OBJECTIVE: To retrospectively study medium term follow up outcomes effects of effect of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients. METHODS: Total of 32 elderly patients with the osteoporotic intertrochanteric fractures were treated with bio-lengthend stem hemiarthroplasty from Jan. 2016 to Jan. 2019 including 14 males and 22 females, aged from 85 to 95 years old with an average of (89.5±4.5) years old. According to classification of Evans, there were 12 cases with type Ⅲ, 11 with type Ⅳ and 9 with type Ⅳ. The time from injury to operation ranged from 0.5 to 9 days with an average of (4.5±3.9) days. The operation time, blood loss and postoperative complications were analyzed. Functional outcome was assessed by Parker Palmer mobility score(PPMS) and Harris hip score. RESULTS: Four patients died within one year after operation, and the mortality was 12.5%. The follow up time for the rest 28 patients ranged from 24 to 60 months with an average of (28.5±4.5) months. The mean operative time was (54.2±22.5) min;the mean blood loss (hidden blood loss+obvious blood loss) was (450±140) ml;the first weight bearing was (3.35±1.35) days. No perioperative death occurred. PPMS were(6.63±1.25), (6.94±1.18), (7.11±0.83), (7.32±1.11) and Harris scores were(67.85±6.19), (71.42±5.57), (73.41±5.62), (77.32±5.24) respectively at 1, 3, 6 months and the final follow-up after operation. There were no significant difference in PPMS and Harris score at 1, 3, 6 months after operation and the final follow-up(P>0.05). There were no complications such as joint dislocation and prosthesis loosening occure at the final follow-up. CONCLUSION On the premise of strictly mastering the case selection criteria, the bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients has a satisfied medium term follow-up outcomes. It can restore hip function in the early stage and improve the quality of life of patients.
Male ; Female ; Humans ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Hemiarthroplasty ; Quality of Life ; Retrospective Studies ; Treatment Outcome ; Hip Fractures/surgery* ; Osteoporotic Fractures/surgery*

Humans ; Consensus ; Hypersensitivity ; Desensitization, Immunologic/adverse effects* ; Immunotherapy/adverse effects* ; Injections, Subcutaneous ; Allergens

Objective To explore the effect of different transcranial pulse current stimulation(tPCS)program on the elimination of fatigue in physical cognitive mixed tasks.Methods Thirty healthy college athletes were randomly divided into group Ⅰ'and groupⅡ',each of 15.Then,both groups of sub-jects exercised on power bicycles.Ten subjects were screened from Group Ⅰ'and Ⅱ'meeting the crite-ria of moderate and severe physical cognitive mixed task fatigue using the Rating of Perceived Exer-tion respectively.Both groups received five tPCS interventions.Before and after each intervention,the subjects were tested for heart rate variability(HRV)and oxygenated hemoglobin(HbO2)concentration,and the effect of different stimulations on the fatigue elimination in physical cognitive mixed tasks of different severities were measured.Meanwhile,the HRV measurements included root mean square of difference between adjacent R-R intervals(RMSSD),standard deviation of all normal-to-normal inter-vals(SDNN),high frequency(HF)and low frequency(LF).Results①After tPCS intervention,the aver-age SDNN,HF and HbO2 increased significantly(P<0.05),while the average IF decreased significantly(P<0.05).②In physical cognitive mixed task of moderate fatigue,the biggest change of each index ap-peared after the tPCS program D(20 min,sensory intensity).③In the physical cognitive mixed task of severe fatigue,the change range of each index was the largest after the tPCS program C(20 min,sensory intensity + 0.2 mA).Conclusion ①After physical cognitive mixed tasks,different tPCS stimu-lation programs have different effects on the elimination of fatigue with an optimal"stimulant dose".②The effects of five intervention programs on the elimination of physical fatigue of athletes are as fol-lows:For the elimination of moderate fatigue of physical cognitive mixed task,program D of tPCS(20 min,sensory intensity)has the greatest effect,while for the elimination of severe fatigue of physical cognitive mixed task,program C of tPCS(20 min,sensory intensity + 0.2 mA)has the greatest effect.

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases

OBJECTIVE: To systematically evaluate the efficacy and safety of conventional therapy combined with moxibustion in the treatment of chronic obstructive pulmonary disease (COPD) in stable phase based on Meta-analysis medicine. METHODS: The randomized controlled trials (RCTs) of moxibustion as adjuvant therapy for COPD were retrieved from the databases of CNKI, Wanfang, SinoMed, PubMed, Web of Science, Cochrane Library and Ebsco. RevMan5.3 software was used for Meta analysis, and the quality of evidence was evaluated according to GRADE standards. RESULTS: A total of 16 RCTs were included, involving 1425 patients. The results of Meta-analysis showed that: compared with the conventional treatment, ①the adjuvant therapy with moxibustion had advantages in reducing the number of acute exacerbations [ CONCLUSION The efficacy of moxibustion as adjuvant therapy for COPD in stable phase is better than that of simple conventional therapy. Due to insufficient clinical evidence and the limitations of this study, clinical safety is unclear and further evidence is needed to support the results.
Humans ; Lung ; Moxibustion ; Pulmonary Disease, Chronic Obstructive/therapy* ; Treatment Outcome

This article aims to investigate the ameliorative effect of Linderae Radix ethanol extract on hyperlipidemia rats induced by high-fat diet and to explore its possible mechanism from the perspective of reverse cholesterol transport(RCT). SD rats were divided into normal group, model group, atorvastatin group, Linderae Radix ethanol extract(LREE) of high, medium, low dose groups. Except for the normal group, the other groups were fed with a high-fat diet to establish hyperlipidemia rat models; the normal group and the model group were given pure water, while each administration group was given corresponding drugs by gavage once a day for five weeks. Serum total cholesterol(TC), triglyceride(TG), high density lipoprotein-cholesterol(HDL-c), low density lipoprotein-cholesterol(LDL-c), alanine aminotransferase(ALT), and aspartate aminotransferase(AST) levels were measured by automatic blood biochemistry analyzer; the contents of TC, TG, total bile acid(TBA) in liver and TC and TBA in feces of rats were detected by enzyme colorimetry. HE staining was used to observe the liver tissue lesions; immunohistochemistry was used to detect the expression of ATP-binding cassette G8(ABCG8) in small intestine; Western blot and immunohistochemistry were used to detect the expression of peroxisome proliferator-activated receptor gamma/aerfa(PPARγ/α), liver X receptor-α(LXRα), ATP-binding cassette A1(ABCA1) pathway protein and scavenger receptor class B type Ⅰ(SR-BⅠ) in liver. The results showed that LREE could effectively reduce serum and liver TC, TG levels, serum LDL-c levels and AST activity, and increase HDL-c levels, but did not significant improve ALT activity and liver index; HE staining results showed that LREE could reduce liver lipid deposition and inflammatory cell infiltration. In addition, LREE also increased the contents of fecal TC and TBA, and up-regulated the protein expressions of ABCG8 in small intestine and PPARγ/α, SR-BⅠ, LXRα, and ABCA1 in liver. LREE served as a positive role on hyperlipidemia model rats induced by high-fat diet, which might be related to the regulation of RCT, the promotion of the conversion of cholesterol to the liver and bile acids, and the intestinal excretion of cholesterol and bile acids. RCT regulation might be a potential mechanism of LREE against hyperlipidemia.
Animals ; Biological Transport ; Cholesterol/metabolism* ; Diet, High-Fat/adverse effects* ; Hyperlipidemias/metabolism* ; Liver/metabolism* ; Rats ; Rats, Sprague-Dawley ; Triglycerides/metabolism*

Objective: To explore preoperative predictive markers for invasive malignancy in intraductal papillary mucinous neoplasm(IPMN). Methods: The retrospective case-controlled study was adopted.Seventy-nine patients who underwent surgery and with pathologically confirmed IPMN from January 2005 to December 2014 at Department of Pancreatic Surgery, Zhongshan Hospital Fudan University were enrolled.Forty-six patients were male and 33 were female,with an average age of (62.9±8.9)years (range:37-82 years).Tumor sites:56 tumors were located at the head of the pancreas,22 were located at the body and tail of the pancreas,and 1 was located across the whole pancreas.Surgical procedures: 51 patients underwent pancreaticoduodenectomy, 22 patients underwent distal pancreatectomy, 4 patients underwent segmental pancreatectomy and 2 patients underwent total pancreatectomy.IPMNs were classified into non-invasive lesions and invasive carcinomas according to the histopathological findings of the tumor.Thirty-two tumors were non-invasive lesions and 47 were invasive carcinomas.The preoperative findings were compared between patients with non-invasive IPMN and patients with invasive carcinoma by univariate analysis using t test and χ² test accordingly,and factors with statistically significance were subsequently submitted to multivariate analysis. Results: Univariate analysis showed that tumor size(P=0.022), carcinoembryonic antigen(P=0.012), CA19-9(P=0.011), lymphocytes(P=0.034), neutrophil-to-lymphocyte ratio(P=0.010)and platelet-to-lymphocyte ratio(PLR)(P=0.004)were predictive markers with statistical significance.Multivariate analysis showed that CA19-9(P=0.012)and PLR(P=0.025) were independent predictive markers for invasive malignancy in IPMN.The area under curve of the combination factor of CA19-9 and PLR(0.864) was larger than that of CA19-9(0.806) or PLR(0.685) alone, and all the authentic indicators of the combination factor were better than those of each alone. Conclusions CA19-9 and PLR are independent predictive markers for invasive malignancy in IPMN.The combination of CA19-9 and PLR has improved efficacy than each alone.

Objective To investigate the employers' and employees' satisfaction of Zhejiang Province on occupation health examination and diagnosis of occupational diseases, and to guide and to standardize the occupation health examination and occupational disease diagnosis. Methods A random sample of 953 employers, 1791 workers with health examination and 135 workers with diagnosis of occupational diseases were selected in the survey, and the questionnaire about the Satisfuction on occupation health examination and occupation disease diagnosis were used in this survey. Results A total of 2879 questionnaires were sent out, in which 2841 valid questionnaires were returned, and the effective recovery rate was 98.68%. The recognition rates on comfortable environment, clear instructions process, workflow notification, and attention notification were all above 98%. The satisfaction rates for all items were above 86%, and the total satisfaction rate was 89.27% . The total satisfaction rates of workers with health examination, workers with diagnosis of occupational diseases and employers were 89.28%, 82.03%, and 90.22%, respectively. The recognition rates on clear instructions process and attention notification, and the satisfaction rates on service attitude, result information and overall satisfaction were significantly different between different types of respondents (P<0.05) . The results of pair wise comparison showed that the satisfaction rates of workers with diseases diagnosis on service attitude, results information and overall satisfaction were significantly lower than those of employers (P<0.05) . The overall satisfaction rate of workers with diagnosis of occupational diseases was lower than that of workers with health examination (P=0.011) . The recognition rates of workers with health examination on clear instructions process and attentions notification were lower than those of employers (P<0.016) . There was a significant difference in the overall satisfaction between respondents in different regions (P<0.01) . Conclusion The service of occupational health examination and occupational disease diagnosis services should be further improved. We should better learn the demands of employees and employers, improve service attitude, optimize service processes, shorten service time, and improve service quality and satisfaction.

Objective The aim of our study was to investigate the influence of hexavalent chromium exposure on mRNA expression of cell cycle related genes in electroplating workers, and to provide population data for investigating the toxic mechanisms of hexavalent chromium. Methods A total of 155 cases of workers occupationally exposed to hexavalent chromium were selected, including 89 males and 66 females, and the average age of workers was 39.65±8.856 years old. Questionnaire was used to collect essential information of workers. Peripheral blood was collected from electroplating workers. The inductively couple plasma mass spectrometry (ICP-MAS) was used to measure total blood chromium content. The workers were divided into four groups according to the blood chromium content. After extracting total RNA from whole blood and reverse transcription, the mRNA expression levels of p16 and CDK6 genes were detected by real-time quantitative PCR. Meanwhile, the levels of blood chromium (BCr) and the mRNA expression of p16 and CDK6 genes were compared among four groups. The impact of BCr, smoking habits, drinking habits, gender on the mRNA expression of CDK6 gene was analyzed. Results The levels of BCr in group 1 to 4 were 0.04ppb, 0.47±0.29 ppb, 2.76±1.16 ppb, 9.36 ±4.38 ppb, respectively, and the difference between every two groups was significant (P<0.05) . The median of p16 gene expression in four groups was 4.22, 7.19, 7.47, and 14.60, respectively, and the difference between every two groups was not significant (P>0.05) . The mRNA expression levels of CDK6 gene in groups 2 to 4 were 15.05, 8.03 and 24.81, respectively, which were significantly higher than that in group 1 (P<0.05) . The results of logistic regression showed that the level of Bcr was the main influence factor, while smoking habits, drinking habits and gender had no obvious impact on the mRNA expression of CDK6 gene. Conclusions Long-term exposure of hexavalent chromium led to higher mRNA expression of CDK6 gene, and it may serve as a biomarker for workers occupationally exposed to hexavalent chromium.

Background:The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment.We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods:We conducted a multicenter,cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014.Each enrolled patient was interviewed using a structured questionnaire.All expenditure data were inflated to the 2014 Chinese Yuan (CNY;1 CNY =0.163 USD).We quantified the overall expenditure and financial burden and by subgroup (hospital type,age at diagnosis,sex,education,occupation,insurance type,household income,clinical stage,pathologic type,and therapeutic regimen).We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results:A total of 2356 patients with a mean age of 57.4 years were included,57.1％ of whom were men;13.9％ of patients had stage Ⅰ cancer;and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY,and the expenditures for stage Ⅰ,Ⅱ,Ⅲll,and Ⅳ disease were 56,099 CNY,59,952 CNY,67,292 CNY,and 82,729 CNY,respectively.Non-medical expenditure accounted for 8.3％ of the overall expenditure.The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY,which accounted for 59.9％ of their previous-year household income and caused 75.0％ of families to suffer an unmanageable financial burden.Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P ＜ 0.05),except for sex.Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less (all P ＜ 0.05).Conclusions:For patients in China,direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable.The financial burden varied among subgroups,especially among patients with different clinical stages of disease,which suggests that,in China,CRC screening might be cost-effective.