BACKGROUND:Periprosthetic fracture of the femoral of the knee after total knee arthroplasty is one of the common complications,and there is a lack of biomechanical research on the periprosthetic fractures of the femoral of the knee under different bone strength conditions.The three-dimensional finite element analysis can provide a biomechanical basis for clinical practice. OBJECTIVE:To investigate the biomechanical changes of anterior femoral notching after total knee arthroplasty under different bone strengths,and to provide a mechanical basis for the clinical prevention of supracondylar femoral periprosthetic fractures after knee arthroplasty. METHODS:The femoral CT data of healthy adults were obtained,and the three-dimensional model of femoral lateral replacement of the knee joint was established by Mimics,Geomagic studio,and Solidworks software.Anterior femoral notching models of different depths were constructed,and the models were imported into ANSYS software to analyze the changes of biological stress on the femoral condyle with different bone strengths and different anterior femoral notching depths.The stress changes of the femoral anterior condyle section after and before the filling of anterior femoral notching with bone cement were analyzed. RESULTS AND CONCLUSION:(1)Under any bone strength,the supracondylar stress increased with the depth of anterior femoral notching.In normal bone conditions,there was a stress abrupt change point when the anterior femoral notching depth was between 3 mm and 4 mm.In the case of osteoporosis,there was a stress abrupt point when the anterior femoral notching depth was between 2 mm and 3 mm.(2)When anterior femoral notching occurred during knee arthroplasty and the depth exceeded the thickness of the bone cortex,the supracondylar stress of the femoral gradually increased as the bone strength decreased.(3)The stress of the anterior femoral condyle section decreased when the model with an anterior femoral notching depth of 3 mm was filled with bone cement.(4)The results show that anterior femoral notching should be avoided during knee arthroplasty,especially in patients with osteoporosis.If anterior femoral notching occurs during surgery,bone cement can be used to evenly fill the anterior femoral notching to reduce the supracondylar stress of the femur and reduce the incidence of periprosthetic fractures of the femoral joint

ObjectiveTo investigate the effect of Yiqi Yangyin Jiedu Huayu prescription on minimal hepatic encephalopathy in liver cirrhosis based on intestinal metabolomics. MethodsA total of 11 patients with liver cirrhosis who were hospitalized in Beijing Ditan Hospital， Capital Medical University， from March to May 2024， and were diagnosed with MHE based on psychometric hepatic encephalopathy score were enrolled as subjects， and 11 healthy family members of the patients were enrolled as control group. Fecal samples were collected for metabolomics analysis from the control group and the patients with MHE before and after treatment with Yiqi Yangyin Jiedu Huayu prescription， and a population cohort study was conducted to investigate the effect of Yiqi Yangyin Jiedu Huayu prescription on intestinal metabolism of patients with MHE. The Fisher’s exact test was used for categorical data between two groups； the independent samples t-test was used for comparison of normally distributed continuous data between two groups， the paired t-test was used for comparision before and after treatment within the same group， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups. ResultsA total of 29 differentially expressed metabolites were detected between the MHE group and the control group， mainly amino acids， organic acids， organic amines， carbohydrates， fatty acids， and vitamins， and there were 12 upregulated metabolites and 17 downregulated metabolites in the MHE group， which were mainly enriched in the metabolic pathways of ornithine， branched-chain amino acid， and aromatic amino acid. After the treatment with Yiqi Yangyin Jiedu Huayu prescription， 80 differentially expressed metabolites were detected in the patients with MHE， mainly carbohydrates， organic acids， and amino acids， and there were 56 upregulated metabolites and 24 downregulated metabolites， which were mainly enriched in the metabolic pathways of ornithine， branched-chain amino acid， and aromatic amino acid. ConclusionYiqi Yangyin Jiedu Huayu prescription can exert a therapeutic effect on patients with MHE by regulating intestinal metabolism.

Objective To compare the efficacy of MRI-transrectal ultrasound(TRUS)software fusion-guided biopsy and cognitive fusion-guided biopsy for detecting prostate cancer(PC).Methods Data of 120 patients with suspected PC(127 lesions)who underwent transperineal prostate biopsy with 2-3 times of target biopsy(TB)and 10 times of system biopsy were retrospectively analyzed.According to TB guidance methods,73 cases(78 lesions)received MRI-TRUS software fusion-guided biopsy were classified into group A,and 47 cases(49 lesions)received cognitive fusion-guided biopsy were classified into group B.The positive rate of PC,clinic significant PC(csPC)and PC in different sized lesions by TB were compared between groups,and the positive rate of PC between 2 or 3 times TB was also compared within each group.Results The positive rate of PC and csPC detected by TB was 55.13%(43/78)and 39.74%(31/78)in group A,53.06%(26/49)and 34.69%(17/49)in group B,respectively,no significant difference was found(all P＞0.05).The positive rate of PC in lesions with the maximum diameter≤10 mm detected by TB in group A was higher than that in group B(P＜0.05),but no significant difference of lesions with the maximum diameter＞10 mm and＜15 mm nor≥15 mm was found between groups(all P＞0.05).No significant difference of positive rate of PC was found between 2 and 3 times TB in group A(P＞0.05),while positive rate of PC of 3 times TB was significantly higher than that of 2 times TB in group B(P＜0.05).Conclusion MRI-TRUS software fusion-guided biopsy had positive rate of PC and csPC similar to that of cognitive fusion-guided biopsy,but was helpful for reducing times of TB and increasing detecting rate for lesions with the maximum diameter≤10 mm.

Objective:To investigate the correlation between intraoperative red blood cell (RBC) transfusion and postoperative continuous renal replacement therapy (CRRT) in patients with acute type A aortic dissection (ATAAD).Methods:Clinical data of 302 patients undergoing emergency surgery for ATAAD in the Department of Cardiac Surgery at Beijing Anzhen Hospital from September 2015 to October 2020 were retrospectively analyzed. Among them, 238 were males with a nean age of(46.3±10.0) years old; 64 were females with a mean age of (52.0±11.7) years old. Patients were divided into the CRRT group and the non-CRRT group based on whether they received CRRT postoperatively. Logistic regression analysis was used to investigate the correlation between intraoperative RBC transfusion and postoperative CRRT. Results:Forty-two patients (13.9%) required CRRT postoperatively. Univariate logistic regression analysis showed that intraoperative RBC transfusion increased the risk of postoperative CRRT ( OR=2.499, 95% CI: 1.266-4.470, P=0.008). However, after adjusting for other variables, multivariate logistic regression analysis showed that the association was not statistically significant ( OR=1.777, 95% CI: 0.583-5.417, P=0.312). Conclusion:The increased risk of postoperative CRRT in ATAAD patients due to intraoperative RBC transfusion is caused by confounding factors, and they are actually not significantly correlated.

Objective:To investigate the correlation between intraoperative red blood cell (RBC) transfusion and postoperative continuous renal replacement therapy (CRRT) in patients with acute type A aortic dissection (ATAAD).Methods:Clinical data of 302 patients undergoing emergency surgery for ATAAD in the Department of Cardiac Surgery at Beijing Anzhen Hospital from September 2015 to October 2020 were retrospectively analyzed. Among them, 238 were males with a nean age of(46.3±10.0) years old; 64 were females with a mean age of (52.0±11.7) years old. Patients were divided into the CRRT group and the non-CRRT group based on whether they received CRRT postoperatively. Logistic regression analysis was used to investigate the correlation between intraoperative RBC transfusion and postoperative CRRT. Results:Forty-two patients (13.9%) required CRRT postoperatively. Univariate logistic regression analysis showed that intraoperative RBC transfusion increased the risk of postoperative CRRT ( OR=2.499, 95% CI: 1.266-4.470, P=0.008). However, after adjusting for other variables, multivariate logistic regression analysis showed that the association was not statistically significant ( OR=1.777, 95% CI: 0.583-5.417, P=0.312). Conclusion:The increased risk of postoperative CRRT in ATAAD patients due to intraoperative RBC transfusion is caused by confounding factors, and they are actually not significantly correlated.

Acute decompensated cirrhosis is a stage of end-stage liver disease during which patients often experience decompensated complications and rapid progression. Systemic inflammatory response is characterized by excessive secretion of inflammatory factors caused by bacterial infection of local tissue and rapid spread to the whole body, thereby affecting the physiological activities of the body and causing organ damage or disorder, and it is a relatively serious inflammatory state. This article elaborates on the occurrence of systemic inflammation, the factors affecting the severity of systemic inflammation, the manifestation of systemic inflammation in different stages of decompensated cirrhosis, and the role of systemic inflammation in complications, in order to gain a deeper understanding of systemic inflammation and apply it in the research and development of new therapies and drugs.

Objective:To analyze and evaluate the decrease of anticoagulant effect of warfarin by herbal and dietary supplements (HDS) based on case report literature.Methods:The case reports on decrease of anticoagulant effect of warfarin by HDS were selected by searching the relevant databases at home and abroad (up to June 24, 2023). The degree of decrease of anticoagulant effect of warfarin by HDS was evaluated according to the reduction degree of international normalized ratio and the occurrence of thrombotic events in patients in the case reports. The reliability scoring criteria of HDS-warfarin interaction was established according to the causality of the interaction between HDS and warfarin, the number of case reports, and the other evidences (warnings issued by relevant national institutions, clinical studies, pharmacokinetic/pharmacodynamic studies, animal studies, etc.). It was evaluated as highly, relatively, possibly, and suspiciously reliable if the total score was ≥9, 6-8, 3-5, and ≤2 points, respectively.Results:A total of 17 case reports were enrolled in the analysis, involving 25 patients and 11 kinds of HDS. Two kinds of HDS reduced the anticoagulant effect of warfarin severely, including ginseng ( Radix Ginseng)[(American ginseng ( Radix Panacis Quinquefolii), red ginseng, etc.] and Myrrh; 5 kinds of HDS reduced the anticoagulant effect of warfarin moderately, including St. John′s wort ( Hypericum perforatum L.), tea [green tea ( Camellia sinensis), black tea], peppermint ( Herba Menthae), coenzyme Q 10, and chitosan; 4 kinds of HDS reduced the anticoagulant effect of warfarin slightly, including milkvetch root ( Radix Astragali seu Hedysari), avocado, seaweed ( Sargassum), and soya ( Glycine max). The reliability of anticoagulant effect reduction of warfarin was evaluated as highly reliable in 1 kind of HDS, namely St. John′s wort (10 points), relatively reliable in 2 kinds of HDS, including ginseng and tea (8 and 6 points, respectively), possibly reliable in 7 kinds of HDS, including Myrrh, peppermint, coenzyme Q 10, chitosan, milkvetch root, avocado, and seaweed (5, 5, 5, 4, 4, 4, and 3 points, respectively), and suspiciously reliable in 1 kind of HDS, namely soya (2 points). Conclusion:The degree and reliability of anticoagulant effect reduction of warfarin by ginseng (American ginseng, red ginseng, etc.), St. John′s wort, and tea (green tea, black tea), are higher, which should be paid attention to by clinicians and clinical pharmacists.

Objective:To analyze and evaluate the decrease of anticoagulant effect of warfarin by herbal and dietary supplements (HDS) based on case report literature.Methods:The case reports on decrease of anticoagulant effect of warfarin by HDS were selected by searching the relevant databases at home and abroad (up to June 24, 2023). The degree of decrease of anticoagulant effect of warfarin by HDS was evaluated according to the reduction degree of international normalized ratio and the occurrence of thrombotic events in patients in the case reports. The reliability scoring criteria of HDS-warfarin interaction was established according to the causality of the interaction between HDS and warfarin, the number of case reports, and the other evidences (warnings issued by relevant national institutions, clinical studies, pharmacokinetic/pharmacodynamic studies, animal studies, etc.). It was evaluated as highly, relatively, possibly, and suspiciously reliable if the total score was ≥9, 6-8, 3-5, and ≤2 points, respectively.Results:A total of 17 case reports were enrolled in the analysis, involving 25 patients and 11 kinds of HDS. Two kinds of HDS reduced the anticoagulant effect of warfarin severely, including ginseng ( Radix Ginseng)[(American ginseng ( Radix Panacis Quinquefolii), red ginseng, etc.] and Myrrh; 5 kinds of HDS reduced the anticoagulant effect of warfarin moderately, including St. John′s wort ( Hypericum perforatum L.), tea [green tea ( Camellia sinensis), black tea], peppermint ( Herba Menthae), coenzyme Q 10, and chitosan; 4 kinds of HDS reduced the anticoagulant effect of warfarin slightly, including milkvetch root ( Radix Astragali seu Hedysari), avocado, seaweed ( Sargassum), and soya ( Glycine max). The reliability of anticoagulant effect reduction of warfarin was evaluated as highly reliable in 1 kind of HDS, namely St. John′s wort (10 points), relatively reliable in 2 kinds of HDS, including ginseng and tea (8 and 6 points, respectively), possibly reliable in 7 kinds of HDS, including Myrrh, peppermint, coenzyme Q 10, chitosan, milkvetch root, avocado, and seaweed (5, 5, 5, 4, 4, 4, and 3 points, respectively), and suspiciously reliable in 1 kind of HDS, namely soya (2 points). Conclusion:The degree and reliability of anticoagulant effect reduction of warfarin by ginseng (American ginseng, red ginseng, etc.), St. John′s wort, and tea (green tea, black tea), are higher, which should be paid attention to by clinicians and clinical pharmacists.

OBJECTIVE: To analyze the clinical and genetic characteristics of a 46,XX case of testicular disease with prostate germ cell tumor and explore its pathogenesis. METHODS: The clinical features and pathological examination of the patient were reviewed, and the genetic basis was analyzed by chromosome karyotyping analysis and fluorescence in situ hybridization. RESULTS: The patient had slightly short stature, small testicles and large breast. Serum alpha fetoprotein was significantly increased, along with increased follicle stimulating hormone, luteinizing hormone and prolactine, and lower level of testosterone. The karyotype was 46,XX. Fluorescence in situ hybridization has identified the presence of SRY gene at the end of short arm of one X chromosome. The pathological diagnosis was primary germ cell tumor of prostate, mainly of yolk sac tumor type. CONCLUSION A rare case of 46,XX testicular disorder of sex development combined with germ cell tumor of the prostate was diagnosed, which has enriched the phenotype spectrum of the disease and provided clues for the treatment of the disease.
Humans ; In Situ Hybridization, Fluorescence ; Male ; Neoplasms, Germ Cell and Embryonal/genetics* ; Prostate ; Sexual Development ; Testicular Diseases

Objective To investigate the effect of Liangxue Jiedu decoction on intestinal flora in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The patients who were hospitalized and diagnosed with HBV-ACLF in Beijing Ditan Hospital from October 2018 to October 2019 were enrolled, and healthy individuals were enrolled as HP group. High-throughput sequencing was used to screen for the differences in bacterial diversity and species between HBV-ACLF patients and healthy individuals, and differentially expressed bacteria between the two groups were screened out at the phylum and genus levels. With the help of in vitro simulated fermentation experiment, fecal samples were collected from the patients with HBV-ACLF and were then cultured in the medium containing different concentrations of Liangxue Jiedu decoction (0, 10%, 50%, and 100%) for 24 hours, and the changes in intestinal flora were analyzed and compared between the HBV-ACLF treatment group, the HBV-ACLF non-treatment group, and the HP group at the genus level. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. Results A total of 10 HBV-ACLF patients were enrolled, with 5 in the HBV-ACLF treatment group and 5 in the HBV-ACLF non-treatment group, and there were 15 individuals in the HP group. Compared with the HP group, the HBV-ACLF non-treatment group had significant reductions in the diversity and abundance of intestinal flora. At the phylum level, Bacteroidetes and Firmicutes were mainly observed in the samples of the HP group, while the HBV-ACLF non-treatment group had a significant reduction in Bacteroidetes and significant increases in Fusobacteria , Proteobacteria , and Fibrobacteres. At the genus level, compared with the HP group, the HBV-ACLF non-treatment group had significant reductions in Ruminococcus, Blautia , and Eubacterium and significant increases in Parabacteroides, Lactobacillus, Fusobacterium , and Streptococcus . The in vitro fermentation experiment showed that compared with the HBV-ACLF non-treatment group, the HBV-ACLF treatment group had significant increases in Ruminococcus, Lachnospira, Bacteroides , and Genusgenus and significant reductions in Fusobacterium and Proteobacteria (all P < 0.05). Conclusion Liangxue Jiedu decoction can regulate intestinal flora disturbance, restore the diversity of intestinal flora, increase dominant bacteria, and reduce pathogenic bacteria, which may be one of its important mechanisms of action in the treatment of HBV-ACLF.