Volume 95  ·  Issue 29  ·  2015

To compare the effectiveness and safety of ibuprofen, celecoxib and flurbiprofen axetil after arthroscopic rotator cuff repair.

From Dec., 2012 to Dec., 2012, 63 arthroscopy rotator cuff repaired patients in Department of Orthopedics&Traumatology, Beijing Jishuitan Hospital, were selected and divided randomized into 3 groups: flurbiprofen axetil, ibuprofen and celecoxib.Each group had 21 patients. All groups take drugs 5 days continuously after operation.In first five days postoperatively, visual analogue scale (VAS) was used to compare pain alleviation.The side effects were assessed among three groups.VAS, Shoulder evaluation functional score, range of shoulder forward elevation, external rotation and internal rotation were recorded, compared between the same patients preoperatively and postoperatively and compared also among three groups.

Pain was relieved postoperatively with time being in all patients.From 4 day postoperatively, flurbiprofen axetil showed significant difference on pain relieving compared with ibuprofen and celecoxib (P<0.05). Side effects of ibuprofen, celecoxib and flurbiprofen axetil was 33.3%, 14.3% and 9.5% separately.No significant difference was found among three groups.Preoperatively, VAS=7.2, SST=6.5, Constant=67.6, UCLA=17; FE=132.6°, ER=37.7°, IR=L1on average.One year postoperatively, in ibuprofen, celecoxib and flurbiprofen axetil group, VAS was 2.0, 2.1, 1.9; SST was 9.2, 8.5, 10.5; Constant was 82.7, 91.2, 90.5; UCLA was 29.9, 33.2, 30.3; FE was 151.2°, 150.0°, 160.3°, ER was 49.2°, 50.7°, 56.7°; IR was ip to T12, T12, T8 level separately. All patients showed significant improvement on VAS, function evaluation score and range of motion one year postoperatively and no significant difference were found among three groups.

Flurbiprofen axetil showed better result compared with ibuprofen and celecoxib on pain control, although all three COX inhibitors are highly-efficient and safe for rotator cuff repaired patients.There is no significant difference among three groups according to side effects and no delayed on tendon healing.

To analyze the causes of back pain after vertebroplasty or kyphoplasty.

1 863 patients with back pain who underwent vertebroplasty or kyphoplasty from Jan. 2004 to Dec. 2014 in Department of Spine Surgery, Beijing Jishuitan Hospital, were followed up for least 3 months after surgery with their back pain evaluated by VAS scores. Related information including preoperative, operative and postoperative factors was gathered. The VAS at last follow-up over 5 or the symptom relief less than 50% was considered as non-relieved, the correlations between the symptom relief and potential influencing factors were analyzed by the Spearman correlation.

Symptom relief was only correlated with postoperative complications (P<0.001). The back pain in 283 cases (15.2%) had not been relieved. Among them, 87 cases got fractures in other vertebrae (adjacent vertebrae in 67 cases, non-adjacent vertebrae in 20 cases); 3 cases got nonunion in the operated vertebrae; 1 case got postoperative infection; 6 cases got misdiagnosis and the other 186 cases had no known causes for the unrelieved pain.

Postoperative back pain after vertebroplasty or kyphoplasty may have variable causes, and some of which have not been entirely understood. If the symptoms are not alleviated or even aggravate after active symptomatic treatment and anti-osteoporotic therapy, underlying causes such as re-fracture, nonunion, infection, pathologic fracture should be sought out.

To compare and evaluate the effect of PFNA-Ⅱand PFNA for the treatment of femoral intertrochanteric fracture.

From August 2009 to August 2012, 238 patients with intertrochanteric fracture in Department of Orthopedics, Affiliated Jiangsu Shengze Hospital of Nanjing Medical University treated with PFNA-Ⅱ(n=112) and PFNA(n=126) were selected in our study. The two treatment groups were comparable in features before the fracture occurred. The clinical data of surgical trauma, complications and postoperative function of the two groups were statistically compared in our study.

The mean operation time in PFNA-Ⅱgroup was significantly shorter than that in PFNA group (54.7±12.1)min vs (67.5±12.9)min, P=0.000 2). Blood loss and fluoroscopy time differed significantly, (77.8±16.4) ml and (2.5±1.1)min in PFNA-Ⅱgroup compared with (110.6±21.9) ml and (3.2±1.4) min in PFNA group. Eight unilateral femoral shaft splits at the distal end of the nail were observed intra-operatively, 7 in PFNA group and 1 in PFNA-Ⅱgroup (P=0.049). During the follow-up period, there was one re-fracture and one implant failure during the follow up period in PFNA group, and only one implant failure in PFNA-Ⅱ group. Thirty-eight patients complained about hip pain and 46 thigh pain in PFNA groups. Nineteen patients complained about hip pain and 7 thigh pain in PFNA-Ⅱ groups. There were no significant differences in the final functional outcome between the two devices.

Compared with PFNA, PFNA-Ⅱobviously shows some advantages, namely easy operation, less blood loss, less operative time and less fluoroscopy time. However, there were no significant differences of functional outcome between the two nails.

To evaluate the relation of serum uric acid levels on admission with short-term clinical outcome and hemorrhagic transformation (HT) in patients with acute ischemic stroke treated with thrombolysis.

A total of 230 acute ischemic stroke patients treated with thrombolysis in our stroke unit from 2010 to 2013 were included. Demographics, disease severity, the uric acid levels on admission and hemorrhagic transformation were prospectively collected. At 90 days, the scores of the modified Rankin Scale>2 (mRS>2) was defined as poor prognosis and the scores of mRS≤2 was defined as excellent outcome. Stepwise Logistic regression models were used to analyze potential factors affecting the prognosis.

The levels of serum uric acid in the patients with excellent outcome were significantly higher than in patients with poor outcome [(375±42) μmol/L vs(250±36)μmol/L, P=0.0026]. Logistic regression analysis revealed that high level of serum uric acid was related to excellent outcome(OR=1.25, 95%CI, 1.04-1.47, P=0.013). The serum uric acid level of non HT patients was significantly higher than the HT patients[(350±51) μmol/L vs (282±38) μmol/L, P=0.015]. After adjustment for the influence factors including age and hypertension, the level of uric acid was still negatively correlated with HT.

Increased serum uric acid levels are associated with low incidence of HT and better prognosis in patients with stroke treated with reperfusion therapy.

To study the relationship between daytime fatigue and hyperarousal in patients with primary insomnia.

One hundred and sixty eighty patients with primary insomnia as research group and 149 healthy people as control group were recruited during November 2013 to December 2014 in the psychiatry department of the Third Affiliated Hospital, Sun Yat-sen University. The Hyperarousal Scale(HAS), Pre-Sleep Arousal Scale(PSAS), Fatigue scale-14(FS-14) and a visual analogue scale (VAS) were used to evaluate the symptom of hyperarousal trait, pre-sleep arousal, daytime fatigue and self reported sleep quality respectively.

The participants in research group had more severe symptoms of hyperarousal trait[(41.9±9.7) vs (27.6±7.0)], pre-sleep arousal[(42.0±7.3) vs (22.1±4.7)], daytime fatigue[(9.2±3.1) vs (3.0±0.7)] than those in control group. According the multiple linear regressions, the daytime fatigue in research group was positively related not only to sleep quality, but also to hyperarousal trait and pre-sleep arousal.

Hyperarousal is an important factor which could affect the daytime fatigue in patients with primary insomnia and should be given more attention to.

To investigate the value of virtual endoscopy in diagnosis and treatment of hydrocephalus after failed shunt.

we performed magnetic resonance imaging (MRI) 3D-SPACE sequence scanning for 76 patients suffering from hydrocephalus after failed shunt. Based on the DICOM data of 3D-SPACE sequence, we three-dimensionally reconstructed the ventricles and simulated virtual endoscopy with 3D-Slicer software. Surgical strategy was made after evaluation of virtual endoscopy images.

Virtual endoscopy based on 3D-SPACE images was helpful to depict the aqueduct or foramen of Monro obstructions, and confirm the reason of shunt failure. Finally, there were 56 hydrocephalus patients (73.7%) were treated with endoscopic assisted third ventricle fistula (ETV), without shunt catheter insertion.

For patients suffering from shunt failure of hydrocephalus, virtual endoscopy has high diagnostic yield rate for providing more detailed anatomical information than conventional MR imaging. Hence, this advanced imaging method is helpful for surgical treatment strategy decision making.

To assess the feasibility of individual contrast injection protocols in triple-rule-out computed tomography examination using a dual-source Flash-chest-pain technique.

From April to August 2014, 63 patients with undifferentiated acute chest pain underwent ECG-synchronized dual-spiral chest CT angiography. 31 Patients, who all had low (<65 bpm) and stable heart rate underwent TRO CT angiography in a Flash mode, with an individual triphasic contrast protocol based on weight (350 mgI/ml, A: 0.7 ml/kg, setting 10 s duration time; B: 8 s mixture of the contrast agent and saline at the same rate; C: 6-7 s saline at the same rate). In contrast, the other patients, who had random heart rate, underwent TRO CT angiography in a traditional retrospectively mode with an identical biphasic contrast protocol(350 mgI/ml, A: contrast agent 90 ml, B: saline 40 ml, injection rate 5 ml/s). Quantitative image analysis assessed vessel attenuation of aorta, coronary and pulmonary artery, signal-to-noise ratio (SNR) and contrast-to noise ratio (CNR). Subjective image was assessed on a 5 point scale (1: excellent, 5: non-diagnosis) by two blind observers. The effective dose was calculated from the dose length product (DLP) using a conversion coefficient of 0.017 mSv·mGy^-1·cm^-1.

There was no significant difference of aorta and coronary artery attenuation, noise, SNR, CNR or subjective image quality between both patient groups. Pulmonary artery attenuation was lower in test group than in control group, but it also can meet the diagnostic criteria. Moreover, the mean contrast agent and the effective dose were lower in test group than in control group(72±10)vs (90±0) ml, P<0.01 and (3.0±0.3) vs (18.8±2.7) mSv,P<0.01.

As to patients with low and stable heart rate, this individual contrast protocol along with dual-source high-pith technique, is capable of achieving satisfactory image which could meet the diagnostic requirements with lower contrast agent and lower effective dose.

To investigate the relationship between structural abnormalities with semi-quantitative score of CT and changes of oxygenation function in patients with post primary tuberculosis.

110 in-patients with post primary tuberculosis in Haihe clinical college of Tianjin medical university from January 2014 to August 2014 were enrolled in this study, all patients underwent CT and blood gas analysis. All lesions in lung as a whole and different CT signs of lesions were evaluated by retrospective semi-quantitative score respectively, total scores obtained by adding the scores of different lesions. The correlation between these scores and the results of blood gas analysis were evaluated. CT scores were compared between group 1 (PaO₂/FiO₂<300 mmHg) and group 2 (PaO₂/FiO₂≥300 mmHg) of patients.

Overall score of lung lesions and total scores which obtained by adding the score of different signs in patients showed correlation with PaO₂/FiO₂, and the method of overall score of lung lesions was easy to do. Scores of nodules and tree-in-bud pattern, consolidation, bronchial lesions, cavity showed correlation between PaO₂/FiO₂. There was no correlation between score of ground-glass opacity and PaO₂/FiO₂. Nodules and tree-in-bud pattern were more common in post primary tuberculosis, 87.3% (96/110) and 70% (77/110) respectively.Lobular consolidation was dominant in consolidation of patients, 83.6%(92/110). Bronchial wall thickening and bronchiectasis had higher incidence in larger airways, 87.3% (96/110) and 75.5% (83/110) respectively. Cavities were given priority to with thin walled, 53.6% (59/110). Overall score of lung lesions and scores of bronchial lesions, consolidation, cavity in groups 1 were significantly higher than group 2.

Semi-quantitative score of CT can better quantify structural abnormalities of the lung, sensitively reflect changes of oxygenation, and bronchial lesions play an important role in the process of post primary tuberculosis.

To evaluate the utility and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU).

From Aug 2013 to Aug 2014, out of 492 patients admitted into Beijing Haidian Hospital ICU, 86 patients were included according to the study.Data including age, sex, APACHE, SAPS and Disease type, were processed using SPSS16.0.

A total of 104 FOBs were performed in 86 patients P who were admitted to the ICU.FOB was useful in 64% of diagnostic procedures and 81% of therapeutic procedures, with an overall utility of 72%.The utility according to pneumonia in 32 cases, utility of 51%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 20 cases, utility of 75%; airway exploration in 18 cases, utility of 75%; hemoptysis in 3 cases, utility of 100%; and difficult airway intubation in 5 cases, utility of 100%.A decrease in pulse-oximeter oxygen saturation (SpO₂) of >5% during FOB was present in 65% cases.Mean SpO ₂ before FOB was 94.0%±5.2%.During the procedure, the mean lowest SpO₂ was 86.8%±8.4%(P<0.000 1)and the mean postprocedural SpO₂ was 93.0%±4.5%(P=0.82). The other minor complications were present in 3.9% of cases.

FOB has a great application field for the patients in ICU.The utility and safety of this operation is credible.

To analyze the clinical characteristics of relapsing polychodritis (RP).

Clinical features and laboratory data of 131 patients with RP were analyzed retrospectively.

The average age at onset was (44±14) years (ranging from 9 to 76). Male to female ratio was 1.22∶1. The most common onset symptom was respiratory system symptom (61.8%), followed by auricle lesions (16.0%), articular cartilage (15.3%), ocular region (7.6%), internal ear system (5.3%), nasal cartilages (4.6%), skin (2.3%) and nervous system (0.8%). During the whole course of the disease, 81.7% of the patients endured a respiratory system involvement; 77.9% and 56.5% of the patients suffered joint symptoms and nasal cartilages lesions, respectively; the involvement of auricle lesions, ocular region and internal ear system were 54.2%, 35.1% and 33.6%. Comparatively, the occurrence rates of skin lesion (10.7%), neurologic disorder (9.2%) and kidney system lesions (1.5%) were low. Analyzing of the laboratory examination data showed that 38.2% and 43.5% of the patients had an increase in white blood count (WBC) and platelet, 86.3% and 82.4% patients showed raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values.

RP is a multi-system involvement disease, which has complicated clinical manifestations. Respiratory tract is the most common site involved, and respiratory system involvement is a prediction of unfavourable prognosis.

To evaluate the anti-apoptosis role of bone marrow mesenchymal stem cells (BMMCs) transplantation to cell cerebral brain ischemia mice.

BMMCs were separated through Ficoll from bone marrow, after amplified in vitro, flow cytometry was used to identify the surface markers. Then cells were transplanted into Middle cerebral artery occlusion(MACO)mice, in situ cell death detection kit and Western blot were used to examine the cell apoptosis. Immunofluorescence and Western blot were used to detect the expression of eNOS, ICAM-1, CD31 which are related to the repair of vascular endothelial cells.

After BMMCs transplantation, the number of apoptosis cells was decreased from (78.2±1.4) to (12.8±3.0), P<0.05. The expression of eNOS (80.0±6.2 vs 31.2±1.6,P<0.01) and CD31 (85±3 vs 45±5,P<0.01), were higher than MACO, while ICAM-1 was lower than MACO (34.1±2.2 vs 85.2±2.8,P<0.01).

BMMCs reduce the cell apoptosis of ischemia mice through regulate the expression of vascular endothelial cells relate genes.

To explore the methylation level of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) gene promoter region in mitochondria of trophoblasts incubated with long-chain fatty acids and the time-effect of methylation modification.

Primary human trophoblast cells and HTR8/Svneo cells were incubated with free fatty acids of various lengths. Long-chain free fatty acids (LC-FFA) was experimental group, short-chain fatty acids (SC-FFA) and medium-chain fatty acids (MC-FFA) were control groups, and blank control was without free fatty acid. Collecting cells and extract DNA at 24, 48 and 72 h incubation respectively. Predicted CpG island location access to 2 000 bp DNA sequences upstream of the transcription start site of LCHAD gene. We designed methylation detection sites and primer originally. Methylation of CpG sites in LCHAD gene promoter region were detected by MassARRAY and analyzed statistically.

(1) We detected methylation of 65% (11/17) CpG sites, including 8 single sites and 3 composite sites, in ampliconic sequences. These CpG sites were at positions: -984, -960, -899, -853, -811, -796, -774, -727, -615, -595, -579, respectively. In different groups methylation level and changes of every site showed differences with the most significant changes at -899 site. (2) Methylation of CpG island in LCHAD gene promoter region: ① Methylation of CpG island in LC-FFA and MC-FFA groups showed rising trend with the time: Methylation level of LC-FFA group at 72 h (0.55±0.08) was significantly higher than that of 48 h (0.35±0.12) and 24 h (0.31±0.04) (P<0.05). Methylation level of MC-FFA group at 72 h (0.44±0.05) was significantly higher than that of 24 h (0.31±0.04) (P<0.05). ② Methylation of CpG island in LCHAD gene promoter region in different groups at different times: Methylation level of LC-FFA group at 72 h was significantly higher than that of the other two groups at 72, 48 and 24 h (P<0.05). (3)Methylation of 11 CpG sites in LCHAD gene promoter region in different groups at 72 h: Methylation level of -899 site in LC-FFA and MC-FFA groups were significantly higher than that of other sites (P<0.05). (4) Methylation level of -899 site in LCHAD gene promoter region in LC-FFA group showed rising trend with the time: (72 h (0.34±0.15), 48 h (0.14±0.05) and 24 h (0.10±0.02),P<0.05). Methylation level of LC-FFA group at 72 h was significantly higher than that of the other two groups at 72, 48 and 24 h (P<0.05).

Methylation modification effect on LCHAD gene promoter region in trophoblast cells incubated with long-chain fatty acids is more significant than with medium-chain and short-chain fatty acids and shows obvious time-effect as incubation time prolonged. The changes at -899 site dominate the degree of methylation in LCHAD gene promoter region.

To establish the research model of ovarian carcinoma in nude mice, and to explore the effect of Paris Phyllin Ⅶ combined with silica nano complex on theinhibition and the antioxidant ability of ovarian carcinoma in nude mice.

Nude mice modelswith ovarian carcinoma were established by axillary subcutaneous inoculation of human SKOV3/DDP resistant ovarian cancer cell 200 μl and were used in the experiment. Treating the nude mice with Paris Phyllin Ⅶ combined with silica nano complex by gavagefor 15 daystoobserve theweight change of the nude mice, tumor inhibition effect and changes of serum antioxidant capacity.

Compared with the negative control group, tumorinhibition rate increased significantly in Paris Phyllin Ⅶ combined with silica nano complex treatment group, and was higher than that in both Paris Phyllin Ⅶ treatment only and silica nano composites treatment onlygroup.The serum superoxide dismutase (SOD) and total antioxidant capacity (T-AOC)level ofParis Phyllin Ⅶ combined with silica nano complex treatment group was significantly higher than that of control group, Paris Phyllin Ⅶ treatment only and silica nano composites treatment onlygroup. The serum malonaldehyde(MDA) level of Paris Phyllin Ⅶ combined with silica nano complex treatment groupwas significantly lower than that of the negative control group.

Paris Phyllin Ⅶ combined with silica nano complex treatment can inhibit the ovarian carcinoma in nude mice, which may mediate by the enhancement ofantioxidant capability innude mice with ovarian cancer.

We conducted a Meta-analysis to explore the relationship between different locations of cerebral artery stenosis and the risk factors in Chinese ischemic cerebral artery disease patients.

We systematically searched electronic literature databases (last search 31 December 2014) for studies reporting the association between cerebral artery stenosis locations and risk factors of ischemic cerebral artery disease. We grouped patients into two groups, only intracranial artery stenosis group and only extracranial artery stenosis group, by the location of cerebral artery stenosis. Meta-analysis was carried out by Review Manager(Version 5.2) provided by Cochrane Collaboration. After the heterogeneity test, the odds ratios (OR) or the mean differences (MD) and 95% confidence interval (95%CI) were combined. The publication bias and sensitivity analysis were tested as while.

A total of thirteen studies were identified, which are including 1 672 patients with intracranial artery stenosis and 1 239 patients with extracranial artery stenosis. The only intracranial artery stenosis patients tend to be younger than the patients of the other group. The combined MD (95%CI) of age was -4.57(-8.22--0.91, P=0.01). Besides, the proportion of smokers in the only intracranial artery stenosis patients was higher than the other group. The combined OR (95%CI) of smoking was 0.08(0.68-0.93, P=0.005).

As to Chinese ischemic cerebral artery disease patients, visible differences of age and smoking were detected between the only intracranial artery stenosis group and extracranial group. However some risk factors of cerebral artery stenosis which were proved by large scale studies, such as hypertension, diabetes and dyslipidemia, were failed to test the visible difference between the two groups.

POEMS syndrome, also known as Takatsuki syndrome, Crow-Fukase syndrome and osteosclerosing myeloma, is a rare clonal plasma cell disease characterized by polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes^[1,2,3]。 Although POEMS syndrome is rare, it has a high rate of misdiagnosis and poor prognosis^[1]。 We retrospectively collected the clinical data of 3 cases of POEMS syndrome in the Department of Neurology of China-Japan Friendship Hospital, and analyzed their clinical characteristics, especially neuroelectrophysiological, bone marrow and neuropathological manifestations, so as to strengthen the understanding of the disease and reduce the misdiagnosis rate.

A 27-year-old female was admitted to the hospital on 14 June 2014 due to "sudden disadvantageous speech 2 d". After waking up in the morning 2 days before admission, he found unfavorable speech and difficulty in finding words, but understood others' speech, was unresponsive, and accompanied by abdominal distension. B-ultrasound in a maternity hospital showed peritoneal effusion. After symptomatic treatment, the above symptoms did not improve significantly. He went to the emergency department of Beijing Chaoyang Hospital 1 day before admission. CT and MRI of the head showed low-density foci in the left frontal and temporal lobes, and he was admitted to the neurology department for acute cerebral infarction. Embryo transfer was performed 10 days before admission. Married, menarche at the age of 14, irregular, about once every 40 days, lasting for 3 to 4 days. Pregnancy 0 delivery 0. Had a history of uterine fibroids 4 years ago. Physical examination: Body temperature 37.8 ℃, blood pressure 123/76 mmHg (1 mmHg =0.133 kPa), clarity, incomplete mixed aphasia, and other nervous system physical examination was roughly normal. In medical examination, the heart auscultation was roughly normal, and the breathing sound of lung auscultation was coarse. Abdominal distension, no abdominal wall varicose veins, no liver palm, spider nevus, no tenderness, rebound pain and muscle tension in the whole abdomen. Positive fluid wave tremor, positive mobile voicing, and mild edema of both lower limbs.

miRNA is a class of single-stranded non-coding RNA that is highly conserved by endogenous evolution and has a wide range of biological functions. In the past decade or so, rapid progress has been made in the field of biology around miRNA biosynthesis, transcription regulation and function. The emergence of this new type of small molecule miRNA expands the complexity of gene regulatory network and deepens our understanding of the pathogenesis and pathological mechanisms of human disease. Ventricular remodeling is the pathological basis of heart failure. It is a pathological change of the heart under long-term stress and/or neuroendocrine factors stimulation, including morphological and structural changes of cardiomyocytes and non-cardiomyocardial components (fibroblasts and endothelial cells, interstitial). At present, miRNA has been widely studied in the cardiovascular field, involving heart development, atherosclerosis, ischemic heart disease (myocardial infarction), heart failure and arrhythmia, etc. This article focuses on its regulatory role in the pathological process of heart failure-ventricular remodeling.

irisin is a new muscle factor reported by the Spiegelman lab in Nature in early 2012^[1]。 The discoverer named it after Iris, the rainbow goddess in Greek mythology, metaphorically, it acts as a messenger of skeletal muscle, transmitting signals from skeletal muscle and communicating the relationship between skeletal muscle and peripheral tissues. Since it was reported, journals such as Science, Nature and Cell have published review articles, believing that irisin may become a new target for the treatment of metabolic diseases^[2,3,4,5]。

The pathological mechanism of sepsis caused by bacterial infection is mainly the generation of "inflammatory storm", including a series of immune cell activation and inflammatory factor release. natural killer T cells (NKT cells) are a subpopulation of T cells, and their role in inflammatory response caused by different causes has been widely paid attention to. At present, it is believed that they also play an important role in sepsis.