Objective To explore the advantages of computer assisted total knee arthroplasty(TKA)by comparing the post-operative 1 year short term effect of the computer assisted TKA and the conventional TKA .Methods A total of 60 patients from September 2013 to September 2014 were randomly divided into two groups and performed TKA by adopting the computer-assisted technology and the conventional technology respectively .The KSS score ,WOMAC score ,Oxford score and long-leg weight-bearing X-ray before operation and at postoperative 1 year were performed for each case and the statistical analysis was conducted . Results All cases were followed up for an average of 12 months (12—14 months) .The mechanical limb axis in the navigation as-sisted group was —0 .033o± 1 .470o ,which in the traditional group was 0 .600o± 2 .989o(t= —1 .711 ,P<0 .05);the proportions of within 3o varus/valgus force lines were 86 .70% and 73 .30% respectively ,the KSS scores were 88 .80 ± 3 .71 and 82 .63 ± 4 .15;the postoperative WOMAC scores were 23 .57 ± 3 .64 and 30 .00 ± 4 .89 respectively ;the Oxford scores were 18 .53 ± 3 .66 and 21 .83 ± 3 .99 ,the differences between the two groups were statistically significant (P<0 .005) .Conclusion TKA by computer navigation guidance can obtain more accurate lower limb force lines ,moreover the navigation group has more advantages in the clinical rehabili-tation effect .

Objective To detect the expression of the transcription factor CCAAT/enhancer-binding protein alpha (C/EBP-α) in the epidermis of psoriasis vulgaris lesions,and to investigate its correlation with abnormal keratinocyte proliferation and disease severity.Methods Biopsy specimens were obtained from the lesions of 30 patients with psoriasis vulgaris and normal skin of 30 healthy human controls.A two-step immunohistochemical procedure was performed to detect the expressions of C/EBP-αt and Ki-67 in these specimens,and Western blot to quantify the expression of C/EBP-α.The proliferation index of keratinocytes was calculated according to the expression intensity of Ki-67.Statistical analysis was carried out by using the SPSS 17.0 software,and Pearson correlation analysis was conducted to assess the relationship of C/EBP-α expression level with proliferation index of keratinocytes and psoriasis area and severity index (PASI) score.Results C/EBP-α was predominantly expressed in the cytoplasm of keratinocytes,while Ki-67 in the nuclei of keratinocytes.Compared with the normal skin,the psoriatic lesions showed a significantly lower expression of Ki-67 (t =7.82,P ＜ 0.05),but higher proliferation index of keratinocytes (t =4.54,P ＜ 0.05).The expression level of C/EBP-α was negatively correlated with the proliferation index of keratinocytes and PASI score in the patients (both P ＜ 0.05).Western blot also showed an obvious decrease in the expression of C/EBP-α in psoriatic lesions.Conclusions The expression of C/EBP-α is decreased in lesions of psoriasis vulgaris,which might be involved in the pathogenesis of psoriasis vulgaris.

BACKGROUND: Both therapeutic effects of stem cell transplantation and differentiation mechanism remain controversial;however, plentiful clinical studies have indicated that stem call transplantation might improve heart function.OBJECTIVE: To evaluate the efficacy of intracoronary autologous bone marrow mononuclear call transplantation for the treatment of chronic heart failure.DESIGN: Case analysis. PARTICIPANTS: A total of 80 patients with chronic heart failure who were selected from Henan People's Hospital from 2003 to 2008 were divided into two groups: autologous bone marrow mononuclear call transplantation group (n=48) and conventional drug therapy group (n=32). There were no significant differences in sex, age, accepting conventional drug therapy,echocardiogram before transplantation, plasma brain natriuretic peptide level, and myocardial perfusion imaging between the two goups (P>0.05).METHODS: A one-year following up before and after cell transplantation, conventional drug therapy was performed in the two groups. Based on conventional drug therapy, autologous bone marrow mononuclear call suspension (10 mL) was slowly poured into coronary artery, and the cell number was adjusted to (3.1±1.6)×10 8. MAIN OUTCOME MEASURES: Changes of heart function were measured using ultrasound apparatus; plasma brain natriuretic peptide levels were detected using double antibodies immumofluorescence method; area of myocardial perfusion defect region was detected using single photon emission computed tomography.RESULTS: Patients in the two groups finished the one-year follow-up, and adverse effects and complications were not found before and after cell transplantation. ①Compared to before cell transplantation, end-systolic volume (ESV) of the left ventricle was significantly decreased in the autologous bone marrow mononuclear cell transplantation group after one year (P < 0.05), but ejection fraction (EF) of the left ventricle was significantly increased (P < 0.05). However, both ESV and EF were not changed in the conventional drug therapy group (P> 0.05). Compared to conventional drug therapy group, ESV and EF were changed significantly in the autologous bone marrow mononuclear call transplantation group after one year (P < 0.05). ②Compared to before cell transplantation, plasma brain natriuretic peptide levels were significantly decreased in the two groups (P < 0.05 or 0.01). Area of myocardial perfusion defect region was significantly decreased (P < 0.05 or 0.01), and the area change in the autologous bone marrow mononuclear call transplantation group was significantly greater than conventional drug therapy group (P < 0.05).CONCLUSION: Autologous bone marrow mononucleer call transplantation is safe and feasible for the treatment of chronic heart failure, and it also can remarkably improve heart function and myocardial perfusion within one year.

Objective:To clarify the evidences of hippocampal injury after radiotherapy avoiding hippocampus and explore its relationships with cognition.Methods:A prospective design was adopted in this study.A total of 183 patients with nasopharyngeal carcinoma treated by intensity modulated radiation therapy (IMRT group) and 30 matched healthy control (HC group)were collected in the Affiliated Hospital of Jiangsu University and Southeast University Affiliated Zhongda Hospital from January 2017 to December 2019. All subjects were assessed by Montreal Cognitive Assessment (MoCA-B) at baseline and 6 months after radiotherapy, then the patients with nasopharyngeal carcinoma were divided into cognitive impairment group and non-cognitive impairment group. Subjects were scanned with Siemens 3.0 T MR, and T 1WI was used as analysis sequence.The individual standardized hippocampus ROIs were extracted based on Montreal Neurological Institute(MNI) brain template.All texture features were calculated using the Radiomics developed by C++and Delphi, and the intra group correlation coefficients (ICC), average direction, machine learning (random forest) and autocorrelation matrix were used for reducing the features dimension. One-way ANOVA and generalized linear models were used to compare the differences among different groups. Pearson correlations analyses were used to evaluate the relationships between important texture features and clinical data. Logistic regressions were used to calculate the abilities of texture features to predict cognitive impairment. Results:After 9 patients who lost follow-up were excluded, a total of 164 patients with nasopharyngeal carcinoma were included as IMRT group.Texture features of ROIs were extracted and dimensionally reduced successfully. Five differences features (Variance, Entropy, GlevNonU, RLNonUni and Contrast)were found among HC group, cognitive impairment group and non-cognitive impairment group, and the last three further showed significant differences within IMRT group (GlevNonU, P=0.011;RLNonUni, P<0.001;Contrast, P<0.001). Hippocampal doses were positively correlated with Variance ( r=0.448, P<0.05), and negatively correlated with Entropy ( r=-0.461, P<0.05). There was a positive correlation between MoCA-B scores with GlevNonU, RLNonUniand Contrast ( r=0.503, P<0.05; r=0.587, P<0.05; r=0.531, P<0.05). GlevNonU and Contrast were independent predictors of cognitive impairment in hippocampal avoidance of radiotherapy (OR=0.731, 95%CI 0.610-0.857; OR=0.651, 95%CI 0.496-0.853). Conclusion:Results of texture analysis could be used as micro imaging evidences of hippocampal injury in radiotherapy avoiding hippocampus, and could also effectively predict the occurrences of cognitive impairment.

Objective To investigate the compliance of secondary prevention and the relationship with the long-term outcomes in patients undergoing percutaneous coronary intervention(PCI).Methods 589 patients undergoing PCI were followed-up,and factors including major adverse cardiac events(MACE)),smoking status and the usage of antiplatelet agents,angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB),statins,beta blocker,calcium channel blocker and nitrates were recorded.Results The average follow-up time was 18.92 months.At discharge,588 patients(99.83%)were prescribed clopidogrel for(7.89±4.96)months;there were 31 patients(5.26%)who completely discontinued antiplatelet therapy during follow-up.At discharge,the prescription rate of aspirin,ACEI/ARB,beta blocker,statins,calcium channel blocker and nitrates was 98.98%,41.94%,63.50%,83.02%,19.69%and 46.52%respectively,whereas at follow-up,these were decreased to 94.4%,35.99%,55.86%,65.89%,17.49%and 35.31%.At follow-up,there were still 105 current smokers(17.83%).Complete cessation of antiplatelet therapy and current smoking were related to the increased risk of non-fatal myocardial infarct(9.68%v.s.1.08%,P＜0.01);smoking(4.76%v.s.0.83%,P＜0.01)andMACE(19.35%v.s.6.45%,P＜0.01);smoking(11.43%v.s.6.20%,P＜0.05).Conclusion Most patients can adhere to secondary prevention during follow-up,however,the compliance with secondary prevention should be improved further.Cessation of antiplatelet therapy and current smoking contribute to poor prognosis.

Objective:To establish an outpatient operation simulation model by using pediatric outpatient data of a third-level maternal and child health hospital in Shenzhen, then to explore and improve hospital management problems.Methods:The hospital information system was used to extract the parameters of the pediatric outpatient data, and the AnyLogic simulation model was used to compare the hospital operation data and simulation data. Through the ideal operation status of the model and the actual state data of the hospital, the problems that were easily overlooked and difficult to investigate were identified. Then the problems were confirmed through on-site tracking investigations, improve process execution, and reduce waiting and congestion.Results:The gap between simulation data and hospital operation data was reflected in the waiting links of the first visit, inspection project and report interpretation. The process transformation of these three links could be the key to improving the overall service capability.Conclusions:Simulation and field tracking are effective ways to explore process problems. The method that simulation model is used to realize the method path of "big data→simulation→site tracking→management analysis improvement" , is suitable for the application and research of hospital process problem discovery.

Parkinson's disease(PD)is a progressive neurodegenerative disorder that tends to occur in the elderly.Its clinical manifestations mainly include motor symptoms and non-motor symptoms, with sleep disorders among common non-motor symptoms of PD.The latest lines of evidence show that sleep disorders are not only clinical manifestations of neurodegenerative diseases, but also an important risk factor for the development and progression of neurodegenerative diseases.There is a bidirectional relationship between sleep disorders and neurodegenerative diseases, including PD.The possible mechanisms include accelerated α-synuclein pathology, deposition of Tau protein, inhibition of the glymphatic system, neuroinflammation and changes in the circadian rhythm system.In this article, we review research progress on the bidirectional relationship between sleep disorders and PD, related mechanisms, and the outlook on the treatment of PD through the management of sleep disorders.

Objective: To investigate the association of sleep quality, depressive symptoms and their interaction with non suicidal self injury (NSSI) among rural middle school students, so as to provide a reference for early prevention and control of NSSI among rural middle school students. Methods: A multi stage cluster sampling method was used to randomly select four rural middle schools in Xuzhou, Jiangsu Province. A total of 1 723 middle school students were investigated according to the principle of grade stratification and class random selection. Paper questionnaires (including demographic factors, Non Suicidal Self Injury Short Scale, Pittsburgh Sleep Quality Index, Patient Health Questionnare-9) were used to conduct the questionnaire survey. Logistic regression model was used to analyze the association of sleep quality, depressive symptoms and their interaction with NSSI among rural middle school students. Results: Totally 30.5% of middle school students had NSSI. Univariate results showed that girls (33.0%) had a higher incidence of NSSI than boys(27.3%), and those with sleep disorders and depressive symptoms had a higher incidence of NSSI, which was 46.8%, 43.6%. The results of multivariate Logistic regression showed that the risk of NSSI in students with sleep disorder was 1.80 times that in those without sleep disorder( OR 95%CI=1.42-2.28, P <0.01). The risk of NSSI in students with depressive symptoms was 3.32 times higher than that in those without depressive symptoms( OR 95%CI=2.60-4.24, P <0.01). The interaction results showed that there was additive interaction between sleep disturbance and depressive symptoms on the occurrence of NSSI behavior in rural middle school students, and the relative excess risk, attributable proportion and synergy index were 1.80, 0.30 and 1.57, respectively. Conclusion Sleep disorder and depressive symptoms are risk factors for NSSI among rural middle school students, and there is additive interaction between them.

Objective:To investigate the predictive values of serum fibroblast growth factor 22 (FGF22) levels and electrical P300 in depression patients occurred mild cognitive impairment (MCI).Methods:A prospective study was performed. A total of 94 depression patients without cognitive impairment admitted to our hospital from January 2020 to August 2021 were chosen. These patients were followed up for one year; Hamilton Depression Scale (HAMD)-24 items and Montreal Cognitive Assessment Scale (MoCA) were used to evaluate the neuropsychological function of the patients every 3 months; according to the occurrence of MCI, the patients were divided into depression with MCI group ( n=57), and depression without MCI group ( n=32). All patients underwent baseline P300 examination and baseline serum FGF22 levels were detected by enzyme-linked immunosorbent assay (ELISA), and the differences in clinical data, P300 examination results and serum FGF22 levels were compared between the two groups. Correlation analysis was performed to analyze the correlations of P300 latency and serum FGF22 level with MoCA scores. Multivariate Logistic regression analysis was used to screen the independent influence factors for MCI in patients with depression. The predictive value of P300 latency and serum FGF22 level in MCI in patients with depression was analyzed by receiver operating characteristic (ROC) curve. Results:As compared with the depression without MCI group, patients in the depression with MCI group had significantly lower years of education and serum FGF22 level, and significantly higher proportion of patients living alone, and statistically higher P300 latency ( P<0.05). The results of correlation analysis showed that the MoCA scores at MCI period were positively correlated with serum FGF22 level ( r=0.665, P<0.001) and negatively correlated with P300 latency ( r=-0.621, P<0.001) in patients from the depression with MCI group. Multivariate Logistic regression analysis showed that serum FGF22 level was a protective factor for MCI in patients with depression ( OR=0.805, 95%CI: 0.737-0.862, P=0.003), and P300 latency was a risk factor for MCI in patients with depression ( OR=1.136, 95%CI: 1.115-1.163, P=0.001). ROC curve analysis showed that the areas under the curve (AUC) of serum FGF22 level, P300 latency, serum FGF22 level combined with P300 latency in predicting MCI in depression patients were 0.779, 0.724, and 0.852, respectively. Conclusion:The abnormal serum FGF22 level and P300 latency are closely related to the occurrence of MCI in patients with depression, and the combination of the two can be used to predict the occurrence of MCI in patients with depression.

Objective:To explore the value of dilated Virchow-Robin spaces (dVRS) in the basal ganglia in predicting basal ganglia atrophy.Methods:A total of 120 patients accepted head MRI and conformed as having dVRS in the basal ganglia in our hospital from May 1, 2015 to April 30, 2016 were chosen in our study; these patients were followed up for 5 years. The basal ganglia volume was observed by 3.0T MRI; according to whether the basal ganglia had atrophy or not, these patients were divided into normal group ( n=82) and atrophy group ( n=38). The general data and dVRS grading between the normal group and the atrophy group were compared. The basal ganglia volume at baseline and 5 years later in patients with different dVRS grading and the difference value of basal ganglia volume at baseline and 5 years later (△basal ganglia volume) were recorded for comparative analysis. Spearman analysis was used to evaluate the correlation between △ basal ganglia volume and dVRS grading. Independent influencing factors for basal ganglia atrophy were analyzed by Logistics regression; receiver operating characteristic (ROC) curve was drawn to evaluate the predictive values of independent influencing factors and their combination in basal ganglia atrophy. Results:Patients in the atrophy group had significantly older age, significantly higher percentage of patients with diabetes history, and significantly higher dVRS grading in the basal ganglia than those in the normal group ( P<0.05). There were significant differences in basal ganglia volume and △ basal ganglia volume at baseline and 5 years later among patients with different dVRS grading ( P<0.05); △ basal ganglia volume gradually increased with the increase of dVRS grading. Correlation analysis showed that △ basal ganglia volume was positively correlated with dVRS grading in basal ganglia ( r s=0.695, P<0.001); after adjusting for age and history of diabetes, the correlation was still positive ( r s=0.667, P<0.001). Logistics regression showed that age ( OR=1.776, 95%CI: 1.372-2.141, P=0.008), diabetes history ( OR=1.513, 95%CI: 1.129-1.954, P=0.011) and dVRS grading in the basal ganglia ( OR=2.855, 95%CI: 2.367-3.283, P=0.006) were independent influencing factors for basal ganglia atrophy. The area under the ROC curve of dVRS grading for predicting the basal ganglia atrophy was 0.709 ( 95%CI: 0.611-0.792, P<0.001), with sensitivity of 61.89% and specificity of 83.59%; that of combined age, diabetes history and dVRS grading in the basal ganglia was 0.783 ( 95%CI: 0.687-0.878, P<0.001), with sensitivity of 73.68% and specificity of 85.19%. Conclusion:The dVRS in the basal ganglia has certain predictive value in basal ganglia atrophy after 5 years.