Masquelet induced membrane technique combined with an external locking plate for treatment of infectious bone defects of the tibia / 中华创伤骨科杂志

Objective:To investigate the efficacy of Masquelet induced membrane technique combined with an external locking plate in the treatment of infectious bone defects of the tibia.Methods:A retrospective study was conducted to analyze the data of 32 patients with infectious bone defects of the tibia who had been treated by Masquelet induced membrane technique combined with an external locking plate at Department of Orthopaedic Surgery, The Fourth Hospital of Wuhan from January 2011 to January 2021. There were 22 males and 10 females, with an age of (43.2±13.1) years. The length of bone defects was (5.1±1.3) cm. By the Cierny-Mader classification, there were 12 cases of type Ⅲ and 20 cases of type Ⅳ. The defects were located at the proximal tibia in 11 cases, at the middle tibia in 12, and at the distal tibia in 9. At the last follow-up, the lower limb function was evaluated by the Paley scale, and the quality of life by the 36-Item Short Form Health Survey (SF-36).Results:All the 32 patients were followed up for (21.2±5.7) months. Normal healing was achieved in 30 cases but delayed healing occurred in 2 cases. The external plate and screws were removed at (23.1±4.6) weeks after operation. There was no infection in the original surgical incision or no injury to the nerve, blood vessel or tendon after operation, but nail tract infection occurred more or less in 3 cases. According to the Paley scale at the last follow-up, the lower limb function was evaluated as excellent in 22 cases, as good in 8, and as fair in 2, giving an excellent and good rate of 93.75% (30/32). The SF-36 quality of life score was (88.9±3.8) points.Conclusion:In the treatment of infectious bone defects of the tibia, Masquelet induced membrane technique combined with an external locking plate can achieve satisfactory clinical outcomes due to its effective control of infection, reduction in delayed healing, good stability and good patient tolerance.

Intelligent Electrocardiogram Analysis in Medicine: Data, Methods, and Applications / 中国医学科学杂志(英文版)

Electrocardiogram (ECG) is a low-cost, simple, fast, and non-invasive test. It can reflect the heart's electrical activity and provide valuable diagnostic clues about the health of the entire body. Therefore, ECG has been widely used in various biomedical applications such as arrhythmia detection, disease-specific detection, mortality prediction, and biometric recognition. In recent years, ECG-related studies have been carried out using a variety of publicly available datasets, with many differences in the datasets used, data preprocessing methods, targeted challenges, and modeling and analysis techniques. Here we systematically summarize and analyze the ECG-based automatic analysis methods and applications. Specifically, we first reviewed 22 commonly used ECG public datasets and provided an overview of data preprocessing processes. Then we described some of the most widely used applications of ECG signals and analyzed the advanced methods involved in these applications. Finally, we elucidated some of the challenges in ECG analysis and provided suggestions for further research.

Biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects / 中华创伤骨科杂志

Objective:To evaluate biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects.Methods:Twenty-eight patients with massive tibial bone defects were reviewed who had been treated at Department of Repair and Reconstruction, Wuhan Puai Hospital from October 2013 to October 2019. They were divided into a bone transport group and a combined bone transport group (bone transport combined external locking plating) according to their surgical methods. In the bone transport group of 14 cases, there were 10 males and 4 females with an age of (38.6±3.2) years and a bone defect of (8.0±0.5) cm; in the combined bone transport group of 14 cases, there were 9 males and 5 females with an age of (39.1±3.9) years and a bone defect of (8.3±0.3) cm. The time for wearing external fixator, fracture healing time, dock-in-site healing time, postoperative function assessment and complications were observed and compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing they were comparable ( P>0.05). The bone transport group were followed up for 12 to 28 months (average, 18.4 months) and the combined bone transport group for 12 to 26 months (average, 16.8 months). The time for wearing external fixator in the combined bone transport group [(8.4±0.7) months] was significantly shorter than that [(13.3±1.4) months] in the bone transport group ( P<0.05). No significant difference was observed between the 2 groups in either the fracture healing time [(8.4±1.3) months versus (7.4±1.2) months] or the dock-in-site healing time [(210.2±9.1) months versus (206.2±9.8) months] ( P>0.05). By the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring, the bone healing was excellent in 6, good in 5 and fair in 3 cases in the bone transport group while excellent in 8, good in 4 and fair in 2 cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate ( P>0.05). By the postoperative functional assessment of the lower extremity, there were 7 excellent, 3 good, 3 fair and one poor cases in the bone transport group while 8 excellent, 5 good and one poor cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate ( P>0.05). In the bone transport group, there were 3 cases of pin track infection, one case of dock-in-site nonunion, 2 cases of poor alignment of lower extremities, 2 cases of skin depression, one case of nail loosening, 5 cases of joint stiffness and 3 cases of delayed union of the distracted bone; in the combined bone transport group, there were one case of pin track infection, 2 cases of poor alignment of lower extremities, 3 cases of skin depression, 3 cases of joint stiffness, 2 cases of delayed union of the distracted bone and one case of refracture. Conclusion:In the sequential treatment of massive tibial bone defects, biplane osteotomy and bone transport combined external locking plating can reduce the time for wearing external fixator and increase the satisfaction of patients.

Changes in Gray Matter Volume in Chronic Nonfluent Aphasia after Cortical Cerebral Infarction / 中国康复理论与实践

Objective:To investigate the changes of gray matter volume in patients with chronic nonfluent aphasia after cortical cerebral infarction and the relationship between gray matter volume and language function. Methods:From June, 2016 to June, 2019, 19 patients with chronic nonfluent aphasia after cortical cerebral infarction from the First Affiliated Hospital of Ji'nan University and 28 healthy subjects (controls) were scanned with structural magnetic resonance imaging. The data were analyzed using voxel-based morphological measurement to measure the gray matter volumes of the brain regions, and the differences between patients and controls were compared. The correlation between volumes of brain regions with difference and scores of items of Aphasia Battery of Chinese (ABC) was analyzed. Results:The gray matter volumes increased in the brain regions of right inferior frontal gyrus triangle, right inferior frontal gyrus island cover, right angular gyrus, the right medial frontal gyrus, left insula, left medial frontal gyrus in the patients; while decreased in right globus pallidus. The volumes of left insular lobe correlated with the scores of repeating (r = 0.665, P = 0.001) and naming (r = 0.638, P = 0.003); and the volumes of right inferior frontal gyrus triangle correlated with the scores of hearing comprehension (r = 0.493, P = 0.031), repeating (r = 0.576, P = 0.009) and naming (r = 0.674, P = 0.001) in the patients. Conclusion:The cortex volumes of left insula and right inferior frontal gyrus triangle increase in patients with chronic nonfluent aphasia after cerebral infarction, which may play a role in the language dysfunction.

Treatment of Gustilo ⅢC open tibiofibular fractures by microsurgery combined with Ilizarov technique / 中华创伤骨科杂志

Objective:To explore the clinical efficacy of microsurgery combined with Ilizarov technique in the treatment of Gustilo ⅢC open tibiofibular fractures.Methods:From January 2014 to December 2016, 20 patients with Gustilo ⅢC open tibiofibular fracture were treated at Department of Hand Surgery 2, Repair and Reconstruction, Wuhan NO. 4 Hospital, Wuhan Puai Hospital. They were 13 men and 7 women, aged from 36 to 56 years (average, 42.6 years). The time from injury to operation ranged from 2 to 6 hours (average, 4.3 hours). The defects were at the proximal bone in 6 cases, at the middle bone in 9 cases and at the distal bone in 5 cases. The area of soft tissue defect ranged from 10 cm×6 cm to 12 cm×9 cm, and the lengths of bone defects averaged 10.3 cm. Microsurgery was conducted at the first stage to repair blood vessels and nerves and to reconstruct blood circulation, and an Ilizarov circular external fixator was installed at the second stage to repair bone and soft tissue defects by two-way bone transport. Bone transport time, wound healing time, bone transport distance, external fixation time, external fixation index, solidification time for the extended area and complications were recorded after operation. The curative efficacy was evaluated by Palay evaluation.Results:All patients were followed up for 12 to 30 months (average, 24 months). After the bone and soft tissue defects were well repaired, all the patients returned to daily life. The time from bone transport to apposition of fracture ends ranged from 50 to 160 days, averaging 75.8 days; the wound healing time ranged from 60 to 150 days, averaging 100.6 days; the bone transport distance ranged from 8 to 13 cm, averaging 10.3 cm; the external fixation time ranged from 12 to 20 months, averaging 14.0 months; the external fixation index was 1.6 months/cm; the solidification time for the extended area ranged from 5 to 16 months, averaging 10.9 months. No infection, malunion or re-fracture was observed; postoperative axis deviation was observed in 2 cases and ankle stiffness in 3 cases. According to the Palay evaluation, 5 cases were excellent, 12 cases good, and 3 cases fair.Conclusion:As microsurgery combined with Ilizarov technique can treat Gustilo ⅢC open tibiofibular fractures effectively by reconstructing limb blood circulation, it is worthy of clinical promotion.

Systematic Review and Meta-analysis of Traditional Chinese Medicine on Inflammatory Factors in Patients with Coronary Heart Disease Complicated with Anxiety and Depression / 中国实验方剂学杂志

To systematically evaluate the effect of traditional Chinese medicine（TCM） on the expression of inflammatory factors in peripheral blood of patients with coronary heart disease complicated with anxiety and depression，and explore its efficacy and safety in treatment of anxiety and depression. In this study，CNKI，VIP database，WanFang database，PubMed and Cochrane Library were searched to collect randomized controlled trials（RCTs） of TCM in the treatment of coronary heart disease complicated with anxiety and depression，and 2 researchers independently screened the literatures and extracted the data. The quality of the included literatures was evaluated with Cochrance bias risk evaluation tool and Meta analysis was conducted by Cochrane Revman 5.3 software. A total of 21 research articles were included，with a total sample size of 2 342 cases，1 175 cases in the treatment group and 1 167 cases in the control group. Meta analysis results showed that the treatment group reduced the hypersensitive C-reactive protein（hs-CRP）［standard mean difference（SMD）=-1.61，95% confidence interval（CI）（-2.14，-1.09），P<0.01］，interleukin（IL）-8［mean difference（MD）=-5.03，95% CI（-8.37，-1.70），P=0.003］，IL-17［MD=-33.27，95% CI（-40.15，-26.39），P<0.01］，tumor necrosis factor（TNF）-α［SMD=-1.18，95% CI（-1.98，-0.38），P<0.01］，and homocysteine（Hcy）［MD=-3.45，95% CI（-4.85，-2.04），P<0.01］. The treatment group was better than the control group in terms of relieving anxiety and depression，i.e. scores of Hamilton anxiety scale（HAMA） ［SMD=-1.97，95% CI（-2.48，-1.46），P<0.01］，Hamilton depression scale（HAMD） ［SMD=-1.94，95% CI（-2.50，-1.38），P<0.01］，and self-rating depression scale（SDS）［SMD=-0.72，95% CI（-0.90，-0.54），P<0.01］，so in terms of ，with statistically significant difference. 4 articles mentioned that no obvious adverse reactions occurred，4 articles mentioned that the treatment group had drowsiness，dry mouth and bitter mouth，gastrointestinal reactions，but the incidence rates were significantly lower than those of the control group. The other 13 articles did not mention the occurrence of adverse reactions.

Advance in Role of White Matter Tracts in Aphasia: Based on Dual Stream Language Model (review) / 中国康复理论与实践

Previous researches about the brain mechanism of aphasia mainly focused on the correspondence between cortical brain regions and language function. Now, more and more researches have found that the connection of white matter tracts in the brain plays an important role in language function. Dual-stream language model hypothesizes that the process of language can be considered as two parallel pathways, dorsal and ventral. The white matter fibers of dorsal stream include arcuate fasciculus and superior longitudinal fasciculi, which are mainly involved in the production of language. The white matter fibers of ventral stream include the inferior frontal-occipital fasciculus, inferior longitudinal fasciculus and uncinate fasciculus, which are mainly responsible for language understanding. The conception of connection mode and specific functional role of these fibers in the language network of patients with aphasia is helpful for the assessment of the features and severity of the patient's language dysfunction and outcome, to guide clinical precision rehabilitation. More researches are needed to elaborate the interaction between the dorsal and ventral streams to well know the brain's language network processing mechanism.

Effection of left ventricular remodeling on systolic synchronization in patients with severe preeclampsia by full-volume imaging technology / 中华超声影像学杂志

Objective:To evaluate the effects of left ventricular remodeling on systolic synchronization in patients with severe preeclampsia(SPE) by full-volume imaging technology.Methods:One hundred and nine patients with SPE were randomly selected as SPE group in the First Hospital of Shanxi Medical University from December 2016 to December 2019, which were further divided into systolic synchrony(SS) group ( n=35) and systolic dyssynchrony(SD) group( n=74). And 34 healthy pregnant women during the same period were selected as normal pregnancy(NP) group. The clinical datas were collected. Parameters including left ventricular end diastolic volume(LVEDV), left ventricular end systolic volume(LVESV), left ventricular ejection fraction(LVEF), spherical index(SpI), left ventricular mass index(LVMI) and systolic dyssynchrony index(SDI) were obtained by full-volume imaging technology. The effects of left ventricular remodeling on systolic synchronization in patients with SPE were analyzed by bivariate correlation, multiple linear stepwise regression analysis and binary Logistic regression analysis, respectively. Results:①Bivariate correlation analysis showed that LVEDV, LVESV, SpI and LVMI were positively correlated with SDI( r=0.335, 0.361, 0.635, 0.680; all P<0.01). ②After adjustment for age, body mass index, systolic blood pressure, course of hypertension, antihypertensive and antispasmodic treatments, gestational diabetes mellitus, subclinical hypothyroidism, LVEF, multiple linear regression analysis showed that SpI and LVMI were independent predictors of SDI (β=0.228, 0.319; all P<0.01). ③Binary Logistic regression analysis showed that SpI and LVMI were independently correlated with left ventricular systolic dyssynchrony [ OR(95% CI)=1.288(1.039-1.598), 1.102(1.019-1.192); all P<0.05]. Conclusions:Left ventricular remodeling in patients with SPE leads to the decrease of left ventricular systolic synchronization, which can reflect subclinical myocardial dysfunction early. Full volume imaging technology can accurately evaluate left ventricular systolic synchronization in patients with SPE.

Primary shortening plus secondary lengthening for Gustilo ⅢC open fractures in the lower limb / 中华创伤骨科杂志

Objective:To evaluate the treatment strategy of primary shortening plus secondary lengthening for Gustilo ⅢC open fractures in the lower limb.Methods:From January 2010 to January 2018, 12 patients (8 males and 4 females) with complex Gustilo ⅢC open fracture in the lower limb received emergency treatment at Department of Orthopaedic Surgery, Wuhan Fourth Hospital. Their ages ranged from 22 to 67 years (average, 41.2 years). All patients were complicated with bone and soft tissue defects associated with nerve and vascular injury in the lower limb. The sizes of soft tissue defects ranged from 4 cm × 2 cm to 17 cm × 12 cm; the main arteries were shortened after debridement by an average of 4.2 cm (from 1.2 cm to 8.3 cm); the broken nerves were shortened after debridement by an average of 4.0 cm (from 1.0 cm to 8.1 cm); the tibial shaft defects averaged 6.3 cm in length (from 2.0 to 9.6 cm). All cases were treated at the first stage by emergency debridement and shortening at the fracture site to directly repair the damaged bone, blood vessels and nerves before the wound was covered. After the limb survived and the wound completely healed, an Ilizarov external fixator was installed to lengthen the limb by bone transport. Recorded were speed of bone lengthening, time with external fixation and complications. The lower limb functions were evaluated at the last follow-up by Paley criteria.Results:The 12 patients were followed up for 14 to 32 months (average, 19.1 months). All the limbs survived with no serious infection. The shortening ranged from 2.0 to 8.2 cm (average, 3.6 cm); the mean speed of bone transport was 0.87 mm/day; the time with external fixation ranged from 11 to 16 months (average, 13.2 months); the bony union was achieved after 10 to 14 months (average, 11.2 months). Postoperative horseshoe inversion was reported in 7 patients, and needle tract infection below Dahl grade 3 in 2 cases. According to Paley criteria, the function of lower limb was rated as excellent in 8 cases, as good in 3 cases, and as fair in one.Conclusion:The treatment strategy of primary shortening plus secondary lengthening using Ilizarov technique has lowered the risk for limb salvage and the surgical difficulty, leading to fine clinical outcomes.

Clinical analysis of 80 death cases with coronavirus disease 2019 / 中华传染病杂志

Objective:To analyze the clinical characteristics and causes of death of 80 dead cases with confirmed coronavirus disease 2019 (COVID-19).Methods:The clinical data of 80 dead patients with COVID-19 who were admitted to Renmin Hospital of Wuhan University from January 11 to February 11, 2020 were retrospectively analyzed.The laboratory examination indexes (including white blood cells, lymphocytes, procalcitonin (PCT), lactic acid, D-dimmer, fibrinogen degradation products, N-terminal pro-brain natriuretic peptide (N-proBNP), ultra sensitive-troponin I, lactate dehydrogenase (LDH) and CD4 + T lymphocyte) of the patients at the time of admission were compared with the indexes at the last time before death. Statistical analysis was conducted by using paired t test or Wilcoxon′s signed rank test. Results:The median age was 72 years old of the 80 patients, and 78.75%(63/80) of them were older than 60 years. Thirty-six cases (45.00%) were severe and 44(55.00%) were critical at admission. Fifty-eight cases (72.50%) had underlying diseases. The common underlying diseases were hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and chronic obstructive pulmonary disease. Comparing the patients′ first laboratory tests at admission with those before death, white blood cells increased (8.01(4.86, 12.29)×10 9/L vs 12.55(8.25, 17.66)×10 9/L), lymphocytes decreased (0.70(0.46, 0.88)×10 9/L vs 0.54(0.39, 0.75)×10 9/L), PCT increased (0.20(0.11, 0.74) μg/L vs 1.00(0.20, 1.99) μg/L), lactic acid increased (2.10(1.40, 3.10) mmol/L vs 3.10(2.60, 4.10) mmol/L), D-dimmer increased (4.33(0.97, 18.98) mg/L vs 15.29(5.17, 53.44) mg/L), fibrinogen degradation products increased (15.90(3.58, 76.60) mg/L vs 63.14(21.23, 110.67) mg/L), N-proBNP increased (1 078.00(347.35, 2 996.50) ng/L vs 3 439.50(1 576.00, 9 281.50) ng/L), ultra-sensitive troponin I increased (0.08(0.03, 0.17) μg/L vs 0.33(0.14, 2.47) μg/L), LDH increased (397.00(327.00, 523.50) U/L vs 624.00(481.00, 854.00) U/L) and CD4 + T lymphocyte decreased (137.00(104.00, 168.00)/μL vs 97.00(67.00, 128.00)/μL). The differences between the two groups were all statistically significant ( W=238.00, 1 053.50, 150.00, 152.00, 192.00, 190.00, 108.00, 57.00, 53.00 and 40.00, respectively, all P<0.05). All patients received antiviral and respiratory-support therapy and the main cause of death was respiratory failure caused by intractable hypoxemia and multiple organ failure. Among them, seven cases died in one day hospitalization, and 66 cases died in seven days hospitalization. Conclusions:Elderly patients with a variety of chronic underlying diseases have poor prognosis. It′s essential to pay more attention and deal with the above clinical characteristics at an early stage to improve the outcome of the COVID-19 patients.

Effect of chronic emotional stress induced by empty bottle stimulation on inflammatory factors in rats with acute myocardial infarction: analysis of the CXCL12/CXCR4 axis / 南方医科大学学报

OBJECTIVE@#To investigate the effect of chronic emotional stimulation induced by empty bottle stimulation on CXCL12/CXCR4-mediated inflammatory response in rats with acute myocardial infarction (AMI).@*METHODS@#Rat models of anxiety were established by a 21-day stimulation with uncertain empty bottle drinking water, and myocardial infarction was induced by ligating the left anterior descending branch of the coronary artery; compound models were established by performing myocardial infarction operation on the 15th day of anxiety modeling. The rats were randomly divided into 4 groups: shamoperated group (=6), myocardial infarction group (=6), compound model group (with myocardial infarcted and anxiety; = 6), and inhibitor group (compound models treated daily with 1 mg/kg AMD3100 for 6 days; =7). Echocardiography was used to examine the LVEF and LVFS to evaluate the cardiac function of the rats. Elevated maze test and open field test were used to evaluate the behaviors of the rats. The expressions of CXCL12, CXCR4, IL-1β, IL-18 and neutrophil active protease (NE) in the myocardial tissues and blood samples were detected with ELISA and immunohistochemistry.@*RESULTS@#The LVEF and LVFS were lower in the compound model group than in the sham group and myocardial infarction group ( < 0.05), and were higher in inhibitor group than in the compound model group ( < 0.05). LVID; d and LVID; s were lower in the inhibitor group than in the compound model group ( < 0.05). Compared to those in the sham group and myocardial infarction group, the rats in the compound model group more obviously preferred to stay in the closed arm ( < 0.05) in EPM; the rats in the inhibitor group had more times of entering and staying in the open arm than the compound model rats ( < 0.05); the horizontal and vertical movements were less in the compound model rats than in those in the sham group and the myocardial infarction group ( < 0.05) in OFT, and the vertical movement of the rats in inhibitor group was higher than those in the compound model group ( < 0.05). The expression of CXCR4 in the marginal zone of myocardial infarction was significantly higher in the compound model group than in the sham-operated group, myocardial infarction group and inhibitor group ( < 0.05). The expressions of IL-1β, IL-18 and NE in the inhibitor group were significantly lower than those in the compound model group ( < 0.05). Compared with at in the sham-operated group, the number of Nissl bodies in the compound model group decreased significantly ( < 0.01).@*CONCLUSIONS@#Chronic emotional stress induced by empty bottle stimulation can lead to dysfunction of the CXCL12/CXCR4 axis, which causes inflammatory cascade after myocardial infarction to worsen myocardial cell necrosis, cardiac function and hippocampal neuronal damage after the infarction.

Risk factors for fatal outcome in patients with severe COVID-19: an analysis of 107 cases in Wuhan / 中华临床感染病杂志

Objective:To analyze the risk factors of fatal outcome in patients with severe COVID-19.Methods:The clinical characteristics of 107 patients with severe COVID-19 admitted in Renmin Hospital of Wuhan University from February 12 to March 12, 2020 were retrospectively analyzed. During the hospitalization 49 patients died (fatal group) and 58 patients survived (survival group). The clinical characteristics, baseline laboratory findings were analyzed using R and Python statistical software. The risk factors of fatal outcome in patients with severe COVID-19 were analyzed with multivariate logistic regression.Results:Univariate analysis showed that the two groups had statistically significant differences in age, clinical classification, dry cough, dyspnea and laboratory test indicators ( P<0.05 or <0.01). The random forest model was used to rank the significance of the statistically significant variables in the univariate analysis, and the selected variables were included in the binary logistic regression model. After stepwise regression analysis, the patient’s clinical type, age, neutrophil count, and the proportion of CD3 cells are independent risk factors for death in severe COVID-19 patients. Dry cough is an independent protective factor for the death of severe COVID-19 patients. Conclusion:COVID-19 patients with fatal outcome are more likely to have suppressed immune function, secondary infection and inflammatory factor storm. These factors may work together in severe patients, leading to intractable hypoxemia and multiple organ dysfunction and resulting in fatal outcome of patients. The study indicates that timely intervention and treatment measures against above factors may be effective to save the lives of patients with severe COVID-19.

Management of acute hand injury during the epidemic of COVID-19: strategies and suggestions / 中华创伤骨科杂志

Objective:To present our strategies and suggestions for management of acute hand injury during the epidemic of COVID-19.Methods:From January 1 to February 20, 2020, 78 patients with acute hand injury were admitted to the Department of Hand Surgery, Wuhan Fourth Hospital. They were 45 males and 33 females, aged from 21 to 69 years (mean, 43.2 years). Of them, 60 were treated from January 1 to 20, 2020, by medical staff under protection of class 1, and 18 from January 21 February 20, 2020, by medical staff under protection of class 2. The COVID-19 infection was recorded in the patients and medical staff as well. The measures taken and experience in control and prevention of 2019-nCoV infection during the epidemic were reviewed.Results:From January 1 to 20, 2020, 5 patients were diagnosed of COVID-19 infection, including 3 mild and 2 moderate cases, and 5 medical staff members were also diagnosed of COVID-19 infection, including 3 mild, one moderate and one severe cases. From January 21 to February 20, 2020, 2 patients were diagnosed of COVID-19 infection, including one mild and one moderate cases, but none of the medical staff was infected by COVID-19.Conclusions:During the epidemic of COVID-19, the front line medical staff may face a high risk of COVID-19 infection in the whole process of management of acute hand trauma. The risk of nosocomial COVID-19 infection can be reduced by complete pre-hospital examination, choice of proper anesthesia and surgical procedures, perioperative prevention measures for medical staff, improved postoperative ward management, and psychological counseling for the patients.

Comparison of the two magnetic resonance deartifact techniques in imaging of different porcelain-fused-to-metal crowns / 华西口腔医学杂志

OBJECTIVE@#This study aimed to compare the porcelain-fused-to-metal (PFM) crown artifact in the magnetic resonance imaging (MRI) of the two magnetic resonance deartifact techniques in studying the application value of the propeller-fast spin-echo T2-weighted sequence (FSE T2WI) in troubleshooting PFM crown artifacts.@*METHODS@#A total of 48 patients with right mandible first molar crown who underwent MRI head examination were chosen as subjects in the study. According to different metal substrates, PFM crowns were divided to three types, namely, nickel-chromium alloy crown, cobalt-chromium alloy crown and titanium crown. The patients received two MRI scan sequences, that is, FSE T2WI and propeller-FSE T2WI sequences. The MRI artifacts areas in two sequences were measured.@*RESULTS@#The difference between FSE T2WI and propeller-FSE T2WI sequences in three kinds of PFM crown was significant (P<0.05).@*CONCLUSIONS@#Propeller-FSE T2WI sequence technique can effectively reduce the metal artifacts of various PFM crowns.

Study on the characteristics and Countermeasures of nursing needs for elderly hospitalized patients based on cluster analysis / 中国实用护理杂志

Objective To understand the basic characteristics of elderly patients in the Comprehensive Ward of emergency department, put forward reliable countermeasures that can be applied to clinical nursing work, in order to provide reliable countermeasures for clinical nursing work. Methods By querying the electronic medical record system, we collected data from patients retrospectively, and used statistical inference and cluster analysis, nonparametric rank sum test and other statistical inference methods to analyze the data. Results Totally 636 patients were included, the average age of 83 years (77,87), the average required nursing project 4 (3,5), the average number of diagnosis 8 (6,11), Charlson comorbidity index (2,5) with an average of 4 points, the average hospitalization was 15 days (11,21);diagnosis the number of top five diseases for acute exacerbation of chronic obstructive pulmonary disease, pneumonia, pulmonary infection, hypostatic pneumonia, aspiration pneumonia and acute exacerbation of chronic heart failure; 15 nursing needs are divided into three categories before statistical analysis, basic nursing, nursing, nursing treatment pipeline, and as cluster variables in 636 patients divided into three groups, which were high demand for nursing care group, nursing group, nursing group needs low demand. The three groups of patients were statistically significant in the number of deaths, age, Charlson complication index, the number of clear diagnosis and the days of hospitalization (P<0.05). Conclusion The average age of hospitalized elderly patients is relatively high. The risk of death is gradually increased after the patients are grouped according to the requirement of nursing. They are more likely to merge more diseases. The number of hospitalized patients is longer and the number of deaths will increase. Clinical nursing staff should recognize the nursing needs of different types of patients and provide better quality care services for them.

Clinical characteristics of drug-induced autoimmune hepatitis / 中国实用内科杂志

OBJECTIVE: To investigate the clinical characteristics of drug-induced autoimmune hepatitis(DIAIH), in order to help clinicians learn more about DIAIH and improve its clinical diagnosis. METHODS: This was a retrospective study in the patients with DIAIH and DILI treated at Shengjing Hospital of China Medical University between January 2013 and December 2017. The population characteristic,related drugs,clinical manifestations,liver biochemical parameters, autoimmune antibodies, and liver pathological features were compared between the two groups. RESULTS: There were 49 patiens with DIAIH and 436 patiens with DILI. The majority of these patients were female. There was a significant difference in the proportion of female patients, with DIAIH(91.84%, 45/49)higher than DILI(70.41%, 307/436)(χ~2=9.111, P=0.003). The patients with DIAIH had a mean age of(50.0±7.4) years. The top three drugs inducing DIAIH were Chinese herbal medicines(53.06%, 26/49), non-steroidal anti-inflammatory drugs(10.20%, 5/49) and fluvastatin(10.20%, 5/49). DIAIH occurred after more than 8 weeks of treatment. There was a significant difference in the proportion of liver failure, with DIAIH(30.61%, 15/49) higher than DILI(14.68%, 64/436)(χ~2=8.20, P=0.004). The risks of DIAIH and DILI with liver failure caused by western medicines were significantly higher than those by Chinese herbal medicines(χ~2=9.77, P=0.002; χ~2=16.09,P<0.001). The positive rate of autoimmune antibody in DIAIH patients was 100%. The positive rate of ANA was 83.67%(41/49), and that of SMA was 16.33%(8/49). The liver pathological features of interface hepatitis, plasma cells and lymphocytes infiltration in DIAIH patients were more obvious than those in DILI patients. CONCLUSION: DIAIH is more common in the female patients and is caused frequently by Chinese herbal medicines. DIAIH caused by western medicines could easily result in liver failure.

Analysis of the main constituents of changshu tablet and its spasmolysis effect against contraction induced by acetylcholine in the rat-isolated intestinal smooth muscle

The Changshu tablet [CST], one kind of Chinese patent medicine with astringent to the intestine and relieving diarrhea, was made by the root of Rose odorata Sweet var. gigantean [Coll.et Hemsl.] Rehd.et Wils. Although CST has a long history of clinical application, but the research of its chemical composition is less. So the objective of this study was to investigate the main constituents and preliminarily research its effect of the contraction of isolated intestine in vitro. The contents of total polyphenols [126.23 mg/g] and total triterpenoids [132.75mg/g] in CST were determined by ultraviolet spectrophotometry. Procyanidin B3, epigallo catechin, catechin, epicatechin, [-]-fisetinidol-[4 alpha, 8]-[-]- catechin, [4 alpha, 8]-[-]-fisetinidol-[-]-epicatechins and [+]-guibourtinidol-[4 alpha, 8]-epicatechin were identified and determined by high performance liquid chromatography and their contents were distributed from 0.04mg/g to 1.46 mg/g. CST showed significant inhibitory effect against acetylcholine-induced contraction on the rat-isolated intestinal smooth muscle with a dose-dependent manner from 0.06 to 0.6 mg/mL. The maxim inhibition rates of CST on duodenum, jejunum, ileum and colon were 65.70 +/- 3.47%, 79.74 +/- 1.27%, 58.90 +/- 1.87% and 45.75 +/- 2.21% respectively. These results indicated that CST has a spasmolytic role in gastrointestinal motility which was probably mediated through inhibition of muscarinic receptors. All these findings promote the improvement of the quality control standard of CST and provide pharmacological foundation for clinical application of CST in gastrointestinal tract

Expression and effect of THEM4/Akt on extracellular matrix deposit in kidney of diabetic mice / 临床与实验病理学杂志

Purpose To investigate the relations of THEM4/Akt expression and extracellular matrix deposit in kidney of diabetic mice. Methods Diabetic mice models were successfully established by intraperitoneally injected STZ. Both normal control mice and diabetic mice were raised for 8 week until they were sacrificed. Western blot, immunohistochemistry and realtime PCR were used to detect the expression of THEM4, phospho-Akt (Ser 473), TGF-β1, a-SMA, Col Ш, FN protein and THEM4 mRNA in the kidneys of normal mice and diabetic mice. Results Compared to normal control mice, THEM4 expression decreased by 37.7％ followed by 3.66, 1.29 2.33, 1.99 and 2.82 times increased of phospho-Akt (Ser473), TGF-β1, a-SMA, Col Ш and FN in kidney of diabetes mellitus. Extracellular matrix accumulation was found in renal interstitial region of diabetic mice. Conclusion The decreased THEM4 might cause extracellular matrix deposit in kidney of diabetic mice by upregulating the phosphorylation of Akt and TGF-β1, α-SMA expression in diabetic mice.

Precision medicine corpus annotation in liver neoplasms / 军事医学

Objective To construct a high-quality precision medicine corpus in liver neoplams and to alleviate the shortage of biomedical corpora .Methods Initial corpus annotation guideline were drafted according to current biomedical corpora, and the guidelines were gradually revised through pre-annotation using Brat tool before formal annotation of the named entities and the relations was started .Results The corpus annotation of 210 abstracts was completed , including 10045 named entities and 2489 semantic relations .Conclusion A high-quality precision medicine corpus in liver neoplasmis made available and the annotation guidelines are formulated .

Sinus tarsus mini incision approach with percutaneous reduction and fixation for Sanders Ⅱ、 Ⅲ calcaneal fractures / 中华骨科杂志

Objective To explore the methods and clinical effect of the sinus tarsus mini incision approach with percutaneous fixation technique in the treatment of Sanders Ⅱ,Ⅲ calcaneus fractures.Methods From January 2015 to May 2016,the clinical data of 64 cases with Sanders Ⅱ,Ⅲ calcaneus fractures who were treated by sinus tarsus mini incision approach with percutaneous reduction and fixation were analyzed retrospectively.The average age was 46.64±10.51 years (range,25-68) and 49 patients were males and 15 patients were females.According to Sander's classification,39 patients were Sanders Ⅱ and 25 were Sanders Ⅲ fracture.Calcaneal varus was corrected and the length,width and height of bone were reduced by sinus tarsus mini incision approach with percutaneous fixation technique.Calcaneal fracture was treated by calcaneal bone plate combined with percutaneous screw fixation.Complications and operation procedure were recorded post-operation.Anteroposterior,lateral and axial views of preoperative and postoperative X-ray and CT scan were taken to assess the classification,restoration and intertion status of fracture.Radiological assessment was performed using B(o)hler's angle and Gissane's angle.Functional outcome was assessed using the Maryland foot score (MFS).Results All of the sixty-four patients were followed up for 12-18 months (average,14.80± 2.03).After surgery,only 4 cases of superficial necrosis of the incision were found,and the incisions were all healed and no infection occurred after surgery.No tendon tenosynovitis was seen after surgery.There were no fracture displacement,internal fixation failure,and fracture deformity healing cases.The mean time of bone union was 9.44±1.38 weeks (8-12 weeks) without fracture deformity healing case.The mean time of bone union was 9.17±1.16 weeks for the 23 cases with bone graft.For the 41 cases without bone graft,the bone healing average time was 9.91 ± 1.62 weeks,and there is no statistically difference between cases with and without bone graft (t=1.936,P=0.061).B(o)hler's angle was 6.625°±4.904° (range,-5°-15°) preoperative,and improved to 31.031°± 4.660° (range,24°-40°),which had statistically significant difference (t=-28.863,P=0.000).Gissane's angle was from preoperative 76.094°±12.981° (range,55°-105°) to 127.328°±6.486° (range,115°-140°) at the time of the latest follow-up,and the difference had statistically significant (t=-28.246,P=0.000).Maryland Score:excellent 30 cases (22 cases of type Ⅱ,8 cases of type Ⅲ),good 27 cases (15 of type Ⅱ,12 of type Ⅲ),fair 7 cases (2 of type Ⅱ,5 of type Ⅲ).The overall good rate was 89.06％ (57/64).Conclusion The tarsal sinus minimally invasive small incision reduction and internal fixation combined with percutaneous reduction and fixation technique in the treatment of ealcaneal fractures,exerts the advantages of small trauma,clear surgical exposure for reduction,reliable fixation,and low incision complications,which is applicable to treat the Sanders Ⅱ,Ⅲ calcaneal fractures.