Objective To quantitatively evaluate the difference in global longitudinal strain(GLS)and global circumferential strain (GCS)of three-layers of cardium between diabetes mellitus (DM)patients using layer-specific speckle-tracking imaging.Methods Fifty-seven DM patients and sixty matched controls were enrolled in the study.GLS and GCS of three-layer cardium were assessed using layer-specific speckle-tracking imaging,available by GE Vivid E9 and EchoPac workstation.Results GLS of three-layer cardium in DM patients were significantly lower than those in normal controls (all P <0.05).GCS of endo-and mid-cardium were significantly lower in DM patients than in normal controls (P < 0.05 ).There was no statistical difference of GCS of epi-cardium between the two groups (P > 0.05 ).GLS and GCS of three-layer cardium was highest in endo-cardium and lowest in epi-cardium.Conclusions GLS of three-layer cardium may be a sensitive indicator of early left ventricular systolic dysfunction in DM patients with normal ejection fraction.

Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.

ObjectiveTo study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). MethodsTwenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years(range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.ResultsAll patients were followed up for average 4.5 years(range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy(7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . ConclusionPeriacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis.

Objective To investigate the association between serum ferritin(SF) level at early and mid trimester of pregnancy and gestational diabetes mellitus (GDM) and insulin resistance (IR).Methods A total of 192 cases of women who were accepted antenatal examination from the first trimester of pregnancy at Yueqing People Hospital from July,2012 to October,2013 was prospectively analyzed and followed up.All cases were divided into two groups:96 cases of GDM pregnant women who were diagnosed as GDM at mid trimester of pregnancy as GDM group,and 96 cases of pregnant women with normal glucose tolerance at the same time as the control,normal glucose tolerance (NGT group).The differences in clinical data were compared between two groups.The relationship between SF level and fasting plasma glucose (FPG),fasting insulin (FINS),homeostasis model assessment insulin resistance (HOMA-IR),and C-peptide was investigated with Spearman rank correlation analysis.The predictive values of SF and relative variables to GDM were calculated by receiver operating characteristic curve (ROC) or Logistic regression analysis.Results (1) There was statistically significant difference in body weight and body mass index (BMI) at prepregnancy and mid trimester of pregnancy,Hb,FPG,FINS,SF,and C-peptide at the first trimester of pregnancy,SF level and FPG and HOMA-IR and C-peptide at mid trimester of pregnancy between two groups (P ＜ 0.01 or P ＜ 0.05).(2) As showed by Spearman rank correlation analysis,there was statistical correlation between SF at mid trimester of pregnancy,and FPG,FINS,HOMA-IR and C-peptide (P ＜0.01 or P ＜ 0.05);while no statistical correlation was found between SF at the first trimester of pregnancy and the same factors above (P ＞ 0.05).(3) The area under the ROC curve of SF at mid trimester of pregnancy for GDM was 0.653.The sensitivity and specificity were 68.8％ and 59.4％ in predicting GDM at the cut-off value of 16.61 ng/ml.As showed by Logistic regression analysis,high level of SF at mid trimester of pregnancy was a independent risk factor for GDM.Odds ratio (OR) was 1.032 (95％ CI:1.008 ～ 1.058,P ＜ 0.01).Conclusions The relationship between SF at different trimester of pregnancy and GDM is variant.There is relationship between high level SF of mid trimester of pregnancy in GDM pregnant women and IR.The level of SF might predict the occurrence of GDM.

Objective:To investigate the etiology, clinical characteristics and outcome of severe pneumonia-associated hemophagocytic lymphohistiocytosis, and to analyze the risk factors for mortality.Methods:Clinical data of patients with severe pneumonia-associated hemophagocytic lymphohistiocytosis admitted to Shenzhen Children′s Hospital from February 2009 to February 2019 were retrospectively analyzed.The data included clinical characteristics, etiology, clinical manifestations, laboratory data, treatment and outcomes of the patients.The clinical characteristics and laboratory data of the survival group and the death group were compared by independent sample t-test. Results:(1) Clinical characteristics: the patients were aged from 3 months to 8 years and 7 months, including 15 males and 15 females.Severe pneumonia-associated hemophagocytic lymphohistiocytosis accounted for 2.74% (30/1 096 cases) of severe pneumonia in the same period.(2) Etiology: Mycoplasma pneumoniae infection was found in 8 cases (8/30 cases, 26.67%), virus infection in 7 cases (7/30 cases, 23.33%, including 5 cases with adenovirus infection, 1 case with EB virus infection, and 1 case with cytomegalovirus infection), Mycoplasma pneumoniae complicated with adenovirus infection in 4 cases (4/30 cases, 13.33%), bacterial infection in 3 cases (3/30 cases, 10%), and fungal infection in 2 cases, Mycobacterium tuberculosis infection in 1 case.The pathogens were not identified in 5 patients.(3) Clinical manifestations: fever and hepatomegaly were present in all patients.Besides, 86.67% (26/30)patients had fever duration more than 10 days, 83.33% (25/30 cases) patients had cough, 76.66% (23/30 cases) patients had splenomegaly, and 33.33% (10/30 cases) patients had nervous system symptoms.Laboratory data showed varying degrees of reduction of binary and ternary systems in 80.00%(24/30 cases) of the patients.Liver function impairment was found in half of the patients, and serum ferritin and lactate dehydrogenase levels were elevated in all patients.(4) The mortality rate was 30.00% (9/30 cases). The differences in age, hypertriglyceridemia and high serum ferritin levels between the survival and death groups were significant (all P<0.05). Conclusions:Severe pneumonia-associated hemophagocytic lymphohistiocytosis is a disease with a high mortality rate.Patients with Mycoplasma pneumoniae and adenovirus pneumonia are more likely to suffer from secondary hemophagocytic lymphohistiocytosis.Younger age, hypertriglyceridemia and high serum ferritin levels are indicative of poor prognosis.

Streptococcus pneumoniae is the leading pathogen of community-acquired pneumoniae, acute otitis media and bacterial meningitis in children.The invasive pneumococcal diseases(IPDs) are also the main cause of death in children under 5 years old.Therefore, it′s an important task to prevent and control pneumococcal diseases in children worldwide, especially in developing countries.The inoculation of 13-valent pneumococcal conjugate vaccine(PCV13) is a chief precaution against IPDs in children, but PCV13 hasn′t been included in the immunization schedule in China.In this study, the research on the epidemiological characteristics of pneumococcal infections and pneumococcal diseases in children in China was reviewed with the view of providing strategic information for the control and prevention of pneumococcal diseases in children.

Objective To retrospectively analyze the clinical characteristics of 5 cases with recurrence of congenital tracheoesophageal fistula (rTEF) and to further understand the diagnosis and treatment of this disease.Methods We totally diagnosed 5 cases of rTEF from September 2015 to July 2016 in the department of respiration of Shenzhen Children′s Hospital.The clinical materials,characteristics,risk factors of recurrence and diagnostic methods were analyzed.Results Two cases were diagnosed of rTEF at 8 years after the first repair,one case was at one year after the initial repair and two cases were at 1 to 2 months after their operations.Three cases manifested mainly in bucking after feeding,recurrent pneumonia and growth retardation.One case was admitted for vomiting and abdominal distension.One case was asymptomatic.Esophageal anastomotic leaks occurred in three cases and esophageal trictures occurred in four cases after their repairs.Three cases accompanied with gastroesophageal reflux and five cases with tracheomalacia.Four cases were performed esophagography,but only two cases were suspected of recurrence.All of five cases were performed bronchoscopy.One case was diagnosed of rTEF directly.Two cases were found suspected fistulas.And another two cases were only found surgical scars.But these four cases were confirmed by Methylene blue test observed by bronchoscopy.Conclusion Although the leading clinical manifestations of rTEF are respiratory symptoms and feeding difficulties,sometimes rTEF is asymptomatic.Because rTEF is usually complicated with the other diseases with similar symptoms,it is possible to miss the diagnosis.Esophageal anastomotic leaks and trictures are the risk factors of recurrence.Bronchoscopy is the first choice for the diagnosis of rTEF,and Methylene blue test is golden standard.Thoracotomy is recommended for the treatment of rTEF.

Objective: To analyze the etiological characteristics of an outbreak of Campylobacter foodborne disease in a middle school in Suzhou City, so as to provide insights into the identification of pathogenic factors of Campylobacter foodborne disease outbreaks. Methods: Eighteen anal swabs from patients, 10 anal swabs from canteen workers, 43 food samples, 2 drinking water samples, 2 food original material samples and 31 environmental samples were collected, and the pathogens were rapidly screened using the gastrointestinal infection detection strip. The pathogens were isolated and cultured using the double-pore filtration membrane method, and cluster analysis of bacterial isolates was performed using pulsed field gel electrophoresis ( PFGE ). In addition, the susceptibility of Campylobacter isolates to antibiotics was tested using the Campylobacter agar dilution method. Results: A total of 63 cases with Campylobacter infections were reported, and the major clinical symptoms included diarrhea ( 51 cases, 80.95% ) and fever ( 39 cases, 61.90% ), while no inpatients or deaths were found. Twelve Campylobacter-positive samples were detected, including 11 anal swabs sampled from patients and one food original material sample. Among the 11 positive anal swabs, there were 10 samples positive for Campylobacter jejuni and one sample positive for C. coli, and of the one positive food original material, C. coli was identified. PFGE analysis showed that 10 C. jejuni isolates of had 100.0% homology, and these 10 isolates were 100.0% resistant to naphthyridic acid, ciprofloxacin and tetracycline, appearing multidrug resistance. Conclusions This is an outbreak of foodborne disease caused by C. jejuni infections. Gastrointestinal infection detection strips, double-pore filtration membrane and PFGE typing are rapid and accurate to identify pathogenic factors.

Objective To investigate the effect and mechanism of oxymatrine on invasion and metastasis of human pancreatic cancer line SW1990 in vitro. Methods Human pancreatic cancer cell line SW1990 was cultured in vitro. Oxymatrine was added into the culture media of SW1990 cells. Then MTT assay was used to determine the effect on proliferation. The adhesive capability, the mobile ability and invasive ability of SW1990 cells were detected by the adhesion assay, the crossing-river test, the transwell migration assay and the matrigel invasion method, respectively. RT-PCR was used to detect the mRNA expression of MMP-2 and VEGF. ELISA method was used to detect the protein levels of the VEGF. Results The growth of SW1990 cells was inhibited by oxymatrine in a dose and time-dependent manner. After 2 mg/ml of oxymatrine treatment for SW1990 cells for 1 h, the adhesive capability inhibitory rate was (35.23 ±8.56) % ; 24 h later, crossing-river time was (65.46 ±4.25) h, which was significantly longer than that in control group [ (34.50 ± 4.12) h, P <0.05)], the number of penetrating cells was 91.9 ±9.6, which was significantly lower than that in control group (144.2±17.2, P <0.05). The mRNA expression of MMP-2 and VEGF, expression of protein of VEGF in SW1990 cells was significantly down-regulated [0.515 ±0.063 vs. 0.817 ±0.054, 0.343 ± 0.072 vs. 0.650 ±0.068; (265.50 ±5.45) pg/ml vs. (441.06 ±16.70) pg/ml, P <0.05]. Conclusions Oxymoron can inhibit the invasion and metastasis ability of pancreatic cancer line SW1990 in vitro, and the mechanism is possibly related to the down-regulation of MMP-2 and VEGF expression.