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BACKGROUND:Bushen Yiqi Huayu granule has the effect of replenishing qi and eliminating blood stasis,tonifying kidney and smoothing collages,and is often used in the treatment of osteoporosis.At present,there are few studies on the effect of Bushen Yiqi Huayu granule on the callus angiogenesis of osteoporotic fractures. OBJECTIVE:To explore the mechanism of Bushen Yiqi Huayu granule by up-regulating extracellular signal-regulated kinase/mitogen-activated protein kinases(ERK/MAPK)signaling pathway to improve callus angiogenesis after fracturing in osteoporotic rats. METHODS:(1)Bone marrow mesenchymal stem cells from osteoporotic SD rats and bone marrow monocytes from C57BL/6 mice were collected.MTT assay was used to detect different doses of Bushen Yiqi Huayu granule on bone mesenchymal stem cell toxicity.Bone mesenchymal stem cells and bone marrow monocytes were cultured in the medium supplemented with 0 and 1.5 mg/mL Bushen Yiqi Huayu granules,respectively,and osteogenic differentiation and osteoclast differentiation were carried out in vitro.(2)144 SD rats were randomly divided into sham operation group,model group,granule group and granule+PD98059 group with 36 rats in each group.The osteoporotic model was established in the model group,granule group and granule+PD98059 group,and only part of the adipose tissue near the ovary was removed in the sham operation group.8 weeks later,all rats received left tibial osteotomy.In the granule+PD98059 group,5 g/kg Bushen Yiqi Huayu granule was given intragastrically,and 0.3 mg/kg PD98059 was injected into the tail vein.The granule group was given 5 g/kg Bushen Yiqi Huayu granule,and the same volume of normal saline was injected into the tail vein.The sham operation group and model group were given an equal volume of normal saline,and the caudal vein was injected with an equal volume of normal saline.Drug administration was conducted once a day for 8 weeks.Fracture healing and callus angiogenesis were observed by X-ray,micro-computed tomography and microvascular perfusion angiography.Bone mineral density and mechanical strength of the callus were measured.The tibia was observed by hematoxylin-eosin staining and Masson staining.Western blot assay and immunohistochemistry were used to examine the expression of ERK/MAPK signaling pathway-related molecules. RESULTS AND CONCLUSION:(1)Compared with the 0 mg/mL group,the alkaline phosphatase activity,mineralization level,p-ERK1/2 and p-p38 MAPK expression levels of osteocytes increased(P<0.05),while the density and volume of osteoclasts decreased in the 1.5 mg/mL group(P<0.05).(2)Compared with the sham operation group,the fracture healing degree of the granule group was similar at 4 and 8 weeks,but there was no significant difference in Lane-Sandhu score,total callus volume,mineralized callus volume,mineralized callus volume/total callus volume,trabecular thickness,vascular number,spacing,thickness,vascular volume/total volume,bone mineral density,ultimate load of callus,stiffness,p-ERK1/2,p-p38 MAPK,p-IκB-α,and p-p65 expression levels(P>0.05).In the model group and granule+PD98059 group,fracture healing was slow,Lane-Sandhu score,total callus volume,mineralized callus volume,mineralized callus volume/total callus volume,trabecular thickness,vascular number,thickness,vascular volume/total volume,bone mineral density,ultimate load of callus,stiffness,p-ERK1/2,p-p38 MAPK,p-IκB-α,and p-p65 expression levels decreased(P<0.05),and vascular spacing increased(P<0.05),compared with the sham operation group.(3)It is indicated that Bushen Yiqi Huayu granule can improve fracture healing,promote callus angiogenesis and alleviate the symptoms of osteoporosis by enhancing the expression of the ERK/MAPK signaling pathway-related molecules in osteoporotic rats.
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Objectives:To explore the burden and trend of cardiovascular diseases(CVD)attributed to household air pollution(HAP)in the world and China from 1990 to 2019. Methods:Based on the Global Burden of Disease(GDB)database in 2019,the CVD data attributed to HAP in China and around the world were extracted,and the mortality and disability-adjusted life years(DALY)and their age standardized rate(ASR)and estimated annual percentage change(EAPC)were used to analyze the burden of disease and trend in China and other regions and countries from 1990 to 2019. Results:From 1990 to 2019,the age-standardized death rate(ASDR)(EAPC=-3.65,95%CI:-3.86 to-3.44),and the age-standardized DALY rate(EAPC=-3.60,95%CI:-3.78 to-3.41)attributable to HAP for CVD globally showed a decreasing trend.In China,the ASDR(EAPC=-5.78,95%CI:-6.17 to-5.38)and the age-standardized DALY rate(EAPC=-5.97,95%CI:-6.32 to-5.62)also showed a declining trend.The burden of males was slightly higher than females,reaching its peak at the age of 75 to 89 years.The largest increase of the burden of CVD attributed to HAP was in Philippines(ASDR:EAPC[95%CI]=0.87[0.21-1.54];age-standardized DALY rate:EAPC[95%CI]=1.32[0.60-2.03]),and the largest decline was in Saudi Arabia(ASDR:EAPC[95%CI]=-18.48[-18.63 to-18.32];age-standardized DALY rate:EAPC[95%CI]=-18.25[-18.38 to-18.12]).In 2019,the highest disease burden of CVD related to HAP per 100 000 people was significantly higher in ASDR(56.67,95%UI:42.08-73.07)and age-standardized DALY rate(1 318.63,95%UI:997.40-1 672.29)in areas with low social demographic index(SDI)than in other SDI areas.In 2019,among the 21 geographical regions and 204 countries in the world,the highest disease burden per 100 000 people was in Oceania,and the highest country was Solomon Islands,the corresponding ASDR of China was 12.52(95%UI:6.35-21.29)and the age-standardized DALY rate was 262.65(95%UI:133.90-447.50). Conclusions:From 1990 to 2019,the age-standardized burden of CVD attributable to HAP in the world and China showed a consistent downward trend,with males slightly higher than females,and the burden concentrated on population between 75 and 89 years old.Although there has been a certain decline in China,the disease burden is still high,so there is still a urgent need to take strong intervention measures to reduce burden of CVD attributable to HAP in China.
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Objective:Based on the construction of intelligent intensive care unit(ICU)in hospital,to analyze the effectiveness of intelligent ICU life support equipment in clinical decision-making assistance.Methods:The functional modules of the ICU ward interaction system,equipment management system,risk response system and intelligent ward round system were designed to collect information and data of life support equipment in diagnosis and treatment,nursing,operation and technical support in real time to provide medical auxiliary decision-making basis for the improvement of diagnosis,treatment and nursing measures for critically ill patients.115 life-support equipment in clinical use in 3 hospitals including Zhujiajiao People's Hospital of Qingpu District,Shanghai from July 1,2018 to December 31,2022 were selected,the traditional assisted decision-making management mode(referred to as traditional mode,83 sets)and intelligent assisted decision-making management mode(referred to as intelligent mode,89 sets,including 57 units of the traditional mode and 32 newly added units)were adopted respectively.The management level and management effect of life support equipment of the two management modes were compared.Results:The data collection time of the equipment of intelligent mode was(5.67±2.80)min,which was less than that of the traditional mode,the accuracy and completeness of data acquisition,as well as the effective resolution rate of equipment deployment and use,monitoring and alarm,equipment failure and emergency response were(99.02±1.14)%,(94.35±3.46)%,(98.78±0.90)%,(98.99±0.91)%,(88.26±5.31)% and(90.23±5.54)%,respectively,which were higher than those of the traditional mode,the difference between was statistically significant(t=6.504,6.474,3.574,7.620,6.784,4.522,3.719,P<0.05).The effective utilization rates of diagnostic decisions for treatment,care and rehabilitation of intelligent mode equipment were(93.83±3.12)%,(94.99±2.47)% and(91.44±4.62)%,respectively,the comprehensive scores of respiratory function support equipment,circulatory function support equipment,blood purification support equipment and emergency monitoring support equipment were(92.97±4.35)points,(94.34±2.95)points,(93.01±2.44)points and(94.11±1.89)points,respectively,which were higher than those of the traditional mode,the difference was statistically significant(t=4.169,4.875,5.159,4.069,3.033,2.757,6.893,P<0.05).Conclusion:Based on the construction of intelligent ICU,it can improve the quality of life support equipment operation data collection,solve the equipment operation problems in a timely manner,provide an effective basis for the decision-making of diagnosis and treatment,nursing and rehabilitation of critically ill patients,and improve the clinical service level of equipment.
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Objective:To compare the medium and long-term efficacy between the deltoid split approach and the conventional deltopectoral approach in locking plate fixation for proximal humerus fractures.Methods:A retrospective study was performed in the 65 patients with proximal humerus fracture who had been operatively treated at Department of Orthopedics, The Third People's Hospital of Nantong from January 2018 to December 2020. They were 20 males and 45 females with an age of (64.6±9.2) years. Of them, 34 were assigned to fixation with proximal humerus internal locking system (PHILOS) through the deltoid split approach (minimally invasive group), and 31 to PHILOS fixation through the deltopectoral approach (conventional group). The 2 groups were compared in terms of general data, operation time, intraoperative blood loss, hospital stay, fracture union time, intraoperative fluoroscopy, postoperative 2-year imaging scores, and Constant-Murley shoulder score at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). In the minimally invasive group and the conventional group, respectively, the intraoperative blood loss was (97.9±16.6) mL and (155.8±27.4) mL, and the frequency of intraoperative fluoroscopy (12.0±1.8) times and (6.7±1.8) times, both showing a statistically significant difference ( P<0.05). There was no significant difference in operation time, hospital stay, or fracture union time ( P>0.05). All patients were followed up for (43.9±5.5) months. There was no statistically significant difference between the 2 groups in postoperative 2-year imaging scores ( P>0.05). Compared with the conventional group, patients in the minimally invasive group had significantly lower Constant-Murley strength scores and significantly lower Constant-Murley scores for the Neer four-part fractures ( P<0.05). Postoperatively, one case of screw protrusion and one case of complete ischemic necrosis occurred in both groups while one case of partial ischemic necrosis was observed in the minimally invasive group and 3 cases of partial ischemic necrosis were observed in the conventional group. Conclusions:In locking plate fixation for proximal humerus fractures, compared with the deltopectoral approach, the deltoid split approach shows advantages of less soft tissue damage, less intraoperative bleeding, and less destruction of the blood supply to the humeral head. However, the deltopectoral approach may be more appropriate for the Neer four-part fractures.
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Objective:To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children.Methods:A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing comparability ( P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] ( P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] ( P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] ( P<0.05). Conclusions:Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.
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Objective:To analyze the status quo and influencing factors of non-alcoholic fatty liver disease in community-dwelling elderly women.Methods:A total of 9 754 female residents aged 60-79 years who attended health check-up in Anting Town Community Health Service Center from June 2019 to December 2021 were enrolled in the study. According to the ultrasound diagnosis, there were 5 220 cases of non-alcoholic fatty liver disease (NAFLD group) and 4 534 cases without NAFLD (non-NAFLD group). The general information, physiological and biochemical indicators were compared between two groups with Mann-Whitney U test and Chi-square test; the influence factors of NAFLD were analyzed with logistic regression. Results:The overall prevalence of NAFLD was 53.52%(5 220/9 754), prevalence in the 65-69 age group was the highest and that in the 75-79 age group was the lowest. Body mass index ( Z=47.667), waist circumference ( Z=45.949), waist-to-hip ratio ( Z=30.805), systolic blood pressure ( Z=7.543), diastolic blood pressure ( Z=7.621), fasting blood glucose ( Z=20.298), glycated hemoglobin ( Z=23.588), alanine aminotransferase ( Z=29.624), aspartate aminotransferase ( Z=7.824), total bilirubin ( Z=4.441), triglyceride ( Z=34.597), low-density lipoprotein cholesterol ( Z=2.476) and blood uric acid ( Z=29.934) levels of NAFLD group were significantly higher than those in non-NAFLD group (all P<0.05); the mean age ( Z=-3.885) and high density lipoprotein cholesterol ( Z=-23.553) in NAFLD group were significantly lower than those in non-NAFLD group (all P<0.001); there were no significant differences in the levels of total cholesterol ( Z=1.762)and creatinine ( Z=1.453) between the two groups (all P>0.05). The proportion of patients had type 2 diabetes mellitus ( χ2=368.395), hypertension ( χ2=208.503), hypertriglyceridemia ( χ2=883.831), hyperuricemia ( χ2=228.562), central obesity ( χ2=1 506.580), high risk of stroke ( χ2=605.322) and high risk of ASCVD ( χ 2=309.434) in NAFLD group were significantly higher than that of non-NAFLD group (all P<0.001). Logistic regression analysis showed that age ( OR=0.937, 95% CI: 0.928-0.946), body mass index ( OR=1.224, 95% CI:1.194-1.255), waist circumference ( OR=1.072, 95% CI: 1.062-1.082), glycosylated hemoglobin ( OR=1.348, 95% CI: 1.275-1.426), alanine aminotransferase ( OR=1.032, 95% CI: 1.026-1.037), triglyceride ( OR=1.757, 95% CI: 1.646-1.875) and serum uric acid ( OR=1.004, 95% CI: 1.004-1.005) levels were the influencing factors for NAFLD in elderly women (all P<0.001). Conclusion:The prevalence rate of non-alcoholic fatty liver disease in the community-dwelling elderly women is high, which are associated with multiple influencing factors.
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Objective: To evaluate the effects of Liu Zi Jue Qigong (LQG)-based breathing training on the curvature and range of motion (ROM) of the thoracic and lumbar spines in different positions. Methods: Forty-seven college students were selected as subjects and randomly divided into an observation group and a control group. In the observation group, 27 subjects received regular LQG-based breathing training for 12 weeks, while 20 subjects in the control group did not receive any intervention. The spine measuring instrument Spinal Mouse was adopted to detect the curvature and ROM of the thoracic and lumbar spines. Results: In the observation group, the changes in the curvatures of thoracic spine in the upright and forward-bending positions showed statistical significance after LQG exercise (P<0.05), while there was no notable difference in the control group. The comparison of ROM of the thoracic spine from the upright position to the forward-bending and load-bearing positions showed statistically significant difference in the observation group (P<0.05), while there was no significant difference in the control group. There was no significant difference in the lumbar curvature and ROM in the two groups after LQG exercise. Conclusion: LQG-based breathing training improves the curvature and ROM of the thoracic spine.
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Objective:To investigate the surgical outcome and prognostic factors of para-split laminotomy for removal of lumbar spinal canal tumors.Methods:Retrospectively review the clinical data of 35 patients suffering lumbar spinal canal tumors, who underwent the para-split laminotomy for tumor resection in Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to August 2019, including 16 males and 19 females, and the age was(40.1±10.6)years. Intraoperative blood loss, operation time, tumor resection, tumor pathological results, perioperative complications were observed. Follow-up situations, including tumor recurrence, bony fusion of laminae and spinal stability. Follow-up using outpatient examination and telephone interview was performed by the end of August 2022. The JOA back pain scoring system was used to evaluate the neurological function of the spinal cord, and paired t-test were performed to compare the overall preoperative and postoperative spinal cord neurological function scores. Linear regression and multiple linear regression were used to analyze the prognostic factors. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and the comparison before and after operation was performed by paired t-test. Mearsurement data of skewed distribution were expressed as M( Q1, Q3). Count data were expressed as cases. Results:The tumors of 35 patients were resected completely. The median blood loss was 100(75, 140)mL and the average operative duration was (181.1±42.7) min. The postoperative pathological results were as follows: 24 neurilemmomas, 6 meningiomas, 4 ependymomas and 1 neurofibroma. There were no surgery-related complications occurred. The postoperative follow-up ranged from 36 to 69 months, with no tumor recurrence or spinal instability, and bony fusion of laminae seen in some patients on CT imaging. The overall spinal cord neurological function scores of pre and post operation were(19.5±3.4)versus(25.4±2.2), Paired t-test analysis revealed a significant difference between the overall postoperative spinal cord neurological function scores and the preoperative scores, and the postoperative scores were better than the preoperative scores( P<0.05). Multiple linear regression analysis showed a positive correlation between preoperative JOA scores and postoperative JOA scores, and postoperative JOA scores has negative correlation with tumor volume and the age at the time of operation ( P<0.05). Conclusion:Para-split laminotomy with less damage to the posterior spinal structures can effectively improve the neurological function of the spinal cord and protect the stability of the lumbar spine in patients with lumbar spinal canal tumors, and the better the preoperative neurological function of the spinal cord, the better the prognosis of patients, and the smaller the tumor volume, the better the prognosis.
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Necrotizing otitis externa is a progressive infectious disease involving the external auditory canal and even the skull base, which can lead to serious complications and even death if not treated in time. In this paper, the latest advances in etiology, pathogenesis, clinical manifestations, diagnosis and treatment were reviewed based on previous literature, providing reference for clinical diagnosis, treatment and future research.
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Humans , Otitis Externa/therapy , Skull Base/pathology , Ear Canal/pathology , HeadABSTRACT
OBJECTIVE@#To explore the clinical phenotype and genetic variant in a child with Verheij syndrome (VRJS).@*METHODS@#A child who had presented at the Soochow University Affiliated Children's Hospital and Wujiang District Children's Hospital in July 2022 for "elevated scapula since early childhood" was selected as the study subject. Peripheral blood samples of the child and his parents were collected and subjected to whole exome sequencing. Candidate variant was verified by Sanger sequencing and bioinformatic analysis.@*RESULTS@#The child had manifested elevated scapulae, torticollis, neck asymmetry, facial dysmorphism, dispersed café-au-lait spots, limited mobility of upper limbs and shoulder joints, and intellectual disability. Sequencing revealed that he has harbored a de novo heterozygous c.405dupT (p.Ile136Tyrfs*4) variant of the PUF60 gene. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), this variant was classified as pathogenic (PVS1+PS2_moderate+PM2_supporting). Combined his clinical features and result of genetic testing, the child was diagnosed with VRJS due to variant of the PUF60 gene.@*CONCLUSION@#The clinical manifestations of VRJS include facial dysmorphism, intellectual disability, elevated scapulae, vertebral fusion, other skeletal malformations, without significant abnormalities of the heart, kidney, and eyes, which need to be distinguished from Klippel-Feil syndrome. Above finding has expended the mutation spectrum of the PUF60 gene and provided a reference for delineation of the genotype-phenotype correlation of the VRJS.
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Child , Child, Preschool , Humans , Male , Cafe-au-Lait Spots , Computational Biology , Genetic Testing , Genomics , Intellectual Disability/genetics , MutationABSTRACT
Objective To investigate the value of serum markers in the early diagnosis of liver cirrhosis with minimal hepatic encephalopathy (MHE). Methods A prospective analysis was performed for 81 patients who were hospitalized and treated in General Hospital of Ningxia Medical University from April 2020 to February 2022, and all these patients were diagnosed with hepatitis B cirrhosis based on clinical manifestation, laboratory examination, and radiological examination or liver biopsy. According to digital connection test A (NCT-A) and digital symbol test (DST), these patients were divided into simple cirrhosis group with 45 patients and MHE group with 36 patients. Related indices were measured, including liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and total bilirubin (TBil)], albumin, blood ammonia, cholinesterase, and prothrombin time. The independent samples t -test was used for comparison of normally distributed continuous data between two groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. The logistic regression analysis and the area under the ROC curve (AUC) were used to investigate the predictive factors for MHE. Results Compared with the simple cirrhosis group, the MHE group had a significant increase in NCT-A score ( Z =-7.110, P < 0.001) and a significant reduction in DST score ( t =12.223, P < 0.001). The univariate analysis showed that there were significant changes in AST, albumin, prothrombin time, cholinesterase, and blood ammonia in the patients with MHE ( Z =-2.319, -2.643, -1.982, -6.594, and -5.331, all P < 0.05), while the multivariate analysis showed that only cholinesterase and blood ammonia were significant predictive factors (all P < 0.05) and were correlated with Child-Pugh score (all P < 0.05). Cholinesterase, blood ammonia, and their combination had an AUC of 0.925, 0.845, and 0.941, respectively, in the diagnosis of MHE, with an optimal cut-off value of 2966, 60, and 0.513, respectively. Conclusion Blood ammonia, cholinesterase, and their combined measurement have a potential clinical value in the early diagnosis of liver cirrhosis with MHE.
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Zhishi Xiebai Guizhi Tang， derived from Synopsis of the Golden Chamber （《金匮要略》， Han dynasty， ZHANG Zhongjing）， is a famous classical prescription commonly used for chest impediment. By means of bibliometrics， the authors collected 63 ancient Chinese medical books related to Zhishi Xiebai Guizhi Tang and screened 36 effective books for statistical analysis of the historical origin， composition， main indications， dosage， processing， decocting method and other aspects of the prescription. The findings revealed that Zhishi Xiebai Guizhi Tang was composed of five medicinal herbs， namely， Aurantii Fructus Immaturus， Allii Macrostemonis Bulbus， Cinnamomi Ramulus， Magnoliae Officinalis Cortex， and Trichosanthis Fructus， with the function of activating Yang， dissipating mass， dispelling phlegm and lowering Qi. The prescription was mainly used to treat chest impediment， chest fullness， chest pain， wheezing， coughing and shortness of breath caused by suppressed Yang Qi， stagnant heart Qi， stagnant phlegm and stasis， and phlegm evil blocking heart， chest or lungs. Additionally， it was found that there were 70 modern literature recording the clinical applications of Zhishi Xiebai Guizhi Tang， and the main system diseases treated were circulatory system （51， 72.85%）， endocrine system （4， 5.7%）， respiratory system （9， 12.85%） and digestive system （6， 8.57%）， of which circulatory system is dominated by coronary heart disease （chest impediment in traditional Chinese medicine）. The involved medical syndrome types mainly included internal obstruction of phlegm heat and turbidity， obstruction of phlegm turbidity and stasis， congealing cold， phlegm， stasis and Qi stagnation， chest Yang depression and combined phlegm and stasis. Ancient medical records and modern clinical application are the keys to ensure the safety and effectiveness of famous classical prescriptions and compound preparations. Therefore， this paper sorted and mined ancient medical books of Zhishi Xiebai Guizhi Tang and statistically analyzed its modern clinical application， aiming to provide a literature reference for the research and development of new drugs and clinical application of the prescription.
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Objective:To systematically review and evaluate the effect of small-dose naloxone on the development of nausea and vomiting during postoperative analgesia with opioid drugs in patients.Methods:Electronic Databases including Pubmed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, and China Science and Technology Journal Database databases were searched from inception to May 2023 for randomized controlled trials involving the effect of small-dose naloxone on the development of adverse effects during postoperative analgesia with opioids. All randomized controlled trials enrolled included naloxone group and control group, the primary outcome was the incidence of postoperative nausea and vomiting, and the secondary outcome was postoperative VAS. Meta-analysis was performed using Stata 16.0 software.Results:Seven randomized controlled trials involving 542 patients were finally included in this meta-analysis. Compared with control group, the incidence of nausea and vomiting during postoperative analgesia was significantly decreased in naloxone group ( P<0.05), and no significant change was found in postoperative VAS scores ( P>0.05). Conclusions:Small-dose naloxone can reduce the development of nausea and vomiting during postoperative analgesia with opioid drugs.
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Objective To explore the protective effect and mechanism of endoplasmic reticulum stress(ERS)signaling pathway PERK/eIF2α/ATF4/CHOP on BRL-3A cell injury by serum containing Zhige oral solution.Methods ①Preparation of drug-containing serum:SD male rats were randomly divided into 3 groups:Zhige oral solution group,Metadoxine group and normal group,and were gavaged with Zhige oral solution,Metadoxine and saline respectively,and the drug-containing serum was prepared by blood sampling from the abdominal aorta for 5 consecutive days of intervention.②Normal BRL-3A cells were cultured,and the cell survival rate of each group was determined by CCK-8 after 24h of cell intervention with different concentrations of ethanol(1.0%,1.5%,2.0%,2.5%,3.0%,5.0%,7.0%,10.0%).③Cultured normal BRL-3A cells were divided into normal group,model group,metadoxine group,and Zhige oral solution low,medium and high dose group(later referred to as low dose group,medium dose group and high dose group),After 24 h,the levels of γ-glutamyl transpeptidase(GGT)and lactate dehydrogenase(LDH)in the supernatant of each group were measured,and the survival rate of BRL-3A cells was measured by CCK-8.The expression levels of PERK/eIF2α/ATF4/CHOP pathway-related mRNA and protein in each group were measured by Real-time PCR and Western blot.Results ①After 24 h of cell intervention with the same concentration of ethanol(1.0%,1.5%,2.0%,2.5%,3.0%,5.0%,7.0%,10.0%),the cell survival rate gradually decreased with the increase of ethanol concentration,and when the ethanol concentration was 5%,the cell survival rate decreased significantly(P<0.05),so the ethanol concentrations of 1.0%,1.5%,2.0%,2.5%,3.0%,5.0%were chosen for the subsequent experiments.②Compared with the normal group,the GGT and LDH contents in the supernatant of the model group were significantly higher(P<0.05),and the expression of PERK/eIF2α/ATF4/CHOP pathway-related factors mRNA and protein were significantly higher(P<0.05),showing a significant state of liver injury.③Compared with the model group,the Zhige oral solution group and the metadoxine group showed different degrees of reduction in the above indexes,with the most significant effect in the Zhige oral solution high-dose group(P<0.05).Conclusion Serum containing Zhige oral solution ameliorated ethanol-induced hepatocyte injury in BRL-3A rats,and the mechanism may be related to the inhibition of endoplasmic reticulum stress PERK/eIF2α/ATF4/CHOP signaling pathway.
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Objective:To analyze the clinical characteristics and predictive factors of SSc associated heart disease.Methods:The clinical data of patients with SSc from January 2016 to December 2021 in Ningbo Medical Center Lihuili Hospital were collected. Aight healthy controls come from the medicial examination center. They were divided into a positive group and a negative group based on whether heart involvement was present or not. The clinical manifestations of the two groups were compared by t test, Wilcoxon signed rank test and χ2 test and Logistic regression or ROC curve was used to analyze the prognostic risk of SSc associated heart disease. Then the transcriptome sequencing was used to analyze the differential gene expression. Results:①A total of 75 SSc patients were treated in our hospital, of which 6 patients with overlap syndrome and 1 patient with congenital heart disease were excluded. The clinical data of 68 patients were analyzed including 16 patients in the positive group and 52 patients in the negative group. Among the 16 patients with cardiac involvement, 12 patients (75.0%) had abnormal electrocardiogram, 9 patients (56.2%) with heart valve disease, 8 patients (50.0%) with abnormal cardiac structure and 8 patients (50.0%) with pericardial effusion. The biomarkers were elevated in 10 cases (83.3%). ②Univariate analysis showed that the positive group had a longer course of disease [120(11.2, 132) months vs 48(24, 90)months, Z=-2.08, P=0.037], and the rate of pulmonary arterial hypertension (50.0% vs 11.5%, χ2=11.07, P<0.001) and renal insufficiency(50.0% vs 3.8%, χ2=20.78, P<0.001) in the positive group were significantly higher than those in the negative group. Further Logistic regression analysis revealed that long course of disease [ OR (95% CI) =1.011 (1.001, 1.021), P=0.031], pulmonary arterial hypertension [ OR (95% CI) =5.431, 95% CI (1.065, 27.710), P=0.042] and renal insufficiency [ OR (95% CI) =30.444 (4.139, 223.938), P<0.001] were risk factors for SSc associated heart disease. ③Nail-fold videocapillaroscopy (NVC) was checked in 63 patients. The difference of abnormal NVC changes between the two groups was statistically significant (93.3% vs 58.3%, χ2=5.87, P=0.013). The total number of capillaries in the positive group was significantly less than that in the negative group [3.5(2, 4.8) vs 6 (5, 7), Z=-2.97, P=0.003]. Further ROC curve analysis showed that the total number of capillaries less than 4.5 predicted the occurrence of cardiac involvement (sensitivity was 80.0%, specificity was 83.8%), and the area under the ROC curve (95% CI) was 0.805 (0.061, 1.000, P=0.003).④The transcriptome of a total of 11 SSc patients (including 6 in the positive group and 5 in the negative group) and 8 healthy controls were analyzed to obtain the synchronously down regulated gene TNFRSF13B. The differences between the three groups were statistically significant ( χ2=11.88, P=0.003), especially in the positive group and the healthy controls( χ2=11.19, P=0.004). Conclusion:SSc patients with long course of disease accompanied by PAH and renal insufficiency are prone to have heart involvement. Early capillary endoscopy is also helpful to predict the risk of heart involvement. Moreover, TNFRSF13B genetic testing is helpful but further study is needed.
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Objective:To evaluate the effect of Activin-A on spinal inflammatory response in rats with incisional pain and the relationship with p38 mitogen-activated protein kinase (MAPK) signaling pathway.Methods:Forty-eight SPF healthy male Sprague-Dawley rats, aged 1 month, weighing 100-150 g, were divided into 4 groups ( n=12 each) by the random number table method: sham operation group (S group), incisional pain group (I group), sham operation + antagonist group (SA group) and incisional pain + antagonist group (IA group). The rat model of incisional pain was prepared in group I and group IA.At the first 30 min of model preparation, the antagonist follicle statin 5 μg/kg was intraperitoneally injected in SA and IA groups, and the normal saline 5 μg/kg was intraperitoneally injected in S and I groups.At 24 h before model preparation (T 0) and 2, 6 and 24 h after model preparation (T 1-3), 3 rats in each group were randomly selected to measure the thermal paw withdrawal latency (TWL). Then 3 rats in each group were randomly sacrificed, and the spinal cord L 4-6 segments were taken for determination of the expression of Activin-A and p38 MAPK mRNA (by quantitative real-time polymerase chain reaction) and contents of tumor necrosis factor-α (TNF-α) and interleukin (IL)-1β (by enzyme-linked immunosorbent assay). Results:Compared with group S, the TWL was significantly shortened, the contents of TNF-α and IL-1β were increased, and the expression of Activin-A and p38 MAPK mRNA was up-regulated at T 1-3 in I and IA groups ( P<0.05), and no significant change was found in each parameter in group SA ( P>0.05). Compared with group SA, the TWL was significantly shortened, the contents of TNF-α and IL-1β were increased, and the expression of Activin-A and p38 MAPK mRNA was up-regulated at T 1-3 in I and IA groups ( P<0.05). Compared with group I, the TWL was significantly prolonged, the contents of TNF-α and IL-1β were decreased, and the expression of Activin-A and p38 MAPK mRNA was down-regulated at T 1-3 in group IA ( P<0.05). Conclusions:Activin-A is involved in spinal inflammatory response through activating the p38 MAPK signaling pathway in rats with incisional pain.
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【Objective】 To explore the clinical effect of unilateral double-channel endoscope-assisted bone graft fusion and internal fixation (ULIF) in the treatment of recurrent lumbar disc herniation. 【Methods】 The clinical data of 22 patients with recurrent lumbar disc herniation treated by ULIF in our hospital from August 2020 to October 2020 were analyzed retrospectively. The study indicators included intraoperative blood loss, operation time, bed rest time, and hospital stay. The follow-up data included visual analogue score (VAS) of low back pain, Japanese Orthopaedic Association score (JOA), OSwestry disability index (ODI) score, as well as 36 concise health status survey (SF-36) scores before operation, and 1 week and 6 months after operation. 【Results】 The average operation time was (179.15±42.06) minutes, the average intraoperative blood loss was (132.67±41.92) mL, the average bed rest time was (1.51±0.42) days, and the average hospital stay was (4.82±1.13) days. The VAS score of low back pain at 1 week after operation was lower than that before operation (all P<0.000 1), and further decreased during the follow-up. The ODI score, JOA score and SF-36 score of postoperative follow-up were significantly different from those before operation (P<0.05). The satisfaction rate was 86.4% at 1 week after operation and 95.4% at 6 months after operation. The proportion of significant clinical efficacy at 1 week after operation and postoperative 6 months was 18.2% and 63.6%, respectively. 【Conclusion】 ULIF has the advantages of short-term recovery, less intraoperative blood loss, short bed rest and hospital stay, and good medium-term clinical effect. It is a safe and reliable minimally invasive technique for spinal surgeons in the treatment of recurrent lumbar disc herniation.
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Objective:To investigate the risk factors and prognosis of varicella zoster virus (VZV) infection in children with thalassemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:The clinical data of 446 children with thalassemia who underwent allo-HSCT from January 2012 to December 2020 in the Department of Hematology and Oncology, Shenzhen Children′s Hospital were retrospectively collected.The clinical features of the patients with VZV infection were analyzed.The patients were divided into different groups according to whether they had VZV infection.Categorical variables between groups were compared using the chi- square tests to investigate the risk factors that were associated with the development of VZV.Survival time was analyzed by the Kaplan-Meier method. Results:VZV incidence was 4.3% (19/446 cases), and the median onset time was 5 months (1.5-11.0 months) after allo-HSCT.Of the 19 cases with VZV infection, 5 cases were complicated with VZV encephalitis.All cases were treated with antiviral agents (Acyclovir alone, or both Acyclovir and Foscarnet), intravenous immunoglobulin and external use of Acyclovir ointment.After 7-28 days of treatment (median treatment time: 14 days), all of their herpes subsided, and the neurological symptoms of patients with VZV encephalitis disappeared.One of the 19 children died.The death was not directly caused by VZV infection, but by secondary graft dysfunction and severe pneumonia 5 months after VZV infection.The incidence of VZV infection following allo-HSCT in children with thalassemia was related to the age of the donor ( P=0.010), but not to the age of the patient ( P=0.378), gender ( P=0.653), disease grade of thalassemia ( P=0.912), type of the donor ( P=0.205), source of stem cells ( P=0.624) and acute graft versus host disease ( P=0.277). VZV infection had no significant effect on the prognosis of thalassemia children after allo-HSCT ( P=0.241). Conclusions:Thalassemia children with VZV infection after allo-HSCT are prone to be complicated with VZV encephalitis.Cord blood transplantation is a high risk factor.VZV infection may not have an impact on survival of children with thalassemia after allo-HSCT.
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Objective:To investigate the risk factors and prognosis of varicella zoster virus (VZV) infection in children with thalassemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:The clinical data of 446 children with thalassemia who underwent allo-HSCT from January 2012 to December 2020 in the Department of Hematology and Oncology, Shenzhen Children′s Hospital were retrospectively collected.The clinical features of the patients with VZV infection were analyzed.The patients were divided into different groups according to whether they had VZV infection.Categorical variables between groups were compared using the chi- square tests to investigate the risk factors that were associated with the development of VZV.Survival time was analyzed by the Kaplan-Meier method. Results:VZV incidence was 4.3% (19/446 cases), and the median onset time was 5 months (1.5-11.0 months) after allo-HSCT.Of the 19 cases with VZV infection, 5 cases were complicated with VZV encephalitis.All cases were treated with antiviral agents (Acyclovir alone, or both Acyclovir and Foscarnet), intravenous immunoglobulin and external use of Acyclovir ointment.After 7-28 days of treatment (median treatment time: 14 days), all of their herpes subsided, and the neurological symptoms of patients with VZV encephalitis disappeared.One of the 19 children died.The death was not directly caused by VZV infection, but by secondary graft dysfunction and severe pneumonia 5 months after VZV infection.The incidence of VZV infection following allo-HSCT in children with thalassemia was related to the age of the donor ( P=0.010), but not to the age of the patient ( P=0.378), gender ( P=0.653), disease grade of thalassemia ( P=0.912), type of the donor ( P=0.205), source of stem cells ( P=0.624) and acute graft versus host disease ( P=0.277). VZV infection had no significant effect on the prognosis of thalassemia children after allo-HSCT ( P=0.241). Conclusions:Thalassemia children with VZV infection after allo-HSCT are prone to be complicated with VZV encephalitis.Cord blood transplantation is a high risk factor.VZV infection may not have an impact on survival of children with thalassemia after allo-HSCT.
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Clinical data of a case of occult pulmonary actinomycosis with foreign body admitted to Shenzhen Children′s Hospital were retrospectively analyzed, and the relevant literatures were retrieved and reviewed.A female patient aged 6 years and 9 months planned to receive hematopoietic stem cell transplantation due to thalassemia.During the plain chest CT examination before the transplantation, flakes of shadows were examined in the right lower lung.The child had no clinical symptoms or pulmonary signs.The granulation tissue hyperplasia of the right lower lobe was detected by tracheoscopy, which was harvested for examination under tracheoscopy, and actinomycete infection was confirmed.Several bone fragments were found wrapped inside the granulation.After 6 months of treatment with Amoxicillin and Clavulanate potassium, the tracheoscopic manifestations and chest CT were improved.Pulmonary actinomycosis is a rare pulmonary infectious disease, which is much rarer in children than adults, manifesting as an insidious onset and atypical clinical manifestations.However, foreign bodies in children′s airway are common, which is favorable to infection.In clinical detection of actinomycete infection, the cause of infection should be concerned to prevent misdiagnosis and mistreatment.