Clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome / 中国基层医药

Objective:To evaluate the clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome.Methods:Eighty patients with piriformis syndrome who received treatment in Huaihe Energy Occupational Disease Prevention Hospital Rehabilitation Medicine Center from February 2021 to December 2022 were included in this study. They were divided into a treatment group ( n = 40) and a control group ( n = 40) according to different treatment methods using a retrospective cohort study design. The treatment group was treated with acupuncture combined with extracorporeal shock wave therapy, once every 7 days for 3 consecutive weeks. The control group was treated with extracorporeal shock wave therapy alone once every 7 days for 3 consecutive weeks.Pre- and post-treatment visual analogue scale scores and clinical efficacy were compared between the two groups. Results:There was no significant difference in baseline data between the two groups (all P > 0.05). After treatment, the visual analogue scale score decreased in each group. After adjusting for covariates, there was no significant difference in visual analogue scale score between the two groups ( F = 112.38, P < 0.001). After adjusting the pre-treatment visual analogue scale score, the post-treatment visual analogue scale score in the treatment group was lower than that in the control group [1.417 (95% CI: 1.151-1.683)]. The total response rate in the treatment group was 97.5% (39/40), which was significantly higher than 82.5% (33/40) in the control group ( Z = -2.03, P = 0.042). Conclusion:Acupuncture combined with extracorporeal shock wave therapy is highly effective on piriformis syndrome.

Is Follow-up Co-Morbidity Assessment via Laboratory Investigations in Older High Energy Trauma Patients Justified? - A Prospective-Retrospective Study

@#Introduction: The objective of the current study was to test our hypothesis that older patients sustaining high energy trauma need to be evaluated for their comorbidities similar to geriatric patients sustaining low energy trauma. Materials and methods: This study was a retrospectiveprospective analysis of 173 patients of more than 50 years of age enrolled between November 2017 and December 2018. Herewith, we have compared retrospectively collected laboratory investigations of 124 fragility fracture patients with prospectively collected laboratory investigations of 49 patients with high energy trauma. The laboratory investigations, including the liver function tests, renal function tests, indices of calcium metabolism, serum electrolytes, complete blood counts, and bone mineral density (BMD) scores. Results: Both groups were similar to each other as far as baseline demographic characteristics were concerned. The proportion of female patients and patients with nonosteoporotic range BMD (T-score >-2.5) was significantly higher in the high-energy fracture group (P value <0.05). Hypoalbuminemia (<3.4gm/dl) 17.3%, abnormalities sodium (<135mmol/L or >148mmol/L) 23.2%, Anaemia (<10g/dl) 12.7%, Hypercalcemia (>10.4mg/dl) 16.3%, Vitamin D deficiency (<20ng/ml) 17.3% are the common laboratory abnormality found in study population. No statistically significant difference was found among the two groups in terms of laboratory investigation abnormalities. Conclusion: The laboratory investigation abnormality in an older patient with a clinical fracture is independent of the mechanism of injury. The results of the current study emphasise the need for a comprehensive laboratory workup in older patients with either high- energy fractures or fragility fractures.

Development and Validation of FFQ for Assessing SugarSweetened Beverages (SSB) and High-Energy Dense Foods Intake among Malaysian Adolescents

@#Introduction: Increased consumption of sugar-sweetened beverages (SSBs) is strongly associated with weight gain, dental cavities, and a higher risk of chronic diseases among adolescents. However, there is no available FFQ for the Malaysian population individually to evaluate and assess the consumption of SSBs and high-energy dense (HED) foods among adolescents. Method: A 24-hour diet recall with 30 adolescents were performed via Google Meet to identify the most common and frequent types of SSBs and HEDs foods consumed nowadays. The food checklist of SSBs and HED foods from literature review search was also provided to the participants. Experts critically reviewed each food item and provide a score for its relevancy and essentiality. Face validity were conducted among 10 adolescents to validate the developed FFQ. Results: The final FFQ consisted of 63 food items with ten categories. This FFQ showed high content validity for individual items with I-CVI ranging from 0.67 to 1.00 and overall questionnaires with S-CVI/Ave valued at 0.97. The calculation of Kappa statistic showed that this newly developed FFQ has excellent inter-rater reliability at the item level with K > 0.74 for 55 items and K = 0.57 only for 4 items. Most of the items were marked as relevant with a CVR score of 1.00. Conclusion: The findings of this study imply that the newly developed FFQ could be utilised to estimate the intake of SSB and HED foods of Malaysian adolescents.

Effects of qianlieshutong capsule combined with extracorporeal shock wave therapy on inflammatory factors and immune function in patients with chronic prostatitis / 中国医师进修杂志

Objective:To investigate the effects of qianlieshutong capsule combined with extracorporeal shock wave therapy on inflammatory factors and immune function in patients with chronic prostatitis (CP).Methods:The clinical data of 100 patients with CP in Yingcheng People′s Hospital from September 2019 to September 2020 were retrospectively analyzed. Among them, 50 cases were treated with extracorporeal shock wave therapy (control group), and 50 cases were treated with qianlieshutong capsule combined with extracorporeal shock wave therapy (observation group). The National Institutes of Healthy chronic prostatitis symptom index (NIH-CPSI), interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, T lymphocyte subsets, small particle of lecithin (SPL) and prostate specific antigen (PSA) before and after treatment were compared between 2 groups. The adverse reactions and efficacy were compared between 2 groups.Results:The total effective rate in observation group was significantly higher than that in control group: 88.0% (44/50) vs. 70.0% (35/50), and there was statistical difference ( χ2 = 4.88, P<0.05). There were no significant differences in NIH-CPSI respective scores and total score before treatment between 2 groups ( P>0.05); the NIH-CPSI respective scores of pain and discomfort, urination, symptoms, quality of life and total score after treatment in observation group were significantly lower than those in control group: (4.15±1.04) scores vs. (6.72±1.13) scores, (1.23±0.39) scores vs. (1.88±0.48) scores, (1.31±0.39) scores vs. (1.91±0.35) scores, (1.68±0.34) scores vs. (2.35±0.32) scores and (8.37±1.02) scores vs. (12.86±1.33) scores, and there were statistical differences ( P<0.01). There were no statistical differences in the prostatic fluid and serum IL-6, IL-8 and TNF-α before treatment between 2 groups ( P>0.05); the prostatic fluid and serum IL-6, IL-8 and TNF-α after treatment in observation group were significantly lower than those in control group, and there were statistical differences ( P<0.01). There were no statistical difference in CD 3+, CD 4+, CD 8+ and CD 4+/CD 8+ before treatment between 2 groups ( P>0.05); there were no statistical difference in CD 3+, CD 4+ and CD 8+ after treatment between 2 groups ( P>0.05), the CD 4+/CD 8+ after treatment in observation group was significantly higher than that in control group (1.48±0.33 vs. 1.35±0.28), and there was statistical difference ( P<0.05). There were no statistical differences in SPL and PSA before treatment between 2 groups ( P>0.05); the SPL after treatment in observation group was significantly higher than that in control group: (33.25±4.08) μg/L vs. (20.96±4.13) μg/L, the PSA was significantly lower than that in control group: (0.81±0.23) μg/L vs. (0.97±0.29) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of adverse reactions between 2 groups ( P>0.05). Conclusions:Qianlieshutong capsule combined with extracorporeal shock wave therapy has a significant efficacy in patients with CP. It can effectively reduce the levels of inflammatory factors in prostate fluid and improve the immune function.

Resultados radiológicos y funcionales en fracturas de platillo tibial de alta energía / Radiological and functional results in high-energy tibial plate fractures

Resumen: Introducción: Las fracturas de platillo tibial por mecanismos de alta energía son lesiones graves que ocurren sobre una articulación de carga. Son difíciles de abordar, ya que además de afectar la estructura ósea de la pierna suelen tener lesiones de partes blandas asociadas. Objetivo: Evaluar los resultados radiológicos y funcionales de las fracturas de platillo tibial de alta energía con un mínimo seguimiento de un año. Material y métodos: Estudio retrospectivo, observacional y multicéntrico. Análisis de los resultados radiológicos y funcionales en el tratamiento de fracturas de platillo tibial de alta energía tratadas mediante reducción abierta y fijación interna (RAFI) entre 2014 y 2019. Resultados: 54 fracturas tratadas mediante RAFI. Seguimiento un año, 98.1% de consolidación en 13 semanas de promedio, 83.4% sin alteraciones del eje en plano coronal, 74% sin ensanchamiento articular postoperatorio. Escalas funcionales: Lysholm 82.1 puntos promedio y Oxford Knee Score (OKS) 39.5 puntos promedio. Conclusión: El rango de movilidad articular se redujo luego de una fractura de platillos tibiales de alta energía, pero con buenos resultados funcionales. Cuanto menor deseje y menor ensanchamiento radiográfico postoperatorio, se obtienen mejores resultados.

Abstract: Introduction: The tibial plateau fractures due to high-energy mechanisms are serious injuries that occur on a load bearing joint. These are difficult to approach because, also affect the bone structure of the leg, they usually have associated soft tissue injuries. Objective: To evaluate the radiological and functional results of high-energy tibial plateau fractures with a minimum follow-up of one year. Material and methods: Retrospective, observational and multicenter study. Analysis of radiological and functional outcomes in the treatment of high-energy tibial plateau fractures, treated by open reduction and internal fixation (ORIF) between 2014 and 2019. Results: 54 fractures treated by ORIF. Follow-up one year. 98.1% consolidation in 13 weeks on average. 83.4% without alterations of the axis in the coronal plane. 74% without postoperative joint widening. Functional scores: Lysholm 82.1 average points and Oxford Knee Score (OKS) 39.5 average points. Conclusion: The joint range of motion was reduced after a high-energy tibial plateau fracture, but with good functional results. The less off axis and less post-operative radiographic widening, the better results are obtained.

Ondas de choque eletromagnéticas na Dermatologia: análise microscópica de sua interação com a possível redução do tecido adiposo em indivíduos obesos / Electromagnetic shock wave therapy in dermatology: Microscopic analysis of its interaction with the possible reduction of adipose tissue in obese individuals

Introdução: a obesidade é uma doença que afeta a saúde pública em nível mundial devido a suas comorbidades e ao risco de morte prematura. Diante disso, a tecnologia de terapia de ondas de choque extracorpóreas (ESWT) pode ser útil em seu tratamento e na prevenção de suas comorbidades. Objetivos: o objetivo foi avaliar se a ESWT é capaz de estimular a lipólise e/ou apoptose da célula adiposa de indivíduos obesos. Métodos: trata-se de um estudo comparativo de intervenção baseado em análises imuno- -histoquímicas de um conjunto de amostras de tecido subcutâneo de mulheres com obesidade, submetidas ao tratamento ESWT. O material biológico foi coletado no momento da cirurgia bariátrica. Resultados: 14 mulheres obesas foram incluídas na pesquisa. Foi evidenciada positividade na expressão de Casp3 (p<0,0001), cCasp3 (p<0,0024), macrófagos CD68+ (p<0,0001), HSL (p<0,0001) e adipofilina (p<0,0013) na amostra intervenção quando comparada ao controle. Conclusões: a ESWT estimula a apoptose com consequente lipólise do tipo autofágica no tecido adiposo de mulheres obesas. Assim, a ESWT pode ser considerada uma terapia adjuvante útil, segura e promissora para redução do tecido adiposo e, consequentemente, para prevenção e/ou tratamento de obesidade

Introduction: Obesity is a disease that affects public health worldwide due to its comorbidities and premature death risk. Therefore, extracorporeal shock wave therapy (ESWT) technology can help treat and prevent its comorbidities. Objective: This study aims to assess whether ESWT can stimulate lipolysis and/or apoptosis of the fat cells of obese individuals. Methods: This is a comparative interventional study based on immunohistochemical analyzes of a set of subcutaneous tissue samples from women with obesity submitted to ESWT treatment. The biological material was collected at the time of bariatric surgery. Results: The survey included 14 obese women. Positivity was shown in the expression of Casp3 (p<0.0001), cCasp3 (p<0.0024), CD68+ macrophages (p<0.0001), HSL (p<0.0001), and adipophilin (p<0.0013) in the intervention sample compared to the control. Conclusions: We conclude that ESWT stimulates apoptosis with consequent autophagic lipolysis in the adipose tissue of obese women. Thus, ESWT can be considered useful, safe, and promising adjuvant therapy for reducing adipose tissue and, consequently, for preventing and/or treating obesity.

Pancreatitis aguda como complicación infrecuente de litotricia extracorpórea por ondas de choque. Comunicación de un caso / Acute pancreatitis as an unusual complication of extracorporeal shock wave lithotripsy. A case report / Pancreatite aguda como complicação pouco frequente de litotrícia extracorpórea por ondas de choque. Comunicação de um caso

Resumen: La litotricia extracorpórea por ondas de choque para el tratamiento de la urolitiasis es un tratamiento ampliamente aceptado, pero no exento de complicaciones. La pancreatitis aguda que se desencadena inmediatamente posterior a este procedimiento es infrecuente, pero puede ser una complicación grave que amenaza la vida del paciente. La aparición aguda de dolor abdominal y vómitos en las horas posteriores al procedimiento, deben hacer al médico tratante sospechar esta complicación. Presentamos el caso de un paciente joven que luego de someterse a una sesión de litotricia para el tratamiento de una litiasis renal derecha instaló una pancreatitis aguda que requirió ingreso a terapia intensiva y que se suma a los escasos informes de casos publicados en la literatura médica.

Summary: Extracorporeal shock wave lithotripsy to treat urolithiasis is a widely aceptable treatment, although it may involve complications. Acute pancreatitis immediately after the procedures is rather unusual, but it may result in a serious life-threatening complication for patients. The appearance of severe pain and vomits a few hours after the procedure should make physicians suspicious of this complication. The study presents the case of a young patient who developed acute pancreatitis after undergoing lithotripsy to treat lithiasis in the right kidney, requiring his admission to the intensive care unit. This will add up to the scarce reports published in the medical literature.

Resumo: A litotrícia extracorpórea por ondas de choque para o tratamento da urolitíase é um tratamento amplamente aceito, mas não isento de complicações. A pancreatite aguda que se desencadeia imediatamente depois deste procedimento não é frequente, porém pode ser uma complicação grave que ameaça a vida do paciente. O surgimento súbito de dor abdominal e vómitos nas horas seguintes ao procedimento devem induzir à suspeita desta complicação. Apresentamos o caso de um paciente jovem que depois de uma sessão de litotrícia para o tratamento de uma litíase renal direita apresentou uma pancreatite aguda com posterior admissão a terapia intensiva; este caso se agrega aos poucos publicados na literatura médica.

Does a staged treatment of high energy tibial plateau fractures affect functional results and bony union? A case series / 中华创伤杂志(英文版)

PURPOSE@#Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.@*METHODS@#Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.@*RESULTS@#Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554).@*CONCLUSION@#A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.

Impact of high-energy diets on the rumen environment and digital cushion in confined cattle / O impacto de dietas de alto valor energético sobre o ambiente ruminal e o tecido digital em bovinos confinados

This study aimed to identify gross and microscopic changes, caused by high-energy diets, in the rumen environment and hoof of confined beef cattle. The study sample comprised 40 confined heifers (Bos taurus) with no disease history divided into four experimental groups using different diets: Group 1 (D1, control), 48:52 forage:concentrate ratio; Group 2 (D2), 30:70 forage:concentrate ratio; Group 3 (D3), 30:70 forage:concentrate ratio + sucrose; Group 4 (D4), 100% concentrate. All animals underwent clinical examination, assessment of ruminal fluid pH and lameness, and sample collection after slaughter for histopathology of the hoof laminae and digital cushion and ruminal tissue. All dependent variables of the study were compared using the SPSS 20.0 statistical software. The variables that did not show normality (HR, RM, ST, and CRT) were compared with application of the Kruskal-Wallis test followed by the Dunnet's multiple comparison test. All other variables were submitted to analysis of variance (ANOVA) followed by Tukey's test. The different diets had an impact on the rumen environment (p<0.05) of the heifers assessed, with momentary general depression in the first 12 h after sucrose induction (D3), as well as mild clinical signs in D4. The animals in D3 and D4 presented lower motility (p<0.05) and ruminal pH (p<0.01) than those in D1. Of the 40 heifers, 27.5% (n=11) showed gross lesions in the epithelium of ruminal pillars, whereas 22.5% (n=9) of those in D3 and D4 presented these lesions. Sole corium thickness varied between heifers in D3 compared with those in D1 and D2 (p<0.05). Therefore, high-energy diets, as used in this study, alter some clinical parameters and the rumen environment, causing lesions in the rumen mucosa, and of lesser intensity, in the hoof corium and laminae, suggestive of laminitis.(AU)

O objetivo deste trabalho foi identificar alterações macroscópicas e microscópicas provocadas por dietas de alto valor energético no ambiente ruminal e casco de bovinos de corte (Bos taurus) em confinamento. Foram utilizadas 40 novilhas mantidas em confinamento, sendo divididas em 4 grupos experimentais: Grupo D1(controle) - 48% de volumoso e 52% de concentrado; Grupo D2 - 30% de volumoso e 70% de concentrado; Grupo D3 - 30% de volumoso e 70% de concentrado + sacarose; Grupo D4 - 100% de concentrado. Foi realizado exame clínico dos animais, avaliação do pH ruminal, da claudicação, além de coletas de amostras post-mortem para análises histopatológicas da região laminar do casco, coxim digital e do rúmen. Todas as variáveis dependentes do estudo foram comparadas por meio do software estatístico SPSS 20.0. As variáveis sem normalidade (FC, MR, Tc e TPC) foram comparadas pelo teste de Kruskal Wallis, seguido pelo teste de comparação múltipla de Dunnet. Todas demais foram submetidas a análise de variância (ANOVA), seguida pelo teste de Tukey. Foi observado impacto das distintas dietas ao ambiente ruminal (p<0,05). Os grupos D3 e D4 exibiram menor motilidade (p<0,05) e pH ruminal (p<0,01). 27,5% (n=11) dos animais tiveram registros macroscópicos de lesões no epitélio dos pilares ruminais enquanto que os submetidos às dietas 3 e 4 foi observada ocorrência de 22,5% (n=9) de lesões macroscópicas no rúmen. As espessuras do córium solear variaram entre os grupos que receberam a indução de sacarose em relação ao grupo controle e novilhas alimentadas com a dieta 2 (p<0,05). Sendo assim dietas com elevada densidade energética, na condição em que foi empregada, alteraram alguns parâmetros clínicos e o ambiente ruminal, provocando lesões na mucosa do rúmen e de pouca intensidade no córium e tecido laminar, sugestiva de laminite.(AU)

Fracturas de fémur proximal de alta energía tratadas con reducción a través de mini-open y clavo cefalo-medular / High energy proximal femur fractures treated with cephalo-medullary nails and open reduction through mini-open approach

OBJETIVO: Evaluar los resultados radiológicos de pacientes con fractura de fémur proximal tratados con clavo cefalo-medular y reducción abierta a través de abordaje mini-open. MATERIAL Y MÉTODOS: Estudio retrospectivo-descriptivo de una serie consecutiva de 45 pacientes (38 hombres, 7 mujeres, edad promedio 52 años) con fractura de cadera de alta energía tratados con clavo cefalo-medular y reducción a través de abordaje miniopen. Se registró el mecanismo del accidente y presencia de lesiones asociadas. En todos los casos se contó con radiografías preoperatorias y tomografía axial computada (TAC). Se clasificaron de acuerdo a la AO. Se registró en número de fragmentos que presentaba la fractura. Se tomaron radiografías de control en forma mensual hasta la consolidación. Se midió el ángulo cervico-diafisiario operado y contralateral. RESULTADOS: Todos los casos fueron secundarios a un accidente de alta energía. Veintidós pacientes presentaron lesiones asociadas. El número de fragmentos promedio fue de 3. La diferencia entre el ángulo cervico-diafisiario post operatorio de la cadera fracturada versus la cadera contralateral fue de 4,9 grados. Un paciente presentó no-unión. El tiempo promedio hasta la consolidación radiográfica fue de 3,7 meses. CONCLUSIÓN: El uso de clavos cefalo-medulares asociado a reducción a través de miniopen en pacientes jóvenes con fractura de fémur proximal de alta energía, presenta buenos resultados radiológicos con bajo número de complicaciones.

OBJECTIVE: To evaluate radiologic results of patients with proximal femur fracture treated with cephalo-medullary nails and open reduction through mini-open approach. MATERIALS AND METHODS: A retrospective-descriptive study of 45 patient consecutive series (38 male, 7 female. Mean age 52 years old) with high energy hip fracture treated with cephalo-medullary nails and open reduction through mini-open approach. Accident mechanism and associated lesions were documented. Every case was evaluated with pre-operative radiography and CT-scan. Fractures were classified according to AO classification. Patients were radiographically controlled monthly until bone healing. Cervical-diaphysial angle was measured and compared bilaterally. RESULTS: Every case was secondary to high energy trauma. 22 patients presented associated lesions. The mean number of bone fragments was 3. The difference between postoperative cervical-diaphysial angle versus contralateral hip was 4.9°. Only 1 patient presented non-union. The mean time until consolidation confirmed with radiography was 3.7 months. CONCLUSION: The use of cephalo-medullary nails associated to open reduction through a mini-open approach in young patients with high energy associated proximal femur fractures, presents satisfactory radiologic results with a low amount of complications.

Antebrachial microvascular flap for reconstruction of the pelvic limb: case report

Complex defects in the soft tissues of the foot and ankle caused by high-energy trauma, infection, cancer or diabetes require rapid and effective treatment which decreases the risk of infection, bone healing time, hospital stay and number total of surgical approaches. Authors report a clinical case of a 23-year-old female patient who suffers high-energy trauma due to a motorcycle accident which causes exposure of the distal third of the tibia, loss of the tibial joint face, and loss of tissue throughout the region of the malleolus medial of the right pelvic extremity. Tissue transfer to the pelvic limb is performed using left contralateral radial antebrachial free flap as donor area. This case report aims to emphasize the key aspects of the high energy trauma approach by using microvascular flaps, as well as the satisfactory evolution of the patient that directly affects the prognosis for life and function.

The characteristics of synovitis under energy Doppler ultrasonography in knee osteoarthritis patients / 中华风湿病学杂志

Objective To investigate the correlation between synovial inflammatory changes (synovial blood signals,synovial thickness,joint effusion) and cartilage injury,meniscus prominence of knee osteoarthritis (KOA) under energy Doppler ultrasound and further to assess the value of ultrasound for prognostic judgment in KOA.Methods A total of 291 KOA patients from our hospital from 2016 to 2018 were collected.The patients with rheumatoid arthritis (RA) with knee joints involved were recruited as control group.The data that conform to the normal distribution were expressed by mean±SD,and others were represented by M (P25,P75).The t test,the rank test and Chi-square test were used between the two groups,and ANOVA or K-W test was used to compare the data between the multiple groups,Spearman correlation analysis was used for correlation analysis.Results ① The proportion of synovial blood flow signal in KOA group was lower than RA group (19.6％ vs 47.7％,x2=286.2,P＜0.01),as well as the typical synovial thickness [2.6(0,3.95) mm vs 3.43 (1.85,6) mm,Z=-3.674,P＜0.01] and popliteal cyst (11.5％ vs 18.5％,x2=4.484,P=0.04).② In KOA group,no significant difference was found between ESR and hs-CRP among different synovial blood signals (H=7.213,H=0.883,all P＞0.05).ESR from KOA group were both significantly lower than controls but the synovial blood signals was the same except for power Doppler signal-2 group (Z=-8.414,Z=-4.991,t=-3.428,all P＜0.05);hs-CRP from KOA group were both significantly lower than controls but the synovial blood signals was the same.③ A total of 489 knee joints were detected in 291 patients with KOA,of which synovial blood flow signals were found in 96 joints,the power Doppler signal-I group was the most frequent in KOA (80/96,83.3％).In addition,joint effusion and synovial thickening were positively correlated with the synovial blood signals,(r=0.277,r=0.411,all P＜0.05).④ At last,the degrees of ultrasound blood flow signal in KOA group was positively associated with the WOMAC score,the Lequsne index and US-1 score (r=0.352,r=0.424,r=0.59,all P＜0.05).Conclusion Energy Doppler ultrasonography can be used to detect the KOA synovitis.Synovitis is not rare in KOA patients,and which is associated with disease activity.However,KOA and RA cannot be differentiated by energy Doppler ultrasonography.

Effects of high energy enteral nutrition on nutritional status and immune function in patients with pulmonary heart failure / 中国中西医结合急救杂志

Objective To investigate the effects of high energy enteral nutrition (EN) on nutritional status and immune function in patients with heart failure caused by pulmonary cardiac disease. Methods Eighty-six patients with heart failure caused by pulmonary heart disease were continuously collected from March 2017 to March 2018 in the Department of Critical Care Medicine of Taizhou First People's Hospital, and they were divided into a high-energy EN group and a standard EN group according to the different use of EN preparations, each group with 43 cases. The high-energy EN group were treated with high energy EN solution TPF-T (Ruineng), and the standard EN group were treated with standard EN solution TP (Ruisu); the initial EN infusion velocity in all the patients was 25 mL/h, the calorific calorie would reach the target to 104.6-125.5 kJ·kg-1·d-1, and the protein would target to 1.5-2 g·kg-1·d-1 within 3 days;the blood glucose was controlled within the scope of 7.8-11.1 mmol/L. The differences in rates of calorie and protein goal targeting situations, nutritional status, inflammatory response and immune function were compared between the two groups. Results From the 3rd day to 7th day after EN application, the rates of calorie and protein goal targeted in the high-energy EN group were significantly higher than those in the standard EN group [calorie targeted rate: 69.77% (30/43) vs. 41.86% (18/43), protein targeted rate: 25.58% (11/43) vs. 11.63% (5/43), all P < 0.05]. With the extension of EN application, nutritional indexes such as albumin (Alb), prealbumin (PA), transferrin (TRF), etc. and the immune indexes such as human leucocyte antigen (HLA)-DR positive rate, immunoglobulins (IgA, IgG), etc. were persistently increased in both groups, reaching the peak values on the 7th day, and the indexes in high-energy EN group were significantly higher than those in the standard EN group [Alb (g/L): 36.43±5.81 vs. 33.79±5.34, PA (mg/L): 278.83±47.56 vs. 251.67±41.92, TRF (mg/L): 3.58±0.64 vs. 3.26±0.81, HLA-RD positive rate: (53.22±6.11)% vs. (50.21±5.69)%, IgA(mg/L): 165.34±40.13 vs. 141.54±38.76, IgG (mg/L): 4 990.68±881.66 vs. 4 211.75±861.54, all P < 0.05]. However, the levels of inflammatory factors such as C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in both groups were gradually decreased, reaching the valley values on the 7th day, and the indexes in high-energy EN group were significantly lower than those in the standard EN group [TNF-α(ng/L): 14.43±8.69 vs. 20.59±9.45, CRP (mg/L): 21.33±6.35 vs. 27.36±7.83, all P < 0.05]. Conclusion High energy EN not only can improve the nutritional status in patients with pulmonary heart failure, but also can reduce patients’ inflammation response and elevate their immune function.

Comparison of clinical efficacy of proximal medial gastrocnemius release and shock wave for treating unilateral chronic plantar fasciitis / 国际外科学杂志

Objective To explore the validity of proximal medial gastrocnemius release (PMGR) for treating unilateral chronic plantar fasciitis.Methods The prospective study was conducted.From January 2018 to July 2018,56 patients who were diagnosed chronic plantar fasciitis in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,were enrolled and divided into study group (n =28) and control group(n =28) according to different therapies.Fifty-six patients were enrolled including 33 males and 23 females,the age was (48.1 ±6.2) years (range,43.9-57.1 years).The patients in study group were treated with PMGR for unilateral chronic plantar fasciitis.Meanwhile,the patients in control group were treated by shock wave therapy,one extracorporeal shock wave therapy was accepted every 3 days,each impact 2 000 times,a total of five times.Visual analogue scale (VAS),the American orthopaedic foot and ankle hindfoot scale (AOFAS) and dorsal extension range of ankle joint of all patients before treatment and 3 months after treatment were recorded and compared.All the patients were outpatient followed for (3.9 ± 0.7) months until October 2018,the pain and function of feet were recorded.Measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD).The data were statistically analyzed by t test between two groups.Count data were analyzed by chi-square test between two groups.Results In study group,preoperative VAS,AOFAS and dorsal extension angleof ankle joint were (6.9 ± 0.8) scores,(48.4 ± 2.8) scores and (10.8 ± 3.9) °,while 3 months after treatment VAS,AOFAS and dorsal extension angleof ankle joint were (2.1 ± 1.0) scores,(82.8 ± 3.6) scores and (21.9 ± 4.8)°.The difference between pre-operation and 3 months after treatment of study group was significant(P ＜ 0.05).In control group,VAS,AOFAS and dorsal extension angle of ankle joint were (6.1 ± 0.7) scores,(49.1 ± 2.8) scores and (11.8 ± 3.6) ° before treatment,while VAS,AOFAS and dorsal extension range of ankle joint were (3.8 ± 1.2) scores,(56.0 ± 3.6) scores and (12.2 ± 3.2) ° at 3 months after treatment.There were significant differences in VAS between pre-treatment and 3 months after treatment (P ＜ 0.05).There were no significant differences in AOFAS and dorsal extension angleof ankle joint between pre-treatment and 3 months after treatment (P ＞ 0.05).At 3 months after treatment,there were significant differences in VAS,AOFAS and dorsal extension angle of ankle joint between two groups(P ＜ 0.05),and the outcome of study gronp was better than the control group.Conclusions PMGR can not only relief pain of foot but also improve ankle function.This is an effective surgical treatment for unilateral chronic plantar fasciitis.

Analysis of radiation effects on some properties of GaAs:Cr and Si sensors exposed to a 22 MeV electron beam / Análisis de los efectos de la radiación en algunas propiedades de sensores de GaAs:Cr y Si expuestos a un haz de electrones de 22 MeV

Abstract Nowadays, the experiments related to High Energy Physics and others fields demand the use of detectors with greater radiation resistance, and the novel material GaAs:Cr has demonstrated excellent radiation hardness compared with other semiconductors. On the basis of evidence obtained in the JINR experiment with the use of 22 MeV electrons beam generated by the LINAC-800 accelerator, an analysis of electron radiation effects on GaAs:Cr and Si detectors is presented. The measured I-V characteristics showed a dark current increase with dose, and an asymmetry between the two branches of behaviors for all detectors. Analyzing the MIP spectra and CCE dose dependence measurements a deterioration process of detectors collection capacity with dose increase was found, although behaviors are somewhat different according to the detector type. The detailed explanation of these effects from the microscopic point of view appears in the text, and are generally linked to the generation of atomic displacement, vacancies and other radiation defects, modifying the energy levels structure of the target material. These changes affect the lifetime and concentration of the charge carriers, and other characteristics of the target material.

Resumen Actualmente, los experimentos relacionados con la física de altas energías y otros campos, demandan el uso de detectores con mayor resistencia a las radiaciones y el novedoso material GaAs:Cr ha demostrado poseer una excelente fortaleza comparado con otros semiconductores. En base a las evidencias obtenidas en el experimento del IUIN con el uso de un haz de electrones de 22 MeV generado por el acelerador LINAC-800, se presenta un análisis de los efectos de la radiación en detectores de Si y GaAs:Cr. Las características I-V medidas mostraron un incremento de la corriente de fuga con la dosis y una asimetría entre las dos ramas de estos comportamientos para todos los detectores. Analizando las mediciones de los espectros MIP y la dependencia de la CCE con la dosis, fue encontrado un proceso de deterioro de la capacidad de detección de los detectores con el aumento de la dosis, sin embargo, los comportamientos son diferentes de acuerdo al tipo de detector. La explicación detallada de estos efectos desde el punto de vista microscópico aparece en el texto, los cuales están relacionados generalmente con la generación de desplazamientos atómicos, vacancias y otros defectos producto de la radiación, modificando la estructura de los niveles energéticos en el material sensor. Estos cambios afectan el tiempo de vida y la concentración de los portadores de carga, así como otras características del material.

Study of charge sharing effect and energy resolution of the Timepix hybrid detector based on gallium arsenide compensated with chromium / Estudio del efecto de compartición de cargas y la resolución energética del detector híbrido Timepix de arseniuro de galio compensado con cromo

Abstract Among the latest ionizing radiation detectors, those based on chromium compensated gallium arsenide (GaAs:Cr) are ones of the most competitive for many applications due to their high Z and strong resistance to radiation damage. They have been used in high energy physics research, medical visualization and spatial technologies, geological prospecting, among other advanced fields. The object of this work is a 900 µm GaAs:Cr detector with Timepix readout technology. Some detector characteristics for three experimental conditions were measured and studied by using the X-rays from a synchrotron and an X-ray tube provided with different materials for obtaining the corresponding fluorescence photons. A complex function was used to decompose the differential spectra into the most important contributions involved. As an additional tool for the research, the mathematical modeling of the mobility of charge carriers generated by radiation within the active volume of the detector was used. The results of these charge sharing effect studies showed a noticeable prevalence in the detector of this effect, changing its contribution according to the experiment characteristics. The detector was calibrated for the planned experiments and the energy resolution was determined. From the analysis of all the obtained results and their comparison with those reported in literature, it was confirmed that the detector has a marked charge-sharing effect between neighboring pixels, being its performance more impaired as the energy of incident photons increases.

Resumen Entre los últimos detectores de radiación ionizante, los basados ​​en arseniuro de galio compensado con cromo (GaAs: Cr) son de los más competitivos para muchas aplicaciones debido a su alto Z y fuerte resistencia al daño de la radiación. Se han utilizado en investigación de física de alta energía, visualización médica y tecnologías espaciales, prospección geológica, entre otros campos avanzados. El objeto de este trabajo es un detector de GaAs: Cr de 900 µm con tecnología de lectura Timepix. Algunas características del detector para tres condiciones experimentales se midieron y estudiaron utilizando rayos X de un sincrotrón y un tubo de rayos X provisto de diferentes materiales para obtener los fotones de fluorescencia correspondientes. Se utilizó una función compleja para descomponer los espectros diferenciales en las contribuciones más importantes involucradas. Como herramienta adicional para la investigación, se utilizó el modelado matemático de la movilidad de los portadores de carga generados por la radiación dentro del volumen activo del detector. Los resultados de estos estudios de efecto de carga compartida mostraron una prevalencia notable en el detector de este efecto, cambiando su contribución según las características del experimento. El detector se calibró para los experimentos planificados y se determinó la resolución de energía. A partir del análisis de todos los resultados obtenidos y su comparación con los reportados en la literatura, se confirmó que el detector tiene un marcado efecto de reparto de carga entre píxeles vecinos, y su rendimiento se ve más afectado a medida que aumenta la energía de los fotones incidentes.

Abordaje de Smith Petersen modificado para fracturas de cuello femoral Pauwels III - Garden IV / Modified Smith Petersen approach to femoral neck fracture Pauwels III - Garden IV

El abordaje de Smith Petersen modificado (SPM), permite la reducción de fracturas del cuello femoral desde anterior, manteniendo la fijación a través de un abordaje lateral. Realizar la reducción bajo visión directa mejoraría la calidad de la reducción y los resultados en fracturas complejas de cuello femoral. MÉTODOS: Estudio retrospectivo de ocho pacientes con fracturas de cuello femoral Pauwels III/Garden IV secundarias a un accidente de alta energía operadas con abordaje SPM. Registramos el tiempo de evolución desde el accidente hasta la cirugía. Se realizó radiografía y tomografía axial computada postoperatoria. Seguimos los pacientes con radiografías mensuales hasta evidenciar consolidación de la fractura y casos de necrosis avascular. RESULTADOS: En promedio, los pacientes fueron operados 2,1 días tras el accidente y fueron seguidos con una mediana de 24,5 meses tras su cirugía. Siete de los ocho pacientes consolidaron. Sólo un caso presentó una no-unión que requirió de una prótesis total de cadera. No hubo casos de necrosis avascular. CONCLUSIÓN: Las fracturas de cuello femoral de alta energía en pacientes jóvenes son lesiones poco frecuentes. Aunque esta serie es pequeña, llama la atención que tratándose de lesiones desplazadas y con rasgos verticales no observamos casos de necrosis avascular, a pesar de algunos casos con prolongado tiempo de evolución desde el accidente hasta la cirugía. Creemos que esas fracturas deben operarse lo antes posible, pero que es más importante lograr una reducción anatómica en vez de retrasar algunas horas la cirugía. En nuestra experiencia, el abordaje de SPM facilita la reducción adecuada en fracturas complejas de cuello femoral.

Modified Smith Petersen Approach (MSP) allows an anterior reduction for femoral neck fractures, keeping the fixation through a lateral approach to the hip. Performing the reduction under direct visualization would improve the quality of the reduction and the outcomes in complex fractures of femoral neck. METHODS: Retrospective study including eight patients with femoral neck fracture classified as Pauwels III / Garden IV, in which MSP was performed. We kept record of the time from the accident until the final surgery. Post-operative studies included plain radiograph and CT scan. Monthly radiographic controls were obtained until fracture healing was achieved or radiological signs of avascular necrosis were found. RESULTS: Surgery was performed in an average of 2.1 days after the accident. Postoperative follow-up was an average of 24.5 month. Consolidation was achieved in seven of the eight patients, only one patient evolved into a nonunion of femoral neck which required a total hip arthroplasty. CONCLUSION: High energy femoral neck fractures in young patients are infrequent injuries. Even though this is a small series of patients it comes to our attention that being displaced fractures with vertical fracture lines we didn't find any case of avascular necrosis despite some of the cases the prolonged timing since the accident to surgery. We believe that this type of fracture should be treated as soon as possible but is more important to achieve an anatomical reduction than pass over the 12 hours threshold. In our experience MSP approach facilitates the achievement of an adequate reduction and complex femoral neck fractures.

Luxación expuesta de rodilla: ¿Qué hemos aprendido en los últimos 20 años? / Open knee dislocations: what have we learn about it in the last 20 years?

INTRODUCCIÓN: La luxación expuesta de rodilla es compleja, de incidencia baja con grandes secuelas funcionales. Existen escasos reportes de series en la literatura relativos a su manejo y resultados. OBJETIVO: El objetivo de este trabajo fue describir los resultados obtenidos de todos los pacientes con luxación expuesta de rodilla tratados durante las últimas dos décadas en nuestro hospital bajo un mismo estándar de tratamiento. MÉTODO: Estudio descriptivo retrospectivo en una serie quirúrgica de 11 pacientes con luxación expuesta de rodilla, tratados entre 1994 y 2015. Todos fueron estudiados y manejados según esquema estandarizado: Angiografía/ angioTC, aseo quirúrgico, fijador externo y reparación neurovascular en casos necesarios. Revisión de registros clínicos e imagenológicos consignando datos demográficos, lesiones concomitantes, número y tipo de cirugías, y complicaciones asociadas. Seguimiento promedio fue de 10,7 años con evaluación mediante encuesta funcionales SF-12/IKDC durante el mes de marzo de 2015. RESULTADOS: Diez pacientes eran hombres, 1 mujeres. Edad promedio al accidente 38,6 años. Mecanismo lesional de alta energía; como referencia la clasificación de Schenck, 1 lesión III-M, 4 tipo IV y los 6 restantes una tipo V. 4 lesiones vasculares (36.4%) y 7 lesiones neurológicas (63.6%). Tratamiento definitivo consistió en 4 reconstrucciones ligamentarias, 2 prótesis, 3 artrodesis y 2 amputaciones supracondíleas. Evaluaciones funcionales dieron como resultados un puntaje promedio de 37 y 48,5 para SF-12 físico y mental respectivamente, y de 44,1 para IKDC. CONCLUSIÓN: La luxación expuesta de rodilla es una lesión infrecuente, muy compleja, asociada a accidentes de alta energía, con complicaciones severas, lo que determina resultados funcionales relativamente malos. La estandarización permite sistematizar las distintas etapas de atención, racionalizar los recursos disponibles evitando la improvisación en momentos críticos, lo que podría incidir en la obtención de resultados.

INTRODUCTION: Open knee dislocation is a complex lesion of low incidence and large functional sequelae. There are few series reports in the literature regarding its management and outcomes. OBJECTIVE: Describe the results obtained from all patients with open knee dislocation treated during the last two decades in our hospital under the same treatment standard. METHOD: Retrospective descriptive study in a surgical series of 11 patients with open knee dislocation, treated between 1994 and 2015. All were studied and managed according to a standardized protocol: Angiography/angioCT, surgical debridement, external fixation and neurovascular repair in necessary cases. Review of clinical and imaging records, recording demographic data, concomitant injuries, number and type of surgeries and associated complications. Average follow-up was 10.7 years, with an evaluation through functional surveys SF-12/IKDC during March 2015. RESULTS: 10 patients were men, 1 woman. Average age at accident 38.6 years. High-energy trauma mechanism of injury; Schenk classification as reference, 1 lesion type III-M, 4 type IV and the remaining 6 type V. 4 vascular lesions (41.7%) and 7 neurological lesions (63.6%). Definitive treatment consisted in 4 ligamentous reconstructions, 2 prostheses, 3 arthrodesis and 3 supracondylar amputations. Functional evaluations showed an average score of 37 and 48.5 for SF-12 physical and mental respectively, and 44.1 for IKDC. CONCLUSION: Open knee dislocation is a rare, very complex, associated to high-energy trauma, with severe complications, which determines relatively poor functional outcomes. Standardization allows to systematize the different stages of attention and rationalize available resources avoiding improvisation at critical moments, which could affect the results.

Effect of different energy of extracorporeal shock waves on diabetic neuralgia in rats / 中华麻醉学杂志

Objective To observe the effects of different energy of extracorporeal shock waves (ECSWs) on diabetic neuralgia in rats.Methods Fifty clean-grade healthy male Sprague-Dawley rats of both sexes,aged 8 weeks,weighing 180-200 g,were divided into 5 groups (n=10 each) using a random number table method:control group (group C),diabetic neuralgia group (group DN),low-energy ECSW group (group L + DN),medium-energy ECSW group (group M + DN),and high-energy ECSW group (group H+DN).Diabetic neuralgia models were established by intraperitoneally injecting streptozotocin (60 mg/kg) in DN,L+DN,M+DN and H+DN groups.ECSWs at 1,2 and 3 bar were applied during 4 consecutive weeks after successful establishment of the model once a week (T1-T4) in L+DN,M+DN and H+ DN groups,respectively.The mechanical paw withdrawal threshold (MWT),thermal paw withdrawal latency (TWL) and motor nerve conduction velocity (MNCV) were measured at T1-T4.Animals were sacrificed after the last measurement,and the sciatic nerve samples were obtained for determination of the expression of tumor necrosis factor-alpha (TNF-α) and interluekin-6 (IL-6) (by Western blot) and expression of TNF-α and IL-6 mRNA (by real-time polymerase chain reaction).Results Compared with group C,MWT,TWL and MNCV were significantly decreased at T1-T4,and the expression of TNF-α and IL-6 protein and mRNA was up-regulated in the other groups (P＜0.05).Compared with group DN,MWT at T2-4 and TWL and MNCV at T3,4 were significantly increased,and the expression of TNF-α and IL-6 protein and mRNA was down-regulated in L+DN,M+DN and H+DN groups (P＜0.05).Compared with group H+ DN,MWT at T2-4 and TWL and MNCV at T3,4 were significantly increased,and the expression of TNF-α and IL-6 protein and mRNA was down-regulated in L+DN and M+DN groups,and the expression of IL-6 mRNA was significantly down-regulated in group L+DN (P＜0.05).Conclusion ECSWs can mitigate diabetic neuralgia in rats,and the low-and medium-energy ECSWs produce better efficacy,and the mechanism is related to inhibiting inflammatory responses.

Growing pigs developed different types of diabetes induced by streptozotocin depending on their transcription factor 7-like 2 gene polymorphisms / 한국실험동물학회지

The different polymorphisms of the transcription factor 7-like 2 (TCF7L2) gene promote variances in diabetes susceptibility in humans. We investigated whether these genotypes also promote differences in diabetic susceptibility in commercial pigs. Growing pigs (Landrace, both sex, 50–60 kg) with the C/C (n=4) and T/T (n=5) TCF7L2 genotypes were identified and intravenously injected with streptozotocin (STZ, 40 mg/kg) twice in weekly intervals, then a high-energy diet was offered. Oral glucose tolerance tests, blood analyses and the homeostasis model assessment-insulin resistance (HOMA-IR) index calculations were performed. The animals were sacrificed at the end of 12 weeks of treatment to reveal the pancreas histomorphometry. The results showed that all of the treated pigs grew normally despite exhibiting hyperglycemia at two weeks after the induction. The glycemic level of the fasting or postprandial pigs gradually returned to normal. The fasting insulin concentration was significantly decreased for the T/T carriers but not for the C/C carriers, and the resulting HOMA-IR index was significantly increased for the C/C genotype, indicating that the models of insulin dependence and resistance were respectively developed by T/T and C/C carriers. The histopathological results illustrated a significant reduction in the pancreas mass and insulin active sites, which suggested increased damage. The results obtained here could not be compared with previous studies because the TCF7L2 background has not been reported. Growing pigs may be an excellent model for diabetic in children if the animals are genetically pre-selected.