OBJECTIVES: To compare the application effect of microwave digestion - vacuum filtration - automated scanning electron microscopy (MD-VF-Auto SEM) method and plankton gene multiplex PCR system in the diagnosis of drowning. METHODS: Lung, liver and kidney tissue of 10 non-drowning cases and 50 drowning cases were prepared for further MD-VF-Auto SEM method analysis and plankton gene multiplex PCR system analysis. The positive detection rate of the two methods in each tissue was calculated. RESULTS: The positive rate of the MD-VF-Auto SEM method detecting diatoms in drowning cases was 100%, and few diatoms were detected in the liver and kidney tissues of 6 non-drowning cases. By using the plankton gene multiplex PCR system, the diatom positive rate of drowning cases was 84%, and all the non-drowning cases were negative. There were significant differences in the positive rate of the liver, kidney tissues between MD-VF-Auto SEM method and plankton gene multiplex PCR system (P<0.05), as well as the total positive rate of cases. However, no significant differences were found in the positive rates of lung tissues (P>0.05). CONCLUSIONS MD-VF-Auto SEM method is more sensitive than plankton gene multiplex PCR system in diatom test. But the plankton gene multiplex PCR system can also detect plankton other than diatoms. Combination of the two methods can provide a more reliable basis for the diagnosis of drowning.
Diatoms/genetics* ; Drowning/diagnosis* ; Humans ; Liver ; Lung ; Microscopy, Electron, Scanning ; Multiplex Polymerase Chain Reaction ; Plankton/genetics*

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has raised concern around the world as an epidemic or pandemic. As data on COVID-19 has grown, it has become clear that older adults have a disproportionately high rate of death from COVID-19. This study describes the early clinical characteristics of COVID-19 in patients with more than 80 years of age. METHODS: Epidemiological, clinical, laboratory, radiological, and treatment data from 17 patients diagnosed with COVID-19 between January 20 and February 20, 2020 were collected and analyzed retrospectively. Treatment outcomes among subgroups of patients with non-severe and severe symptoms of COVID-19 were compared. RESULTS: Of the 17 hospitalized patients with COVID-19, the median age was 88.0 years (interquartile range, 86.6-90.0 years; range, 80.0-100.0 years) and 12 (70.6%) were men. The age distribution of patients was not significantly different between non-severe group and severe group. All patients had chronic pre-existing conditions. Hypertension and cardiovascular diseases were the most common chronic conditions in both subgroups. The most common symptoms at the onset of COVID-19 were fever (n = 13; 76.5%), fatigue (n = 11; 64.7%), and cough (n = 5; 29.4%). Lymphopenia was observed in all patients, and lymphopenia was significantly more severe in the severe group than that in non-severe group (0.4 × 10/L vs 1.2 × 10/L, P = 0.014). The level of serum creatinine was higher in the severe group than in the non-severe group (99.0 μmol/L vs 62.5 μmol/L, P = 0.038). The most common features of chest computed tomography images were nodular foci in 10 (58.8%) patients and pleural thickening in 7 (41.2%) patients. All patients received antiviral therapy, while some patients also received intravenous antibiotics therapy (76.5%), Chinese medicinal preparation therapy (Lianhuaqingwen capsule, 64.7%), corticosteroids (35.3%) or immunoglobin (29.4%). Eight patients (47.1%) were transferred to the intensive care unit because of complications. Ten patients (58.8%) received intranasal oxygen, while 3 (17.6%) received non-invasive mechanical ventilation, and 4 (23.5%) received high-flow oxygen. As of June 20, 7 (41.2%) patients had been discharged and 10 (58.8% of this cohort, 77.8% of severe patients) had died. CONCLUSION The mortality of patients aged 80 years and older with severe COVID-19 symptoms was high. Lymphopenia was a characteristic laboratory result in these patients, and the severity of lymphopenia was indicative of the severity of COVID-19. However, the majority of patients with COVID-19 in this age cohort had atypical symptoms, and early diagnosis depends on prompt use of a viral nucleic acid test.
Age Factors ; Aged, 80 and over ; Antiviral Agents ; therapeutic use ; China ; epidemiology ; Clinical Laboratory Techniques ; Coronavirus Infections ; diagnosis ; epidemiology ; pathology ; Female ; Humans ; Lung ; diagnostic imaging ; pathology ; Male ; Pandemics ; Pneumonia, Viral ; diagnosis ; epidemiology ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To evaluate the association between rotator cuff tear and the proximal migration of humeral head. METHODS: In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI. RESULTS: In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071). CONCLUSION UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.
Humans ; Humeral Head ; Magnetic Resonance Imaging ; Retrospective Studies ; Rotator Cuff ; Rotator Cuff Injuries ; Shoulder Joint

BACKGROUND: Acetabulum anterior column shape is complex, and closed to femoral artery, and femoral nerve. Fixed screws easily went into the acetabulum. Currently, there was less data on quantitative anatomy data of pelvic acetabulum fracture with anterior column plate internal fixation. OBJECTIVE: To compare the pelvis gender differences by analyzing digital anatomical features of normal adult acetabulum anterior column section through digital three-dimensional reconstruction and measurement. METHODS: Totally 30 normal adults (half male and half female) received pelvic CT scans, and data were obtained. Using Materialise Mimics Innovation Suite 16.0 software, the boundary of the pelvis was used as reference line for sectioning. The obturator groove, iliopubic eminence, anterior inferior iliac spine, and the anterior superior iliac spine were used as a reference mark. In 15 males and 15 females (30 sides), the corresponding boundary line from obturator groove to the anterior superior iliac spine of acetabular anterior column was sliced into 5 mm-thick sections. The tangent line was vertical to the boundary line. The tangent plane was vertical to the upper plane of the anterior column. The angle and length of each section 5, 10, 15 mm points from the boundary line to the acetabulum, and the perpendicular distance from anterior and posterior edges of the acetabulum to anterior inferior iliac spine, iliopubic eminence and the pubic tubercle. RESULTS AND CONCLUSION: (1) Acetabular anterior column from the obturator groove to the anterior superior iliac spine section was not significantly different (P > 0.05). (2) No matter in males or females, the tangent angle of the fifth layer section was minimum, and the tangent length of the sixth layer section was longest. The length and angle of the second slice at 5 mm point were not significantly different between males and females. However, above indexes in others were significantly larger in females than in males (P < 0.05). (3) Results indicated that in different fracture ranges and different fixation plate positions, the angle and length of pedicle screws are dynamic, so we only selected in accordance with above range, but cannot fix in a certain value. The design of the most accurate and effective placement angle and length should be aimed at nailing design parameters for each individual patient. The use of Mimics software can be used for three-dimensional reconstruction of CT data of adult acetabular anterior column fracture, and can measure the number of indexes, and provide a theoretical reference for the clinical diagnosis and treatment of acetabular anterior column fracture.

OBJECTIVE: To observe the impact of energy saving light,incandescent light and circadian light on the ethology of depressive rats and explore its possible mechanism on affecting the secretion of melatonin. METHODS: Thirty rats aged 6weeks were randomly selected from 40 specific pathogen free health female SD rats after they adapted to the living environment,depressive rat models were established in the rats by bilateral ovariectomy combined with isolated living and chronic unpredictable mild stress stimulation at the age of 11-14 weeks. Then these 30 ovariectomized rats were randomly divided into 3 intervention groups,including an energy saving light group,an incandescent light group and a circadian light group,with 10 rats in each group. The rats in these 3 groups were given specific experimental light intervention for 3 weeks respectively at the age of 17 weeks. The other 10 rats were raised in conventional environment as the control group. Their body weights were measured at the age of 17,19,20 and 21 weeks. The ethology tests were carried out by sucrose preference test and the open-field test at the age of 7,14 and 20 weeks respectively. The melatonin levels in peripheral blood of 7 time points from 19: 30 to 8: 30 were measured in the rats at age of 21 weeks. One rat in each group at every time point was randomly selected for examination. RESULTS: At the age of 17 weeks before light-intervention,the body weights of rats in 4 groups showed no significant difference( P > 0. 05). After light-intervention,at the age of 17-20 weeks,the body weights of rats in 3 intervention groups were gradually increased with the increase of age( P < 0. 05).There was no significant difference between body weights of rats at the age of 21 weeks and those at the age of 20 weeks in each group( P > 0. 05). At age of 7 weeks,no significant differences were found in sucrose consumption and standing scores among these 4 groups( P > 0. 05). After the depressive models were established,at the age of 14 weeks before light-intervention,in rats of these 3 intervention groups,the sucrose consumption and standing scores were lower than those of the control group( P < 0. 05),and there was no significant difference found in the above 2 indexes among these 3intervention groups( P > 0. 05). At the age of 20 weeks after light-intervention,the sucrose consumption and standing scores were not significantly different from each other among the 4 groups( P > 0. 05). The peak levels of melatonin in the peripheral blood of rats in these 3 intervention groups were higher than that in the control group. The peak levels onsets of melatonin in peripheral blood of rats in the circadian light group and the energy saving light group were earlier or 2 hours delayed compared to that of control group,while it was similar between the incandescent light group and control group.CONCLUSION: The circadian light,the energy saving light and the incandescent light are similarly effective in improving the behaviors of depressive rats. The circadian light can delay the onset of peak level of melatonin in peripheral blood.

OBJECTIVE: To explore the effect of~(56)Fe~(17+)heavy ion on the expression of phosphorylated histone H2AX( γH2AX) of human lymphccytes. METHODS: The Epstein-Barr virus transformed human B lymphocyte cell lines( PengEBV) were selected and exposed to~(56)Fe~(17+)heavy ion at irradiation dose of 0. 0( control group),0. 1,0. 3,0. 5,0. 7,1. 0 and 2. 0 Gy,respectively,with the dosing rate of 0. 23-0. 55 Gy / min. Flow-cytometry was used to detect the changes of expression of γH2AX at time points of 0,2,4,8,48 and 72 hours after irradiation. RESULTS: The expression of γH2AX showed interaction existed between radiation dose and the treatment time after radiation( P < 0. 01). Compared with the control at the same time points,the expression of γH2AX increased at the dose of 0. 3-2. 0 Gy and the time points of 2-72hours( P < 0. 05). The expression of γH2AX at the dose of 0. 3-2. 0 Gy and time points of 8-72 hours was lower than those at the same dose and time points of 2 and 4 hours( P < 0. 05). When the dose was at 0. 5,1. 0 or 2. 0 Gy,the expression of γH2AX decreased with the increasing time of exposure in 72 hours( P < 0. 05). At the dose of 0. 0-1. 0 Gy and the time points of 2-4 hours,the expression of γH2AX increased with the increasing dose of irradiation( P < 0. 01). CONCLUSION: The expression of γH2AX in Peng-EBV cells shows a dose-response relationship within 2-4 hours after 0. 0-1. 0 Gy irradiation of~(56)Fe~(17+).

OBJECTIVETo evaluate the ASES, Constant and HSS score systems and their significance on postoperative function of the shoulder.

METHODSTotally 172 cases of proximal humeral fracture of five affiliated hospital from September 2004 to September 2008 were analyzed. All the functional outcome of the involved shoulder were evaluated by ASES, Constant, HSS score and patient self score. The correlations and agreement of three shoulder scales were analyzed with Pearson correlation test and Bland-Altman plot in different age groups and fracture types.

RESULTS(1) The Constant score were lower than other two scores in the same age group and fracture type (F = 13.62 and 4.80, P < 0.05). (2) The correlations between three shoulder scales: ASES and Constant (r = 0.754, P = 0.0003), ASES and HSS (r = 0.755, P = 0.0001), Constant and HSS (r = 0.858, P = 0.0002). The correlations between three shoulder scales and patient self evaluation: ASES (r = 0.602, P = 0.0002), Constant (r = 0.705, P = 0.0001), HSS (r = 0.663, P = 0.0037). The Bland-Altman plot shows three shoulder scales have good agreement. (3)The correlation between Constant score and patient self evaluation decreased in the elder group and severe fracture type.

CONCLUSIONSASES, Constant, HSS shoulder score systems are all fit to evaluate the functional outcome of the shoulder, they have good correlation and agreement. Constant score in recommended for its high correlation coefficient with patient self evaluation score. However, its age bias must be paid attention in clinical practice. ASES shoulder score can be used in remote follow-up.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Shoulder Fractures ; physiopathology ; surgery ; Shoulder Joint ; physiopathology ; Trauma Severity Indices ; Young Adult

BACKGROUNDFor some specific comminuted unstable intra-articular fracture, the plaster cast can not maintain the alignment of the articular surface effectively. The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.

METHODSFrom January 2002 to March 2010, 539 cases of distal radius fracture were treated with open reduction and internal fixation, including 184 males and 355 females aging 21 - 72 years (mean 57 years). Fractures were caused by falling to the ground in 459 cases, by traffic accident in 62 cases and by athletic injuries in 18 cases. Of 539 cases, there were 523 cases of closed fracture and 16 cases of open fracture. According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification, there were 14 cases of A2 type, 22 of A3 type, 18 of B1 type, 24 of B2 type, 62 of B3 type, 91 of C1 type, 162 of C2 type and 146 of C3 type. The time from injury to operation was 1 - 16 days (mean 5 days). All patitents received open reduction and internal plate screw fixation. Forty-seven patients with bone defect were given 6 - 15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.

RESULTSAll incisions healed by first intention after operation. Patients were followed up for 15 to 32 months postoperatively (mean 22 months). The fractures healed within 10 - 18 weeks after operation (mean 12 weeks). During the last follow-up, the mean palmar tilt was (7.0 ± 0.9)° and the mean ulnar variance was (21.0 ± 4.2)°, showing significant difference when compared with preoperation ((-5.0 ± 1.2)° and (8.0 ± 3.8)°). The radial heights were not abbreviated. According to Gartland and Werley assessment system, the results were excellent in 314 cases, good in 163 cases, fair in 46 cases, and poor in 16 cases 12 weeks after operation, the excellent and good rate was 88.5%.

CONCLUSIONSThe clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory. Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.

Adult ; Aged ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVESTo investigate the clinical features of femoral neck fractures and analyze related causes.

METHODSThe clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed.

RESULTSA total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites.

CONCLUSIONSThe incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Femoral Neck Fractures ; diagnosis ; diagnostic imaging ; epidemiology ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate prospectively the effectiveness of kyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/lumbar vertebrae and correction of the deformity.

METHODSTwenty-five patients with thoracic/ lumbar vertebral osteoporotic compression fracture were admitted to our hospital between March 2007 and March 2008, and treated by kyphoplasty with SKY bone expander system. Patient's pain status was rated with Visual Analogue Scale (VAS) score system 1 day before and 1 hour, 48 hours, 6 months, 12 months after surgery. In addition, Rolland-Morris and Oswestry disability questionnaires (RDQ and ODI) were used for survey 1 day before and 1, 6, 12 months after surgery. Pre- and post-operative vertebral heights and Cobb's angles were measured based on the X-ray films and statistically analyzed.

RESULTSThere were 27 fractured vertebrae in these 25 patients. After SKY kyphoplasty, the Cobb's angles (9.8 degree ± 9.76 degree) were significantly reduced compared with preoperative angles (17.18 degree ± 9.35 degree P < 0.05), and the average improvement rate was 39%. Patients'pain VAS scores were also greatly improved after operation (P < 0.05). Moreover, postoperative RDQ and ODI scores were significantly smaller than preoperative values (P < 0.05).

CONCLUSIONSKyphoplasty with SKY bone expander system provides an effective method for treating thoracic/ lumbar vertebral osteoporotic compression fracture, with the advantages of small surgical wound and short duration. It can effectively recover the anterior and medial heights of fractured vertebrae (33% and 50%, respectively), reduce the Cobb's angle, quickly alleviate pain and improve patients'quality of life in a relatively short time period.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Lumbar Vertebrae ; injuries ; Male ; Osteoporotic Fractures ; surgery ; Thoracic Vertebrae ; injuries ; Tissue Expansion Devices