A) and another group of 42 patients (group B) was sampled. About the comparison of baseline characteristics, a fourfold table χ2 test was conducted on gender, and two independent samples t-test was applied to age between group A and group B. Spin as well as tilt angles for group A were obtained from the patients using both approaches, and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group. Stent graft placement of group B was based on the conventional approach. Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement. They were also compared with a fourfold table χ2 test.

Results

Gender difference was not found between group A and group B (χ2=0.80, P >0.05), and age difference was not statistically significant (F=2.55, homogeneity of variance, t=−1.46, P >0.05). A significant difference was found between the conventional and the MPR approaches for spin angle (t=9.17) as well as tilt angle (t=2.07), P <0.05. Percentage of proximal distributed markers (5.0%) of group A was significantly lower than that of group B (42.9%), χ2=15.92, P <0.05; and incidence of complications (5.0%) of group A was also significant lower than that of group B (21.4%), χ2=4.76, P <0.05.

Conclusions

Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA. It is feasible in endovascular treatment of type B aortic dissection, and can effectively and safely guide surgical operations.
Midterm results of diagnostic treatment and repair strategy in older patients presenting with nonrestrictive ventricular septal defect and severe pulmonary artery hypertension
Authors: Liu Aijun , Li Zhiqiang , Li Xiaofeng , Fan Xiangming , Su Junwu , Zhang Jing , He Yan , Liu Yinglong
Published: January 2024

Background

Congenital heart disease with severe pulmonary arterial hypertension (SPAH), previously thought to have irreversible pulmonary vascular disease (PVD), has been recently successfully corrected using diagnostic treatment and repair strategy by our surgery team. This study aimed to evaluate the midterm results of a selected cohort of older patients with nonrestrictive ventricular septal defect (VSD) and SPAH using diagnostic treatment and repair strategy.

Methods

The records of 56 patients older than six years with nonrestrictive VSD and SPAH undergoing diagnostic treatment and repair strategy from 2006 to 2012 were retrospectively reviewed. All patients received advanced pulmonary arterial hypertension (PAH) therapy and radical repairs were performed when transcutaneous oxygen saturation (SPO2) increased up to 93%.

Results

There were no operative deaths. SPO2 and baseline six-minute walk test (SMWT) distance of all selected patients increased significantly and mean pulmonary artery pressure (MPAP) regressed significantly after diagnostic treatment and at late follow-up (P<0.01). The incidence of late postoperative PAH was seen in six (10.7%) patients and by Logistic regression analysis, early postoperative PAH was an independent risk factor related to late postoperative PAH.

Conclusions

Diagnostic treatment and repair strategy was effective and safe for treatment of nonrestrictive VSD and SPAH and the midterm results were excellent. Diagnostic treatment strategy was effective in assessing the reversibility of SPAH in older patients associated with nonrestrictive VSD and the PVD in these selective patients is generally reversible.
Computer-assisted minimally invasive spine surgery for resection of ossification of the ligamentum flavum in the thoracic spine
Authors: Yuan Qiang , Zheng Shan , Tian Wei
Published: January 2024

Background

Ossification of the ligamentum flavum (OLF) has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy. Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF. The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery (CAMISS) for posterior decompression in patients with thoracic myelopathy caused by OLF.

Methods

In all cases, the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system. Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved. The outcomes were evaluated by a modified Japanese Orthopedic Association (JOA) scoring system and recovery rates.

Results

The mean duration of follow-up for the 14 cases was 3.9 years. All patients experienced neurological recovery, the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7% (excellent in two cases, good in eight, fair in three, and unchanged in one).

Conclusion

CAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine.
Safety and feasibility of transulnar versus transradial artery approach for coronary catheterization in non-selective patients
Authors: Geng Wei , Fu Xianghua , Gu Xinshun , Jiang Yunfa , Fan Weize , Wang Yanbo , Li Wei , Xing Kun , Liu Chen
Published: January 2024

Background

Transradial approach catheterization is now widely used in coronary angiography and angioplasty. The ulnar artery, which is one of the two terminal branches of the brachial artery, may be a potential approach for cardiac catheterization. The aim of this study was to evaluate the safety and feasibility of a transulnar approach for coronary catheterization in non-selective patients.

Methods

A total of 535 consecutive patients were randomly assigned to transulnar approach (TUA) group (n=271) or transradial approach (TRA) group (n=264) upon arrival at the catheterization laboratory. Allen's test and inverse Allen's test were not routinely performed. Ultrasound-Doppler assessment of the forearm artery was performed before the procedure, two days after the procedure, and 30 days after the procedure. The primary endpoints of study were the rate of successful artery cannulation and the access-site related complications. The secondary endpoints included the number of needle punctures, total time for the procedure, and major adverse cardiac events (MACE).

Results

Successful puncture of the objective artery was obtained in 91.5% of the patients in the TUA group, and 95.1% of the patients in the TRA group (P >0.05). There was no significant difference in hematoma complications between the two groups (7.7% vs. 4.2%, P=0.100). A motor abnormality of the hand was observed in one patient in the TUA group. There were no arteriovenous fistula or pseudoaneurysm observed in our study. Three (1.1%) patients in the TUA group and 8 (3.0%) patients in the TRA group had occlusion of the access artery (P=0.137), but none of the patients had symptoms or signs of hand ischemia. There were no significant differences in MACE between the two groups during follow-up.

Conclusion

The transulnar approach is an effective and safe technique for coronary catheterization in non-selective patients.
Expression of partial tandem duplication of mixed lineage leukaemia in patients with acute leukaemia and their relatives
Authors: He Yi , Wang Dongning , Li Xudong , Hu Yuan , Wang Wenwen , Huang Renwei
Published: January 2024

Background

Partial tandem duplication of mixed lineage leukaemia (MLL-PTD) is detected both in patients with acute leukemia and in healthy people. However, MLL-PTD in relatives of patients with MLL-PTD has not been reported. The objective of this study was to investigate the expression of MLL-PTD in patients with acute leukemia and in their relatives.

Methods

The bone marrow or peripheral blood was collected from patients with acute leukaemia and their relatives. Nested reverse transcription-polymerase chain reaction (RT-PCR) was applied to detect the mRNA expression of the MLL-PTD fused gene, and further confirm in genomic DNA level.

Results

Analysing MLL-PTD in case 1, the patient's older brother and his younger brother were positive, while his mother and his son were negative. The exon type in case 1 was e9/3 fusion, but in his older brother, it was e9/3 and e11/3 fusion, and in his younger brother, it was e9/3, e10/3, and e11/3 fusion. MLL-PTD in case 2 was negative, but in the patient's older sister was positive, and the exon type was e9/3, e10/3, and e11/3.

Conclusions

The expression of MLL-PTD was present in cases with acute leukaemia with a single expression type. However, various expression types were detected in their healthy relatives. MLL-PTD can couple with other chromosome aberrations, and its impact on disease prognosis remains to be studied further.
A novel, minimally invasive rat model of normothermic cardiopulmonary bypass model without blood priming
Authors: Yaobin Zhu , Donghai Liu , Xiaofeng Li , Aijun Liu , Qiang Wang , Chenhui Qiao , Jing Zhang , Qiuming Liao , Yanbo Zhang
Published: January 2024

Background

Cardiopulmonary bypass (CPB) has been shown to be associated with systemic inflammatory response leading to postoperative organ dysfunction. Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model. The purpose of this study was to establish a novel, minimally invasive rat model of normothermic CPB model without blood priming.

Methods

Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into CPB group (n=10) and control group (n=10). All rats were anaesthetized and mechanically ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular and further transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery. The volume of the priming solution, composed of 6% HES130/0.4 and 125 IU heparin, was less than 12 ml. The surface of the hollow fiber oxygenator was 0.075 m2. CPB was conducted for 60 minutes at a flow rat of 100-120 ml· kg-1· min-1in CPB group. Oxygen flow/perfusion flow was 0.8 to 1.0, and the mean arterial pressure remained 60-80 mmHg.

Results

All CPB processes were successfully achieved. Blood gas analysis and hemodynamic parameters of each time point were in accordance with normal ranges. The vital signs of all rats were stable.

Conclusions

The establishment of CPB without blood priming in rats can be achieved successfully. The nontransthoracic model should facilitate the investigation of pathophysiological processes concerning CPB-related multiple organ dysfunction and possible protective interventions. This novel, recovery, and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injuryin vivo.
Baseline proteinuria, urinary osmotic pressure, and renal function as positive predictors of corticosteroids plus cyclophosphamide treatment efficacy in IgA nephropathy
Authors: Fang Jing , Li Wenge , Li Duo , Tan Zhao
Published: January 2024

Background

Very limited data are available on factors predictive of corticosteroids plus cyclophosphamide treatment efficacy on IgA nephropathy (IgAN). The aim of the study was to research the clinical factors predictive of treatment efficacy in IgAN.

Methods

One hundred and fifty-nine patients with IgAN (proteinuria ≥2 g/d and estimated glomerular filtration rate 30-89 ml·min-1·1.73 m-2) were treated with corticosteroids/cyclophosphamide followed by a 12-month follow-up. According to their response, these patients were divided into remission group (proteinuria <0.5 g/d) and non-remission group (proteinuria ≥0.5 g/d), and their clinical data collected.

Results

In the present study, 72.96% of the individuals underwent a complete remission, and their response was related to baseline proteinuria, urinary osmotic pressure, and renal function (P <0.05). Patients with baseline proteinuria more than 3 g/d, urinary osmotic pressure greater than 600 mOsm/L, and eGFR 60-89 ml·min-1·1.73 m-2 responded well to the combination of corticosteroids and cyclophosphamide (86.90% vs. 57.33%, P=0.000; 81.48% vs. 64.10%, P=0.014; 83.17% vs. 55.17%, P=0.000).

Conclusion

The response to the combination of corticosteroids and cyclophosphamide might be well associated with baseline proteinuria, urinary osmotic pressure, and renal function in patients with IgAN.
Association of farnesyl diphosphate synthase polymorphisms and response to alendronate treatment in Chinese postmenopausal women with osteoporosis
Authors: Liu Yi , Liu Haijuan , Li Mei , Zhou Peiran , Xing Xiaoping , Xia Weibo , Zhang Zhenlin , Liao Eryuan , Chen Decai , Liu Jian , Tao Tianzun , Wu Wen , Xu Ling
Published: January 2024

Background

Genetic factors are important in the pathogenesis of osteoporosis, but less is known about the genetic determinants of osteoporosis treatment. We aimed to explore the association between the gene polymorphisms of key enzyme farnesyl diphosphate synthase (FDPS) in mevalonate signaling pathway of osteoclast and response to alendronate therapy in osteoporotic postmenopausal women in China.

Methods

The study group comprised 639 postmenopausal women aged (62.2±7.0) years with osteoporosis or osteopenia who had been randomly assigned to low dose group (70 mg/2w) or standard dose group (70 mg/w) of alendronate in this 1-year study. We identified allelic variant of the FDPS gene using the polymerase chain reaction and restriction enzyme Faul. Before and after treatment, serum levels of calcium, phosphate, alkaline phosphatase (ALP), cross linked C-telopeptide of type I collagen (β-CTX) were detected. Bone mineral density (BMD) at lumbar spine and proximal femur was measured. The association was analyzed between the polymorphisms of FDPS gene and the changes of BMD, bone turnover biomarkers after the treatment.

Results

The FDPS rs2297480 polymorphisms were associated with baseline BMD at femoral neck, and patients with CC genotype had significantly higher baseline femoral neck BMD ((733.6±84.1) mg/cm2) than those with AC genotypes ((703.0±86.9) mg/cm2) and AA genotypes ((649.8±62.4) mg/cm2) (P <0.01). No significant difference in BMD at lumbar spine was observed among different genotypes of FDPS. The percentage change of serum ALP level was significantly lower in patients with CC genotype (-22.9%) than that in those with AC genotype (-24.1%) and AA genotype (-29.8%) of FDPS after 12 months of alendronate treatment (P <0.05). Neither percentage change of BMD nor β-CTX level after alendronate treatment had association with FDPS genotype.

Conclusions

FDPS gene was probably a candidate gene to predict femoral neck BMD at baseline. FDPS gene alleles could predict change percentage of ALP after treatment of alendronate, but possibly had no significant relationship with the responsiveness of BMD to alendronate therapy.
Jaundice as a prognostic factor in patients undergoing radical treatment for carcinomas of the ampulla of Vater
Authors: Zhou Jianguo , Zhang Qian , Li Peng , Shan Yi , Zhao Dongbing , Cai Jianqiang
Published: January 2024

Background

Carcinomas of the ampulla of Vater (CAV) is a relatively rare malignant gastrointestinal tumor, and its postoperative prognostic factors have been well studied. However, as its first symptom, the impact of jaundice on the prognosis of CAV is not so clear. This study aims to explore the role of jaundice as a prognostic factor in patients undergoing radical treatment for CAV.

Methods

The clinical data of 195 patients with CAV who were treated in the Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from January 1989 to January 2013 were retrospectively analyzed. Among them, 170 patients with pathologically confirmed CAV entered the statistical analysis. Jaundice was defined as a total bilirubin serum concentration of ≥3 mg/dl.

Result

Of these 170 patients, 99 (58.20%) had jaundice at presentation. Jaundice showed significant correlations with tumor differentiation (P=0.002), lymph node metastasis (P=0.016), pancreatic invasion (P=0.000), elevated preoperative CA199 (P=0.000), depth of invasion (P=0.000), and tumor stage (P=0.000). There were more patients with pancreatic invasion in the jaundice group than in the non-jaundice group. Also, lymph node metastasis was more common in the jaundice group (n=26) than in the non-jaundice group (n=8). The non-jaundice group had significant better overall 5-year disease-free survival (72.6%) than the jaundice group (41.2%, P=0.013). Jaundice was not significantly correlated with the postoperative bleeding (P=0.050).

Conclusions

Jaundice in patients with CAV often predicts more advanced stages and poorer prognoses. Pancreatic invasion and lymph node metastasis are more common in CAV patients with jaundice. Jaundice is not a risk factor for postoperative bleeding and preoperative biliary drainage cannot reduce the incidence of postoperative complications.