Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults (version 2023) / 中华创伤杂志

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Analysis of protective mechanism of silk protein based cryoprotectants / 生物医学工程学杂志

Dimethyl sulfoxide (Me SO) supplemented with fetal bovine serum (FBS) is a widely used cryoprotectant combination. However, high concentration of Me SO is toxic to cells, and FBS presents problems related to diseases such as bovine spongiform encephalopathy and viral infections. Silk protein is a kind of natural macromolecule fiber protein with good biocompatibility and hydrophilicity. The aim of this paper is to analyze the cryoprotective mechanism of silk protein as cryoprotectant. Firstly, differential scanning calorimetry (DSC) was used to measure the thermal hysteresis activity (THA) of silk protein. The THA of 10 mg/mL sericin protein was 0.96°C, and the THA of 10% (V/V) fibroin protein was 1.15°C. Then the ice recrystallization inhibition (IRI) of silk protein-PBS solution was observed with cryomicroscope. The cold stage was set at - 7°C, after 40 minutes' incubation, the mean grain size rate (MGSR) of sericin protein and fibroin protein were 28.99% and 3.18%, respectively, which were calculated relative to phosphate buffer saline (PBS) control. It is indicated that sericin and silk fibroin have certain effects of inhibiting recrystallization of ice crystals. Finally, the structure and physicochemical properties of silk protein were analyzed by Fourier transform infrared spectroscopy (FTIR). The results showed that the content of the random coil was 75.62% and the β-sheet structure was 24.38% in the secondary of sericin protein. The content of the β-sheet structure was 56.68%, followed by random coil structure 22.38%, and α-helix 16.84% in the secondary of fibroin protein. The above analysis demonstrates the feasibility of silk fibroin as a cryoprotectant, and provides a new idea for the selection of cryoprotectants in the future.

Influences of Surfactants on Contact Angle of Pharmaceutical Excipients / 中国药师

Objective:To investigate the effect of surfactants on contact angle of pharmaceutical excipients and further study the effect of surfactants at different concentrations on the wettability of excipients and the effect of of surfactants and excipients at different proportions on the wettability of tablets. Methods:Different kinds of excipients were selected for tabletting,and surfactant solutions at different concentrations were prepared. The contact angle of the solutions on the surface of the tablets was measured by a contact angle tester. Results:The contact angle between the surfactants below the critical micelle concentrations and the tablets was the smallest and the wettability was the best. The change of the contact angle on the tablets with hydrophilic materials was less than that with hydropho-bic ones for most of the surfactants at the same concentration. Conclusion:After the addition of surfactants,the contact angle of excip-ient tablets significantly decreases, however, the contact angle will be stable after the amount of surfactants reaches a certain ratio, which shows significant reference value for tablet formula design.

The values of different study designs on the levels of evidence: a descriptive analysis of the researches published in four general medical journals in 2009 / 中华内科杂志

Objective To discuss the levels of evidence provided by different study designs.Methods Websites of N Engl J Med, JAMA, Lancet, and BMJ were accessed to identify research articles (systematic review and meta-analysis included) published in 2009. A standardized data collection form was established using Epidata 3. 1 software to extract the "title", "country of lead author", "clinical problem" (such as treatment, diagnosis, etc. ) and "study design" of eligible studies. Descriptive statistics was conducted with SPSS 13.0. Results Over all, 844 studies were included, among which 35.7% were RCT,9. 4% systematic review and Meta-analysis, and 54. 9% other types of studies. Regarding clinical problems,34. 2%, 19. 7%, 13.7%, 6. 0% and 5. 1% of the included researches addressed the issues of treatment,etiology/risk factors, prevention, disease frequency and prognosis, respectively. The study designs that were most frequently adopted to explore these problems were RCT (70.6%), cohort study (44. 6% ), RCT (68. 1% ), cross-sectional study ( 56. 9% ), and cohort study ( 93.0% ), respectively. Conclusions High-level evidence does not come exclusively from RCT and systematic review, as each type of study may have its unique value in health related research. The clinical problem of interest, the previous work that has been done to approach the same issue, as well as other factors should be taken into account when deciding whether the selected study design is appropriate.