Comparison between tension band and cerclage with X-Plate and lag screws in treatment of comminuted patellar fractures

BackgroundComminuted patellar fractures are not rare, and the ideal treatment method remains controversial. The present study was conducted to evaluate effects and compare complications of two different methods used to treat comminuted patellar fractures.MethodsFrom March 2010 to August 2016, 102 cases of 34-C2 or 34-C3 comminuted patellar fractures were treated at our hospital, wherein patients received two different treatments: titanium cable tension band with cerclage method (group A) and intrafragmentary screws with X-shaped plating technique (group B). At follow-ups, articular step-off, range of motion (ROM), Lysholm scores, time of union, and complications were recorded and analyzed. Radiographic and clinical data as well as rate of complications were statistically analyzed.ResultsIn total, 87 patients were included in the final analysis (n = 47 in group A and n = 40 in group B). No significant differences were noted in terms of cost of implant, age, gender, rate of 34-C3 fractures, rate of layered inferior pole fractures, postoperative articular step-off and union time. At 2-year follow-up, average Lysholm scores, ROM and rate of complications were (89.0 ± 4.5), (122°±12°) and (27.7%) in group A and (90.2 ± 3.9), (124°±11°) and (17.5%) in group B, respectively, with no significant differences (p > 0.05). The mean time of surgery in group B was shorter than that in group A with significant difference (p < 0.05).ConclusionsTreatment using the intrafragmentary screws and plate method for amenable comminuted patellar fractures achieved similar complication rate and favorable functional outcomes at the 2-year follow-up, which was comparable to the titanium cable tension band with cerclage method. Thus, the intrafragmentary screws and plate method is effective, safe and convenient for 34-C2/C3 comminuted patellar fractures, especially appropriate for patients with layered fragments.     

药物性肝损伤与免疫性肝损伤肝组织中lncRNA表达谱的差异分析

目的:研究长链非编码RNA(lncRNA)在药物性肝损伤及免疫性肝损伤中表达谱的变化,并分析二者的差异。方法:利用lncRNA芯片技术分别检测对乙酰氨基酚诱导的小鼠药物性肝损伤及刀豆蛋白A诱导的小鼠免疫性肝损伤肝组织的lncRNA表达谱,通过对原始数据进行预处理达到均一化后,筛选出差异表达lncRNA并进行分析。结果:与正常肝脏组织比较,变化1.5倍以上并且差异有统计学意义(P0.05)的lncRNA被认为是差异表达的lncRNA;药物性肝损伤肝组织中变化1.5倍以上的共68条,其中升高1.5倍以上的共21条,降低1.5倍以上的共47条;免疫性肝损伤肝组织中变化1.5倍以上的共60条,其中升高1.5倍以上的共17条,降低1.5倍以上的共43条。所有的lncRNA中有8条lncRNA同时在2种肝损伤肝组织中上调,在药物性肝损伤肝组织上调的lncRNA中占38%,在免疫性肝损伤肝组织中占47%;有28条lncRNA同时在2种肝损伤肝组织中下调,在药物性肝损伤肝组织下调的lncRNA中占59%,在免疫性肝损伤肝组织中占65%。结论:与正常肝脏组织比较,药物性肝损伤肝组织和免疫性肝损伤肝组织中lncRNA表达谱均发生明显变化,且2种不同肝损伤肝组织比较,lncRNA表达谱也存在差异,提示2种肝损伤肝组织中这些同时上、下调的lncRNA可能参与了2种肝损伤之间相似或是相同的病理生理过程,而那些表达不同的lncRNA可能参与相对特异的肝损伤机制的发生。     

Predictive value of blood concentration of biologics on endoscopic inactivity in inflammatory bowel disease: A systematic review

BACKGROUND Although blood concentration of biologics is an important composition of disease management in inflammatory bowel disease(IBD)patients,complexity and uncertainty of biological management encourage many disputes in predicting the outcome of IBD patients through blood concentration of biologics.AIM To verify the predictive value of blood concentration of biologics on endoscopic inactivity in IBD patients under different situations.METHODS We searched PubMed/MEDLINE,Embase,and Web of Science up to May 2020 and identified IBD patients as the research cohort as well as the correlations between blood concentration of biologics and endoscopic inactivity in IBD patients as the research direction.RESULTS A total of 23 articles with 30 clinical studies and 1939 IBD patients were included.The predictive cut-off value of blood concentration of infliximab on mucosal healing should be 2.7-10.6μg/mL in IBD.Blood concentration of infliximab reaching 5.0-12.7μg/mL or more increased the probability of fistula healing/closure in perianal fistulizing Crohn's disease.Blood concentration of adalimumab reaching 7.2-16.2μg/mL or more could predict mucosal healing in IBD.The predictive cut-off value of blood concentration of adalimumab on fistula healing/closure should be 5.9-9.8μg/mL in perianal fistulizing Crohn's disease.Blood concentration of vedolizumab surpassing 25.0μg/mL indicated mucosal healing in ulcerative colitis patients under maintenance therapy and the predictive cut-off value of blood concentration on mucosal healing or endoscopic remission under induction therapy in IBD could be 8.0-28.9μg/mL.CONCLUSION Blood concentration of biologics should not be utilized to predict endoscopic inactivity of IBD independently due to discrepancies in clinical studies,whereas conducting therapeutic drug monitoring intensively contributes to precise therapy.     

The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation

BackgroundThe shortage of donor liver restricts liver transplantation (LT). Nowadays, donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver. Although it is now possible to perform ABO-incompatible (ABO-I) LT, antibody-mediated rejection (AMR) has been recognized as the primary cause of desperate outcomes after ABO-I LT. Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury. Therapeutic plasma exchange (TPE) can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.Data sourcesWe searched PubMed and CNKI databases using search terms “therapeutic plasma exchange”, “ABO-incompatible liver transplantation”, “ABO-I LT”, “liver transplantation”, “LT”, “antibody-mediated rejection”, and “AMR”. Additional publications were identified by a manual search of references from key articles. The relevant publications published before September 30, 2020 were included in this review.ResultsDifferent centers have made different attempts on whether to use TPE, when to use TPE and how often to use TPE. However, the control standard of lectin revision level is always controversial, the target titer varies significantly from center to center, and the standard target titer has not yet been established. TPE has several schemes to reduce antibody titers, but there is a lack of clinical trials that provide standardized procedures.ConclusionsTPE is essential for ABO-I LT. Hence, further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.     

阿米福汀对骨髓增生异常综合征患者红细胞寿命的影响

目的研究骨髓增生异常综合征(myelodysplastic syndrome,MDS)患者的红细胞寿命以及阿米福汀对红细胞寿命的影响。方法回顾性分析浙江省中医院血液科2017年1月-2018年7月期间81例MDS患者的临床资料,分为阿米福汀治疗组(49例)和支持治疗组(32例)。以同期9名正常志愿者为正常对照,采用内源性一氧化碳呼气试验法测定患者及志愿者的红细胞寿命,分析MDS患者红细胞寿命及阿米福汀对红细胞寿命的影响。结果 81例初发MDS患者(未经输血支持)平均红细胞寿命为(33.41±10.96)d,与正常对照红细胞寿命(121.11±32.59)d相比明显缩短(P<0.01)。阿米福汀治疗组:部分缓解1例,血液学改善13例,疾病稳定12例,总有效率53.1%。治疗后MDS患者的红细胞寿命(42.24±12.99)d,与治疗前相比明显延长(P<0.01)。支持治疗组:血液学改善2例,疾病稳定9例,总有效率34.4%,红细胞寿命(34.53±7.50)d,与治疗前相比未明显改善。红细胞寿命与疗效关系分析表明,血液学改善患者的红细胞寿命(45.92±9.24)d,较正常对照组红细胞寿命短(P<0.01),与治疗前比较明显延长(P<0.01)。其余患者红细胞寿命治疗前后无统计学意义。结论 MDS患者红细胞寿命缩短,阿米福汀治疗后可提高患者红细胞寿命。     

浙江省《新型冠状病毒肺炎中医药防治推荐方案(试行第四版)》解读

[目的]解读浙江省《新型冠状病毒肺炎中医药防治推荐方案(试行第四版)》,协助指导临床用药。[方法]从中医学理论角度,分析阐述新型冠状病毒肺炎的病因病机、分期分型及辨证论治。[结果]新型冠状病毒肺炎属于中医"疫病"范畴,为湿邪与疫毒疠气合而为病,易耗气伤阴动血。浙江方案针对高风险人群推荐玉屏风散加减。针对肺炎患者分期分型论治,将其分为轻型-疫毒袭肺、普通型-疫毒郁肺、重型-疫毒壅肺、危重型-疫毒闭肺、恢复期-肺脾两虚,分别投以荆防败毒散、麻杏石甘汤合千金苇茎汤、葶苈泻肺汤、参附汤、香砂六君丸加减治疗。[结论]浙江省《新型冠状病毒肺炎中医药防治推荐方案(试行第四版)》体现浙派中医特色,融入中医治未病思想,以期在疫情防治中发挥作用。     

三斑海马及其混伪品的DNA条形码分子鉴定研究

目的 建立三斑海马Hippocampus trimaculatus的COI、16 S rRNA和ATP6的条形码序列数据库,应用DNA条形码技术从分子水平快速准确鉴定三斑海马和其他正伪品海马,探讨海马属药材鉴定的新方法。方法 提取三斑海马药材的基因组DNA,PCR扩增COI、16 S rRNA和ATP6的序列并进行双向测序,所得序列采用软件Codon Code Aligner V4.2对测序峰图进行校对拼接,应用ClustalX软件进行序列比对,MAGA5.0软件计算三斑海马的种内种间遗传距离(Kimura2-Parameter,K2P),构建邻接树(Neighbor-joingtree,NJTree)聚类分析不同品种海马药材的鉴定结果。结果 获得的三斑海马线粒体COI、16 S rRNA、ATP6序列长度分别649、572、603～605 bp,其中3个条形码序列的种内变异位点碱基数分别为8、4和15,种内的变异率较小,COI、16 S r RNA、ATP6序列的平均种内K2P遗传距离0.002、0.001和0.006,均远小于三斑海马的种间K2P距离;NJ树结果显示三斑海马与其他海马均可明显区分,具有良好的单系性。结论 COI、16 S r RNA、ATP6序列作为条形码均可以鉴定三斑海马及其他混伪品海马药材,为动物类药材及其混伪品和近源物种的分子鉴定提供依据,为对保障海马临床用药安全提供了新的技术手段。