Treatment of stage Ⅱ-Ⅲ Kümmell disease with robot-assisted bone cement-augmented pedicle screw fixation / 中国骨伤

OBJECTIVE@#To evaluate the early clinical efficacy of robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation in the treatment of stageⅡ-Ⅲ Kümmell disease.@*METHODS@#The clinical data of 20 patients with stageⅡ-Ⅲ Kümmell's disease who underwent robot-assisted percutaneous bone cement-augmented pedicle screw fixation between June 2017 and January 2021 were retrospectively analyzed. There were 4 males and 16 females, aged from 60 to 81 years old with an average age of (69.1±8.3) years. There were 9 cases of stageⅡand 11 cases of stage Ⅲ, all of which were single vertebral lesions, including 3 cases of T11, 5 cases of T12, 8 cases of L1, 3 cases of L2, and 1 case of L3. These patients did not exhibit symptoms of spinal cord injury. The operation time, intraoperative blood loss, and complications were recorded. The position of pedicle screws and the filling and leakage of bone cement in gaps were observed using postoperative CT 2D reconstruction. The data of the visual analogue scale (VAS), Oswestry disability index (ODI), kyphosis Cobb angle, wedge angle of the diseased vertebra, and anterior and posterior vertebral height on lateral radiographs were statistically analyzed preoperatively, 1 week postoperatively, and at the final follow-up.@*RESULTS@#Twenty patients were followed up for 10 to 26 months, with an average follow-up of (16.0±5.1) months. All operations were successfully completed. The surgical duration ranged from 98 to 160 minutes, with an average of (122±24) minutes. The intraoperative blood loss ranged from 25 to 95 ml, with an average of (45±20) ml. There were no intraoperative vascular nerve injuries. A total of 120 screws were inserted in this group, including 111 screws at grade A and 9 screws at grade B according to the Gertzbein and Robbins scales. Postoperative CT indicated that the bone cement was well-filled in the diseased vertebra, and cement leakage occurred in 4 cases. Preoperative VAS and ODI were (6.05±0.18) points and (71.10±5.37)%, respectively, (2.05±0.14) points and (18.57±2.77)% at 1 week after operation, and (1.35±0.11) points and (15.71±2.12) % at final follow-up. There were significant differences between postoperative 1 week and preoperative, and between final follow-up and postoperative 1 week(P<0.01). Anterior and posterior vertebral height, kyphosis Cobb angle, and wedge angle of the diseased vertebra were(45.07±1.06)%, (82.02±2.11)%, (19.49±0.77) °, and (17.56±0.94) ° preoperatively, respectively, (77.00±0.99)%, (83.04±2.02)%, (7.34±0.56) °, and (6.15±0.52) ° at 1 week postoperatively, and (75.13±0.86)%, (82.39±0.45)%, (8.38±0.63) °, and (7.09±0.59) ° at the final follow-up.@*CONCLUSION@#Robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation demonstrates satisfactory short-term efficacy in treating stageⅡ-Ⅲ Kümmell's disease as an effective minimally invasive alternative. However, longer operation times and strict patient selection criteria are necessary, and long-term follow-up is required to determine its lasting effectiveness.

Development, reliability, and validity testing of the Sense of Security Scale for Medical Staff / 中国职业医学

OBJECTIVE: To establishment the Sense of Security Scale for Medical Staff and test its reliability and validity. METHODS: The pre-test version scale was formulated through methods of literature review, semi-structured interviews with clinical medical staff, discussion with members of research groups, and consultation with medical experts. A total of 350 and 403 medical staff who worked in a tertiary A hospital in Guangdong Province were selected as the prediction and the verification samples, respectively, by convenience sampling method. The reliability and validity of the final version scale were tested by item analysis, exploratory factor analysis and confirmatory factory analysis. RESULTS: Through item analysis, it was determined that the scale was mainly composed of 24 items. Exploratory factory analysis extracted five characteristics: environmental factors, patient factors, self factors, organizational management, and social support, that explained 72.8% of the total variation. The results of confirmatory factory analysis showed that the ratio of chi-square to degree of freedom was 2.851, the mean square error of approximation was 0.068, the standardized mean square residual was 0.078, the goodness of fit index was 0.883, the normative fit index was 0.904, the comparative fit index was 0.935, the non-standard fitting index was 0.924, and the incremental fitting index was 0.936. The results of reliability and validity test showed that the total Cronbach alpha coefficient, Spearman-Brown coefficient and retest reliability were 0.939, 0.967 and 0.808, respectively. The item reliability of each item was 0.420-0.814, the composite reliability was 0.775-0.920, the content validity ratio was 0.904, the convergent validity was 0.514-0.741, and the discriminative validity was 0.717-0.861. CONCLUSION: The reliability and validity of each dimension of the Sense of Security Scale for Medical Staff is good, and it can be used as an evaluation tool to measure the sense of security in medical staff.

Clinical Observation of Treatment of Qishen Xiaodian Decoction Combined with Laser Acupoint Irradiation for Recurrent Hen?ch-Sch?nlein Purpura in Children / 中国中医药信息杂志

Objective To investigate the clinical efficacy of Qishen Xiaodian Decoction combined with laser acupoint irradiation for treatment of recurrent Hen?ch-Sch?nlein purpura (HSP) in children. Methods Totally 120 cases of children with recurrent HSP were divided into treatment group and control group according to the digital random table method, with 60 cases in each group. The control group was given anti-allergy, hormones, immunosuppressive agents and other conventional treatment for 4 weeks, while the treatment group was treated with Qishen Xiaodian Decoction based on conventional treatment, 1 dose each day, morning and night (age 4–5 take 1/3 dose, age >5–10 take the half dose, and age >10–14 take the whole dose), for 4 weeks. Zusanli, Xuehai, and Sanyinjiao acupoints were under laser vertical irradiation, 12 min for each time, once a day for 2 weeks. The disappearing time of the main symptoms and the total effective rate of the two groups were compared. Peripheral blood contents of Th17 and Treg cells and serum interleukin-17 (IL-17), and transforming growth factor β1 (TGF-β1) level before and after the treatment were observed. The recurrence rate in 6 months and in 12 months of the two groups were compared. Results The disappearing time of rash, abdominal pain and joint swelling pain and kidney damage of the treatment group were less than those of the control group (P<0.01). The total effective rate was 95％(57/60) in treatment group, significantly higher than control group 80％ (48/60), with statistical significance (P<0.05). Compared with before treatment, Th17 cell content, serum IL-17 and TGF-β1 decreased, and Treg cell content increased after treatment of the two groups (P<0.01). Compared with the control group, contents of Th17 cell and serum IL-17 of the treatment group decreased (P<0.01). The recurrence rate was lower than that of the control group in 6 and 12 months after treatment, with statistical significance (P<0.05). Conclusion Based on the conventional western medicine treatment, Qishen Xiaodian Decoction combined with laser acupoint irradiation on recurrent HSP in children can quickly relieve symptoms and reduce the recurrence rate.

Efficacy and safety of Firebird sirolimus-eluting stent in treatment of complex coronary lesions in Chinese patients: one-year clinical and eight-month angiographic outcomes from the FIREMAN registry / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Off-label application of drug-eluting stents (DES) during percutaneous coronary intervention (PCI) was not uncommon in daily practice, however DES in treating Chinese patients with complex lesion subset was under-investigated. The primary objective of the FIREMAN registry was to evaluate the long term efficacy and safety of the Firebird sirolimus-eluting stent (SES) in treating patients with complex coronary lesions. Here we report the mid-term of one-year clinical outcomes and eight-month angiographic follow-up results of FIREMAN registry.</p><p><b>METHODS</b>The FIREMAN registry was a prospective multi-center registry, which included 1029 consecutive patients undergoing PCI with Firebird SES implantation between September 2006 and July 2007 in 45 centers in China. The clinical follow-up was designed to be performed at 1, 6, 12, 18, 24, 30 and 36 months post index procedure, and non-mandatory angiographic follow-up at 8 months was planned. One hundred percent site monitoring was conducted.</p><p><b>RESULTS</b>Long lesions (59.2%), multi-vessel disease (50.4%), and small vessel disease (31.6%) were mostly found in angiography. Major adverse cardiac events (MACE) occurred in 51 (5.1%) patients at 1 year clinical follow-up, including cardiac mortality in 6 (0.6%), non-fatal myocardial infarction in 11 (1.1%), and target lesion revascularization in 36 (3.5%) of the patients. Definite and probable stent thrombosis (ST) by Academic Research Consortium (ARC) definition occurred in 12 (1.36%) patients at one-year clinical follow-up. The 8-month binary restenosis rate was 5.7% in-segment and 4.3% in-stent, respectively. Late lumen loss was (0.21 ± 0.40) mm in-segment and (0.23 ± 0.36) mm in-stent, respectively. Furthermore, Cox regression analysis revealed that diabetes, small vessel diameter, and chronic total occlusion were independent predictors of ST.</p><p><b>CONCLUSIONS</b>The results showed that the Firebird SES was effective and safe in treating Chinese patients with complex coronary lesions and occurrence of ST rate at one-year clinical follow-up was acceptable, however further long-term follow-up was still necessary. (NCT00552656)</p>

The mutation spectrum of phenylalanine hydroxylase gene in patients with phenylketonuria in Henan province / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of the phenylalanine hydroxylase (PAH) gene mutations in patients with phenylketonuria (PKU) in Henan province, China, in order for providing basic information for clinical genetic counseling and prenatal diagnosis.</p><p><b>METHODS</b>All the exons and partial flanking introns of the PAH gene were detected by polymerase chain reaction (PCR) and bi-directional sequencing in 34 patients with PKU from Henan province.</p><p><b>RESULTS</b>A total of 23 different disease-causing mutations were identified which corresponded to 92.65% (63/68) of the PAH alleles, including 12 missense mutations, 4 nonsense mutations, 4 splicing junction mutations, and 3 deletion mutations. Among them, A156P and P69_S70delinsP(delCTT) were novel mutations; IVS2+ 5G to C, G332E, IVS10-14C to G and L367 to Wfs were reported in Chinese population for the first time according to the PAH database (www.pahdb.mcgill.ca). Among all the 13 exons, exon 7 harbored the most type of mutations, exon 11 and exon 5 the second. The most common mutations included R243Q (17.65%, 12/68), V399V (11.76%, 8/68), IVS4-1G to A (8.82%, 6/68), R400T(7.35%, 5/68), Y166X(5.88%,4/68) and G247R(5.88%, 4/68). In addition, 9 other gene variations were found in this study.</p><p><b>CONCLUSION</b>The mutation spectrum and frequency of the PAH gene of patients with phenylketonuria in Henan province were slightly different from those from other parts of China.</p>

Absence of gender disparity in short-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing sirolimus-eluting stent based primary coronary intervention: a report from Shanghai Acute Coronary Event (SACE) Registry / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Randomized, controlled trials have demonstrated the superiority of sirolimus-eluting stent (SES) implantation during primary percutaneous coronary intervention (PCI), as opposed to bare-metal stents, in patients with ST-elevation myocardial infarction (STEMI). This study aimed to test the hypothesis that clinical benefits of SES treatment were independent of gender in this setting.</p><p><b>METHODS</b>A total of 2042 patients with STEMI undergoing SES-based primary PCI were prospectively enrolled into Shanghai Acute Coronary Event (SACE) registry (1574 men and 468 women). Baseline demographics, angiographic and PCI features, and in-hospital and 30-day major adverse cardiac events (MACE) were analyzed as a function of gender.</p><p><b>RESULTS</b>Compared with men, women were older and more frequently had hypertension, diabetes, and hypercholesterolemia. Use of platelet glycoprotein IIb/IIIa receptor inhibitor (GPI, 65.5% vs. 62.2%, P = 0.10) and procedural success rate (95.0% vs. 94.2%, P = 0.52) were similar in both genders. In-hospital death and MACE occurred in 3.8% and 7.6%, and 4.5% and 8.1% in the male and female patients, respectively (all P > 0.05). At 30-day follow-up, survival (94.3% vs. 93.8%, P = 0.66) and MACE-free survival (90.2% vs. 89.3%, P = 0.52) did not significantly differ between men and women. After adjustment for differences in patient demographics, angiographic and procedural features, there were no significant difference in either in-hospital (OR = 0.77, 95%CI of 0.48 to 1.22, P = 0.30) or 30-day mortality (OR = 1.28, 95%CI of 0.73 to 2.23, P = 0.38) between women and men.</p><p><b>CONCLUSION</b>Despite more advanced age and clustering of risk factors in women, female patients with STEMI treated by SES-based primary PCI had similar in-hospital and short-term clinical outcomes as their male counterparts.</p>

Impact of different clinical pathways on outcomes of patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the RAPID-AMI study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Current guidelines support primary percutaneous coronary intervention (primary PCI) as the first treatment of choice (as opposed to thrombolytic therapy) for patients with acute ST-segment elevation myocardial infarction (STEMI) especially when delivered within 12 hours of symptom onset. We aimed to evaluate the impact of different clinical pathways on reduction of reperfusion delay and subsequent improvement in outcomes in patients with STEMI.</p><p><b>METHODS</b>From November 2005 to November 2007, 546 consecutive patients with definite STEMI, who upon arrival at the emergency room were triaged to undergo primary PCI, were included. Of them, 271 patients were brought directly to catheterization laboratory (rapid group), and 275 patients were admitted to the coronary care unit (CCU) or cardiac ward first, and then transferred to the catheterization laboratory (non-rapid group). Primary endpoint was door-to-balloon (D2B) time, and secondary endpoints included infarct size assessed by peak CK-MB level and rates of major cardiac adverse events (MACE) including death, reinfarction, or target-vessel revascularization during hospitalization and at 30-day clinical follow-up.</p><p><b>RESULTS</b>Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein IIb/IIIa receptor inhibitors before angiography (84.0% and 77.1, P = 0.042) and had TIMI 3 flow in the culprit vessel at initial angiogram (17.1% and 9.2%, P = 0.007) in the non-rapid group. The D2B time was shortened ((108 +/- 44) minutes and (138 +/- 31) minutes, P < 0.0001), and number of patients with D2B time < 90 minutes was greater (22.6% and 10.9%, P < 0.0001) in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality (4.1% and 5.8%) and cumulative MACE rate (7.0% and 9.8%) did not significantly differ between rapid and non-rapid groups. At 30 days, cumulative death- and MACE-free survival rates were improved in the rapid group (94.5% and 89.5%, P = 0.035; 90.1% and 84.0%, P = 0.034, respectively).</p><p><b>CONCLUSIONS</b>Clinical pathway with bypass of CCU/cardiac ward admission was associated with rapid reperfusion, smaller infarct size, and improved short-term survival for patients with STEMI undergoing primary PCI. In the future, it is essential to reduce the time delay for patients presenting at off-hours.</p>

Comparison of effects between China made sirolimus-eluting stents and bare stents for treating patients with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the clinical outcomes between China made sirolimus-eluting stents (SES) and bare metal stents (BMS) implantation in patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>Consecutive patients with AMI underwent primary percutaneous coronary intervention (PCI) were randomly divided into SES group (n = 87) and BMS group (n = 86). The incidence of major adverse cardiac events (MACE including death, reinfarction, in-stent thrombosis, restenosis rate, target vessel revascularization) up to 6 months post PCI were assessed.</p><p><b>RESULTS</b>Postprocedure vessel patency, enzymatic release, cardiac function, and the incidence of short-term MACE were similar between the two groups (all P > 0.05). Two in-stent thrombosis was diagnosed in the SES group and bare stents group respectively (2.4% vs. 2.3%, P > 0.05). At 6 months, In-stent restenosis rate (4.5% vs. 40.0%, P < 0.01) and the in-segment restenosis rate (6.8% vs. 44.9%, P < 0.01) as well as MACE (8.0% vs. 24.4%, P < 0.01), which is mainly due to a marked reduction in the risk of target vessel revascularization (3.4% vs. 11.6%, P < 0.05) were significantly lower in SES group compared to BMS group.</p><p><b>CONCLUSION</b>The China made SES were not associated with an increased risk of in-stent thrombosis but significantly reduced restenosis rate and MACE at 6 months post primary angioplasty in patients with AMI.</p>

Effects of antidepressant therapy in patients with suspected "angina pectoris" and negative coronary angiogram complicating comorbid depression / 中华心血管病杂志

<p><b>OBJECTIVE</b>We observed the therapeutic effectiveness and safety of different antidepressants as well as the correlation between symptomatic improvement of depression and improvement of chest pain in patients with susceptible "angina pectoris" and negative coronary angiogram complicating comorbid depression.</p><p><b>METHODS</b>In this double-blinded randomized study, a total of 123 eligible patients were allocated into three groups: (1) Group F: fluoxetine 20 mg QN (n = 41); (2) Group P: Placebo 1 tablet QN (n = 40); (3) Group F + O: fluoxetine 20 mg + olanzapine 2.5 mg QN for the former 2 weeks and only fluoxetine 20 mg QN for the latter 2 weeks (n = 42). The total therapy duration was 4 weeks. HAMD, HAMA and self-evaluation table of chest pain were obtained before therapy, at the end of 1 and 2 weeks after therapy.</p><p><b>RESULTS</b>Baseline HAMD and HAMA scores and self-evaluation score of chest pain were similar among 3 groups and all scores were significantly improved post various therapies in the order of group F + O > group F > group P. The rate of score decrease were seen after 1 week treatment in group F + O and after 2 week treatment in group F. There was a significant positive correlation between the rates of self-evaluation chest pain score decrease and HAMD (r = 0.867, P < 0.001) and HAMA (r = 0.854, P < 0.001) score decreases after 4 weeks therapies (P < 0.05). During the whole course of treatment, no serious adverse reaction was found in all patients.</p><p><b>CONCLUSION</b>In patients with suspected "angina pectoris" and negative coronary angiogram complicating comorbid depression, the antidepressants were safe and significantly improved the symptoms of depression and anxiety and chest pain. Low dose fluoxetine plus short term olanzapine regimen was superior to fluoxetine alone regimen in terms of stronger and quicker symptom improvement.</p>

Turbid-phlegm is an important pathogenesis of restenosis after percutaneous transluminal coronary intervention / 中国中西医结合杂志

The occurrence rate of restenosis after percutaneous transluminal coronary intervention (PCI) was quite high. Traditional Chinese medicine (TCM) has been proved to have the effect in preventing and curing restenosis. In this article, turbid-phlegm was proved to be directly related with restenosis after PCI in aspects of coronary arteriography, blood lipid, blood viscosity, fibrolysis system, free radicals, plasma homocysteine, insulin resistance, etc. So it is one of the important pathogenetic factors of restenosis after PCI in TCM.

Determination of astragaloside Ⅳ in Qixiu Granules by HPLC-ELSD / 中成药

AIM: To determine astragaloside Ⅳ in Qixiu Granule (Radix Astragali seu Hedysari, Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, etc.) by HPLC ELSD. METHODS: HPLC ELSD was used in the quantitative analysis by using Alltima C 18 chromatography column and acetonitril water (34∶66) as a mobile phase. The flow rate of mobile phase was 1mL?min -1 . The tube temperature of the detector was 100?C. The flow rate of pure air was 2.7L?min -1 . RESULTS: The regressione quation was Y=-4.40?105+2.07?105X, r=0.9992 (3.73～13.59?g). The average recovery of astragaloside Ⅳ was 100.73%, RSD was 3.97%. CONCLUSION: The method is simple, reliable, accurate and can be regard as the quantity control method of Qixiu Granule.

Study of Neurobehavioral Teratogenesis in Offspring of Pregnant Rats Exposed to Hyperthermia and Irradiation / 实用儿科临床杂志

Objective To study whether hyperthermia and ionizing radiation could produce combined effects on the neurobehaviors of neonatal rats.Methods These rats who were pregnant for 8 or 9 days received respectively total body irradiation by 60Co-rays .When the rats were pregnant for 10 days,the temperature of rat anus was kept at (37?0.5) ℃,(41?0.5) ℃,(42?0.5) ℃,respectively in warming boxes and lasted for 2,3,4,5 minutes.The neurobehaviors of neonatal rats were observed.Results In contrast to control group and 37 ℃group ,when pregnant rats were exposed to high temperature.the neonate rats were delayed for the appearance of four physiologic markers,the age of acquisition for four reflexes and the time of learning and memory(P