The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement (n=3), aortic root replacement (n=43), hemi-arch replacement /total arch replacement+elephant trunk technique (n=32), thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36). In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1), respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2). Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.
Aneurysm, Dissecting/*surgery ; Aortic Aneurysm, Thoracic/*surgery ; Retrospective Studies ; Vascular Surgical Procedures/methods ; Young Adult

Objective:To evaluate the outcome of telerehabilitation in pain control and function recovery after total knee arthroplasty. Methods:CNKI, Wanfang Data (WF), CBM, VIP, PubMed, Web of Science, Medline, Springer Link, and Cochrane Library were searched on the effects of telerehabilitation on the patients after total knee arthroplasty, and the literatures of random control trials (RCT) study in English and Chinese in the above databases from 2000 to 2018 were collected. Literature screening, quality evaluation, data extraction and data analysis were carried out by 2 researchers. The indexes of outcome in the RCT studies included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), extension and flexion range, the Timed Up and Go Test (TUGT), Visual Analogue Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results:A total of 6 RCT studies were included, with a total of 601 cases, 301 in the intervention group and 300 in the control group. There was difference in extension range (MD = 0.30, 95%CI: 0.20 to 0.40, P < 0.001), TUGT scores (MD = -5.17, 95%CI: -9.79 to -0.55, P = 0.03), VAS scores (MD = -0.43, 95%CI: -0.85 to -0.01, P = 0.04) and KOOS scores (MD = -1.10, 95%CI: -1.63 to 0.57, P < 0.0001) between two groups. There was no significant difference in WOMAC scores (MD = -0.32, 95%CI: -2.30 to 1.65, P = 0.75), flexion range (MD = 0.68, 95%CI: -2.28 to 3.63, P = 0.65), and muscle strength (MD = 13.77, 95%CI: -3.89 to 31.43, P = 0.13) (P > 0.05) between two groups. Conclusion:Telerehabilitation is effective to improve extension range, ambulation, pain and quality of life, while it is uncertainly effective in flexion range, knee function and muscle strength.

Objective:To evaluate the effect of threshold inspiratory muscle training (TIMT) on respiratory muscle strength and clinical outcomes for machinery ventilates patients. Methods:The Cochrane Library, PubMed, Embase, Web of Science, CBM, Wanfang Database, CNKI and VIP were searched for the randomized controlled trials (RCT) about the effect of TIMT on respiratory muscle strength and clinical outcomes from establishment to July 1st, 2018. Two researchers strictly evaluated literature quality and extracted information, and then a Meta-analysis was carried out. Results:A total of 14 literatures were included with 650 patients, 323 cases in the experimental group and 327 cases in the control group. Compared with the control group, the massive inspiratory pressure (MIP) increased (MD = -6.65, 95%CI -8.27~-5.03, P < 0.001), the respiratory muscle strength increased (MD = -5.04, 95%CI -7.68~-2.04, P = 0.0002), the weaning time reduced (MD = -1.01, 95%CI -1.65~-0.37, P = 0.002), the mechanical ventilation time shortened (MD= -2.24, 95%CI -4.33~-0.15, P = 0.04), as well as the intensive care unit (ICU) length of stay (MD= -3.41, 95%CI -6.06~-0.76, P= 0.01). There was no significant difference in maximum expiratory pressure (MEP) (MD= 1.22, 95%CI -6.55~9.00, P = 0.76), the rate of reintubation/tracheotomy (RR = 0.99, 95%CI 0.56~1.73, P = 0.96) and mortality (RR= 1.05, 95%CI 0.53~2.06, P = 0.89) between two groups. Conclusion:TIMP could improve MIP and respiratory muscle strength of patients with mechanical ventilation, shorten the weaning time, the mechanical ventilation time and the ICU length of stay, and then reduce the incidence of weaning failure.

<b>INTRODUCTIONb>Polymerase chain reaction (PCR)-based molecular techniques are useful adjunctive tools in the diagnosis of cutaneous T-cell lymphomas (CTCL). This study compares the sensitivity of PCR analysis of the T-cell receptor-gamma (TCR-gamma) gene rearrangements using conventional polyacrylamide gel electrophoresis (PCR-PAGE) and fluorescent capillary electrophoresis (PCR-FCE).

<b>MATERIALS AND METHODSb>A total of 22 paraffin blocks were analysed using PCR-PAGE and PCR-FCE. There were 17 cases of mycosis fungoides (MF), 4 cases of non-MF CTCL and 1 case of lymphoblastic leukaemia.

<b>RESULTSb>Complete agreement was obtained between PCR-PAGE and PCR-FCE in 19 of the 22 cases, giving a concordance rate of 86.4%. PCR-FCE had a higher sensitivity of 77.3%, compared to 63.6% for PCR-PAGE, allowing the detection of 3 additional cases of clonal T-cell rearrangements, which had equivocal or polyclonal bands on PAGE. Two of these 3 cases were in erythrodermic MF patients. PCR-FCE also allowed the detection of matching clones in serial specimens taken from different sites and at different time intervals in patients with MF. However, matching clones from different specimens can be achieved qualitatively in PCR-PAGE by running and comparing these on the same polyacrylamide gel block.

<b>CONCLUSIONSb>Both PCR-PAGE and PCR-FCE are useful in detecting T-cell clones in CTCL, with both methods being comparable in sensitivity and showing a high concordance rate of 86.4%. PCR-FCE has the added advantage of exhibiting semiquantitative properties, which may be important in early or erythrodermic MF cases, but the requirement for sophisticated and costly machinery limits its availability to high-capacity laboratories. The well-established PCR-PAGE method is a suitable alternative in routine clinical applications.

Base Sequence ; Electrophoresis, Agar Gel ; Electrophoresis, Capillary ; methods ; Electrophoresis, Polyacrylamide Gel ; Fluorescence ; Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor ; Humans ; Lymphoma, T-Cell ; diagnosis ; Mycosis Fungoides ; Polymerase Chain Reaction ; methods ; Sensitivity and Specificity

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion of a Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion of a Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous bone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.
Bone Transplantation ; Femoral Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; Fractures, Ununited ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged

<b>Objective:b> To understand the influence of diurnal temperature range (DTR) on influenza incidence in the elderly in Beijing and to conduct a subgroup analysis. <b>Methods:b> The incidence data of daily influenza cases in the elderly and daily meteorological data from 2014 to 2016 in Beijing were collected for this study. A generalized additive model (GAM) was used to explore whether the relationship between daily influenza cases and DTR is a linear one. A distributed lag non-linear model (DLNM) was established to quantify the lagged effect of DTR on daily influenza incidence in the elderly. The model was also used to estimate the effects of DTR on daily influenza incidence among various subgroups. <b>Results:b> A total of 4 097 influenza cases in the elderly were notified during study period. The mean DTR was 10.153 ℃. A linear relationship between daily influenza incidence and DTR was detected by using GAM. DTR was significantly associated with daily influenza incidence between lag0 and lag5 with a maximal effect at lag0. An 1 ℃ increase of DTR was associated with a 2.0% increase in daily influenza incidence in the elderly (95%CI: 0.9%-3.0%). The RR values of males, females, people aged 60-69 years, people aged ≥70 years were 1.018 (95%CI: 1.005-1.032), 1.021(95%CI: 1.007-1.035), 1.012 (95%CI: 1.002-1.022), 1.025 (95%CI: 1.012-1.039), respectively. The influencing time of DTR on females (lag6) was longer than males (lag2). <b>Conclusions:b> DTR was associated with increased risk of influenza in the elderly in Beijing. It is necessary to take targeted measures in the elderly to control the incidence of influenza when DTR becomes greater.
Aged ; Beijing ; China/epidemiology* ; Female ; Humans ; Incidence ; Influenza, Human/epidemiology* ; Male ; Middle Aged ; Temperature

Objective To explore the value of ultrasonography in diagnosis of patients with gynecological acute abdomen and differential diagnosis.Methods Totally 68 patients with gynecological acute abdomen were selected.Color Doppler ultrasonography was performed for all the patients,and the results of ultrasonography were compared with the postoperative pathological results.The coincidence rate of ultrasound diagnosis was calculated.Results All the patients underwent ultrasonography,including 38cases of ectopic pregnancy,7 cases of acute pelvic inflammatory disease,10 cases of incomplete abortion,5 cases of ovarian cyst rupture,and 2 cases of ovarian cyst torsion.Postoperative pathological diagnosis showed that there were 40 cases of ectopic pregnancy,8 cases of acute pelvic inflammatory disease,12 cases of incomplete abortion,6 cases of ovarian cyst rupture,and 2 cases of ovarian cyst torsion.Coincidence rates of ultrasonography in diagnosing ectopic pregnancy,acute pelvic inflammatory disease,incomplete abortion,ovarian cyst rupture and ovarian cyst torsion were 95.00％,87.50％,83.33％,83.33％ and 100.00％ respectively,and the total coincidence rate was 91.18％.Conclusion Ultrasonography has the advantages such as simple operation,non-invasive,rapid and so on.It can provide a reliable imaging information for the diagnosis and differential diagnosis of gynecological acute abdomen.

Objective To explore the value of ultrasonography in diagnosis of patients with gynecological acute abdomen and differential diagnosis.Methods Totally 68 patients with gynecological acute abdomen were selected.Color Doppler ultrasonography was performed for all the patients,and the results of ultrasonography were compared with the postoperative pathological results.The coincidence rate of ultrasound diagnosis was calculated.Results All the patients underwent ultrasonography,including 38cases of ectopic pregnancy,7 cases of acute pelvic inflammatory disease,10 cases of incomplete abortion,5 cases of ovarian cyst rupture,and 2 cases of ovarian cyst torsion.Postoperative pathological diagnosis showed that there were 40 cases of ectopic pregnancy,8 cases of acute pelvic inflammatory disease,12 cases of incomplete abortion,6 cases of ovarian cyst rupture,and 2 cases of ovarian cyst torsion.Coincidence rates of ultrasonography in diagnosing ectopic pregnancy,acute pelvic inflammatory disease,incomplete abortion,ovarian cyst rupture and ovarian cyst torsion were 95.00％,87.50％,83.33％,83.33％ and 100.00％ respectively,and the total coincidence rate was 91.18％.Conclusion Ultrasonography has the advantages such as simple operation,non-invasive,rapid and so on.It can provide a reliable imaging information for the diagnosis and differential diagnosis of gynecological acute abdomen.

<b>Backgroundb> Some studies have shown that PM_2.5 exposure is closely related to central nervous system diseases that lead to cognitive dysfunction and change the composition of intestinal flora. However, there are few studies on the role of intestinal flora in PM_2.5-induced depression- and anxiety-like behaviors in mice. <b>Objectiveb> To observe the effects of PM_2.5 exposure on depression- and anxiety-like behaviors and the composition of intestinal flora in mice, and to explore the role of intestinal flora in regulating 5-hydroxytryptamine (5-HT) in depression- and anxiety-like behaviors in mice exposed to PM_2.5. <b>Methodsb> Eight-week-old male SPF C57BL/6J mice were randomly divided into control group (NS group), probiotic group (LGG group), PM_2.5 group (PM group), and combined exposure group (PML group), 6 mice in each group. Mice in the PM group and the PML group were exposed to PM_2.5 in a dynamic exposure cabinet for 6 h per day, 6 d a week for 7 consecutive weeks, and the PM_2.5 concentrations were approximately 8 times higher than the outdoor concentration. The LGG group and the PML group were orally administered with Lactobacillus rhamnosus while the NS group and the PM group were orally administered with the same amount of saline. Elevated plus maze test and open field test were used to detect depression and anxiety in mice. Fecal samples of mice were collected to evaluate intestinal flora abundance, diversity, and structure between groups using high-throughput sequencing of 16S rRNA. ELISA was employed to detect the levels of 5-HT in serum and hippocampus. Spearman correlation was used to analyze the correlations of differential intestinal flora with 5-HT level in hippocampus and depression- and anxiety-like behavior indicators in mice. <b>Resultsb> The percentage of open-arm entry [M(P₂₅, P₇₅)] in the PM group was 0.0% (0.0%, 33.3%), lower than those in the NS group [47.7% (25.0%, 50.8%) ] and the PML group [46.9% (40.0%, 50.0%)], and the differences were statistically significant (P<0.05). The total travelled distance and the time spent in central area (\begin{document}$\bar x \pm s $\end{document}) in the PM group were (2.01±0.90) m and (10.31±1.99) s respectively, shorter than those of the NS group [(3.80±0.89) m, (14.47±3.07) s], the total travelled distance in the PML group [(2.73±1.12) m] was shorter than those of the NS group and the LGG group [(4.21±1.08) m], and the differences were statistically significant (P<0.05). Compared to the NS group, the Simpson index of the PM group significantly increased (P<0.05). Compared to the LGG group, the Simpson index of the PML group significantly decreased (P<0.05). The results of Beta diversity analysis showed that there were differences in the composition of intestinal flora among the four groups of mice. Compared with the NS group and the LGG group, the abundances of Erysipelotrichaceae and Dubosiella in the PM group and the PML group increased, while the abundances of Prevotellaceae_UCG-001 decreased, and the differences were statistically significant (P<0.05). In hippocampus, the level of 5-HT in the PM group [(135.02±10.31) μg·g⁻¹] was lower than those in the NS group [(178.77±43.15) μg·g⁻¹] and the LGG group [(224.85±22.98) μg·g⁻¹], and the level of 5-HT in the PML group [(161.27±15.81) μg·g⁻¹] was lower than that in the LGG group (P<0.05). 5-HT level in hippocampus was significantly positively correlated with the relative abundance of Prevotellaceae_UCG-001 (r=0.6090, P=0.012). The percentage of open-arm entry was significantly negatively correlated with the relative abundance of Dubosiella (r=−0.4630, P=0.023). <b>Conclusionb> Atmospheric PM_2.5 exposure may cause depression- and anxiety-like behaviors in mice. The observed behavior dysfunction may be associated with the changes in diversity and relative abundance of intestinal flora as well as the decrease of 5-HT level. Such depression- and anxiety-like behaviors are alleviated after adding probiotics.

Objective:To observe the relationship between cervical curvature and spinal drift distance after laminectomy with lateral mass screw fixation, and its effect on clinical outcome. Methods:From January, 2017 to October, 2018, a total of 117 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation, and 90 of them completed the follow-up. According to the patients' cervical curvature (CC), they were divided into three groups: those CC between 0° to 5° were in Group A (n = 28), 5° to 16.5° in Group B (n = 36) and CC > 16.5° in Group C (n = 26). The spinal drift distance, nerve recovery, axial symptoms and C₅ palsy were recorded and analyzed. Results:There were significant differences in CC and spinal drift distance (F > 152.119,P < 0.001), and no significant difference was found in laminectomy width and incidence of C₅ palsy (P > 0.05) among three groups. The Japanese Orthopaedic Association (JOA) score significantly increased in all the groups post operation and at the last follow-up (t > 8.869,P < 0.001), and no significant difference was found among there groups at the same time (P > 0.05), as well as the incidence of C₅ palsy (F = 0.472,P = 0.625). There was significant difference in the score of Visual Analogue Scale of axial symptoms among three groups (F > 34.800,P < 0.001), which was lower in groups B and C than in group A (t > 5.845,P< 0.001), and no significant differene was found between group B and group C. Conclusion:On the basis of the same laminectomy width, the greater the CC was, the more favorable the spinal drift went backwards. The loss of CC was related to the occurrence of axial symptoms, but was not correlated with the neurological recovery and C₅ palsy.