Objective To investigate the syndrome types of traditional Chinese medicine ( TCM) in senile hypertension patients by cluster analysis. Methods Case report sheet for senile hypertension was formed, and then the general data and TCM syndrome information of 495 cases of senile hypertension were recorded. The frequency of syndrome information of the enrolled cases was analyzed, and then the syndrome types were classified by cluster analysis. Results The symptoms with high frequency in senile hypertension patients were dizziness ( 75.9%) , insomnia ( 33.1%) , chest distress ( 29.9%) , poor appetite ( 23.2%) , headache (22.4%), slippery pulse (54.9%), greasy fur (51.7%), stringy pulse (49.7%), and white fur (47.8%) . The main syndrome patterns of 495 cases of senile hypertension were upward hyperactivity of liver yang (23.8%), Qi deficiency and phlegm turbidity (21%), kidney qi deficiency (19.8%), phlegm blended with blood stasis (18.4%), and phlegm heat (17.0%) . Conclusion Senile hypertension patients are dominated with the syndrome types of upward hyperactivity of liver yang, Qi deficiency and kidney deficiency, and are usually complicated with phlegm turbidity, phlegm heat and blood stasis. The complicated syndromes of phlegm turbidity and blood stasis are commonly-seen. The results of cluster analysis are expected to supply evidence for the syndrome differentiation of senile hypertension.

Objective:Explore the hydrogen-nuclear magnetic resonance ( 1H-NMR) application potential of metabolomics in early screening of vitamin A deficiency(VAD). Methods:From January to June 2019, 40 cases of left-behind children with confirmed VAD <1 year old were enrolled in Zunyi area as VAD group, and 40 healthy children were selected as healthy control group.Urine from the 2 groups of children was collected and 1H-NMR spectrum was measured.By combining metabonomics technology and multivariate statistical analysis, the 2 groups of metabolites were compared, and the differential metabolites of children with VAD were screened out. Results:Compared with VAD group [(0.56±0.10)μmol/L], the difference in the serum retinol concentration of healthy control group [(1.35±0.18)μmol/L] was statistically significant ( t=23.93, P<0.001). Compared with healthy group, VAD group showed higher level of methylmalonate, 2-ketoisovalerat, N-acetyl glycoprotein signal, dimethylglycine and betaine, with statistically significant differences (| r|>0.602, all P<0.05). The level of Isovalerylglycine, 2-hydroxyisobutyrate, creatine, phosphate choline/glycerophosphocholine, 4-PY and Hippurate were significantly decreased, with statistically significant differences (| r|>0.602, all P<0.05). Conclusions:Compared with healthy children, children with VAD have differences in urine Metabolites.Differential metabolites are closely correlated with intestinal microecological ba-lance, digestive system diseases, respiratory system diseases, immune-related diseases, energy metabolism, growth and development.Urine 1H-NMR metabolomics analysis has potential application value in the early screening of VAD.

Objective To analyze the associations of age and gender with post-operative outcomes after pilon fracture and the effect of interaction between age and gender on the outcomes.Methods A retrospective cohort study was performed of the 101 successive patients with pilon fracture who had been treated by open reduction and internal fixation from March 2009 to November 2013 and completely followed up.The distributions of potential prognostic factors (diabetes,injury mechanism,open fracture,Rüedi-Allg(o)wer classification and AO classification) were analyzed in different age and gender groups.The outcomes were evaluated in terms of reduction quality by the Burwell-Charnley criteria,time for return to work,traumatic osteoarthritis by Kellgren-Lawrence grading scale and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.The odds ratio and regression coefficients were estimated by Logistic regression and linear regression model;P values for interaction between age and gender were estimated by likelihood ratio tests.Results Of all the 101 pilon patients,84 were male and 12 were the aged.The distributions of gender (P =0.028) and mechanism (P =0.032) were significantly different between the aged and the younger patients,showing there were more females in the aged patients and low-energy injury was more likely to cause a pilon fracture in the aged patients.As multivariate analyses suggested,with the above influencing factors controlled,a median follow-up of 41.2 months revealed age was an independent favorable prognostic factor for reduction quality (OR =3.919,P =0.041).The association between gender and time for return to work was significantly different between the aged and the younger patients,as indicated by interaction analyses (P =0.030).Conclusions There may be more females in the aged patients with pilon fracture than in the younger ones.It is likely that the aged patients sustain a pilon fracture because of low-energy injury and achieve a fracture reduction of poorer quality.Although the quality of reduction may be poorer for the aged,there may be no significant difference between the aged and the younger patients in the mid-long-term AOFAS score.It is advisable for surgeons to provide personalized treatment to better help the patients.

Objective To explore the feasibility and surgical techniques of primary suture by rigid choledochoscope combined with laparoscopic common bile duct exploration.Methods Clinical materials of 53 patients with primary suture by rigid choledochoscope combined with laparoscopic common bile duct exploration were analyzed retrospectively.Results 53 patients completed opera-tions successfully.The operating time was 90 to 168 minutes,with average duration of 112 min-utes.Postoperative hospital stay was 6 to 9 days,with an average length of 6.6 days.No postoper-ative complications such as bleeding,abdominal infection,bile leakage,bile duct stricture and resid-ual biliary stones were observed.Conclusion Under the premise of strictly selecting cases with common bile duct stones,rigid choledochoscope combined with laparoscopic common bile duct explo-ration for primary suture is a feasible method,it has the advantages of less trauma,fast recovery and short hospital stay,so it is worthy of popularization.

Objective To explore the feasibility and surgical techniques of primary suture by rigid choledochoscope combined with laparoscopic common bile duct exploration.Methods Clinical materials of 53 patients with primary suture by rigid choledochoscope combined with laparoscopic common bile duct exploration were analyzed retrospectively.Results 53 patients completed opera-tions successfully.The operating time was 90 to 168 minutes,with average duration of 112 min-utes.Postoperative hospital stay was 6 to 9 days,with an average length of 6.6 days.No postoper-ative complications such as bleeding,abdominal infection,bile leakage,bile duct stricture and resid-ual biliary stones were observed.Conclusion Under the premise of strictly selecting cases with common bile duct stones,rigid choledochoscope combined with laparoscopic common bile duct explo-ration for primary suture is a feasible method,it has the advantages of less trauma,fast recovery and short hospital stay,so it is worthy of popularization.

Objective:To evaluate the efficacy of remimazolam for induction and maintenance of general anesthesia in patients undergoing abdominal surgery.Methods:A total of 100 patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective abdominal surgery with general anesthesia requiring tracheal intubation, were enrolled in this study and divided into 2 groups ( n=50 each) using a random number table method: remimazolam group (group R) and propofol group (group P). Anesthesia was induced by intravenously infusing propofol 1.0-2.5 mg/kg in group P and remimazolam 0.15-0.35 mg/kg in group R. Sufentanil 0.4-0.5 μg/kg and rocuronium 0.6 mg/kg were intravenously injected in group R and group P. Anesthesia was maintained by intravenously injecting remimazolam 0.3-1.0 mg·kg -1·h -1 in group R and propofol 4-12 mg·kg -1·h -1 in group P. Remifentanil 8-15 μg·kg -1·h -1 was intravenously injected in group R and group P. Narcrotrend index (NI) was maintained at 37-64 (D 0-D 2). The success of sedation, time for loss of consciousness, time of disappearance of eyelash reflex, time when NI dropped to D 0, incidence of tidal volume, respiratory rate and apnea after the patients lost consciousness, duration of stay in post-anesthesia care unit, the fluctuation range of mean arterial pressure at 1, 3 and 5 min of induction, and the development of intraoperative and postoperative adverse events. Results:The success rate of sedation in group R and group P was 100%.Compared with group P, time for loss of consciousness, time of disappearance of eyelash reflex and time when NI dropped to D 0 were significantly prolonged, tidal volume and respiratory rate were increased, the incidence of apnea after the patients lost consciousness was decreased, awakening time was shortened, the incidence of intraoperative sinus bradycardia, injection pain and dream was decreased, fluctuation range of blood pressure at 1, 3 and 5 min of induction was decreased in group R ( P<0.05). Conclusion:Remimazolam can be safely and effectively used for induction and maintenance of general anesthesia in patients undergoing abdominal surgery, and its induction dose is 0.15-0.35 mg/kg, and maintenance dose is 0.3-1.0 mg·kg -1·h -1.

Objective:To explore whether the deep deltoid ligament (DL) rupture affects the mid-term clinical efficacy of pronation-external rotation (PER) ankle fracture or not.Methods:A ret-rospective study was conducted to analyze the clinical data of 50 patients with ankle fracture of PER type Ⅲ or Ⅳ who had been treated at Department of Orthopedic Trauma, Beijing Jishuitan Hospital from January 2013 to December 2014.They were 37 males and 13 females with an average age of 30.2 years(from 16 to 68 years). According to their type of medial ankle injury, the patients were divided into 2 groups.The experimental group, consisting of 28 patients with deep DL rupture but no medial ankle fracture, did not undergo DL repair operation; the control group, consisting of 22 patients with supracollicular medial malleolar (SMM) fracture but no deep DL rupture, underwent open reduction and internal fixation (ORIF) for SMM.Both groups were treated with ORIF of fibular fracture in addition to syndesmosis screw fixation.The 2 groups were compared in terms of the medial malleolus space and distal tibiofibular space on the imaging exams at more than 6 months, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analog scale (VAS) pain scores at the mid-term follow-ups.Results:The differences between the 2 groups in gender, age and mode of concomitant subluxation or dislocation were statistically significant ( P<0.05), but there were no sig-nificant differences between the 2 groups in injury violence, height of fibular fracture line, presence of total dis-location, rate of posterior malleolus fracture, rate of posterior malleolus fixation, implant removal, or operation time ( P>0.05).Imaging exams were conducted for 38 patients at 6 or more months after surgery.The medial malleolus space was 3.7 mm and the distal tibiofibular space 4.5 mm for the 21 cases in the experimental group; the medial malleolus space was 3.4 mm and the distal tibiofibular space 4.4 mm for the 17 cases in the control group.The 3-year follow-up AOFAS scores of the experimental group and the control group were 98.3 and 94.6 respectively; VAS scores were 0.4 and 1.5; the 5-year follow-up AOFAS scores of the experimental group and the control group were 97.1 and 93.6 respectively,and VAS scores were 0.5 and 1.2 respectively.Logistic regression analysis of ordered multi-classification showed that the AOFAS and VAS scores at 3-year and 5-year follow-ups had no significant correlation with the deep DL rupture for the patients<45 years old( P>0.05).Patient age was correlated with the 5-year follow-up AOFAS scores ( P=0.021). Conclusion:In ankle fracture of PER type Ⅲ or Ⅳ treated with lateral malleolar and syndesmosis screw fixation, nonoperative treatment of the deep DL rupture may not influence the mid-term clinical efficacy for the patients less than 45 years old.

OBJECTIVETo analyze the relationship between metabolites of polycyclic aromatic hydrocarbons (PAHs) and serum uric acid levels in coke oven workers and to provide new clues to the pathogenic mechanism of PAHs.

METHODSA total of 1302 coke oven workers were divided into four groups, namely control group and low-, intermediate-, and high-dose exposure groups. The concentrations of ambient PAHs at each workplace were determined by high-performance liquid chromatography. The detailed information on the occupational history and health of workers was collected by questionnaire survey and physical examination, and so were their blood and urine samples. Serum uric acid and creatinine levels were measured using a Hitachi 7020 automatic biochemical analyzer. Ten urinary PAH metabolites were detected by gas chromatography-mass spectrometry.

RESULTSSerum uric acid levels were the highest in the high-dose exposure group, followed by the intermediate- and low-dose exposure groups, and were the lowest in the control group. There were significant correlations between serum uric acid levels and the quartiles of 1-hydroxynaphthalene and 1-hydroxyphenanthrene (P < 0.05). After adjustment for PAH metabolite-related relationship, only urinary 1-hydroxyphenanthrene was significantly correlated with serum uric acid levels (P = 0.001). After adjustment for confounding factors and using the 1st quartile of 1-hydroxyphenanthrene as a reference, the odds ratio for hyperuricemia in subjects with the 2nd, 3rd, and 4th quartiles of 1-hydroxyphenanthrene were 1.55, 1.57, and 2.35, respectively.

CONCLUSIONUrinary 1-hydroxyphenanthrene is associated with a dose-response increase in serum uric acid levels in coke oven workers, and exposure to phenanthrene in PAHs may be a risk factor for hyperuricemia.

Objective: To explore the molecular mechanism of docosahexaenoic acid (DHA) on regulating the phenotype switching of hypoxia-induced pulmonary arterial smooth muscle cells (PASMCs). Methods: The PASMCs were isolated from Sprague Dawley rats. PASMCs were divided into five groups: normal control group, hypoxia group (1%O₂, 94%N₂, 5% CO₂ stimulation for 12 hours), hypoxia+ DHA group (10 μmol/L DHA pretreatment followed by 12 hours hypoxia), hypoxia+ DHA+ NFATc1 overexpression group (transfection of the NFATc1 lentivirus for 24 hours, followed by hypoxia stimulation for 12 hours after 10 μmol/L DHA treatment), and hypoxia+ DHA+ siNFATc1 group (transfection the siNFATc1 for 24 hours, followed by hypoxia stimulation for 12 hours after 10 μmol/L DHA treatment). The hypoxia stimulation was achieved by use of a special hypoxia incubator (1%O₂, 94%N₂, 5%CO₂). The expressions of NFATc1 of various groups were determined by qRT-PCR and Western blot. The expression of α-SMA was determined by immunofluorescence staining, qRT-PCR and Western blot. The expression of SM22 was determined by qRT-PCR. The proliferation of PASMC was determined by EDU staining. Results: The mRNA and protein expression levels of NFATc1 were significantly upregulated in hypoxia group compared with the normal control group (P<0.05), while hypoxia-induced upregulation of NFTAc1 could be significantly downregulated by DHA treatment (P<0.05). The α-SMA positive cell number, protein and mRNA levels of α-SMA and the mRNA level of SM22 were significantly lower in the hypoxia group than in normal control group, which could be significantly reversed by DHA, the protective effects could then be abolished by NFATc1 overexpression. Above indices were significantly lower in the hypoxia+ DHA+ siNFATc1 group than in hypoxia+ DHA+ NFATc1 overexpression group (P<0.05). The proliferation of PASMCs was significantly higher in the hypoxia group than in the control group (P<0.05), and which could be significantly reduced by DHA (P<0.05), and the protective effect of DHA could be significantly abolished by overexpression of NFATc1 (P<0.05). The proliferation of PASMCs was significantly lower in the hypoxia+ DHA+ siNFATc1 group than in the hypoxia+ DHA+ overexpression NFATc1 group (P<0.05). Conclusion DHA could prevent hypoxia-induced PASMCs phenotype switching and proliferation by inhibiting NFATc1 signaling.

OBJECTIVE: To explore the genetic basis and pregnancy outcome of fetuses with urinary system anomalies. METHODS: Ultrasonographic features, genetic testing and pregnancy outcomes of 337 fetuses with urinary system anomalies identified by prenatal ultrasonograhy were collected for analysis. RESULTS: Ultrasonographic features of the fetuses were mainly characterized by hydronephrosis or hydronephrosis, polycystic kidney disease, and renal dysplasia. Thirty four fetuses (10.1%) were found to harbor a genetic defect, including 14 numerical chromosomal disorders, 10 structural chromosomal aberrations, and 10 pathogenic copy number variations (CNVs). In 31 cases, the parents elected induced labor. For the 303 fetuses with negative findings, 142 were born by spontaneous delivery or Caesarean section, 48 cases underwent induced labor, 1 case had miscarriage, and the remaining 112 cases had unknown or missed pregnancy outcomes. CONCLUSION Hydronephrosis or hydronephrosis, polycystic kidney disease, and renal dysplasia are the most common findings among fetuses with urinary system anomalies. Approximately 10.1% of such fetuses are positive by genetic testing.
Cesarean Section ; Chromosome Aberrations ; DNA Copy Number Variations ; Female ; Fetus ; Genetic Testing ; Humans ; Pregnancy ; Pregnancy Outcome ; Prenatal Diagnosis ; Ultrasonography, Prenatal