Risk factors for mortality in diabetic peritoneal dialysis patients

Objective To investigate the risk factors of all-cause mortality in diabetic patients on peritoneal dialysis (PD). Methods As a single-center retrospective cohort study, all incident PD patients who were catheterized at the First Affiliated Hospital of Nanchang University between November 1, 2005 and February 28, 2017 were included. Patients were divided into diabetes mellitus group (DM group) and non-diabetes mellitus group (NDM group). Outcomes were analyzed by Kaplan-Meier method. Multivariate Cox proportional hazards models were utilized to assess the risk factors of all-cause mortality. Results A total of 977 patients were enrolled. Compared with NDM group, patients in DM group were older (47.5±14.4 vs 59.3±11.3, P＜0.01), had more cardiovascular disease (CVD) (7.5% vs 20.3%, P＜0.01), higher levels of serum hemoglobin (78.2±17.2 vs 82.3±14.6 g/L, P＜0.01) , and lower levels of serum albumin (36.1±5.0 vs 32.7±5.6 g/L, P＜0.01). The one-, three- and five-year patient survival rates of DM and NDM group were 89.7%, 56.0%, 31.9% and 94.7%, 81.3%, 67.4%, respectively.Survival rate was significantly lower in DM group than in NDM group ( χ2=63.51, P＜0.01). Stratified analysis showed that DM group had significant lower survival rate than NDM group in patients younger than 70 years old ( χ2= 73.35, P＜0.01), while survival rate was similar between the two groups patients older than 70 years old ( χ2= 0.003, P=0.96). Multivariate Cox proportional hazards model analysis showed that DM (HR: 1.74, 95%CI: 1.27-2.38, P＜0.01), age (HR: 1.05, 95%CI: 1.04-1.06, P＜0.01), leukocyte (HR: 1.06, 95%CI: 1.00-1.12, P=0.04) and triglyceride (HR: 1.19, 95%CI: 1.07-1.32, P＜0.01) were all independent risk factors for all-cause mortality of PD patients. However, age (HR: 1.05, 95%CI: 1.04-1.07, P＜0.01) and alkaline phosphatase (HR: 1.01, 95%CI: 1.00-1.01, P=0.02) were independent risk factors for all-cause mortality of diabetic patients. Conclusions Long-term survival rate was lower in diabetic PD patients than in non-diabetic PD patients. DM, age, leukocyte and triglyceride were independent risk factors of mortality in PD patients. Age and alkaline phosphatase were independent risk factors of mortality in diabetic patients.     

Genex人工骨椎体成形与内固定术治疗老年胸腰椎爆裂性骨折

目的:探讨Genex人工骨作椎体成形材料与椎弓根钉系统复位固定术治疗胸腰椎骨折的方法与疗效。方法:采用Genex人工骨作椎体成形材料与椎弓根钉系统复位固定胸腰椎骨折22例通过影像学检查与ASIA标准评价手术疗效。结果:术后6个月以骨折椎体为中心摄侧位X线片,显示椎体高度恢复未丢失,椎体骨组织密度接近正常。CT扫描发现椎体内骨缺损完全消失,骨缺损区已为正常骨组织。椎体前后缘高度及Cobb角,手术前与手术后及随访期测量,均有显著性差异(P0.01),神经功能均有1～2级的恢复。结论:Genex人工骨作为成形材料进行椎体成形术,生物相容性好,骨诱导能力强,无并发症,椎体高度及Cobb角丢失少。     

影响髋关节表面置换术后关节功能恢复的多因素分析

目的探讨影响股骨头缺血性坏死患者行髋关节表面置换术后关节功能恢复的因素。方法1997年6月至2008年7月对股骨头缺血性坏死患者45例47髋行半髋关节表面置换,男25例,女20例;年龄29—49岁,平均36．6岁。应用Harris髋关节评分对疗效进行评定。研究患者的年龄、性别、体重指数、职业、病因、Ficat分期、髋部手术史、股骨假体柄干角、术后开始锻炼时间等相关因素,在单因素分析基础上应用Logistic回归模型作多因素分析。应用SPSS13．0进行统计学分析,其中Harris髋关节评分作为因变量,分为优、较好、良、差4类,其中前2类视为功能恢复满意。结果45例患者随访1—11年,平均8．6年。Harris髋关节评分：优15例,较好20例,良8例,差2例,满意率为77．8％。单因素分析结果发现患者的体重指数、Ficat分期、股骨假体柄干角、术后开始锻炼时间4个因素与髋关节功能恢复显著相关（P〈0．05）。Logistic回归发现此4个因素是影响髋关节功能恢复的主要因素。结论体重指数、Ficat分期、股骨假体柄干角、术后锻炼时间可明显影响髋关节表面置换术后功能恢复。     

Different Sites and Prognoses of Gastrointestinal Stromal Tumors of the Stomach: Report of 187 Cases

Background  

The stomach is the most common site of gastrointestinal stromal tumors (GISTs), but the clinical behavior of gastric GISTs at different sites is unclear. This study was designed to evaluate the clinicopathological (CP) parameters and influence of different gastric sites on outcome in patients with GIST.     

胫骨远端前外侧解剖型锁定钢板治疗不稳定性Pilon骨折的生物力学研究

目的探讨胫骨远端前外侧解剖型锁定钢板治疗不稳定性Pilon骨折的生物力学性能。方法将7具新鲜湿润的成人踝关节标本随机分为四组,1具标本作为正常对照组(N组);其余6具均造成胫骨远端不稳定性Pilon骨折,分成3组,每组2具标本,分别采用胫骨远端前外侧解剖型锁定钢板(A组)、三叶草钢板(B组)、重建钢板固定(C组),后两组为对照组,测试各组的远端轴向强度、刚度,扭转生物力学性能,胫距关节面接触特征。结果 A组在胫骨远端不稳定性Pilon骨折的远端轴向强度、刚度,扭转生物力学性能以及胫距关节面接触特征上接近N组(P0.05),优于B、C组(P0.05)。结论胫骨远端前外侧解剖型锁定钢板治疗不稳定性Pilon骨折不但具有优越的生物力学性能,而且操作简便、安全可靠,Pilon骨折固定的关节稳定性明显比其他内固定材料占有较大的优势,是较为理想的选择。     

Disruption of Renal Tubular Mitochondrial Quality Control by Myo-Inositol Oxygenase in Diabetic Kidney Disease

Diabetic kidney disease (DKD) is associated with oxidative stress and mitochondrial injury. Myo-inositol oxygenase (MIOX), a tubular-specific enzyme, modulates redox imbalance and apoptosis in tubular cells in diabetes, but these mechanisms remain unclear. We investigated the role of MIOX in perturbation of mitochondrial quality control, including mitochondrial dynamics and autophagy/mitophagy, under high-glucose (HG) ambience or a diabetic state. HK-2 or LLC-PK1 cells subjected to HG exhibited an upregulation of MIOX accompanied by mitochondrial fragmentation and depolarization, inhibition of autophagy/mitophagy, and altered expression of mitochondrial dynamic and mitophagic proteins. Furthermore, dysfunctional mitochondria accumulated in the cytoplasm, which coincided with increased reactive oxygen species generation, Bax activation, cytochrome C release, and apoptosis. Overexpression of MIOX in LLC-PK1 cells enhanced the effects of HG, whereas MIOX siRNA or d-glucarate, an inhibitor of MIOX, partially reversed these perturbations. Moreover, decreasing the expression of MIOX under HG ambience increased PTEN-induced putative kinase 1 expression and the dependent mitofusin-2–Parkin interaction. In tubules of diabetic mice, increased MIOX expression and mitochondrial fragmentation and defective autophagy were observed. Dietary supplementation of d-glucarate in diabetic mice decreased MIOX expression, attenuated tubular damage, and improved renal functions. Notably, d-glucarate administration also partially attenuated mitochondrial fragmentation, oxidative stress, and apoptosis and restored autophagy/mitophagy in the tubular cells of these mice. These results suggest a novel mechanism linking MIOX to impaired mitochondrial quality control during tubular injury in the pathogenesis of DKD and suggest d-glucarate as a potential therapeutic agent for the amelioration of DKD.     

Imaging of Dermatofibrosarcoma Protuberans of Breast

Abstract: Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue malignancy. We report a 45‐year‐old woman diagnosed with DFSP involving the breast. Ultrasound of DFSP revealed a heteroechogenetic breast mass, which showed normal adjacent dermis. Mammography disclosed a high‐density mass without microcalcification. MRI showed an enhancing lobulated lesion with small area of cystic change and hemorrhage. The patient underwent excision biopsy and pathology revealed DFSP of the breast. DFSP involving the breast is rare and preoperative diagnosis by imaging could be a challenge for clinicians. A solitary mixed echogenicity and ill‐defined soft tissue with no microcalcification located in the subdermal region could indicate the presence of DFSP.     

短期重复使用几种精神药物对小鼠自主活动和脑单胺递质的影响

目的 观察短期重复使用几种精神药物对小鼠自主活动和脑单胺递质的影响,以评价药物作用的耐受性和副作用。方法 雄性小鼠作为实验对象。中枢兴奋药实验分3组（每组n＝6）：①对照组;②咖啡因（Caf）组30mg/kg;③右旋苯丙胺（Dex）组10mg/kg。催眠药实验分4组（每组n＝6）：①对照组;②三只仑（TZ）组0．04mg/kg;③速可眠（Sec）组60mg/kg;④裉黑素（Mel）组120mg/kg。小鼠灌胃给药,1次／d。于第1天和第7天称重和测定自主活动。Dex和TZ连续用药7d后,用高效液相色谱法测定小鼠大脑皮层单胺递质及其代谢产物的变化。结果 ①对照组和用药组的体重差异无显著性意义;②连续用药7d,Caf和Dex对自主活动的兴奋作用较第1天明显增强（P＜0．05）;③连续用药7d,虽然催眠药对小鼠自主活动仍有显著的抑制作用,但作用强度较之第1天明显降低（P＜0．05）;④Dex和TZ连续用药7d,小鼠在脑皮层单胺递质水平明显改变,但Dex组的双羟基苯乙酸（DOPAC）和5－羟基吲哚乙酸（5－HIAA）及TZ组的5－HIAA明显降低（P＜0．05）。结论 ①连续应用催眠药1周,其作用有一定的耐受性;②重复使用Dex和TZ1周对鼠脑单胺递质的代谢可能产生不良影响。     

茶多酚对5500m低压条件下吸纯氧引起的小鼠心肌自由基代谢异常的保护作用

目的 观察天然抗氧化剂茶多酚（Tea Polyphenols,TP)对模拟飞行低压吸纯氧引起的小鼠心肌自由基代谢异常的保护作用。方法 42只雄性昆明种小鼠随机分为3组（n=14):对照组（A）、5500m低压吸氧组（B）和TP保护组（C）。B、C两组置于动物低压舱在5500m低压下吸氧（＞96％）,2h/d,3d/wk,共8wk。上舱暴露前,C组灌胃给予TP100mg/kg,另2组给予蒸馏水。末次实验后次日将小鼠断头处死,迅速取出心肌组织。测定心肌超氧化物歧化酶（SOD）活性和丙二醛（MDA）、一氧化氮（NO）含量。另外,用免疫组化法对心肌组织Cu,Zn-SOD和诱生型NO合酶（iNOS)的含量进行定性观察。结果 与对照比较,B组MDA水平、SOD添性和Cu,Zn-SOD酶含量明显升高（P＜0．05）;TP有明显保护作用：降低MDA生成（P＜0．01）,SOD活性和含量恢复正常。与之相反,重复5500m低压吸氧暴露后,心肌NO含量和iNOS表达明显降低。重复给予TP使NO代谢恢复正常。结论 天然抗氧化剂茶多酚对模拟飞行低压吸纯氧引起的心肌自由基代谢异常具有保护作用。     

保留假体的序贯疗法治疗骨肿瘤保肢术后假体周围感染

目的:探索应用保留假体的"多米诺"序贯疗法治疗骨肿瘤保肢术后假体周围感染的注意事项和临床疗效。方法:收集并回顾性分析2016年1月至2020年1月共11例采用保留假体的序贯疗法治疗骨肿瘤保肢术后假体周围感染患者资料,其中男8例,女3例;年龄（51.82±15.57）岁（范围21~74岁）。股骨远端肿瘤膝假体6例,胫骨近...