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Objective:To investigate the efficacy of Compound Musk combined with nimodipine combined with minimally invasive surgery in the treatment of hypertensive cerebral hemorrhage and the effects on serum inflammation, stress and apoptosis.Methods:Prospective research methods was used. A total of 118 patients with hypertensive intracerebral hemorrhage who received treatment in the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from March 2017 to January 2021 were randomly divided into control group and Compound Musk group (59 cases in each group). After minimally invasive surgery, patients in the control group were treated with nimodipine on the basis of conventional treatment, while patients in the Compound Musk group were treated with compound musk on the basis of the control group. After 2 weeks, the efficacy was evaluated and the levels of serum inflammatory indexes, oxidative stress indexes and apoptosis indexes were measured.Results:The total effective rate in Compound Musk group was higher than that in control group: 98.3% (58/59) vs. 88.1% (52/59), and the difference was statistically significant ( P<0.05). After 2 weeks of treatment, serum inflammatory indexes including nuclear factor-κB (NF-κB), interleukin-1β (IL-1β), matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-9 (MMP-9); apoptosis indexes including soluble Fas receptor (sFas), soluble Fas ligand (sFAS-L); oxidative stress indexes including advanced oxidation protein products (AOPP), malondialdehyde (MDA) decreased, and some oxidative stress indexes including glutathione peroxidase (GSH-Px), catalase (CAT) increased. The levels of the above inflammatory indexes, apoptosis indexes and oxidative stress indexes in Compound Musk group were lower than those in control group, NF-κB: (18.96 ± 2.17) ng/L vs. (24.10 ± 3.23) ng/L, IL-1β: (12.88 ± 1.74) ng/L vs. (15.19 ± 1.63) ng/L, MMP-3: (5.62 ± 0.95) ng/L vs. (7.97 ± 0.86) ng/L, MMP-9: (7.07 ± 0.86) ng/L vs. (9.26 ± 1.13) ng/L, sFas: (3.24 ± 0.38) μg/L vs. (4.19 ± 0.53) μg/L, sFas-L: (209.17 ± 24.39) ng/L vs. (288.54 ± 37.61) ng/L, AOPP: (10.76 ± 1.84) μg/L vs. (13.51 ± 2.09) μg/L, MDA: (2.87 ± 0.32) μmol/L vs. (3.45 ± 0.34) μmol/L, and the differences were statistically significant ( P<0.05). Some of the above oxidative stress indexes were higher than those in control group, GSH-Px: (3 274.91 ± 376.09) U/L vs. (2 854.19 ± 325.22) U/L, CAT: (60.82 ± 7.43) U/L vs. (52.17 ± 6.48) U/L, the differences were statistically significant ( P<0.05). During treatment, there was no significant difference in the incidence of rash, diarrhea, drug-induced liver and myocardial injury between two groups ( P>0.05). Conclusions:Compound Musk has a positive effect on improving the curative effect and internal environment of patients with hypertensive intracerebral hemorrhage after minimally invasive surgery, and will not increase the occurrence of serious adverse reactions.
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Tongxie Yaofang， also known as Baizhu Shaoyaosan， was first recorded in Danxi's Experiential Therapy （《丹溪心法》） by ZHU Danxi in the Yuan dynasty. It is composed of Atractylodis Macrocephalae Rhizoma， Paeoniae Radix Alba， Citri Reticulatae Pericarpium， and Saposhnikoviae Radix， and serves as the representative prescription for the treatment of painful diarrhea. It has the functions of tonifying the spleen， emolliating the liver， relieving pain， and checking diarrhea， and is mainly used in the treatment of gastrointestinal diseases such as irritable bowel syndrome （IBS） and ulcerative colitis （UC）. In addition， it is effective in treating gastrointestinal disorders with mental and psychological abnormalities， as well as obstinate anorexia in children， depression syndrome， and respiratory diseases. Experimental research and clinical practice have shown that Tongxie Yaofang has multi-component， multi-pathway， and multi-target characteristics in the treatment of diseases. The mechanism of Tongxie Yaofang in treating diseases is mainly attributed to anti-inflammation， immune function regulation， intestinal hypersensitivity improvement， emotion regulation， etc. Monoterpene glycosides， flavonoids， chromones， lactones， and other components contained play an important therapeutic role. The research on the systems biology of Tongxie Yaofang， such as metabolomics， proteomics， and network pharmacology， provides a scientific basis for clarifying its mechanism of action and expanding its clinical application. However， there are still some problems to be solved， such as difficulty in combining diseases and syndromes and lack of in-depth systematic research. Through the retrieval and collation of relevant literature， this paper systematically reviewed the material basis， pharmacological effects， and systems biology research of Tongxie Yaofang， aiming to lay a foundation for in-depth research on its mechanism in treating diseases and rational application in clinical practice.
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Zuojinwan is a classic Chinese medicine prescription recorded in the Danxi's Experiential Therapy， with Coptidis Rhizoma and Euodiae Fructus in a ratio of 6 ∶ 1. It can treat symptoms such as liver fire hypochondriac pain， stomach duct pain， vomiting， and acid swallowing. There are many pharmacological studies on Zuojinwan in modern times， especially in the digestive tract， but the prescription also has its unique effect on digestive tract cancer， and its anti-tumor studies mainly focus on colorectal cancer and gastric cancer. Colorectal cancer is the third most common type of cancer in the world and the second deadliest malignancy. At present， a number of studies have shown that the basic pharmacological studies of anti-colorectal cancer by Zuojinwan include the proliferation， apoptosis， invasion， energy metabolism， epigenetics， and drug resistance of colorectal cancer. Alkaloids are the main active ingredients of Zuojinwan， such as berberine， evodiamine， coptisine， palmatine， and rutaecarpine. Compared with the effect of Zuojinwan on colorectal cancer， studies on the effect of berberine and evodiamine on tumor angiogenesis， tumor-promoting inflammation， and intestinal flora are carried out， except the studies on the resistance of berberine and the effect of evodiamine on energy metabolism. In addition， coptisine， palmatine， and rutaecarpine can regulate the proliferation， apoptosis， and metastasis of colorectal cancer cells， the proliferation and apoptosis of colorectal cancer cells， tumor-promoting inflammatory response， and the proliferation， migration， and invasion of colorectal cancer cells， respectively. Moreover， other studies have shown that the combination of berberine and evodiamine can have a synergistic effect on the growth， migration， and invasion of colorectal cancer cells and can reduce the cardiac toxicity induced by evodiamine. Therefore， this paper summarizes the studies on the anti-colorectal cancer mechanism of Zuojinwan and its main monomer components in recent years， so as to provide a theoretical basis for future clinical research and development of new high-efficiency and low-toxicity anti-colorectal cancer drugs and lay a solid foundation for clinical practice.
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Objective:To investigate the appropriate pretreatment methods for single cell RNA sequencing of airway aspirate cells.Methods:Four fresh airway aspirate specimens were collected from four patients with acute respiratory tract infections. These specimens were digested with airway aspirate digester and prepared into single cell suspension. The cells were used for library construction directly (DE), or fixed with 10×Genomics Chromium Next GEM Single Cell Fixed RNA Sample Preparation Kit and then mixed to construct the library (DF), or cryopreserved, thawed, fixed (FF) before mixed to construct the library. All three methods were treated with oil emulsion using 10 4 cells and subjected to single-cell sequencing using the 10×Genomics platform. The number of obtained cells, data quality, annotated cell types and expression of marker genes were analyzed. Differences in the expression of highly variable genes (HVGs) of the same cell subsets obtained by the three pretreatment methods were compared using Pearson correlation. Expression of the differentially expressed genes in the same cell subpopulation obtained by different pretreatment methods was also compared. The correlation of the expression of differentially expressed genes between the same cell subsets obtained by the three pretreatment methods was analyzed by Pearson correlation. Results:The median numbers of single cells obtained using DE, FF and DF methods were 2 733, 1 140 and 5 897 ( P>0.05). The unique molecular identifiers were higher than 500. The median numbers of genes obtained using the three methods were 801, 887 and 1 259 ( P>0.05). The cells with novelty score over 0.8 accounted for 99%, 87% and 93%, respectively. There were nine cell subsets obtained by the three methods, including squamous cells, secretory cells, ciliated cells, T cells, B cells, macrophages, plasma cells and neutrophils. DF and FF methods could obtain more basal cells with specific high expression of keratin 5 than DE method. The differentially expressed and highly variable genes in the same cell subsets obtained by the three pretreatment methods showed high consistency in their expression with a significant correlation ( P<0.001). Conclusions:Under the same sequencing data volume, the quality of data obtained from fixed airway aspirate single-cell suspensions using the method of probe hybridization and transcriptome sequencing was comparable to that obtained directly from fresh cells. This method was more suitable for the pretreatment of clinical samples used for single-cell RNA sequencing.
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Objective:To investigate the alterations of amplitude of low frequency fluctuation (ALFF) and functional connectivity (FC) in patients with Parkinson′s disease (PD) with apathy.Methods:From May 2016 to August 2019, PD patients and age-, gender-and education level-matched healthy controls (HC) in the First Affiliated Hospital of Nanjing Medical University were prospectively recruited. The clinical and resting-state functional MRI (rs-fMRI) data of PD patients and HC were analyzed. According to the Starkstein Apathy Scale (SAS) scores, PD patients were divided into PD with apathy (PD-A) group and PD without apathy (PD-NA) group. Rs-fMRI images were processed by DPABI based on MATLAB. ALFF values were calculated and the standard ALFF (zALFF) were obtained. ANOVA and Post-Hoc t test were performed to compare the differences in local brain activity among the three groups. The brain regions with significant different zALFF values were selected as the seeds to calculate the FC values of the whole brain. The associations between FC values and the SAS scores were performed using pearson correlation analyses. Results:A total of 75 PD patients (50 males, 25 females, aged from 44 to 88 years) and 41 HC (25 males, 16 females, aged from 54 to 72 years) were enrolled. There were 42 patients in the PD-A group and 33 patients in the PD-NA group. Significant differences were found in zALFF values among the PD-A, PD-NA and HC groups ( P<0.05). After Post-Hoc t test, compared with the HC group, zALFF values were significantly increased in the right middle frontal gyrus in the PD-A group ( P<0.05) and significantly decreased in the left precuneus in the PD-NA group; The zALFF values of the right middle frontal gyrus and left precuneus in the PD-A group were significantly higher than those in PD-NA group ( P<0.05). Brain regions with different zALFF values were used as seeds for whole-brain FC. Compared with PD-NA group, FC values between the right middle frontal gyrus and bilateral precuneus, left superior frontal gyrus and its medial side, left middle frontal gyrus, left angular, left anterior cingulate gyrus, left posterior cingulate gyrus, left parahippocampal gyrus were significantly decreased in the PD-A group ( P<0.05). Additionally, FC values of PD patients between the right middle frontal gyrus with the left precuneus, the left superior frontal gyrus and its medial side, and the left middle frontal gyrus were negatively correlated with SAS scores ( r=-0.31, -0.30 and -0.34, both P<0.05). Conclusion:PD-A and PD-NA patients have different brain functional activities and connections in the frontal lobe, parietal lobe and limbic system, suggesting that apathy in PD may be associated with the abnormal functional connections of the frontal-parietal cortical circuit and the frontal-limbic-striatal loop.
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Objective:To investigate the CT characteristics of bronchiolar adenoma (BA) in order to improve the understanding of the disease and to increase the accuracy of preoperative diagnosis.Methods:The clinical, imaging and pathological data of 69 patients with BA confirmed by surgical resection and pathology at Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences from December 2018 to November 2020 were retrospectively reviewed. The type, the location and the size of the lesions, the distance from the lesion to the adjacent pleura, as well as the morphological characteristics including lobulation, spiculation, bubble lucency and pleural indentation were analyzed and recorded. The follow-up CT data were also reviewed.Results:Among 69 BAs, pre-operation chest CT displayed visible lesion in 25 cases, and showed negative in 44 cases. According to the lesion density, the 25 BAs on CT images were classified into solid type ( n=8), ground-glass type ( n=8), cystic type ( n=6) and cyst type ( n=3). There were 15 lesions in the right lung (1 in the upper, 2 in the middle and 12 in the lower lobe) and 10 lesions in the left lung (5 in the upper and 5 in the lower lobe). Ten lesions were found adjacent to the pleura. As for the other 15 cases, the distance between the lesion and the adjacent pleura was (10±7) mm. Calcification was displayed in one cystic type BA case. The maximum diameter of 25 BAs were 4.4-30.3 mm, with the median value of 9.6 mm. The lobulation, spiculation, bubble lucency, and pleural indentation of lesions were detected in 20, 11, 12, and 6 cases. In total there were 11 patients received the preoperative follow-up CT, and 4 cases showed enlargement in diameter (including 2 cases of solid type, 1 of ground-glass type and 1 of cystic type). The growth rate was 0.43-2.14 mm/year, with the median value of 1.67 mm/year. Imaging signs including spiculation ( n=1), bubble lucency ( n=1) and lobulation ( n=1) were newly discovered on the preoperative follow-up CT. Postoperative follow-up CT was performed in 13 cases, without any recurrence or metastasis found. Conclusions:CT imaging features of BA usually display as a single pulmonary solid or ground-glass nodule, and also can be presented as cystic or cyst type in several cases. Lesions can appear the lobulation, spiculation and bubble lucency, with calcification rarely found. A few of BA cases can enlarge during follow-up.
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Acute respiratory tract infection is the most common infectious disease in children, which seriously threatens children′s health.Rapid and accurate etiological diagnosis is of great significance for the clinical treatment and control of these diseases.Pathogen nucleic acid test was applied and became the main method of respiratory tract infection diagnosis for its high sensitivity and specificity.To regulate the application of pathogen nucleic acid amplification test in respiratory tract infection in children, improve the diagnosis level, expert consensus on nucleic acid amplification test of respiratory pathogens in children was prepared to guide the application and promote pathogens diagnosis ability.
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Aging-elevated DNMT3A R882H-driven clonal hematopoiesis (CH) is a risk factor for myeloid malignancies remission and overall survival. Although some studies were conducted to investigate this phenomenon, the exact mechanism is still under debate. In this study, we observed that DNMT3A R878H bone marrow cells (human allele: DNMT3A R882H) displayed enhanced reconstitution capacity in aged bone marrow milieu and upon inflammatory insult. DNMT3A R878H protects hematopoietic stem and progenitor cells from the damage induced by chronic inflammation, especially TNFα insults. Mechanistically, we identified that RIPK1-RIPK3-MLKL-mediated necroptosis signaling was compromised in R878H cells in response to proliferation stress and TNFα insults. Briefly, we elucidated the molecular mechanism driving DNMT3A R878H-based clonal hematopoiesis, which raises clinical value for treating DNMT3A R882H-driven clonal hematopoiesis and myeloid malignancies with aging.
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Objective:To investigate the curative effect of suture anchor in the treatment of ankle joint fracture complicated with distal tibiofibular syndesmosis injury.Methods:From January 2017 to August 2019, data of 65 patients with Weber C type ankle fracture combined with posterior malleolus fracture in our hospital who underwent surgical treatment were retrospectively analyzed and were divided into two groups according to the treatment method of injury: suture-anchor repair group (suture-anchor was used to repair the anterior inferior tibiofibular ligament) and screw fixation group (cortical bone screw was used to fix the tibiofibular syndesmosis). Among them, 17 cases were treated with suture-anchors to repair the anterior inferior tibiafibular ligament, including 7 males, 10 females, 11 left and 6 right. In the Lauge-Hanson subgroup, there were 10 cases of pronation external rotation (PER), and 7 cases of pronation abduction (PA). The mean age was 43.76±15.83 years old. Forty-eight patients were treated with cortical screw fixation, including 33 males, 15 females, 34 left and 14 right. In the Lauge-Hanson subgroup, there were 30 cases of PER, and 18 cases of PA. The mean age was 39.90±13.57 years old. The differences in operation time, number of fluoroscopy, quality of reduction and postoperative complications were compared between the two groups. The ankle joint function was compared at 16 weeks postoperatively and at the last follow-up. The ankle joint function score was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score.Results:All the 65 patients were followed up and the average follow-up time of 65 cases was 16.88±4.46 months. All the fractures were clinically healed 12-16 weeks after operation. The operative time of screw fixation group was 123.71±41.36 min, and the number of fluoroscopy was 25.17±16.29 times, while the operative time of suture-anchor repair group was 99.94±24.16 min and the number of fluoroscopy was 16.26±10.58 times. The difference between the two groups was statistically significant ( t=2.048, 2.175; P=0.045, 0.033). In the screw fixation group, the mean anterior and posterior distance of the tibiofibular syndesmosis was 3.15±1.35 mm, and 6.48±1.43 mm, respectively. In the suture-anchor repair group, the mean anterior distance of the syndesmosis was 2.06±1.47 mm, and the mean posterior distance of the syndesmosis was 6.76±1.78 mm. There was statistically significant difference in the distance of anterior distance of the syndesmosis ( t=3.328, P=0.002), while there was no statistically significant difference in the posterior distance of the syndesmosis ( t=0.701, P=0.486). The incidence of postoperative complications was 16.67% (8/48) in the screw fixation group and 5.88% (1/17) in the suture-anchor repair group, which was no statistically different ( χ2=1.282, P=0.258). The excellent and good rates of AOFAS ankle-hindfoot scores were 91.67% (44/48) in the screw fixation group and 88.24% (15/17) in the suture-anchor repair group at 16 weeks; 95.83% (46/48) in the screw fixation group and 94.12% (16/17) in the suture-anchor repair group at the last follow-up. There was no significant difference ( P >0.05). Conclusion:Compare with screw fixation in the treatment of acute distal tibiofibular syndesmosis injury, suture-anchor repair of anterior inferior tibiofibular ligament is a safe and effective method. It can increase the anatomical reduction rate of anterior distance of the syndesmosis, and reduce the operation time without increasing the incidence of complications.
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Objective:To carry out investigation and analysis of an extensive skin radiation injury to the back accidentally caused by interventional procedure and to explore the problems faced in the event with emphasis on avoiding the reoccurance of similar events in the future.Methods:The data were collected by consulting the patient′s detailed medical history, collecting and analyzing clinical diagnosis and treatment data, tracking and observing their clinical manifestations and signs. The patient′s peripheral blood samples were also collected, together with the biological dose estimated and the equipment data collected on the site of the interventional treatment hospital.Results:The whole body dose to the patient was estimated to be 0.95 Gy. The typical values of kerma rate of radiation incident on the body surface due to fluoroscopic procedures were 373.5 mGy/min in subtraction modality and 47.8 mGy/min in fluoroscopy modality, respectively. The annual effective dose to the interventional radiologist was 20.51 mSv due to his operation in long-time radiation exposure conditions, higher than 3.09 mSv for other interventional radiologists with similar workload in the same department. The whole body and local clinical manifestations of the patients were in line with radiation injury. No clear diagnosis has been obtained in several hospitals, nor can obvious treatment outcomes be obsevered.Conclusion:Combined with the biological dose estimation result and clinical manifestations, the case was diagnosed as degree Ⅳ skin radiation injury. Radiation injury is closely related to whether the operation is conducted according to the standard and the output dose of X-ray machine. Non-specialized hospitals should strengthen clinical diagnosis and treatment of radiation injury.
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Respiratory viruses can cause a variety of serious respiratory infections and diseases of tissues and organs outside the respiratory tract, raising a potentially severe threat to the society.Virus replication and survival rely on the internal mechanism of host cells, and the latter also produce a variety of restriction factors that target viral invasion, genome transcription and replication, and assembly and release to block viral infection.Herein, this study reviewed the research progress of the antiviral effects of the host restriction factors of common respiratory viruses and their underlying mechanisms.
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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become one major threat to human population health. The RNA-dependent RNA polymerase (RdRp) presents an ideal target of antivirals, whereas nucleoside analogs inhibitor is hindered by the proofreading activity of coronavirus. Herein, we report that corilagin (RAI-S-37) as a non-nucleoside inhibitor of SARS-CoV-2 RdRp, binds directly to RdRp, effectively inhibits the polymerase activity in both cell-free and cell-based assays, fully resists the proofreading activity and potently inhibits SARS-CoV-2 infection with a low 50% effective concentration (EC
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To explore early prevention and control of coronavirus disease 2019 （COVID-19） outbreak based on system dynamics model analysis. The data of early outbreak of COVID-19 were collected from the World Health Organization，covering countries of the China，United States，United Kingdom，Australia，Serbia and Italy. The susceptible-exposed-infected-recovered （SEIR） model was generalized and then its parameters were optimized. According to the parameters in the basic infection number expression，the sensitivity in the system dynamics model was used to quantitatively analyze the influence of the protection rate，infection rate and average quarantine time on the early spread of the outbreak. Based on the analysis results，targeted prevention and control measures for the early outbreak of COVID-19 were proposed. The generalized SEIR model had a good fit for the early prediction and evaluation of COVID-19 outbreaks in six countries. The spread of COVID-19 was mainly affected by the protection rate，infection rate and average quarantine time. The improvement of the protection rate in the first ays was the most important:the greater the protection rate，the fewer the number of confirmed cases. The infection rate in the first 5 days was the most critical:the smaller the infection rate，the fewer the number of confirmed cases. The average quarantine time in the first 5 days was very important:the shorter the average quarantine time，the fewer the number of confirmed cases. Through the comparison of key parameters of six countries，Australia and China had implemented strict epidemic prevention policies，which had resulted in good epidemic prevention effects. In the early stage of the outbreak，it is necessary to improve the protection rate，shorten the average quarantine time，and implement strict isolation policies to curb the spread of COVID-19.
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Humans , COVID-19 , China/epidemiology , Disease Outbreaks , Quarantine , SARS-CoV-2ABSTRACT
Objective:To evaluate the efficacy of orthogonal low profile double-plate osteosynthesis (DPO) in the treatment of Neer type IIB distal clavicular fractures.Methods:A retrospective case-control study was carried out to analyze the clinical data of 31 patients with Neer type IIB distal clavicular fractures admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from June 2016 to October 2017. There were 23 males and 8 females, aged 45-76 years(mean, 61.8 years). The left side was involved in 24 patients and right sidein 7. Out Of them, 7 patients were treated with hook plate osteosynthesis (HPO) (HPO group), 13 patients with precontoured distal clavicular locking plate osteosynthesis (LPO) (LPO group), and 11 patients with DPO (DPO group). The Constant-Murley shoulder functional outcomes, clavicle-coracoids distance (CCD), complications and hardware related symptomswere compared between groups.Results:All the patients were followed up for 10-27months(mean, 15.1 months). At the latest follow-up, Constant-Murley score was (93.8±5.1)points in LPO group and (94.8±5.8)points in DPO group, better than (84.3±13.2)points in HPO group ( P<0.05), while there was no significant difference between DPO and LPO groups ( P>0.05). CCD was increased(1 patient in HPO group, 5 in LPO group, 3 in DPO group), but there was no significantdifference between groups( P>0.05). No infection or implant breakage occurred in each group. One patient had nonunion in HPO group, 1 had malunion at trapezoid ligament bony end in LPO group and all had bone union in DPO group, showing no significant difference between groups ( P>0.05). Two patients had acromial bone corrosion and 1 had distal clavicle osteolysisin in HPO group, but not in LPO and DPO groups ( P<0.05). Three patients had hardware related symptoms in HPO group, 6 in LPO group, and none in DPO group ( P<0.05). Conclusion:Orthogonal low profile DPO can be a good choice for the treatment of distal clavicle Neer type IIB fractures, for it has advantages of good functional outcomes, lower complications and less hardware related symptoms.
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Objective@#To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect.@*Methods@#From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were collected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and internal fixation. If the patient was older (>65 years old) or with severe local bone defect, total knee arthroplasty should be performed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the original fracture line osteotomy; 2. the tibial tubercle + original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy.@*Results@#All patients were followed up for 12-30 months (average 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the original internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 patients underwent fibular head osteotomy+ original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow-up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (average 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post-operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm collapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infection of the wound surface after operation.@*Conclusion@#It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different characteristics of the tibial plateau fracture malunion of the patients.
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Objective@#To explore the clinical effect of posterior deformity correction combined with anterior lesion re-moval and bone graft in the treatment of non-curable severe tuberculous thoracolumbar kyphosis.@*Methods@#All of 27 patients with non-curable severe tuberculous thoracolumbar kyphosis treated by posterior deformity correction combined with primary or secondary anterior debridement and bone grafting from January 2013 to July 2017 were retrospective analyzed, including 10 males and 17 females. The age ranged from 2 to 38 years with an average of 17.3±9.9 years. Posterior column osteotomy, spinal cord de-compression, cantilever bar pressing technique and intraoperative longitudinal traction were used to correct kyphosis. According to clinical symptoms, Cobb angle correction rate of kyphosis deformity, sagittal SVA of spine, height difference before and after opera-tion, operation time, intraoperative bleeding volume, complications, and the effect of the operation was evaluated. Symptoms and functional evaluation indicators included visual analogue scale (VAS), American Spinal Injury Association (ASIA) spinal cord inju-ry classification, Oswestry dysfunction index (ODI), and Kirkaldy-Willis functional score. Laboratory tests included erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Eck fusion grading standard was used to evaluate the degree of bone graft fusion.@*Results@#All the 27 patients successfully underwent the operation. The operation time was 210-530 minutes, with an aver-age of 343.0±71.5 minutes, while the bleeding volume was 300-2 600 ml, with an average of 1 168.5±606.7 ml. The preoperative Cobb angle ranged from 81 to 144 degrees, with an average of 105.2±17.7 degrees; the postoperative Cobb angle ranged from 5 to 47 degrees, with an average of 28.2±0.3 degrees, and the average correction rate was 72.9%±9.8%; the preoperative sagittal SVA ranged from 96.66 mm to 78.76 mm, with an average of 40.5±20.4 mm; and the postoperative sagittal SVA ranged from 33.61 mm to 44.96 mm, with an average of 26.6±12.6 mm. The height difference before and after operation was 26.8-172.7 mm, with an aver-age of 67.5±37.8 mm. The follow-up period ranged from 12 to 36 months, with an average of 19.3±6.7 months. At the last follow-up, the loss of Cobb angle ranged from 1 degree to 8 degree, with an average of 4.3°±1.8° degree. The postoperative nutritional sta-tus of all patients was significantly improved. At 3 months after operation, the average VAS score was 1.1±0.6 and the improve-ment rate was 47.5%. The difference was statistically significant (t=6.31, P<0.05). At 3 months after operation, the average ODI was 6.5%±4.1%, and the improvement rate was 68.1%. The difference was statistically significant (t=8.41, P<0.05). At the last fol-low-up, all the patients were improved to grade E in ASIA except one patient from grade B to grade D, and one stayed at grade E. Kirkaldy-willis functional score: excellent in 24 cases, good in 2 cases, and good in 1 case, with a total good/good rate of 88.9%. Cerebrospinal fluid leakage occurred in 3 patients after surgery, and pleural effusion occurred in 4 patients after surgery. No recur-rence of tuberculosis, loosening of internal fixation, fracture or loss of obvious correction were found during the follow-up. Accord-ing to the Eck fusion classification standard, at the time of the last follow-up bone graft area of all 27 cases reached I level fusion.@*Conclusion@#For non-curable severe tuberculous thoracolumbar kyphosis with multi-segment vertebral body loss, good deformity correction and proper recovery of vertebral height can be achieved by posterior osteotomy combined with cantilever beam tech-nique and intraoperative longitudinal traction. The combination of anterior debridement and bone graft fusion is a safe and reliable method.
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Objective@#To explore the changes and significance of local brain activity in different motor subtypes of Parkinson disease(PD) using resting-state functional MRI (rs-fMRI) based on regional homogeneity (ReHo) analysis.@*Methods@#A total of 84 PD patients and age-and gender-matched 29 healthy controls undergoing rs-fMRI were included. PD patients were divided into two groups of tremor dominant(TD) (n=45) and postural instability gait difficulty(PIGD) (n=39) according to the Unified Parkinson′s Disease Rating Scale (UPDRS) scores. Data processing assistant for resting-state fMRI (DPARSF) and resting-state fMRI data analysis Toolkit (REST) V1.8 based on MATLAB were used to calculate the ReHo which measured brain activity in different motor subtypes of PD. Analysis of covariance and post-hoc t-tests were performed to detect the differences of local brain activity among the three groups.Correlation analyses were performed between ReHo values of the regions showing group differences and TD and PIGD scores respectively.@*Results@#Compared to healthy controls, the TD group exhibited increased ReHo in the right superior and middle frontal gyrus, left cerebellum(13 to 21 voxels, P<0.05), while decreased ReHo in the left temporal lobule, left putamen, left paracentral lobule, and bilateral thalamus (12 to 91 voxels, P<0.05). The PIGD group showed increased ReHo in the right superior frontal gyrus, right middle frontal gyrus and anterior cingulate gyrus (ACC) (55 to 92 voxels, P<0.05), while decreased ReHo in the left putamen, left pallidum, left temporal lobule, right occipital lobule, bilateral thalamus, bilateral middle cingulate gyrus, bilateral supplementary motor area (SMA) (15 to 78 voxels, P<0.05). Compared with PIGD, the TD group showed increased ReHo in the left temporal lobule, left cerebellum, bilateral middle cingulate gyrus (19 to 51 voxels, P<0.05), whereas decreased ReHo in the left paracentral lobule, bilateral cuneus, right superior frontal gyrus, and right ACC (14 to 68 voxels, P<0.05). Additionally, ReHo in the left thalamus and left putamen negatively correlated with TD scores (r=-0.355 and -0.498, both P<0.05). ReHo in the left thalamus and right thalamus negatively correlated with PIGD scores (r=-0.478 and -0.397, both P<0.05).@*Conclusions@#The changes of brain activity in TD are located in the cerebello-thalamo-cortical (CTC) circuit and the striatal-thalamo-cortical (STC) loop while the changes in PIGD are largely located in the STC loop and visual network cortex. This specific pattern of intrinsic activity in TD and PIGD may provide insights into the neurophysiological mechanisms of PD with different motor subtypes.
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Objective To explore the feasibility of the Star-VIBE sequence in esophageal MRI,and compare it with the conventional VIBE sequence.Methods Fifteen healthy volunteers underwent Star-VIBE and VIBE sequences scanning after injecting MRI contrast agent.Two groups of MR images were independently scored in the ability to display esophageal wall,respiratory motion artifacts,cardiovascular pulsation artifacts,overall motion artifacts and overall image quality by the two radiologists,respectively.SNR of esophagus,CNR between esophagus and paravertebral muscles were measured and compared.Results Star-VIBE was superior to VIBE in the ability to display esophageal wall,respiratory motion artifacts,cardiovascular pulsation artifacts,overall motion artifacts and overall image quality (the ability to display esophageal wall:Z＝－3.268,P＝0.001;respiratory motion artifacts:Z＝－3.205,P＝0.001;cardiovascular pulsation artifacts:Z＝－4.644, P＝0.000;overall motion artifacts:Z＝－3.904,P＝0.000;overall image quality:Z＝－2.808,P＝0.005),while no significant differences were found on SNR and CNR between the two sequences (SNR:t＝－1.5 3 9 ,P＝0.1 3 5 ;CNR:t＝－0.874,P＝0.3 89 ).Conclusion The Star-VIBE sequence is insensitive to the physiological motion artifacts,and it can provide better image quality than the conventional VIBE sequence in esophageal MRI.
ABSTRACT
Objective ToinvestigatethepatternsofbrainactivityabnormalitiesinpatientswithParkinson’sdisease(PD)with freezingofgait(FOG),andtoexploretheneuropathologicalmechanismofFOG.Methods Resting-statefunctionalMRI(rs-fMRI) scanswereobtainedfrom31PDpatientsand16healthycontrols(HCs).Accordingtothefreezingofgaitquestionnaire(FOG-Q),31 PDpatientsweredividedinto15PDFOG(+)and16PDFOG(－).ANCOVAandPost-Hocttestwereperformedtoassessinter groupdifferenceofbrainactivityabnormalitybasedonregionalhomogeneity.Results ComparedtoHCs,PDFOG(+)showeddecreased ReHointheleftinferiortemporalgyrus,rightlingual,bilateralfusiform,rightoccipitalgyrus,rightcalcarine,andrightcerebellum, whileincreasedReHointherightmiddlefrontalgyrus,rightsuperiorfrontalgyrus,rightprecentralgyrus,andrightsupplementary motorarea(SMA).ComparedtoPDFOG(－),PDFOG(+)exhibitedincreasedReHointherightprecentralgyrus,rightmiddle frontalgyrus,rightinferiorfrontalgyrus,andrightSMA,whiledecreasedReHoinleftfusiform.Conclusion Thisstudysuggests thatFOGinPDisassociatedwithabnormalitiesincerebellum,frontallobeandvisualnetwork,whichishelpfultounderstandthe neuralmechanismsunderlyingFOGinPD.
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Objective To investigate the incidence of cognitive dysfunction in postpartum women who underwent epidural or non-drug labor analgesia and the influence factors.Methods A prospective cohort study was performed in 1 618 uneventful singleton pregnancies in International Peace Maternity and Child Health Hospital from January 2017 to January 2018.Women who received epidural labor analgesia were assigned to the epidural group (n=803),and those who received Doula technique non-drug labor analgesia rather than labor analgesia to the control group (n=815).Cognitive function was assessed using symbol digit modalities test (SDMT90) and Montreal cognitive assessment (MoCA) 1 d and 42 d after delivery.Incidence of maternal cognitive dysfunction,SDMT90 scores and pain intensity measured by visual analogue score (VAS) at the cervical dilatation of 3,6 and 10 cm between the two groups were compared using independent sample t-test,Chi-square test or logistic regression analysis.Results MoCA and SDMT90 scores of the epidural group were significantly higher than those of the control group 1 d after delivery (27.1 ± 1.5 vs 26.2± 1.8,49.1 ±2.4 vs 42.5 ± 3.6;t=3.775 and 16.956,both P＜0.05),but the incidence of postoperative cognitive dysfunction (POCD) in the epidural group was remarkably lower comparing to the control group [13.9％ (112/803) vs 21.2％ (173/815),x2=14.769,P=0.002].The VAS scores of the epidural group at the cervical dilatation of 3,6 and 10 cm were all lower than those of the control group (2.3 ± 0.6 vs 6.9± 1.3,3.3 ± 0.9 vs 8.7± 0.9,5.7± 0.9 vs 9.7± 0.4;t=0.013,0.011 and 0.015;all P＜0.001).Logistic regression analysis indicated that VAS scores ≤ 3 at the cervical dilatation of 3,6 and 10 cm were protective factors against the incidence ofPOCD 1 d after delivery [OR(95％CI):0.238 (0.198-0.287),0.180 (0.145-0.222) and 0.112 (0.088-0.142),all P＜0.001],while the absence of epidural labor analgesia was a risk factor (OR=4.698,95％CI:1.812-11.321,P＜0.001).Conclusions Epidural labor analgesia can reduce the incidence of postpartum cognitive dysfunction in women 1 d after delivery.The incidence of POCD has close relationship with the VAS scores at the cervical dilatation of 3,6 and 10 cm and epidural labor analgesia.