Clinical effectiveness of less invasive intramedullary nail fixation combined with titanium cable cerclage for subtrochanteric fractures / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the surgical technique and clinical effect of less invasive intrame-dullary nail fixation combined with titanium cable cerclage in the treatment of subtrochanteric fractures.@*METHODS@#A retrospective study was performed in 46 cases of subtrochanteric fractures in Peking University People's Hospital from January 2015 to December 2017. Among them, there were 14 males and 32 females, with an average age of (77.83±10.66) years (44-92 years); 17 cases on the left side and 29 cases on the right side. The causes of injury included crash from a height, traffic accident and accidental fall. According to Seinsheimer classification, there were 26 cases of type Ⅱ, 11 cases of type Ⅲ, 9 cases of type Ⅳ, and these cases were all closed injury. After admission, these patients underwent continuous tibial tuberosity bone traction to maintain the length and force line of the lower extremity, so as to reduce the difficulty of intraoperative fracture reduction. Anticoagulant therapy was given before operation to reduce perioperative thrombotic complications. All the patients were treated with less invasive intramedullary nail fixation combined with titanium cable cerclage. Operation time, blood loss during surgery, time of fracture healing were recorded, Harris and Sanders scoring system were used to assess hip function after operation at each follow-up time point.@*RESULTS@#All the included patients underwent surgery successfully. Average operative time and intraoperative blood loss of these patients were (131.09 ± 20.06) min and (191.96±111.03) mL, respectively. All the patients were followed up satisfactorily, with an average follow-up time of 28 months. The fractures received bone healing within 3-6 months, average hospital stay was (10.61±2.85) days. The Sanders score was excellent in 3 cases, good in 37 cases and common in 6 cases, with an excellent and good rate of 86.96%. The Harris score was excellent in 6 cases, good in 36 cases, with an excellent and good rate of 91.30%. There were no cases of wound infection, loss of reduction, nonunion of fracture or internal fixation failure. Hip pain symptoms were effectively relieved in most patients.@*CONCLUSION@#Less invasive intramedullary nail fixation combined with titanium cable cerclage can obtain good alignment and stability of fracture ends, which is an effective method for the treatment of subtrochanteric fractures.

A mid-term clinical follow-up study on repair of the meniscus tears by a modified arthroscopic outside-in puncture suture technique / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical effect of a modified arthroscopic outside-in suture technique in the treatment of meniscus tear using a spinal needle.@*METHODS@#From January 2015 to October 2017, 95 patients treated with this method were followed-up. Among these cases, there were 36 males and 59 females. The age of the patients ranged from 16 to 77 years, (46.79±18.07) years in average. Among them, there were 28 patieats aged 16-35, 53 patients aged 36-65, and 14 patients aged over 65 years old. 28 cases were diagnosed with medial meniscus tear, 43 cases with lateral meniscus tear and 24 cases with both medial and lateral meniscus tear. Causes of the injury included sports, sprain, etc. According to Barrett standard, the clinical healing of meniscus tear was judged. Lysholm score, knee range of motion, visual simulation score (VAS) and magnetic resonance imaging (MRI) were used to evaluate the postoperative knee function and recovery of the patients.@*RESULTS@#The 95 patients were followed up for 22 to 36 months, with an average of (28.32±3.98) months. According to Barrett standard, 90 patients (94.7%) obtained meniscus clinical healing. Meniscal healing rates were 96.43%, 96.23% and 85.71% in the three age groups, respectively. The meniscal healing rate was lower in the elderly group, but there was no significant difference in statistical results (P=0.262). Five patients had deep tenderness in the joint space of the injured side, and the overstretch test was positive. The preoperative and postoperative VAS scores, Lysholm scores and knee motion were compared in each group, and the differences were statistically significant (P < 0.01). At the end of the last follow-up, there were no cases of knee joint effusion, swelling and interlocking, and the joint function was effectively improved in most patients. No surgical site infection, periarticular vascular/nerve injury or knotting reaction was found during the follow-up.@*CONCLUSION@#This modified arthroscopic outside-in suture technique using a spinal needle has the characteristics of simple operation, small trauma and rapid recovery, and the mid-term follow-up results were satisfactory. Therefore, we consider this method to be a safe and efficient method for the treatment of meniscus anterior horn and body tear.

Evaluation of therapeutic efficacy of arthroplasty with Swanson prosthesis in the surgical treatment of 2-5 metatarsophalangeal joint diseases / 北京大学学报(医学版)

OBJECTIVE@#Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint.@*METHODS@#From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up, 2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery.@*RESULTS@#The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P < 0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P < 0.01), the excellent rate was 81.3%.@*CONCLUSIONS@#With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.

Application of multidisciplinary team (MDT) in the treatment of severe trauma / 北京大学学报(医学版)

OBJECTIVE@#To explore the effect of multi-disciplinary team (MDT) in general hospitals on severe trauma patients.@*METHODS@#This study reviewed the treatment of patients with severe trauma in trauma center of Peking University People's Hospital from March 2017 to April 2019. The baseline information: the patients' gender, age, injury mechanism, etc.; the start indicators: the Glasgow coma scale (GCS), trauma index (TI), injury severity score (ISS); the start related indicators: time for activation, time for MDT to arrive, time for CT scan, time for damage control surgery; patient treatment and prognosis: ICU (intensive care unit) length of stay, number of cured and discharged patients, number of dead cases, number of patients transferred to rehabilitation hospital, were all analyzed. It discussed the composition of MDT, the initiation scheme, the indicators of initiation of MDT for severe trauma, and analyzed the correlation between the application of MDT and the prognosis of patients.@*RESULTS@#From March 2017 to April 2019, 112 trauma patients were treated by MDT in Peking University People's Hospital. There were 69 males and 43 females. The minimum age was 15 years, the maximum age was 89 years, most of them were 36-55 years old. The main injury mechanism was traffic accident injury. The GCS, TI, ISS were 13.0±2.9, 13.0±2.8, and 21.5±11.9, respectively. It took 3.7±0.8 minutes to start the call, 6.1±0.9 minutes for MDT personnel to arrive at the emergency rescue area, 23.8±3.0 minutes for fast CT and 92.6±15.4 minutes for injury control operation. All the hospitalized patients were treated effectively. ICU (Intensive care unit) hospitalization time was 12.6±6.7 days. 55 discharged patients were cured, 5 died (1 died of hemorrhagic shock, 4 died of severe brain injury) and 52 transferred to rehabilitation hospital.@*CONCLUSION@#The treatment of severe trauma patients by MDT in trauma center of general hospitals can greatly improve the ability and level of treatment of severe trauma patients, make up for the lack of treatment of severe trauma especially multiple trauma patients in large general hospitals, and improve the treatment effect of severe trauma patients. It provides a reference model for large general hospitals to treat patients with severe trauma and multiple trauma and for the construction of trauma centers.

Correlation Analysis of Rubella Incidence and Meteorological Variables Based on Chinese Medicine Theory of Yunqi / 中国结合医学杂志

OBJECTIVE@#To analyze the correlations between the incidence of rubella and meteorological factors over the same period and previous periods including 1, 2, 3 and 4 year ago (defined according to Chinese medicine Yunqi theory of "pestilence occurring after 3 years") and establish the rubella-meteorological forecast models for Beijing area, China.@*METHODS@#Data regarding the incidence of rubella between 1990 and 2004 from Beijing Center for Disease Control and Prevention, and the meteorological variables including daily average temperatures, daily average wind speeds, average precipitations, average relative humidity, average vapor pressures and average low cloud covers between 1986 and 2004 were collected from the Beijing Meteorological Observatory. Descriptive statistics and back-propagation artificial neural network for forecast model's establishment were adopted for data analysis.@*RESULTS@#The average temperature and relative humidity have a great contribution (100%) to the rubella morbidity. But the combination of other meteorological factors contributed to improve the accuracy of rubella-meteorological forecast models. The forecast accuracy could be improved by 76% through utilizing a combination of meteorological variables spanning from 3 years ago to the present rather than utilizing data from a single year or dating back to more earlier time than 3 years.@*CONCLUSIONS@#There is a close relationship between the incidence of rubella and meteorological variables in current year and previous 3 years. This finding suggests that rubella prediction would benefit from consideration to previous climate changes.

Clinical Efficacy Evaluation of Abdominal Acupuncture plus Cervical Curvature Traction for Cervical Spondylosis of Vertebral Artery Type / 上海针灸杂志

Objective To observe the clinical efficacy of abdominal acupuncture plus cervical curvature traction in treating cervical spondylosis of vertebral artery type. Method Eighty patients with cervical spondylosis of vertebral artery type were divided by the random number table into two groups, with 40 cases in each group. The treatment group was intervened by abdominal acupuncture plus cervical curvature traction, and the control group was given oral administration of flunarizine. The two groups were compared before and after treatment in terms of clinical symptom score, cervical vertigo symptom and function assessment scale, and hemodynamics, etc. Result Both groups attained significant efficacy, and the total effective rate was 92.5％ in the treatment group, markedly higher than 77.5％ in the control group (P<0.05); the score of cervical spondylosis symptom scale in the treatment group was higher than that in the control group after treatment, and the difference was statistically significant (P<0.05); after treatment, the evaluations of vertigo, neck-shoulder pain, headache, daily living and work, mental and social adaptation were significantly improved in both groups (P<0.01). Conclusion Abdominal acupuncture plus cervical curvature traction can obviously improve symptoms such as vertigo, neck-shoulder pain, headache, daily living and work, and mental and social adaptation, and boost the blood flow velocity of vertebrobasilar artery in patients with cervical spondylosis of vertebral artery type. The achievement of therapeutic efficacy is associated with the improvement of vertebrobasilar blood supply.

Effect of Acupuncture at Points Neiguan(PC6) and Shuigou(GV26) on Caspase-3 and PARP-1 Expressions in the Cerebral Cortex in Rats with Cerebral Ischemia-reperfusion / 上海针灸杂志

Objective To investigate the inhibiting effect of acupuncture at points Neiguan(PC6) and Shuigou(GV26) on caspase-3, and PARP-1 mRNA and protein expressions in the cerebral cortex in rats with cerebral ischemia-reperfusion. Method Forty male SD rats were randomized to normal, sham operation, model and acupuncture groups. A model of middle cerebral artery infarction was made by modified Longa thread occlusion. Neurological function was scored using a 6-grade 5-point Bederson's scale. Caspase-3, and PARP-1 mRNA and protein expressions in rat cerebral cortex were determined using real-time PCR and Western Blot at 24 hrs after cerebral ischemia. Result Neurological deficit was reduced in the acupuncture group of rats with cerebral ischemia-reperfusion compared with the model group (P<0.01). Acupuncture could down-regulate caspase-3, and PARP-1 mRNA and protein expressions and there was a statistically significant difference compared with the model group (P<0.05, P<0.01; P<0.05, P<0.05). Conclusion Acupuncture at points Neiguan and Shuigou can down-regulate caspase-3, and PARP-1 mRNA and protein expressions in the cerebral cortex in rats with cerebral ischemia-reperfusion.

Repeatability and Reproducibility of Quantitative Assessment of the Retinal Microvasculature Using Optical Coherence Tomography Angiography Based on Optical Microangiography / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The aim of this study was to determine the repeatability and reproducibility of optical coherence tomography angiography (OCTA) based on optical microangiography (OMAG) measurements of macular vessels in normal eyes.</p><p><b>METHODS</b>In this prospective cohort study, 40 eyes of 40 healthy volunteers underwent repeated OCTA (Cirrus HD-OCT 5000 angiography system, Carl Zeiss Meditec, Inc.) scans on two separate visit days. On each visit day, the eyes were scanned three times. The following parameters were used to quantitatively describe the OCTA images of the superficial vascular network: vessel area density (VAD), vessel skeleton density (VSD), vessel diameter index (VDI), vessel perimeter index (VPI), vessel complexity index (VCI), flux, and foveal avascular zone (FAZ). Coefficient of variation (CV) and intraclass correlation coefficient (ICC) were calculated for evaluating intravisit and intervisit repeatability, as well as interobserver reproducibility.</p><p><b>RESULTS</b>The measurements showed high repeatability [CVs ⪕ 4.2% (intravisit) and ⪕ 4.6% (intervisit)] and interobserver reproducibility (ICCs ⪖ 0.923) for all parameters.</p><p><b>CONCLUSION</b>This study demonstrated good repeatability and reproducibility of OCTA based on OMAG for the measurement of superficial vessel parameters in normal eyes.</p>

The short-term and long-term effects on neck pain caused by cervical spondylosis treated with combination of acupuncture and moxibustion with seed-sized moxa cone / 中国针灸

<p><b>OBJECTIVE</b>To evaluate the short-term and long-term effects on treatment of neck pain caused by cervical spondylosis with the combination of acupuncture and moxibustion with seed-size moxa cone.</p><p><b>METHODS</b>One hundred and forty-five patients of neck pain were randomly divided into an acupuncture-moxibustion group (49 cases), an acupuncture group (48 cases) and a moxibustion group (48 cases). Acupoints of Bailao (Extra), Dazhui (GV 14), Jianzhongshu (SI15) and Zhongzhu (TE 3) were adopted for all the 3 groups. Acupuncture was applied at all the acupoints with 20 min needling retention for the acupuncture group. Moxibustion with seed-size moxa cone was used with 5 cones on each point for the moxibustion group. And both acupuncture and moxibustion with seed-size moxa cone were adopted for the acupuncture-moxibustion group. The treatment was applied once every 3 days, and 10 treatments should be finished within 4 weeks. Follow-up should be carried out for 3 months. The short-term and long-term effects were evaluated with the scores of Northwick Park Pain Questionnaire (NPQ) and McGill Pain Questionnaire (MPQ) as the indices of therapeutic effect.</p><p><b>RESULTS</b>The NPQ score and MPQ score of all the 3 groups after the treating course and the 3-month follow-up were both decreased when compared with those before the treatment (all P<0. 05). The scores of NPQ and MPQ the acupuncture-moxibustion group were lower than that of the other two groups. And the difference had obvious significance (P<0. 05). High efficiency of pain relieving for cervical spondylosis could be found in all the 3 groups, which showed that short-term and long-term effects were good for all the 3 groups. And the highest curative effect could be found in acupuncture-moxibustion group.</p><p><b>CONCLUSION</b>Combination of acupuncture and moxibustion with seed-size moxa cone has reached a superior effect in short-term and long-term for neck pain caused by cervical spondylosis.</p>

Acupuncture at "Siguan" combined with Gallbladder Meridian acupoints for migraine: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe and evaluate the clinical effect of acupuncture at "Siguan" combined with the Gallbladder Meridian acupoints on migraine.</p><p><b>METHODS</b>With randomized controlled trial design, 87 patients were randomly divided into an observation group (42 cases) and a control group (45 cases). The observation group was treated with acupuncture at "Siguan" including Hegu (LI 4) and Taichong (LR 3), combined with the Gallbladder Meridian acupoints including Fengchi (GB 20), Shuaigu (GB 8), Qiuxu (GB 40) and Zulinqi (GB 41), while the control group was treated with acupuncture at the Gallbladder Meridian acupoints, including Fengchi (GB 20), Shuaigu (GB 8), Qiuxu (GB 40), Zulinqi (GB 41), Yanglingquan (GB 34) and Hanyan (GB 4). The treatment was given every other day in two groups, 3 times per week for totally 6 weeks. The migraine intensity, migraine frequency and lasting time of each migraine were observed before and after treatment, and 3-month follow-up was performed after treatment. The clinical efficacy in two groups was evaluated.</p><p><b>RESULTS</b>Compared with those before treatment, the migraine intensity, frequency and lasting time were all reduced significantly after treatment in the two groups (all P<0.01), which were more obvious in the observation group (all P<0.05). At the end of the treatment, the total effective rate was 95.2% (40/42) in the observation group and 80.0% (36/45) in the control group, which had statistical difference (P<0.05). After 3-month follow-up, the total effective rate was 88.1% (37/42) in the observation group and 75.6% (34/45) in the control group, which had no statistical difference (P>0.05).</p><p><b>CONCLUSION</b>The "Siguan" combined with the Gallbladder Meridian acupoints could significantly relieve the migraine intensity, frequency and lasting time, and its improvement of symptoms and short-term efficacy are superior to those of the Gallbladder Meridian acupoints alone.</p>

The present-stage advantage diseases of abdominal acupuncture from reports of clinical randomized controlled trial / 中国针灸

The reports of clinical randomized controlled trial (RCT) that takes abdominal acupuncture as main treatment are arranged in order to summarize its advantage diseases at current stage. Up to May 1st, 2012, 107 reports that meet the inclusion criteria are collected by computer retrieval in CBM database, CNKI, VIP, Wan fang database, PubMed, Embase and manual retrieval in outdated issue database of Guangzhou University of CM. Diseases that has better efficacy by abdominal acupuncture are summarized. There are 38 kinds of present-stage advantage diseases of abdominal acupuncture, including internal medicine, surgery, gynaecology, pediatrics, orthopedics and dermatology, but those are far less than abdomen needle indications in the Abdominal Acupuncture Therapy written by Professor BO Zhi-yun. The doctors of abdominal acupuncture should not only pay attention to the application of RCT in clinical research to acquire high-quality reports, but also improve one's level of treatment and research of abdominal acupuncture to apply it into more specialist areas.

Simultaneous determination of two constituents of compound felodipine controlled release tablets by HPLC / 中国药学杂志

OBJECTIVE: To establish an HPLC method to determine the dissolutions of felodipine and metoprolol tartrate in compound felodipine controlled release tablets. METHODS: An HPLC method was established with Agilent Eclipse C18 column (4.6 mm×250 mm, 5 μm).A mixture of 0.3% SDS (pH adjusted to 2.5 with phosphoric acid)-acetonitrile-methanol V:V:V(40:50:10) was used as the mobile phase. The column temperature was 25°C. The flow rate was 1 mL·min-1 and the detection wavelength was set at 233 nm. RESULTS: The relative retention time of felodipine and metoprolol tartrate was 6.20 and 8.45 min respectively. The linear ranges of these two drugs were 1-24 μg·mL-1 (r=0.9999) and 10-240 μg·mL-1 (r=0.9999). The average recoveries of felodipine and metoprolol tartrate were 99.99% and 99.91% respectively. The RSDs of this method were all less than 2%. CONCLUSION: The established method is sensitive, accurate and reliable for determination of the dissolutions of felodipine and metoprolol tartrate in compound felodipine controlled release tablets.

Minimally invasive video-assisted thyroidectomy for accidental papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy with 5 years follow-up / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Minimally invasive video-assisted thyroidectomy (MIVAT) has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy (CT) for papillary thyroid microcarcinoma (PTMC).</p><p><b>METHODS</b>Thirty-one patients were treated with MIVAT and 37 with CT. Their pathological characteristics, surgical complications, 5-year postoperative thyroglobulin (TG) and ultrasonic results were followed up.</p><p><b>RESULTS</b>All the patients took levothyroxine for suppressing thyroid stimulating hormone (TSH) after surgery, and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months. There was no statistically significant difference between the CT and MIVAT groups for sex ratio, operation time, positive lymph nodes, complications and prognosis, but the MIVAT group had better cosmetic results.</p><p><b>CONCLUSIONS</b>MIVAT did not differ significantly from CT for PTMC after 5 years follow-up, but it did have better cosmetic results. MIVAT is a safe and valid surgical technique for selected cases.</p>

Expression of Class I integrase gene in Acinetobacter baumannii and drug-resistance / 中南大学学报(医学版)

OBJECTIVE@#To explore the expression level of class I integrase (intI 1) mRNA in Acinetobacter baumannii from biofilm cells and planktonic cultured cells ,and to analyze the drug-resistance of Class I integron positive strains.@*METHODS@#Acinetobacter baumannii were collected from hospitals,and Class I integron strains were screened by gene amplification. Total RNA of Class I integron positive strains was extracted, and the intI1 mRNA expression in the bioflim cells and planktonic cultured cells was measured by RT-PCR. Susceptibilities to antibiotics of Class I integron positive strains were also examined.@*RESULTS@#The intI1 gene mRNA was expressed under 2 conditions, and the mRNA expressed in the biofilm cells was about 4 times higher than that in the planktonic cultured cells. Among the 64 strains of Acinetobacter baumannii, 46 strains were Class I integron positive strains. The antibiotic resistance of intI1 gene cassette-positive strains was higher than that of gene cassette-negative strains.@*CONCLUSION@#The intI1 gene mRNA can be up-regulated in Acinetobacter baumannii biofilm cells.Class I integron plays an important role in drug resistance. It is much easier to capture gene cassettes for bacteria under biofilm condition.

Function and gene expression of the active efflux transporters in drug-resistant Candida albicans / 中南大学学报(医学版)

OBJECTIVE@#To investigate the function and gene expression of active efflux transporters in drug-resistant candida albicans.@*METHODS@#The broth microdilution method was performed to determined the minimal inhibitory concentration of 4 antifungal drugs to 20 candida albicans. We compared the efflux of Rhodamine 6G between sensitive and some of fluconazole-resistant candida albicans, and screened out the resistant strains with significantly increased efflux of Rhodamine 6G. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to measure the mRNA levels of active efflux gene CDR1 and CDR2.@*RESULTS@#The efflux of Rhodamine 6G was significantly increased in some fluconazole-resistant strains when glucose was added, and the gene expressions of CDR1 and CDR2 were also obviously increased, compared with those in the sensitive strains.@*CONCLUSION@#The excessive expression of active efflux pump gene is related to the resistance to fluconazole in candida albicans. The measurement of Rhodamine 6G efflux is a useful method for the identification of drug-resistant strains induced by the excessive expression of active efflux pump.