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Objective:To explore the clinical effect of radial extracorporeal shockwave therapy on delayed union of forearm fractures in children with ultrasonic guidance.Methods:A retrospective analysis of information on 18 children with delayed forearm fracture union who received ultrasonic guided extracorporeal shockwave therapy from February 2018 to June 2019 was conducted. Among them, there were 14 males and 4 females; Age: 9.44±3.75 years (range, 3-15 years); All the children were closed forearm fractures, including 13 cases of ulna and 5 cases of radius. Initial fixation methods: intramedullary nails fixation in 8 cases, Kirschner wire fixation in 4 cases, steel plate fixation in 2 cases, external fixation in 2 cases, conservative treatment in 2 cases; The classification of fracture nonunion were: 14 cases of hypertrophy, 4 cases of atrophy; The course of disease was 4.0 (3.0, 6.0) months. The front and lateral X-ray films of the affected side forearm were taken before treatment, 3 months and 6 months after treatment. The scores of callus condition were performed using Lane-Sandhu X-ray scoring standard and Fernandez-Esteve X-ray evaluation standard of callus grade.Results:All children completed treatment and were followed up for 6 months. The bone healing standard was the disappearance of the fracture line shown by anterior and lateral X-ray films. Within 6 months after treatment, 11 patients got bone union. The healing rate was 61.11% (11/18). The average of Lane-Sandhu X-ray scores before treatment, 3 months and 6 months after treatment were 3.0 (1.0, 4.0), 6.0 (4.0, 8.0) and 10.0 (5.0, 12.0), respectively, there were statistically significant differences in pairwise comparisons at each time point. And the average scores of Fernandez-Esteve X-ray evaluation standard for callus grade were 1.0 (1.0, 2.0), 3.0 (2.0, 4.0), and 4.0 (3.0, 4.0), respectively, there were statistically significant differences from 3 months and 6 months after treatment to preoperative group, while there was no statistically significant difference between 3 months and 6 months after treatment. The mixed effects model analysis results showed that only the Lane Sandhu X-ray score and Fernandez Esteve X-ray standard score of callus grade at different follow-up time points were significantly different. There was no statistically significant difference in age, gender, number of shockwave treatments and interval time from the first treatment after the initial fixation.Conclusion:The radial extracorporeal shockwave therapy can effectively treat the delayed healing of forearm fractures in children; the X-ray score has been significantly improved. The treatment is highly accepted by children and their parents, and can be used as one of the methods to treat delayed healing of fractures in children in the future.
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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.
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Objective:To explore the clinical effect and application value of simultaneous modulated accelerated radiotherapy (SMART) in the suspicious positive lymph nodes of head and neck.Methods:From January 2017 to February 2019, 60 patients with suspected positive lymph nodes in the head and neck in the Hanzhong Central Hospital of Shaanxi Province were divided into experimental group and control group according to different treatment plans, and 30 patients in each group were included. In the experimental group, 63.36 to 66.66 Gy patients were treated with SMART, while in the control group, 54.12 to 60.06 Gy patients were treated with conventional neck prophylactic radiation. In order to evaluate the feasibility of the method, the change of the short diameter of the largest cross section of the suspicious positive lymph nodes in the two groups were observed, and the adverse reactions in the treatment of the two groups were analyzed.Results:There was no significant difference between the two groups before treatment ( P>0.05). After treatment, the size of short diameter of lymph nodes in the two groups was smaller than that before treatment. The maximum short diameter of the largest cross section of lymph nodes in the experimental group was smaller than that before treatment: (0.43 ± 0.07) cm vs. (0.72 ± 0.10) cm, and the difference was statistically significant ( P<0.05). In the control group, the maximum short diameter of the largest cross section of lymph node decreased after treatment, and the difference was not statistically significant ( P>0.05). After treatment, the reduction of the short diameter in the experimental group was more obvious than that in the control group. The maximum short diameter of the largest cross section between the two groups: (0.43±0.07) cm vs. (0.66±0.08)cm was statistically significant ( t = 11.523, P<0.05). Before treatment, hemoglobin (HGB) levels of the two groups were in the normal physiological range, and there was no significant difference between the two groups ( P>0.05); the white blood cell (WBC) levels of the two groups at different time after treatment were compared: in the first week (7.83 ± 2.53) × 10 9/L vs. (8.26 ± 3.16) × 10 9/L, in the third week (7.14 ± 3.65) × 10 9/L vs. (7.08 ± 2.53) × 10 9/L, in the fifth week (5.47 ± 2.81) × 10 9/L vs. (6.41 ± 2.57) × 10 9/L, and in the seventh week (4.36 ± 2.59) × 10 9/L vs. (4.98 ± 1.64) × 10 9/L, and there were statistical differences ( P<0.05), which indicated that the WBC index levels of the two groups were gradually decreased during the treatment, and the decreased degree of the experimental group was higher than that of the control group. The levels of HGB and PLT were maintained in the normal physiological range before and after treatment, and there was no significant difference between the two groups ( P>0.05). The main complications in the treatment of the experimental group were xerostomia and stomatitis. The adverse reactions in the control group were pain in the target area of radiotherapy. There was no significant difference between the two groups ( P>0.05). Conclusions:The application of IMRT is an effective method for the treatment of occult lymph node metastasis, and it is also a therapeutic diagnostic method, which can provide evidence for the study of the law of lymph node metastasis in the head and neck. The safety and tissue tolerance of IMRT in the treatment of suspicious positive lymph nodes in the head and neck are good, which can be used for the suspicious lymph nodes in the head and neck. The treatment of positive lymph nodes and the evaluation of patients′ prognosis provide an effective way of clinical treatment.
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Objective:To investigate the correlation between single nucleotide polymorphism of corticosteroids receptor gene(NR3C1)and children with asthma and to analyze the efficacy of inhaled corticosteroid(ICS)treatment.Methods:The study included a control group(100 healthy children)who participated in the physical examination and an asthma group(101 children with bronchial asthma)who were hospitalized in the General Hospital of the Northern Theater Command from October 2018 to October 2020.Genomic DNA was extracted from peripheral blood samples of all enrolled subjects and then the polymorphism of the glucocorticoid receptor gene locus of NR3C1 was analyzed using SNaPshot SNP gene detection technology.The comparisons of allele frequency in rs41423247、rs7701443 between two groups were performed and the treatment effects of ICS in the asthma group were evaluated at the 12th week of treatment.Results:The frequencies of GG, GC, and CC genotypes of rs41423247 locus of NR3C1 were 75.2%, 21.8%, and 3.0% in the asthma group and 72.0%, 24.0%, and 4.0% in the control group, respectively, and there were no statistically significant differences between the two groups( χ2=0.333, P>0.05). The frequencies of GG, GA, and AA genotypes of rs7701443 locus of NR3C1 were 45.5%, 39.6%, and 14.9% in the asthma group and 56.0%, 31.0%, and 13.0% in the control group, respectively, and there were no statistically significant differences between the two groups( χ2=2.259, P>0.05). After ICS treatment, the C-ACT/ACT scores were not significantly improved in children with CC genotypes at rs41423247 locus( P>0.05), while children with GG and GC genotypes were obviously improved( P<0.05). The scores of C-ACT/ACT showed obvious differences among three genotypes of rs41423247 locus after treatment with ICS( P<0.05). The C-ACT/ACT scores of all were significantly improved in children with GG, GA, or AA genotypes at rs7701443 locus after treatment with ICS( P<0.05), while there was no significant difference among those three genotypes( P>0.05). Significantly improved pulmonary function following ICS treatment in children with asthma was observed in GG and GC genotypes of rs41423247 locus of NR3C1( P<0.05), while only MMEF was improved in CC genotype( P<0.05). Meanwhile, those pulmonary function indexes were improved in all genotypes of rs7701443 after treatment with ICS( P<0.05). Conclusion:Both rs41423247 and rs7701443 locus at NR3C1 gene have polymorphisms.But there were no significant differences in the polymorphism of rs41423247 and rs7701443 locus of NR3C1 between the asthma group and the control group.Different genotype frequencies of rs41423247 and rs7701443 at NR3C1 locus in children with asthma have different effects on ICS treatment.
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In recent years, the problem of bacterial resistance has become more and more serious, which has brought troubles to global public health and medical care. The time and money required to develop new antibiotics is even greater than before. Bacteriophage is a kind of virus that can specifically infect bacteria, fungi, actinomycetes and other microorganisms. Relying on host bacteria to replicate in large numbers, rich species, low research and development cost, the value of anti-infection therapy is very considerable. It is a new generation of biological antimicrobial agents with great potential. This paper briefly describes the sterilization mechanism, progress of research on anti-infection aspect and clinical application of phage, in order to provide reference for phage anti-infection treatment and clinical application.
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Objective:To investigate the relationship between rs2075748 and rs542269 single nucleotide polymorphisms of cholinergic muscarinic receptor 1 (CHRM1)gene and susceptibility of childhood asthma, as well as the differences of pulmonary function and serum acetylcholine(Ach)levels among different genotypes.Methods:A total of 156 asthmatic children who were treated in the outpatient or hospitalized in the General Hospital of the Northern Theater Command from September 2018 to September 2020 were selected as the case group, while 134 non-asthmatic children who had a healthy physical examination were selected as the control group.The SNaPshot SNP typing technique was used to analyze the genotype of the CHRM1 gene rs2075748 and rs542269 of the study subjects.Serum Ach level was detected by double antibody sandwich method, and the pulmonary function of the case group was detected.Results:After analyzing the CHRM1 gene polymorphism, it was found that the CC, CT, and TT genotype frequencies at rs2075748 were 65.4%, 28.8%, 5.8% in the case group, and 62.8%, 32.4%, 4.8% in the control group.The C and T allele frequencies were 79.8% and 20.2% in the case group, 74.3% and 25.7% in the control group.There were no significant difference in the genotype and allele frequency distribution between the two group ( χ2=2.688, 2.530, both P>0.05), and there were no significant difference in the recessive and dominant modes between the two groups ( χ2=0.338, 2.686, both P>0.05). The TT and CT genotype frequencies at rs542269 locus were 72.4% and 27.6% in the case group, 62.7% and 37.3% in the control group.The T and C allele frequency were 86.2% and 13.8% in the case group, 81.3% and 18.7% in the control group.The genotype and allele frequency distribution were not obvious different between the two group ( χ2=3.145, 2.544, both P>0.05). The risk of asthma with variant CT and TT at rs2075748 locus of CHRM1 gene were not statistically different from that of wild-type CC (both P>0.05), and the risk of asthma with variant CT at rs542269 locus was no different from that of wild-type TT ( P>0.05). The difference in FEF50% Pred and FEF75% Pred of different genotypes at rs2075748 were statistically significant( F=3.118, 4.808, both P<0.05), wild-type CC was lower than variant CT(both P<0.05). There were no statistically significant difference in pulmonary function among different genotypes at rs542269 (both P>0.05). There was significant difference in serum Ach level between different genotypes of rs2075748 ( F=4.716, P<0.05), variant CT was lower than wild-type CC ( P<0.05), variant TT was lower than wild-type CC ( P<0.05), while no significant difference was find between variant CT and TT ( P>0.05). There was no significant difference in serum Ach level between different genotypes of rs542269 ( P>0.05). Conclusion:The rs2075748 locus of CHRM1 gene is not susceptible to asthma, but it may be related to the small airway function of asthmatic children, besides there are differences in serum Ach levels with different genotypes, and the variant serum Ach level is lower.The rs542269 locus is not a susceptibility site for asthma, and there are no difference in pulmonary function and serum Ach levels in asthmatic children with different genotypes.
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Objective:To evaluate the feasibility of surgery for upper cervical spine anomaly instability achieved by readjusting the clivus-axial angle (CAA) and evaluating available screw trajectories based on preoperative virtual simulation reduction using 3D CT reconstruction.Methods:From January 2014 to September 2019, 52 patients (28 males, 24 females; mean age 46.7 years; range 18-64 years) with upper cervical spine anomalies were enrolled in a retrospective study. DICOM data of preoperative CT scanning of cervical spine were imported into Mimics 15.0 to reconstruct the 3D model of atlantoaxial joint. The target range of CAA was set with the value measured in fusing images of extension view of cervical spine as the upper bound; and 140°, the lower limit of normal CAA range, was set as the lower bound. The trajectories of screws were sought within the target range of CAA. The exact CAA value of the available trajectories was set as the target angle of intraoperative reduction . The preoperative, postoperative and simulated target CAA values were compared. The accuracy of screw placement was evaluated according to the Gertzbein-Robbins scale. The pre- and postoperative neck disability index (NDI) and Nurick scale were also compared.Results:Among 52 patients, available screw trajectories existed in 35 patients. With the validation under computer-assisted navigation as the gold standard, 37 patients underwent Magerl screws fixation (Magerl group) while the other 15 patients underwent screw-rods fixation (screw-rods group). In Magerl group, no significant difference was found between simulated target CAA values (150.1°±6.6°) and postoperative CAA values (149.0°±6.5°)( t=1.194, P=0.240); postoperative CAA values were significantly larger than preoperative CAA values (124.0°±8.9°)( t=-13.499, P< 0.001). In screw-rods group, no significant difference was found between simulated target CAA values (150.4°±5.6°) and postoperative CAA values (150.2°±6.1°) ( t=0.319, P=0.754); postoperative CAA values were also significantly larger than preoperative CAA values (121.9°±8.3°)( t=-12.431, P< 0.001). Follow-up data were obtained in all 52 patients, with a mean follow-up time of 1.7±0.9 years (range, 0.5-4 years). A total of 106 screws were placed into 52 patients, including 74 in Magerl group and 32 in screw-rods group. According to the Gertzbein-Robbins scale, 88 and 15 were classified into grade A and B respectively; and 97.1% (103/106) of screws were acceptable. No severe complications such as vertebral artery injury and low cranial nerve palsy occurred. The postoperative NDI (9.7±6.4 vs. 27.4±8.7) and Nurick scale (1.1±1.4 vs. 2.6±1.3) decreased significantly compared to preoperative ones, respectively. Conclusion:Preoperative virtual simulation can evaluate available screw trajectories and provide the target CAA values for guidance of intraoperative reduction. Based on this, readjusting the CAA under computer-assisted navigation were safe and feasible, and warranted the possibility of a single posterior reduction and fusion approach for reducible upper cervical anomaly instability.
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Sepsis is a common clinical critical disease, which is one of the main causes of septic shock and multiple organ dysfunction syndrome (MODS). Since traditional clinical interventions are simple and limited, the mortality of sepsis remains high and is also one of the main causes of death of intensive care unit (ICU) patients. Nicotinamide has a wide range of cytoprotective effects. A large number of studies have shown that nicotinamide can play an important role in infection and sepsis by repairing mitochondrial function to restore adenosine triphosphate (ATP) level, inhibiting poly (ADP-ribose) polymerase (PARP) activation, inhibiting proinflammatory mediators and antioxidant damage. This article reviews the pathogenesis of sepsis and the role of nicotinamide in sepsis treatment, aiming to provide references for exploring new therapeutic directions and effective therapeutic measures for sepsis.
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Spinal surgery is a technically demanding and challenging procedure because of the complicated anatomical structures of the spine and its proximity to several important tissues. Surgical landmarks and fluoroscopy have been used for pedicle screw insertion but are found to produce inaccuracies in placement. Improving the safety and accuracy of spinal surgery has increasingly become a clinical concern. Computerassisted navigation is an extension and application of precision medicine in orthopaedic surgery and has significantly improved the accuracy of spinal surgery. However, no clinical guidelines have been published for this relatively new and fast-growing technique, thus potentially limiting its adoption. In accordance with the consensus of consultant specialists, literature reviews, and our local experience, these guidelines include the basic concepts of the navigation system, workflow of navigation-assisted spinal surgery, some common pitfalls, and recommended solutions. This work helps to standardize navigation-assisted spinal surgery, improve its clinical efficiency and precision, and shorten the clinical learning curve.
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As an important sub-discipline of dentistry,orthodontics is regarded as the post-graduate education for postgraduates and advanced doctors both at home and abroad.Orthodontics is a professional,practical and systematic discipline,therefore,the conventional education model is hard to get a good result.In this study,a new idea of four-component instructional design model(4C/ID)guided by "integration" was explored in the education of orthodontics,combined with the author's study experience in the University of Pennsylvania.The 4C/ID mainly included four elements: learning tasks,supportive information,procedural information and part-task practice,which emphasized in providing learners a set of real,specific and work-oriented complete learning tasks,so as to replace "partial task learning" to "overall task learning".This study explored the 4C/ID and its application on clinical teaching in orthodontics.
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As an important sub-discipline of dentistry, orthodontics is regarded as the post-graduate education for postgraduates and advanced doctors both at home and abroad. Orthodontics is a professional, practical and systematic discipline, therefore, the conventional education model is hard to get a good result. In this study, a new idea of four-component instructional design model (4C/ID) guided by "integration" was explored in the education of orthodontics, combined with the author's study experience in the University of Pennsylvania. The 4C/ID mainly included four elements: learning tasks, supportive information, procedural information and part-task practice, which emphasized in providing learners a set of real, specific and work-oriented complete learning tasks, so as to replace "partial task learning" to "overall task learning". This study explored the 4C/ID and its application on clinical teaching in orthodontics.
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Objective@#To provide the normal value of atlas (C1) inner sagittal diameter in adults thus defining the diagnostic value of developmental canal stenosis at C1 and to establish the Jishuitan (JST) morphological classification for C1 developmental canal stenosis in craniovertebral junction (CVJ) anomalies.@*Methods@#From December 2010 to November 2018, 101 patients with various CVJ anomalies (50 males, 51 females; mean age 48.8±12.9 years, range 15-78 years; the anomaly group) and 857 patients with normal CVJ (461 males, 396 females; mean age 50.2±8.3 years, range 21-79 years; the normal group) were enrolled in a retrospective study. In the anomaly group, 92 cases of atlantoaxial dislocation were furtherly divided into three subgroups according to Wadia classification: atlantoaxial dislocation with os odontoideum (OO subgroup, n=33), atlantoaxial dislocation with occipitalization of the atlas (OA subgroup, n=24), atlantoaxial dislocation without both OO and OA (AAD subgroup, n=35); the rest of the anomaly group was combined with Chiari malformation (CM subgroup, n=9). The range of C1 inner sagittal diameter in each group was measured via CT scan images. The normality of C1 inner sagittal diameter of each group was tested via Shapiro-Wilk method. T test was performed on C1 inner sagittal diameter of each group. The diagnostic value of C1 developmental canal stenosis was defined as the lower bound of 95% confidence interval (CI) for the mean of the normal group. The C1 morphology of developmental canal stenosis cases in anomaly group were analyzed via CT scan images thus establishing the JST morphological classification for C1 developmental canal stenosis in CVJ anomalies.@*Results@#The mean C1 inner sagittal diameter was 29.05±1.60 mm (range, 24.05-33.50, 95%CI: 25.91-32.19). C1 developmental canal stenosis was defined as C1 inner diameter ≤ 25.91 mm. The mean C1 inner sagittal diameter of the whole anomaly group was 26.84±2.04 mm (95%CI: 22.84-30.84), which differed significantly from that in the the normal group (t=10.504, P< 0.01). A total of 33 cases meeting the criteria of C1 inner diameter ≤ 25.91 mm were diagnosed as C1 developmental canal stenosis, including 14 cases of the OO subgroup, 4 cases of the OA subgroup, 15 cases of the AAD subgroup and none of the CM subgroup. Based on the C1 morphological characteristics of 33 cases, the JST classification of C1 developmental canal stenosis in CVJ anomalies was established, which could be divided into type I-III. Type I: little atlas type, 84.9% (28/33), normal C1 posterior arch morphology without C1 occipitalization; Type II: atlas posterior arch incurving type, 3.0%(1/33), C1 posterior arch incurves towards spinal canal, without C1 occipitalization; Type III atlas occipitalization type, 12.1% (4/33), furtherly divided into: type IIIa with normal C1 posterior arch morphology; type IIIb with incurving C1 posterior arch.@*Conclusion@#The normal value of C1 inner sagittal diameter in adults was from 24.05 to 33.50 mm. The criteria of C1 inner sagittal diameter ≤ 25.91 mm can be used as the radiographic diagnostic value of C1 developmental canal stenosis. C1 developmental canal stenosis in CVJ anomalies can be classified according to the JST classification system.
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Inflammation and infection are main causes of death in critically ill patients. But traditional treatment are non-comprehensive and limited. Human CCAAT/enhancer binding protein epsilon (C/EBPε) is a key transcription factor regulating the terminal differentiation of neutrophils. It plays an important role in anti-inflammatory and anti-infective process by regulating inflammatory response cells. This article reviews the changes of C/EBPε in inflammation and infection, related regulatory mechanisms and targeted reversal measures, in order to provide references for exploring new directions and effective measures for inflammation and infection treatment.
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Inflammation and infection are main causes of death in critically ill patients. But traditional treatment are non-comprehensive and limited. Human CCAAT/enhancer binding protein epsilon (C/EBPε) is a key transcription factor regulating the terminal differentiation of neutrophils. It plays an important role in anti-inflammatory and anti-infective process by regulating inflammatory response cells. This article reviews the changes of C/EBPε in inflammation and infection, related regulatory mechanisms and targeted reversal measures, in order to provide references for exploring new directions and effective measures for inflammation and infection treatment.
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Inflammation and infection are main causes of death in critically ill patients. But traditional treatment are non-comprehensive and limited. Human CCAAT/enhancer binding protein epsilon (C/EBPε) is a key transcription factor regulating the terminal differentiation of neutrophils. It plays an important role in anti-inflammatory and anti-infective process by regulating inflammatory response cells. This article reviews the changes of C/EBPε in inflammation and infection, related regulatory mechanisms and targeted reversal measures, in order to provide references for exploring new directions and effective measures for inflammation and infection treatment.
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Objective To provide the normal value of atlas (C1) inner sagittal diameter in adults thus defining the diag?nostic value of developmental canal stenosis at C1 and to establish the Jishuitan (JST) morphological classification for C1 develop?mental canal stenosis in craniovertebral junction (CVJ) anomalies. Methods From December 2010 to November 2018, 101 pa?tients with various CVJ anomalies (50 males, 51 females; mean age 48.8±12.9 years, range 15-78 years; the anomaly group) and 857 patients with normal CVJ (461 males, 396 females; mean age 50.2±8.3 years, range 21-79 years; the normal group) were en?rolled in a retrospective study. In the anomaly group, 92 cases of atlantoaxial dislocation were furtherly divided into three sub?groups according to Wadia classification: atlantoaxial dislocation with os odontoideum (OO subgroup, n=33), atlantoaxial disloca?tion with occipitalization of the atlas (OA subgroup, n=24), atlantoaxial dislocation without both OO and OA (AAD subgroup, n=35); the rest of the anomaly group was combined with Chiari malformation (CM subgroup, n=9). The range of C1 inner sagittal diam?eter in each group was measured via CT scan images. The normality of C1 inner sagittal diameter of each group was tested via Shap?iro?Wilk method. T test was performed on C1 inner sagittal diameter of each group. The diagnostic value of C1 developmental canal stenosis was defined as the lower bound of 95% confidence interval ( CI) for the mean of the normal group. The C1 morphology of de?velopmental canal stenosis cases in anomaly group were analyzed via CT scan images thus establishing the JST morphological clas?sification for C1 developmental canal stenosis in CVJ anomalies. Results The mean C1 inner sagittal diameter was 29.05±1.60 mm (range, 24.05-33.50, 95% CI: 25.91-32.19). C1 developmental canal stenosis was defined as C1 inner diameter≤25.91 mm. The mean C1 inner sagittal diameter of the whole anomaly group was 26.84±2.04 mm (95% CI: 22.84-30.84), which differed signifi?cantly from that in the the normal group (t=10.504, P<0.01). A total of 33 cases meeting the criteria of C1 inner diameter≤25.91 mm were diagnosed as C1 developmental canal stenosis, including 14 cases of the OO subgroup, 4 cases of the OA subgroup, 15 cases of the AAD subgroup and none of the CM subgroup. Based on the C1 morphological characteristics of 33 cases, the JST clas?sification of C1 developmental canal stenosis in CVJ anomalies was established, which could be divided into type I-III. Type I: lit?tle atlas type, 84.9% (28/33), normal C1 posterior arch morphology without C1 occipitalization; Type II: atlas posterior arch incurv?ing type, 3.0% (1/33), C1 posterior arch incurves towards spinal canal, without C1 occipitalization; Type III atlas occipitalization type, 12.1% (4/33), furtherly divided into: type IIIa with normal C1 posterior arch morphology; type IIIb with incurving C1 posterior arch. Conclusion The normal value of C1 inner sagittal diameter in adults was from 24.05 to 33.50 mm. The criteria of C1 inner sagittal diameter≤25.91 mm can be used as the radiographic diagnostic value of C1 developmental canal stenosis. C1 developmen?tal canal stenosis in CVJ anomalies can be classified according to the JST classification system.
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Objective: To conduct retrospective analysis of clinical features of patients with ulcerative colitis in JiangsuProvince Hospital of Traditional Chinese Medicine (TCM) . Methods: Ulcerative colitis medical records in jiangsuprovince hospital of TCM were selected and used to retrospectively analyze the feature such as gender, age, course of thedisease, clinical type, stage, severity, and pathological parts. Results: The study include 290 cases of male and 235 casesof female with the ratio of 1.2:1. Peak incidence was between 20 to 60 years old. Dietary factor was the most commoncause, followed by fatigue, environment, medicine and emotional factors. There were 28 (5.33％) patients at remissionstage, and 497 (94.67％) patients at active stage. In patients at active stage, there were 78 (15.69％) patients newlydiagnosed, and 419 (84.31％) patients with chronic recurrent type. There 92 (18.51％) rectum type patients, 156 (31.39％) left half colon type patients and 249 (50.10％) extensive colon type patients. There were 275 (55.33％) mild patients, 149 (29.98％) moderate patients and 73 (14.69％) severe patients. The main symptoms were bloody purulent stool, diarrheaand abdominal pain. There were 375 (71.43％) patients with bloody purulent stool, and symptom disappearance rate was89.07％ after treatment. There were 335 (63.81％) patients with diarrhea, and symptom disappearance rate was 71.64％after treatment. There were 319 (60.76％) patients with abdominal pain, and symptom disappearance rate was 85.89％after treatment. There were 3 cases of complications. Drug therapy was mainly based on integrated Chinese and westernmedicine (86.29％) . For Chinese medicine treatment, there were 453 patients (87.45％) with oral Chinese medicine, 401 patients (77.41％) with Chinese medicine enema, and 10 patients (1.93％) with foot bath. For western medicine treatment, there were 392 patients (75.68％) treated with oral amino salicylate drugs, 100 patients (19.31％) with anal used aminosalicylate drugs, 88 patients (16.99％) with glucocorticoid, 18 patients (3.47％) with immunosuppressive agent and 441 patients (85.14％) with microecological preparation. Conclusion: The types of ulcerative colitis patients in our hospitalwere mainly chronic recurrent type at active stage with mild to moderate and extensive colon type. The treatment wasmainly based on integrated Chinese and western medicine, with significant improvement in symptoms of bloody purulentstool, diarrhea and abdominal pain. 99.61％ patients were discharged with a better condition
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Chronic overuse disease of the shoulder is very common in clinical practice.Its pathogenesis is complicated and its treatment is often a combination of medication,rehabilitation and surgery.In recent years,its diagnosis tends to be more definite,leading to more specific treatment.Extracorporeal shock wave therapy has been successfully used in the treatment of such orthopaedic diseases as plantar fasciitis and lateral epicondylitis,and has been tried by some scholars in the treatment of chronic overuse disease of the shoulder.Its therapeutic effect has also been demonstrated to some extent on calcific tendonitis,non-calcific tendonitis and adhesive capsulitis.This review outlines the progress in research of extracorporeal shock wave therapy for the treatment of chronic overuse disease of the shoulder.
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Objective To design and develop an air purification system for intensive care ambulances,which can effectively purify the air in the compartment and sterilize the microbes in the air.Methods By integrating titanium dioxide photocatalysts with air filtration materials,an air purification system was designed that was capable of effective sterilization of microbes in the air via photocatalytic oxidation and decomposition,and of effective filtration of particles in the air through HEPA filters.The protection effect was evaluated by air filtration and sterilization tests in accordance with the related national standards.Results The air cleanliness could reach the 100 000 level with bacteria counts no more than 1 CFU per pan for 15 minutes in the ambulance compartment when the air purification system worked normally,which could meet the demands of environmental hygienic standards for intensive care units.Conclusion The air purification system can effectively purify and sterilize the air in the compartment of an intensive care ambulance.The effects of air purification meet the requirements of related hygienic standards,which can satisfy the demands of treatment and intensive care for the victims in the ambulance.
ABSTRACT
ObjectiveTo observe the clinical effects of mirabilite external application and neostigmine injection at Zusanli acupoint combined with Xuebijing intravenous injection on patients with severe sepsis.Methods A history-prospective controlled study was conducted. Patients with severe sepsis admitted to the Fourth People's Hospital of Jiangsu University from January 2012 to November 2015 were enrolled. Twenty-one cases admitted from January 2014 to November 2015 were assigned as a research group and treated with application of mirabilite external application, Zusanli acupoint injection of neostigmine combined with intravenous Xuebijing injection; 22 patients with Xubijing treatment from January 2012 to November 2015 were included in a Xubijing group; 21 patients with routine therapy from January 2012 to November 2013 were included in a control group. The changes of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), mean arterial pressure (MAP), oxygenation index (OI), serum creatinine (SCr), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, sequential organ failure assessment (SOFA), gastrointestinal function score, blood platelet count (PLT), plasma prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimmer in three groups before and after treatment were observed; the length of stay in ICU and the 28-day mortality were compared among the three groups. Results Compared with those before treatment, WBC, PCT, CRP, SCr, APACHE Ⅱ score, SOFA score, gastrointestinal function score, APTT, PT, and D-dimer were all obviously lower after treatment for 7 days in various groups; OI, MAP, PLT were significantly higher, and the improvement degree of WBC, PCT, CRP, SCr, APACHE Ⅱ score, SOFA score, gastrointestinal function score, OI in research group was more significant than those of control group and Xubijing group [WBC (×109/L): 7.52±0.75 vs. 12.87±4.13, 10.88±0.66, PCT (μg/L): 1.14±0.55 vs. 6.32±1.39, 3.47±1.94, CRP (mg/L): 21.0±9.2 vs. 65.0±13.6, 35.0±13.9, OI (mmHg, 1 mmHg = 0.133 kPa): 357.0±20.4 vs. 295.0±20.4, 309.0±21.4, SCr (μmol/L): 7.89±2.35 vs. 14.33±9.17, 11.27±4.65, APACHE Ⅱ score: 10.38±0.75 vs. 18.27±2.57, 13.09±4.10, SOFA score: 1.05±0.66 vs. 6.01±2.33, 3.26±1.03, gastrointestinal function score: 0.31±0.11 vs. 2.01±0.46, 1.85±0.29, all P 0.05]. Conclusions The treatment of mirabilite external application and neostigmine injection at Zusanli acupoint combined with Xuebijing intravenous injection can obviously improve the clinical symptoms, blood coagulation indexes and organ functions, reduce the levels of inflammatory indexes, shorten the time of the length of stay in ICU and elevate the survival rate of patients with severe sepsis.