Diagnosis and treatment of Charcot spinal arthropathy / 中华骨科杂志

Charcot Spinal Arthropathy (CSA) is a rare and progressive serious degenerative spinal disease. The clinical manifestations of CSA are concealed and atypical, which could lead to missed misdiagnosis, disease prognosis, and a huge burden on patients. However, there is no systematic review of CSA in China. The causes of CSA are mainly divided into spinal cord injury and non-injury neuropathy. The risk factors for CSA caused by spinal cord injury include long-segment fixation, scoliosis, laminectomy, overload spinal exercise and obesity. CSA usually occurs in the lower thoracic or lumbar spine. The symptoms of CSA include spinal deformity, unbalanced sitting posture and local pain. The CSA can be diagnosed after excluding non-specific chronic inflammation in histology and other inflammatory diseases or tumor based on the following items, damage to proprioception, pain and temperature perception, bone destruction, absorption and new bone formation on imaging. Conservative treatment can be considered for patients with CSA who have good stability without infections, stable nerve function, skin fistulas, balanced sitting posture, and autonomic dysfunction. Surgery is recommended for patients with symptoms lasting for more than 6 months with spinal instability, skin fistulas or complicated infections. Before surgery, it is recommended to evaluate the heterotopic ossification or rigidity of both hip joints. During operation, more attention should be paid to the adequate removal of necrotic tissue and inflammatory tissue in the lesion and sufficient bone grafting. Spinal fusion is recommended at the sacrum or pelvis. Postoperative complications include failure of internal fixation, new Charcot joint formation, difficulty in wound healing and infection. The authors emphasize that the overall thoracolumbar spine should be followed up for patients with spinal cord injury and paraplegia for the long-term. The typical symptoms of CSA are helpful for early diagnosis and selection of appropriate interventions.

Strategies for general surgery related issues in the treatment of critically ill patients diagnosed with COVID-19 / 中华消化外科杂志

In order to improve the cure rate of critically ill patients in Wuhan epidemic area and reduce the fatality rate, the state have dispatched medical staffs from the whole country to support Wuhan and treat critically ill patients in dedicated facilities. A medical team from the First Affiliated Hospital of Xi’an Jiaotong University, consisting of 133 medical staffs major in critical care medicine, respiralogy, infection, cardiology, and general surgery, entirely took over the critical care unit of the East Hospital of the Renmin Hospital of Wuhan University, and formed a multidisciplinary collaboration team with local medical staffs to treat patients together. Up to March 13th in 2020, the author′s medical team has admitted a total of 109 patients, of which 48 had been discharged up on recovery. Critically ill patients with Corona Virus Disease 2019 mainly have elder age, comorbidities, complicated conditions, and difficult diagnosis and treatment. The author and the author′s team combined with clinical practice, share experience and strategies of general surgery related issues in the treatment of critically ill patients, providing reference for collegues in general surgery.

Therapeutic effect of vacuumassisted closure combining surgical treatments on chronic osteomyelitis after severe open fractures / 中国医师进修杂志

Objective To evaluate the effect of vacuumassisted closure (VAC) combining surgical treatments on chronic osteomyelitis after severe open fractures. Methods Fifty-eight patients with severe high energy open fractures were enrolled,35 patients were randomized to the experimental group and had identical treatment except that VAC was applied to the wounds between irrigation and debridement procedures, 23 patients were randomized to the control group and underwent initial irrigation and debridement followed by standard fine mesh gauze dressing. The infection rate, therapeutic effect and health condition were evaluated between the two groups. Results All patients were followed up for 14 - 36 (28.0 ± 7.3 ) months.Control group developed 7 cases ( 30.4%, 7/23 ) with deep infections, whereas experimental group developed 2 cases (5.7%,2/35) with deep infections. There was significant difference between the two groups (P =0.024). There were 24 cases (68.6%,24/35) grade A healing in experimental group,whereas there were 13cases (56.5%, 13/23) grade A in control group,the difference was very singificant (P＜0.05). The health total score of experimental group was higher than that of control group at 3,9 months after operation (P =0.013,0.005). Conclusions Patients treated with VAC have a higher recovery rate,shorter length of stay and satisfactory curative effect compared with patients randomized to the traditional methods. VAC represents a promising new therapy for osteomyelitis after severe open fractures.

Allelopathic effects of companion species on spore germination and gametophyte development in Cibotium barometz / 中国中药杂志

<p><b>OBJECTIVE</b>To study the relationship between Cibotium barometz and its companion species, Arachniodes falcate and Alpinia japonica, we used aqueous leachates of the two companions to deal with C. barometz spores.</p><p><b>METHOD</b>Spores of C. barometz were translated on MS culture which contained different concentration of aqueous extracts of the two companions, the germination and gametophyte development were observed and recorded.</p><p><b>RESULT</b>All extracts inhibited and delayed the C. barometz spores germination and rhizoid elongation was inhibited. It also had obvious inhibition to the prothallus formation and sexual differentiation. And the higher concentration, the more obvious inhibition of aqueous extracts of the two companion species.</p><p><b>CONCLUSION</b>The two companion species have allelopathic effects on the spore germination and gametophyte development of C. barometz. And it may have an influence on sporogon ontogenesis and the population expansion.</p>

Unilateral versus bilateral cerebral perfusion in deep hypothermia circulatory arrest surgery / 中华胸心血管外科杂志

Objective To study the applicability of unilateral and bilateral antegrade cerebral perfusion during deep hy-potbermia circulatory arrest (DHCT) surgery and to determine a better method of brain protection. Methods 60 patients un-derwent aortic arch surgery were random divided into either unilateral cerebral perfusion group with a cannula in the innominate artery (n = 30 ) , or bilateral cerebral peffusion gToup with an additional cannula in the left carotid artery ( n = 30 ). S-100β,neuron specific enolase (NSE) were assayed at the following time points: the beginning of cardiopulmonary bypass (T_1), the beginning of circulatory arrcst( T_2 ), antegradc cerebral perfusion (ACP) 25 min( T_3 ), the end of ACP( T_4 ), the end of car-diopulmonary bypass ( T_5 ) , 1h( T_6 ) , 6h ( T_7 ) and 24h( T_8 ) after operation. Neurological deficit incidence and mortality were also obtained. Results There is no statistical significance for S-100β and NSE plasma concentration among time points of T_1、T_2 and T_3. But every time point among T_4、T_5、T_6、T_7 ,Ts do have statistical significances. The incidence of central nervous system dysfunction in group unilateral ACP was higher than that in group bilateral ACP ( 33.33% vs. 10.00%, P = 0.028 ).But there is no significant difference between the two groups in mortality( 3.33% vs. 6.66% ,P = 1. 000 ). Conclusion There is no significant difference between unilateral ACP and bilateral ACP in 25 min during DHCA. But as the DHCA time extends, the effect of bilateral ACP will be better.

Analysis of fingerprint and bioactive components in different parts of Scutellaria tsinyunensis by HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>Used HPLC to set up fingerprint of medicinal-plant Scutellaria tsinyunensis collected from Jinyun mountain of Chongqing, and to determine four flavonoids in its root, stem and leaf.</p><p><b>METHOD</b>Analysis was carried out on a COSMOSIL C18-PAQ column (4.6 mm x 250 mm, 5 microm) with acetonitrile and H2O-H3PO4-THF(85:12:0.3) as the mobile phases in a gradient elution, with a flow rate of 1.0 mL x min(-1). The column temperature was 30 TC, and the detection wavelength was 275 nm. The fingerprints of ten populations were determined, and the data were analyzed by the similarity evaluation software.</p><p><b>RESULT</b>The mutual mode of HPLC fingerprint was established. There were 14 common peaks in all, each peak was well separated. The peak was steady and showed good repeatability. Compared with the mutual mode, the similarities of 10 samples were 0.987 0.994, 0.993, 0.971, 0.983, 0.994, 0.981, 0.981, 0.988, 0.972, and the average similarity was 0.984. The chromatographic profiles of 10 samples were very similar. The four flavonoids were determined successfully by this method. The results showed that the content of flavonoids in the root was the most, and the leaf was the least.</p><p><b>CONCLUSION</b>This method was steady and reliable which could be applied in identification, genetic diversity analysis, protection and utilization of S. tsinyunensis.</p>