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ObjectiveTo systematically review the existing studies on Xueshuantong for injection（lyophilized） in the treatment of acute cerebral infarction（ACI）， and to clarify the clinical value of Xueshuantong for injection（lyophilized） through comprehensive clinical evaluation， so as to promote clinical rational drug use and relevant policy transformation. MethodEvidence of Xueshuantong for injection（lyophilized） in terms of safety， effectiveness， economy， innovation， suitability， accessibility， traditional Chinese medicine（TCM） characteristics（6+1 dimensions） and information service was comprehensively collected. Evidence-based medicine， questionnaire survey， health technology assessment， pharmacoeconomic evaluation and other research methods were used， and the multi-criteria decision analysis model was used to measure each dimension， in order to comprehensively evaluate the clinical value of Xueshuantong for injection（lyophilized）. ResultSpontaneous reporting system， Meta-analysis of adverse reactions， and active safety monitoring study showed that the main adverse reactions of Xueshuantong for injection（lyophilized） were rash， pruritus， chest tightness， headache， dizziness and other general adverse reactions， the incidence of serious adverse reactions was judged to be rare， the known risk was small， the evidence was sufficient， and the safety evaluation was grade A. The results of Meta-analysis showed that Xueshuantong for injection（lyophilized） combined with conventional treatment for ACI was superior to conventional treatment in terms of improving neurological deficit score， improving daily activity score and clinical efficacy， and the effectiveness evaluation was grade B. The results of pharmacoeconomic evaluation showed that Xueshuantong for injection（lyophilized） combined with conventional treatment was relatively economic compared with conventional treatment alone， with the total clinical effective rate as the effect parameter， but the incremental effect was not significant， the economic evaluation was grade B. In addition to ACI and unstable angina of coronary heart disease， the drug also had good clinical efficacy in central retinal vein occlusion， and had a wider range of indications and awarded 16 patents， and its innovation evaluation was grade B. The suitability of medical personnel and patients was good without special technical and management requirements， and the suitability was evaluated as grade B. Xueshuantong for injection（lyophilized） had reasonable price， good affordability， certain prescription restrictions and general availability， the accessibility evaluation was grade B. Since the drug is an injection of effective parts of TCM， no grade evaluation of its TCM characteristics is conducted. The legal and non-legal information evaluation results of Xueshuantong for injection（lyophilized） showed that all the information was complete and in accordance with the requirements of national standards. Based on the grade scores of the 6 dimensions， the clinical comprehensive evaluation of Xueshuantong for injection（lyophilized） in the treatment of ACI was calculated as category B by CSC 2.0. ConclusionThe clinical value of Xueshuantong for injection（lyophilized） is good， and it is suggested that it can be directly translated into relevant policy outcomes for basic clinical medication management.
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Objective@#To investigate the clinical efficacy of subacromial anterolateral small incision approach with open reduction and internal fixation with proximal humeral locking system (PHILOS) for proximal humeral fractures.@*Methods@#A retrospective case-control study was conducted to analyze the complete medical records of 76 patients with proximal humeral fractures admitted to the Department of Traumatic Surgery, Fujian Provincial Hospital from April, 2013 to December, 2017. There were 22 males and 54 females, aged from 25 to 89 years [(60.4±16.4)years]. All patients had closed fractures. According to Neer classification, there were 12 patients of type II, 46 patients of type Ⅲ, and 18 patients of type IV. The duration from injury to operation ranged from 1 to 10 days [(4.4±1.9)days]. All patients received treatment of open reduction fixation with PHILOS. Forty patients received subacromial anterolateral small incision approach with percutaneous interactive reduction and internal fixation of humerus head and humerus shaft, including four patients of Neer type II, 26 patients of type III, and 10 patients of type IV (minimally invasive group). Thirty-six patients received the deltopectoral approach with reduction and internal fixation, including eight patients of type II, 20 patients of type III, and 8 patients of type IV (conventional group). The total length of incision, the operation time, intraoperative blood loss, hospitalization time, review of the neck angle with X-ray 1 week after surgery, and the fracture healing after 6 months, the ipsilateral Neer shoulder joint function score at 6 months after surgery and complications were compared.@*Results@#All patients were followed up for 3-12 months [(9.2±1.7)months], and there were six patients lost to the follow-up including four of the minimally invasive group and two of the conventional group. In the minimally invasive group and the conventional group, the total length of incision was 6.0(6.0, 6.8)cm and 11.5(10.0, 15.0)cm ( P<0.01), the operation time was (122.2±31.8)minutes and (136.9±36.6)minutes ( P>0.05), the intraoperative blood loss was 100(80, 150)ml and 175(100, 200)ml (P<0.01), the hospitalization time was (15.3±8.3)days and (16.2±5.1)days (P>0.05), the neck-shaft angle was (134.7±2.5)° and (134.6±2.6)°(P>0.05). A total of 70 patients obtained good bone healing. At 6 months after operation, the Neer shoulder function score of the affected side in the minimally invasive group was excellent in 30 patients, good in four patients, and fair in two patients, with the excellent and good rate of 96%, and for conventional group the score was excellent in 20 patients, good in eight patients, and fair in six patients, with the excellent and good rate of 84%(P<0.05). There was no complication in the minimally invasive group, but axillary nerve injury was found in one patient in the conventional group.@*Conclusion@#For the proximal humerus fracture, compared with the traditional deltopectoral approach, the subacromial anterior lateral small incision approach with percutaneous humeral head and humeral shaft reduction and interal fixation has the advantages of smaller incision, less bleeding and better functional recovery, which is a minimally invasive and effective treatment.
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Objective To investigate the clinical efficacy of subacromial anterolateral small incision approach with open reduction and internal fixation with proximal humeral locking system (PHILOS) for proximal humeral fractures.Methods A retrospective case-control study was conducted to analyze the complete medical records of 76 patients with proximal humeral fractures admitted to the Department of Traumatic Surgery,Fujian Provincial Hospital from April,2013 to December,2017.There were 22 males and 54 females,aged from 25 to 89 years [(60.4 ± 16.4)years].All patients had closed fractures.According to Neer classification,there were 12 patients of type Ⅱ,46 patients of type Ⅲ,and 18 patients of type Ⅳ.The duration from injury to operation ranged from 1 to 10 days [(4.4 ± 1.9)days].All patients received treatment of open reduction fixation with PHILOS.Forty patients received subacromial anterolateral small incision approach with percutaneous interactive reduction and internal fixation of humerus head and humerus shaft,including four patients of Neer type Ⅱ,26 patients of type ⅢH,and 10 patients of type Ⅳ (minimally invasive group).Thirty-six patients received the deltopectoral approach with reduction and internal fixation,including eight patients of type Ⅱ,20 patients of type Ⅲ,and 8 patients of type Ⅳ (conventional group).The total length of incision,the operation time,intraoperative blood loss,hospitalization time,review of the neck angle with X-ray Ⅰ week after surgery,and the fracture healing after 6 months,the ipsilateral Neer shoulder joint function score at 6 months after surgery and complications were compared.Results All patients were followed up for 3-12 months [(9.2 ± 1.7) months],and there were six patients lost to the follow-up including four of the minimally invasive group and two of the conventional group.In the minimally invasive group and the conventional group,the total length of incision was 6.0(6.0,6.8) cm and 11.5 (10.0,15.0) cm (P ＜ 0.01),the operation time was (122.2 ± 31.8) minutes and (136.9 ± 36.6) minutes (P ＞ 0.05),the intraoperative blood loss was 100 (80,150) ml and 175 (100,200) ml (P ＜ 0.01),the hospitalization time was (15.3 ± 8.3) days and (16.2 ± 5.1) days (P ＞ 0.05),the neck-shaft angle was (134.7 ± 2.5) ° and (134.6 ± 2.6) ° (P ＞ 0.05).A total of 70 patients obtained good bone healing.At 6 months after operation,the Neer shoulder function score of the affected side in the minimally invasive group was excellent in 30 patients,good in four patients,and fair in two patients,with the excellent and good rate of 96％,and for conventional group the score was excellent in 20 patients,good in eight patients,and fair in six patients,with the excellent and good rate of 84％ (P ＜ 0.05).There was no complication in the minimally invasive group,but axillary nerve injury was found in one patient in the conventional group.Conclusion For the proximal humerus fracture,compared with the traditional deltopectoral approach,the subacromial anterior lateral small incision approach with percutaneous humeral head and humeral shaft reduction and interal fixation has the advantages of smaller incision,less bleeding and better functional recovery,which is a minimally invasive and effective treatment.
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Objective To investigate the clinical effect of blocking nail in treatment of hypertrophic nonunion after interlocking intramedullary nailing of femoral shaft fractures.Methods A retrospective case series study was made on 11 patients with hypertrophic nonunion following interlocking intramedullary nailing of femoral shaft fractures from January 2006 to February 2016.There were 8 males and 3 females,aged (32.4 ± 6.8) years (range,19-48 years).Comminuted fractures were noted in three patients,long oblique or spiral fractures in two,multi-segment fractures in two,and transverse fractures in four.Time interval between this surgery and intramedullary nailing of femoral shaft fractures was (11.5 ±3.1) months (range,6-18 months).All blocking nails were inserted into pulp cavity of distal ends of the site of the bone nonunion.Fracture healing time,wound healing and postoperative complications were detected.Outcome was evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).Results All patients were followed up for (27.2 ± 4.6) months (range,24-36 months).Bone union was observed within (9.8 ± 3.4) months except that bone nonunion occurred in two cases requiring locking plate fixation and autologous bone grafting to provide union,with the healing rate of 91％.No wound infection,nail breakage and nail loosening occurred after operation.At postoperative 3 months,4 months,5 months,6 months,12 months and 24 months,VAS and ODI differed significant from the preoperative detections (P ＜ 0.05).Conclusion Blocking nail technique is associated with increased stability of intramedullary nails and fracture ends,low incidence of complications and high bone healing rate in treatment of hypertrophic nonunion after femoral interlocking intramedullary nailing.
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Objective To investigate the clinical characteristics of cervical spine injury associated with chest injury by contrast with simple cervical spine injury.Methods A retrospective analysis was performed on records of 116 patients with cervical spine injury hospitalized from March 2009 to September 2014.There were 65 patients with simple cervical spine injury (simple injury group) and 51 patients with associated chest injury (associated injury group).Data recorded were the causes of injury, injury segment, treatment choices (tracheotomy rate, mechanical ventilation use and non-operative treatment), treatment time (operation rate at different time, time from injury to operation and length of hospital stay) , complications (electrolyte disorder, respiratory infection, respiratory dysfunction or failure, urinary tract infection, gastrointestinal bleeding and multiple organ dysfunction syndrome), and treatment outcome.Results The main cause of injury for the two groups was high falling.Lower cervical segment was the most likely to be affected.Significant differences were detected between the simple injury group and associated injury group with regard to tracheotomy rate (63％ vs.42％), rate of mechanical ventilation (41％ vs.25％), rate of early surgery (29％ vs.58％), rate of delayed surgery (69％ vs.30％), time from injury to operation [(7.2 ± 3.7) d vs.(3.1 ± 1.3) d], length of hospital stay [(22.6-± 5.5) d vs.(17.3 ± 3.7)d], electrolyte disorder rate (35％ vs.17％), incidence of respiratory system infection (55％ vs.35％), and respiratory dysfunction (43％ vs.25％) (P ＜0.05).After treatment, American Spinal Injury Association (ASIA) scale for grade D was significantly lower in associated injury group than in simple injury group (25％ vs.39％ P ＜ 0.05).Conclusion Cervical spine injury associated with chest injury is severe injury, often requiring tracheotomy and mechanical ventilation, and demonstrates difficulties to be effectively treated in the early phase, long hospitalization, various complications and high morbidity.
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A three-dimensional (3D) transrectal ultrasound (TRUS) imaging system is presented in this paper. The 3D imaging system is used for diagnosing diseases of prostate. The 3D image is reconstructed by a series of two-dimensional image data which is obtained through rectum. It can be a guide to prostate needle biopsies. The system is built by two parts: hardware and software. In the hardware, the mechanical device, stepper motor, control circuit, B Mode TRUS and personal computer (PC) workshop are presented. The software includes the firmware of micro control unit and software of the PC workshop. In order to evaluate the performance of the 3D imaging system, we did experiments with water and agar phantoms, and the results demonstrated the system's ability of 3D imaging with high-precision.
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Humans , Male , Biopsy, Needle , Imaging, Three-Dimensional , Phantoms, Imaging , Prostate , Diagnostic Imaging , Rectum , Software , UltrasonographyABSTRACT
Objective To investigate the curative effect of damage control theory in treating severe polytrauma patients combined with bone and joint injury. Methods A retrospective study was done on data including complication, death rate, fracture healing and joint function recovery of 63 patients with severe polytrauma combined with bone and joint injury( average ISS ≥27 points) admitted to our hospital from January 2006 to June 2009. Results Of all the patients, 57 shock patients were cured,three died of hemorrhagic shock within two hours after admission and one patient died of severe traumatic brain injury 11 hours after admission. One patient died of ARDS at 24 hours postoperatively and one died of multiple organ failure at day 6 after injury. Fracture healing was achieved in 52 patients, with satisfactory recovery of the limb function. Amputation was performed in two patients and three patients had mild claudication and pain walking. Conclusion Damage control strategy has great clinical significance in guidance of treatment of severe polytrauma combined with bone and joint injury.
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AIM:To research the characteristics of ventricular electrophysiology in right ventricular rapid pacing-induced congestive heart failure (CHF) dogs. METHODS:Dogs (n = 16) were randomly divided into 2 groups:the control (n = 7) and the CHF group (n = 9) induced by rapid right ventricular pacing at 240 pulse·min-1 for 4 to 5 weeks. The electrophysiologic parameters were evaluated by the technique of standard electric stimulation and monophasic action potential (MAP) recording. RESULTS:(1) Ventricular effective refractory period (VERP), ventricular MAP duration (MAPD90), ventricular late repolarization duration (VLRD) and intra- ventricular conduction time (IVCT) were prolonged by 26％ (P ＜ 0. 01), 43％ (P ＜ 0. 01), 318％ (P ＜ 0. 05), and 19％ (P ＜ 0. 01), respectively in CHF group. (2)The ratio of VERP to MAPD90(VERP/MAPD90) was decreased by 13％ (P＜0.05) in CHF group. (3) The dispersion of ventricular recovery time (VRT - D) was increased by 185％ (P ＜0. 01) in CHF group. (4) The ventricular fibrillation threshold (VFT) was decreased by 48％ (P ＜ 0. 01) in CHF group. CONCLUSION:The abnormal electrophysiological changes in the CHF condition may be contributing factors of lethal ventricular arrhythmias and sudden cardiac deaths in CHF.
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[Objective]To explore clinical class,surgical treatment and clinical results of clavicle fracture with internal fixation.[Method]A retrospective analysis of 146 cases of clavicle fracture was reported.Totally 146 cases of clavicle fracture accepted by our department from January of 1996 to June of 2006 were carried out the operation using plate shaft.There were 98 males and 78 females.Aged from 8 to 84 years,average of 38.6 years.The average age of the patients at surgery were 38.6 years(ranged 8 to 84 years).There were 9 cases in proximal 1/3,115 cases in middle 1/3 and 12 cases in distal 1/3 of clavicle,accompanied by 7 cases of brachial-plexus injury,4 cases of vascular injury,16 cases of another fracture.There were 7 cases of old clavicle fracture.Surgical methods: Both proximal 1/3 and middle 1/3 of clavicle fracture were treated by AO reconstruction plate or similar plate.Fracture pieces of clavicle were enlaced with screws or steel wire before fixation with plate.The distal of clavicle fracture should be fixed with 3 screws.The distal 1/3 of clavicle fracture with acromioclavicular luxation was treated by reconstruction plate or c clavicle hook plate.Patient could exercise their shoulder joint at 48 hours postoperatively.Post operative evaluation: Clinical results of clavicle fracture with internal fixation were evaluated with appearance,fracture healing time, shoulder joint function and living quality around fracture.[Result]Patients were followed up more than 6 months after operation.Adopt Neer standard to evaluate the patient's function after the operation.There were excellent results in 96 cases and good in 50 without injury of subclavicular nerve and blood vessel,infection,loose and prolapse of internal fixation devices and fracture disunion and malunion and macrosis bony callus.X-ray shows clavicle fracture healing completely.The patients can get painless free-running.[Conclusion]Internal fixation for treatment of clavicle fracture is characterized by little wound,firm fixation and early movement of the joint and is an effective method to cure clavicle fracture.
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【Objective】To evaluate the impact of stent implantation on proliferation and apoptosis in media vascular smooth muscle cells and to explore the mechanism of restenosis after stent implantation.【Methods】Fifty male New Zealand rabbits were randomized into balloon group and stent group.Control group were set up.The materials were harvested on 3,7,14,28 and 56 day after operation and the following investigation were carried out.① Assessing the expression of proliferating cell nuclear antigen (PCNA) and Cyclin E of media smooth muscle cells with immunohistochemistry;② Analyzing apoptosis of media smooth muscle cells by TUNEL technique.【Results】The expressions of PCNA,Cyclin E and apoptosis in stent and balloon groups were markedly increased compared to control groups.① Stent group induced significant increased expression of PCNA and Cyclin E in the media smooth muscle cells compared to balloon group.On day 7,the positive rates of PCNA and Cyclin E were 24.36±0.55% vs 18.74±1.09% (P<0.01) and 22.65±1.00% vs 17.68±1.10% (P<0.01) respectively;② Stent group induced much more significant apoptosis than balloon group.The highest rate of apoptosis appeared on day 7:12.46±1.13% vs 5.54±0.53% (P<0.01);③By calculating the ratio of positive rates of PCNA to apoptosis and Cyclin E to apoptosis respectively,the ratio of balloongroup was higher than that of stent group.【Conclusion】Stent group induces augmented proliferation and much more significant apoptosis of media smooth muscle cells compared to balloon group.It shows that the severity of restenosis is relieved after stent implantation.
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AIM: To investigate the changes of intrarenal endothelin system in the course of congestive heart failure. METHODS: A canine congestive heart failure model induced by rapid right ventricular pacing was used in the present study. Twenty-one mongrel dogs divided randomly into 3 groups: control, congestive heart failure 2 weeks(CHF2) and congestive heart failure 4 weeks (CHF4). The severity of heart failure was evaluated by means of hemodynamic measurement. The concentration of plasma endothelin was detected via RIA, and the expression of endothelin was detected by RT-PCR. RESULTS: The concentration of plasma endothelin in both of CHF2 and CHF4 elevated significantly. In CHF2, the expression of endothelin receptor B(ETB) in renal medulla increased significantly. And in CHF4, the expression of preproendothelin, endothelin receptor A(ETA) and ETB increased both in renal cortex and medulla. Furthermore, in cortex, the expression of ETA increased more significantly than ETB, while in medulla, ETB expressed much more than ETA. CONCLUSION: The changes of renal endothelin system expression plays a role in the regulation of water and electrolyte balance during the progress of congestive heart failure.
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AIM: To evaluate expression of the components of endothelin system in pulmonary tissue in a canine pacing-induced congestive heart failure model. METHODS: Twenty-one dogs were divided into 3 groups received 2 (pacing 2 group) or 4 weeks (pacing 4 group) rapid right ventricular pacing, respectively, whereas the other group consisted of 7 dogs received sham-operation as control group. Haemodynamic parameters were detected via left and right heart catheterization. Plasma endothelin-1 was determined by means of RIA. In addition, RT-PCR was used to quantify expression of mRNA of components of endothelin system using ?-actin as internal control. One-way ANOVA and linear regression analysis were used for statistical study. RESULTS:Plasma endothelin-1 increased significantly in heart failure animals. The ratio of preproET-1 to ? actin mRNA was significantly increased from 0.14?0.06 in control group to 0.35?0.08 in pacing 2 group and 0.53?0.08 in pacing 4 group ( P