肥胖患者膝关节表面置换术后的早期康复

目的探讨肥胖患者初次膝关节置换术后早期康复的方法。方法自2009年1月至2012年6月共完成肥胖患者初次膝关节置换42例42膝,男8例,女34例;年龄60～78岁,平均65岁,身体质量指数（BMI）33—52,平均46。术后早期进行持续被动关节运动增加关节活动度（ROM）和进行股四头肌及胭绳肌肌力的强化训练,延长住院时间至术后14d。分别以术前2d、术后2d、1、2、4、8、12、24周作为观察点,使用VAS疼痛评分、WOMAC评分和ROM对膝关节功能及疼痛程度进行评价。结果术后VAS疼痛评分、WOMAC评分低于术前,术后ROM高于术前,差异均有统计学意义。所有指标在术后4周以后均有逐步改善,但差异没有统计学意义。结论肥胖患者膝关节置换术后早期行功能锻炼及适当延长住院时间可以提高膝关节功能。     

大气污染与不良妊娠结局关系的研究进展

流行病学研究发现大气污染对人群健康已造成一定影响［1］。但以往学者多关注大气污染对成人死亡率和呼吸道疾病发病率的影响,而与不良妊娠结局关系的研究近期才得以重视。不良妊娠结局指正常妊娠以外所有的病理妊娠及分娩期并发症,包括早产、胎膜早破、自然流产、低出生体重、出生缺陷和新生儿窒息等孕产妇及围产儿的不良结局。本文将对大气主要污染物大气颗粒物（PM）、氮氧化物（NOX）、二氧化硫（SO2）、一氧化碳（CO）和臭氧（O3）与不良妊娠结局的低出生体重、早产、出生缺陷、流产、死产和婴儿期死亡之间关系进行综述。     

Shall we take a second thought before applying radiofrequency ablation for resectable HCC ≤2 cm?

Hepatocellular carcinoma (HCC), a disease with poor survival rates unless recognized and treated early, ranks as the fifth most common cancer worldwide. Previous researches has led some authors to choose radiofrequency ablation (RFA) as the primary treatment even the tumor is resectable. Dr. Roayaie’s study retrospectively analyzed the surgical outcome of HCC ≤2 cm. The results obtained in the studies indicate that anatomic resection may achieve better survival for patients with well-preserved liver function, and without liver cirrhosis. This research also revealed the presence of satellite lesions and microvascular invasion were evident in such early tumors, as the benefit of anatomic resection is unique and cannot be duplicated by ablation. Further RCTs with large sample sizes and long-term follow-up are still required to clarify which should be the best treatment of choice.     

Species-Specific Bioaccumulation of Halogenated Organic Pollutants and Their Metabolites in Fish Serum from an E-Waste Site,South China

Halogenated organic pollutants (HOPs)—including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), polybrominated diphenylethers (PBDEs), polybromobiphenyls (PBBs), dechlorane plus (DP), tetrabromobisphenol A (TBBPA), and hexabromocyclododecanes (HBCDs) as well as PCB metabolites (methylsulfone [MeSO₂-]) and hydroxylated (OH-) PCBs and OH-PBDEs—were determined in the serum of mud carp and northern snakehead from an electronic-waste (e-waste) site in South China. The average concentrations (mean ± SD) of ΣPCBs, ΣPBDEs, ΣOCPs, ΣPBBs, ΣTBBPA, ΣHBCDs, and ΣDP were 1410 ± 324, 70 ± 20, 3.0 ± 0.4, 2.8 ± 0.8, 1.6 ± 0.4, 1.0 ± 0.2, and 0.3 ± 0.03 ng/g wet weight (ww) in mud carp and 6430 ± 781, 468 ± 49, 22.4 ± 1.1, 7.0 ± 0.6, 2.9 ± 2.3, 5.5 ± 1.1, and 4.6 ± 0.6 ng/g ww in northern snakehead, respectively. MeSO₂-PCBs, OH-PCBs, and OH-PBDEs were detected at a total concentration of 0.44 ± 0.03 and 9.7 ± 0.3 ng/g ww in mud carp and northern snakehead, respectively. The congener profiles of PCBs, PBDEs, OH/MeSO₂-PCBs, and OH-PBDEs were found to be significantly different between the two fish species, possibly as a result of species-specific bioaccumulation and/or metabolism of the HOPs. Chirality of ten PCB congeners and α-HBCD, as well as the f _anti values of DP in the serum samples, supported the species-specific biotransformation of HOPs. Furthermore, the presence of covaried and counter-varied enantiomeric fractions of PCBs between the two fish species indicated species- and congener-specific enantiomer enrichment of PCBs.     

Drinking-Water Disinfection By-products and Semen Quality: A Cross-Sectional Study in China

Background: Exposure to disinfection by-products (DBPs) has been demonstrated to impair male reproductive health in animals, but human evidence is limited and inconsistent.Objective: We examined the association between exposure to drinking-water DBPs and semen quality in a Chinese population.Methods: We recruited 2,009 men seeking semen analysis from the Reproductive Center of Tongji Hospital in Wuhan, China, between April 2011 and May 2012. Each man provided a semen sample and a urine sample. Semen samples were analyzed for sperm concentration, sperm motility, and sperm count. As a biomarker of exposure to drinking-water DBPs, trichloroacetic acid (TCAA) was measured in the urine samples.Results: The mean (median) urinary TCAA concentration was 9.58 (7.97) μg/L (interquartile range, 6.01–10.96 μg/L). Compared with men with urine TCAA in the lowest quartile, increased adjusted odds ratios (ORs) were estimated for below-reference sperm concentration in men with TCAA in the second and fourth quartiles (OR = 1.79; 95% CI: 1.19, 2.69 and OR = 1.51; 95% CI: 0.98, 2.31, respectively), for below-reference sperm motility in men with TCAA in the second and third quartiles (OR = 1.46; 95% CI: 1.12, 1.90 and OR = 1.30; 95% CI: 1.00, 1.70, respectively), and for below-reference sperm count in men with TCAA in the second quartile (OR 1.62; 95% CI: 1.04, 2.55). Nonmonotonic associations with TCAA quartiles were also estimated for semen parameters modeled as continuous outcomes, although significant negative associations were estimated for all quartiles above the reference level for sperm motility.Conclusion: Our findings suggest that exposure to drinking-water DBPs may contribute to decreased semen quality in humans.Citation: Zeng Q, Wang YX, Xie SH, Xu L, Chen YZ, Li M, Yue J, Li YF, Liu AL, Lu WQ. 2014. Drinking-water disinfection by-products and semen quality: a cross-sectional study in China. Environ Health Perspect 122:741–746; http://dx.doi.org/10.1289/ehp.1307067     

Unsupervised classification of major depression using functional connectivity MRI

The current diagnosis of psychiatric disorders including major depressive disorder based largely on self‐reported symptoms and clinical signs may be prone to patients' behaviors and psychiatrists' bias. This study aims at developing an unsupervised machine learning approach for the accurate identification of major depression based on single resting‐state functional magnetic resonance imaging scans in the absence of clinical information. Twenty‐four medication‐naive patients with major depression and 29 demographically similar healthy individuals underwent resting‐state functional magnetic resonance imaging. We first clustered the voxels within the perigenual cingulate cortex into two subregions, a subgenual region and a pregenual region, according to their distinct resting‐state functional connectivity patterns and showed that a maximum margin clustering‐based unsupervised machine learning approach extracted sufficient information from the subgenual cingulate functional connectivity map to differentiate depressed patients from healthy controls with a group‐level clustering consistency of 92.5% and an individual‐level classification consistency of 92.5%. It was also revealed that the subgenual cingulate functional connectivity network with the highest discriminative power primarily included the ventrolateral and ventromedial prefrontal cortex, superior temporal gyri and limbic areas, indicating that these connections may play critical roles in the pathophysiology of major depression. The current study suggests that subgenual cingulate functional connectivity network signatures may provide promising objective biomarkers for the diagnosis of major depression and that maximum margin clustering‐based unsupervised machine learning approaches may have the potential to inform clinical practice and aid in research on psychiatric disorders. Hum Brain Mapp 35:1630–1641, 2014. © 2013 Wiley Periodicals, Inc.     

Expertise modulates local regional homogeneity of spontaneous brain activity in the resting brain: An fMRI study using the model of skilled acupuncturists

Studies on training/expertise‐related effects on human brain in context of neuroplasticity have revealed that plastic changes modulate not only task activations but also patterns and strength of internetworks and intranetworks functional connectivity in the resting state. Much has known about plastic changes in resting state on global level; however, how training/expertise‐related effect affects patterns of local spontaneous activity in resting brain remains elusive. We investigated the homogeneity of local blood oxygen level‐dependent fluctuations in the resting state using a regional homogeneity (ReHo) analysis among 16 acupuncturists and 16 matched nonacupuncturists (NA). To prove acupuncturists' expertise, we used a series of psychophysical tests. Our results demonstrated that, acupuncturists significantly outperformed NA in tactile‐motor and emotional regulation domain and the acupuncturist group showed increased coherence in local BOLD signal fluctuations in the left primary motor cortex (MI), the left primary somatosensory cortex (SI) and the left ventral medial prefrontal cortex/orbitofrontal cortex (VMPFC/OFC). Regression analysis displayed that, in the acupuncturists group, ReHo of VMPFC/OFC could predict behavioral outcomes, evidenced by negative correlation between unpleasantness ratings and ReHo of VMPFC/OFC and ReHo of SI and MI positively correlated with the duration of acupuncture practice. We suggest that expertise could modulate patterns of local resting state activity by increasing regional clustering strength, which is likely to contribute to advanced local information processing efficiency. Our study completes the understanding of neuroplasticity changes by adding the evidence of local resting state activity alterations, which is helpful for elucidating in what manner training effect extends beyond resting state. Hum Brain Mapp 35:1074–1084, 2014. © 2013 Wiley Periodicals, Inc.     

Thoracolumbar spinal tuberculosis in children with severe post-tubercular kyphotic deformities treated by single-stage closing–opening wedge osteotomy: preliminary report a 4-year follow-up of 12 patients

Purpose

The correction of severe post-tubercular kyphosis (PTK) is complex and has the disadvantage of being multistaged with a high morbidity. In this study, we evaluated the outcomes of children who underwent single-stage closing–opening wedge osteotomy as a surgical treatment of PTK of the thoracolumbar spine.

Method

Our study group included 12 children with thoracolumbar PTK (seven boys and five girls) with an average age of 9.4 years (range 6–12 years), who were treated at our institution from January 2004 to October 2009. The American Spinal Injury Association Impairment Scale and visual analog scale score were used to classify neurologic function. All patients underwent halo-pelvic traction before surgery and were treated with single-stage closing–opening wedge osteotomy.

Result

The duration of surgery averaged 99 min (range 70–150 min). Average blood loss was 782 ml (range 560–1,200 ml), and the average length of hospital stay was 12 days (range 8–16 days). The neurological function of all patients improved significantly after the procedure. The mean preoperative kyphotic angle was 83.3° (range 59–118°), which had reduced to 27.6° (range 20–38°) at the final follow-up visit. All patients had solid fusion, and no major complications were observed through the final follow-up visit.

Conclusion

Single-stage closing–opening wedge osteotomy is an effective method to correct severe thoracolumbar PTK. A main advantage of the procedure is that it is a posterior-only, single-staged surgery, allowing for significant correction with minimal complications.