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Table of Content

    25 May 2020, Volume 41 Issue 5
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    Study on the relationship between Lp(a) and progression of non-culprit coronary lessions after stent implantation in culprit lessions#br#
    WANG Xun1， WANG Ze-jing2， XIAO Kang2
    2020, 41(5):  501-505.  doi:10.3969/j.issn.1007-3205.2020.05.002
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    ［Abstract］ Objective〖HTSS〗To observe the relationship between lipoprotein a［Lp(a)］ and the progression of non-culprit coronary lessions after successful stent implantation in culprit lessions.
    〖WTHZ〗Methods〖HTSS〗In total, 296 patients who underwent coronary angiograms angain with a time interval from 6 to 12 months after successful stent implantation at culprit lessions were enrolled in our center. The patients were divided into progression group（n=46, 15.5%） and non-progression group（n=250, 84.5%). First, single factor analysis was used to select factors with significant differences between two groups of patients, and then Logistic regression was used to analyze whether the above factors were independent risk factors for non-criminal disease progression after coronary stent implantation.
    〖WTHZ〗Results〖HTSS〗Single factor analysis showed the prevalence of diabetes, cardiac ejection fraction, multi-vessel disease, Lp(a), and low-density lipoprotein cholesterol  between two group were statistically  significant(P＜0.05). In univariate analysis, patients of progression group showed higher levels of Lp（a）, higher incidence of multivessel diseases, higher incidence of diabetes, Less reduce of LDL, lower ejection fraction(EF). On multivariate logistic regression analysis, independent predictors of the progression of nonculprit coronary lesions included Lp (a) increase (≥300 mg/L) ，multivessel diseases, diabetes, less reduce of LDL（＜0616 mmol/L), lower EF（＜50%) .
    〖WTHZ〗Conclusion〖HTSS〗Lp(a) increase(≥300 mg/L) is an independent risk factor for the progression of non-culprit coronary lessions after successful stent implantation in culprit lessions.
    Correlation of GRACE score with cTnI, BNP and GA levels in NSTEMI patients and its predictive value
    GUO Xiang-yi, LIU Wei, CHENG Jian-xin
    2020, 41(5):  506-509.  doi:10.3969/j.issn.1007-3205.2020.05.003
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    ［Abstract］ Objective〖HTSS〗To explore the correlation and predictive value of global acute coronary event registration(GRACE) score with cardiac troponin I(cTnI), brain natriuretic peptide(BNP) and glycosylated serum albumin(GA) levels in patients with non ST elevation myocardial infarction(NSTEMI).
    〖WTHZ〗Methods〖HTSS〗A total of 153 NSTEMI patients admitted were selected as research objects. According to grace score, subjects were divided into three groups: high risk group(49 cases) Grace score >140, medium risk group(58 cases) Grace score 109-140, low risk group(46 cases) Grace score ≤108. The levels of cTnI, BNP and GA were measured in each group, and the occurrence of mace was followed up for 6 months. The predictive value of grace score, cTnI, BNP and GA levels to mace was analyzed by ROC.
    〖WTHZ〗Results〖HTSS〗Single factor analysis of variance showed that the levels of cTnI, BNP and GA in patients with different grace risk grades were statistically significant(P＜0.01); the levels of cTnI, BNP and GA in high-risk group and middle-risk group were higher than those in low-risk group, while the levels of cTnI, BNP and GA in high-risk group were higher than those in middle-risk group, and the differences were statistically significant(P＜0.05). Grace score was positively correlated with cTnI, BNP and GA(P＜0.05). There were 12 cases of MACE in the high-risk group within 6 months after operation,5 cases in the middle-risk group and 1 case in the low-risk group, the difference was statistically significant(P＜0.05). The results of ROC curve analysis of 12 cases showed that AUC of grace score, cTnI, BNP and GA were 0.761, 0.674, 0.662 and 0.669 respectively, cut off value was 151.00, 3.83 mg/L, 340.72 μg/L and 20.01 respectively, sensitivity was 66.70%, 94.40%, 77.80% and 50.00%, specificity was 74.10%, 45.20%, 54.10% and 81.50%, Youden index was 0.408, 0.396, 0.374， 0.318, respectively.
    〖WTHZ〗Conclusion〖HTSS〗Grace score is positively correlated with cTnI, BNP and GA levels in NSTEMI patients, and has predictive value and predictive value for mace, among which grace score had the highest predictive value.
    The relationship between TSH, Hcy and carotid intima-media thickness in type 2 diabetic patients#br#
    ZHANG Yong-zhong1， YU Xin-long2， WEI Hai-qing3*
    2020, 41(5):  510-514.  doi:10.3969/j.issn.1007-3205.2020.05.004
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    ［Abstract］ Objective〖HTSS〗To analyze the relationship between thyroid stimulating hormone(TSH), homocysteine(Hcy) and intima-media thickness(IMT) in patients with type 2 diabetes mellitus.
    〖WTHZ〗Methods〖HTSS〗A retrospective study was conducted to enroll patients with normal thyroid function and normal IMT(40 cases). The normal IMT group was included in the observation group. Patients(40 cases) with normal thyroid function IMT thickening were included in the observation group, 45 healthy people were included in the control group. The age, course of diabetes, Hcy, TSH, serum total cholesterol(TC), body mass index(BMI), triglyceride(TG), high density lipoprotein cholesterol(HDL-C) were compared between IMT normal group, IMT thickening group and control group low density lipoprotein cholesterol(LDL-C), fasting blood glucose(FPG), glycosylated hemoglobin(HbA1c), IMT and serum creatine(SCR) levels.
    〖WTHZ〗Results〖HTSS〗Compared with the control group, the age, FPG, Hcy, TSH, HbA1c levels in the normal IMT group were significantly increased, and HDL-C was decreased. The above differences were statistically significant(P＜0.05). Compared with the control group, age, BMI, FPG, TG, Hcy, TSH, HbA1c, IMT were significantly increased in the IMT thickening group, and HDL-C was significantly decreased, the difference was statistically significant(P＜0.05). Compared with the normal IMT group, the IMT thickening group was older, and the BMI, MT, TG, and FPG were all increased, and the difference was statistically significant(P＜0.05). IMT was positively correlated with TSH(r=0.012, P=0.048), positively correlated with Hcy(r=0.003, P=0.002), and positively correlated with BMI(r=0.069, P=0.013).
    〖WTHZ〗Conclusion〖HTSS〗The carotid intima-media thickness of patients with type 2 diabetes is affected by many factors, such as BMI, TG, FPG, TSH, Hcy, etc. Among them, Hcy, BMI, TSH and IMT thickening are risk factors for predicting atherosclerosis .
    Evaluation of vestibular function in patients with peripheral vertigo by swivel chair test 
    ZHANG Ping-shu, HOU Xiu-xiang, QIAN Lin-lin, WANG Jing, ZHANG Jian, YUAN Xiao-dong*
    2020, 41(5):  515-518.  doi:10.3969/j.issn.1007-3205.2020.05.005
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    ［Abstract］Objective〖HTSS〗To evaluate vestibular ocular motility in patients with acute peripheral vertigo by observation of swivel rotation test.
    〖WTHZ〗Methods〖HTSS〗A total of 146 patients with acute peripheral dizziness were selected, and divided into following groups:18 cases with bidirectional rotation abnormality group, 67 cases with left rotation abnormality group, 61 cases with right rotation abnormality group, and 30 healthy checkers were selected. Video nystagmogram detector was used to observe the changes of index, gain, time constant, gain asymmetry ratio and asymmetry ratio of time constant in patients' swivel emergency stop test in the semi-darkroom environment.
    〖WTHZ〗Results〖HTSS〗When rotating to the left, the gain and time constant of the leftward rotation abnormal group and the bi-directional rotation abnormal group were lower than those of the control, the time constant of the rightward rotation abnormal group was lower than that of the control group（P＜0.01）. When rotating to the right, the gain and time constant of the rightward rotation abnormal group and the bi-directional rotation abnormal group were lower than those of the control group（P＜0.01）. When rotating to the left, the gain and time constant of the leftward rotation abnormal group  were lower than that rotating to the right（P＜0.01）. When rotating to the right, the gain and time constant of the rightward rotation abnormal group  were lower than that rotating to the left（P＜0.01）.The gain asymmetry ratio and time constant asymmetry ratio of the left-rotation abnormal group and the right-rotation abnormal group were significantly higher than that of the control group（P＜0.01）.The results of Logistic regression analysis showed that the right turn gain of swivel chair and the asymmetrical gain ratio of swivel chair were the influencing factors of peripheral vertigo（P＜0.01）.
    〖WTHZ〗Conclusion〖HTSS〗The swivel chair rotation test can objectively evaluate the vestibular function of patients with acute peripheral vertigo and provide the dynamic change characteristics of the vestibular system after damage.
    Changes of serum NT-proBNP, CRP, IL-10 and TNF-α levels in children with sepsis and their relationship with prognosis#br#
    XING Jing, LU Yan-hui, WANG Yan-fei, LI Xiao-juan, WANG Rui-juan, SUN Xi-bin
    2020, 41(5):  519-523.  doi:10.3969/j.issn.1007-3205.2020.05.006
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    ［Abstract］ Objective〖HTSS〗To analyze the changes of serum N-terminal pro-brain natriureticpeptide(NT-proBNP), C-reactive protein(CRP), interleukin-10(IL-10) and tumor necrosis factor-α(TNF-α) in children with sepsisand their relationship with prognosis.
    〖WTHZ〗Methods〖HTSS〗Eighty children with sepsis(observation group) and 30 healthy children(control group) were enrolled in the study. Levels of serum NT-proBNP, CRP, IL-10 and TNF-α were compared between two groups within 5 days after admission. Above indicators in children with sepsis in different conditions were analyzed. According to the 28-dayprognosis of children with sepsis, they were divided into the good prognosis group and the poor prognosis group. Levels of serum NT-proBNP, CRP, IL-10 and TNF-α were compared between two groups within 5 days after admission. The predictive value of NT-proBNP, CRP, IL-10 and TNF-α levels for death of children with sepsis was analyzed.
    〖WTHZ〗Results〖HTSS〗The serum levels of NT proBNP, CRP and TNF-α in the observation group increased first and then decreased from the first day to the fifth day after admission, while the serum levels of NT proBNP, CRP and TNF-α in the observation group were higher than those in the control group, while the serum levels of IL-10 were lower than those in the control group(P＜0.05). The mean NT proBNP, CRP and TNF-α of septic shock children were higher than those of general sepsis and severe sepsis children in 5 days after admission, while IL-10 was lower than those of general sepsis and severe sepsis children(P＜0.05). The average levels of NT proBNP, CRP and TNF-α in the patients with good prognosis were lower than those in the patients with poor prognosis, while IL-10 was higher than those in the patients with poor prognosis(P＜0.05). The area under ROC curve predicted by NT proBNP was 0.868, which was larger than that of CRP, IL-10 and TNF-α.
    〖WTHZ〗Conclusion〖HTSS〗The levels of NT proBNP, CRP, IL-10 and TNF-α in children with sepsis were significantly changed within 5 days after admission, and they were closely related to the prognosis and should be monitored.
    Expressions of CK（AE1/AE3）by immunohistochemical staining in the frozen sentinel lymph nodes of breast cancer
    YANG Hui-chai， YIN Dan-jing， LIU Yue-ping
    2020, 41(5):  524-527,561.  doi:10.3969/j.issn.1007-3205.2020.05.007
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    ［Abstract］ Objective〖HTSS〗To investigate the value of application of CK(AE1/AE3) by immunohistochemical staining in sentinel lymph node metastasis analysis of breast cancer patients.
    〖WTHZ〗Methods〖HTSS〗A total of 1 585 sentinel lymph node tissues of breast cancer were collected. The frozen residual tissues of sentinel lymph nodes were subjected to standardized dehydration, transparent, paraffin-embedded and sectioned. Hematoxylin-eosin staining(HE) and immunohistochemical CK(AE1/AE3) markers were used to compare the difference of the two methods in sentinel lymph node metastasis screening.
    〖WTHZ〗Results〖HTSS〗 Immunohistochemical staining of 1 585 sentinel lymph node tissues showed that there were 95 lymph node macrometastases, 36 lymph node micrometastasis, and 54 isolated tumour cells(ITC); The results of HE staining showed that the frozen report was 5 cases of suspicious lymph node metastasis. But immunohistochemical staining of CK(AE1/AE3) showed that there was no metastasis in 3 cases.
    〖WTHZ〗Conclusion〖HTSS〗Immunohistochemical staining of CK(AE1/AE3) in sentinel lymph nodes of breast cancer patients can reduce the false positive rate of HE staining, help to detect solitary tumor cells, improve the accuracy of lymph node metastasis, thus effectively assist pathological diagnosis, and provide a basis for the selection of clinical treatment.
    Clinical observation of lower limb complications after obtaining vein graft by No-Touch technique#br#
    LIU Yu， GU Jian-jun， ZHANG Wen-li， BU Ji-qiang， SUN Yong-quan， CHEN Zi-ying*
    2020, 41(5):  528-531.  doi:10.3969/j.issn.1007-3205.2020.05.008
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    ［Abstract］Objective〖HTSS〗To summarize the clinical experience of No-Touch technology to obtain vein grafts, and compare with the traditional long-incision method to obtain lower limb complications after vein grafts.
    〖WTHZ〗Methods〖HTSS〗A total of 201 patients who underwent off-pump coronary artery bypass grafting(CABG) were selected. The control group consisted of 59 patients obtain vein grafts by traditional long incision, and the experimental group consisted of 142 patients obtain vein grafts by No-Touch technique. Comparison of postoperative lower limb complications between 2 groups.
    〖WTHZ〗Results〖HTSS〗The incidence of pain or numbness, edema or exudation and subeschar healing in the test group was significantly higher than that in the control group(P＜0.05). There was no significant difference in the incidence of infection or dehiscence between two groups(P＞0.05).
    〖WTHZ〗Conclusion〖HTSS〗The incidence of lower limb complications in obtaining vein grafts by No-Touch technique is significantly higher than that by traditional long incision. The related factors with high complications of lower limb after obtaining vein grafts with No-Touch technique should be further explored.
    Clinical study of vacuum suction therapy combined with Alprostadil and Apalstat in the treatment of diabetic foot ulcers
    ZHANG Liang， ZHANG Ji-chun， PANG Zi-xuan， WANG Yu-bing
    2020, 41(5):  532-535.  doi:10.3969/j.issn.1007-3205.2020.05.009
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    ［Abstract］Objective〖HTSS〗To evaulate the clinical efficacy of vacuum sealing drainage combined with Alprostadil and Apalstat in the treatment of diabetic foot ulcers(DFU).
    〖WTHZ〗Methods〖HTSS〗Fifty-four patients with DFU were admitted to our research. According to random number table method, 27 cases were divided into control group and observation group. Routine treatment was adopted to both groups. Among them, patients in the control group were treated with vacuum sealing drainage combined with Alprostadil; patients in the observation group were treated with vacuum sealing drainage combined with Alprostadil and Apalstat. The reduction rate of wound,the cover rate of granulation tissue,the thickness of granulation tissue,the clearance rate of bacteria and the healing time of the wound were compared between two groups after treatment.
    〖WTHZ〗Results〖HTSS〗In both groups the reduction rates of wound were increased significantly, and in observation group it was higher than that in the control group. And all of the difference between two groups at all time point were statistically significant(P＜0.01). The growth thickness, coverage rate and bacterial clearance rate of granulation tissue in the observation group were higher than those in the control group, and the difference was statistically significant(P＜0.01). The wound healing time of the observation group was lower than that of the control group(P＜0.01).
    〖WTHZ〗Conclusion〖HTSS〗Vacuum sealing drainage combined with Alprostadil and Apalstat in the treatment of DFU patients has a significant effect and shortens the healing time of ulcers.
    Effects of Liraglutide on visceral fat in overweight and obese patients with type 2 diabetes mellitus#br#
    WANG Xin1, LEI Lin1, LU Cai-ping1, HUO Qian-ping2, LIU Chen-xi1, REN Qiao-hua1
    2020, 41(5):  536-539,544.  doi:10.3969/j.issn.1007-3205.2020.05.010
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    ［Abstract］ Objective〖HTSS〗To observe the effect of Lilalutide on insulin resistance and visceral fat in type 2 diabetes mellitus (T2DM) patients treated by insulin combined with metformin with poor glycemic control. 
    〖WTHZ〗Methods〖HTSS〗Eighty cases of overweight and obese T2DM patients were screened, and the glycated hemoglobin(HbA1c) was consistent with that of 7%≤HbA1c≤ 11%. They were randomly divided into two groups, the insulin combined with metformin group(control group) and the insulin combined with metformin group with Liraglutide(Liraglutide group), and the treatment was conducted for 24 weeks. Body weight(WT) before and after treatment, waist circumference,(WC), body mass index(BMI), fasting blood sugar(FPG), total cholesterol(TC), three triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), HbA1c, fasting insulin( FINS), insulin resistance index(HOMA-IR) and visceral fat area(VFA) changes were observed.
    〖WTHZ〗Results〖HTSS〗After treatment, FPG, TC, TG, HbA1c, LDL -C,FINS, HOMA -IR in the control group were all reduced and HDL-C was increased, with statistically significant differences(P＜0.05). WT, WC, BMI, FPG, HbA1c, TC, TG, FINS, HOMA-IR and VFA were all reduced and HDL-C was increased in the Liraglutide group compared with that before treatment, the difference was statistically significant(P＜0.05).After treatment, WT, WC, BMI and VFA in Liraglutide group were all lower than those in the control group(P＜0.05). Compared with the control group, the daily insulin dose of Liraglutide group decreased(P＜0.05). Decreased VFA was positively correlated with decreased WT, WC and BMI(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗The application of Liraglutide in overweight and obese patients with type 2 diabetes can not only lower blood sugar but also reduce weight, improve insulin resistance and reduce visceral fat, with clinical benefits.
    Clinical analysis of total arthroscopic ligation fixation in the treatment of posterior cruciate ligament avulsion fracture
    REN Jing-tian, XIAO Chu-fan, WANG Qing-tian, LI Wei, SHAO De-cheng*
    2020, 41(5):  540-544.  doi:10.3969/j.issn.1007-3205.2020.05.011
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    ［Abstract］ Objective〖HTSS〗To explore the clinical effect of TigerTape ligation fixation through double posteromedial portal under arthroscopy in the treatment of posterior cruciate ligament avulsion fracture.
    〖WTHZ〗Methods〖HTSS〗Twenty-two patients with posterior cruciate ligament avulsion fracture were treated with TigerTape line bandage fixation. The treatment method, operation time, complications, postoperative functional training and fracture healing were recorded. The joint stability, extension and flexion were compared to evaluate the joint function before and after surgery.
    〖WTHZ〗Results〖HTSS〗The average operation time was 79.52±17.42(60-100) minutes. There was no blood transfusion during and after operation. At two days after surgery, deep vein thrombosis(DVT) was detected in 5 patients in which 3 were in intermuscular veins, 1 was in anterior tibial vein and 1 was in posterior tibial vein. All patients showed no evidence of DVT after 1 week of anticoagulation treatment. No serious complications such as infection, blood vessel or nerve injury, pulmonary embolism or joint stiffness was found. The follow-up duration average 16.91±6.23(6-24) months. The average healing time of fracture was 5.93±1.21(4-8) months. X-ray examination showed that all patients met the clinical healing standard on 6 months after operation. No malunion or nonunion was found. Posterior drawer test was negative. All patients returned to normal activity after operation. After operation the Lysholm score was significantly improved(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗In patients with posterior cruciate ligament avulsion fracture, TigerTape ligation fixation through double posteromedial portalunder arthroscopy can effectively fix the fracture and restore the knee joint function with the superiority of surgery safety, minimal invasion and faster recovery.
    Analysis of risk factors for non-union of the docking siteafter bone transfer for traumatic chronic osteomyelitis of the tibia#br#
    ZHONG Wen-long1， WANG Xin-wei1*， YANG Si-min2， GUO Zai-ran1， ZHANG Lei1， CHEN Jiang-fei1
    2020, 41(5):  545-548,553.  doi:10.3969/j.issn.1007-3205.2020.05.012
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    ［Abstract］ Objective〖HTSS〗To investigate the risk factors of non-union of the docking site after bone transfer for traumatic chronic osteomyelitis of the tibia.
    〖WTHZ〗Methods〖HTSS〗The clinical data of 138 patients with traumatic tibia chronic osteomyelitis who underwent therapy by bone transfer were reviewed. Single factor analysis was used to analyze the related factors by Chi-square test, and logistic regression was used for multivariate analysis to screen risk factors.
    〖WTHZ〗Results〖HTSS〗A total of 138 cases were followed up for 8-48 months, and the average was (24.76±8.49) months. Eighty-one cases had bone union and 57 cases had non-union, the incidence was 41.3%, including 21 cases(15.2%) due to osteoarthritis, 18 cases(13.0%) with poor line position, 13 cases(9.4%) with atrophy of bone resorption, and 5 cases(3.6%) with soft tissue incarceration. The results of single factor analysis showed that age, smoking, local soft tissue condition, bone moving distance and moving direction were the affecting factors fornon-union of the docking site after bone transfer for traumatic chronic osteomyelitis of the tibia(P＜0.05). Multiple factor Logistic regression analysis showed that age, smoking, local soft tissue conditions, and bone moving distance were risk factors for non-union of the docking site after bone transfer for traumatic chronic osteomyelitis of the tibia(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗Bone transfer is an effective method for the treatment of traumatic chronic osteomyelitis of the tibia combined with large bone defect,but there is a high probability of postoperative nonunion at the docking site. And age, smoking, local soft tissue conditions, and bone moving distance are risk factors.
    Therapeutic effect of different medial reduction types of anterior medial cortex combined with INTERTAN fixation for intertrochanteric fractures
    LIU Dian-kui1, MA Wen-hai2*, ZHANG Qian2, LI Yong-wang2, NIE Guang-long1
    2020, 41(5):  549-553.  doi:10.3969/j.issn.1007-3205.2020.05.013
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    ［Abstract］ Objective〖HTSS〗To explore the effect of different anterior cortical support reduction combined with an antegrade femoral intramedullary fixation on intertrochanteric fractures.
    〖WTHZ〗Methods〖HTSS〗A retrospective analysis was performed on 128 patients who met the diagnostic criteria of intertrochanteric fracture.According to the contrastive relationship between the anterior medial cortex of the head and neck bone mass and the anterior medial cortex of the femoral shaft bone mass on the postoperative bilateral orthotopic X-ray, the patients were divided into positive support group(80 cases), neutral support group(23 cases) and negative support group(17 cases). The changes of femoral neck shaft angle and femoral neck length were compared among 3 groups of patients immediately and 3 months after operation, the time of the first time patients underwent weight-bearing,and the differences of Harris scores at 3 and 6 months after operation were compared.
    〖WTHZ〗Results〖HTSS〗Femoral neck length and femoral neck shaft angle loss in the negative support group and the neutral support group were greater than that in the positive support group. The first time of weight-bearing was longer than that of the positive support group, the loss of femoral neck length and neck stem angle in the negative support group was more than that in the neutral support group, and the first time of weight-bearing was longer than that in the neutral support group, the difference was statistically significant(P＜0.05). The Harris scores of negative support group and neutral support group were lower than that of positive support group at 3 and 6 months after operation, and the Harris scores of negative support group were lower than that of neutral support group at 3 and 6 months after operation, the difference was statistically significant(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗Different anterior medial cortical support reduction combined with INTERTAN fixation, the positive and neutral support groups are much better than the negative support group, which can make full contact between the two ends of the fracture, improve the stability of the postoperative fracture, restore the line of force, reduce postoperative complications.

     

    Comparison on clinical curative effect of dual mobility total hip replacement and PFNA on intertrochanteric fractures in the elderly#br#
    LIU Dai-zhong, LI Qiang，DENG Li-qing
    2020, 41(5):  554-557.  doi:10.3969/j.issn.1007-3205.2020.05.014
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    ［Abstract］ Objective〖HTSS〗To explore clinical curative effect of dual mobility total hip replacement(DMTHR) and proximal femoral nail anti-rotation(PFNA) on intertrochanteric fractures(IF) in the elderly.
    〖WTHZ〗Methods〖HTSS〗Seventy-seven elderly IF patients who were admitted to the hospital were enrolled. Thirty-two patients underwent DMTHR(DMTHR group), while the other 45 patients underwent PFNA(PFNA group). Perioperative indexes, pain scores, postoperative hip function and occurrence of complications were compared between two groups.
    〖WTHZ〗Results〖HTSS〗The operation time, weight-bearing time on the ground and hospitalization time in DMTHAPR group were shorter than those in PFNA group, while intraoperative blood loss was more than that in PFNA group(P＜0.05). At 2 weeks after surgery, there was no significant difference in pain scores between two groups (P＞0.05). At 3 and 6 months after surgery, pain scores in DMTHAPR group were significantly lower than those in PFNA group(P＜0.05). At the last follow-up, Harris score of DMTHAPR group was better than that of PFNA group(P＜0.05). There was a statistically significant difference in the Harris score between the total hip double-action replacement group and the PENA group（P＜0.05）.
    〖WTHZ〗Conclusion〖HTSS〗The curative effect of DMTHAPR is relatively better on IF in the elderly. Compared with PFNA, it can shorten postoperative recovery time, and improve hip function.
    Improvement and evaluation of abdominal external fixation with catheter preserved after prostate green laser vaporization
    SHI Lei, XU Hui, CHEN Jun-xiao, LIU Jiao-jiao, GE Hong, QI Jin-chun*
    2020, 41(5):  558-561.  doi:10.3969/j.issn.1007-3205.2020.05.015
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    ［Abstract］ Objective〖HTSS〗To explore the effect of external fixation of urethral tube and abdomen in patients after greenlight photoselective vaporization of the prostate（PVP）. 
    〖WTHZ〗Methods〖HTSS〗A total of 172 patients who underwent PVP were selected by objective sampling, 83 patients in the control group and 89 patients in the observation group. The control group received routine external fixation of upper 1/3 of the lateral thigh catheter, and the observation group received abdominal external fixation of the catheter. The incidence of urine color change, satisfaction during indwelling and the firmness of external fixation were compared between two groups.
    〖WTHZ〗Results〖HTSS〗The occurrence rate of urine color reddening in the observation group was significantly lower than that in the control group. The satisfaction and total satisfaction of patients in the observation group in terms of comfort, convenience, privacy protection were higher than those in the control group. The firmness of external fixation device in the observation group was better than that in the control group, and the difference was statistically significant(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗Fixing urinary catheter on the abdomen in patients after PVP can reduce the incidence of bleeding, promote the recovery of patients, and improve the satisfaction during the period of indwelling catheter, which is worthy of clinical promotion.
    A comparative study of the effect of transurethral bipolar plasmakinetic prostatectomy and transurethral plasmakinetic prostatectomy in the treatment of benign prostatic hyperplasia
    KAN Jin-long1, LIU Jian2， GUO Ping-ying3, CHANG Xue-liang3, QI Jin-chun3, AN Shu-hui3*
    2020, 41(5):  562-565.  doi:10.3969/j.issn.1007-3205.2020.05.016
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    ［Abstract］Objective〖HTSS〗To investigate the efficacy of transurethral bipolar plasmakinetic enucleation and resection of the prostate(PKERP) and transurethral plasmakinetic resection of the prostate(PKRP) in the treatment of benign prostatic hyperplasia(BPH).
    〖WTHZ〗Methods〖HTSS〗The clinical data of 89 patients with BPH were retrospectively analyzed. They were divided into PEKRP group(40 cases) and PKRP group(49 cases) according to different surgical methods. The preoperative, perioperative and postoperative follow-up data of the 2 groups were compared.
    〖WTHZ〗Results〖HTSS〗The operation time, postoperative catheter retention time and hospitalization time of the PKERP group were shorter than those of the PKRP group, and the decrease in hemoglobin was less than that of the PKRP groupP＜0.01). There was no significant difference in the incidence of complications between two groups(P＞0.05). There was no significant difference in the IPSS score, QOL score and maximum urinary flow rate between two groups before and after surgery(P＞0.05). The postoperative IPSS score and QOL score in two groups were lower than those before the operation, and the maximum urine flow rate was greater than that before the operation(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗Both PKERP and PKRP can effectively improve the urination symptoms of patients. The incidence of complications is similar. PKERP is superior to PKRP in terms of operation time, hemoglobin reduction, postoperative urinary catheter retention time, and hospitalization time.
    The effect of rhEGF combined with skin and soft tissue expander on TLR4 level and type Ⅰ collagen Ⅲ ratio in patients with facial and neck scar plastic surgery#br#
    LIU Hong-yan， JIANG Ting*， HUANG Wen-lian， PU Xiao-shu
    2020, 41(5):  566-569.  doi:10.3969/j.issn.1007-3205.2020.05.017
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    ［Abstract］Objective〖HTSS〗To study effects of the human recombinant epidermal cell growth factor, recombinant human epidermal cell length factor(rhEGF) combined with skin and soft tissue expander on TLR4 level and type Ⅰ collagen Ⅲ ratio in patients with facial and neck scar plastic surgery.
    〖WTHZ〗Methods〖HTSS〗A total of 108 patients with facial and neck scar were selected and divided into observation group and control group, according to the random number table method. The control group was treated with skin and soft tissue dilatation, while the observation group was treated with rhEGF and skin and soft tissue dilatation. Compare the immediate retraction rate, skin expansion ratio, expansion time, collagen type Ⅰ/Ⅲ ratio, hydroxyproline(hydroxyprolin, OHP) content, Toll-like receptor 4(Toll-like receptor4, TLR4) expression level, clinical efficacy, adverse events of 2 groups of patients.
    〖WTHZ〗Results〖HTSS〗 In the observation group, immediate retraction rate, expansion of completion time, collagen type Ⅰ/Ⅲ ratio were significantly lower than those of the control group, and skin expansion rate and OHP of the observation group were significantly higher than those of control group(P＜0.01). The repair effect of the observation group was better than that of the control group, and the total effective rate was higher than that of the control group(P＜0.01).
    〖WTHZ〗Conclusion〖HTSS〗RhEGF combined with skin and soft tissue expander has a good effect in the treatment of facial and neck scar, with low incidence of adverse reactions and good safety.
    Down regulation of MCT1 expression inhibits proliferation and promotes apoptosis of Hela cells#br#
    ZHAO Juan, LI Long*
    2020, 41(5):  570-573,578.  doi:10.3969/j.issn.1007-3205.2020.05.018
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    ［Abstract］ Objective〖HTSS〗To investigate the effect of down-regulation of monocarboxylate transporter1(MCT1) on the proliferation and apoptosis of Hela cells and its mechanism.
    〖WTHZ〗Methods〖HTSS〗HeLa cells were divided into three groups: untransfected group, negative control group and MCT1 siRNA group. The expression of MCT1, Bcl-2 and Bax protein in Hela cells was detected by Western blot, Hela cell proliferation was detected by MTT, Hela cell cycle distribution and apoptosis rate were detected by flow cytometry.
    〖WTHZ〗Results〖HTSS〗Compared with the control group, the expression level of MCT1, Bcl-2, Bax protein, cell proliferation, cycle distribution and apoptosis rate of Hela cells in the negative control group had no significant difference(P＞0.05), but the expression level of MCT1 and Bcl-2 protein, cell proliferation activity and the percentage of cells in S phase in the MCT1-siRNA group were significantly reduced, while the expression level of Bax protein and the percentage of cells in S phase were significantly reduced The percentage and apoptosis rate in G0/G1 phase were significantly increased(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗Down regulation of MCT1 expression can inhibit Hela cell proliferation by inducing cell cycle arrest, and promote Hela cell apoptosis by up regulation of Bax and down regulation of Bcl-2 protein expression.
    Clinical study of Kangfuxin Liquid combined with lidocaine assisted oxygen therapy in the treatment of recurrent oral ulcer#br#
    XIANG Hai-dong, WANG Yi-long, LIU Cong-na, HU Xiao-lin, GAO Qi*
    2020, 41(5):  574-578.  doi:10.3969/j.issn.1007-3205.2020.05.019
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    ［Abstract］ Objective〖HTSS〗To investigate the clinical effect of Kangfuxin liquid combined with lidocaine assisted oxygen therapy on recurrent oral ulcer.
    〖WTHZ〗Methods〖HTSS〗A total of 107 patients with recurrent oral ulcer were randomly divided into control group(53 cases) and study group(54 cases) by random number table method. The control group was treated with lidocaine and oxygen therapy, while the study group was treated with Kangfuxin solution, lidocaine and oxygen therapy. The pain relief degree of the two groups was compared 6 days after treatment. Six days after the treatment, the cure rate of the two groups was compared, the levels of CD3+, CD4+, CD8+, IL-6 and TNF-α were compared, and the recurrence and adverse reactions of the two groups were followed up.
    〖WTHZ〗Results〖HTSS〗After treatment, the pain index of the study group was lower than that of the control group, the healing time was shorter than that of the control group, the total effective rate was higher than that of the control group, the levels of CD3+, CD4+ and CD4+/CD8+ were higher than that of the control group, the levels of TNF-α and IL-6 were lower than that of the control group, and the recurrence rate was lower than that of the control group(P＜0.05 or P＜0.01). There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).
    〖WTHZ〗Conclusion〖HTSS〗The treatment of recurrent oral ulcer with Kangfuxin liquid combined with lidocaine adjuvant oxygen therapy can enhance the efficacy, relieve pain, improve the immune function, reduce the inflammatory response, reduce the recurrence rate, and have fewer adverse reactions.
    Effect of extraction of the mandibular third molar by coronectomy on inferior alveolar nerve injury#br#
    WANG Xue-tao, LI Cong, LI Fang-ning
    2020, 41(5):  579-581,586.  doi:10.3969/j.issn.1007-3205.2020.05.020
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    ［Abstract］ Objective〖HTSS〗To observe the effects of extraction of the mandibular third molar by coronectomy on inferior alveolar nerve injury.
    〖WTHZ〗Methods〖HTSS〗Sixty-two patients who requested for extraction of the mandibular third molar(root apex of the wisdom tooth connecting with mandibular canal) were selected and divided into the coronectomy group and the traditional extraction group according to the extraction method. The incidence of inferior alveolar nerve injury, bleeding rate, duration of postoperative pain and patient's satisfaction were compared between the two groups at 1 week after surgery. The incidence of infection in both groups at 18 months after surgery, the situation of root fracture displacement at different time points(6 months, 12 months and 18 months after surgery) were observed.
    〖WTHZ〗Results〖HTSS〗There was no significant difference in the bleeding rate between the two groups at 1 week after surgery(P＞0.05). The incidence of inferior alveolar nerve injury in the coronectomy group was significantly lower than that in the traditional extraction group(0.00% vs 18.52%)(P＜0.05). The duration of postoperative pain in the coronectomy group was significantly shorter than that in the traditional extraction group(P＜0.01). The satisfaction of the coronectomy group was significantly better than that of the traditional extraction group(P＜0.05). There was no significant difference in the incidence rate of infection between two groups at 18 months after surgery(P＞0.05). The root fracture displaced(0.51±0.06) mm, (1.14±0.13) mm, (1.48±0.17) mm and (1.50±0.18) mm at 3 months, 6 months, 12 months and 18 months respectively after surgery, tending to be stable. 21 patients had their roots removed by secondary extraction.
    〖WTHZ〗Conclusion〖HTSS〗Extraction of the mandibular third molar by coronectomy can alleviate the injury to the inferior alveolar nerve and relieve postoperative pain. It is satisfactory and with clinical feasibility.
    Adverse reactions, curative effect and outcome difference between the two kinds of blood transfusion methods
    GUO Gang1， ZHAO Ni1*， LIU Ya-dong2
    2020, 41(5):  582-586.  doi:10.3969/j.issn.1007-3205.2020.05.021
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    ［Abstract］Objective〖HTSS〗To explore the adverse reactions, transfusion efficacy and outcome difference of two kinds of transfusion methods.
    〖WTHZ〗Methods〖HTSS〗Seventy patients with autogenous blood transfusion with lumbar fracture(experimental group) and 70 patients with allogeneic blood transfusion with lumbar fracture(control group) were selected. Blood routine examination and coagulation function were carried out before and 1,3,7 days after blood transfusion in both groups. Adverse reactions of blood transfusion were recorded in both groups. The immunoglobulin level, complement level and outcome between two groups was compared.
    〖WTHZ〗Results〖HTSS〗The activated partial thromboplastin time and prothrombin time of the two groups showed a trend of first prolonging and then shortening, the difference between time points was statistically significant(P＜0.01), and there was no significant difference between groups and between groups in interaction between time points(P＞0.05). The hematocrit of the two groups first decreased and then increased, the difference between time points was statistically significant(P＜0.01), and there was no significant difference between groups, between groups and time points interaction(P＞0.05). The hemoglobin, platelets and leukocytes of the two groups all decreased first and then increased. The interaction between time points and between groups was statistically significant(P＜0.01), but there was no significant difference between groups(P＞0.05). The blood transfusion of the two groups decreased first and then increased, the change range of the experimental group was large, and the interaction among groups, time points and between groups was statistically significant(P＜0.01). The level of immunoglobulin G and immunoglobulin M decreased in the control group, but not in the experimental group. The level of immunoglobulin G and immunoglobulin M in the experimental group was significantly higher than that in the control group, and the interaction among groups, time points and time points was statistically significant(P＜0.01). There was no significant difference in the interaction of C3 between groups, time points and between groups(P＞0.05). The clinical effect of the experimental group was better than that of the control group, and the incidence of adverse reactions and hospitalization expenses were significantly lower than that of the control group(P＜0.05). There was no significant difference in mortality between two groups(P＞0.05).
    〖WTHZ〗Conclusion〖HTSS〗Autotransfusion is superior to allogeneic transfusion in blood transfusion effect and recovery speed. Autotransfusion has the advantages of safety, economy, high cure rate, low incidence of adverse reactions and low mortality.
    Clinical application of contrast-enhanced ultrasound in evaluating the therapeutic effect of microwave ablation for breast nodules#br#
    LIU Xiao-lu, LIU Jing-ping，SONG Qian, WU Feng,WANG Qian, ZHENG Wei-wei
    2020, 41(5):  587-591.  doi:10.3969/j.issn.1007-3205.2020.05.022
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    ［Abstract］Objective〖HTSS〗To explore the applied value of contrast-enhanced ultrasound in evaluating the therapeutic effect during and after microwave ablation for breast nodules.
    〖WTHZ〗Methods〖HTSS〗The 43 breast nodules of 30 patients admitted in our hospital were underwent Ultrasound-guided microwave ablation treatment. Before and after microwave ablation operation, two-dimensional ultrasound and contrast-enhanced ultrasound were used to measured the location, number and volume of nodules, observed the distribution and intensity of blood flow in nodules and determined ablation range. Intravenous contrast-enhanced ultrasound detection was carried out immediately after microwave ablation to observe the enhancement state of contrast agent in nodules. The nodules were divided into 3 groups: 1.5-3.5 cm3, ＞3.5-5 cm3 and more than 5 cm3 according to the enhanced volume, to calculate the ablation rate of lesions of each group and evaluate the ablation effect. Supplementary treatment for residual lesions which were incomplete ablation was carried out. The patients were followed up by two-dimensional ultrasound and contrast-enhanced ultrasound after 1, 6 and 12 months of ablation, observed whether there were contrast agent perfusion in nodules and measured the volume and volume reduction rate of nodules. The evaluation of curative effect was also carried out.
    〖WTHZ〗Results〖HTSS〗Two-dimensional ultrasound and contrast-enhanced ultrasound both detected blood flow signals in all 43 breast nodules. 15 minutes after microwave ablation, the ablation rates of lesions with enhanced volume of 1.5-3.5 cm3, ＞3.5-5 cm3 and more than 5 cm3 were 97.45%, 89.99% and 67.05% respectively，there was significant statistical difference（P＜0.01）. Contrast-enhanced ultrasound showed there were 8 residual tissue which had a small amount of irregular contrast medium perfusion at the edge of nodules. The successful rate of primary ablation was 81.4%. Supplementary ablation treatment for residual incomplete ablation areas was carried out. There was significant statistical difference among the volume of breast nodules  before and after 1, 6 and 12 months of microwave ablation operation(P＜0.01).  The volume reduction rates were 44.1%, 58.5% and 72.3% respectively, there was significant statistical difference（P＜0.01）.  There were significant differences in clinical efficacy and total effective rate(72.09%, 93.02%,100%) after 1, 6 and 12 months of microwave ablation operation(P＜0.01).
    〖WTHZ〗Conclusion〖HTSS〗Contrast-enhanced ultrasound can more accurately determine the location and blood flow distribution of the lesion before microwave ablation and accurately evaluate the ablation effect after ablation operation, so timely supplementary treatment can be provided for incomplete ablation areas. Postoperative follow-up can timely and accurately detect whether residual lesions reappeared again and achieve the complete ablation of breast nodules.
    Analysis of the status of death anxiety among nurses in Hebei Chest Hospital and clinical intervention
    XUE Na-na1, LIU Yu-fang1, XIAO He-mei2, ZHAO Shu-yun1, LIANG Hui-zhen1, YU Feng-xue3*
    2020, 41(5):  592-596.  doi:10.3969/j.issn.1007-3205.2020.05.023
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    ［Abstract］Objective〖HTSS〗To understand the demand for death anxiety training of intensive care unit(ICU) nurses in a tertiary hospital in Hebei Province and the effect of systematic training, and provide a reference for the purposeful and systematic implementation of systematic death education and training in the future.
    〖WTHZ〗Methods〖HTSS〗The nurses working in the ICU of the Chest Hospital of Hebei Province were taken as the research objects, and survey analysis was performed through the “Chinese version of the Death Anxiety Scale” and the death anxiety training requirement percentage system.
    〖WTHZ〗Results〖HTSS〗The older the ICU nurses were, the higher the death anxiety level was(P＜0.01). The higher the age, the higher the education, the higher the professional title, and the longer the number of working years, the higher the ICU nurse′s death education needs score(P＜0.01). Death anxiety score was positively related to the need for death education(P＜0.05). Logistics regression results showed that the title level was an important factor affecting the demand for death education and training. The death anxiety score of ICU nurses after training was significantly lower than before training(P＜0.05).
    〖WTHZ〗Conclusion〖HTSS〗The death anxiety score is positively related to the demand for death education training. The higher the level of professional title, the stronger the urgency of receiving systematic death education training. After training, the death anxiety score of ICU nurses was significantly reduced, which is worth promoting death education training.
    Preliminary clinical study on the relationship between important epiphyseal site and epiphyseal closure time, fracture site and fracture incidence#br#
    ZHAO Kuo, MENG Hong-yu, TIAN Si-yu, WANG Zhong-zheng, LI Jun-yong, ZHANG Ying-ze*
    2020, 41(5):  604-606.  doi:10.3969/j.issn.1007-3205.2020.05.026
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    ［Abstract］〖HTSS〗The occurrence and closure time of epiphysis in human body are different with bone sites. We found that when the fracture was subjected by indirect violence, the fracture rate of epiphysis is higher, the site with late epiphyseal closure is more likely to fracture than the adjacent site, and there is a certain correlation between the fracture line and epiphyseal fusion part. In this article, we made a preliminary clinical study on the relationship between important epiphyseal site and epiphyseal closure time, fracture site and fracture incidence.