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Objective:To explore the morphological characteristics, treatment strategies and clinical results of complex hyperextension tibial plateau fractures.Methods:From October 2017 to January 2019, data of 27 patients with complex hyperextension tibial plateau fractures were retrospectively analyzed. There were 19 males and 8 females with an average age of 43.4 years (range, 23-68 years). According to Schatzker classification of tibial plateau fractures: there are 8 cases of type IV, 5 of type V, and 14 of type VI; according to the three-column theory classification: there are 8 cases of two-column fracture and 19 cases of three-column fracture. Bicondylar fractures were treated with medial Tomofix locking plate and anterolateral L-shaped locking plate through medial and anterolateral approach; tibialmedial condylar fractures was treated with T-shaped plate and posteromedial locking plate through extended medial approach. Patients with anterior tibial fractures were treated with horizontal strip plate through modified anterior median approach. Combined soft tissue or bone injury was repaired. The fracture healing and reduction were evaluated by X-ray and CT scan. The reduction of tibial plateau fracture was evaluated by Rasmussen radiology standard, and the knee joint function was evaluated 12 months after the operation by the score of American hospital for special surgery (HSS).Results:All the 27 surgeries were performedsuccessfully. The operation time was 130-350 minutes, with an average time of 165 minutes. Twenty-seven cases were followed up for 12-24 months, with an average period of 15.8 months. All fractures were healed. The average clinical healing time was 13.5 weeks (range, 10-18 weeks). Twelve months after operation, Rasmussen's radiology score was 13-18, with an average of 16.7 points, among them there were 19 excellent and 8 good. Twelve months after the operation, the score of HSS knee joint was 82-98, with an average score of 93.2 points, and there were 22 cases excellent, 4 cases good and 1 case fair. The excellent and good rate was 96.2% (26/27).Conclusion:Complex hyperextension tibial plateau fractures often combined with tibial bicondylar, medial tibial condyle or anterior tibial fractures. According to the morphological characteristics of complex hyperextension tibial plateau fractures, using appropriate surgical approach and internal fixation, repairing ligament soft tissue structure and reconstructing knee joint stability can achieve satisfactory results.
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Objective:To summarize the clinical manifestations, epidemiological features and progress of diagnosis and treatment of gout in the spinal canal.Methods:A 59-year-old male patient was admitted to the hospital due to back pain, weakness in both lower limbs, hypoaesthesia and feeling of walking and stepping on cotton for more than one month. The preoperative imaging examination showed there were space-occupying lesions in the spinal canal at the T 8, 9 level with severe canal stenosis. The patient underwent posterior T 8, 9 laminectomy decompression, debridement and T 7-T 10 pedicle screw internal fixation under general anesthesia. The thoracic spinal gout was diagnosed by postoperative pathology. Further, the following keywords, "gout", "gout of spinal canal", "gout of spine" and "intraspinal gout", were used to search in the Chinese and English databases. A total of 62 patients with intraspinal gout were retrieved. The age, gender, involved disease, history of gout or hyperuricemia, laboratory indicators and imaging data of 63 patients were collected. Results:A total of 63 patients with intraspinal gout were retrieved. The gender of one patient was unknown. The remaining patients included 54 males (87.1%, 54/62) and 8 females (12.9%, 8/62) with the ratio of male to female 6.75∶1. The average age was 52(35, 67) years (range 20-82 years) and the peak onset period was 60-79 years. Fifty-six cases (88.9%, 56/63) of all patients suffered the disease from one single site of the spine, including 26 cases in the lumbar-sacral (46.4%), 22 cases (39.3%) in the thoracic spine and 8 cases (14.3%) in the cervical spine. However, only 7 patients had the disease at more than two sites at the same time accounting for 11.1% of all patients (7/63). Fifty-three patients (91.4%, 53/58) had a history of hyperuricemia with an average duration of 8.6 years (range 3 months to 28 years). The clinical symptoms of intraspinal gout were not specific. There were 70.5% (43/61) patients had local pain and up to 98.4% (60/61) patients had varying degrees of neurological dysfunction. X-ray examinations often showed no positive results due to technical limitations. Among 41 patients with CT imaging data, 31 cases showed mid-to-high density elliptical or irregular calcifications in the spinal canal and the remaining 10 patients showed medium-low density soft tissue masses. There were 96.2% (51/53) of patients with intraspinal gout showed medium or low signal on T1WI MRI examination but without high signal or low signal on T2WI (40 cases of high signal, 13 cases of high signal or mixed signal). All 63 patients were finally diagnosed by pathological examination and 5 of them with histological features. The main pathological features included foreign body granuloma, red-stained crystal-like deposits in the cytoplasm of foreign body giant cells, birefringent spindle or needle-like crystals under polarized light microscope.Conclusion:Gout in the spinal canal is a rare condition. Dual-energy CT has high sensitivity and specificity in identifying gout and it can provide a more accurate method in diagnosis of spinal gout. However, the final diagnosis depends on postoperative pathology. If case of spinal instability or neurological dysfunction, surgery had to be performed. Hyperuricemia should be treated in order to reduce the risk of acute attacks.
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Objective:To study the effect of spleen and marrow strengthening method combined with CAG regimen on the quality of life(QOL) of elderly patients with acute myeloid leukemia with spleen-kidney Yang deficiency syndrome.Methods:From June 2017 to October 2018, 50 elderly patients with acute myeloid leukemia with spleen-kidney Yang deficiency were randomly divided into treatment group and control group by random number table method, with 25 patients in each group.The patients in the control group were treated with CAG regimen(Ara-C+ Acla+ G-CSF), while the patients in the treatment group were treated with CAG regimen and leukemia prescription I, which was the empirical prescription for spleen and kidney Yang deficiency syndrome in elderly patients with acute myeloid leukemia.The patients were treated for two courses.The traditional Chinese medicine (TCM) syndromes and QOL scores of patients in two groups were compared and observed.Results:Before treatment, there was no statistically significant difference in the score of TCM syndromes between the two groups ( P>0.05). After treatment, the improvement of TCM syndromes in the treatment group had statistically significant difference compared with before treatment[before treatment (9.29±4.22)points, after treatment (5.04±3.83)points, t=3.656, P=0.001], but that in the control group had no statistically significant difference ( P>0.05). The treatment group was better than the control group ( t=-2.081, P=0.044). The total effective rate of the treatment group was 58.33% (14/24), which was significantly higher than that of the control group[26.32% (5/19)], and the difference was statistically significant (χ 2=5.831, P<0.05). Before treatment, there was no statistically significant difference in the total score of QOL between the two groups ( P>0.05). After treatment, the scores of QOL in both two groups were improved, the differences were statistically significant[the control group: (40.37±2.93)points vs.(38.21±2.76)points, t=2.337, P=0.025; the treatment group: (41.46±2.57)points vs.(36.54±2.34)points, t=6.929, P=0.000], and the QOL score of the treatment group was better than that of the control group ( t=-2.145, P=0.038). Conclusion:The improvement of TCM syndromes and QOL of elderly patients with acute myeloid leukemia with spleen-kidney Yang deficiency syndrome treated by spleen and marrow strengthening method combined with CAG regimen is better than that treated by CAG chemotherapy alone.
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Objective@#To observe the effect of Yiqi Yangyin Liangxue method on peripheral blood platelet count and CD4+ CD25+ regulatory T cells(Treg) in mice model of immune thrombocytopenic purpura(ITP).@*Methods@#A total of 100 mice were randomly divided into blank control group, model group, Chinese medicine group, hormone group, Chinese medicine+ hormone group, with 20 mice in each group.In addition to the blank control group, the other four groups were intraperitoneally injected with guinea pig anti-mouse platelet serum(APS) to establish the ITP model.The peripheral blood platelet counts of mice in each group were determined by animal blood analyzer before modeling, before and after gavage, and CD4+ CD25+ Treg cells in each group were detected by flow cytometry after gavage.@*Results@#After intragastric administration, compared with the model group, the peripheral blood platelet count of mice in the other groups increased significantly[(413.55±38.84)×109/L, (710.45±124.52)×109/L, (768.10±127.42)×109/L, (908.05±89.66)×109/L, t=-10.18, -11.90, -22.63, all P<0.01], and the proportion of CD4+ CD25+ Treg cells in peripheral blood increased significantly[(1.649±0.286)%, (2.000±0.193)%, (2.286±0.271)%, (2.648±1.883)%, t=-4.54, -7.221, -13.031, all P<0.01]. All indicators of the Chinese medicine+ hormone group had statistically significant differences compared with those of the Chinese medicine group and the hormone group(t=-5.759, -4.107, -10.762, -4.902, all P<0.01).@*Conclusion@#Yiqi Yangyin Liangxue method may up-regulate the expression of CD4+ CD25+ Treg cells in peripheral blood of ITP mice, thereby reducing excessive platelet damage.
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Objective@#To explore the effects of Yiqi Yangyin Liangxue method on platelets, interleukin-10(IL-10) and transforming growth factor beta (TGF-β) of immune thrombocytopenic purpura(ITP) model mice, and to analyze its curative effect and possible mechanism.@*Methods@#A total of 100 ITP model mice were randomly divided into blank group, model group, single Chinese medicine group, single hormone group and Chinese medicine combined with hormone group.Drug intervention was started on the 8th day after the establishment of the model, and the drug was given for a total of 14 days.The blood of mice was collected and the levels of platelets, TGF-β and IL-10 in serum of mice in each group were detected.@*Results@#There was no statistically significant difference in platelet count among all groups before modeling(F=0.556, P>0.05). Before administration, there was statistically significant difference between the model group and the blank group (t=28.207, P<0.01), there were no statistically significant differences between the model group and the traditional Chinese medicine group, hormone group, hormone+ traditional Chinese medicine group (t=-1.96, -0.464, -0.979, all P>0.05). After gastric administration, the platelet counts in the traditional Chinese medicine group[(710.45±124.52)×109/L], hormone group[(768.10±127.42)×109/L], hormone+ traditional Chinese medicine group[(908.05±89.66)×109/L] were significantly higher than that in the model group[(413.55±38.84)×109/L](t=-10.18, -11.90, -22.63, all P<0.01). After gastric administration, there was no statistically significant difference between the traditional Chinese medicine group and the hormone group(t=-1.447, P>0.05). After gastric administration, the platelet count of the hormone+ traditional Chinese medicine group was significantly higher than that of the hormone group and the traditional Chinese medicine group(t=-4.017, -5.759, all P<0.01). There was statistically significant difference in IL-10 level among groups after administration(F=32.20, P<0.01). IL-10 levels between the model group[(20.28±0.75)ng/L] and traditional Chinese medicine group[(21.41±1.40)ng/L], hormone group[(21.79±1.14)ng/L] and traditional Chinese medicine+ hormone group[(23.14±1.34)ng/L] had statistically significant differences (t=-3.18, -4.93, -8.33, all P<0.01). There was no statistically significant difference between the traditional Chinese medicine group and hormone group(t=-0.927, P>0.05). There were statistically significant differences between the traditional Chinese medicine+ hormone group and traditional Chinese medicine group, hormone group (t=-3.97, -3.43, all P<0.01). There was statistically significant difference in TGF-beta level among all groups after administration(F=31.16, P<0.01). The TGF-β levels between the model group[(82.32±3.42)ng/L] and Chinese medicine group[(88.10±8.51)ng/L], hormone group[(90.03±4.50)ng/L] and Chinese medicine combined with hormone group[(94.41±2.53)ng/L] had statistically significant differences (t=-2.82, -6.10, -12.70, all P<0.01). There was no significant difference in TGF-β level between the Chinese medicine group and hormone group(t=-0.90, P>0.05). There were statistically significant differences in in TGF-beta level between the traditional Chinese medicine+ hormone group and Chinese medicine group, hormone group (t=-3.18, -3.79, all P<0.01).@*Conclusion@#Yiqi Yangyin Liangxue method can reduce platelet destruction by regulating the levels of IL-10 and TGF-β and inhibiting immunity, and it has good therapeutic effect on ITP.
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<p><b>INTRODUCTION</b>This study examines the effectiveness of double-marker analysis for α-fetoprotein (AFP) and β-human chorionic gonadotropin (β-hCG) combined with measurement of nuchal fold thickness (NT) in the detection of Down's syndrome (DS) in Mainland Chinese subjects during second trimester prenatal screening.</p><p><b>MATERIALS AND METHODS</b>We examined pregnant women with a singleton pregnancy between 15 and 21 weeks of gestation who underwent second trimester screening for DS using double-marker analysis for AFP and β-hCG combined with ultrasound measurement of NT. The combined risk of DS was calculated. A cut-off of 1/270 was used to define a pregnancy at high-risk of DS. Amniocentesis was offered to all patients with high-risk pregnancies.</p><p><b>RESULTS</b>Using double-marker analysis for AFP and β-hCG in combination with measurement of NT, the detection rate of DS increased from 66.7% to 77.8% when compared with double-marker analysis alone with similar false-positive rates (4.35%, 4.83% respectively). Using receiver operating characteristic curve (ROC) analysis, we determined that the double-marker analysis combined with measurement of NT exhibited an increased area under the curve (AUC) of 0.835 (95% CI: 0.743 to 0.927) when compared to double-marker analysis alone, which had an AUC of 0.748 (95% CI: 0.635 to 0.860). In addition, both methods were more effective than any other single test such as AFP, free β-hCG or NT measurement.</p><p><b>CONCLUSION</b>Second trimester prenatal screening using double-marker analysis for AFP and β-hCG combined with measurement of NT is effective for the detection of DS in Mainland Chinese pregnancies.</p>