Arthroscopy with subscapularis upper one-third tenodesis for treatment of recurrent anterior shoulder instability independent of glenoid bone loss.

BACKGROUND: Recurrent anterior shoulder instability is a common traumatic injury, the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head. The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable. AIM: To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability, and to develop a method to further improve anterior stability and reduce the recurrence rate. METHODS: Between January 2015 and December 2018, male patients with recurrent anterior shoulder instability were selected. One hundred and twenty patients had a glenoid defect < 20% and 80 patients had a glenoid defect > 20%. The average age was 25 years (range, 18-45 years). Patients with a glenoid defect < 20% underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis. The patients with a glenoid defect > 20% underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis. All patients were assessed with Rowe and Constant scores. RESULTS: The average shoulder forward flexion angle was 163.6° ± 8.3° and 171.8° ± 3.6° preoperatively and at the last follow-up evaluation, respectively. The average external rotation angle when abduction was 90° was 68.4° ± 13.6° and 88.5° ± 6.2° preoperatively and at the last follow-up evaluation, respectively. The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6 ± 3.2 and 95.2 ± 2.2, respectively (P < 0.05). The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4 ± 3.5 and 95.8 ± 3.3, respectively (P < 0.05). No postoperative dislocations were recorded by the end of the follow-up period. CONCLUSION: Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect, enhanced anterior stability of the shoulder, and did not affect postoperative range of motion of the affected limb.

Applications of the ultrasound-guided nerve block technique for nonanalgesic effects.

The nerve block technique guided by ultrasound has been able to accurately block tiny nerves throughout the body in recent years. It has been increasingly used to treat multisystem diseases or analgesia in surgical patients, but the latter accounted for the vast majority of cases. The nonanalgesic effect of nerve blocks is also in wide demand. After searching ultrasound-guided nerve block works on the PubMed database, we systematically summarized the current clinical application of the nerve block technique and the unique role and related mechanism of nerve block in the prevention and treatment of multi-system diseases or symptoms, including disorders of the circulatory and respiratory systems, postoperative cognitive dysfunction, immune function, posttraumatic stress disorder, and postoperative digestive system, to put forward the potential prospective application in future and serve as a reference for future research of nerve block therapy in these diseases mentioned.

Sevoflurane inhalation has a cognitive impairing effect of aging rats involving the regulation of AChE and ChAT.

Background: Acetylcholinesterase (AChE) and choline acetyltransferase (ChAT) are closely related to the regulation of learning and memory. Nevertheless, whether sevoflurane has influence on cognition through regulating the expression of AChE and ChAT remains unclear. Methods: Aging rat model was established by subcutaneously injection of D-galactose for 6 consecutive weeks. To determine the role of AChE and ChAT in sevoflurane-induced cognitive impairment, the Morris water maze (MWM) was used to assess the cognitive and memory function after sevoflurane exposure. Then, the variations of AChE and ChAT was detected by western blotting analysis and quantitative real-time polymerase chain reaction (qRT-PCR) respectively. Results: Our result indicated that aging model rats had showed cognition decline at 2 hours and 1week after exposure to sevoflurane. Moreover, the expression of AChE and ChAT enhanced in rats that had inhaled sevoflurane. Interestingly, our study also found that the increase of oxygen concentration had a positive impact on the gene expression of ChAT. Conclusion: We have identified that the overexpression of AChE and ChAT improved significantly cognitive function after sevoflurane exposure.

CT imaging character of different brain regions in different ages of Diannan small-ear pigs.

Objective: To collect and establish normal data of the brain regions of Diannan small-ear (DSE pigs, basically throughout measuring and comparing computed tomography values of the barin. Methods: 12 ordinary DSE pigs were divided into juvenile, adult, old groups based on the physiological ages (n=4) A SOMATOM Definition AS 64-row 128-slice 4D spiral CT scanner (SOMATOM Definition AS, Germany) was used to collect CT images of DSE pigs, record and analyze the scanning data. Results: Compared with the juvenile group, the CT values of the right frontal lobe, right parietal lobe, right temporal lobe, left temporal lobe, and right occipital lobe were significantly higher in the elderly group. Compared with the adult group, the CT values of the right frontal lobe, left frontal lobe, right parietal lobe, right temporal lobe, left temporal lobe, and right occipital lobe of the elderly group were significantly higher. Conclusion: The results of the study can be used to evaluate the changes in CT values of various brain regions in piglets of different ages and future pig head injury models or other studies that require CT-based analysis.

The expanded effects of sevoflurane on the nervous system: the harmful effect of residual concentration of sevoflurane on the respiratory system through neurogenic inflammation.

Background: Neurogenic inflammation caused by sevoflurane may not only limite to the nervous system, but also expand to the respiratory system. The purpose of this study was to investigate the expression changes of transient receptor potential vanilloid 1 (TRPV1), neurokinin A (NKA), neurokinin B (NKB), calcitonin gene related peptide (CGRP) and substance P (SP) in 14, 21 and 42-day-old rats after inhaling 0.4% sevoflurane, in order to evaluate whether the residual sevoflurane be harmful to the respiratory system through neurogenic inflammation. Methods: The anesthetic inhalation device was designed to allow 14, 21 and 42-day-old rats inhale 0.4% sevoflurane, while rats in the control group inhaled 40% O2 for 1h. Rats in the antagonist group inhaled 0.4% sevoflurane or 40% O2 for 1 h after Capsazepine (CPZ) pretreatment. The expression of TRPV1 in lung tissue was detected by western blot, and the expression of NKA, NKB, CGRP and SP in trachea was detected by immunohistochemistry. Results: After inhaling 0.4% sevoflurane, the expression of TRPV1 in lung tissue of 14 and 21-day-old rats was significantly higher than that of the control group, as well as increased the expression of CGRP and SP in the trachea of 14-day-old rats and NKA, NKB, CGRP and SP in the trachea of 21-day-old rats. CPZ pretreatment could antagonize these effects. Conclusion: Residual sevoflurane during resuscitation of inhalation anesthesia could induce neurogenic inflammation by activating TRPV1, which damaged to the developing respiratory system, but has no significant effect on the respiratory system in adulthood.

Eye-related Emergency Department Visits with Ophthalmology Consultation in Taiwan: Visual Acuity as an Indicator of Ocular Emergency.

To investigate the epidemiology of eye-related emergency department (ED) visits and to determine if visual acuity (VA) could be an indicator for determining the timing for managing ocular emergencies, we have conducted the retrospective study which included patients visited the ED for eye-related reasons and had received ophthalmology consultations at a referral center in Taiwan in 2015. Among 46,514 consultations, 5,493 were ophthalmology consultations (11.8%). After exclusion, 5,422 were eligible for analysis. Among them, 1,165 (21.5%) had not likely emergent diagnoses, 4,048 (74.7%) had likely emergent diagnoses, and 209 patients (3.9%) could not be determined. The logMAR VA was 0.31 ± 0.48, 0.66 ± 0.78, and 1.00 ± 0.94 in groups with not likely emergent, likely emergent, and undetermined diagnoses, respectively. Among all eye-related ED visits, 10.3% of patients received ophthalmologic intervention or were admitted to the ophthalmology ward. A LogMAR VA score of 0.45 (decimal equivalent of 0.4) had the highest discrimination power for identifying whether a patient needed ophthalmology intervention or admission to ophthalmology ward (area under the curve: 0.802, sensitivity: 0.800, specificity: 0.672). In our study, we found VA could be an indicator for determining the priority and time of ocular emergencies requiring ophthalmic intervention in patients visiting the ED for eye-related reasons.

MicroRNA-139-3p Suppresses Tumor Growth and Metastasis in Hepatocellular Carcinoma by Repressing ANXA2R.

The direct roles of miR-139-3p on hepatocellular carcinoma (HCC) cell growth and metastasis remain poorly understood. We attempted to demonstrate the regulatory role of miR-139-3p in HCC progression and its underlying mechanisms. Here we showed that miR-139-3p expression was significantly reduced in the HCC tissues compared to paratumor tissues. Exogenous overexpression of miR-139-3p inhibited the migration and invasion of HCC cells, whereas downregulation of miR-139-3p was able to induce HCC HepG2 and SNU-449 cell migration and invasion. In addition, miR-139-3p inhibited HCC growth and lung metastasis in an in vivo mouse model, which is mainly regulated by annexin A2 receptor (ANXA2R). Finally, we identified that the expression of miR-139-3p was inversely correlated with ANXA2R expression in human HCC tissue. All these results demonstrated that miR-139-3p inhibited the metastasis process in HCC by downregulating ANXA2R expression.

Addition and Subtraction Theory of TCM Using Xiao-Chaihu-Decoction and Naturopathy in Predicting Survival Outcomes of Primary Liver Cancer Patients: A Prospective Cohort Study.

To investigate the therapeutic effect of combined Xiao-Chaihu-Decoction and naturopathic medicine therapy on survival outcomes of patients' PLC. In XCHD group (n = 76), patients were treated with Xiao-Chaihu-Decoction in accordance with the addition and subtraction theory of TCM; in NM group (n = 89), patients were managed by naturopathic medicine; in combined group (n = 70), the same volume of Xiao-Chaihu-Decoction combined with naturopathic medicine procedures was applied. There were no evident statistical differences of age, gender, KPS score, body weight, smoking status, AFP levels, HbsAg status, TBIL levels, tumor diameters, and numbers among different groups, showing comparability among groups. No significant difference was found regarding the total remission rate and stability rate of tumors in patients treated by Xiao-Chaihu-Decoction and naturopathic medicine, except the combined therapy. KPS scores were significantly improved after treatment among groups. After treatment, 52.8% cases maintained a stable or slight increase in weight, of which 42.1%, 48.3%, and 70.0% cases maintained weight stably in the XCHD group, NM group, and combined treatment group, respectively. Xiao-Chaihu-Decoction associated with naturopathy may predict improved prognostic outcomes in PLC patients, along with improved remission and stability rates, increased KPS scores, and stable weight maintenance.

Outcomes of an emergency department intensive care unit in a tertiary medical center in Taiwan: An observational study.

PURPOSE: The boarding of critically ill patients in the emergency department (ED) could reduce quality of care and increase mortality. An ED intensive care unit (ICU) was set up in a 3715-bed medical center to facilitate timely delivery of critical care. This study reports comparative outcomes of EDICU patients with specialty ICU patients. MATERIALS AND METHODS: Medical records of adult nontrauma ED patients admitted to nonsurgical ICUs (EDICU, medical, cardiac, alimentary, and neurological units) between January 2007 and July 2011 were retrospectively reviewed. The respective number of admissions, bed turnover rate, and length of stay were compared. Cox regression models were also applied to compare inhospital mortality risks among these patients. RESULTS: With only 13% (14/108) of all ICU beds, EDICU admitted 36% (3711/10449) of patients. Emergency department ICU patients had an unfavorable adjusted hazard ratio for inhospital mortality compared with medical ICU and cardiac ICU patients, but after excluding patients with an ICU length of stay of 2 days or less, the difference in hazard ratio became nonsignificant. CONCLUSIONS: Emergency department ICU has admitted a disproportionately higher proportion of patients without sacrificing quality of care. Specialty care could be secured through direct communication between EDICU and specialty physicians and forming close collaboration between departments and ICUs.

Changes in serum alanine aminotransferase levels in telbivudine versus lamivudine treatment for chronic hepatitis B: a meta-analysis.

OBJECTIVE: A meta-analysis to compare the efficacy and safety of telbivudine (TBV) and lamivudine (LAM) in patients with chronic hepatitis B (CHB), assessed via changes in serum alanine aminotransferase (ALT) levels. METHOD: The electronic literature databases PubMed®, Embase®, Web of Science, Cochrane Library, CISCOM, CINAHL, Google Scholar, China BioMedicine and China National Knowledge Infrastructure were searched for relevant studies. The effect of TBV and LAM treatment on serum ALT was assessed using standard mean differences (SMDs) and 95% confidence intervals (CI). RESULTS: The meta-analysis included six studies (TBV n = 202; LAM, n = 208). Post-treatment ALT levels were significantly lower than pretreatment values for both TBV and LAM (TBV: SMD = 3.00, 95%CI 1.91, 4.09; LAM: SMD = 2.33, 95%CI 1.58, 3.07). Post-treatment ALT was significantly lower after treatment with TBV than LAM (SMD = 0.58, 95%CI 0.21, 0.94). CONCLUSION: Both LAM and TBV are effective in normalizing ALT levels in patients with CHB, but TBV may be a better choice due to its lower rates of drug resistance.

[Prevention and treatment mechanism of qingxia therapy (based on yinchenhao decoction and dachengqi decoction) on hepatocyte apoptosis in rats with acute hepatic injury induced by lipopolysaccharide/D-galactosamine].

OBJECTIVE: To study the prevention and treatment mechanism of Qingxia therapy (based on Yinchenhao Decoction and Dachengqi Decoction) on hepatocyte apoptosis in rats with acute hepatic injury induced by lipopolysaccharide plus D-galactosamine (LPS/D-GalN). METHODS: The acute hepatic injury model was established by LPS/D-GalN and then intervened with Qingxia therapy. Serum liver function, PT and liver tissue pathology were observed, hepatocyte apoptosis index was detected by Tunel, protein expressions of BCL-2, BAX and Caspase-3 were detected by Western blotting. RESULTS: Qingxia therapy could significantly decrease serum ALT, AST and TBIL levels (P < 0.01 or 0.05), reduce hepatocyte necrosis and inflammatory cell infiltration. There were more apoptotic cells in model group, which had significant differences compared with Qingxia group and control group. Protein expressions of BAX and Caspase-3 in model group were significantly higher than those in control group and Qingxia group (P < 0.05), but BCL-2 protein expression in model group was lower (P < 0.05). CONCLUSION: Qingxia therapy can ameliorate the liver function and hepatic tissue pathology of rats with hepatic injury induced by LPS/D-GalN, alleviate hepatocyte apoptosis in rats, prevent and treat hepatocyte apoptosis by down-regulating the protein expressions of Caspase-3 and BAX, up-regulating the protein expression of BCL-2, and adjusting the balance of BCL-2/BAX.

Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis: a systematic review and meta-analysis.

The diagnostic value of procalcitonin (PCT) for patients with liver cirrhosis is unclear. We searched the PubMed, EMBASE, and Cochrane databases for studies published through December 2013 that evaluated the diagnostic performance of PCT for patients with acute or chronic liver disease with suspected systemic infection. We summarized the test performance characteristics by using forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Our search identified 230 citations, of which 10 diagnostic studies that evaluated 1144 patients and 435 bacterial infection episodes (32.1%) were ultimately included for analysis. The bivariate pooled sensitivity estimates were 79% (95% confidence interval [CI]: 64%-89%) for PCT tests and 77% (95% CI: 69%-84%) for C-reactive protein (CRP) tests. Pooled specificity estimates were higher for both PCT and CRP tests (PCT, 89% [95% CI: 82%-94%]; CRP, 85% [95% CI: 76%-90%]). The positive likelihood ratio for PCT (LR+, 7.38, 95% CI: 4.70-11.58) was sufficiently high to qualify PCT as a rule-in diagnostic tool, and the negative likelihood ratio for CRP was sufficiently low to qualify CRP as an acceptable rule-out diagnostic tool (LR- 0.23, 95% CI: 0.13-0.41) in patients with no signs of infection. Available clinical evidence showed that PCT has comparable accuracy to CRP for the diagnosis of systemic infection in patients with liver cirrhosis. Compared with patients with normal liver function, both PCT and CRP tests have acceptable accuracy for diagnosing bacterial infection among patients with liver cirrhosis.

Proteolysis of noncollagenous proteins in sea cucumber, Stichopus japonicus, body wall: characterisation and the effects of cysteine protease inhibitors.

Proteolysis of noncollagenous proteins in sea cucumber, Stichopus Japonicus, body wall (sjBW) was investigated. The proteins removed from sjBW by SDS and urea extraction were mainly noncollagenous proteins with molecular weights about 200kDa (Band I) and 44kDa (Band II), respectively. Band I and Band II were identified as major yolk protein (MYP) and actin, respectively, from holothurian species by liquid chromatography-mass spectrometry (LC-MS/MS) with significant scores. Based on TCA-soluble oligopeptide assay, the optimum proteolysis condition of noncollagenous proteins was at 46.3°C and pH 6.1, by response surface methodology. The proteolysis of MYP, and actin, was partially inhibited by cysteine protease inhibitors, including Trans-epoxysuccinyl-l-leucyl-amido (4-guanidino) butane (E-64), iodoacetic acid, antipain and whey protein concentrate. These results suggest that cysteine proteases are partially involved in the proteolysis of noncollagenous proteins in body wall of sea cucumber, S. japonicus.

catena-Poly[[tetra-aqua-nickel(II)]-µ-(9,10-dioxo-9,10-dihydro-anthracene-1,4,5,8-tetra-carboxyl-ato)-κ(2)O(1):O(8)-[tetra-aqua-nickel(II)]-µ-4,4'-bipyridine-κ(2)N:N'].

In the crystal of the title polymeric complex, [Ni(2)(C(18)H(4)O(10))(C(10)H(8)N(2))(H(2)O)(8)](n), each Ni(II) cation is coord-in-ated by four water mol-ecules in the equatorial plane, and is further bridged by an 9,10-dioxo-9,10-dihydro-anthracene-1,4,5,8-tetra-carb-oxy-l-ate anion and a 4,4'-bipyridine ligand in the axial directions, forming a distorted octa-hedral geometry. The 9,10-dioxo-9,10-dihydro-anthracene-1,4,5,8-tetra-carboxyl-ate anion is centrosymmetric with the centroid of the quinone ring located about an inversion center; the 4,4'-bipyridine ligand is also centrosymmetric with the mid-point of the C-C bond linking two pyridine rings located about another invertion center. The 9,10-dioxo-9,10-dihydro-anthracene-1,4,5,8-tetra-carboxyl-ate anion and bypiridine ligand bridge the Ni(II) cations, forming a polymeric chain along the b axis. π-π stacking is observed between pyridine and benzene rings [centroid-centroid distance = 3.705 (2) Å]. All of the coordinating water mol-ecules are involved in O-H⋯O hydrogen bonding.

Evaluation of the value of rapid D-dimer test in conjunction with cardiac troponin I test for early risk stratification of myocardial infarction.

We sought to determine the diagnostic value of a D-dimer test for myocardial infarction (MI). The prospective cohort study was carried in the ED of a university hospital. All included patients were tested for D-dimer and cardiac troponin I (cTnI) on ED admission and additional cTnI 6 h later. AMI was retrospectively confirmed by employing the ESC-ACC-AHA-WHF 2007 universal definition. The discriminative value of D-dimer test was assessed by ROC curve analysis. Multivariate analysis was used to identify independent risk factors associated with D-dimer elevation other than MI. A total of 178 patients were included in this study. Median D-dimer levels were significantly higher in MI patients. A D-dimer value greater than 200 ng/ml was significantly associated with MI. When used alone, the test has a high sensitivity of 91.8% but a low specificity of 23.9%. Combined use of cTnI and D-dimer tests raised the sensitivity to 98.4% and helped early triage a subgroup of low risk patients. However, the test had the downside of 58% false positives. High false positives could be partly explained by the high prevalence of underlying hypercoagulable comorbidities. Diabetes mellitus with chronic renal insufficiency was identified as the strongest risk factor associated with D-dimer elevation in patients without MI. D-dimer test alone has a low diagnostic value for MI. Co-existing hypercoagulable conditions may confound the results. Combining cTnI and D-dimer tests enables early identification a low risk group of patients for MI at the cost of high false positives.

Potentially lethal enteric bleeding in the ED.

Spontaneous or primary aortoduodenal fistula (PADF) is an uncommon etiology of upper gastrointestinal bleeding and may potentially cause sudden and unexpected death. Early diagnosis of this disease is difficult, and the mortality rate was reported near 100% when surgery is delayed. The emergency physician (EP) plays a major role in the early diagnosis of aortoduodenal fistula. A PADF should be included in the differential diagnosis when EPs treated emergency department patients with gastrointestinal bleeding, especially those in combination with known abdominal aortic aneurysm or palpable pulsating abdominal mass. Besides, abdominal computed tomography should be considered in patients with recurrent large amount of gastrointestinal bleeding without significant endoscopic findings. Prompt diagnosis and surgical intervention may preserve the life of these patients.

[Surgical treatment for varicose vein].

OBJECTIVE: To explore the techniques and outcomes of the surgical treatment for varicose vein. METHODS: Totally 2 200 patients with varicose vein received surgical treatment in our hospital from July 2000 to January 2006. The latest techniques for endovenous occlusion were used for most cases, among which 1 802 cases were treated with endovenous laser treatment (EVLT) combined with transilluminated powered phlebectomy (TIPP), 82 cases with radiofrequency endovenous occlusion (RFO) combined with TIPP, and 218 cases with limited invaginated vein stripping and foam sclerotherapy. The remaining 98 cases were treated with laser, radiofrequency or ligation for saphenous vein trunk, and with resection, electric coagulation, and transfixation for vein clusters as additional methods. Perforators were also cut and ligated as well. RESULTS: Satisfied surgical results were obtained in all cases. The average operative time was 40 minutes (range 20-78 minutes). CONCLUSIONS: Limited invaginated vein stripping, EVLT, and RFO can be used to treat saphenous vein reflux. Surgical resection, transfixation, electric coagulation, and sclerotherapy are reasonable options for vein cluster or tributaries. Transection and ligation of the perforators are important. TIPP is ideal for the treatment of vein clusters.

[Treating severe stenosis of internal carotid artery with carotid endarterectomy].

OBJECTIVE: To explore the effective and safety of carotid endarterectomy (CEA) in the treatment of severe stenosis of internal carotid artery. METHODS: The clinical data of 95 patients with internal carotid artery stenosis and treated by CEA in our hospital from October 1998 to October 2006 were retrospectively analyzed. Transient ischemic attack (TIA) was found in 65 patients and cerebral infarction in 21 patients before operations. Diagnoses were confirmed by selective angiography, and > 70% stenosis of internal carotid artery was found in all patients and > 95% stenosis was found in 50 patients. Stenosis or occlusion of the contralateral carotid artery was also found in 35 patients. Coronary artery stenosis was confirmed in 43 patients with preoperative coronary angiography. CEA and coronary artery bypass grafting (CABG) were simultaneously performed in 18 patients. RESULTS: After the operation, the clinical symptoms significantly improved in all patients. One case experienced hypoglossal nerve injury. One patient died of heart attack during follow-up. CONCLUSION: CEA is an effective and safe treatment for severe stenosis of internal carotid artery.

[The clinical study on chronic hepatitis B treated by the four-step therapeutics of Traditional Chinese Medicine].

OBJECTIVE: To observe the clinical curative effect of chronic hepatitis B treated by the four-step therapeutics of Traditional Chinese Medicine (TCM). METHODS: 120 patients with mild or moderate Chronic Hepatitis B (CHB) were randomly divided into two groups: 80 patients in treatment group and 40 in control group. All enrolled cases accorded with the enroll standard. In treatment group, the patients were divided into mild moderate and severe degree of immune intervention based on the ALT level and treated with four-step therapeutics according to the dialectical theory. In control group, all patients were administered 100mg Lamivudine orally daily for two years. RESULTS: The loss rates of HBeAg, HBV-DNA, precore mutation were 58.9%, 78.9% in treatment group respectively, and 33.3%, 38.9% in control group. There were significant defferences between them. The total effectiveness ratio of two groups has no significant difference. After the treatment, the value of HA, PCIII, IV. C,LN decreased dramatically in treatment group and the antihepatic fibrosis results of treatment group were superior to those of control group. The four-step therapeutics of TCM could improve the ALT value and the ALT value declined to normal after the virus indexes' loss. The response rate in treatment group of ALT-elevating patients was higher than those of no ALT- elevating patients. CONCLUSION: The four-step therapeutics of TCM is effective in treating the CHB patients.