Advances in Pharmacological Research on Anti-knee Osteoarthritis of Active Components of Salviae Miltiorrhizae Radix et Rhizoma / 中药新药与临床药理

Knee osteoarthritis(KOA)is a degenerative joint disease with a high incidence,which has seriously affected the quality of life of middle-aged and elderly people.Salviae Miltiorrhizae Radix et Rhizoma,a commonly used traditional Chinese medicinal for activating blood and removing stasis,has been proved to have a certain preventive effect on KOA in basic research and clinical application.Studies have found that the active ingredients of Salviae Miltiorrhizae Radix et Rhizoma have a variety of anti-KOA effects,such as regulation of inflammatory factors,anti-oxidative stress,inhibition of chondrocyte apoptosis,regulation of cartilage matrix degradation,and promotion of chondrocyte autophagy.It can reduce joint pain and inflammatory edema,delay articular cartilage degeneration,and maintain cartilage matrix homeostasis.This paper reviews the effect and mechanism of the effective components from Salviae Miltiorrhizae Radix et Rhizoma on the prevention and treatment of KOA,and analyzes the shortcomings of its related research.Our aim is to provide reference for the clinical treatment of KOA.

Role of Wnt signaling Pathway in Diabetic Osteoporosis and Traditional Chinese Medicine Intervention： A Review / 中国实验方剂学杂志

Diabetic osteoporosis （DOP） is a kind of bone complication caused by diabetes， which is characterized by the decrease of bone mineral density， the change of bone microstructure and the increase of bone fragility. The process of DOP is closely related to high glucose， insulin resistance， oxidative stress and other mechanisms. The Wnt/β-catenin signaling pathway plays an important role in mediating insulin resistance and bone metabolic balance in diabetes. Regulation of Wnt signal transduction promotes the expression of glycogen synthase kinase-3β（GSK-3β）phosphorylation and improves glucose and lipid metabolism. The Wnt/β-catenin signaling pathway is also an important way regulating osteocyte-driven bone remodeling， which not only plays an important regulatory role in the balance between osteoblasts and osteoclasts and improve bone metabolic homeostasis， but also promotes the expression of osteopontin， osteocalcin and type Ⅰ collagen， and improves bone proliferation and osteogenic differentiation by regulating the Wnt pathway. In recent years， the research of traditional Chinese medicine （TCM） in the prevention and treatment of DOP has gradually increased， and the exploration of TCM to interfere with the Wnt pathway to improve DOP has made some progress. This paper collects and summarizes the studies on the Wnt signaling pathway in glucose metabolism， bone metabolism and DOP worldwide in the past decade， as well as the related literature on the intervention of DOP by TCM compounds （classical and other compounds）， single Chinese medicine and TCM monomers based on the Wnt pathway， in order to provide a reference and direction for the development of new drugs for clinical prevention and treatment of DOP.

Icariin Regulates Glucocorticoid-induced Autophagy of Bone Microvascular Endothelial Cells Through PI3K/Akt/mTOR Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the impact of icariin （ICA） on autophagy in glucocorticoid-induced bone microvascular endothelial cells （BMECs） mediated by the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway. MethodBMECs were isolated and cultured from femoral heads obtained during total hip arthroplasty and identified using immunofluorescence staining. The experimental cells were divided into four groups： A control group， a glucocorticoid group （100 mg·L-1 hydrocortisone）， an ICA group （100 mg·L-1 hydrocortisone+6.7×10-3 mg·L-1 ICA）， and a Rapamycin group （100 mg·L-1 hydrocortisone+6.7×10-3 mg·L-1 ICA+1 mg·L-1 rapamycin）. Autophagy in BMECs was induced using 100 mg·L-1 hydrocortisone. LC3 fluorescence staining was used to observe the peak of autophagy at different time points. Western blot analysis was employed to analyze the expression of autophagy-related proteins and PI3K/Akt/mTOR pathway proteins in each group. Electron microscopy was used to observe autophagosomes and autolysosomes in the cells. ResultHydrocortisone at 100 mg·L-1 induced autophagy in BMECs， reaching a peak at around 5 hours， which then declined with further intervention. Compared to the control group， the glucocorticoid group showed cell membrane damage， disordered organelle arrangement， and a large number of autophagosomes and autolysosomes. Compared to the glucocorticoid group， the ICA group had more intact cell membranes， sparser organelle arrangement， and fewer autophagosomes and autolysosomes. Compared to the ICA group， the Rapamycin group showed cell membrane damage， disordered organelle arrangement， and more autophagosomes and autolysosomes. Compared to the control group， the glucocorticoid group had significantly increased expression of light chain 3B （LC3B）， Atg4B， and p62 （P<0.01）. Compared to the glucocorticoid group， the ICA group showed significantly decreased expression of LC3B， Atg4B， p62， and Beclin-1 （P<0.01）. Compared to the ICA group， the Rapamycin group had significantly increased expression of Atg4B and p62 （P<0.01）. Compared to the control group， the glucocorticoid group had significantly decreased expression of p-PI3K/PI3K， p-Akt/Akt， and p-mTOR/mTOR （P<0.01）. Compared to the glucocorticoid group， the ICA group showed significantly increased expression of p-PI3K/PI3K， p-Akt/Akt， and p-mTOR/mTOR （P<0.01）. Compared to the ICA group， the Rapamycin group had significantly decreased expression of p-PI3K/PI3K， p-Akt/Akt， and p-mTOR/mTOR （P<0.01）. Ubiquitination levels were significantly decreased in the glucocorticoid group compared to the control group （P<0.01）. Compared to the glucocorticoid group， ubiquitination levels were significantly increased in the ICA group （P<0.01）， and significantly decreased in the Rapamycin group compared to the ICA group （P<0.01）. ConclusionThe glucocorticoid-induced autophagy in BMECs is time-dependent. ICA inhibits glucocorticoid-induced autophagy in BMECs， and this effect may be related to the regulation of the PI3K/Akt/mTOR pathway.

Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture (version 2023) / 中华创伤杂志

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Breath-by-breath measurement of exhaled ammonia by acetone-modifier positive photoionization ion mobility spectrometry via online dilution and purging sampling / 药物分析学报

Exhaled ammonia(NH3)is an essential noninvasive biomarker for disease diagnosis.In this study,an acetone-modifier positive photoionization ion mobility spectrometry(AM-PIMS)method was developed for accurate qualitative and quantitative analysis of exhaled NH3 with high selectivity and sensitivity.Acetone was introduced into the drift tube along with the drift gas as a modifier,and the characteristic NH3 product ion peak of(C3H6O)4NH4+(K0=1.45 cm2/V·s)was obtained through the ion-molecule reaction with acetone reactant ions(C3H6O)2H+(K0=1.87 cm2/V·s),which significantly increased the peak-to-peak resolution and improved the accuracy of exhaled NH3 qualitative identification.Moreover,the interference of high humidity and the memory effect of NH3 molecules were significantly reduced via online dilution and purging sampling,thus realizing breath-by-breath measurement.As a result,a wide quantitative range of 5.87-140.92 μmol/L with a response time of 40 ms was achieved,and the exhaled NH3 profile could be synchronized with the concentration curve of exhaled CO2.Finally,the analytical capacity of AM-PIMS was demonstrated by measuring the exhaled NH3 of healthy subjects,demon-strating its great potential for clinical disease diagnosis.

Chinese Medicine Regulates Knee Osteoarthritis-related Signaling Pathways： A Review / 中国实验方剂学杂志

As the research of traditional Chinese medicine （TCM） on knee osteoarthritis （KOA） is progressing， researchers have discovered that a variety of Chinese medicines can delay the progress of KOA by regulating signaling pathways at the molecular level. The Chinese medicines and their active ingredients mentioned in this article are associated with the signaling pathways in KOA. They can regulate the levels of targeted molecules via different signaling pathways to inhibit cartilage inflammatory cytokine， apoptosis， and cartilage matrix degradation and promote chondrocyte autophagy， so as to reduce the synovial inflammatory edema and delay cartilage degeneration. This paper systematically reviews the studies about the TCM intervention of KOA. Baicalein can reduce the inflammatory cytokines and apoptosis and promote the autophagy of chondrocytes by blocking the phosphatidylinositol-3 kinase/protein kinase （PI3K/Akt） signaling pathway. Cornuside I can decrease the phosphorylation activity of Janus kinase 2/signal transducer and activator of transcription 3 （JAK2/STAT3） pathway to reduce synovial inflammation and delay cartilage matrix degeneration. Salvianolic acid A can reduce inflammation and cartilage matrix degradation by inhibiting the phosphorylation of the nuclear factor-κB （NF-κB） pathway. Emodin can reduce the activity of Wnt/β-catenin pathway to inhibit the decomposition of collagen and proteoglycan. Myristicoside can inhibit apoptosis by blocking the p38 mitogen-activated protein kinase （p38 MAPK） signaling pathway. Akebia saponin D can enhance the activity of nuclear factor E2-related factor 2/heme oxygenase 1（Nrf2/HO-1） pathway to inhibit oxidative stress in chondrocytes. The saponins in Achyranthis Bidentatae Radix reduce cartilage matrix degradation by enhancing the transforming growth factor-β （TGF-β）/Smad signaling pathway. Crocin inhibits the cartilage inflammation and apoptosis factor increase by stimulating the activity of hippo-Yes-associated protein （Hippo-YAP）. Ligustrazine blocks the Notch pathway to improve the morphology and abnormality of chondrocytes. Oleanolic acid reduces the destruction and degeneration of cartilage matrix via the estrogen signaling pathway. The above summary aims to provide references for future clinical and experimental research on KOA.

Clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version) / 中华创伤杂志

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.

Effect of whole body vibration training on balance function of stroke patients with hemiplegia / 中国基层医药

Objective To explore the clinical effect of whole body vibration training on stroke patients with hemiplegia and its effect on patients'balance function.Methods Eighty-six stroke patients with hemiplegia admitted to the Second Hospital of Jiaxing from June 2017 to December 2018 were divided into control group (43 cases)and observation group (43 cases) by random number table method.The control group received routine training,while the observation group received whole body vibration training on the basis of the control group.Both two groups were treated for 12 weeks.The changes of upper limb motor function,daily living ability and Berg balance scale (BBS)scores before and after intervention were compared between the two groups.Results After intervention,the FMA scores of the control group and the observation group were (37.89 ± 5.34)points and (49.61 ± 5.47)points,respectively,which were higher than before intervention (observation group:t =21.706,control group:t =10.272,all P ＜0.05).The FMA score of the observation group was higher than that of the control group (t =10.054,P ＜0.05).The improved Barthel index (MBI) scores of the observation group and the control group were (68.98 ± 7.91)points and(52.15 ± 6.87) points,respectively,which were higher than those before intervention (observation group:t =22.170,control group:t =10.119,all P ＜ 0.05).The MBI score in the observation group was higher than that in the control group (t =10.534,P ＜ 0.05).The BBS scores of the observation group and the control group were (59.98 ±6.47) points and (48.98 ± 3.71) points,respectively,which were higher than those before intervention (observation group:t =20.820,control group:t =13.877,all P ＜0.05).The BBS score in the observation group was higher than that in the control group (t =9.672,P ＜ 0.05).Conclusion Whole body vibration training has good clinical effect on stroke patients with hemiplegia,and it can improve upper limb motor function,daily living ability and balance function.

Biomechanical Characteristics of Internal Fixation Methods for Treating Thoracolumbar Burst Fractures / 医用生物力学

Objective To analyze the biomechanical characteristics of 3 different posterior internal fixation methods for treating thoracolumbar burst fracture by three-dimensional finite element (FE) method. Methods The FE fixation models of normal thoracolumbar, short-segment posterior fixation (SSPF), short-segment posterior fixation with intermediate screws at fractured level (SSPFI) and long-segment posterior fixation (LSPF) were established, respectively. The biomechanical characteristics of L1 centrum and the adjacent intervertebral disc under 6 kinds of motion states (spinal flexion, extension, lateral bending and axial rotation), in normal thoracolumbar model and 3 fixation models were compared by FE analysis. Results L1 centrum equivalent stress distributions in normal thoracolumbar model, SSPF model, SSPFI model, LSPF model were 31.63, 13.41, 110.35, 13.17 MPa, respectively. The maximum equivalent stress of adjacent intervertebral disc in normal thoracolumbar model was 3.84 MPa, which was located in L1-2 intervertebral disc; the maximum equivalent stress of adjacent intervertebral disc in 3 fixation models was 0.41, 0.36, 0.40 MPa, respectively, which was all located in T12-L1 intervertebral disc. Conclusions Fixation in short segment of the fractured vertebrae could lead to an increase of stress in the centrum. The stress of the adjacent intervertebral disc in 3 fixation models was smaller than that in normal spinal model.

Ethical Reflections on the Enlightenment of American Off-Label Drug Use to Our Country / 中国医学伦理学

Off-label drug use to some extent meets the clinical medication,achieves the most needed treat-ment of patients and promotes the development of medicine,but there exists certain risks at the same time.Through the analysis of the phenomenon of off-label drug use,from the perspective of medical ethics,this paper proposed that it should adhere to the principles of beneficence and respect,specifically,correcting the motives of off-label drug use,strict review of supporting evidence,ensuring patient's informed consent,strengthening ethical review andintroducing the insurance sharing mechanism,so as to achieve both the guarantee of patient's medication safety and the aversion of medical personnel's practice risks.

Locking compression plate versus retrograde intramedullary nail for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis / 中华创伤杂志

Objective To evaluate the efficacy of locking compression plate (LCP) and retrograde intramedullary nail (RIMN) in the treatment of periprosthetic fractures after total knee arthroplasty (TKA),providing reference for surgeons to select the fixation approach.Methods Cochrane Library,PubMed,Embase,Medline,Wanfang database,VIP Database for Chinese Technical Periodicals,and China National Knowledge Infrastructure (CNKI) were searched to identify the retrospective comparison studies (RCS) which compared the clinical outcomes of LCP and RIMN for patients with periprosthetic supracondylar fractures of the distal femur after TKA.The quality of included literatures was evaluated by Newcastle-Ottawa scale(NOS).Meta-analysis was performed using Revman 5.3 software to compare the operation time,Knee society score (KSS),fracture healing time,nonunion rate,reoperation rate,and incidence of complications between the two groups.Results Ten retrospective comparison studies involving 487 patients were identified including LCP group (296 cases) and RIMN group (191 cases).The meta analysis results showed that no significant differences were found in the operation time (MD =10.89,95％ CI-9.56-31.33,P ＞ 0.05),KSS (MD =1.11,95％ CI-8.88-11.10,P =0.83),fracture healing time (MD =0.00,95％ CI-1.51-1.51,P ＞0.05),nonunion rate (OR =0.71,95％ CI 0.38-1.31,P ＞ 0.05),reoperation rate (OR =0.65,95％ CI 0.22-1.91,P ＞ 0.05),and complication incidence rate (0R=0.69,95％CI0.38-1.26,P＞0.05) between these two groups.Conclusions There are no significant differences in the operation time,KSS,fracture healing time,nonunion rate,reoperation rate,and complications between LCP and RIMN groups.LCP and RIMN have similar clinical outcomes in treating periprosthetic supracondylar femoral fracture following TKA.

Effect of flurbiprofen axetil for postoperative analgesia on blood coagulation: a meta-analysis / 中华创伤骨科杂志

Objective To analyze the effect of flurbiprofen axetil (FA) on blood coagulation in patients undergoing surgery through systematic review and meta-analysis.Methods PubMed,WanFang and CNKI databases were searched from their establishment to August 2017 by computer retrieval for relevant literature on the blood coagulation effect of FA.The references of the studies included were also searched by hand.Two reviewers independently screened the literature,extracted data from full-text articles,and evaluated the methodological quality of included studies.All data were analyzed by Review Manager 5.3.Results Altogether 11 studies were finally included,consisting of 10 RCTs and one case-control study,involving 643 patients undergoing surgery.The mean Jadad score for all the studies included were less than 3,suggesting low methodological quality of the studies included.The pool analysis of 4 blood coagulation indexes (prothrombin time,thrombin time,activated partial thromboplastin time and fibrinogen) and platelet count showed that there were no significant differences between the control group and flurbiprofen axetil group before treatment and at 30 min,1-2 h,6-8 h,12 h,24 h and 48 h after treatment(P ＞ 0.05).As for other outcomes like Sonoelot coagulation indexes [activated clotting time of whole blood,coagulation rate and platelet function (PF)],time to peak,mean platelet volume,maximum platelet aggregation rate,platelet aggregation rate at 1 min (PAG1),platelet aggregation rate at 5 min (PAG5) and platelet aggregation rate maximum,no significant differences were found except in one study where PF was found to be lower at 2 h after treatment in the FA group than in the control group.Conclusion Use of FA in common clinical doses is safe for postoperative analgesia,because blood coagulation may not be significantly affected.

Cocktail therapy reduces hidden blood loss after total knee arthroplasty / 中国组织工程研究

BACKGROUND:Blood loss after total knee arthroplasty is a common problem that wil affect the clinical effects. As a kind of hemostatic medicine, tranexamic acid has been more and more used in reducing bleeding after joint replacement. However, there are few studies concerning the combined use of tranexamic acid with other hemostatic drugs. OBJECTIVE:To evaluate the efficacy and safety of intra-articular administration of cocktail wine (tranexamic acid plus diluted-epinephrine) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty. METHODS:From July 2013 to October 2015, 113 patients scheduled to undergo total knee arthroplasty were randomized into two groups. Cocktail wine group (57 patients) received intra-articular cocktail wine (3 g tranexamic acid plus 0.25 mg diluted-epinephrine;1:200 000). Tranexamic acid group (56 patients) received 3 g topical tranexamic acid alone. Al patients were not drain inserted after the operation. During perioperative period, intraoperative blood loss, postoperative dominant blood loss, occult blood loss and al ogeneic blood transfusion were observed. Within postoperative 90 days, the incidences of symptomatic deep venous thrombosis and pulmonary embolism were observed. RESULTS AND CONCLUSION:(1) The topical administration of cocktail wine significantly reduced total blood loss (P=0.007), hidden blood loss (P=0.000) and transfusion rate (0%vs. 5.4%), without increasing the risk of thromboembolic and hemodynamic complications (P>0.05). (2) Therefore, the hemostatic effect of topical tranexamic acid plus diluted-epinephrine was better than tranexamic acid alone. Their combination does not produce severe adverse reactions, and can be used as an important method to reduce blood loss after total knee arthroplasty.

Three-dimensional analysis of pedicle screw entry point and lateral concave between articular process in lower cervical vertebrae / 中国组织工程研究

BACKGROUND: The existing technique takes articular process and lateral mass as a reference mark. Due to differences of subjective judgment in operation and the impact of articular hyperplasia, some errors of screw entry point selection and serious complications such as vertebral artery or cervical spinal cord injury easily occurred, which limit the clinical application of the technique. At present, it is very important to select a constant reference mark of cervical pedicle screw entry point.OBJECTIVE: Three-dimensional reconstruction CT images were made to measure the relationship between the lower cervical pedicle screw entry point and the lateral concave between articular process.METHODS: Three-dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity, and the occurrence rate and morphological characteristics of the lateral concave between articular process were observed. The following parameters were determined on specific reconstructed CT image of C3-C7: (1) the distance between pedicle axis projection point in the posterior surface and the outer edge of lateral mass in transversal section through bilateral pedicle axis and (2) the distance between the point and the lateral concave between articular process in oblique sagittal section through homolateral pedicle axis. Mean value and standard deviation were counted and statistics difference was compared.RESULTS AND CONCLUSION: (1) The lateral concave between articular process in lower cervical vertebrae was a obvious and less constant proliferative anatomical landmark and its occurrence rate was 100%. (2) Using CT technology of 3D reconstruction, C3-C7 lower cervical transversal section through bilateral pedicle axis and oblique sagittal section through homolateral pedicle axis were successfully obtained. (3) In transversal section, the left and right distances between C3-C7 pedicle axis projection point in the posterior surface and the outer edge of lateral mass were (4.1±0.9)mm and (4.3±0.9) mm, and the difference was not statistically significant (P=0.609). Except for C3 and C7, C4 and C7,there was no significant difference in the measured values of the same side (P > 0.05). (4) In oblique sagittal section, the left and right distances between C3-C7 point and the lateral concave between articular process were (-0.3±1.7) mm and (-0.3±1.6) mm, and the difference was not statistically significant (P=0.916). Except for C3 and C4, there was significant difference in the measured values of the same side (P < 0.05). (5) The above results suggest that the lower cervical pedicle entry point and the lateral concave between articular process have a relatively constant orientation relationship in transversal section and a large variation in the sagittal section.

Treatment of Targeted Percutanous Ozone Ablation on Lumbar Disc Herniation with High Intensity Zone in Lumbar Disc Annulus Fibrosus / 现代生物医学进展

Objective:To observe the clinical effects of targeted percutanous ozone ablation on lumbar disc herniation (LDH) patients with high intensity zone (HIZ) in lumbar disc annulus fibrosus on MRI T2 weighted imaging.Methods:136 LDH patients with HIZ in lumbar disc annulus fibrosus on MRI T2 were divided into two groups according to therapy methods.In group A,75 patients were injected with 2 ～5 mL of 40 μg/mL mixture of O3 and O2 after targeted percutanous puncturing under the guidance of X-Ray machine with C-type arm.In group B,61 patients were treated with conservative treatment.MacNab score criterion and Oswestry disability index (ODI) were used in assessment of the efficacy.Results:Except 24 patients,all the other cases were followed up for 18 ～ 44 months.At the postoperative 1st,2nd,3rd,6th,9th,12th and 18th month,according to MacNab score criterion,the effective rates were respectively 88.00 ％,90.67 ％,93.33 ％,89.39 ％,84.85 ％,78.13 ％ and 73.44 ％ in group A and respectively 68.85 ％,62.30 ％ 55.74 ％,61.82 ％,58.12 ％,54.17 ％ and 47.92 ％ in group B.There were significant differences between two groups at the same time point (P＜0.05).At the postoperative 12th and 18th month,ODI was lower in group A,and there was no significant difference between two time points (P＞0.05).But it was significant different with that preoperatively and in group B at the same time point (P＜0.05).Conclusion:Targeted percutanous ozone ablation is an effective method with stable clinical efficacy in treating LDH with HIZ in lumbar disc annulus fibrosus on MRI T2 weighted imaging.

Value of Red Cell Distribution Width in the Prognosis of Patients with Multiple Myeloma / 现代检验医学杂志

Objective To investigate the relationship between red blood cell distribution width (RDW) and prognosis in patients with multiple myeloma (MM).Methods The population that studied consisted of 27 patients with multiple myeloma and 30 healthy controls.The RDW was calculated according to the results of blood routine examination and compared between patients and healthy controls.Then,compared the difference between the two groups of RDW.MM patients were treated with international standard staging (ISS),and the differences of RDW in different stages were analyzed.ISS staging was used to draw the receiver operating curve (receiver operating characteristic curve,ROC curve),then take RDW14.65 ％ as the best cut-off point,the MM patients were divided into low RDW group (RDW=14.65 ％) and high RDW group (RDW ＞14.65％).Overall survival (OS) condition were compared between the above two groups.The impacts of RDW on OS were analyzed by Kaplan-Meier and Log-rank test.Results The average RDW value in experimental and controlled were 15.60 ％ ± 2.35 ％ vs 12.72 ％ ±0.61 ％ separately (t=6.201,P＜0.001),with statistical differences.The average RDW value in low ISS(Ⅰ + Ⅱ stage) and high ISS (Ⅲ stage) were 13.99 ％ ± 1.08％ vs 16.55 ％±2.39％ separately (t=3.800,P=0.001).The median survival time of low RDW and high RDW group was 13 months and 8 months respectively,and the difference was statistically significant (x2=6.481,P =0.011).Conclusion RDW increased in patients with MM,the risk stratification higher prognosis is worse.

Imaging measurement and clinical significance of the angle between the axis of pedicle and the plane of lamina in lower cervical vertebra / 中南大学学报(医学版)

Objective:To explore the imaging measurement and clinical significance of the angle between the axis ofpedicle and the plane of lamina in lower cervical vertebra.Methods:Three dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity,and the angle between the axis ofpedicle and the plane of lamina was measured with the specific reconstructed CT image of C3-C7.Results:1) The left and right transverse angle of C3-C7 between the axis of pedicle and the ipsilateral plane oflamina were 98.3°±6.3°,98.0°±5.1°,97.5°±6.9°,95.1°±5.0°,85.8°±5.4°and 96.7°±8.2°,98.7°±7.1°,97.8°±3.6°,93.2° ±6.2°,86.8° ±5.7°,respectively,which showed a gradual decreasing trend.Meanwhile the angle ofC3-C6 was more than 90 degrees and C7 was less than 90 degrees.In addition to C6 with C3 and C7 with other segments,the rest of the differences between the sections was not statistically significant (all P＞0.05).2) The left and right transverse angle of C3-C7 between the axis of pedicle and the pedicle of vertebral arch of lamina were 0.2°±4.5°,1.2°±7.2°,-0.8° ±6.8°,-3.3°±5.4°,-14.7° ±4.0° and-1.6°±5.4°,1.9°±4.6°,-0.5° ±6.0°,-4.6° ±5.3°,-13.7°±3.4°,respectively,which showed a first increasing and then reducing trend.Meanwhile the angle of C4 was maximum angle.In addition to C6 with C3;C6 with C4,and C7 with other segments,the differences between the sections was not statistically significant (all P＞0.05).3) The left and right sagittal angle of C3-C7 between the axis of pedicle and the ipsilateral plane of lamina were 77.7°±7.6°,77.0°±7.1°,85.3° ±8.4°,94.1°±2.2°,94.9°±3.8° and 78.5° ±7.1°,76.2° ±6.2°,86.4°±6.4°,94.0°±2.7°,95.6°±3.8°,respectively,which showed a gradual increasing trend.The angle of C3-C4 was less than 90 degrees.Cs showed large variation and C6-C7 was more than 90 degrees.In addition to C3 with C4 and C6 with C7,the differences between the sections was statistically significant (all P＜0.05).There was no significant difference between the two sides of the above indexes (all P＞0.05).Conclusion:In low cervical vertebra,there is a certain angle relationship between the axis of pedicle and the plane of lamina,which can provide reference for the clinical determination of angle of pedicle screw insertion.

Investigation on Production of Cluster Ions UsingSurface-Assisted Laser Desorption/Ionization Mass Spectrometry / 分析化学

Surface-assisted laser desorption/ionization mass spectrometry (SALDI-MS) has become an indispensable tool in macromolecule and small molecule analysis for solid and liquid samples.However, there were few studies focusing on the ionization mechanisms especially for the small molecules.In this work, the compounds of pyrene, coronene and rubrene which have similar molecular structures were used to investigate the ionization mechanism via SALDI-MS.Additionally the effect of the laser power on the product ions was also investigated.It was found that strong cluster ions peaks nM+(M=pyrene, coronene) were observed for pyrene and coronene, and daughter ions of coronene by loss of C2H2 were also observed.On the contrary, no cluster ion was obtained for rubrene, only daughter ions with the losses of nC6H5 (n=1, 2, 3) were acquired.Finally, the ionization mechanisms were discussed.The formation of clusters of pyrene and coronene was attributed to the interaction of π-π bands.For rubrene, the spatial barrier weakened the interaction of π-π bands because the four phenyl groups were not on the same plane of skeleton structure, thus impeding the formation of cluster ions.

Thoracic paravertebral block versus epidural anesthesia combined with moderate sedation for percutaneous nephrolithotomy

Objective: To investigate the feasibility of thoracic paravertebral block [TPVB] for percutaneous nephrolithotomy [PCNL] in comparison with epidural anesthesia [EA] combined with moderate sedation

Subjects and Methods: One hundred American Society of Anesthesiologists [ASA] I-II adult patients scheduled for first-stage unilateral PCNL were randomly assigned to receive either TPVB or EA. All patients were given standard sedation and analgesia with propofol and sufentanil. Patient characteristics, surgical outcomes, anesthetic outcomes, and time to first use of a patient-controlled intravenous analgesic [PCIA] device and postoperative consumption of sufentanil in the first 24 h were recorded. Intergroup differences of the parameters were analyzed using an independent t test, Mann-Whitney test, and X2 test as appropriate

Results: Patients who received TPVB consumed more propofol during ureteroscopy [56.2 +/- 28.4 vs. 42.9 +/- 27.5 mg, p < 0.05] and more sufentanil during ureteroscopy [9.7 +/- 4.8 vs. 3.9 +/- 2.7 microg, p < 0.05] and during PCNL [7.0 +/- 4.3 vs. 1.9 +/- 1.8 microg, p < 0.05] than those who received EA. The volume fluids infused in patients who received TPVB was less than in those who received EA [854 +/- 362 vs. 1,320 +/- 468 ml, p < 0.05]. Time to first PCIA use, postoperative 24-hour consumption of sufentanil, and other parameters were comparable between groups

Conclusions: In this study, TPVB was as effective and safe as EA in providing intraoperative anesthesia and postoperative analgesia for PCNL, although more sedatives and analgesics were used during PCNL in patients who received TPVB

Development of Unidirectional Negative Corona Discharge Ion Mobility Spectrometer for Detection of Explosives / 分析化学

Abstract Ion mobility spectrometry ( IMS) based explosives detectors is wieldy deployed at the check points of airport, etc, so the development of new ionization method to replace the radioactive 63 Ni ion source in IMS is highly demanded. In this study, a novel negative corona discharge was developed for ion mobility spectrometer for rapid detection of trace explosives, which was running in the unidirectional mode to efficiently remove nitrogen oxides and ozone produced from the discharge process. The diameter of target electrode was 3 mm, the distance between the needle and the target electrode was 2 mm, the discharge voltage was 2400 V and the flow rate of drift gas was 1200 mL/min. Under the optimized conditions, the dominant reactant ions was O-2(H2O)n and could be used to directly detect the common explosives, such as trinitrotoluene (TNT), ammonium nitrate (AN), nitroglycerin (NG), pentaerythritol tetranitrate (PETN) and hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX). The limit of detection of TNT was 200 pg/μL. These results indicated that negative corona discharge ionization source, with the advantanges of the high sensibility, simple structure and no radioactivity, could be used as a potential and promising ionization source for ion mobility spectrometry to detect explosives.