Posterior Ankle Decompression With Os Trigonum or Stieda Process Resection in Dancers: Case Series Report and Review of the Literature

This case series reports the outcome of posterior ankle decompression and os trigonum or Stieda process resection utilizing an open posterolateral approach in 54 professional, pre-professional, and dedicated recreational dancers. All procedures were performed by a single surgeon at the same facility between 2008 and 2018. The surgical technique is described in detail. Data related to results of the surgery were gathered via follow-up questionnaire and verified by referencing the patients’ medical records. Outcomes were self-assessed in terms of categories ranging from excellent through moderate to poor. Eighty-nine percent of the dancers (N = 48 of 54) chose excellent or good, 11% (N = 6) chose moderate, and none selected poor. These results were compared with those achieved in 17 previous studies reporting the use of both open (posterolateral and posteromedial) and arthroscopic/endoscopic techniques in dancers. This comparison found similarly favorable reported outcomes, but also great variation in methodology for determining patient reported outcomes (PROs). While the preferred surgical technique for posterior ankle decompression remains controversial, the open posterolateral approach utilized in this series resulted in high expectation of return to dance with minimal complications. The need for a dancer-specific PRO tool is discussed.     

Clinicopathological characteristics,prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma

PurposeTo investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC).Patients and MethodsRecords of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival.ConclusionUTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC.     

人文医疗在阴式全子宫切除术联合阴道后壁修补术治疗子宫脱垂合并肠疝患者中的应用

目的探究人文医疗在阴式全子宫切除术联合阴道后壁修补术治疗老年子宫脱垂合并肠疝(阴道后壁膨出)患者中的应用效果。方法选择2018年1月至2019年12月期间天长市中医院收治子宫脱垂合并肠疝患者120例作为研究对象。全部入选病例均行阴式全子宫切除术联合阴道后壁修补术治疗,采用随机数字表法将病例分为对照组和观察组,各60例。对照组给予常规护理,观察组给予人文医疗护理。对比2组患者中文版知觉压力量表(CPSS)评分、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分、心理弹性量表-简表(RS-14)、护理服务满意度、皮质醇(Cor)、心率及平均动脉压。结果护理前,2组CPSS、SDS、SAS及RS-14评分组间比较的差异无统计学意义(P>0.05);护理7 d后,2组CPSS、SDS、SAS及RS-14评分均较护理前降低,且观察组均低于对照组,差异有统计学意义(P<0.05)。观察组患者的满意度(96.67%)较对照组高(80.00%),差异有统计学意义(P<0.05)。观察组手术结束时2组患者的Cor、心率及平均动脉压较对照组低,差异有统计学意义(P<0.05)。结论人文医疗应用于子宫脱垂合并肠疝患者护理中,能够改善其不良情绪,缓解心理压力,减少手术的应激反应,提高患者对护理满意度。     

Risk Factors and Outcomes for Preoperative Asymptomatic Pulmonary Embolism in Patients Aged 60 Years and Over with Hip Fracture

ObjectiveTo investigate the risk factors for, and outcomes of, preoperative asymptomatic pulmonary embolism (PE) in patients ≥60 years old following delayed operation for hip fracture.MethodsFrom March 2017 to December 2018, 90 patients aged ≥60 years with hip fracture who suffered a delay in surgery were recruited to this prospective study following admission to our hospital. Computed tomography pulmonary angiography (CTPA) was used to detect preoperative asymptomatic PE and calculated its incidence. Time from injury to admission, baseline characteristics, medical comorbidities, and blood biomarker levels were evaluated as potential risk factors. Logistic regression analysis was used to identify risk factors. Mortality and major bleeding events were recorded and compared between individuals with PE and without. Data were analyzed by t‐test, Mann–Whitney U test, χ ² test, Fisher''s exact test, and logistic regression analysis.ResultsThe incidence of preoperative asymptomatic PE was 18.9% (17/90 patients). In the univariate analysis, the risk factors for preoperative asymptomatic PE were male sex, hypertension, cerebrovascular accident, smoking, plasma D‐dimer level, potassium level, urea level, creatinine level, and cysteine level. Multivariate logistic regression analysis showed that the risk of preoperative asymptomatic PE was higher in patients with hypertension (odds ratio [OR] = 10.048; 95% confidence interval [CI], 1.118–90.333), cerebrovascular accident (OR = 20.135; 95% CI, 1.875–216.164), smoking (OR = 48.741; 95% CI, 4.155–571.788), high plasma D‐dimer levels (OR = 1.200; 95% CI, 1.062–157.300), and high plasma potassium levels (OR = 12.928; 95% CI, 1.062–157.300). All patients were followed up for 21.0 months (range, 2 to 36 months). Mortality within the first year postoperatively was higher in patients with PE (29.41% vs 9.59%, P = 0.046).ConclusionsIn view of the high incidence of preoperative asymptomatic PE and the inferior prognosis in individuals with PE, routine CTPA examination for preoperative asymptomatic PE could be useful for patients aged ≥60 years with hip fracture for whom surgery is delayed.     

椎间盘退变的腰椎活动节段力学模型

椎间盘是人体组织中最早发生退行性改变的部位。本文报告采用三维有限元方法建立的椎间盘退变腰椎活动节段的力学模型,着重分析其在直立时的应力分布与载荷传递情况。模型共有388个节点,组成293个单元,所得结构较为合理可靠。作者认为,本模型具有其独特的优点。可望用于进一步的研究。     

褐云玛瑙螺中枢内支配大触角肌肉神经元的分布

实验用荧光素Ｂｂ逆行追踪方法，研究了褐云玛瑙螺支配大触角肌肉活动的神经元在中枢的分布，结果表明，Ｂｂ标记神经元大多分布于同侧脑节，少量分布于侧脑节，同侧口球节，足节和侧节，Ｂｂ标记神经元大多为中小型神经元，个别属于大型神经元。     

Primary study of iontophoresis of zinc ion in treatment of retinitis pigmentosa

We report here the preliminary effects of zinc iontophoresis in treatment of 26 Rp patients who had decreased zinc serum level or abnormal ratio of serum copper to zinc. Through more than 20 to 30 times of therapy, the vision of 15.38% eyes increased more than "3 lines", 4% eyes increased more than 5 degrees in the visual field, 13.46% eyes improved in dark adaptation threshold (greater than 1.0), the visual functions of the rest eyes were slightly improved or unimproved. The fundus didn't change before & after treatment. There were no changes of ERG in 8 eyes of 4 cases. In addition, the advantages and disadvantages between Zn iontophoresis and Zn compound taken orally, the improvement of vision by direct electric current therapy, the relationship between the metabolism of Zn element and Vit A and influence of Zn over the mechanism of dark adaptation were also briefly discussed.     

Rsa I与Sma I多态性寡核苷酸阵列检测法的建立及其与血栓性疾病的相关性研究

目的 建立血管性血友病因子（vWF)基因Rsa I、Sma I多态性寡核苷酸阵列检测方法,对基因芯片在单核苷酸多态性（SNP）检测上的应用进行探讨;研究两位点多态性与血栓性疾病的发生有无相关关系。方法 设计、合成两组寡核苷酸探针,使用3甲氧基氨基丙基硅烷、戊二醛等化学物质,实现探针与固相支持物玻片的连接。 应用不对称PCR方法扩增Rsa I、Sma I多态性片段,在扩增体系中掺入荧光标记dUTP,获得被测片段的单链标记产物。对核酸杂交反应的温度、动力学和离子浓度 变化进行研究,获得最佳的杂交鉴别条件。对20名正常人,酶切法确定多态性基因型,再用寡核苷酸阵列法检测,以验证该方法的准确性。使用该方法对50例血栓病人进行检测,探讨血栓性疾病的发生与vWF基因Rsa I、Sma I多态性的关系。结果 寡核苷酸阵列法和酶切法对20例标本检测的符合率为1005;血栓病人与正常人Rsa I、Sma I两位点多态性的基因型GG、GA、AA和CC、CT、TT分别为4．0％、12．0％、84．0％和24．0％、44．0％、32．0％,正常人分别为1．4％、11．8％、86．8％和8．8％、57．4％、33．8％,血栓病人等位基因频率G、A和C、T分别为10．0％、90．0％和46．0％、54．0％,正常人分别为7．4％、92．6％和37．5％、62．5％,血栓病人与正常人之间两位点多态性的基因型和等位基因频率的差异均无显著意义（P＞0．05）。结论 成功建立vWF基因 Rsa I、Sma I多态性寡核苷酸阵列检测方法,为基因芯片技术在SNP检测上的应用提供依据。未获明确证据表明Rsa I、Sma I多态性与血栓的发生有关。     

胸水细胞端粒酶活性检测对良恶性胸腔积液的鉴别诊断价值

目的：探讨胸水细胞端粒酶活性对良、恶性胸腔积液的鉴别诊断价值。方法：用改良的PCR-ELISA法检测37例恶性、32例良性胸水细胞端粒酶活性,并与胸水细胞学、癌胚抗原（CEA）诊断结果进行比较。结果：37例恶性胸腔积液中有26例端粒酶活性阳性（26/37）,阳性率为70.27%,高于良性胸腔积液中端粒酶海性表达（2/32,P＜0.01);端粒酶活性检测诊断恶性胸水敏感性为70.27%,特异性为93.75%,与胸水细胞学诊断符合率为54.05%;其敏感性高于胸水CEA诊断结果（敏感性为51.35%)。结论：胸水细胞端粒酶活性检测作为细胞学检查的辅助手段能提高恶性胸水的诊断率,有助于良、恶性胸腔积液的鉴别诊断。     

加热对人肝癌耐药细胞模型-7721/Adm细胞内药物浓度的影响

目的 探讨比较43℃加热前后人肝癌细胞－7721（以下简称7721细胞）和耐药人肝癌细胞模型－7721／Adm(以下简称7721／Adm细胞）细胞内阿霉素（ADM）药物浓度的变化。方法 以体外培养的人肝癌细胞－7721和作自行培养建立的人肝癌细胞模型－7721／Adm为研究对象,采用水浴加温法、流式细胞荧光技术观察阿霉素化热前后7721和7721／Adm细胞胞内阿霉素（ADM）浓度的变化。结果 加热后7721组提高30．8％,HCC－7721／Adm组提高51％。结论 加热可明显提高这两种细胞内的阿霉素浓度,从而提高这两种细胞的化疗敏感性,为临床克服多药耐药问题提供了重要依据。