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The standardization of pediatric Tuina is beneficial to pediatric Tuina practitioners in a norm practices. The paper collects the content from teaching textbooks, TCM ancient books and database literature, and tries to develop the technical specifications of pediatric Tuina by four rounds Delphi surveys and expert consensus. This specification covers the manipulation of pediatric Tuina, the position of acupoints, the effects of acupoints and the diagnosis and treatment of pediatric Tuina, including indications, contraindications, cautious use, operation steps and methods.
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Objective:To explore the clinical effect of a two-staged repair and reconstruction of composite soft tissue defect of dorsal wrist with transfer of free flap (in stage-one) repair and followed by transplantation of allogeneic tendon (in stage-two) reconstruction.Methods:From December 2018 to January 2021, 6 cases with dorsal wrist composite tissue injury and extensor tendon defect were treated in the Department of Hand and Microsurgery of the Fourth People's Hospital of Guiyang City. Four cases were treated with free anterolateral thigh flap (ALTF) combined with allogeneic tendon in the first stage to reconstruct finger dorsiflexion function, and 2 cases were treated with free ilioinguinal flap combined with allogeneic tendon in the second stage to reconstruct finger dorsiflexion function. The age of the patients ranged from 22 to 62 years old. The areas of defect were 5.0 cm×12.0 cm-8.0 cm×20.0 cm. Two cases had 2 extensor tendons defect, 1 had 3 extensor tendons defect, 2 had 4 extensor tendons defect, and 1 had 5 extensor tendons defect. The length of extensor tendon defects was 7.0-22.0 cm. In 5 cases, the wounds were covered by VSD for 5 to 7 days after complete emergenly debridement. Then, after the wounds had been cleared and clean, the wounds of 3 cases were covered with free ALTF, 2 with free ilioinguinal flap, and 1 with free ALTF after skin graft scar resection. At 3-4 months later, the extension function of digit was reconstructed with the transplantation of allogeneic tendons. Postoperative appearance of the flaps and functions of digits were observed at the outpatient clinics during the follow-up.Results:The postoperative follow-up lasted for 10 to 26 (15 in average) months. All 6 flaps surrived completely, and 1 case was further treated with flap thinning at 4 months after the second surgery. During the follow-up, all flaps healed well and were good in appearance and texture. Meanwhile, the donor areas were all healed well with no dysfunction nor sensory disorder. All the transplanted tendons were in good glide without adhesion. The active motion of metacarpophalangeal joints ranged from (10±10) ° to (80±10) °. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, at the final follow-up, 4 cases were excellent and 2 cases were good.Conclusion:It is safe and effective that using the two-staged procedure in repair of composite tissue defect of dorsal wrist with stage-one ALTF or ilioinguinal flap transfer combined with stage-two reconstruction with transplantation of allogeneic tendon. It can minimize the adhesion after tendon transplantation and donor site damage
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@#To explore the main influencing factors of acute ischemic stroke complicated with depression in elderly patients，and to establish an individualized prediction of depression risk histogram model. Methods A total of 330 elderly patients with acute ischemic disease admitted to our hospital from March 2018 to March 2021 were selected as the model group，and 120 patients with depression treated from June 2018 to December 2020 were selected as the validation group. Clinical data of the two groups were collated. Univariate and Logistic multivariate regression models were used to explore the influencing factors of depression in AIS patients. And R software is used to verify the individualized prediction risk histogram model. Results There were significant differences in age，diabetes mellitus，hypertension，chronic kidney disease，serum creatinine，EGFR，BNP，hs-CRP and cardiac function Ⅳ grade between the two groups （P<0.05），and was determined to be related to depression in AIS patients. R software was used to establish a histogram model for predicting the risk of depression in AIS patients. According to the histogram score，the score of cardiac function Ⅳ was 40.30 points，and the score of associated diabetes was 24.00 points. With the increase of age，the decrease of EGFR and the increase of hs-CRP，the corresponding score of the histogram model increased，and the risk of complicated depression also increased. The practicability and feasibility of the model were verified （internal and external）. The C-index value of the model was 0.857 and 0.823 in the model group and the validation group，respectively. When ROC curve was used to analyze the predictive risk efficiency of this model for patients with depression in the model group and the validation group，the AUC of the model group was 0.841，while the AUC of the validation group was 0.817.Conclusion This study showed that the patient’s age，diabetes mellitus，cardiac function grade Ⅳ，EGFR and hs-CRP were independent influencing factors for depression. The individualized predictive histogram model based on this model has good resolution and accuracy，and can be widely used in the prediction of other clinical diseases.
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BACKGROUND:Pneumonectomy, extracorporeal circulation, lung transplantation and pulmonary embolism can cause ischemia/reperfusion injury of lung tissue. Lung ischemia/reperfusion injury is an important factor of lung function disorders after lung transplantation. OBJECTIVE:To analyze the effect of ischemic postconditioning on rat models of lung ischemia/reperfusion injury. METHODS:Twenty-four male SD rats were randomly divided into sham, ischemia/reperfusion and ischemic postconditioning groups (n = 8 rats/group) to establish the lung ischemia/reperfusion injury model. The rats in the sham group were only subjected to separation of the hilum of left lung and pulmonary arteries and veins, without blocking. The rats in the ischemia/reperfusion group were subjected to another 2 hours of reperfusion after 1 hour of lung ischemia. The rats in the ischemic postconditioning group were first subjected to 30 seconds of lung ischemia and 30 seconds of reperfusion for three times, and then to 2 hours of reperfusion. After the experiment, the specimens of lung tissue were obtained to detect the wet/dry weight ratio of lung tissue, activities of superoxide dismutase, malondialdehyde and myeloperoxidase, the contentsof inflammatory cytokines tumor necrosis factor α, interleukin-1β and interleukin-6, and the histopathological changes of lung tissue were observed. RESULTS AND CONCLUSION:Compared with the sham group, the wet/dry weight ratio of lung tissue, activities of myeloperoxidase and myeloperoxidase, the levels of tumor necrosis factor α, interleukin-1β and interleukin-6 were significantly increased (P < 0.05) in the ischemia/reperfusion and ischemic postconditioning groups, however, the increase levels of these indices were not significant in the ischemic postconditioning group, and the contents and activities in the ischemic postconditioning group were al significantly decreased (P < 0.05) compared with those in the ischemia/reperfusion group. In the ischemia/reperfusion and ischemic postconditioning groups, the activity of superoxide dismutase was obviously lower than that in the sham group, however, the activity of superoxide dismutase in the ischemic postconditioning group was obviously higher than that in the ischemia/reperfusion group. Pathological examination showed that thickened alveolar wal, edema and a large amont of inflammatory cel infiltrations were observed in the lung tissue of rats in the ischemia/reperfusion group. The degrees of alveolar wal thickening and edema in the lung tissue of rats in the ischemic postconditioning group were mild compared with the ischemia/reperfusion group, and in addition, some inflammatory cels were infiltrated. The histopathological scores of lung tissue in the ischemic postconditioning group were lower than those in the ischemia/reperfusion group. These results suggest that ischemic postconditioning plays its protective role on rat models of ischemia/reperfusion injury by inhibiting inflammatory cel accumulation, oxygen free radical production and pro-inflammatory cytokine release after ischemia/reperfusion injury.
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To study the influence of individualized medication guidance based on an Short Messaging Service( SMS) platform on the medication compliance in the patients with diabetes. Methods: Totally 100 cases of diabetic patients from the outpa-tient section were randomly divided into two groups using a number method with 50 ones in each, namely odd number was in the obser-vation group and even number was in the control group. The observation group was given pharmaceutical guidance based on the SMS technology platform by pharmacists, and the control group was given telephone follow-up once a week to understand the medical situa-tion. At the beginning of the study and after three-month treatment, the medication compliance in the two groups was evaluated, and the control situation of blood glucose was also compared. Results:There was no significant difference in the medication compliance be-tween the two groups at the beginning (P>0. 05). After the 3-month treatment, the blood glucose and medication compliance between the two group had statistical significance (P<0. 01). Conclusion:Based on a mobile phone short message technology platform, indi-vidualized clinical pharmaceutical guidance can significantly improve the medication compliance in diabetic patients.
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BACKGROUND: Neuroglioma is easy to recur, the focus of infection in which is rich in new vessels. Different expression of vascular endothelial growth factor (VEGF) may be related with the pathologic changes and recurrence of tumor.OBJECTIVE: To analyze the characteristics of VEGF expression in recurrent brain glioma.DESIGN: Control test.SETTLNG: Department of Neurosurgery, West China Hospital of Sichuan University.PARTICIPANTS: Forty-four (22 pairs) samples of neurogliocytoma before and after the recurrence with complete clinical data were collected from143 paraffin embedded samples, which were obtained from the operation between June 1996 and June 2001 in West China Hospital and pathologically proved to be brain gliomas. Samples were collected separately from the first operation and first recurrence, in which 8 cases belonged to grade Ⅰ of Kernohan scale, 10 were grade Ⅱ , 14 were grade Ⅲ and 12 were grade Ⅳ. The enrolled samples were divided into two groups: primary group and recurrent group with 22 cases in each group.METHODS: The immunohistochemiscal method was adopted. First antibody was goat-anti-human VEGF (mono-antibody), and second antibody was rabbit-anti-goat with the working concentration of 1:50. The phosphate buffered solution (PBS) was taken as negative control for staining instead of first antibody. The protein expression of VEGF in brain gliomas of 44 cases before and after the recurrence were detected and the cross-check analysis was conducted by combing with pathologic grades. ① The buff grains in intracytoplasm were positive signals. ②MPLAS-500 media mix chromatic pathologic imaging and literal analytical system were used to detect the PU (positive unit) value and number of tumor cells.③95% were the critical value of PU value, and the positive cell rates were calculated respectively. ④Routine hematoxylin-eosin stain was used for pathologic grades (Kernohan). MAIN OUTCOME MEASURES: ① PU value and the intensity of VEGF expression in brain glioma samples before and after the recurrence. ②The pathologic grades of brain gliomas before and after the recurrence. RESULTS: ①The expression of VEGF in primary and recurrent groups of brain glioma: the primary group was 21.927 3±6.607 and the recurrent group was 33.054 5±6.684. ② Pathologic grades: In 8 cases of primary grade Ⅰ gliomas, there were 2 cases of grade Ⅱ in recurrence, 5 cases of grade Ⅲ in recurrence, 1 case of grade Ⅳ in recurrence. In 6 cases of primary grade Ⅱ gliomas, there were 2 cases of grade Ⅱ in recurrence, 1case of grade Ⅲ in recurrence, 3 cases of grade Ⅳ in recurrence. In 6eases of primary grade Ⅲ .gliomas, 2 cases of grade Ⅲ in recurrence, 4cases of grade Ⅳ in recurrence. In 2 cases of primary grade Ⅳ gliomas,there were 2 cases of grade Ⅳ in recurrence. ③ Differences in PU value of VEGF protein expressions and pathologic grades of brain glioma samples before and after recurrence in self-compared detection were remarkable (P＜0.05).CONCLUSION: The expression of VEGF in recurrent glioma is higher than primary glioma, and there is a worsening tendency in recurrent tumor and the high-expression of VEGF in glioma plays an important role in the recurrence.
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Pi-dan is a signifi cant conception,which comes from Inner Canon of Huangdi.From the vivid description of Pi-dan in Inner Canon of Huangdi,we consider that the formation and process of Pi-dan is equivalent to metabolic syndrome.They are have the same etiological factor:obesity,the same pathogenesis:abdominal fullness and interior heat,and they can result in diabetes,hypertension,hyperlipidemia,fat liver,gout and a series of severity vascular complication.The theory of Pi-dan exactly points out that obesity the original cause of metabolic syndrome,and suggests that early prevention and treatment for obesity is an important method to prevention metabolic syndrome and its complications.The main pathogenesis of Pi-dan is abdominal fullness and interior heat,and the main therapeutic methods are Xiaogaojiangzhuo,Kaiyuqingre,and Huoxuetongluo.