Objective To analyze the risk factors of pulmonary non-tuberculous mycobacterial (NTM) infection in sputum acid-fast bacilli positive and/or mycobacteria culture positive patients.Methods One hundred and sixty-three patients with pulmonary NTM infection were recruited from Jan 2006 to Jun 2011 in Shanghai Pulmonary Hospital and 326 patients with sputum positive pulmonary tuberculosis who were selected by random systemic sampling method in the same period were recruited as control.The data were retrospectively analyzed.The related factors were compared between groups by chi-square test.The risk factors of pulmonary NTM infection were analyzed by binary Logistic regression model.Results There were statistically significant differences of age,history of smoking,chronic obstructive pulmonary disease (COPD),bronchiectasis,thin walled cavities focus,purified protein derivative (PPD) test between patients with pulmonary NTM infection and patients with pulmonary tuberculosis (all P＜0.05).Univariate analysis showed that age [45-60year (OR=2.637,95％CI:1.631-4.264; P＜0.001); ＞60 year (OR=4.194,95％CI:2.581-6,813 ; P＜0.001)],history of smoking [10-20 year (OR=1.842,95％CI:1.0843.070; P=0.024),＞20 year (OR=2.040,95％CI:1.167-3.567; P=0.012)],COPD (OR=2.698,95％CI:1.588-4.583; P＜0.001),bronchiectasis (OR=3.566,95％CI:2.343-5.427;P＜0.001),thin walled cavities focus (OR=2.592,95％CI:1.581-4.250; P＜0.001) and a weak-positive reaction of PPD test (OR=2.389,95％CI:1.276-4.472; P=0.006) were all risk factors of pulmonary NTM infection.Multivariate analysis showed that age＞60 year (OR=3.961,95％CI:2.183-7.189 ; P＜0.001),bronchiectasis (OR =3.880,95 ％ CI:2.342-6.487 ; P＜0.001),thin walled cavities focus (OR=2.898,95％CI:1.567-5.360; P＜0.001),COPD (OR=2.503,95％ CI:1.289-4.857; P=0.007),age45-60 year (OR=2.452,95％CI:1.391 4.325; P=0.002)anda weak-positive reaction of PPD test (OR=2.295,95％CI..1.132-4.652; P=0.021) were independent risk factors of pulmonary NTM infection.Conclusion In sputum acid-fast bacilli positive and/or mycobacteria culture positive patients,age≥ 45 year,COPD,bronchiectasis,thin walled cavities focus and a weak-positive reaction of PPD test are risk factors of pulmonary NTM infection.The clinicians should pay close attention to the results of species identification.

ObjectiveTo investigate the anti-tuberculosis treatment response and outcomes in treatment naive patients infected with multidrug-resistant tuberculosis (MDR-TB).MethodsA total of 408 patients who were diagnosed with MDR-TB in Shanghai Pulmonary Hospital from January 2006 to January 2009 were recruited in this study.These patients were divided into two groups based on their previous treatment history:treatment naive group and re treatment group. The treatment response,outcomes andadverse eventswere observed. The outcomes of thesetwo groupswere compared by cohort analysis and x2 test.ResultsThe sputum conversion rates,the lesions absorption rate and the cavity closing or shrinking rate of the treatment naive MDR TB group were significantly higher than those of the re treatment group,while the adverse events rate was not significantly different between two groups (x2 =0.434,P＞0.05).Among 89 treatment naive cases,66 cases (74.16％) were cured,8(8.99％) completed the full treatment course,7(7.87％) were treatment failure,3(3.37％) died,and 5(5.62％) were lost to follow-up.Among the 319 cases of re-treatment MDR TB group,134 (42.01％) were cured,31(9.72％) completed the full treatment course,116 (36.36％) were treatment failure,12(3.76％) died,26(8.15％) were lost to follow-up.The cure rate of the treatment naive MDR-TB group was significantly higher than that of re-treatment group (x2=28.783,P＜0.01).The factors influencing the treatment outcomes included the stage of the disease,the range of lesions and cavity, the patients'generalnutritional status, underlying complications,and the drug-resistant strains. Conclusions The anti-tuberculosis treatment outcomes are better in treatment naive patients with MDR-TB infection compared to the treatment experienced and retreated patients.Therefore,the status of the drug resistance should be closely monitored in order to detect MDR-TB as early as possible.With the early diagnosis,the treatmcnt regimen may be modified timely and as a result the treatment outcomes can be improved.

Objective To investigte the inhibit effects of drug combination of Kanglaite injection(KLT) and TXT on human pulmonary epithelial cells(95D) in vitro,and to find the best time of combination.Method 95D cell growth inhibition was measured with MTT assay.Results Various concentration of KLT and TXT could inhibit the proliferation of 95D cell,and KLT could enchance the sensiti vity of 95D cell to TXT(P

Objective: To explore the clinical value of plasma copeptin level on major adverse cardiovascular event (MACE) occurrence in patients with acute ST-segment elevation myocardial infarction (STEMI) during hospitalization.
Methods: Our research included 2 groups:STEMI group, n=80 and Control group, n=80 patients with stable coronary artery disease (CAD). All patients were treated in our hospital from 2012-06 to 2014-06. Plasma level of copeptin was detected by ELISA, other relevant examinations were conducted to study the MACE occurrence in STEMI patients.
Results: Plasma copeptin level in STEMI group (523.26 ± 142.69) pg/ml was higher than that in Control group (345.25 ± 89.36) pg/ml, P<0.05. In STEMI group, there were 28/80 (35%) patients suffered from MACE, compared with non-MACE patients, they had increased plasma copeptin, cardiac muscle protein I (cTnI), kinase isoenzyme (CK-MB) and left ventricular ejection fraction (LVEF), P<0.05. Multivariate regression analysis indicated that plasma copeptin, cTnI and LVEF were the independent risk factors for MACE occurrence. According to occurred area under the curve, compared with cTnI and CK-MB, plasma copeptin level had the higher predictive value to judge the ROC, positive/negative possibility, sensitivity and speciifcity for MACE occurrence in STEAMI patients, P<0.05.
Conclusion: Plasma copeptin level could effectively predict MACE occurrence in patients with acute STEMI during
hospitalization, it may predict their prognosis at certain point.

Objective:To investigate the effect and mechanism of exosomes derived from human umbilical cord mesenchymal stem cells (hUC-MSC) in repair of tendon injury in rats.Methods:The hUC-MSC were cultured and the surface markers were identified by flow cytometry. The cells were induced to differentiate into osteoblasts, chondroblasts and adipocytes using a specific media. Meanwhile, the exosomes were isolated from the cell supernatant using exosome separation columns, and were identified by transmission electron microscopy, PKH67 staining and Western blot. A total of 40 Wistar rats were used to establish the Achilles tendon injury model by surgical resection. The rats were divided into hUC-MSC group (Group A) (with 100 μg exosome injected at the injured site) and control group (Group B) (with 250 μl normal saline injected at the injured site) according to the random number table, with 20 rats per group. The expressions of transforming growth factor β (TGF-β), bone morphogenetic protein (BMP-2), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF-2), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the tendon tissues of both groups were detected using q-PCR, Western blot and immunofluorescence assay at 4 weeks following injection. The expression of collagen III in the injured tissues of both groups was detected by immunohiestochemistry.Results:The isolated and cultured hUC-MSC presented fusiform under an inverted microscope. After osteogenic differentiation, the cells exhibited a cube nodular structure, and the Alizarin red staining was positive. After adipogenic differentiation, the fat was observed inside the cells, which was red by oil red O staining. After chondroblast differentiation, the cells secreted a large amount of glycosaminoglycans, and a strong positive was revealed by Alisin blue staining. The hUC-MSC-derived exosomes showed round disc shape with a depressed internal structure under a transmission electron microscope, which was verified via PKH67 staining. The Western blot analysis showed high expressions of motility-related protein-1 (CD9) and lysosomal associated membrane protein 3 (CD63). The q-PCR test revealed that the mRNA expressions of TGF-β (4.887±0.767), BMP-2 (3.079±0.150), VEGF (3.108±0.508) and FGF-2 (4.211±0.522) in Group A were markedly higher than those in Group B (1.000±0.062, 0.918±0.129, 1.004±0.103, 1.010±0.169, respectively) ( P<0.01), and that the mRNA expression of IL-1β (0.697±0.037) and TNF-α (0.793±0.021) in Group A was markedly lower than those in Group B (1.004±0.089 and 1.006±0.015, respectively) ( P<0.01). The Western blot analysis revealed that the protein expressions of TGF-β (1.434±0.041), BMP-2 (1.798±0.177), VEGF (1.552±0.113) and FGF-2 (1.357±0.039) in Group A were markedly higher than those in Group B (1.002±0.032, 0.992±0.068, 1.007±0.070, 0.994±0.051) ( P<0.01), and that the protein expressions of IL-1β (0.705±0.016) and TNF-α (0.840±0.045) in Group A was markedly lower than those in Group B (1.000±0.016, 1.003±0.040) ( P<0.01). The immunofluorescence revealed that the positive expression rates of TGF-β and VEGF in Group A were not significantly different from those in Group B ( P>0.05). However, the positive expression rates of BMP-2 (2.278±0.208) and FGF-2 (4.656±0.106) in Group A were markedly higher than those in Group B (0.315±0.101, 1.661±0.110) ( P<0.05 or 0.01), and the positive expression rates of IL-1β (1.677±0.947) and TNF-α (1.520±0.088) in Group A were greatly lower than those in Group B (4.296±0.291, 2.373±0.273, respectively) ( P<0.01). In Group A, the tendon collagen fibers were arranged regularly and tightly, with relatively significant expression of collagen III; while the tendon collagen fibers in Group B were distributed loosely, accompanying broken scarlike healing. Conclusion:The hUC-MSC-derived exosomes can prompt the repair of the injured tendon tissues, which may be associated with the function in up-regulating the expressions of growth factors including TGF-β, BMP-2, VEGF and FGF-2, enhancing the expression of collagen III and inhibiting the expression of the inflammatory cytokines including IL-1β and TNF-α.

Objective:To compare the clinical prognosis of modified and traditional knotless suture bridge technique in treatment of rotator cuff tear under shoulder arthroscopy.Methods:A retrospective case-control study was conducted to analyze 60 patients with rotator cuff tear admitted to Affiliated Hospital of Qingdao University from June 2018 to June 2019，including 19 males and 41 females，aged 32-74 years［（59.3±10.1）years］. There were 26 patients on the left side and 34 patients on the right side，with the body mass index（BMI）of 19.5-32.4 kg/m 2［（25.5±2.6）kg/m 2］，rotator cuff tear of 2.0-3.7 cm［（2.7±0.4）cm］and pain duration of 2-88 days［（26.2±17.1）days］. A total of 31 patients were repaired with a modified knotless suture bridge（modified group）and 29 patients with a traditional knotless suture bridge（traditional group）. Comparison was made between the two groups in aspects of range of motion of shoulder flexion，abduction and external rotation，visual analog scale（VAS），University of California Los Angeles（UCLA）should function score，Constant shoulder function score，retear and complications at postoperative 3 and 12 months. Results:All patients were followed up for 9-15 months［（12.0±1.8）months］. Three months after operation，the two groups showed no significant differences in shoulder range of motion of abduction，flexion，external rotation，UCLA shoulder function score or Constant shoulder function score（ P>0.05）；while VAS was（2.7±1.2）points in modified group，significantly lower than（3.4±1.2）points in traditional group（ P<0.05）. Twelve months after operation，the shoulder range of motion of abduction and flexion in modified group was（146.9±21.4）° and（150.4±16.2）°，significantly higher than that in traditional group［（130.7±27.4）°，（140.6±18.4）°］（ P<0.05）；There was no significant difference in external rotation activity between the two groups（ P>0.05）；VAS，UCLA shoulder function score and Constant shoulder function score［（1.2±0.5）points，（29.5±2.3）points，（80.4±5.4）points，respectively］in modified group were significantly higher than those in traditional group［（1.5±0.5）points，（27.2±2.7）points，（76.3±6.6）points，respectively］（ P<0.05）. Three months after operation，there was no significant difference in the classification of Sugaya between the two groups（ P>0.05）. Twelve months after operation，the classification of Sugaya was significantly different between the two groups（ P<0.05），with no retear in modified group but 3 patients with retear in traditional group. No postoperative complications occurred，such as non-healing，infection or persistent swelling. Conclusion:For patients with rotator cuff tear，the modified knotless suture bridge technique under shoulder arthroscopy has better range of motion and function，more obvious pain relief and a lower rate of retear than the traditional technique.

Objective:To compare the clinical efficacy between modified open wedge high tibial osteotomy (MOWHTO) versus traditional open wedge high tibial osteotomy (TOWHTO) for varus knee osteoarthritis (KOA).Methods:A retrospective study was conducted to analyze the 50 patients (60 knees) with varus KOA who had received high tibial osteotomy at Department of Sports Medicine, The Affiliated Hospital of Qingdao University between September 2019 and December 2020. The patients were divided into 2 groups according to different ways of osteotomy: a traditional group and a modified group. In the traditional group subjected to TOWHTO, there were 25 cases (30 knees); in the modified group subjected to MOWHTO, there were 25 cases (30 knees). In MOWHTO, the bone block attached to the medial collateral ligament (MCL) of the knee was first chiseled at the MCL insertion before osteotomy to reduce excessive stripping of the MCL in the osteotomy area, and then the bone fragment attached to the MCL was filled into the osteotomy area to increase bone filling and bone coverage after the alignment of the lower limb was corrected. The hip-knee-ankle angle (HKAA), medioproximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured preoperatively and at 18 months postoperatively in both groups to evaluate correction of the alignment of the lower limb. Fracture healing time, bone loss in the osteotomy area, Hospital for Special Surgery (HSS) knee score and visual analogue scale (VAS) were recorded to evaluate the postoperative efficacy.Results:There was no statistically significant difference between the TOWHTO and MOWHTO groups in the general clinical data before operation, showing comparability ( P>0.05). At 18 months after operation, HKAA was (179.1° ± 1.1°) in the TOWHTO group and (179.3° ± 0.7°) in the MOWHTO group while MPTA was (91.9° ± 0.4°) in the TOWHTO group and (91.9° ± 0.4°) in the MOWHTO group, showing no statistically significant difference between the 2 groups ( P>0.05) but a significant difference between preoperation and postoperation in each group ( P<0.05). At 18 months after operation, JLCA was (1.8° ± 0.4°) in the TOWHTO group, significantly larger than that in the MOWHTO group (1.5° ± 0.4°), HSS score was 81.5 (79.5, 83.0) points in the TOWHTO group, significantly lower than that in the MOWHTO group [85.0 (82.5, 87.5) points], and VAS was 1.8 (1.6, 2.0) points in the TOWHTO group, significantly higher than that in the MOWHTO group [1.5 (1.5, 2.0) points] (all P<0.05). At 18 months after operation, the preoperative JLCA was significantly improved in both groups ( P<0.05). The time required for a fracture healing score higher than 4 points was (3.3 ± 0.6) months in the TOWHTO group and (4.5 ± 0.9) months in the MOWHTO group, and the rate of bone loss in the osteotomy area was 20% in the TOWHTO group (6/30) and 0 (0/30) in the MOWHTO group, both showing a significant difference between the 2 groups ( P<0.05). Conclusions:Both TOWHTO and MOWHTO can effectively treat varus KOA. MOWHTO is more effective in promoting bone healing in the osteotomy area, reducing bone defects in the osteotomy area and improving knee function.

Objective:To evaluate a new imaging sign, named" bilateral water sign" (BWS), which can evaluate the neurovascular compression of primary trigeminal neuralgia (TN).Methods:A prospective study was conducted on 85 primary TN patients admitted to our hospital from March 2017 to March 2019. All patients accepted magnetic resonance 3D-T2W-DRIVEN sequence examination and multiplanar reconstruction (MPR) for post-processing. The sequential nerve (low signal)-cerebrospinal fluid (high signal)-vessel (low signal)-cerebrospinal fluid (high signal)-nerve (low signal) signs on the recombination plane were named as "BWS". The sensitivity, specificity, positive predictive value and negative predictive value of BWS in evaluating the neurovascular compression were calculated respectively, by combining with intraoperative situation of microvascular decompression (MVD).Results:In 85 TN patients, 46 patients (54.12%) had BWS. The sensitivity was 57.14%, the specificity was 75.00%, the positive predictive value was 95.65% and the negative predictive value was 15.38%. There was a statistically significant difference in the degree of neurovascular compression between patients with and without BWS ( P<0.05); and degree of neurovascular compression was severer in patients with BWS. Conclusion:BWS can evaluate the relation of neurovascular compression in TN patients and suggest the degree of neurovascular compression.