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Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Objective To investigate the impact of hyponatremia on the short-term prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).Methods The present study included 324 patients with acute STEMI treated with PCI within 12 hours after admission from March 2014 to May 2016.Patients were divided into three groups according to plasma sodium levels (Na+) at admission:group A with Na+ ＜ 130 mmoL/L,group B with Na + 130-134 mmol/L and group C with Na + ≥ 135 mmol/L (normal plasma sodium level).Clinical data and biochemical variables were compared among the three groups.Logistic regression analysis was used to examine the correlation between plasma sodium levels and short-term prognosis.Results There were significant differences in age,fasting glucose,NT-proBNP,LVEF (left ventricular ejection fraction) and hsCRP (high sensitive C-reactive protein) among the three groups (P ＜ 0.05).The mortality in group A was obviously higher than that in Group B (20.0％ vs.6.3％,P ＜ 0.05) and in group C (20.0％ vs.6.0％,P ＜ 0.05).In addition,there were significant differences in rates of cardiogenic shock and acute renal failure among three groups.Logistic regression analysis showed that old age,low LVEF and hyponatremia were independent risk factors for 30-day mortality (P ＜ 0.05).Compared with group B,patients in group A had significantly high risks of death (OR =3.058,95％ CI:1.339-4.358,P =0.003),suggesting that the high risk of 30-day mortality associated with the severity of hyponatremia.Conclusions At admission,the hyponatremia in patients with acute STEMI treated with PCI is an independent risk factor for 30-day mortality,and prognosis worsens with the severity of hyponatremia.
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Objective: To explore the effect of therapeutic application of pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound and holmium laser lithotripsy for complex kidney stone. Methods: 124 patients with complex renal calculus were selected and divided into observation group (62 cases) and control group (62 cases) as randomly number table. The patients of observation group were cured by pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound while patients of control group were cured by holmium laser lithotripsy. A series of correlative indicators, such as some correlative indexes in during and post operation, complication situation of post operation and kidney function, were compared. Results:The differences about bleeding volume during operation and postoperative hospital stay between the two groups were significant (t=12.475, t=7.659, P<0.05). For clearance rate of calculus and incidence of complication, the differences between the two groups were significant (x2=6.048, x2=7.159, P<0.05). And the differences of separation index of renal pelvis collective system, creatinine and urea nitrogen post treatment between the two groups also were significant (t=8.529, t=7.058, t=10.596, P<0.05). Conclusion: Comparing with the traditional holmium laser lithotripsy, the clinical better effect of pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound for complex renal calculi is significant. Its series of advantages, such as shorter operation time, faster recovery, safer and reliable for patients and lower incidence of postoperative complication and so on, can effectively relieve the renal function for patients.
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Objective To observe the clinical efficacy of the TESSYS (transforaminal endoscopic spine system) technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine for the treatment of lumbar disc herniation.Methods Thirty-nine patients with lumbar disc herniation were treated by the TESSYS technique of percutaneous transforaminal endoscopic discectomy,and then received oral use of modified herbal medicine Xubi Recipe,a formula mainly having the actions of tonifying kidney and strengthening governor vessel for 4 weeks after the operation.The visual analogue scale (VAS) and Oswestry disability index (ODI) and modified MacNab criteria were employed to assessed the surgical outcomes before the operation,and 3 and 6 months after the operation.Results (1) All of the 39 cases completed the operation successfully,and were followed up for 6-12 months after the operation.(2) Three and 6 months after the operation,the VAS scores and ODI scores were obviously lower than those before the operation,and the differences were significant (P ＜ 0.05).(3) Six months after the operation,the excellent rate of clinical efficacy assessed by modified MacNab criteria was 89.74％.(4) Only 4 cases had severer transient pain and numbness in the affected limbs,and there was no occurrence of complications of permanent neural root trauma,dural tear,vascular injury,intestinal damage,spondylodiscitis or retroperitoneal hematoma.Conclusion The TESSYS technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine is effective for the treatment of the lumbar disc herniation with the advantages of satisfactory short-term effect,less bleeding,less trauma,faster recovery and less complications.
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Objective To investigate the effect of herbs for nourishing kidney and strengthening governor vessel on postoperative intervertebral fusion rate in elderly patients with degenerative lumbar spinal stenosis ( DLSS) . Methods A retrospective analysis was carried out for the clinical data of 72 elderly DLSS patients treated with modified transforaminal lumbar interbody fusion (TLIF) during the period from October, 2012 to October, 2013. The patients were divided into two groups, 39 in Chinese medicine group and 33 in control group. Operative efficacy was evaluated with Japanese Orthopaedic Association ( JOA) scores for assessment of cervical myelopathy, postoperative function improvement was evaluated by Oswestry disability index (ODI) scores, and lumbar interbody fusion was evaluated by the modified Brantigan scores. Results (1) During the follow-up period, patients of the two groups had no complications such as screw breaking or loosening, cage displacement, or endplate collapse. (2) Before opera tion and 3 days after operation, the differences of JOA scores were insignificant between the two groups (P>0.05) . (3) Significant difference of intragroup ODI scores were shown 12 months after operation vs 6 months after operation, and between 6 months after operation and pre-operation in the two groups (P<0.01) . ODI scores of Chinese medicine group 6 and 12 months after operation were lower than those of the control group, the difference being significant ( P<0.05 or P<0.01) . ( 4) The results of modified Brantigan scoring showed that the interbody fusion rate 6 months after operation was 71.79% in Chinese medicine group, higher than 48.48% in the control group ( P<0.05) . Twelve months months after operation, the interbody fusion rate was 87.18% in Chinese medicine group, higher than 66.67% in the control group (P<0.05) . Conclusion Herbs for nourishing kidney and strengthening governor vessel may improve the lumbar interbody fusion rate and the quality of life of the elderly DLSS patients treated by modified TLIF.
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Objective To observe the clinical efficacy of qi-based acupuncture treatment in treating chronic gastritis due to liver-stomach disharmony. Methods Totally 120 patients with chronic gastritis due to liver-stomach disharmony were randomized into group A, group B, and group C, 40 in each group. Group A was intervened by qi-based acupuncture treatment; group B was by medication;group C was by sham acupuncture by selecting points 1 cm away from the points selected in group A. The therapeutic efficacies were evaluated after 4-week treatment. Results The total effective rate was 95.0%in group A, versus 75.0%in group B and 45.0% in group C, and the total effective rates in group A and B were significantly different from that in group C (P<0.01, P<0.05). The total effective rate in group A was significantly different from that in group B (P<0.05). Conclusions Qi-based acupuncture treatment is an effective approach in treating chronic gastritis due to liver-stomach disharmony.
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Associations between "lipid-related" candidate genes, blood lipid concentrations and coronary artery disease (CHD) risk are not clear. We aimed to investigate the effect of three newly identified lipids loci from genome-wide association studies on CHD and blood lipid levels in Chinese Han population. The genotypes of SNPs at three newly identified lipid loci and blood lipids concentrations were examined in 1360 CHD patients and 1360 age- and sex-frequency matched controls from an unrelated Chinese Han population. Allele T of rs16996148 occurred less frequently in CHD patients with the odds ratio (OR) being 0.64 (95% CI 0.50 to 0.81), after adjusting for conventional risk factors and was associated with a 33% decreased CHD risk (P<0.01) comparing with the major allele G. Individuals with GT genotype had the lowest CHD risk. No associations were found between the polymorphisms of other two loci with CHD risk and all three SNPs had no effect on lipid profile in this population. SNP rs16996148 on chromosome 19p13 is significantly associated with lower risk for CHD in Chinese Han population. However, it remains unresolved why these lipid-related loci had significantly less effects than the correspondingly expected effects on blood lipids levels in this population.
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Based on investigating the protection and possible mechanism of LC on acute hepatic injury in mouse induced by medicine,we discussed the procedure of scientific research and analyzed in detail the enlightenment in the experiment.
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Objective To investigate effects of endothelial adhesion molecule platelet endothelial cell odhesion molecule-1(PECAM-1),intercellular adhesion molecule-3(ICAM-3) and CD44 on lymphangiogenesis. Methods The lymphatic endothelial cells of the canine thoracic ducts were isolated and incubated.PECAM-1,ICAM-3 and CD44 on the lymphatic endothelial cells were labeled and visualized under fluorescence microscope and confocal laser scanning microscope.The endothelial cells stimulated by TNF-? or LPS were treated with the blocking antibodies against PECAM-1, ICAM-3 and CD44 respectively.The proliferation and migration of cells were determined with cell counting. The three-dimensional collagen gel model of lymphangiogenesis was prepared, and then the tube formation was viewed. The total length and area of the tubes formed from lymphatic endothelial cells were measured and their characteristics were examined with a transmission electron microscope. Results PECAM-1, ICAM-3 and CD44 were expressed on the lymphatic endothelial cells. In the control, TNF-? and LPS groups, the percentage of the migrated cells decreased and the total length and area of the tubes reduced after PECAM-1, ICAM-3 and CD44 of the cells were blocked respectively. The proliferated cells reduced after PECAM-1 or CD44 of the cells were blocked. However, there were no significant changes in the numbers of proliferated cells when ICAM-3 of the cells was blocked. In the semi-ultrathin and ultrathin sections, the tube structures formed by lymphatic endothelial cells were similar to lymphatic capillary.Conclusion PECAM-1, ICAM-3 and CD44 are expressed on the cultured lymphatic endothelial cells. These adhesion molecules are involved in lymphangiogenesis that includes proliferation, migration and tube formation of endothelial cells.