[Effects of menopausal factor on fine anatomy of bladder urethra and vagina in women undergoing vaginal delivery]

Objective: To explore the effects of menopausal factor on fine anatomy of bladder, urethra and vagina in women undergoing vaginal delivery. Methods: Gynecological patients in Nanfang hospital from January 2013 to October 2016 were collected, and then the patients whose MRI images quality meet the require of reconstruction, with the history of vaginal delivery experience, without any cesarean section experience, and the first labor time was ≤30 years old were enrolled. The patients who had pelvic floor dysfunction when done MRI examinations were excluded. Finally, 238 cases were randomly selected out, and 238 models of data were reconstructed and measured by Mimics and UG software. The independent t test was used to do the comparison between menopausal group and those not yet menopause. Results: First, we built 238 3D models totally. Second, the parameters related with bladder and urethra: the angle of bladder and urethra, β angle, urethra pubic angle, α angle, retropubic space, the length between bladder neck and edge of pubic midpoint, and urethral striated muscle thickness of menopausal group were bigger than those of pre-menopausal group. While for the urethra tilt angle, the former group was smaller than that of the latter group. But there was no significant statistical differences between two groups. Third, the parameters related with vagina: the proximal urethral vaginal gap of the post-menopause group was smaller than that of pre-menopausal group, while for the middle and distal urethral vaginal gap, the former group was bigger than that of the latter group. The length and width of vaginal anterior wall of the post-menopausal group were smaller than those of pre-menopausal group. Beside the middle urethral vaginal gap, all the difference between two groups had no statistical meaning. The 2D shape of axial vaginal, H type occupation of the former group was obviously lower than that of the latter group. Conclusions: Menopause has an effect on fine anatomy of pelvic organ. Especially on the shape of vagina, the middle urethral vaginal gap become much wider after menopause, the occupation of shallow concave type become much higher post-menopausal. It means the lateral and backward support function of the urethra and vagina is relatively weakened after menopausal, and the shape of vagina become smaller.

[Genotype-phenotype correlation in patients with alternating hemiplegia of childhood]

Objective: To explore the correlation between ATP1A3 genotype and phenotype in children with alternating hemiplegia of childhood (AHC). Methods: This was a retrospective study. The clinical data and peripheral blood DNA of AHC patients were collected in Peking University First Hospital from August 2005 to December 2017. ATP1A3 gene mutations were screened by Sanger sequencing or next generation sequencing (NGS). AHC patients were divided into difference groups according to different hotspot mutations. SPSS 23.0 was used to analyze the correlation between genotype and phenotype. Variance analysis was used to compare the measurement data between groups. Chi square test was used to compare the categorical data between groups. Kruskal-Wallis test was used to compare the unidirectional ordered data between groups. Least-significant difference(LSD) was used to compare the data between two groups. Results: A total of 119 AHC patients were recruited, including 68 males and 51 females. The onset age of 113 (95.0%) patients was within 18 months. There were 119 cases (100.0%) with hemiplegic seizures, 109 cases (91.6%) with abnormal eyeball movements, 104 cases (87.4%) with dystonia, 31 cases (26.1%) with autonomic neurological symptoms, 31 cases (26.1%) with epileptic seizures and 117 cases (98.3%) with long-term developmental delay. In 113 patients (95.0%) with ATP1A3 gene mutations, 111 were de novo mutation and 2 were genetic mutations. A total of 39 mutation types were found, including 37 missense mutations and 2 deletion mutations. Seventeen of them were novel mutations. The three hotspot mutations were D801N (n=34, 30.1%), E815K (n=20, 17.7%) and G947R (n=13, 11.5%). The age of onset of D801N and E815K were earlier than G947R ((3.1±2.1)and (2.3±2.3)vs.(6.4±7.7) months, P=0.004 and 0.003). The age of first hemiplegic events of D801N and E815K were earlier than G947R((6.4±3.1) and (6.8±3.3) vs. (11.4±10.1) months, P=0.004 and 0.016). More patients with E815K mutations presented epilepsy than those with D801N (P=0.003) and G947R (P=0.001). More patients with E815K mutations presented greater motor and intellectual disability than the patients with D801N (P=0.001) and G947R mutations (P=0.001). Conclusions: ATP1A3 gene is the main causative gene of AHC. Three hotspot mutations, D801N, E815K and G947R, were found. Hotspot mutation E815K is associated with the most severe phenotype, which presented an earlier age at the time of the first paroxysmal manifestation and first hemiplegic event, severer developmental delay and a greater proportion of epilepsy.

Novel knowledge-based system with relation detection and textual evidence for question answering research

With the development of large-scale knowledge bases (KBs), knowledge-based question answering (KBQA) has become an important research topic in recent years. The key task in KBQA is relation detection, which is the process of finding a compatible answer type for a natural language question and generating its corresponding structured query over a KB. However, existing systems often rely on shallow probabilistic methods, which are less expressive than deep semantic representation methods. In addition, since KBs are still far from complete, it is necessary to develop a new strategy that leverages unstructured resources outside of KBs. In this work, we propose a novel Question Answering method with Relation Detection and Textual Evidence (QARDTE). First, to address the semantic gap problem in relation detection, we use bidirectional long-short term memory networks with different levels of abstraction to better capture sentence structures. Our model achieves improved results with robustness against a wide diversity of expressions and questions with multiple relations. Moreover, to help compensate for the incompleteness of KBs, we utilize external unstructured text to extract additional supporting evidence and combine this evidence with relation information during the answer re-ranking process. In experiments on two well-known benchmarks, our system achieves F₁ values of 0.558 (+2.8%) and 0.663 (+5.7%), which are state-of-the-art results that show significant improvement over existing KBQA systems.

Effects of fermented soybean meal on carbon and nitrogen metabolisms in large intestine of piglets

Fermented soybean meal (FSM), which has lower anti-nutritional factors and higher active enzyme, probiotic and oligosaccharide contents than its unfermented form, has been reported to improve the feeding value of soybean meal, and hence, the growth performance of piglets. However, whether FSM can affect the bacterial and metabolites in the large intestine of piglets remains unknown. This study supplemented wet-FSM (WFSM) or dry-FSM (DFSM) (5% dry matter basis) in the diet of piglets and investigated its effects on carbon and nitrogen metabolism in the piglets' large intestines. A total of 75 41-day-old Duroc×Landrace×Yorkshire piglets with an initial BW of 13.14±0.22 kg were used in a 4-week feeding trial. Our results showed that the average daily gain of piglets in the WFSM and DFSM groups increased by 27.08% and 14.58% and that the feed conversion ratio improved by 18.18% and 7.27%, respectively, compared with the control group. Data from the prediction gene function of Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) based on 16S ribosomal RNA (rRNA) sequencing showed that carbohydrate metabolism function families in the WFSM and DFSM groups increased by 3.46% and 2.68% and that the amino acid metabolism function families decreased by 1.74% and 0.82%, respectively, compared with the control group. These results were consistent with those of other metabolism studies, which showed that dietary supplementation with WFSM and DFSM increased the level of carbohydrate-related metabolites (e.g. 4-aminobutanoate, 5-aminopentanoate, lactic acid, mannitol, threitol and β-alanine) and decreased the levels of those related to protein catabolism (e.g. 1,3-diaminopropane, creatine, glycine and inosine). In conclusion, supplementation with the two forms of FSM improved growth performance, increased metabolites of carbohydrate and reduced metabolites of protein in the large intestine of piglets, and WFSM exhibited a stronger effect than DFSM.

[Clinical phenotypes of TBC1D24 gene related epilepsy]

Objective: To summarize the clinical features of TBC1D24 gene mutations associated with epilepsy. Methods: All the patients with TBC1D24 gene compound heterozygous mutations were retrospectively collected at the Pediatric Department of Peking University First Hospital from March 2015 to July 2017, and the features of clinical manifestations, electroencephalogram, and neuroimaging were analyzed. Results: Eighteen cases with TBC1D24 gene compound heterozygous mutations were included. The age of seizure onset was 1 day to 8 months, and the median age was 90 days. Seizure types included generalized tonic-clonic seizures (GTCS) in 3 cases, focal seizures in 18 cases, myoclonus in 18 cases, and 17 cases had focal myoclonus and myoclonus status. The focal myoclonus involving one or multiple muscle groups, sometimes migrating and alternating, lasting up to minutes to several days, and could be terminated by sleep or sedation drugs. In 11 cases, myoclonus was exacerbated by fever or infections, and 2 cases developed into myoclonic status during infection, in a severe case with the loss of consciousness. The magnetic resonance imaging (MRI) of seven patients was abnormal, including cerebral atrophy or cerebellar atrophy with abnormal signals. Segment myoclonus was captured in 10 patients, but without correlated epileptiform discharges. There were ten cases had varying degrees of developmental delay, 7 were normal, and one patient died of status epilepticus at the age of 4 months. Three cases had hearing disorders. In the 18 patients, the clinical phenotype of 4 cases consisted of epilepsy of infancy with migrating focal seizures, 2 with progressive myoclonus epilepsies, 1 with Dravet syndrome, 1 with DOORS syndrome, and 3 with unclassified epileptic encephalopathy. Conclusions: The clinical feature of TBC1D24 gene mutation related epilepsy was focal myoclonus, and tended to develop into myoclonic status epilepticus, and could be aggravated by infections, and terminated by sleep or sedation drugs. Mental retardation involved or not, neuroimaging could present with cerebral atrophy or cerebellar atrophy with abnormal signals.

[Lentivirus media miR-1246 knockdown inhibits tumor growth and promotes apoptosis of SiHa cells]

Objective: To study the effect of lentivirus-mediated microRNA (miR) -1246 RNA interference (RNAi) on biological characteristics and behaviors in cervical cancer cells as well as to identify the downstream signaling pathways affected. Methods: MiR-1246 specific cDNA was synthesized and cloned into the recombinant lentiviral vector (LV-miR-1246-inhibitor) . The SiHa cells were devided into three groups: no viral infection (negative control, NC) , infection with control virus (LV-NC) , and infection with miR-1246-inhibitor virus (LV-miR-1246-inhibitor) . The expression of the miR-1246 was detected by reverse transcription (RT) -PCR. Cell growth was analyzed by cell counting kit 8 (CCK-8) assay. The invasion was dectected by transwell matrige gel. Cell apoptosis was detected by flow cytometer. The growth of xenograft tumors was also investigated. Expression of thrombospondin-2 (THBS2) , matrix metalloproteinase (MMP) 2, 9 were also evaluated in the cells. Results: (1) The expression level of miR-1246 in SiHa cells (0.11±0.13) was significantly lower in group LV-miR-1246-inhibitor than those in the group LV-NC and the group NC (1.14±0.86 and 1.30±0.73, respectively; P<0.01) . (2) The proliferation of SiHa was also markedly suppressed in CCK-8 at 96 hours (P<0.01) . (3) The number of group LV-miR-1246-inhibitor was significantly less than those in the LV-NC and NC groups in transwell invasion assay (71±4, 162±5 and 188±5, respectively; P<0.01) . (4) The apoptosis rate of SiHa cells in the group LV-miR-1246-inhibitor [ (16.10±3.37) %] was significantly lower than those of group LV-NC and group NC [ (5.67±0.89) % and (1.78±0.08) %,P<0.01]. (5) The tumor volume in the nude mice group LV-miR-1246-inhibitor [ (287±59) mm(3)] was significantly lower than those in the LV-NC and NC groups [ (571±137) and (657±144) mm(3), respectively; P<0.01]. (6) Compared with the LV-NC group and the NC group, THBS2 protein expression in the tumor tissue of the nude mice in the group LV-miR-1246-inhibitor was significantly increased (P<0.05) , while the expression levels of MMP-2 and MMP-9 protein were significantly decreased (P<0.01) . Conclusion: These results suggest that miR-1246 functions during cervical cancer pathogenesis and tumor formation via the THBS2, MMP signaling pathway.

[Effect of ubiquitous mitochondrial creatine kinase on cisplatin sensitivity of human nasopharyngeal carcinoma cell line CNE-1]

Objective: To investigate the effect of ubiquitous mitochondrial creatine kinase 1(CKMT1) on the sensitivity of human nasopharyngeal carcinoma cell line CNE-1 to DDP. Methods: CNE-1 cells were transiently transfected with CKMT1 overexpression (CKMT1) or empty vector (EV). The growth curve and DDP IC50 were developed by MTT assay, plate clone formation assay was performed by gradient concentration of DDP treatment, cell cycle and apoptosis were detected by flow cytometry, levels of apoptosis related protein Bax/Bcl-2/C-PARP and the transcription factor p-STAT3-Tyr705 were detected by Western Blot. Results: The transfection efficiencies of CKMT1 and EV were more than 90% with a higher proliferation rate in the CKMT1-transfected cells. However, the CKMT1-transfected cells had a DDP IC50 of 2.76 μmol/L, which was significantly lower than that of 4.60 μmol/L in the EV-transfected cells (P<0.01). With the treatment of certain concentration of DDP, the CKMT1-transfected cells had a lower clone formation rate, the cell cycle arrested more obviously in G2/M phase, and the apoptosis rate was higher (P<0.01), with higher levels of Bax/C-PARP (P<0.05 or P<0.01), but lower levels of Bcl-2 (P<0.01) and p-STAT3-Tyr705 (P<0.01), compare with the EV-transfected cells. Conclusions: CKMT1 may inhibit the activation of STAT3, increasing the sensitivity of CNE-1 to chemotherapeutic drug DDP.

[Factors associated with illicit drug use intention in secondary vocational school students based on theory of triadic influence]

Objective: To explore the factors associated with illicit drug use (IDU) intention in secondary vocational school students based on theory of triadic influence (TTI), and provide theoretical foundation for IDU prevention education. Methods: A total of 8 870 students were selected from secondary vocational schools in 5 cities in China through multistage cluster sampling. A self-administered questionnaire was used to collect the information about students' sensation seeking (SS), parental monitoring (PM), perceived availability of drug (PAD), social benefit expectancies(SBE), refusal efficacy (RE) and social norms and IDU intention. Based on the TTI, the logistic regression model was used to analyze the factors associated with IDU. Results: Among the intrapersonal stream of influence, the higher levels of SS was the risk factor associated with IDU (OR=1.71, 95%CI: 1.22-2.41, P<0.01), medium RE level (OR=0.18, 95%CI: 0.14-0.23, P<0.001) and high RE level (OR=0.17, 95%CI: 0.13-0.22, P<0.001) were the protective factors for IDU intention. Among the interpersonal stream of influence, medium PM level (OR=0.46, 95%CI: 0.37- 0.56, P<0.001) and high PM level (OR=0.33, 95%CI: 0.24-0.46, P<0.001) were the protective factors for IDU intention, perceived others' drug use as well as perceived others' approval of substance use were risk factors for IDU intentions (P<0.001); Among sociocultural environmental stream of influence, perceived easy availability of drugs (OR=3.47, 95%CI: 2.69-4.48, P<0.001) and perceived SBE of drugs (OR=2.04, 95%CI: 1.69-2.46, P<0.001) were risk factors for IDU intentions (P<0.001). Conclusions: High levels of SS and SBE, perceived easier availability of substance, perceived others' substance use and perceived others' approval of substance use positively predict the students' intention of IDU. IDU prevention education for adolescents should be focused on the above factors, and parental supervision and students' refuse skills should be improved.

[International consensus (ICON) on audiological assessment of hearing loss in children]

Summary The prevalence of hearing loss in newborns and infants is estimated between 1 to 3.47 cases per 1000 live births. Neonatal screening for hearing loss and audiological evaluation are becoming more extensively carried out. However, there is no consensus regarding the use of audiometry and other electrophysiological tests in current practices. This article is intended to provide professionals with recommendations about the "best practice" based on consensus opinion of the session's speakers, and a review of the literature on the efficacy of various assessment options for children with hearing loss.

Structured education using Dose Adjustment for Normal Eating (DAFNE) reduces long-term HbA1c and HbA1c variability

AIMS

Previous evidence has demonstrated that participation in the Dose Adjustment for Normal Eating (DAFNE) education programme can reduce HbA_1c and severe hypoglycaemia in people with Type 1 diabetes. In a number of studies, increased HbA_1c variability has been associated with higher diabetic morbidity and mortality. No studies have examined the impact of structured education on HbA_1c variability in Type 1 diabetes.

METHODS

People with Type 1 diabetes who had attended DAFNE were identified for inclusion from the Scottish Care Information-Diabetes dataset. HbA_1c median and variability, expressed as coefficient of variation (CV) before and after DAFNE was calculated.

RESULTS

Some 1061 individuals participated in DAFNE education and 687 met the inclusion criteria. A significant median reduction in HbA_1c [-3.5 mmol/mol (-0.3%)] was seen at 12 months with a significant reduction [-1.5 mmol/mol (-0.1%)] still seen at 60 months of follow-up. HbA_1c variability as measured by CV was significantly lower during the post-DAFNE period: 0.08 (IQR 0.05-0.12) reduced to 0.07 (IQR 0.05-0.10); P = 0.002.

CONCLUSION

The data confirm that DAFNE participation improves glycaemic control in Type 1 diabetes with benefits being sustained for 5 years. This study is the first to demonstrate reduced HbA_1c variability after completion of structured education. This is new evidence of the beneficial impact of DAFNE on glycaemic profile.

Differential Cross Section and Photon-Beam Asymmetry for the γ[over →]p → π^{-}Δ^{++}(1232) Reaction at Forward π^{-} Angles for E_{γ}=1.5-2.95 GeV

Differential cross sections and photon-beam asymmetries for the γ[over →]p→π^{-}Δ^{++}(1232) reaction have been measured for 0.7<cosθ_{π}^{c.m.}<1 and E_{γ}=1.5-2.95  GeV at SPring-8/LEPS. The first-ever high statistics cross-section data are obtained in this kinematical region, and the asymmetry data for 1.5<E_{γ}(GeV)<2.8 are obtained for the first time. This reaction has a unique feature for studying the production mechanisms of a pure uu[over ¯] quark pair in the final state from the proton. Although there is no distinct peak structure in the cross sections, a non-negligible excess over the theoretical predictions is observed at E_{γ}=1.5-1.8  GeV. The asymmetries are found to be negative in most of the present kinematical regions, suggesting the dominance of π exchange in the t channel. The negative asymmetries at forward meson production angles are different from the asymmetries previously measured for the photoproduction reactions producing a dd[over ¯] or an ss[over ¯] quark pair in the final state. Advanced theoretical models introducing nucleon resonances and additional unnatural-parity exchanges are needed to reproduce the present data.

The influence of obesity on functional outcome and quality of life after total knee arthroplasty: a ten-year follow-up study

Aims

This study investigated the influence of body mass index (BMI) on patients' function and quality of life ten years after total knee arthroplasty (TKA).

Patients and Methods

A total of 126 patients who underwent unilateral TKA in 2006 were prospectively included in this retrospective study. They were categorized into two groups based on BMI: < 30 kg/m² (control) and ≥ 30 kg/m² (obese). Functional outcome was assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), and Oxford Knee Score (OKS). Quality of life was assessed using the Physical (PCS) and Mental Component Scores (MCS) of the 36-Item Short-Form Health Survey.

Results

Results Patients in the obese group underwent TKA at a younger age (mean, 63.0 years, sd 8.0) compared with the control group (mean, 65.6 years, sd 7.6; p = 0.03). Preoperatively, both groups had comparable functional and quality-of-life scores. Ten years postoperatively, the control group had significantly higher OKS and MCS compared with the obese group (OKS, mean 18 (sd 5) vs mean 22 (sd 10), p = 0.03; MCS, mean 56 (sd 10) vs mean 50 (sd 11), p = 0.01). After applying multiple linear regression with the various outcomes scores as dependent variables and age, gender, and Charlson Comorbidity Index as independent variables, there was a clear association between obesity and poorer outcome in KSFS, OKS, and MCS at ten years postoperatively (p < 0.01 in both KSFS and OKS, and p = 0.03 in MCS). Both groups had a high satisfaction rate (97.8% in the control group vs 87.9% in the obese group, p = 0.11) and fulfillment of expectations at ten years (98.9% in the control group vs 100% in the obese group, p = 0.32).

Conclusion

Although both obese and non-obese patients have significant improvements in function and quality of life postoperatively, obese patients tend to have smaller improvements in the OKS and MCS ten years postoperatively. It is important to counsel patients on the importance of weight management to achieve a more sustained outcome after TKA. Cite this article: Bone Joint J 2018;100-B:579-83.

Surgical treatment of osteoporotic degenerative spinal deformity with expandable pedicle screw fixation: 2-year follow-up clinical study

BACKGROUND

Osteoporotic bone offers poor purchase for the instrumentation in patients with degenerative spinal deformity (DSD), which could lead to several complications. Recently, augmentation methods to improve pedicle screw fixation have been proposed. This retrospective study was to investigate the clinical and radiographic outcomes of expandable pedicle screws (EPS) in patients with osteoporotic DSD.

HYPOTHESIS

Expandable pedicle screws (EPS) provide excellent instrument fixation in patients with osteoporotic DSD, improving radiographic and clinical outcomes.

MATERIALS AND METHODS

A total of 27 (6 males and 21 females) DSD patients who underwent orthopedics operation with EPS were retrospectively studied. Full-length standing spinal radiographs were obtained in all patients pre- and postoperatively and again at the two-year follow-up. The functional evaluations before operation and at two-year follow-up were graded with Scoliosis Research Society outcomes instrument-22 (SRS-22) and Oswestry Disability Index (ODI) scoring system.

RESULTS

All patients obtained good corrective outcomes on spinal deformity. The preoperative ODI score was 36.7% and reduced to 11.9% at two-year follow-up (p=0.0000). Before operation, the SRS-22 function, pain, appearance and mental scores were 2.7±0.4, 3±0.6, 2.7±0.5 and 2.9±0.6, respectively. The scores at two-year follow-up were significantly improved to 3.8±0.7, 4.2±0.6, 4.3±0.6 and 4.4±0.7, respectively (p=0.0000). The SRS-22 satisfaction score was 4.6±0.4 at two-year follow-up. No instances of screw breakage, loosening or pullout in any patient at follow-up.

DISCUSSION

EPS provides excellent instrument fixation in patients with osteoporotic DSD, improving radiographic and clinical outcomes at two years' follow-up.

TYPE OF STUDY

Retrospective case series study.

LEVEL OF EVIDENCE

IV.

Effects of tumor-associated macrophages on the proliferation and migration of esophageal cancer-associated lymphatic endothelial cells

The aim of this study was to explore whether M2 macrophages can be transformed into M1 macrophages, and to investigate the effect of different types of macrophages on the proliferation, migration and ring-forming ability of esophageal cancer-related lymphatic endothelial cell (LEC). Human monocytic leukemia cell line (THP-1 cell) was induced to differentiate to M1 macrophages (M1 group) and M2 macrophages (M2 group), and co-cultured with esophageal cancer-associated LEC. The individual esophageal cancer co-cultured with LEC was used as control. Different types of macrophages were observed by Cell counting kit-8 (CCK-8). Enzyme-linked immunosorbent assay (ELISA) was used to detect the VEGF-C concentration; the expression of VEGFR-3 protein and its mRNA was detected by Western blot and qRT-PCR, respectively. The positive rate of the M1 group induced by IFN-γ and LPS was significantly higher than that of M2 macrophages (48.57%5.98% vs 25.83%1.95%). The expression of VEGF-C in the supernatant of the M2 group was higher than that in the control group, but no significant differences regarding the expression of VEGF-C between M1 and control groups were found. In addition, the expression of VEGFR-3 on both mRNA and protein in esophageal cancer-related LEC of the M2 group was significantly higher than those in the control group; however, the M1 group had a significantly lower VEGFR-3 level on both mRNA and protein than the control group. Human M2 macrophages can be transformed into M1 macrophages, and can promote the proliferation, migration and ring-forming ability of esophageal cancer-associated LEC.

[Feasibility and safety of paclitaxel-eluting balloon for the treatment of de novo coronary lesions]

Objective: To evaluate the safety and feasibility of treating de novo coronary lesions with paclitaxel-eluting balloon. Methods: This is a retrospective study, which enrolled 76 patients with 80 de novo coronary lesions treated with paclitaxel-eluting balloons(<30% residual stenosis and there was no blood flow limited dissection after pretreatment) from April 2015 to November 2016 in Guangdong general hospital. The data of basic characteristics,procedures,devices and follow-up information were retrieved and analyzed. The primary endpoint was the composite of cardiac death, recurrent myocardial infarction and target lesion revascularization. Results: (1)The age was (63.3±10.3) years. There were 68.4%(52/76) acute coronary syndrome patients, prevalence of type 2 diabetes was 36.8%(28/76), and 64.5%(49/76)patients with at least one high bleeding risk. (2)The lesion length was (17.4±7.6)mm, and the stenosis was (88.1±8.2)%.The reference vessel diameter≥2.75 mm accounted for 51.2% (41/80), and bifurcation stenosis accounted for 67.5%(54/80). (3)53.7%(43/80) lesions were pretreated with scoring balloon to optimize plaque modification. The paclitaxel-eluting balloon length and diameter were (22.3±5.5)mm and (2.74±0.52)mm.The residual stenosis was (12.3±10.3)%. Procedural success was 88.8%(71/80).Bail-out stenting rate was 5.0%(4/80). (4)The median follow-up duration was 12(6, 25) months. Primary endpoint occurred in 3 cases (3.9%), including 2 cardiac deaths(1 patient died of recurrent myocardial infarction, and 1 patient died of acute heart failure induced by severe mitral insufficiency), and one patient receivedtarget lesion revascularization. Conclusion: In case of no more than 30% residual stenosis and no blood flow limited dissection after lesion pretreatment,it is safe and feasible to treat de novo coronary lesionsusing paclitaxel-eluting balloon.

[Strategy for minimally invasive cochlear implantation and residual hearing preservation]

In the past few decades, considerable development was achieved in the cochlear implantation following the emergence of innovative electrode array and advances in minimally invasive surgery. Minimally invasive technique led to a better preservation of residual low-frequency hearing. The loss of residual hearing was caused by complicated factors. According to previous studies, a slower and stable speed of electrode insertion and the use of perioperative steroids were demonstrated to have a positive impact on hearing preservation. The selection of electrode array or its insertion approaches didn't show any distinctive benefits in hearing preservation.

[Lung transplantation for connective tissue disease-associated interstitial lung disease recipient]

Objective: To investigate the timing and complications of lung transplantation for the treatment of connective tissue disease-associated interstitial lung disease (CTD-ILD). Method: The clinical data of connective tissue-associated disease lung transplantation recipients from September, 2015 to February, 2017 were collected. Results: 11 patients with CTD-ILD were evaluated by lung transplantation and were treated with lung transplantation. Including 2 cases dermatomyositis/polymyositis and interstitial lung disease (PM/DM-ILD), 4 cases rheumatoid arthritis and interstitial lung disease (RA-ILD), 4 cases of primary Sjgren's syndrome and interstitial lung disease (pSS-ILD), 1 case of systemic sclerosis and interstitial lung disease (SSc-ILD). There are 6 cases are CTD-ILD-PAH patients of all. There were 5 males and 6 females, aged 37-70 years, with an average age of (52.73±9.53) years. 7 patients received single lung transplantation, 4 patients received double lung transplantation. 3 patients died in the early postoperative period, one for pulmonary embolism, one for septic shock and heart failure, one for severe primary graft failure (PGD). The remaining patients were followed up (4-24 months) with good survival, no acute and chronic rejection and other complications were observed. The survival rate was similar to that of other disease sources. Conclusion: There is no recurrence, acute and chronic rejection and other complications were observed in CTD-ILD and/or PAH lung transplant recipients. And the survival rate was comparable to that of other disease sources.Lung transplantation is a safe and effective choice for selected CTD-ILD patients.

[Two-stage total hip arthroplasty using an antibiotic-loaded cement spacer for infected internal fixation of hip fractures]

Objective: To evaluate the application and clinical results of two-stage total hip arthroplasty in the treatment of the deep hip infection following the internal fixation of hip fractures. Methods: From May 2007 to November 2014, 21 patients with active hip infection secondary to internal fixation of hip fractures were treated with two-stage total hip arthroplasty using a temporary antibiotic-loaded cement spacers. Of 21 cases, 15 were males and 6 were females, aged from 27 to 64 years (mean, 45); there are 18 cases of femoral neck fractures and 3 cases of intertrochanteric fractures. The serologic examination and X-ray were taken at 1 month, 3 months, 6 months, 12 months and annually thereafter post-operatively to evaluate the clinical results and prosthesis status. Harris hip score system was used to evaluate the joint function. Results: All patients were successfully treated with two stage operations under general anesthesia. The operational interval was 12-44 weeks (mean, 21) and 1 spacer breakage. For the arthroplasty, cementless components were used in 20 cases and cemented component was use in 1 case. The patients were followed up 25-102 months ( mean, 55 ) and infections were eradicated in all hips. The Harris hip score was improved from 23.24±11.81 pre-operatively to 90.24±3.92 post-operatively and the difference was statistically significant (P<0.05). According to this scoring criteria, the excellent and good rate reached up to 95%. At latest fellow-up, the location of prosthesis were well and the function of hip joint was satisfied. All cases had no dislocation, periprosthetic fracture, ectopic ossification or any other complications at the latest fellow-up. Conclusion: By means of an antibiotic-loaded cement spacer, two-stage total hip arthroplasty is an effective salvage procedure eradicating infection and providing functional improvement to the infected internal fixation of hip fractures. The early and mid-term clinical effects are satisfied.