Objective To evaluate the effect of surgical management of primary venous reflux disease in lower extremity. Methods Literatures about the surgical management of venous reflux disease in lower extremity were collected and reviewed. Results In patients with primary venous reflux disease,comprehensive surgical management of concomitant superficial,deep and perforating veins might greatly improve the clinical effect.Conclusion Comprehensive surgical management will be the direction of surgical management of primary venous reflux disease in lower extremity.

BACKGROUND: The effects of low-level laser biostimulation have been proved by various experimental studies and clinical application, which are manifested as tissue repairing, analgesia, antiinflammation, etc.OBJECTIVE: To observe the effects of He-Ne laser and low-level CO2 laser irradiation on fracture healing.DESIGN: A randomized controlled animal experiment. SETTING: Research Room of Laser Medicine, Chengde Medical College.MATERIALS: Forty-eight healthy male New Zealand rabbits, weighing 2.0-2.5 kg, were used.METHODS: The experiments were carried out in the Research Room of Laser Medicine, Chengde Medical College from 1998 to 2003. ①The 48 rabbits were induced into models of experimental fracture of the left radius, and then they were divided into three groups with 16 rabbits in each group: control group, He-Ne laser irradiation group and CO2 laser irradiation group. The fracture areas of the animals in the He-Ne and CO2 laser irradiation groups were respectively irradiated with 28 mW/cm2 He-Ne laser and 150 mW/cm2 CO2 laser for 10 minutes, once a day. ② The animals were killed on the 15th and 35th days after taking roentgenogram respectively. At 15 days, the collagen and calcium contents in callus were detected. At 35 days, the biomechanic anti-torsion strength was examined.MAIN OUTCOME MEASURES: ①Results of roentgenogram in each group; ② Collagen and calcium contents in callus; ③ Results of biomechanic anti-torsion strength.RESULTS: Totally 45 rabbits were involved in the analysis of results. ① On the 15th and day after fracture, the roentgenogram, collagen and calcium contents in callus in the He-Ne and CO2 laser irradiation groups were better than those in the control group, and the collagen and calcium contents in callus were higher in the CO2 laser irradiation group than in the He-Ne laser irradiation group [(341.9±30.1) vs (302.1±28.7) mg/g; (197.1±19.7)vs (156.5±17.6) mg/g, P＜ 0.05]. ②On the 35th days after fracture, the biomechanic anti-torsion functions in the He-Ne and CO2 laser irradiation groups were superior to that in the control group, and there were no significant difference between the two laser irradiation groups. ③ The results of roentgenogram in the He-Ne and CO2 laser irradiation groups were better than that in the control group both on the 15th and 35th days after fracture, and there was no significant difference between the two irradiation groups.CONCLUSION: Both CO2 laser and He-Ne laser irradiations can accelerate the process of fracture healing, and the curative effect of CO2 laser is better than that of He-Ne laser on the 15th day after fracture, but there is no significant difference clinically between the CO2 laser and the He-Ne laser irradiations on the 35th day after fracture.

Objective To compare the efficacy between open reduction internal fixation and nonoperative treatment of multiple rib fractures.Methods Pubmed,Embase,Chinese National Knowledge Infrastructure database (CNKI),Chinese Biological Medical Literature database (CBM),Wanfang database and VIP database were searched for relevant studies comparing the effect of open reduction internal fixation and non-operative treatment of multiple rib fractures during 1990 and 2016.RevMan 5.3 software was used for the meta-analysis to compare differences of the two treatments concerning hospital stay,total ICU stay,duration of mechanical ventilation,proportion of pneumonia and atelectasis and pulmonary function.Results Eleven studies containing 799 patients met the inclusion criteria,including 431 patients in internal fixation group and 368 patients in non-operative group.Two groups had significant differences in hospital stay (95％ CI-11.00--3.34,P ＜-0.05),total ICU stay (95％ CI -4.48--1.29,P ＜ 0.05),duration of mechanical ventilation (95％ CI-7.52--1.54,P ＜ 0.05),proportion of pneumonia (95 ％ CI 0.19-0.42,P ＜ 0.05),proportion of atelectasis (95 ％ CI 0.24-0.57,P ＜ 0.05) and total lung capacity (95 ％ CI 1.57-1.97,P ＜ 0.05),forced vital capacity (FVC) (95 ％CI 0.98-1.27,P ＜ 0.05) and forced expiratory volume in one second (FEV1) (95％ CI 0.68-0.95,P ＜ 0.05).Conclusion Open reduction internal fixation of multiple rib fractures can significantly improve rehabilitation rate,reduce incidence of pulmonary complications dnring hospitalization,and facilitate recovery of lung function.

Objective Psoriasis vulgaris (PV) is easy to prone to recur and hard to cure and little research has been done on combined treatment on PV.The article was to study the clinical effects of total glucosides of paeony capsules (TGP) combined with acitretin and compound flumethasone on PV as well as the peripheral blood cytokine levels.Methods 126 patients with PV who visited our hospital from October 2015 to January 2017 were randomly divided into combined treatment group (63 cases) and control group (63 cases).Both groups were treated with oral acitretin and topical compound flumethasone, what's more, the compound flumethasone group received oral TGP treatment, 8 weeks for a course.The clinical therapeutic effects were evaluated by the levels of peripheral blood IL-17, IL-18, IL-23, TNF-α level, PASI score and percentage of total skin lesions before and after the treatment.Results After the treatment, the concentration of IL-17, IL-18, IL-23 significantly decreased(P<0.05), which was significantly less in combined treatment group compared with control group (IL-17 [61.18±8.91] vs [78.64±7.85], IL-18 [68.56±17.95] vs [79.49±18.64], IL-23 [70.13±12.16] vs [91.18±16.89] pg/ML)(P<0.05).Moreover, the TNF-α level, the PASI score and the percentage of total skin lesions significantly decreased in both groups after treatment(P<0.05), which was significantly less in combined treatment group compared with control group (TNF-α level [14.47±7.53] vs [23.49±8.12]ng/L, PASI score [4.09±1.29] vs [7.29±5.13], the percentage of total skin lesions [6.17±4.59]% vs [8.09±5.18]%) (P<0.05).Conclusion TGP combined with acitretin and compound flumethasone can significantly enhance the clinical therapeutic effects and effectively regulate the levels of the IL-17, IL-18, IL-23 and TNF-α level, which results in treating psoriasis vulgaris.

Objective:To investigate the effect of thrombus burden on the clinical outcome of endovascular recanalization in large vessel occlusive stroke.Methods:Patients with acute anterior circulation occlusion who underwent endovascular treatment within 24 hours after onset in Zhengzhou University People′s Hospital from January 2018 to December 2019 were retrospectively collected. According to the clot burden score (CBS) of DSA, total objectives were divided into CBS≥6 group (24 cases) and CBS<6 group (38 cases). Clinical data of the two groups were collected and the modified Rankin scale (mRS) was used to evaluate the clinical outcome at 90 days after surgery. Independent sample t-test, Wilcoxon rank sum test and χ 2 test were used to compare the clinical data between the two groups. Independent risk factors affecting the clinical outcome were analyzed by binary logistic regression. Results:There were no statistically significant differences in basic demographic data, stroke risk factors and other factors between the CBS≥6 group and CBS<6 group ( P>0.05).The proportion of using tirofiban after surgery in the CBS≥6 group (63.2%, 24/38) was lower than that in the CBS<6 group (87.5%, 21/24) (χ2=4.380, P=0.044). The discharge NIHSS score of the CBS≥6 group was [5.0 (3.3, 7.8) points] lower than CBS<6 group [8.5 (1.8, 14.5) points] ( Z=5.221, P=0.022). The proportion of postoperative mRS 0-2 was (91.7%, 22/24) in the CBS≥6 group higher than CBS<6 group(39.5%, 15/38) (χ2=20.486, P=0.001), there were no statistically significant differences between the two groups ( P<0.05). The results of binary logistics regression analysis showed the CBS groups (OR=0.042, 95%CI 0.007-0.244 , P=0.001) was an independent risk factor affecting good outcome. Subgroup analysis of whether tirofiban was used or not showed there was no statistically significant difference in clinical prognosis between the two groups ( P>0.05). Conclusions:The clinical outcome of CBS≥6 group is significantly better than that of CBS<6 group, and patients with small thrombus burden are more likely to get a good clinical outcome of 90 days.

Objective:To transfer the interleukin 37 (IL-37) gene to cervical cancer Hela cells,and to explore the killing effect of IL-37 on the HeLa cells and its enhancement in the chemotherapy sensitivity of HeLa cells.Methods:The pIRES2-EGFP (NC group) and pIRES2-EGFP/IL-37 (IL-37 group) plasmids were transfected into the HeLa cells.Q-PCR and Western blotting methods were used to detect the expression levels of IL-37 mRNA and protein.The activities of HeLa cells in NC group,IL-37 group,DDP group and IL-37+DDP group were detected by CCK8 method,and the inhibitory rates of cells were calculated.The gene expressions of signal transducer and activator of transcription 3 (STAT3) and Cyclin D1 were detected by RT-PCR method.Results:Compared with NC group,the expression levels of IL-37 mRNA and protein in IL-37 group were significantly increased (P＜0.01).The activities of HeLa cells in DDP (5-15 mg · L-1) groups were inhibited after administration for 24-72 h (P＜ 0.01);the inhibitory rates in IL-37 + DDP group were higher than those in DDP group within 48 h after administration (P＜0.05).Compared with IL-37 group,the inhibitory rates in IL-37+DDP group was increased with 96 h after administration (P＜0.05).Compared with NC group,the expression levels of STAT3 and Cyclin D1 mRNA in IL-37 group were significantly decreased (P＜0.01).Conclusion:The over-expression of IL-37 can inhibit the proliferation of cervical cancer cells and enhance the effect of DDP on the chemotherapy of cervical cancer cells which may be related to the down-regulation of the expressions of STAT3 and Cyclin D1 by IL-37.

Objective:To screen the incidence of proteinuria in rural areas of Shanxi province and construct a risk prediction model of proteinuria based on machine learning algorithm.Methods:It was a cross-sectional investigation study. The residents ≥30 years old in rural areas of Shanxi province from April to November 2019 were screened by multi-stage stratified sampling method, and data from questionnaire surveys, physical examinations, and laboratory examinations were collected. Urine albumin/creatinine ratio ≥30 mg/g was defined as proteinuria, and the incidence of proteinuria was calculated. Subjects were divided into proteinuria group and non-proteinuria group. The machine learning binary classification model of proteinuria and non-proteinuria was constructed based on the stackable integrated logistic regression algorithm (SE-LR), logistic regression, support vector machine, decision tree, random forest and extreme gradient lift algorithms, respectively. The area under the receiver operating characteristic curve, accuracy, recall, and F1 weights were used to evaluate the predictive efficiency of the comparison models. Finally, the importance of the predictive features of the model with the best overall performance was ranked.Results:There were 8 869 rural residents included in the study, aged (58.59±9.49) years old, with 3 872 males (43.66%) and 4 997 females (56.34%). The prevalence of proteinuria in rural areas of Shanxi province was 13.49% (1 196/8 869). Blood pressure, pulse, body mass index, waist circumference, proportion of obesity or overweight, proportion of hypertension, proportion of moderate to severe salt intake, glycosylated hemoglobin, uric pH value, urinary specific gravity, proportion of positive urinary occult blood, proportion of positive urinary glucose, proportion of positive urinary ketone body, proportion of urinary red blood cell count ≥5/μl, proportion of urinary white blood cell count ≥10/μl and urinary α1 microglobulin in the proteinuria group were all higher than those in the non-proteinuria group (all P<0.05). The proportions of lack of exercise and drinking history in the proteinuria group were lower than those in non-proteinuria group (both P<0.05). The overall performance of SE-LR model was the best, with the area under the curve (0.736, 95% CI 0.719-0.746) slightly lower than that of the logistic regression model (0.745, 95% CI 0.680-0.762), and the highest accuracy (0.844), recall rate (0.621) and F1 weighting value (0.801). In the SE-LR model, the orders of importance of the top 10 features were urinary α1- microglobulin, urinary occult blood, urinary sugar, uric acid basicity, smoking history,overweight or obesity, body mass index, total cholesterol, glycosylated hemoglobin and hypertension. Conclusions:The prevalence of proteinuria is high in rural areas of Shanxi province. The risk prediction model of proteinuria established by machine learning algorithm can predict the risk of proteinuria and identify its risk factors, which can provide a scientific basis for disease prevention, intervention, and treatment in the community and clinic to a certain extent.

Objective:To investigate the relationship of antinuclear antibody (ANA) status with clinical features and malignancy risk in adult patients with dermatomyositis.Methods:A retrospective analysis was performed to analyze clinical data from 101 inpatients with dermatomyositis in Department of Dermatology, the First Affiliated Hospital of Soochow University from April 2008 to April 2018. These patients were divided into ANA-positive group and ANA-negative group, and differences in myopathy and malignancy risks as well as other clinical features were analyzed between the 2 groups. A 2-year follow-up was undertaken among 92 patients. Chi-square test was used to analyze and compare clinical features between the 2 groups, and a multivariate regression model was used to analyze the relationship of ANA status with amyopathic dermatomyositis and malignancies.Results:Among the 101 patients with dermatomyositis, there were 42 males and 59 females, aged 55.13 ± 14.63 years; 14 patients had amyopathic dermatomyositis, 6 patients had hypomyopathic dermatomyositis, and 81 patients had myopathic dermatomyositis; 42 (41.58%) cases were positive for ANA, and 59 (58.41%) were negative for ANA. Compared with the ANA-negative group, the ANA-positive group showed significantly decreased incidence of cervical erythema (33.33% vs. 59.32%, P=0.010) and shawl sign (14.28% vs. 35.59%, P=0.017) . Twenty-eight (27.72%) patients with dermatomyositis were complicated by malignancies. Malignancies were found in 5 (11.9%) of ANA-positive patients, and in 23 (38.98%) of ANA-negative patients. Univariate analysis showed that ANA-negative patients with dermatomyositis had a higher risk of malignancies compared with ANA-positive patients with dermatomyositis, with an odds ratio of 7.52 (95% CI: 1.62-13.78, P=0.003) . In the multivariate regression model, the absence of ANA ( OR=4.34, 95% CI: 1.37-13.72, P=0.012) and cervical erythema ( OR=3.27, 95% CI: 1.20-8.91, P=0.020) were associated with high incidence of malignancies, while the absence of ANA was not significantly correlated with the occurrence of amyopathic dermatomyositis ( OR=0.99, 95% CI: 0.32-2.99, P=0.980) . Conclusions:ANA-negative adult dermatomyositis patients with cervical erythema had an increased risk of malignancies. Thus, close follow-up and regular tumor screening are necessary in these patients.

A 65-year-old male patient, who had a history of chronic lymphocytic leukemia for 3 years, presented with erythematous swelling of the right cheek for 20 days and scattered papules on the back and upper extremities for 10 days. Twenty days prior to the presentation, the patient was hospitalized for disseminated herpes zoster. Skin examination showed diffuse dark red swollen plaques in the facial area under the right eyelid as well as on the right auricle and external acoustic meatus, with a sense of infiltration on palpation; scattered brown crusts were left behind at the sites of healed herpes zoster lesions, and scattered depressed scars were observed among these crusts; scattered infiltrative, mung bean- to soybean-sized, light red papules with a smooth surface were seen on the back of the neck, back and upper limbs. Histopathological examination of the facial skin lesions revealed nodular infiltration of epithelioid cells, lymphocytes and many multinucleated giant cells in the dermis and subcutaneous adipose tissue; immunohistochemical staining showed positive staining for CD68, CD20, CD79a, CD3, CD2, CD10, CD5 and Bcl-2, scattered positive staining for Ki-67, and negative staining for CD23, cyclin D1, Bcl-6, multiple myeloma oncogene 1, CD21, CD35 and myeloperoxidase. The patient was diagnosed with Wolf′s isotopic response manifesting as granulomatous inflammation after disseminated herpes zoster. The patient was treated with intravenous drips of methylprednisolone at a dose of 40 mg/d, and the skin lesions were gradually improved and subsided. No recurrence was observed during 4 years of follow-up.

Objective To investigate the efficacy and safety of a direct aspiration first-pass thrombectomy (ADAPT) technique in treating acute atherosclerotic intracranial large vessel occlusion. MethodsSeventy-two patients with acute atherosclerotic intracranial large vessel occlusion underwent endovascular treatment in our hospital from March 2018 to March 2019 were chosen in our study; ADAPT technique was used in 24 patients, and Solitaire stent combined with penumbra suction catheter extraction (Solumbra) technique was used in 48 patients. Remedial measures were adopted after the failure of recanalization. Modified intraoperative cerebral infarction thrombolysis grading was used for vascular recanalization evaluation. The prognoses of the patients were determined according to modified Rankin scale (mRS) scores 3 months after operation, and the efficacy and safety of the patients in the two groups were compared.ResultsAs compared with patients in the Solumbra group, patients in the ADAPT group had statistically shorter time from femoral artery puncture to reflow (P<0.05). The first-time recanalization rates of patients in Solumbra group and ADAPT group were 25.0％ and 16.67％, without statistically significant difference (P>0.05). The final recanalization rates of patients in Solumbra group and ADAPT group were 83.33％ and 75.00％, without statistically significant difference (P>0.05). There was no significant difference in proportion of patients with good prognosis, incidence of perioperative symptomatic intracranial hemorrhage and mortality between the two groups (P>0.05). ConclusionFor patients with acute atherosclerotic intracranial large vessel occlusion, endovascular treatment with ADAPT technique is comparable with Solumbra technique.