PD-1 inhibitor plus anlotinib for metastatic castration-resistant prostate cancer: a real-world study / 亚洲男科学杂志(英文版)

Management and treatment of terminal metastatic castration-resistant prostate cancer (mCRPC) remains heavily debated. We sought to investigate the efficacy of programmed cell death 1 (PD-1) inhibitor plus anlotinib as a potential solution for terminal mCRPC and further evaluate the association of genomic characteristics with efficacy outcomes. We conducted a retrospective real-world study of 25 mCRPC patients who received PD-1 inhibitor plus anlotinib after the progression to standard treatments. The clinical information was extracted from the electronic medical records and 22 patients had targeted circulating tumor DNA (ctDNA) next-generation sequencing. Statistical analysis showed that 6 (24.0%) patients experienced prostate-specific antigen (PSA) response and 11 (44.0%) patients experienced PSA reduction. The relationship between ctDNA findings and outcomes was also analyzed. DNA-damage repair (DDR) pathways and homologous recombination repair (HRR) pathway defects indicated a comparatively longer PSA-progression-free survival (PSA-PFS; 2.5 months vs 1.2 months, P = 0.027; 3.3 months vs 1.2 months, P = 0.017; respectively). This study introduces the PD-1 inhibitor plus anlotinib as a late-line therapeutic strategy for terminal mCRPC. PD-1 inhibitor plus anlotinib may be a new treatment choice for terminal mCRPC patients with DDR or HRR pathway defects and requires further investigation.

Single-cell analysis reveals an Angpt4-initiated EPDC-EC-CM cellular coordination cascade during heart regeneration

Mammals exhibit limited heart regeneration ability, which can lead to heart failure after myocardial infarction. In contrast, zebrafish exhibit remarkable cardiac regeneration capacity. Several cell types and signaling pathways have been reported to participate in this process. However, a comprehensive analysis of how different cells and signals interact and coordinate to regulate cardiac regeneration is unavailable. We collected major cardiac cell types from zebrafish and performed high-precision single-cell transcriptome analyses during both development and post-injury regeneration. We revealed the cellular heterogeneity as well as the molecular progress of cardiomyocytes during these processes, and identified a subtype of atrial cardiomyocyte exhibiting a stem-like state which may transdifferentiate into ventricular cardiomyocytes during regeneration. Furthermore, we identified a regeneration-induced cell (RIC) population in the epicardium-derived cells (EPDC), and demonstrated Angiopoietin 4 (Angpt4) as a specific regulator of heart regeneration. angpt4 expression is specifically and transiently activated in RIC, which initiates a signaling cascade from EPDC to endocardium through the Tie2-MAPK pathway, and further induces activation of cathepsin K in cardiomyocytes through RA signaling. Loss of angpt4 leads to defects in scar tissue resolution and cardiomyocyte proliferation, while overexpression of angpt4 accelerates regeneration. Furthermore, we found that ANGPT4 could enhance proliferation of neonatal rat cardiomyocytes, and promote cardiac repair in mice after myocardial infarction, indicating that the function of Angpt4 is conserved in mammals. Our study provides a mechanistic understanding of heart regeneration at single-cell precision, identifies Angpt4 as a key regulator of cardiomyocyte proliferation and regeneration, and offers a novel therapeutic target for improved recovery after human heart injuries.

Anti-CASPR2 antibody-associated autoimmune encephalitis： a case report / 四川精神卫生

This paper elaborated a case of an elderly patient with anti-contactin-associated protein-like 2 （CASPR2） antibody-associated autoimmune encephalitis. It illustrated the common manifestations and diagnostic process of anti-CASPR2 antibody-associated encephalitis， and the analysis of clinical symptoms and ancillary findings had contributed to gaining insight into the diagnosis of autoimmune encephalitis in elderly patients characterized by distinct psycho-behavioral abnormalities and cognitive decline， as well as suggesting the possibility that autoimmune encephalitis in elderly may exacerbate the development of cerebrovascular disease.

The role of lipid peroxidation in modulating immune function / 药学学报

The immune system plays a pivotal role in the pathogenesis and progression of diseases. Lipid peroxidation, as a key effector molecule in the execution of ferroptosis, exerts critical effects on the functionality and survival of various immune cells and is involved in the pathological processes of multiple diseases. There is accumulating evidence suggesting the presence of ferroptosis in immune cells as well. Lipid peroxidation is closely associated with immune cell function. Accumulation of lipid peroxidation products in immune cells can lead to ferroptosis, directly impacting immune cell function. Non-immune cells, through lipid peroxidation-mediated cell death, release signaling molecules that regulate immune cell function. They jointly influence the body's homeostasis. This article provides a comprehensive review of the latest research progress on the regulatory role of lipid peroxidation in immune function. It analyzes the relationship between lipid peroxidation and immune cells, and provides a theoretical foundation for potential strategies targeting cellular lipid peroxidation and immunotherapy in the treatment of diseases.

Application of situation video feedback combined with problem-based learning in clinical clerkship teaching of cardiac surgery for medical students in class of organ-systems-based curriculum / 中华医学教育探索杂志

Objective:To study the application effects of situation video feedback combined with problem-based learning (PBL) on the clinical clerkship teaching of cardiac surgery for medical students in experimental class of organ-systems-based curriculum (OSBC).Methods:Medical students of Batch 2016 and 2018 OSBC reform experimental class of Jianghan University were selected as the research objects. The study group used situation video feedback combined with PBL teaching method to conduct cardiac surgery clerkship teaching, and the control group used conventional teaching method. At the end of the clerkship, the self-made "Clerkship Satisfaction Questionnaire" was distributed for questionnaire survey and the theoretical test was carried out at the same time. After the course, the theoretical examination was conducted, and the results were compared. SPSS 17.0 was used for t-test and Chi-square test. Results:The clerkship satisfaction investigation results showed that the study group was more satisfied than the control group in such 10 aspects as improving the interest of learning, learning efficiency, the ability of teamwork, clinical thinking, interpersonal communication, combining theory with practice, active knowledge acquirement, language expression, understanding knowledge point, and confidence to become a real doctor. Moreover, there were significant differences in improving the interest of learning, the ability of clinical thinking, and combining theory with practice ( P<0.05). The two theoretical test scores of the study group [(77.46±4.73) points and (79.80±7.53) points] were significantly higher than those of the control group [(70.68±5.16) points and (75.94±8.16) points] ( P<0.05). Conclusion:Situation-based video feedback combined with PBL can improve the clinical clerkship teaching effect of cardiac surgery for medical students under the teaching mode of OSBC.

Effect of Qinggan Xiefei Fang on increasing susceptibility of influenza virus caused by "liver fire invading lung" / 药学学报

In this study, chronic emotional stress-induced H1N1 influenza susceptibility model was employed to simulate the states of "emotional stagnation" and "liver fire invading lung", and the protective effect of Qinggan Xiefei Fang on viral pneumonia was investigated. Survival rate and morbidity rate of mice were observed within 21 days after H1N1 infection, the symptoms of viral pneumonia and the level of phospholipid peroxidation were detected in lungs of mice after 6-day infection. The experimental results showed that Qinggan Xiefei Fang could alleviate the decline of survival rate and morbidity rate of mice caused by chronic constraint stress loaded with H1N1, inhibit the replication of H1N1 and the production of inflammatory factors, reduce the level of phospholipid peroxidation, and improve the symptoms of pneumonia in mice. The results also showed that compound-target network of Qinggan Xiefei Fang contained 171 compounds and 260 corresponding targets involved in the signaling pathway of oxidative stress, inflammation and immunity. All the above results indicate that Qinggan Xiefei Fang protecting influenza virus pneumonia was related to the regulation of oxidative stress. The animal experimental protocol has been reviewed and approved by Laboratory Animal Ethics Committee of Jinan University, in compliance with the Institutional Animal Care Guidelines.

The current status of faculty development in general practice residency training bases in Hebei province / 中华全科医师杂志

Objective:To analyze the current status of faculty development in general practice residency training bases in Hebei Province.Methods:A questionnaire survey with deep interview was conducted among 79 faculty from 24 general practice residency training bases in Hebei Province during November to December 2020.Results:Among 79 participants, 21 were males (26.58%) and 58 were females (73.42%), 41 (51.90%) of whom were aged 31-40 years; 44 (55.70%) were general practitioners, and 35 (44.30%) were specialists. There were no significant differences in sex, age, education background, professional title, between faculty with general practice background and specialist background (all P>0.05); while there were significant differences in job-transfer training, teaching training for general practice, the training form, teaching method grasped, understanding the work contents of general practice, the view and prospect for general practice between general practitioner faculty and specialist faculty (all P<0.05). The score of ward round teaching of general practice faculty was significantly higher than that of specialist faculty ( P<0.05) The interview showed that all faculty members were willing to teach, most of them had increased work pressure after engagement in teaching, and there was lack of incentive policies for teaching in some bases. Conclusions:The current status of faculty development in the general practice residency training base in Hebei Province is basically satisfactory, but there is lack of general practice training for faculty with specialist background; the professional identity of general practitioner need to be enhanced, and their status and treatment need to be improved.

Evaluation of general practice residency training bases in Hebei province / 中华全科医师杂志

Objective:To evaluate of the general practice residency training bases in Hebei Province.Methods:Based on the 2020 Standardized Residency Training Base Evaluation Index-General Practitioners of Chinese Medical Doctor Association,24 training bases in Hebei Province were assessed;and the satisfaction questionnaire survey and in-depth interview were conducted among 124 general practice trainees who were randomly selected in November 2020. Results:All 24 bases set the general practice department in the hospitals as required. However, the annual outpatient visits in department of general practice were less than 20000 in 45.83% (11/24) bases, only 41.67% (10/24) bases met the teaching requirements of general practice, and 33.33% (8/24) bases fulfilled the provincial target for general practice residency training enrollment; only 3 bases (13.64%) had the pass rate≥85% in medical licensing examination in the previous year. For the training satisfaction, 66.94% (83/124) trainees were satisfied with residency training, and 33.06% (41/124) were moderately satisfied. There was significantly difference in the satisfaction degrees among trainees with different expectations of career prospects (χ 2=24.436, P<0.05). Conclusions:Basically, the management system of general practice residency training bases has been completed and the construction of teaching teams has been standardized in Hebei Province. But the job attraction of general practitioner is inadequate, the training bases need to be strengthened, and the training quality needs to be improved.

Analysis of the Mechanism of Yam Protein in the Prevention and Treatment of Diabetes-induced Erectile Dysfunction Based on RNA-Seq Technology / 中国药房

OBJECTIVE：To study the potential mechanism of yam protein （DOT） in the prevention and treatment of diabetes-induced erectile dysfunction （DIED）. METHODS ：DIED model was induced by high-glucose and high-fat diet and intraperitoneal injection of streptozotocin （40 mg/kg）. The experiment was set up in the normal control group （normal saline ）， model group （normal saline ），DOT low-dose ，medium-dose and high-dose groups （0.3，0.6，0.9 mg/kg），sildenafil group （positive control ，4.4 mg/kg），with 9 rats in each group. In the stage of successful establishment of diabetes model and initiation of inducing DIED ，rats in each group were given relevant solution intragastrically ，once a day ，for consecutive 11 weeks. Body weight，fasting plasma glucose （FPG），the times and rate of penile erection ，fasting insulin （FINS），insulin resistance index （IR），the contents of endothelial nitric oxide synthase （eNOS）and cyclic guanosine monophosphate （cGMP）in penile cavernous tissue were determined so as to evaluate the intervention effects of DOT on DIED model rats. High-glucose damaged mice cavernous endothelial cells （MCECs）model was induced by 30 mmol/L glucose for 48 h，and then give DOT 125，250，500 μg/mL. The cell viability was detected so as to evaluate the effects of DOT on high-glucose damaged MCECs model. RNA-Seq mail：xingxin0902@163.com technology was adopted to screen the differentially expressed genes between normal MCECs and high-glucose damaged MCECs，high-glucose damaged MCECs and MCECs treated with 250 μg/mL DOT. Gene ontology（GO）function enrichment analysis and KEGG pathway enrichme nt analysis were performed for differentially expressed genes. The common differentially expressed genes between 2 groups were analyzed ，and mRNA expressions of six key genes were validated. RESULTS ：Different doses of DOT could reverse the reduction of body weight ，the increase of FINS and IR ，the reduction of the times and rate of penile erection ，the decrease of eNOS and cGMP contents in penile cavernous tissue of DIED model rats ；above indexes of DIED model rats were reversed significantly after treated with high-dose of DOT（P＜0.05 or P＜0.01）. 125，250，500 μg/L DOT could significantly improve the activity of high-glucose damaged MCECs （P＜0.05 or P＜0.01）. RNA-Seq technology showed that compared with normal MCECs ，a total of 48 differentially expressed genes were found in high-glucose damaged MCECs. Compared with high-glucose damaged MCECs ，a total of 779 differentially expressed genes were found in MCECs treated with DOT. The differentially expressed genes of 2 groups were mainly cellular process in biological process annotation ，cellular part in cell component annotation and binding molecular function in molecular function annotation ，which were mainly enriched in extracellular matrix receptor interaction pathway ，mismatch repair pathway ， phosphatidylinositol 3 kinase-protein kinase B （PI3K-Akt）signal pathway and so on. Among differentially expressed genes of 2 groups，13 common differentially expressed genes such as Aldh1a1，Abcc5，Tac1 were found. DOT could significantly reverse the expression of the above common differentially expressed genes in high-glucose damaged MCECs. After validation ，DOT could significantly reverse the mRNA expression of TGF-β3，Txnip，Aldh1a1，Loxl1，Mt1 and Mt2 in high-glucose damaged MCECs. CONCLUSIONS：DOT could improve the symptom of DIED model rats ，the mechanism of which may be related to biological pathway of inhibiting fibrosis and reducing oxidative stress ，so as to improve the endothelial function of cavernous body.

Evaluation of adhesive bone conduction hearing aid in pediatric patients with unilateral congenital aural atresia / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the auditory efficacy and subjective satisfaction of adhesive bone conduction hearing aid in children with unilateral congenital aural atresia (UCAA). Methods: Ten subjects (5 males and 5 females) diagnosed with UCAA with an average age of 8.3 years old (ranged from 5 to 15) were included in Beijing Tongren Hospital, Capital Medical University from January to August 2019. The free sound field hearing threshold, word recognition score in quiet, speech reception threshold in noise and sound localization ability (results were measured by RMS error) tests were performed in unaided and aided situation, respectively. Subjective satisfaction questionnaires were also distributed to subjects. Paired t test and Wilcoxon signed rank test were used as statistical analysis methods. Results: The average hearing threshold in aided condition was improved by (21.9±4.4) dB (t=15.8，P<0.05). Speech recognition abilities were generally improved both under quiet and noise (P<0.05);however, when the binaural summation, squelch and head shadow effects were analyzed respectively, the binaural squelch effect was not statistically improved (P>0.05), while the other effects were improved in aided condition (P<0.05). In sound localization test, there was no significant difference of the RMS error value between the unaided and aided situation (P>0.05). The subjects got high satisfaction rates in three subjective questionnaires. Conclusion: The adhesive bone conduction hearing aid can provide significant audiological benefit for children with UCAA as well as raising the quality of their life.

A network pharmacology and molecule docking approach to investigating active compounds and mechanisms of gonglaoye-xianhecao herbal pair for ischemic stroke / 中国药理学通报

Aim To clarify the mechanism of Gonglaoye and Xianhecao herbal pair in the treatment of ischemic stroke so as to obtain the substantive evidence using network pharmacology data mining and molecular docking. Methods The main compounds of traditional Chinese medicine were obtained by TCMSP platform and consulting literature, the drug action targets were obtained by TCMSP, and the known genes about ischemic stroke were collected by searching Drugbank, Disgenet, TTD, Genecards, OMIM database, thus the drug-compound-target network map was constructed, and the common target proteins and main compounds were screened. The visual protein-protein interaction network map (PPI) was constructed by string. With the help of Cytoscape software, the original target network of active components was constructed and analyzed, and the gene ontology GO and Jingdu gene and genome encyclopedia KEGG analysis were carried out to analyze the GO function and KEGG pathway enrichment of the common targets of drugs and diseases. Finally, the molecular docking of the core protein and the core compound was carried out according to the relevant node parameters of the compound and protein. Results Seventeen active components and 296 potential targets of Gonglao leaf and crane herbs in the treatment of ischemic stroke were screened. GO enrichment was mainly concentrated in the response to oxides, cell response to chemical stimulation, positive regulation of cell metabolism, constant effect, active regulation of stimulus response, cell communication and so on. KEGG was mainly involved in signaling pathways such as PI3K-Akt, Ras, neuron ligand receptor interaction and so on. Molecular docking showed that quercetin and other active components had high affinity and tight connection with core targets such as AKT1. Conclusions The treatment of ischemic strokec is mainly through the mechanism of ursolic acid, hyperin and other active components, AKT1, cMAPK3 and other multi-targets, PI3K-AKT and other multi-pathway interaction mechanisms. Through this study the theoretical support can be provided for the further clinical application of Gonglaye and crane herbs, providing basic ideas for future experimental research and new drug research and development.

Impact of proximal femoral shape on leg length discrepancy after total hip arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD) after total hip arthroplasty(THA).@*METHODS@#Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019. All patients' age, sex, side and pelvis anteroposterior digital radiography were retraspectively analyzed. There were 69 males and 62 females, 57 cases of left hip and 74 cases of right hip. The age ranges from 25 to 89 with an average age of 62 years. There were 48 cases of osteoarthritis and 83 cases of osteonecrosis. In this study, femoral cortical index (FCI) was used as the classification of proximal femoral shape, and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography. Grouping according to FCI:> 0.6 was Dorr A group, 0.5 to 0.6 was Dorr B group, 0.6, the postoperative LLD was 6.30 mm (IQR 1.00 to 10.95 mm). When FCI was 0.5 to 0.6, the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm). FCI<0.5, the postoperative LLD was 1.95 mm(IQR -2.50 to 6.68 mm). LLD comparison of different proximal femoral shape was statistically significant (@*CONCLUSION@#High FCI increases the risk of lower extremity prolongation after surgery on the affectedside, while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side. The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extremities after total hip replacement.

Clinical Analysis of Eight Cases of Pemphigus with High Titers of Anti-desmoglein Antibodies in Remission / 中国医学科学院学报

Objective To investigate the clinical manifestations,diagnosis,treatment,and laboratory examination characteristics of 8 pemphigus patients with high titers of anti-desmoglein antibodies in remission. Methods A retrospective study was conducted for the pemphigus patients diagnosed and treated in the department of dermatology from January 2013 to September 2020.The patients should have the serum anti-desmoglein antibodies ≥150 U/ml in remission or the antibody levels dropped less than 20%(calculated based on the maximum detection limit of 150 U/ml)of their initial ones detected before treatment,and the clinical and laboratory data of patients eligible for the inclusion criteria were collected. Results Among the 134 pemphigus patients with available follow-up data during this period,a total of 8 patients met the criteria,with the follow-up period of 21-85 months and the remission duration of 18-70 months.They all received less than or equal to 10 mg/d prednisone and had high titers of anti-desmoglein antibodies.At their first visit,the number of patients with positive anti-desmoglein 1/desmoglein 3 antibodies was 7.Two patients still had high titers of anti-desmoglein 1 antibodies 19 months and 21 months after they achieved remission,and 5 patients had high titers of anti-desmoglein 3 antibodies in 18-70 months.There was one patient showing high titers of both antibodies,especially for anti-desmoglein 1 antibodies.This patient relapsed after 19 months' remission while other patients were still in clinical remission. Conclusions Some pemphigus patients showed persistent high titers of anti-desmoglein antibodies in remission.Anti-desmoglein 3 antibodies were more common to keep positive,while high titer of anti-desmoglein 1 antibodies was less observed.The high titer of anti-desmoglein 1 antibodies had a correlation with recurrence.For the pemphigus patients with long-term clinical remission but high antibody titer,the dosages of corticosteroids should be adjusted carefully according to their actual clinical manifestations and the positive antibody type.For the patients with high titer of anti-desmoglein 1 antibodies,the dosage reduction of corticosteroids should be appropriately slower.

Characterization of specialized innate immune cells in the omentum / 生理学报

The great omentum is an intraperitoneal organ and plays an important role in protecting the environment of the peritoneal cavity. Several specialized innate immune cells including B1 cells and resident macrophages are found in the omentum, which may be attributed to the unique niche and its special stromal cells. However, it is not clear how these omental innate immune cells contribute to the peritoneal immunity. This review attempts to summarize the latest research on the omental innate immunity and discuss its involvement in the immune response of the peritoneal cavity.

Study on Improvement Effects of Total Ginsenosides on D-galactose Induced PC 12 Cell Senescence and Its Me- chanism / 中国药房

OBJECTIVE：To study the improvement effects of total ginsenosides on the senescence of PC 12 cells induced by D-galactose and its mechanism. METHODS ：Rat pheochromocytoma （PC12）cells were treated with D-galactose to establish cell senescence model. CCK- 8 method was used to screen the D-galactose modeling concentration and total ginsenosides concentration. Normal control group ，model group ，total ginsenosides low and high concentration groups were set up. Cell senescence ，cell apoptosis rate ，apoptotic cycle and mitochondrial membrane potential （MMP），cell adenosine triphosphate （ATP）and reactive oxygen species （ROS）levels in each group were detected. The expression of apoptosis related proteins [B lymphoma 2（Bcl-2）and its related egg X protein （Bax），cytochrome C （Cyt-C）] and oxidative damage related proteins [nuclear factor 2 related factor 2 （Nrf2），heme oxygenase 1（HO-1）] were detected. In addition ，positive drug group [ 5 mmol/L N-acetyl-L-cysteine（NAC）] and positive control group [ D-galactose+5 mmol/L NAC] were set up to compare the levels of oxidative damage related proteins. RESULTS：D-galactose could significantly inhibit the survival rate of PC 12 cells，with a critical concentration of 20 mg/mL. The total ginsenosides could significantly increase the survival rate of D-galactose induced senescent cells with a median effective concentration（EC50）of 65 μg/mL，and then the low and high concentrations of total ginsenosides were set at 55 and 65 μg/mL. Compared with normal control group ，the number of aging cells increased ，the apoptotic rate and percentage of G 1 phase were significantly increased i n model group. the percentage of S phase ，MMP and ATP contents ，the protein expression of Bcl- 2 and Cyt-C in mitochondria were decreased significantly ，whileROS content ，the protein expression of Bax ，Nrf2 and Cyt-C protein in endochylema were increased significantly （P＜0.05 or P＜0.01）. Compared with model group ，the number of E-mail：sunqiao150509@163.com aging cells reduced ，the apoptosis rates and percentage of G 1 phase were significantly decreased in total ginsenosides low and high concentration groups ，the percentage of S phase ，the contents of MMP and ATP （except for low concentration group ），protein expression of Bcl- 2，Nrf2 and HO- 1 as well as protein expression of Cyt-C in mitochondria were increased significantly ；ROS level （except for low concentration group ）and Bax protein as well as protein expression of Cyt-C were decreased significantly. The protein expression of Nrf 2 and HO- 1 were increased significantly in positive control group （P＜0.05 or P＜0.01）， but it was lower than that of total ginsenosides groups . CONCLUSIONS：Total ginsenosides can improve D-galactose induced senescence of P 12 cells，the mechanism of which may be related to activating Nrf 2 antioxidant signal pathway to antagonize D-galactose induced oxidative stress and alleviating mitochondrial dysfunction.

Advances in anti-tumor drug research based on reactive oxygen regulation / 药学学报

Reactive oxygen species (ROS) which were partial metabolites of oxygen are highly reactive. Different concentrations of ROS have different effects on tumor development. Tumor cells have a high level of reactive oxygen species. The antioxidant system of tumor is in highly activated state, and thus modulation of reactive oxygen species levels could be an effective strategy to target cancer cells. Treatment with small molecules that disrupt the redox balance can kill tumor cells first. This paper outlines the main ideas of developing anti-tumor drugs based on reactive oxygen species regulation, and summarizes the representative drugs and research progress according to the mechanism of action, in an effort to suggest potential reference and ideas for developing anti-tumor drugs based on reactive oxygen species regulation.

Epidemiological investigation of tibial plateau fracture in 18 hospitals in 5 provinces and cities in north China from 2010 to 2011 / 中华创伤骨科杂志

Objective:To compare and analyze the epidemiological characteristics of adult tibial plateau fractures in 5 provinces and cities in north China.Methods:Picture archiving and communication system (PACS) and medical record systems were used to search for clinical data of adult tibial plateau fractures which had been treated from 2010 to 2011 in 18 hospitals in 5 provinces and cities in north China (Beijing, Tianjing, Hebei Province, Shanxi Province and Inner Mongolia Autonomous Region). The patients included were divided into 14 age groups (one age group from 16 to 19 years, every 5 years as an age group from 20 to 79 years, and one age group ≥80 years). They were also divided into 2 groups according to the Schatzker classification, a simple fracture group (types Ⅰ-Ⅳ) and a complex fracture group (types Ⅴ-Ⅵ). The gender distribution, age distribution, and complexity of adult tibial plateau fractures were compared between the 5 provinces and cities.Results:A total of 2,845 patients were included, accounting for 1.8% (2,845/155,971) of all the adult fractures, 19.5% (2,845/14,569) of tibiofibular fractures and 29.1% (2,845/9,782) of intra-knee fractures at the same period. Their average age was 45.5 years, with the age group from 40 to 44 years accounting for the largest proportion. There were statistically significant differences between the 5 provinces and cities in north China in the male to female ratio ( P<0.05) but not in the age distribution ( P>0.05). In the age groups >44 years, the proportion of female patients increased gradually, reaching 70.0% (21/30) at the age group of ≥80 years, showing statistically significant differences between them ( P<0.001). There were significant differences between the simple and complex fracture groups in the gender and age distributions ( P<0.05), but not in the mean age at fracture ( P>0.05). The male patients in the simple and complex fracture groups showed a unimodal curve which peaked at the age group from 40 to 44 years. The female patients showed a unimodal curve which peaked at the age group from 55 to 59 years in the simple fracture group but lower bimodal curves which peaked at the age groups from 35 to 39 years and from 55 to 59 years in the complex fracture group. In both fracture groups, the proportion of female patients increased steadily with age beyond the age group from 40 to 44 years, showing significant differences by the linear trend test ( P<0.001). Conclusions:Tibial plateau fractures prevailed in both males and females between 40 and 44 years old. Simple and complex fractures showed different features in terms of gender and age.

Myofascial self-release law / 中华创伤杂志

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.

Short-term outcomes of rod-shaped glass bone graft for treatment of tibial plateau fracture / 中华创伤骨科杂志

Objective To analyze the short-term outcomes of rod-shaped glass bone graft for the treatment of tibial plateau fracture.Methods From January 2019 to February 2019,4 patients with tibial plateau fracture underwent minimally invasive reduction and new glass bone graft at Trauma Emergency Center,The Third Hospital of Hebei Medical University.They were 2 men and 2 women,aged from 31 to 67 years (average,42 years).The fractures happened at 3 left sides and one right side.According to Schanzker's classification,3 cases were type Ⅱ and one case was type Ⅲ.According to Zhang's classification for tibial plateau fractures,they were all type Ⅰ.The reduction was carried out under general anesthesia by a Zhang's traction device and a self-made rod.A rod-shaped glass bone graft of appropriate size was implanted along the bone tunnel.The plate was implanted through small incisions after fluoroscopy results were satisfactory.Intraoperative arthroscopic examination was used to assess fracture displacement before wound closure.The operation time,incision length,fluoroscopic frequency for insertion of guide needle,intraoperative blood loss,and short-term postoperative complications were recorded for each patient.Results The operation time for the patients averaged 37.5 min,the total length of all incisions 7.0 cm,the fluoroscopy required for insertion of guide needle 8.8 times,and the intraoperative blood loss 40.0 ml.All incisions were healed by the first intention.Postoperative intermuscular thrombosis occurred in 2cases.No postoperative infection or related complications happened.Conclusion Rod-shaped glass bone graft can lead to positive short-term outcomes for tibial plateau fractures,but a more reliable conclusion necessitates further clinical trials with a large sample size and long-term follow-up.

Minimally invasive reduction and fixation for fractures of tibial intercondylar spine with Zhang's reduction device / 中华创伤骨科杂志

Objective To discuss the clinical effects of minimally invasive reduction and fixation with Zhang's reduction device for fractures of tibial intercondylar spine.Methods Five patients with tibial intercondylar spine fracture underwent treatment and reduction with Zhang's reduction device from December 2018 to February 2019 at Orthopedic Trauma Center,The Third Hospital of Hebei Medical University.They were 3 men and 2 women,aged from 25 to 56 years (average,43 years).The left side was affected in 2 cases and the right side in 3.By the Meyers classification,there were 2 cases of type Ⅱ and 3 ones of type Ⅲ.All the patients underwent the same surgical procedures and postoperative treatment.Their operation time,amount of bleeding,number of fluoroscopy required for insertion of guide pin,postoperative complications,fracture healing and knee joint range of motion at the last follow-up were recorded.Results The operation time for the 5 patients averaged 50.0 min,amount of bleeding 23.0 mL,and number of fluoroscopy required for insertion of guide pin 12.6 times.Their knee joint range of motion at the last follow-up ranged from 0° to 136.0°.All the incisions obtained primary union with no infection.Their hospitalization time ranged from 7 to 15 d (average,10.5 d).They obtained an average follow-up of 4.3 months (from 2 to 6months).All the fractures achieved union with no malunion,nonunion or refracture.Conclusions The minimally invasive reduction and fixation with Zhang's reduction device for fractures of tibial intercondylar spine can lead to satisfactory clinical effects.It is less invasive than open reduction and simpler than arthroscopic surgery so that it is more appropriate to be popularized in primary hospitals.However,this method has not been widely applied in clinic and more clinical trials are needed.