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Objective:To explore intraoperative assessment of blood supply to the femoral head after femoral neck fracture, and the correlation between the blood supply and postoperative osteonecrosis of the femoral head.Methods:A retrospective analysis was performed of the 63 patients with femoral neck fracture who had been treated at Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University by open reduction and internal fixation with hollow compression screws from April 2016 to March 2021. They were 39 males and 24 females with an age of (44.9±13.6) years. There were 42 cases of Garden type Ⅲ and 21 cases of Garden type Ⅳ. Time from injury to operation was (4.1±2.4) days. After internal fixation, a hole was drilled using a 2.0 mm Kirschner wire at 2.0 cm above the femoral head-neck junction to observe the velocity, color, and characteristics of the blood oozing at the drill hole. The patients were divided into a good oozing group of 51 cases in whom bright red blood oozing was observed within 15 seconds after drilling and a poor oozing group of 12 cases in whom dark red blood oozing was observed beyond 15 seconds after drilling. The incidence of postoperative femoral head necrosis, Harris hip score, and visual analogue scale (VAS) for pain were compared between the 2 groups. Single factor and multi factor analyses were conducted using the Cox regression model to analyze the factors influencing postoperative femoral head necrosis in the patients.Results:The 63 patients were followed up for 24 (18, 36) months. The 2 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). Femoral head necrosis was observed in 3 cases in the good oozing group and in 5 cases in the poor oozing group, showing a significant difference between the 2 groups ( P<0.05). The Harris hip score [90.0 (86.0, 92.0)] and the VAS pain score [1.0 (1.0, 2.0)] at 1 year after surgery in the good oozing group were significantly better than those in the poor oozing group [85.5 (71.3, 88.8) and 2.5 (1.0, 3.8)] ( P<0.05). Multivariate Cox regression analysis showed that Garden type Ⅳ ( HR=6.784, 95% CI: 1.324 to 35.664, P=0.023) and intraoperative poor blood oozing ( HR=10.744, 95% CI: 2.359 to 51.774, P=0.003) were risk factors for femoral head necrosis after cannulated compression screw fixation of fractures of displaced femoral neck ( P<0.05). Conclusions:The blood supply to the femoral head after femoral neck fracture can be directly assessed by drilling a hole in the femoral head after open reduction and internal fixation. Intraoperative poor blood oozing is a risk factor for the femoral head necrosis after cannulated compression screw fixation of fractures of displaced femoral neck.
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Objective@#In view of the difficulty of the shortage of new coronavirus nucleal acid test in the early COVID-19 outbreak, to explore the application value of chest CT in screening COVID-19 patients.@*Methods@#Retrospective analysis was performed on the data of patients with fever who received chest CT and new coronavirus nucleal acid test during January 25, 2020 to February 2, 2020 in Zhongnan Hospital of Wuhan University. A total of 587 patients were enrolled, including 290 males and 297 females, aged from 11.0 to 96.0 (51.3±17.1) years old. Take the nucleic acid test results as the gold standard, the sensitivity, specificity and rate of missed diagnosis of CT screening COVID-19 were calculated.@*Results@#Among the 587 patients, there were 433 positive cases (73.8%, 433/587) and 154 negative cases (26.2%, 154/587) of novel coronavirus nucleic acid test. Using CT screening, 494 cases (84.2%, 494/587) were positive and 93 cases (15.8%, 93/587) were negative. The sensitivity of CT screening COVID-19 was 97.7% (423/433), specificity was 53.9% (83/154) and rate of missed diagnosis was 2.3% (10/433).@*Conclusions@#In the early COVID-19 outbreak, CT screening has the advantages of high sensitivity and low rate of missed diagnosis of COVID-19, which can compensate for the shortage of new coronavirus nucleal acid test and can be used as the basis for rapid screening for early prevention and control of COVID-19 outbreak.
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Medical information registration of rare disease cases serves as scientific basis for development of population intervention strategy, improvement of medical service system, better patient medical support level, and higher medicine accessibility. Based on their hospital work, the authors introduced the development practice of an all-dimensional management system for such information registration, in terms of formulating policies, establishing organizational structure, organizing and publicizing policies for the medical service of rare diseases, maintaining registration data and so on, so as to provide the reference for the management of registration work of rare diseases.
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Objective:In view of the shortage of new coronavirus nucleal acid test in the early COVID-19 outbreak, the application value of chest CT in screening COVID-19 patients was explored.Methods:Retrospective analysis was performed on the data of patients with fever who received chest CT and new coronavirus nucleal acid test during January 25, 2020 to February 2, 2020 in Zhongnan Hospital of Wuhan University. A total of 587 patients were enrolled, including 290 males and 297 females, aged from 11.0 to 96.0 (51.3±17.1) years old. Taking the nucleic acid test results as the gold standard, the sensitivity, specificity and rate of misdiagnosis of CT screening were calculated.Results:Among the 587 patients, there were 433 positive cases (73.8%, 433/587) and 154 negative cases (26.2%, 154/587) of novel coronavirus nucleic acid test. Using CT screening, 494 cases (84.2%, 494/587) were positive and 93 cases (15.8%, 93/587) were negative. The sensitivity of CT screening was 97.7% (423/433), specificity was 53.9% (83/154) and rate of misdiagnosis was 2.3% (10/433).Conclusions:In the early COVID-19 outbreak, CT screening has the advantages of high sensitivity and low rate of misdiagnosis, which can compensate for the shortage of new coronavirus nucleal acid test and can be used as a rapid screening for early prevention and control.
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Objective: To establish a GC method for the determination of borneol and camphor in Xingkening capsules. Methods:A capillary column using polyethylene glycol 20000 (PEG-20M) as the stationary phase (30 m×0. 53 mm,1 μm) was employed. The flow rate of carries gas (N2) was 3. 0 ml·min-1. The inlet temperature was 200℃, the temperature of flame ionization detector was 210℃, the column temperature was 140℃, and the split ratio was 1 ∶ 1. Results: The linear range of borneol was 13. 25-1 325. 19 μg·ml-1(r=0. 999 9), and the average recovery was 100. 22% with the RSD of 0. 92% (n=6). The linear range of camphor was 1. 029-16. 464 μg·ml-1(r=0. 997 5),and the average recovery was 98. 89% with the RSD of 2. 78% (n=6). Conclusion: The method is simple, accurate and reliable, which can be used for the quality control of borneol and camphor in Xingkening capsules.
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Objective: To establish the UPLC typical chromatogram and evaluate the quality of Jinji pills. Methods: The UPLC typi-cal chromatogram was performed on an Agilent proshell 120 C18column (150 mm×4. 6 mm,2. 7 μm) with gradient elution by the mobile phase of acetonitrile-0. 1% phosphoric acid aqueous solution system at a flow rate of 0. 8 ml·min-1. The detection wavelength was 240 nm. Results: The UPLC typical chromatogram included 15 common peaks when taking berberine hydrochloride as the reference peak, and 7 of them were identified by the comparison with the reference substances. Conclusion: The established methods have high specificity and good repeatability, and can be used for the quality control of the product.
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Objective To explore the effect of the use of flap transplantation combined with Masquelet tech-nique in the repair of long bone accompanied with soft tissue defect. Methods The retrospective study includes 16 cases of bone defects over 6.0 cm combined with soft tissue defect from March,2013 to March,2016,13 males and 3 females, of which the ages range from 16 to 65 years. The length of bone defect ranged from 6.0 to 12.0 cm, with an average of 8.5 cm,while the wound defect ranged from 5.2 cm×3.5 cm to 16.0 cm×7.5 cm. There were 8 cases out of 16 involve an infection:3 cases of Staphylococcus aureus(including 1 MRSA),2 cases of Staphylococcus epidermidis, 2 cases of Enterobacter cloacae, and 1 case of Acinetobacter baumannii. The 1 stage surgery in all patients admitted to hospital after complete debridement and external fixation, the clean wounds with bone defect received antibiotic-impregnated bone cement filling operation and a flap transplantation or transposition directly after the debridement, but the infected wounds received vacuum sealing drainage treatment firstly, associated with adequate use of antibi-otics for 1-2 weeks and then the bone cement filling and flap transplantation with infection totally controlled.After 8-12 weeks, we conducted the secondary internal fixation surgery replacing antibiotic-impregnated bone cement with autogenic cancellous bone, vancomycin artificial bone as well as rhBMP-2. All the cases were followed for 6 to 18 months. Results All patients with primary surgery are effectively controlled after 1-4 weeks of anti-infection treat-ment exclusive of the case with MRSA.As the condition of the patient with MRSA relapse,we changed to convention-al treatment: placed a continuous irrigation and suction equipment instead of the bone cement filling, the wound healed completely without fistula formation of osteomyelitis in 6 months after the treatment of Ilizarov technique. All transplantation and transposition flaps survived. As for those who received a secondary bone graft operation, all achieved a bony union in a period of 4-6 months. Conclusion The combination of flap transplantation and Masquelet technique is an effective method to repair limb long bone and soft tissue defect currently.
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Objective:To identify toddalolactone and establish the analysis method for Jinji tablets.Methods: An Hypersil DBS C18column(250 mm×4.6 mm,5 μm) was used. The mobile phase consisted of acetonitrile-0.1% phosphoric acid solution. The flow rate was 0.8 ml·min-1and the detection wavelength was at 330 nm. Toddalolactone was identified by an LC-MS method and the re-sult was compared with that of the reference regent.TLC and HPLC analytical methods were used for analysis of toddalolactone.Re-sults:Totally 58 batches of Jinji tablets were tested,and the suspected samples were confirmed by HPLC-MS/MS.Toddalolactone was detected out from 20 batches of samples. Conclusion:The method is simple,rapid and accurate, which is able to detect toddalolac-tone quickly and effectively.
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Objective To summarize the clinical experience of treating long bone defect with vascularized fibular graft.Methods From January,2008 to January,2015,31 cases of long bone defect were treated with vascularized fibula composite or not composite tissue flap graft.The length of transplanted fibula was 9-20 cm,and the flap area was 5 cm×3 cm to 21 cm×14 cm.All patients were followed up regularly.Limb function was assessed 12 months after surgery.Results Thirty-one cases of vascularized fibular flap survived after surgery.Thirty patients were followed up for 1.5 to 6 years (average,2.5 years).One patient was lost to follow-up.The bone defects of patients followed up were healed.There was one case fracture occurred for trauma,was treated with plaster cast for 6 months and healed.The transplanted fibular thickened for 1.3 to 2.5 years(average,1.6 years).Conclusion Vascularized fibular graft can reconstruct long bone defect for single use and shorten the duration of treatment with a good limb function.For cases combined soft tissue defect,vascularized fibula composite tissue flap can be applied to repair at the meantime.
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Objective:To establish an HPLC method for the determination of ginsenoside Rg1 ,ginsenoside Re and ginsenoside Rb1 in Xueluotong capsules. Methods:A column of Waters Symmetry C18 ( 250 mm × 4. 6 mm,5 μm) at the temperature of 35 ℃ was used to separate the target components, the mobile phase consisted of acetonitrile-water with gradient elution, the flow rate was 1. 0 ml ·min-1 , the detection wavelength was 203 nm and the injection volume was 10 μl. Results:The linear range of ginsenoside Rg1 was 0. 055-2. 732 μg(r=0. 9998), and the average recovery was 107. 23% with RSD of 1. 17%(n=6). The linear range of ginsenoside Re was 0. 341-8. 542 μg(r=0. 9999), and the average recovery was 101. 63% with RSD of 3. 52%(n=6). The linear range of gin-senoside Rb1 was 0. 717-14. 336 μg(r=0. 9997), and the average recovery was 100. 63% with the RSD of 3. 79%(n=6). Conclu-sion:The method is simple, accurate and reliable, which can be used for the quality control of Xueluotong capsules.
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Objective:To analyze the osmotic pressure of citicoline sodium injection from different manufacturers to provide experi-mental basis for improving the national standard of the product. Methods:The cryoscopic method was used to detect the osmotic pres-sure of 479 batches of citicoline sodium injection from 45 pharmaceutical factories. Results:The osmotic pressure of citicoline sodium injection was within the range of 359-692 mOsmol · kg-1 , that of citicoline sodium for injection was within the range of 401-1408 mOsmol·kg-1 , and that of citicoline sodium chloride injection was within the range of 278-299 mOsmol·kg-1 . Conclusion:The os-motic pressure of citicoline sodium injection and citicoline sodium for injection from different manufacturers is obviously different. It is necessary to detect osmotic pressure in the quality standard in order to evaluate the quality of preparation process.
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Objective To further understand the clinical manifestations and improve clinical diagnosis of patients with leptomeningeal metastasizing high-grade glioma.Methods Sixteen patients with leptomeningeal metastasizing high-grade glioma (WHO classification:grade Ⅲ-Ⅳ) in Department of Radiotherapy,the First Hospital of Jilin University from July 2010 to September 2015 were respectively analyzed.The pathological types included anaplastic gliomas (1),anaplastic oligodenastrocytoma (1),glioblastoma (12),small-cell glioblastoma (1),gliosarcoma (1).We reviewed the relative clinical manifestations of the patients,and further compared them with 163 patients with systemic malignant solid tumors at corresponding period.Results The median time from initial diagnosis to the diagnosis of leptomeningeal metastasis was 13.0 months (range 2-19 months).Plain and enhanced magnetic resonance imaging was obtained in all patients.The main radiographic characteristics included ependymal enhancement (11),leptomeningeal enhancement (3),nodules of implantation metastasis in spinal canal (1),cranial nerve enhancement (2),and ventricular dilatation (1).Eight patients received cerebrospinal fluid examination.The diagnosis of leptomeningeal metastasis in 15/16 patients was determined by radiographic findings.Comparing with leptomeningeal metastasis from systemic malignant tumors at the corresponding period,the incidence of headache in patients with high-grade glioma was significantly lower (6/16 vs 81.6％ (133/163);x2 =16.3,P ＜ 0.01);and the incidence of cranial nerve paralysis was also significantly lower (4/16 vs 56.4％ (92/163);x2 =5.79,P =0.016 1).The incidence of nerve root symptoms was lower than that of systemic malignant tumors,though without statistically significant difference (2/16 vs 26.4％ (43/163);x2 =1.49,P=0.222).Nine patients respectively received chemotherapy,intrathecal chemotherapy or intrathecal chemotherapy combined with whole brain radiotherapy.The median survival tine was 4.5 months (range 0.7-13.3 months).Conclusions The imaging examination played an important role in the diagnosis of high-grade leptomeningeal metastasizing glioma.Comparing with the systemic malignant solid tumors,the leptomeningeal metastasizing high-grade glioma had its unique clinical characteristics.
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Objective:To establish a quantitative method for the determination of lysine hydrochloride in pediatric compound lysine granules. Methods:The quantitative determination was performed on an amino acids analyzer. The cationic resin column(150 mm × 4. 6 mm,7 μm)was used. The mobile phase was citrate buffer solution (pH 3. 45) and citrate buffer solution (pH 10. 85) with gradient elution at a flow rate of 0. 45 ml·min-1 . The detection wavelengths were set at 570 nm and 440 nm. Results:The linear range of lysine hydrochloride was 2. 692-21. 536 μg·ml-1(r=0. 999 5), and the average sample recovery was 98. 85% with RSD of 0. 63% (n=9). Conclusion:The method is sensitive, simple and reproducible. It can be used for the quality control of pediatric compound lysine gran-ules.
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Objective To improve the understanding of leptomeningeal metastasis (LM),we analyzed the data of clinical manifestations,imaging findings and cytological analysis of cerebrospinal fluid (CSF) in a group of patients with LM of malignant solid tumors.Methods The clinical data of 94 patients with LM of malignant solid tumors between 2009 and 2014 in our hospital were retrospectively analyzed.We compared the clinical manifestations and auxiliary examinations of patients with different pathological types of LM.The Chi-square test was used to compare the results.Results The pathological types included adenocarcinoma (61),small cell carcinoma (24),squamous carcinoma (6),melanoma (1),large-cell carcinoma (1),and hepatocellular carcinoma (1).The median age was 58 (37-75) and the median KPS score was 40 (10-80).About 98.9％ (93/94) patients had neurologic symptoms.Neuroimaging examination was performed in 84 patients,with the sensitivity of 88.1％ (74/84);cytological analysis of CSF was performed in 85 patients,with the sensitivity of 88.2％ (75/85);while CSF biochemical examination was performed in 85 patients,with the sensitivity of 90.6％ (77/85).The sensitivity of cytology in adenocarcinoma (96.6％,56/58) was higher than those in small cell carcinoma (80％,16/20;P =0.056).The sensitivity of neuroimaging in small cell carcinoma (95.8％,23/24) was higher than that in adenocarcinoma (83.3％,45/52;P =0.409).However,the sensitivity of cytology (1/5) and neuroimaging (4/6) in squamous carcinoma was low,which led to the need of comprehensive analysis for the diagnosis.The incidence of headache,spinal nerve-related symptoms,ependymal enhancement and metastatic nodules of lumbosacral intraspinal in adenocarcinoma and small cell carcinoma showed statistically significant difference,which was 88.5％ (54/61) and 29.2％ (7/24;P ＜ 0.01),18.0％ (11/61) and 45.8％ (11/24;P =0.008),2/6 and 25.0％ (6/24;P=0.017),1.9％ (1/61)and50.0％ (12/24;P ＜ 0.01),respectively.Conclusions Neuroimaging and CSF examination are still the key points for the diagnosis of LM of malignant solid tumors.The clinical manifestations are correlated with pathological types of primary tumor.
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Purpose Protein is the main influencing factors for diffusion weighted imaging (DWI) signals and apparent diffusion coefficient (ADC), it results in hyperintensity on DWI and low ADC, but not fully matched in clinic. This paper aims to investigate the effect of protein type and concentration on the signal intensity (SI) and ADC of DWI. Materials and Methods Different concentrations of albumin, globulin solution and the mixed solution were created in vitro. DWI was performed on GE 1.5T superconducting nuclear MRI system. Results ① There was a linear negative correlation between the ADC value and the concentrations of protein solution (at 37℃, ra= - 0.849, Pa0.05; at 40℃ , r= - 0.270, P>0.05). ② SI of the albumin solution was significantly higher than the globulin solution at the same concentration and temperature (t=3.96, P0.05). Conclusion The nature of the cystic fluid can be understood preliminarily through quantitative analysis of the cystic fluid DWI and ADC values, so as to provide theoretical basis for the qualitative diagnosis of cystic lesions in vivo.
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Talus necrosis is difficult to cure in clinical practice and how to treat it remains con-troversy.Microsurgical methods provide a new path for curing the disease and good curative effects have been achieved according to the literature.This article reviewed microsurgical treatments for talus necrosis in recent years and it may provide references for clinical practice.
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BACKGROUND:The severity of tissue injury varies with the causes of the amputated finger. Simple soft tissue, vessels or nerves injury could be easily repaired by adjacent finger flap or abdominal flaps. However, these treatments are short of long repair time, reoperation and unsatisfactory appearance of the finger. OBJECTIVE:To investigate the efficiency of Flow-through flap from the fibular side of great toe to repair skin and soft tissue defects in digital replantation. METHODS:From January 2011 to October 2013, Flow-through flap from the fibular side of great toe was applied to repair soft tissue injury in digital replantation for 11 cases (8 males and 3 females, age ranged from 23 to 42 years. Skin defects ranged from 2.0 cm ×1.5 cm to 4.0 cm×2.2 cm; vascular defect ranged from 1-3 cm, 1.5 cm averagely; and the flap size ranged from 2.2 cm×1.7 cm to 4.5 cm×2.5 cm. RESULTS AND CONCLUSION:The folow-up time of al patients was 6-18 months. Digital replantation was successful in al the 11 cases. Ten cases were healed by first intention, and one case was gradualy rescued after dressing change. Patients were satisfied with the flap and the peripheral sensation. The peripheral discrimination of patients was 4 to 10 mm. The fingers functioned wel in flexion and extension. Of the 11 cases, 9 cases were valued excelent and 2 cases was rated as good, according to the upper extremity function evaluation standard of the Hand Surgey Branch of Chinese Medical Association. Flow-through flap from the fibular side of great toe is an ideal method to repair skin soft tissue and vascular defects in digital replantation.
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Objective To investigate the value of application of magnetic resonance imaging (MRI) in diagnosis and treatment of leptomeningeal metastases from malignant solid tumors.Methods A retrospective analysis was conducted depend on the radiological data of 63 patients who had been diagnosed as leptomeningcal metastasis of malignant solid tumors.Results All patients received brain MRI examination.26 patients underwent cervical or lumbar spine MRI examination.The MRI images showed nodular enhancement in the gyri and sulci,leptomeningeal linear enhancement,dura mater thickening and enhancement,ependymal enhancement,intraventricular metastasis,intraspinal metastatic nodules,communicating hydrocephalus,subdural hydroma and negative imaging.Ncuroimages of ependymal enhancenent,intraventricular metastasis and intraspinal implantation metastasis appeared in 5,7 and 9 patients with small cell carcinoma,respectively,which were higher than that of the other pathological types (P =0.002,P =0.009,P ＜ 0.000 1).Seizure occurred in 7 patients after intrathecal chemotherapy,of which 5 patients had pia mater linear enhancement.Among 33 patients treated with radiotherapy combined with intrathecal chemotherapy,3 patients had poor prognosis,of which 2 patients had negative imaging findings.The conditions of 25 patients were improved obviously after treatment,of which 21 patients showed different imaging remission in MRI re-examination.Conclusions The contrast MRI has an important assistant effect in diagnosis of leptomeningeal metastasis of malignant solid tumors.The MRI findings and clinical features are related with the pathological types.The pia mater linear enhancement indicates a high possibility of seizures after inthathecal chemotherapy,and it suggests that the preventive treatment should be given for such patients.MRI is not applicable to evaluate severity,prognosis and curative effect of the disease.
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Objective To investigate the correlation between BMI and insulin dose in diabetic patients after short-term continuous subcutaneous insulin infusion (CSII). Methods Three hundred patients with type 2 diabetes mellitus (T2DM) were enrolled and randomized into the normal weight (BMI < 23 kg/m2) group, overweight (BMI 23 ~ 25 kg/m2) group and obesity (BMI≥25 kg/m2) group. The metabolic and anthropometric parameters of each group were compared and the related factors which may influence insulin dose were analyzed. Results The insulin dose per weight in the overweight group or in the obesity groups was significantly lower than that in the normal weight group. Weight and BMI were negatively correlated with the insulin dose per weigh. Conclusions Differences of glycemia level , β-cell function and insulin resistance exist in Chinese type 2 diabetes patients with different BMI. The stratification of BMI should be considered before estimating the insulin dose by body weight in CSII therapy.
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Objective To compare the planning quality and acute toxicity between RapidArc and fixed gantry angle dynamic intensity modulated radiotherapy (IMRT) in the postoperative radiotherapy for cervical cancer patients.Methods All 35 patients with cervical cancer who had received postoperative radiotherapy were studied,including 17 patients with RapidArc and 18 patients with IMRT.All plans were prescribed 50 Gy in 25 fractions.The dose-volume histogram data,the conformity index and homogeneity index of the targets,the monitor units (MUs) and delivery time were compared.During the treatment,the incidence of acute intestinal and bladder side effects were also compared.Results Compared to IMRT,the conformity index of RapidArc was better(t =3.13,P ＜ 0.05),but the homogeneity index was slightly worse (t =-4.25,P ＜ 0.05).The V20 and V30 of femoral head planned by RapidArc was significantly lower than that by IMRT (t =2.56,2.34,P ＜ 0.05).The mean MU for RapidArc was reduced by 52.1％ compared with IMRT.The mean treatment time for RapidArc was decreased by 46.8％ compared with IMRT.There was no difference in the incidence of acute intestinal and bladder toxicity between the two groups.Conclusion For patients with cervical cancer who need prophylactic postoperative radiotherapy,both RapidArc and IMRT plan can achieve equal target coverage and organs at risk(OAR) sparing.There is no significant difference in dosimetric parameters and acute toxicity between the two groups.Compared with IMRT,RapidArc plan has fewer MUs and less treatment time and significantly improves the treatment efficiency.