Objective To assess the diagnostic predictive value of Wells score and modified Geneva score for acute pulmonary embolism by prospective case series and to explore a more suitable scoring system for Chinese population.Methods All the patients suspected of pulmonary embolism (PE) and received CT pulmonary angiography (CTPA) were enrolled consecutively in Fuxing Hospital,Capital Medical University,China,from June 2009 to August 2011.Before CTPA test or on condition that test results were unknown,clinical scoring was assessed prospectively by the Wells score and the modified Geneva score.The probability of PE in each patient was assessed and the patients were divided into low,moderate and high probability groups according to the clinical scores.The result of CTPA was used as the diagnostic gold standard for PE.Diagnostic accuracy in each group was analyzed.The predictive accuracy of both scores was compared by AUCROC curve.Results A total of 139 patients met our enrollment criteria and 117 eligible patients entered our study at last.PE was diagnosed in 47 patients by CTPA with an overall prevalence of 40.2％.Prevalence of PE in the low,moderate and high pretest probability groups assessed by the Wells score and by the simplified modified Geneva score were 7.1％ (3/42),42.9％ (21/49),88.5％ (23/26)and 10.0％ (3/30),48.1％ (37/77),7/10,respectively.AUCROC curves for the Wells score and the simplified modified Geneva score were 0.872 ( 95％ CI 0.810-0.933 ) and 0.734 ( 95％ CI 0.643-0.825 )respectively,with a significant difference ( P =0.005 ).Conclusion The Wells score is more accurate for clinical predicting acute PE than the modified Geneva score.

Objective To clone and express the alkaline protease AprA , one important virulence factor secreted by Pseudomonas aeruginosa(PAE)in Escherichia coli, to clone and express the inhibitor of AprA (AprI) and its substrate flagellin , and to detect the function of AprA and the inhibitory function of AprI .Methods The genes encoding AprA ,AprI and flagellin gene were amplified respectively by PCR using PAE PAO 1 genome DNA as the template .The expression vec-tors (pET-28a-AprA, pET-28a-AprI and pET-28a-Flagellin) were constructed and transformed into E.coli BL21(DE3) respectively.The recombinant AprA protein was expressed by IPTG induction and purified via denaturing and renaturation. The recombinant AprI and flagellin were expressed and purified by Ni 2+affinity chromatography .The cleavage activities of AprA on flagellin were detected by SDS-PAGE.Results Recombinant AprA , AprI and flagellin protein were expressed and purified .It was demonstrated that AprA cleaved flagellin , which was blocked by AprI .Conclusion Recombinant AprA could cleave its substrates as an alkaline protease , and its inhibitor AprI inhibits the activities of AprA .This study will contribute to further investigations on the role of AprA in the pathogenesis of PAE .

Objective To compare the clinical efficacy and safety of pegylated interferon α-2a (Peg IFN α-2a) or adefovir dipivoxil(ADV) monotherapy and their combination therapy in HBeAg positive chronic hepatitis B (CHB) patients. Methods An open randomized controlled multicenter clinical trial was performed. One hundred and twenty cases with CHB were divided into 3 groups: Peg IFN α-2a monotherapy (group A), ADV monotherapy (group B) and Peg IFN α-2a plus ADV combination therapy (group C). The virological response (VR), serological response (HBeAg, HBsAg clearance and seroconversion), biochemical response (BR) and sustained response (SR) were tested at week 24 and 48 of therapy and week 48 of follow-up after end of treatment (EOT) for'evaluation of therapeutic effects, safety and drug resistance. The efficacy was compared using X2 test. Results At week 48 of treatment, the VR (HBV DNA ≤500 copy/mL) rates were 36. 8%(14/38), 37. 5%(15/40) and 62. 9% (22/35), respectively in groups A, B and C; that in group C was higher than those in groups A and B (X2 = 4. 933, 4. 801, respectively; both P < 0. 05); HBeAg seroconversion rates in three groups were 44. 7% (17/38), 17. 5% (7/40) and 51. 4% (18/35), respectively. At week 48 of follow-up,SR rates in three groups were 34. 2%(13/38), 15. 0%(6/40) and 48. 6% (17/35), respectively; those in groups C and A were higher than that in group B (X2 = 9. 894,P<0. 01;X2 =3. 903, P<0. 05, respectively). Conclusions VRs at week 24 and 48 of Peg IFN α-2a plus ADV combination therapy are better than Peg IFN α-2a or ADV monotherapy. SRs at week 48 of follow-up after Peg IFN α-2a monotherapy and combination therapy are both better than ADV monotherapy.

Objective: To summarize the clinical application patterns in acupuncture-moxibustion treatment of AD by reviewing the clinical literatures on acupuncture-moxibustion for Alzheimer disease (AD) published between January 2009 and December 2019. Methods: China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), Chinese Medicine Acupuncture-moxibustion Information Database, PubMed Medical Data Retrieval Service System, Springer Database and Ovid Technologies (OVID) were retrieved to screen clinical studies of acupuncture-moxibustion treatment of AD according to the inclusion and exclusion criteria to conduct quantitative, clustering and association analyses. Results: In acupuncture-moxibustion treatment of AD, the frequently used points were Baihui (GV 20), Zusanli (ST 36), Sishencong (EX-HN 1), Taixi (KI 3), Sanyinjiao (SP 6), and Neiguan (PC 6) in the descending order. Regarding meridians, the most frequently used one was the Governor Vessel, followed by the Stomach Meridian of Foot Yangming and Gallbladder Meridian of Foot Shaoyang. From the perspective of body regions, the points in the head-face region and the lower-limb region had the highest frequencies, followed by the upper-limb, back and chest-abdomen regions. The point group, Baihui (GV 20) and Sishencong (EX-HN 1)-Neiguan (PC 6)-Sanyinjiao (SP 6), showed the most significant association, and the group winning the second place was Baihui (GV 20) and Sishencong (EX-HN 1)-Neiguan (PC 6)- Zusanli (ST 36). The clustering analysis showed that the commonly used point pairs included Zusanli (ST 36)-Sishencong (EX-HN 1) and Taixi (KI 3)-Sanyinjiao (SP 6), which were closely associated with Baihui (GV 20). By analyzing the three commonly used acupuncture-moxibustion methods, acupuncture plus medication was found achieving the best result in the total effective rate and mini-mental state examination (MMSE) score, followed by monotherapy of electroacupuncture therapy, and these two methods were superior to acupuncture alone (P<0.05); the scores of MMSE, Alzheimer disease assessment scale-cognitive section (ADAS-cog) and activity of daily living scale (ADL) showed significant improvements after treatment (all P<0.01). Conclusion: In the acupuncture-moxibustion prescriptions for AD, the main points are Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Zusanli (ST 36), Sanyinjiao (SP 6) and Taixi (KI 3). Monotherapy of acupuncture has the highest frequency amongst the treatment methods, but its effective rate is lower than that of acupuncture plus medication and monotherapy of electroacupuncture.

Adenocarcinoma/surgery* ; Esophageal Neoplasms/surgery* ; Esophagogastric Junction/surgery* ; Gastrectomy ; Humans ; Margins of Excision ; Neoadjuvant Therapy ; Retrospective Studies ; Stomach Neoplasms/surgery*

Objective: To observe the intervention effect of auricular point sticking on dry eye in myopia patients after small-incision lenticule extraction (SMILE) surgery.Methods: This was a prospective randomized controlled study conducted among the myopia patients who received SMILE surgery at Eye and ENT Hospital of Fudan University. The post-SMILE operation patients who screened by the inclusion and exclusion criteria were randomized into a control group and a treatment group. Patients in the control group were given 0.1％ fluorometholone and 0.5％ carboxymethylcellulose sodium eye drops, while the treatment group was given additional unilateral auricular point sticking for 1 month. The patients were estimated using ocular surface disease index (OSDI), Schirmer tear test-1 (STT-1), tear film break-up time (TF-BUT), corneal fluorescein staining (CFS) score, corneal sensitivity (CS) and visual quality (VQ) at 1 d, 1 week and 1 month after surgery; the changes in anxiety and depression were also observed in the patients. Results: Compared with the first day after operation, CS in the nasal region was improved in the treatment group, and the VQ score increased in the control group patients at 1 week after operation (both P<0.05); at 1 month after operation, the TF-BUT increased, CFS score decreased, CS in the central and nasal regions increased (all P<0.05), and VQ score increased (P<0.01) in the treatment group, and the CS in the central, upper, lower and nasal regions were improved (all P<0.05), and VQ score increased (P<0.01) in the control group. The between-group comparison showed that the differences in the change of TF-BUT were statistically significant at 1 week and 1 month after surgery, respectively (both P<0.05). Conclusion: Auricular point sticking therapy can increase the TF-BUT and accelerate the repair of ocular surface function in post-SMILE patients.

Objective To compare the clinical effects of microneurosurgery by supraorbital key-hole or endonasal transsphenoidal approaches in the treatment of pituitary adenoma and investigate their complications. Methods We retrospectively analyzed the data of 87 patients with pituitary adenoma of which the anteroposterior diameter was less than 3 cm. These patients, admitted to our hospital from May, 2006 to June, 2008, were operated in an endoscope-assisted microsurgical manner via a supraorbital key-hole approach (n=42) or an endonasal transsphenoidal approach (n=45). The efficacy of these two approaches was compared and their complications were observed. Results The excision rate of the pituitary adenoma developing on or around the sella turcica operated through the supraorbital key-hole approach was significantly higher than that through the endonasal transsphenoidal approach(P< 0.05); while that of microadenoma or adenoma developing towards the sphenoid sinus operated through the supraorbital keyhole approach was statistically lower than that through the endonasal transsphenoidal approach (P<0.05). No obvious differences on the improvement of endocrine secretion, visual acuity and field was noted in these two approaches (P>0.05). The incidence rate of epistaxis and unilateral dysosphresia in the supraorbital key-hole approach was significantly lower as compared with that in the endonasal transsphenoidal approach (P<0.05). Conclusion Rarely having such complications as dysosphresia, epistaxis and sphenoiditis, neuroendoscopic surgery through supraorbital key-hole approach is the best way of treating the pituitary adenoma developing on or around the sella turcica and worth to promote in clinic.

China ; epidemiology ; Drug Resistance, Bacterial ; Dysentery, Bacillary ; epidemiology ; microbiology ; Humans ; Serotyping ; Shigella ; classification ; drug effects ; isolation & purification

OBJECTIVETo evaluate speech outcomes in patients of maxillary reconstruction with free fibula composite flap.

METHODSSpeech measurements of 20 patients of maxillary reconstruction with free fibula composite flap were collected. Palatopharyngeal valve, the symmetry and movement of soft palate, hypernasality and nasal emission were examined by nasoendoscopy. At the same time the speech intelligibility was measured.

RESULTSNo palatopharyngeal valve insufficiency was found and all the soft palates had good symmetry and movement. The average speech intelligibility was 98.4%.

CONCLUSIONSFree fibula composite flap can reconstruct the phonatory structure and support the function of soft palate, which can restorate speech function well. It is a good choice for maxillary reconstruction.

Adult ; Female ; Fibula ; Humans ; Male ; Maxilla ; surgery ; Middle Aged ; Speech Intelligibility ; Surgical Flaps

OBJECTIVECleidocranial dysplasia (CCD) is a dominantly inherited skeletal dysplasia caused by mutations in the osteoblast-specific transcription factor-encoding gene, core binding factor α1 (CBFA1). Over 90 mutations in CBFA1 gene have been published to date in 500 independent cases of CCD, including missense mutations, deletions, insertions, frameshift, and splice mutations. However, mutational screening of the CBFA1 gene is still far from saturation, and more novel mutations will be identified to enrich the insights into the molecular basis for the pathogenesis of CCD. The aim of this study was to explore the clinical and image features and detect the mutations of CBFA1 gene in two CCD families.

METHODIn this study, the clinical features were investigated in two CCD families, radiological and CT examinations regarding osseous malformation were carried out over the entire body of these patients with CCD. Blood (2 ml) was drawn from all affected individuals, unaffected family members and one hundred unrelated normal controls, Genomic DNA was extracted from whole blood with PureGene DNA extraction kit and PCR was performed with eight pairs of PCR primers for exons 0 to 7 of the CBFA1 gene. The mutations of CBFA1 gene were screened in these two CCD families.

RESULT(1) The clinical features of patients with CCD include delayed closure of fontanelles, frontal bossing, dysplasia of clavicles, late tooth eruption, and other skeletal anomalies. X-ray and CT examination showed the bulging calvarium, patent fontanelles, wide cranial sutures, multiple Wormian bones, dental dysplasia or aplasia of clavicles. (2) Two mutations were identified, one is novel missense mutation (c.1259C > T[p.T420I]) in CBFA1 gene exon 7, other (c.577C > T[p.R193X]) was reported in Chinese cases with CCD for the first time.

CONCLUSION(1) The clinical and image features of patients in two CCD families include delayed closure of fontanelles, frontal bossing, dysplasia of clavicles, late tooth eruption, and other skeletal anomalies. (2) The T420I and R193X mutations of CBFA1 were reported, expanding the spectrum of CBFA1 mutations causing CCD.

Child ; Child, Preschool ; Cleidocranial Dysplasia ; genetics ; pathology ; Core Binding Factor Alpha 1 Subunit ; genetics ; DNA Mutational Analysis ; Exons ; Female ; Humans ; Male ; Mutation ; Pedigree ; Phenotype