Comparison of clinical outcomes after anterior cruciate ligament reconstruction with hamstring tendon autograft versus soft-tissue allograft: A meta-analysis of randomised controlled trials.

BACKGROUND: Hamstring tendon autografts and soft-tissue allograft are commonly used for anterior cruciate ligament (ACL) reconstruction. However, the clinical outcomes between these two grafts are controversial. This meta-analysis was performed to compare clinical outcomes of primary ACL reconstruction with hamstring tendon autografts versus soft-tissue allografts. MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Library were searched through 8 September 2017 to identify randomized controlled studies that compared hamstring tendon autografts with soft-tissue allografts for primary ACL reconstruction. Two authors independently graded the methodological quality of each eligible study using the Cochrane Collaboration tool and extracted relevant data. Statistical heterogeneity among the trials was evaluated with chi-square and I-square tests. A sensitivity analysis was conducted to explore sources of heterogeneity. Subgroup analysis was performed to identify potential differences according to type of reconstruction technique (single-bundle or double-bundle). RESULTS: Eight studies with 785 combined patients (396 hamstring tendon autografts and 389 soft-tissue allografts) were included. Two studies had a high risk of bias. The other six studies had unclear risk of bias. There were significant differences between the groups in subjective International Knee Documentation Committee (IKDC) score (mean difference [MD], 2.43; 95%CI, 0.69-4.18; p = 0.006), Tegner score (MD, 0.24; 95%CI, 0.03-0.45; p = 0.03), and side-to-side difference (MD, -1.37; 95%CI, -2.44 to -0.30; p = 0.01). There was no significant difference between the groups in Lysholm score, complications, pivot shift test, anterior drawer test, Lachman test, overall IKDC score, or range of motion. Subgroup analysis demonstrated that for primary ACL reconstruction using the single-bundle technique, soft-tissue allografts were inferior to hamstring tendon autografts in subjective IKDC score, anterior drawer test, and side-to-side difference. CONCLUSION: Soft-tissue allografts are inferior to hamstring tendon autografts with respect to subjective patient evaluation and knee stability but superior in the complication of hypoesthesia for patients undergoing primary ACL reconstruction.

Irradiated allograft versus autograft for anterior cruciate ligament reconstruction: A meta-analysis and systematic review of prospective studies.

BACKGROUND: Irradiated allografts and autografts are commonly used for anterior cruciate ligament (ACL) reconstruction. The outcomes between these two grafts are controversial. This meta-analysis and systematic review of prospective comparative studies was performed to compare the clinical outcomes, including knee functionality, stability, subjective evaluation, complications, and failure, of irradiated allografts and autografts in primary ACL reconstruction. MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Library were searched from database inception to 12 August 2017 to identify prospective studies that compared irradiated allografts with autografts for primary ACL reconstruction. Randomized controlled trials were included in the meta-analysis. Prospective cohort studies were included in the systematic reviews. Two reviewers independently assessed the study quality and extracted relevant data. Statistical heterogeneity among the trials was evaluated by the chi-square and I-square tests. RESULTS: Four randomized controlled trials and two prospective cohort studies involving 18,835 patients met the inclusion criteria. In the meta-analysis, significant differences were observed in knee stability and subjective evaluation with respect to the KT-2000 score (p < .0001), pivot shift test (p = .001), anterior drawer test (p = .0001), Lachman test (p = .0002), subjective International Knee Documentation Committee (IKDC) score (p < .0001), Cincinnati knee score (p = .04), Lysholm score (p = .01), and Tegner score (p = .03). However, the differences in functional assessment in terms of the overall IKDC score (p = .21), range of motion (p = .94), Harner's vertical jump test (p = .09), Daniel's one-leg hop test (p = .50), and complication rate (p = .34) were not significant between the two groups. Failure was reported in two prospective cohort studies in 302 of 14,829 (2%) patients in the autograft group and 157 of 3941 (4%) patients in the irradiated allograft group. CONCLUSION: Irradiated allografts are inferior to autografts for patients undergoing primary ACL reconstruction with respect to knee stability and subjective evaluation. However, no significant differences were found between the two groups in terms of function and complication. The robustness of the findings might need to be further validated because of the limited number of randomized controlled trials. More randomized controlled trials with longer follow-ups are required to further evaluate the failure rate in the two groups.

Pulse signal analysis of patients with coronary heart diseases using Hilbert-Huang transformation and time-domain method.

OBJECTIVE: To explore characteristic of pulse signal to distinguish patients with coronary heart diseases (CHD) from patients without CHD and healthy adults, and accordingly evaluate the potential role of pulse signal to diagnosis CHD. METHODS: Totally 407 patients enrolled from 4 collaborating medical centers were assigned to a CHD group (205 patients) and a non-CHD group (202 patients). The healthy control group (62 adults) enrolled from Shanghai University of Traditional Chinese Medicine. Pulse signals were collected using the synchronous multiplex pulse signal acquisition system. The pulse signals were analyzed and extracted using Hilbert-Huang transformation (HHT) and time-domain, respectively. The time-domain parameters of pulse signal were processed by the analysis of variance (SNK test). RESULTS: Special patterns in the CHD group pulse signal were found in this study: (1) time-domain parameters of pulse signal, h1, h3, h4, h3/h1, ts, t4/t were increased and w was wider; (2) 44% of C2 waves in HHT were chaotic and disordered and 72% of C waves were exhibited irregularly with average amplitude over 10 g-forces, which were all significantly different from controls. CONCLUSION: Characteristic wave and time-domain parameters of pulse signal were extracted using HHT and time-domain which could be served as a non-invasive approach for assessing patients with CHD.

The role of central nervous system on hypoglycemia and the feasibility of the brain theory in traditional Chinese medicine on treatment of diabetes mellitus.

The central nervous system (CNS) plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine (TCM) has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.

Metabolic markers and microecological characteristics of tongue coating in patients with chronic gastritis.

BACKGROUND: In Traditional Chinese Medicine (TCM), tongue diagnosis has been an important diagnostic method for the last 3000 years. Tongue diagnosis is a non-invasive, simple and valuable diagnostic tool. TCM treats the tongue coating on a very sensitive scale that reflects physiological and pathological changes in the organs, especially the spleen and stomach. Tongue coating can diagnose disease severity and determine the TCM syndrome ("Zheng" in Chinese). The biological bases of different tongue coating appearances are still poorly understood and lack systematic investigation at the molecular level. METHODS: Tongue coating samples were collected from 70 chronic gastritis patients and 20 normal controls. 16S rRNA denatured gradient gel electrophoresis (16S rRNA-DGGE) and liquid chromatography and mass spectrometry (LC-MS) were designed to profile tongue coatings. The statistical techniques used were principal component analysis and partial least squares-discriminate analysis. RESULTS: Ten potential metabolites or markers were found in chronic gastritis patients, including UDP-D-galactose, 3-ketolactose, and vitamin D2, based on LC-MS. Eight significantly different strips were observed in samples from chronic gastritis patients based on 16S rRNA-DGGE. Two strips, Strips 8 and 10, were selected for gene sequencing. Strip 10 sequencing showed a 100% similarity to Rothia mucilaginosa. Strip 8 sequencing showed a 96.2% similarity to Moraxella catarrhalis. CONCLUSIONS: Changes in glucose metabolism could possibly form the basis of tongue coating conformation in chronic gastritis patients. The study revealed important connections between metabolic components, microecological components and tongue coating in chronic gastritis patients. Compared with other diagnostic regimens, such as blood tests or tissue biopsies, tongue coating is more amenable to, and more convenient for, both patients and doctors.