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By exploring the core ideas of the "Xingnao Kaiqiao" theory, analyzing the relationship between the "Xingnao Kaiqiao" theory and the TCM encephalopathy, and exploring the necessity of acupuncture for the treatment of TCM encephalopathy, in order to clarify how to diagnose and treat brain diseases in acupuncture and moxibustion. The "Xingnao Kaiqiao" is the core of the theory of the "Tiaoshen", the acupuncture of "Xingnao Kaiqiao" was based on the principle of "Xingnao","Xingshen" and "Tiaoshen", the idea of the "Tiaoshen" was inseparable from the diagnosis and treatment of the TCM encephalopathy. Based on the special features of acupuncture therapy and complexity and particularity of TCM encephalopathy, acupuncture and moxibustion treatment of encephalopathy was supposed to have their own unique system of syndrome differentiation and treatment. During the practice of acupuncture, the diagnosis and treatment of TCM encephalopathy should be based on "brain", "Xingnao Tiaoshen" as a general rule, adding and subtracting from the main points of the "Xingnao Kaiqiao", and the different brain diseases are matched with appropriate treatments.
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Objective To explore the association of the magnitude of systolic blood pressure reduction(SBPr)with post-procedure 24 h symptomatic intracranial hemorrhage(sICH)and 90-day clinical outcomes in patients with successful endovascular thrombectomy(EVT).Methods Consecutively registered patients with EVT caused by anterior circulation large vessel occlusion stroke(LVOS)in the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital)between July 2015 and April 2023 and patients with successful reperfusion were analyzed.Demographic data,medical history(hypertension,diabetes),the trial of Org 10172 in acute stroke treatment(TOAST)classification,the baseline National Institutes of Health Stroke Scale(NIHSS)score and the baseline Alberta stroke early CT(ASPECT)score of patients were collected.And procedure related parameters(including time from onset to puncture,time from onset to reperfusion,occluded site[internal carotid artery,M1 segment of middle cerebral artery,M2 segment of middle cerebral artery],collateral circulation status[determined based on preoperative occluded angiography showing the range of collateral circulation in the occluded vessel area,defined as good collateral circulation with a reflux range of ≥ 50％and poor collateral circulation with a reflux range of＜50％]),immediate postoperative reperfusion status(evaluated using the modified thrombolysis for cerebral infarction[mTICI]grading,successful reperfusion defined as mTICI grading of 2b-3),24 hours sICH,and 90 days clinical outcomes(evaluated using the modified Rankin scale score at 90days after EVT,with a score ≤ 2indicating a good prognosis and a score＞2indicating a poor prognosis).SBPr was defined as(baseline SBP-mean SBP)/baseline SBP x 100％.According to the the magnitude of SBPr,SBPr is divided into 5 categories(＜-10％,-10％-10％,＞10％-20％,＞20％-30％and＞30％).Based on the clinical outcomes at 90 days and the occurrence of sICH at 24 hours after EVT,patients were divided into a good prognosis group and a poor prognosis group,as well as an sICH group and a non-sICH group.The relationship between SBPr and postoperative 90 days clinical prognosis or sICH was analyzed using a binary Logistic regression model.Subgroup analysis was conducted based on a history of hypertension(yes and no),continuous intravenous hypotensive therapy(yes and no),baseline ASPECT scores(3-5 and 6-10),and collateral circulation status(good and bad).Using a restricted cubic plot to depict the relationship between SBPr and sICH and clinical prognosis at 90days.Results(1)In total,731 patients were included.The median age was 71(62,77)years and 424(58.0％)were men.The median baseline NIHSS score was 14(12,18),the median baseline ASPECT was 9(7,10),405(55.4％)patients achieved 90-day modified Rankin scale score 0-2,and 35 patients(4.8％)developed sICH.(2)Multivariate analysis showed that the older age(OR,1.036,95％CI 1.017-1.056),the higher baseline NIHSS score(OR,1.095,95％CI1.049-1.144),the lower baseline ASPECT score(OR,0.704,95％CI 0.636-0.780),diabetes(OR,1.729,95％CI 1.084-2.758),bad collateral circulation(good collateral circulation vs.bad collateral circulation,OR,0.481,95％CI 0.332-0.696)and SBPr＞30％(SBPr-10％-10％as a reference,OR,2.238,95％CI 1.230-4.071),the higher the risk of poor clinical outcomes at 90 days(all P＜0.05).Continuous intravenous hypotensive therapy is a risk factor for postoperative 24 h sICH(OR,2.278,95％CI 1.047-4.953;P=0.038),while SBPr 20％-30％is associated with a lower risk of postoperative 24 h sICH(SBPr-10％-10％as a reference,OR,0.362,95％CI0.131-0.998;P=0.049).(3)The restrictive cube plot shows that there is a U-shaped relationship between SBPr after EVT and poor clinical outcomes at 90 days,while there is a nearly linear relationship with the occurrence of sICH.The more SBP reduction,the lower the incidence of sICH.(4)In the subgroup analyses,in the non-hypertension history and the good collateral circulation group,SBPr＞30％has a higher risk of poor clinical outcomes compared to SBPr-10％-10％(OR and 95％CI were 2.921[1.000-8.528]and 2.363[1.078-5.183],respectively,with P=0.05 or P＜0.05);After EVT,the group receiving continuous intravenous hypotensive therapy and the baseline ASPECT score 6-10 groups showed a significant correlation between SBPr＞30％and poor clinical outcomes at 90 days(SBPr-10％-10％as a reference,OR and 95％CI were 2.646[1.168-5.993]and 2.481[1.360-4.527],respectively,with P＜0.05).The correlation between SBPr and lower incidence of sICH was only found in the subgroup of poor collateral circulation(SBPr-10％-10％as a reference,SBPr＞20％-30％:OR,0.133,95％CI 0.027-0.652;SBPr＞30％:OR,0.104,95％CI 0.013-0.864;all P＜0.05).Conclusions Among patients who achieved successful reperfusion with EVT,SBPr might be related to a worse functional outcome at 90 days and sICH 24 h after operation.However,the relationship may exhibit significant heterogeneity across different subgroups.Baseline ASPECT score,history of hypertension,collateral circulation,and the use of continuous venous hypertension after EVT have been highlighted in individualized blood pressure management after EVT.
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Ischemic stroke is a common clinical cerebrovascular disease，and its incidence is increasing year by year. Current clinical treatments for stroke mainly include thrombolysis and intravenous thrombectomy，both of which are subject to significant time constraints and often result in residual symptoms，reducing the quality of life for patients. Research has found that there are multiple pathways and mechanisms in the pathological process of stroke，such as the cyclic GMP-AMP synthase （cGAS）/stimulator of interferon gene （STING） pathway. Currently，researchers in China and abroad have conducted extensive studies on the occurrence and development of ischemic stroke， as well as the mechanism of traditional Chinese medicine （TCM） intervention for stroke. The results indicate that traditional Chinese medicine（TCM） can regulate the cGAS/STING pathway to reduce inflammation and oxidative stress，decrease neuronal cell death，and effectively alleviate brain damage from stroke，and it has unique advantages in improving symptoms and prognosis. This article summarized the recent research progress of the mechanism of cGAS/STING pathway regulation in stroke and related TCM intervention，so as to provide new ideas for the treatment of ischemic stroke with TCM characteristics.
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Objective:To evaluate the safety and efficacy of endovascular thrombectomy (EVT) in acute anterior circulation large vessel occlusive stroke (ALVOS) and explore the related influencing factors for prognoses in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECT).Methods:Patients with acute ALVOS who underwent EVT in Yijishan Hospital of Wannan Medical College from January 2019 to June 2022 were sequentially enrolled. (1) Patients were divided into a low ASPECT group (0-5) and a non-low ASPECT group (6-10), and the differences between the two groups were compared with respect to incidence of perioperative complications and good prognosis rate [modified Rankin scale (mRS) score≤2] 90 days after onset. (2) According to the prognoses 90 days after onset, the low ASPECT group was divided into the good prognosis (mRS score≤2) and poor prognosis (mRS score>2) subgroup. Univariate analysis and multivariate logistic regression analysis were used to investigate the independent risk factors for prognoses of the low ASPECT patients after EVT.Results:A total of 582 patients [age 26-94(69±11) years, 345 male patients (59.3%)] were enrolled for analysis. The baseline ASPECT score was 8 (7, 10), and the baseline NIHSS score was 14 (11, 18). Among them, 102 (17.5%) patients were in the low ASPECT score group and 480 (82.5%) patients were in the non-low ASPECT score group. In the total cohort, patients in the low ASPECT score group had a higher incidence of symptomatic intracranial hemorrhage, lower 90-day good prognosis rate, and higher 90-day mortality rate. Further, propensity score matching statistical analysis showed that patients in the low ASPECT score group had a significantly higher incidence of malignant brain edema after EVT treatment (40.0% vs. 17.6%, χ2=9.13, P=0.003), and a significantly lower 90-day good prognosis rate (24.7% vs. 41.6%, χ2=4.96, P=0.026), but there was no significant difference in the incidence of symptomatic intracranial hemorrhage and 90-day mortality between the two groups (40.3% vs. 26.0%, χ2=3.55, P=0.060). Among 102 patients with low ASPECT score, 22 (21.6%) patients had good prognosis and 80 (78.4%) had poor prognosis. Multivariate logistic regression analysis showed that history of atrial fibrillation ( OR=4.478, 95% CI 1.186-16.913, P=0.027) was an independent risk factor for poor prognosis of EVT in patients with low ASPECT score, while good collateral circulation (grade 2 vs. grade 0: OR=0.206, 95% CI 0.051-0.842, P=0.028) was a protective factor for good prognosis of EVT in patients with low ASPECT score. Conclusions:Although the 90-day good prognosis rate of EVT treatment for patients with low ASPECT score was lower than that of the non-low ASPECT group, 21.6% patients still benefitted from EVT treatment, especially patients with non-atrial fibrillation and good collateral circulation. Future studies involving more patients are needed to validate our observations.
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Objective:To investigate the association between door-in-door-out time (DIDO) and clinical outcome of patients with acute large vessel occlusion stroke (AIS-LVO) of anterior circulation after early endovascular therapy (EVT).Methods:The patients with AIS-LVO of anterior circulation who received EVT in the advanced stroke center of the Yijishan Hospital of Wannan Medical College from February 2019 to December 2021 were retrospectively analyzed. The baseline characteristics, time metrics and clinical outcomes were collected. DIDO was defined as the duration of time from arrival to referral at the primary stroke center, and the primary outcome was favorable clinical outcome, as evaluated by a modified Rankin Scale score of 0 to 2 at 3 months after EVT. Univariate and multivariate regression analysis was used to explore the relationship between DIDO and early endovascular treatment clinical outcomes in patients with AIS-LVO.Results:A total of 320 patients [aged (69.6±10.2) years] were enrolled. The baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program early CT score were 14 (11, 18) and 8 (7, 9). The DIDO time was 76 (50, 120) minutes. DIDO was not an independent correlation factor for clinical outcomes in patients with EVT in the overall population. However, in patients receiving early EVT (onset-to-reperfusion≤300 minutes), DIDO ( OR=1.030, 95% CI 1.001-1.059, P=0.041) was an independent correlating factor of clinical outcome in patients with EVT. According to the receiver operating characteristic curve, the DIDO cutoff of 74.5 minutes can be used as an important indicator of prehospital delay in referral to EVT for large vascular occlusion stroke. Door to computed tomography time ( OR=1.393, 95% CI 1.212-1.601, P<0.001) and computed tomography to transfer time ( OR=1.386, 95% CI 1.220-1.575, P<0.001) were factors associated with DIDO≤74.5 minutes in a multivariate analysis in this time frame. Conclusions:In transferred patients undergoing EVT early, DIDO has a signifificant impact on clinical outcome. DIDO can be used as an important quality control indicator to evaluate the referral process for patients with AIS-LVO.
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Objective:To evaluate the benefits and risks of advanced age patients with acute anterior circulation large vessel occlusive stroke (ALVOS) accepted mechanical thrombectomy (MT), and explore the related influencing factors for prognoses in these patients.Methods:Six hundred and eighty patients with acute anterior circulation ALVOS accepted MT in 3 comprehensive stroke centers from January 2014 to December 2020 were sequentially collected. (1) Patients were divided into advanced age group (≥80 years old) and non-advanced age group (<80 years old) according to age, and the differences between the two groups were compared in successful postoperative vascular recanalization rate, incidence of perioperative complications, and good prognosis rate (modified Rankin scale [mRS] scores≤2) and mortality 90 d after onset. (2) Patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores>2) according to the prognoses 90 d after onset; univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the patients after MT. (3) According to the prognoses 90 d after onset, the advanced age patients were divided into good prognosis subgroup (mRS scores≤2) and poor prognosis subgroup (mRS scores>2). Univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the elderly patients after MT.Results:(1) In these 680 patients, 92 patients (13.5%) were into the advanced age group and 588 patients (86.5%) were in the non-advanced age group; patients in the advanced age group had significantly lower successful recanalization rate (67.4% vs. 77.9%), significantly lower good prognosis rate 90 d after onset (20.7% vs. 50.2%), and statically higher mortality 90 d after onset (40.2% vs. 21.1%) as compared with the non-advanced age group ( P<0.05); however, there was no significant difference between the two groups in the incidences of symptomatic intracranial hemorrhage (sICH, 15.6% vs. 10.6%) and malignant cerebral edema (MCE, 12.2% vs. 17.6%, P>0.05). The baseline data of the advanced age and non-advanced age patients were further matched with propensity score matching analysis (1:1) and statistically analyzed: the 91 elderly patients had significantly lower good prognosis rate 90 d after onset (20.9% vs. 36.3%) and MCE incidence (12.4% vs. 33.3%) than the 91 non-elderly patients ( P<0.05); there was no significant differences in successful vascular recanalization rate (67.0% vs. 71.4%), sICH incidence (15.7% vs. 17.6%) or mortality 90 d after onset (39.6% vs. 37.4%) between the two groups ( P>0.05). (2) Among the 680 patients, 314 (46.2%) had good prognosis and 366 (53.8%) had poor prognosis. As compared with the good prognosis group, the poor prognosis group had significantly higher proportion of patients at advanced age, significantly lower proportion of male patients, significantly higher proportion of patients with hypertension, diabetes or atrial fibrillation, significantly lower baseline Alberta Stroke early CT (ASPECT) scores, significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores, statistically higher proportion of patients with cardiogenic embolism, significantly lower incidence of tandem lesions, significantly shorter time from onset to sheathing, statistically higher proportion of internal carotid artery occlusion, significantly lower proportion of patients with grading 2 collateral circulation, and significantly lower proportion of successful vascular recanalization ( P<0.05). Advanced age ( OR=3.144, 95%CI: 1.675-5.900, P<0.001) was an independent factor for prognoses 90 d after MT, in addition to baseline ASPECT scores, baseline NIHSS scores, diabetes mellitus, successful recanalization, and collateral circulation grading. (3) In the advanced age group, there were 19 patients (20.7%) with good prognosis and 73 patients (79.3%) with poor prognosis. As compared with the good prognosis subgroup, the poor prognosis subgroup had significantly lower proportion of male patients, significantly lower proportion of patients with grading 2 collateral circulation or complete recanalization, and significantly higher baseline NIHSS scores ( P<0.05). Baseline NIHSS score ( OR=1.482, 95%CI: 1.187-1.850, P=0.001) was an independent factor for prognoses 90 d after MT in advanced age patients. Conclusion:Although advanced age is an independent risk factor for prognoses of patients with acute anterior circulation ALVOS accepted MT, there are still some advanced age patients benefiting from MT without increased complications, especially for those with low baseline NIHSS scores.
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Objective:To explore the influence of blood pressure (BP) profiles 24 h after early endovascular treatment (EVT), including mean blood pressure and blood pressure variability, in clinical prognoses of patients with acute large vessel occlusion stroke (ALVOS) of anterior circulation 90 d after EVT.Methods:Clinical data and blood pressure profiles of patients with ALVOS of anterior circulation who received EVT in our hospital from July 2014 to February 2019 were prospectively collected. The 90-d modified Rankin scale (mRS) scores were used as clinical prognosis evaluation, and modified thrombdysis in cerebral infarction (mTICI) was used as evaluation criteria for recanalization of postoperative occlusive blood vessels. Multivariate Logistic regression analysis was used to determine the independent influencing factors for prognoses 90 d after EVT.Results:(1) Two hundred and sixteen patients were collected; 159 patients were with successful recanalization and 57 patients were with unsuccessful recanalization; 90 d after EVT, 95 patients (44%) had good prognosis and 121 patients (56%) had poor prognosis. As compared with patients in the good prognosis group, patients in the poor prognosis group had signficantly advanced age, signficantly higher proportion of patients with atrial fibrillation, signficantly higher baseline NIHSS scores, and signficantly lower baseline ASPECT scores ( P<0.05); and the differences of occlusion locus were statistically significant between patients from the good and poor prognosis groups ( P<0.05). Patients in the poor prognosis group had significantly higher baseline systolic blood pressure (SBP), mean SBP, max SBP, and significantly higher standard deviation, variable coefficient, and continuous variation of SBP, and statistically higher standard deviation, variable coefficient, and continuous variation of diastolic blood pressure (DBP) as compared with those in the good prognosis group ( P<0.05). Multivariable Logistic regression analysis showed that the standard deviation and continuous variation of SBP were independent influencing factors for clinical prognoses 90 d after EVT ( OR=1.116, 95%CI: 1.002-1.243, P=0.047; OR=1.116, 95%CI: 1.016-1.227, P=0.022). (2) In patients with successful recanalization, as compared with patients in the good prognosis subgroup, patients in the poor prognosis subgroup had signficantly advanced age, statistically higher proportions of patients with diabetes mellitus and atrial fibrillation and baseline NIHSS scores, and statistically lower baseline ASPECT scores ( P<0.05); and the differences of occlusion locus and first choices of treatment were statistically significant between patients in the good and poor prognosis subgroups ( P<0.05). Patients in the poor prognosis subgroup had significantly higher baseline SBP and max SBP, and significantly higher standard deviation, variable coefficient, and continuous variation of SBP, and statistically higher variable coefficient of DBP as compared with those in the good prognosis subgroup ( P<0.05). Multivariable Logistic regression analysis showed the standard deviation, variable coefficient, and continuous variation of SBP were independent influencing factors for clinical prognoses 90 d after EVT ( OR=1.164, 95%CI: 1.021-1.326, P=0.023; OR=1.191, 95%CI: 1.007-1.409, P=0.041; OR=1.141, 95%CI: 1.018-1.279, P=0.024). However, in patients with unsuccessful recanalization, there were no significant differences in blood pressure proliles between the good prognosis subgroup and poor prognosis subgroup ( P>0.05). Conclusion:The blood pressure variability 24 h after EVT is correlated with the clinical prognoses of patients with ALVOS of anterior circulation 90 d after EVT.
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Colorectal cancer (CRC) is one of the most common malignancies worldwide. In recent years, the overall incidence of CRC in China has shown an upward trend. According to the national estimates of cancer in China, CRC was the second most commonly diagnosed cancer of the digestive system. Screening of CRC can significantly reduce its morbidity and mortality. The screening methods are diverse. At present, a two-step screening program based on fecal immuno-chemical test (FIT) and colonoscopy is recommended by authoritative guidelines or consensus in many countries. Other screening methods can be used as individualized options and supplements. Multigene germline mutation detection should be performed for extremely high-risk population with multiple colorectal polyps (>10 polyps) and CRC personal or family history; or with more than 20 polyps.
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Objective:To observe the incidence, risk factors of malignant brain edema (MBE) and the influence of MBE on outcomes after early successful recanalization of acute large vascular occlusion stroke (ALVOS).Methods:A total of 149 patients (age (68±11) years, male 85 (57.0%)) with ALVOS who underwent early endovascular treatment and achieved successful recanalization at the First Affiliated Hospital of Wannan Medical College from July 2014 to February 2019 were retrospectively analyzed. Baseline data, perioperative data, and 90-day prognostic information were collected from patients enrolled in the study. Univariate and multivariate analyses were used to explore the relationship between MBE and outcomes, and the risk factors of MBE.Results:Among the 149 patients, baseline National Institutes of Health Stroke Scale score was 16 (13, 20), baseline Alberta Stroke Project early CT score was 9 (8, 10), the time of onset-to-puncture was (248.3±61.3) minutes, and the onset-to-recanalization time was (312.4±69.7) minutes. MBE occurred in 23 patients (15.4%, 23/149). The 90-day favorable outcome (90-day modified Rankin Scale score≤ 2) in patients with MBE was significantly lower than those without MBE (17.4% (4/23) vs 61.1% (77/126), χ 2=14.985, P<0.001), and the 90-day mortality in patients with MBE was significantly higher than those without MBE (43.5% (10/23) vs14.3% (18/126), χ 2=10.861, P=0.003). MBE was shown to be an independent predictor of 90-day poor outcome (adjusted OR=12.078, 95 %CI 1.934-75.443, P=0.008) and death (adjusted OR=4.146, 95 %CI 1.060-16.216, P=0.041). Multivariate Logistic regression analysis showed that the collateral circulation status was related to the incidence of MBE in patients with ALVOS after successful recanalization (level 2 vs level 0, adjusted OR=0.109, 95 %CI 0.021-0.563, P=0.008). Conclusions:MBE is an independent risk factor of ALVOS patients with poor outcome or death in 90 days. For patients with ALVOS, even if the occlusive vessels have been successfully recanalized after early endovascular treatment, MBE is still not uncommon. The collateral circulation state is an independent predictive factor of the development of MBE after recanalization by early endovascular treatment in patients with ALVOS.
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Objective To evaluate the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation.Methods From February 2014 to June 2017,15 patients (15 feet) with intra-articular calcaneal fracture associated with peroneal tendon dislocation were treated at Department of Foot and Ankle Surgery,Orthopaedics Hospital of Zhengzhou.There were 9 males (9 feet) and 6 females (6 feet),and 8 left feet and 7 right feet.The patients were aged from 20 to 55 years (average,42.5 years).After reduction of calcaneal fractures,titanium plates and screws were used for fixation.The bone canal was established on the lateral malleolus,and the torn superior peroneal retinaculum was fixed to the lateral malleolus by suture after reduction of the peroneal tendon.The ankle joint was immobilized with a plaster brace in the metatarsal flexion for 6 weeks.The postoperative outcomes were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS);complications were recorded.Results All the 15 patients were followed up for 12 to 36 months (average,20.5 months).All the calcaneal fractures fully healed and no re-dislocation of the peroneal tendon occurred.The AOFAS hindfoot-ankle scores ranged from 80 to 95 points,averaging of 87.4 points;the VAS scores ranged from 0 to 5 points,averaging 1.5 points.Delayed wound healing was observed in one case but primary healing was achieved eventually with regular dressing change.Another case presented with symptoms of injury to the cutaneous branch of the sural nerve which disappeared after oral administration of neurotrophic drugs for 6 months.Another case suffered from subtalar arthritis accompanied by persistent pain which disappeared after subtalar arthrodesis.No other complications were observed in the other patients.Conclusion In the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation,the peroneal tendon dislocation should be treated simultaneously with the intra-articular calcaneal fracture to achieve satisfactory clinical outcomes.
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Objective To investigate the association of post-stroke depression (PSD) with tryptophan hydroxylase 2 (TPH2) gene polymorphism and related clinical risk factors of PSD.Methods Three hundred and seventy-six patients diagnosed as having acute ischemic stroke for the first time, admitted to our hospital from March 2015 to September 2017, were chosen in our study. According to Hamilton depression scale scores and Diagnostic and statisistical Manual of Mental Disorders, fourth edition (DSM-IV), these patients were divided into PSD group and non-PSD group. High-resolution melt analysis was used to complete the genotyping ofTPH2gene rs4641528 and rs1386494 in the enrolled patients. The correlations of single nucleotide polymorphisms and PSD were analyzed. Logistic regression analysis was performed on items with statistically significant differences in univariate analysis to identify independent factors affecting PSD.Results There were 104 patients into the PSD group and 272 patients into the non-PSD group; there were statistically significant differences between the two groups in years of education and NIHSS scores (P<0.05). There were no significant differences in rs1386494 genotype and allele frequency between the two groups (P>0.05); there were significant differences in rs4641528 genotype and allele frequency between the two groups (P> 0.05). The C allele inthe chromosomes of PSD patients accounted for 54.3％, while the C allele in the chromosomes of non-PSD patients accounted for 43.4％; the presence of allele (C) increased the risk of PSD (OR=1.552, 95％CI: 1.126-2.141,P=0.007). The results of multivariate Logistic regression analysis showed that baseline NIHSS scores and genotypes of rs4641528 (C/C+C/T) were independent influencing factors of PSD.Conclusion TPH2rs4641528 gene polymorphism and baseline NIHSS scores are found to be associated with depression 3 months after stroke in south Anhui province.
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Objective To investigate the efficacy of open reduction and osteotomy combined with internal fixation to reconstruct the distal tibial articular surface in the treatment of old pilon fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 20 patients with old pilon fracture admitted to Zhengzhou Orthopaedic Hospital from July 2014 to February 2018.There were 14 males and six females,aged 21-45 years,with an average of 31.5 years.According to AO classification,there were four patients with C1 type,seven with C2 type and nine with C3 type,all of which were closed fractures.Eleven patients received non-operative treatment while nine patients underwent surgeries.After the surgery,malunion was seen in eight patients,and incomplete union in 12 patients.There were eight patients with posterior articular surface collapse of distal tibia,seven patients with anterior articular surface collapse of distal tibia,three patients with varus deformity and two patients with valgus deformity.All patients were treated with open reduction and osteotomy with internal fixation to reconstruct the articular surface of distal tibia.The time of fracture healing was recorded,and the Visual Analogue Scale (VAS),ankle flexion and extension range of motion,and AOFAS ankle-hind foot function score were compared before and at the last follow-up.The complications were recorded.Results All patients were followed up for 7-36 months,with an average of 26.4 months.Fracture healing time was 3-7 months,with an average of 4.1 months.At the last follow-up,VAS,ankle metatarsal flexion,dorsal extension and AOFAS scores were significantly improved compared with those before operation [(1.9 ± 1.0)points vs.(6.6 ± 1.4)points,(31.6 ±2.4)° vs.(18.5 ±4.4)°,(25.7 ±2.7)° vs.(15.6 ±2.7)°,(79.6±7.3)points vs.(42.6 ±5.6)points] (P＜0.05).One patient developed severe ankle traumatic arthritis 7 months after operation and underwent fusion of ankle joint.Conclusion For old pilon fracture,open reduction and osteotomy to reconstruct the distal tibial articular surface can effectively relieve pain,improve joint mobility and restore ankle function.
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Objective@#To investigate the efficacy of open reduction and osteotomy combined with internal fixation to reconstruct the distal tibial articular surface in the treatment of old pilon fracture.@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 20 patients with old pilon fracture admitted to Zhengzhou Orthopaedic Hospital from July 2014 to February 2018. There were 14 males and six females, aged 21-45 years, with an average of 31.5 years. According to AO classification, there were four patients with C1 type, seven with C2 type and nine with C3 type, all of which were closed fractures. Eleven patients received non-operative treatment while nine patients underwent surgeries. After the surgery, malunion was seen in eight patients, and incomplete union in 12 patients. There were eight patients with posterior articular surface collapse of distal tibia, seven patients with anterior articular surface collapse of distal tibia, three patients with varus deformity and two patients with valgus deformity. All patients were treated with open reduction and osteotomy with internal fixation to reconstruct the articular surface of distal tibia. The time of fracture healing was recorded, and the Visual Analogue Scale (VAS), ankle flexion and extension range of motion, and AOFAS ankle-hind foot function score were compared before and at the last follow-up. The complications were recorded.@*Results@#All patients were followed up for 7-36 months, with an average of 26.4 months. Fracture healing time was 3-7 months, with an average of 4.1 months. At the last follow-up, VAS, ankle metatarsal flexion, dorsal extension and AOFAS scores were significantly improved compared with those before operation [(1.9±1.0)points vs. (6.6±1.4)points, (31.6±2.4)° vs. (18.5±4.4)°, (25.7±2.7)° vs. (15.6±2.7)°, (79.6±7.3)points vs. (42.6±5.6)points] (P<0.05). One patient developed severe ankle traumatic arthritis 7 months after operation and underwent fusion of ankle joint.@*Conclusion@#For old pilon fracture, open reduction and osteotomy to reconstruct the distal tibial articular surface can effectively relieve pain, improve joint mobility and restore ankle function.
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Objective This study aims to investigate the potential correlation between the rs1187929 polymorphism of tyrosine kinase B gene and post-stroke depression (PSD). Methods A total of 78 depression patients (PSD) and 112 non-depression patient controls (NPSD patients) were included in the study. All participants were evaluated using the Hamilton Rating Scale for Depression (HAMD) and further divided into PSD and NPSD groups. PSD patients were diagnosed in accordance with DSM-V criteria. The rs1187929 polymorphism of TrkB was genotyped by using PCR product purification and Sanger double termination sequencing. Results The total prevalence rate was 41.05% . The prevalence rate was 42.86% in men and 38.82% in women ( 字2=0.316,P=0.57). The CC, CT and TT frequencies of PSD group were 26.92% , 48.72% and 24.36% respectively. The CC, CT and TT frequencies of NPSD group were 42.86%, 45.54% and 11.61% respectively. Based on the CC genotype, the relative risk of homozygous mutant TT was 3.341 (字2=7.347, P=0.007, OR=3.341),and the T allele frequency in the PSD group was 48.72% which was higher than 34.38% in the NPSD group. The relative risk of allele T relative to allele C was 1.814 (字2=7.798, P=0.005, OR=1.814). Homozygous mutant TT and allele T were risk factors for post-stroke depression (P<0.05). Conclusion There is a correlation between rs1778929 gene polymorphism and PSD in Han population in South Anhui Province, which warrants further large-scale studies.
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Objective To study the staging of cerebral parenchymal cysticercosis by fractional anisotropy(FA) value and average diffusion coefficient(DCavg) value on diffusion tensor imaging(DTI). Methods Forty-eight patients (30 men and 18 wemen) with cerebral parenchymal cysticercosis were admitted to the First Affiliated Hospital of Dali University from January in 2015 to December in 2016.Their averge age was(34±11)years(rang from 19 to 65 years).Eight patients with subclinical stage, 13 patients with vesicular stage, 15 patients with colloidal-vesicular stage,and 12 patients with granular-nodular stage of cerebral neurocysticercosis were included in this study. The data of FA and DCavg of lesions with different stages were measured, as well as the contralateral normal brain parenchyma. The FA values and DCavg values of lesions were analyzed by variance analysis,respectively.Paired t test was used to compare the FA and DCavg values of the lesions and the contralateral brain.Results The FA values of lesions with subclinical stage, vesicular stage, colloidal-vesicular stage, and granular-nodular stage of cerebral parenchymal cysticercosis were 0.074 7±0.002 5,0.105 8±0.003 1,0.127 3±0.002 1,and 0.159 3±0.001 4, respectively.The differences were statistically significant among the stages(F=639.17,P<0.05).The DCavg values were(1.312 5±0.006 7)×10-3,(1.514 2±0.005 9)×10-3,(1.112 1±0.005 8)×10-3,and(1.093 2±0.008 4)× 10-3mm2/s for lesions with each stage, respectively. There was a significant difference in the DCavg values among the stages(P<0.05).The data of FA and DCavg for lesions with every stage had a significant difference from those of normal contralateral brain(F=491.24, P<0.05). Conclusion The parameters FA and DCavg values of diffusion tensor imaging may be helpful in the diagnosis of different stages of cerebral parenchymal cysticercosis,and may provide guidance for clinical treatment.
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Objective To compare the effect of fluoroscopic triggering method and empirical delay method on image quality in the liver Gd-EOB-DTPA dynamic enhanced MRI,and to investigate the value of fluoroscopic triggering method in Gd-EOB-DTPA dynamic enhanced MRI.Methods The patients underwent Gd-EOB-DTPA dynamic enhanced MRI were randomly divided into two groups according to the starting modes in the artery phase.Group A used fluoroscopic triggering method and group B used empirical delay method.Eliminating the images with severe respiratory motion artifacts,the quality of the remaining images in 78 cases of group A and 85 cases of group B were assessed in scores (excellent=5 scores;good=4 scores).Data was statistically analyzed with Mann-whitney tests,and P<0.05 was considered statistically significant.Results The excellent rate of the images in group A was 96.15% (75/78).The excellent rate of the images in group B was 67.06% (57/85).There were significant differences between the two groups in the excellent rate (χ2=27.889, P<0.001)and the image quality scores (Z=-4.747,P<0.001).Conclusion For the liver Gd-EOB-DTPA dynamic enhanced MRI, fluoroscopic triggering method is more likely to get better image quality and higher success rate in artery phase than empirical delay method,which indicates that fluoroscopic triggering method have obviously advantages in clinical applications.
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Objective To explore the technique of laparoscopic reoperation in the treatment of common bile duct stones.Methods A retrospective analysis of the clinical data of 54 cases of common bile duct stones undergoing laparoscopic common bile duct stone surgery in our hospital from January 2011 to December 2015 was conducted.Through the choice of puncture hole, the exposure of the liver surface and the confirmation of the common bile duct, T-tube drainage and primary suture of common bile duct were carried out for the treatment of bile duct stone.Results The laparoscopic operations were successful in 52 cases, while conversions to open surgery were required in 2 cases.During the operation, the amount of bleeding was about 40-150 ml (average, 70 ml), the operation time was 75-180 min (average, 120 min), and the postoperative gastrointestinal function recovery time was 24-48 h (average, 27±13 h).There were 1 case of duodenal perforation injury, 2 cases of bile leakage, and 2 cases of residual stones after operation, which were cured with laparoscopic repair, prolonged drainage time, and choledochoscope treatment via abdominal sinus.Postoperative hospital stay was 6-9 d (average, 7±1.5 d).A total of 54 cases were followed up for 3-24 months (mean, 14.8 months).All the patients recovered well, without bile duct stricture or stone recurrence.Conclusion As long as the application of skilled laparoscopic surgery methods and separation of surgical area skills, laparoscopic bile duct surgery for the treatment of common bile duct stones is safe and feasible.
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[Objective]To study doctor LEI Feng's life story from Zhejiang Province in late Qing Dynasty from the point of view of the social history. [Methods]With the research methods of history and philology, collect relevant historical materials, to study LEI Feng 's life story from the view of social history. [Results]LEI Feng was born in the nineteenth year of the Daoguang Emperor of the Qing Dynasty(1839), died in the fourteenth year of the Guangxu Emperor of the Qing Dynasty(1888), at the age of 49. LEI Feng had a daughter named GONG Yuyun(about 1870-1899), a son named LEI Dazheng(?-1899), two students named ChENG Xi and JIANG Cheng, LEI Feng's father named LEI Huanran(?-about 1862), LEI Huanran's medical teacher was CHENG Zhitian. [Conclusion]LEI's medical family in Quzhou city of Zhejiang Province inherited from father to son and teacher to student, they both had their own medical literatures, the academic origin of LEI's medical family was Xin'an medicine;though LEI Feng called himself an ordinary person, he was good at writing poem, calligraphy and painting even music, he played a special role in traditional Chinese medicine 's social history.
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It has always been considered that() printed byis the earliest version. In comparative study, it is found that there are two versions in thedynasty, one is the original, stored in the Library of China Academy of Sciences and another one is the revision, stored in the Library of Tianjin University of TCM, Zhejiang Provincial Library and the Library of China Academy of Chinese Medical Sciences. The last item, Chengjiang (CV 24) in thein volume 7 is included in the revised edition, but not covered in the original one, which is the difference between the two versions. Both of the versions were in thedynasty, rather than the block-printed one in thedynasty.
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Objective Research on the correlation of dyslipidemia of civil aviation pilots and the TCM constitution aimed to explore that how professional environmental affects the lipid metabolism and the constitution.MethodsMeasure the lipid statusand TCM constitution of 656 pilots, and 496 of them with dyslipidemia were studied. The sample were stratified according to the age and the types of dyslipidemia, including young and middle-aged groups, only abnormal total cholesterol metabolism (TC), only abnormal triglyceride metabolism (TG), and both abnormal cholesterol and triglycerides metabolism groups and then the differences in prevalence of traditional Chinese medicine in different groups were analyzed and discussed. ResultsThe prevalence of abnormal lipid metabolism was 75.61% in 656 pilots. The top three TCM constitutions among the pilot with dyslipidemia were phlegm dampness constitution (35.89%), dampness heat constitution (33.06%) and deficiency of Yang(20.97%). If age was not considered, the prevalence of TCM constitutions were not significantly different between the groups of only abnormal TC and TG (P>0.05), while the prevalence of Yang deficiency and dampness heat constitutions of only either TC or TG abnormal group were significantly higher than those of the group of both abnormal TC, TG (χ2 values were 6.793, 5.077, P<0.05). Take age as considered, TC metabolic abnormalities in youth group, the prevalence of damp heat constitution of the only TC abnormal group was higher than both TC, TG abnormal group (χ2=7.637,P<0.01); and the prevalence of Qi deficiency and Yang deficiency constitution of the only TG abnormal group were higher than both TC, TG abnormal group (χ2values were 6.139, 7.525,P<0.05). In the middle-aged group, the prevalences of Yang deficiency and Qi stagnation constitution of only TC abnormal group were higher than only TG abnormal group (χ2 values were 9.750, 3.922,P<0.05), and the prevalence of Yang deficiency of only TC abnormal group was higher than both TC, TG abnormal group (χ2=5.208,P<0.05). The prevalence of Yang deficiency of both TC, TG abnormal group was higher than only TG abnormal group (χ2= 4.489,P<0.05). Conclusions The result showed high prevalence of dyslipidemia in the population of civil aviation pilots. Age and lipid metabolism status could affect the types of TCM constitution. Damp-heat constitution was the common type of TCM constitution in the population of the young pilot, and Yang deficiency and Qi stagnation constitution were the common types in the population of middle-aged people whose lipid metabolism were disorder. The group of only abnormal TC influence on TCM constitution more than both abnormal TC and TG.