Table of Content

25 November 2018, Volume 39 Issue 11

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The role and mechanism of ERK pathway in apoptotic cells inhibiting CCL5 expression

TONG Yuhong1, YANG Xi2, YIN Mo2, SHEN Jiacheng3, WANG Enping2, QIAN Xuesong4*

2018, 38(11):  1244-1248,1252.  doi:10.3969/j.issn.10073205.2018.11.002

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［Abstract］〓Objective〖HTSS〗〓To investigate the effect of extracellular regulated protein kinases(ERK) pathway on apoptotic cells inhibiting lipopolysaccharides(LPS) induced inflammatory CC chemokine ligand 5(CCL5) secreted by macrophages.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Apoptotic cells were prepared by Jurakt cells and the apoptosis rate was detected by flow cytometry. Bone marrow induced macrophages(BMDM) and RAW264.7 cells were stimulated by LPS to observe the effect of apoptotic cells on the expression of CCL5 induced by LPS. To observe the role of ERK pathway in inhibiting CCL5 expression in apoptotic cells, RAW264.7 cells were transfected with control plasmids PcDNA3.1, MEKK2/3 and MEK5. The cells were treated with LPS(1 mg/L), apoptotic cells(apo) and LPS(1 mg/L) + apo for 6 hours respectively. The expression of CCL5 mRNA was detected by realtime quantitative PCR. The ERK pathway was blocked and the expression of CCL5 mRNA was observed.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The expression of CCL5 mRNA in LPS stimulation group and LPS + apoptotic cell stimulation group was significantly higher than that in blank group and apoptotic cell stimulation group. The expression of CCL5 mRNA in LPS + apoptotic cell stimulation group was significantly lower than that in LPS stimulation group(P＜0.05). The expression of CCL5 mRNA in PD98059 5 mmoL/L, 10 mmoL/L, 20 mmoL/L group was lower than that in DMSO group, the expression of CCL5 mRNA in PD98059 10 mmoL/L, 20 mmoL/L group was lower than that in PD98059 5 mmoL/L group, and the expression of CCL5 mRNA in PD98059 20 mmoL/L group was lower than that in PD98059 10 mmoL/L group(P＜005). CCL5 mRNA levels in PcDNA3.1 transfection group, MEKK2/3 transfection group and MEK5 transfection group were significantly higher than those in control group, MEKK2/3 transfection group and MEK5 transfection group were significantly higher than those in PcDNA3.1 transfection group, and CCL5 mRNA levels in MEK5 transfection group were significantly higher than those in MEKK2/3 transfection group(P＜005). The decay rate of CCL5 mRNA in group D98059 was faster than that in blank group(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Apoptotic cells can inhibit the expression of CCL5 induced by LPS, and ERK signaling pathway plays an important role in the inhibition of CCL5 expression by apoptotic cells.


Efficacy and safety of pantoprazole in the treatment of aspirin related peptic ulcers in elderly hypertensive patients with diabetes mellitus#br#

LI Jianjun, PENG Lan

2018, 38(11):  1249-1252.  doi:10.3969/j.issn.10073205.2018.11.003

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［Abstract］ Objective〖HTSS〗〓To evaluate the efficacy and safety of pantoprazole in the treatment of aspirin related peptic ulcers in elderly hypertensive patients with diabetes mellitus.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The elderly hypertensive patients(n=98) with diabetes mellitus suffering peptic ulcer caused by lowdose aspirin were chosen, and then randomly divided into observation group and control group(each n=49). The observation group was given pantoprazole and the control group was given ranitidine. Endoscopy was performed after 4 weeks treatment and telephone followup was performed after 6 months treatment. The gastrointestinal symptoms, changes in endoscopic mucosal, and adverse effects including major adverse cardiovascular events were compared between two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Endoscopic mucosal healing rate(97.96%) of the observation group was higher than that of the control group(83.67%), and the incidence of gastrointestinal symptoms(10.20%) and the incidence of adverse reactions(12.24%) of the observation group were significantly lower than those of the control group(26.53%, 28.57%) after 4 weeks of treatment(P＜005). The incidence of gastrointestinal symptoms and adverse reactions in the observation group was 8.16% and 14.28% respectively，which were lower than those of the control group（24.49%， 32.65%） after 6 months treatment （P＜005）.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Pantoprazole is effective and tolerable in the treatment of aspirin related peptic ulcer in elderly hypertensive patients with diabetes mellitus. It is worthy of clinical promotion.

Effect of interventional treatment of carotid artery stenosis on cerebral microbleeds

ZHANG Jun1, ZHAO Xian2*, CAO Xianguo1, SONG Zhe1, LIU Huiqin1

2018, 38(11):  1253-1256,1261.  doi:10.3969/j.issn.10073205.2018.11.004

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［Abstract］ Objective〖HTSS〗〓To investigate the changes of cerebral microbleeds(CBMs) after carotid angioplasty and stenting(CAS) in patients with ischemic stroke.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 67 patients of ischemic stroke with carotid artery stenosis greater than or equal to 70% were selected as group A. All conformed to the indications of interventional therapy by digital subtraction angiography(DSA) and CAS treatments were performed. 76 patients of ischemic stroke with carotid artery stenosis greater than or equal to 70% were selected as group B and were not treated with CAS. 80 patients with ischemic stroke with carotid artery stenosis less than 50% were selected as group C. Susceptibility weighted imaging(SWI) scanning by 3.0 T magnetic resonance imaging(MRI) was used to count the new CMBs.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓At 6 months, there were 8 new CMBs(11.94%) in group A, 19 new CMBs（25.00%） in group B and 7 new CMBs(8.75%) in group C. The differences between group A and group B, group B and group C were significant （P＜005）. At 12 months, the new CMBs were 11(16.42%) in group A, 24(31.58%) in group B and 10（12.50%） in group C. There were significant statistical differences between group A and group B, group B and group C（P＞005）.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The longtime new CMBs numbers after CAS treatment of patients with ischemic stroke whose carotid artery stenosis were greater than or equal to 70% can reach the level of patients with carotid artery stenosis less than 50%. The prognosis of patients with ischemic stroke was improved to some extent.


Predictive value of apolipoprotein E gene polymorphism and homocysteine on poststroke depression in elderly patients#br#

HUANG Junfang, HUANG Jianmin, MENG Lanqing, LI Xuebin*

2018, 38(11):  1257-1261.  doi:10.3969/j.issn.10073205.2018.11.005

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［Abstract］〓Objective〖HTSS〗〓To investigate the predictive value of apolipoprotein E（APOE） gene polymorphisms and homocysteine(Hcy) on poststroke depression in the elderly. 
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 109 stroke patients admitted were selected and divided into stroke group(65 cases) and poststroke depression group(44 cases) according to whether the patient had depression. Both groups were tested for APOE polymorphisms(including genotype distribution and allele ε2, ε3, ε4 frequencies) and serum Hcy levels. The genotype distributions of ε2/ε2, ε2/ε3, ε2/ε4, ε3/ε3, ε3/ε4, ε4/ε4, the frequencies of alleles ε2, ε3, ε4, serum Hcy levels were compared between the two groups. Different genotypes were calculated to predict the sensitivity of poststroke depression in the elderly. The sensitivity of poststroke depression was plotted and the receiver operating characteristic(ROC) curve was plotted for serum Hey to predict poststroke depression.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The genotypes of the two groups were most common with ε3/ε3, and the distribution of the six different genotypes was not statistically significant(P＞005). There was no significant difference in the frequency of ε2 and ε3 gene between the two groups(P＞005). The frequency of ε4 gene in the poststroke depression group was higher than that in the stroke group(P＜005). Among different genotypes, the ε4/ε4 had the highest sensitivity of 83.33%(5/6) to predict poststroke depression. The serum Hcy levels in the poststroke depression group were higher than those in the stroke group(P＜005). There were no significant difference in serum Hcy levels in different genotypes between the two groups(P＞005). The serum Hcy level predicts ROC curve area for poststroke depression in the elderly with 0.744, a sensitivity of 64.70%, a specificity of 81.20%, and a critical value of 18.455 μmol/L.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The serum homocysteine and APOE gene polymorphisms can be used as predictors of poststroke depression in elderly stroke patients and provide references for elderly stroke patients to reduce the incidence of poststroke depression.


Study on the changes of serum electrolytes levels in patients with acute paraquat poisoning

MENG Zhaohua, JIN Yingli, ZHU Tieying, TIAN Yingping*

2018, 38(11):  1262-1265.  doi:10.3969/j.issn.10073205.2018.11.006

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［Abstract］〓Objective〖HTSS〗〓To explore the clinical significance of changes in serum electrolytes levels in patients with acute paraquat poisoning.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 104 patients with acute paraquat poisoning were selected. Death during hospitalization was used as the end point of observation, while the >30 days survival was treated as cured. In this way, patients were divided into death group and cure group. The levels of serum potassium, serum calcium, serum sodium and carbondioxide combining power(CO2CP) in the first and fourth days of hospitalization were compared between the two groups. The changes of serum potassium, serum calcium, serum and CO2CP levels in the cure group were observed dynamically on the 1 st, 4 th, 7 th, 10 th, 13 th, 16 th and 30 th day after admission.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓On the first day of admission, the CO2CP of the death group was significantly lower than that of the cure group(P＜005). There was no significant difference in serum potassium, serum calcium and serum sodium levels between the two groups(P>0.05). On the fourth day of admission, only 28 patients survived in the death group. The levels of serum potassium, serum calcium, serum sodium and CO2CP in the two groups were significantly lower than those on the first day of admission. The levels of serum potassium, serum calcium and CO2CP in the death group were significantly lower than those in the cure group(P＜005). There was no significant difference in serum sodium levels between the two groups(P>0.05). For the patients in the cure group,the levels of serum potassium, serum calcium and CO2CP were decreased first and then increased over time. On the 16 th day, the serum potassium level was higher than that on the 4 th and 7 th day. On the 4 th, 7 th, 10 th, 13 th and 16 th day, the serum calcium level was lower than the first day, and on the 6 th day, the serum calcium was lower than the 4 th day. On the 10 th day, the CO2CP level was higher than the 4 th day, and the CO2CP level was higher than the 1 st, 4t h, 7 th and 10 th days on the 13 th and 16 th day(P＜005).There was no significant difference in serum sodium levels in different time points(P>0.05).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The stress state, inflammatory response and multiple organ damage caused by paraquat can affect the electrolyte level of the body and reduce the level of serum electrolytes, which should be given enough attention in the treatment.


Dynamic changes and significance of inflammatory markers in patients with early postoperative infection treated with VSD retaining internal fixation#br#

SUN Jiantao, JIA Shikong, LIU Minghui,BAI Zhijin, BAI Yandong, TIAN Xuezhong*

2018, 38(11):  1266-1269,1274.  doi:10.3969/j.issn.10073205.2018.11.007

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［Abstract］ Objective〖HTSS〗〓 To investigate the dynamic change rule and prognostic significance of white blood cell（WBC）, erythrocyte sedimentation rate（ESR）, procalcitonin（PCT） and creactive protein（CRP） in the treatment of early infection after fracture surgery by retaining internal fixation while using vacuum sealing drainage（VSD）.  
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 45 patients with deep infection after internal fixation were treated by VSD. WBC, ESR, PCT and CRP were recorded before and 1, 3, 7, 14 and 21 days after operations. The results were divided into cured group and noncured group according to whether the patients were cured or not. The selfcontrol study within the group and the intergroup control study were carried out.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There was no significant difference in the interaction of WBC in group, time, group·time between the cured group and the noncured group(P ＞005). ESR in both groups was increased slightly after operation, and decreased gradually after the peak on the 3 rd day. There were significant differences in the interaction among group, time, group·time(P＜005). PCT was decreased both in the cured group and the noncured group, and there were significant differences in the interaction among group, time, and group·time(P＜005). CRP in the cured group reached the peak on 3rd day after operations, and then was decreased; The level of CRP was increased significantly in the noncured group as time increases, and there were significant differences in the interaction among group, time, and group·time(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓CRP were raised early after operation, and continued to rise, suggesting that preserving internal fixation and curing the infection after internal fixation was less possibility. Removal of internal fixation should be considered and other therapies should be used. WBC did not change significantly within 3 weeks after operation, and was not recommended for early prognosis.


The comparative study of direct anterior approach and anterolateral approach in total hip arthroplasty#br#

WANG Rui, HU Chengdong, LI Dongfeng, HUO Xiwei, WANG Fei, LI Yanfei

2018, 38(11):  1270-1274.  doi:10.3969/j.issn.10073205.2018.11.008

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［Abstract］〓Objective〖HTSS〗〓To observe the clinical effective of direct anterior approach(DAA) and the anterolateral approach(ALA) in total hip arthroplasty(THA).
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Retrospective analysis of 132 patients who undergoing THA in our hospital was used. According to the surgical approach, they were divided into ALA group(79 cases) and DAA group(53 cases). The related data especially complications in intraoperative and postoperative was observed and analyzed. The intraoperative and postoperative data between the 2 groups was observed, especially the occurrence of perioperative complications. 
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Patients in DAA group had shorter incision length, partial weight time and hospitalization than those in ALA group. The intraoperative blood loss and postoperative drainage were less than those in ALA group. The difference was statistically significant(P＜005). There was no statistical difference in the operation time between the two groups(P＞005). The VAS scores in both groups showed a gradual decrease and DAA group had a lower VAS score than ALA group. Harris hip function score showed a gradual increase trend after surgery, and the score in DAA group was higher than that in ALA group(P＜005). The hip function in DAA group was better than that that in ALA group. The rate of excellent and good of hip function in DAA group was significantly higher than that of ALA group(P＜005). There was no significant difference in perioperative complications between the 2 groups(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Compared with ALA, DAA has the characteristic of less traumatic, little intraoperative and postoperative blood loss, short hospital stay, and good joint function recovery. It is suitable for experienced senior doctors to carry out.


Efficacy analysis of 1ess invasive stabilization system and percutaneous compression plate in treatment of intertrochanteric fractures combined with lateral wall fractures#br#

SUN Ping， GAO Tiantian， ZHANG Wei， FU Shiping

2018, 38(11):  1275-1278.  doi:10.3969/j.issn.10073205.2018.11.009

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［Abstract］ Objective〖HTSS〗〓To observe the efficacy of 1ess invasive stabilization system(LISS) and percutaneous compression plate(PCCP) in treatment of intertrochanteric fractures combined with lateral wall fractures and their impact on hip function.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 82 patients with intertrochanteric fractures associated with lateral wall fractures, were divided into observation group and control group according to the random number method. Each group had 42 cases. Observation group was treated with LISS internal fixation, and control group was treated with PCCP internal fixation. The efficacy, operation time, intraoperative blood loss, intraoperative fluoroscopy time, full load time, fracture healing time, Parkerpalmer mobility score  and complication rate were observed after operation.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓All patients were followed up for an average of(14.37±5.64) months from 6 months to 24 months. The excellent and good rate was 97.62% in observation group which was significantly higher than 80.95% in control group(P＜005). There was no significant difference of operation time and intraoperative blood loss between observation group and control group(P＞005), the intraoperative fluoroscopy time, full load time, fracture healing time in observation group were significantly decreased or lower than those in control group(P＜005). The indoor activities score, outdoor activities score, selfcare score and total score in observation group were significantly higher than those in control group(P＜005). The incidence of complications in observation group was 7.14%(3/42), which was no significant difference of 11.90%(5/42) in control group(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓LISS in treatment of intertrochanteric fractures combined with lateral wall fractures is superior to PCC. It has the advantages of small trauma, early weight training and rapid hip function recovery, it is worthy of clinical application.


Retrospective analysis of clinical data of repair of different age crus skin soft tissue defects in patients with peroneal artery perforator fasciocutaneous flap#br#

MA Pingnan， DENG Yongshang， WEN Wenxing， XIONG Shengwen， ZHOU Zhuo， LUO Weidong

2018, 38(11):  1279-1282,1286.  doi:10.3969/j.issn.10073205.2018.11.010

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［Abstract］ Objective〖HTSS〗〓To retrospective analyze clinical data of different age repair crus skin soft tissue defects in patients with peroneal artery perforator fasciocutaneous flap.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 46 patients with soft tissue defect of the leg were selected for the study，by using the distally based peroneal artery perforator fasciocutaneous flap repair. According to the age of the patients, they were divided into 18 cases in the children group（under 15 years old）  and 28 cases in the adult group（over 15 years old）.  The flap repair effect, flap survival and complication of donor site were compared between the two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The repair effect of the two groups were not statistically significant(P＞005) compared with the rate of good. The complete survival rate of the flap in the children group was not statistically significant compared with the adult group(P＞005). There was no significant difference in the incidence of complications such as partial necrosis and marginal necrosis between the two groups(P＞005). There was no significant difference in sex ratio, location of rotation point and proximal position between the two groups(P＞005). The proportion of the wound site in the lower leg was lower than that in the adult group, and the proportion in the Achilles tendon and ankle region was higher than that in the adult group, the difference was statistically significant(P＜005). The proportion of spoke injury in children group was higher than that in adult group, but the proportion of crush injury and sports injury was lower than that of adult group, the difference was statistically significant(P＜005). There was no significant difference between the two groups in terms of injury to operation time(P＞005). There was no significant difference in the incidence of hyperpigmentation and sensory anesthesia between the two groups(P＞005). The incidence rate of skin itching and scar in children group was higher than that in adult group, the difference was statistically significant(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Different ages of crus skin soft tissue defects in patients with peroneal artery perforator fasciocutaneous flap has good repairing effect and survival rate. 〖JP2〗However, the skin flap and donor site of skin flap are more likely to develop skin itching and scarring in children.

Effect of ultrashort wave on the dysfunction of shoulder and elbow joint after abdominal flap surgery#br#

ZHANG Hongxin, WANG Jie, JIANG Meichao， YANG Shuo, LIAN Yong*

2018, 38(11):  1283-1286.  doi:10.3969/j.issn.10073205.2018.11.011

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［Abstract］ Objective〖HTSS〗〓To investigate the clinical effect of ultrashort wave combined with physical exercise on preventing the dysfunction of shoulder and elbow joints in patients with abdominal skin flap.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 40 patients(age>20 years) with hand injuries were randomly divided into two groups: 20 patients for experimental group(group A), patients received the ultra short wave therapy and the passive activities of shoulder and elbow after surgery, and the patients received standard rehabilitation exercise after dissection of the pedicles of abdominal flaps; 20 patients for control group(group B), patients received conventional nursing care without ultra short wave therapy after dissection of the pedicles of abdominal flaps. Measuring the shoulder and elbow activity of patients after dissection of the pedicles of abdominal flaps at first day, a week and one month , HSS score for shoulders and Mayo score for elbows of patients were implemented after the surgeries. Differences between the two groups were compared by statistical analysis.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The motion range of joints of patients in the experimental group was better than the control group. HSS score for shoulders and Mayo score for elbows of patients in the experimental group were higher than the control group. There were significant differences between the  two groups.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The ultrashort wave combined with physical exercise therapy could improve the motion range and the function of joints in patients with abdominal skin flap, reducing joint pain and improving the quality of life of patients.


Effect of periarticular injection combined with intravenous tranexamic acid on postoperative blood loss after primary total hip arthroplasty#br#

GUO Yongchuan1, LOU Xihua1, MA Shouzhan1, HU Wenhai2*

2018, 38(11):  1287-1290,1295.  doi:10.3969/j.issn.10073205.2018.11.012

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［Abstract］〓Objective〖HTSS〗〓To investigate the effect of periarticular injection combined with intravenous tranexamic acid on postoperative blood loss after total hip arthroplasty.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Fiftynine patients who met the inclusion criteria were randomly divided into intravenous tranexamic acid group（intravenous group， twentysix casess） and periarticular injection combined with intravenous group（combined group， thirtythree cases）. Both groups received primary total hip arthroplasty， and were separately treated with tranexamic acid 2.0 g added to 100 mL saline intravenous infusion at the beginning of the operation and Tranexamic acid 1.0 g added to 100 mL saline intravenous infusion at the beginning. After Joint installation is finished, 1.0 g tranexamic acid added to saline 50ml periarticular injection was treated, and hidden blood loss, blood transfusion rate, blood transfusion volume of two groups were compared.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The hidden blood loss, blood transfusion volume and blood transfusion cases in the combined group were significantly lower than those in the intravenous group(P＜005). There was no significant difference in postoperative complications between the two groups(P＞005) .
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Periarticular injection combined with intravenous tranexamic acid after artificial total hip arthroplasty can significantly reduce the hidden blood loss, the blood transfusion rate and the volume of blood transfusion required，which is worth applying in clinical practice.

Correlation analysis between postoperative exudation and response after posterolateral endoscopic spine surgery based on bone drill#br#

WANG Peng1， DIAO Wenbo2*， JIA Lulu3， CHENG Jie4, ZHAO Jian1, LI Jing1

2018, 38(11):  1291-1295.  doi:10.3969/j.issn.10073205.2018.11.013

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［Abstract］〓Objective〖HTSS〗〓To observe the effect of postoperative drainage and intravenous mannitol infusion on the complications of posterolateral spinal endoscopic neurolysis based on spiral drill.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A retrospective analysis of 69 cases of lumbar disc herniation with radiculopathy patients, who divided into control group, treatment group 1, treatment group 2 was used. The control group was given routine operation, the treatment group 1 was given routine operation+mannitol intravenous drip treatment; the treatment group 2 was given routine operation+postoperative drainage treatment. The Numerical Rating Scale(NRS ） scores and Japanese Orthopaedic Association(JOA） scores were compared in the 3 groups before and after treatment.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There were significant differences of interblock, time dissimilarity, and interaction of interblock with time dissimilarity among the 3 groups for NRS scores and JOA scores(P<001). The treatment group 2 was superior to the treatment group 1, and the treatment group 1 was superior to the control group.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Postoperative drainage and intravenous mannitol infusion for posterolateral spinal endoscopic neurolysis based on spiral drill are more effective than previous single operation for postoperative complications.


Vacuum sealing drainage combined with stamp skin grafting in the treatment of 24 cases suffering from soft tissue infection with defect#br#

ZHONG Wenlong1， YANG Simin1， GUO Zairan2， WANG Xinwei2*

2018, 38(11):  1296-1299.  doi:10.3969/j.issn.10073205.2018.11.014

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［Abstract］ Objective〖HTSS〗〓To observe the clinical efficacy of vacuum sealing drainage(VSD) combined with stamp skin grafting in the treatment of soft tissue infections with defects.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Twentyfour patients were selected with skin infections and defects admitted to Luoyang orthopedic hospital of Henan province. After vital signs became stable, all patients were received debridement surgery in the first stage, and VSD was used to continuously press and suck the wound for 5 to 14 days(replace one or two times) until the wound granulation tissue was fresh without infection. In the second stage, the intermediate split thickness skin graft was taken from inner thigh and was cut into stampshaped pieces of skin about 0.5 cm×0.5 cm. The wound was attached with skin pieces at a distance of 2 mm, then was covered by the meshy vaseline gauze. And the sterile dressing was used for pressurized bandage. After 7 days, the dressing was observed.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Granulation tissues of all patients were granular, bright red, and free from infection after the first stage of treatment. Two weeks after stage Ⅱ skin grafting: 23 cases were excellent, 1 case was good, and there was no pain in the affected area. One patient failed to cover the wound completely because of sliding and overlapping of some skin flaps due to inappropriate movement, and the wound healed after repeated dressing changes in the later period. One patient had a small quantity of skin pieces that were dry and had poor activity(not necrotic) on the edge of the wound. They was coated with a thin layer of MEBO moist burn cream and survived on its own. After 3 to 12 months of followup, the color, elasticity, sensation and joint activity of the skin graft area were normal without secondary skin infection, necrosis, limb weight disability and secondary surgery.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓VSD combined with stamp skin grafting in the treatment of skin and soft tissue infections of extremities and trunk with defects has the advantages of simple operation, short hospitalization time, low cost, definite curative effect and fewer complications, which is worthy of clinical promotion.


The clinical efficacy of laparoscopic cholecystectomy for choledocholithiasis after open cholecystectomy#br#

TANG Tong， ZHANG Jun， CHEN Lei， LIU Mingzhong

2018, 38(11):  1300-1303,1310.  doi:10.3969/j.issn.10073205.2018.11.015

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［Abstract］ Objective〖HTSS〗〓To investigate the clinical efficacy of laparoscopic cholecystectomy for choledocholithiasis after open cholecystectomy.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 58 cases of open cholecystectomy patients were divided into control group and observation group using random number table method.The observation group of 29 cases were underwent laparoscopic choledocholithotomy, other 29 cases were underwent open choledocholithotomy.The perioperative indicators(blood loss, operative time, pain duration, exhaust time and hospitalization time), postoperative complications(biliary fistula, incision infection, biliary stricture, residual stones) and liver functionswere were observed in two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The observation group pain duration, hospitalization time, exhaust time and amount of bleeding in operation were less than that in the control group, the difference was statistically significant(P＜005). The two groups had no statistically significant differences in operative time, the incidence of residual stones, biliary fistula, incision infection and biliary stricture of various complications(P＞005). The total complication rate in the observation group was significantly lower than that in the control group(P＜005). Before operation, there was no significant difference between 2 groups of aspartate aminotransaferase, alanine aminotransferase and total bilirubin(P＞005). Two weeks after the operation, the above indexes between 2 groups were significantly decreased(P＜005), but there was no statistical difference between 2 groups(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓For patients undergoing open cholecystectomy, laparoscopic choledocholithotomy has less trauma, rapid postoperative recovery, and low complications, which is helpful to the recovery of liver function.


Association between hTERT gene single nucleotide polymorphism rs2736100 loci and tumor susceptibility in Asian populations：a Metaanalysis#br#

QIN Tong， HAN Zhenwei， TENG Zhihai， CHANG Xueliang， LI Jingdong， WANG Yaxuan*

2018, 38(11):  1304-1310.  doi:10.3969/j.issn.10073205.2018.11.016

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［Abstract］ Objective〖HTSS〗〓To investigate the relationship between human telomerase reverse transcriptase(hTERT) gene polymorphism rs2736100 and tumor in Asian population. 
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓According to the inclusion and exclusion criteria, relevant literature were searched based on key words in Chinese and English databases. Documents that met the requirements were screened, and related data were extracted. Stata 12.0 statistical software was used to merge and analyze the extracted data. Meanwhile, odds ratio(OR) and its 95% confidence interval(95%CI) were calculated.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Totally 34 casecontrol studies were included, including 47 148 tumor patients and 75 673 controls. Metaanalysis results showed that hTERT gene polymorphism rs2736100 could significantly increase tumor genetic susceptibility in Asian populations(B vs A, OR=1.25，95%CI=1.20-1.29， P=0000), (BB vs AA, OR=1.56, 95%CI=1.45-1.67, P=0000）, (AB vs AA, OR=1.22, 95%CI=1.17-1.28, P=0000）, (AB+BB vs AA, OR=1.30, 95%CI=1.24-1.37, P=0000), (BB vs AB+AA, OR=1.39, 95%CI=1.32-1.47, P=0000). Moreover, 36 815 lung cancer patients and 64 149 controls were included in this study. Metaanalysis results indicated that rs2736100 could significantly increase lung cancer susceptibility in Asian populations(B vs A, OR=1.28, 95%CI=1.23-1.32, P=0000）, (BB vs AA,OR=1.64, 95%CI=1.52-1.76, P=0001）, (AB vs AA, OR=1.27, 95%CI=1.21-1.33, P=0015), (AB+BB vs AA, OR=1.35, 95%CI=1.28-1.42, P=0001), (BB vs AB+AA, OR=1.42, 95%CI=1.35-1.50, P=0030）.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓In Asian populations,rs2736100 polymorphism of hTERT gene is a risk factor for tumor susceptibility.


GBMexo promotes microglia mediated inflammatory response#br#

YANG Jiankai1, QI Xuejiao2, JIAO Baohua1, ZHAO Zongmao1, LYU Zhongqiang1, LI Chen1

2018, 38(11):  1311-1315.  doi:10.3969/j.issn.10073205.2018.11.017

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［Abstract］〓Objective〖HTSS〗〓To investigate the role and mechanism of exosomes derived from glioblastoma multiforme cell(GBMexo)  in facilitating microgliaelicited activation of inflammatory network and chemotherapeutic resistance.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓U87 and BV2 cells were cultured, and exosomes derived from U87(U87exo)  was isolated. We labeled U87exo with GFP,  and added them to BV2 cell culture medium for monitoring cargo delivery. Except for PBS control group,  BV2 microglias were treated with 1 mg/L lipopolysaccharides(LPS) and U87exo at different concentrations, while they were divided into LPS group, LPS+exo(50 mg/L) group, LPS+exo(100 mg/L) group and LPS+exo(200 mg/L) group. Morphological changes of BV2 microglias in the five groups were observed after 24 h under phasecontrast microscoy. The BV2 cells and the cell cultured supernatant were harvested for detection of lactate dehydrogenase(LDH), tumor necrosis factorα(TNFα), interleukin 1β(IL1β） and interleukin 6(IL6) by ELISA, inducible nitric oxide synthesis(iNOS) and CXC chemokine receptor type 5(CXCR5) mRNA level by RTPCR, as well as protein expression changes by western blotting.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓U87exo were transfered into BV2 cells and  promoted microglia activation and morphological changes. Compared with control group, the levels of LDH, TNFα, IL1β, IL6, iNOS mRNA and CXCR5 mRNA were higher in LPS group, LPS+exo(50 mg/L) group, LPS+exo(100 mg/L) group and LPS+exo(200 mg/L) group(P＜005). Compared with LPS group, the levels of LDH, TNFα, IL1β, IL6, iNOS mRNA and CXCR5 mRNA were higher in LPS+exo(50 mg/L) group, LPS+exo(100 mg/L) group and LPS+exo(200 mg/L) group(P＜005). Compared with LPS+exo(50 mg/L) group, the levels of LDH, TNFα, IL1β, IL6, iNOS mRNA and CXCR5 mRNA were higher in LPS+exo(100 mg/L) group and LPS+exo(200 mg/L) group(P＜005). Compared with LPS+exo(100 mg/L) group, the levels of LDH, TNFα, IL1β, IL6 and iNOS mRNA were higher in LPS+exo(200 mg/L) group(P＜005), while CXCR5 mRNA were lower in LPS+exo(200 mg/L) group(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓These results proved that GBMexo facilitated microgliaelicited activation of inflammatory network in microenvironment as well as chemotherapeutic resistance, which will provide a powerful basis for further understanding and treatment of glioma. 


Clinical application of low dose chest DR

ZHANG Xinqi1， ZHANG Yinfeng1， CUI Shou1， GAO Yanhui2

2018, 38(11):  1316-1320.  doi:10.3969/j.issn.10073205.2018.11.018

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［Abstract］〓Objective〖HTSS〗〓To explore an operable digital radiography(DR) lowdose examination method.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 500 patients who underwent chest DR examination were enrolled. The patients were divided into 5 groups according to their chest thickness. Group A(body thickness H≤20 cm) 100 cases, group B(body thickness H＞20-22 cm)110 cases, group C(body thickness H＞22-25 cm )100 cases, group D(body thickness H＞25-27 cm)90 cases, group E(body thickness H>27 cm)100 cases. A, B, C, D and E were randomly divided into manual control group A1 group(50 cases), B1 group(55 cases), C1 group(50 cases), D1 group(45 cases), E1 group(50 cases). Automatic exposure control(AEC) group A2 group(50 cases), B2 group(55 cases), C2 group(50 cases), D2 group(45 cases), E2 group(50 cases). Manual control group exposure conditions are A1 group 102 kV/0.8 mAs, B1 group 109 kV/0.8 mAs, C1 group 117 kV/0.8 mAs, D1 group 125 kV/0.8 mAs, E1 group 133 kV/1 mAs, AEC group exposure conditions are 125 kV/0.7-3 mAs, other imaging parameters are the same. The radiation dose was measured by a dosimeter. Quality scoring and noise evaluation were performed for each image. For all chest radiographs, the right upper lung field, beneath edge of diaphragm, and background exposure area were measured for optical density.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The average radiation dose of group A1, B1, C1, D1 and E1 was significantly lower than that of A2, B2, C2, D2 and E2 groups, and the difference was statistically significant(P＜005). There was no significant difference in the image quality score, noise evaluation, and chest Xray density between the manual control group(A1, B1, C1, D1 and E1) and the AEC group(A2, B2, C2, D2 and E2)(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓In the chest DR examination, the radiation dose received by the patient is significantly reduced by setting the exposure conditions and optimizing the exposure parameters according to the patient′s chest thickness, and the image quality can still be guaranteed, so this method is worth of promotion.


The value of diffusion weighted imaging in differential diagnosis of pulmonary tuberculosis and pneumonia

ZHANG Ying， GENG Guang， LI Zhen， ZHANG Qi， HOU Zhihua

2018, 38(11):  1321-1323,1329.  doi:10.3969/j.issn.10073205.2018.11.019

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［Abstract］ Objective〖HTSS〗〓To explore the value of MRI diffusion weighted imaging(DWI) in the differential diagnosis of tuberculosis and pneumonia.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 47 pneumonia or pulmonary tuberculosis patients were collected, and all of them were received CT and MRI examination. The tuberculosis group included three types: consolidation, tuberculosis cavity and tuberculoma. The pneumonia group mainly manifested as consolidation. In DWI examination, b value was set as 0, 500 s and 800 s/mm2,and the best examination b value was chosen according to signal noise ratio and contrast to noise ratio of the image. Under the best b value, MRI signal character and apparent diffusion coefficient(ADC) values between the three types of tuberculosis and pneumonia was interpreted.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The difference between pneumonia consolidation phase and pulmonary tuberculosis consolidation in T1WI was not significant statistically. In T2WI, signal/spinal cord of tuberculosis consolidation was higher than that of pneumonia consolidation phase, which had statistical difference(P＜005). The ADC value comparison between pulmonary tuberculosis types and pneumonia consolidation: ADC value of pneumonia group was higher than that of the tuberculosis consolidation group, the ADC value of tuberculosis consolidation and tuberculoma were higher than that of tuberculosis cavity wall, and they had statistical difference(P＜005). There was not statistically different between tuberculosis consolidation and tuberculoma(P＞005). There was not statistically different between pneumonia consolidation and tuberculoma(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓ADC value of pneumonia group is higher than that of the tuberculosis consolidation, tuberculoma and tuberculosis cavity wall. DWI can be used as an important way to identify tuberculosis and pneumonia besides CT.


Efficacy and safety of combined intravenous anesthesia with nalbuphine and propofol during painless induced abortion surgery#br#

CHENG Yanxin, CHANG Heping, ZHANG Jian, LIU Yajing， ZHAO Senming*

2018, 38(11):  1324-1329.  doi:10.3969/j.issn.10073205.2018.11.020

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［Abstract］〓Objective〖HTSS〗〓To evaluate the efficacy, analgesic effect and the safety of nalbuphine combined with propofol in outpatient induced abortion.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 120 patients with ASA grade Ⅰ to Ⅱ induced abortion were randomly divided into control group and experimental group, 60 cases in each group. The experimental group was intravenously injected with 0.2 mg/kg nabuprofen hydrochloride(diluted to 2 mL), and intravenously injected with propofol 2.0 mg/kg one minute later. The control group received intravenous injection of 2 mL of normal saline as control, and 1 minutes after intravenous injection of propofol 3.0 mg/kg. The anesthesia effect, propofol dosage during operation, recovery time, uterine contractile pain score at 5 and 30 minutes after operation and adverse reactions were observed. Systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and pulse oxygen saturation(SpO2) were recorded at T0(entering the room), T1(the eyelash reaction disappeared), T2(at the beginning of the operation), T3(at the end of the operation)and T4(5 minutes after the operation).
〖HTH〗〖WTHZ〗Results〖HTSS〗〓SBP and DBP in the two groups showed a trend of decreasing first and then increasing, the difference was statistically significant between the time points(P＜005). There was no significant difference in the interaction between groups and time points(P＞005), and there was no significant difference between the two groups(P＞005). HR of the two groups showed a trend of decreasing first and then increasing, and the interaction between groups and time points(P＜005) and between groups was statistically significant(P＜005), but there was no significant difference between the two groups(P＞005). SpO2 of the two groups showed a gradual upward trend, the difference was statistically significant between time points(P＜005), there were no significant difference in the interaction between groups and time points and between groups(P＞005). The dosage of propofol in the experimental group was less than that in the control group, and the recovery time was shorter than that in the control group(P＜0.05). The pain score of uterine contraction in the experimental group was significantly lower than that in the control group at 5 and 30 minutes after operation, and the satisfaction was better than that in the control group(P＜005). There was no significant difference in the incidence of complications between the 2 groups(P＞0.05).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Hydrochloride nalbuphine combined with propofol is a safe and effective anesthesia method in artificial abortion. Hydrochloride nalbuphine markedly reduced the dosage of propofol, showed an outstand analgesic effect on postoperative uterine contraction pain without obvious adverse reactions.


Application of laryngeal mask airway combined with bronchial blocker in patients undergoing thoracoscopic thymectomy

LIU Zhiqi1， YAN Ruyu2, YANG Yanchao1, MA Xiaojing1, SONG Tieying1*

2018, 38(11):  1330-1333.  doi:10.3969/j.issn.10073205.2018.11.021

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［Abstract］ Objective〖HTSS〗〓To study the feasibility of application of laryngeal mask with bronchial blocker for thoracic anesthesia.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Twenty patients were divided into 2 groups(n=10 each)using a random number table: endotracheal tube bronchial blocker group(group T) and laryngeal mask plus bronchial blocker group(group L). Midazolam 0.05 mg/kg, sufentanil 0.4 μg/kg, propofol 1.5 mg/kg and cisatracurium 0.2 mg/kg were injected intravenously for induction of anesthesia. An enhanced endotracheal tube with inner diameter 7.5 was inserted in group T, and the laryngeal mask airway was placed in group L .Then the bronchial blocker was inserted into the lateral bronchus under the guidance of fiberoptic bronchoscopy in 2 groups. During the operation the bronchial occluder cuff was inflated, and the surgical lateral bronchus was sealed, with one healthy lung ventilation. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen saturation, end tidal carbon dioxide, lactic acid and cortisol concentration were recorded before intubation and intubation immediately. The positioning duration of bronchial occluder, pulmonary collapse, propofol dosage, operation time, bleeding volume, extubation time and postoperative airway mucosal injury were compared between the two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The MAP、HR and cortisol concentration were higher at intubation immediatelythan that before intubation in group T(P＜005).The data in group Lshowed no significant changesexcept that the HR increased. Compared with group T, the MAP、HR and cortisol concentration were lower in group L（P＜005）. There were no significant differences in the positioning duration of bronchial occluder and pulmonary collapse between the two groups. Compared with group T, the propofol dosage were lower andthe extubation time was shorter in group L（P＜005）.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Laryngeal mask with bronchial blocker may be considered an alternative onelung ventilation technique, which can be used in thoracic anesthesia.


Correlation between serum 25hydroxyvitamin D level and ankle bone marrow edema syndrome#br#

NI Guangxiao1, ZHOU Guang2, SUN Weili1, MENG Ran1, FENG Yingfa3, WANG Pu4

2018, 38(11):  1334-1338.  doi:10.3969/j.issn.10073205.2018.11.022

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［Abstract］ Objective〖HTSS〗〓To investigate the relationship between level of serum 25hydroxyvitamin D［25(OH)D］ and ankle bone marrow edema syndrome.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓We made a retrospective analysis of clinical date of ninety three patients who were diagnosed with BMES in ankle joint. Pearson′s linear correlation analysis and multiple linear regression analysis were used to analyze the relationship between serum 25(OH)D levels and American Orthopedic Foot and Ankle Society(AOFAS) scores, Visual Analogue Scale(VAS) scores, age, sex and number of affected bones.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓In all 93 patients, the serum levels of 25(OH)D ranged from 17.69 to 57.07nmol/l with an average serum 25(OH)D levels of (32.6±11.8) nmol/l, and 83.9%(78/93) of patients had low vitamin D levels with serum levels of 25(OH)D below 50 nmol/l, 61.3%(57/93) of patients were vitamin D deficient, 22.6%(21/93)of patients were vitamin D insufficient, and only 16.1%(15/93) patients had sufficient vitamin D levels(serum levels of 25(OH)D≥50 nmol/l). In All patients , the AOFAS scores ranged from 44.90 to 94.60, with an average of 63.1±12.8. The VAS scores ranged from 1.0 to 10.0, with an average of 5.6±2.1. The number of affected ankle bones ranged from 2 to 7, with an average of 4.2 ± 1.6. Statistical analysis showed no significant difference comparing vitamin D levels with sex of patients(P＞005). Pearson correlation analysis showed that the serum levels of 25(OH)D was positively correlated with the AOFAS scores(r=0.907, P＜005), and negatively correlated with the VAS scores and the number of affected ankle bones(r=-0.832, r=-0.707, P＜005). There was no significant correlation with age(r=-0.082, P＞005). By multiple linear regression analysis, the correlation between AOFAS scores , VAS scores and the serum levels of 25(OH)D was strongest, the serum levels of 25(OH)D was positively correlated with AOFAS scores, and negatively correlated with VAS scores(standardized regression coefficients=0.593, -1.615, P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Serum levels of 25(OH)D were associated with joint function, pain, and number of affected bones in patients with ankle joint bone marrow edema syndrome（BMES）, and were closely related to AOFAS scores and VAS scores. Therefore, lowlevel vitamin D may be an important factor in the pathogenesis and progression of ankle joint BMES. Vitamin D supplementation will be a new target for the prevention and treatment of ankle joint bone marrow edema syndrome.