Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears using the long head of biceps tendon: the biomechanical and clinical study / 中华骨科杂志

Objective:To investigate the biomechanical characteristics and clinical outcomes of arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears (MIRCT) using the long head of biceps tendon (LHBT) with tenotomizing its distally or not (the "Chinese way" ).Methods:Eight fresh-frozen cadaveric shoulders were used to create a MIRCT model by detaching the footprints of the supraspinatus and infraspinatus tendons on the greater tuberosity. LHBT autograft was transferred and securely fixed onto the footprint of supraspinatus tendon for superior capsular reconstruction. Further, all cadaveric specimens were assigned to the tenotomy group or reservation group (4 cadaveric specimens in each group) according to whether the distal part of LHBT was tentomized or not. Biomechanical tests were conducted to observe the stiffness, ultimate load of fixed LHBT and to measure the length between LHBT tear site and its insertion on the superior labrum. A total of 41 patients with MIRCT who underwent arthroscopic superior capsular reconstruction using LHBT autograft between July 2016 and December 2018 were enrolled in the study. There were 17 males and 24 females, aged from 46 to 76 years (62.6±7.3 years). All patients were assigned to the tenotomy group (23 cases) or reservation group (18 cases) according to whether the distal part of LHBT was tentomized or not. The visual analogue scale (VAS), University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and Fudan University Shoulder Score (FUSS) were used to evaluate the clinical outcomes. The range of motion (ROM) of shoulder was recorded before and after operation. Magnetic resonance imaging was used to assess the structural integrity of reconstructed tissue at 12 months after operation (refers to the failure of the transposed LHBT, which may be accompanied by a retear of partial repaired supraspinatus tendon).Results:Biomechanical research showed that the stiffness, ultimate load of fixed LHBT and the length between LHBT tear site and its insertion on the superior labrum in the reservation group (54.0±6.6 N/mm, 141.8±15.9 N, 93.3±12.4 mm, respectively) were significantly higher than those in the tenotomy group (25.7±4.2 N/mm, 80.8±8.0 N, 47.4±2.0 mm, respectively) ( P<0.05). All patients were followed up for 12-18 months (14.5±1.8 months) without significant complications and adverse reactions. No matter the distal part of LHBT was tentomized or not, the ROM and clinical scores (VAS score, UCLA score, Constant-Murley score, ASES score and FUSS) of patients improved significantly at 1 year follow-up than that before operation ( P<0.05). However, there were no significant differences between the reservation group and tenotomy group in terms of postoperative ROM [flexion, abduction, external rotation at side, internal rotation (vertebral level) were 144.3°±15.5° vs. 148.0°±10.3°, 145.1°±14.1° vs. 142.3°±11.2°, 67.3°±14.4° vs. 62.7°±11.7°, 8.3±2.1 vs. 7.8±2.5, respectively], VAS scores (2.3±1.6 vs.1.5±1.2), functional scores (Constant-Murley score, UCLA score, ASES score and FUSS were 88.2±11.4 vs. 85.6±9.6, 29.3±2.8 vs. 31.4±3.5, 86.8±11.8 vs. 82.6±9.2, 92.1±10.1 vs. 88.3±8.2, respectively) and structural failures (35.2% vs. 30.0%, P>0.05). Conclusion:Arthroscopic superior capsular reconstruction using LHBT with reserving its distal part could achieve higher mechanics strength. However, the short-term follow-up showed that tenotomizing the distal part of LHBT exerted no obvious influence on postoperative function and structural integrity.

Outcomes and quality of life evaluation following endoscopic endonasal approach for sinonasal malignancies / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyse the outcomes and the prognostic factors of patients with sinonasal malignancies following endoscopic endonasal approach, and to compare the pre- and post-operative quality of life.@*Methods@#A retrospective single-center review of 79 patients who underwent endoscopic endonasal approach for sinonasal malignancies in Beijing Tongren Hospital from October 2004 to March 2017 was performed, including 51 males and 28 females, with a median age of 48 years. Data of demography, imaging (including nasal CT and MRI before operation), histopathology and treatment strategy were collected. Recurrence and distant metastasis were diagnosed according to endoscopic examination, MRI and general check-up after surgery. Pre- and post-operative quality of life scores were obtained by sinonasal outcome test-22, visual analog scale and anterior skull base surgery questionnaire. SPSS 22 software was used for statistical analysis.@*Results@#The study consisted of 13 pathological types with sinonasal T1-T4 stage tumors, including cervical lymph nodes and/or distant metastasis. All patients underwent endoscopic endonasal approach surgery. After 43 months of median follow-up time, the overall, disease-free, and recurrence-free survival rates at 1, 3, 5 and 10 years was 97.4%, 92.5%, 92.5% and 83.7%; 83.2%, 68.3%, 56.8% and 33.6%; 84.5%, 66.6%, 58.0% and 34.4%, respectively. Postoperative recurrence was an independent risk factor affecting the overall survival rate (HR=8.852, P=0.044), and preoperative recurrence (secondary surgery) was an independent risk factor affecting the disease-free and recurrence-free survival rate (HR value was 2.237 and 2.095 respectively, P value was 0.029 and 0.047 respectively). After surgery, the olfaction and nasal scab got worse, while the nasal obstruction and breathing were improved.@*Conclusions@#Endoscopic endonasal approach for sinonasal malignancies can achieve satisfactory outcomes, and has obvious advantages in improving the quality of life. Postoperative recurrence and preoperative recurrence are the prognostic factors.

Simultaneous Determination of 4 Kinds of Effective Components in Volatile Oil of Forsythia suspensa by QAMS / 中国药房

OBJECTIVE： To establish a method for simultaneous determination of α-pinene， β-pinene， limonene and α-terpineol in volatile oil of Forsythia suspensa. METHODS： GC method was adopted. The determination was performed on HP-5 capillary column through temperature-programmed route. The inlet temperature was 230 ℃， and detector temperature was 250 ℃； split sampling was applied （split ratio of 8 ∶ 1）； the air flow rate was 300 mL/min， the hydrogen flow rate was 30   mL/min， the tail gas flow rate was 30 mL/min， and the injection volume was 1 μL. Using limonene as internal reference， relative correction factors of α-pinene， β-pinene and α-terpineol were established， and the reproducibility of relative correction factors were investigated by using different chromatographs and columns， and chromatographic peak location of components was measured. The contents of above components were calculated with QAMS， and then compared with the results of external standard method. RESULTS： The linear range of α-pinene， β-pinene， limonene and α-terpineol were 16.5-990.0， 38.1-2 287.5， 8.2-491.2， 2.4-142.5  μg/mL， respectively （r≥0.999 1）. RSDs of precision， reproducibility and stability tests were all lower than 3％ （n＝6）. Average recoveries were 99.7％-105.5％（RSD＜4％，n＝9）. Compared with limonene （1.00），the average relative correction factors of α-pinene， β-pinene and α-terpineol were 0.91，0.86 and 1.11（n＝3）； relative retention time were 0.69-0.74， 0.81-0.86， 1.25-1.35（RSD＜3％，n＝3）. By using different chromatographs and columns， RSDs of relative correction factors were 0.21％-4.65％（n＝6）. Compared with external standard method， determination results of above 4 components were consistent （the absolute value of relative error were all less than 7％）. CONCLUSIONS： QAMS can be used for simultaneous determination of 4 kinds of effective components in volatile oil from F. suspensa.

Clinical efficacy analysis of adult sinonasal rhabdomyosarcoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical prognostic impact factors of adult sinonasal rhabdomyosarcoma (SNRMS).@*METHOD@#The clinical features, treatment methods, and disease outcome were reviewed retrospectively for twenty-three adult SNRMS between 2006 January and 2014 December. The survival analysis was performed by Kaplan-Meier estimate and the comparison between groups by Log-rank test. Multivariate analysis was carried out by Cox proportional hazard model.@*RESULT@#Patients' ages ranged from 18 to 59 years (median, 23.2 years). With a median follow-up of 20 moths (3-47 moths), 14 cases dead and 9 cases alive, the 1-year and 2-year overall survival (OS) rates were 77.1% and 35.0%, respectively. Within the 1-year and 2-year OS rates,early stage group had a higher overall survival rates than advanced diease group (100.0%, 66.7% and 83.3%, 10.5%, P < 0.05); combined therapy group had a higher overall survival rates than single treatment group (86.7%, 50.0% and 50.8%, 0, P < 0.05). In the non-metastasis group (21 cases), 1-year and 2-year distant metastasis rates were 38.1% and 70.5%, respectively. Multivariate analysis showed that radiotherapy, chemotherapy and tumor diameter less than 5 cm were good prognostic factors (P < 0.05), while the lymph node metastasis, meningeal involvement and orbital involvement were poor prognostic factors (P < 0 05). In the 14 cases of dead patients, 92 8% (13/14) died of distant metastasis.@*CONCLUSION@#Adult RMS had a high advanced rate with poor prognosis. Distant metastasis is the leading cause of death. Controlling distant metastasis is a key to improve the survival rate.

Analysis of 48 Cases of Lornoxicam-induced ADR in Beijing / 中国药房

OBJECTIVE:To investigate the characteristics and regularity of lornoxicam related ADR,and to provide reference for rational and safe use of lornoxicam. METHODS:From Jan. 1,2006 to Dec. 31,2013,lornoxicam related ADR reports collect-ed by National ADR Monitoring System in Beijing were analyzed retrospectively about their characteristics and related factors. RE-SULTS:In the statistical period,there were 48 ADR reports related to lornoxicam. The people over 40 years age accounted for 62.5%. 38 patients used lornoxicam by intravenous infusion or intramuscular injection ,accounting for 79.17%. The clinical mani-festations were diverse and complex,in which skin(32.96%)and gastrointestinal damage(25.00%)were more common ADR oc-curred within 30 min,accounting for 35.42%,and it would be better after stopping drug or 1-3 days symptomatic treatment. CON-CLUSIONS:The rational use of lornoxicam can reduce the occurrence of ADR. Suggestion on the use of the drug,is that the pa-tient should be monitored for security,in order to reduce the risk of ADR.

Effect of TPF induction chemotherapy on locally advanced squamous-cell cancer of hypopharynx / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo observe the short term effects and adverse effects of induction chemotherapy with Paclitaxel,Cisplatin and Fluorouracil(TPF) in locally advanced squamous cell cancer of hypopharynx. METHODS78 cases locally advanced squamous-cell cancer of hypopharynx form jan 2011 to oct 2013 for the first time treated by TPF scheme,after 2 cycles,to recheck CT scan and evaluate therapeutic effective.RESULTSAll 78 cases patients achieved 156 cycles chemotherapy,CR was 4 cases (5.1%),PR 55 cases (70.5%),SD 17 cases (21.8%), PD 2 cases (2.6%). Total effective rate (CR+PR) was 75.6%,and with low incidence ofⅢ/Ⅳ grade side effect. Logistic regression analysis shows that there is a significant correlation between effective rate and low differentiation cancer.CONCLUSIONFor locally advanced squamous-cell cancer of hypopharynx patients,the TPF chemotherapy scheme showed good therapeutic effective and safety,could be a choice for the induction chemotherapy treatment in locally advanced squamouscell cancer of hypopharynx. The patients with low differentiation cancer may have benefit from the induction chemotherapy.

Determination of Five Heavy Metals and Harmful Elements in Freeze-dried Rehmannia from Different Habitats / 中国药师

Objective:To analyze the content of Pb, Cd, Cu, As and Hg in freeze-dried Rehmannia from different habitats by FAAS and double channels AFS. Methods:The contents of Pb,Cd and Cu in Rehmannia from different habitats were directly deter-mined by FAAS, while the contents of As and Hg were determined by double channels AFS after pretreated with HNO3-HClO4 . Re-sults:It was shown that each element had good linear relationship with the correlation coefficient above 0. 997 4. The average recovery was 97. 88%-100. 90% with RSD of 0. 019% -4. 20% (n=6). Meanwhile, the concentrations of 5 harmful elements and heavy met-als in 4 batches of 10 samples were higher than the limits described in Chinese pharmacopoeia. Conclusion:The results measured by the method are considered to be accurate, quick and easy to be operated. It can be used to determine heavy metals and harmful ele-ments in freeze-dried Rehmannia from different habitats.

Research on compatibility chemistry of acid-alkaline pair medicines in formulas of traditional Chinese medicine / 中国中药杂志

Compatibility chemistry of acid-alkaline pair medicines in formulas of traditional Chinese medicine (TCM) is an important research field which should merit to pay attention. The ideas and methods in prescription compatibility research on formulas containing alkaline-acid pair medicines were summarized from the aspect of chemical groups of alkaline and acid ingredients; the research results were introduced and analyzed; the research meaning was elaborated; and the expectation of the field was viewed.

Effects of HCCR-2 antisense nucleic acid on HepG2 cells / 中华消化外科杂志

Objective To investigate the effects of antisense recombinant euraryotic expression vector of HCCR-2 on the proliferation and apoptosis of HepG2. Methods The antisense recombinant eukaryotic expression vector of HCCR-2 was constructed. The vector was stably transfected to the HepG2 cells, and positive clones were selected by G418 (antiseuse vector group), pIRES2-EGFP vector was transfected into the HepG2 cells in the same way (pIRES2-EGFP group). The conditions of the nontransfected HepG2 cells were used as control (HepG2 group). Changes in cell growth curve, cell cycle, cell apoptosis and morphology of HepG2 cells after the transfec-tion were detected by MTT method, flow cytometry and transmission electron microscopy, respectively. All the data were analyzed by one-way ANOVA and chi-square test. Results The expression level of HCCR-2 mRNA was down-regulated to 0.39±0.04 in antisense vector group, and the expression level of HCCR-2 mRNA in pIRES2-EGFP group and HepG2 group were 0.62±0.06 and 0.72±0.03, respectively, with significant difference among the 3 groups (F=43.701, P<0.05). The apoptotic rate of HepG2 cells in antisense vector group, pIRES2-EGFP grop and HepG2 group were 13.30%, 2.51% and 2.07%, respectively, with significant difference among the 3 group (χ2=6.793, 8.721, P<0.05). The growth of HepG2 cells in antisense vector group was retarded, and was blocked in G0/G1 stage. Conclusions The HCCR-2 antisense recombinant eukaryotic expression vector can inhibit the mRNA expression of HCCR-2 and promote the apoptosis of cells. HCCR-2 may be involved in cell regulation and the proliferation of hepatocellular carcinoma cells.

DNA location embB 306 regarded as the molecular marker for drug resistant Mycobacterium tuberculosis / 中华检验医学杂志

Objective To investigate the prevalence of mutation in the locus 306 of embB gene in multi-drug resistant (MDR) Mycobacterium tuberculosis (TB) and evaluate the prospects for using it as a molecular marker to detect MDR-TB.Methods The 291 strains enrolled in this study were from the reference laboratory of Shanghai municipal centers for disease control and prevention, all of which had been tested for drug susceptibility.Mutation in embB 306 was screened both by amplification refractory mutation system (ARMS) and DNA sequencing.The mutation frequencies of embB 306 in the sample groups varied in drug resistance were statistically analyzed.Results 38(51.4% ) of the 74 MDR-TB were embB 306-mutant (X2 =93.8,P＜0.01).Of the 24 TB resistant to at least two drugs but not MDR, 9(37.5% ) were embB 306 mutant (X2 =60.1 ,P＜0.01 ).But only two(4.9% ) embB 306-mutant strains were found in 41 strains resistant to only one drug (X2 =6.8,P=0.0093).None embB 306-mutant strains were found in 152 pansensitive strains.The specificity of using embB 306 as a molecular marker for detecting multi-drug resistant TB was 94.9% (206/217).Conclusions As a molecular marker for screening drug resistant TB,especially MDR-TB, the gene locus embB 306 shows a relatively high sensitivity and specificity, promising a sound future for its application in clinics to realize fast screening of patients infected with MDR-TB and to provide evidence for appropriate medication.

Value of totally implantable central venous access ports / 中国医师杂志

Objective To evaluate the application of totally implantable central venous access ports. Methods A retrospective a-nalysis of 217 cases was made on the application and complication of totally implantable central venous access ports from October 2003 to May 2008. Results Venous access ports, which were connected to central venous system via subclavian vein in 199 cases and jugularis interna vein in 17 cases, were implanted into subcutaneous of chest wall. The success rate of implantation was 99.6% (216/217). The ports worked well in 207 cases (95.8%), and 9 ports (4.2%) were removed due to complications. Associated complications included subclavi-ana arterial puncture in 3 cases (1.4%) and local hematoma in one patient. Ventricular tachycardia occurred in one patient due to catheter was inserted into the right ventricle (0.4%). Five patients had soft tissue infections around ports (2.3%) and the ports were removed in 2 eases due to anti-infections therapy failure. Catheter dislocation happened in 2 cases (0.9%). The catheter obstruction was observed as a complication, which comprised three instances of catheter distortion and three of catheter-associated venous thrombosis, the ports in these six patients were removed (2.8%). The overall complication was 7.8%. Conclusions Totally implantable central venous access ports can provide a long-term and safe intravenous access to patients who need long-term intravenous infusion, especially for cancer patients received chemotherapy. Although the operation is simple, there are some complications and need to be carefully monitored.

The diagnosis and surgical treatment of primary gastric lymphoma / 中华普通外科杂志

Objeetive To probe the clinical diagnosis and surgical treatment of primary gastric lymphoma (PGL). Methods Clinical data of 23 PGL patients identified by postoperative pathology were analyzed retrospectively. Sixteen patients underwent subtotal gastrectomy,3 patients underwent total gastrectomy,2 patients underwent palliative resection and 2 patients underwent exploratory laparotomy only. Postoperatively 21 patients received adjuvant treatment(chemotherapy and/or radiotherapy).The variables analyzed were type of surgery, histological type in accordance with Kiel's classification, Involvement of lymph nodes. Ann Arbor stage classification. Results The overall 5-year survival rate of these patients Was 80%,that of low grade malignancy patients was 90%,and of high grade malignancy was 40%.Thirteen patients were classified as stage Ⅰ E and seven as stageⅡE and three as stageⅢor Ⅳ,the 5-year survival rate was 90%,67%and 0,respectively.Nineteen patients underwent radical resection with 5-year survival rate of 92.3%.No patients undergoing palliative resection have survived more than 5 years. The prognosis of PGL with low grade malignancy and that of early stages(IE and Ⅱ E)and those undergoing radical excision was better than those with high grade malignancy, that of advanced stage(Ⅲand Ⅳ),and that undergoing palliative resection. Conclusions Preoperative diagnosis relies mainly on gastroscopy with biopsy and CT scan. For patients with early stage disease,radical resection combined with adjuvant therapy is the key factor in improving the prognosis. Chemotherapy or/and radiotherapy is useful management for patients with advanced stage disease.

Colonoscopy in preoperative staging and treatment of colorectal cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment.</p><p><b>METHODS</b>28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made.</p><p><b>RESULTS</b>Endoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89% (25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow-up for 12 - 40 months.</p><p><b>CONCLUSION</b>Correct preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.</p>

Effects on micro-vessel density after pre-operative intra-arterial infusion chemotherapy in colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal cancer.</p><p><b>METHODS</b>Twenty-eight patients with colorectal cancer, treated by surgery from February to October 2000, were divided into two groups randomly. There were 12 patients in group A (pre-operative intra-arterial infusion chemotherapy) and 16 in group B (control). Arterial contrast technique was used in group A, then mitromycin 10 mg, 5-Fu 1,000 mg, epirubicin 60 mg were given through Weidner's way.</p><p><b>RESULTS</b>Micro-vessel density in the center, surface of the tumor and adjacent tissue around the tumor were 40.46 +/- 7.06, 52.27 +/- 18.40, 49.92 +/- 8.15 in group A, and 46.09 +/- 12.21, 73.44 +/- 22.06, 51.94 +/- 12.64 in group B. Micro-vessel density on the surface in group A was significantly lower than that of group B (P < 0.05), with no significance between the center and the adjacent tissue.</p><p><b>CONCLUSION</b>Pre-operative intra-arterial infusion chemotherapy is able to reduce micro-vessel density on the surface of colorectal tumor.</p>

Laparoscopic Detection of Malignant Peritoneal Mesothelioma / 中国医师杂志

Objective To improve the diagnostic rate of laparoscopy for malignant peritoneal mesothelioma (MPM) and enhance acquaintance with this disease. Methods The appearance of laparoscopic detection was retrospectively analysed in 25 patients with pathologically proved MPM. Results Hyperemia, edema and faint vascular net in parietal peritoneum were seen in all patients, and the thick or thin callus-like thickened parietal peritoneum was also observed. There were some grey nodes of various size, distribution and number in parietal and visceral peritoneum in all patients. The purplish red masses with hyperemia and edema were seen in abdominal cavity in 21 patients (21/25,84%). Several small masses cold be connected each other to become one big mass. All patients had yellow turbid or bloody ascites. Conclusion MPM had special characteristics under laparoscopy. Laparoscopic detection possesses the advantages of safety, little trauma, less hurt and high diagnostic rate. Laparoscopic detection and biopsy may be the best method for diagnosis of MPM.