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OBJECTIVE To improve the quality standard of Yi medicine Gynura japonica， and to evaluate its quality. METHODS Using 15 batches of G. japonica from different producing areas as samples， the contents of water， total ash， acid- insoluble ash and water-soluble extract were determined according to the method stated in part Ⅳ of Chinese Pharmacopoeia （2020 edition）. The contents of total alkaloid （calculated by senecionine） was determined by UV spectrophotometry. The contents of senecionine and seneciphylline were determined by HPLC. Using above 7 indexes as evaluation indexes， cluster heat map analysis， principal component analysis （PCA） and entropy weight approximation ideal ranking （TOPSIS） were used to evaluate the quality of medicinal material comprehensively. RESULTS Among 15 batches of G. japonica， the moisture contents were 8.88%-12.60%， the total ash contents were 4.43%-11.02%， the acid-insoluble ash contents were 0.56%-3.45%， the water-soluble extract contents were 21.71%-53.91%， the total alkaloid contents （calculated by senecionine） were 0.15%-0.39%， and the contents of senecionine and seneciphylline were 0.01% -0.05% and 0.01%-0.06% respectively. According to the results of various indicators， it was preliminarily proposed that the water content in the sample of G. japonica should not exceed 13.00%， the total ash content should not exceed 11.50%， the acid-insoluble ash content should not exceed 3.70%， the water-soluble extract should not be less than 20.70%， the total alkaloid content should not be less than 0.15%， the contents of senecionine and seneciphylline should not be less than 0.01% both. The results of cluster heat map analysis showed that the 15 batches of samples could be divided into four categories； the results of PCA and TOPSIS showed that the samples with high-quality ranking were jsq-2， jsq-5， jsq-6 and jsq-10， and the samples with low-quality ranking were jsq-4， jsq-13 and jsq-14. CONCLUSIONS In this study， the quantitative analysis method of total alkaloids （calculated by senecionine）， senecionine and seneciphylline in G. japonica is established， and the limits of each index are preliminarily determined. Among 15 batches of samples， the qualities of medicinal material collected from Linza Village of Ganluo County of Liangshan Yi Autonomous Prefecture， Machangping Village of Luojishan Town of Puge County of Liangshan Yi Autonomous Prefecture and other places are better.
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As an important complementary form of decoction pieces of traditional Chinese medicine（TCM）， TCM dispensing granules has the advantages of being free of decoction， easy to take， easy to carry and easy to be dispensed， which greatly improves the capacity of emergency services of TCM and is more in line with the needs of modern society. With the end of the pilot project of TCM dispensing granules， the market has been fully liberalized， the competition has been intensified， and it is in the transition period of switching between the new standard and the old one， and there are some problems such as the shortage of varieties， the change of specifications and the difference of quality， and the production enterprises are facing new opportunities and challenges. Based on this， the authors intend to systematically sort out the policies and regulations， enterprise layout and standard formulation since the pilot of TCM dispensing granules. In view of the problems in the post-pilot stage and from the perspective of survival and development of enterprises， it is suggested that enterprises should establish a quality control system for the whole industry chain of TCM dispensing granules to reduce process costs and increase enterprise competitiveness， further increase the investment in scientific research， overcome the key technical problems of difficult varieties， actively and orderly promote the research of national standards， in order to ensure the integrity of clinical formula varieties， and establish and improve the efficacy evaluation mechanism of TCM dispensing granules， build a consistency evaluation system between TCM dispensing granules and decoction pieces. Government departments should strengthen the guidance， fully mobilize the enthusiasm of scientific research institutions， enterprises and hospitals， and explore the establishment of "government-industry-study-research-application" mode to promote the development of TCM dispensing granule industry.
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Objective:To investigate the clinical effects of electroacupuncture assisted with facial expression muscle control rehabilitation training in the treatment of patients with severe idiopathic facial paralysis.Methods:A total of 130 patients with severe idiopathic facial paralysis who met inclusion criterion were chosen and randomly divided into 2 groups, 65 patients in each, from January 2017 to December 2019 in our hospital. The control group were treated with facial expression muscle control rehabilitation training and western medicine, and the experiment group with electroacupuncture on the basis of the control group. Both groups were treated for 8 weeks and followed up for 6 months. The facial nerve function was evaluated by H-B scale and facial nerve sunny brook scale the quality of daily life was evaluated by Facial Disability Index Physical Function (FDIP) scale and Facial Disability Index Social Function (FDIS) scale. The latency/M wave amplitude of motor evoked action on orbicularis oculi muscle and orbicularis ORIS muscle were measured by EMG evoked potential instrument. The occurrence of hemifacial spasm during follow-up was recorded. The clinical effective rates were evaluated.Results:The total effective rate of experiment group was 92.31% (60/65), which was significantly higher than that of the control group 76.9% (50/65) ( χ2=6.495, P=0.039). The H-B scale scores of experiment group after treatment were significantly less than that of the control group ( t=3.438, P<0.01). The facial nerve sunny brook scale scores of experiment group after treatment were significantly more than that of the control group ( t=2.674, P=0.032). The FDIP scores of experiment group after treatment were significantly less than that of the control group ( t=3.986, P<0.01). The FDIS scores of experiment group after treatment were significantly more than that of the control group ( t=4.621, P<0.01). The NCV latency of orbicularis oculi muscle [(2.51 ± 0.27) ms vs. (2.82 ± 0.46) ms, t=4.258] and orbicularis oris muscle [(2.97 ± 0.22) ms vs. (3.35 ± 0.40) ms, t=4.783] of observation group were significantly lower than those in the control group ( P<0.01). The M wave amplitudes of orbicularis oculi muscle [(1.83 ± 0.45) mV vs. (1.30 ± 0.39) mV, t=3.827] and orbicularis oris muscle [(2.58 ± 0.60) mV vs. (1.97 ± 0.36) mV, t=4.017] of observation group were significantly higher than those in the control group ( P<0.01). The incidence of facial spasm with follow-up of experiment group for 4.62% (3/65) was significantly lower than that of the control group for 15.38% (10/65) ( χ2=9.271, P=0.033). Conclusion:Electroacupuncture assisted with facial expression muscle control rehabilitation training in the treatment of patients with severe idiopathic facial paralysis can relieve clinical symptoms, improve facial nerve function, improve the quality of daily life and be helpful to reduce the facial spasm risk.
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Objective To explore the optimal diagnosis and treatment strategy of tumors at the foramen magnum,the clinical characteristics were analyzed retrospectively.Methods The clinical data of 58 cases with foramen magnum tumors treated with microsurgery in our department were collected and analyzed retrospectively.And intraoperative neurophysiological monitoring was employed in later 21 cases.Results Gross total resection was achieved in 48 of the 58 cases ; Five of the 10 patients with VA encased by tumors were totally resected.Full resection was achieved in 43 of the last 48 cases.Forty-three of the 47 cases with intradural tumors got complete resection,and total resection was achieved in 3 and 2,respectively,in 9 intra-extradural communicated tumors and 2 extradural ones.Symptoms were significantly improved in 50 cases,worsened in 5 patients,and maintained stable in the last 3 patients.Post-operative symptoms were obviously improved in the later 21 cases with intraoperative neurophysiological monitoring employed and the therapeutic effect of the treatment was much better than the former cases.Three patients died postoperatively.Fifty cases got complete follow-up from 6 months to 3 years.Among them,forty-four patients had a KPS score of 80-100,but the other 6 patients less than 80.Conclusion Microsurgical treatment for foramen magnum tumors is effective.Optimal surgical approaches and precise micro-operative techniques are crucial for the tumor removing.It is quite difficult and risky to fully resect the intra-extradural communicated tumors and the ones encasing vertebral artery.Preoperative evaluation should be profound.The application of intra-operative electrophysiological monitoring and the timely management of post-operative complications can improve the prognosis obviously.
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Objective To screen possible factors affecting prognosis of chondrosarcoma.Methods A total of 37 patients with chondrosarcoma,who had undergone surgical treatment from December 2005 to March 2008 in our hospital and had complete follow-up data and definitive pathological diagnosis,were enrolled in this retrospective study.There were 16 males and 21 females,ageing from eleven to eighty-four years (average,42.8 years).The univariate analysis of survival rate was performed with Kaplan-Meier method and tested with the Log-rank test.Chi-squared test or Fisher's exact test were used to analyze numeration data,and then the significant indexes after univariate analysis were performed multivariate analysis with COX regression model to screen the independent factors affecting prognosis.On the basis of literatures,8factors including gender,age,duration of disease,tumor site,Enneking stage,surgical approach,distant metastasis and local recurrence were analyzed.Results Statistical significance was found in Enneking stage,surgical approach and distant metastasis,which indicated that they were related to survival rate 3years after surgery.However,gender,age,duration of disease,tumor site,and local recurrence had no significant correlation with prognosis.After multivariate analysis of Enneking stage,surgical approach,distant metastasis,the results showed that Enneking stage and surgical procedure were the independent prognostic factors,while distant metastasis was not an independent prognostic factor.Conclusion Enneking stage and surgical approach are the independent prognostic factors for chondrosarcoma,which can be used to evaluate prognosis of chondrosarcoma.
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Objective To investigate technique and indications of proximal femoral autograft for pelvic reconstruction after tumor resection.Methods Between October 2006 and May 2011,5 patients with primary malignant pelvic tumor underwent tumor resection,pelvic reconstruction by proximal femoral autograft,and hip reconstruction by tumor prosthesis.There were 3 males and 2 females,aged from 19 to 55years (average,30.6 years).There were 3 cases of chondrosarcoma and 2 cases of primitive neuroectodermal tumor (PNET).The tumor involved zone Ⅰ and zone Ⅱ in 3 cases,and zone Ⅱ and zone Ⅲ in other 2cases.All 5 patients were followed up,and complications,MSTS (Musculoskeletal Tumour Society) score and prognosis were recorded.Results At final follow-up,one patient died of pulmonary metastasis,one patient survived with local recurrence,and other 3 patients survived without recurrence.The complications consisted of local recurrence,prosthesis loosening,nonunion,infection,and sciatic nerve palsy.One patient underwent revision surgery for prosthesis loosening 26 months after the initial operation.One patient underwent amputation for local recurrence 6 months after the initial operation.The average MSTS score was 19.2.Conclusion Proximal femoral autograft is an effective method for pelvic reconstruction after tumor resection,which can be used for defect in zone Ⅱ and zone Ⅲ,as well as in zone Ⅰ and zone Ⅱ.However,the method has a high rate of complications.The short-term result is similar to that of pelvic prosthesis,while the long-term result needs further observation.
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Objective To investigate the clinical effect of subtrochanteric osteotomy plus dynamic hip/condyle screw (DHS/DCS)fixation to treat the fibrous dysplasia of the proximal femur with coxa vara.Methods Twenty-six clinical cases of femoral fibrous dysplasia with coxa vara were retrospectively analysed from April 2001 to May 2010.There were 9 males and 17 females,with a median age of 19(10 to 53).Forteen patients presented with monostotic disease,and 12 with polyostotic disease.The length of the lesion for polyostotic disease was from 9 cm to 36 cm,while for monostotic disease was from 7 cm to 15 cm.Seventeen cases were merged with pathologic fracture.The neck shaft angles were from 65 to 110 degree preoperation.The shortage of limbs was from 1.5 cm to 4.5 cm.Twenty-one patients involved in femoral neck were fixed with DHS and the other 5 cases with DCS.Results The duration of operation was from 80 to 170 min.The amout of bleeding was from 280 to 1650 ml with the average of 960 ml.The average postoperative neck shaft angles were 127 degree(119 to 140).The shortened limbs were extended 2.3 cm for average (1.5 to 3.6 cm).The follow-up time was from 9 to 118 months with the average of 39 months.All patients with osteotomy were healed.The neck shaft angle of 1 case decreased from post-operative 126°to 115°56months post-operatively,no coxa adducta recurrented and all internal fixations were in position.Hip screw backed out through the barrel in one case with the shortage of femoral neck.One case had femoral fracture after an injury.According to Guille function standard,24 cases were regarded as satisfied and 2 cases as unsatisfied.Conclusion Subtroehanteric osteotomy plus DHS/DCS fixation can effectively correct the fibrous dysplasia of the proximal femur with coxa vara,and significantly improve the function.
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Objective To explore the surgical treatment strategy for tibial pilon fractures.Methods Forty-seven patients with tibial pilon fractures surgically treated in our hospital from May 2005 to March 2008 were retrospectively studied. There were 37 males and ten females, at mean age of 42 years (range 23-46 years). There were 51 sides of tibial pilon fractures, for four patients were with bilateral tibial pilon fractures. Injury causes included traffic accidents in 34 patients, fall from height in 12 and bruise by heavy objects in five. Open fractures were determined in seven patients and close fractures in 44 patients. According to Ruedi-Allgower classification, there were six sides of type Ⅰ fractures, 28 type Ⅱ fractures and 17 type Ⅲ fractures. According to Tscherna-Grotzen tissue injuries classification,open fractures were determined as 1° in two patients, 2° in three and 3° in two; close injuries were defined as 0° in two patients, 1° in 27 and 2° in 15. Distal tibia was partitioned as anterolateral column,anteromedial column and posterior column in order to select reasonable internal fixation. Eighteen fractures were treated with DePuy T plate, 10 with AO cloverleaf pattern plate, two with AO small T plate,two with locking plate, four with Link anterolateral anatomic plates and 15 with Orthofix overtake-anklejoint outside-fixed frame combined with limited internal fixation. Results The patients were followed up for a mean time of 23 months (range 12-44 months). According to Mazur ankle evaluation grading system, 29 patients were graded as excellent, 13 good, seven fair and two poor, with an excellence rate of 82.4%. Conclusions Correct operation time and treatment plans on the basis of Ruedi-Allgower classification and Tscherne-Gotzen classifications of soft tissues and reasonable internal fixation according to the condition of the involved three column in distal tibia can decrease postoperative complications and achieve good and satisfactory clinical effect.
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Objective To investigate the clinical characteristics,minimal invasive operation technique and perioperative management of lateral ventrieular tumors.Methods The clinical characteristics,image diagnosis,surgical approaches and postoperative management and surgical outcomes of 65 consecutive cases of lateral ventricular tumors were retrospectively analyzed.Results In our series,total resection was achieved in 54 cases,and subtotal resection was achieved in 11 cases.Lateral ventricular tumors were mostly found in male and in the left side.Headache caused by increased intracranial pressure was the most common clinical symptom.Ependymocytoma and astrocytic glioma are the most common pathologic diagnosis.Postoperative complications included fever (26 cases),hydrocephalus (9 cases),intraventricular hematoma (7 cases) of which 2 cases were evacuated by craniotomy,epilepsy (7 cases),wound infection (3 cases).Postoperative death was happened in 3 cases.Two of them died of respiratory failure due to postoperative epilepsy.Conclusion Early discovery of lateral ventricle tumors,meticulous operation,subtle micromanipulation and right postoperative treatment are the criticality to improve the rate of total resection of lateral ventricle tumors through microsurgical treatment and reduce postoperative complications and mortality.