Objective To investigate the changes of insulin resistance and islet β cell function in gout patients with different status of glucose metabolism, and to analyse metabolic features in gout patients with hyperglycemia. Methods Ninety-six patients with gout were consecutively enrolled into the study and were divided into normal glucose tolerance group ( NGT, n = 35 ) , impaired glucose regulation group ( IGR, n = 27 ) , and diabetic group (DM, n=34). Height, weight, blood pressure, fasting plasma glucose, fasting insulin, HbA1C,serum uric acid, C-reactive protein (CRP), total cholesterol (TC), and triglycerides were determined in all subjects. Body mass index (BMI), homeostasis model assessment for insulin resistance index (HOMA-IR),homeostasis model assessment for β cell function index (HOMA-B), and insulin sensitivity index (ISI) were calculated. Results Compared with the NGT group, the levels of BMI, 2hPG, fasting insulin, HbA1C,TC,triglycerides, CRP, HOMA-IR in the DM and IGR groups were higher while ISI was lower (0.023±0.018 and 0.024±0.017 vs 0. 052±0. 026, P<0.05 ). HOMA-B was significantly different among the three groups ( 87.6±25. 1,126.46±34. 2, and 173.75±32.1, P<0.05). Family history of diabetes was more commonly seen in DM group than NGT group ( 41.17% vs 11.4%, P< 0.05 ). Logistic analysis showed that age, BMI, systolic blood pres(s)ure, triglyceride, CRP, and ISI were independently associated with diabetes, but not with uric acid.Conclusions Severe insulin resistance, β cell dysfunction, increased BMI and CRP, lipid disorders, and hereditary susceptibility may be the main metabolic features of gout patients with hyperglycemia.

OBJECTIVETo detect the expression of RhoA in the bronchoalveolar lavage fluid (BLF) from asthma patients allergic to dust mites and study its clinical significance.

METHODSBLF was collected from 47 mite-allergic asthma patients, 15 asthma patients non-allergic to dust mites and 7 healthy volunteers to detect RhoA expression by immunohistochemistry.

RESULTSThe total positivity rates of RhoA expression were 66.7% in mite-allergic asthma patients, 70.2% in asthma patients non-allergic to dust mites and 0 in healthy volunteers, showing significant difference between the 3 groups (P<0.01). No statistical difference was observed in RhoA expression levels between male and female asthma patients allergic to dust mites (P>0.05). The total positivity rate was 83.3% in asthma children allergic to dust mites, higher than that in other patients with different ages, but their RhoA expression levels showed no significant differences (P>0.05). The total positive rates were 33.3%, 57.9%, 88.2% and 100.0% in patients with clinical grades I, II, III and IV, showing significant differences (P<0.05).

CONCLUSIONSThe positivity rate of RhoA in the BLF is higher in asthma patients allergic to dust mites than in normal healthy subjects, increases with the clinical grade.

Adolescent ; Adult ; Aged ; Antigens, Dermatophagoides ; Asthma ; etiology ; metabolism ; Bronchoalveolar Lavage Fluid ; chemistry ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; rhoA GTP-Binding Protein ; metabolism

Objective To explore the bacteriostatic efficacy of snake venom antibacterial peptide OH-CATH and chitosan as ar-tificial implant coating on escherichia coli (E .coli) .Methods The catheters and dacron patches (blank group ,chitosan group ,cef-operazone group and antibacterial peptide group) were performed the pretreatment .Then the in vitro bacteriostatic test was conduc-ted to evaluate the antibacterial activity U value on E .coli ATCC 25922 and cephalosporin-resistant E .coli on 1 d and on 7 d after putting it into plasma .Results The cefoperazone group and the antibiotic peptide group had the very powerful antibacterial activity on E .coli ATCC 25922 on 1 ,7 d ,but the antibacterial activity of the cefoperazone group was stronger than that of the antibiotic peptide group(P<0 .05);the cefoperazone group had no antibacterial activity on cephalosporin-resistant E .coli ,but the antibiotic peptide group had significantly antibacterial activity on 1 ,7 d(P<0 .01) .Conclusion Snake venom antibacterial peptide OH-CATH has very obvious antibacterial effect on the standard strain and drug-resistant strain of E .coli and its value applied in artificial im-plant coating is affirmed .

Objective To explore the clinical features and repositioning maneuver effects of benign paroxysmal positional vertigo ( BPPV ).Method The clinical features of 326 patients with BPPV from August 2009 to July 2011 were analyzed retrospectively.Different types of BPPV were compared.Results BPPV was more common in female and the peak period of onset was between the ages of 50 and 60.The average latency of vertigo attack was ( 1.52 ± 1.22) s and 43 patients ( 13.2％ ) had no obvious latency.The median duration of vertigo attack was 10 s,with less than 60 s in 312 patients (95.7％) and between 60—180 s in 13 patients (4.0％).The latency of vertigo attack of posterior semicircular canal-BPPV ( ( 1.74 ± 1.21 ) s) was longer than that of horizontal semicircular canal-BPPV ( ( 0.96 ± 1.06 ) s,t =5.546,P ＜0.01 ).But there were no differences in the gender,the course of disease and the duration of vertigo attack.The patients with posterior semicircular canal-cupulolithiasis were younger than those with posterior semicircular canal-canalithiasis.The duration of vertigo attack of posterior semicircular canalcupulolithiasis was longer than that of posterior semicircular canal-canalithiasis.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis were longer than that of horizontal semicircular canal-canalithiasis and the age was older.Conclusions The posterior semicircular canal is more involved in BPPV.The latency of vertigo attack of posterior semicircular canal-BPPV is longer than that of horizontal semicircular canal-BPPV.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis are longer than that of horizontal semicircular canal-canalithiasis and the age is older.

Objective To explore the clinical features of vestibular paroxysmia (VP).Methods The clinical features of 51 patients with VP from January 2009 to April 2011 were analyzed retrospectively.The treatment effectiveness of antiepileptics was evaluated.Results The ratio of male to female was 1 ∶ 1.55 in the 51 patients with VP and the course of disease was 10 days to 20 years.In 46 patients (90.2％) the attacks occurred at rest,whereas 37 patients (72.5％) were precipitated by a head turn or a body turn.Three minutes hyperventilation-induced vertigo was found in 13 patients (25.5％) and Fukuda test was positive in 15 patients (29.4％).Forty patients (78.4％) were abnormal in brainstem auditory evoked potentials (BAEP) and the interpeak latency of wave Ⅰ-Ⅲ was prolonged than 2.2 ms in 26 patients (51.0％).There were 47 ears had neurovascular cross-compression (NVCC),which were unilateral in 37 patients and bilateral in 5 patients,with type Ⅰ in 23 ears(48.9％),type Ⅱ in 5 ears(10.6％),type Ⅲ in 17 ears(36.2％) and type Ⅳ in 2 ears(4.3％).Three month-treatment led to a significant reduction in the attack frequency(3 (2,7) per month vs 15 (9,30) per month,Z =-6.156,P ＜ 0.01),in the attack duration(2(1,4) s vs 12(6,20) s,Z =-6.066,P ＜0.01),and a reduction in the visual analogue scale of vertigo (1.86 ±0.57 vs 5.83 ± 1.12,t =1.984,P ＜ 0.01).Conclusions Briefvertigoattacksatrestis the character of VP.Three minutes hyperventilation-induced vertigo is helpful for the diagnosis of VP.The prolongation of the interpeak latency of wave Ⅰ-Ⅲ in BAEP is the character of VP.NVCC widely existed in the patients with VP and types Ⅰ and type Ⅲ was more common.Using antiepileptics,a better treatment effectiveness can be obtained.

BACKGROUND:Vertebral compression fracture is a common disease in the current orthopedic field.However,the occurrence of re-fracture in neighboring vertebrae after surgery is a problem that cannot be ignored,which has a serious impact on the normal life of patients. OBJECTIVE:The aim of this study is to establish four postoperative models with different recovery heights using computed tomography images.By using finite element analysis,we derived the stresses on the neighboring vertebrae at different recovery heights and further explored the importance of postoperative recovery of the height of the injured vertebrae. METHODS:A finite element model of the thoracolumbar spine(T11-L3)was established and validated,on the basis of which four postoperative finite element models of L1 with different recovery heights of 100%,80%,60%,and 40%were constructed,in which the cement capacity varied with the recovery height.The specific models are as follows:Model 1 was the postoperative model with normal recovery height,and the cement capacity was 8.3 mL.Model 2 was the postoperative model in which 20%of the anterior height of the L1 was removed and the posterior convexity angle became 10.41°,and the cement capacity was 6.9 mL.Model 3 was the postoperative model in which 40%of the anterior height of the L1 was removed and the posterior convexity angle became 20.17°,and the cement capacity was 4.7 mL.Model 4 was a postoperative model with 60%of the L1 anterior height removed and the posterior convexity angle changed to 28.85°,with a cement capacity of 3.6 mL.For evaluation of the postoperative model,we applied a moment of 7 Nm and an axial force of 500 N.The followings were recorded and analyzed:peak stresses in the L2 upper endplate and T12 lower endplate;peak stresses in the L2 and T12 cancellous bone. RESULTS AND CONCLUSION:(1)The highest peak stresses for each condition of the L2 upper endplate,T12 lower endplate,L2 cancellous bone,and T12 cancellous bone occurred in Model 1 and Model 4.In particular,the T12 lower endplate,except for the posterior extension condition,the anterior flexion,left and right lateral bending,and left and right rotation conditions all reached their highest peak stresses in Model 4,with stresses of 50.3,33.1,44.9,34.3,and 31.9 MPa.(2)Based on the peak stresses in the adjacent vertebral endplates and cancellous bone,after excluding Model 1 and Model 4,the minimum peak stresses for most of the conditions appeared in the Model 2,and the minimum peak stresses appeared in the Model 2 in 66.6%of the cases,especially in the upper endplates of the L2 and cancellous bone except for the posterior extension condition,the minimum peak stresses all appeared on the Model 2.(3)Therefore,controlling the recovery height at about 100%and 40%of the original height was a dangerous recovery height,which had a greater impact on the neighboring vertebrae.Controlling the recovery height at about 80%of the original height may be a more ideal choice.With a recovery height of about 80%of the original height,the adjacent vertebrae are subjected to less stress,thus reducing the risk of re-fracture of the adjacent vertebrae in the patient.

Objective: To investigate the clinicopathologic and molecular features of the rare cribriform morular variant of papillary thyroid carcinoma (CMV-PTC). Methods: The clinicopathologic data of 10 patients with CMV-PTC were retrospectively reviewed. Immunohistochemical (IHC) staining was done using LSAB method. DNA sequencing for APC were applied using Sanger method. BRAF V600E mutation was examined using ARMS method. The cytological, morphological, IHC and molecular features were analyzed. Results: All patients were female at an average age of 27 years old. The tumors were mostly located in the right lobe of thyroid. Fine needle aspiration cytology was performed in three patients; two were diagnosed as suspicious for PTC and one as PTC. Nine tumors presented as solitary nodule and two as multiple nodules in both lobes. Infiltration was demonstrated in three cases. The average size was 2.6 cm. The neoplastic cells were arranged in papillary, cribriform, solid and glandular patterns, with rare or without colloid inside the lumen. The number of morula varied, ranging from zero to many. The neoplastic cells were variably enlarged, showing round, oval or spindle shape. Nuclear irregularity was identified as irregular membrane, nuclear grooves or pseudoinclusion, but no typical ground glass feature. Peculiar nuclear clearing could be observed in the morular cells. IHC staining showed the neoplastic cells were negative for thyroglobulin and p63, but positive for TTF1, cytokeratin 19 and estrogen receptor. Diffuse staining with cytokeratin was seen in the neoplastic cells and the morula. Specific cytoplasmic and nuclear staining of β-catenin was seen in the neoplastic cells but not the morula. Ki-67 proliferation index was 1%-30%. No recurrence or metastasis was observed. One patient was demonstrated to harbor both somatic and germline mutations of the APC gene, who was found to have adenomatous polyposis and her mother died of colonic carcinoma. No BRAF V600E mutation was detected. Conclusions CMV-PTC is rare and shows atypical cytological and clinicopathological features, and it is easily misdiagnosed.TG, TTF1, ER and β-catenin are specific IHC markers for CMV-PTC. The morula is negative for cytokeratin 19, in contrast to squamous metaplasia. Although CMV-PTC has indolent clinical behavior, a definite diagnosis is necessary to rule out the possibility of APC gene mutation and related extra-thyroidal neoplasm, such as FAP and Gardner syndrome.

Objective:To explore the risk factors for death within 1 year after hip fracture surgery in the elderly.Methods:A case control study was made on the clinical data of 551 elderly patients with hip fracture treated in Second Affiliated Hospital of Soochow University from January 2019 to December 2020, including 182 males and 369 females; aged 65-100 years [80(73,86)years]. Joint replacement, cannulated screw fixation or proximal femoral nail fixation were performed. The patients were divided into survival group ( n=494) and death group ( n=57) based on the death within 1 year after surgery recorded at postoperative telephone follow-up. The gender, age, hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, neurological diseases, chronic renal failure, anemia on admission, fracture types, American anesthesiologist Association (ASA) classification, operative methods, preoperative waiting time, duration of operation and perioperative blood transfusion were recorded in two groups. Univariate Cox regression was used to analyze the correlation between the above indexes and death within 1 year after surgery. All indexes with P<0.2 in the univariate analysis were included in multivariate Cox regression analysis to clarify the independent risk factors for death within 1 year after surgery. Results:Univariate Cox regression analysis showed that death within 1 year after surgery correlated with gender, age chronic respiratory diseases, chronic renal failure and anemia on admission (all P<0.01), but not with hypertension, diabetes, cardiovascular diseases, neurological diseases, fracture types, ASA classification, operative methods, preoperative waiting time, duration of operation or perioperative blood transfusion (all P>0.05). Multivariate Cox regression analysis showed that male ( HR=2.08, 95% CI 1.20, 3.61, P<0.01), age ≥ 80 years ( HR=2.22, 95% CI 1.15, 4.28, P<0.05), chronic respiratory diseases ( HR=2.54, 95% CI 1.19, 5.40, P<0.05), chronic renal failure ( HR=4.57, 95% CI 1.27, 16.44, P<0.05), anemia on admission ( HR=2.82, 95% CI 1.38, 5.76, P<0.01) were significantly associated with death within 1 year after surgery. Conclusion:Male age≥ 80 years, chronic respiratory disease, chronic renal failure and anemia on admission are independent risk factors for death within 1 year after hip fracture surgery in the elderly.

BACKGROUND:The elastic modulus of traditional bone implants is large and does not match the elastic modulus of human bone,which will cause a stress shielding effect and lead to bone resorption.The trabecular scaffold of the triply periodic minimal surface with radial gradient has elastic modulus matching with human cancellous bone,and its yield strength is greater than that of human cortical bone,which provides a new choice for the design of bone scaffold. OBJECTIVE:Triply periodic minimal surface structure with radial gradient was constructed by the implicit surface method.The sample was manufactured by laser selective melting technology,and the quasi-static compression test was carried out to obtain trabecular scaffolds with mechanical properties matching human bones. METHODS:Four types of the trabecular scaffolds of the triply periodic minimal surface with a radial gradient of G,I,P and D were established by the implicit surface method.Samples were manufactured by laser selective melting technology.We observed the surface morphology of the molded sample,evaluated the molding quality,conducted a quasi-static compression test,and evaluated the mechanical properties of the samples. RESULTS AND CONCLUSION:The quasi-static compression test results showed that compared with the four triply periodic minimal surface scaffolds,the platform stress of the G scaffold had less fluctuation and no failure or fracture,indicating that the G scaffold had the best plasticity.The mechanical properties of the G scaffolds with 45%,55%and 65%porosities were analyzed.It was found that the elastic modulus of G scaffolds with 55%porosity was within the range of elastic modulus of human cancellous bone(0.022-3.7 GPa),and the yield strength was close to the maximum yield strength of human cortical bone(187.7-222.3 MPa).In conclusion,G triply periodic minimal surface scaffold with 55%porosity can reduce the stress shielding effect,bear a higher body load,improve the stability of the implant,and prolong the service life of the implant.

Objective:To evaluate the clinical value of sonography based volume computer aided display heart (SonoVCADheart) in the display of key diagnostic elements in basic fetal echocardiographic views.Methods:4D volume data based on fetal four-chamber view of 80 singleton fetuses (including 57 normal fetuses and 23 fetuses with heart abnormalities) were collected by using a volumetric probe from the Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from January 8-22, 2019. Four to five volume datasets based on four-chamber view of the heart were rapidly acquired from each fetus. Three doctors (Doctor A: Engaged in fetal echocardiography diagnosis for more than 15 years, Doctor B and C: 6 months of regular fetal echocardiography training but lack of experience) with different fetal echocardiographic experiences performed off-line processing using SonoVCADheart combined tomographic ultrasound imaging (TUI) at different times to obtain eight standard echocardiographic diagnostic views, and to score the elementary contents of each echocardiographic view. The scores of the same doctor at different times, the scores of less experienced doctors and experienced doctor, and the scores between normal and abnormal fetuses, and the time required for analysis and diagnosis among all doctors were analyzed and compared, respectively. The diagnostic coincidence rates of SonoVCADheart for fetuses with cardiac malformations were also assessed.Results:A total of 279 volume datasets obtained from 57 normal fetuses, an average of 4.89/fetus, and 109 volume datasets obtained from 23 fetuses with cardiovascular abnormalities, an average of 4.74/fetus, and all volume datasets were used for SonoVCADheart analysis. The volume percentage of all the elements in the 8 diagnostic views with image quality≥2 points shown by SonoVCADheart in the normal fetuses was about 70.61%-74.91%, in the abnormal fetuses was about 53.21%-55.96%. There were no significant differences in the scores between the same doctor at different times, the scores between inexperienced doctors, and the scores among experienced and less experienced doctors(all P>0.05). There were significant differences in the scores between normal and abnormal fetuses except for all of the superior and inferior vena cava view and the aorticarch view of doctors A and C(all P<0.05). The time required for experienced doctor A and inexperienced doctors B and C to obtain 8 diagnostic views and to complete the diagnosis was statistically significant ( P<0.05). There was no significant difference in the time required for the inexperienced doctors B and C to obtain 8 diagnostic sections and to complete the diagnosis ( P>0.05). There was statistically significant difference in the diagnosis time required for doctor A using SonoVCADheart and two-dimensional echocardiography in fetuses with cardiovascular malformations ( P<0.05). However, there was no statistically significant difference in the time required in the normal fetus between SonoVCADheart and two-dimensional echocardiography ( P>0.05). The diagnostic coincidence rate of SonoVCADheart for fetuses with cardiac malformations is about 89.91%-90.83%. Conclusions:SonoVCADheart is a repeatable and stable novel fetal heart processing tool enabling displaying eight standard diagnostic sections of the fetal heart, and has potential clinical application value in the standardization of image acquisition and sequence display.