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Objective:To report the surgical techniques and clinical outcomes of multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates.Methods:A retrospective study was performed in the 26 patients with patellar multi-fragmentary fracture who had undergone open reduction and 3-D internal fixation with locking plates from November 2016 to July 2020 at Department of Orthopaedic Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University. There were 17 males and 9 females, with an average age of 62.6 years (from 31 to 90 years). The patellar fractures were exposed and reduced via the longitudinal anterior midline incision of the knee. After the reduction was initially maintained with a cerclage wire, a trimmed and pre-contoured 3.5 mm locking plate was applied onto the patellar surface. After-wards, locking screws were inserted from the lower pole to the upper pole of the patella, from the anterior to the posterior and from the lateral to the medial, respectively, to complete the multi-planar fixation. Follow-ups assessed the B?stman score, knee pain visual analogue scale (VAS), radiographic image and fracture healing, range of motion of the knee, and complications.Results:All the 26 patients were followed up for 12 to 56 months (average, 28 months). Crutches were used while walking until an average of 1.6 months (from 1 to 3 months) after operation in all patients. At the last follow-up, the B?stman score averaged 27.5 points (from 17 to 30 points), yielding 12 excellent, 13 good and 1 poor case with an excellent to good rate of 96.2% (25/26); the knee pain VAS averaged 1.2 points (from 0 to 5 points); the active knee flexion averaged 125° (from 100° to 150°). No breakage, loosening or displacement of the patellar plates or screws was observed during follow-up, but cerclage wire breakage occurred without any symptom in 11 cases. Four patients complained of hardware irritation, and 4 patients underwent hardware removal after fracture union.Conclusion:Multi-dimensional fixation with locking plates is a viable and safe surgical option for patellar multi-fragmentary fractures, due to its satisfactory therapeutic outcomes.
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Objective@#To evaluate the efficacy and safety of low dose sublingual nifedipine dripping pills (5 mg) in treating moderate and severe hypertension in comparison with normal dose (10 mg) of sublingual nifedipine dripping pills.@*Methods@#This study was designed as a randomized, double-blind, positive drug parallel controlled, multi-center, non-inferiority clinical trial. Patients with moderate and severe hypertension were enrolled by 14 clinical trial centers, randomly divided into the trial group (sublingual 5 mg nifedipine dripping pills) and the control group (sublingual 10 mg nifedipine dripping pills). The changes in blood pressure were monitored continuously within 2 hours after the initial administration, repeated the dose in 20 minutes interval after the initial administration for up to additional 3 doses (maximum 4 doses) if the antihypertensive efficacy was not satisfactory. The efficacy of antihypertensive therapy between the two groups was evaluated by repeated administration rates and blood pressure changes at 60 minutes post the initial administration, and the safety of treatment was evaluated by recording adverse event rate of the two groups.@*Results@#The anti-hypertensive effective rates at 60 minutes after sublingual administration were 83.5% (202/242) and 86.7% (208/240) respectively between the trial group and control group (χ2=1.307, P=0.253) . On the aspect of antihypertensive effectiveness at 60 minutes after single dose of sublingual administration, the anti-hypertension effective rates of the trial group and the control group were 85.6% (154/180) and 87.2% (164/188) respectively (χ2=0.221, P=0.639). Prevalence of the repeated administration was also similar between the two groups (25.6%(62/242) in the trial group and 21.7% (52/240) in the control group, χ2=1.043, P=0.307). On the safety aspect, there was no adverse events/reactions in the trial group, but there were 15 cases of adverse events/reactions occurred in control group (6.25%, χ2=15.611, P<0.001).@*Conclusions@#In the treatment of moderate to severe hypertension, the antihypertensive efficacy of low dose nifedipine dripping pills is similar to that of conventional dosage, and the safety profile of low dose nifedipine dripping pills is better than that of the conventional dose.
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Objective To assess the clinical value of lung ultrasound (LUS) B-lines in diagnosis of rheumatoid arthritis (RA) associated interstitial lung diseases (RA-ILD).Methods Forty-five consecutive patients with RA who underwent a high resolution computed tomography (HRCT) scan of the chest,were also examined by LUS for detection of B-lines(within 1 month independently in all patients).The B-lines score was obtained by summing the number of total 50 inter-costal spaces (ICSs) of chest wall.Pulmonary fibrosis was quantified by HRCT as previously described by the 30-point Warrick score.Results B-lines score significantly correlated with the Warrick score [(r=0.778,95％CI(0.627,0.872),P＜0.05].Receiver operating characteristic (ROC) curve confirmed that B-lines cut-off point 77[sensitivity of 100％,specificity of 64.3％ respectively,area under curve [AUC] =0.86,95％CI(0.724,0.945)] and 108[sensitivity of 90％,specificity of 88.6％ respectively,AUC=0.879,95％CI(0.747,0.957)] had an optimal power to discriminate mild (Warrick score＜8) and severe fibrosis (Warrick score＞15):Conclusion The data confirm that LUS is a useful technique to identify ILD in RA.In RA-ILD,B-lines correlate significantly with HRCT and are able to identify mild and severe degree of fibrosis.LUS is a promising non-invasive and non-ionizing strategy for screening RA-ILD.
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<p><b>OBJECTIVE</b>To assess the association of CYP2C19 gene polymorphisms with the incidence of ischemic stroke among patients receiving clopidogrel therapy following coronary stenting for coronary artery disease.</p><p><b>METHODS</b>Clinical data of patients receiving clopidogrel therapy after coronary stenting were retrospectively studied. For a case-control study, 137 patients with acute cerebral infarction and 122 non-stroke patients were selected. Based on the variants of the CYP2C19 gene detected by a DNA microarray assay, the patients were further divided into the wild-type group(CYP2C19*1/*1) and mutant group(defined by the presence of at least one loss-of-function allele, including CYP2C19*1/*2, CYP2C19*1/*3, CYP2C19*2/*2, CYP2C19*2/*3 and CYP2C19*3/*3). The incidences of ischemic stroke in the two groups were compared through a chi-square analysis. The influence of CYP2C19 gene polymorphisms and clopidogrel therapy on the incidence of ischemic stroke was analyzed through multivariable logistic regression.</p><p><b>RESULTS</b>A total of 259 patients were enrolled. The case and control groups showed no difference in terms of gender and age. There were 123 cases (47.5%) in the CYP2C19 wild-type group and 136 cases (52.5%) in the mutant group. The incidence of ischemic stroke of mutant group was significantly higher than that of wild-type group (59.9% vs. 44.3%, X2=6.398, P=0.042). Multivariate analysis revealed that loss-of-function polymorphisms of the CYP2C19 gene carried a 1.13 times greater risk for ischemic stroke compared to wild-type genotype (OR=2.13, 95%CI: 1.23-3.71).</p><p><b>CONCLUSION</b>The efficacy of clopidogrel for the prevention of ischemic stroke in post-coronary stent patients may be reduced by the insufficiency of the CYP2C19 gene. The dosage of clopidogrel therapy should be adjusted based on its polymorphisms.</p>
Subject(s)
Humans , Brain Ischemia , Cytochrome P-450 CYP2C19 , Genetics , Genotype , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors , Therapeutic Uses , Polymorphism, Genetic , Stents , Stroke , Ticlopidine , Therapeutic UsesABSTRACT
Objective To investigate the metabolite changes in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric symptoms using magnetic resonance spectroscopy (MRS) and explore the associations between image findings and clinical variables. Methods Twenty-two SLE patients with neuropsychiatric symptoms (NPSLE), twenty-one SLE patients without neuropsychiatric symptoms (non-NPSLE) and twenty healthy controls (HCs) underwent routine MRI scan and multivoxel magnetic reson-ance spectroscopy (MVS). The absolute metabolite concentrations were measured bilaterally in the posterior cingulate gyrus (PCG), dorsal thalamus (DT), lentiform nucleus (LN) and posterior paratrigonal white matter (PWM) using LCModel and SAGE software. The relationships between metabolite con-centrations and cognitive function scores were analyzed by Spearman rank correlation. Single-factor Chi-square analysis and t-test were used for analysis. Results ① Compared to control subjects, NPSLE patients had significantly lower N-acetylaspartate (NAA) values in bilateral PCG and DT, with the mean differences of -1.504 [95% confidence interval ( CI) (-2.335, -0.672), P=0.001], -1.460 [95%CI (-2.349, -0.570), P=0.002], -1.259 [95%CI (-1.894, -0.625), P=0.000] and -1.022[95%CI (-1.688, -0.356), P=0.003] for RPCG, LPCG, RDT and LDT, respectively. The concentration of total creatinine were observed to decline in RPCG and RDT, with the mean differences of-1.094 [95%CI (-1.845, -0.342), P=0.003], -0.955 [95%CI (-1.630, -0.280), P=0.006], -1.259 [95%CI (-1.894,-0.625), P=0.006] respectively. Glutamine and glutamate-values decreased significantly in RDT [mean difference=-2.586, 95%CI (-4.139, -1.033), P=0.002]. ② Compared to non-NPSLE patients, NPSLE patients had a lower NAA level in LPCG [mean difference=-1.256, 95%CI (-2.146, -0.367), P=0.006]. Positive correlations between mini-mental state examination scores [RPCG: rs=0.312, P<0.05; LPCG: rs=0.355, P<0.01], Montreal cognitive assessment scores (RPCG: rs=0.362, P<0.01; LPCG: rs=0.285, P<0.05) and NAA values in bilateral PCG were detected. Conclusion Both NPSLE and non-NPSLE patients may have metabolite dysfun-ctions in different brain regions. The cognitive disorder in SLE patients may be interpreted by neuronic damage of PCG.
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Objective To observe the effect of alteplase intra-arterial thrombolysis combined with continuous monitoring of transcranial Doppler (TCD) in patients with acute cerebral infarction. Methods Fifty-four patients with acute cerebral infarction were divided into TCD group and control group by random digits table method. The patients of 2 groups were given alteplase intra-arterial thrombolysis, and the patients of TCD groups were combined with continuous monitoring of TCD. The degree of clinical neurologic impairment was evaluated by National Institutes of Health stroke scale (NIHSS) and Barthel index (BI). The condition of vascular recanalization was evaluated by the change of blood flow signal of TCD. CT was performed within 1 d after thrombolysis to detect intracranial hemorrhage and other adverse reaction. The degree of clinical neurologic impairment, blood vessel recanalization rate after thrombolysis and recanalization time and incidence of intracranial hemorrhage and other adverse reaction were compared between 2 groups. Results There were no statistical difference in NIHSS score before thrombolysis and 1 h after thrombolysis between 2 groups (P>0.05). The NIHSS scores 7 and 30 d after thrombolysis in TCD group were significantly lower than those in control group:(8.1 ± 4.9) scores vs. (12.1 ± 4.2) scores and (6.9 ± 3.1) scores vs. (10.9 ± 3.9) scores, there were statistical differences (P<0.05). The BI scores 7 and 30 d after thrombolysis in TCD group were significantly higher than those in control group: (78.5 ± 13.8) scores vs. (60.8 ± 12.4) scores and (82.6 ± 13.5) scores vs. (63.2 ± 12.9) scores, and there were statistical differences (P<0.05). The blood vessel recanalization rate 24 h after thrombolysis in TCD group was significantly higher than that in control group: 70.4% (19/27) vs. 44.4% (12/27), the recanalization time after thrombolysis was significantly shorter than that in control group: (36.4 ± 9.5) min vs. (58.5 ± 12.4) min, and there were statistical differences (P<0.05). No adverse reaction like intracranial hemorrhage and so on was found by CT detection within 1 d after thrombolysis in the 2 groups. Conclusions Alteplase intra-arterial thrombolysis combined with continuous monitoring of TCD in acute cerebral infarction has good curative effect, and no obvious adverse reaction.
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Objective To observe the operation of Nav1.6 voltage-gated sodium channels in rats with acute cerebral injury after electroacupuncture therapy and investigate the mechanism.Methods Male Sprague-Dawley rats were randomly divided into an ischemia control group (IC,n =48),an electroacupuncture group (ET,n =48),a nimodipine therapy group (NT,n =48) and a sham operation group (SO,n =24),and were treated accordingly.A model of acute cerebral ischemia was induced by occlusion of the right middle cerebral artery using the suture method.The expression of Nav1.6,the concentration of Ca2+ and infarct volume were observed at 6 h,1 d,2 d and 3 d after ischemia with the real-time quantitative fluorescence PCR,immunofluorescence and 2,3,5-triphenyl tetrazolium chloride methods,respectively.Results The Joshua score for neural function was zero in the sham operation group,and increased gradually in the three other groups 6 h and1 and 2 d after ischemia.The average Joshua score 3 d after ischemia was significantly lower than 1 d earlier in each group.In the ET group the expression of Nav1.6 was significantly upregulated at first,followed by a significant decrease.The concentration of Ca2+ behaved similarly.However,no significant changes were observed in the infarction volume percentage.At 3 d after ischemia the expression of Nav 1.6,the Joshua grades,the Ca2+ concentrations and the infarction volume percentage were all significantly lower in the ET group compared with the IC,NT and SO groups.Conclusion Electroacupuncture therapy after acute cerebral ischemia can inhibit the expression of Navl.6,reduced Na + inflow and calcium overload,and mitigate acute cerebral ischemic injury,at least in rats.The protective effect may be attributed to inhibiting the expression of Nav 1.6.
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Objective To investigate the correlation between large artery atherosclerotic stroke and paraoxonase 1 (PON1) Q192R polymorphism.Methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the PON1 Q192R polymorphism of 120 patients with large artery atherosclerotic stroke (case group) and 117 healthy subjects (control group).Results There was significant difference in the genotype distribution of PON1 Q192R (x2 =18.727,P＜0.001) and the allele frequency distribution (x2 =16.427,P ＜0.001) between the case group and the control group.Multivariate logistic regression analysis showed that RR genotype was an independent risk factor for large artery atherosclerotic stroke (odds ratio 1.377,95％ confidence interval 1.032-2.185; P =0.026).Conclusions The allelic gene mutation rate of PON1 Q192R in patients with large artery atherosclerotic stroke was significantly higher than that in the healthy population.RR genotype is an independent risk factor for large artery atherosclerotic stroke.
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Objective To evaluate the clinical efficacy and safety of the intra-articular injection of recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) in inflammatory arthritis patients with refractory knee effusion.Methods Ten inflammatory arthritis patients presented with refractory knee effusion after treatment of intra-articular steroid injection were involved.They received intra-articular injection rhTNFR:Fc (12.5mg twice weekly).The clinical efficacy and safety were assessed the first and second week after injection.Results At 1 week and 2 weeks,the total effective rate was 60％ and 70％ respectively.Patients and physicians global assessment score (visual analogue scale VAS 0-100mm),joint tenderness and movement pain scale (VAS) were significantly improved.Knee circumference was reduced as compared with baseline (all P ＜ 0.05).Conclusion Intra-artiular injection of rhTNFR:Fc in improving patients with refractory knee effusion is a worthwhile clinical treatment attempt.
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Objective To discuss the clinical characteristics of acute myocardial infarction (AMI) and coronary artery lesion fea-tures for Uygur nationality and Han nationality in Xinjiang Dushanzi area .Methods The AMI patients during hospitalization from January 2005 to January 2012 were divide into two groups ,Group A(Uygur nationality ,n=40) and Group B(Han nationality ,n=130) ,and compared the aspects of risk factors ,morbidity situation and electrocardiogram changes etc ,carried out the coronary an-glography and analyzed the coronary artery lesion features of patients in two groups .Results The two groups of patients are male-dominated ,the AMI incidence of Uygur patients was higher than Han nationality before 60 years old(P<0 .01);More morbidities of Uygur nationality were related with the alcohol drinking (32 .5% ) ,mood disorders (40 .0% ) ,diabetes (52 .5% ) and hyperlipi-demia(72 .5% )(P<0 .01) ,and mainly coronary artery lesions were three blood vessels (P< 0 .05) .The Han nationality patients with high blood pressure have more proportion (P<0 .05) ,mainly coronary artery lesions were single blood vessel (P<0 .05) .No significant differences were observed after comparing the location of infarction and related infarction blood vessels of patients in two groups .Conclusion The onset age of Uygur AMI patients in Xinjiang Dushanzi area is younger ,and the coronary artery disease is worse .It is necessary to improve the lifestyles and change unhealthy eating habits and to carry out the active intervention in early stage .
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Objective: To explore the relationship between insulin sensitivity index （ISI）and extent of coronary atherosclerosis in Uygur and Han nationality patients. Methods: A total of 125 patients with coronary heart disease were enrolled, including 59 Uygur nationality patients and 66 Han nationality patients. There were 42 cases with stable angina pectoris, 52 cases with unstable angina pectoris, 31 cases with old myocardial infarction, 53 cases with type 2 diabetes and 35 cases with hypertension. Relevant medical history of patients [age, body mass index (BMI) etc.] was collected and laboratory examination （blood lipid, fasting blood glucose, fasting insulin etc.）were performed, and extent of coronary atherosclerosis was evaluated by coronary angiography in all patients. ISI was calculated and its relationship with extent of coronary atherosclerosis was analyzed. Results: In both nationality patients, ISI was negatively correlated with extent of coronary atherosclerosis (Han nationality: r=-0.71, P=0.03, Uygur nationality: r=-0.52, P=0.04). ISI was negatively correlated with BMI, glycosylated hemoglobin (HbA1c) and low density lipoprotein –cholesterol (LDL-C) (r=-0.45, -0.68, -0.55, P<0.05 all) in Han nationality patients; ISI was positively correlated with high density lipoprotein–cholesterol (HDL-C, r=0.67, P<0.01), and negatively correlated with HbA1c, LDL and lipoprotein a (r=-0.47, -0.35, -0.42, P<0.05) in Uygur nationality patients. Conclusion: Insulin resistance participates and promotes formation and development of coronary atherosclerotic plaques. Controlling weight, blood glucose and LDL-C levels etc. can decrease insulin resistance and prevent occurrence and development of coronary heart disease.
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Objective To investigate abnormal glucose metablism of patients with stroke in hospital in Foshan in order to design more reasonable diagnostic and treatment plans.Methods Our study was conducted in 557 patients with stroke who were in hospital in Neurology Department of the First Hospital of Foshan from June 2007 to April 2008 (all were consistent with diagnostic criteria of stroke).Sex,age,history of diabetes mellitus and smoking,height,weight,blood pressure,waist circumference,random blood glucose,fasting blood glucose and oral glucose tolerance test of all were recorded when they were in hospital Results All 368 individuals (66.1%) had abnormal blood glucose,including 185 cases (33.2%) of diabetes,183 cases (32.9%) of impaired glucose tolerance and 189 cases (33.9%) of normal sugar tolerance.Furthermore,about 89.1% (189/368) cases with impaired glucose regulation and 14.1% (26/185) cases of diabetes were misdiagnosed if they did not undergo oral glucose tolerance test.Conclusions Most of patients with stroke in Foshan have impaired glucose regulation,who have been diagnosed by oral glucose tolerance test,in favour of us to better design more reasonable diagnostic and treatment plans.
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<p><b>OBJECTIVE</b>To detect the relationship between point mutations on exon 2 of parkin gene and sporadic early-onset Parkinson's disease.</p><p><b>METHODS</b>The point mutations on exon 2 of parkin gene were detected using polymerase chain reaction(PCR), agarose electrophoresis, single strand conformation polymorphism(SSCP), DNA sequencing and analysis of restrict enzyme in DNA of 60 Parkinson's disease patients with an onset age under 50 and 120 normal controls.</p><p><b>RESULTS</b>One homozygous mutation (G(237)-->C) on exon 2 was found by sequencing and verified by analysis of restrict enzyme, whereas no mutation was found in normal controls.</p><p><b>CONCLUSION</b>Point mutations on exon 2 of parkin gene are likely to be related to sporadic early-onset Parkinson's disease.</p>