Systematic review and Meta-analysis of Gusongbao preparation in treatment of primary osteoporosis / 中国中药杂志

This study aims to provide evidence for clinical practice by systematically reviewing the efficacy and safety of Gusongbao preparation in the treatment of primary osteoporosis(POP). The relevant papers were retrieved from four Chinese academic journal databases and four English academic journal databases(from inception to May 31, 2022). The randomized controlled trial(RCT) of Gusongbao preparation in the treatment of POP was included after screening according to the inclusion and exclusion criteria. The quality of articles was evaluated using risk assessment tools, and the extracted data were subjected to Meta-analysis in RevMan 5.3. A total of 657 articles were retrieved, in which 15 articles were included in this study, which involved 16 RCTs. A total of 3 292 patients(1 071 in the observation group and 2 221 in the control group) were included in this study. In the treatment of POP, Gusongbao preparation+conventional treatment was superior to conventional treatment alone in terms of increasing lumbar spine(L2-L4) bone mineral density(MD=0.03, 95%CI[0.02, 0.04], P<0.000 01) and femoral neck bone mineral density, reducing low back pain(MD=-1.69, 95%CI[-2.46,-0.92], P<0.000 1) and improving clinical efficacy(RR=1.36, 95%CI[1.21, 1.53], P<0.000 01). Gusongbao preparation was comparable to similar Chinese patent medicines in terms of improving clinical efficacy(RR=0.95, 95%CI[0.86, 1.04], P=0.23). Gusongbao preparation was inferior to similar Chinese patent medicines in reducing traditional Chinese medicine syndrome scores(MD=1.08, 95%CI[0.44, 1.71], P=0.000 9) and improving Chinese medicine syndrome efficacy(RR=0.89, 95%CI[0.83, 0.95], P=0.000 4). The incidence of adverse reactions of Gusongbao preparation alone or combined with conventio-nal treatment was comparable to that of similar Chinese patent medicines(RR=0.98, 95%CI[0.57, 1.69], P=0.94) or conventio-nal treatment(RR=0.73, 95%CI[0.38, 1.42], P=0.35), and the adverse reactions were mainly gastrointestinal discomforts. According to the available data, Gusongbao preparation combined with conventional treatment is more effective than conventional treatment alone in increasing lumbar spine(L2-L4) bone mineral density and femoral neck bone mineral density, reducing low back pain, and improving clinical efficacy. The adverse reactions of Gusongbao preparation were mainly gastrointestinal discomforts, which were mild.

Effect of duodenal stump reinforcement on postoperative complications in patients undergoing laparoscopic radical gastrectomy / 中华胃肠外科杂志

Objective: To evaluate the influence of duodenal stump reinforcing on the short-term complications after laparoscopic radical gastrectomy. Methods: A retrospective cohort study with propensity score matching (PSM) was conducted. Clinical data of 1204 patients with gastric cancer who underwent laparoscopic radical gastrectomy at the First Affiliated Hospital of Army Medical University from April 2009 to December 2018 were collected. The digestive tract reconstruction methods included Billroth II anastomosis, Roux-en-Y anastomosis and un-cut-Roux- en-Y anastomosis. A linear stapler was used to transected the stomach and the duodenum. Among 1204 patients, 838 were males and 366 were females with mean age of (57.0±16.0) years. Duodenal stump was reinforced in 792 cases (reinforcement group) and unreinforced in 412 cases (non-reinforcement group). There were significant differences in resection range and anastomotic methods between the two groups (both P<0.001). The two groups were matched by propensity score according to the ratio of 1∶1, and the reinforcement group was further divided into purse string group and non-purse string group. The primary outcome was short-term postoperative complications (within one month after operation). Complications with Clavien-Dindo grade ≥ III a were defined as severe complications, and the morbidity of complication between the reinforcement group and the non-reinforcement group, as well as between the purse string group and the non-purse string group was compared. Results: After PSM, 411 pairs were included in the reinforcement group and the non-reinforcement group, and there were no significant differences in baseline data between the two groups (all P>0.05). No perioperative death occurred in any patient.The short-term morbidity of postoperative complication was 7.4% (61/822), including 14 cases of anastomotic leakage (23.0%), 11 cases of abdominal hemorrhage (18.0%), 8 cases of duodenal stump leakage (13.1%), 2 cases of incision dehiscence (3.3%), 6 cases of incision infection (9.8%) and 20 cases of abdominal infection (32.8%). Short-term postoperative complications were found in 25 patients (6.1%) and 36 patients (8.8%) in the reinforcement group and the non-reinforcement group, respectively, without significant difference (χ2=2.142, P=0.143). Nineteen patients (2.3%) developed short-term severe complications (Clavien-Dindo grade ≥IIIa), while no significant difference in severe complications was found between the two groups (1.7% vs. 2.9%, χ2=1.347, P=0.246). Sub-group analysis showed that the morbidity of short-term postoperative complication of the purse string group was 2.6% (9/345), which was lower than 24.2% (16/66) of the non-purse string group (χ2=45.388, P<0.001). Conclusion: Conventional reinforcement of duodenal stump does not significantly reduce the incidence of duodenal stump leakage, so it is necessary to choose whether to reinforce the duodenal stump individually, and purse string suture should be the first choice when decided to reinforce.

The Research of Effects of Applying Cataplasm of Paris Polyphylla Smith Var. Yunnanensis (Franch.) Hand.-Mazz on Acute Gouty Arthritis and Inflammation / 昆明医科大学学报

Objective This study is designed to improve topical medication in the Department of Orthopedics in Kunming Municipal Hospital of Traditional Chinese Medicine by applying cataplasm made from the active ingredient (polyphyllin) of Paris polyphylla Smith var. yunnanensis (Franch.) Hand.-Mazz ("Dian Chonglou"in Chinese) and to study the mechanism of anti-inflammation. Methods SD male rats were randomly divided into two groups: control group and treatment group. The rats in two groups were all injected 50ul 5% sodium urate suspension into tibiotarsal joint cavity to duplicate the model of acute gouty arthritis.The rats in the control group were applied with cataplasm without polyphyllin, whereas those in the treatment group applied with cataplasm of polyphyllin. After 4,24,48,72 hours,the ankle diameter and circumference were measured. ELISA was used to test the interleukin-1β (IL-1β) andtumor necrosis factor (TNF) in peripheral blood. Western blotting was applied to detect the changes in TLR4 expression of monocyte.Results Compared with the control group, the added value of the diameter and circumference of ankle decreased significantly in the treatment group 4, 24,48 and 72 h after the treatment.IL-1β in the treatment group was lowered at 4,24 and 72 h. TLR4in the treatment group decreased at 48 h. Conclusion Cataplasm with polyphyllin can alleviate the acute inflammatory reaction in gouty joint of rat by reducing the expression of IL-1βand TLR4.

Correlation analysis between position of head, cervical curvature classification and balance of cervical spine through lateral plain radiograph measurement / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the relationship between position of head, cervical curvature type and associated cervical balance parameters in a neutral looking-forward posture.</p><p><b>METHODS</b>Cervical lateral X-rays of 60 patients with cervical spondylosis were selected from January to December 2015. There were 22 males and 38 females with an average age of (35.5±10.9) years old. The measured parameters included cervical curvature type, McGregor slope, C2 lower end plate slope, T1 slope, center of gravity to C7 sagittal vertical offset (CG-C7 SVA), and C2 to C7 sagittal vertical offset (C2-C7 SVA). The parameters were analyzed using Spearman correlation.</p><p><b>RESULTS</b>The cervical curvature type was significantly correlated with C2 lower endplate slope, C0-C2 angle (total degree of C2 lower endplate slope plus McGregor slope), CG-C7 SVA and T1 slope (<0.05), but it was not significantly correlated McGregor slope (>0.05). C2 lower endplate slope and C2-C7 SVA (r=0.87) were significantly (<0.05) correlated with CG-C7 SVA (<0.05).</p><p><b>CONCLUSIONS</b>There was certain some relationship among position of head, cervical curvature type and associated cervical balance parameters in a neutral looking-forward posture. The center of gravity of the head would backwards shift following faced upward. A position of extension with posterior-shifting of the head would suggest that it may be accompanied with a relatively normal lordosis of the cervical spine. Some patients with abnormal curvature showed slightly bended head in the natural posture. Health education toward these people would be meaningful to restore the balance of their neck.</p>