Objective To explore the relationship between pulse pressure and aortic relative pulse wave velocity in the patients with hypertension by Doppler tissue imaging.Methods Velocities of abdominal aortic wall motion were measured in ninety one patients with essential hypertension.Electro mechanical time(EMT),pre ejection period (PEP) and the patient height(H) were measured and recorded respectively,and pulse wave time (PWT) was defined as EMT-PEP and relative pulse wave velocity (RPWV) as H/PWT.Results RPWV in the patients with pulse pressure ≥60 mm Hg ( 1 mm Hg = 0.133 kPa) was significantly greater than that of the patients with pulse pressure

Objective To explore the feasibility of endothelial function of dorsal artery of foot in patients with type 2 diabetes(T2DM) by high frequency ultrasound combined with warm bath test.MethodsThirty-five patients with T2DM and thirty normal people were collected,all subjects were examined by high frequency ultrasound.Diameter of brachial artery in baseline and after reactive hyperaemia were detected;Diameter of dorsal artery of foot in baseline and after the foot immersed in 40℃ warm water for 5 minutes were acquired.Flow mediated dilatation of dorsalis pedis artery(FMDDPA) and flow mediated dilatation of brachial artery(FMDBA) were calculated and compared.Multiple stepwise regression analysis was used to examine the correlation between FMDDPA and hemoglobin A1c(HbAlc). Results The FMDDPA and FMDBA were decreased in patients with T2DM (P<0.01).The FMDDPA and FMDBA were correlated significantly(r=0.864,P<0.01).In stepwise regression analysis,HbA1c is the most affecting factor for FMDDPA (R2=0.321,P<0.01).Conclusions Ultrasound combined with warm bath test can be used to detect the change of endothelial function of dorsal artery of foot in patients with T2DM,which have a certain clinical application value in endothelial function of terminal limb artery.

Objective To investigate the relationship between the C-reactive protein (CRP) and nonalcoholic fatty liver disease (NAFLD) prevalence.Methods In this study,63,486 workers who had participated in the Kailuan health examination from July 2012 to October 2013 and without history of drinking,myocardial infarction,stroke and cancer and without data incomplete were recruited.The observation population was divided into three groups according to the levels of CRP at baseline:group 1 (＜ 1 mg/L),group 2 (1-3 mg/ L) and group 3 (＞3 mg/L).The prevalence of NAFLD among three groups was observed.Multiple logistic regression was used to calculated relationship between the CRP and NAFLD prevalence.Results The prevalence of NAFLD in group 1,group 2 and group 3 were 26.9％,42.1％ and 49.3％,respectively,and the differences were significant (x2=2 192.31,P ＜ 0.01).Logistic model showed that after adjustment for age,gender,waist circumference and other confounders,the association between CRP and NAFLD was strong and the OR value (95％ CI) among the group 1,group 2 and group 3 were 1.00,1.49 (1.42-1.56),1.54 (1.45 -1.64),respectively.Conclusion CRP is independently associated with the nonalcoholic fatty liver disease.

BACKGROUND: Recent literatures have showed that percutaneous kyphoplasty can effectively avoid nerve damage, pulmonary embolism, and insufficient vertebral height and other security risks when bone cement is infused into affected vertebrae in percutaneous vertebroplasty. OBJECTIVE: To compare the effect of percutaneous kyphoplasty and percutaneous vertebroplasty in repair of osteoporotic vertebral compression fractures. METHODS: A total of 106 patients with senile osteoporotic vertebral compression fractures were randomly divided into trial group and control group (n=53 per group). Patients in the trial group were treated with percutaneous kyphoplasty, and those in the control group treated with percutaneous vertebroplasty. Al patients were fol owed up for 6 months after repair. The vertebral compression deformation, bone cement distribution, midline vertebral bone cement condition, vertebral height restoration, bone cement leakage, vertebral kyphosis, progressive spinal col apse, nerve damage, as wel as visual analog scale scores and Oswestry disability index scores in these two groups were compared. RESULTS AND CONCLUSION: Compared with the control group, there was less bone cement leakage and vertebral compression deformation in the trial group. Moreouer, in the trial group, bone cement distributed uniformly, vertebral height restoration was good and effective, pain was obviously relieved, and the probability of vertebral kyphosis, progressive spine col apse and nerve damage was significantly reduced (al P < 0.05). These results suggest that percutaneous kyphoplasty can effectively relieve the pain of patients with osteoporotic vertebral compression fractures, restore vertebral body height and reduce the incidence of complications, which effectively guarantees the postoperative restoration of motor function.

Objective To assess the elasticity change of common carotid artery in early stage of atherosclerosis in patients with type 2 diabetes by velocity vector imaging(VVI).Methods Sixty patients with type 2 diabetes were divided into group A(32 cases)and group B(28case)according the vascular complications(including Macroangiopathy and Microangiopathy).Patients without vascular complications belong to group A,others belong to group B.Fifty-eight healthy volunteers were supplied as normal control group.Time to the peak of velocity(VTTP),maximum of velocity(Vmax),maximum of strain(Smax),and maximum of strain rate(SRmax)of six segment(anterolateral wall,anterior wall,anteromedial wall,posteromedial wall,posterior wall,posterolateral wall)were measured,which were supplied by VVI automatic analysis software.Results VTTP,Smax and SRmax had no significant differences in any segments intra-group A,B and control group(P＞0.05).Vmax had significant differences in some segments in control group,group A and group B,Vmax of anterior wall,anterolateral wall and posterolateral wall were higher than those of posterior wall,posteromedial wall and anteromedial wall(P＜0.05).VTTP,Vmax,Smax and SRmax of corresponding segments had significant differences among group A,group B and control group(P＜0.05),control group＞group A＞group B(P＜0.05).Conclusions The change of common carotid elasticity can be detected in early stage of atherosclerosis in patients with type 2 diabetes by VVI.

Objective To study the synchronization of carotid artery wall motion with atheroscleroticsoft eccentric plaque using velocity vector imaging(ⅤⅥ). Methods Seventy-two patients with carotid artery atherosclerotic soft eccentric plaque were enrolled in this study. Their carotid arteries were examined using Acuson Sequoia 512 instrument respectively.Combined with ECG,two dimensional imaging of short axis view of carotid artery atherosclerotic soft eccentric plaque were recorded and analyzed on-line using ⅤⅥ software. The carotid artery wall of short axis was automatically divided into 6 segments. Time to peak index (TTPI)was calculated respectively. Results The TTPI was significantly higher than that of control group (P＜0.001). A cut-off value＜0.595 of TTPI for assessing the synchronization of carotid artery wall motion had a sensitivity of 93.9%,a specificity of 91.7%,respectively. Conclusions ⅤⅥ provides a new tool to assess the synchronization of arterial wall motion.

OBJECTIVETo observe the effect of resting heart rate (RHR) on the progression to hypertension in patients with prehypertension.

METHODSPeople who participated the physical examination between 2006 and 2007 at Kailuan medical group and diagnosed as prehypentension were selected as the observation cohort. The second and the third physical examination were conducted between 2008 and 2009 and between 2010 and 2011. The observation population was divided into five groups according to the different levels of RHR at baseline: the first group ( ≤69 beats/min), the second group (70-74 beats/min), the third group (75-79 beats/min), the fourth group (80-84 beats/min) and the fifth group ( ≥85 beats/min). The rate of the progression to hypertension was compared among five groups, and the relationship between RHR and the progression to hypertension was estimated using Cox proportional hazard analysis.

RESULTSA total of 34 512 patients with prehypentension were recruited and 25 392 patients were involved in the final statistics after excluding patients who died or were lost to follow-up. A total of 13 228 (52.1%) patients with prehypentension developed hypertension during follow-up. The rate of the progression to hypertension increased with the RHR (first group: 51.2%, second group: 50.1%, third group: 52.9%, fourth group: 53.5%, fifth group: 57.5%). Multiple Cox regression models showed that the risk of the progression to hypertension increased with the RHR levels. Patients in the fifth group carried 1.25 times higher risk for developing hypertension than patients in the second group after adjustment for age, gender, systolic blood pressure, diastolic blood pressure, waist circumference, body mass index, triglyceride, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, fasting blood glucose, serum uric acid, C-reactive protein, smoking, drinking, physical exercise and family history of hypertension at baseline.

CONCLUSIONElevated RHR is an independent risk factor for the progression to hypertension in patients with prehypertension.

Adult ; Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Cohort Studies ; Disease Progression ; Female ; Heart Rate ; Humans ; Hypertension ; Male ; Middle Aged ; Prehypertension ; Proportional Hazards Models ; Risk Factors ; Triglycerides

Objective:To investigate the effectiveness of postoperative radiotherapy using shrinking field for patients with extremity soft tissue sarcoma (STS), mainly focusing on the local control rate and adverse events.Methods:Clinical data of 49 extremity STS patients who received postoperative intensity-modulated radiotherapy in the First Hospital of Tsinghua University from October 2017 to March 2021 were retrospectively analyzed. Target volumes were contoured on CT and MRI fusion images. The tumor bed was defined as GTV tb, with 3 cm expansion in the longitudinal direction and 1.5 cm expansion in the radial direction to construct CTV (the target volume should be properly repaired according to the anatomical barrier, and the edema area around the tumor should be included). GTV tb and CTV were expanded in all directions by 0.5 cm to construct PTV1 and PTV2 respectively, at a dose of 95%PTV1 63-66 Gy, 95%PTV2 50-56 Gy,1.8-2.0 Gy/f. The dose of surgical volume should be given at 70 Gy for patients who had a microscopic positive margin. Results:The median follow-up time was 32.1 months (7.9-45.6 months). The 3-year local failure-free survival (LFFS), overall survival (OS)and distant metastasis-free survival (DMFS) were 91.7%,77.6% and 71.5%, respectively. Univariate analysis showed that patients with a microscopic positive margin were more likely to develop local recurrence ( P<0.05). The incidence of grade 2 or above wound complications, joint stiffness, fracture, edema and skin fibrosis were 2%, 4.1%, 2%, 8.2% and 26.5%, respectively. Conclusion:Postoperative radiotherapy with shrinking field provides excellent local control rate and low incidence of late adverse events in patients with extremity STS.

Objective:To investigate the early clinical effectiveness of using customized 3D printed acetabular augment to repair large acetabular bone defects in delayed total hip arthroplasty after failed treatment of acetabular fractures.Methods:A retrospective study was conducted to analyze the 6 patients who had undergone 3D printed acetabular augment to reconstruct acetabular bone defects in delayed total hip replacement from July 2021 to January 2023 after failed treatment of acetabular fractures. They were all males, with an age of (51.3±15.0) years. Paprosky classification: 2 cases of type ⅡB, 1 case of type ⅡC, and 3 cases of type ⅢA. Recorded were surgical time, intraoperative bleeding, hospitalization time, and visual analogue scale (VAS), and modified Merle d'Aubigné & Postel score, Harris hip score, and leg length discrepancy at the last follow-up.Results:For the 6 patients, the mean surgical time was (222.5±46.9) min, the mean intraoperative bleeding 1,100 (1,000, 2,625) mL, the mean hospitalization time (9.0±4.5) d, and the mean follow-up time (11.8±7.9) months. At the last follow-up, the VAS [(2.5±1.0) points] significantly decreased compared with the preoperative value [(6.2±0.8) points], the modified Merle d'Aubigné & Postel score [(13.2±2.1) points] and Harris hip score [(67.8±15.3) points] significantly increased compared with the preoperative values [(6.7±0.8) and (34.2±8.4) points], the vertical position of center of rotation [(22.5±5.2) mm] and the horizontal position of center of rotation [(40.7±2.6) mm] were significantly reduced compared with the preoperative values [(38.1±14.2) and (53.1±10.0) mm] ( P<0.05). At the last follow-up, the leg length discrepancy was (6.2±3.6) mm, showing no statistically significant difference from the preoperative value [(18.7±1.7) mm] ( P>0.05). At the last follow-up, no clear line at the cup-bone or augment-bone interface, or no possible prosthetic loosening or displacement was observed on the X-ray films. Conclusion:In delayed total hip arthroplasty after failed treatment of acetabular fractures, the customized 3D printed augment for repair of large bone defects in the acetabulum can reconstruct the normal rotation center of the hip joint, provide reliable stability for the cup prosthesis, and enable patients to obtain significant improvements in hip function.

Objective To explore the management of postoperative infection following open reduction and internal fixation for acetabular fractures.Methods Ten patients were treated and completely followed up in Beijing Jishuitan Hospital from February 2012 to December 2016 for postoperative infection after open reduction and internal fixation for acetabular fracture.They were 9 males and one female,aged from 14 to 64 years(mean,40.6 years).According to Letournel classification,there were 2 double-column fractures,2 anterior descending transverse fractures,2 anterior column fractures,one posterior wall fracture,and one posterior wall fracture.Eight cases developed surgical regional infection within 2 weeks after internal fixation,and 2 presented with symptoms of infection more than 3 months after fracture fixation.Vacuum sealing drainage (VSD) was used to treat one case of acute superficial infection;open debridement surgery,carrier with sensitive antibiotics and intravenous antibiotics were used to treat 7 cases of acute deep infection and 2 cases of chronic deep infection.Results The infection symptoms disappeared 9 days after removal of VSD device in the one case of acute superficial infection.Normal fracture union was achieved in 6 cases after their infection was controlled;4 cases had to undergo total hip arthroplasty because their articular structure was damaged after control of infection.The 10 patients were followed up for 6 to 54 months (mean,25.7 months).Their Harris scores at the last follow-up averaged 74.8 (from 32 to 92).Conclusions Negative-pressure wound therapy is an effective management for acute superficial infection after acetabular fracture.Deep acute infection needs early repeated debridement combined with sensitive antibiotic carrier to protect joint function.For infection which is difficult to control or chronic infection associated with structural damage,repeated debridement combined with sensitive antibiotic spacer is effective for infection control at the first stage and artificial total hip arthroplasty can be carried out at the second stage when the infection is controlled.