Case-control study on two suturing methods for the repairing of complete rupture of the deltoid ligament / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical outcomes between two suturing methods using non absorbable materials through drilling the bone and suturing anchors for the treatment of complete rupture of the deltoid ligament.</p><p><b>METHODS</b>From January 2009 to January 2013, 58 hospitalized patients with ankle fracture combined with complete rupture of the deltoid ligament were treated with suturing using non absorbable materials through drilling the bone or suturing anchors. There were 29 patients who received suturing treatments using non absorbable materials through drilling the bone (Group A), including 18 males and 11 females, with an average age of (39.76 +/- 11.81) years old. According to the Lauge-Hansen classification, 12 patients had supination external rotation (SER) injuries with IV degree, 5 patients had pronation external rotation (PER) injuries with III degree, 10 patients had PER injuries with IV degrss, and 2 patients had pronation abduction injuries with III degree. There were 29 patients who received treatments with suturing using anchors (Group B), including 14 males and 15 females, with an average age of (41.79 +/- 13.28) years old. According to the Lauge-Hansen classification,9 patients had SER injuries with IV degree, 6 patients had PER injuries with III degree,13 patients had PER injuries with IV degree, and 1 patient had pronation abduction injuries with III degree. All the patients were treated with open reduction and internal fixation, as well as reconstruction of deltoid ligaments to restore the stability of the medial ankle structures. The clinical examination, imaging evaluation, American society for ankle surgery (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the clinical results after operation, and the results of the two groups were compared and analyzed statistically.</p><p><b>RESULTS</b>The follow-up duration of the 58 patients ranged from 23 to 40 months,with an average of 27.3 months. All the patients had fracture union, and the mean healing time was 12.3 weeks (ranged, 10 to 17 weeks). There were no incision complications and ankle instability. There were no significant differences between two groups in AOFAS (P=0.666) and the VAS (P=0.905).</p><p><b>CONCLUSION</b>Treatments of complete rupture of the deltiod ligaments with the two suturing methods get similar good clinical effects, but the suturing using non absorbable materials through drilling the bone has several advantages such as reducing the financial burden of patients, saving social medical resources and avoiding the shortcoming in difficult removal of anchor suture.</p>

Simultaneous determination of gallic acid and hesperidin contained in Xiaogu capsule by HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To develop an HPLC method for simultaneous determination of gallic acid and hesperidin in Xiaogu capsule, in order to provide a simple, rapid and accurate method for quality control of the compound preparation of traditional Chinese medicine.</p><p><b>METHOD</b>Xiaogu capsule was extracted with methanol heating reflux method. Synergi 4 mu Hydro-RP 80A (4.6 mm x 250 mm, 5 microm) was adopted as the chromatographic column, with acetonitrile--0.04 mol x L(-1) phosphate monobasic sodium solution (20: 80) as the mobile phase. The flow rate was 1.0 mL x min(-1), the detection wavelength was 283 nm, and the column temperature was 25 degrees C.</p><p><b>RESULT</b>Under the conditions, gallic acid and hesperidin reached the baseline resolved peak, with a good linearity within the range of 21.6-216.0 mg x L(-1) (r = 0.999 93) for gallic acid, and 4.5-45.0 mg x L(-1) (r = 0.999 95) for hesperidin, respectively. Their average recoveries (n = 9) were 101.5% (RSD 3.7%) and 94.7% (RSD 2.7%), respectively. The average contents of gallic acid and hesperidin contained in Xiaogu capsule were detected to 5.10% and 0.091 1%, respectively.</p><p><b>CONCLUSION</b>The method established in this study can determine the content of gallic acid and hesperidin contained in Xiaogu capsule in a rapid and accurate manner, which provided reference for quality evaluation of the medicine.</p>

Clinical efficiency of computer-assisted pedicle screw placement versus conventional method: a meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical efficacy of computer-assisted pedicle screw placement and conventional placement in the treatment of spinal disease.</p><p><b>METHODS</b>A systematic search of studies published between Jan. 1990 and Feb. 2012 was conducted using Medline, Embase, OVID, ScienceDirect and Cochrane Review databases. Randomized controlled trials (RCTs) and prospective controlled trials of comparing computer-assisted pedicle screw placement to conventional method performed at one center or multi-centers providing data on accuracy of placement and clinical effects were identified. Two study authors independently reviewed the 93 articles originally identified and selected 10 for analysis. Study title,demographic characteristics,number of pedicle screw,anatomical area and outcomes were extracted manually from all selected studies. RevMan 5.1 software was used for meta-analysis.</p><p><b>RESULTS</b>Ten studies encompassing 2813 pedicle screws met the inclusion criteria. Overall,the result of meta-analysis indicated that there were significant differences between two groups in accuracy in placement of pedicle screw [OR = 2.58, 95% CI (1.18, 5.63)], insertion time [WMD = -2.15, 95% CI (-2.36, -1.94)]. However, there was only one study reported preparation time of pedicle screw of navigation group was longer than conventional group. No neurological complication in navigation group was reported.</p><p><b>CONCLUSION</b>As a safety supplementary measure, computer navigation provide better accuracy in placement of pedicle screw and insertion time. The preparation time of pedicle screw may prolong due to the complexity of navigation system. Further reseach should include randomized controlled trials with well-planned methodology to limit bias.</p>

A survey on the attitudes of doctors towards health insurance payment in the medical consortium / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Medical consortium is a specific vertical integration model of regional medical resources. To improve medical resources utilization and control the health insurance costs by fee-for-service plans (FFS), capitation fee and diagnosis-related groups (DRGs), it is important to explore the attitudes of doctors towards the different health insurance payment in the medical consortium in Shanghai.</p><p><b>METHODS</b>A questionnaire survey was carried out randomly on 50 doctors respectively in 3 different levels medical institutes.</p><p><b>RESULTS</b>The statistical results showed that 90% of doctors in tertiary hospitals had the tendency towards FFS, whereas 78% in secondary hospitals towards DRGs and 84% in community health centers towards capitation fee.</p><p><b>CONCLUSIONS</b>There are some obvious differences on doctors' attitudes towards health insurance payment in 3 different levels hospitals. Thus, it is feasible that health insurance payment should be supposed to the doctors' attitudes using the bundled payments along with the third-party payment as a supervisor within consortium.</p>

Study on the genotypes of 260 Mycobacterium tuberculosis isolates by Spoligotyping method in Jiangsu province, China / 中华流行病学杂志

Objective To study the genotypes of Mycobacterium tuberculosis(M.tuberculosis)strains isolated from Jiangsu province and to explore the relationship between the 'Beijing family' and the drug resistance of M.tuberculosis.Methods Two hundred and sixty M.tuberculosis strains were isolated from 30 drug surveillance sites in Jiangsu province.Susceptibility of the isolates to the first-line antituberculosis drugs(isoniazid,streptomycin,rifampicin and ethambutol)was tested by using the proportion method.Molecular typing of M.tuberculosis strains was determined by Spoligotyping and analyzed with BioNumerics software.Results Based on Spoligotyping fingerprint,260 strains showed 34 different genotypes,including 27 exclusive genotypes and 7 shared genotypes.These strains could be clustered into two groups:the Beijing family(80.4％,209/260)and the Non-Beijing family(19.6％,51/260).Data from logistic regression analysis revealed that infection by the Beijing family was related to an increased risk of multi-drug resistant M.tuberculosis,with the OR(95％ CI)of 11.07(1.45-84.50).Non-Beijing families including T1,T2,H3,H4,CAS,LAM,U and MANU2 families were also found.Among them,the CAS,LAM and MANU2 families were first reported in Jiangsu province.Conclusion It was revealed that the marked gene polymorphisms did exist in M.tuberculosis strains.The Beijing family had been the predominant strain circulating in Jiangsu province,which might be related to multi-drug resistant M.tuberculosis strains.

A study on building data warehouse of hospital information system / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system.</p><p><b>METHODS</b>To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers: datacenter layer, system-function layer, and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information.</p><p><b>RESULTS</b>Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making.</p><p><b>CONCLUSIONS</b>This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is required for further research.</p>

Pituitary stalk interruption syndrome: a report of 9 cases / 中华神经医学杂志

Objective To explore the clinical characteristics of pituitary stalk interruption syndrome (PSIS) to raise our awareness of this disease. Methods The clinical data, including clinical manifestations, MR image changes and disorders of endocrine system, of 9 patients admitted to our hospital were collected and analyzed. Results Eight of 9 patients showed absence of pituitary stalk under MRI with height of the pituitary no more than 3 mm; only one exceptional patient with traumatic etiology showed 4.5 mm of the pituitary. Two patients were adult-onset and clearly induced by head trauma, and both of them were hospitalized due to pituitary crisis; the other 7 patients, having the disease at the age of 5 to 12, were complained of growth and development retardation at the age of 17 to 28. All the patients were totally deficient in growth hormone (GH) and pituitary gonadotropin (GnH) secretion; in addition, secondary hypothyroidism and hypocortisolism occurred in 6 of the 7 young-onset patients. No consanguinity, sign of pituitary crisis, and septooptic dysplasia were noted in those young-onset patients.Conclusion PSIS is characterized by absence of pituitary stalk and pituitary hypoplasia, by GH and GnH deficiency, and mostly combined with ACTH and TSH deficiency of different extent.

Linker for activation of T cells contributes to airway inflammation in an asthmatic mouse model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Allergic asthma is associated with airway inflammation and hyperresponsiveness caused by dysregulated production of cytokines secreted by allergen-specific helper T-type 2 (Th2) cells. The linker for activation of T cells (LAT) is a membrane-associated adaptor protein, which has been shown to take part in regulating T cell receptor (TCR) signaling and T cell homeostasis. In this study, we established an asthmatic mouse model to examine the changes in LAT levels during allergic airway disease and the effects of LAT transgenic expression on airway inflammation.</p><p><b>METHODS</b>T cells from mouse lung tissues were isolated from allergen challenged (ovalbumin (OVA)) and control mice, and the purity of these isolated T cells was examined by fluorescence-activated cell sorter (FACS). Semi-quantitative RT-PCR and Western blotting were used to detect the expression of the LAT gene and LAT protein, respectively. After an intranasally administered mixture of pCMV-HA-LAT plasmid and Lipofectamine 2000, 24 hours before and 72 hours after allergen challenge, the BALF cell count and the differential cytologies were studied. In addition, IL-4 and IFN-γ levels in the BALF were determined by ELISA, and pathological changes in lung tissues were observed.</p><p><b>RESULTS</b>LAT protein and mRNA expression were decreased in lung T cells in a mouse model of allergen-induced airway disease. After intranasal administration of pCMV-HA-LAT, histopathological examination of the lungs showed that intervention with LAT overexpression prevented mice from developing airway inflammation, and the number of total cells, eosinophils, neutrophils, and lymphocytes in the BALF was reduced significantly compared with the OVA sensitized and challenged group. In addition, the Th2 cytokine IL-4 decreased, while the Th1 cytokine IFN-γ increased compared to the OVA sensitized and challenged group or the OVA sensitized group plus pCMV-HA treatment.</p><p><b>CONCLUSION</b>This study demonstrates that LAT might effectively diminish Th2 cytokine responses, lung histopathological changes and lung inflammation to allergen challenge in a model of experimentally induced asthma.</p>

Small interfering RNA-mediated knockdown of Notch1 in lung / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The immunologic response to allergens mediated by T lymphocytes is an incipient key element in the pathogenesis of asthma, and Th1/Th2 balance is regarded as the core of asthma pathogenesis. Notch is a single-pass transmembrane receptor protein that regulates differentiation, proliferation and apoptosis in a broad range of cells. It is considered that the Notch signal pathway works in every stage of T cell development and differentiation. Whether the pathway of asthma pathogenesis is related to Notch1 remains unknown. This study is aimed to investigate whether the pathway of asthma pathogenesis is related to Notch1 by examining the effect of knockdown of the Notch1 gene by small interfering RNA on T cell differentiation.</p><p><b>METHODS</b>An OVA-induced asthma mouse model was established. The expression of Notch1 in the tissue and T cells of the lung from asthmatic mice was detected by RT-PCR and Western blotting. The expression of Notch1 and cytokine interleukin (IL)-4 and interferon (IFN)-gamma in activated lung T cells was detected by RT-PCR and enzyme-linked immunosorbent assay after blocking Notch1 by small interfering RNA.</p><p><b>RESULTS</b>The mRNA and protein expression of Notch1 increased significantly both in the lung tissue and lung T cells of asthmatic mice (both P < 0.05). IL-4 decreased and IFN-gamma increased significantly in active lung T cells after Notch1 was blocked by Notch1-specific small interfering RNA (IL-4: (2.51 +/- 0.51) pg/ml vs 0.64 +/- 0.27) pg/ml protein; IFN-gamma: (21.72 +/- 4.24) pg/ml vs (39.79 +/- 4.09) pg/ml protein, P < 0.05).</p><p><b>CONCLUSION</b>This study demonstrated that the Notch1 signal might play a role in the pathogenesis of asthma by its involvement in Th1/Th2 differentiation.</p>

Pituitary stalk interruption syndrome due to trauma: analysis of 2 cases / 中华神经医学杂志

Objective To analyze the clinical characteristics of pituitary stalk interruption syndrome (PSIS) for its better understanding. Methods The clinical manifestations and endocrine alterations were analyzed retrospectively in 2 PSIS cases, and the literatures concerning this disease were reviewed. Results Both of the 2 adult patients had definite history of head injuries, and one of them exhibited nervous system sequelae. The diagnoses remained erroneous for 15 and 2 years, respectively. This disease was characterized by gradual clinical hypopituitarism, and both of the 2 patients were admitted for pituitary crisis, which occurred for several times in 1 case;neither of the patients had diabetes insipidus. Endocrine examination suggested hypofunction of the thyroid gland, sexual gland and adrenal glands due to hypopituitarism. Magnetic resonance imaging revealed pituitary atrophy, pituitary stalk interruption and posterior lobe hyperintensity in the infundibular recess. So far only 2 juvenile cases of traumatic PSIS were reported, which had distinct differences from early-onset PSlS and from simple traumatic hypopituitarism without pituitary stalk interruption. Conclusion Traumatic PSIS is a rare clinical entity. In cases of endocrine alterations following head injury, traumatic PSIS might be suspected and appropriate treatment should be administered.

Analgesic effect of ozone on neuropathic pain in rats / 中华神经医学杂志

Objective To investigate the optimal concentration and site for ozoneadministration to relieve neuropathic pain in rats. Methods Twenty-four adult male rats with sciaticnerve injury (SNI) were randomized equally into 4 groups, and received ozone injections for analgesia atdifferent sites, namely the operative site, the sciatic nerve, the L5 spinal nerve or the operative site inaddition to the L5 spinal nerve. Another 4 groups of rats with SNI (n=6) had ozone injections at theconcentrations of 40, 50, 60, or 70 μg/mL, all administered at both the operative site and the L5 spinalnerve. The analgesic effects of the ozone injections were evaluated using paw withdrawal threshold test inall the rats. Results In rats with ozone injection at both the operative field and the L5 spinal nerve, themechanical pain threshold was significantly increased in comparison with that in rats with injections atother sites (P<0.05), but different doses of ozone simultaneously injected at the two sites did not producesignificant differences in the pain threshold (P>0.05). Conclusion Ozone produces obvious analgesiceffects in rats with SNI-induced neuropathic pain when injected at both the operative site and thespinal nerve, and ozone within the concentration range from 40 to 70 μg/mL has similar analgesic effect.

Effects of tumor necrosis factor-? on metabolism of skeletal muscle protein in rats with chronic obstructive pulmonary disease and underlying mechanisms / 上海第二医科大学学报

Objective To study the effects of tumor necrosis factor-?(TNF-?) on hypermetabolism of skeletal muscle protein in rats with chronic obstructive pulmonary disease(COPD) and explore the mechanisms. Methods Forty-five SD rats were randomly divided into normal control group,COPD group and COPD +TNF-? group(n=15).Rat COPD models were established by passive cigarette smoking in COPD group and COPD +TNF-? group.After dissecting and isolating the extensor digitorium longus(EDL) muscles,the EDL muscles were either cultured with media containing 10 ug/L recombinant rat TNF-? or without TNF-?.The subsequent changes in ubiquitin mRNA and protein levels were determined by real-time quantitative PCR and Western blot,respectively. Results The expressions of ubiquitin mRNA and protein of COPD group and COPD+TNF-? group were higher than those of normal contro1 group(P