The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy for hallux valgus with severe metatarsal adduction / 中国骨伤

OBJECTIVE@#To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction.@*METHODS@#From March 2017 to August 2021, 37 patients ( 69 feet ) with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed, including 8 males(11 feet) and 29 females (58 feet), aged from 67 to 83 years old with an average of (70.03±2.87) years old;3 cases on the left side, 2 cases on the right side and 32 cases on both sides. Visual analogue scale(VAS) was used to evaluate degree of pain relief before operation, 6 weeks after operation and at the final follow-up. American Orthopaedic Foot and Ankle Surgery (AOFAS) forefoot score was used to evaluate function of the affected foot before operation and final follow-up. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured before operation and at the final follow-up.@*RESULTS@#Thirty-seven patients(69 feet) were followed up from 12 to 48 months with an average of(22.8±0.6) months. Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of (8.00±1.21) weeks after operation, without delay and nonunion. HVA was increased from (44.30±2.84)° before operation to (15.20±2.13) °at the final follow-up, and had statistical difference(t=65.781, P<0.05);while no difference in IMA before and after operation(P>0.05). VAS was decreased from (6.73±1.48) points to (2.78±0.71) points at 6 months after operation(t=3.279, P<0.05), and had difference compared with the latest follow-up(1.16±1.12)(t=4.859, P<0.05). AOFAS forefoot score increased from (52.14±5.78) preoperatively to (86.70±4.86) at the fonal follow-up, and 25 feet got excellent results, 40 feet good and 4 feet fair.@*CONCLUSION@#The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and appearance of forefoot, stabilize the first sequence, and significantly improve walking function.

Effects of environmental factors on refractive development of children and adolescents in different pubertal stages / 中国学校卫生

Objective@#To explore the effect of puberty on refractive development of children and adolescents and its interaction with outdoor activities, near work and the use of electronic products, so as to provide a reference for strategies for intervening myopia.@*Methods@#Cluster sampling method was used to select 776 students aged 7-13 from a nine year consistent school in Shanghai to participate and were followed up for 2 years. All participants underwent cycloplegic refraction and ocular axial length measurement once a year, as well as pubertal development, average daily outdoor time, near work time and time of electronic products usage. The influencing factors and interaction effects of refractive parameters in different puberty stages were analyzed by generalized estimation equation.@*Results@#At baseline, 634 children participated in cycloplegic refraction, of which 350 were myopic (55.2%). There were significant differences in axial length, average daily outdoor time, near work time and time of using electronic products at different stages of puberty ( F = 4.10 ，4.24，5.54，9.20， P <0.05). There was interaction between puberty and outdoor time on axial length development ( β =0.133, P < 0.05), and the interaction between puberty and the time of near work or using electronic products was not statistically significant ( P >0.05).@*Conclusion@#Puberty may play a regulatory role in the relationship between outdoor time and refractive development among Chinese children and adolescents.

Research Progress of Immunotherapy for Non-small Cell Lung Cancer with Drive Gene Mutation / 中国肺癌杂志

Lung cancer is the most lethal malignancy around the world and non-small cell lung cancer (NSCLC) accounts for 80% of all cases. Most of the NSCLC patients has "driver gene mutations" and targeted therapy achieved a relatively good efficacy, but some patients progressed or relapsed after treatment. Previous studies demonstrated that immune checkpoint inhibitor could improve the prognosis of advanced-stage NSCLC and prolong the survival time. However, the efficacy of immune therapy varies in NSCLC patients with different immune and molecular features. The efficacy of immune therapy was controversial in NSCLC patients with driver gene mutation. The present review will summarize the immune characteristics of NSCLC patients with driver mutation and the directions of immunotherapy for patients with driver mutation.
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Clinical features of neurogenic bladder with vesicoureteral reflux in children / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of vesicoureteral reflux (VUR) in children with neurogenic bladder (NB), and to provide a reference for its early diagnosis and treatment.@*METHODS@#Clinical data were collected from 26 children with NB and urinary tract infection who were admitted to the Department of Pediatric Nephrology from January 2014 to December 2019. According to the presence or absence of VUR, the children were divided into a VUR group with 11 children and a non-VUR group with 15 children. Clinical features were compared between the two groups.@*RESULTS@#Compared with the non-VUR group, the VUR group had a significantly higher proportion of children with non-@*CONCLUSIONS@#When NB children have the clinical manifestations of non-

Comparison of the clinical effect of platelet rich plasma and autogenous osteochondral transplantation in the treatment of talar cartilage injury / 中国基层医药

Objective:To evaluate the clinical effect of intra-articular injection of platelet rich plasma in the treatment of talar cartilage injury.Methods:From May 2017 to May 2019, 128 patients with talar cartilage injury who were treated in Marine Police Hospital of the Chinese People's Armed Police Force were selected as the study objects.According to the random number table method, they were divided into two groups, with 64 patients in each group.The control group was treated with autogenous osteochondral transplantation, and the study group was treated with autogenous platelet rich plasma intra-articular injection.The degree of pain response was compared between the two groups.The change of ankle function was evaluated, the degree of ankle dorsiflexion and plantar flexion were measured, and the complications after treatment were observed.Results:After treatment, the visual analogue scale(VAS) score of the study group[(2.41±0.34)points] was significantly lower than that of the control group[(3.57±0.45)points]( t=8.639, P<0.05). The ankle hind-foot scale(AOFAS) score of the study group[(88.73±6.68)points] was significantly higher than that of the control group[(82.35±6.41)points]( t=3.684, P<0.05). The overall excellent and good rate of ankle function of the study group(95.31%) was significantly higher than that of the control group(82.81%)(χ 2=5.133, P<0.05). In the study group, the ankle dorsiflexion[(24.83±3.31)°] and plantar flexion[(44.92±5.17)°] were significantly higher than those in the control group[(20.65±3.08)° and (39.61±5.27)°]( t=5.247, 4.083, all P<0.05). The overall incidence of complications in the study group(21.88%) was significantly lower than that in the control group(7.81%)(χ 2=5.006, P<0.05). Conclusion:Compared with autograft osteochondral transplantation, the intra-articular injection of platelet rich plasma can effectively alleviate the pain response of patients with talar cartilage injury, improve the ankle joint function and activity recovery level, and reduce the incidence of complications, which is worthy of clinical application.

The pathological characteristics and outcomes of 40 surgically treated stage M1b non-small cell lung cancer patients / 中华肿瘤杂志

Objective@#Clinical evidences of surgically treated stage M1b non-small cell lung cancer (NSCLC) patients were limited. This study aimed to summarize the clinical data of these patients to explore the prognostic factors of this population.@*Methods@#From January 1999 to December 2012, the clinical data of 40 stage M1b NSCLC patients, including 24 males and 16 females, who underwent surgery were collected by Cancer Hospital, Chinese Academy of Medical Sciences. Kaplan-Meier method, log rank test and Cox risk regression model were used to analyze the prognose of these patients and their influence factors.@*Results@#A total of 40 patients were available for survival analysis. The Survival rates of the whole population at 1, 3 and 5 years were 70.0%, 40.0% and 22.5%, respectively. The median survival time (MST) was 31.5 months. The outcomes of 23 patients underwent primary tumor resection and local treatment of metastatic site (MST: 41.5 months) were significantly better than those of 13 patients with only primary tumor resection (MST: 15.5 months) and 4 patients with thoracic exploration (MST: 14.5 months) (P<0.05). Multivariate analysis showed that patients without pleural effusion, brain metastasis, chemotherapy and targeted therapy had a statistically better survival (P<0.05).@*Conclusions@#The overall survivals of surgically treated stage M1b NSCLC patients appear encouraging, and some selected patients may even achieve a long-time survival. Multimodality treatment including surgical lung resection and radical treatment of metastasis should be considered for these patients.

Mining and Analysis of the Formulation Rules of Chinese Patent Medicine for Cold Based on 2015 Edition of Chinese Pharmacopeia（Part Ⅰ） / 中国药房

OBJECTIVE： To mine and analyze the formulation rules of Chinese patent medicine for cold， and to provide reference for clinical dialectical medication and R&D of new medicine for cold. METHODS： The name， dosage form， formulation， function of curing of Chinese patent medicines for cold were collected from 2015 edition of Chinese Pharmacopeia （part Ⅰ） and then input into TCM Inheritance Assistant Platform V 2.5； use frequency of TCM were counted. Apriori algorithm and association rules were used to analyze the core medicinal material combination （10％ support and 0.65 confidence）. New formulation combinations were extracted by unsupervised entropy hierarchical clustering method. RESULTS： A total of 130 kinds of Chinese patent medicine （196 Chinese patent medicine with the same prescription and different dosage forms） for treating cold were collected， including granules （47）， pills （32）， tablets （31）， mixtures （31）， etc. 264 medicinal materials were involved. The cold syndromes contained wind-heat syndrome， wind-cold syndrome， summer-dampness syndrome and Qi deficiency syndrome. Top 3 medicinal materials in the list of use frequency were Glycyrrhiza uralensis （45.38％）， Scutellaria baicalensis （32.31％） and Platycodon grandiflorus （31.54％）. There were 28 core medicinal material combinations， among which the top 3 were               G. uralensis-P. grandiflorus，  Mentha haplocalyx-P. grandiflorus and S. baicalensis-Forsythia suspensa. New combinations were excavated， including Nepeta cataria-P. grandiflorus-M. haplocalyx-Citrus reticulate-Folium Perillae-Citrus aurantium- Poria cocos， F. suspense-S. baicalensis-Lonicera japonica- Arctium lappa-Fermented soybean. CONCLUSIONS： This study analyzed the formulation rules of Chinese patent medicine for treating cold by using the TCM inheritance assistant platform V2.5， which can provide reference for clinical dialectical medication and R&D of new medicines for cold.

Anterior superior malleolus flap and second toe transplantation for thumb reconstruction with soft tissue and first web defect / 中华显微外科杂志

Objective To explore the clinical efficacy of anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair or first web reconstruction.Methods A total of 13 cases were underwent anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair from June,2008 to January,2016.There were 9 males and 4 females.The average age was 25 years old,ranging from 18 to 52.There were 3 cases of Ⅲ-degree thumb defect with soft tissue defect of hand,6 cases of Ⅳ-degree thumb defect with soft tissue defect of hand,3 cases of single Ⅴ-degree thumb defect and 1 Ⅴ-degree thumb defect with soft tissue defect.There were 5 patients accompanied with injury of other fingers of the affected hand.And the thenar muscles were also damaged to a varied degree.There were 10 patients with soft tissue defect before surgery,with the wound surface ranging from 3 cm × 5 cm-6 cm × 13 cm.And the wound of other 3 cases was closed.After the surgery,follow-up visit was conducted on the appearance,sensation,function,daily life and working condition of reconstructed thumb,the appearance and function condition of donor site.Results The reconstructed thumbs and anterior superior malleolus flaps in 13 cases survived and healed primarily.The average post-operative followed-up time was 5.5 years,ranging from 2.5 to 10.0 years.The appearance of reconstructed thumb was satisfactory,and the temperature sensation,pain sensation and touch sensation were recovered.The two-points discrimination was 8-18 mm.Moreover,the flexion and extension function,opposing function and finger-to-thumb function was recovered,which could meet the demand of daily life and work.The appearance of donor site was satisfactory,without claudication,pain or dysfunction.The survival of transplanted skin area in the calf was good,with no ulcer noticed.According to the Trial Standard for Thumb and Finger Reconstitution Functional Assessment of Hand Surgery Society of Chinese Medical Association,there were 10 cases excellent results,2 good and 1 fair.Conclusion Application of anterior superior malleolus flap and second toe transplantation for first-stage thumb reconstruction and soft tissue defect repair or thenar muscles and first web reconstruction is an effective therapeutic approach.

Surgical outcomes of nephrectomy for elderly patients with renal cell carcinoma

Objective: The feasibility of curative surgery for elderly patients with renal cell carcinoma [RCC] remains controversial and under discussion. The main aim of this study was to evaluate the long-term benefits of curative surgery as a treatment for RCC in elderly patients

Methods: We retrospectively considered 672 patients with RCC who underwent partial nephrectomy or radical nephrectomy between January 2004 and July 2014. X-tile program was used to determine the optimal age cutoff values with CSS as endpoint

Results: Patients were divided into the following groups according to their age using the method of X-tile program: a young group [< 40 years], a young-old group [40-75] and an old-old group [>/=75]. Following multivariate analysis age >/= 75 years was determined to be an independent risk factor for overall survival [HR=4.36; 95% CI: 1.31-14.48; P=0.016]; interestingly, this was not the case for cancer-specific survival [HR = 2.65; 95% CI: 0.77-9.16; P=0.124]. Furthermore, an age of 40 to 75 years was not a risk factor according to univariate and multivariate analysis

Conclusion: After determining the age cutoff values, there was no significant difference in prognosis between young and old patients with RCC

The necessity of artificial kidney seeper in the ultrasonography-guided percutaneous nephrolithotomy: a randomized controlled study / 中华外科杂志

Objective@#To investigate the necessity of artificial kidney seeper which made through inserting a ureteral tube in the ureter to the ultrasonography-guided percutaneous nephrolithotomy (PCNL).@*Methods@#This was a randomized prospective study. Patients who conformed to the inclusion and exclusion criteria were enrolled at Department of Urology, Frist Affiliated Hospital of Wenzhou Medical University from January 2016 to May 2017. Totally 291 patients were included in the study. Patients were randomly assigned into two groups (artificial kidney seeper group and non-artificial kidney seeper group) in different kidney seeper level (5 to <10 mm, 10 to 20 mm) respectively. The artificial kidney seeper group was inserted by a ureteral cathedral, then were underwent the ultrasonography-guided PCNL in prone position. The non-artificial kidney seeper group were underwent the ultrasonography-guided PCNL in prone position directly. The t test, χ2 test, repeated measure analysis was used to data measurement, respectively.@*Results@#Four patients who diagnosed pyonephrosis were excluded. On the 5 to <10 mm level, fever rate (14.6% vs. 4.8%, χ2=5.07, P=0.03), operation time ((65.7±9.9)min vs. (50.3±7.4)min, t=11.47, P=0.00), cost ((18 327±903) yuan vs. (14 583±784) yuan, t=24.50, P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences. And on the 10 to 20 mm level, fever rate (14.5% vs. 3.39%, χ2=4.53, P=0.03), operation time ((66.0±9.9)min vs. (52.4±8.9)min, t=8.30, P=0.00), cost ((16 548±537) yuan vs. (13 102±629) yuan, t=32.10, P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences. And there were no statistical differences in the success rate of puncturing, the failures of the treatment to the stone pieces falling into the ureter and clearance rate of the stone and so on. In this study, 2 cases recovered after received transfusion and digital subtraction angiography artery embolization treatments; D-J tube was indwelled into 4 cases guiding by super smooth thread; 4 cases were finished the surgeries with the help of ureteroscopy, because the stone pieces fell into the ureter during the surgeries. And there was no patients developing septic shock, adjacent viscera injury or other serious complications.@*Conclusion@#For seasoned doctors, there is no necessity of regularly artificial kidney seeper for PCNL when the pre-operation seeper ranging from 5 to 20 mm.

Clinical analysis of repairing the defect of hand with reverse island skin flap of upper carpal cutaneous branches of ulnar artery / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of repairing soft tissue defect after hand wound using reverse island skin flap of upper carpal cutaneous branches of ulnar artery.</p><p><b>METHODS</b>From June 2010 to November 2016, 12 patients with hand soft tissue defects were repaired by reverse island skin flap of upper carpal cutaneous branches of ulnar artery, including 9 males and 3 females with an average age of (35.2±9.4) years old ranging from 22 to 58 years. The defect area varied from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm. Time interval from injury to operation ranged from 3 to 15 days with an average of (8.4±2.6) days. The flap was designed beforehand according to the size of the defect, sharply dissected the aponeurotic fascia from the proximal to the distal, abscised the communicating branch between the flap and the ulnar artery at the wrist epithelial branch, repairing the defect of flap with method of metastasis retrograde. The sensation, shape of the flap and hand function were observed, and the upper extremity function was evaluated according to the standard of hand surgery branch from Chinese Medical Association to assessment of functional recovery.</p><p><b>RESULTS</b>The flaps in 10 patients obtained primary healing, the healed time was 14 to 18 days with an average of(15.0±1.5) days. Two patients occurred distal flap necrosis, and wound surface healed after change dressing and skingrafting cover. All patients were followed up from 3 to 15 months with an average of(7.0±3.8) months. According to the upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, 2 cases got excellent results, 7 good, 2 fair and 1 poor.</p><p><b>CONCLUSIONS</b>Reverse island skin flap of upper carpal cutaneous branches of ulnar artery for the treatment of soft tissue defect caused by hand wound has advantages of concealed donor area, no need sacrifice the main blood vessel, flap thin and no need repair it for thick and thin.</p>

Lapidus operation combined with bone setting manipulation in treatment of hallux valgus in elderly patients / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of Lapidus operation combined with bone setting manipulation of traditional Chinese medicine in treating hallux valgus in elderly patients.@*METHODS@#From March 2013 to October 2017, 53 elderly patients (87 feet) with hallux valgus were treated with Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine, including 12 males (18 feet) and 41 females (69 feet), ranging in age from 65 to 92 years old, with an average of (76.3±4.8) years old. Visual analogue scale(VAS) was used to evaluate the degree of relief of foot pain before and 26 months after operation. American Orthopaedic Foot and Ankle Society(AOFAS) was used to evaluate the function of foot pain. The changes of hallux valgus angle(HVA angle), interphalangeal angle (IMA angle) and metatarsal wedge angle(MCA angle) were compared on X-ray films.@*RESULTS@#All the patients were followed up, and the duration ranged from 12 to 42 months, with an average of(26.0±2.7) months. In all patients, the first metatarsal joint reached bone fusion within 6 to 8 months, with an average of 4.7 months. The preoperative VAS score was 8.06±1.44, which was significantly different from 2.14±1.98 at 26 months(<0.05). The preoperative AOFAS score was 53.90±7.89, which was significantly different from 92.80±2.78 at 26 months(<0.05). The HVA, IMA and MCA were significantly improved from preoperative(38.60±2.72)°, (21.90±1.91)° and(20.90±2.20)° to the latest follow-up(17.80±1.94)°, (9.70±2.56)° and(11.70±0.48)°(<0.05). According AOFAS score, 74 feet got an excellent result, 11 good and 2 fair.@*CONCLUSIONS@#Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine on the treatment of hallux valgus foot in elderly patients has satisfactory clinical effects, shortens the time of osteotomy and fixation, protects the soft tissue around the osteotomy end and promotes the bone fusion on the most satisfactory position.

Meta-analysis of androgen deprivation therapy for prostate cancer related with diabetes / 药物评价研究

Objective To examine whether androgen deprivation therapy (ADT) is associated with increased risk of diabetes in men with prostate cancer (Pca).Methods The study data were systematically searched from Medline,Embase,and Cochrane Library Central Register.Studies comparing ADT vs control aimed at treating Pca,reporting diabetes as outcome were included.Results Eight studies met inclusion criteria with a total of 65 695 ADT users and 91 893 non-ADT users investigating the relationship between ADT and diabetes.The incidence of diabetes was 39％ higher in ADT groups,and significant association was observed in overall analysis [RR =1.39,95％CI(1.27-1.53),P ＜ 0.01].In subgroup-analyses stratified by ADT types,diabetes was found to be significantly associated with gonadotropin-releasing hormone (GnRH) alone [RR =1.45,95％CI(1.36-1.54),P ＜ 0.01),GnRH plus oral anti-androgen (AA) [RR =1.40,95％CI(1.01-1.93),P ＜ 0.01] and Orchiectomy [RR =1.34,95％CI(1.20-1.50),P ＜ 0.01],but not with AA alone [RR =1.33,95％CI(0.75-2.36),P =0.33].Conclusions ADT,especially GnRH alone,GnRH plus AA and orchiectomy can increase the incidence of diabetes in patients with Pca.

Expression of androgen receptor and embryonic stem cell associated transcript 4 in breast cancer patients with over-expression of human epidermal growth factor receptor 2 and their clinical significances / 肿瘤研究与临床

Objective To investigate the expression and clinical significance of androgen receptor (AR) and embryonic stem cell associated transcripts 4 (NANOG) in breast cancer patients with human epidermal growth factor receptor 2 (HER-2) over-expression, and to analyze its relationship with clinicopathologic features of breast cancer. Methods 143 breast cancer patients with HER-2 over-expression were selected from the screening of 1052 cases of invasive breast cancer according to estrogen receptor (ER), progesterone receptor (PR) and HER-2 status. The protein expression of AR and NANOG was assayed by using immunohistochemistry.The relationship between AR expression and clinicopathological features was analyzed by χ2 test. The correlation between AR expression and NANOG expression was analyzed by Spearman correlation analysis. Results The positive expression of AR was 35.7 % (51/143). The AR expression was not associated with age and menstruation status (both P>0.05), and was associated with tumor size, clinical TNM staging and lymphatic metastasis (all P< 0.05). The positive rate of NANOG were 53.1 %(76/143), and NANOG proteins were negative in adjacent normal breast tissue and benign breast lesions. The positive rate of AR was 27.6%(21/76) in NANOG-positive cases, whereas the positive rate of AR was 44.8%(30/67) in NANOG-negative cases, and the difference was statistically significant (χ2=4.526, P=0.033). There was an inverse correlation between NANOG and AR expressions (r= -0.255, P= 0.002). Conclusion AR and NANOG may be new targets for endocrine therapy and molecular biological therapy.

Heart Rate Variability in Patients with Acute Ischemic Stroke at Different Stages of Renal Dysfunction: A Cross-sectional Observational Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction.</p><p><b>METHODS</b>This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography (ECG). Autonomic function was measured based on the heart rate variability (HRV) using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate (eGFR), and stroke severity was rated according to the National Institutes of Health Stroke Scale (NIHSS). The Barthel index and modified Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression.</p><p><b>RESULTS</b>In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval (SDANN) index (P = 0.022), very low frequency (VLF) (P = 0.043), low frequency (LF) (P = 0.023), and ratio of low-to-high frequency power (LF/HF) (P = 0.001) were significantly lower than those in the patients with a normal eGFR. A multinomial linear regression indicated that eGFR (t = 2.47, P = 0.014), gender (t = -3.60, P < 0.001), and a history of hypertension (t = -2.65, P = 0.008) were the risk factors of LF/HF; the NIHSS score (SDANN index: t = -3.83, P < 0.001; VLF: t = -3.07, P = 0.002; LF: t = -2.79, P = 0.006) and a history of diabetes (SDANN index: t = -3.58, P < 0.001; VLF: t = -2.54, P = 0.012; LF: t = -2.87, P = 0.004) were independent factors for the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project (t = -2.38, P = 0.018) was related to the SDANN index.</p><p><b>CONCLUSIONS</b>Autonomic dysfunction is aggravated with the progression of eGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfunction.</p>

Perioperative intensive statin therapy improves outcomes in patients with ischemic stroke undergoing middle cerebral artery stent implantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate whether intensive statin therapy during the perioperative period improves outcomes in patients undergoing middle cerebral artery (MCA) stent implantation for ischemic stroke.</p><p><b>METHODS</b>Forty patients with ischemic stroke undergoing delayed stent implantation in our department from January, 2010 to November, 2014 were randomized to intensive statin group (atorvastatin, 80 mg/day, 3 days before till 3 days after intervention; n=20) and standard therapy group (atorvastatin, 20 mg/day, n=20). All the patients received long-term atorvastatin treatment thereafter (20 mg/day). Serum levels of C-reactive protein (CRP), vascular cell adhesion molecule-1 (VCAM-1), and soluble extracellular matrix metalloproteinase inducer (EMMPRIN/CD147) were measured at 24 h before and 24 h after the intervention. The primary end point was procedure-related intra-stent thrombosis, 1-month incidence of major adverse cerebrovascular events (stroke, transient ischemic attack, in-stent restenosis, death or unplanned revascularization).</p><p><b>RESULTS</b>The basic clinical data were similar between the two groups before the intervention (P>0.05). In the intensive therapy group, the levels of CRP, VCAM-1, and sCD147 were significantly lower at 24 h after the intervention than the levels before intervention (P<0.05) and the postoperative levels in the standard therapy group (P<0.05). The levels of CRP, VCAM-1, and sCD147 were all increased after the intervention in the standard therapy group (P>0.05). The incidence of primary end point was lower in intensive therapy group than in standard therapy group (P<0.05).</p><p><b>CONCLUSION</b>In patients undergoing MCA intravascular stent implantation for ischemic stroke, perioperative intensive statin therapy improves the patients' outcomes, reduces the levels of CRP, VCAM-1 and sCD147 molecules, and lowers the incidences of cerebrovascular events.</p>

Progress of Clinical Study on Acupuncture Treatment of Chemotherapy-induced Peripheral Neuropathy in the Recent Decade / 上海针灸杂志

Literatures on acupuncture-moxibustion treatment of chemotherapy-induced peripheral neuropathy (CIPN) in the recent decade were searched in the databases of Pubmed, MEDLINE, Biological Abstracts, EMBASE, Sinomed, CNKI, Wanfang, VIP, et al. The general situation was comprehensively analyzed and reviewed from experimental design, treatment method, efficacy evaluation, mechanism research and so on. The results showed that acupuncture has a certain therapeutic effect, but the research is still in the preliminary stage, the relative literatures are insufficient and in a low quality. There is still a controversy on the efficacy of acupuncture in the treatment of CIPN. High quality, large sample and multicenter randomized controlled trials and systematic reviews are needed to verify the efficacy of acupuncture. The mechanism of acupuncture treatment of CIPN is still unclear and needs further research and exploration.

Missense mutation R1345Q in CACNA1A gene causes a new type of ataxia with episodic tremor: clinical features, genetic analysis and treatment in a familial case / 南方医科大学学报

<p><b>OBJECTIVE</b>Mutations in CACNA1A, which encodes the P/Q-type calcium channel subunit, are responsible for at least 3 allelic diseases, namely type 2 episodic ataxia (EA-2), familial hemiplegic migraine?type-1 (FHM1), and spinocerebellar ataxia type-6?(SCA 6). Herein we present a case of ataxia with episodic tremors in a 19-year-old man with a missense mutation of CACNA1A gene and summarize the clinical features, genetic analysis and treatment in this case and in his affected family members.</p><p><b>METHODS</b>Physical examinations were conducted for the patient and his affected family members. DNA sample from the proband was analyzed with next-generation sequencing technology to identify the causative mutation. Sanger sequencing was used to confirm the gene mutation in the family members.</p><p><b>RESULTS</b>Physical examinations of the patient revealed signs of ataxia, drunken gait, and tremor of his head and body. Four other members in his family had similar but much milder symptoms. A heterozygous missense mutation in CACNA1A (NM_001127221.1 c.4034G->A, p.R1345Q, exon 25) was identified in the proband, which was confirmed in the affected family members. The proband did not respond to methazolamide treatment, but his tremor symptom was well controlled with flunarizine, a calcium channel blocker.</p><p><b>CONCLUSION</b>Based on the clinical features, mutation analysis and treatment response, we suggest that this patient with a missense CACNA1A mutation, R1345Q, has a new type of ataxia with episodic tremor other than any of EA2, FHM1, or SCA 6.</p>

Evaluation of effect of acupuncture and moxibustion and level of intervention based on cumulative Meta-analysis and fuzzy comprehensive evaluation:sudden hearing loss / 中国针灸

Clinical evidences of acupuncture and moxibustion for sudden hearing loss(SHL) were completely collected, and the quality of the evidences was evaluated by Jadad scale. Cumulative Meta-analysis and the time tendency test for the results were implemented by STATA 12.0. Descriptive and academic cross-sectional investigation was carried out among senior professional doctors with acupuncture and moxibustion background in 31 provin-ces of China, and the advices of specialists were analyzed by fussy comprehensive evaluation. Thirty-eight researches were included. Cumulative Meta-analysis indicated that acupuncture and moxibustion combined with medication achieved better cured and total effects compared with multiple medicines[RR=1.57, 95%CI(1.38,1.79); RR=1.34, 95%CI(1.28,1.81)], and the efficacy had no time variability. The cured and total effects of acupuncture and moxibustion were superior to those of multiple medicines, but the results needed to be further verified. Five hundred and sixty-one questionnaires were put out in the 31 provinces, and 93.40% of ones were collected and eligible. Fuzzy comprehensive evaluation showed a tendency to overall improvement by acupuncture and moxibustion as the main intervention in the specialists' advice. Cumulative Meta-analysis and fussy comprehensive evaluation are applicable to estimate the effect and intervention level of acupuncture and moxibustion with low quality evidence.

Effect of HDAC-6 on PD cell induced by lactacystin

Objective: To explore the effects of histone deacetylase 6(HDAC-6) on the PD cell model induced by proteasome inhibitor lactacystin. Methods: Human neuroblastoma SK-N-SH cells were cultured. The wild type pcDNA3.1-alpha-synuclein eukaryotic expression plasmid was transferred into the cells which then were divided into control group, group L, group T and group T+L. The cells of group L were added with 5 μmol/L lactacystin dissolved indimethylsulfoxide (DMSO) to induce PD cell model with abnormal protein aggregation, the cells of control group were treated with 5 μmol/L DMSO, the cells of group T were treated with 5 μmol/L selective HDAC-6 inhibitor tubacin dissolved in DMSO, and the cells of group T+L were treated with 5 μmol/L lactacystin and 10 μmol/L tubacin dissolved in DMSO. The expression levels of alpha-synuclein oligomers, HSP-27 and HSP-70 were detected by Western blot and the cell survival rate of all the groups was detected by MTT colorimetric assay, and compared 24 h after the cells were treated. Results: The expression levels of alpha-synuclein oligomers, HSP-27 and HSP-70 of the cells of group L were significantly higher than the control group, and the cell survival rate was significantly lower (P 0.05). Conclusions: The expression level of alpha-synuclein oligomers can be improved and the cell survival rate can be reduced by the PD cell model induced by lactacystin and treated with selective HDAC-6 inhibitor tubacin, which means that alpha-synuclein oligomers of the PD cell model induced by lactacystin can be inhibited and the cell survival rate can be improved by HDAC-6, and the mechanism may be related to the increased of HSP-27 and HSP-70.