Ethnicity and health inequalities: an empirical study based on the 2010 China survey of social change (CSSC) in Western China

BACKGROUND

In China, ethnic minorities often live in frontier areas and have a relatively small population size, and tremendous social transitions have enlarged the gap between eastern and western China, with western China being home to 44 ethnic minority groups. These three disadvantages have health impacts. Examining ethnicity and health inequality in the context of western China is therefore essential.

METHODS

This paper is based on data from the 2010 China Survey of Social Change (CSSC2010), which was conducted in 12 provinces, autonomous regions and province-level municipalities in western China and had a sample size of 10,819. We examined self-rated health and disparities in self-rated health between ethnic minorities and Han Chinese in the context of western China. Self-rated health was coded as poor or good, and ethnicity was coded as ethnic minority or Han Chinese. Ethnic differences in self-rated health was examined by using binary logistic regression. Associations among sociodemographic variables, SES variable, health behaviour variable, health problem variables and self-rated health were also explored.

RESULTS

Fourteen percent of respondents reported their health to be poor. A total of 15.75% of ethnic minorities and 13.43% of Han Chinese respondents reported their health to be poor, indicating a difference in self-rated health between ethnic minorities and Han Chinese. Age, gender, marital status, education, alcohol, and health problems were the main factors that affected differences in self-rated health.

CONCLUSION

In western China, there were obvious ethnic disparities in self-rated health. Elderly ethnic minorities, non-partnered ethnic minorities, ethnic minorities with an educational level lower than middle school, and ethnic minorities with chronic disease had higher odds of poor self-rated health.

[Clinical efficacy of damage control orthopaedics in treatment of patients with severe traumatic brain injury combined with limb fracture]

Objective: To explore the clinical efficacy of damage control orthopaedics in treatment of patients with severe traumatic brain injury combined with limb fracture. Methods: Total 149 patients with sTBI combined with limb fracture treated in Emergency Surgery Department of Shandong University Qilu Hospital from January, 2011 to December, 2018 were collected. Patients that were treated with immediate definitive fixation before March 31st, 2013 were included into the routine treatment group (group A, 47 cases), and that were treated with damage control orthopaedics (DCO) after April 1st, 2013 were included into the DCO group (group B, 102 cases). The clinical data during hospitalization and prognosis 3 months after injury was analyzed retrospectively. Then according to the risk of postoperative ICP increase, the two groups were divided into low risk subgroup and high risk subgroup. The postoperative ICP, length of stay and GOS score were statistically analyzed. Results: There were no statistically significant differences in sex, age, preoperative GCS score, imaging type of lesion and initial intraoperative ICP between the two groups. The postoperative ICP and incidence of coagulation dysfunction were significantly higher in group A [(17.1±4.6) mmHg, 29.8%] than that in group B[(15.0±4.3) mmHg, 13.7%] separately(P<0.05), and there was no significant difference of length of stay and GOS score between the two groups (P=0.475 and 0.097, respectively). As for the subgroup with low risk of postoperative ICP increase, there was no significant difference in postoperative ICP and GOS score between group A and B, and the length of stay of group B was significantly longer than that of group A (P<0.05). As for the subgroup with high risk of postoperative ICP increase, there was no significant difference in the length of stay between group A and B (P=0.667), and for group A the postoperative ICP was higher and GOS score was lower than that of group B (P<0.05). Conclusions: For patients with sTBI combined with limb fracture, the application of DCO should be based on the severity of traumatic brain injury. For patients with high risk of postoperative ICP increase, DCO can significantly improve the prognosis of patients.

[Space maintenance for the premature loss of the second primary molar]

Space reduction after the premature loss of the second primary molars is one of the important factors affecting the occurrence of malocclusion, often increasing the demand for orthodontic treatment. It has great significance to select and apply appropriate appliances to maintainthe space soon after the premature loss of the second primary molars. The space should be maintained until the adjacent teeth and the successors erupt successfully. This review summarizes the selection and clinical application of the space maintainer for the premature loss of the second primary molars in different periods, to improve dentists' awareness of the importance of space maintainers and to provide advises for clinical choices.

[A clinical study of Proteus syndrome caused by a mosaic somatic mutation in AKT1 gene]

Objective: Proteus syndrome is a rare disease. The aim of the present study was to analyze the clinical characteristics and gene mutations of Proteus syndrome with a case report and relevant literature review. Methods: Clinical data of the patient with Proteus syndrome were collected in detail and biochemical measurements and radiological examinations were conducted. Tissues from phalanges with lesions were obtained to extract DNA, and Sanger sequencing of AKT1 gene was carried on. The pathogenic mutation was further tested in peripheral blood samples of the patient, his parents and 250 healthy volunteers. Orthopaedic surgery was performed on the affected limbs of the patient. Results: The patient was presented with progressive overgrowth of the right extremity, scoliosis, cerebral connective tissue nevus and lower extremity venous. A heterozygous mutation of AKT1 gene (c. 49G>A) was identified in DNA extracted from the affected bone tissue of the patient, but not be found in genomic DNA of peripheral blood samples from the patient, his parents and 250 healthy volunteers. Movement function of the affected limb improved significantly after the operations. Conclusions: The prominent features of Proteus syndrome are overgrowth of one extremity and cerebral connective tissue nevus. A mosaic somatic mutation of AKT1 gene is one of the pathogenic mutations for Proteus syndrome, and orthopedic surgery may be a good way to improve symptoms of the disease.

[Clinical outcome of postchemotherapy retroperitoneal lymph node dissection and predicting retroperitoneal histology in advanced nonseminomatous germ cell tumours of the testis]

Objective: To explore the clinical outcome of advanced testicular nonseminomatous germ cell cancer patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND), and to analyze the relevant prognostic factors of lymph node pathological. Methods: A total of 43 consecutive testicular nonseminomatous germ cell cancer patients underwent PC-RPLND between March 2001 and December 2014 in Department of Urology at Sun Yat-sen University Cancer Center were retrospectively reviewed. The average age of the patients was (29.0±11.5) years (ranging from 12 to 58 years). Before PC-RPLND, 22 patients were classified as phase Ⅱ, while 21 were phase Ⅲ. Primary tumor histology revealed seminomatous elements in 19 cases, embryonal cell carcinoma in 22 cases, yolk sac tumor in 13 cases, chorionic carcinoma in 3 cases, mature teratomatous elements in 11 and immature teratomatous elements in 2 cases. Patients were treated with cisplatin-based chemotherapy after orchectomy and then underwent surgical resection of retroperitoneal lymph nodes.After PC-RPLND, all patients underwent a periodic review including the blood routine, biochemistry routine and computed tomography or ultrasonograph of the chest, the abdomen and the pelvis. The association of pathological data with patient's clinic features and the correlations between molecular features detected with each other were assessed by the t test, χ(2) and Fisher's exact test. Multivariate logistic regression were used to assess prognostic factors. Results: The median operative time was 278 minutes (ranging from 50 to 715 minutes). Median blood loss was 425 ml (ranging from 50 to 5 000 ml). Eight patients received blood transfusion intra-operatively, 2 patients underwent adjunctive surgical procedures, 4 patients developed ileus and 4 had an ascites chylosus following PC-RPLND, 1 patient had a postoperative hyperthermia and retrograde ejaculation was present in 10 patients. The transverse diameter of the residual tumor in patients ranged from 0.8 to 18.2 cm. Necrosis, teratoma and viable germ cell tumors were found in 15, 17 and 11 of all patients. The median follow-up time was 46 months (ranging from 6 to 169 months). There were 39 patients had no tumor recurrence, 7 patients were found recurrence after PC-RPLND, 5 died of malignant germ cell tumor. The normal serum lactate dehydrogenase (LDH) level before chemotherapy (HR=25.811, 95%CI: 0.678 to 982.624, P=0.017) and relative changes more than 50% in retroperitoneal lymph node size (HR=0.016, 95%CI: 0 to 0.698, P=0.032) were statistically significant prognostic factors of the presence of necrosis. Conclusions: Since most residual masses are not sensitive to chemotherapy, PC-RPLND is still an essential part of the treatment of metastatic testicular nonseminomatous germ cell cancer. Patients with the normal serum LDH level before chemotherapy and a shrinkage of 50% or more in retroperitoneal mass have a considerably chance of having necrosis in the retroperitoneum resection. This may help to refine the selection of candidates for PC-RPLND.

[Rush poppers use and risks of human papillomavirus infection among men who have sex with men in Urumqi: mediation effect through high-risk sexual behaviors]

Objective: To study the prevalence of rush poppers use among men who have sex with men (MSM) in Urumqi and to analyze the mediating effect of high-risk sexual behavior between the use of rush poppers and human papillomavirus (HPV) infection. Methods: From January to June 2018, 651 MSM were recruited through network and publicity. Data was collected by using online questionnaire and anal swab were collected from them for HPV genotyping. According to Baron and Kenny's criterion, multivariate logistic regression models was used to analyze the mediation effect of high-risks sexual behaviors (multiple sexual partners, anal intercourse condom use) between rush poppers use and HPV infection. Results: A total of 651 subjects were (32.0±8.0) years old, and 174 subjects (26.7%) had ever used rush poppers in the past 6 months, while 350 subjects (46.9%) had more than 2 sexual partners and 188 subjects (28.9%) did not use anal condom. After adjusting age and marital status, rush poppers use was associated with HPV infection (OR (95%CI) was 2.34 (1.63-3.36), P<0.05), and sexual partners in the past 6 months (OR (95%CI) was 2.72 (1.89-3.93), P<0.05).After adjustment for age, marital status, sexual partners in the past 6 months, and anal condom use, rush poppers use was still associated with HPV infection (OR (95%CI) was 2.21 (1.53-3.19), P<0.05).After adjustment and adjustment of age, marital status, rush poppers use and anal sex condom use, the number of sexual partners at nearly 6 months was still associated with HPV infection (OR (95%CI) was 1.46 (1.05-2.04), P<0.05). Conclusion: Sexual partners in the past 6 months have a mediation effect between rush poppers use and HPV infection in Urumqi. For the prevention of sexually transmitted diseases, we should focus on rush poppers use.

[Posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a case report]

This case report concerns a 22-year-old woman who had been diagnosed with systemic lupus erythematosus (SLE). She had intermittent fever, butterfly erythema, photosensitivity, oral ulcers, and multiple arthralgia in the past seven years, but she did not adhere to regular treatments. The edema of the lower extremities and face aggravated in the recent two weeks, so she was admitted to our Department of Rheumatology and Clinical Immunology. Meanwhile, we found she had severe hypertension, the maximal blood pressure was 170/120 mmHg. The patient had high SLE disease activity (the disease activity index score was as high as 23) with blood involvement, acute renal insufficiency, multiple serous effusion and rash. After one week treatments of intravenous methylprednisolone 80 mg daily and other drugs, her conditions made some extent improvement. However, she suffered sudden epileptic attacks. No positive neuropathological signs were found, and the blood pressure was up to 190/130 mmHg before the onset of the seizures. Her cerebrospinal fluid (CSF) pressure was 330 mmH₂O, the CSF protein level was normal value, and the white blood cell count was 0 cell/mm³, with no signs of infection. Cranial MRI showed vasogenic edema at bilateral parietal, occipito-parietal regions, and centrum ovale. We prescribed drugs of decreasing intracranial pressure, intravenous drugs of decreasing blood pressure and midazolam for sedation, without corticosteroid impulse therapy. She recovered consciousness in the next day, without epilepsy recurrence. We eventually diagnosed it as posterior reversible encephalopathy syndrome (PRES), according to the history, laboratory results, imaging featuresand clinical outcome. PRES is a disorder of reversible subcortical vasogenic brain edema in patients with acute neurological symptoms (eg, seizures, encephalopathy, headache, and visual disturbances). PRES is mainly caused by blood pressure changes or endothelial injury, which lead to breakdown of the blood-brain barrier and subsequent brain edema. Most patients have a favourable prognosis. SLE complicated with PRES is not rare, especially in patients with disease activity, hypertension, lupus nephritis and/or renal insufficiency, and use of cytotoxic drugs, early recognition and appropriate treatment remain important. Brainstem involvement, intracranial hemorrhage, renal insufficiency and high disease activity of lupus are risk factors for poor prognosis.

[A case of gout secondary to primary myelofibrosis]

A 52-year-old man was referred to our department with a 2-year history of polyarthritis. He was diagnosed as gout due to acute arthritis of bilateral feet dorsum 2 years ago,but he didn't receive any standard treatment. 1 year ago,there were more and more joints evolved during the gout attack, and many subcutaneous nodules occurred. When he presented to our clinic 1 month ago,the urate acid level was as high as 715 μmol/L. Moreover, we could find bone erosion in the X rays of his hand and foot,as well as synovitis,double contour sign and tophus on the ultrasound examination. The diagnosis of gout was clearly and definitely. However, he had leukocytosis and thrombocytosis for 4 years in the past history, and the urate acid level was only 400 μmol/L at that time. He also had well-controlled hypertension. The family history was unremarkable. Furthermore, we found megalosplenia on his physical examination. The bone marrow examination showed myelofibrosis and JAK2 V617F gene was positive. He was diagnosed as primary myelofibrosis and treated with interferon-α, together with urate acid-lowing therapy (febuxostat 60 mg once daily). Following-up for 1 year,the dosage of febuxostat decreased to 40 mg once daily, and the patient didn't have gout attack again, some of the tophus diminished, and the urate acid level ranged from 400 to 500 μmol/L. Gout is a common disease in clinical practice,usually combined with metabolic syndrome,chronic renal failure and specific drugs using (diuretic and calcineurin inhibitors). However,it is relatively rare to see gout associated with myeloproliferative diseases, including polycythemia vera, primary thrombocythemia, primary myelofibrosis and chronic myelocytic leukemia. In these diseases, the turnover of nucleic acids is greatly augmented, and an excess of purine metabolites, including uric acid, is released. In the natural course of gout, the appearance of tophus from the first onset of arthritis usually takes several years. This patient only had one traditional risk factor, but his urate acid level was remarkably high and he developed tophus in a short term. After treatment of primary myelofibrosis, the symptom of gout partially alleviated. Careful physical examination and medical history taking lead to the diagnosis of secondary gout, which should be reminded in the daily practice.

[Application of carbon nanoparticle in neck Ⅵ lymph node dissection for papillary thyroid carcinoma]

Objective:To investigate the application value of carbon nanoparticle lymph tracer in Ⅵ lymph node dissection for papillary thyroid cancer.Method:One hundred and forty-eight patients with papillary thyroid cancer from October 2015 to May 2016 were enrolled into the retrospective analysis. Seventy-five cases with carbon nanoparticle injected in operation were divided into observation group, while the other seventy-three cases without lymph tracer were divided into control group. The number of neck Ⅵ lymph nodes and metastatic lymph nodes between the two groups were compared, as well as the incidence of parathyroid injury and postoperative hypocalcemia. Result:There were no significant difference in age, gender, tumor size, pathology or type of operation between the two groups(P>0.05). Parathyroid injury incidence in the observation group significantly lower than the control group (5.33% vs 5.33%, P< 0.05). There was significant difference in the number of neck Ⅵ lymph node dissection between the two groups (observation group: 6.51±4.65, control group: 4.42±3.10, P< 0.05).Conclusion:Carbon nanoparticle injected as a lymph tracer in thyroid surgery is helpful, the characteristics of the parathyroid gland negative imaging can effectively decrease the rate of parathyroid gland injury.

[Retrospective clinical analyses of otogenic intracranial infections]

Objective: To investigate the clinical characteristics and treatment options for otogenic intracranial infections. Method: Clinical records of all the patients of otogenic intracranial infections admitted to the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were retrospectively analyzed. Their clinical presentations, radiological findings, culture results, and medical and surgical therapy modalities, as well as treatment outcomes were studied. Results: Sixteen cases were identified. The majority of the otogenic patients had a history of cholesteatoma, other rare events included congenital cerebrospinal fluid otorhinorrhea, Gorham-Stout disease and after radiation therapy for nasopharyngeal carcinoma. Meningitis, cerebral venous thrombosis and brain abscess were the primary intracranial infection. Eight patients had received modified radical mastoidectomy at least one time. Results of routine culture for cerebrospinal and pus samples had high negative rate. All patients received initial empirical broadspectrum intravenous antibiotics therapy. Four cases of brain abscesses were drained or excised at the same time for otologic surgery. The mortality rate was 6.25% (1 case). Conclusions: Cholesteatoma is still the most commonly primary disease of otogenic intracranial complications. Diagnosis and treatment of otogenic intracranial infections require multidisciplinary cooperation. Surgical intervention for primary ear lesions and intracranial abscess is still the main option in the treatment of otogenic intracranial infections.

[Comparison of clinical values in decision making between cone beam CT and conventional approach in furcation involvement of maxillary molar]

Objective: To compare the use of cone beam computed tomography (CBCT) and conventional approach (clinical probing and periapical radiograph) in assessing furcation involvement (FI) of maxillary molars and making treatment decisions. Methods: Thirty-two subjects were selected from the pool of patients at the Department of Periodontology, Tianjin Stomatology Hospital & Hospital of Stomatology, NanKai University from January 2015 to December 2016. All the patients have a diagnosis of generalized chronic periodontitis. Ninety-five maxillary molar with FI from the radiography database were analysed. Two doctors used conventional approach and CBCT images to assess FI and make treatment decision respectively. If the clinical and radiographic findings did not clearly indicate a distinct periodontal therapy, two treatment options were considered. Results: There was statistical difference of the FI diagnosis between traditional group and CBCT group assessment of the 95 molars (P=0.000). Thirty-five maxillary molars (36.8%, 17 patients) got two treatment recommendations by conventional approach but 7 (7.4%, 5 patients) by CBCT-based approach. When with the less invasive treatment recommendation, there was statistical difference between conventional approach and CBCT-based approach (P=0.001). An agreement was observed in 63.2% (60/95) of the teeth, while in another 29.5% (28/95) the CBCT-based treatment decision was more invasive than the conventional approach. When with the more invasive treatment recommendation, there was also statistical difference between two approaches (P=0.045). An agreement was observed in 86.3% (82/95) of the teeth, while in another 3.2% (3/95) the CBCT-based treatment decision was more invasive than the conventional approach. Conclusions: CBCT images of maxillary molars may provide detailed information of FI and a reliable basis for treatment decision.

[Correlation between nailfold capillaroscopic findings and presence of interstitial lung disease in systemic sclerosis patients]

OBJECTIVE

To evaluate the correlation between nailfold capillaroscopic (NC) findings and the presence of interstitial lung disease (ILD) in systemic sclerosis (SSc) patients.

METHODS

We retrospectively involved 71 SSc patients, 45 patients with ILD. NC was performed in all the patients according to the standard method. The NC findings were semi-quantitatively scored, including enlarged and giant capillaries, hemorrhages, loss of capillaries, avascular areas, ramified/bushy capillaries and disorganization of the vascular array. The demographic and clinical data collected were gender, age, presence/absence of Raynaud phenomenon (RP), duration of RP, serological acute phase reactants and antibodies, presence of ILD (also evaluated the CT score for ILD) and pulmonary function parameters.

RESULTS

Among the 71 patients, the frequency of the women was 91.5%, the mean age was (52.59±12.77) years, and disease duration was (3.00±6.00) years. NC changes of the scleroderma pattern were observed in 90.1% patients. There were 45 patients with ILD and 26 patients without ILD. The patients with ILD had significantly higher loss of capillaries score [0.50 (1.03) vs. 0.00 (0.43), P=0.003], avascular area score [0.75 (1.24) vs. 0.25 (0.83), P=0.006] and ramified/bushy capillaries score [0.33 (0.88) vs. 0.13 (0.25), P=0.006] compared with those without ILD. Moreover, ramified/bushy capillaries score together with diffused SSc were independent risk factors for the presence of ILD. And the score of giant capillaries were significantly lower in the patients with more severe ILD group [0.25 (0.94) vs. 0.00 (0.28), for the mild and severe ILD groups respectively, P=0.019]. There was no statistically significant difference between the two groups with respect to the scores of enlarged capillaries, hemorrhages, or disorganization of the vascular array.

CONCLUSION

Capillary deletion and severe deformity in NC were associated with the presence of ILD in SSc patients. And patients with less giant capillaries had more severe ILD involvement. These indicated that NC maybe a useful tool to evaluate ILD in SSc.

[Association between D-dimer levels and clinical events in patients with mechanical heart valve replacement under oral anticoagulation therapy]

Objective: To investigate the association between D-dimer levels and clinical events in patients with mechanical heart valve replacement under oral anticoagulation therapy. Methods: This prospective study included 640 consecutive patients underwent mechanical heart valve replacement in Wuhan Asia Heart Hospital between January 2013 and June 2014.Patients were assigned to abnormal D-dimer group (D-dimer level>cut off value, n=88) and normal D-dimer group (D-dimer level≤cut off value, n=552) according to D-dimer levels measured at 3 months after the initiation of oral anticoagulation therapy.All patients were followed up for 24 months or until the observation of the end points, which included thrombotic events, bleeding events and all-cause deaths.The anticoagulation therapy was monitored once per 1-2 months by the international normalized ratio (INR), and the target value was 1.8-3.0. Results: During a follow-up period of 24 months, rates of total clinical events (19.30%(17/88) vs. 5.8%(32/552), P<0.01), thrombotic events (11.4%(10/88) vs. 2.3%(13/552), P<0.01), and all-cause deaths (8.0%(7/88) vs. 2.0%(11/552), P<0.01) were all significantly higher in abnormal D-dimer group than in normal D-dimer group.There were no significant difference in bleeding events between the two groups (2.3%(2/88) vs. 3.1%(17/552), P=0.77). Multivariate Cox regression analysis showed that high D-dimer level was an independent risk factor of total clinical events (HR=3.86, 95%CI 1.92-7.76, P<0.01), thrombotic events(HR=5.29, 95%CI 2.12-13.10, P<0.01), and all-cause deaths(HR=5.32, 95%CI 1.71-16.60, P<0.01), but which was not correlated with bleeding events(HR=1.36, 95%CI 0.27-6.84, P=0.71). Conclusion: Elevated D-dimer levels are linked with clinical events in patients with mechanical heart valve replacement under oral anticoagulation therapy.

[Performance of the 2015 ACR/EULAR classification criteria compared with other classification criteria for diagnosis of gout in Chinese patients]

OBJECTIVE

To evaluate the ability of 2015 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria to diagnose gout compared with the widely used 1977 American Rheumatism Association (ARA) criteria and other criteria in clinical practice in Chinese patients, and to compare the sensitivity and specificity of different classification criteria for gout in early and established diseases.

METHODS

The patients who had ankle arthritis and visited the Department of Rheumatology and Clinical Immunology, Peking University First Hospital between February 2012 and February 2016 were screened. The patients who had been already diagnosed with gout or pyrophosphate deposition disease through arthrocentesis or tissue aspiration and those who had been diagnosed with rheumatoid arthritis, spondyloarthritis, and osteoarthritis were excluded. The patients were diagnosed by two experienced rheumatologists and all of them were followed up for at least one year. Early disease was defined as symptom onset of no more than 2 years; established disease was defined as symptom duration of more than 2 years. The 2015 ACR classification criteria were divided into clinical form with clinical parameters included and complete form with not only clinical parameters but also synovial fluids tests, imaging findings and monosodium urate (MSU) included. The two forms above were short for "clinical form (incorporating clinical parameters)" and "complete form (incorporating imaging and MSU data)" respectively.

RESULTS

In this study, 284 patients suffering from ankle arthritis were inclu-ded in the study, 219 of them were classified as gout and 65 of them had alternative diagnoses. The sensitivity and specificity of 2015 ACR complete form (incorporating imaging and MSU data) for diagnosing gout were 88.13% and 95.38%, respectively. The area under the curves (AUC) of 2015 ACR "complete form (incorporating imaging and MSU data)", 2015 ACR "clinical form (incorporating clinical parameters)", 2010 Netherlands criteria and 1977 ARA criteria were 0.982, 0.983, 0.963, and 0.928, respectively. For the 94 early gout patients, the AUC of the above criteria were 0.973, 0.968, 0.916, and 0.910, respectively. For the established gout patients, the AUC were 0.987, 0.991, 0.982, and 0.936, respectively. For the patients with disease duration within two years, the odd ratio (OR) for sensitivity of 2015 ACR "complete form (incorporating imaging and MSU data)", 2015 ACR "clinical form (incorporating clinical parameters)", 2010 Netherlands criteria and 1977 ARA criteria were 1.562 (1.003-2.435), 1.500 (1.001-2.346), and 1.812 (1.177-2.791), nevertheless, for the patients with established gout, the OR were 1.702 (1.300-2.229), 1.607 (1.224-2.110), and 1.821 (1.396-2.377), respectively.

CONCLUSION

The 2015 ACR/EULAR criteria are more accurate in gout diagnosis compared with the 1977 ARA criteria by elevating the sensitivity and specificity, in respective of the disease duration. The 2015 ACR/EULAR criteria may serve as new diagnostic tools in daily clinical practice in Chinese patients.

[A Sjögren's syndrome patient with prominent aortic valve involvement: a case report]

Sjögren's syndrome is a systemic autoimmune disease which is characterized by xerosis, and multiple organs can be affected, causing interstitial lung disease, renal tubular acidosis, blood system involvement, peripheral neuropathy, and liver damage, but cardiac involvement is rare. Here we report a case of Sjögren's syndrome with prominent aortic valve involvement. A 66-year-old woman was admitted for exertional dyspnea, and the ultrasonic cardiogram showed severe aortic stenosis with moderate regurgitation. Preoperative examination for valve replacement found that the patient had elevated erythrocyte sedimentation rate and positive rheumatoid factor, so she was referred to the rheumatology outpatient department for further examination and treatment. Further questions about medical history found that the patient had dry eyes and dry mouth for more than ten years, and had obvious caries. Further laboratory examination showed elevated serum immunoglobulin levels and positive anti-nuclear antibody. The findings of ophthalmologic examination and labial gland biopsy also supported the diagnosis of Sjögren's syndrome. After treatment of glucocorticoids and hydroxychloroquine for ten months, her dyspnea symptoms were obviously improved in the patient, and the rheumatoid factor had become negative while her erythrocyte sedimentation rate normal. Repeated ultrasonic cardiogram examination showed that her aortic stenosis was also improved. The patient has been followed up for four years, and her condition kept stable. Cardiac involvement in Sjögren's syndrome can affect all parts of the heart, but valve involvement is relatively rare. The specific relationship between cardiac involvement and Sjögren's syndrome and the mechanisms behind these associations both need further research.

Effects of precursor solution composition on the performance and I-V hysteresis of perovskite solar cells based on CH3NH3PbI3-xClx

Precursor solution of CH₃NH₃PbI_3-xCl_x for perovskite solar cells was conventionally prepared by mixing PbCl₂ and CH₃NH₃I with a mole ratio of 1:3 (PbCl₂:CH₃NH₃I). While in the present study, CH₃NH₃PbI_3-xCl_x-based solar cells were fabricated using the precursor solutions containing PbCl₂ and CH₃NH₃I with the mole ratios of 1:3, 1.05:3, 1.1:3, and 1.15:3, respectively. The results display that the solar cells with the mole ratio of 1.1:3 present higher power conversion efficiency and less I-V hysteresis than those with the mole ratio of 1:3. Based on some investigations, it is concluded that the higher efficiency could be due to the smooth and pinhole free film formation, high optical absorption, suitable energy band gap, and the large electron transfer efficiency, and the less I-V hysteresis may be attributed to the small low frequency capacitance of the device.

[Optimization of alkaline hydrolysis based on the side chain of diethyl ester 4-amino-N5-formyl-N8, N10-dideazatetrahydrofolic acid]

OBJECTIVE

To optimize and establish the best hydrolysis method of diethyl ester 4-amino-N⁵-formyl-N⁸, N¹⁰-dideazatetrahydrofolate through the optimization of simple compound of diethyl N-(4-aminobenzoyl)-L-glutamate.

METHODS

To increase the low yield of hydrolysis reaction of diethyl ester 4-amino-N⁵-formyl-N⁸, N¹⁰-dideazatetrahydrofolate due to the by-products and difficult purification, we studied the effect of NaOH and KOH, two kinds of alkalis, three concentrations between 0.175-1 mol/L and five types of reaction time involved in 20, 30, 60, 120 and 180 min on the common side chain diethyl N-(4-aminobenzoyl)-L-glutamate. A high performance liquid chromatography was established for measuring the target product and the by-products in reaction liquid in different reaction conditions. Finally, on the basis of the best hydrolysis method of diethyl ester 4-amino-N⁵-formyl-N⁸, N¹⁰-dideazatetrahydrofolate, we completed the optimization of the hydrolysis reaction conditions of diethyl ester 4-amino-N⁵-formyl-N⁸, N¹⁰-dideazatetrahydrofolate.

RESULTS

We developed the best reaction condition for the hydrolysis of diethyl ester 4-amino-N⁵-formyl-N⁸, N¹⁰-dideazatetrahydrofolate, which could be carried out easily and efficiently. The results indicated that treated with the optimized condition of 0.3 mol/L KOH in 60 min at the room temperature, diethyl ester 4-amino-N⁵-formyl-N⁸, N¹⁰-dideazatetrahydrofolate was converted into its diacid derivative in 95.6 % yield, which turned to be a better reaction condition compared with the previous reaction condition. The structures of those compounds were identified to be correct by 1H nuclear magnetic resonance(1H NMR), 13C nuclear magnetic resonance(13C NMR) and electrospray ionization time of flight mass spectrometry (ESI-MS). The purity of the diacid derivative of the compound was determined to be 96% by high performance liquid chromatography(HPLC).The new hydrolysis reaction condition could not only avoid the formation of single ester hydrolysis product and amide bond hydrolysis product, but also improve the yield of the hydrolysis reaction.

CONCLUSION

We have developed an efficient reaction for the hydrolysis of diethyl ester 4-amino-N⁵-formyl-N⁸, N¹⁰-dideazatetrahydro. Since the final step of the synthesis of classical folic acid antagonists is always the catalyzed hydrolysis of the side chain glutamate, the reaction also has great significance for anti-folic acid anti-tumor inhibitors synthesis.

[Clinical efficacy of acute intraoperative encephalocele prevention strategy for severe traumatic brain injury]

Objective: To explore the clinical efficacy of prevention strategy for acute intraoperative encephalocele of patients with severe traumatic brain injury (sTBI). Methods: A total of 173 patients with sTBI, who treated in Emergency Neurosurgery Department of Shandong University Qilu Hospital from January, 2011 to September, 2015 were collected and divided into research group and control group, according to their therapeutic strategy.The clinical data during hospitalization and prognosis 1 year after injury was analyzed retrospectively to clarify the effect of acute encephalocele prevention strategy. Results: There were no statistically significant differences in sex, age, preoperative Glasgow coma scale score and imaging type of lesion between patients from the two groups.The highest intraoperative intracranial pressure in the research group and control group were (35.71±4.13) mmHg and(34.85±3.81) mmHg, respectively.The acute encephalocele incidence of the research group (7 cases, 6.5%) was significantly lower than that of the control group (13 cases, 19.7%) (P<0.01). Subgroup analysis showed that the incidence of acute encephalocele in patients with only unilateral lesions was low (1.3%), while higher (19.4%) in patients with both unilateral lesions and other secondary lesions or diffuse brain swelling.The prognosis of the patients was evaluated by Glasgow Outcome Scale according to the follow-up 1 year after injury, and it was suggested that the percentage of patients with good outcome in the research group (62 cases, 57.9%) was remarkably higher than that in the control group (26 cases, 39.4%) (P=0.018). Conclusions: For sTBI patients with high risk of acute encephalocele, prevention strategy was found to be able to retard the progression of delayed hematoma and diffuse brain swelling, prevent the acute encephalocele during operation, and then significantly improve the prognosis.

[The adhesion separation operation with CO₂ laser combined withtriamcinolone acetonide vocal cord submucosal injection for the treatment to vocal cord adhesion]

Objective:To investigate the effect of adhesion separation operation with CO₂ laser via prop-up laryngoscope combine with triamcinolone acetonide submucosal injection via electrolaryngoscope to vocal cords adhesion.Method:Sixteen cases of vocal cord adhesion patients(2 cases of children,14 cases of adult) were enrolled in the study. Fourteen patients had the history of surgery(Reinke edema,vocal polyp,pediatric laryngeal papilloma,laryngeal cancer),2 cases were diagnosed as laryngeal tuberculosis. Adhesion separation operation and triamcinolone acetonide submucosal injection(once a week,three weeks) were conducted. All patients were examined with electronic laryngoscope every month for six monthes.Result:Fourteen patients had good triangle shape of glottis vocalis and good sound voice. One cases of laryngeal cancer and 1 cases of laryngeal tuberculosis patients still had adhesion in the anterior commissure of the vocal cords,but with the improvement in breathing and pronunciation.Conclusion:Adhesion separation operation with CO₂ laser via prop-up laryngoscope combine with triamcinolone acetonide submucosal injection via electrolaryngoscope were effective for treatment to vocal cord adhesion,whichimprove the patient's breathing and voice with little trauma and few complications.

[Influence of long-time video operation on hemodynamics of the retrobulbar arteries in operators]

Objective: To investigate the influence of long-time video operation on hemodynamics of the retrobulbar arteries in operators. Methods: From March to October, 2015, a total of 120 soldiers for office work engaged in video surveillance were enrolled as study group, and 155 fire fighters were enrolled as control group. The incidence of eye discomfort was compared between the two groups. Color Doppler ultrasound was used to measure and compare the peak systolic velocity (PSV) , end-diastolic velocity (EDV) , and resistance index (RI) of the central retinal artery (CRA) and the short posterior ciliary artery (SPCA) , and the correlation of video operation time with the hemodynamic parameters of the retrobulbar arteries was analyzed. Results: The study group had a significantly higher incidence rate of eye discomfort than the control group (P<0.05) . Compared with the control group, the study group had significant reductions in the PSV and EDV of the CRA and the SPCA and a significant increase in the RI of the CRA (P<0.05) . Video operation time was negatively correlated with the PSV and EDV of the CRA and the SPCA (r=-0.61, -0.54, -0.65, and-0.68, all P<0.05) and positively correlated with the RI of the CRA and the SPCA (r=0.56 and 0.63, P<0.05) . Conclusion: Long-time video operation can increase the incidence of eye discomfort and lead to increased blood resistance of the CRA and the SPCA and reduced retinal perfusion.

[Effects of video work on the ocular vascular hemodynamic and visual of the operators]

Objective: To investigate the effects of long time video display terminal (VDT) operation on the ocular vascular hemodynamic and visual acuity. Methods: During March and October 2015, 120 cases of video monitoring warriors were selected as study group, another 155 cases of logistics personnel as the control group. The low vision of the two groups was calculated and compared, and the color Doppler flow imaging was used to measure the central retinal artery (CRA) , short posterior ciliary artery (SPCA) , anterior ciliary artery (ACA) , (peak systolic velocity, PSV) , end diastolic velocity (EDV) and (resistance index (RI) . The differences of hemodynamic parameters between these two groups were evaluated, and the relationship between the visual acuity and each hemodynamic parameter was analyzed. Results: The visual acuity of the study group was[0.8 (0.4-1.2) ], much lower than the control group, and the rate of low version in the study group was 40.00%, much higher than that of the control group. Compared with the control group, both of ACA and CRA of SPCA, PSV and EDV in the study group were decreased, while RI of CRA, ACA were increased (P<0.05) ; Compared with the control group, no statistical significance was found in the RI of SPCA in the study group (P>0.05) . The PSV and EDV were negatively correlated with visual acuity (r value of PSV and visual acuity were -0.352, -0.265 and -0.304; r value of EDV and visual acuity were -0.324, -0.348 and -0.365, while RI was positively correlated with visual acuity (r value were 0.363, 0.326 and 0.344) . Conclusion: Our data suggest that long time video operation may be associated with changes of ocular vascular hemodynamic parameters and raise the incidence of low vision.

[Accuracy of computer aided measurement for detecting dental proximal caries lesions in images of cone-beam computed tomography]

Objective: To establish and validate a computer program used to aid the detection of dental proximal caries in the images cone beam computed tomography (CBCT) images. Methods: According to the characteristics of caries lesions in X-ray images, a computer aided detection program for proximal caries was established with Matlab and Visual C++. The whole process for caries lesion detection included image import and preprocessing, measuring average gray value of air area, choosing region of interest and calculating gray value, defining the caries areas. The program was used to examine 90 proximal surfaces from 45 extracted human teeth collected from Peking University School and Hospital of Stomatology. The teeth were then scanned with a CBCT scanner (Promax 3D). The proximal surfaces of the teeth were respectively detected by caries detection program and scored by human observer for the extent of lesions with 6-level-scale. With histologic examination serving as the reference standard, the caries detection program and the human observer performances were assessed with receiver operating characteristic (ROC) curves. Student t-test was used to analyze the areas under the ROC curves (AUC) for the differences between caries detection program and human observer. Spearman correlation coefficient was used to analyze the detection accuracy of caries depth. Results: For the diagnosis of proximal caries in CBCT images, the AUC values of human observers and caries detection program were 0.632 and 0.703, respectively. There was a statistically significant difference between the AUC values (P=0.023). The correlation between program performance and gold standard (correlation coefficient r(s)=0.525) was higher than that of observer performance and gold standard (r(s)=0.457) and there was a statistically significant difference between the correlation coefficients (P=0.000). Conclusions: The program that automatically detects dental proximal caries lesions could improve the diagnostic value of CBCT images.