简介：AbstractPurpose:The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field. However, many complications following the use of tourniquets have been reported. Tourniquet pain is the most common complication. This study aimed to find the actual incidence of pain associated with tourniquet use in orthopedic surgery and the various factors.Methods:It is a prospective observational study conducted on 132 consecutive cases. Patients aged 18-70 years with musculoskeletal problems of the forearm and leg requiring surgery were included in the study. Patients with open injuries or contraindications such as diabetes mellitus, compromised circulatory states, neurological deficit, compartment syndrome and unable to give informed consent were excluded. The parameters assessed included duration of tourniquet use, tourniquet pressure, type of anesthesia, any interval release of the tourniquet and reapplication after a reperfusion period, whether upper or lower limb surgery, severity of tourniquet pain, timing of tourniquet release and complications. Chi-square and non-parametric Mann-Whitney U test were used for data analysis.Results:In upper limb surgeries, if duration of surgery was less than 60 min, 14 (51.8%) cases experienced tourniquet pain and 13 (48.1%) had no pain, and if duration of surgery was more than 60 min, 24 (60.0%) had pain and 16 (40.0%) experienced no pain. In lower limb surgeries if duration of surgery was less than 60 min, 2 (7.7%) experienced pain and 24 (92.3%) had no pain, and if duration of surgery was more than 60 min, 14 (35.8%) experienced pain and 25 (64.8%) had no pain. Degree of tourniquet pain increases with the duration of surgery. Statistically, there was significant association between tourniquet inflation time and tourniquet pain in both upper and lower limbs (p = 0.034 and 0.024, respectively)Conclusion:Incidence of tourniquet pain was in direct proportion to the duration of tourniquet use and was higher in cases with regional anesthesia. Other risk factors assessed including tourniquet pressure, upper or lower limb surgery, tourniquet release time and interval had no significant contribution to the incidence or severity of tourniquet pain.

简介：Thecorneahasuniquefeaturesthatmakeitausefulmodelforregenerativemedicinestudies.Itisanavascular,transparent,denselyinnervatedtissueandanypathologicalchangescanbeeasilydetectedbyslitlampexamination.Cornealsensitivityisprovidedbytheophthalmicbranchofthetrigeminalnervethatelicitsprotectivereflexessuchasblinkingandtearingandexertstrophicsupportbyreleasingneuromediatorsandgrowthfactors.Cornealnervesareeasilyevaluatedforbothfunctionandmorphologyusingstandardinstrumentssuchascornealesthesiometerandinvivoconfocalmicroscope.Alllocalandsystemicconditionsthatareassociatedwithdamageofthetrigeminalnervecausethedevelopmentofneurotrophickeratitis,araredegenerativedisease.Neurotrophickeratitisischaracterizedbyimpairmentofcornealsensitivityassociatedwithdevelopmentofpersistentepithelialdefectsthatmayprogresstocornealulcer,meltingandperforation.Currentneurotrophickeratitistreatmentsaimatsupportingcornealhealingandpreventingprogressionofcornealdamage.Novelcompoundsabletostimulatecornealnerverecoveryareinadvanceddevelopmentstage.Amongthem,nervegrowthfactoreyedropsshowedtobesafeandeffectiveinstimulatingcornealhealingandimprovingcornealsensitivityinpatientswithneurotrophickeratitis.Neurotrophickeratitisrepresentsanusefulmodeltoevaluateinclinicalpracticenovelneuro-regenerativedrugs.

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简介：ComparisonsintheratesofstomachandcoloncancerbetweencountriesoftheEastandthoseoftheWestsuggestthatdietaryfactorsplayasignificantroleincarcinogenesisofthegastrointestinaltract.However,ithasbeendifficulttoclarifywhichofthemanyfactorsthatinfluencecarcinogenesisareinfactalteredbydiet.Geneticdeterminants,dietaryhabits,

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简介：AbstractBackground:The detrimental outcomes of right ventricular pacing on left ventricular electromechanical function ultimately result in heart failure, a phenomenon termed pacing-induced cardiomyopathy (PICM) in clinical research. This study aimed to validate prognostic factors that can be used to identify patients with higher susceptibility to progress to the stage of cardiomyopathy before pacemaker implantation.Methods:This observational analysis enrolled 256 patients between January 2013 and June 2016, 23 (8.98%) of whom progressed to PICM after 1 year of follow-up. A Cox proportional hazard model was used to analyze the prognostic factors associated with PICM. Dose-response analysis was used to evaluate the relationship between significant indicators in multifactor analysis and PICM.Results:The mean values of left ventricular ejection fraction before and after pacemaker implantation in 23 patients diagnosed with PICM were 62.3% and 42.7%, respectively. Univariate analysis showed that sex, atrio-ventricular block, paced QRS duration, and ventricular pacing percentage were significantly associated with PICM. In the multivariate analysis, male sex (hazard ratio: 1.20, 95% confidence interval [CI]: 1.09-1.33, P < 0.005), paced QRS duration (hazard ratio: 1.95 per 1 ms increase, 95% CI: 1.80-2.12, P < 0.001), and ventricular pacing percentage (hazard ratio: 1.65 per 1% increase, 95% CI: 1.51-1.79, P < 0.001) were independent prognostic factors associated with the development of PICM. The ventricular pacing percentage and paced QRS duration level defined by the dose-response analysis were positively associated with PICM (P < 0.05).Conclusions:Our findings indicated that paced QRS duration and ventricular pacing percentage were the most sensitive prognostic factors for PICM.

简介：BackgroundThepurposeofotomicrosurgeryinmoderntimesistoachievecompleteremovalofdisease,whichisthebasisforhearingrehabilitation.Artificialossiclesareimportantforhearingrehabilitation.Oneofthematerialsishydroxyapatitethatactsasossicularreplacementprosthesis(HAprosthesis,PORP&TORP)andiscommonlyusedassubstituteboneinclinics.AlthoughHAprosthesesfeaturegoodbiocompatibility,stabilityandcertainresistancetoinfection,thestructureofthematerialcanbedecomposedandabsorbed.Baseduponanimalexperimentsandclinicalapplication,thisarticleexplorestheinfectivityofHAprosthesesandinfluencingfactors.MaterialsandMethodsHAprostheseswereimplantedinthebullainguineapigs.InfectedHAprostheseswereexaminedunderascanningelectronmicroscope.NinetypatientsimplantedwithHAprostheseswerefollowedformorethan3months.Fivecasesthathadundergonerevisionoperationswerereported.ResultsScanningelectronicmicroscopyshowedthatthenormalcompactstructureshaddisappearedandbecomelooseininfectedHAprostheses,withtheirmicroporesinfiltratedwitheffusion,fibroustissueandinflammatorycells.Asaresult,thenormalceramicstructurewasdecomposedandthemicroporesstructuredisappeared.TheinfectedmesotympanuminthereportedcasesalsoledtoHAinfection.Theshapeandstructureofboneweredestroyed,whichwasvisiblebyvisualexaminationandlightmicroscopy.Theprocessofcholesteatomarecurrencewasalwaysassociatedwithinfection,althoughtheHAprosthesiswassometimesspared.ConclusionWhileHAprosthesisisanti-infectivetosomeextent,long-terminfectionandcholesteatomarecurrencecanleadtodestructionanddecompositionofHAprostheses.Long-terminfectedmiddleearcavity,dysfunctionalEustachiantube,residualandrecurrentcholesteatomaandotherfactorscancausedecompositionofHAprosthesisandresultinhearingloss.

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简介：BackgroundShort-termhospitalreadmissionsafterpercutaneouscoronaryintervention(PCI)accountforhighermedicalcostsandpoorprognosisofpatientswithcoronaryarterydisease(CAD).However,patientsathighriskforreadmissionarenotyetidentified.MethodsAtotalof1416patientssuccessfullytreatedwithPCIwereincluded.Dataofage,sex,presentationtypeofCAD,cardiacfunction,coexistentdiseases,contrastdose,numbersoflesionsandstentsimplanted,procedurecomplication,out-of-hospitalmedicationwerecollected.Coxregressionmodelwasemployedtoanalyzethemultiplefactorsinfluencingreadmission.Results75.8%ofallreadmissionswereduetoCADandtheaveragereadmissiontimewas422days.UnivariateanalysisandmultivariateCoxregressionmodeleventuallyshowedthatpatientswithanyprocedurecomplicationsand/ormorelesionsinnumberwereathigherriskforreadmissionwhileolderage,smoke,urgentPCIandmorestentsimplantedpreventedthemfromreadmitting.ConclusionThemajorcauseofreadmissionafterPCIisstillCADitself.DuringtheindexhospitalizationofPCI,patientswithmulti-vesseldiseaseneedcarefultreatmentandprocedurecomplicationsshouldbepreventedinordertoextendtheintervalofreadmission.

简介：AbstractObjectives:Describe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact. Identify which otolaryngology subspecialties are the most scholarly. Describe if NIH funding to one’s choice of medical school, residency, or fellowship has any impact on one’s scholarly output. Determine other factors predictive of an academic otolaryngologist’s productivity.Study design:Analysis of bibliometric data of academic otolaryngologists.Methods:Active grants from the National Institutes of Health (NIH) to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database. Faculty listings from these departments were gleaned from departmental websites. H index was calculated using the Scopus database.Results:Forty-seven otolaryngology programs were actively receiving NIH funding. There were 838 faculty members from those departments who had a mean h index of 9.61. Otology (h index 12.50) and head and neck (h index 11.96) were significantly (P < 0.0001) more scholarly than the rest of subspecialists. H index was significantly correlative (P < 0.0001) with degree of NIH funding at a given institution. H index was not significantly higher for those that attended medical school (P < 0.18), residency (P < 0.16), and fellowship (P < 0.16) at institutions with NIH funding to otolaryngology departments.Conclusions:H index is a bibliometric that can be used to assess scholarly impact. Otology and head and neck are the most scholarly subspecialists within otolaryngology. NIH funding to an individual’s medical school, residency, or fellowship of origin is not correlative with one’s scholarly impact, but current institutional affiliation and choice of subspecialty are.

简介：AbstractBackground:Although there are few studies mentioned there may be some relationship between psoriatic arthritis (PsA) and osteoporosis, clinical data in real world still need to be clarified in China. The aim of this study was to assess the areal and volumetric bone mineral density (BMD), frequency of fracture, and risk factors in patients with PsA.Methods:A total of one hundred PsA patients who visited Peking University First Hospital and one hundred age- and sex-matched healthy controls with DXA data were enrolled in the study. Patients with clinical fractures confirmed by X-ray during follow-up were also recorded. Clinical characteristics of the patients were recorded and compared between the abnormal BMD group and the normal BMD group, as well as between the fracture and non-fracture groups. Risk factors for fracture and low BMD were analyzed.Results:Mean BMD at the total hip and femoral neck was significantly lower in PsA patients than that in healthy controls (0.809 ± 0.193 vs. 0.901 ± 0.152 g/cm2, P = 0.041; 0.780 ± 0.146 vs. 0.865 ± 0.166 g/cm2, P = 0.037, respectively). Moreover, lumbar spine BMD was negatively correlated with psoriasis duration, swollen joint count and DAS28-CRP (r = -0.503, -0.580, -0.438; P < 0.05). Total hip BMD and femoral neck BMD were negatively correlated with HAQ (r = -0.521, -0.335; P < 0.05). Fractures occurred in 29 patients during the follow-up period. Logistic regression analysis showed that older age (OR 1.132 [95% CI: 1.026-1.248), P < 0.05], higher HAQ score (OR 1.493, 95%CI: 1.214-1.836, P < 0.01), higher disease activity index for psoriatic arthritis (OR 1.033, 95% CI: 1.002-1.679, P < 0.05) and hip joint involvement (OR 6.401, 95% CI: 4.012-44.180, P < 0.05) were risk factors for fracture in the multivariate model.Conclusions:Increased risks of osteoporosis and fracture were found in PsA patients compared to healthy controls. Besides age, high disease activity and hip joint involvement were risk factors for decreased BMD and fracture.

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简介：AbstractObjective:The aim of the study was to investigate the pregnancy outcomes and possible influencing factors concerning complicated monochorionic (MC) multiple pregnancies undergoing selective fetal reduction using radiofrequency ablation (RFA).Methods:This retrospective cohort study included 54 women with complicated MC multiple pregnancy who underwent selective fetal reduction using RFA at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2015 to March 2020. According to the indications for RFA, the 54 women were divided into three groups: complex complications (n = 30), structural anomalies (n = 18), and triplet pregnancy (n = 6). According to the gestational age for RFA, all patients were divided into three groups: 16-19+6 weeks (n = 17), 20-23+6 weeks (n = 17), and 24-26+6 weeks (n = 20). We analyzed the pregnancy outcomes (including the overall survival rate (OSR), gestational age at delivery, birth weight of newborns) and postoperative complications such as miscarriage, and intrauterine fetal death (IUFD) according to the indications and gestational age of reduction by using suitable statistical testing.Results:The OSR was 83.3% (45/54). The mean ± standard deviation (SD) of gestation at the time of reduction was 21.6 ± 3.2 weeks. The GA at delivery was 34.0(32.0,37.5) weeks. The mean ± SD of newborns’ birth weight was 2118 ± 685 g. The overall rates of miscarriage, PROM, and IUFD were 9.3% (5/54), 7.4% (4/54), and 7.4% (4/54), respectively. According to the indications for reduction, the OSR for complex complications, structural anomalies, and triplet pregnancy groups were 83.3% (25/30), 83.3% (15/18), and 83.3% (5/6), respectively. Statistically significant differences were only found in the mean birth weight among the three groups (P < 0.05). No significant difference was found in the rate of miscarriage, and mean gestation at delivery among the three groups (P > 0.05). In the group with complex complications, the OSR of twin-to-twin transfusion syndrome, selective intrauterine growth restriction, twin reversed arterial perfusion sequence, and twin anemia polycythemia sequence were 66.7% (6/9), 93.3% (14/15), 80.0% (4/5), and 100.0% (1/1), respectively, with no significant difference among these groups (P > 0.05). According to the gestational age of reduction, the OSRs among the three groups were 82.4% (14/17), 76.5% (13/17), and 90.0% (18/20), respectively, and the rate of miscarriage, IUFD, and mean gestation age at delivery among these groups showed no significant difference (P > 0.05).Conclusion:Selective fetal reduction by RFA is an important treatment method for complicated MC multiple pregnancy, although it may lead to complications like miscarriage, and IUFD. The indication of reduction seems to affect the pregnancy outcome. An optimal treatment plan should be selected according to the patient’s conditions in clinical practice.

简介：AbstractType 1 diabetes (T1D) is an autoimmune disease that resulted from the severe destruction of the insulin-producing β cells in the pancreases of individuals with a genetic predisposition. Genome-wide studies have identified HLA and other risk genes associated with T1D susceptibility in humans. However, evidence obtained from the incomplete concordance of diabetes incidence among monozygotic twins suggests that environmental factors also play critical roles in T1D pathogenesis. Epigenetics is a rapidly growing field that serves as a bridge to link T1D risk genes and environmental exposures, thereby modulating the expression of critical genes relevant to T1D development beyond the changes of DNA sequences. Indeed, there is compelling evidence that epigenetic changes induced by environmental insults are implicated in T1D pathogenesis. Herein, we sought to summarize the recent progress in terms of epigenetic mechanisms in T1D initiation and progression, and discuss their potential as biomarkers and therapeutic targets in the T1D setting.

简介：BACKGROUND:ResearchfocusedonthequalityoflifeofepilepticpatientsbeganonlyveryrecentlyinChina;inparticular,mostresearchhasfocusedonchildren,butlessonepilepticadults.OBJECTIVE:Tosurveyandanalyze11influentialfactorsforqualityoflifeinadultswithepilepsybyusingqualityoflifeepilepsy-31scale.DESIGN:Cross-sectionalstudy.SETTING:DepartmentofNeurology,FirstHospitalAffiliatedtoJinanUniversity;DepartmentofNeurology,FirstAffiliatedHospitalofWenzhouMedicalCollege.PARTICIPANTS:Atotalof107adultswithepilepsyforlongerthanoneyearwereselectedfromDepartmentofNeurology,FirstHospitalAffiliatedtoJinanUniversitybetweenMarch2004andDecember2006.TheincludedpatientsmettheClassificationandDiagnosticCriteriaofEpilepticAttackpublishedbyInternationalAnti-EpilepsyLeaguein1981,andtheyprovidedinformedconsent.METHODS:Generalstates,includingcourse,attackfrequency,marriagestatus,educationallevel,occupationaltypes,economicstatus,attacktypes,drugtypes,anddrugamount,wererecorded.ThereweresevenaspectsintheQualityofLifeEpilepsy-31scale,includingattackworry,lifesatisfaction,emotion,vigor/tiredness,druginfluence,cognitivefunction,andsocialfunction.Thescorespositivelycorrelatedwiththequalityoflife.Possibleinfluentialfactorsforqualityoflifewereanalyzedbyone-wayANOVAandmultivariateregressionanalysis.MAINOUTCOMEMEASURES:Course,attackfrequency,marriagestatus,educationallevel,occupationaltypes,economicstatus,attacktypes,drugtypes,drugamount,age,andsex.RESULTS:Atotalof107epilepticpatientswereincludedinthefinalanalysis.Influentialfactorsforqualityoflifeinepilepticadultsincludedattackfrequency,educationallevel,economicstatus,attacktypes,drugamount,age,andcourseofdisease(P<0.05).Amongthem,attackfrequencynegativelycorrelatedwithattackworry,lifesatisfaction,emotion,vigor/tiredness,cognitivefunc

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简介：Objective:Toexploretheriskfactorsofnosocomialinfectioninseverecraniocerebraltraumaandthewayofprevention.Methods:Theclinicaldataof387patientswithseverecraniocerebraltraumawerereviewed.Results:Thetotalnosocomialinfectionrateofthisstudywas22.99%.Pulmonarynosocomialinfectionpresentedmostfrequently.TheG-bacilliwerethemostcommoninfectiousbacteria.Themortalityrateoftheinfectiongroupwas38.20%.Conclusions:Complicationsofnosocomialinfectionaffecttheprognosisofcraniocerebraltraumapatients.Nosocomialinfectionisrelatedtotheageofthepatients,craniocerebraltraumaseverity,unreasonableutilizationofantibioticsandinvasiveoperations,suchastrachealcannula,mechanicalventilation,urethralcatheterizationanddeepvenouscatheterization.Patientswithseverecraniocerebraltraumashouldbecarefullytreatedandnursedtoavoidnosocomialinfection.Inordertoreducetherateofnosocomialinfection,intensivemeasurementshouldbeadopted.

简介：OjbectiveTofindtheindependentpredictorsforrestenosisaftercoronarystenting.MethodsQuantitativeangiographywasperformedon60cases(67successfullydilatedlesions)afterangio-plastyover6-monthsfollow-up,andbothunivariateandmultivariatelogisticregressionanalysisweredonetoi-dentifythecorrelationsofrestenosiswithclinicalfactors.ResultsThetotalrestenosisratewas31.3%(21of67lesions),andaccordingtounivariateanalysisthepatientswhounderwentcoronarystenting≥3.5mmhadalowerrateofrestenosis(P<0.01).Collateralcirculationtotheobstructionsite,highmaximalinflationpressure,smokingandthelessminimallumendiameterafterPTCAmadetherateofrestenosishigherower(P<0.05).Multivariatelogisticregressionanalysisshowedthatcoronarystenting≥3.5mmhadalowrateofrestenosis,buthighmaximalinflationpressureandsmokingmadetherestenosisratehigher.ConclusionCoronarystentsize,maximalinflationpressureand.smokin

简介：AbstractLong-term and stable preservation of bacteriophages is of crucial importance. Although many efforts have been made in the past decades to explore the influence of external factors on bacteriophage preservation, there is still little understanding, and a systematic description is lacking. In this study, we explored the influence of different factors on the preservation of lytic bacteriophage VP3, one of the typing bacteriophages of Vibrio cholerae O1 biotype El Tor, and attempted to optimize its preservation. We examined external factors, including temperature, solution, and cryoprotectant, in stable cooling/freezing conditions or alternate cooling/freezing and thawing. We found that whether in Luria-Bertani (LB) medium or SM buffer, in terms of 20-week stable cooling or freezing, -20 °C was the most damaging while 4 °C, -80 °C, and -196 °C were protective. Thirteen cycles of alternate cooling/freezing and thawing caused a loss in the survival rates of bacteriophages. The addition of cryoprotectant, glycerol (30%, w/v) or dimethyl sulfoxide (DMSO, 10%, w/v) significantly improved the survival rates of bacteriophages preserved at -20 °C. However, at 4 °C, -80 °C, and -196 °C, the cryoprotectant effect was only slightly positive or even harmful. In summary, for bacteriophage VP3, the best preservation method is to directly preserve the bacteriophage stocks in LB medium at -80 °C or -196 °C instead of storing them in SM buffer or adding cryoprotectant. Our results provided insights into the external influencing factors on bacteriophage VP3 during preservation at low temperature and can be applied to the optimization of bacteriophage preservation in the future.