简介：AbstractObjective:To determine the incidence of preeclampsia (PE) and preterm PE in Spain and to identify the risk factors for developing the disease.Methods:This is a multicenter prospective cohort study performed at six maternity units across Spain. Women with singleton pregnancies attending their first-trimester routine visit at the hospital were offered participation. Maternal and pregnancy characteristics, including mean arterial pressure, as well as ultrasound findings were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for subsequent development of PE.Results:A total of 5868 pregnancies were recruited for this study, including 174 (3.0%) cases of PE, 47 (0.8%) cases of preterm PE and 127 (2.2%) cases of term PE. Median maternal age was 33.9 years (interquartile range: 30.1 to 36.9) and median gestational age at the routine visit was 12.7 weeks (interquartile range: 12.3 to 13.0). However, 293 (5.0%) of the women were on aspirin treatment during pregnancy, likely reducing the true incidence of the disease. As expected, increasing body mass index (P < 0.001), uterine artery pulsatility index (P= 0.011) and mean arterial pressure (P < 0.001), assisted conception (P= 0.013), previous personal (P < 0.001) or family history of PE (P= 0.024) and chronic hypertension (P= 0.001) were identified as independent risk factors for developing subsequent PE during pregnancy. Screening for PE by maternal factors alone leads to a detection rate of 36.8% (64/174) at 10.0% (587/5868) screen positive rate.Conclusion:In Spain, 3.0% of singleton pregnancies are complicated by PE and 0.8% require delivery before term due to its severity. Screening of PE by risk factors alone is only able to detect about 40% of total PE at 10% screen-positive rate.

简介：AIM:ToevaluatethecompletionrateanddiagnosticyieldofthePillCamSB2-exincomparisontothePillCamSB2.METHODS:Twohundredcasesusingthe8-hPillCamSB2wereretrospectivelycomparedto200casesusingthe12hPillCamSB2-exatatertiaryacademiccenter.Endoscopicallyplacedcapsuleswereexcludedfromthestudy.Demographicinformation,indicationsforcapsuleendoscopy,capsuletype,studylength,completionofexam,clinicallysignificantfindings,timestampofmostdistantfinding...

简介：AbstractPurpose:Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces. Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition, as well as neutralizing the strain inhibiting fracture healing. The XS nail® (Intercus GmbH, Bad Blankenberg, Germany), an intramedullary implant exerting compression across the entire fracture surface, unlike plates, leaves a minimal extra-cortical profile, and can be secured with threaded locking wires, thereby retaining the anatomical reduction without displacement or steps within the articular surface, which was often found in tension band wiring. After encouraging initial results, the long-term outcome was assessed.Methods:This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®. Patients over the age of 18 years eligible for the study must have undergone surgery for isolated, recent (less than 14 days) traumatic olecranon fractures, without concomitant injuries to the ipsilateral elbow and forearm. Further exclusion criteria were pseudarthrosis, re-fractures and osteotomy for distal humerus surgery, as well as polytraumatized patients unable to aid in their own recovery. Data were retrospectively gathered by standardised questionnaire and patient records, as well as surgery and anesthesiology reports. Data analysis was performed using Microsoft Office Excel® 2016.Results:There were 32 patients, 13 males (mean age 49.0 years) and 19 females (mean age 68.9 years) with 11 Schatzkers type D, 7 each type A and C, 5 type B and 2 type E at an average of 55.2 months, all showing complete consolidation. Of them, 6 patients had a loss of range of motion with more than 10° in the sagittal plane, and only 1 patient exceeded 10° reduction of supination. Twenty-five patients reported being pain-free under all circumstances, and all but 2 patients (93.75%) had returned to their previous activity level. The average disabilities of the arm, shoulder and hand score was 21.15 (range 0-88.3), and the overall Mayo elbow performance index was 91.87, without complications, such as wound infection, neurovascular impairment or premature hardware removal.Conclusion:Using the XS nail® system, all fracture types can be successfully treated and the rate of complications was lower than that treated by standard methods published in current literature. An excellent functional outcome, high range of motion as well as good retention of reduction without soft tissue irritation makes this a very suitable implant for fractures subject to tension.

简介：AIM:Toevaluatethecorrelationofshearwaveelastography(SWE)resultswithliverfibrosishistologyandquantitativefunctionreserve.METHODS:Weeklysubcutaneousinjectionof60%carbontetrachloride(1.5mL/kg)wasgivento12caninesfor24wktoinduceexperimentalliverfibrosis,witholiveoilgivento2controlcanines.At24wk,liverconditionwasevaluatedusingclinicalbiochemistryassays,SWEimaging,lidocainemetabolitemonoethylglycine-xylidide(MEGX)test,andhistologicfibrosisgrading.Clinicalbiochemistryassayswereperformedattheinstitutionalcentrallaboratoryforroutineliverfunctionevaluation.Liverstiffnesswasmeasuredintriplicatefromthreedifferentintercostalspacesandexpressedasmeanliverstiffnessmodulus(LSM).PlasmaconcentrationsoflidocaineanditsmetaboliteMEGXweredeterminedusinghigh-performanceliquidchromatographyrepeatedinduplicate.Liverbiopsysampleswerefixedin10%formaldehyde,andliverfibrosiswasgradedusingthemodifiedhistologicalactivityindexKnodellscore(F0-F4).Correlationsamonghistologicgrading,LSM,andMEGXmeasureswereanalyzedwiththePearsonlinearcorrelationcoefficient.RESULTS:At24wkliverfibrosishistologicgradingwasasfollows:F0,n=2(control);F1,n=0;F2,n=3;F3,n=7;andF4,n=2.SWELSMwaspositivelycorrelatedwithhistologicgrading(r=0.835,P<0.001).Specifically,theF4grouphadasignificantlyhigherelasticmodulusthantheF3,F2,andF0groups(P=0.002,P=0.003,andP=0.006,respectively),andtheF3groupalsohadasignificantlyhighermodulusthanthecontrolF0group(P=0.039).LSMwasnegativelyassociatedwithplasmaMEGXconcentrationsat30min(r=-0.642;P=0.013)and60min(r=-0.651;P=0.012),timeto?ofthemaximumconcentration(r=-0.538;P=0.047),andtheareaunderthecurve(r=-0.636;P=0.014).Multiplecomparisonsshowedidenticaldifferencesinthesethreemeasures:significantlylowerwithF4(P=0.037)andF3(P=0.032)ascomparedtoF0a

简介：AIMTo评估剩余的excimer激光修正的功效和安全在有intraocular的奔流抽取以后的折射错误透镜(IOL)培植在不平常cases.METHODSTotally有高剩余的24个病人在有IOL培植的奔流外科以后的折射错误被检验。22个病人有phacoemulsification和IOL培植的历史，并且二与IOL培植有囊外的奔流抽取。外科手术前的医药记录的详细检查被做解释奔流以后的折射错误的起源。所有病人经历了photorefractirekeratectomy(PRK)改进。吝啬的结果措施是折射，uncorretted视觉尖酸(UCVA)，最好改正的视觉尖酸(BCVA)和角膜的透明性并且列在后面在上面从1到剩余变常眼的8y.RESULTSThe主管原因是在有高近视和先天的透镜畸形的反常眼睛的不精确的IOL计算，两个都由角膜的散光列在后面导致的缝术并且先存在。在奔流外科以后并且在激光改进前，吝啬的球形的等价物(SE)是-0.56?潢吗？

简介：AIM:Toevaluatethelongtermclinicalresultsofmechanicalno-alcohol-assistedlaserepithelialkeratomileusis(LASEK)versusstandardphotorefractivekeratectomy(PRK)forlow-moderatemyopia.METHODS:Twenty-fiveeyestreatedwithLASEKandtwenty-fiveeyestreatedwithPRKwereevaluatedwithameanfollow-updurationof60mo.Mechanicalseparationoftheepitheliumwasperformedwithbluntspatulaandwithoutapplicationofalcohol.LaserablationwasperformedwiththeMEL-70excimerlaser.Allpatientswereexamineddailyuntilepithelialclosure;at1,3,6,and12mo,andeveryyearsubsequently.Mainoutcomemeasureswereuncorrecteddistancevisualacuity(UDVA),correcteddistancevisualacuity(CDVA),manifestrefraction,haze,efficacyandsafetyindexes.RESULTS:Twenty-oneeyesand22eyescompletedfollow-upof60moinLASEKandPRKgrouprespectively.Manifestrefractionat60mofollow-upwas-0.01and0.26inLASEKandPRKgrouprespectively.IntheLASEKgroupmeanUDVAandmeanCDVAafter60mowere20/22and20/20respectively(P>0.01).InthePRKgroupmeanUDVAandmeanCDVAat60mofollow-upwere20/20and20/20after60mo(P>0.01).Theefficacyindexeswere0.87and0.95,andthesafetyindexeswere1.25and1.4respectivelyforLASEKgroupandPRKgroup.CONCLUSION:BothstandardPRKandno-alcoholLASEKoffersafeandeffectivecorrectionoflow-moderatemyopiainthelongtermwithoutanystatisticallysignificantdifferencebetweenthetwogroups.

简介：AbstractBackground:Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.Methods:This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.Results:At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t = 0.221, P = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U = 789.500, P = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively (P > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups (P > 0.05).Conclusions:Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.Trial registration:Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj= 13334.

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简介：在这研究，我们比较了由我们与慢可编程的结冰的快速的结冰的内部方法人的精子结冰/融化重复的效果。从11个normozoospermic题目的精子样品通过密度坡度被处理并且把aliquots划分了成三：非结冰，快速的结冰并且慢可编程的结冰。在快速的结冰组的精子活动性和生存能力最好在慢结冰比那些组织(P<；0.01)在结冰/融化的第一，第二和第三个周期以后，但是在形态学没有差别。在第二个实验，快速的结冰在20个题目被重复三次。从每个融化的周期的样品用碱的彗星试金为DNA破碎被评估。DNA破碎开始在结冰/融化的第二个周期以后更加增加了。在第三个实验，快速的结冰在10个题目反复被做，直到没有能动精子在融化以后被观察。结冰/融化那个产出的不能动的精子重复的中部的数字是七(范围：5-8，意味着：6.8)。在结论，我们表明了那我们的快速的结冰方法给了更好的结果比的使用的处理精液结冰/融化重复标准慢可编程的结冰。这个方法能帮助在帮助繁殖技术最大化宝贵cryopreserved精子样品的用法。

简介：AbstractBackground:Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods:We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with 13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results:The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42 vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mL vs. 183.00 ± 217.13 mL, P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion:IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

简介：Objective:Polycystickidneydisease(PKD)isthemajorcauseofkidneyfailureandmortalityinhumans.Ithasalwaysbeensuspectedthatthedevelopmentofcystickidneydiseasesharesfeatureswithtumorigenesis,althoughtheevidenceisunclear.Methods:Wecrossedp53mutantmice(p53N236S,p53S)withWernersyndromemiceandanalyzedthepathologicalphenotypes.TheRNA-seq,ssGSEAanalysis,andreal-timePCRwereperformedtodissectthegenesignaturesinvolvedinthedevelopmentofdiseasephenotypes.Results:Wefoundenlargedkidneyswithfluid-filledcystsinoffspringmicewithagenotypeofG3mTerc-/-WRN-/-p53S/S(G3TM).PathologyanalysisconfirmedtheoccurrenceofPKD,anditwashighlycorrelatedwiththeincidenceoftumorigenesis.RNA-seqdatarevealedthegenesignaturesinvolvedinPKDdevelopment,anddemonstratedthatPKDandtumorigenesissharedcommonpathways,includingcomplementpathways,lipidmetabolism,mitochondriaenergyhomeostasisandothers.Interestingly,thisG3TMPKDandtheclassicalPKD1/2deficientPKDsharedcommonpathways,possiblybecausethemutantp53ScouldregulatetheexpressionlevelsofPKD1/2,Pkhd1,andHnf1b.Conclusions:WeestablishedadualmousemodelforPKDandtumorigenesisderivedfromabnormalcellularproliferationandtelomeredysfunction.TheinnovativepointofourstudyistoreportPKDoccurringinconjunctionwithtumorigenesis.ThegenesignaturesrevealedmightshednewlightonthepathogenesisofPKD,andprovidenewmolecularbiomarkersforclinicaldiagnosisandprognosis.

简介：AbstractImportance:There are a variety of musculoskeletal malformations and injuries that can occur in newborns. These can be a significant cause of perinatal death or a reason for miscarriage and can lead to long-term functional issues if not managed appropriately. There is no systematic and well-established screening program for neonatal musculoskeletal malformations and injuries in China now.Objective:To report the incidence and types of congenital musculoskeletal malformations in two hospitals in Shenzhen City, to explore and discuss the details of the screening procedure and improve future prevention and treatment.Methods:From October 2013 to May 2014, 2564 one-day-old newborns were screened by a pediatric orthopedic physical examination, in combination with ultrasonography when required, and the incidence and variety of diseases were recorded statistically.Results:Among 2564 screened newborns, the following musculoskeletal conditions were identified: congenital muscular torticollis (CMT) (seven cases, 0.27%), hip subluxation (four cases, 0.16%), hip dysplasia (47 cases, 1.83%), congenital talipes equinovarus (CTEV) (two cases, 0.08%), congenital talipes calcaneovalgus (15 cases, 0.58%), polydactyly (nine cases, 0.35%), syndactyly (one case, 0.04%), and spinal hemivertebra (one case, 0.04%). Additionally, there were five (0.19%) neonates with birth injuries.Interpretation:It is feasible to carry out neonatal screening and identification of musculoskeletal malformations and birth injuries in China. This is helpful as timely detection and early intervention for many of these conditions can avoid permanent functional impairment in these children.

简介：AbstractBackground:Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.Methods:We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight.Results:From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.Conclusions:Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.

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简介：AbstractBackground:The transmission and fatal risk of severe fever with thrombocytopenia syndrome (SFTS), an emerging infectious disease first discovered in China in 2009, still needed further quantification. This research aimed to analyze the SFTS clusters and assess the transmission and mortality risk for SFTS.Methods:Both epidemiological investigation and case reports regarding SFTS clusters in China during 2011-2021 were obtained from the Public Health Emergency Information Management System of the Chinese Center for Disease Control and Prevention Information System. The transmission risk was evaluated by using the secondary attack rate (SAR) and relative risk (RR). Mortality risk factors were analyzed using a logistic regression model.Results:There were 35 SFTS clusters during 2011-2021 involving 118 patients with a fatality rate of 22.0%. The number of clusters annually increased seasonally from April to September. The clusters mainly occurred in Anhui (16 clusters) and Shandong provinces (8 clusters). The SAR through contact with blood or bloody fluids was much higher than that through contact with non-bloody fluids (50.6% vs 3.0%; χ2 = 210.97, P < 0.05), with an RR of 16.61 [95% confidence interval (CI): 10.23-26.97]. There was a statistically significant difference in the SAR between exposure to the blood of a deceased person during burial preparation and exposure to the living patients’ blood (66.7% vs 34.5%; χ2= 6.40, P < 0.05), with an RR of 1.93 (95% CI: 1.11-3.37). The mortality risk factors were a long interval from onset to diagnosis [odds ratio (OR)= 1.385), 95% CI: 1.083-1.772, P= 0.009) and advanced age (OR: 1.095, 95% CI: 1.031-1.163, P= 0.01).Conclusions:The SFTS clusters showed a high mortality rate and resulted in a high SAR. Contact with a bleeding corpse was associated with a higher infection risk, compared with contacting the blood from living patients. It is important to promote early detection and appropriate case management of patients with SFTS, as well as improved handling of their corpses, to prevent further transmission and mortality.

简介：瞄准：用液体血管注射剂硅酮与阴茎尺寸扩大报导我们的经验。方法：在2003年8月和2006年7月之间，324个人(意味着年龄35年，range19-65年)在阴茎柄的背面、侧面的方面上收到了在阴茎皮肤和阴茎海绵体之间的一系列液体硅酮皮下注射，在局部麻醉下面。数字相片拿的过程前并且过程以后(n=324)，并且阴茎轮廓大小(n=30)产出的客观结果。主观结果从病人和满足的搭挡证词被导出。后续平均20个月(范围1-36月)。结果：Threehundred和24个过程是主要扩大。大多数人(61%)结婚了，7%被他们的搭挡伴随，并且93%被割除。吝啬的测量阴茎圆周was9.5厘米(7.5-11.5厘米)预告的处理和12.1厘米(10.3-15.3厘米)处理以后(在直径的圆周和0.84厘米的27%的吝啬的增加)。病人和搭挡满足已经在开始的二治疗以后被表示。性欲活动能在8h以后被恢复。复杂并发症(温和檫伤)容易被解决。结论：阴茎尺寸扩大使用液体血管注射剂硅酮没有立即或短期的复杂并发症产出很令人满意的短期的结果。

简介：AbstractPurpose:Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.Methods:Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated.1 All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.Results:Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient =-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.