Clinical outcomes of robot-assisted transforaminal percutaneous endoscopic lumbar discectomy / 中华骨科杂志

Objective:To introduce a new TIANJI robot assisted targeted puncture technique, and discuss the feasibility and clinical effect of transforaminal percutaneous endoscopic lumbar discectomy (tPELD) using this technique.Methods:The first 14 consecutive cases of single level lumbar disc herniation who underwent robot assisted tPELD procedure were retrospectively analyzed. The mean age was 46.3±16.0 years old (ranged from 16-72). After data transferred from C-arm to robot system and automatic registration, surgeons made plans of the trajectory on robot system based on intraoperative 3-dimensional images of lumbar spine. Move robotic arm to planned position, guide an accurate puncture pathway and establish working cannula. 25 consecutive patients who underwent conventional C-arm assisted tPELD surgery during the same period of time were assessed as the controlled group. The mean age was 45.5±13.7 years old (ranged from 16-68). All patients were followed up for 12 months. Clinical effect was assessed by visual analogue scale (VAS), Oswestry disability index (ODI) and Modified Macnab criteria. Intraoperative parameters and surgery-related complications were recorded.Results:The baseline data of age, surgical level, types of herniation, preoperative VAS scores and ODI had no significant difference between two groups ( P>0.05). In robot group, one case was converted to open microdiscectomy during operation due to technical failure. The other thirteen cases had successful robot assisted tPELD surgeries and were assessed accordingly. The new technique had good clinical outcomes. The immediate post-operative VAS score 2.85±1.79 and the last follow-up VAS score 1.50±1.04 were both significantly decreased than that before surgery 7.62±0.92 ( F=69.747, P<0.01); the last follow-up ODI 18.89%±12.16% was significantly reduced from the pre-operative ODI 71.19%±12.12% ( t=15.430, P<0.01). Between two groups, the immediate post-operative VAS score ( t=0.568, P=0.574), the last follow-up VAS score ( t=0.713, P=0.481), and last follow-up ODI had no significant difference ( t=0.171, P=0.865). The excellent or good rate of modified Macnab criteria at the last follow-up was 92.30% in robot group, comparing to 84.0% in controlled group. The fluoroscopic times during surgery of robot group 8.8±5.5 was significantly lowered the in controlled group 21.3±8.3 ( P<0.01). One case in robot group and two cases in controlled group had recurrence during follow-up period (recurrence rate 7.7% vs. 8.3%). However, there was no significant complications such as nerve root injury, dura injury or increased intracranial pressure in both groups. Conclusion:This study confirmed the feasibility of this new technique. Preliminary results indicated that TIANJI robot could help to build an easy, accurate and safe procedure of tPELD surgery.

The high-resolution chest CT findings and clinical features of dermatomyositis with anti-melanoma differentiation-associated gene 5 antibody / 中华风湿病学杂志

Objective:To investigate the high resolution computed tomography (HRCT) findings, laboratory test results and clinical manifestations of anti-melanoma differentiation-associated gene 5 (MDA5) antibody positive dermatomyositis complicated with lung interstitial lesions, and to analyze the correlation between the HRCT findings and clinical course of disease.Methods:Twenty-seven patients with anti-MDA5 antibody positive associated dermatomyositis (DM) were included and divided into two groups: acute/subacute group ( n=15) and chronic group ( n=12). HRCT images of lung were analyzed. Clinical data including gender, age, clinical manifestations and course of disease, anti-Ro52 antibody, creatine kinase (CK), antinuclear antibody (ANA), anti-Jo-1 antibody and erythrocyte sedimentation rate (ESR) were also collected. χ2 test was adopted for statistical analysis. Results:① Interstitial changes were 100%(27/27). The proportion of unilateral localized distribution was the most [48%(13/27)], followed by bilateral localized distribution [30%(8/27)], and bilateral diffuse distribution [22%(6/27)). ② Among the HRCT findings of lung interstitial changes, ground glass shadow was the most common presentations [59%(16/27)], followed by subpleural curve sign [63%(17/27)] and interlobular septal thickening [56%(15/27)], while honeycomb sign [0(0/27)] had the lowest rate of presentation. ③ Compared with the chronic progressive group, the acute/subacute progressive group presented as chest tightness (80% vs 8%, χ2=13.715, P<0.05) and dyspnea (47% vs 0, χ2=7.560, P<0.05). Acute/subacute HRCT showed ground glass opacity (87% vs 25%, χ2=10.501, P<0.05). The prominent HRCT showed interlobular septal thickening in the chronic course group (83% vs 33%, χ2=6.750, P<0.05). ④ The anti-MDA5 antibody (+++) index was significantly different (88% vs 25%, χ2=8.168, P<0.05). There was no significant difference in anti-Ro52 antibody (+), ANA(+), anti-Jo-1 antibody(+), CK elevation and ESR elevation between the two groups ( P>0.05). Conclusion:Most dermatomyositis patients with positive anti-MDA5 antibody are complicated with interstitial lung lesions, the HRCT manifestations of lung are diverse. In order to confirm the diagnosis of this disease, clinical manifestations, laboratory and pathological examinations are required.

Effect of high-flow nasal cannula oxygen on patients with chronic obstructive pulmonary disease and mild hypercapnia: a retrospective cohort study based on the Medical Information Mart for Intensive Care-Ⅳ database / 中华危重病急救医学

Objective:To observe the effect of high-flow nasal cannula oxygen therapy (HFNC) in patients with chronic obstructive pulmonary disease (COPD) and mild hypercapnia, and to evaluate the early predictive ability of physiological parameters in these patients.Methods:A retrospective cohort study was conducted based on Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ) updated in September 2020 and the data of adult patients with COPD and mild hypercapnia [45 mmHg (1 mmHg = 0.133 kPa) < arterial partial pressure of carbon dioxide (PaCO 2)≤ 60 mmHg] from 2008 to 2019 were collected. These patients were assigned to the HFNC group or non-invasive ventilation (NIV) group according to whether they received HFNC or NIV. Baseline data such as gender, age, body mass index (BMI), simplified acute physiology scoreⅡ (SAPSⅡ), Charlson comorbidity index (CCI) and physiological parameters were collected. A propensity score matching was conducted according to the baseline data of the HFNC group patients. The 48-hour and 28-day intubation rates, 28-day mortality, length of intensive care unit (ICU) stay, the length of hospital stay, and the changes in physiological parameters within 48 hours after treatment were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn and the ratio of heart rate over pulse oxygen saturation (HR/SpO 2) and ROX index [SpO 2 / (inhaled oxygen concentration, FiO 2×respiratory rate, RR)] were analyzed to predict the 24-hour and 48-hour intubation rates. Results:A total of 524 520 inpatient records were screened and 153 patients were included, while 37 patients in the HFNC group and 116 patients in NIV group. There were 31 patients in the HFNC group and 84 patients in the NIV group remained after propensity score matching according to the baseline data. There were no significant differences in the baseline data of gender, age, BMI, SAPSⅡ, CCI score, physiological parameters and prognosis data except the length of ICU stay. The length of ICU stay in HFNC group was significant longer than that of the NIV group [days: 4.6 (3.1, 10.0) vs. 3.1 (1.6, 5.8), P < 0.05]. HR and RR at 40- 48 hours were significantly lower than those at 0-8 hours after treatment only in the HFNC group [HR (bpm): 84.1±12.2 vs. 91.1±16.4, RR (times/min): 19.8±4.9 vs. 21.6±4.1, both P < 0.05]. Both in the HFNC group and NIV group the pH increased (7.42±0.08 vs. 7.36±0.05 and 7.41±0.06 vs. 7.36±0.05, both P < 0.05) and PaCO 2 decreased significantly [mmHg: 46.3 (39.5, 51.0) vs. 49.8 (45.5, 54.0) and 46.0 (40.5, 51.5) vs. 49.5 (45.5, 55.3), both P < 0.05]. The HR, PaO 2 were higher in the HFNC group than those in the HFNC group at 40-48 hours after treatment [HR (bpm): 91.1±15.4 vs. 84.1±12.2, PaO 2 (mmHg): 99.5 (86.0, 132.3) vs. 85.8 (76.5, 118.0), both P < 0.05], PaO 2/FiO 2 were lower in the HFNC group than that in the HFNC group at 40-48 hours after treatment [mmHg: 223.8 (216.5, 285.0) vs. 278.0 (212.3, 306.0), P < 0.05]. Both HR/SpO 2 and ROX index at 4 hours after treatment had predictive value for 24-hour and 48-hour intubation in the HFNC group. The areas under ROC curve (AUC) of HR/SpO 2 at 4 hours after treatment in the HFNC group were larger than those of ROX index for predicting 24-hour and 48-hour intubation (24-hour: 0.649 vs. 0.574, 48-hour: 0.692 vs. 0.581, both P < 0.01); the 95% confidence interval (95% CI) of 4 hours HR/SpO 2 and for ROX index predicting 24 hours and 48 hours intubation were 0.497-0.780, 0.567-0.799, 0.450-0.694 and 0.454-0.716, respectively. The high sensitivity of HR/SpO 2 and ROX index in predicting 24-hour and 48-hour intubation were 84.6%, 92.9%, 88.2% and 94.4%, respectively, and the low specificity were 52.3%, 23.7%, 54.7% and 29.6%, respectively. Conclusions:HFNC can be used in COPD patients with mild hypercapnia, but it cannot replace NIV. The accuracy of ROX index at 4 hours after HFNC treatment in predicting intubation in COPD patients with mild hypercapnia is poor.

Single scrotal-incision orchidopexy without ligation of processus vaginalis for palpable undescended testis / 中华男科学杂志

Objective@#To determine the feasibility and short-term effect of single scrotal-incision orchidopexy (SSIO) without ligation of the processus vaginalis (PV) in the treatment of palpable undescended testis (PUDT).@*METHODS@#This retrospective study included 109 cases of PUDT (125 sides) and 15 cases of impalpable undescended testis (IUDT). The former underwent SSIO without PV ligation (group A, n = 53) or standard inguinal orchidopexy with PV ligation (group B, n = 56) while the latter received laparoscopic exploration (group C). We analyzed the success rate of SSIO in the management of PUDT, postoperative complications, and incidence rates of hernia and hydrocele, and compared the relevant parameters between groups A and B.@*RESULTS@#The median age of the PUDT patients was 1.4 (0.6－11.0) years. Group A included 24 cases of left PUDT (2 with hydrocele), 20 cases of right PUDT (1 with hydrocele), and 9 cases of bilateral PUDT, the success rate of which was 95.1%. Group B consisted of 27 cases of left PUDT, 22 cases of right PUDT (3 with hernias), and 7 cases of bilateral PUDT. The rate of PV patency in the PUDT patients was 80.8% (101/125). Laparoscopic exploration of the 15 IUDT patients revealed 2 cases of congenital testis absence, 6 cases of testis dysplasia, all treated by surgical removal, 3 cases of staying around the inner ring, descended by inguinal orchidopexy, and the other 4 treated by laparoscopic surgery. The incisions healed well in all cases, with no testicular atrophy, inguinal hernia or hydrocele.@*CONCLUSIONS@#Single scrotal-incision orchidopexy without PV ligation is a safe and feasible procedure for the treatment of palpable undescended testis, which avoids the risk of inguinal hernia or hydrocele.

L-VDCC autoregulation abnormality contributes to calcium overload in myocardial ischemia-reperfusion injury / 生理学报

Calcium overload is a vital mechanism of myocardial ischemia-reperfusion injury, which is a hot therapeutic target in cardiovascular research. It has been well recognized that the dysfunction of calcium relevant proteins, including L-type voltage- dependent calcium channel (L-VDCC), sarco/endoplasmic reticulum ATPase 2a (SERCA2a)/phospholamban (PLB), RyR2, Na/Caexchanger, Na/Hexchanger, etc. contributes to calcium overload in cardiomyocytes during ischemia-reperfusion injury, in which the diastolic calcium concentration is increased and the amplitude of calcium transients is decreased. There are two phases in calcium increase. The early phase is partially mediated by calcium channels, and the latter one is mainly mediated by Na/Caexchanger. L-VDCC, a main subtype of calcium channels in myocardium, is involved in calcium overload, but the underlying molecular mechanism is not well elucidated yet. L-VDCC is regulated by intrinsic and extrinsic pathways. PKG and PKA as extrinsic regulators are not proper candidates to increase L-VDCC activity of cardiomyocyte in vitro, whereas the myocardial ischemia-reperfusion injury is highly possible to enhance L-VDCC activity by delaying calcium-dependent inactivation (CDI), advancing calcium-dependent facilitation (CDF), and weakening distal carboxy terminus (DCT) inhibition. Therefore, it is rational to propose that the L-VDCC autoregulation abnormality may play an important role in calcium overload during myocardial ischemia-reperfusion injury.

Clinical efficacy of EH composite material combined with CAD/CAM technique in plastic treatment of unilateral micrognathia / 中华医学美学美容杂志

Objective To evaluate the clinical efficacy in the treatment of unilateral micrognath ia by using EAM medical resin and hydroxyapatite (EH) composite material combined with the CAD/ CAM technique.Methods From July 2011 to October 2015,12 cases of unilateral micrognathia caused by different reasons were treated,based on the representative traits and requirements,refering to the unsymmetric counter part by right of CAD/CAM technique.By the 3-dimensional design and reconstruction,we reformed the EH composite material into purposed shape,and insert it in the operative area.Results All the materials were closely suitable to the mandible surfaces.1 case failed because the wound was torn apart;the other 11 patients recovered more than 6 months and were satisfied with the external appearance.Conclusions The EH composite materials combined with CAD/ CAM techniques could be a potential characterized remedy for the unilateral micrognathia.

Action mechanism of apoptosis in the development of acute lung injury after severe acute pancreatitis / 解放军医学杂志

Objective To explore the role of apoptosis in the development of acute lung injury (ALI) after severe acute pancreatitis (SAP) and its mechanism via Notch/Hes signal transduction pathway in the pathologic process.Methods Fifty healthy male Sprague Dawley rats were randomly divided into,sham group (n=8) and model group (n=42).Tissue samples of model group were collected randomly at 3 (n=10),6 (n=10),12 (n=10) and 24h (n=12) after model establishment.Tissue collection of Sham group was conducted at 3h.Left lung wet/dry weight ratio (W/D) was calculated;Histological scores of pancreatic and lung tissues were assessed under microscope;myeloperoxidase (MPO) and tumor necrosis factor-α (TNF-α) of lung tissues were determined by enzymatic-chemical method and radioimmunoassay method respectively.Apoptosis of lung cells was evaluated by TUNEL assay followed by calculation of apoptosis index.Protein levels of Notch-l,Hes-1 and Hes-5 were also detected semi-quantitatively by Western blotting.Results The lung tissue W/D of model rats exhibited a gradual increment at the prior 12 hours,and the ratio was significantly higher than that of sham group at each time point (P＜0.01) while it reached the peak at 12h time point.Pancreatic and lung pathological scores of model groups were increased at all time points and significantly higher than sham group (P＜0.01).Lung pathological scores of model groups achieved a peak at 12h.Meanwhile,lung MPO and TNF-α of model groups showed the same increment trend at each time points.The apoptosis index (AI) of lung cells in model groups were higher than that in sham group (P＜0.01).Compared with sham group,the model groups showed lower protein expression levels of Notch-1,especially at 3,6 and 12h (P＜0.05).Notch-1 protein expression level of 12h group was lower than that of 3,6 and 24h groups (P＜0.01).Correlation analysis found that apoptosis of lung cells was significantly negatively related to histopathological scores (r=-0.834,P＜0.01).The Notch-1 protein expression showed positive correlation with AI (r=0.515,P=0.004),but significantly negative correlation with W/D (r=-0.593,P=0.001),histological scores (r=-0.306,P=0.002),MPO (r=-0.687,P＜0.01) and TNF-α (r=-0.574,P=0.001) in the lung tissue.Conclusions Lung cell apoptosis,which is negatively correlated to tissue injury levels,may play an important role in the development of ALI after SAP.Inhibitory state of Notch-1 signaling transduction can aggravate ALI in the pathologic process.

Characteristics of head injuries-data from the Jiangsu Injury Surveillance System, 2006-2014 / 中华流行病学杂志

Objective To understand the epidemiological characteristics of head injuries through data gathered from the Jiangsu Injury Surveillance System.Methods Data on head injury that occurred during 2006-2014 were collected from the Jiangsu injury surveillance system and analyzed by SPSS 19.0 software.Results From 2006 to 2014,data on 133 172 cases of head injuries were collected which accounting for 26.2％ (133 172/509 175) of all the injury cases.Among them,males were 2.18 times higher than the females.The top five leading causes of head injuries were falls 24.6％ (32 796/133 172),blunt force injuries 24.4％ (32 446/133 172),motor car accident injuries 20.3％ (26 993/133 172),knife or sharp force injuries 10.7％ (14 183/133 172) and non-motor car accident injuries 6.7％ (8 919/133 172).Main locations that head injuries occured would involve roads/ streets 32.5％ (43 262/133 172),working places 22.2％ (29 526/133 172),at home 20.5％ (27 925/ 133 172) and public residences 10.8％ (14 367/133 172).Recreation activates 37.9％ (50 479/133 172),driving 26.1％(34 749/133 172),paid jobs 24.8％ (33 034/133 172) were the three major activities related to head injuries.Severity of injuries would depend on the situations on site.As for minor injuries,bruise accounted for 63.5％ (67 929/106 912).Brain trauma 21.5％ (5 119/23 803) and fracture 14.9％ (3 554/23 803) appeared an increasing trend.Severe injuries would include brain trauma 74.6％ (1 833/2 457).78.8％ (104 940/133 172) of the patients with head injuries would go home after receiving treatment the hospital,with fetality only as 0.1％ (134/133 172).Conclusion Data from the Jiangsu surveillance program showed that Head injury appeared the highest proportion among all the body injuries that called for special attention.

Degradation and clinical application of absorbable suture materials / 中国组织工程研究

BACKGROUND:Absorbable suture with good biocompatibility and mechanical strength has been extensively used in the clinic. OBJECTIVE: To explorein vitro degradation of different absorbable sutures, to analyze the clinical superiority of absorbable sutures and the influential factors for itsin vitro degradation. METHODS: After retrieval of related literatures concerning degradation and application of absorbable suture material, we retrospectively analyzed relevant articles addressing influential factors for performance and degradation of absorbable suture materials, and comparison of clinical absorbable and nonabsorbable sutures, thereby providing theoretical evidence for clinical application. RESULTS AND CONCLUSION: Absorbable sutures can be completely degraded and absorbed by the body, with no adverse reaction and no scars after wound healing. Absorbable sutures overcome the shortcomings of nonabsorbable sutures that cannot break down in the body. The absorption of its degradation products in vivo has two pathways: one is the phagocytosis of giant cels and phagocytes in the body, and the other is that the degradation products enter the body fluids and blood. For example, lactic acid is absorbed and excretedvia the systemic circulation. There is a very complicated physiological environment in the human body, and various factors can affect material properties. In addition, the different kinds of materials have different degradation mannersin vivo. Therefore, it is necessary to design, synthesize and process biodegradable polymer materialswith special properties within a certain range to meet the clinical needs.

Inhibitory effect of Aristolochia fruit on Cytochrome P450 isozymes in vitro and in vivo

The mature fruits of Aristolochia debilis, known in China by the name, "Madouling" has been popularly prescribed in Asia, particularly in China, to treat a range of conditions including gynaecological problems, arthritis and wound healing. This study was aimed to evaluate the potential effect of Madouling on the cytochrome P450 [CYP] isozymes in vitro in microsomal fractions and in vivo in rats. The influence of Madouling on CYPs activity was first explored by an in vitro method of estimating levels of four respective metabolites in rat liver microsomes. The results were re-examined in vivo in rats by using a cocktail approach involving the probe drugs theophylline, tolbutamide, chlorzoxazone and dapsone. Pharmacokinetics of the four substrates was used to analyze the activities of the targeting isozymes. In vitro study revealed that Madouling decreased the activity of CYP1A2, 3A1 and 2E1. However, no significant influence on CYP2C6 was found. These results coincided with those of in vivo study to a great degree except that in vivo estimation the herb didn't inhibit CYP1A2 significantly. From the data obtained, Madouling is suggested as a c and idate for clinically significant CYP interactions. Drug co-administrated with Madouling may need dose adjustment.

Monitoring on injuries in Jiangsu sentinel hospitals, from 2006 to 2013 / 中华流行病学杂志

Objective To analyze the characteristics on injuries,using data from the Jiangsu sentinel hospitals,from 2006 to 2013,to develop a injury prevention strategy.Methods Data was collected from the ‘National Injury Monitoring Report Card' of six sentinel hospitals from two surveillance points from 2006 to 2013.Results Information from 448 778 cases was analyzed.The numbers of male cases outnumbered the females,with sex ratio as 1.72:1.The top five causes of injuries were as follows:falls (27.21％),traffic-related (26.23％),blunt (17.50％),knife/sharp instrument (13.87％) and animal injury (6.59％).Injuries mainly occurred in June,July and August,at 8 to 10 O'clock in the morning.The major places where injuries occurred were road/street (31.58％),home (23.47％),industries and construction sites (21.38％).Recreation activities (36.12％),driving vehicle (25.26％),and at work (24.78％) were the major activities when injuries took place.Most injury cases were unintentional(92.65％) and deliberately(violence/attack) (6.36％).Conclusion All the injuries showed an yearly increase,from 2006 to 2013,with main causes as falls and traffic-related ones.Injuries among teenagers and the elderly should be paid special attention to,with targeted interventions taken.

Analysis on influencing factor of the complications of percutaneous dilational tracheotomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To Analyze the influence factors on the complications of percutaneous dilational tracheotomy.</p><p><b>METHODS</b>Between August 2008 and February 2014, there were 3 450 patients with the indications of tracheotomy accepted percutaneous dilational tracheostomy, mainly using percutaneous dilational and percutaneous guide wire forceps in these cases. Statistical analysis was performed by SPSS 19.0 software on postoperative complications, the possible influence factors including age, gender, etiology, preoperative hypoxia, obesity, preoperative pulmonary infection, state of consciousness, operation method, operation doctor and whether with tracheal intubation.</p><p><b>RESULTS</b>Among 3 450 patients, there were 164 cases with intraoperative or postoperative complications, including postoperative bleeding in 74 cases (2.14%), subcutaneous emphysema in 54 cases (1.57%), wound infection in 16 cases (0.46%), pneumothorax in 6 cases (0.17%), mediastinal emphysema in 5 cases (0.14%), operation failed and change to conventional incision in 4 cases (0.12%), tracheoesophageal fistula in 2 cases (0.06%), death in 3 cases(0.09%).Obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method were the main influence factors, with significant statistical difference (χ(2) value was 0.010, 0.000, 0.002, 0.000, 0.000, 0.000, all P < 0.05). Gender, age, operation doctor and whether there was the endotracheal intubation were not the main influence factors. There was no significant statistical difference (P > 0.05).</p><p><b>CONCLUSION</b>Although percutaneous dilational tracheostomy is safe, but the complications can also happen. In order to reduce the complications, it is need to pay attention to the factors of obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method.</p>

Application of 3D-printing kidney and stones for PCNL planning and teaching: a preliminary research / 中华泌尿外科杂志

Objective To explore the possibility of three-dimensional (3D) kidney replications for clinical and teaching of percutaneous nephrolithotomy (PCNL).Methods The CT urography (CTU) DICOM format data from 5 patients with kidney calculi were selected from March 1st to June 1st,2015.Thresholding technique,region growing technique,edit mask technique and multiple slice edit technique were used in sequence by Mimics software.And five 3D replications were printed by Object 500 3D printer.The sizes of the replications were measured and the replications were punctured.Results The 3D replications of the kidneys were successfully designed and printed.The average difference of the long axes between 3D replications and patients' kidneys was 0.283cm,the average difference of the diameters was 0.212cm,and the average difference of the diameter of the stones was 0.244cm.The sizes of the 3D replications were basically consistent with those of patients' kidneys.The simulative puncturing was successful.Conclusions After comparing the 3D replications with their original 2D CT images,the anatomical details are found basically the same.The 3D replications could provide 3D visual observations of organ anatomy for surgeons.

Effects of Extracorporeal Shock Wave Therapy on Early to Mid-term Knee Osteoarthritis: A Randomized Controlled Clinical Tri-al / 中国康复理论与实践

@#Objective To investigate the effect of extracorporeal shock wave therapy (ESWT) on early and mid-term knee osteoarthritis (KOA). Methods 70 patients were randomly assigned to ESWT group (n=34) or control group (n=36). The ESWT group was given shock wave on unilateral knee, while the control group accepted shock wave with the energy density of 0. They were evaluated with Visual Analog Scale (VAS) on movement, Lequesne Index and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index before and 12 weeks after the intervention. Results The scores of VAS, Lequesne Index and WOMAC Osteoarthritis Index improved more in the ESWT group than in the control group after intervention (P<0.01). Conclusion ESWT is effective on KOA as a non-surgical treatment.

Effect of raw Radix Rehmanniae on the pharmacokinetics of pioglitazone in rats

Raw Radix Rehmanniae [RRR] is a frequently used traditional Chinese medicine in the treatment of diabetes mellitus according to the statistics on all of the anti-diabetic formulas recorded in New National Traditional Chinese Medicine. Pioglitazone and RRR may be co-administrated for presumably enhanced therapeutic effects because of the common indications. Therefore, the aim of the study was to evaluate the effect of RRR on the pharmacokinetics of pioglitazone in healthy rats and type 2 diabetic rats. The pharmacokinetic effect of RRR on pioglitazone was studied in healthy rats and type 2 diabetic rats. A validated UPLC-MS/MS method was used to analyze the concentration of pioglitazone in blood samples. The pharmacokinetic parameters were calculated using non-compartmental analyses by Winnonlin 5.0.1. In healthy group, the pre-treatment of RRR significantly [P<0.05] reduced the C[max] but enhanced the V/F of pioglitazone; whereas in T2DM group, significant increase of C[max] and decrease of V/F and T[1/2] were found after the rats were pre-treated with RRR. However, AUC[0-t] and CL/F remained unchanged in both healthy group and T2DM group. In conclusion, co-administration with RRR could alter the pharmacokinetic profiles of pioglitazone to statistically significant levels.

Stapled haemorrhoidectomy in the choice of anastomosis site in patients with severe circumferential prolapsed haemorrhoids / 国际外科学杂志

Objective To explore the correlation of the distance between anastomosis and dentate line in patients with severe circumferential prolapsed haemorrhoids treated by stapled haemorrhoidectomy with the patients' postoperative clinical manufestival score, and assess its value in the choice of anastomosis site in stapled haemorrhoidectomy. Methods One hundred and six patients with severe circumferential prolapsed haemorrhoids was treated by stapled haemorrhoidectomy. The distance between anastomosis and dentate line was documented during the operation, effect of the treatment and complications were also documented postoperatively. All above-mentioned data were analysed statisticaly by one-way ANOVA and ridit test.Results Four groups were established in 106 patients according to the distance between anastomosis and dentate line. Patients with distance less than 1.0cm were defined as group A, between 1.0 cm and 1.5 cm as group B, between 1.5 cm and 2.0 cm as group C, more than 2.0 cm as group D. Concerning the postoperative incontinence score, satisfaction index and complications such as haemorrhage,ederma of anal everage,residal skin-tags, there was no significant difference between all groups. But there was significant difference between four groups in score of pain. Conclusions Patients with severe circumferential prolapsed haemorrhoids treated by Stapled haemorrhoidectomy tend to have good clinical outcome. The appropriate distance between anastomosis and dentate line should be chosed by the status of prolapsed haemorrhoids.

Correlation between syndrome factor combination and cardiac function as well as blood-lipid in coronary heart disease / 中西医结合学报

OBJECTIVE: To discuss the distribution laws of traditional Chinese medicine (TCM) syndrome factor and their combination in coronary heart disease (CHD), and to study the correlation between the TCM syndrome factor combination and cardiac function as well as blood-lipid. METHODS: The parameters of the cardiac function of 300 patients with a final diagnosis of CHD by coronary angiography were measured by echocardiography, and the levels of blood lipids in the CHD patients were detected. An analysis of the correlation was done between the TCM syndrome factor combination and cardiac function as well as blood-lipid in CHD. RESULTS: The TCM syndrome factor combinations of CHD were blood stasis due to qi deficiency, qi and yin deficiency, intermingled phlegm and blood stasis, and yang deficiency and blood stasis. The ejection fraction of CHD patients with yang deficiency and blood stasis was markedly decreased. The levels of triglyceride and low-density lipoprotein cholesterol in CHD patients with intermingled phlegm and blood stasis were markedly increased, and the level of triglyceride in CHD patients with qi and yin deficiency was markedly increased too. CONCLUSION: The treatment of CHD should aim directly at the symptoms and causes. It is also proved that some compound traditional Chinese herbal medicines for supplementing qi and activating blood circulation, nourishing yin and resolving phlegm, and activating yang should be used in treatment of CHD. In cases of CHD with low cardiac function, particular emphasis should be laid on activating yang and blood circulation, while in cases of CHD with blood-lipid disturbance, particular emphasis should be laid on resolving phlegm and activating blood circulation, replenishing qi and nourishing yin.

Clinical observation on the efficacy of Xiaoshui decoction combined with intrapleural perfusion of cisplatin in treating malignant pleural effusion / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the clinical efficacy of Xiaoshui decoction (XSD) combined with intrapleural perfusion of cisplatin in the treatment of malignant pleural effusion.</p><p><b>METHODS</b>Fifty-one patients with malignant pleural effusion were randomly assigned to two groups. The treated group (26 patients) received oral administration of XSD combined with intrapleural perfusion of cisplatin, and the control group (25 patients) was only treated with intrapleural perfusion of cisplatin. The effects of the short-term efficacy, quality of life scores and clinical symptom scores of malignant pleural effusion were evaluated.</p><p><b>RESULTS</b>The short-term efficacy in the treated group and the control group was 72.0% and 58.3%, respectively, and no significant difference was found (P>0.05). In contrast, the quality of life in the treated group was significantly improved compared to that of the control group (P<0.05), and so was the symptom remission (P<0.05).</p><p><b>CONCLUSIONS</b>The combined therapy of XSD and intrapleural perfusion of cisplatin did not show obvious improvement in short-term efficacy, but the therapy remarkably alleviated the symptoms and improved the quality of life of patients.</p>

The conception of theoretical structure of PRO efficacy scale of traditional Chinese medicine in coronary heart disease / 中华中医药杂志

By reviewing the research on patient reported outcomes (PRO) and the understanding of the theory of traditional Chinese medicine in coronary heart disease, the author found that the evaluation scale of PRO in coronary heart disease in traditional Chinese medicine should be guided by the theory of traditional Chinese medicine, including the theories of ‘heart-oriented, five internal organs correlation, internal injuries by seven emotions, unity of body and mind, correspondence between human and nature’ and other modern theoretical framework of PRO scale.It was believed that the physical, psychological, independence and social sphere constructed a special PRO efficacy scale of traditional Chinese medicine in coronary heart disease. The field of physiology on the scale was guided by ‘heart-based, five internal organs correlation' theory as the main line, and the scale was divided into various aspects in order to reflect all aspects of uncomfortable self-feeling of patients. Finally, 19 sides such as chest pain, chest tightness, heart palpitations, flank pain, insomnia, soreness and weakness of waist and knees, frequent urination at night, anorexia, weakness, spontaneous perspiration, shortness of breath, individual ability, daily life, positive feelings, negative feelings, personal relations and social support needed, level of social services, social intercourse and economy, healthy and medical care formed the theoretical structure model of the scale,which established the theory foundatio for the further development of PRO scale.