Objective To study the safety and effectiveness of arc edge needle therapy for moderate to severe tenosynovitis of the flexor digitorum tendon in the thumb.Methods A total of 62 patients with moderate to severe stenosing tenosynovitis of the flexor digitorum thumb who met the inclusion criteria were collected.The patients were randomly assigned 1:1 to the arc edge needle group and the needle knife group using a random number table method.Among them,31 patients in the arc edge needle group were treated with arc edge needles,while 31 patients in the needle knife group were treated with traditional needle knife release surgery.Both groups were treated once.Record the number rating scale(NRS),range of motion(ROM),Quinell grade,and disease efficacy score(WDES)of patients before and after treatment at various stages(1 week,2 weeks,4 weeks),and at follow-up after 24 weeks to evaluate the treatment effect.Results During the 24 weeks follow-up of 62 patients after treatment,the Quinell grading comparison between the two groups showed that the arc edge needle group was better than the needle knife group(P<0.05);The total effective rate of disease efficacy score(WDES)was 96.77%in the arc edge needle group and 83.87%in the needle knife group.The clinical total effective rate of the arc edge needle group was better than that of the needle knife group(P<0.05);After treatment,both groups showed significant improvement in pain numerical score(NRS)and joint range of motion(ROM),and the degree of improvement increased over time(P<0.05);And the inter group comparison at 1 week,2 weeks,4 weeks and 24 weeks time points after treatment showed that the curved blade needle was superior to the needle knife group in improving pain and joint mobility(P<0.05).Conclusion Both the 45° tenosynovitis incision and release surgery with arc edge needle and traditional needle knife release surgery are effective in treating moderate to severe tenosynovitis of the thumb flexor digitorum tendon.However,the 45° tenosynovitis incision and release surgery with arc edge needle has significant advantages in improving pain,interphalangeal joint mobility,and safety.

Objective:To study the survival and prognostic factors for the recurrent extracranial malignant germ cell tumors (MGCTs) in children, and to explore feasible salvage treatment.Methods:A retrospective study.Pediatric patients with recurrent extracranial MGCTs diagnosed in Shanghai Children′s Medical Center between January 2010 and January 2020 were retrospectively recruited.Comprehensive treatment regimens included surgery, chemotherapy and radiation.Kaplan-Meier survival analysis and Cox regression model were employed to analyze the survival and prognostic factors for children with recurrent extracranial MGCTs.Results:A total of 172 children with extracranial MGCTs were treated, including 21 (12.2%) recurrent cases.The median time of MGCT recurrence after the end of the first treatment was 11 months.Finally, 19 patients were recruited after excluding 2 non-eligible cases, including 10 boys and 9 girls with the age at recurrence of 26 (8-170) months.The follow-up time was 57 (13-122) months.Salvage chemotherapy, complete resection and radiotherapy were performed in 16, 14 and 4 patients, respectively.The 4-year overall survival (4yr-OS) rate was (82.5±9.2)%(19 cases). The 4yr-OS rate was significantly higher in patients managed with surgery but without adjuvant chemotherapy at the initial treatment (13 cases) than those managed with chemotherapy at the initial treatment (6 cases)[(92.3±7.4)% vs.(60.0%±21.9)%, P=0.002]. Univariant and Cox multivariant regression analyses showed that failure to achieve the normal range of alpha fetoprotein after 3 cycles of chemotherapy significantly influenced the survival of recurrent extracranial MGCTs. Conclusions:For patients with recurrent extracranial MGCTs, comprehensive treatment approaches like complete surgical resection, chemotherapy, and radiotherapy offer a favorable survival rate.Specifically, recurrent and re-treated patients who initially received surgery alone without adjuvant chemotherapy have a higher survival rate compared to those who received chemotherapy during the initial treatment.

Objective To assess the impact of intravenous esketamine administered prior to car-diopulmonary bypass(CPB)initiation on ventricular function and internal carotid artery blood flow in pa-tients undergoing heart valve replacement surgery.Methods Sixty patients underwent elective CPB heart valve replacement,38 males and 22 females,aged 18-75 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅱ or Ⅲ,NYHA cardiac function classification Ⅰ-Ⅲ,and a left ventricular ejection fraction(LVEF)of≥45％,were selected.The patients were randomly divided into two groups:esketamine group(group E)and normal saline group(group C),30 patients in each group.Total intravenous anesthesia was used during the operation.Following the initiation of CPB,group E received an intravenous infusion of es-ketamine at a rate of 0.5 mg·kg-1·h-1 until the conclusion of the procedure,while group C received an equivalent volume of normal saline concurrently at the same rate.HR,MAP,CVP,and cardiac output index(CI)were recorded before anesthesia induction,during skin resection,and within 60 minutes after stopping CPB.LVEF,left ventricular global longitudinal strain(GLS),global longitudinal time-to-peak strain standard deviation(GLTSD),global circumferential strain(GCS),global circumferential time-to-peak strain standard deviation(GCTSD),right ventricular ejection fraction(RVEF),right ventricular GLS,and GLTSD were obtained during skin resection,within 40 minutes of CPB,and 60 minutes after stopping CPB.rScO2,BIS,concentrations of Hb and lactic acid(Lac),peak systolic flow velocity(SPV),quantity of flow-internal carotid artery(Q-ICA),and blood flow resistance index(RI)were recorded before anesthesia induction,during skin resection,within 40 minutes of CPB,and within 60 minutes after stopping CPB.Concentrations of cardiac troponin Ⅰ(cTnⅠ),alanine aminotransferase(ALT),creatinine(Cr),and neuron-specific enolase(NSE)were recorded before anesthesia induction and 6 hours after operation.Spon-taneous resuscitation after CPB,postoperative extubation time,duration of ICU stay,total hospital stay,in-cidence of adverse cardiac events,and 30-day postoperative mortality were recorded.Results Compared with group C,group E exhibited a significant increase in CI within 60 minutes after stopping CPB(P＜0.05).The LVEF,RVEF,and right ventricular GLS demonstrated significant increases within 60 minutes after stopping CPB in group E compared with group C(P＜0.05).The left ventricular GLS and left ven-tricular GCTSD displayed significant increases 30 minutes after stopping CPB in group E compared with group C.The RI exhibited a significant increase within 40 minutes of CPB in group E compared with group C(P＜0.05).There were no significant differences in cTnⅠ,ALT,Cr,NSE,spontaneous resuscitation affter CPB,postoperative extubation time,duration of ICU stay,total hospital stay,incidence of cardiac adverse events,and 30-day postoperative mortality between the two groups.Conclusion Administration of esket-amine following the onset of CPB in patients undergoing cardiac surgery demonstrates a significant elevation in CI post-CPB cessation.Furthermore,it may augment ventricular longitudinal strain,thereby enhancing myocardial contraction,leading to increased postoperative ventricular ejection fraction,and sustaining hemo-dynamic stability.

Objective:To summarize the clinical characteristics, prognostic factors and treatment outcomes of childhood aggressive mature B-cell lymphoma after liver transplantation.Methods:This retrospective study included 18 children with newly diagnosed aggressive mature B-cell lymphoma after liver transplantation and treated from June 2018 to June 2022 in the Department of Hematology and Oncology of Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine. Clinical characteristics, treatment and outcomes of patients at last evaluation were analyzed. Overall survival (OS) and event free survival (EFS) rates were calculated by Kaplan-Meier method and Log-Rank analysis was performed to find factors of poor prognosis.Results:Among all 18 patients, there were 6 males and 12 females, and the age of onset was 40 (35, 54) months. The interval from transplant to tumor diagnosis was 21 (17, 35) months and 5 patients had early onset disease (<1 year since transplant). Seventeen patients had abdominal lesions. Diarrhea, vomiting and abdominal masses were the main clinical manifestations. All patients were Epstein-Barr virus (EBV) related posttransplant lymphoproliferative disorders (PTLD). One patient received individualized therapy due to critical sick at diagnosis, and the remaining 17 patients received CP (cyclophosphamide, methylprednisolone plus rituximab) and (or) modified EPOCH (prednisone, etoposide, doxorubicin, vincristine, cyclophosphamide plus rituximab) regimens. Of all 18 patients, 15 cases got complete response, 2 cases got partial response, 1 patient died of severe infection. The 2-year OS and EFS rates of 18 patients were (94±5)% and (83±8)%, respectively. None of age, gender or early onset disease had effect on OS and EFS rates in univariate analysis (all P>0.05). Conclusions:The symptoms of PTLD were atypical. Close surveillance of EBV-DNA for patients after liver transplantation was crucial to early stage PTLD diagnosis. CP or modified EPOCH regimen was efficient for pediatric patients with aggressive mature B cell lymphoma after liver transplantation.

Objective: To analyze the association between sleep chronotype and suicidal psychological behaviors among middle school students, so as to provide a scientific basis for the prevention and control of middle school students suicide. Methods: In October 2021 and November 2022, a multistage cluster sampling method was used to conduct baseline and followup surveys in Shenyang, Zhengzhou, Nanchang, and Taiyuan cities in China, and a total of 6 656 middle and high school students were included as the research subjects. The Chisquare test was used to analyze the groups differences, and generalized estimating equation was used to analyze the associations between middle school students sleep chronotype and suicide ideation, suicide plan and suicide attempt, and the grade stratification was carried out. Results: Baseline detection of suicide ideation, suicide plan, and suicide attempt were 26.3%, 12.6%, and 5.3%, respectively, with followup rates of 21.0%, 10.0%, and 4.8% for each, and varied significantly by gender, academic stress, smoking or alcohol use, and anxiety or depressive symptoms among middle school students (χ2=11.93-880.20, P<0.05). After adjusting for gender, academic stress, physical activity, smoking, alcohol use, anxiety and depressive symptoms, generalized estimating equations showed that compared with the morning sleep chronotype, the OR(95%CI) for suicide ideation, suicide plan and suicide attempt were 1.61(1.36-1.89), 1.66(1.35-2.05) and 1.41(1.06-1.88) among evening chronotype students, and were higher among junior 1.78(1.39-2.27), 2.00(1.48-2.69) and senior middle school students 1.84(1.44-2.35), 1.67(1.20-2.33) (P<0.05). Conclusion There is a positive association between evening sleep chronotype and middle school students suicidal psychological behavior, and improving sleep chronotype may be one of the effective measures to prevent middle school students suicide.

To investigate the correlation of polymorphisms at the rs1837253 and rs3806933 loci of the thymic stromal lymphopoietin(TSLP)gene with asthma susceptibility and Eos,IgE,and FeNO levels in children.A total of 143 asthmatic children were selected as the study group,and 112 healthy children undergoing routine health examinations at the same hospital were chosen as the control group.The MassARRAY SNP genotyping technology was used to detect the genotypes at two loci,while serum IgE levels were determined by using the turbidimetric scattering method.The distribution differences in genotype and allele frequencies between the two groups were analyzed,along with the effects of different genotypes on Eos,IgE,and FeNO levels.There was no statistically significant difference in the distribution of rs1837253 allele and genotype frequencies as well as rs3806933 allele frequencies between the two groups(P＞0.05).However,asthma group rs3806933 CT genotype frequency was higher than the control group,and CC genotype frequency was lower than the control group(P＜0.05).Compared with the wild-type genotypes,children who carried rs1837253 CT+CC and rs3806933 CT,CT+TT genotypes had an increased risk of asthma(CT+CC vs TT:OR=2.737,95%CI:1.514-4.945;CT vs CC:OR=2.058,95%CI:1.194-3.543;CT+TT vs CC:OR=1.843,95%CI:1.109-3.062).There was an overall statistical difference in Eos counts among the three genotypes at the rs1837253 locus in the asthma group(P＜0.05,correction for multiple comparisons P＞0.05),but not in the control group(P＞0.05).There were no statistically significant differences in Eos%,IgE,and FeNO levels among the genotypes at the two loci and no significant difference in Eos counts among genotypes at the rs3806933 loci(P＞0.05).Taken together,polymorphisms at rs1837253 and rs3806933 loci in the promoter region of the TSLP gene are associated with asthma susceptibility in children.rs3806933 CT genotype may serve as a potential genetic marker for asthma,and rs1837253 CT+CC and rs3806933 CT+TT genotypes are risk factors for asthma in children;the rs1837253 locus polymorphism tended to affect blood Eos counts,while the two SNPs were not associated with Eos%,serum IgE,and FeNO levels.

Objective:To explore the mediating effect of carotid atherosclerosis on serum triglyceride-glucose (TyG) index and silent lacunar infarction (SLI) in non-diabetic population.Methods:A total of 2 482 patients were selected from the Health Examination Center of Hebei General Hospital from January 2019 to December 2021. The basic demographic information, biochemical parameters, calculated TyG index and carotid plaque score were collected. SLI was diagnosed according to the criteria formulated by Chinese Society of Neurology. Participants were divided into SLI group and non-SLI group according to whether there was SLI in brain magnetic resonance imaging, and the non-SLI group was normal without lacunar infarction. Spearman correlation analysis was used to explore the correlation between TyG index and carotid plaque score. Binary Logistic regression analysis was used to analyze the effects of TyG index and carotid plaque score on SLI. Bootstrap was used to explore whether carotid plaque score mediated the association between TyG index and SLI.Results:There were 471 patients (18.98%) who had SLI, and 2 011 patients (81.02%) did not. Carotid plaque score [2(0, 5) vs 1(0, 3)] and TyG index [7.17(6.81, 7.64) vs 7.12(6.77, 7.54)] were increased in the SLI group compared with the non-SLI group ( Z=-4.213, Z=-2.636, P<0.05). Spearman correlation analysis showed that carotid plaque score was positively correlated with TyG index ( r=0.083, P<0.001). Multivariate Logistic regression analysis indicated that carotid plaque score ( OR=1.047, 95% CI 1.002-1.094) and TyG index ( OR=1.329, 95% CI 1.106-1.598) were independent risk factors for SLI ( P<0.05). Mediated effect analysis showed that TyG index had a direct effect on the incidence of SLI (β=0.265, 95% CI 0.102-0.428). Carotid plaque score partially mediated the effect of TyG index on the incidence of SLI (β=0.024, 95% CI 0.009-0.043), and the mediating effect accounted for 8.30% of the total effects. Conclusion:In non-diabetic population, TyG index and carotid plaque score are predictors of SLI, and the carotid plaque score is a partial mediator in the effect of TyG index on the incidence of SLI.

Objective:To evaluate the value of autologous platelet-rich plasma (aPRP) separation-retransfusion for blood conservation in the patients undergoing thoracolumbar laminectomy.Methods:Sixty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-60 yr, with body mass index of 19-30 kg/m 2, scheduled for elective thoracolumbar laminectomy, were divided into 2 groups ( n=30 each) using a random number table method: conventional blood conservation group (group C) and aPRP blood conservation group (group aPRP). Group C received tranexamic acid and autologous blood salvage-retransfusion. Group aPRP received aPRP separation-retransfusion, tranexamic acid and autologous blood salvage-retransfusion. The volume of allogeneic blood transfused, percentage of patients who did not need the allogeneic blood transfusion and adverse reactions were recorded. Venous blood samples were collected for blood routine examination and for determination of the plasma concentrations of interleukin-6 (IL-6) and IL-10 at 1 day before operation (T 0), when the volume of blood loss reached 500 ml (T 1), immediately after surgery (T 2), and at 24 and 48 h after surgery (T 3, 4). The incidence of hypoxemia and amount of 24-h wound drainage were recorded. Results:Compared with group C, the amount of allogeneic red blood cells, plasma transfused and 24-h wound drainage were significantly decreased ( P<0.05), the percentage of patients who did not need the allogeneic red blood cell and plasma transfusion was increased (30% vs 47%, 10% vs 60%, P<0.05), the plasma concentrations of IL-6 and IL-10 at T 2-4 were significantly decreased ( P<0.05), and the incidence of hypoxemia in PACU was decreased in group aPRP (27% vs 10%, P<0.05). Conclusions:aPRP separation-retransfusion can provide marked improvement in conventional blood conservation in the patients undergoing thoracolumbar laminectomy.

Humans ; Aortic Valve/surgery* ; Retrospective Studies ; Transcatheter Aortic Valve Replacement ; Sex Factors ; Heart Valve Prosthesis Implantation ; Treatment Outcome ; China ; Aortic Valve Stenosis/surgery* ; Risk Factors ; Risk Assessment

Human-derived lysozyme is a general term for a group of naturally occurring alkaline proteins in the human body that are capable of lysing bacterial cell walls. Its action is characterized by its ability to cleave the β-(1,4)-glycosidic bond between N-acetylglucosamine and N-acetylmuramic acid in peptidoglycan. Human-derived lysozyme has a variety of properties such as antibacterial, anti-inflammatory, antiviral and immune enhancing, and is therefore widely used in the domestic and international pharmaceutical markets. This review summarizes the structural features, expression sites, biological functions of human-derived lysozymes and its market applications.
Humans ; Muramidase ; Anti-Bacterial Agents