Comparison of efficacy of platelet-rich plasma and extracorporeal shock wave for the treatment of chronic insertional Achilles tendinopathy / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of platelet-rich plasma (PRP) and extracorporeal shock wave in treating chronic insertional Achilles tendinopathy.@*METHODS@#From February 2019 to August 2021, 42 patients with chronic insertional Achilles tendinopathy were selected and divided into PRP group(20 patients, 28 feet) and shock wave group (22 patients, 29 feet). In PRP group, there were 12 males and 8 females, aged 47.00(28.00, 50.75) years old, and the courses of disease ranged 7.00(6.00, 7.00) months;PRP injection was performed in the Achilles tendon stop area of the affected side. In shock wave group, there were 16 males and 6 females, aged 42.00(35.75, 47.25) years old;and the courses of disease was 7.00(6.00, 8.00) months;shock wave was performed in Achilles tendon stop area of the affected side and triceps surae area. Visual analogue scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) were applied to evaluate clnical effect before treatment, 1, 3 and 6 months after treatment, and satisfaction of patients was investigated.@*RESULTS@#VAS and VISA-A score in both groups were significantly improved at 1, 3 and 6 months after treatment than before treatment (P<0.05), VAS and VISA-A score in PRP group at 6 months after treatment were significantly higher than those at 1 and 3 months after treatment, and VAS and VISA-A score in shock wave group were lower than those at 1 and 3 months after treatment (P<0.05). There was no significant difference in VAS and VISA-A score between two groups before treatment, 1 and 3 months after treatment(P>0.05), while VAS and VISA-A score in PRP group were better than those in shock wave group at 6 months after treatment(P<0.05), and the satisfaction survey in PRP group was better than that in shock wave group(P<0.05).@*CONCLUSION@#PRP injection has a good clinical effect on chronic insertional Achilles tendinopathy with high patient satisfaction, and medium-and long-term effect of PRP injection for the treatment of chronic insertional Achilles tendinopathy is better than that of extracorporeal divergent shock wave.

Effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing radical mastectomy / 中国医师杂志

Objective To investigate the effect of ultrasound-guided serratus plane (SP) block on efficacy of postoperative analgesia in patients undergoing radical mastectomy.Methods From February 2012 to October 2016,sixty American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n =30 each):SP block group (observation group) and control group.After induction of anesthesia,ultrasoundguided homolateral SP block was performed,and 0.375％ ropivacaine 20 ml was injected in observation group,while the equal volume of normal saline was used instead in control group.The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in the two groups.The scores of prince henry pain scale (PHPS) were evaluated at 2,4,8,12 and 24 hours (T1,T2,T3,T4,T5) after operation.The consumption of sufentanil,propofol and remifentanil were recorded,meantime the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up,calculating D1/D2.The adverse effects were also recorded.Results The scores of PHPS at T1 [(1.4 ± 0.6) scores vs (3.1 ±0.7) scores],T2 [(1.5 ±0.7) scores vs (2.9 ±0.9) scores],T3 [(1.7 ±0.6) scores vs (2.8±0.8) scores],and the consumption of sufentanil [(53.4 ± 16.8) μg vs (87.8 ±24.6) μg],remifentanil [(288.7 ±42.2) μg vs (376.5 ±61.7) μg] were significantly lower in observation group than in control group,while D1/D2 (0.89 ±0.13 vs 0.57 ±0.19) was higher (P ＜0.05).The incidence of adverse reactions was significantly lower in the observation group (0 vs 23.3 ％) (P ＜ 0.05).Conclusions Ultrasound-guided SP block reduces the consumption of perioperative opioids and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.

A PKLR Gene Novel Complex Mutation in Erythrocyte Pyruvate Kinase Deficiency Detected by Targeted Sequence Capture and Next Generation Sequencing / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the molecular mechanism of erythrocyte pyruvate kinase deficiency (PKD).</p><p><b>METHODS</b>Targeted sequence capture and next-generation sequencing (NGS) were used to detect the regions of exon and exon-intron boundarie of PKLR gene in a clinical suspected PKD patient. The protein function of mutant gene was forecasted by the SIFT and PolyPhen-2 databank, after the mutation of PKLR gene in the patient was detected by the NGS technology, its genotype was confirmed by Sanger sequencing.</p><p><b>RESULTS</b>The patient was found to have peculiar double heterozygous mutations: 661 G>A (Asp221Asn) of exon 5 and 1528 C>T (Arg510Ter) of exon 10, resulting in amino acid substitution Asp221Asn and Arg510Ter, these mutations were also further confirmed by Sanger sequencing. The complex mutations were infrequent and each of them was able to cause diseases.</p><p><b>CONCLUSION</b>The complex mutations of both 661 G>A and 1528 C>T of PKLR gene are the molecular mechanism of PKD. Simultaneous existance of above-mentioned complex mutations in PDK patient was never been previously reported at home and abroad.</p>

Research advances on anti-ANGPT2 antibody in acute myeloid leukemia / 中国实验血液学杂志

Angiopoietin2( ANGPT2 ) plays an important role in tumor angiopoiesis. ANGPT2 antagonises ANGPT1 resulting in an effect on the stability of blood vessels, which promotes tumor growth, invasion, proliferation as well as relating to tumor vascular density. A lot of researches published papers about anti-ANGPT2 for the treatment of tumor, and have made some progresses. In this review, the role of ANGPT2 in the pathogenesis of acute myelogenous leukemia (AML), including its effects on proliferation of leukemia cells, bone marrow angiopoiesis, tumor invasion and metastasis are briefly summarised in order to provide the basis for targeted ANGPT2 in treatment of AML.

Modified limited L incision with distraction bone block arthrodesis for subtalar osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the functional outcomes of modified limited "L" incision beside the Achilles tendon with distraction bone block arthrodesis in treatment of subtalar osteoarthritis.</p><p><b>METHODS</b>From March 2009 to September 2012, a total of 22 cases of old calcaneus fractures with subtalar osteoarthritis were treated with modified limited "L" incision and distraction bone block arthrodesis including 13 males and 9 females with a mean age of 35.3 years old (ranged 22 to 49). The mean time from calcaneal fracture was 21 months (ranged 11 to 32). According to the Stephens-Sanders classification, 16 cases were type II and 6 were type III. The modified-AOFAS ankle-hindfoot score was used for functional outcomes evaluation.</p><p><b>RESULTS</b>There was one incision necrosis and no infection, implant failure, bone-graft absorbed or talus necrosis was note at the follow-up time. A total of 21 cases were followed up for a mean time of 29 months (ranged from 18 to 46 months). All of the cases reached a bony union within 4 months postoperation. The mean modified-AOFAS ankle-hindfoot score was 82.6 points (ranged from 66 to 92 points),reached a significantly improvement in comparing with the mean preoperative score (50.8 points,ranged from 32 to 65 points, P < 0.01).</p><p><b>CONCLUSION</b>The modified limited"L" incision beside the Achilles tendon with distraction bone block arthrodesis is an acceptable and alternative treatment method for subtalar osteoarthritis. This method is easy to use and with less complication. It can correct the main pathological changes and reach good functional outcomes.</p>

Birth defects among children aged 0-4 in Chongqing in 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To learn the prevalence of birth defects in Chongqing.</p><p><b>METHODS</b>A total of 6579 children aged 0 - 4 were chosen by multistage cluster sampling method in central economic districts of Chongqing. A total of 32 kinds of birth defects were selected. All the birth defects, except for the visible congenital malformation, must be diagnosed by the hospital in county. And municipal experts would make a consultation for those that couldn't be diagnosed at the level of county. Investigators trained strictly made a body examination and inquired medical history from May to September in 2010.</p><p><b>RESULTS</b>A total of 6541 subjects, aged from 0 to 4, were recruited in the present study, and 216 of them were born with birth defects. The total prevalence was 33.48‰ (95%CI: 29.09‰-37.87‰). There were 25 kinds of birth defects in total, the first five were hernia (20.15‰), congenital heart disease (2.17‰), polydactylism (2.02‰), cryptorchid (1.86‰) and funnel chest (1.86‰). The prevalence among boys was 52.99‰ (178/3359), higher than girls 12.29‰ (38/3092) (χ2=82.42, P<0.05). The prevalence in each group aged 0, 1, 2, 3, 4 were 39.30‰ (36/916), 38.79‰ (41/1057), 36.46‰ (56/1536), 28.38‰ (47/1656), 27.99‰ (36/1286), respectively. There were no statistical differences in each group (χ2=4.83, P=0.31). The prevalence in countryside was 40.17‰ (136/3386), higher than that in town 26.18‰ (80/3065) (χ2=9.83, P<0.05).</p><p><b>CONCLUSION</b>The rate of birth defects in Chongqing was moderate, and boys and kids in rural areas had a higher prevalence rate than their counterparts.</p>

Clinicopathologic correlation between CD4-positive T lymphocyte counts and superficial lymphadenopathy in HIV-positive/AIDS patients / 中华病理学杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological correlation between CD4(+) T lymphocyte count and superficial lymphadenopathy HIV/AIDS patients.</p><p><b>METHODS</b>A total of 1066 HIV/AIDS patients were included in this study. The incidence of superficial lymphadenopathy, peripheral blood CD4(+) T lymphocyte counts and histological features of superficial lymphadenopathy were analyzed.</p><p><b>RESULTS</b>Among 1066 patients, 126 cases (11.8%) presented with superficial lymphadenopathy. Of the 126 cases, there were 69 cases with CD4(+) T lymphocyte counts < 100/µl and clinical diagnoses including tuberculosis (37 cases), reactive hyperplasia (8 cases), AIDS-related lymphadenopathy (18 cases), penicillium diseases (12 cases), fungal infection (5 cases) and non-tuberculous mycobacterial infection (1 case). Twenty-six cases had CD4(+) T lymphocyte counts between 100/µl to 200/µl and clinical diagnosis including tuberculosis (12 cases), reactive hyperplasia (8 cases), AIDS-related lymphadenopathy(6 cases), penicillium disease (2 cases) and non-Hodgkin lymphoma (1 case). Twenty-nine cases had CD4(+) T lymphocyte counts > 200/µl and clinical diagnoses including tuberculosis (11 cases), reactive hyperplasia (12 cases), AIDS-related lymphadenopathy (3 cases), Penicillium diseases (1 case) and non-Hodgkin lymphoma (4 cases). The CD4(+) T lymphocyte counts among patients with tuberculosis, AIDS-related lymphadenopathy and Penicillium diseases were significantly different (χ(2) = 8.861, P = 0.012). A significant correlation between the incidence of superficial lymphadenopathy and CD4(+) T lymphocyte counts was found (χ(2) = 375.41, P = 0.000).</p><p><b>CONCLUSIONS</b>The most common cause of superficial lymphadenopathy in HIV/AIDS patients is tuberculosis, followed by lymph node reactive hyperplasia, AIDS-related lymphadenopathy and Penicillium disease. Low CD4(+) T lymphocyte count correlates with an increased incidence of superficial lymphadenopathy and the risk of opportunity infection. Therefore, determination of peripheral blood CD4(+) T lymphocyte count should become an integral marker for the early diagnosis and treatment of superficial lymphadenopathy in HIV/AIDS patients.</p>

Effective analysis of open reduction and internal fixation for the treatment of acute Lisfranc joint injury / 中国骨伤

<p><b>OBJECTIVES</b>A retrospective study was used to evaluate the short to intermediate outcomes of open reduction and internal fixation of acute Lisfranc joint injuries.</p><p><b>METHODS</b>From January 2003 to December 2009, 47 patients with Lisfranc injuries were treated in the study,41 patients were analyzed in current study with an average age of thirty-one years old. All of patients were treated with open reduction and internal fixation. According to the Myerson classification system, there were 9 type-A fractures, 7 type-B1, 11 type-B2, 10 type-C1, 5 type-C2. The AOFAS scale and VAS scale were used for the outcome measurement at the final follow-up.</p><p><b>RESULTS</b>There were 41 patients with 42 operations were followed up and with a mean time of 36 months (ranged, 12 to 71 months). The mean AOFAS score was (84.2 +/- 2.8) points (ranged, 65 to 100 points), with an excellent and good rate of 81 percent. The mean VAS score was (2.6 +/- 0.5) points (ranged, 0 to 6 points). Three patients developed superficial infection, and two developed skin necrosis. Nineteen patients had weight-bearing or walking pain. All of the patients had radiographic evidence of degenerative change, four with malunion of the second tarsometatarsal joint, and two of the patients with hallux valgus deformity change.</p><p><b>CONCLUSION</b>According to the results of the study, anatomic reduction and internal fixation can get the satisfactory results for the treatment of acute Lisfranc injuries during a short to intermediate follow-up time. All of the patients would have different degree of tarsometatarsal joint degenerative changes, but these changes are non-progressive and associated with minimal loss of function.</p>

Experimental study on viscoelasticity of lumbar yellow ligament in young and old people / 医用生物力学

Objective To compare the stress relaxation and mechanical properties of creep viscoelasticity in the young and old’s spine and to provide the reference for the mechanical mechanism of viscoelasticity of yellow ligament degeneration. Method Twenty specimens of elderly patients with degenerative lumbar yellow ligament degeneration as the older group, and twenty specimens of young patients with lumbar yellow ligament injuries as the youth group were used respectively. All the yellow ligament specimens were from the yellow ligament between the fourth and fifth of lumbar vertebra (L4~L5). Stress relaxation experiment and creep experiment were conducted on the specimens by the strain increasing speed as 1%/s and the stress increasing speed as 0.5 MPa/s respectively. The experimental temperature was (36.5±0.5) ℃ and the experimental time was 7 200 s. Ninety stress relaxation and creep data were collected, and the data were dealt with the statistical analysis and normalization methods. Results The 7 200 s stress of yellow ligament in the youth group decreased by 1.42 MPa, while the 7 200 s stress of yellow ligament in the older group decreased by 1.91 MPa. The 7 200 s strain of yellow ligament in the youth group increased by 3.39%, while the 7 200 s strain of yellow ligament in the older group increased by 2.07%. The 7 200 s stress in two groups all increased and the increased strain data showed statistically significance (P<0.05). The stress relaxation curve changed in the form of logarithm and the creep curve changed in the form of index. Conclusions The 7 200 s stress relaxation and creep in the yellow ligament of the older group all decreased and the mechanical properties of viscoelasticity changed.

Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture-operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures.</p><p><b>METHODS</b>We searched multiple databases in English (including EMBASE, PubMed, and OVID) and in Chinese (including CNKI, WANFANG, and VIP), as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software.</p><p><b>RESULTS</b>Eight randomized controlled trials (RCTs) involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher (Z = 3.33, P < 0.01). However, the moderate (Z = 4.27, P < 0.01) and minor (Z = 5.59, P < 0.01) complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter (Z = 2.65, P < 0.01). The inability to return to previous level sporting rate and ankle joint decreased range of motion (ROM) rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups.</p><p><b>CONCLUSIONS</b>Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alternative especially for the older and patients with lower sporting requirements.</p>

Complications in total ankle arthroplasty: a meta analysis / 中华外科杂志

<p><b>OBJECTIVES</b>To provide a cumulative data about the complications of second or third generation ankle prostheses in the literature, and to provide a summary high-grade complications associated with implant failure.</p><p><b>METHODS</b>A comprehensive search for all relevant articles published in English from January 1995 to December 2010 was conducted. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of results across studies was performed for the complications and failure rate.</p><p><b>RESULTS</b>Thirty-five primary studies with 4395 implants were identified. The three highest complications of total ankle arthroplasty were aseptic loosening (12.51%), intra-operative bone fracture (11.97%) and bony impingement (11.27%). The three high-grade complications associated with implant failure were aseptic loosening (45.00%), infection (33.00%) and malalignment (29.00%). The pooled mean failure rate was 10.98% (95%CI: 8.80% - 13.16%), and the pooled mean failure rate of STAR implant was 14.20% (95%CI: 10.64% - 17.76%).</p><p><b>CONCLUSIONS</b>It is found that aseptic loosening, infection and malalignment are high-grade complications associated with implant failure in total ankle arthroplasty. The orthopaedic surgeons should be more careful in the operation, and the patients should coordinate with the post-operative rehabilitation plan.</p>

Treatment of open calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>Review the series cases of open calcaneal fractures, to discuss the clinical outcome and evaluate the effective factors associated with the prognosis.</p><p><b>METHODS</b>Between 2004 and October 2009, 427 calcaneal fractures were treated, 22 of these fractures were open, 15 feet of 15 patients were available for the follow-up. There were 9 males and 6 females with a mean age of 34.7 years (range 18 to 66). According to the Sanders classification, there were 2 type I fractures, 3 type II, 6 type III and 4 type IV. According to the Gustilo classification, there were 1 of type 1, 4 of type II, 5 of type III A, and 5 of type III B open fracture. According to the open calcaneal injury subtypes (OCIS), there were 1 of type IA, 2 of type II A,7 of type II B, 2 of type IIIA and 3 of type III B. All patients were treated with intravenous antibiotics, immediate and repeat irrigation and debridement, temporary wound coverage, and initial stabilization of the limb. Clinical examination, radiographs and AOFAS ankle-hindfoot scores were used for outcome measurement.</p><p><b>RESULTS</b>The average follow-up time was 16.4 months (8 to 31 months). The mean AOFAS score was (74.6 +/- 10.4) (range 58 to 94). There were 4 feet required tissue transfer for wound coverage. An infection developed at the sites of 5 fractures,4 of witch were Gustilo type III, 2 deep infections with osteomyelitis developing at the site of 1 patient, no patient required amputation.</p><p><b>CONCLUSION</b>These findings do not reflect as high a deep infection and osteomyelitis rate for open calcaneal fractures as previously reported, if early and satisfying debridement, evaluate the soft tissue injury carefully, and choose the right time and indications for internal fixation. In addition, early internal fixation should be avoided for Gustilo type III and OCIS type B calcaneal fractures.</p>

Construction of eukaryotic expressing vector of multiple myeloma mucin-1 and its expression in COS-7 cells in vitro / 中国实验血液学杂志

In order to construct an eukaryotic expression vector for gene of multiple myeloma mucin1 (muc1-2vntr) gene and to express it in COS-7 cells in vitro, so to provide the basic material for further research of multiple myeloma DNA vaccine. muc1-2vntr coding gene was used as a research gene and a KOZAK sequence was inserted before the gene Hind III and XbaI restriction sites were inserted before and after the coding gene. Then the whole sequence was synthesized and inserted into pcDNA3.1/myc-his B vector, and the resulted recombinant vector was transformed into E.coil competent cells to get an engineering strain, the recombinant plasmid pcDNA3.1-2vntr/myc-his B identified by restriction analysis and DNA sequencing were transfected into COS-7 cells by liposome-mediated gene transfer method. Finally, fluorescent microscopy was used to assess GFP expression and Western blot analysis using muc1 monoclonal antibody was used to recognize vntr, confirming the expression of vntr. The results showed that the full length of synthesized muc1-2vntr gene, as expected, was 140 bp. Both restriction analysis and DNA sequencing demonstrated that pcDNA3.1-2vntr/myc-his B included the whole translation frame region and muc1-2vntr gene. Furthermore, the fluorescence microscopy proved that the recombinant plasmid had been successfully transfected into COS-7 cells. The expression of mucin-1 protein was observed both in the transfected cell and the cell supernatant by Western blot. It is concluded that the pcDNA3.1-2vntr/myc-his B has been successfully constructed and expressed in COS-7 cells in vitro, which provides the basic material for further researches of mucin-1 function and possible multiple myloma DNA vaccine.

The expression of serum MUC1 in multiple myeloma / 白血病·淋巴瘤

Objective To evaluate the clinical value of serum MUC1(sMUC1)in the patients with multiple myeloma.Methods The enzyme linked immunosorbent assay(ELISA)was used to compare the sMUC1 levels in the 12 cases of newly diagnosed multiple myeloma.15 cases of post-chemotherapy and 46 healthy donors.Results The mean concentration of sMUC1 in the newly diagnosed patients with multiple myeloma was 33.44 U/ml(10.86～88.80 U/ml).In the patients of post-chemotherapy the mean concentration was 11.6U/ml(3.92～22.22 U/ml),and in the healthy donors the concentration was 12.81 U/ml(3.84～30.45 U/ml).The level of sMUC1 in the new diagnosed patients was significandy higher than that in the patients of post-chemotherapy(P=0.001)and healthy donors(P=0.000).There was no significant difference between post-chemotherapy and healthy donors(P=0.461).Conclusion sMUC1 may be one of the tumor markers for the diagnosis of multiple myeloma.sMUC1 could also be used as one of the indicators of prognosis and the evaluation of the chemotherapy efficacy.sMUC1 might be a potential target for the immunotherapy to the patients with multiple myeloma.

Characteristic and clinicopathologic significance of lymphangiogenesis in colorectal cancer / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the distribution patterns and proliferative activity of lymphatic vessels in colorectal carcinomas (CRC) and their relationship with tumor metastasis and disease prognosis.</p><p><b>METHODS</b>The microlymphatic density (MLD) and microvascular density in tumoral and non-tumoral areas of 96 cases of CRC were evaluated by immunohistochemistry, using monoclonal antibodies for podoplanin and CD34 respectively. The Ki-67 expression of the lymphatic and blood vessels was detected by double-labeling immunohistochemistry. The relationship between MLD and clinicopathologic features and prognosis was analyzed.</p><p><b>RESULTS</b>The lymph vessels at central and superficia1 portions of CRC often had a reticular architecture with numerous tiny and ill-defined lumina, while those at the tumor borders had large and open lumina. The MLD at tumor borders (51.2 +/- 25.5) was significantly higher than that in normal colorectal mucosa (29.4 +/- 9.0) and other portions of CRC (P < 0.01). The Ki-67 labeling index of the lymphatic lining cells at tumor borders (0.23 +/- 0.17) was significantly higher than that in other portions of CRC (P < 0.05). The MLD significantly correlated with lymphatic involvement by tumor cells, regional lymph node metastasis and distant metastasis (P < 0.01). The 5-year survival rate was also significantly lower in patients with high MLD (P < 0.05).</p><p><b>CONCLUSIONS</b>Neolymphatic vessels are commonly seen in CRC, especially at tumor borders. High MLD at tumor borders is associated with metastasis. The detection of MLD at tumor borders may thus be useful in predicting lymph node metastasis and prognosis in patients with CPC.</p>