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Objective:To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on behavioral and psychological symptoms and quality of life in patients with mild to moderate Alzheimer disease (AD).Methods:Forty mild and moderate patients who met the diagnostic criteria of AD in the tenth edition of the International Classification of Diseases from May 2017 to December 2018 in the Seventh People′s Hospital of Wenzhou City were selected and divided into the control group (20 cases) and the rTMS group (20 cases) according to random number list. The control group was treated with basic treatment while the rTMS group was treated with rTMS on the basis of the basic treatment. The scores of AD assessment scale-cognitive section (ADAS-cog), mini mental state examination (MMSE), neuropsychiatric inventory (NPI), activity daily living (ADL), and quality of life in AD (QOL-AD) were observed and compared between the two groups before and after treatment.Results:There were no significant differences in ADAS-cog, MMSE, NPI, ADL, and QOL-AD scores between the rTMS group and the control group before treatment ( P>0.05). After treatment, the MMSE, ADL, and QOL-AD scores of the rTMS group were significantly higher than those of the control group: (22.80 ± 3.83) scores vs.(20.30 ± 5.49) scores, (63.05 ± 17.24) scores vs. (54.15 ± 9.20) scpres, (37.55 ± 7.94) scores vs. (31.00 ± 11.45) scores; the ADAS-cog and NPI scores were significantly lower: (18.45 ± 4.16) scores vs.(22.15 ± 5.01) scores, (57.2 ± 16.25) scores vs. (72.65 ± 39.37) scores, (27.15 ± 7.53) scores vs. (34.65 ± 14.91) scores, and there were significantly differences ( P<0.05). At the same time, the MMSE, ADL, and QOL-AD scores of the rTMS group were significantly higher than those before treatment, the ADAS-cog and NPI scores were significantly lower, and the difference was statistically significant ( P<0.05). Conclusions:rTMS can effectively improve the behavioral and psychological symptoms of patients with mild to moderate AD and significantly improve the quality of life.
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BACKGROUND:Avulsion fractures of the tibial attachment of the posterior cruciate ligament have been repaired using open reduction and rivet fixation, hol ow screw fixation, or arthroscopic reconstruction of the posterior cruciate ligament. These methods ignore the importance of early tension reconstruction of the posterior cruciate ligament, so their efficacies are uncertain. Determining the optimal fixation method and how best to restore knee stability remain controversial. OBJECTIVE:To observe the stability of new bone fixation plate for the repair of avulsion fracture of the tibial attachment of the posterior cruciate ligament. METHODS/DESIGN:We wil conduct a prospective, single-center, self-control ed, clinical trial at the Cangzhou Central Hospital, Hebei Province, China. Fracture fragments and the injured posterior cruciate ligament wil be exposed in 20 patients with avulsion fracture of the tibial attachment of the posterior cruciate ligament through a posterior approach and open reduction. The posterior cruciate ligament wil be reconstructed with a new type of bone plate. Al patients wil be fol owed for 3 and 12 months. Primary outcome:The Hospital for Special Surgery knee score wil be used to evaluate knee function preoperatively and 3 and 12 months postoperatively. Secondary outcomes:Lysholm Knee Scoring Scale, X-ray, computed tomography, and magnetic resonance imaging wil be used to assess knee morphology preoperatively and 3 and 12 months postoperatively. Patient satisfaction wil also be assessed at 3 and 12 months postoperatively. The study protaol was registered at clinicaltrials.gov.NCT03059368. The study protocol has been approved by the Ethics Committee of Cangzhou Central Hospital of China. Al protocols wil be conducted in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent wil be provided by al participants. DISCUSSION:This trial wil evaluate a newly-designed plate fixation device for early tension reconstruction of the posterior cruciate ligament to repair avulsion fractures of the tibial attachment of the posterior cruciate ligament and restore knee stability. This trial wil verify the plate's efficacy, provide an experimental basis for treating avulsion fractures of the tibial attachment of the posterior cruciate ligament, and provide a method of maximizing knee stability.
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BACKGROUND:Dynamic hip screws have been considered as a classic method for intertrochanteric fracture. However, migration of the hip screw resulting in cut-out of the femoral head remains the most common mechanical failure, which requires secondary surgery. OBJECTIVE:On the basis of the traditional dynamic hip screw, we modified the lag screw, designed new internal fixation system as cemented dynamic hip screws to explore the feasibility and the biomechanical properties for the treatment of osteoporotic intertrochanteric fracture. METHODS:A total of 24 hip samples were harvested from fresh cadavers with osteoporosis. Bone density was measured. According to the standards, the specimens were made into intertrochanteric fracture models of AO31-A1 type. Of each specimen, one side implanted with cemented dynamic hip screws served as experimental group, and another side implanted with traditional dynamic hip screw served as control group. Axial compression, twisting and fatigue load biomechanics were tested. Their biomechanical functions were compared. RESULTS AND CONCLUSION:Stress intensity, axial stiffness and horizontal shear stiffness were higher in the experimental group than in the control group (P<0.05). At torsion angle of 3°, torsional moment was higher in the experimental group than in the control group (P<0.05). Fatigue load was higher in the experimental group than in the control group (P<0.05). Results suggested that cemented dynamic hip screw internal fixation system in the treatment of senile osteoporotic intertrochanteric fracture can effectively enhance the hip screw holding force and prevent femoral cutting. Biomechanical property, stiffness, endurance resistance and stability of cemented dynamic hip screw are better than traditional dynamic hip screw.
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Objective To discuss the clinical significance of internal fixation through anterolaterel and posteromedial approaches in the treatment of closed sagittal Pilon fractures of Topliss classification and compare the effects of the two approaches.Methods The study involved 57 patients with closed sagittal Pilon fractures treated with open reduction and internal fixation from 2007 to 2010,including 29 patients treated through anterolateral approach (Group A) and 28 through posteromedial approach (Group B).All patients were with closed fractures,and all surgery time windows were 10-19 days.The two groups were compared in aspects of gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window,operation time,intra-operative blood loss,ambulation time,infection and necrosis rate of skin and soft tissue,length of stay,ankle joint function recovery after internal fixation,and intra-operative X-ray reduction.Results All patients were followed up for 12-26 months (mean,20 months) except for one patient in the Group A,with total follow-up rate of 98％.The two groups showed no significant differences regarding the gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window selection,operation time,intra-operative blood loss,and ambulation time (P ＞0.05).While,the infection and necrosis incidence of skin and soft tissue,and the hospital stay we re significantly lower and shorter in the Group A than that in the Group B (P ＜ 0.05 ).Two patients in the Group A were complicated with toe extensor tendon adhesion,which was released by removing the fixation.Fifteen patients had wound infection during hospitalization,including three patients in the Group A and 12 in the Group B,but they were all cured after treatments like dressing.Fifteen patients were treated with stage Ⅰ allogeneic bone graft and 11 with autologous iliac bone graft.All the patients obtained bone union.Conclusions Topliss classification of closed sagittal Pilon fractures has clear clinical significance in surgical plan selection and operative procedures.Both of the anterolateral and posteromedial approaches can achieve good effects in the treatment of closed sagittal Pilon fractures due to high energy injury.However,the anterolateral approach is relatively a better choice,for it brings in a lower incidence of infection and necrosis of skin and soft tissue and a shorter length of hospital stay.