Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases / 医学前沿

Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273 = 6.2% vs. 7/20= 35%, P = 0.0004 for all cases; 17/77= 22% vs. 7/9= 77.7%, P = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical TCM principles (e.g., clearing heat and dampening phlegm). Lastly, 59% of the patients received treatment, including antiviral, antibiotics, and Chinese patent medicine, before admission. This situation might have some effects on symptoms, such as fever and dry cough. By using EMR data, we described the clinical features and therapeutic characteristics of 293 COVID-19 cases treated via the integration of TCM herbal prescriptions and Western medicine. Clinical manifestations and treatments before admission and in the hospital were investigated. Our results preliminarily showed the potential effectiveness of TCM herbal prescriptions and their regularities in COVID-19 treatment.

Biomechanical Comparison of Anatomical and Vertical Reconstruction for Coracoclavicular Ligament / 医用生物力学

Objective To conduct a comparative study of the biomechanical characteristics of anatomical and vertical reconstruction for the coracoclavicular ligament. Methods Thirty fresh adult cadaveric specimens of the shoulder joint were dissected, whereas other soft tissues of the shoulder joint were resected, and only the clavicle-coracoclavicular ligament-scapula structures were retained. All the specimens were randomly divided into three groups, with ten specimens in each group. In Group 1, the coracoclavicular ligament was retained; in Group 2, the cone ligament was reconstructed vertically based on the classical Steven technique; and in Group 3, the conical ligament was reconstructed anatomically based on the central site of the original ligament. Biomechanical tests under vertical tensile resistances were conducted separately on the three groups, and the tensile forces that caused the rupture of the coracoclavicular ligament or reconstruction failure were recorded. Results In Group 1, clavicle and coracoid fractures were not found, and the tensile force that caused the coracoclavicular ligament rupture was (650.41 + 35.88) N. In Group 2, clavicle fracture (two cases), endobutton pull-out from the clavicle (two cases) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (725.68 + 35.37) N. In Group 3, clavicle fracture (three cases ), endobutton pull-out from the clavicle (one case) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (765.15+13.68) N. Conclusions The tensile forces in the anatomical and vertical reconstruction of the coracoclavicular ligament were both superior to those of the primary ligament, with the anatomical reconstruction being superior to vertical reconstruction under a tensile effect.

The efficacy of SLAP repair and biceps tendon tenotomy and fixation for type Ⅱ SLAP lesions in shoulder arthroscopic:a Meta-analysis / 中华骨科杂志

Objective To evaluate the effects of SLAP repair and biceps tendon tenotomy and fixation in treating type Ⅱ superior labrum from anterior to posterior in shoulder arthroscopy.Methods PubMed,CNKI,VIP,and Wanfang database were searched electronically to screen randomized controlled trials and non randomized controlled trials that comparing two surgical methods for type Ⅱ SLAP lesions.In addition,we also retrieved the domestic orthopedic magazine and searches references that we had included in the present study.According to the criterion,screening literatures,data extraction and quality assessment were conducted by two reviewers independently.Meta-analysis was performed by using RevMan 5.3 software to evaluate UCLA scores,ASES scores,VAS scores and SST scores.Results A total of 7 articles were included in the present study,including 3 literatures in Chinese and 4 in English.There were 2 randomized controlled trials and 5 non randomized controlled trials.Two hundred and fifty-six patients were enrolled in the present study,including one hundred and twenty-five patients with SLAP repair and one hundred and thirty-one patients with biceps tendon tenotomy and fixation.Meta-analysis showed that there was significant difference in total score of UCLA [MD=2.55,95％CI(0.57,4.53),P=0.01] and shoulder function in the UCLA scoring system [MD=0.62,95％ CI(0.21,1.02),P=0.003] compared with SLAP repair.There was no difference in the UCLA scoring system,including pain [MD=0.99,95％CI(-0.15,2.14),P=0.09],flexion [MD=0.16,95％CI(0.01,0.32),P=0.06],strength [MD=0.03,95％CI(-0.15,0.22),P=0.74],satisfaction [SMD=0.18,95％ CI(-0.57,0.93),P=0.64] compared with SLAP repair.There was significant difference in ASES scores [MD=6.32,95％CI(2.55,10.08),P=0.001] between two groups.There was no difference in VAS scores [MD=0.54,95％CI (-0.64,1.72),P=0.37] and SST scores [MD=0.81,95％CI(-0.23,1.86),P=0.13] between two groups.Conclusion The UCLA scores,ASES scores and surgical results of biceps tendon tenotomy and fixation are superior to SLAP repair in treating type Ⅱ SLAP lesions.However,there is no significant advantage in pain,flexion,strength and satisfaction between the two groups.