[Clinical features of mononucleosis because of Epstein-Barr virus and cytomegalovirus co-infection in adult patients]

Objective: To identify the clinical features of mononucleosis caused by co-infection of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in adult patients. Methods: A total of 103 inpatients with mononucleosis in Peking University Third Hospital from May 2013 to May 2016 were collected as the study subjects.The patients were divided into three groups according to the responsible pathogens: 33 patients infected with EBV and CMV, 53 infected with EBV alone and 17 infected with CMV alone.Furthermore, a case-control study was employed to retrospectively compare the clinical characteristics and prognosis with χ(2,) t or rank tests. Results: The incidences of sore throat, pharynx congestion, tonsil enlargement, tonsil membrane, lymphadenectasis in co-infected patients were statistically lower than those in EBV-infected patients(χ(2)=19.202-25.492, all P<0.05), and were equivalent to those in CMV-infected patients(χ(2)=0.078-4.381, all P>0.05). The levels of alkaline phosphatase, glutamyl transferase, lactic dehydrogenase, white blood cell count and atypical lymphocyte in co-infected patients were statistically lower than those in EBV-infected patients(t/U=3.471-104.629, all P<0.05), and were similar to those in CMV-infected patients(t/U=0.447-24.330, all P>0.05). The levels of alanine aminotransferase and total bilirubin in co-infected patients were equivalent to those in the other two groups(U=1.695, 6.371, both P>0.05). The duration of fever in co-infected patients[(18±9) d] was between EBV alone [(15±7) d] and CMV alone [(21±7) d]infected patients. Conclusions: Co-infection of EBV and CMV is not uncommon.The clinic manifestation of co-infection is more like CMV infection. Liver injury and duration of fever shows no aggravation.

Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial

A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis.

INTRODUCTION

The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults.

METHODS

We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60-88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes.

RESULTS

There was a -3.0° (95% CI -5.2, -0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05.

CONCLUSIONS

Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis.

TRIAL REGISTRATION NUMBER AND NAME OF TRIAL REGISTER

ClinicalTrials.gov; identifier NCT01751685.

[Meta analysis of parallel versus perpendicular double plating for distal humerus fracture of type C in adults]

Objective: To evaluate the effects of parallel versus perpendicular double plating for distal humerus fracture of type C. Methods: A standardized comprehensive literature search was performed by PubMed, Embase, Cochrane library, CMB, CNKI and Medline datebase.Randomized controlled studies on comparison between parallel versus perpendicular double plating for distal humerus fracture of type C before December 2015 were enrolled in the study.All date were analyzed by the RevMan 5.2 software. Results: Six studies, including 284 patients, met the inclusion criteria.There were 155 patients in perpendicular double plating group, 129 patients in parallel double plating group.The results of Meta-analysis indicated that there were statistically significant difference between the two groups in complications (OR=2.59, 95%CI: 1.03 to 6.53, P=0.04). There was no significant difference between the two groups in surgical duration (MD=-1.84, 95% CI: -9.06 to 5.39, P=0.62), bone union time (MD=0.09, 95%CI: -0.06 to 0.24, P=0.22), Mayo Elbow Performance Score (MD=0.09, 95%CI: -0.06 to 0.24, P=0.22), Range of Motions (MD=-0.92, 95%CI: -4.65 to 2.81, P=0.63) and the rate of excellent and good results (OR=0.64, 95%CI: 0.27 to 1.52, P=0.31). Conclusion: Both perpendicular and parallel double plating are effective in distal humerus fracture of type C, parallel double plating has less complications.

Autophagy in renal tubular injury and repair

Autophagy is a fundamental cellular process that maintains normal function and structure of the cell. It can be induced during stress and serves as an adaptive response for cell survival. Normal kidneys have high metabolic demands yet are relatively hypoxic, especially in the medulla and papilla. Injury or ageing aggravates metabolic perturbation and activates autophagy in many types of renal cells. In the kidney, tubular epithelial cells consume the most energy due to active transport mechanisms and therefore are the most susceptible to injuries from hypoxic or low-energy states. This brief review will summarize current understandings of the biological function and molecular regulation of epithelial autophagy during tubular injury and repair.

[Effects of saliva contamination on bond strength of resin-resin interfaces]

OBJECTIVE

To estimate the bond strength between different resin composite interfaces, and to evaluate the effect of saliva contamination and management with the contamination on the bond strength.

METHODS

Two commercial resin composites containing different types of fillers (AP-X: barium-glass; P60: quartz) were tested in this study. The basic composite blocks were made of AP-X. After wet-ground flatted, the experimental groups were divided into three groups according to the surface treatment: (1)Direct bonding group: the bonding surface was rinsed with distilled water for 20 s, then dried with oil-free air for 20 s; (2)Saliva contamination group: the bonding surface was bathed in saliva for 30 min, then distilled water was rinsed for 20 s and dried with oil-free air for 20 s; (3)Saliva contamination and 75% ethanol wiping group: bonding surface bathed in saliva for 30 min, then wipe the surface with 75% ethanol, distilled water rinse for 20 s and dry with oil-free air for 20 s; The control group was made of the basic composite bulks of AP-X directly bonding with composite P60. Cut each resin block into 1 mm×1 mm×14 mm sticks, observing the micro-structures and detecting the micro-tensile strength of the resin composite interfaces. The bonding strength was measured using micro-tensile tester, then calculated and statistically analyzed by one-way ANOVA.

RESULTS

Scanning electronic microscope observation revealed that the control group as well as the direct bonding subgroups, two different resin tags were in good contact with each other. The saliva contamination subgroups had lots of gaps or craters, indicating saliva might have been trapped in the composite buildup and wiping the surface with 75% ethanol had no effect. The micro-tensile bond strength of the control group was (84.07±1.57) MPa and significantly higher than all the other 3 experimental subgroups(P<0.001). In experimental groups, the micro-tensile strength of 3 subgroups was (76.08±2.42) MPa, (70.98±2.33) MPa and (71.08±2.33) MPa, respectively. The saliva contamination subgroup was significant lower than the direct bonding subgroup(P<0.001), but no statistical significance with the ethanol wiping subgroup(P=0.893).

CONCLUSION

The bond strength of inner polymerization of resin-resin was greater, but decreased after resin composites interfacial bonding. Saliva contamination reduced the tensile bond strength between resin composites surface, wiping the surface with 75% ethanol had no effect.

[Role and mechanism of hydrogen sulfide in cigarette smoke induced chronic obstructive pulmonary disease related pulmonary vascular remodeling in rats]

Objective: To investigate the role and mechanism of hydrogen sulfide (H2S) in rats with chronic obstructive pulmonary disease (COPD) related pulmonary vascular remodeling. Methods: Twenty four healthy male Sprague-Dawley rats were randomly divided into 4 groups: control group, cigarette smoke (CS) group, CS+ Sodium hydrosulfide (NaHS) group and CS+ DL-propargylglycine (PPG) group. Rats in control group were fed normally and breathed clear air, and for the rest groups, passive cigarette smoke inhalation method were adopted to establish COPD model. After 8 weeks, the rats in corresponding groups were treated by NaHS or PPG. After 16 weeks, the markers of pulmonary vascular remodeling in all groups were measured. Proliferation marker proliferative cell nuclear antigen (PCNA) and oxidative stress marker 3-neurotrophin (3-NT) in all groups were measured by immunohistochemistry (IHC). Results: Compared with control group, the airway resistance was increased (0.859±0.283 vs 0.578±0.088, P<0.05) and the pathological scores was much higher in CS group, which suggested that the COPD model was successful. The degree of small resistance pulmonary artery medial wall thickness and full vascular muscularization of CS group were much higher (0.54±0.20 vs 0.37±0.12, 0.39±0.08; 0.61±0.16 vs 0.20±0.12, 0.34±0.13, all P<0.01)than control group and CS+ NaHS group, there was no significant difference between CS+ PPG group and CS group. In accordance with the results of morphometric analysis, the proliferation marker PCNA was more in CS group when compared with control group and CS+ NaHS group (0.27±0.08 vs 0.12±0.06, 0.14±0.06, both P<0.05), there was no significant difference between CS+ PPG group and CS group. Furthermore, the IHC also showed that 3-NT significantly increased in CS group compared with control group and CS+ NaHS group (0.26±0.08 vs 0.18±0.04, 0.19±0.06, both P<0.01), there was no significant difference between CS+ PPG group and CS group as well. In addition, the small resistance pulmonary artery medial wall thickness had strong correlation with the expression level of oxidative stress marker 3-NT (r=0.906, P<0.001). Conclusion: H2S significantly attenuates cigarette smoke induced COPD related pulmonary vascular remodeling, which could be related to its ability to decrease oxidative stress.

Clinical effects in resection of congenital choledochal cyst of children and jejunum Roux-Y anastomosis by laparoscope

OBJECTIVE

We compared the effects and complications in resection of the congenital choledochal cyst (CCC) and hepatic duct jejunum Roux-Y anastomosis by laparoscopy and open surgery.

PATIENTS AND METHODS

We continuously selected 156 cases of pediatric patients with CCC, which were divided into 70 cases of the laparoscopic group and 86 cases of laparotomy group according to the treatment methods. Then the success rate of surgery, intraoperative and postoperative bleeding, intraoperative and postoperative complications was compared.

RESULTS

It was found that after 65 cases (92.9%) completed in the laparoscopic group and all completed in laparotomy group there was less intra-operative blood loss of laparoscopic group than that of the open surgery group. However, the difference of postoperative hemorrhage in two groups was not statistically significant (p >0.05). The intra-operative complications in the two groups were not significantly different (p >0.05); in the laparoscopic group, the postoperative complication rate was significantly lower than open surgery group (p <0.05).

CONCLUSIONS

Laparoscopic resection of CCC combined with jejunum Roux-Y anastomosis has good prospects.