Application experience of ventricular intracranial pressure monitoring in the treatment of traumatic multiple intracranial hematoma / 中国医师进修杂志

Objective:To investigate the significance of ventricular intracranial pressure monitoring in the treatment of traumatic multiple intracranial hematoma (TMIH).Methods:The clinical data of 14 TMIH patients treated with ventricular intracranial pressure monitoring from January 2016 to August 2021 in Beijing Luhe Hospital, Capital Medical University were analyzed retrospectively. The patients were followed up 6 months after injury, and the Glasgow outcome score (GOS) was assessed.Results:All the 14 patients successfully completed ventricular intracranial pressure probe placement. Among them, 8 patients recovered well after continuous monitoring of ventricular intracranial pressure and continuous cerebrospinal fluid drainage. Their ventricular intracranial pressure probe was placed for 5 to 10 (7.3 ± 2.2) d, with no intracranial infection occurred; and their GOS was 5 scores 6-month follow-up after injury. Six cases underwent craniotomy for hematoma removal due to the expansion of intracranial hematoma or aggravation of edema, and decompressive craniectomy was performed during the operation; 6-month follow-up after injury, GOS of 5 scores was in 3 cases, 4 scores in 2 cases, 3 scores in 1 case.Conclusions:The condition of TMIH patients is complex and changeable, and ventricular intracranial pressure monitoring can improve the prognosis of TMIH patients.

Efficacy and safety of Changsulin ? compared with Lantus ? in type 2 diabetes: a phase Ⅲ multicenter, randomized, open-label, parallel, controlled clinical trial / 中华内科杂志

Objective:To compare the efficacy and safety of Changsulin ? with Lantus ? in treating patients with type 2 diabetes mellitus (T2DM). Methods:This was a phase Ⅲ, multicenter, randomized, open-label, parallel-group, active-controlled clinical trial. A total of 578 participants with T2DM inadequately controlled on oral hypoglycemic agents were randomized 3∶1 to Changsulin ? or Lantus ? treatment for 24 weeks. The efficacy measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), 8-point self-monitoring of blood glucose (SMBG) profiles from baseline, and proportions of subjects achieving targets of HbA1c and FPG. The safety outcomes included rates of hypoglycemia, adverse events (AEs) and anti-insulin glargine antibody. Results:After 24 weeks of treatment, mean HbAlc decreased 1.16% and 1.25%, FPG decreased 3.05 mmol/L and 2.90 mmol/L, 2hPG decreased 2.49 mmol/L and 2.38 mmol/L in Changsulin ? and in Lantus ?, respectively. No significant differences could be viewed in above parameters between the two groups (all P>0.05). There were also no significant differences between Changsulin ? and Lantus ? in 8-point SMBG profiles from baseline and proportions of subjects achieving the targets of HbA1c and FPG (all P>0.05). The rates of total hypoglycemia (38.00% and 39.01% for Changsulin ? and Lantus ?, respectively) and nocturnal hypoglycemia (17.25% and 16.31% for Changsulin ? and Lantus ?, respectively) were similar between the two groups (all P>0.05). Most of the hypoglycemia events were asymptomatic, and no severe hypoglycemia were found in both groups. No differences were observed in rates of AEs (61.77% vs.52.48%) and anti-insulin glargine antibody (after 24 weeks of treatment, 6.91% vs.3.65%) between the two groups (all P>0.05). Conclusions:Changsulin ? shows similar efficacy and safety profiles compared with Lantus ? and Changsulin ? treatment was well tolerated in patients with T2DM.

Establishment and Verification of Personalized Musculoskeletal Model Based on nmsBuilder and OpenSim / 医用生物力学

Objective To establish a personalized musculoskeletal multi-body dynamics model of total knee replacement (TKR) by two software nmsBuilder and OpenSim, and verify this established model by using bouncy and medthrust gait patterns. Methods Based on skeletal data from a patient, the body, skeletal landmark clouds and muscular landmark clouds were established for automatically generating reference systems and muscles. The musculoskeletal model generated by nmsBuilder was introduced into OpenSim, and inverse kinematics, static optimization and knee joint force analysis were performed successively. Finally, the model was driven by bouncy gait and medthrust gait respectively, and the results were compared with experimental measurements. Results Except for the lateral joint contact forces, the predicted magnitude and trend of knee joint contact forces by the model had a good agreement with the experimental data, and the constructed skeletal muscle multi-body dynamics model could be used for knee joint research. Conclusions The established musculoskeletal multi-body dynamics model could predict the medial, lateral and total tibiofemoral joint contact forces simultaneously by inputting the marker positions and the ground reaction forces. The research ideas of this study can provide references for designing personalized knee prostheses for TKR patient.

Latissimus dorsus flap for reconstruction of severe leg trauma / 中华创伤骨科杂志

Objective To report the clinical outcomes of latissimus dorsus flap used to reconstruct severe trauma on lower leg.Methods From May 2011 to September 2016,12 patients were treated for severe trauma on lower leg at Orthopaedic Department,General Hospital of Rocket Force.They were 10 men and 2 women,aged from 22 to 54 years (average,37.5 years).According to the Gustilo classification,their open fractures were of type ⅢA in 2 cases and of type ⅢB in 10.The areas of soft tissue defect ranged from 15 cm × 8 cm to 35 cm × 12 cm.Their wounds were covered with latissimus dorsus flaps;the dorsal expansion of the ankle joint was reconstructed after their bone infection was controlled.Two flaps were anastomosed directly to the anterior tibial vessels and one flap to the femoral vessels.The other 9 flaps were anatomosed to the lateral circumflex femoral artery,bridging with the greater saphenous vein (average length:32 cm).Ten flaps were neuroanatomosed with the motor branch of common peroneal nerve and 2 with the motor branch of vastus lateralis.The therapeutic outcomes were evaluated in terms of repair of soft tissue defects,control of infection and range of active dorsal flexion of the ankle at neutral position.Results The 12 patients were followed up for an average of 3.5 years (from 1 to 6 years).All the 12 flaps survived and infections were eradicated.The fractures were healed with muscle strength of grade 3 to grade 4.Their ankle extension was reconstructed.Their limbs were preserved with satisfactory limb function.The bone exposures of 5 cm × 3 cm and 6 cm × 3 cm in area after debridement respectively in 2 cases of Gustilo type ⅢA were covered with latissimus dorsus flaps.The range of active dorsal flexion of the ankle at neutral position increased from preoperative 10.5° to postoperative 19.1° on average.Conclusion In treatment of severe trauma on lower leg,latissimus dorsus flaps can be used to repair skin wound,control infection and reconstruct ankle function simultaneously,with advantages of reduced operative procedures,a high rate of limb preservation,and better function recovery.

Microsurgical techniques combined with bone transportation for osteomyelitis following open fracture on the leg / 中华创伤骨科杂志

Objective To evaluate the efficacy of microsurgical techniques combined with bone transportation for osteomyelitis following open fracture on the leg.Methods From April 2007 to April 2016,25 patients with osteomyelitis caused by severe open injury on the leg were treated at Orthopaedic Department,General Hospital of Rocket Force.They were 22 men and 3 women,aged from 19 to 65 years (average,36.5 years).Their open injury was located at upper tibia in 6 cases,at middle tibia in 6 and at lower tibia in 13.Eight patients received internal fixation with plate and 17 unilateral external fixation.By the Cierny-Mader classification,their chronic osteomyelitis was of type Ⅲ in 14 cases and of type Ⅳ in 11.The tibial defects after excision of infectious segment ranged fromn 5 to 14 cm in length (average,8.8 cm).After infectious tissues were removed,antibiotic bone cement chains were inserted into the defects.The open wounds were covered with microsurgical pedicled or free flaps.Bone transportation with unilateral external fixation was used to deal with the bone defects after removal of the infectious bone.Results Bone infection was controlled in the 25 patients.The rate of infection control after one debridement procedure was 76.0％ (19/25),and that after 2 debridement procedures was 24.0％ (6/25).Flap repair led to early closure of the open wounds.The successful rate of wound closure after one operative procedure was 84.0％ (21/25),and that after secondary operation was 16.0％ (6/25).Bony union of tibial defects was achieved in all the 25 patients with no recurrence of osteomyelitis.The patients were followed up for 18 to 36 months (average,24.6 months).Re-fracture happened in one case and was treated with another operation.Bone union time starting from bone transportation ranged from 8 to 18 months (average,10.5 months).Time for external fixation ranged from 12 to 20 months (average,18.4 months).Conclusion For osteomyelitis caused by severe open injury on the leg,microsurgical techniques can be used to repair open wounds and bone transportation to reconstruct bone defects after removal of infectious bone.

Study on microsurgical treatment by unilateral subfrontal approach in 16 patients with large olfactory groove meningiomas / 中国医师进修杂志

Objective To study the method and therapeutic effect of microsurgical treatment by unilateral subfrontal approach in patients with large olfactory groove meningiomas. Methods The clinical data of 16 patients with large olfactory groove meningiomas who had underwent microsurgical treatment by unilateral subfrontal approach from January 2010 to December 2017 were analyzed retrospectively. Results Total removal of tumor (Simpson Ⅰ and Ⅱ grade) was achieved in 14 cases and subtotal removal of the tumor (Simpson Ⅲ) was in 2 cases. No patient died from the microsurgery. The treatment effect was satisfactory in all patients during the follow- up. Conclusions The microsurgical treatment by unilateral subfrontal approach in patients with large olfactory groove meningiomas conforms to the concept of minimal invasive surgery, which provides enough surgical space, and the effect of surgery is satisfactory. So the approach is a good choice for the removal of large olfactory groove meningiomas.

Analysis of Risk Factors for Nosocomial Infections and Drug Resistance of Pathogens in 480 Patients with Craniocerebral Injury / 医药导报

Objective To investigate the risk factors for nosocomial infections and analyze pathogens drug resistance in patients with craniocerebral injury so as to provide scientific basis for clinical precaution and treatment.Methods A retrospective survey was conducted to collect the clinical data of 480 patients with craniocerebral injury including the gender,age and therapeutic process of patients by medical history,for analyzing the related factors causing nosocomial infections via SPSS 18.0 software.Then,the results of bacterial culture and drug sensitivity test were recognized to analyze drug resistance of pathogenic bacteria.Results The nosocomial infections occurred in 100 of 480 patients with craniocerebral injury,with an infection rate of 20.83%.The univariate analysis indicated that the risk of nosocomial infections was associated with age,tracheal tube,deep vein catheterization,the length of tracheotomy,the length of hospital stay,diabetic mellitus and hemoglobin ≤110 g·L-1 (P<0.05).Totally 191 strains of pathogens have been isolated,including 118 (61.8%) strains of gram-negative bacteria,46 (24.1%) strains of gram-positive bacteria and 27 (14.1%) strains of fungi.The Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli were dominant among the gram-negative bacteria,and the drug resistance rates of them to cefazolin and cefotaxime were high;The Staphylococcus aureus,Enterococcus faecalis and Staphylococcus were the major species of the gram-positive bacteria,which were insensitive to penicillin and clindamycin;the Candida albicans was the major species of the fungi.Conclusion The incidence of nosocomial infections is high in the patients with craniocerebral injury,which is accociated with many risk factors.Therefore,it is necessary to strengthen the control of the risk factors so as to effectively reduce the incidence of nosocomial infections.

Investigation and Analysis of the Anticoagulant Therapy for Patients with Non-valvular Atrial Fibrillation in Our Hospital / 中国药房

OBJECTIVE:To investigate the current situation of anticoagulant therapy for patients with non-valvular atrial fibril-lation,and to provide reference for standardized anticoagulant therapy. METHODS:A total of 1056 patients with non-valvular atri-al fibrillation were collected from our hospital during Jul. 2015-Jun. 2016. According to 2012 European Society of Cardiology Guide-lines for the Management of Atrial Fibrillation,the risks of thrombosis and hemorrhage were evaluated,and the standardized anti-coagulant therapy was also evaluated. RESULTS:Among 1056 patients with non-valvular atrial fibrillation,the number of patients with thrombosis risk score ≥1 was 1028,accounting for 97.3%. 763 patients received antithrombosis therapy,and only 139 pa-tients were given warfarin anticoagulant therapy. The international normalized ratio(INR)of prothrombin time in just 30.9% of pa-tients receiving warfarin was in line with the standard before discharge. CONCLUSIONS:The anticoagulant therapy for patients with non-valvular atrial fibrillation is still not optimistic,and effective measure should be adopted to improve the standardization of anticoagulant therapy in the patients with atrial fibrillation.

Study on the application value of percutaneous dilation tracheostomy on the neurological ;intensive patients / 中国医师进修杂志

Objective To explore the application value of percutaneous dilational tracheostomy in the neurological intensive patients. Methods The clinical data of 298 neurological intensive patients treated with percutaneous dilational tracheotomy were analyzed retrospectively from June 2010 to July 2016. Results Percutaneous dilational tracheostomy was successfully performed in all of the 298 cases. The mean operation duration was (6.8 ± 2.2) minutes with a rang of 2 to 15 min. There were 1 case with tracheal tube placement difficulties, 1 case in whom the trachea spatium was strayed into, 1 case with arrhythmia, 10 cases with mild bleeding and 5 cases with moderate bleeding. No severe bleeding, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula and other complications caused by the operation were found. And no death case was found. Conclusions Percutaneous dilational tracheostomy is a rapid and minimally invasive technique, which is a better choice for patients with severe neurological diseases.

Serum nesfatin-1 levels in gestational diabetes mellitus in relation to insulin resistance and pancreatic β-cell function / 中华内分泌代谢杂志

The association of serum nesfatin-1 levels with insulin resistance and pancreatic β-cell function in gestational diabetes mellitus was investigated.Oral glucose tolerance test(OGTT) was performed in ninety pregnant women from 24,to 28 gestational weeks.They were divided into three groups according to OGTT:45 nomal controls,27 gestational diabetes mellitus with fasting plasma glucose (FPG) of 5.1 mmol/L to 7.0 mmol/L (GDM1),18 gestational diabetes mellitus with FPG more than 7.0 mmol/L (GDM2).Serum nesfatin-1 levels were significantly higher in patients with GDM1 and GDM2 than in controls (P＜0.01),and in GDM2 group it was also higher than GDM1 group(P＜0.05).Fasting serum nesfatin-1 was positively correlated with FPG,30 min plasma glucose,1 h plasma glucose,2 h plasma glucose,homeostasis model assessment for insulin resistance,and PGAUC,but negatively correlated with homeostasis model assessment for β-cell function.Furthermore,multiple stepwise regression analysis showed that FPG was the independent influencing factor of serum nesfatin-1 level.Nesfatin-1 was positively correlated with insulin resistance,while negatively correlated with pancreatic β-cell function.Nesfatin-1 may play a role in the pathogenesis of gestational diabetes mellitus.

Glycosylated hemoglobin A1c for the diagnosis of diabetes mellitus: a meta-analysis / 中华内科杂志

Objective To assess the diagnostic value of glycosylated hemoglobin A1c (HbA1c) ≥6.5％ for diabetes in Chinese adults with oral glucose tolerance test(OGTT) as the reference standard.Methods Major databases were searched to get all diagnostic tests with HbA1c ≥ 6.5％ for diabetes in Chinese adults.QUADAS items were used to evaluate the quality of the eligible studies.Meta-disc software was used to perform comprehensive quantitative assessment for all included studies and summary ROC (SROC) curve were drawn.Results A total of 11 studies were included.The outcomes of the diagnostic value with HbA1c ≥6.5％ were as the following:pooled sensitivity 0.62 (95％ CI:0.60-0.64),pooled specificity 0.96 (95％ CI:0.95-0.96),diagnostic odds ratio (DOR) 40.25 (95％ CI:20.79-77.95) and AUCSROC 0.7702 (sx =0.0636).Conclusions The diagnostic specificity is pretty high for the diagnostic test with HbA1c ≥6.5％,while sensitivity is low.Combination of HbA1c and glucose tests is needed to reduce the missed diagnosis rate.

Clinical follow-up observation for 34 type 2 diabetic patients with six-year intensive insulin therapy / 中华内分泌代谢杂志

The data collected from 34 type 2 diabetic patients receiving intensive insulin therapy for six years showed that the yearly mean HbA1C was less than 7.0％,and none of the patients showed severe hypoglycemia,occurrence or evident progression of retinopathy or nephropathy,and the islet β cell function gained improvement.The DQOL score,used to evaluate the quality of patients' life had no significant change during the observation ( P ＞0.05 ).It is satisfactory and safe to maintain long-term glycemic control with prolonged intensive insulin therapy in patients with type 2 diabetes,and that such therapy does not induce untoward influence on the quality of diabetic patients life.

Association between polymorphisms of transcription factor 7-like 2 gene and type 2 diabetes mellitus in Hefei district / 中华内分泌代谢杂志

To explore the association between polymorphisms of transcription factor 7-like 2 gene (TCF7L2) and type 2 diabetes mellitus in Hefei district. The results suggest that the genetic variation DG10S478 in the TCF7L2 gene was not associated with type 2 diabetes mellitus in Hefei district ( P>0.05 ). However, its attribution to the susceptibility of type 2 diabetes mellitus in Hefei is not important.

Impact of waist-to-hip ratio on the genetic phenotype in probands of type 2 diabetes / 中华内分泌代谢杂志

Objective To explore the impact of waist-to-hip ratio (WHR) in type 2 diabetic probands on the phenotype of insulin resistance and β-cell function in normoglycemic first-degree relatives. Methods One hundred and eighty-six type 2 diabetic probands and 489 normoglycemic first-degree relatives were selected from 186 type 2 diabetes core families. 115 first-degree relatives (FDR1 group) of probands with low WHR (1st quartile: <0.86 for males and <0.84 for females) and 106 first-degree relatives (FDR2 group) of probands with high WHR (4th quartile: >0.92 for males and >0.89 for females) were identified to intensively study from 489 normoglycemic first-degree relatives. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to estimate insulin sensitivity, and β-cell function was quantified as the ratio of the incremental insulin to glucose responses over the first 30 min (△I30/△G30) during the oral glucose tolerance test. The latter measure was also adjusted for the assay of insulin sensitivity as it modulated β-cell function (△I,,30>·△G-1,30·HOMA-IR-1). Results The body mass index, the waist circumference and waist-to-height ratio in female first-degree relatives, systolic blood pressure, triglyceride and HOMA-1R were significantly higher in FDR2 group than those in FDR1 group andhigh density lipoprotein cholesterol,△I30/△G30, △I-130·HOMA-IR-1were significantly lower in FDR2 group than those in FDRI group (P < 0.05 or P < 0.O1). The waist circumference and waist-to-height ratio in relatives of probands with low and high WHR were positively correlated with the HOMA-IR. However, the least square regression analysis showed that the slope from regression in FDR2 group were significantly steeper than thatin FDR1 group(both P <0.01). Conclusion The normoglycemic first-degree relatives of the type 2 diabetic probands with high WHR had much more evident phenotype of insulin resistance and decreased β-cell function, and a slight increase in abdominal obesity had a greater impact on insulin resistance.

Role of insulin pump in controlling of hyperglycemia of patients with type 2 diabetes mellitus / 中国医师进修杂志

Objective To compare the effect of treating hyperglycemia on insulin pump therapy in newly diagnosed type 2 diabetes mellitus(T2DM) and the patients with failure to oral antidiabetic therapy. Methods Selecting 32 patients with newly diagnosed T2DM(NDM group)and 64 T2DM patients with failure to oral antidiabetic therapy(ODM group),which were treated by insulin pump,having no significant difference of the level of blood glucose,body mass index(BMI),age,proportion of sex between NDM group and ODM group. Results (1)The mean time and the maximal dosage of insulin for blood glucose to be targeted in NDM group were all lower than those in ODM group(P all

Effect of TNF-? on PPAR?2 mRNA expression in 3T3-L1 adipocytes transfected with the human recombinant adiponectin / 中国糖尿病杂志

Objective To observe effect of TNF-? on PPAR?2 mRNA expression in 3T3-L1 cells transfected with human recombinant adiponectin. Methods The 3T3-L1 preadipocytes were transfected with the recombinant plasmid pcDNA3.1+-hADPN.The PPAR?2 mRNA expression was quantitated by semi-quantitative RT-PCR. Results (1)Compared with controls(the 3T3-L1 cells and the 3T3-L1 cells with plasmid), the PPAR-?2 mRNA expression of 3T3-L1 cells with human recombinant adiponectin was higher(P

Effects of Cu~(2+), Zn~(2+) and Mn~(2+)on postsynaptic sites / 中国药理学通报

Effects of Cu2+,Zn2+and Mn2+ on responses to ACh were studied with toad rec-tus abdominis. Cu2+, Zn2+and Mn2+concentra-tion- dependently shifted the concentration-response curves for ACh to the right unparallelly and reduced the maximal response considerably. The pAh values of Cu2+ , Zn2+ and Mn2+ were 3.69, 2.95 and 2. 62, respectively. The inhibitory potent of Cu2+ and Zn2+ seemed to be 11.7 times and 2. 1 times respectively more thanthat of Mn2+. It was suggested that Cu2+, Zn2+ and Mn2+postsynaptically interfere with the action of ACh. However, Zn2+in lower concentration shifted the bottom section of the curve for ACh to the left and top, and shifted the top section of the curve to the right, suggesting that Mn2+in lower concentration be possessed of partial agonistic property.