Objective To facilitate a better understanding of the progress in the research, diagnosis and treatment of Peutz Jeghers syndrome (PJS).Methods Almost all the papers related to PJS from various magazines published in English and Chinese in recent years were reviewed. Current progresses in PJS research and related diagnosis and treatment were discussed in this review.Results PJS is a rare inherited disease with autosomal dominant trait, which is characterized by the presence of hamartomatous gastrointestinal polyps and mucocutaneous pigmentation of the lips, buccal mucosa, and digits. This syndrome is commonly complicated with intestinal obstruction, bleeding, or intussusception,and patients with this disease are at high risk for the development of both GI and extraintestinal malignancies. STK11 on chromosome 19p13.3 are responsible for most cases of PJS. The polyps of PJS tend to have a high incidence of malignant change, and the recurrence of malignancy after treatment is also high. Conclusion The STK11 has been identified as one of the main genes responsible for PJS and has close correlation with formation and development of tumors. Patients with PJS are at high risk for the development of both GI and extraintestinal malignancies.

Objective:To investigate the feasibility of MRI measurement for normal fetal aortic arch isthmus diameter and ductus arteriosus diameter between 20 to 36 weeks of gestation and analyze its relationship with gestational age.Methods:This retrospective study enrolled 257 pregnant women with an unclear fetal four-chamber view in prenatal ultrasonography, whose following fetal MRI examination results showed no structural cardiac abnormalities, in Shanghai Children's Medical Center Affiliated to the Medical College of Shanghai Jiaotong University from June 2018 to June 2020. Postnatal echocardiography confirmed cardiac structures were normal in all cases. MRI images were reviewed to measure the diameter of the aortic arch isthmus, defined as the aortic arch isthmus's central diameter, in the transverse section of the aortic arch in steady-state free precession sequence imaging and the diameter of ductus arteriosus near the descending aorta. The average values were calculated after repeating each measurement three times. The 5th, 50th and 95th percentiles and their 95% CI of the aortic arch isthmus diameter and the ductus arteriosus diameter corresponding to different gestational age and the mean value and its 95% CI of the ratio of the aortic arch isthmus diameter to the ductus arteriosus diameter were calculated. Pearson correlation analysis and regression analysis were used to evaluate the relationship of the aortic arch isthmus diameter and the ductus arteriosus diameter with gestational age. Results:The regression equation between the aortic arch isthmus diameter and gestational age was as follows: the aortic arch isthmus diameter (mm) =-2.85+0.22×gestational age (weeks), and there was a positive linear correlation between them ( R2=0.737, P<0.001). The 50th percentile of the aortic arch isthmus diameter was 1.8-3.5 mm at 20-28 weeks and 3.5-5.0 mm at 28-36 weeks. The regression equation between the diameter of ductus arteriosus and gestational age was as follows: the diameter of ductus arteriosus (mm) =-2.17+0.19×gestational age (weeks), and a positive linear correlation between them was revealed ( R2=0.606, P<0.001). The 50th percentile of the diameter of ductus arteriosus was 2.0-3.5 mm at 20-28 weeks and 3.2-4.8 mm at 28-36 weeks. The 95% CI for the ratios of the aortic arch isthmus diameter to the ductus arteriosus diameter at 20, 22, 24, 26, 28, 30, 32, 34 and 36 weeks of gestation were 0.8-1.1, 0.8-1.0, 0.8-1.0, 0.8-1.3, 0.8-1.5, 0.9-1.5, 0.9-1.7, 0.9-1.1 and 1.0-1.3, respectively, and were all close to 1. Conclusions:It is feasible to measure fetal aortic arch isthmus diameter and ductus arteriosus diameter at 20-36 weeks of gestation in MRI, and both measurements have a linear correlation with gestational age.

Objective To analyze and compare the long-term therapeutic effect and image changes of conservative therapy versus lumbar discectomy for lumbar disc herniation to provide valid reference for its clinical treatment. Methods The clinical data from 182 patients with single-level lumbar disc herniation, who were treated from January 1983 to June 2008 and followed-up for more than 10 years, were analyzed retrospectively. These patients were divided into conservative treatment (CT) group (n=73) with a mean follow-up time of 17.61±3.87 years, and surgery group (n=109) with a mean follow up time of 17.17±3.47 years. In the CT group, 49 patients were male, 24 female; there were 44 patients with L4-L5 disc herniation, and 29 L5-S1 disc herniation. In 109 patients in the surgery group, 71 were male, 38 female; 68 had L4-L5 disc herniation, 41 had L5-S1 disc herniation, and all of them received lumbar discectomy. The long-term therapeutic effects were reviewed and compared retrospectively in the two groups, including clinical manifestations, image changes, neurofunctional evaluation, height of morbid intervertebral space, adjacent segment intervertebral space and the incidence of cephalad adjacent segment degeneration. Results Eight of 73 patients received lumbar spinal canal decompression because of intermittent claudication in the CT group, and 13 in surgery group underwent resurgery for recurrent lumbar disc herniation. At final follow up, the height of morbid intervertebral space (0.62±0.15cm)in surgery group was significantly lower than that in CT group (0.69±0.13cm, P<0.05), the Oswestry score (23.9%±6.3% in surgery group, 23.3%±6.5% in CT group) and height of adjacent segment intervertebral space (0.83±0.11cm in surgery group, and 0.82±0.11cm in CT group) were statistically compared, and no significant difference was found between the two groups. Five patients in CT group and 9 in surgery group were found to have degenerative instability by imaging, however, none of them presented obvious clinical symptoms. According to UCLA criteria, cephalad adjacent segment degeneration occurred in 8 patients (12%) of CT group, and in 23 (22%) of surgery group, and the incidence of cephalad adjacent segment degeneration was significantly higher in surgery group than in CT group (P<0.05). Conclusions The height of morbid intervertebral space is remarkably lower, and less of them trigger clinical symptom from adjacent segment degeneration in patients treated with lumbar discectomy. Both conservative therapy and lumbar discectomy can obtain better long-term results for lumbar disc herniation.

Objective To analyze the potential risk factors of sudden death at home in senile people. Methods 38 cases of cardiac arrest in a community occurring at home from 1993 to 2004 were retrospectively analyzed. The data concerning their condition of health before death, the diagnosis of the diseases confirmed, the predisposing causes of cardiac arrest, and the season and time of death were collected and analyzed. Results It was found that hypertension, CHD and diabetes were the predominant diseases in senile patients died of out-of-hospital cardiac arrest. Most of the deaths occurred in April, 73.7% of the deaths occurred during 6:00-18:00, and 81.6% cases occurred in their homes. Conclusion In senile patients, the cardiovascular diseases may be the main risk factors of out-of-hospital cardiac arrest. The patients with myocardial infarction, arrhythmia and heart failure constitute the high risk group of cardiac arrest. Usually death occurs without a portent.

[Objective]To discuss the failure and countermeasure of Ni-Ti shape memory alloy fixer for treatment of limb fracture.[Method]A retrospective survey was performed in 259 cases with fracture treated by Ni-Ti shape memory alloy fixer.Eight cases of the fixer had been ruptured,risen,loosen after operation.[Result]The failure case of Ni-Ti shape memory alloy fixer for treatment of limb fracture were 8 case in 259 case.There were one case of ulna and two cases of femur fracture had be ruptured after the first operation,healing up after the second operation.The fixer has been risen of shoulder bone and femur fracture in each one and two cases of clavicle,the fracture has be malformation concrescence.One case of patella fracture was loosn after concrescence.[Conclusion]The requisite for Ni-Ti shape memory alloy fixer is needed for treatment of limb fracture,the right operation's condition,the best type and length are selected for different part,the convalescent exercise is regnired after operation to avoid failure of treatment.

[Objective]To compare the reliability and value of clinical signs,MRI imaging and arthroscopy in management of meniscal tears in order to increase the diagnostic rate.[Method]A retrospective study was done on 176 cases undergoing MRI examination and arthroscopic treatment,and being diagnosed as meniscal injuries in knee joint by any one of the three clinical,MRI or arthroscopic examinations.Using arthroscopic diagnosis as the standard,the sensitivity,specificity.and overall accuracy of clinical diagnosis and MRI were then calculated respectively.Significant differences between arthroscopic diagnosis and clinical diagnosis or MRI diagnosis were analyzed using statistical method of Chi-square test.[Result]The sensitivity,specificity and accuracy of clinical diagnosis were 79.3%,26.3% and 73.8% respectively.There was statistically significant difference between arthroscopic diagnosis and clinical diagnosis.The sensitivity,specificity and accuracy of MRI diagnosis were 94.1%,92.9% and 93.4% respectively.The difference between arthroscopic diagnosis and MRI diagnosis had no statistically significance and can be used as an important examination before knee arthroscopy.[Conclusion]MRI is a reliable,noninvasive diagnostic tool for meniscal tears and can be used as an important examination before knee arthros copy with MRI examination combining with the clinical signs,diagnotic rate of meniscal tears can be increased.Unnecessary arthroscopic therapy could be avoided.

Objective To observe the changes of four quantitative indexes of diabetic macular edema by using optical coherence tomography.Methods Eighty-nine patients (155 eyes) with diabetic retinopathy were included in this project and were divided into two groups according to the present of diabetic macular edema:Negative group (56 cases,100 eyes) and positive group(33 cases,55 eyes).In addition,23 cases (42 eyes) of normal volunteers constituted the normal control group.All the objects accepted an optical coherence tomography examination and the indexes including central retinal thickness (CRT),subfoveal choroidal thickness (SFCT) and integrity of external limiting membrane(ELM) as well as inner/outer segment (IS/OS) were measured and analyzed.Results The average CRT of positive group (219.048 ± 16.798) μm was significantly thicker than that of control group(217.775 ± 26.866) μm and negative group (280.418 ±74.187) μm (P ＜0.001).Mean SFCT among control group (312.893 ±140.559) μm,negative group (302.080 ± 125.287) μm and positive group (293.745 ±140.517) μm had no statistical significance (P =0.781).There were 3 eyes with disrupted ELM layer in the negative group and 8 eyes in the positive group.Difference between them was proved to be significant (P =0.019).Similarly,the integrity of IS/OS layer had significant difference between negative group (5 eyes disrupted) and positive group (19 eyes disrupted) (P ＜ 0.001).Conelusion CRT of patients with diabetic macular edema is always increased and the integrity of ELM or (and) IS/OS can be disrupted in many cases.Indexes including CRT and the integrity of ELM or (and) IS/OS can be used to evaluate the severity of diabetic macular edema quantificationally.

BACKGROUND:The tourniquet is usualy fuly used or bilateraly used in partial time during bilateral total knee arthroplasty. However, very few people try to use it on one side and on the other side in partial time.
OBJECTIVE:To investigate the effective strategy of using a tourniquet in simultaneous bilateral total knee arthroplasty.
METHODS:80 patients (160 knees) with severe osteoarthritis who underwent simultaneous bilateral total knee arthroplasty in the Department of Orthopedics, Chinese PLA Medical School from January to December 2013 were divided into two groups according to the different tourniquet strategies. In test group (n=40), left knees did not receive tourniquet, and right knees received tourniquet in partial time. In control group (n=40), al knees received tourniquet in the whole time. The perioperative and postoperative blood loss, 3-day postoperative thigh sweling rate and pain visual analog scale, 3-week and 1-year postoperative Knee Society Score were recorded in both groups.
RESULTS AND CONCLUSION:There were no statisticaly significant differences between two groups in perioperative total blood loss (P > 0.05). However, postoperative blood loss in test group was less than that in control group (P < 0.05). The visual analog scale scores were significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). Visual analog scale scores on the left side were lower than on the right side in the test group at 3 days post surgery (P < 0.05). Bilateral thigh sweling rate was significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). The thigh sweling rate was lower on the left side than on the right side in the test group at 3 days after surgery (P < 0.05). Knee Society Score was higher in the test group than in the control group in the early stage, and no significant difference in long-term Knee Society Score was detected (P > 0.05). These findings verify that taking the strategy that the first knee without tourniquet and the second knee with part time tourniquet technique in simultaneous bilateral total knee arthroplasty wil aleviate pain and sweling after operation and promote early functional rehabilitation without increasing the perioperative total blood loss.

Carcinoembryonic Antigen ; analysis ; Humans ; Luminescence

Objective To investigate the effects of duration of active phase on delivery mode and pregnancy outcome.Methods Data of 417 women with abnormal active phase identified from 1744 term-birth,singleton,cephalic presentation primiparas who had tried vaginal delivery in Peking University First Hospital from January 1,2009 to December 31,2009 were retrospectively studied.Effects of different durations of protracted active phase on pregnancy outcomes were compared between women with vaginal delivery or cesarean section by Chi square test.Results The incidence of protracted active phase was 23.9％ (417/1744); and the incidence of prolonged active phase was 2.9％ (50/1744).There were 205 cases of cesarean section and 212 cases of vaginal deliveries.The incidence of neonates hospitalization in Department of Pediatrics in vaginal delivery group with active phase ≥6 h was higher than that of those with active phase ＜6 h [20.6％ (26/126) vs 8.1％ (7/86),x2 =6.07,P＜0.05].The incidence of intrauterine infection in cesarean section group with active phase ＜6 h were higher than that of those with active phase ≥6 h [22.7％ (30/132) vs 6.8％(5/73),x2 =8.37,P＜0.01].In vaginal group with protracted active phase before 6 cm of cervical dilation,the incidences of postpartum hemorrhage (4.8％,9/186),maternal complications (3.8％,7/186) and neonates hospitalization (15.6％,29/186) were similar with those after 6 cm of cervical dilation [6.2％ (1/16),x2=0.12; 0.0％ (0/16),x2=0.01 and 12.5％ (2/16),x2=0.00; all P＞0.05] respectively.In cesarean delivery group with cervical dilation ≥6 cm,the incidence of neonates hospitalization was higher than that of those with cervical dilation ＜6 cm [60.0％ (6/10) vs 19.9％ (34/171),x2 =8.83,P＜0.05].There were no difference in maternal age,gestational age,body mass index at delivery,volume of postpartum hemorrhage and neonatal birth weight between women with cesarean section whose protracted active phase ≥4 h or ＜4 h when cervical dilation at 3 cm (P＞ 0.05 respectively).The incidence of neonates hospitalization was low in women whose indication of cesarean section was protracted active phase (11.2％,9/80),while it was high when protracted active phase complicated with intrauterine infection (42.1％,16/38).Conclusions Protracted active phase with cervical dilation less than 6 cm might not need active management if neither the mother nor the fetus is compromised.The infants born vaginally should be closely monitored if the active phase is over 6 h.