Pulmonary thromboendarterectomy is a curative resolution for chronic thromboembolic pulmonary hypertension associated with antiphospholipid syndrome: a retrospective cohort study

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and life-threatening condition with poor prognosis in patients with antiphospholipid syndrome (APS). Pulmonary thromboendarterectomy (PTE) is the optimal surgical option for CTEPH.

Objectives

This retrospective cohort study aimed to evaluate the efficacy and risk of PTE in patients with APS-associated CTEPH.

Methods

Consecutive patients with APS-associated CTEPH diagnosed between January 2012 and September 2017 at Peking Union Medical College Hospital were retrospectively evaluated. Demographics, clinical manifestations, antiphospholipid antibody (aPL) profiles, and pulmonary arterial hypertension–targeted medications were collected. Deterioration of cardiac function and death were chosen as the endpoints, in order to assess the effect of PTE on short-term and long-term prognoses (evaluated by the change of cardiac function after treatment and cardiac deterioration or death in the follow-up, respectively).

Results

A total of 20 patients with APS-associated CTEPH were enrolled, and eight patients underwent PTE. Chi-square test ( p = 0.01) and Kaplan–Meier curves (log rank test, p = 0.04) showed that there were statistically significant differences in both short-term and long-term prognoses between patients with and without PTE.

Conclusion

These results provide strong evidence that PTE is a curative resolution in patients with APS-associated CTEPH. Following a full specialized and multidisciplinary risk-benefit evaluation to limit the risk of thrombosis or bleeding and to manage possible thrombocytopenia, PTE is at least a temporal curative resolution for CTEPH complicated with APS.

[Meta analysis of surgical treatment for old Monteggia fracture in children]

Objective: To analysis the treatment effect of the ulnar osteotomy and ring-shaped ligament reconstruction for the treatment of old Monteggia fracture in children by using Meta analyze, and the difference of clinical curative effect was compared in order to provide the basis for the selection of clinical treatment options for old Monteggia fractures in children. Methods: We searched databases such as CNKI, Wanfang database, Medline, PubMed, Embase and Science through computer, at the same time, the references of relevant documents were retrieved manually, and the data processing was carried out by the RevMan5.3 statistical software provided by the Cochrane cooperation network by incorporating the exclusion criteria. The results were obtained and analyzed. Results: A total of 17 standard literature, 438 cases, 224 cases of ulnar osteotomy, 214 cases with ring ligament repair and reconstruction were obtained. The operation scheme, which was mainly based on the lengthening of ulna osteotomy, was superior to the reconstruction of ring ligament reconstruction. The complications and second operation rates of the former was less than that of the latter. Conclusion: The surgical methods for the reconstruction of the ulna osteotomy and the ring-shaped ligament have advantages and disadvantages. The choice of the operative plan for the old Monteggia fracture should be based on the following factors: the time of the old Monteggia fracture formation, the degree of the ulnar and radial deformity and the familiarity of the operative method.

[Application and prospect of three-dimentional printing in stomatology]

Three dimentional printing is a new rapid prototyping technology based on digital model files, which developed through a combination of multi-disciplines such as information technology, precision machinery and materials science. With rapid development in recent years, three dimentional printing technology has been widely used in the medical fields, stomatology especially. It gradually penetrates into various parts of stomatology, such as education, practice and innovation, making stomatology clinical medicine more and more efficient, accurate and minimally invasive. Combined with basic research and clinical cases, this article describes the application and developent prospects of three dimentional printing technology in stomatology.

[An analysis of the subcutaneous immunotherapy on the pulmonary function and symptoms of asthma and rhinitis in children]

Objective:To evaluate the effect of subcutaneous immunotherapy on allergic asthma and rhinitis in children.Method:A prospective study was adopted to analysis 3 years SCIT treatment of 144 cases of children with allergic asthma and rhinitis. Before and after SCIT treatment for 1 year, 2 and 3 years, FEV1, daytime and night symptoms of asthma and rhinitis were evaluated.Result:After 3 years of SCIT treatment, the FEV1 had significantly increased (F= 243.05, P< 0.01), and with the duration of the treatment was further improvement (P< 0.01). Compared with the baseline, treatment 1 year in daytime, nighttime symptoms scores of asthma and nighttime symptoms scores of rhinitis had significantly reduced (P< 0.01). All symptoms were reduced further by 2 years of treatment (P< 0.01) compared with 1 year. Compared with the 2 years of treatment, daytime symptoms of asthma and rhinitis of 3 years SCIT treatment was improved significantly (P< 0.05).Conclusion:Subcutaneous immunotherapy with 3 years in children allergic with asthma and rhinitis can play a significant effect.

[The state-of-the-art development in research on oral mucositis induced by chemotherapy]

Chemotherapy is one of the effective methods to treat cancer. However, the chemotherapy agents may cause a series of adverse reactions due to the nonselective characteristics that affect not only tumor cells, but also normal cells. Oral mucositis induced by chemotherapy is a common oral complication caused by chemotherapy in clinic. It brings great suffering to the patients and also interferes with the procedure of chemotherapy. Because of its high incidence in patients receiving chemotherapy and the significant influence, there are more researches on oral mucositis induced by chemotherapy which let us have further understanding of it. This review article will introduce the pathogenesis, risk factors, clinical manifestations, assessments, treatment and prevention of oral mucositis induced by chemotherapy.

Universal newborn screening: A roadmap for action

Newborn screening (NBS) prevents morbidity and mortality by screening babies for selected disorders in the first days of life so that early diagnosis and treatment can be initiated. Congenital disorders impact an estimated 8 million or 6% of annual births worldwide, and of the top five that contribute 25% to the global burden of these disorders, three can be identified and managed by NBS. There are determined pockets of activity in Latin America, Sub-Saharan Africa, and the Asia Pacific region, where partnerships among government, non-governmental organizations, academia, the private sector and civil society are developing novel NBS programs that are both saving lives and preventing disability in those who survive.

Can you detect early dementia from an email? A proof of principle study of daily computer use to detect cognitive and functional decline

OBJECTIVE

To determine whether multiple computer use behaviours can distinguish between cognitively healthy older adults and those in the early stages of cognitive decline, and to investigate whether these behaviours are associated with cognitive and functional ability.

METHODS

Older adults with cognitive impairment (n = 20) and healthy controls (n = 24) completed assessments of cognitive and functional abilities and a series of semi-directed computer tasks. Computer use behaviours were captured passively using bespoke software.

RESULTS

The profile of computer use behaviours was significantly different in cognitively impaired compared with cognitively healthy control participants including more frequent pauses, slower typing, and a higher proportion of mouse clicks. These behaviours were significantly associated with performance on cognitive and functional assessments, in particular, those related to memory.

CONCLUSION

Unobtrusively capturing computer use behaviours offers the potential for early detection of neurodegeneration in non-clinical settings, which could enable timely interventions to ultimately improve long-term outcomes.

Incidence of fractures among patients with rheumatoid arthritis: a systematic review and meta-analysis

This study is the first meta-analysis investigating the pooled incidence rates of fractures among patients with RA. Our results demonstrated that this population is at high risk of overall and fragility fractures. Consideration of vertebral imaging and RA-specific risk factor assessment may aid in fracture prevention for this vulnerable group.

INTRODUCTION

This systematic review and meta-analysis aims to estimate the incidence of fractures (overall and fragility) in patients with rheumatoid arthritis (RA).

METHODS

MEDLINE, EMBASE, and CENTRAL were searched for cohort studies reporting incidence of fractures among patients with RA. Two reviewers independently assessed all studies for inclusion and extracted data. Pooled analyses of incidence rates and relative risk of fractures were conducted using a random-effects model. Subgroup analyses investigated potential sources of heterogeneity, and predictors of fractures were summarized.

RESULTS

Twenty-five studies were included in total. The pooled incidence rates of overall and fragility fractures were 33.00 (95% CI 18.39-59.21) and 15.31 (95% CI 10.43-22.47) per 1000 person-years, respectively. Patients with RA had a higher risk of overall (RR 1.52, 95% CI 1.07-2.14) and fragility (RR 1.61, 95% CI 1.44-1.79) fractures. Subgroup analyses suggested a higher risk of fragility fractures among female patients (31.03 vs. 23.75 per 1000 person-years). The pooled site-specific incidence rates of vertebral, hip, forearm, and proximal humeral fractures were 7.51 (95% CI 3.27-17.23), 4.33 (95% CI 2.26-8.27), 3.40 (95% CI 2.27-5.10), and 1.86 (95% CI 1.36-2.53) per 1000 person-years, respectively. Clinical vertebral fractures were underestimated compared with radiographic screening (4.29 vs. 42.40 per 1000 person-years). Predictors of fractures included both traditional OP risk factors and RA-specific factors.

CONCLUSIONS

Patients with RA are at high risk of incident overall and fragility fractures. Consideration of vertebral imaging for patients with additional OP risk factors, including RA-specific risk factors, may help with early OP diagnosis and timely intervention.

The prognosis of pulmonary arterial hypertension associated with primary Sjögren's syndrome: a cohort study

Pulmonary arterial hypertension (PAH) is a rare and severe complication of primary Sjögren's syndrome (pSS). Cohort studies indicate that the underlying diseases of PAH associated with connective tissue disease (CTD-PAH) in Asian countries are different from that in the United States and in Europe. This study investigated the clinical characteristics, survival, and prognostic factors of pSS-PAH in Chinese patients. We enrolled 29 patients with pSS-PAH who visited our referral center during August 2007 and May 2015. PAH was confirmed by right heart catheterization (RHC). Baseline demographic data, clinical manifestations, laboratory tests, autoantibody results, hemodynamics data, and treatment regimens were analyzed. All patients were followed up at the Department of Rheumatology, Peking Union Medical College Hospital (PUMCH) every three to six months. All patients were female. Mean age of pSS onset was 34.4 ± 11.1 years. Mean age of PAH diagnosed by RHC was 40.6 ± 9.0 years. There was no significant difference in age, disease duration, and hemodynamic findings between the survivors and the non-survivors in this cohort. The overall one-, three-, and five-year survival rates were 80.2%, 74.8%, and 67.4%, respectively. Prognostic factors of mortality were time between pSS onset and PAH onset (HR 1.102, 95% CI 1.017-1.185, p = 0.018) and cardiac index < 2 l/min/m² (HR 5.497, 95% CI 1.063-28.434, p = 0.042). In contrast, the use of immunosuppressants (HR 0.110, 95% CI 0.024-0.495, p = 0.004) was related to better survival. This study demonstrates that the predictors of mortality in patients with pSS-PAH include delayed onset of PAH in pSS and worse cardiac function. Immunosuppressants can improve the prognosis of pSS-PAH.

[Research advances in hepatocyte-like cells from human induced pluripotent stem cells and their application]

Induced pluripotent stem cells (iPSCs) have the potential of proliferation and differentiation into a variety of somatic cells, including hepatocyte-like cells (HLCs). HLCs from human iPSCs (hiPSC-HLCs) have similar features and functions as primary hepatocytes and are used as an efficient in vitro model of hepatocytes, which brings hope to studies on liver diseases and drug hepatotoxicity evaluation. This article reviews the research advances in hiPSC-HLCs and their application in the fields of disease model, drug hepatotoxicity evaluation, and cell transplantation and discusses the future perspectives of the application of hiPSC-HLCs.

Gene-Activated Matrices for Cartilage Defect Reparation

A cartilage defect has a very limited ability to repair itself spontaneously due to the shortage of blood. Many attempts have been made to restore the integrity of cartilage in clinical and experimental studies. Recently, tissue engineering has emerged as a new protocol for lost tissue regeneration. Meanwhile, the defect-repairing environment can be improved by gene therapy methods. Gene-activated matrices (GAM) fabricated with biomaterials and plasmids fill the cartilage defects to restore the integrity of joint surface, facilitating repair cell adhesion and proliferation as well as the synthesis of extracelluar matrix. And they also serve as a local gene delivery system, inducing therapeutic agent expression at the repair site. In the present study, we fabricated two- and three-dimensional matrices from chitosan and gelatin, then added a plasmid DNA encoding transforming growth factors-β1 (TGF-β1) for cartilage defect regeneration. First, we demonstrated primary chondrocytes could maintain their biological characteristics and secrete therapeutic proteins when they were cultured onto GAM in vitro. Subsequently we inserted three-dimensional GAM into cartilage defects of rabbit knee joints. With the results of the new cartilage tissue formation, we came to the conclusion that GAM was helpful for new tissue production and this therapeutic protocol provided a cheap, simple, and effective method for cartilage defect reparation.

[Holistic integrative medicine: application in prevention and treatment of oral mucosal diseases]

Holistic integrative medicine (HIM), as one of the important ideas in the field of medicine, arouses great concern recently. HIM regards the human body as a whole, turns data and evidence in medical research back to facts, integrates technologies and experience developed in clinical research into medical skills. The repeated practices at the levels of fact, experience, and medical skills will generate true knowledge to solve the wide spread problems brought by linearized thinking and fragmented knowledge. With the development of highly divided medical disciplines, how to utilize and practice HIM has become a common concern of the medical community. Specialization of stomatology, which is a first level discipline like medicine, has also become a trend for years. However, holistic concept cannot be overlooked, especially in the development of oral medicine. This article aims at the communication and exchange of knowledge about HIM among dental professionals. In order to serve the patients better, the authors look forward to practicing the HIM concept in the field of oral medicine through the efforts of us all.

Monte Carlo study of the ordering in a strongly frustrated liquid crystal

We have performed Monte Carlo simulations to investigate the temperature dependence of the ordering of the side chains of the X-shaped liquid crystal molecules which are arranged in a hexagonal array. Each hexagon contains six side chains, one from each side of the hexagon. Each liquid crystal molecule has two, dissimilar, side chains, one that contains silicon and one that contains fluorine. Like chains attract each other more strongly than unlike chains and this drives an order-disorder transition. The system is frustrated because it is not possible to find a configuration in which all the hexagons are occupied by either all silicon or all fluorine chains. There are two phase transitions. If only pairwise interactions are included it is found that there is an interesting fluctuating phase between the disordered phase and the fully ordered ground state. This did not agree with the experiments where an intermediate phase was seen that had long range order on one of the three sublattices. Agreement was found when the calculations were modified to include attractive three-body interactions between the silicon chains.

[The research progress of CO(2) laser in the treatment of oral lichen planus]

Oral lichen planus (OLP) is a common oral mucosal disease. The etiology of OLP is not clear. The treatment of OLP is difficult as some of the OLP patients have little effects to the conventional mucosal treatments. In recent years, laser therapy has been adopted to treat patients with OLP. The CO(2) laser therapy has drawn much attention of doctors and scholars because of its advantages in treating the OLP. This review article mainly discusses the principle, effects and some state-of-the-art progresses in OLP treatment using CO(2) laser.