ABSTRACT
Objective:To analyze the risk factors of clinically significant bleeding in patients with severe acute pancreatitis (SAP).Methods:The clinical data of SAP patients who were managed at Changhai Hospital affiliated to Naval Medical University from January 1, 2014 to October 31, 2022 were retrospectively analyzed. Twenty-nine SAP patients with clinically significant bleeding were classified to form the bleeding group. There were 23 males and 6 females, aged (56.25±14.01) years old. Another 116 SAP patients with similar general data but with no clinically significant bleeding during the same hospitalization period were included to form the non-bleeding group based on a ratio of 1∶4. There were 94 males and 22 females, aged (56.14±13.96) years old in this non-bleeding group. The general data, modified CT severity index (MCTSI), bedside index for severity of acute pancreatitis (BISAP) and other clinical data of the two groups were collected to determine the risk factors of bleeding in SAP patients.Results:Of the 29 patients with bleeding, 6 had gastrointestinal bleeding, 14 had intra-abdominal bleeding, and 9 had mixed bleeding sites, 15 were cured and discharged, and 14 died. All the 29 SAP patients with bleeding received treatment using drugs. In addition, 8 patients underwent successful hemostasis using digital subtraction angiography, 3 underwent successful endoscopic hemostasis, 2 underwent successful surgical hemostasis, and 2 underwent successful conservative drug hemostasis. Multivariate logistic regression analysis showed that SAP patients with higher MCTSI ( OR=1.824, 95% CI: 1.187-2.802), longer prothrombin time (PT) ( OR=3.431, 95% CI: 1.470-8.007) and higher BISAP ( OR=2.286, 95% CI: 1.054-4.957) had an increased risk of bleeding (all P<0.05). Conclusion:The prognosis of SAP patients was compromised with bleeding. High MCTSI, prolonged PT, and high BISAP were independent risk factors for bleeding in SAP patients.
ABSTRACT
Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.
ABSTRACT
Objective To analyze the influence of ligaments surrounding sacroiliac joints (SIJs) on stability of SIJs by finite element method. Methods The finite element lumbar spine-pelvis-femur model was established. Based on this normal model, all SIJ ligaments in both sides were removed in turn, to establish models without iliolumbar ligaments, sacroiliac anterior ligaments, sacroiliac posterior ligament, sacrotuberous ligaments, sacrospinous ligaments, sacroiliac interosseous ligaments, respectively. The models were used to simulate physiological motions of the spine. The range of motion (ROM) and average stress on the left and right SIJs were analyzed and compared with the normal models. Results Compared with the normal SIJ model, no significant differences in the ROM of bilateral SIJs were found in the models without sacrotuberous ligaments, sacrospinous ligaments and sacroiliac posterior ligaments; for the model without acroiliacinterosseous ligaments, there was no significant difference in the ROM of the left SIJs under spinal right rotation and ROM of the right SIJs under spinal extension, but the ROM of bilateral SIJs increased significantly under the other spinal physiological activities. Under the physiological activities of the spine, the average stress of the SIJ surface in the left and right sides of the model without acroiliacinterosseous ligaments significantly decreased. Conclusions Of all the sacroiliac ligaments, the sacroiliac interosseous ligaments showed the maximum influences on the stability of SIJs. The research findings are helpful to investigate the mechanism of SIJ subluxation and provide certain theoretical basis for clinical treatment of SIJ subluxation.
ABSTRACT
BACKGROUND: Cervical rotation manipulation is a non-surgical method of cervical spondylosis, showing significant treatment efficacy. But the safety for patients with carotid artery atherosclerosis remains obscure. OBJECTIVE: To analyze the hemodynamic changes of atherosclerotic carotid arteries treated by cervical rotatory manipulation, and to explore the effect of cervical rotatory manipulation on the hemodynamics of atherosclerotic plaque. METHODS: Eight cases of stenosis of ramification of the carotid artery with plaque on MRI. The hemodynamic model of carotid artery atherosclerosis was established, assigned with general boundary conditions and simulated the cervical stretch during cervical rotatory manipulation. All models were grouped and stretched into 0％ (control group), 7％ and 16％ stretch to simulate the hemodynamic changes of atherosclerotic plaque. The hemodynamic parameters, including average wall shear stress, the maximum wall shear stress, the average maximum wall shear stress, the blood velocity of the plaque, and blood flow vectorgraph were compared among groups. RESULTS AND CONCLUSION: (1) All hemodynamic parameters had no significant differences between 7％ stretch and control groups (P＞ 0.05). Compared with the control group, the wall shear stress, the maximum wall shear stress, and the maximum wall shear stress in the 16％ stretch group were significantly increased (P ＜ 0.05), and other indexes showed no significant differences. (2) In summary, different stretches by cervical rotatory manipulation possess different effects on plaque, and a 16％ stretch may affect the hemodynamics of plaque.
ABSTRACT
Objective To explore the effect of cervical rotatory manipulation on tensile mechanical properties of carotid artery with atherosclerotic plaque.Methods Thirty healthy male New Zealand rabbits were selected and randomly divided into experimental group,model control group and blank control group.Carotid atherosclerosis models were made in the experimental group and model control group.The experimental group received the intervention of cervical rotatory manipulation,but the model control group did not.The blank control group did not receive any intervention.After 3 groups received different interventions,their differences in tensile mechanical properties of rabbit carotid artery were observed.Results The ultimate strain,ultimate load and physiological elastic modulus of rabbit carotid arteries in 3 groups were statistically significant (P ＜0.05);The ultimate strain in the experimental group was 24.87％ and 52.09％ lower than that in the model control group and blank control group,respectively;the ultimate load in the experimental group was 2.21 and 3.47 times of the model control group and blank control group,respectively;the physiological elastic modulus in the experimental group was 1.60 and 1.89 times of the model control group and blank control group,respectively.Conclusions Compared with normal carotid artery,the presence of carotid atherosclerotic plaque will reduce tensile mechanical properties of the carotid artery,and cervical rotatory manipulation will further reduce tensile mechanical properties of the carotid artery with carotid atherosclerotic plaque.Therefore,for patients with carotid atherosclerotic plaque,it is better to avoid cervical manipulation.
ABSTRACT
BACKGROUND:Anterior cruciate ligament (ACL) injury is a commonly sport-induced knee joint injury that does serious harm to the knee stability. ACL reconstruction is a commonly used treatment method, but researches on 1/2 peroneus longus tendon (PLT) graft are rarely reported. OBJECTIVE: To investigate the clinical outcomes of removing the autologous ipsilateral 1/2 PLT under arthroscopy for ACL reconstruction. METHODS:106 patients with complete ACL rupture in the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University from December 2010 to December 2014 were enrolled, and autologous ipsilateral 1/2 PLT was removed under arthroscopy for ACL reconstruction. At baseline, 3, 6 and 12 months postoperatively, the knee stability was evaluated manually through the anterior drawer test, Lachman test, and pivot-shift test, and the knee function was evaluated by Tegner activity scale, Lysholm and International Knee Documentation Committee scores. RESULTS AND CONCLUSION: Postoperative anterior drawer test, Lachman test, and pivot-shift test tests were negative in all patients. In terms of Tegner activity scale, Lysholm and International Knee Documentation Committee scores, there were significant differences at baseline and postoperative 3 months as compared with postoperative 6 months (P 0.05). These results indicate that autologous ipsilateral 1/2 PLT is a good choice for ACL reconstruction under arthroscopy, achieving rapid and satisfactory functional recovery of the knee joint, which is not only minimally invasive and easy to operate, but also exhibits good therapeutic efficacy.
ABSTRACT
Objective To investigate the effects of Xinshang Xuduan Decoction(XXD, mainly composed of Rhizoma Drynariae, Radix Dipsaci, and Eupolyphaga seu Steleophaga) on the proliferation and differentiation of rat osteoblasts and bone morphogenetic protein 2(BMP-2)expression in the osteoblasts . Methods The animal serum containing XXD was prepared by serum pharmacological method and then was mixed together with α-MEM for the cell culture. Osteoblasts were isolated from the skull bone of SD neonatal rats by collagenase digestion and were identified by alkaline phosphatase(ALP) staining and alizarin red staining. The third and fourth generations of osteoblasts were treated with XXD at the volume fraction of 5%, 10%, 20% for 24, 48 , 72 hours respectively, and then the proliferation of the cells was evaluated by Cell Counting Kit-8(CCK-8). In the other test, osteoblasts were cultured with blank control serum, and 10% serum containing XXD, Radix Dipsaci, and Rhizoma Drynariae, respectively, and then the ALP activity was examined by using ALP assay kit and the expression of BMP-2 was investigated by enzyme-linked immunosorbent assay(ELISA). Results XXD had a dose- and time-dependent effect on the proliferation of rat osteoblasts in a suitable volume fraction range from 5% to 20%, and the effect of XXD at 10% was the best. Compared with the blank control serum group, ALP activity was increased in the cells treated with 10% serum containing XXD, Radix Dipsaci, and Rhizoma Drynariae(P<0.01). On culturing day 7, the expression of BMP-2 was increased in 10% XXD group and Rhizoma Drynariae group(P<0.05). Conclusion XXD can increase the ALP activity and BMP-2 expression in the osteoblasts in vitro, so does the single herb of Rhizoma Drynariae. And their therapeutic mechanism in promoting the healing of fractures may be related with the enhancement of osteogenesis of osteoblasts.
ABSTRACT
This study was aimed to investigate the efficacy, acceptance, complications / adverse events treated with traditional manipulation and bed rest for patients with acute nonspecific low back pain (ANLBP). A total of 60 ANLBP patients were distributed into the Group A/B randomly and equally. Patients in Group A were treated by bed rest absolutely for one week; meanwhile patients in Group B were treated by traditional manipulation for one week. IBM SPSS20.0 was used to analyze the Visual Analogue Scale (VAS), Chinese Oswestry Disability Index (ODI), acceptance, complications / adverse events and others. The results showed that VAS and ODI reduced after one-week treatment in Group A and B (t = 14.67, 11.55, allP < 0.001 andt = 24.80, 15.35, allP <0.001). Differences of VAS and ODI were with significant difference between Group A and B (t = 3.24, 2.75,P =0.002, 0.009). Scores of acceptance and complications / adverse events were with significant difference between Group A and B (t = 2.65,P = 0.01 andχ2= 10.00,P = 0.002). It was concluded that both manipulation and bed rest can alleviatepain due to ANLBP, promote functional recovery. However, traditional manipulation can better improve symptoms, easier to be accepted by patients with less complications / adverse events.
ABSTRACT
BACKGROUND:It is generaly recognized that cervical rotation manipulation can increase the risk of detachment of unstable plaques in carotid atherosclerosis, but few studies are reported on the influence of cervical rotation manipulation on the stable plaque in early carotid atherosclerosis. OBJECTIVE:To explore the influence of the cervical rotation manipulation on the lipid contents in carotid atherosclerotic plaque in a rabbit model of early carotid atherosclerosis. METHODS:After being fed for 15 days with normal diet, 30 male New Zealand White rabbits were further fed for 18 weeks with normal diet (n = 10; control group) or a high-fat diet containing 2% cholesterol, 10% lard and 88% normal granules to build rabbit models of early carotid atherosclerosis with stable carotid plaque (n = 20). At 14 weeks of feeding with high-fat diet, the experimental rabbits fed with high-fat diet were randomly divided into a cervical rotation manipulation group (n = 10) and a model group (n = 10). The rabbits in the cervical rotation manipulation group underwent cervical rotation manipulation to the left and right sides, once each side, with the maximal range of rotation. Total five cervical rotation manipulations, once every 3 days, were performed. RESULETS AND CONCLUSION:The 1 450 cm-1 and 1 660 cm-1 peaks of the Raman spectrum of lipid in the carotid atherosclerotic plaque of rabbit models were not distinctly present in the control group, however, they were obviously observed in the cervical rotation manipulation group and model group. Nevertheless, the relative intensity differences at spectrum characteristic peaks were not significant between cervical rotation manipulation group and model group (P > 0.05). The environmental findings indicate that the lipid content in carotid atherosclerotic plaque of rabbit models of early carotid atherosclerosis cannot be increased after short-term administration of cervical rotation manipulation.
ABSTRACT
Objective To observe the influence of the stress and displacement when the normal sacroiliac joint is exerted load simulating oblique-pulling manipulation, and to analyze the stress and displacement distribution when a three-dimensional finite element model of normal pelvis is exerted by oblique-pulling manipulation. Methods Lateral position was simulated on the three-dimensional finite element model of normal pelvis and it exerted loads horizontally forth and back, then the stress and displacement distribution were calculated. Results When the normal sacroiliac joint was exerted load simulating oblique-pulling manipulation, stress of the pelvis was mainly concentrated on the anterior inferior part of the left iliac fossa from the front view, with a maximum stress of 0.540E+07. The maximum value of internal and external strain of normal sacroiliac joint was 8.682 × 10-4m;the maximum value of anteropostreior strain was 3.337 × 10-4m;and the maximum value of up and down strain of normal sacroiliac joint was 3.284 × 10-4m. Conclusions The focus of the sacroiliac joint stress is mainly on the anterior and posterior superior borders when the normal pelvis exerted oblique-pulling manipulation. The internal and external strain of normal sacroiliac joint is maximal, the anteropostreior strain ranges the second, and the up and down strain is minimal.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the outcome after sacral canal injection in patients with disc herniation associated with without sciatica.</p><p><b>METHODS</b>From December 2010 to June 2011, 65 patients with acute low back pain without sciatica due to lumbar disc herniation or bulging confirmed by CT or MRI were randomly divided into sacral canal injection group (experimental group) and lumbar oblique wrench group (control group): the experimental group had 35 cases, including 30 males and 5 females, with an average age of (43.90 +/- 1.14) years old ranging from 33 to 56 years old. The control group had 30 cases, including 27 males and 3 females,with an average age of (44.00 +/- 1.19) years old ranging from 34 to 57 years old. The course of morbidity was 1 to 3 days. All patients received sacral canal injection or lumbar oblique wrench method. The visual analog scale (VAS) scores before and at 30 min after treatment were compared between two groups.</p><p><b>RESULTS</b>The symptom of acute low back pain were relieved obviously. The average VAS scores before and after treatment in experimental group were decreased from 6.63 +/- 0.97 to 3.06 +/- 1.51,in control group were from 6.67 +/- 0.96 to 3.93 +/- 1.20 respectively. These two methods could improve the VAS score,but the effect of sacral canal injection group was better than that of lumbar oblique wrench group, there was statistically differences (P < 0.05).</p><p><b>CONCLUSION</b>It is effective that the methods of sacral canal injection and lumbar oblique wrench applied to patients with acute low back pain without sciatica due to lumbar disc herniation or bulging confirmed, the former has better effect.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Injections, Spinal , Intervertebral Disc Displacement , Drug Therapy , Lidocaine , Lumbar Vertebrae , Prednisone , Sacrococcygeal Region , Visual Analog ScaleABSTRACT
Objective To compare the clinical effects of extracorporeal shock wave treatment (ESWT) on lumbar ramus posterior nervorum spinalium syndrome and to compare the effectiveness of applying it in X-ray orientation with pain-point orientation.MethodsSixty patients with lumbar ramus posterior nervorum spinalium syndrome were randomly divided into an X-ray orientation group and a pain-point orientation group with 30 subjects in each group.The two groups then received ESWT with the X-ray orientation and pain-point orientation,respectively.The ESWT was delivered at the energy of 0.12 to 0.20 mJ/cm2 and the frequency of 60-80 pulses per minutes.A total of 1000-1500 shock wave pulses were delivered every time.Three sessions of ESWT were administered,with a 3-5 days of interval between each session.The results were rated using the 75 scores of the lumbar function quantification index recommended by Greenough.Ratings were done before treatment,and after the first,the second and the third treatment.ResultsThere was no significant difference between the groups' average index scores before treatment.There were however significant differences from the baseline scores after the first,the second and the third treatments.There was no significant difference in average lumbar function quantification scores between the groups after the first treatment,but the inter-group differences were statistically significant after the second and the third treatments.After three treatments the cure rate in the X-ray orientation group was 76.7％ and overall effectiveness was 93.3％.Both were significantly higher than in the pain-point orientation group (33.3％ and 76.7％ respectively).ConclusionsThe advantages of X-ray orientation when administering ESWT for lumbar rami posterior nervorum spinalium syndrome are more exact positioning and more effective treatment.The effect was obviously better than with pain-point orientation.
ABSTRACT
@#Objective To study the relationship between activity of thorax and each spinal intervertebral angle in patients with ankylosing spondylitis. Methods Each spinal intervertebral angle of 41 patients with ankylosing spondylitis were measured by Spinalmouse in different postures. And the activity of thorax was measured. Correlation between activity of thorax and shape of spinal were analyzed. Results The activity of thorax positively correlated with the entire lumbar spinal column in flexion (P<0.01), as well as the intervertebral angle of L1/2, L2/3 and L4/5 in flexion (P<0.05), but negatively correlated with the intervertebral angle of L1/2 and L2/3, curvature of the entire lumbar spinal column in upright and the intervertebral angle of L1/2, L3/4, curvature of the entire lumbar spinal column in extension. Conclusion There was a significant relation between activity of thorax and lumbar vertebra motor ability.
ABSTRACT
BACKGROUND: Although the fixed-point cervical vertebra rotating reduction has a notable treatment effect, yet it has not been deeply studied in the medical field. Some clinical surgeons feel difficult to make an accurate control on the power and rotatory joint position while operating, even results in iatrogenic injury. OBJECTIVE: To discuss the action mechanism of rotatory technique based on the central rotatory point of cervical vertebra fixed-point rotatory technique. METHODS: Samples were scanned through a 64-row spiral CT working platform at 1-mm layer distance. The picture's profilogram data were extracted from the image processing functional module in PHILIPS MEDICAL SYSTEMS, and then the three-dimensional structure of the upper cervical vertebra was reconstructed and displayed. Taking the axis spinous process peak (point A), odontoid process vertical axes (point B), and the midpoint (point C) of their link as the rotating axes (the rotating central point in simulation), spherical system on each point was set up. The intersection angle of the links between the axis' spinous process peak and the lower jaw, and between the odontoid process vertical axes and the lower jaw before and after rotation were all measured. RESULTS AND CONCLUSION: While applying fixed-point rotation of the cervical spine, the rotatory centre is the vertical axle center of the odontoid process, rather than the handy axis spinous process peak. The rotatory angle of the axle centre is larger than the observation angle. A new concept of fixed-axis rotation should be accepted and its principle should be comprehended in order to appropriately apply the cervical rotatory technique.
ABSTRACT
Objective:To improve the accuracy of the rotary manipulations of the neck in the treatment of neck pain, according to subjective and objective clinical findings. Methods: Two groups of 60 outpatients diagnosed with neck pain were suited to the manipulation and each group was 30 cases. The diagnosis of neck pain was made with conventional clinical evaluation, including history, palpation examinations, CT scan and X-ray. Group A received a manipulation of obliquely pulling the neck. While group B received manipulation of pulling the rotated and located neck. Subjects received a maximum of 10 treatments over a 3-week treatment period. Both treatment groups were assessed with subjective (cervicodynia, neck discomfort, upper limb numbness, vertigo and tinnitus) and objective (cracking sounds). The cracking sounds during two of the manipu1ations were recorded by a microphone positioned at both sides of the neck. The sounds were compared in patients of two groups. Statistical analysis was conducted with a one-factor within-subjects analysis of variance tests and descriptive statistic. Results: Analysis of the subjective indicated that the cases with upper limb numbness were reduced from 12 to 6 in group 2, while the cases with vertigo and tinnitus were reduced from 13 to 4 in group 1. Analysis of the objective indicated two kinds of neck rotary manipulations act not only on the rotary-side facet joints, but on the opposite to the rotary side on1y in a few cases. The results showed that manipulation of pulling the rotated and located neck has a small action range and centralized action points, while manipulation of obliquely pulling the neck has many action segments and discentra1ized action points. Conclusion: It was concluded that the rotary manipu1ations act mainly on the rotary side, not on the opposite, and that manipulation of obliquely pulling the neck has a wider action range and a better therapeutic effect on cervical upper-segment lesions, while manipulation of pulling the rotated and located neck has a limited action range and is suitable for cervical lower-segment lesions. There were some relations between the joint sounds during the manipulation and clinical curative effect.
ABSTRACT
[Objective] To analyze the stress distribution in facet joint of lumbar spine on normal and degenerative models with biomechanical method during the manipulation. [Methods] The finite element model of lumbar facet joint of L4-5 were reconstructed with finite element method and imaging method. Different movements such as anteflexion, retroflexion, lateral flexion, rotation and compression were loaded on the models and then stress distribution during the mimetic spinal manipulation was analyzed and compared. [Results] The facet joint of lumbar spine has an important role in resisting load, especially in resisting rotation. [ Conclusion ] The strong flexion-rotation manipulation should be avoided for seriously degenerative subject.