BACKGROUND:In perioperative period of total knee replacement in elderly patients, it is crucial to maintain the normal function of blood coagulation. However, many factors may influence coagulation function of patients in perioperative period. Of them, anesthesia is an important factor. Different anesthesia methods wil produce different effects on blood coagulation. Appropriate anesthesia methods should be selected in the clinic to maintain the stability of coagulation function. OBJECTIVE:To explore the effect of application of general anesthesia and epidural anesthesia in elderly knee replacement and the effects on the function of blood coagulation. METHODS:A retrospective analysis was performed on clinical data of 135 elderly patients after total knee replacement in Dongying Hospital of Shandong Provincial Hospital Group from September 2012 to September 2013. Al patients were divided into control group (67 cases;general anesthesia) and observation group (68 cases;epidural anesthesia) according to the mode of anesthesia. Coagulation indexes and D-dimer levels were observed before anesthesia, 6 hours after anesthesia, and 1 day after replacement in both groups. The incidence of deep venous thrombosis was measured and compared between the two groups in 12-month fol ow-up.
RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference was detected in blood coagulation indexes at different time points in the two groups (al P>0.05). However, significant differences in D-dimer levels were detectable between the two groups at 6 hours after anesthesia and in the morning at 1 day after replacement. D-dimer levels were significantly lower in the observation group than in the control group (al P<0.05). The incidences of deep venous thrombosis were 3%and 21%in the observation and control groups, respectively, showing significant differences (P<0.05). These results suggest that epidural anesthesia during elderly totak knee replacement obtained good effects, and could maintain stable coagulation function.

Atherosclerosis (AS) is one of the most essential factors to cause cardio-cerebrovascular diseases. Abundant experience has been acquired in treatment of AS by traditional Chinese medicine (TCM) with its own distinctive diagnostic and therapeutic principles. To expell phlegm and relieve blood stasis, a hot topic of TCM therapeutic principle for AS, is reviewed in this paper.
Atherosclerosis ; blood ; drug therapy ; pathology ; Blood Circulation ; drug effects ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Phytotherapy ; Syndrome

BACKGROUNDA causal link between the metatarsus adductus and hallux valgus is not clear. The aim of this study was to investigate the configurations of the metatarsus adductus deformity by radiological measurements and reappraise the relationship between hallux valgus and metatarsus adductus.

METHODSThe first step was evaluation of the relationship between metatarsus adductus and hallux valgus on 143 dorsoplantar weight-bearing radiographs diagnosed as hallux valgus which was also known as bunions. Measurements including the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the Kilmartin angle (KA), the tibial sesamoid position (TSP), and metatarsus adductus angle were taken. The metatarsus adductus angle is defined by Sgarlato's angle (SMA) and Engel's angle (EMA) respectively.

RESULTSThe metatarsus adductus angle positively correlates with the HVA (r = 0.590, P = 0.000) and KA (r = 0.601, P = 0.000), yet negatively correlates with the grade of TSP, (r = -0.348, P = 0.000). Contradiction of diagnosis existed in 22 (22/100) subjects diagnosed as metatarsus adductus by SMA yet normal by EMA. In this group, the correlation between HVA and metatarsus adductus angle was negative (r = -0.472, P = 0.027).

CONCLUSIONSEMA and SMA defined metatarsus adductus by different deformity apexes. Metatarsus adductus configurations in that the apex of the deformity lay in either the base of metatarsals or tarsus. They respectively correlate positively or negatively to the HVA.

Adult ; Aged ; Aged, 80 and over ; Female ; Foot Deformities, Congenital ; diagnostic imaging ; physiopathology ; Hallux Valgus ; diagnostic imaging ; physiopathology ; Humans ; Male ; Metatarsus ; abnormalities ; diagnostic imaging ; Middle Aged ; Radiography ; Young Adult

OBJECTIVETo establish a nested case-control study cohort in myelodysplastic syndrome (MDS) patients and investigate the clinical characteristics, WHO subtype and risk factors associated with MDS evolution to leukemia of this cohort.

METHODSAll patients, ≥18 years of age, provided by 24 Shanghai hospitals with initial clinical findings consistent with a hematopoietic abnormality between June 2003 and April 2007, were the candidates for inclusion in this study. The blood and bone marrow samples of every patient should be provided at baseline. Diagnosis was made by incorporating morphologic, immunophenotypic, cytogenetic and molecular features according to WHO classification criteria. Cytogenetic analysis was performed using conventional G-banding karyotyping and fluorescence in situ hybridization (FISH) techniques. Cumulative risk of evolution was estimated by Kaplan-Meier method. Prognostic factors were evaluated by univariate Log-rank method and multivariate Cox proportional hazard models.

RESULTSA total of 435 patients were diagnosed as MDS. The median age of MDS onset was 58(18-90) years, with 248 male patients and 187 female patients (male: female 1.33: 1). The percentage of cases with refractory cytopenia with multilineage dysplasia (RCMD) was the highest (65.5%), while that of refraetory anemia (RA) (2.3%), refractory anenia with ring sideroblast (RARS) (1.1%) and 5q-syndrome (0.5%) was lower. Trisomy 8 (+8) was the most common chromosome abnormalities (71 cases, 12.7%). The mean follow-up time was 20.3 (4.2-57.1) months. Cases were patients with evolution by the end of follow-up, while controls were patients without evolution by that time. Case group included 41 patients and control group included 342 patients. Univariate analysis showed that the age, sex, WHO subtype, WBC count, absolute neutrophil count (ANC), IPSS cytogenetic subgroup, IPSS group and bone marrow blast percentage were significant risk factors for leukemia-free survival (LFS). Multivariate analysis of COX model showed that the age, sex, WHO subtype, IPSS cytogenetic subgroup and bone marrow blast were independent risk factors for LFS.

CONCLUSIONA nested case-control study cohort of MDS patients is established. The clinical characteristics and WHO subtype of MDS patients in Chinese Shanghai are different from that in Western countries. The independent risk factors for MDS evolution are age, sex, WHO subtype, IPSS cytogenetic subgroup and bone marrow blast percentage.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Bone Marrow ; Case-Control Studies ; China ; Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Human, Pair 5 ; Chromosomes, Human, Pair 8 ; Cri-du-Chat Syndrome ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Leukemia ; Male ; Middle Aged ; Myelodysplastic Syndromes ; Proportional Hazards Models ; Risk Factors ; Trisomy ; Young Adult

INTRODUCTIONAnatomical markers can help to guide lag screw placement during surgery for internal fixation of fifth metatarsal base fractures. This study aimed to identify the optimal anatomical markers and thus reduce radiation exposure.

METHODSA total of 50 patients in Huashan Hospital, Shanghai, China, who underwent oblique foot radiography in the lateral position were randomly selected. The angles between the fifth metatarsal axis and cuboid articular surface were measured to determine the optimal lag screw placement relative to anatomical markers.

RESULTSThe line connecting the styloid process of the fifth metatarsal base with the second metatarsophalangeal (MTP) joint intersected with the fifth metatarsal base fracture line at an angle of 86.85° ± 5.44°. The line connecting the fifth metatarsal base styloid with the third and fourth MTP joints intersected with the fracture line at angles of 93.28° ± 5.24° and 100.95° ± 5.00°, respectively. The proximal articular surface of the fifth metatarsal base intersected with the line connecting the styloid process of the fifth metatarsal base with the second, third and fourth MTP joints at angles of 24.02° ± 4.77°, 30.79° ± 4.53° and 38.08° ± 4.54°, respectively.

CONCLUSIONThe fifth metatarsal base styloid and third MTP joint can be used as anatomical markers for lag screw placement in fractures involving the fifth tarsometatarsal joint. The connection line, which is normally perpendicular to the fracture line, provides sufficient mechanical stability to facilitate accurate screw placement. The use of these anatomical markers could help to reduce unnecessary radiation exposure for patients and medical staff.

Bone Screws ; China ; Foot ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Metatarsal Bones ; radiation effects ; surgery ; Patient Positioning ; Radiation Exposure ; Radiography ; Stress, Mechanical

Objective: To investigate the application value of cerebrospinal fluid circulating cell-free DNA (cfDNA) in the diagnosis and treatment of leptomeningeal metastases in non-small-cell lung cancer (NSCLC). Methods: Twenty-five patients with leptomeningeal metastases of NCSLC from Fudan University Huashan Hospital North during the period from September 2017 to November 2018 were enrolled. All 25 patients were confirmed leptomeningeal metastases by cerebrospinal fluid cytology and immunocytochemical staining of cytokeratin(CK7), carcinoembryonic antigen(CEA), thyroid transcription factor-1(TTF-1) and Ki67. The cerebrospinal fluid cfDNA was extracted and genetic variation of 12 genes including epidermal growth factor receptor(EGFR), TP53 and anaplastic lymphoma kinase(ALK) was detected by next-generation sequencing [PlasAim TM gene non-invasive detection of lung cancer (12 gene) kit, Singlera Genomics].The application value of cerebrospinal fluid cfDNA in the diagnosis and treatment of leptomeningeal metastases of NSCLC was analyzed with the cfDNA mutation data and the clinical follow-ups. Results: Morphologically typical lung cancer tumor cells with tumor immunochemistry markerCK, CK7 and CEA were found in the cerebrospinal fluid of all 25 patients. Next generation sequencing of cerebrospinal fluid showed that 96% (24/25) patients had at least one single nucleotide variation (SNV) or copy number variation (CNV). The EGFR and TP53 mutations were identified in 80% (20/25) and 48%(12/25) of the patients, respectively. In addition, patients with bone metastases had a higher rate of EGFR mutations than those without bone metastases (100% vs 64%, P<0.05). Changes in the mutant allele frequency of EGFR and TP53 in cerebrospinal fluid were consistent with patients′ disease progression parameters including neurological symptoms, imaging, and tumor biomarkers. The results indicate that genetic alteration of EGFR in cerebrospinal fluid cfDNA is an actionable biomarker for targeted therapy of leptomeningeal metastases of lung cancer. Conclusion Cerebrospinal fluid cfDNA accurately reveals the unique genetic background of leptomeningeal metastasis in NSCLC, showing great application value in the diagnosis and treatment of the leptomeningeal metastasis of NSCLC.

Myelodysplastic syndrome (MDS) is a group of heterogeneous clonal disease involving one or more series of hematopoietic cells. Its pathogenesis is still unclear. No effective targeted drug is available to prevent this disease progression. MDS originates in hematopoietic stem cells. Recent researches found that the complex abnormal gene expression occurred in bone marrow CD34⁺ cells plays a key role in development of MDS. Some of these genes are closely related with the patient's prognosis and survival, such as DLK1, ribosomal transcripts gene, Toll-like receptors gene, EPA-1 and interferon-stimulated genes. Due to heterogeneity of this disease, abnormal gene expression profiles in bone marrow CD34⁺ cells are closely associated with particular FAB or cytogenetic subtypes. To elucidate the pathogenesis of MDS and investigate its therapeutic target, this article reviews progress of researches on abnormal gene expression profiles of hematopoietic stem/progenitor cells in low-risk, high-risk patients and MDS patients who carry common cytogenetic abnormalities.
Antigens, CD34 ; Bone Marrow Cells ; metabolism ; Disease Progression ; Gene Expression ; Hematopoietic Stem Cells ; metabolism ; Humans ; Myelodysplastic Syndromes ; genetics ; Prognosis

OBJECTIVETo identify methylation profiles in myelodysplastic syndrome (MDS) and to provide the biomarkers for the early diagnosis and differential diagnosis of MDS.

METHODSGenes were screened for hypermethylation by genome-wide DNA methylation profiles. Transcription down-regulation was determined with a gene expression microarray. Methylation-specific, real-time, and bisulfite-sequencing PCR cloning and sequencing were performed to validate selected genes in MDS cases and non-malignant hematologic diseases (controls). Diagnostic test, such as sensitivity and specificity, was used to evaluate the value of methylation patterns.

RESULTSA draft of methylation patterns was established and refined to 6 genes after validation in 211 patients and 60 controls. The hypermethylated genes were ABAT (97%), DAPP1 (98%), FADD (89%), LRRFIP1 (96%), PLBD1 (89%), and SMPD3 (85%). A combination of 5 or more than 5 genes showed a specificity of 95% and sensitivity of 91.4% for the diagnosis of MDS. The accuracy of diagnosis was 92.3%.

CONCLUSIONWe demonstrated here that the ABAT, DAPP1, FADD, LRRFIP1, PLBD1 and SMPD3 genes are hypermethylated and downregulated in MDS. The six genes could be the markers of the methylation patterns in MDS, as a noninvasive approach for the diagnosis of MDS.

DNA Methylation ; Down-Regulation ; Gene Expression ; Genome, Human ; Humans ; Myelodysplastic Syndromes ; diagnosis ; genetics

Objective    To assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis. Methods    A total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed. Results    The amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%,  respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). Conclusion    WHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.

OBJECTIVETo establish a myelodysplastic syndrome transformed to leukemia cell line stably expressing green fluorescent protein (GFP), and to evaluate its biological characteristics and applications.

METHODSSKM-1 cells were transfected by lentiviral particles with vector of GFP. The GFP positive single cell clone was isolated by limiting dilution and continued being cultured. The cells were injected into mice subcutaneously and were screened in vivo. Then SKM-1/GFP cells were obtained after tumour plaque was separated and cultivated. The cell morphology was observed by fluorescence microscopy. The GFP expression was further detected by flow cytometry. The cell proliferation was analysed by CCK-8 assay. SKM-1/GFP cells were inoculated to subcutaneous tissue of the immunodeficiency mice. The growth and invasion of the tumour were observed after tumour formation.

RESULTSNo differences in cell morphology and growth characteristics were observed between SKM-1 cells and SKM-1/GFP cells. The rate of GFP expression was 100%. No differences in cell proliferation were observed between SKM-1 cells and SKM-1/GFP cells. The tumour mass was observed after 14 days of subcutaneous vaccination in NOD/SCID mice. Spontaneous fluorescence from plaque was observed by living fluorescence microscopy at 30th day after vaccination. Homogenous GFP positive cells were observed by fluorescence microscopy in the frozen section of tumour mass. The invasion of SKM-1/GFP cells was also detected in heart, liver, stomach and kidney of mice.

CONCLUSIONA myelody-splastic syndrome transformed to leukemia cell line stably expressing green fluorescent protein has been established successfully, which can track tumor cell sensitively and can be applied to the research of minimal residual leukemia. The establishment of SKM-1/GFP cells may serve as a powerful means for studing myelodysplastic syndrome transformation.