1.Clinical application of an artificial intelligence system in predicting benign or malignant pulmonary nodules and pathological subtypes
Zhuowen YANG ; Zhizhong ZHENG ; Bin LI ; Yiming HUI ; Mingzhi LIN ; Jiying DANG ; Suiyang LI ; Chunjiao ZHANG ; Long YANG ; Liang SI ; Tieniu SONG ; Yuqi MENG
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2025;32(08):1086-1095
		                        		
		                        			
		                        			Objective To evaluate the predictive ability and clinical application value of artificial intelligence (AI) systems in the benign and malignant differentiation and pathological type of pulmonary nodules, and to summarize clinical application experience. Methods A retrospective analysis was conducted on the clinical data of patients with pulmonary nodules admitted to the Department of Thoracic Surgery, Second Hospital of Lanzhou University, from February 2016 to February 2025. Firstly, pulmonary nodules were divided into benign and non-benign groups, and the discriminative abilities of AI systems and clinicians were compared. Subsequently, lung nodules reported as precursor glandular lesions (PGL), microinvasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) in postoperative pathological results were analyzed, comparing the efficacy of AI systems and clinicians in predicting the pathological type of pulmonary nodules. Results In the analysis of benign/non-benign pulmonary nodules, clinical data from a total of 638 patients with pulmonary nodules were included, of which there were 257 males (10 patients and 1 patient of double and triple primary lesions, respectively) and 381 females (18 patients and 1 patient of double and triple primary lesions, respectively), with a median age of 55.0 (47.0, 61.0) years. Different lesions in the same patient were analyzed as independent samples. Univariate analysis of the two groups of variables showed that, except for nodule location, the differences in the remaining variables were statistically significant (P<0.05). Multivariate logistic regression analysis showed that age, nodule type (subsolid pulmonary nodule), average density, spicule sign, and vascular convergence sign were independent influencing factors for non-benign pulmonary nodules, among which age, nodule type (subsolid pulmonary nodule), spicule sign, and vascular convergence sign were positively correlated with non-benign pulmonary nodules, while average density was negatively correlated with the occurrence of non-benign pulmonary nodules. The area under the receiver operating characteristic curve (AUC) of the malignancy risk value given by the AI system in predicting non-benign pulmonary nodules was 0.811, slightly lower than the 0.898 predicted by clinicians. In the PGL/MIA/IAC analysis, clinical data from a total of 411 patients with pulmonary nodules were included, of which there were 149 males (8 patients of double primary lesions) and 262 females (17 patients of double primary lesions), with a median age of 56.0 (50.0, 61.0) years. Different lesions in the same patient were analyzed as independent samples. Univariate analysis results showed that, except for gender, nodule location, and vascular convergence sign, the differences in the remaining variables among the three groups of PGL, MIA, and IAC patients were statistically significant (P<0.05). Multinomial multivariate logistic regression analysis showed that the differences between the parameters in the PGL group and the MIA group were not statistically significant (P>0.05), and the maximum diameter and average density of the nodules were statistically different between the PGL and IAC groups (P<0.05), and were positively correlated with the occurrence of IAC as independent risk factors. The average AUC value, accuracy, recall rate, and F1 score of the AI system in predicting lung nodule pathological type were 0.807, 74.3%, 73.2%, and 68.5%, respectively, all better than the clinical physicians’ prediction of lung nodule pathological type indicators (0.782, 70.9%, 66.2%, and 63.7% respectively). The AUC value of the AI system in predicting IAC was 0.853, and the sensitivity, specificity, and optimal cutoff value were 0.643, 0.943, and 50.0%, respectively. Conclusion This AI system has demonstrated high clinical value in predicting the benign and malignant nature and pathological type of lung nodules, especially in predicting lung nodule pathological type, its ability has surpassed that of clinical physicians. With the optimization of algorithms and the adequate integration of multimodal data, it can better assist clinical physicians in formulating individualized diagnostic and treatment plans for patients with lung nodules.
		                        		
		                        		
		                        		
		                        	
2.Dynamic Monitoring and Correlation Analysis of General Body Indicators, Blood Glucose, and Blood Lipid in Obese Cynomolgus Monkeys
Yanye WEI ; Guo SHEN ; Pengfei ZHANG ; Songping SHI ; Jiahao HU ; Xuzhe ZHANG ; Huiyuan HUA ; Guanyang HUA ; Hongzheng LU ; Yong ZENG ; Feng JI ; Zhumei WEI
Laboratory Animal and Comparative Medicine 2025;45(1):30-36
		                        		
		                        			
		                        			ObjectiveThis study aims to investigate the dynamic changes in general body parameters, blood glucose, and blood lipid profiles in obese cynomolgus monkeys, exploring the correlations among these parameters and providing a reference for research on the obese cynomolgus monkey model. Methods30 normal male cynomolgus monkeys aged 5 - 17 years old (with body mass index < 35 kg/m² and glycated hemoglobin content < 4.50%) and 99 spontaneously obese male cynomolgus monkeys (with body mass index ≥35 kg/m² and glycated hemoglobin content < 4.50%) were selected. Over a period of three years, their abdominal circumference, skinfold thickness, body weight, body mass index, fasting blood glucose, glycated hemoglobin, and four blood lipid indicators were monitored. The correlations between each indicator were analyzed using repeated measurement ANOVA, simple linear regression, and multiple linear regression correlation analysis method. Results Compared to the control group, the obese group exhibited significantly higher levels of abdominal circumference, skinfold thickness, body weight, body mass index, and triglyceride (P<0.05). In the control group, skinfold thickness increased annually, while other indicators remained stable. Compared with the first year, the obese group showed significantly increased abdominal circumference, skinfold thickness, body weight, body mass index, triglyceride, and fasting blood glucose in the second year(P<0.05), with this increasing trend persisting in the third year (P<0.05). In the control group, the obesity incidence rates in the second and third years were 16.67% and 23.33%, respectively, while the prevalence of diabetes remained at 16.67%. In the obese group, the diabetes incidence rates were 29.29% and 44.44% in years 2 and 3, respectively. Among the 11-13 year age group, the incidence rates were 36.36% and 44.68%, while for the group older than 13 years, the rates were 28.13% and 51.35%. Correlation analysis revealed significant associations (P<0.05) between fasting blood glucose and age, abdominal circumference, skinfold thickness, body weight, and triglyceride in the diabetic monkeys. Conclusion Long-term obesity can lead to the increases in general physical indicators and fasting blood glucose levels in cynomolgus monkeys, and an increase in the incidence of diabetes. In diabetic cynomolgus monkeys caused by obesity, there is a high correlation between their fasting blood glucose and age, weight, abdominal circumference, skinfold thickness, and triglyceride levels, which is of some significance for predicting the occurrence of spontaneous diabetes. 
		                        		
		                        		
		                        		
		                        	
3.Role of Endoplasmic Reticulum Stress in Atherosclerosis and Its Regulation by Traditional Chinese Medicine: A Review
Qingzhi LIANG ; Zhengtao CHEN ; Ruoran ZHOU ; Jiying LI ; Yuan ZHANG ; Chunguang XIE ; Qiyue YANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(5):226-235
		                        		
		                        			
		                        			Atherosclerosis (AS) is a chronic inflammatory pathological process in which lipid and/or fibrous substances are deposited in the intima of arteries, and it is one of the pathological bases of many cardiovascular and cerebrovascular diseases. Endoplasmic reticulum stress (ERS) is a protective mechanism of cell adaptation. Moderate ERS can reduce abnormal protein aggregation and increase the degradation of misfolded proteins to repair and stabilize the internal environment, while excessive ERS can cause unfolded protein reaction, activate inflammation, oxidative stress, apoptosis, autophagy, and other downstream pathways, and lead to cell damage, or even apoptosis. A large number of studies have shown that ERS mediates a variety of pathological processes related to AS, affects endothelial cells, smooth muscle cells, macrophages, endothelial progenitor cells, and other cell components closely related to its occurrence and development, influences the progress of AS by regulating cell function, and promotes the formation of AS plaque, the transformation of stable plaque to unstable plaque, and the rupture of unstable plaque. Regulation of ERS may be a key target for the prevention and treatment of AS, and it is a research hotspot at present. Traditional Chinese medicine (TCM) believes that the origin of AS is the imbalance of Yin and Yang, the disharmony of Zangfu organs, and the abnormal operation of Qi, blood, and body fluid, which leads to the accumulation of phlegm, blood stasis, and other pathological products in the pulse channels, making the blood flow blocked or misfunction and causing the disease, which belongs to the syndrome of deficiency in origin and excess in superficiality. As the pathogenesis of AS is complex, and the symptoms are diverse, TCM has significant advantages in treating AS because of its multiple targets, multiple pathways, stable efficacy, strong individualization, and high safety. This paper systematically elaborated on the role of ERS in the occurrence and development of AS and summarized the mechanism research on the regulation and control of ERS by Chinese herbal monomer, Chinese herbal extract, Chinese herbal compound, and proprietary medicine, so as to provide a theoretical basis for clinical research and drug development in the prevention and treatment of AS. 
		                        		
		                        		
		                        		
		                        	
4.The reconstruction techniques and mid-term clinical outcomes of hip revision for acetabular bone defect after total hip arthroplasty
Bohan ZHANG ; Jun FU ; Guoqiang ZHANG ; Yonggang ZHOU ; Jiying CHEN ; Wei CHAI
Chinese Journal of Surgery 2024;62(9):836-846
		                        		
		                        			
		                        			Objective:To analyze three reconstruction techniques and mid-term clinical outcomes of hip revision for acetabular bone defect after total hip arthroplasty (THA).Methods:This is a retrospective case series study. Included in the study were 109 patients (109 hips) with acetabular bone defect after THA reconstructions in hip revisions from January 2015 to December 2021 in the Senior Department of Orthopaedics, the Forth Medical Center of Chinese People′s Liberation Army General Hospital and the Department of Orthopaedics, the First Medical Center of Chinese People′s Liberation Army General Hospital. According to the preoperative simulated surgeries and different bone defect reconstruction techniques, patients were divided into a normal cup group, an augment group or a triflange group,respectively. There were 54 patients (54 hips) in the normal cup group, reconstructed with the uncemented porous metal cup (including Jumbo cup), with 23 males and 31 females, aged (59.6±9.9) years (range:32 to 76 years); 44 patients (44 hips) in the augment group, reconstructed with the individualized three-dimensional (3D) printed porous metal augment and uncemented porous metal cup, with 18 males and 26 females, aged (52.8±13.6) years(range:17 to 76 years); 11 patients (11 hips) in the triflange group, reconstructed by the individualized 3D printed porous metal triflange cup, with 5 males and 6 females, aged (59.4±11.2) years (range: 43 to 78 years). Radiographic results, including rotation center height, rotation center offset, and leg length discrepancy (LLD) and clinical results, including Harris hip score (HHS) and visual analogue scale(VAS) were evaluated outpatient at 3, 6, 12 months after the operation and annually thereafter. The last follow-up was completed in March 2024, and all parameters at the last follow-up and before the operation were compared. Paired sample t test and repeated measurement ANOVA were used for the radiographic and clinical parameters before and after the operation. Results:All hip revisions for patients with acetabular bone defect after THA were completed and followed for more than two years. The follow-up time of the normal cup group was (6.5±1.7) years (range: 2.8 to 9.3 years), and that of the augment group was (6.0±1.3) years (range: 3.5 to 9.0 years). The follow-up time of the triflange group was (2.8±0.6) years (range: 2.0 to 3.8 years). At the last follow-up, the rotation center height, rotation center offset and LLD of 54 hips in the normal cup group were (24.2±5.6) mm, (29.1±5.5) mm and (4.6±3.3) mm, respectively, and the rotation center height and LLD were significantly lower than those of the preoperative hips ( t=9.671, P<0.01; t=6.073, P<0.01). In the augment group, the rotational center height, the rotation center offset and the LLD of 44 hips were (22.4±9.0) mm, (25.4±5.5) mm and (6.0±4.0) mm, respectively, which were significantly lower than those of the preoperative hips ( t=9.071, P<0.01; t=11.345, P<0.01; t=4.927, P<0.01). In the triflange group, the rotational center height, the rotation center offset and LLD of 11 hips were (22.7±6.0) mm,(30.9±8.0) mm and (5.3±2.2) mm, respectively, and the rotation center height and LLD were significantly lower than those of the preoperative hips ( t=2.716, P=0.022; t=6.226, P<0.01). At the last follow-up, fractures occurred in 3 patients and dislocation occurred in 1 patient in the normal cup group, and fracture reduction and closed reduction were administered under anesthesia, respectively. In the augment group, dislocation occurred in 1 patient and open reduction under anesthesia was performed. The HHS and VAS of the three groups improved significantly after surgery and the differences were statistically significant (all P<0.01). There was no complication in the triflange group. The X-ray at the last follow-up showed that all prostheses and augments were in stable positions and no loosening or migration was observed. Conclusions:For patients with acetabular bone defect after THA undergoing hip revisions, preoperative surgical simulation and rehearsal could help surgeons choose convenient and efficient reconstruction techniques. The targeted selection of Jumbo cup, individualized 3D printed metal augment, and customized triflange cup could achieve satisfactory clinical outcomes.
		                        		
		                        		
		                        		
		                        	
5.The reconstruction techniques and mid-term clinical outcomes of hip revision for acetabular bone defect after total hip arthroplasty
Bohan ZHANG ; Jun FU ; Guoqiang ZHANG ; Yonggang ZHOU ; Jiying CHEN ; Wei CHAI
Chinese Journal of Surgery 2024;62(9):836-846
		                        		
		                        			
		                        			Objective:To analyze three reconstruction techniques and mid-term clinical outcomes of hip revision for acetabular bone defect after total hip arthroplasty (THA).Methods:This is a retrospective case series study. Included in the study were 109 patients (109 hips) with acetabular bone defect after THA reconstructions in hip revisions from January 2015 to December 2021 in the Senior Department of Orthopaedics, the Forth Medical Center of Chinese People′s Liberation Army General Hospital and the Department of Orthopaedics, the First Medical Center of Chinese People′s Liberation Army General Hospital. According to the preoperative simulated surgeries and different bone defect reconstruction techniques, patients were divided into a normal cup group, an augment group or a triflange group,respectively. There were 54 patients (54 hips) in the normal cup group, reconstructed with the uncemented porous metal cup (including Jumbo cup), with 23 males and 31 females, aged (59.6±9.9) years (range:32 to 76 years); 44 patients (44 hips) in the augment group, reconstructed with the individualized three-dimensional (3D) printed porous metal augment and uncemented porous metal cup, with 18 males and 26 females, aged (52.8±13.6) years(range:17 to 76 years); 11 patients (11 hips) in the triflange group, reconstructed by the individualized 3D printed porous metal triflange cup, with 5 males and 6 females, aged (59.4±11.2) years (range: 43 to 78 years). Radiographic results, including rotation center height, rotation center offset, and leg length discrepancy (LLD) and clinical results, including Harris hip score (HHS) and visual analogue scale(VAS) were evaluated outpatient at 3, 6, 12 months after the operation and annually thereafter. The last follow-up was completed in March 2024, and all parameters at the last follow-up and before the operation were compared. Paired sample t test and repeated measurement ANOVA were used for the radiographic and clinical parameters before and after the operation. Results:All hip revisions for patients with acetabular bone defect after THA were completed and followed for more than two years. The follow-up time of the normal cup group was (6.5±1.7) years (range: 2.8 to 9.3 years), and that of the augment group was (6.0±1.3) years (range: 3.5 to 9.0 years). The follow-up time of the triflange group was (2.8±0.6) years (range: 2.0 to 3.8 years). At the last follow-up, the rotation center height, rotation center offset and LLD of 54 hips in the normal cup group were (24.2±5.6) mm, (29.1±5.5) mm and (4.6±3.3) mm, respectively, and the rotation center height and LLD were significantly lower than those of the preoperative hips ( t=9.671, P<0.01; t=6.073, P<0.01). In the augment group, the rotational center height, the rotation center offset and the LLD of 44 hips were (22.4±9.0) mm, (25.4±5.5) mm and (6.0±4.0) mm, respectively, which were significantly lower than those of the preoperative hips ( t=9.071, P<0.01; t=11.345, P<0.01; t=4.927, P<0.01). In the triflange group, the rotational center height, the rotation center offset and LLD of 11 hips were (22.7±6.0) mm,(30.9±8.0) mm and (5.3±2.2) mm, respectively, and the rotation center height and LLD were significantly lower than those of the preoperative hips ( t=2.716, P=0.022; t=6.226, P<0.01). At the last follow-up, fractures occurred in 3 patients and dislocation occurred in 1 patient in the normal cup group, and fracture reduction and closed reduction were administered under anesthesia, respectively. In the augment group, dislocation occurred in 1 patient and open reduction under anesthesia was performed. The HHS and VAS of the three groups improved significantly after surgery and the differences were statistically significant (all P<0.01). There was no complication in the triflange group. The X-ray at the last follow-up showed that all prostheses and augments were in stable positions and no loosening or migration was observed. Conclusions:For patients with acetabular bone defect after THA undergoing hip revisions, preoperative surgical simulation and rehearsal could help surgeons choose convenient and efficient reconstruction techniques. The targeted selection of Jumbo cup, individualized 3D printed metal augment, and customized triflange cup could achieve satisfactory clinical outcomes.
		                        		
		                        		
		                        		
		                        	
7.Clinical efficacy of robot-assisted total hip arthroplasty
Shuai ZHANG ; Cheng LIU ; Xiangpeng KONG ; Xiang LI ; Guoqiang ZHANG ; Jiying CHEN ; Wei CHAI
Chinese Journal of Orthopaedics 2023;43(17):1137-1145
		                        		
		                        			
		                        			Objective:To explore the impact of robot assisted total hip arthroplasty (THA) on the accuracy of prosthesis placement and its clinical efficacy.Methods:A total of 432 patients (549 hips) who underwent robot-assisted primary THA for various diseases of the hip in the Department of Orthopaedics of the Fourth Medical Center of the PLA General Hospital from August 2018 to October 2022 was retrospectively analyzed. There were 174 male and 258 female with an average age of 54.2±12.7 years old and body mass index (BMI) of 23.2±4.3 kg/m 2. There were 301 left hips and 248 right hips. All patients were operated under general anesthesia using the standard posterior lateral surgical approach to THA. The Harris hip score (HHS), forgotten joint score (FJS), the Western Ontario and McMaster University (WOMAC) osteoarthritis index and patient satisfaction were used to evaluate the clinical outcomes. The anterior inclination, abduction angle, lower extremity discrepancy and the position of the center of rotation (COR) of the hip joint were radiographically accessed preoperatively, intraoperatively and postoperatively. The composition ratio of the acetabular cup in the safe zone was also calculated. Results:Five hundred and forty-nine consecutive hips (432 patients) underwent robotic-assisted THA with a mean follow-up of 23.6±16.2 months. The mean operative time was 86.2±35.4 min, and the mean blood loss was 236.7±94.5 ml. At the last follow-up, the mean HHS score for this group was 91.4±15.4, the WOMAC score was 8.4±6.5, the FJS score was 77.4±23.4, and the satisfaction score was 9.1±2.7 points. The mean postoperative measurement of acetabular cup anteversion was 21.2°±4.8° and abduction was 40.8°±4.3°. About 93.7% (511 patients) had an acetabular cup within the safety zone of ±10° of the target angle, and 84.6% (464 patients) had an acetabular cup within the safety zone of ±5° of the target angle. A total of 4 complications occurred. Acute periprosthesis infection happened in a case of developmental dysplasia of the hip (DDH) and was cured by DAIR (debridement, antibiotics, irrigation, retention of prosthesis). One case of thigh pain of unknown reason was treated with a revision operation, during which no loosening or malposition of the prosthesis was found. After replacing the femoral head component no pain was complained by the patient. One case of hematoma and nerve compression was considered to be caused by blood vessels injury when a titanium cable was used to fix the distal femoral fracture during the surgery. The nerve injury returned to normal within 1 month. One case of dislocation happened immediately after surgery and was revised by replacing a different head. The patient was fully recovered. In addition to software and mechanical failures of the robot itself, complex hip joint diseases would be a risk factor for the termination of robot assisted surgery due to the occurrence of adverse events related to robots in 16 hips. Considering the existence of a certain termination rate in robot assisted surgery, sufficient preparation should be made when applying robot assisted technology in complex hip joint diseases.Conclusion:In robotic-assisted THA, preoperative planning can be achieved with precise and reproducible acetabular cup positions, significantly increasing the chance of locating the acetabular cups in the safety zone, and obtaining satisfactory results in restoring COR and leg length.
		                        		
		                        		
		                        		
		                        	
8.Establishment of Ischemia-Reperfusion Model in Cynomolgus Macaques and Effects of Edaravone Intervention
Mengxian PAN ; Xiaojiao HUANG ; Zhongli HUANG ; Guo SHEN ; Pengfei ZHANG ; Yong ZENG ; Wenfeng LI ; Huabo ZHOU ; Zhumei WEI
Laboratory Animal and Comparative Medicine 2023;43(2):136-144
		                        		
		                        			
		                        			ObjectiveTo establish an ischemia-reperfusion model in cynomolgus macaques and to analyse the effects of edaravone intervention. MethodsA total of fifteen adult male cynomolgus macaques were randomly divided into three groups: sham operation (Sham group, n=3), ischemia-reperfusion model (Model group, n=6) and edaravone treatment (Edaravone group, n=6). Ischemic-reperfusion model of cynomolgus macaques was established by clamping the M1 branch of the left cerebral artery for 1 h. After 2 h of reperfusion, the animals in Edaravone group were injected with 0.5 mg/kg edaravone intravenously for intervention treatment, while the animals in Sham and Model groups were injected with an equal volume of normal saline intravenously, twice a day, from the 2nd to 7th day. The behavioral video recordings, clinical observations and neurological deficit scores of cynomolgus macaques were obtained, and brain edema volume and cerebral ischemia volume were statistically analyzed. ResultsCompared with the Sham group, the animals in Model group showed typical symptoms of ischemic stroke, with a significant increase in the neurological deficit score, the volumes of edema and infarct of brain tissue (all P<0.01). Compared with Model group, the neurological deficit score, the volumes of edema and infarct of brain tissue were significantly reduced in Edaravone group (all P<0.05). ConclusionAn animal model of ischemia-reperfusion in cynomolgus macaques was successfully established, and edaravone was confirmed to alleviate the damage caused by ischemia-reperfusion. 
		                        		
		                        		
		                        		
		                        	
9.Investigation on serum pertussis toxin antibody levels in children aged 0-14 in Hangzhou
Jie CHEN ; Jiying XIAO ; Li ZHANG ; Jun ZHOU ; Suling WU
Chinese Journal of Applied Clinical Pediatrics 2022;37(24):1895-1898
		                        		
		                        			
		                        			Objective:To investigate the serum antibody level in children with pertussis in Hangzhou city, and to evaluate the incidence of pertussis in children and the immunization effect of vaccine.Methods:A retrospective study was conducted.The pertussis toxin IgG antibody levels in 1 486 children aged 0-14 who received physical exa-mination in Hangzhou Children′s Hospital from January to December 2018 of were collected and analyzed.Serum antibody level ≥30 IU/mL was considered seropositive.The children enrolled were divided into the 0-3-year-old, 4-6-year-old, 7-9-year-old and 10-14-year-old groups; then the children under 3 years old were subdivided into groups of 0-<3 months, 3-<6 months, 6-<9 months, 9-<12 months, 12-<18 months, and 18-≤ 36 months; finally, the children were grouped according to their vaccination times, the pertussis toxin IgG antibody level and the infection rate of pertussis were compared among different groups by Mann- Whitney U, Kruskal- Wallis and χ2 tests. Results:The overall positive rate of the pertussis toxin IgG antibody was 23.62% (351/1 486), and the median antibody concentration was 6.60 IU/mL.Among children aged 0-14, the 0-3-year-old children had the highest positive rate of the pertussis toxin IgG antibody and the highest median antibody concentration, which were 24.58% (29/118) and 6.95 IU/mL, respectively.There was no significant difference in the antibody positive rate and the median antibody concentration among different age groups (all P>0.05). Among different subgroups of children aged 0-3, the pertussis toxin IgG antibody positive rate and the median antibody concentration were statistically significant (all P<0.05). It was predicted that the pertussis infection rate in children over 3 years old in Hangzhou was about 45.99%.The patients receiving more than 3 doses of vaccination accounted for 87.48% (1 300/1 486), and their antibody positive rate was 25.46% (331/1 300). After excluding unvaccinated children, the comparison results suggested that there was statistical significance in the antibody positive rate and median antibody concentration among different vaccination groups ( χ2=24.467, 67.438, all P<0.001). Conclusions:The serum pertussis toxin IgG antibody positive rate in children aged 0-14 in Hangzhou is low, but their predicted pertussis infection rate is higher.Children aged 0-14 are easy to become a main source of infection.Therefore, it is necessary to pay attention to and strengthen the vaccination plan and research, enhance the monitoring of the infection source, and prevent the " recurrence of pertussis" .
		                        		
		                        		
		                        		
		                        	
10.Study on the intestinal motility characteristics of 225 patients with different subtypes of constipation based on high-resolution colon manometry
Chenmeng JIAO ; Chen XU ; Yuwei LI ; Jiying CONG ; Tingting LIU ; Yongjun YU ; Zhao ZHANG ; Jun LIU
Chinese Journal of Digestion 2021;41(12):835-841
		                        		
		                        			
		                        			Objective:To compare the results of high-resolution colonic manometry (HRCM) in patients with four subtypes of constipation: slow transit constipation(STC), outlet obstruction constipation (OOC), mixed STC and OOC, and normal transit constipation(NTC), and to explore the intestinal motility characteristics of patients with different subtypes of constipation.Methods:From 20th January 2017 to 20th September 2020, the HRCM results of 225 patients with functional constipation who visited the Department of Anorectal Surgery of Tianjin Union Medical Center were retrospectively analyzed. According to the results of colonic transit test, 225 patients were divided into STC group (108 cases), OOC group (36 cases), mixed group (28 cases) and NTC group (53 cases). General information such as Wexner constipation scores, clinical symptoms (decreased desire to defecate, sensation of anorectal blockage, hand-assisted defecation, spontaneous bowel movements frequency<3 times per week), the incidence, frequency within one day (hereinafter referred to as frequency), average velocity, average wave amplitude, average duration of contraction, average length of contraction, and the dynamic index (DI) of average pressure of high-amplitude propagating contraction (HAPC), as well as the frequency, average wave amplitude, average duration of contraction, and the DI of average pressure of low-amplitude propagating contraction (LAPC) were compared among the four groups. One-way ANOVA and multiple comparison, Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:The Wexner constipation scores of the STC, OOC, mixed and NTC group were 13.17±4.04, 13.97±4.55, 11.36±4.03 and 11.58±4.06, respectively, and the difference was statistically significant ( F=3.879, P<0.05). The Wexner consipation scores of the STC and OOC group were both higher than the mixed and NTC group, and the difference were statistically significant (One-way ANOVA and multiple comparison, all P<0.05). The proportion of decreased desire to defecate, sensation of anorectal blockage, hand-assisted defecation, spontaneous bowel movements frequency<3 times per week of STC, OOC, mixed and NTC group were 47.2% (51/108), 36.1% (13/36), 14.3% (4/28), 20.8% (11/53); 42.6% (46/108), 75.0% (27/36), 46.4% (13/28), 64.2% (34/ 53); 31.5% (34/108), 38.9% (14/36), 3.6% (1/28), 18.9% (10/53); 90.7% (98/108), 77.8% (28/36), 82.1% (23/28) and 62.3% (33/53), and the differences were statistically significant ( χ2=17.093, 12.463, 13.437 and 18.927; all P<0.01). The proportion of decreased desire to defecate of STC group was higher than that of mixed and NTC group, and spontaneous bowel movements frequency<3 times per week was higher than that of OOC and NTC group, and the differences were statistically significant ( χ2=10.014, 10.518, 4.418 and 19.016; all P<0.05). The proportion of sensation of anorectal blockage of OOC group was higher than that of STC and mixed group, and the proportion of hand-assisted defecation was higher than that of the mixed and NTC group, and the differences were statistically significant ( χ2= 9.511, 5.486, 10.948 and 4.363, all P<0.05). The incidence of HAPC in STC, OOC, mixed and NTC groups was 39.8% (43/108), 36.1% (13/36), 57.1% (16/28), and 60.4% (32/53), respectively, and the difference was statistically significant ( χ2=8.880, P=0.031). The incidence of HAPC in STC group and OOC group were lower than that of NTC group, and the differences were statistically significant ( χ2=6.041 and 5.050, P=0.014 and 0.025). There were no statistically significant difference in the frequency, average velocity, average amplitude, average duration of contraction, average length of contraction and DI of pressure of HAPC in four groups, and there were no statistically significant difference in the frequency, average amplitude, average duration of contraction, and DI of pressure of LAPC in the four groups (all P>0.05). Conclusions:Doctors can more clearly and objectively observe the intestinal motility characteristics of patients with different subtypes of constipation through HRCM. HRCM provides a strong basis for the diagnosis and further treatment of functional constipation, and has a high clinical application value.
		                        		
		                        		
		                        		
		                        	
            
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