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Objective:To evaluate the clinical outcomes of Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy in the treatment of talus osteochondral lesions with autologous osteochondral transplantation (AOT).Methods:From January 2017 to December 2019, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy were performed in the AOT treatment of 11 patients with talus osteochondral lesions. They were 9 men 2 women, with a mean age of 32. 6 years (range, from 22 to 45 years). Their lesions were all Hepple type V. Their American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), International Knee Documentation Committee Knee Evaluation Form (IKDC) score, and imaging data were measured pre- and post-operatively for assessment of clinical outcomes.Results:All the patients were followed up for 13 to 24 months (average, 15.6 months). Their AOFAS (94.3±2.9) and VAS (1.2±0.4) scores at the final follow-up were significantly improved compared with the pre-operative values (49.5±6.6 and 5.7±1.2) ( P<0.05). There was no significant difference between their pre- and post-operative IKDC scores for the ipsilateral knee joint ( P>0.05). The imaging showed that the talus cystic change disappeared and the grafted bone was fully fused with the talus with no abnormal change in the joint space. Conclusion:In the AOT treatment of talus osteochondral lesions, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy can obviously relieve ankle pain and improve ankle function.
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Objective:To investigate the changes of skeletal muscle-derived microparticles (SKMPs) and their scaving proteins lactadherin in peripheral blood of patients with perihip fractures and their effects on blood coagulation. It provides a theoretical basis for clinical evaluation of hypercoagulability in patients with perioperative hip fractures.Methods:A total of 44 patients (72.87±13.9 years old) with perihip fractures from October 2020 to January 2021 were included in the fracture group, and 40 healthy people were included in the group without fracture. Activated clotting time (ACT) in fracture group and control group was measured by coagulation and platelet function analyzer. The level of SKMPs in peripheral venous blood was determined by flow cytometry. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of MPs scaving proteins lactadherin in peripheral blood of fracture group and control group.Results:A total of 44 patients with perihip fractures were included. There were 33 (75%) femoral neck fractures and 11 (25%) intertrochanteric fractures. SKMPs concentration in peripheral blood of perihip fracture group 175.73/μl; postoperative fracture group 124.28/μl; Normal control group 90.69/μl. ACT was (377.5±76.2) s in the perihip fracture group, (498.1±97.1) s in the post-fracture group, and (505.7±44.0) s in the control group. Correlation analysis showed that there was a linear relationship between SKMPs count and ACT value in fracture patients ( r=-0.52, P<0.001). There was no significant correlation between SKMPs concentration and ACT value in peripheral venous blood of the post-fracture group ( P>0.05); Lactadherin protein concentration in perihip fracture group: 2 779.61 pg/ml; Fracture postoperative group 1 985.38 pg/ml; Normal control group 1 651.19 pg/ml. There is a positive correlation between Lactadherin concentration and SKMPs concentration with a correlation coefficient of 0.70. Conclusion:SKMPs plays a role in the hypercoagulability of patients with perihip fractures. Decompensation of lactadherin protein may be one of the causes of perioperative hypercoagulation in patients with hip fractures.
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@#Objective To evaluate the effect of perioperative nebulization of ipratropium bromide on preoperative pulmonary function and incidence of postoperative pulmonary complications as well as safety in chronic obstructive pulmonary disease (COPD) patients who underwent lung resection in thoracic surgery. Methods During November 18, 2013 to August 12, 2015, 192 COPD patients with a necessity of selective surgical procedures of lobectomy or right bilobectomy or segmentectomy under general anaesthesia in 10 centers were 1 : 1 randomized to an ipratropium bromide group (96 patients) and a placebo group (96 patients), to compare the effect on preoperative pulmonary function and incidence of postoperative pulmonary complications. The average age of treated patients was 62.90±6.50 years, with 168 male patients and 22 female patients. Results The demographic and baseline characteristics were well-balanced between the two groups. The adjusted mean increase of forced expiratory volume in one second (FEV1) in the ipratropium bromide group was significantly higher than that in the placebo group (169.90±29.07 mL vs. 15.00±29.35 mL, P<0.05). The perioperative use of ipratropium bromide significantly decreased incidence of postoperative pneumonia (2.6% vs. 14.1%, P<0.05). There was no ipratropium bromide related adverse event (AE) observed in this trial. Conclusion This trial indicates that perioperative nebulization of ipratropium bromide significantly improves preoperative lung function and reduces postoperative pneumonia in COPD patients undergoing lung resection in thoracic surgery, and has good safety profile.
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BACKGROUND@#There is a certain correlation between vitamin nutritional status and cancer patients. Studies have shown that vitamin deficiency increases the risk of cancer. The purpose of this study is to understand the vitamin D nutritional status of cancer patients and to provide scientific basis for further nutritional intervention.@*METHODS@#Cancer patients who visited Shandong Cancer Hospital from July 2017 to June 2019 were included in this retrospective study. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured. Univariate analysis and multiple linear regression analysis were carried out using SPSS 20.0.@*RESULTS@#A total of 2,487 cancer patients were evaluable for this analysis. Mean 25(OH)D concentration was (12.70±6.82) ng/mL; the prevalence of vitamin D deficiency [25(OH)D concentration less than 20.00 ng/mL] was of 92.20%. In univariate analysis, age, body mass index (BMI), season and types of cancer were associated with 25(OH)D concentrations. In the multivariate analysis, BMI (β=0.71), age (β=-0.56), season (β=-0.99 for winter; β=-0.76 for autumn vs summer) and types of cancer (β=-1.17 for lung cancer; β=-1.45 for esophageal-gastric cancer; β=-1.05 for colorectal cancer vs other types of cancer) were independently and significantly associated with 25(OH)D levels (P<0.05).@*CONCLUSIONS@#Vitamin D deficiency was highly prevalent among cancer patients. Age, BMI, season and types of cancer may be associated with 25(OH)D levels, which indicate that monitoring of vitamin D level for cancer survivor should be taken into account.
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OBJECTIVE@#To investigate changes in intestinal flora in patients with primary Sj?gren syndrome (pSS) and explore the relationship between pSS disease activity and intestinal flora structure.@*METHODS@#Fecal samples were collected from 18 female pSS patients, including 9 patients with active disease (group A) and 9 with disease inactivity or low activity (group B), with 10 healthy subjects as the control group. The total bacterial DNA was extracted from the fecal samples for PCR amplification, and Illumina Hiseq 2500 high-throughput sequencing was performed for the v3-v4 region of 16Sr DNA gene to obtain the biological information of the intestinal flora. The intergroup OTU analysis, structural diversity analysis, significant difference analysis and LEFSE analysis were performed with information mining of the literature think tanks.@*RESULTS@#The dilution curves generated based on the OTUshannon index for analysis of sample complexity showed that the measured data were relatively complete and could reflect the diversity of the microorganisms in the subjects. Analysis of the Alpha diversity index showed that the Shannon index differed significantly between group A and group B, and the Simpson index differed significantly between group A and group B and between group A and the control group ( < 0.05). Sequence analysis the 3 groups all consisted mainly of 4 phylum (, , , showed that the intestinal flora in and ) and 4 genera (, , , and ), all showing no significant differences among the 3 groups ( > 0.05) with the exception of genus, which differed significantly among the 3 groups ( < 0.05). The 16S v3-v4 region in the genus , , , , , , , , , , -, and differed significantly among the 3 groups ( < 0.05). The high-dimensional biometrics and genomic characteristics of the intestinal microorganisms differed significantly among the 3 groups ( < 0.05). According to the size of LDA SCORE (effect size), the core flora in group A included the genera , , -, , -, , , , and , as compared with the genera , , , , , -, , - and in the control group.@*CONCLUSIONS@#Patients with pSS have significant changes in the diversity of intestinal flora, especially in some specific bacteria in genus and in 16S v3-v4 region of the bacteria. The differences in the core bacteria in the intestinal flora of pSS patients suggest the role of flora structure changes in the pathogenesis of pSS.
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Humans , Bacteria , Classification , Genetics , Biodiversity , DNA, Bacterial , Genetics , Feces , Microbiology , Gastrointestinal Microbiome , RNA, Ribosomal, 16S , Genetics , Sjogren's Syndrome , MicrobiologyABSTRACT
The latest diagnosis and treatment plan (4th edition) of 2019 novel coronavirus pneumonia has been issued. The diagnosis and treatment plan highlights the concept of integrated traditional Chinese and Western medicine, and Xuebijing injection was referred for three times. Xuebijing injection was successfully developed based on the theory of 'three syndromes and three methods'. The theory of 'three syndromes and three methods' is a theoretical system of integrated traditional Chinese and Western medicine on critical diseases proposed by Professor Wang Jinda and his team in the 1970s, and it is one of the main contents of Wang Jinda's academic thought. The theory of 'three syndromes and three methods' has a deep foundation of traditional Chinese medicine theory, and it is still being continuously enriched and improved. It is also supported by multiple evidence-based data. Therefore, 'three syndromes and three methods' has rich theoretical connotation and tenacious vitality.
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The latest diagnosis and treatment plan (4th edition) of 2019 novel coronavirus pneumonia has been issued. The diagnosis and treatment plan highlights the concept of integrated traditional Chinese and Western medicine, and Xuebijing injection was referred for three times. Xuebijing injection was successfully developed based on the theory of "three syndromes and three methods". The theory of "three syndromes and three methods" is a theoretical system of integrated traditional Chinese and Western medicine on critical diseases proposed by Professor Wang Jinda and his team in the 1970s, and it is one of the main contents of Wang Jinda's academic thought. The theory of "three syndromes and three methods" has a deep foundation of traditional Chinese medicine theory, and it is still being continuously enriched and improved. It is also supported by multiple evidence-based data. Therefore, "three syndromes and three methods" has rich theoretical connotation and tenacious vitality.
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Pelvic girdle pain and low back pain associated with pregnancy and pregnancy is one of the common diseases of women during pregnancy. Because pregnant women lack comprehensive knowledge of relevant physiopathology, they will mistakenly believe that clinical intervention treatments may have potentially harmful effects on the fetus. Therefore, many pregnant women refused to receive effective medical intervention. However, low back pain during pregnancy is closely related to their daily life. The pain will have a negative impact on the daily life of pregnant women, causing inconvenience and even obstacles in life. All these have caused great harm to the physiology and psychology of pregnant women, and also make the treatment of this disease have broader socio-economic value and significance. In clinical practice, the Kinesiotaping can effectively relieve the symptoms of pregnant women with low back pain during pregnancy. The clinical operation is simple and convenient, and the potential risk is small. In this paper, the research progress in the application of kinesiotaping treatment of low back pain during pregnancy was summarized.
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OBJECTIVE@#To investigate changes in intestinal flora in patients with primary Sj?gren syndrome (pSS) and explore the relationship between pSS disease activity and intestinal flora structure.@*METHODS@#Fecal samples were collected from 18 female pSS patients, including 9 patients with active disease (group A) and 9 with disease inactivity or low activity (group B), with 10 healthy subjects as the control group. The total bacterial DNA was extracted from the fecal samples for PCR amplification, and Illumina Hiseq 2500 high-throughput sequencing was performed for the v3-v4 region of 16Sr DNA gene to obtain the biological information of the intestinal flora. The intergroup OTU analysis, structural diversity analysis, significant difference analysis and LEFSE analysis were performed with information mining of the literature think tanks.@*RESULTS@#The dilution curves generated based on the OTUshannon index for analysis of sample complexity showed that the measured data were relatively complete and could reflect the diversity of the microorganisms in the subjects. Analysis of the Alpha diversity index showed that the Shannon index differed significantly between group A and group B, and the Simpson index differed significantly between group A and group B and between group A and the control group ( < 0.05). Sequence analysis the 3 groups all consisted mainly of 4 phylum (, , , showed that the intestinal flora in and ) and 4 genera (, , , and ), all showing no significant differences among the 3 groups ( > 0.05) with the exception of genus, which differed significantly among the 3 groups ( < 0.05). The 16S v3-v4 region in the genus , , , , , , , , , , -, and differed significantly among the 3 groups ( < 0.05). The high-dimensional biometrics and genomic characteristics of the intestinal microorganisms differed significantly among the 3 groups ( < 0.05). According to the size of LDA SCORE (effect size), the core flora in group A included the genera , , -, , -, , , , and , as compared with the genera , , , , , -, , - and in the control group.@*CONCLUSIONS@#Patients with pSS have significant changes in the diversity of intestinal flora, especially in some specific bacteria in genus and in 16S v3-v4 region of the bacteria. The differences in the core bacteria in the intestinal flora of pSS patients suggest the role of flora structure changes in the pathogenesis of pSS.
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Female , Humans , Bacteria , DNA, Bacterial , Feces , Gastrointestinal Microbiome , RNA, Ribosomal, 16S , Sjogren's SyndromeABSTRACT
Objective To analyze the clinical efficacy and prognosis of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases.Methods Medical records of 104 patients with SBRT for pulmonary oligometastases in our hospital between 2012 and 2018 were retrospectively reviewed.SBRT was performed by intensity modulated radiation therapy (IMRT) technique before December 2015,and by helical tomotherapy (HT) technique in others.The local control (LC),progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.Cox-regression was used for univariate analyses and multivariate analyses.The radiotherapy-related adverse events were evaluated by NCICTCAE V4.0.Results The 1-,2-and 3-year LC rates were 86.6％,75.9％ and 72.3％,respectively.The 1-,2-and 3-year PFS rates were 40.9％,28.4％ and 22.1％,respectively.The 1-,2-and 3-year OS rates were 75.9％,53.2％ and 43.53％,respectively.The median OS time was 26.6 months.Multivariate analyses showed that the pathologic type of primary tumor,the volume of lung oligometastases and the carcino-embryonic antigen (CEA) level before SBRT were the independent prognostic factors of LC (x2 =28.66,P＜0.05).The way of tumor progression after SBRT was the independent prognostic factor of OS (x2=40.01,P＜0.05).Meanwhile,there were no significant differences in the LC and OS between HTSBRT and IMRT-SBRT.Radiation pneumonitis was the major adverse event of SBRT (n =25,24.04％).Less than 7％ patients experienced grade 2 and above radiation pneumonitis.Conclusions SBRT shows high local control rates and tolerable adverse events in the treatment of pulmonary oligometastases.There were no significant differences in the clinical efficacy and adverse events between HT-SBRT and IMRT-SBRT,which means they are all suitable for clinical application.
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The?"three?certificates?and?three?methods"?is?a?combination?of?Chinese?and?Western?medicine?for?the?treatment?of?sepsis?proposed?by?Professor?Wang?Jinda,?a?pioneer?in?Chinese?emergency?medicine.?The?"Wei?Qi?Ying?Xue"?syndrome?differentiation?is?a?dialectical?theory?proposed?by?Ye?Tianshi,?a?famous?doctor?in?the?Qing?Dynasty,?for?the?treatment?of?warm?diseases.?The?"three?certificates?and?three?methods"?theory?of?"toxin-heat?syndrome"?(inflammation?storm)?to?the?"blood?stasis?syndrome"?(coagulation?storm)?conversion?mainly?focus?on?the?"Wei?Qi?Ying?Xue"?syndrome?differentiation?of?the?"Wei,?Qi?syndrome"?to?"Ying,?Xue?syndrome",?and?poison.?The?conversion?of?"toxin-heat?syndrome"?to?"blood?stasis?syndrome"?is?a?watershed?in?the?progression?of?common?infections?to?sepsis.?The?timely?application?of?Xuebijing?injection?can?cut?off?this?transformation,?which?is?one?of?the?reasons?why?Xuebijing?injection?can?treat?sepsis.
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Septic shock is a pathological stage during the progress of sepsis. The mortality rate is high, and timely, standardized and comprehensive treatment is of great significance in reducing the mortality rate. At present, there are many domestic and international guidelines for the diagnosis and treatment of sepsis and septic shock. On this basis, China Association of Integrative Medicine Emergency Medicine Committee organized experts to collect evidence-based medical evidence and expert experience in the diagnosis and treatment by integrated Chinese and Western medicine, and referred to the Expert consensus on diagnosis and treatment of sepsis with integrated traditional Chinese and Western medicine published by China Association of Integrative Medicine Emergency Medicine Committee in 2013, developed Expert consensus on diagnosis and treatment of septic shock with integrated traditional Chinese and Western medicine. The consensus provided a "China approach" for the resolution of this worldwide problem. In the "China approach", the staging of septic shock is "longitude", and the "four syndromes and four methods" treatment thought is "latitude". Under the framework of interlaced latitude and longitude, we recommend a series of effective integrated Chinese and Western medicine treatment. The method embodies the wisdom of China and has certain guiding significance for the clinical treatment of septic shock.
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A farm worker in Baodi District of Tianjin was diagnosed with Tsutsugamushi disease due to fever and intermittent cough for more than 3 months.The patient's diagnosis and treatment process was complicated, and the diagnosis was delayed in the early stage of the disease because the clinician neglected the occupational history and lacked knowledge about the prevention and control of tsutsugamushi disease. As an important part of the epidemiological history, occupational history is crucial for the diagnosis of occupational related diseases. Clinical thinking runs through the whole process of clinical diagnosis and disease treatment, and correct clinical thinking can effectively reduce the occurrence of misdiagnosis.Clinicians should ask and record career history in detail to improve the quality of health care.
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The interface of ligaments, tendons, and bones are susceptible to damage, often fail to heal themselves, and even cannot achieve a good prognosis after surgery. Interface tissue engineering is a comprehensive strategy to functionally connect soft and hard tissues to regenerate original anatomical functions and structures, thereby improving clinical efficacy. In this paper, the interface tissue engineering and composite tissue regeneration in soft tissue healing were systematically reviewed. The recent advances in interface engineering were summarized, based on the treatment of structural damage from two common soft tissue-bone connections (ligamentous bone connections, tendon bone connections), from the development of single tissue to composite tissue structures. The latest interface tissue engineering innovation structure design and potential clinical applications in recent years were reviewed. For future research, in-depth research on the mechanisms of interface development, regeneration, and internal environment balance, structure-function relationships, and biological processes that drive interface development, regeneration, and internal environment balance are still necessary. The innovative studies on interface tissue engineering have promoted the significance of the integration of tissue engineering and clinical, and the construction of complex tissues, so that it has broader significance for the future regeneration of total joints.
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The interface of ligaments, tendons, and bones are susceptible to damage, often fail to heal themselves, and even cannot achieve a good prognosis after surgery. Interface tissue engineering is a comprehensive strategy to functionally connect soft and hard tissues to regenerate original anatomical functions and structures, thereby improving clinical efficacy. In this paper, the interface tissue engineering and composite tissue regeneration in soft tissue healing were systematically reviewed. The recent advances in interface engineering were summarized, based on the treatment of structural damage from two common soft tissue-bone connections (ligamentous bone connections, tendon bone connections), from the development of single tissue to composite tissue structures. The latest interface tissue engineering innovation structure design and potential clinical applications in recent years were reviewed. For future research, in-depth research on the mechanisms of interface development, regeneration, and internal environment balance, structure-function relationships, and biological processes that drive interface development, regeneration, and internal environment balance are still necessary. The innovative studies on interface tissue engineering have promoted the significance of the integration of tissue engineering and clinical, and the construction of complex tissues, so that it has broader significance for the future regeneration of total joints.
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Idiopathic systemic capillary leak syndrome (ISCLS) is a rare disease, the clinical manifestation is increased acute episodic capillary leakage (SCL), leading to protein-rich fluid leakage from the blood vessels to the interstitial tissue space, resulting in progressive systemic edema, hypoproteinemia, hypotension, blood concentration and other clinical symptoms. Because of ISCLS frequent recurrences, high mortality, pathogenesis unclear and no definite treatment plan, it is extremely important to fully understand the disease to carry out early intervention to save the patients' lives. This article reviews the progress of ISCLS, including its disease onset characteristics, clinical features, pathological mechanism, diagnosis and treatment of ISCLS.
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Expert Consensus on the Application of Chinese Patent Medicine for Acute Upper Respiratory Tract Infection was established under the joint sponsorship of Specialty Committee of Emergency of World Federation of Chinese Medicine Societies, Emergency Physician Branch of Chinese Medical Doctor Association, Emergency Medicine Professional Committee of Chinese Association of Integrative Medicine and Chinese Emergency Medical Parternerships. In the consensus, the Chinese patent medicines for treatment of acute upper respiratory tract infection (AURI) were summarized and analyzed, and after the expert writers had discussed the contents of the consensus together, they decided to formulate the experts' consensus related to the AURI, expecting to provide a reference to the clinical treatment of this disease.
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Bullous pemphigoid is a chronic obstinate dermatological disease. Hormone is the main therapeutic method, but the disease course is rather long, relapse is frequently seen and difficult to be radically cured; many complications may occur such as pulmonary infection, etc. From traditional Chinese medicine (TCM) basic principal points of view "lung governing skin and hair" and "strengthen the body resistance to eliminate pathogenic factors", the author explored the TCM therapy of bullous pemphigoid. By using clearing away lung heat and invigorating lung qi as the main principles supplemented by invigorating spleen and kidney, eliminating phlegm and blood stasis for treatment of such disease, relatively satisfactory therapeutic results were obtained.
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Objective: To investigate the clinicopathological characteristics and prognostic factors in breast carcinoma patients with bone-only metastasis (BOM). Methods: A total of 967 patients with metastatic breast cancer treated in Tianjin Medical University Insti-tute and Hospital between January 2009 and December 2016 were screened, and the case data were retrospectively analyzed. These data involve 180 cases in the BOM group and 787 cases in the non-BOM group. We performed univariate analysis and Cox regression model multivariate analysis of prognostic factors in patients with BOM. Subgroup analysis was performed according to the hormone re-ceptor (HR) status, number of bone metastases, and treatment approaches. Results: Patients in the BOM group had a median progres-sion-free survival (PFS) of 19.4 months, and non-BOM patients had a median PFS of 10.0 months. Patients in the BOM group had a me-dian overall survival (OS) of 45.6 months. The proportions of patients with HR positivity were 81.7% (147/180) in the BOM group and 64.7% (509/787) in the non-BOM group (P<0.001). Cox regression model multivariate analyses found that HR status, location of bone metastases, number of bone metastases, and treatment approach were independent factors influencing the prognosis of patients with BOM. Among patients with HR-positive BOM, the prognosis of patients receiving endocrine therapy (P=0.004) or combinatory therapy (P<0.001) was significantly better than that of patients receiving chemotherapy alone. The number of bone metastases and endocrine therapy were independent prognostic factors in patients with HR-positive BOM. Patients with single bone metastases who received en-docrine therapy (P=0.004) or combinatory therapy (P=0.002) had better prognosis than patients who received chemotherapy alone. Patients with multiple bone metastases who received combinatory therapy had better prognosis than patients who received endo-crine therapy (P=0.04) or chemotherapy alone (P<0.001). Conclusions: For HR-positive BOM patients, especially those with single me-tastases, endocrine therapy can obtain satisfactory outcomes. For patients with multiple metastases, combinatory therapy can be con-sidered.
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Objective To explore the effect of 3d digital reconstruction and printing technology on the teaching of complex orthopedics. Methods A total of 90 interns in the Second Affiliated Hospital of Inner Mongolia Medical University from September 2016 to September 2017 were selected as research subjects. According to the different teaching methods, they were divided into control group (n=45) and experimental group (n=45). The former received traditional teaching;the latter used three-dimensional digital reconstruction and printing technology to print out complex fracture models of patients, digitally reproduced fracture classification, developed scientific surgical plans through fracture models, and simulated surgical fixation methods. Examination was divided into clinical skills and written exam according to exam outline requirements; Self-cognitive ability score included professional interest, fracture understanding, etc. The satisfaction of the medical students in the experimental group was determined using self-made questionnaires. t test was used to compare data between groups. Results Experimental groups' scores for surgical skills (84.36 ±0.28) and theoretical knowledge (87.55 ±0.44) were higher than the control group, and the differences were statistically significant (P<0.05). The professional interest of the experimantal group was higher than that of the control group, and the difference was statistically significant (P<0.05). The students' classroom atmosphere was significantly better compared with the control group, and the difference was statistically significant (P<0.05). Conclusion Using 3 d digital reconstruction and printing technology to establish modes in complex orthopedics teaching process can effectively improve interns' surgical skills and theoretical knowledge, and promote student satisfaction.