Volume 100 ·  Issue 15 ·  2020

The prevalence of knee osteoarthritis (OA) reaches 14.3% in Chinese people over 50 years old^[1]； It is the main cause of disability of middle-aged and elderly people, and brings huge medical and economic burden to society. Knee OA treatment options are diverse, and previous guidelines recommended non-pharmacological treatments such as exercise and weight loss as cornerstones^[2,3,4]。 Due to the differences in culture and living habits, if the existing foreign guidelines are directly extended to Chinese patients, they may face problems such as insufficient implementation. At present, there is no clinical guideline for exercise therapy of patients with knee OA in China. Therefore, we developed guidelines for exercise therapy of knee OA for the Chinese population based on literature and clinical experience, aiming to provide evidence-based recommendations for exercise therapy.

To explore the relationships between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and KIM-based white matter lesion (WML) and carotid atherosclerotic plaque.

From November 2018 to July 2019, 155 patients admitted to the Department of Neurology of the First Affiliated Hospital of Anhui Medical University were enrolled, with 125 cases of brain MRI manifestations of white matter lesions allocated to WML group and 30 cases of normal MRI in control group (NC group). According to KIM classification, WML patients were further divided into juxtaventricular white matter lesion (JVWML) group (n=30), periventricular white matter lesion (PVWML) group (n=33), juxtacortical white matter lesion (JCWML) group (n=30) and deep white matter lesion (DWML) group (n=32). Clinical Data of vascular risk factors in all subjects was collected and reviewed. Serum Lp-PLA2 content was determined by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). Carotid atherosclerosis plaques were detected by carotid artery ultrasonography and divided into stable and vulnerable plaques, and thus total score of each plaque was subsequently calculated according to the Crouse method.

The Lp-PLA2 ((117±37) ng/ml vs (95±30) ng/ml), stable Crouse plaque integral (CPI) (0 (0,2.5) vs 0) and unstable CPI (0 (0,3.4) vs 0) in the WML group were significantly higher than those in the NC group (all P<0.05). Lp-PLA2 ((138±41) ng/ml) and unstable CPI (1.5(0,3.8)) in the PVWML group were significantly higher than those in the NC group (allP<0.05). Lp-PLA2 levels in the PVWML group were significantly higher than those in the JVWML group ((100±28) ng/ml) and JCWML group ((101±27) ng/ml) (allP<0.05). Correlation analysis revealed that blood glucose (r=0.600, P=0.000), triglyceride (TG) (r=0.371, P=0.034), low-density lipoprotein cholesterol (LDL-C) (r=0.367, P=0.036) and Lp-PLA2 (r=0.567, P=0.001) were positively correlated with unstable CPI in PVWML group, while it is negatively correlated with HDL-C (r=-0.368, P=0.035). Multivariate linear regression of all relevant factors and unstable CPI in the PVWML group showed that blood glucose (b=0.463, P<0.01) and Lp-PLA2 (b=0.347, P<0.05) were still positively correlated with unstable CPI.

Serum Lp-PLA2 is an indicator of atherosclerosis, which is associated with carotid instability plaques in periventricular WML, suggesting that inflammatory mechanism plays an important role in the development of ischemic white matter lesions.

To observe in-hospital and 1-year prognosis of patients with acute myocardial infarction after one year of coronary stent implantation.

From January 2015 to February 2018, 329 patients with acute myocardial infarction (AMI) after 1 year of coronary artery stent implantation were enrolled and received coronary angiography. These patients were divided into two groups (very late stent thrombosis (VLST) group and denovo group) according to whether the occurrence of acute myocardial infarction was due to stent thrombosis (ST), and in-hospital and long-term (1 year) outcomes were compared between the two groups. The primary end points included cardiac death and recurrent acute myocardial infarction. The secondary study end points included target lesion revascularization (TLR), re-stent thrombosis, heart failure, and stroke.

In total, 72.9% of patients with AMI after one year of coronary stent implantation were caused by VLST. There were no significant differences of both primary and secondary end-point events between the two groups during in-hospital period (3.3% vs 3.4%, P=0.987; 5.4% vs 4.5%, P=0.956). After a mean follow-up of 1 year, there were no significant differences of the primary end-point events between the two groups. The secondary end-point events and TLR incidence were higher in the VLST group (16.3% vs 6.7%, P=0.026; 9.6% vs 2.2%, P=0.026). Kaplan and Meier survival analysis showed that there were no significant differences of the 1-year cumulative non-primary and non-secondary end-point survival rates between the two groups (P=0.124 and 0.004, respectively). COX regression analysis showed that heart function ≥Ⅲ level (Killip’s) and VLST were independent predictive risk factors for end-point events, while postprocedural thrombolysis in myocardial infarction (TIMI) flow grade 3 was an independent protective factor.

In-hospital end points show no significant differences between VLST and denovo groups patients. However, the VLST group patients have a poor prognosis and a higher proportion of TLR after 1 year follow-up. The patients with heart function ≥Ⅲ level (Killip’s) or VLST have a poor prognosis, while the patients with postprocedural TIMI flow grade 3 have a good prognosis.

To analyze whether there is a difference in the influence of coronary artery disease (CAD) on the clinical features and prognosis of three different types of heart failure patients.

Complete clinical data of 1 520 hospitalized patients with heart failure from Tianjin Medical University General Hospital and Tianjin Chest Hospital from March 2014 to February 2016 was retrospectively reviewed. According to left ventricular ejection fraction (LVEF), the patients were divided into three groups: heart failure with reduced ejection fraction group (HFrEF), heart failure with mid-range ejection fraction group (HFmrEF)and heart failure with preserved ejection fraction group (HFpEF). Each group was further classified into two subgroups according to absence or presence of CAD (No CAD′ and 'With CAD′). In the HFrEF group, 197 patients were categorized into 'No CAD′ sub-group while 435 patients were into 'With CAD′ sub-group. Likewise, 63 patients in HFmrEF group fell into 'No CAD′ sub-group while 367 were into 'With CAD′ sub-group. Seventy two patients in the HFpEF group were in the 'No CAD′ sub-group with 386 in the 'With CAD′ sub-group. Clinical features and 2-year prognosis between different subgroups were compared.

(1) The relationship between CAD and clinical features of different types of heart failure: the proportions of HFrEF, HFmrEF and HFpEF combined with CAD were 68.8%, 85.3% and 84.3%, respectively (P<0.05). Compared with the 'No CAD′ subgroups, patients in the 'With CAD′ subgroups were older, and had higher NT-proBNP levels, higher rates of hypertension and diabetes, and lower rates of atrial fibrillation. Also, there were more use of antiplatelet and nitrate drugs in the 'With CAD′ sub-groups ( P<0.05). (2) Risk of different types of heart failure combined with CAD: after multivariate adjustment, HFrEF had a lower risk of CAD (HFrEF vs HFmrEF: RR=0.389, 95%CI 0.281-0.540; HFrEF vs HFpEF: RR=0.408, 95%CI 0.298-0.560). (3)The influence of CAD on the prognosis of different types of heart failure: CAD increased the risk of mortality in the HFrEF group (HR=1.631, 95%CI 1.119-2.377), and cardiovascular events in all three types of heart failure (HR: HFrEF 1.725, 95%CI 1.325-2.246; HFmrEF 1.815, 95%CI 1.144-2.879; HFpEF 1.900, 95%CI 1.218-2.963).

Patients with HFmrEF and HFpEF have a higher prevalence and risk of CAD than patients with HFrEF. CAD is associated with an increased risk of cardiovascular events in all types of heart failure and increases the risk of all-cause mortality among HFrEF group. CAD is an important factor influencing the clinical features and prognosis of patients with all types of heart failure.

To compare the radiation dose and image quality of noncontrast chest CT and detection of ground-glass opacity pulmonary nodules (GGN) in domestic 128-slice spiral CT with the other CT scanners from three main stream manufacturers.

From May 8, 2018 to October 31, 2018, noncontrast chest CT images from Neusoft 128-slice CT (75 males, 25 females, (42±16) years), dual-source 64-slice CT (53 males, 47 females, (50±16) years) and dual-source 128-slice CT scanners(69 males, 31 females, (62±17) years), Toshiba 128-slice CT (51 males, 49 females, (58±13) years) and GE 128-slice CT scanner (55 males, 45 females, (60±10) years) were collected in Eastern Theater Command and Tianjin People’s Hospital. Radiation dose and image quality were evaluated.GGN detected both in Neusoft CT and dual-source CT scanners were used to analyze the displaying ability of lesions.

The noise in lung window of Neusoft CT ((37.8±4.9) HU) was higher than that of other mainstream CT scanners, and the noise in mediastinal window ((8.4±1.9) HU) was lower than that of GE 128-slice CT ((9.8±3.2) HU), but higher than that of dual-source CT and Toshiba 128-slice CT ((6.9±3.5)HU) (P<0.05). The absolute value of lung SNR in Neusoft CT was lower than that of other mainstream CT scanners, and the SNR in aorta (4.6±1.3) was lower than those of dual-source CT and Toshiba 128-slice CT(6.8±2.2) (P<0.05), but was not statistically significant compared with GE 128-slice CT (5.0±1.7). The mean CT value of upper lung ((-863±31) HU) at Neusoft CT was higher than 128-row dual-source CT ((-869±35) HU), and the mean CT value of aorta ((37±7) HU) was lower than that of Toshiba 128-slice CT((42±7) HU) and GE 128-slice CT ((45±9) HU) (P<0.05), while the mean CT values of the remaining lung and aorta were not statistically significant (P>0.05). The two readers had good to excellent consistency for image quality in five scanners (the highestkappa value=0.984). The delineation ability of Neusoft CT for GGN boundary was lower than that of dual-source CT (P<0.05), but had similar abilities to display the solid components, lobulation, burring, vacuoles, vascular bundle sign and pleural depression sign of GGN (allP>0.05). Radiation dose of Neusoft CT was lower than Toshiba 128-slice CT, but higher than dual-source 64-sliceCT and GE 128-slice CT scanners (P<0.05).

With lower radiation dose than Toshiba 128-slice CT, Neusoft CT chest examination can meet the requirements of clinical diagnosis, but higher radiation dose and the lower image quality than dual-source CT and GE 128-slice CT shown in this study indicate further improvement is needed in terms of software and hardware.

Non-invasive prediction of IDH1 mutations by establishing a quantitative radiographic model based on DTI-based whole-tumor texture analysis.

Preoperative MRI images of patients with surgically confirmed astrocytoma were collected in the First Affiliated Hospital of Soochow University from February 2016 to June 2019, including T₁WI, T₂WI, DTI, and T₁-contrast enhancement images.A total of 38 patients were included, consisting of 12 mutants and 26 wilds, 20 males and 18 females, the average age was (49±15) years old.The ROIs were drawn on each level of the T₂WI image using MaZda software and copied to the ADC and FA maps to extract texture feature parameters. The LASSO regression was used to determine the best radiomics features, radiological scores were calculated, and binary Logistic regression was used to construct a prediction model, then the ROC curve was used to analyze the diagnostic efficiency and the calibration curve was used to evaluate model prediction performance.

The four most valuable radiomics features were determined by LASSO regression, and then the radiomics scores and Logistic regression models of each patient were established. The radiomics scores of the wild and mutant groups were 2.3±0.3 and 1.8±0.4. There were significant differences between the groups (P<0.05). The ROC curve analysis showed an AUC of 0.837 with sensitivity and specificity of 91.7% and 61.5%, respectively. The Logistic regression model had good predictive performance with AUC of 0.907, sensitivity and specificity of 91.7% and 84.6%.

DTI-based whole tumor radiomics model is benefit for predicting astrocytoma IDH1 mutations.

To discuss the diagnostic value potential of ¹⁸F-FDG PET/CT and intravoxel incoherent motion (IVIM) in genotype EGFR of lung cancer.

A total of 116 cases proved pathologically pulmonary space occupying lesions (72 males, 44 females; age range was 31-85 years; 37 cases of high differentiation; 53 cases of middle differentiation, 26 cases of low differentiation) were prospectively collected from August 2017 to March 2019 in Henan Provincial People′s Hospital. EGFR gene detection was performed in 50 patients (wild type 20 cases, mutant 30 cases). Whole body PET/CT and lung MR-imaging were performed before treatment in all patients. Comparison of PET/CT, IVIM semi-quantitative parameters between positive and negative of EGFR by Student-t test or Mann-Whitney U test. Evaluation diagnostic efficacy of each parameter to EGFR by drawing ROC curves. The optimum diagnostic threshold, specificity, sensitivity, positive predictive value, negative predictive value and the diagnostic accuracy were calculated. The diagnostic accuracy of ¹⁸F-FDG PET/CT combined with IVIM was calculated.

The quantitative parameters standard intake(SUV), apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D^*), perfusion fraction (f) were 8.7±3.5, (1.59±0.26) ×10^-3 mm²/s, (1.04±0.12)×10^-3 mm²/s, (3.9±3.0)×10^-2 mm²/s, 0.43±0.16 and the above parameters of the wild group were 14.3±3.3, (1.34±0.26)×10^-3 mm²/s, (0.89±0.12)×10^-3 mm²/s, (3.5±2.5)×10^-2 mm²/s, 0.40±0.11, respectively. The difference of quantitative parameters SUV (t=4.196, P=0.0001), ADC (t=2.502, P=0.0018), D (t=3.158, P=0.006) between the EGFR mutant group and the wild group was statistically significant. The difference of quantitative parameters D^* (t=0.361, P=0.721), f (t=0.627, P=0.536) was not statistically significant. ROC curve was drawn and the area under the curves for diagnosis of EGFR mutations by SUV, ADC, D, D^*, f was 0.880, 0.755, 0.820, 0.575, 0.550. The diagnostic accuracy of these parameters above mentioned was 80.0%, 76.7%, 73.3%, 66.7%, 53.3% respectively. The diagnostic accuracy of SUV combined with ADC, D values was 83.3% and 80.0%.

PET/CT and IVIM have certain diagnostic value for EGFR typing of lung cancer gene.

To investigate the differences in efficacy between drug-eluting beads transbronchial arterial chemoembolization (DEB-BACE) combined with systemic chemotherapy and systemic chemotherapy alone for unresectable lung squamous cell carcinoma.

Totally 60 cases of unresectable lung squamous cell carcinoma undergoing systemic chemotherapy in Yancheng Third People Hospital were retrospectively selected as the research object. According to patients′ wishes, they were divided into chemotherapy-only group (group A) and combined treatment group (group B). Group A received gemcitabine combined with cisplatin chemotherapy. DEB-BACE was applied in the first half, and systemic chemotherapy was administered in the second half (starting 3 d after BACE). The first half and the second half of the chemotherapy dose were 1/2 of the drug dose in the chemotherapy alone group. The short-term efficacy, incidence of toxic side effects, peripheral blood T lymphocyte subsets, serum vascular endothelial growth factor (VEGF) levels, and survival time were compared between the two groups.

After 2 cycles of treatment, the total effective rates of group A and group B were 50.0% (15/30) and 76.7% (23/30) (P<0.05), the incidence of nausea and vomiting (63.3% vs 20.0%), decreased appetite (76.7% vs 43.3%), hair loss (86.7% vs 40.0%), and bone marrow suppression (40.0% vs 10.0%) in group A were higher than in group B (all P<0.05). After 2 cycles of treatment, the levels of CD3⁺, CD4⁺and CD4⁺/CD8⁺in the two groups were higher than before treatment (group A: 47.7%±6.6% vs 52.3%±7.7%, 31.5%±4.9% vs 34.7%±5.8%, 1.05±0.24 vs 1.18±0.32; group B: 49.2%±7.0% vs 62.0%±14.0%,29.2%±5.5% vs 42.2%±7.3%, 1.07±0.26 vs 1.39±0.42; all P<0.05), while the level of CD8⁺was lower than before treatment (group A: 30.4%±5.4% vs 24.5%±4.8%; group B: 29.5%±4.1% vs 21.1%±4.5%; all P<0.05). The CD3⁺, CD4⁺, and CD4⁺/CD8⁺ levels in group A were lower than those in group B (P<0.05), while CD8⁺level was higher than in group B (P<0.05). After 2 cycles of treatment, the VEGF levels in the two groups were lower than before treatment (group A: (423±85) vs (352±64) ng/L; group B: (404±114) vs (296±66) ng/L; P<0.05), and the VEGF level in group A was higher than that in group B (P<0.05). The 1-year survival rates of groups A and B were 54.9% and 77.9%, and the 2-year survival rates were 17.2% and 41.7% (Log rank χ ²=4.750, P=0.029).

DEB-BACE combined with systemic chemotherapy is superior to systemic chemotherapy in the treatment of unresectable lung squamous cell carcinoma. It can reduce toxic and side effects, improve immune function and prolong survival time, which is worthy of clinical application.

To present the technique and clinic effect of the combined method of proximalization of the patella and double boundle reconstruction of medial patellofemoral ligament (MPFL) with adductor magnus tendon autograft for the treatment of habitual dislocation of patella (HDP) in adolescent.

From August 2016 to August 2018, a total of 33 consecutive skeletally immature adolescent patients (37 knees) with HDP were surgically treated in Beijing Jishuitan Hospital and were retrospectively reviewed. Among them, 10 patients (12 knees) with severe quadriceps contracture underwent the index comprehensive procedure. There were 4 males and 6 females with a mean age of (12.1±1.4) years (10 to 14 years old) at the operation. Before surgery and at the final follow-up, subjective symptoms were scored by Lysholm knee score, physical examination and radiological assessment were performed.

of patellar tracking were assessed by congruence angle and lateral patellofemoral angle. Results Patients were followed up for an average period of 23 months (12-36 months). No infection, patella redislocation were observed in all cases. Lysholm scores improved from 77±9 before surgery to 96±6 at the final follow-up (t= −23.155, P<0.05). There was a statistically significant improvement in the congruence angle, from 72.4°±17.2° preoperatively to -7.5°±4.8° at the final follow-up (t=21.392, P<0.01) and in the lateral patellofemoral angle, from -64.6°±9.4° preoperatively to 6.5°±3.7° at the final follow-up (t=-22.874,P<0.01).

In this short term study, the novel comprehensive procedure, including proximalization of the patella and double boundle reconstruction of MPFL with adductor magnus tendon autograft, treats HDP effectively in skeletally immature adolescent patients with severe quadriceps contracture.

To investigate the preoperative constitutional varus alignment (CA) inpatients withvarus osteoarthritic knees and coronal femoral lateral bowing (FLB) by comparing the femoral axis of the patients and volunteers′ with straight femoral shaft (SFS) and healthy knees, which would be used to guide the selection of valgus correction angle(VCA) of distal femur in total knee anthroplasty (TKA).

From January 2018 to December 2018, 45 nonconsecutive patients (90 knees) with varus osteoarthritic knees and obvious FLB (>5°) received primary TKA,and 50 limbs with healthy knees and SFS in 25 volunteers were studied at Xinqiao Hospital.The medial proximal femoral angle (MPFA) and anatomic lateral distal femoral angle (a-LDFA) were measured and compared between the two groups.The VCA formed by distal femoral mechanical axis (DMA) and distal femoral anatomic axis (DAA) in patients and the VCA based on neutral mechanical axis (NMA) in volunteers were also compared. The Pearson′s correlation analysis was performed between the angle of bowing (α) and the VCA based on NMA in patients. The measurement data was compared witht test between the two groups.

The results showed that the MPFA and the a-LDFA were not significantly different between the volunteers with SFS and patients with FLB (MPFA:84.9°±3.7° vs 85.6°±1.8° and a-LDFA:81.7°±1.7° vs 81.2°±1.6°, t=1.26, 1.70, both P>0.05). The VCA based on NMA in volunteers with SFS was 5.5°±0.6°(4.5°-7.4°), the preoperative DAA-DMA angle was 5.3°±0.7°(4.3°-7.8°) in patients with FLB, there was no significant difference between the two groups (t=1.70, P=0.09). The angle of bowing (α) was 7.9°±2.9° (6°-16°), the VCA based on NMA was 8.4°±1.5°(5°-10°), there was a significantly positive correlation between VCA and α (R=0.607, P<0.01).

There is no significantly proximal or distal femoral deformity in patients with varus osteoarthritic knee and FLB (>5°), the degree of the DMA-DAAangle based on the DMA doesn′t change with the increasing angular deformity of the bowing, then the bowing would be reserved if the distal femur is cut based on DMA in TKA and the preoperative CA should be restored successfully.

To set up a prediction scoring system for the hypoxemia in infants with Pierre Robin sequence after weaning and evaluate its clinical value.

Data of consecutive patients from November 2016 to June 2019, who underwent mandibular distraction osteogenesis in Guangzhou Women and Children′s Medical Center, were retrospectively analyzed (n=148). All the cases were divided into two groups according to the appearance of hypoxemia after weaning. They were randomly divided into the derivation cohorc (2/3,n=100) and the validation cohort (1/3,n=48). Single factor and multiple logistic regression analysis were used to select the independent risk factors related to hypoxemia and establish a prediction model. A prediction scoring system was developed in accordance with assigning of the value of each variable β in the model. Internal verification of scoring system by validation population. Data of consecutive patients from July 2019 to November 2019, who underwent mandibular distraction osteogenesis, were prospectively analyzed ( n=26). The diagnostic accuracy were conducted to evaluate the clinical value of the scoring system.

The logistic regression demonstrated that age at operation, pulmonary infection and the length of distraction less than 5 mm at weaning were the independent risk factors for hypoxemia. The P value of logistic regression model in Hosmer and Lemeshow goodness of fit test was 0.848, and a prediction scoring system was established accordingly. The area under the ROC curve of the scoring system was 0.890, and the optimum critical value was 53. The sensitivity, specificity, accuracy of the model were 78.6%(11/14),86.1%(74/86), 85.0%(85/100) respectively. The predictive effectiveness of the scoring system in the retrospective validation population was similar to that in the modeling population. 26 patients were included in the prospective analysis. The area under ROC curve of the scoring system was 0.870. The sensitivity, specificity and accuracy were 80.0%(5/6),95.0%(20/21), 96.1%(25/26) respectively.

The prediction scoring system established in the study are efficacious for the hypoxemia in infants with Pierre Robin sequence after weaning.

To establish mouse models of Candidemia, and investigates statistically significant polypeptide peaks to provide auxiliary diagnosis of this disease.

A total of 170 specific pathogen free adult male ICR mice with body mass of 27-30 g were completely randomly divided into Candida albicans infection group (n=80), Candida parapsilosis infection group (n=80) and the normal control group (n=10), and the two kinds of Candidemia mouse models were established via tail vein injection. The serum samples were analyzed by Matrix-assisted laser desorption-ionization time of flight mass spectrometry and relevant software, and the polypeptide peaks with significant differences were screened to establish diagnostic models.

A total of 65 differential polypeptide peaks were obtained compared with the Candida albicans infection group and the normal control group. Combined with m/z 1 100.4, 1 581.0, 3 808.0 as differential polypeptide peaks to established the diagnostic model, the sensitivity was 95.24%(40/42), the specificity was 90.63%(29/32), the accuracy rate was 93.24%(69/74), and the AUC value of the ROC curve was 0.972(95%CI: 0.941-1.000). A total of 73 differential polypeptide peaks were obtained compared with Candida parapsilosis infection group and the normal control group. Combined with m/z 1 433.2, 1 148.5, 4 093.5, 4 522.2, 8 140.9, 8 234.6 as differential polypeptide peaks to established the diagnostic model, the sensitivity was 95%(38/40), the specificity was 81.25%(26/32), the accuracy rate was 88.89%(64/72), and the AUC value of the ROC curve was 0.953(95%CI: 0.903-1.000). A total of 78 differential polypeptide peaks were obtained compared with Candida albicans infection group and Candida parapsilosis infection group. Combined with m/z 2 736.9, 8 091.5, 8 153.7 as differential polypeptide peaks to established the diagnostic model, the accuracy of distinguishing C. albicans infection from C. parapsilosis infection was 98.78%(81/82).

Successfully screened the differential polypeptides and established the related diagnostic models. Which is helpful to find serum biomarkers for the auxiliary diagnosis of Candidemia, and provides a basis for the early diagnosis and the rational use of drugs.