Shanghai Jiaotong University Affiliated Sixth Research Articles

Effectiveness and safety of new umbilical paramedian semilunaris approach for transverse abdominis plane block: a prospective, single-arm, observational, evaluation study.

The transversus abdominis plane (TAP) block is a widely used, safe and effective technique for abdominal surgery analgesia, but its range of blocking is not sufficient for some surgeries requiring a large incision. Here we present the novel concept of an ultrasound-guided linea semilunaris block, a modified approach to TAP block, which can potentially offer a wider blocking range. Patients undergoing open colorectal surgery at the Shanghai Jiaotong University Affiliated Sixth People's Hospital between May and July 2021 were enrolled to receive ultrasound-guided linea semilunaris block. All blocks were performed in the holding area of the operating theater under routine hemodynamic monitoring while patients were conscious with low-dose opioids. All patients were supine, and a linear probe identified the semilunar line as the connection between the transverse and rectus muscles. Next, 20 mL of 0.25% ropivacaine was injected in the semilunar line using the in-plane technique bilaterally. The main indicator of the blocking range was measured. Postoperatively, the visual analog score (VAS) from 4 to 24 h (every 2 h), the time of the first remedial analgesia, the bowel movement starting time and complications were also recorded. A total of 31 potentially eligible studies were identified for inclusion. The extent of the cutaneous sensory block was: 3.46±0.59 cm below the xiphoid, 1.74±0.37 cm above the symphysis pubis, 2.02±1.24 cm outside the left midclavicular line, and 2.19±1.25 cm outside the right midclavicular line. The highest and lowest median [interquartile range (IQR)] VAS pain scores were 4 [4-5] of 10 h and 2 [1-2] of 4 h postoperatively. The bowel movement starting time was 3.7±1.1 days after gastrointestinal surgery. There were four patients with nausea and vomiting but none had adverse reactions attributable to local anesthetic (LA) poisoning. The ultrasound-guided umbilical paramedian semilunaris approach to TAP block is a safe and effective technique in clinical practice, which may provide more effective analgesia than traditional TAP block for open colorectal surgery with a median abdominal incision. Further randomized controlled trials are needed to confirm our results.

Sarcoma arising in fibrous dysplasia: a clinicopathological analysis

Objective: To study the clinicopathologic characteristics and risk factors of sarcoma arising in fibrous dysplasia. Methods: A total of 18 cases were collected from January 2008 to July 2018 in Shanghai Jiaotong University Affiliated Sixth People's Hospital. The characteristics and the histologic type were retrospectively reviewed. IBM SPSS 19 was used for statistical analysis. Results: The male to female ratio of patients with fibrodysplastic sarcomatosis was 1.57∶1.00. The age of onset ranged from 24 to 87 years (mean 49 years). The long bones, especially the femur, were most frequently involved. Nine cases were osteosarcomas, three cases were high grade sarcoma and six cases were low grade sarcoma. Logistic regression analysis showed that age was an independent risk factor for sarcomatous change, compared with polyostotic or recurrent cases. Value of Wals was 13.61 (P<0.05), and odds ratio was 12.82,95% confidence interval was 3.31-49.70. Conclusions: Fibrodysplasia sarcomatosis is clinically nonspecific and the risk of sarcomatous changes increases approximately 12-fold when age of onset of fibrous dysplasia is over 40 years.

Application Value of Predictive Model Based on Maternal Coagulation Function and Glycolipid Metabolism Indicators in Early Diagnosis of Gestational Diabetes Mellitus.

ObjectiveTo investigate whether first-trimester fasting plasma glucose (FPG), blood coagulation function and lipid metabolism could predict gestational diabetes mellitus (GDM) risk.MethodsFrom October 2020 to May 2021, a total of 584 pregnant women who took prenatal care in Shanghai Jiaotong University Affiliated Sixth People's Hospital were chosen as the observation subjects. The clinical information and serum samples of all pregnant women were collected at 10–13 weeks of gestation and the blood coagulation function, fasting blood glucose and lipid profiles of the pregnant women were detected. A 75 g oral glucose tolerance test was performed up to 24–28 weeks of gestation. One hundred forty-two pregnant women with GDM and 442 pregnant women without GDM were detected. Data were expressed by x ± s or median (interquartile range) and were analyzed using student's t-test, Wilcoxon rank sum test and Logistic regression analysis. The area under the curve (AUC) was calculated by receiver operating characteristic curve (ROC) to analyze the predictive values.ResultsCompared with non-GDM group, age, pre-pregnancy BMI, FPG, FIB, D-Dimer, FDP, FPG, TC, TG, LDL-C, sdLDL-C, APOB and APOE in GDM group were significantly higher than those in non-GDM group, while PT, INR, APTT and TT were significantly lower than those in non-GDM group. Univariate logistic regression analysis was used to explore the risk factors of GDM. Gestational age, pre-pregnancy BMI, FPG, PT, INR, APTT, FIB, TT, D-Dimer, TC, TG, LDL-C, sdLDL-C, APOB and APOE were all independent predictors of GDM. Multivariatelogistic regression showed that pre-pregnancy BMI, FPG, APTT, TT, TG, LDL-C, sdLDL-C and APOB were risk factors for GDM. The AUC of the established GDM risk prediction model was 0.892 (0.858–0.927), and the sensitivity and specificity were 80.71 and 86.85%, respectively; which were greater than that of pre-pregnancy BMI, FPG, APTT, TT,TG, LDL-C, sdLDL-C, APOB alone, and the difffference was statistically signifificant (P < 0.05).ConclusionsFPG, APTT, TT, TG, LDL-C, sdLDL-C, APOB and pre-pregnancy BMI in early pregnancy has important clinical value for the prediction of GDM, We combined these laboratory indicators and established a GDM risk prediction model, which is conducive to the early identification, intervention and treatment of GDM, so as to reduce the morbidity of maternal and infant complications.

Association between handgrip strength and cognition in a Chinese population with Alzheimer\u2019s disease and mild cognitive impairment

BackgroundThis study aimed to explore the level and changes in handgrip strength among preclinical Alzheimer’s disease (AD) and AD patients and to evaluate the association between handgrip strength and cognitive function.MethodsA total of 1431 participants from the memory clinic of Shanghai JiaoTong University Affiliated Sixth People’s Hospital and community were enrolled in the final analysis, including 596 AD, 288 mild cognitive impairment (MCI), and 547 normal individuals (NC). All participants received a comprehensive neuropsychological assessment. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment-Basic (MoCA-BC), and the Chinese version of Addenbrooke’s Cognitive Examination III (ACE-III-CV) were used as cognitive tests. The receiver operating characteristic curve (ROC) was plotted to assess the power of handgrip strength as a screening measure to discriminate AD and MCI.ResultsThe results showed that handgrip strength in the MCI group was significantly lower than that of NC group, and the AD group had a further decline (both P < 0.01). Multivariate logistic regression was performed with the handgrip strength quartiles, and the results showed that the ORs of AD for increasing levels of handgrip strength were 1.00, 0.58 (0.46–0.78), 0.51 (0.36–0.73), and 0.50 (0.35–0.68), showing a decreasing trend (Pfor trend < 0.01). The ROC curve demonstrated that the handgrip strength cutoff points for the identification of AD were 16.8 and 20.7 kg among the female participants above and under 70 yrs and 24.4 and 33.3 kg for the male participants above and under 70 yrs, respectively. Similarly, for the identification of MCI, cutoff points were 17.5 and 21.9 kg for females above 70 yrs and under 70 yrs, and 25.8 and 36.2 kg for males above 70 yrs and under 70 yrs, respectively.ConclusionsOur study provided the further knowledge on the relationship between noncognitive features and cognition in populations with differing cognitive status, revealed that the stronger handgrip strength was associated with better performances on cognitive function. It can be speculated that handgrip strength can help early recognition of Chinese AD patients.

Diagnosis and surgical treatment of sinonasal phosphaturic mesenchymal tumor

Objective: To investigate the diagnosis and surgical treatment of sinonasal phosphaturic mesenchymal tumor (PMT). Methods: The medical records of nine patients who had been diagnosed as sinonasal PMT in Department of Otorhinolaryngology Head and Neck Surgery, Shanghai JiaoTong University Affiliated Sixth People's Hospital between January 2015 and May 2020 were collected, including 4 males and 5 females, ranging from 36 to 59 years. The patient's previous history, clinical manifestations, imaging findings, laboratory results, surgical procedure, pathological results and postoperative follow-up data were analyzed by descriptive statistical analysis. Results: All patients presented hypophosphatemia and tumor-induced osteomalacia (TIO) with a disease course of 1 to 19 years. The imaging examination and intraoperative findings identified two cases with peripheral tissue infiltration, two cases with contralateral nasal cavity invasion, and one case with intracranial invasion. Five patients underwent unilateral endoscopic resection while two patients underwent bilateral endoscopic resection, and the remaining two patients underwent unilateral transorbital ethmoid artery ligation plus endoscopic tumor resection and endoscopic combined with transfrontal tumor resection (n=1 each). Expect for one case developed recurrence and intracranial involvement, the other patients achieved clinical remission and no recurrence was observed during the six-month follow-up. Conclusions: The diagnosis of sinonasal PMT needs combination of clinical manifestation, imaging, and pathological findings. Complete surgical excision and long-term postoperative follow-up are imperative.

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.

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).

The radiological research for pelvis asymmetry of unilateral developmental dysplasia of the hip in adult.

ObjectivesTo investigate whether adult patients with unilateral developmental dysplasia of the hip (UDDH) have pelvic asymmetry and what correlation existing between them.MethodsA total of 100 adult patients with UDDH were enrolled in the retrospective observational study in Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China, between January 2012 and February 2014. The anteroposterior pelvic radiographs were reviewed and the pelvic heights and ischium heights were measured and compared between the affected and non-affected sides to find out the relationship between the pelvic morphology and hip dysplasia.ResultsThe pelvic heights demonstrated significant differences between the non-affected side and the affected side in patients with Crowe type II-IV UDDH (p<0.05), but not in patients with Crowe type I UDDH (p=0.09). There were significant differences in the bilateral ischium heights in patients with Crowe type III and IV UDDH (p<0.05), but not in patients with Crowe type I and II UDDH (p=0.78, p=0.055). In addition, the degree of hip dysplasia was positively associated with the degrees of asymmetry of pelvis (r=0.78, p<0.001) and ischium (r=0.72, p<0.001) in UDDH patients.ConclusionThe pelvic asymmetry exists in adult patients with UDDH. In addition, the degree of asymmetry has correlation with the degree of hip dysplasia. We recommend that it should be taken more cautions to use teardrops and ischial tuberosity as anatomy landmarks to balance leg-length discrepancy for unilateral DDH patients in preoperative planning and total hip arthroplasty.

Clinical efficacy of complex splenectomy in 235 patients

Objective To explore the clinical efficacy and safety of complex splenectomy. Methods The retrospective cohort study was adopted. The clinical data of 235 patients including 135 from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 67 from Shanghai Jiaotong University Affiliated First People's Hospital, 26 from Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7 from 85 Hospital of PLA who underwent complex splenectomy from January 2005 to December 2015 were collected. All the patients received total splenectomy after splenic artery ligation. The observation indexes included: (1) surgical situations, (2) major complications including intraperitoneal hemorrhage, pulmonary complication, left subphrenic abscess and peritoneal effusion, (3) follow-up situations: portal vein (PV) complications (splenic venous thrombo-phlebitis, thrombosis of splenic vein and main portal vein thrombosis), survival of patients. The follow-up using outpatient examination and telephone interview was performed up to March 2016, and patients received regularly ultrasound reexamination, computed tomography (CT) rescan, routine blood retest and coagulation function. Measurement data with normal distribution were presented as ±s, and count data were analyzed using the chi-square test. Results (1) Surgical situations: of 235 patients, 200 patients underwent secondary spleen pedicle severance and 35 patients underwent non-secondary spleen pedicle severance. Volume of intraoperative blood loss and duration of splenic resection were (268±103)mL and (82±29)minutes. (2) Major complications: of 31 patients with postoperative complications, intraperitoneal hemorrhage was detected in 12 patients, pulmonary complication in 17 patients, left subphrenic abscess in 3 patients and massive peritoneal effusion in 21 patients. Some patients were combined with multiple symptoms. The patients with above complications were cured after reoperations and non-operative treatments. (3) Follow-up situations: PV complications: splenic venous thrombo-phlebitis was detected in 16 patients, thrombosis of splenic vein in 17 patients, thrombosis of splenic vein combined with main portal vein thrombosis in 7 patients, and they were improved after the treatments of anti-inflammation, anti-coagulation and thrombolysis. The thrombi rate after splenectomy was 32.4%(12/37) in patients with schistosoma-related cirrhosis and 8.1%(12/149) in patients with HBV-related cirrhosis, with a statistically significant difference (χ2=10.9, P<0.05). Survival of patients: of 235 patients, 228 were followed up for (7.9±4.2)years, with good survival. Conclusion Complex splenectomy is safe and effective, and the key procedure determining the safety of complex splenectomy includes careful preoperative evaluation, delicate surgical technique, proper splenic pedicle severance and peritoneal wounds. Key words: Portal hypertension; Complex splenectomy; Splenomegaly

Gestational diabetes mellitus in Chinese women

Objective: To determine whether foreign diagnostic criteria for the diagnosis of gestational diabetes mellitus (GDM) are suitable for Chinese pregnant women. Methods: The study participants were 340 pregnant women receiving obstetric care at the Shanghai Jiaotong University–Affiliated Sixth People's Hospital in Shanghai, China. The normal-pregnancy group comprised 190 women with no risk factor for GDM and the high-risk pregnancy group comprised 150 women who had at least one high-risk factor for GDM. All women took the diagnostic 100-g, 3-h oral glucose tolerance test (100-g 3-h OGTT) between 24 and 28 weeks of pregnancy. The results of the 100-g 3-h OGTT were classified according to three different sets of diagnostic criteria: (1) new, “Chinese” diagnostic criteria based on the results from the 100-g 3-h OGTT performed in the 190 healthy participating women; (2) the Carpenter and Coustan criteria; and (3) the National Diabetes Data Group (NDDG) criteria. Venous plasma glucose (VPG) was measured by the glucose oxidase method. A consistency check was used for analysis. Obstetric and neonatal outcomes were recorded. Results: With 97.5% as the statistical cutoff value for the 100-g 3-h OGTT, the new diagnostic criteria for this study, based on data obtained from the 100-g 3-h OGTT performed on the 190 participating healthy pregnant women, were 5.2, 10.3, 8.9, and 7.7 mmol/L at 0, 60, 120, and 180 min. The ê value was 0.83 for the new criteria vs. the Carpenter and Coustan criteria ( P<0.001) and 0.70 for the new criteria vs. the NDDG criteria ( P<0.001). In women with GDM and gestational-impaired glucose tolerance (GIGT), the incidence rates of macrosomia by the new criteria and the Carpenter and Coustan criteria were similar, but higher than the rates calculated with the NDDG criteria ( P<0.05). Conclusion: With venous plasma glucose level measured by the glucose oxidase method, the Carpenter and Coustan criteria are applicable to Chinese pregnant women for diagnosis of GDM.