Objective To discuss the application of the"rotating guidewire and correcting the filter recovery hook direction technique"("rotation-correction loop technique"for short),a technique invented by the authors in clinical practice,in the retrieval of complex inferior vena cava filter(IVCF),and to discuss its technical skills and advantages.Methods The clinical data of 417 patients carrying an IVCF,who were admitted to the Department of Vascular Surgery of Second Hospital of Shanxi Medical University of China to retrieve IVCF between January 2022 and December 2022,were retrospectively analyzed.Taking the time spent on the retrieval of IVCF and the intraoperative radiation dose as the evaluation indicators,the advantages and disadvantages of the standard filter retrieval technique,the"rotation-correction loop technique"and the other loop-assisted techniques were compared.Results Both the intraoperative radiation dose and the time spent on the retrieval of IVCF using"rotation-correction loop technique"were remarkably lower than those of other loop-assisted techniques(P＜0.000 1).Conclusion For the retrieval of complex IVCF,especially for the IVCF which is heavily tilted and/or its recovered hook is attached to the vascular wall,the use of"rotation-correction loop technique"can shorten the time spent on the the retrieval of IVCF and reduce the intraoperative radiation dose.This technique carries high safety and practicability,the device is simple and it can be manipulated by single physician,which is conducive to clinical application and promotion.(J Intervent Radiol,2024,33:289-294)

ObjectiveTo analyze the failure of antiretroviral therapy (ART) and drug resistance characteristics among the newly reported HIV-infected patients in Taizhou City from 2020 to 2022. MethodsBlood samples, sociodemographic characteristics and ART information of the newly reported HIV-infected patients who received ART for ≥6 months in Taizhou City from 2020 to 2022 were collected for the detection of recent infections and HIV-1 genotypic drug resistance. Multivariate logistic regression analysis was used to analyze the influencing factors of treatment failure. The gene sequences of cases with failed ART were submitted to the HIV drug resistance database of Stanford University to determine the drug resistance mutation sites and drug resistance characteristics. ResultsAmong the 1 023 newly reported HIV-infected patients receiving ART, the median age （P₂₅，P₇₅） was 47 (33, 58) years, 81.4% were male, 66.4% (679/1 023) were infected through heterosexual transmission, 74.7% had a WHO clinical stage Ⅰ/Ⅱ, 62.2% had a baseline CD4 count of >200 cell·μL^-1, 94.4% (966/1 023) received an immediate ART, and 78.7% were long-term infected. Among the 66 patients with treatment failure (6.5%), the likelihood of treatment failure was lower in those with homosexual transmission (OR=0.39, 95%CI: 0.17‒0.84) and without history of sexually transmitted disease (STD) (OR=0.45, 95%CI: 0.24‒0.92), but higher in those with a baseline CD4 count of ≤200 cell·μL^-1, delayed ART (OR=3.19, 95%CI: 1.24‒7.52), and primary drug resistance (OR=4.69, 95%CI: 1.68‒11.89). Among the 36 HIV-infected patients with virological failure, 27 sequences were successfully amplified, with a successful amplification rate of 75.0% (27/36). The total drug resistance rate was 55.6% (15/27), of which the drug resistance rates of nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 37.0% (10/27), 51.9% (14/27) and 3.7% (1/27), respectively. Among the NNRTIs, the degree of resistance to efavirenz and nevirapine was consistent, with a majority (51.9%) of highly drug-resistant. K103N and M184V were the most common mutation sites, but PIs mutations occured less frequently. A total of 8 genotypes of HIV-1 were detected, in which subtype CRF01_AE accounted for 37.0% (10/27), followed by CRF07_BC [14.8% (4/27)], CRF08_BC [14.8% (4/27)] and subtype C [14.8% (4/27)]. ConclusionDuring the period from 2020 to 2022, the newly reported HIV-infected individuals in Taizhou City were predominated by long-term infections. Immediate initiation of ART can reduce the risk of treatment failure in HIV-infected individuals. Virological treatment failures are primarily associated with resistance to NRTIs and NNRTIs. It is recommended to strengthen active detection and promptly initiate ART to minimize the occurrence of ART failure. Simultaneously, there is a need to intensify drug resistance detection targeted for those with treatment failure, so as to provide a scientific guidance for drug replacement.

Objective:To investigate the effect of different negative pressure level on drain volume after augmentation mammoplasty through inframammary fold incision, and try to put forward the appropriate negative pressure level for the best prognosis of patients.Methods:This was a randomized controlled clinical study. Patients who underwent prosthetic augmentation mammoplasty through inframammary fold incision in the Medical Beauty Center of the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2021 were selected as the study subjects. Patients were divided into 4 groups by random number table method and different levels of negative pressure drainage were applied: 600 ml adjustable negative pressure drain bottle was used uniformly after operation by -80--85 kPa group, -40--60 kPa group, and -15--30 kPa group. In 0--5.2 kPa group, 300 ml drain drum was applied after operation. The criteria for drain removal was that the drain volume within 24 hours was less than 10 ml and the drainage fluid was clear. Daily drain volume, duration of drain placement, total drain volume, acceptance of the drain device and postoperative complications were recorded in the four groups. The corresponding indexes of each group were statistically analyzed by SPSS 21.0. Measurement data were expressed as Mean±SD. One-way analysis of variance was used for comparison between groups, and LSD- t test was used for pair comparison between groups. P<0.05 was considered statistically significant. Results:A total of 80 patients were included, 20 in each group. Inter-group equilibrium analysis: there was no significant difference in age, body mass index, distance from midclavicular point to nipple, distance from inferior mammary fold to nipple, and breast tissue thickness among 4 groups ( P>0.05). Evaluation of curative effect between groups: on the first and second day after operation, there was no significant difference in drain volume between -80--85 kPa group and -40--60 kPa group ( P>0.05), but there was significant difference among other groups ( P<0.05). There was significant difference in drain volume on the third day after operation, total drain volume and duration of drain placement between the four groups ( P<0.05). The lower the negative pressure level was, the less drain volume on the third day after surgery and the less total drain volume, and the shorter duration of drain placement. The duration of drain placement of the four groups were (5.6±0.7) d (-80--85 kPa group), (4.8±0.5) d (-40--60 kPa group), (4.0±0.5) d (-15--30 kPa group), and (3.2±0.4) d (0--5.2 kPa group), respectively. Safety evaluation: the complication rate of -80--85 kPa group, -40--60 kPa group, -15--30 kPa group and 0--5.2 kPa group were 2.5% (1/40), 2.5% (1/40), 0(0/40) and 15.0% (6/40), respectively. The complication rate of 0--5.2 kPa group was the highest. Investigation on the acceptance of the drainage device (no impact/dissatisfaction): 75 patients expressed dissatisfaction, with a dissatisfaction rate of 93.75%(75/80). Conclusion:In augmentation mammoplasty through inferior fold incision low negative pressure provides less drain volume, shorter drain placement. Negative pressure between -15 to -30 kPa is optimal.

Objective:To investigate the effect of different negative pressure level on drain volume after augmentation mammoplasty through inframammary fold incision, and try to put forward the appropriate negative pressure level for the best prognosis of patients.Methods:This was a randomized controlled clinical study. Patients who underwent prosthetic augmentation mammoplasty through inframammary fold incision in the Medical Beauty Center of the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2021 were selected as the study subjects. Patients were divided into 4 groups by random number table method and different levels of negative pressure drainage were applied: 600 ml adjustable negative pressure drain bottle was used uniformly after operation by -80--85 kPa group, -40--60 kPa group, and -15--30 kPa group. In 0--5.2 kPa group, 300 ml drain drum was applied after operation. The criteria for drain removal was that the drain volume within 24 hours was less than 10 ml and the drainage fluid was clear. Daily drain volume, duration of drain placement, total drain volume, acceptance of the drain device and postoperative complications were recorded in the four groups. The corresponding indexes of each group were statistically analyzed by SPSS 21.0. Measurement data were expressed as Mean±SD. One-way analysis of variance was used for comparison between groups, and LSD- t test was used for pair comparison between groups. P<0.05 was considered statistically significant. Results:A total of 80 patients were included, 20 in each group. Inter-group equilibrium analysis: there was no significant difference in age, body mass index, distance from midclavicular point to nipple, distance from inferior mammary fold to nipple, and breast tissue thickness among 4 groups ( P>0.05). Evaluation of curative effect between groups: on the first and second day after operation, there was no significant difference in drain volume between -80--85 kPa group and -40--60 kPa group ( P>0.05), but there was significant difference among other groups ( P<0.05). There was significant difference in drain volume on the third day after operation, total drain volume and duration of drain placement between the four groups ( P<0.05). The lower the negative pressure level was, the less drain volume on the third day after surgery and the less total drain volume, and the shorter duration of drain placement. The duration of drain placement of the four groups were (5.6±0.7) d (-80--85 kPa group), (4.8±0.5) d (-40--60 kPa group), (4.0±0.5) d (-15--30 kPa group), and (3.2±0.4) d (0--5.2 kPa group), respectively. Safety evaluation: the complication rate of -80--85 kPa group, -40--60 kPa group, -15--30 kPa group and 0--5.2 kPa group were 2.5% (1/40), 2.5% (1/40), 0(0/40) and 15.0% (6/40), respectively. The complication rate of 0--5.2 kPa group was the highest. Investigation on the acceptance of the drainage device (no impact/dissatisfaction): 75 patients expressed dissatisfaction, with a dissatisfaction rate of 93.75%(75/80). Conclusion:In augmentation mammoplasty through inferior fold incision low negative pressure provides less drain volume, shorter drain placement. Negative pressure between -15 to -30 kPa is optimal.

OBJECTIVE: To explore the molecular mechanism of a case where RhD genotyping did not match serological results. METHODS: The serological results of 8 members from two generations of this family were analyzed. And according to Mendelian law of inheritance, RhD genotyping, zygotic type determination and gene sequencing were performed for the family members. RESULTS: The proband and one of her cousins have the same RhD alleles, both of them have a 336-1G>A intron variant RhD allele and a complete RhD deletion allele. The variant alleles are inherited from two of their parents with blood relationship, while the complete-deleted alleles come from the other. 336-1G>A means that the last base G of the second intron of the RhD gene is mutated to A, which leads to a negative RhD serology and a positive genotype in the proband. CONCLUSION There was a rare 336-1G> A intron variant gene (RhD * 01N.25) in this family, which was a recessive gene relative to the RhD gene and resulted in RhD phenotype negative.
Alleles ; Female ; Genotype ; Humans ; Introns/genetics* ; Pedigree ; Phenotype ; Rh-Hr Blood-Group System/genetics*

Objective:To evaluate the changes of metamorphopsia in patients with rhegmatogenous retinal detachment (RRD) who underwent primary vitrectomy and to analyze the correlation between macular microstructure changes and metamorphopsia.Methods:It was a retrospective clinical study. From January 2017 to January 2019, 57 patients (57 eyes) with RRD were examined and diagnosed in the Department of Ophthalmology of Baoding First Central Hospital were enrolled in this study. All patients underwent 23G PPV. All patients had retinal anatomical reduction after the first PPV. The best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscope, indirect ophthalmoscope, changes of metamorphopsia, and optical coherence tomography (OCT) were examined before PPV and 1, 6, 12 months after the operation. The BCVA examination was performed using the international standard visual acuity chart, which was converted into a logarithm of the minimum angle of resolution (logMAR) BCVA for the record. The macular fovea retinal thickness (CRT) was measured by Carl Zeiss Cirrus HD-OCT5000 instrument from Carl Zeiss Company, Germany, and the microstructural changes in the macular area were recorded, including the presence of the anterior macular membrane (ERM), cystic macular edema (CME), subretinal fluid (SRF), and the integrity of the ellipsoid zone (EZ) and outer membrane (ELM). The value of metamorphopsia (M value) was measured by the M-Chart table. The changes of BCVA, M value, and the microstructure of the macular area before and after operation were analyzed. The correlation between BCVA and M value was analyzed by Pearson correlation. Spearman correlation analysis was used to analyze the correlation between the changes of macular microstructure and BCVA and M values.Results:The mean logMAR BCVA before the operation was 1.15±0.43. At 1, 6, and 12 months after the operation, the mean logMAR BCVA was 0.62±0.17, 0.39±0.18, and 0.34±0.13, respectively. The visual acuity improved significantly after operation compared with before operation, and the difference was statistically significant ( F=119.731, P=0.000). The mean CRT before the operation was 476.0±104.1 μm. At 1, 6, and 12 months after the operation, the average CRT were 299.8±29.9, 272.2±17.8, and 261.0±19.3 μm, respectively. The average CRT after the operation was significantly lower than those before the operation ( F=185.518, P=0.000). At 1, 6, and 12 months after the operation, the mean M values were 0.62±0.54, 0.43±0.41, and 0.32±0.36, respectively; the difference was statistically significant ( F=6.568, P=0.020). After the operation, 48 eyes (84.2%, 48/57) had microstructural abnormalities in the macular area, including EZ and ELM integrity disruption, SRF, CME, and ERM. Correlation analysis showed that M value was significantly positively correlated with BCVA, CRT, and SRF height before operation ( r/ rs=0.672, 0.385, 0.932; P<0.05). There was no correlation between M value and BCVA ( r/ rs=0.503), EZ and ELM integrity ( r/ rs=0.497, 0.472), SRF ( r/ rs=0.416), CME ( r/ rs=0.821) and ERM ( r/ rs=0.632) after operation ( P>0.05). Conclusions:The BCVA is significantly increased and the metamorphopsia is improved after anatomically successful RRD surgery. Postoperative M value is highly correlated with preoperative BCVA, CRT, and SRF.

Objective:To analyze the predictive ability of HIV infection risk assessment tool for men who have sex with men (MSM). Sentinel surveillance data of MSM in Taizhou prefecture of Zhejiang province was used.Methods:MSM involved in AIDS sentinel surveillance program in Taizhou from 2013 to 2017 were included in the study and items listed in the HIV infection risk assessment tool for MSM was revised. Related data on questions and options involved in sentinel surveillance was collected and individual risk scores were calculated. We determined the predictive ability of this tool by comprehensive analyzing the HIV infection status and individual risk scores.Results:A total of 1 944 MSM were included in the study, with an average age of (35.04±13.28)years old. Most of them were recruited from the venues (55.7%) and 48.2% were never married. Among these MSM, HIV infection rate was 12.6%(245/1 944) with the median of risk score as 23.99, versus 20.36 from the HIV negative ones. Significant differences appeared on the risk scores between the target populations that with different HIV status (Mann-Whitney test, P=0.007). According to the principle of decision tree, MSM were divided into two groups according to risk scores: ≤18.66 and >18.66. It appeared that the risk scores were in parallel with the rates of HIV infection ( χ2=13.102, P<0.001). Results from the multivariate analysis showed that MSM with higher risk score were more likely to be infected with HIV (>18.66 vs. ≤18.66: a OR=1.72, 95% CI: 1.27-2.32, P<0.001). Area under the ROC curve (AUC) for HIV infection was 0.553 (95% CI: 0.516-0.590, P=0.007). At the point of risk score 19.01, Youden’s index appeared the maximum, with sensitivity as 0.69 and specificity as 0.43, of this tool. Conclusions:The HIV infection risk assessment tool for MSM developed based on Delphi method can predict the risk of HIV infection in MSM to some extent. MSM with higher risk score seemed likely to be infected with HIV. Items of this tool need to be adjusted for the verification of the tool through cohort studies in the near future.

Objective To compare the surgical effects between minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider and open anterior ondontoid screw fixation in the treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ.Methods From July 2011 to July 2016,28 adults with odontoid fracture of Anderson-D'Alonzo type Ⅱ were treated at Department Ⅱ of Spinal Surgery,Hospital of 89 Army Group of Chinese PLA.Of them,15 were treated by minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider (guider group) while the other 13 by open anterior ondontoid screw fixation (open group).All the patients were male,aged from 31 to 59 years (average,42.7 years).The 2 groups were compared in terms of incision length,operation time,intraoperative bleeding,intraoperative fluoroscopic frequency and hospital stay.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible (P ＞ 0.05).All the patients were followed up for 12 to 45 months (average,22.1 months).The internal fixation was in good place and clinical union achieved in all the 28 patients.The incision length (2.2 ± 0.1 cm),operation time (45.0 ± 3.1 min),intraoperative bleeding (29.0 ± 2.3 mL) and intraoperative fluoroscopic frequency (15.5 ± 1.9 times) for the guider group were all significantly less than those (2.9 ±0.7 cm,61.6±3.8 min,51.6±3.9 mL and 21.7±3.2 times,respectively) for the open group (P ＜0.05),but there was no significant difference between the 2 groups in hospital stay (6.5 ± 0.5 d versus 6.5 ± 0.6 d) (P ＞ 0.05).Conclusion In the treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ,compared with open anterior ondontoid screw fixation,the minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider may lead to a smaller incision,shorter operation time,less blood loss and a lower fluoroscopic frequency.

Objective To evaluate the effects of early tracheostomy and late tracheostomy on the prognosis of patients with cervical spinal cord injury,so as to provide evidence based guidance for the timing of tracheostomy.Methods Relevant literatures studying the timing of tracheostomy in patients with cervical spinal cord injury were searched in PubMed,Embase,Medline,Cochrane Library,Chinese Biological Medical Literature database (CBM),China National Knowledge Infrastructure database (CNKI),and VIP journal database with time range from journal establishment to March 2018.The retrieved articles were screened according to the inclusion and exclusion criteria.The article quality was rigorously evaluated according to the Newcastle-Ottawa scale (NOS).Meta analysis was conducted using Review Manager 5.3 software to compare the mechanical ventilation time,ICU stay,incidence of pneumonia,incidence of complications,and mortality between early and late tracheostomy in patients with cervical spinal cord injury.Results A total of eight articles of cohort study including 466 patients were included,with 241 patients in the early tracheostomy group and 225 patients in the late tracheostomy group.The eight articles were all determined as high quality studies according NOS.The results of Meta analysis showed that there were significant differences between the two groups in terms of the total mechanical ventilation time (MD =-12.28,95％ CI-20.09--4.47,P ＜ 0.01),post tracheostomy mechanical ventilation time (MD =-9.92,95％ CI-14.27--5.57,P ＜ 0.01),total ICU stay (MD =-10.30,95％ CI-17.12--3.47,P ＜ 0.01),post tracheostomy ICU stay (MD =-5.79,95％ CI -6.53--5.05,P ＜ 0.01),incidence of complications (RR =0.56,95％ CI 0.38-0.83,P ＜ 0.01),and mortality (RR =0.34,95％ CI 0.15-0.78,P ＜ 0.05).However,no significant differences were detected between the two groups in the incidence of total pneumonia (RR =0.77,95％ CI 0.57-1.05,P ＞0.05) and the incidence of post tracheostomy pneumonia (RR =0.80,95％ CI 0.51-1.26,P ＞0.05).Conclusion Early tracheostomy can shorten the mechanical ventilation time,ICU stay,incidence of complications,and mortality,but it cannot reduce the incidence of pneumonia.

Objective To analyze the physicochemical properties and photothermal properties after introducing a certain proportion of phaeophorbide into polyvinyl alcohol-lipoic acid polymer.Methods The "one-step" method was adopted to synthesize the PVA27K-4 ％LA-10 ％ Pheide (PLP) polymer.The laser particle diameter tester was used to detect the particle size,polydispersity index and ζ potential of PLP nanoparticle (PLPN);the morphology was observed under transmission electron microscope (TEM);the in vitro fluorescent and photothermal properties were investigated by using spectrophotometric method and infrared thermal imager;the ovarian-cancer nude mice models were established and the preliminary in vivo experiment evaluation was performed.Results The synthetic PLP polymer could self-assembly form spherical PLPN in aqueous environment,which showed the tightly spherical structure under TEM.The average particle diameter,polydispersity index and ζ potential were (22.92 ± 9.00)nm,(0.117±0.056) and (-25.43±0.77)mV respectively.The fluorescence intensity of PLPN in PBS solution was significantly lower than that in SDS solution (P＜0.05).However,the temperature of the PBS solution of PLPN was significantly higher than that of the SDS solution after exposure to the near infrared light (P＜0.05).In the model of tumor-bearing nude mice,PLPN could targetaccumulated in the tumor site.The temperature in the tumor site was significantly increased after exposure to the near infrared light,which could kill tumor cells.Conclusion PLPN could emit red fluorescence,and could target-accumulated in tumor site and conduct the in vivo image,which has significant photothermal conversion properties in vivo and in vitro,and can effectively inhibit the tumor growth in vivo.