[Clinical and molecular characteristics of GATA2 related pediatric primary myelodysplastic syndrome]

Objective: To clarify the prevalence, clinical features and molecular characteristics of germline GATA2 mutations in pediatric primary myelodysplastic syndromes (MDS) . Methods: Next-generation sequencing technology was used to detect mutations in GATA2 and other myeloid malignancy genes in 129 children with primary MDS from Jan. 2007 to Jan. 2018. The relationship between genotypes and phenotypes was analyzed. Results: Germline GATA2 mutations accounted for 8.5% (11/129) of all primary MDS cases, and 14.0% (11/50) of MDS with excess blasts (MDS-EB) and acute myeloid leukaemia with myelodysplasia-related changes (AML-MRC) . Compared with GATA2 wild-type patients, GATA2 mutated patients were older at diagnosis[8 (1-16) years old vs 6 years old (range: 1 month old-18 years old) , P=0.035]and higher risk of monosomy 7 (72.7%vs 5.2%, P<0.001) and classified into MDS-EB and AML-MRC compared with refractory cytopenia of childhood (RCC) (63.6%vs 36.4%, P=0.111) . The multivariate analysis showed SETBP1 mutation (P=0.041, OR=9.003, 95%CI 1.098-73.787) and isolated monosomy 7 (P=0.002, OR=24.835, 95%CI 3.305-186.620) were significantly associated with germline mutated GATA2. Overall survival (OS) and outcomes of hematopoietic stem cell transplantation (HSCT) were not influenced by GATA2 mutational status. Conclusions: Our data identify germline GATA2 mutations have a high prevalence in older pediatric patients with monosomy 7, and high risk of progression into advanced MDS subtypes. GATA2 mutation status does not affect OS in pediatric primary MDS.

Comparison of the therapeutic effect between the simultaneous and staged unicompartmental knee arthroplasty (UKA) for bilateral knee medial compartment arthritis

Background

To compare the efficacy and safety of simultaneous vs staged unicompartmental knee arthroplasty (UKA) for bilateral unicompartmental osteoarthritis of the knee.

Methods

We performed a retrospective analysis of prospectively collected data on 93 patients with bilateral knee medial compartment arthritis underwent simultaneous UKA (Group A, 39) or staged UKA (Group B, 54 cases) from January 2008 to December 2015. Group A: 6 males and 33 females aged 64.9 ± 7.7 years; Group B: 5 males and 49 females aged 64.2 ± 6.4 years. There were no statistically significant differences in pre-operative age, sex ratio, or body weight index between the groups (P > 0.05). Groups were compared in terms of total anesthesia time, volume of drainage, blood transfusion rate, hemoglobin level on post-operative day 3, total post-operative inpatient days, treatment expenses, post-operative therapeutic effect (KSS scores), and complications.

Results

All patients had follow-up visits post-operatively. The follow-up visit interval was 32–133 months and 41.9 months on average. Total anesthesia time, postoperative length of hospital stay, and hospitalization expenses in Group A were significantly less than those of Group B (P < 0.05). Hemoglobin levels in Group A were significantly lower than those of Group B at post-op day 3 (P < 0.05). However, no significant differences in volume of drainage, the rate of transfusion, complications, and KSS scores were detected between Groups A and B (P > 0.05).

Conclusions

Both simultaneous and staged UKA achieved the desired therapeutic effect in treatment of bilateral knee medial compartment arthritis. However, simultaneous UKA reduced the cost and the postoperative length of hospital stay without increasing post-operative complications.

[Clinical and cardiac magnetic resonance features of apical hypertrophic cardiomyopathy patients complicating with left ventricular apical aneurysm]

Objective: To evaluate the clinical and cardiac magnetic resonance (CMR) features of apical hypertrophic cardiomyopathy (ApHCM) patients complicating with left ventricular apical aneurysm (LVAA). Methods: CMR confirmed 25 ApHCM patients complicating with LVAA from January 2010 to December 2017 in Fuwai hospital were included in this study, and the baseline clinical data and CMR characteristics were retrospectively analyzed. There were 14 pure ApHCM (hypertrophy limited at the apical segments) complicating with LVAA patients and 11 mixed ApHCM (predominantly apical hypertrophy along with thickening of contiguous non-apical left ventricular region) with LVAA patients. Results: In this patient cohort,age of 84% (21/25) patients ranged between 20-70 years old, and 68% (17/25) were male. There were 68% (17/25) patients with complaint of chest distress symptom, 56% (14/25) with complaint of chest pain, 32% (8/25) with complaint of palpitation,16% (4/25) with complaint of dyspnea, and 12% (3/25) presented as syncope. ST-T segment changes of electrocardiogram were observed in all patients, and giant negative T waves were detected in 80% patients (20/25). The rate of missed diagnosis by echocardiography for detecting ApHCM and LVAA was 16% (4/25) and 68% (17/25), respectively. CMR showed discrete thin-walled dyskinetic or akinetic segment of the most distal portion of the left ventricular chamber in ApHCM patients with LVAA. Transmural late gadolinium enhancement of the aneurysmal rim was detected in 76% (19/25) patients, and the maximum transverse dimension of aneurysm was bigger in patients with transmural late gadolinium enhancement than in patients without transmural late gadolinium enhancement ((22.0±10.8)mm vs. (11.7±4.0) mm, P=0.033). Conclusion: ApHCM with LVAA patients have distinct cardiac clinical features, and CMR is the most useful tool for the accurate and objective evaluation of this disease.

[Clinical study on the reduction of ocular surface bacteria in pre-operative cataract surgery patients by cleansing the eyelid margins]

Objective: To explore the clinical significance of ocular surface bacteria inhibition by cleaning eyelid margins before surgery in cataract patients. Methods: Case-control study. Thirty-five patients (45 eyes) with age-related cataracts who were proposed to receive treatment of Phacoemulsification combined with cataract extraction and intraocular lens implantation at Peking University 3(rd) hospital were included. The experimental group consisted of 9 males and 15 females with the average age of (69.8±11.5). The control group consisted of 6 males and 15 females with the average age of (61.8±16.2). In the experimental group, bacteria samples from the conjunctival sac and eyelid margins were collected at three times separately and were cultured for identification: first sampling was taken prior to application of any type of antimicrobial measures; second sampling was taken after application of lid scrub twice daily for 7 days to cleanse their eyelid margins by the patients;the last sampling was taken after patients' application of Levofloxacin antibiotic eye drops 3 times per day continuously for 3 days prior to surgery. In the control group, bacteria samples from the conjunctival sac and eyelid margins were collected at two times separately and were cultured for identification: first sampling was taken before application of any antimicrobial measures;second sampling was taken after patients' application of only Levofloxacin antibiotic eye drops successively for 3 days before surgery. Then the results of bacteria culture of the two groups above were compared. Results: In the experimental group, according to the eyelid margins bacteria cultures results of the first sampling (taken before application of any antibacterial measures), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 83.3% (20/24), 70.8% (17/24), 45.8% (11/24), respectively; according to the bacteria cultures results of the second sampling (tanken after application of lid scrub for cleaning the eyelid margins for 7 days), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 58.3% (14/24), 45.8% (11/24), 25% (6/24), respectively;According to the bacteria cultures results of the third sampling (taken after application of antibiotic eye drops for three days), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 20.8% (5/24), 20.8% (5/24), 4.2% (1/24), respectively. In the experimental group, we compared the bacterial positive rate of the samples taken after patients' application of antibiotics for 3 days to the bacterial positive rate of the samples taken prior to application of any antibacterial measures to have found that the total positive rate, the positive rates of common bacteria and rare bacteria decreased significantly (P<0.05) and the difference in between are of statistical significance. In the control group, according to the eyelid margins bacteria cultures results of the first sampling (taken before application of any antibacterial measures, the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 81% (17/21), 66.7% (14/21), 19% (4/21), respectively;According to the bacteria cultures results of the second sampling (taken after the application of antibiotic eye drops for three days), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 38.1% (8/21), 14.3% (3/21), 33.3% (7/21) respectively. When comparing the experimental group to the control group, the experimental group yielded significantly better results than the control group for the rate of reduction of rare bacteria in the eyelid margin after using antibiotics for 3 days. This is due to the lid scrub being used with the antibiotics. The difference are of statistical significance (χ(2)=6.518, P=0.017). There was no statistically significant difference between the experimental and control group in terms of the total positive rate as well as the positive rate of common bacteria and rare bacteria in the conjunctival sac. Conclusions: The cleaning of the eyelid and eyelid margin with lid scrub prior to cataract surgery combined with antibiotics eye drops will achieve excellent antibacterial effects for common and rare bacteria in the eyelid and conjunctival sac. The antibacterial effect of using lid scrub with antibiotic eye drops is more favorable than that of using antibiotic eye drops only. However, the lid scrub eyelid hygiene products cannot replace preoperative antibiotics independently. (Chin J Ophthalmology, 2018, 54: 445-451).

[Clinicopathological analysis of anti-mitochondrial antibody negative primary biliary cholangitis-autoimmune hepatitis overlap syndrome]

Objective: To explore the clinicopathological features of anti-mitochondrial antibody (AMA) negative and positive patients with primary biliary cholangitis-autoimmune hepatitis overlap syndrome (PBC-AIH OS). Methods: Seventy-four cases diagnosed as PBC-AIH OS from June 2017 to April 2018 were enrolled in this study. Among them, forty cases were AMA negative (negative group) and thirty-four cases were AMA positive (positive group). The clinical manifestations, serum biochemical indexes, immunological indexes and histological data of the negative group were compared with the positive group. Mann-Whitney U test and theχ (2)test were used for statistical analysis. Results: There was no significant difference in sex, age, clinical manifestations and major liver function indexes (ALT, AST, ALP, GGT, TB, DB) between the negative group and positive group (P> 0.05). The level of IgM in the negative group (1.68 ± 0.87) was significantly lower than positive group (3.77 ± 2.88)(P< 0.05). The positive rates of antinuclear antibodies (ANA) and gp-210 antibodies was lower than positive group (P< 0.05). There were no significant differences in the stages of inflammation and fibrosis between the two groups (P> 0.05), and the bile duct injury was more significant in the negative than positive group (P< 0.05). Conclusion: The serum IgM level of AMA-negative PBC-AIH OS is low, and immunological antibody is often negative, which makes bile duct injury apparent in liver histology. A liver biopsy should be carried out as soon as possible for early diagnosis and treatment.

[The influence factors of quality-of-life in patients with thyroid-associated ophthalmopathy]

Objective: To assess the risk factors associated with decreased quality-of-life in patients with thyroid-associated ophthalmopathy (TAO). Methods: Cross-sectional study. One hundred and twelve patients with TAO and 68 controls were recruited to answer the Graves' ophthalmopathy quality-of-life questionnaire (GO-QOL) from January 2014 to April 2016. The GO-QOL included two subscales: the visual functioning and the psychosocial consequences. The differences in the GO-QOL scores between TAO patients and controls were analyzed. The influences of multiple factors on the GO-QOL scores among TAO patients were explored. Results: Among 112 TAO patients, 63 were male and 49 were female, with an average age of (45.4±13.1) years. Among 68 controls, 36 were male and 32 were female, with an average age of (39.5±10.8) years. Independent sample t test showed that TAO patients had significantly lower scores than controls in the visual functioning subscale and the psychosocial consequences subscale (55.63±29.02 vs 97.48±6.96, t=-14.58, P<0.01; 57.61±29.97 vs100±0.00, t=-14.97, P<0.01). Among TAO patients, smokers were associated with significantly lower psychological subscale scores than non-smokers (t=-2.284, P=0.024). Patients with abnormal primary position of eye scored significantly lower than those with normal alignment in functional (t=-3.979, P<0.001) and psychological subscales (t=-2.154, P=0.034) Patients with abnormal eye movement had significantly lower functional scores than those without (t=-2.975, P=0.004). One-way analysis of variance showed that higher CAS scores were significantly related to lower psychological subscale scores (F=3.178, P=0.018). Patients with upper eyelid retraction had significantly lower psychological subscale scores than those without (F=3.562, P=0.032). Pearson correlation analysis showed that age was negatively correlated with functional subscale scores (r=-0.366; P<0.01). TAO course was negatively correlated with functional (r=-0.235, P<0.05) and psychological subscale scores (r=-0.320, P<0.01). The degree of exophthalmos was negatively correlated with psychological subscale scores (r=-0.209, P<0.01). Multivariable linear regression analysis showed that only primary position of eye (P=0.013) and TAO course (P=0.007) were negatively correlated with functional subscale scores and only CAS scores (P=0.022) and TAO course (P=0.024) were negatively correlated with psychological subscale scores. Conclusion: Risk factors associated with lower quality-of-life among TAO patients included abnormal primary position of eye, higher CAS scores, and longer TAO course.(Chin J Ophthalmol,2017,53: 575-582).

[Clinical study on liver function, virology, serological changes and the safety of drug withdrawal in pregnant women who are chronic HBV carriers during pregnancy and postpartum]

Objective: To observe the changes of liver function, virology and serology and the safety of drug withdrawal in pregnant women who are chronic hepatitis B virus (HBV) carriers. Methods: A prospective clinical cohort was established to enroll pregnant women who are chronic HBV carriers and they were divided into the nucleoside/nucleotide analogs (NAs) intervention group and the non-NAs intervention group according to patients' wishes. Liver function, HBV DNA and HBV serological markers were detected at gestation, postpartum 6 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks. Results: 351 patients were enrolled, 320 in the NAs intervention group and 31 in the non-NAs intervention group. The proportion of postpartum hepatitis flares in both groups was higher than that in pregnancy (39.4% vs 12.5%, P < 0.001; 38.7% vs 3.2%, P = 0.001). Six weeks postpartum was the peak period of hepatitis flares, and 96.0% (121/126) of the hepatitis flares occurred within 24 weeks postpartum. At 6 weeks postpartum, there were 6 cases of alanine aminotransferase (ALT) ≥ 10 times upper limit of normal (ULN) in the NAs intervention group. The rate of the hepatitis flare after drug withdrawal was 16.7% (34/203). Conclusion: Regardless of the presence or absence of NAs intervention, pregnant women who are chronic HBV carriers have a certain proportion of hepatitis flares during pregnancy and postpartum, and the hepatitis flare even have a tendency to be severe. Therefore, drug withdrawal after delivery is not always safe, which requires close observation and classification. At 6 weeks postpartum, the incidence of hepatitis flares was high, and those who meet the treatment indications can get better therapeutic effects if given appropriate treatment. The vast majority (96%) of postpartum hepatitis flares occur within 24 weeks, so it is recommended to follow up to at least 24 weeks postpartum after discontinuation.

[Management of liver dysfunction during pregancy and postpartum in pregnant women who are chronic carriers of hepatitis B virus]

The reports of liver dysfunction during pregnancy or postpartum have gradually increased in pregnant women who are chronic carriers of hepatitis B virus (HBV), but there is no consensus on when to intervene and how to deal with it. This article reviewed recent literature reports and found that pregnant women who are chronic carriers of HBV, regardless of intervention of nucleos(t)ide analogs (NAs), have a certain proportion of hepatitis flares or severe disease during pregnancy and postpartum, suggesting that postpartum drug withdrawal is not always safe, and close follow-up is required. Furthermore, it recommends that treatment should be in accordance to the gestational weeks and ALT levels. NAs are the main treatment choice in the onset of hepatitis flares during pregnancy, however, postpartum hepatitis flares requires NAs or interferon therapy, and it have been reported that combination of NAs and interferon might achieve higher therapeutic response.

[Effects of overexpression of Notch intracellular domain on proliferation and osteogenic differentiation of human periodontal ligament stem cells]

Objective: To investigate the effect of overexpression of Notch intracellular domain (NICD) on proliferation and osteogenic differentiation of human periodontal ligament stem cells (hPDLSC). Methods: The third generation hPDLSC with stable overexpressing of NICD were assigned as experimental group, normal hPDLSC were as negative control group and hPDLSC transfected with empty vector were as blank control group. The effect of overexpressing NICD on proliferation ability of hPDLSC was detected by using cell counting kit-8 (CCK-8). Alizarin Red staining and real-time quantitative PCR (qPCR) were used to detect the effects of NICD on cementum attachment proteins (CAP), osteocalcin (OCN), Runt-related transcription factor 2 (RUNX2) and Notch signal pathway receptor Notch1. The effect of overexpressing NICD on hPDLSC osteogenic protein RUNX2 and flag marker protein (used to label NICD) were detected by using Western blotting. Results: CCK-8 results showed that there were no significant differences in A values amongst the three groups for 1-2 days (P>0.05). The number of cells in the experimental group was significantly increase than that of the two control groups from the third to seventh days (A values were 0.203±0.016, 0.364±0.014, 0.449±0.020, 0.549±0.020 and 0.570±0.020, respectively) (P<0.05). Alizarin red staining showed that compared with the blank control group and negative control group, the mineralized nodules in the experimental group had smaller formation range and lighter color, and the differences were statistically significant (P<0.05). The expressions of CAP gene (0.751±0.058, 0.887±0.025), osteocalcin gene (0.592±0.051, 0.670±0.045) and RUNX2 gene (0.319±0.038, 0.684±0.055) at 14 and 21 days in the experimental group were significantly lower than those in the negative control group respectively (P<0.05). However, the expression levels of Notch1 gene at 14 and 21 days (2.507±0.047, 4.041±0.219) were significantly higher than those of negative and blank control groups (P<0.05). The results of Western blotting showed that the expressions of flag marker protein (0.167±0.007, 0.204±0.010) at 14 and 21 days in the experimental group were significantly higher than those in the negative and blank control groups (P<0.05). However, the expressions of RUNX2 protein (0.075±0.006, 0.074±0.013) at 14 and 21 days were significantly lower than that in the negative control group (0.092±0.003, 0.118±0.008) and blank control group (0.174±0.006, 0.212±0.008) (P<0.05). Conclusions: Overexpression of NICD can promote the proliferation capacity of hPDLSC and inhibit its osteogenic differentiation.

[Prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province in 2017]

Objective: To understand prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province. Methods: A multi-stage random cluster sampling method was used to select 3 032 residents aged 50-69 years old in Zhejiang Province. The demographic characteristics, prevalence and control of hypertension were collected through a questionnaire survey, and physical measurement was also performed. The stratified random sampling method was used to detect the level of sodium and potassium in the 24 h urine of 676 subjects. The total amount of 24 h urinary sodium ≥102.55 mmol and the ratio of 24 h urinary sodium and potassium content ≥2 were defined as excessive. Results: The prevalence of hypertension (95%CI) was 56.89% (54.39%-59.40%), and the awareness, treatment and control rate of hypertension were 58.25% (55.01%-61.49%), 45.37% (42.10%-48.65%) and 19.75% (17.01%-22.50%), respectively. 78.99% (n=534) of residents had excessive 24 h urinary sodium, and 95.41% (n=360) of residents had excessive ratio of 24 h urinary sodium and potassium. Conclusion: The prevalence of hypertension in residents aged 50-69 years old in Zhejiang Province was at a high level, and the control of hypertension was not satisfactory in 2017. Most of residents have excessive level of sodium intake and the level of sodium and potassium intake was not balanced.

[Low-levels of HBsAg quantification at 48-week in HBeAg-negative chronic hepatitis B patients are the advantageous population for HBsAg clearance]

Objective: To analyze the therapeutic effect on HBeAg-negative chronic hepatitis B patients treated with Peg-IFNα-2a combined with NAs to obtain the influencing factors for predicting HBsAg clearance. Methods: A retrospective study was conducted to investigate the effect of pegylated interferon alpha-2a combined with nucleoside analogues (lamivudine/adefovir dipivoxil) on HBeAg-negative chronic hepatitis B. The treatment course was 96 weeks. Patients were followed up 120 weeks after the treatment. HBsAg clearance at 120 weeks was taken as the objective of the study. Logistic regression and receiver operating characteristic curve analysis screened the related factors affecting HBsAg clearance. χ (2) test was used to compare count data. Results: 111 patients were treated with pegylated interferon alpha-2a combined with nucleoside analogues, and 107 patients completed the scheduled course of treatment and follow-up. HBsAg clearance rate at120 week was 29.0% (31/107). The influencing factors for analysis were: (1) gender had no effect on HBsAg clearance rate; age and baseline levels of HBV DNA and alanine aminotransferase had no significant effect on HBsAg clearance; low baseline level of HBsAg (< 3.023 lgIU/ml) was beneficial to HBsAg clearance. The area under the working characteristic curve of the subjects was 0.746, the positive predictive value was 44.4%, and the negative predictive value was 86.8%. (2) HBsAg quantification or decline in 24 weeks and 48 weeks of treatment had a good predictive effect on HBsAg clearance, and the 48 weeks predicted value was higher than 24 weeks. When the HBsAg quantification was≤2.070 lgIU/ml at 48 weeks, the area under the receiver operating characteristic curve was 0.931, the positive predictive value was 52.8%, and the negative predictive value was 94.4%. When HBsAg decreased from baseline to≥0.991 lgIU/ml, the area under the receiver operating characteristic curve was 0.888, the positive predictive value was 50.8%, and the negative predictive value was 97.9%. (3) The analysis of HBsAg subgroup levels at 48 weeks suggested that the "interval analysis" can forecast HBsAg clearance more exactly than "nodal analysis" .The final HBsAg clearance rate of 100 IU/ml < HBsAg≤1 000 IU/ml, 10 IU/ml < HBsAg≤100 IU/ml and HBsAg≤10 IU/ml groups reached 6.7%, 31.8% and 67.7%, respectively. (4) The ALT abnormal group in the course of treatment obtained a higher HBsAg clearance rate (48.0%, 12/25). Conclusion: 96-weeks long-term treatment with pegylated interferon-alpha -alpha-2a combined with nucleoside analogues for HBeAg-negative chronic hepatitis B has a good predictive value for HBsAg clearance at baseline and during treatment. The "interval level" of HBsAg at 48-weeks is more accurate in predicting HBsAg clearance, suggesting that HBeAg-negative chronic hepatitis B patients with low HBsAg levels at 48-weeks are the advantageous populations with HBsAg clearance. These patients are worthy of prolonged treatment to pursue "clinical cure".

[The effects of different activators on the release curve of human platelet-rich plasma]

Objective: To compare and analyze the effects of different activators on the release curve of TGF-β(1) and PDGF-AB in platelet rich plasma(PRP). Methods: A total of 36 ml peripheral venous blood was obtained from 10 healthy adult volunteers, and the PRP was made by secondary centrifugation. The platelet activator was made by bovine thrombin 1 000 U in 1 ml 10% calcium chloride solution. The Thrombin-PRP group was made by PRP and the activator in a ratio of 10∶1.The Calcium chloride-PRP group was made in a ratio of 10∶1 by PRP and 10% calcium chloride solution instead. The fresh whole blood(whole blood group) and inactived PRP(PRP group) were used as the control groups. The 4 groups were incubated in warm water of 37 ℃ for 0, 1, 8, 24,72 and 168 h. A quantitative sandwich enzyme-linked immunosorbent assays(ELISA) was used to examine the amount of TGF-β(1) and PDGF-AB in different time points of each group. The release curves of TGF-β(1) and PDGF-AB were based on afore-mentioned data, and then comparisons of the release curves of TGF-β(1) and PDGF-AB in different groups were performed by repeated measurement variance analysis. Results: (1)The levels of TGF-β(1) and PDGF-AB in the whole blood group and the PRP group continued to increase within 168 h. PRP immediately formed into a gel after mixture with thrombin combined and calcium chloride, and the concentrations of TGF-β(1) and PDGF-AB reached the peak in 1 h after activation; increased from (42±21)ng/ml and (77±18)ng/ml to (84±21)ng/ml and (124±35)ng/ml, respectively, and then decreased gradually. The release curve was direct and rapid. The PRP became a gel state in approximate 1 h after mixture with calcium chloride, and the concentrations of TGF-β(1) and PDGF-AB were slowly rising and remained high at 168 h. (2)The AUC(0-168h) of TGF-β(1) and PDGF-AB in the PRP group was higher than that in the whole blood group (all P<0.05) , and the AUC(0-168h) of TGF-β(1) in the Calcium chloride-PRP group was higher than that in the Thrombin-PRP group(Z=-2.26, P<0.05).However, there was no significant difference in the AUC(0-168h) of PDGF-AB between the Calcium chloride-PRP group and the Thrombin-PRP group(Z=-1.512, P=0.131). Conclusion: Using calcium chloride as activator can get a higher release concentration of TGF-β(1) and PDGF-AB and a longer release time, with the largest area under the curve.

Cementless distal fixation modular stem without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more

INTRODUCTION

Hemiarthroplasty (HA) using standard-length femoral stem with reconstruction of femoral calcar or using calcar replacing prosthesis for unstable intertrochanteric fractures in elderly patients is a viable option. However, both of the techniques increase the complexity of procedure, operative trauma and complication. This study evaluated the clinico-radiological results of the MP-Link cementless distal fixation modular prosthesis without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more.

HYPOTHESIS

Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, do not need to reconstruct the femoral calcar.

MATERIALS AND METHODS

Forty-two patients (42 hips) underwent bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures from January 2008 to January 2012. Five (11.9%) patients were lost to follow-up. The 37 remaining patients (37 hips) were available for evaluation. The mean age was 83.9±5.2 years. Their clinico-radiological data were prospectively gathered.

RESULTS

All of 37 patients, 4 patients (10.8%) died within 1 year postoperatively. At the final follow-up, 31 (83.8%) out of 37 patients were regained preoperative ambulatory status; the mean Harris hip score (HHS) of the 15 patients who died during the follow-up period of 7-59 months, was 84.5±2.4 points; the 22 healthy patients were followed for 68.6±14.7 months, with mean HHS of 84.6±2.8 points. Radiologically, none of stems had evidence of loosening; 16 stems had subsidence of 2-3mm without clinical significance; the bone in-growth fixation was achieved in 24 patients and stable fibrous fixation in 13 patients.

DISCUSSION

Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, without reconstruction of the femoral calcar, may achieve a satisfactory clinico-radiological outcome, and could regain preoperative ambulatory status in most patients (83.3%).

LEVEL OF EVIDENCE

IV, Retrospective study.

[Study of bone mineral density and serum bone turnover markers in newly diagnosed systemic lupus erythematosus patients]

OBJECTIVE

To investigate the changes of bone mineral density (BMD) and serum bone turnover factor in newly diagnosed systemic lupus erythematous (SLE) patients.

METHODS

Eighty newly diagnosed SLE patients and 80 age and gender matched healthy controls were enrolled. None of the SLE patients had ever received glucocorticoid, immunosuppressive agents or vitamin D. BMD was measured at radius,lumbar spine and hip by dual X ray absorptiometry (DXA). Bone turnover markers including serum levels of tartrate-resistant acid phosphatase 5b (TRAP5b),bone alkaline phosphatase (BAP) and 25-hydroxy vitamin D3 (25-OH-VD3) were measured by enzyme-linked immunosorbent assay (ELISA). Logistic regression was employed to analyze the risk factors associated with decreased BMD.

RESULTS

Mean age of the SLE patients was (32.8±12.4) years, and 85% were female, none of whom were post-menopausal. BMD was significantly reduced in all the measured sites, compared with the healthy controls. Sixteen (20%) of the patients were osteopenic in at least one site measured locations. The serum levels of 25-OH-VD3 were markedly reduced in the newly diagnosed SLE patients than those of the normal controls [(46.1+12.3) nmol/L vs. (25.4+11.2) nmol/L, P<0.001)]. The serum levels of 25-OH-VD3 in the SLE patients with nephritis were much lower than those without nephritis (P=0.04). A significant negative correlation was demonstrated between the serum concentration of 25-OH-VD3 and the disease activity scores as measured by SLE disease activity index (SLEDAI) (r=-0.3,P=0.001). The serum TRAP5b concentration was positively correlated with SLEDAI (r=0.435,P=0.003). Age (P=0.058) and SLEDAI (P=0.085) were probably associated with decreased BMD in Logistic regression analysis.

CONCLUSION

The study showed reduced BMD in untreated SLE patients. The role of chronic inflammation was of probable importance in bone metabolism.

[Molecular mechanisms and relationship of M2-polarized macrophages with early response in multiple myeloma]

目的

探讨替代活化型巨噬细胞（M2 MΦ）和多发性骨髓瘤（MM）早期治疗反应的关系及其在发病机制中的可能作用。

方法

采用免疫组化法标记240例MM患者骨髓标本中的MΦ；建立体外M2 MΦ诱导培养体系，构建Transwell共培养模型与RPMI 8226和U266细胞共培养，CCK-8法检测M2 MΦ对细胞增殖的影响，流式细胞术检测对地塞米松（1 µ mol/L）诱导骨髓瘤细胞凋亡的影响，ELISA法检测对TNF-α和IL-6表达的影响，real time PCR法检测对趋化因子、血管内皮生长因子（VEGF）及其受体表达的影响。

结果

①依据骨髓组织M2 MΦ浸润程度将患者分为高浸润组（92例）和低浸润组（148例），高浸润组患者早期治疗有效率明显低于低浸润组，差异有统计学意义（23.9%对73.0%，χ²=60.31，P<0.001）。②培养24、36 h，共培养组细胞增殖能力较对照组显著上升：M2 MΦ+RPMI 8226细胞组与对照组比较，P值分别为0.005、0.020；M2 MΦ+U266细胞与对照组比较，P值分别为0.030、0.020。③地塞米松诱导后，共培养组与对照组比较，RPMI 8226细胞凋亡率下降（29.0%对71.0%，t=4.97，P=0.008），U266细胞凋亡率也下降（24.9%对67.7%，t=6.99，P=0.002）。④共培养48 h后，与对照组比较，加入M2 MΦ后可促进RPMI 8226和U266细胞分泌IL-6、TNF-α，促进表达CCL2、CCL3、CCR2、CCR5、VEGFA、VEGFR-1和VEGFR-2。

结论

MM患者骨髓组织M2 MΦ浸润程度和早期治疗反应相关。M2 MΦ通过促进骨髓瘤细胞分泌系列炎症因子、趋化因子和相关受体的表达，从而促进骨髓瘤细胞增殖以及保护骨髓瘤细胞免于凋亡。

[Effect of nasal glucocorticoid combined with loratadine or montelukast on allergic rhinitis]

Objective:To evaluate the effect of nasal glucocorticoid combined with second-generation antihistamines or leukotriene receptor antagonists on the treatment of moderate severe allergic rhinitis, and explore the optimal scheme of personalized treatment for AR patients.Method:Fiftyseven patients with persistent moderatesevere allergic rhinitis were randomly divided into three groups and treated by mometasone furoate aqueous nasal spray (group MOM), mometasone furoate aqueous nasal spray combined with loratadine (group MOM+L), mometasone furoate aqueous nasal spray combined with montelukast (group MOM+M) for 4 weeks. Four major clinical symptoms of allergic rhinitis: nasal congestion, nose itching, sneezing and runny nose were evaluated by "symptom rating score" before treatment and after treatment for 4 weeks.Result:After treatment, the total nasal symptom scores of each group showed a decreasing tendency, and the differences between various time points were statistically significant (P< 0.05). For the symptom of nasal congestion, the symptom score of MOM+M group was significantly lower than that of MOM group and MOM+L group at the 2nd and 4th week after treatment. For the symptoms of sneezing and nasal itching, MOM+L group had the lowest score at each time point after treatment and the difference was statistically significant compared with MOM group (P< 0.05), but there was no significant difference between MOM group and MOM+M group (P> 0.05). For the symptom of runny nose, the score of MOM+L group was significantly lower than MOM group (P< 0.05) at the 1st and 2nd week, MOM+M group was significantly lower than MOM group (P< 0.05) at the 2nd and 4th week, while there was no significant difference between MOM+L group and MOM+M group (P> 0.05).Conclusion:Nasal glucocorticoid alone or combined with secondgeneration antihistamines or leukotriene receptor antagonists can effectively control nasal symptoms of moderatesevere allergic rhinitis, yet the effect of combination therapy is better. For nasal congestion, nasal glucocorticoid combined with leukotriene receptor antagonists have a better effect. For nasal itching and sneezing, the choice of nasal glucocorticoid combined with second-generation antihistamines may be more sensible. For runny nose, nasal glucocorticoid combined with second-generation antihistamines or leukotriene receptor antagonists have similar efficacy.

Prognostic factors to survival of patients with chondroblastic osteosarcoma

This study was aimed to reveal the changes in survival rates and prognostic factors to survival of chondroblastic osteosarcoma (COS).Patients from the Surveillance, Epidemiology, and End Results (SEER) database were retrieved. Kaplan-Meier survival analysis and Cox proportional hazard model were used during analysis.There were significant differences on overall survival between subtypes of osteosarcoma (P < .001*). Overall survival of COS did not change significantly during last forty years (P = .610), and cancer-specific survival increased to a plateau in 1980s and then remained stable (P = .058). Younger onset age, patients of white race, well and moderately differentiated tumors, and surgery independently predicted better overall (Hazard ratio [HR]: 1.034, P < .001*; HR: 0.538, P = .004*; HR: 0.240, P = .020* and HR: 0.350, P < .001*, respectively) and cancer-specific (HR: 1.031, P = .002*; HR: 0.592, P = .036*; HR: 0.098, P = .027* and HR: 0.253, P < .001*, respectively) survival. Metastasis at diagnosis independently predicted worse overall (HR: 3.108, P < .001*) and cancer-specific (HR: 4.26, P < .001*) survival compared to no metastasis.Younger onset age, white race, well and moderately differentiated tumors, no metastasis at diagnosis and surgical resection can independently predict better overall and cancer-specific survival of COS.

Resveratrol alleviates heat stress-induced impairment of intestinal morphology, microflora, and barrier integrity in broilers

This study was to investigate the effect of resveratrol on intestinal morphology, microfloras, and barrier integrity of broilers subjected to heat stress. Two-hundred-seventy 21-day-old Cobb male broilers were randomly allocated to 3 treatment groups, each of which included 6 replicates with 15 birds per replicate. The 3 treatment groups were as follows: the control group, in which birds were exposed to thermoneutral condition (22 ± 1°C), and the heat stress group and heat stress + resveratrol (400 mg/kg) group, in which birds were exposed to cyclic heat stress (33 ± 1°C for 10 h/d from 0800 to 1800 h and 22 ± 1°C for the remaining time. Compared with birds in the control group, birds in the heat stress group exhibited decreased (P < 0.05) final body weight, average daily gain, average daily feed intake, villus height, villus height to crypt depth ratio, goblet cells numbers, populations of Lactobacillus and Bifidobacterium, and mRNA levels of mucin-2, claudin-1, occludin, zona occludens-1, and E-cadherin, and increased (P < 0.05) crypt depth, serum D-lactic acid and fluorescein isothiocyanate dextran contents and diamine oxidase activity, and populations of Salmonella, Escherichia coli, and Clostridium. Compared with birds in the heat stress group, birds in the heat stress + resveratrol group exhibited decreased (P < 0.05) crypt depth, serum D-lactic acid and fluorescein isothiocyanate dextran contents, and populations of Escherichia coli, and increased (P < 0.05) final body weight, villus height, villus height to crypt depth ratio, goblet cells numbers, populations of Lactobacillus and Bifidobacterium, and mRNA levels of mucin-2, claudin-1, occludin, and E-cadherin. Taken together, these results indicated for the first time that dietary addition of resveratrol was effective in partially ameliorating the adverse effects of heat stress on intestinal barrier function in broilers by restoring the impaired villus-crypt structure, modifying the profiles of intestinal microfloras, and altering the mRNA expression of intestinal tight junctions- and adherence junctions-related genes.

[Expression of osteoprotegerin and receptor activator of nuclear factor kappa-B ligand in mandibular ramus osteotomy healing with administration of different doses of parathyroid hormone]

Objective: To investigate the effect of parathyroid hormone (PTH) on the bone healing of mandibular ramus osteotomy. Methods: The mandibular ramus osteotomy model was established in sixty rabbits and these rabbits were randomly divided into experimental group A, experimental group B and control group. In the experimental group A and experimental group B, the rabbits were given PTH (20 and 40 μg/kg respectively) every other day after operation. In the control group, 1 ml saline was given. The animals were sacrificed at 1 week, 2 weeks, 3 weeks and 4 weeks postoperatively. The new bone formation was observed by histology and cone bone CT. The expression of osteoprotegerin and receptor activator of nuclear factor kappa-B (RANKL) in the new bone was detected by real-time quantitative PCR. Results: The experimental groups has better osteogenesis and the bone mineral density than the control group in osteotomy area. The experimental group B showed the best osteogenesis.Osteoprotegerin mRNA expression in experimental group A (1.127±0.035, 1.742±0.049, 1.049±0.062, 1.063±0.036) was significantly higher than that in the control group in each period (0.965±0.082, 1.254±0.071, 0.793±0.061, 0.684±0.055) (P=0.010, P=0.000, P=0.001, P=0.020), while group B (1.416±0.205, 2.648±0.168, 1.652±0.091, 1.712±0.070) was significantly higher than group A (P=0.000, P=0.010, P=0.023, P=0.003). RANKL mRNA expression in control group (1.666±0.086, 1.058±0.105, 0.885±0.124, 0.972±0.136) was significantly higher than that of the group A (0.788±0.036, 0.585±0.017, 0.692±0.017, 0.527±0.051) (P=0.001, P=0.006, P=0.003, P=0.028) in each period, while group A was significantly higher than group B(0.247±0.022, 0.240±0.034, 0.134±0.011, 0.103±0.050) (P=0.000, P=0.001, P=0.002, P=0.012). Conclusions: PTH can upregulate the expression of osteoprotegerin and reduce expression of RANKL, thus promoting new bone formation. Intermittent administration of high dose of parathyroid hormone can further promote the healing process after mandibular ramus osteotomy.

Dietary resveratrol supplementation prevents transport-stress-impaired meat quality of broilers through maintaining muscle energy metabolism and antioxidant status

This experiment was to evaluate the effect of dietary resveratrol (Res) supplementation (0, 400 mg/kg) on growth performance, meat quality, and muscle anaerobic glycolysis and antioxidant capacity of transported broilers. A total of 360 21-day-old male Cobb broilers was randomly allotted to 2 dietary treatments (Res-free group and Res group) with 12 replicates of 15 birds each. On the morning of d 42, after a 9-hour fast, 24 birds (2 birds of each replicate) were selected from the Res-free group and then equally placed into 2 crates, and the other 12 birds (one bird of each replicate) were selected from the Res group and then placed into the other crate. All birds in the 3 crates were transported according to the following protocols: 0-hour transport of birds in the Res-free group (control group), 3-hour transport of birds in the Res-free group (T group), and 3-hour transport of birds in the Res group (T + Res group). The results showed that Res not only improved feed conversion ratio (P < 0.05) but also tended to improve birds’ final body weight (P < 0.10). In the Res-free group, a 3-hour transport increased serum corticosterone concentration, muscle malondialdehyde (MDA) and lactate contents, and muscle lactate dehydrogenase (LDH) activity, while it decreased muscle glycogen content, total superoxide dismutase (T-SOD), and glutathione peroxidase (GSH-PX) activities (P < 0.05), which induced decreased breast meat quality (lower pH_24h and higher drip loss and L*_24 h, P < 0.05). Nevertheless, compared with the T group, Res increased muscle glycogen content and T-SOD and GSH-PX activities (P < 0.05 or P < 0.10), while it decreased muscle MDA content and LDH activity (P < 0.05), which is beneficial to the meat quality maintenance of transported broilers (lower drip loss, L*_24 h, and higher pH_24h, P < 0.05 or P < 0.10). This study provides the first evidence that dietary resveratrol supplementation prevents transport-stress-impaired meat quality of broilers, possibly through decreasing the muscle anaerobic glycolysis metabolism and improving the muscle antioxidant capacity.

[Langerhans cell sarcoma: a clinicopathologic analysis of four cases]

Objective: To investigate the clinicopathological features, differential diagnosis, and genetic alteration of Langerhans cell sarcoma (LCS). Methods: Four cases of LCS were collected from Fujian Provincial Hospital and Fuzhou General Hospital of Nanjing Military Command of PLA from July 2013 to January 2017. Clinicopathological features and immunophenotype were retrospectively reviewed in four LCS cases combined with genetic mutation analysis of BRAF and ALK. Results: Four cases included 2 women and 2 men with ages from 42 to 79 years (median=59.3 years). The size of the tumors ranged from 2.5-7.8 cm. Histologically, at the low power field, the tumors consisted of highly cellular proliferation in fascicules, whirlpool and diffuse sheets arrangement. The tumor cells were kidney-or horseshoe-shaped to round epithelioid cells or enlarged spindle cells. The neoplastic cells showed cytological atypia, hyperchromatic nuclei with prominent 1 to 2 nucleoli. Multinucleated giant cells were also found. Mitotic activity was approximately (50-70) mitoses/10 HPF. Immunohistochemically, the tumor cells were positive for S-100 protein (4/4), SOX10(3/4), Langerin/CD207(4/4), CD1a(3/4), CD68(3/4), CD163(3/4), and INI-1(4/4). Ki-67 index was 30%-80%. Gene mutation analysis showed that one case had BRAF V600E mutation but none had ALK gene alteration. Conclusions: LCS is a rare tumor with highly malignant potential and distinct morphologic features.The primary treatment for LCS is completely surgical excision and chemotherapy. The prognosis is generally poor.