Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Osteoarthritis, Knee ; therapy

Objective To evaluate the clinical effects of total knee arthroplasty (TKA) in treatment of severe adults Kashin-Beck disease (KBD). Methods Sixteen cases of KBD patients underwent TKA in Shaanxi Provincial People's Hospital, including 2 males (2 knees) and 14 females (17 knees), aged 41 to 56 years, mean (56.38 ± 6.40) years, left knee in 8 cases and right knee in 11 cases, knee varus in 15 cases and valgus knees in 4 cases. Visual Analogue Scale/Score (VAS), Hospital for Special Surgery (HSS) scores, knee range of motion, varus deformity and postoperative complications were observed before and after TKA. Results In this group of TKA patients, the levels of VAS scores in pre-total knee arthroplasty (pre-TKA), 2 weeks post-total knee arthroplasty (post-TKA), 3 months post-TKA, and at the end of the follow-up were 7.51 ± 1.00, 3.56 ± 1.29, 1.83 ± 1.40 and 1.10 ± 0.87, respectively. The level of VAS scores in 2 weeks post-TKA was significantly lower than that in pre-TKA (P<0.01), and the VAS levels were continued to decrease in post-TKA (all P< 0.01). Total HSS score at the end of the follow-up post-TKA was 78.60 ± 5.30, which was significantly higher than that in pre-TKA (43.59 ± 10.08, t=19.21, P< 0.01). At the end of the follow-up post-TKA, in addition to the muscle strength, the levels of pain, knee function, activity, flexion deformity and stability (25.94 ± 4.17, 15.88 ± 3.70, 14.09 ± 1.03, 6.79 ± 2.25, 8.58 ± 1.30) were significantly higher than those in pre-TKA (11.56 ± 5.39, 7.56 ± 1.75, 9.86 ± 3.85, 3.05 ± 3.22, 5.00 ± 3.07, t= 16.00, 8.32, 6.43, 7.07, 6.95, all P< 0.01). At the end of follow-up post-TKA, the knee degree of extension [(3.05 ± 2.71)°] was significantly lower than that in pre-TKA [(15.11 ± 11.30)°, t= -5.40, P< 0.01], the knee degree of flexion [(115.79 ± 9.65)°] was significantly higher than that in pre-TKA [(93.95 ± 22.40)°, t=6.02, P< 0.01), the degree of varus [(2.40 ± 2.40)° ] and valgus [(3.75 ± 2.50)° ] deformity was significantly lower than those in pre-TKA [(11.33 ± 10.43)°, (18.00 ± 5.72)°, t = - 4.15, - 3.61, all P< 0.05]. One patient was diagnosed as knee tuberculosis in 6 months post-TKA. There was no complication in this group of patients. Conclusion The TKA in severe adults knee of KBD can significantly reduce knee pain, improve knee function, correct joint deformities and improve quality of life in patients, and shows good clinical results.

Objective:To establish a 180-day mortality predictive score based on frailty syndrome in elderly sepsis patients [elderly sepsis score (ESS)].Methods:A prospective study for sepsis patients aged 60 years and above who were admitted to a medical intensive care unit of the General Hospital of Southern Theatre Command from January 1st, 2018 to December 31st, 2018 was conducted. Univariate analysis was performed on 19 independent variables including gender, age, body mass index (BMI), tumor, charlson comorbidity index (CCI), activity of daily living (ADL), instrumental activity of daily living (IADL), mini-mental state examination (MMSE), geriatric depression scale (GDS), clinical frail scale (CFS), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS), acute physiology and chronic health evaluation (APACHEⅡ, APACHEⅣ), modified NUTRIC score (MNS), multiple drug resistance (MDR), mechanical ventilation (MV), continuous renal replacement therapy (CRRT) and palliative care. Continuous independent variables were converted into classified variables. Multivariate binary regression analysis of risk factors was conducted to screen independent risk factors which affecting 180-day mortality in elderly sepsis patients. Then a 180-day mortality predictive score was established, and the discrimination of the mortality of patients using CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS scores were compared.Results:A total of 257 patients were enrolled, with a 180-day mortality of 60.7%. Univariate analysis showed that age, tumor, CCI, ADL, IADL, MMSE, CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS, MDR, MV, CRRT, palliative care were risk factors of 180-day mortality in elderly sepsis patients [age: odds ratio ( OR) = 1.027, 95% confidence interval (95% CI) was 1.005-1.050, P = 0.018; tumor: OR =2.001, 95% CI was 1.022-3.920, P = 0.043; CCI: OR = 1.193, 95% CI was 1.064-1.339, P = 0.003; ADL: OR = 0.851, 95% CI was 0.772-0.940, P = 0.001; IADL: OR = 0.894, 95% CI was 0.826-0.967, P = 0.005; MMSE: OR = 0.962, 95% CI was 0.937-0.988, P = 0.004; CFS: OR = 1.303, 95% CI was 1.089-1.558, P = 0.004; SOFA: OR = 1.112, 95% CI was 1.038-1.191, P = 0.003; GCS: OR = 0.918, 95% CI was 0.863-0.977, P = 0.007; APACHEⅡ: OR = 1.098, 95% CI was 1.053-1.145, P < 0.001; APACHEⅣ: OR = 1.032, 95% CI was 1.020-1.044, P < 0.001; MNS: OR = 1.315, 95% CI was 1.159-1.493, P < 0.001; MDR: OR = 2.029, 95% CI was 1.197-3.437, P = 0.009; MV: OR = 6.408, 95% CI was 3.480-11.798, P < 0.001, CRRT: OR = 2.744, 95% CI was 1.529-4.923, P = 0.001, palliative care: OR = 5.760, 95% CI was 2.177-15.245, P < 0.001]. By binary regression analysis, CFS stratification ( OR = 1.934, 95% CI was 1.267-2.953, P = 0.002), MV ( OR = 4.531, 95% CI was 2.376-8.644, P < 0.001), CRRT ( OR = 2.471, 95% CI was 1.285-4.752, P = 0.007), palliative care ( OR = 6.169, 95% CI was 2.173-17.515, P = 0.001) were independent risk factors of 180-day mortality in elderly patients with sepsis. The model of "ESS = 0.660×CFS stratification+1.511×MV+0.905×CRRT+1.820×palliative care" was established. Receiver operating characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) for predicting 180-day mortality by ESS was 0.785 (95% CI was 0.730-0.834, P < 0.001). When the best cut-off value was 2.2 points, its sensitivity was 78.9%, specificity was 70.3%, the positive predictive value was 80.4%, and the negative predictive value was 68.3%. Simplified ESS was defined as "0.5×CFS stratification+1.5×MV+1×CRRT+2×palliative care". ROC curve analysis showed that AUC for predicting 180-day mortality by simplified ESS was 0.784 (95% CI was 0.729-0.833, P < 0.001). When the best cut-off value was 2.0 points, sensitivity was 76.9%, specificity was 70.3%, the positive predictive value was 80.0%, and the negative predictive value was 66.4%. Compared with CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ and MNS, ESS had a significant difference in discriminating 180-day mortality in elderly patients with sepsis (AUC was 0.785 vs. 0.607, 0.607, 0.600, 0.664, 0.702, 0.657, 95% CI: 0.730-0.734 vs. 0.537-0.678, 0.537-0.677, 0.529-0.671, 0.598-0.730, 0.638-0.766, 0.590-0.725, all P < 0.05). Conclusions:CFS, MV, CRRT, and palliative care are independent risk factors of 180-day mortality in elderly patients with sepsis. We established ESS based on these risk factors. The ESS model has good discrimination and can be used as a reference and assessment tool for prediction and treatment guidance in elderly patients with sepsis.

Super hydrophobic interface modified with silver nanoparticles was fabricated for the detection of pesticide residues.By using a chemical reduction method,silver nanoparticles were deposited on the substrate surfaces with different microscopic pore structures.Two kinds of composite substrates,including regular stainless steel mesh and cellulose polyester film,were used.The pre-treatment of the substrate with fluoridated reagents was used to form a super hydrophobic interface,which made the target molecules on the surface concentrate effectively.The surface with the cellulose polyester substrate was used to detect Rhodamine 6G (R 6G) effectively with surface enhanced Raman scattering (SERS) technique.The results showed that the detection hmit was 10-16 mol/L.In addition,the surfaces based on the stainless steel mesh and cellulose polyester substrate were used to detect trichlorfon pesticide with detection limits of 1 × 10-15 mol/L and 1 × 10-16 mol/L,respectively.

Microvesicles (MVs) are the heterogeneous mixtures of vesicles. MVs released by leukemia cells constitute an important part of the leukemia microenvironment. MVs might act as important reservoirs of microRNAs (miRNAs). It is worth evaluating whether MVs possess some unique miRNA contents that are valuable in understanding the pathogenesis. In this study, we investigated the miRNA expression patterns of Nalm-6-derived MVs, Jurkat-derived MVs and normal cell-derived MVs using miRNA microarrays. The potential target genes regulated by differentially expressed miRNAs were also predicted and analyzed. Results demonstrated that 182 miRNAs and 166 miRNAs were differentially expressed in Nalm-6-MVs and Jurkat-MVs, respectively. Many oncogenes, tumor suppressors and signal pathway genes were targeted by these aberrantly expressed miRNAs, which might contribute to the development of B-ALL or T-ALL. Our findings expanded the potential diagnostic markers of ALL and provided useful information for ALL pathogenesis.

Objective To study the clinical features,diagnosis and treatment of eosinophilic granuloma of bone(EGB).Methods Twelve cases(8 male and 4 female)of EGB and their medical record,imaging examinations,follow-up data were reviewed,and the lesion sites,symptom and clinical features were analyzed with reference to relative literature.Results Nine unifocal cases were found in the cervical spine(3 cases),the thoracic spine(1 case),the lumber spine(1 case),the femur(1 case),the metacarpal bones(1 case),and the ilium(2 cases).Three multifocal cases were found in the thoracic and lumber spine(1 case),in the femur,the multiple ribs,the skull,the scapula(1 case)and in the skull,the femur,the ilium(1 case).The most common presenting symptom was pain at the lesion site and restricted motion was obviously in the cervical lesion.The case of the thoracic lesions was found neurologic deficit.Osteolytic destruction was found in the radiologic examination in EGB and the periosteal reaction was found in the long bone lesions,and vertebra plana was considered as typical cha-racteristics in the spine lesion.The lesions not in the spine were diagnosed by biopsy,exclusive methods and close following-up were performed in the spine lesions.Two unifocal were healed spontaneously and three were performed with curettage with one bone grafting.Multifocal and the lesions in the spine underwent chemotherapy.All cases were followed up and no recurrence was found.Conclusions EGB is commonly solitary and not seldom in the spine.Topical pain may be chief complaint.Osteolytic image was found in the radiologic examination.Biopsy and exclusive methods combining closely follow-up were used for diagnosis.EGB is self-limited observation,so curettage or chemotherapy can be used in treatment,and prognosis is good.

Objective To investigate the effect of selenium on proliferation and apoptosis of chondrocytes of articular cartilage cultured in vitro in Kaschin-Beck disease(KBD) patients and normal person, to explore the role of selenium in control of KBD, and to provide evidence for selenium's effect on the growth of normal cartilage cells. Methods The articular cartilage samples of grade Ⅱ and Ⅲ KBD patients were selected according to the national "Clinical Diagnosis of KBD" (GB 16003-1995). Chondrocytes of 5 KBD and 5 non-endemic normal accidentswere separated and cultured in vitro. KBD group and control group were given different doses of selenium (0,0.0125,0.0250,0.0500,0.1000,0.2500,0.5000,1.0000 mg/L, respectively). Methyl thiazolyl tetrazolium (MTT),flow cytometric analysis, and immunocytochemical staining were used to observe the effect of selenium on cell growth and apoptosis in KBD and normal persons. Results MTT results showed that the cell proliferation rate in each dosage group of the control group at the 6th day(0.086 ± 0.025,0.077 ± 0.012,0.073 ± 0.027,0.071 ± 0.017,0.058 ± 0.028,0.052 ± 0.028 and 0.046 ± 0.037) was significantly lower than that of 0 mg/L group(0.138 ± 0.026,all P ＜ 0.05);the average cell proliferation rate was negative( - 0.001 ± 0.001, - 0.003 ± 0.000, - 0.003 ± 0.001and - 0.004 ± 0.001 ) in 0.1000 - 1.0000 mg/L dose group, which was significantly lower than that of the 0 mg/L group(0.025 ± 0.003, all P ＜ 0.05);compared with 0 mg/L group(0. 115 ± 0.011), the KBD 0.2500 mg/L dose group promoted cell proliferation(0.128 ± 0.037, P ＜ 0.05), the KBD 1.0000 mg/L dose group inhibited cell growth (0.071 ± 0.019, P ＜ 0.05). The apoptotic rate of 0.0500 - 1.0000 mg/L dose control group [ (18.88 ± 0.02)%,(17.58 ± 0.01)%, (17.09 ± 0.04)%, (56.00 ± 0.02)%, (57.85 ± 0.03)% ] were higher than that of the 0 mg/L group[(13.51 ± 0.01)%, all P ＜ 0.05];compared with 0 mg/L group[(25.84 ± 0.02)%], the apoptotic rate in KBD 0.0250 - 0.2500 mg/L dose group [ ( 13.69 ± 0.02) %, ( 15.96 ± 0.03 ) %, ( 16.68 ± 0.03 ) %, ( 16.67 ± 0.02) % ]were lower, and the apoptotic rate in 0.5000, 1.0000 mg/L dose group [ (59.58 ± 0.03)%, (73.48 ± 0.04)% ] were significantly higher(all P ＜ 0.05). The Fas expression in KBD 0.0500 - 0.2500 mg/L dose groups[ (41.2 ± 1.5)%,(40.3 ± 2.0)%, (50.2 ± 2.5)%] were lower than those of the same dose control group with selenium intervention [(52.4 ± 1.0)%, (67.2 ± 4.0)%, (75.1 ± 5.0)%, all P ＜ 0.05], the caspase-3 expression in KBD 0.0500,0.1000 mg/L dose groups[ (40.8 ± 1.1 )%, (45.1 ± 2.1 )%] were lower than those of the same dose control group with selenium intervention[ (68.0 ± 3.0)%, (70.6 ± 3.5)%, all P ＜ 0.05 ]. Conclusions Appropriate dose of selenium supplementation (0.1000 - 0.2500 mg/L) could promote the growth of KBD chondrocyte, decrease cell apoptosis,but have a damage when the dose of selenium ＞ 0.5000 mg/L;doses of selenium that could promote the growth of KBD chondrocyte does not mean to promote the growth of normal cartilage cells in vivo.

ObjectiveTo identify the framework for assessing health related quality of life(HRQOL) of Kaschin-Beck disease(KBD),in order to reflect the impact of KBD on quality of life in patients with the disease.MethodsQualitative descriptive research was adopted.Semi-open ended questions were developed by using the World Health Organization(WHO) definitions of health and quality of life.Group interview and face to face interviews were conducted on 48 patients with KBD and 29 health care experts on KBD in Linyou and Yongshou counties,Shaanxi province,which were higher prevalence areas of KBD.Content template analysis was conducted and the template was based on the WHOQOL-100's framework.ResultsThe framework of HRQOL for KBD included four domains:physical activity,familial/social support,economic and psychological state.There were also eleven facets which were:pain and discomfort,physical function and activity limitation,diet and sleeping,social relationship,concerns of family responsibilities,social support,economic,housing and the surrounding environment,appearance concerns,mental health,and general state of health.The total entries were 69.ConclusionsThe framework for assessing HRQOL of KBD is established.The framework highlights the impact of KBD on the patients' quality of life with higher specificity.

Objective To investigate the apoptosis of articular chondrocyte and the expression of Bcl-2, Bax, Fas and iNos in articular cartilage with Kashin-Beck disease(KBD) in order to understand the pathogenesis of chondronecrosis in KBD. Methods The collected samples of human articular cartilage were divided into two groups: control group (15 samples from 15 cases), KBD group (15 samples from 15 cases). KBD patients were diagnosed by "Pathological Criteria to Diagnose KBD in China". Chondrocyte apoptosis was detected by TUNEL staining, and the Bcl-2, Bax, Fas and iNos positive articular chondrocytes were stained by the B-SA of immunohistochemistry. Articular cartilage was classified three zones and the positive rate were counted by light microscope for cytoplasimic staining by polyclonal antibodies of Bcl-2, Bax, Fas and iNos and apoptotic chondrocytes by TUNEL. Results ① The percentage of positive apoptotic chondrocytes stained by TUNEL in the middle zone of articular cartilage from the KBD-children group(33.60±2.71%) was higher than that of the control (1.33±0.41% t=11.59, g=28, P<0.01). ②The percentage of chondrocytes staining for Bcl-2, Bax, Fas and iNos among the upper and the middle zone in KBD group were significantly higher than that of the control (t=11.75-18.65, g=14, P<0.01); the remarkable difference in the expression of Bcl-2, Bax, Fas and iNos among the upper, the middle and the deep zones was also seen in KBD articular cartilage (F=73.49-114.42, g=42, P<0.01), and staining for Bcl-2, Bax, Fas and iNos in KBD children was prominent in the upper zone(41.93±12.26%, 45.60±15.78%, 53.60±16.49%, 45.47±14.02%) and the middle zone(14.93±3.50%, 13.87±4.32%, 23.27±4.83%, 21.67±6.82%)of articular cartilage, respectively. Conclusion The chondrocyte apoptosis and the present of Bcl-2, Bax, Fas and iNos positive chondrocytes in articular cartilage of children with KBD were significantly higher than that of the control.

Objective To investigate and analyze the preventive effect of boron on the cartilage damage in rats with intake excessive fluoride. Methods Fifty-ix Sprague-Dawley rats were divided into the control group (C, intake distilled water), the excessive fluoride dose group (EF, intake distilled water with 100 ppm F-) and the boron prevention group (P, intake distilled water with 100 ppm F- as well as the supplemental boron dietary). 3 to 5 months later, fluorine contents in serum, RNA contents in costal cartilage were assayed. The morphological changes in tibia growth plate cartilage (GPC) in rats were observed. Results Although exposed to the same dose of fluoride, the fluorine contents in serum in rats of P group decreased notably compared with those of EF group, the damage of tibia GPC under optical and electron microscope lessened significantly, and RNA contents in costal cartilage increased obviously in the 3rd month. Conclusion Boron added could decrease the fluorine level in the body and relieve the toxic symptom of excess fluoride, and thus boron has a preventive effect on skeletal fluorosis.