Jiao Tong University Affiliated Sixth Research Articles

Analysis of clinical effect of mini-invasive knotless bridge-suture technique for acute achilles tendon rupture

Objective To investigate clinical effect of minimally invasive knotless bridge-suture technique for acute achilles tendon rupture. Methods The clinial data of 23 patients with acute achilles tendon rupture treated in Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from August 2017 to February 2018 were analyzed retrospectively. There were 21 males and 2 females, aged (37.1±5.6) years, with an age range of 29-51 years. Minimally invasive knotless bridge-suture technique was performed in all cases until the soft tissue condition of the patients improved. Patients were followed up by outpatient review at 3 weeks, 6 weeks, 3rd, and 6th months postoperatively, followed by every 3 months, followed up 12 to 18 months, and the deadline was April 2019. Ratio of perimeter of the affected lower extremity to that of the uninjuried, number of repetitions for one leg calf rise in one minute, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, the achilles tendon total rupture score(ATRS) and time to return to work were investigated at last follow-up, as well as complications during the follow-up period. Results Twenty-three cases were followed up. At last follow-up, ratio of perimeter of the affected lower extremity to that of the uninjuried was (92.7±1.8)%, number of repetitions for one leg calf rise in one minute was (25±2) times, AOFAS ankle-hind foot score was (91.5±2.2) scores, ATRS was (92.6±2.4) scores, time to return to work ranged from 6 to 9 weeks. All patients underwent first-stage healing. No skin necrosis, superficial infection and sural nerve injury occurred. No achilles tendon re-rupture was seen during the follow-up period. Conclusion Minimally invasive knotless bridge-suture technique for acute achilles tendon rupture is applied easily and less invasive, enabling patients to return to work earlier and proved to be a secure and effective treatment. Key words: Achilles tendon; Suture technique; Rehabilitation; Knot

The study of the value of H3F3A G34W immunohistochemical staining in the diagnosis of giant cell tumor of bone

Objective: To investigate the diagnostic role of H3F3A G34W immunohistochemistry in giant cell tumor of bone. Methods: A total of 275 tumors were collected from 2016 to 2018 at Shanghai Jiaotong University Affiliated Sixth People's Hospital, including 136 giant cell tumors of bone, 31 general osteosarcomas, 3 osteoclast-rich osteosarcomas, 3 brown tumors, 34 chondroblastomas, 29 giant cell tumors of tendon sheath, 20 primary arteromatoid bone cysts and 19 non-ossifying fibromas. Results: Among the 136 cases of giant cell tumor of bone,82 patients were male and 54 were female. The age ranged from 15 to 72 years (median age 38 years). Nuclear positivity for H3F3A G34W was seen in 119/136(87.5%) giant cell tumors of bone and 1/31(3.2%) general osteosarcoma,while all osteoclast-rich osteosarcomas, brown tumors, chondroblastomas, giant cell tumors of tendon sheath, primary arteromatoid bone cysts and non-ossifying fibroma were negative. Conclusions: The monoclonal antibody against the G34W mutated site of H3F3A is a specific biomarker for giant cell tumor of bone and useful for the diagnosis and differential diagnosis of giant cell tumor of bone. Meanwhile,for those cases in which giant cell tumor of bone are diagnosed basing on clinical,pathologic and radiographic features but are negative for H3F3A G34W,should be tested for rare mutations or H3F3A wild type.

Fast and Accurate Retinal Identification System: Using Retinal Blood Vasculature Landmarks

The expansion of automation techniques and increased risk of identity theft have led emphasis on the tremendous need of automated identification system. Due to the high recognition accuracy and robustness to changes in human physiology, retinal biometric identification system has drawn much attention in this research field. In this paper, we aim to propose an automatic fast and accurate retinal identification system for the multisample dataset. The proposed approach uses a hybrid segmentation technique to segment out both thick/thin vessels for effectively balancing the difference of wavelet response between thick/thin blood vessels. As a result, recognition accuracy is improved. A Principle Component Analysis-based feature processing approach is proposed for efficiently reducing the dimensionality of a large number of vessels features. It significantly reduces computation time and accelerates the matching process in the retinal identification system. The proposed technique is validated on DRIVE, STARE, VARIA, RIDB, HRF, Messidor, DIARETDB0, and a large multisample per subject database created by authors using the images provided by Dr. Chen (Shanghai Jiao Tong University Affiliated Sixth People Hospital). Experimental results demonstrated that the proposed approach outperforms other existing techniques. Segmentation achieves an overall accuracy of 99.65% with the recognition rate of 99.40% on all these databases.

Hepatic Nitric Oxide Synthase 1 Adaptor Protein Regulates Glucose Homeostasis and Hepatic Insulin Sensitivity in Obese Mice Depending on Its PDZ Binding Domain

Background: NOS1AP is an adaptor protein and its SNP rs12742393 was associated with type 2 diabetes (T2D). However, it remains uncertain whether NOS1AP plays a role in regulation of insulin sensitivity. Hepatic insulin resistance contributed to the development of T2D. Here, we investigated whether NOS1AP is involved in the regulation of hepatic insulin sensitivity and its underlying mechanisms. Methods: Liver specific NOS1AP condition knockout (CKO) and NOS1AP overexpression mice were generated and fed with a high fat diet. SNPs of NOS1AP gene were genotyped in 86 human subjects. Findings: NOS1AP protein is highly expressed in human and mouse liver. CKO mice exhibited impaired pyruvate, glucose and insulin tolerance, and increased lipid deposits in the liver. Conversely, overexpression of NOS1AP in liver of obese mice improved pyruvate and/or glucose, and insulin tolerance, and attenuated liver lipid accumulation. Moreover, hepatocytes from CKO mice exhibited an elevated glucose production and mRNA expressions of Pc and Pck1. Overexpression of NOS1AP potentiated insulin-stimulated activation of IR/Akt in liver from obese mice. The insulin sensitizing effect of NOS1AP could be mimicked by overexpression of C-terminal domain of NOS1AP in ob/ob mice. Furthermore, NOS1AP expression in liver was associated with ER homeostasis through down-regulation of p-eIF2a-ATF4-CHOP pathway. Subjects with rsl2742393 of NOS1AP have a higher risk for hepatic steatosis. Interpretation: Our data demonstrate a novel role of NOS1AP in regulating hepatic insulin sensitivity and maintenance of ER homeostasis in liver, which implicates NOS1AP a therapeutic target for the prevention and treatment of T2D. Funding Statement: This work was supported by the National Natural Science Foundation of China (81670707, 31340072) (to C. Wang), and National Basic Research Program of China (Nation 973 Program) (2011CB504001) (to W. Jia). Declaration of Interests: The authors declare no conflict of interests. Ethics Approval Statement: The protocol was approved by the Ethics Committee of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (2018-KY-026 (K)) and followed the principles of the Declaration of Helsinki.

Synergistic effects of Yiqi Huazhuo Gushen herbal formula and valsartan on metabolic syndrome complicated with microalbuminuria

Purpose : To study the effects of a combination of Yiqi Huazhuo Gushen formula and valsartan on metabolic syndrome (MetS) complicated with microalbuminuria. Methods : Patients with MetS (100), recruited from Department of the Traditional Chinese Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital, Fudan University; and Department of Endocrinology, Hospital of Integrated Traditional Chinese and Western Medicine in Yueyang, Shanghai University of Traditional Chinese Medicine, were randomly divided into two sets: control group (n = 50) given valsartan treatment, and Chinese herbal medicine (CHF) group (n = 50) given Yiqi Huazhuo Gushen formula in addition to valsartan. Both therapeutic regimens were given once a day for 12 weeks. The parameters measured were conversion rate of microalbuminuria (MA), ratio of urinary albumin to creatinine (UACR), 24- h total volume of urinary protein (24hTP), urinary transferrin, urinary β2 microglobulin, constitutional index (CI), and waist-hip ratio (WHR). Other indices assessed were peak systolic and diastolic pressure (SBP and DBP), mean arterial blood pressure (MABP), fasting plasma glucose (FPG), postprandial 2 h blood glucose (2hPG), glycosylated hemoglobin (GH), steadystate model for insulin resistance (HOMA-IR), total cholesterol (TC), glycerin trilaurate (TG), low density lipoprotein (LDL), and high-density lipoprotein (HDL). Results : All 100 subjects completed the clinical study. The outcome revealed that compared with 10.00 % in controls, the negative conversion of MA reached 28.00 % in the CHF group (p < 0.050). CHF produced reductions in MA, UACR, BMI, 24hTP and urinary β2 microglobulin (p < 0.05). It also led to marked increases in BMI, WHR, SBP, MAP, FPG, 2hPPG, HbA1c and HOMA-IR, and significant decreases in TG (p < 0.05). Conclusion : These results suggest that CHF treatment results in alleviation of microalbuminuria and multiple cardiovascular risk factors in metabolic syndrome complicated with microalbuminuria. These effects correlate with improvements in insulin sensitivity and rectification of abnormal fat distribution. Keywords : Metabolic syndrome, Microalbuminuria, Yiqi Huazhuo Gushen formula, Insulin resistance, Central obesity

MELK Promotes Endometrial Carcinoma Progression via Activating mTOR Signaling Pathway

Maternal embryonic leucine zipper kinase (MELK) is upregulated in a variety of human tumors, where it contributes to a malignant phenotype and correlates with a poor prognosis. Nonetheless, the biological function of MELK in endometrial carcinoma (EC) progression remains largely unknown. In this study, we investigated the mRNA and protein expression of MELK in EC by in silico and immunohistochemical (IHC) methods. We found that MELK expression was significantly higher in patients with EC, and that high expression of MELK was associated with serous EC, high histological grade, an advanced clinical stage, and shorter overall survival and disease-free survival. A MELK knockdown decreased the capacity for cell proliferation and migration in vitro and subcutaneous tumorigenesis in vivo. Chromatin immunoprecipitation and a luciferase reporter assay were performed to demonstrate that high expression of MELK may be caused by transcription factor E2F1. Moreover, we found that MELK directly interacts with MLST8 and then activates the mTORC1 and mTORC2 signaling pathway to promote EC progression. OTSSP167, an effective MELK inhibitor, suppressed the cell proliferation driven by MELK. Thus, we identified the crucial role of the E2F1-MELK-mTORC1/2 axis in the progression of EC, which may contain potential therapeutic targets of EC. Funding Statement: This work was supported by National Natural Science Foundation of China (Nos.81672565). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: All of the patients provided written informed consent, and all the experiments were approved by the Research Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and complied with the Declaration of Helsinki.

Influence of Apolipoprotein A-I and B Genetic Variations on Insulin Resistance and Metabolic Syndrome in Obstructive Sleep Apnea

Background: Both apolipoprotein A-I (APOA-I) and apolipoprotein B (APOB) are associated with insulin resistance, metabolic syndrome (MetS), and obstructive sleep apnea (OSA). However, whether multiple single nucleotide polymorphism (SNP) variants of APOA-I and APOB exert a collaborative effect on insulin resistance and MetS in OSA remains uncertain. Methods: Initially, 12 APOA-I SNPs and 30 APOB SNPs in 5,259 subjects were examined. After strict screening, four APOA-I SNPs and five APOB SNPs in 4,007 participants were included in this study. For each participant, the genetic risk score (GRS) was calculated based on the cumulative effect of multiple genetic variants of APOA-I and APOB. Logistic regression analyses were used to evaluate the relationships between APOA-I/APOB genetic polymorphisms, insulin resistance, and MetS. Results: Patients with insulin resistance had a lower APOA-I GRS and higher APOB/APOA-I and APOB levels after adjustments [odds ratio (OR) = 0.917, P = 0.001; OR = 2.285, P < 0.001; OR = 3.168, P < 0.001, respectively]. Individuals with MetS had a lower APOA-I GRS and APOA-I level and higher APOB/APOA-I and APOB levels after adjustments (OR = 0.870, 0.09, 14.488, 6.098, respectively, all P < 0.001). In addition, individuals in the top quintile of the APOA-I genetic score distribution had a lower risk of insulin resistance and MetS after adjustments (OR = 0.761, P = 0.007; OR = 0.637, P < 0.001, respectively). Conclusion: In patients with OSA, APOA-I genetic variation contributes to insulin resistance and MetS, whereas APOB genetic variation contributes to MetS only. Funding Statement: National Key RD National Natural Science Foundation of China (81770987, 81700896, 81701306, 81770988); Innovation Program of Shanghai Municipal Education Commission (2017-01-07-00-02-E00047); multi-center clinical research project from school of medicine, Shanghai Jiao Tong University (DLY201502) and Shanghai Shen-Kang Hospital Management Center Project (SHDC12015101). Declaration of Interests: The authors declare that they have no competing interests. Ethics Statement Approval: The ethics committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital approved this study according to Helsinki Declaration II. All the participants have given the informed consent before taking part in the study.

Clinical effects of lentinan combined with budesonide inhalation in treating acute exacerbation of chronic obstructive pulmonary disease under mechanical ventilation.

In the present study, the clinical efficacy of the immune modulator lentinan combined with inhalation of the corticosteroid budesonide in treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD) under mechanical ventilation was assessed. A total of 72 cases of AECOPD treated at Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Shanghai, China) between June 2016 and September 2017 were enrolled. The AECOPD patients were randomly divided into an experimental group (n=36) and a control group (n=36). All of the patients received ventilator support and endotracheal intubation was performed. The experimental group was orally administered lentinan and budesonide was administered via atomization inhalation through a Y-tube and the control group received only budesonide via Y-tube. After the treatment, airway pressure, the time of mechanical ventilation and the time of stay at the intensive care unit for the experimental group were significantly lower than those for the control group (P<0.001). The plasma levels of adiponectin, D-dimer, interleukin-17 and high-sensitivity C-reactive protein, as well as the pressure of CO2 in the experimental group were significantly lower than those in control group (P<0.001). Furthermore, the partial O2 pressure in the experimental group was significantly higher than that in the control group (P<0.001). After the combined treatment, the proportions of CD3+ and CD4+T-cells in the blood were elevated, while the proportion of CD8+T-cells was decreased, compared with those in the experimental group at baseline or the control group post-treatment. In conclusion, the strategy of lentinan treatment combined with budesonide inhalation for AECOPD patients under mechanical ventilation demonstrated improved clinical efficacy compared with budesonide alone. (Chinese Clinical Trial Registry no. ChiCTR1800019088).

Interrelationships Among Apolipoprotein B/Apolipoprotein A-I Ratio, Insulin Resistance and Obstructive Sleep Apnea: A Large-Scale Observational Study

Background: The apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) ratio has been recognized as a new predictor of cardiovascular diseases (CVD). However, the interrelationships between the ApoB/ApoA-I ratio and common CVD risk factor [insulin resistance, obstructive sleep apnea (OSA)] remain unclear. Methods: A total of 6,433 suspected OSA consecutively admitted to our sleep center were screened and 4,813 were included. Anthropometric, fasting biochemical, and polysomnographic parameters were collected. The relationships between insulin resistance, OSA risk, and the ApoB/ApoA-I ratio were evaluated through logistic regressions analysis and restricted cubic spline (RCS) analysis. Mediation analyses were qualified to assess the interrelationships. Results: Patients with OSA had a lower level of ApoA-I and a higher ApoB and ApoB/ApoA-I ratio. The fully adjusted odds ratios (95% confidence intervals) for both OSA [1 (reference), 1.406 (1.129-1.751), 1.556 (1.236-1.958), and 1.943 (1.508-2.505)] and insulin resistance [1 (reference), 1.424 (1.176-1.725), 1.948 (1.359-1.998), 2.019(1.658-2.459)] increased from the first to the fourth quartiles of the ApoB/ApoA-I ratio. Finally, the RCS mapped a nonlinear dose-effect relationship between the ApoB/ApoA-I ratio and risk of insulin resistance and OSA. OSA was also independently associated with insulin resistance. Mediation analyses showed insulin resistance explain 7.4%, 3.6% and 10.8% of the association between apnea-hypopnea index, oxygen desaturation index, micro-arousal index and ApoB/ApoA-I ratio, respectively. Conclusions: Our study revealed that ApoB/ApoA-I ratio was positively associated with an increased risk for insulin resistance and OSA severity. Insulin resistance may serve as a potential mediator in OSA-related lipoprotein disorders and further increase CVD risk. Funding Statement: This study was supported by grants-in-aid from National Key R&D Program of China (2017YFC0112500), National Natural Science Foundation of China (81770987), Shanghai Sailing Program (17YF1414300), multi-center clinical research project from school of medicine, Shanghai Jiao Tong University (DLY201502) and Shanghai Shen-Kang Hospital Management Center Project of Shanghai (SHDC12015101). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The ethics committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital approved this study according to Helsinki Declaration II. All the participants have given the informed consent before taking part in the study.

Engineered Nail Grafts Induce Nail Plate Regeneration Ectopically

Fingertip injuries are among the most common orthopedic injuries. Improper treatments of severe fingertip injuries lead to functional and cosmetic problems, including long-lasting chronic pain, hyperpathia, disesthesia, finger shortening, nail malformation, and other sequelae. A multitude of techniques have been applied for reconstruction of digital tip soft-tissue injuries, while no substitutes are available for nail regenerative repair. Because of the unique characteristics of decellularized materials, we predicted that decellularized nail scaffolds could be used as the substitute for damaged subungual tissue to promote nail plate regeneration. Here, we decellularized subungual tissues collected from amputated digits via detergents to create decellularized subungual tissue scaffolds. We then repopulated the decellularized subungual tissue scaffolds with human bone mesenchymal stem cells, and tested the cellular proliferation, migration and differentiation changes. To test in vivo function, we transplanted bioengineered subungual tissues in an ectopic position and observed nail plate-like generation with higher water permeability. These results provide a proof of principle for the generation of transplantable nail grafts based on decellularized nail scaffolds derived from clinical wasted amputated nails, providing important thinking for clinical treatment for digit tip trauma. Funding Statement: The work was sponsored by grants from the National Natural Science Foundation of China (nos. 81772338 and 81572122); Interdisciplinary Program of Shanghai Jiao Tong University (YG2017ZD05); and Shanghai Leading Talent Plan. Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: The collection of subungual tissues was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (no. 2018KY001), and informed consent was obtained from all patients. All animal experiments were performed in accordance with the guidelines set of the Institutional Animal Care and Use Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital.

Comparison of the effects of albumin and crystalloid on mortality among patients with septic shock: systematic review with meta-analysis and trial sequential analysis.

This study aimed to compare the effects on mortality of albumin and crystalloid, used for fluid resuscitation among adult patients with septic shock, through conducting a meta-analysis and trial sequential analysis (TSA). Meta-analysis and TSA conducted at Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Data were collected from several major databases including MEDLINE, EMBASE, Clinical Trials.gov and Cochrane Central Register of Controlled Trials. Studies that compared the effects of albumin therapy versus crystalloid therapy on mortality among adult septic shock patients were eligible for inclusion in the analyses. The study name, year of publication, country of the trial, albumin concentration, type of crystalloid and all reported mortalities at different follow-up endpoints were extracted. Compared with crystalloid, albumin did not decrease all-cause mortality at the final follow-up. However, in TSA, the required information size was not achieved in all groups, which means that the effect size was not definitive and further RCTs are needed to confirm or deny these findings. Compared with crystalloid solutions, albumin was unable to decrease all-cause mortality. However, TSA indicated that these results could be false-negative. Additional randomized controlled trials are needed to clarify this discrepancy.

The Coexistence of Hyperuricemia and Low Urine Uric Acid Excretion Further Increases the Risk of Chronic Kidney Disease in Type 2 Diabetes

Aims: To investigate whether hyperuricemia and decreased urine uric acid excretion (UUAE) are associated with increased risk of chronic kidney disease (CKD), and whether the coexistence of hyperuricemia and low UUAE further increases the CKD risk in type 2 diabetes mellitus (T2DM). Methods: Based on serum uric acid (SUA) and UUAE levels, 2 846 T2DM inpatients were divided into patients with SUA and UUAE (group 1), normal SUA and low UUAE (group 2), hyperuricemia and normal UUAE (group 3), and hyperuricemia and low UUAE (group 4). Hyperuricemia was defined as SUA levels ≥ 420 μmol/L in men and ≥ 360 μmol/L in women. Low UUAE was defined as UUAE levels < the first UUAE quintiles (< 2161 μmol/24h in men and 1977 μmol/24h in women). Results: There was significantly increased trend of the prevalence of CKD (4.3%, 12.6%, 18.3% and 47.8%, p< 0.001), albuminuria (20.2%, 26.4%, 36.9% and 54.9%, p< 0.001), and macroalbuminuria (3.3%, 10.1%, 10.7% and 31.9%, p< 0.001) from group 1 to 4. After controlling for multiple confounding factors, the prevalence of CKD (p<0.001) and the urinary albumin levels (p=0.013) had obviously increased trend, while eGFR levels had markedly decreased trend from group 1 to 4 (p<0.001). Conclusion: Hyperuricemia and low UUAE levels were closely associated the presence of CKD, and the concomitant presence of hyperuricemia and decreased UUAE levels further increased the CKD risk in T2DM. The combined application of SUA and UUAE levels may help identify the type 2 diabetics at higher CKD risk. Funding Statement: This work was supported by grants from the National Natural Science Foundation of China (81170759, 81770813, 81770810) and the Science and Technology Commission of Shanghai Municipality (15411960600). Declaration of Interests: There are no conflicts of interest. Ethics Approval Statement: The study was carried out in accordance with the “Declaration of Helsinki” and approved by the human research ethic committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and all patients had given written informed consent before participated in the study.

The prevalence and determinants of genitourinary syndrome of menopause in Chinese mid-life women: a single-center study

Objective: This study aimed to explore the prevalence and determinants of genitourinary syndrome of menopause (GSM) in Chinese mid-life women.Methods: A cross-sectional single-center study was performed among 40–65-year-old women who participated in physical examinations at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital from December 2015 to December 2016. The participating women were questioned about their genitourinary symptoms, and the relationships between these symptoms and the women’s demographic characteristics were evaluated.Results: The prevalence of GSM was 30.8%, the most frequent symptom was decreased sexual desire (18.4%), and the frequency of vulvovaginal symptoms and lower urinary tract symptoms was 17.5% and 14.8%, respectively. In addition, most of the symptoms were mild. In postmenopausal women, the prevalences of GSM and the three aforementioned symptoms were higher than those in perimenopausal women (p < 0.05). Based on binary logistic regression analysis, GSM was found to be associated with postmenopause (p = 0.007; odds ratio (OR) 1.52), at least two abortions (p = 0.035; OR 1.42), body mass index (BMI) ≥ 30 kg/m2 (p = 0.032; OR 1.91) and diabetes (p = 0.041; OR 1.94).Conclusions: GSM is common in Chinese mid-life women, and associations between GSM and postmenopause, abortion, BMI and diabetes were identified. Health-care practitioners should actively discuss urogenital symptoms with middle-aged female patients and take appropriate interventions to improve the health of their urogenital tract and quality of life.

Assessment of condylar morphology and position using MSCT in an Asian population.

The purpose of the present study was to investigate the volume, surface, morphometric index (MI), and position of the condyle in a normal population by applying Mimics 17.0 software. Then, the difference between left and right sides, sex, and age can be explored, which will contribute to establish the reference value of condylar morphology and position in normal individuals, and help us to study characteristics of condylar morphology and position in abnormal individuals. Three-hundred subjects were enrolled in our study from the radiology department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital. They were divided into three groups according to the age: group 1 (18-24years old), group 2 (25-34years old), and group 3 (35-44years old). Each group included 100 subjects (with 50 males and 50 females). They were examined using multislice computed tomography (MSCT) after that. All images of condyle were reconstructed by Mimics 17.0 software, so as to measure the volume, surface, and MI of condyle, and to analyze the position of condyle in the articular fossa by means of joint spaces. The differences of condylar volume, surface, and MI between left and right sides were not obvious (P> 0.05). The condylar volume and surface were greater in males than females (P< 0.05), while their condylar MI existed no difference (P> 0.05). No statistical differences were found in volume and surface among three age groups. However, the MI of group 1 was statistically lower than that of group 3 (P< 0.05). On the other hand, no significant differences were found between left and right condylar position (P> 0.05). Nevertheless, there were significant differences of condylar position regarding the gender and age (P< 0.05). This study showed no significant differences in condylar morphology and position between left and right sides, but factors of gender and age were proven to have a certain influence on the morphology and position of the condyle. This information can be clinically useful in establishing the diagnostic criteria for condylar morphology and position in the normal Asian population. Examination of condylar morphology and position is important for evaluating the abnormalities and bony changes that affect the temporomandibular joint (TMJ). So, this will be conducive to the diagnosis and the evaluation of therapeutic effect of temporomandibular joint diseases. Also, it is important to evaluate these indexes prior to commencing orthodontic treatment, because TMJ abnormalities play a critical role in orthodontic treatment planning.

A simple risk score based on sleep quality for predicting depressive symptoms in menopausal women: a multicenter study

ABSTRACTObjective: We aim to establish a simple risk score based on sleep quality for predicting depressive symptoms in menopausal women through a cross-sectional investigation.Materials and methods: A total of 705 Chinese women aged 40–60 years were included in this cross-sectional investigation of a self-report questionnaire from the Physical Examination Center at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. Depressive symptoms and sleep quality were evaluated using self-rating depressive symptom scale (SDS)and the Pittsburgh Sleep Quality Index (PSQI), respectively. After setting up a logistic regression model and computing the odds ratio value, we further calculated and predicted the risk score for depressive symptoms and then established a risk score system. Finally, we validated the risk score in two investigations (Validation 1 and Validation 2).Results: The risk scoring system for predicting depressive symptoms included a history of cancer, subjective sleep quality, sleep disorder and daytime dysfunction, with total scores ranging from 0–35 points. The receiver operating characteristic (ROC) sample curve was 0.801 (95% CI 0.753–0.848). The Area Under the Curve (AUC) was 0.832 (95% CI 0.738–0.925) in Validation 1 and 0.799 (95%CI 0.667–0.930) in Validation 2. The best cutoff point for depressive symptoms in the sample population was ≥8 points, and the sensitivity and specificity were 0.698 and 0.824, respectively. The sensitivity was 0.775 and 0.667 in Validation 1 and Validation 2, respectively.Conclusions: The risk score for predicting depressive symptoms in menopausal women based on sleep is convenient. Because there is no complex assessment of multiple scales requiredIt may be a preliminary screening tool for depressive symptoms in menopausal women.

Characteristics, management, and outcome of primary hyperparathyroidism at a single clinical center from 2005 to 2016.

Over the last decade, the prevalence of primary hyperparathyroidism (PHPT) has increased sharply, and the number of individuals with parathyroid cancer is still trending upward. Little is known about the clinical outlook of the disease over the last decade in China. The aim of this study was to describe the clinical characteristics of PHPT patients at our center from January 2005 to December 2016. Two hundred sixty patients with PHPT visiting Shanghai Jiao Tong University Affiliated Sixth People's Hospital were enrolled retrospectively. The clinical manifestations and biochemical abnormalities of these patients were analyzed. Among all patients, 73.1% had symptomatic PHPT, while the number of symptomatic and asymptomatic patients increased 1 to 2.5 times and 1.5 to 3 times, respectively, from 2005 to 2016. Bone pain and single adenoma were the most frequent signs and pathological results. The patients with parathyroid carcinoma over the last 5years accounted for 90% (9/10) of all parathyroid carcinoma patients from 2005 to 2016, and parathyroid carcinoma patients had higher levels of serum calcium, parathyroid hormone (PTH), and serum creatinine (P < 0.05) than parathyroid hyperplasia and parathyroid adenoma patients. Most patients with PHPT in China still exhibit classic clinical and biochemical features. Both symptomatic and asymptomatic patients have increased over the last 12years. Although the proportion of parathyroid carcinoma was small, a noticeable upward tendency was observed at our center.

Research on the effects of compound matrine injection combined with chemotherapy on elderly patients with colorectal cancer

Objective To study the effect of compound matrine injection combined with chemotherapy on the immune function and life quality of elderly patients with colorectal cancer. Methods Seventy patients with colorectal cancer treated in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital South Campus from January 2010 to December 2013 were involved in this survey.They were divided into the control group and the observation group randomly, each group had 35 cases, the control group was treated with chemotherapy only, the observation group was treated with compound matrine injection combine with chemotherapy.The curative effect, life quality and immune function in the two groups were compared. Results The number of complete remission patients in the observation group was 8 cases (22.86%), the number of partial remission cases was 16 cases (45.71%), the effective rate was 68.57%, while the control group had 4 cases of complete remission (11.43%), 11 cases of partial remission (31.43%), the effective rate was 42.86% (Z=-2.259, P=0.024). In the observation group, life quality was significantly improved in 10 cases (28.57%), improved in 19 cases (54.29%), the effective rate was 82.86%, while in the control group, life quality was significantly improved in 4 cases (11.43%), and improved in 10 cases (28.57%), the effective rate was only 40%.The improvement rate of the two groups was statistically significant (Z=-3.497, P=0.000). Before treatment, the immune function indexes of patients in the two groups were close (P>0.05), after treatment, the immune function in both groups were significantly improved, CD3+ , CD4+ , CD4+ /CD8+ levels of patients in the observation group were higher than those in the control group, while the CD8+ level in the observation group was lower than that of the control group (t=-3.968, P=0.000; t=-5.351, P=0.000; t=-5.474, P=0.000; t=6.407, P=0.000). The follow-up time of the two groups was 36 months.After 36 months, the survival rates of the observation group and the control group were 85.7% (30/35) and 80.0% (28/35) respectively, and the difference was not statistically significant (χ2=0.402, P=0.526). Conclusion Compound matrine injection combined with chemotherapy can significantly improve the clinical efficacy of elderly patients with colorectal cancer, improve the immune function and quality of life, it is worthy of clinical application. Key words: Compound matrine injection; Chemotherapy; Elderly colorectal cancer; Immune function; Life quality

Correlation between STK33 and the pathology and prognosis of lung cancer.

Correlation between the expression of STK33 and the pathology of lung cancer was investigated, to explore its effects on prognosis. Hundred and two lung cancer patients diagnosed by pathological examinations were randomly selected in Shanghai Jiao Tong University Affiliated Sixth People's Hospital from February, 2012 to February, 2017 to serve as observation group, and the tumor tissues were collected. At the same time, 19 patients with lung benign lesions were selected and lung tissues were also collected to serve as control group. RT-qPCR was used to detect the expression of STK33 mRNA in tissues. Expression levels of STK33 protein were detected and compared by SP immunohistochemistry staining and western blot analysis. Statistical analysis was performed to analyze the correlation between STK33 expression and the pathology and prognosis of lung cancer. Results of PCR showed that expression level of STK33 gene in control group was significantly lower than that in observation group (p<0.05). The expression level of STK33 mRNA in lung adenocarcinoma and squamous cell carcinoma was lower than that in lung small cell carcinoma and large cell carcinoma (p<0.05). Western blot analysis showed that the expression level of STK33 protein in lung small cell carcinoma and large cell carcinoma was significantly higher than that in lung adenocarcinoma and squamous cell carcinoma (p<0.05). Immunohistochemistry staining showed that the positive rate of STK33 in lung large cell carcinoma (100%) and small cell carcinoma (100%) was significantly higher than that in lung adenocarcinoma (88.1%) and squamous cell carcinoma (86.2%) (p<0.05). The 5-year survival rate analysis showed that the recurrence-free survival rate and overall survival rate of STK33 gene high expression level group were significantly lower than those of low expression level group (p<0.05). The differential expression level of STK33 is related to the pathology and prognosis of lung cancer, which is of great value in clinical diagnosis and prognosis evaluation.

Clinical observation on monovision of cataract surgery with different near addition

Objective: To observe the influence on spectacle independence, satisfaction and visual function after cataract surgery monovision with different ADD. Methods: Prospective clinical study. All patients were collected from the department of ophthalmology, Shanghai JiaoTong University Affiliated Sixth People's Hospital who were diagnosed as bilateral cataract from Oct. 2013 to Mar. 2015. This study comprised 64 cases (128 eyes). All consecutive patients scheduled to undergo bilateral cataract phacoemulsification and implantation of a monofocal AcrySof IQ IOL. The average age of patients was (65.4± 6.0) years old, ranged from 51 to 70 years. 28 males and 36 females. According to the different demands of spectacle independence and living habits of patients, all cases were divided into two groups: MV1 group (32 patients), whose near addition being 1.25-1.75 D and MV2 group (32 patients), whose near addition being 2.25-2.75 D. Parameters 6 months postoperatively included binocular uncorrected distance, intermediate, and near visual acuities, stereo vision and refractive states were analyzed. Parameters of spectacle independence, subjective visual symptoms and patient satisfaction according to visual function questionnaire were analyzed at the same time. T test was used to compare uncorrected visual acuity. Whitney U test was operated in stereo vision comparison. Chi-square test was applied in sex-distribution comparison and visual function questionnaire between two groups. Results: The uncorrected distance vision in MV1 group was (0.09±0.09), while it was (0.11±0.08) in MV2 group. The uncorrected intermediate vision in MV1 group was (0.27±0.25), and it was (0.30±0.22) in MV2 group. There were no significant difference between two groups in bilateral uncorrected distance vision (t=1.62, P=0.264, LogMAR), intermediate (t=- 0.23, P=0.876, LogMAR). However, there was significant difference between two groups in uncorrected near vision (t=2.38, P=0.021, LogMAR). It was (0.06±0.06) in MV1 group and (0.02±0.07) in MV2 group. Moreover, near stereo vision was better in MV1 group than MV2 group (Z=- 1.29, P=0.031). On the questionnaire, all patients in two groups had no significant difference in their daily lives discomfort (χ(2)=0.10, P=0.756). In MV2 group, there were 2 patients complained obstacles while walking stairs dimly. In MV1 group, there were 3 patients had to wear low degrees of presbyopic glasses when they were on near work. Percentage of patients spectacle independence was less than 90% in MV1 groups. In MV2 group, one case needed low degrees of myopic glasses when he was on intermediate computer work and playing table games. Conclusion: Different near addition has similar advantages to different patients on spectacle independence, satisfaction and visual function after cataract surgery. (Chin J Ophthalmol,2017,53: 451-454).

Effects of continuous positive airway pressure on neurocognitive architecture and function in patients with obstructive sleep apnoea: study protocol for a multicentre randomised controlled trial

ObjectivesMany clinical studies have indicated that obstructive sleep apnoea (OSA), the most common chronic sleep disorder, may affect neurocognitive function, and that treatment for continuous positive airway pressure (CPAP) has...