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1.
Article in Chinese | WPRIM | ID: wpr-910009

ABSTRACT

Objective:To explore the clinical efficacy of microsurgery combined with Ilizarov technique in the treatment of Gustilo ⅢC open tibiofibular fractures.Methods:From January 2014 to December 2016, 20 patients with Gustilo ⅢC open tibiofibular fracture were treated at Department of Hand Surgery 2, Repair and Reconstruction, Wuhan NO. 4 Hospital, Wuhan Puai Hospital. They were 13 men and 7 women, aged from 36 to 56 years (average, 42.6 years). The time from injury to operation ranged from 2 to 6 hours (average, 4.3 hours). The defects were at the proximal bone in 6 cases, at the middle bone in 9 cases and at the distal bone in 5 cases. The area of soft tissue defect ranged from 10 cm×6 cm to 12 cm×9 cm, and the lengths of bone defects averaged 10.3 cm. Microsurgery was conducted at the first stage to repair blood vessels and nerves and to reconstruct blood circulation, and an Ilizarov circular external fixator was installed at the second stage to repair bone and soft tissue defects by two-way bone transport. Bone transport time, wound healing time, bone transport distance, external fixation time, external fixation index, solidification time for the extended area and complications were recorded after operation. The curative efficacy was evaluated by Palay evaluation.Results:All patients were followed up for 12 to 30 months (average, 24 months). After the bone and soft tissue defects were well repaired, all the patients returned to daily life. The time from bone transport to apposition of fracture ends ranged from 50 to 160 days, averaging 75.8 days; the wound healing time ranged from 60 to 150 days, averaging 100.6 days; the bone transport distance ranged from 8 to 13 cm, averaging 10.3 cm; the external fixation time ranged from 12 to 20 months, averaging 14.0 months; the external fixation index was 1.6 months/cm; the solidification time for the extended area ranged from 5 to 16 months, averaging 10.9 months. No infection, malunion or re-fracture was observed; postoperative axis deviation was observed in 2 cases and ankle stiffness in 3 cases. According to the Palay evaluation, 5 cases were excellent, 12 cases good, and 3 cases fair.Conclusion:As microsurgery combined with Ilizarov technique can treat Gustilo ⅢC open tibiofibular fractures effectively by reconstructing limb blood circulation, it is worthy of clinical promotion.

2.
Chinese Journal of Trauma ; (12): 961-967, 2021.
Article in Chinese | WPRIM | ID: wpr-909963

ABSTRACT

The development of hand surgery in China began from the 1950s. Although it started late compared with the Western countries,it has developed rapidly. It has made remarkable achievements,such as the world's first severed finger replantation,the first severed arm replantation,the first second toe transplantation for thumb reconstruction,and the first contralateral C 7 nerve root transfer,etc. It has been gradually popularized,developed and expanded in whole China,and has now steadily moved to the world and is gradually surpassing the international standards. On the 100th anniversary of the founding of the Communist Party of China,the authors review the history and achievements in hand surgery to show the spirit of hard struggle,persistent development and continuous progress of Chinese hand surgeons,to forge ahead the spirit of persistance,unity,inheritance and innovation for the development of hand surgery in China.

3.
Frontiers of Medicine ; (4): 292-301, 2021.
Article in English | WPRIM | ID: wpr-880958

ABSTRACT

The high- and the low-molecular weight hyaluronic acids (HMW-HA and LMW-HA, respectively) showed different biological activities in inflammation. However, the role of LMW-HA in inflammatory response is controversial. In this study, we aimed to investigate the effect of bioactive hyaluronan (B-HA) on lipopolysaccharide (LPS)-induced inflammatory responses in human macrophages and mice. B-HA was produced from HA treated with glycosylated recombinant human hyaluronidase PH20. Human THP-1 cells were induced to differentiate into macrophages. THP-1-derived macrophages were treated with B-HA, LPS, or B-HA + LPS. The mRNA expression and the production of inflammatory cytokines were determined using quantitative real-time PCR and enzyme-linked immunosorbent assay. The phosphorylation levels of proteins in the nuclear factor-κB (NF-κB), mitogen-activated protein kinase (MAPK), and IRF-3 signaling pathways were measured using Western blot. The in vivo efficacy of B-HA was assessed in a mouse model of LPS-induced inflammation. Results showed that B-HA inhibited the expression of TNF-α, IL-6, IL-1, and IFN-β, and enhanced the expression of the antiinflammatory cytokine IL-10 in LPS-induced inflammatory responses in THP-1-derived macrophages and in vivo. B-HA significantly suppressed the phosphorylation of the TLR4 signaling pathway proteins p65, IKKα/β, IκBα, JNK1/2, ERK1/2, p38, and IRF-3. In conclusion, our results demonstrated that the B-HA attenuated the LPS-stimulated inflammatory response by inhibiting the activation of the TLR4 signaling pathway. B-HA could be a potential anti-inflammatory drug in the treatment of inflammatory disease.


Subject(s)
Animals , Cytokines , Hyaluronic Acid , Lipopolysaccharides , Mice , NF-kappa B/metabolism , Signal Transduction , Toll-Like Receptor 4
4.
Article in Chinese | WPRIM | ID: wpr-884234

ABSTRACT

Objective:To evaluate the treatment strategy of primary shortening plus secondary lengthening for Gustilo ⅢC open fractures in the lower limb.Methods:From January 2010 to January 2018, 12 patients (8 males and 4 females) with complex Gustilo ⅢC open fracture in the lower limb received emergency treatment at Department of Orthopaedic Surgery, Wuhan Fourth Hospital. Their ages ranged from 22 to 67 years (average, 41.2 years). All patients were complicated with bone and soft tissue defects associated with nerve and vascular injury in the lower limb. The sizes of soft tissue defects ranged from 4 cm × 2 cm to 17 cm × 12 cm; the main arteries were shortened after debridement by an average of 4.2 cm (from 1.2 cm to 8.3 cm); the broken nerves were shortened after debridement by an average of 4.0 cm (from 1.0 cm to 8.1 cm); the tibial shaft defects averaged 6.3 cm in length (from 2.0 to 9.6 cm). All cases were treated at the first stage by emergency debridement and shortening at the fracture site to directly repair the damaged bone, blood vessels and nerves before the wound was covered. After the limb survived and the wound completely healed, an Ilizarov external fixator was installed to lengthen the limb by bone transport. Recorded were speed of bone lengthening, time with external fixation and complications. The lower limb functions were evaluated at the last follow-up by Paley criteria.Results:The 12 patients were followed up for 14 to 32 months (average, 19.1 months). All the limbs survived with no serious infection. The shortening ranged from 2.0 to 8.2 cm (average, 3.6 cm); the mean speed of bone transport was 0.87 mm/day; the time with external fixation ranged from 11 to 16 months (average, 13.2 months); the bony union was achieved after 10 to 14 months (average, 11.2 months). Postoperative horseshoe inversion was reported in 7 patients, and needle tract infection below Dahl grade 3 in 2 cases. According to Paley criteria, the function of lower limb was rated as excellent in 8 cases, as good in 3 cases, and as fair in one.Conclusion:The treatment strategy of primary shortening plus secondary lengthening using Ilizarov technique has lowered the risk for limb salvage and the surgical difficulty, leading to fine clinical outcomes.

5.
Article in Chinese | WPRIM | ID: wpr-883834

ABSTRACT

Objective:To investigate the predictive value of different glycemic variability indexes within 6 hours on the short-term prognosis of septic shock patients.Methods:A retrospective study was conducted. The 133 patients with septic shock admitted to intensive care unit (ICU) of Nanjing Hospital Affiliated to Nanjing Medical University from December 2014 to December 2019 were enrolled. Patients with septic shock admitted to ICU died during hospitalization were enrolled in the death group and others in the survival group. General data of the patients including gender, age, underlying disease, site of infection, duration of mechanical ventilation, length of ICU stay, whether to use continuous renal replacement therapy (CRRT) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores within 24 hours were collected. The blood glucose (GLUadm), mean arterial pressure (MAP), serum creatinine (SCr) and procalcitonin (PCT) were recorded at ICU admission. The patients admitted to ICU received bundle therapy within 6 hours and blood glucose was observed every 2 hours. The blood glucose difference (GLUdif), average blood glucose (GLUave), blood glucose standard deviation (GLUsd) and blood glucose variation coefficient (GLUcv) within 6 hours were calculated. Multivariate Logistic regression analysis was used to analyze the prognostic factors of short-term prognosis of patients with septic shock, and receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of glycemic parameters for short-term prognosis of septic shock patients.Results:A total of 133 patients with septic shock were admitted to ICU, among them 87 patients survived and 46 patients died during the ICU hospitalization. Compared with the survival group, the SCr at ICU admission and APACHEⅡ score within 24 hours were significantly higher in the death group [SCr (μmol/L): 208.5 (143.0, 286.5) vs. 172.0 (91.0, 234.0), APACHEⅡ score: 30.28±6.67 vs. 24.03±5.90, both P < 0.05], the length of ICU stay was shorter [days: 4.00 (2.00, 10.25) vs. 9.00 (4.00, 13.00), P < 0.01]. However, there were no significant differences in the baseline data of gender, age, underlying disease, infection site, CRRT ratio, MAP or PCT at ICU admission between the two groups. Compared with the survival group, the GLUsd and GLUcv within 6 hours in the death group were higher [GLUsd (mmol/L): 2.33 (1.95, 3.14) vs. 2.02 (1.66, 2.52), GLUcv: (31.00±7.06)% vs. (23.31±10.51)%, both P < 0.05]. There were no statistically significant differences in the levels of GLUadm, GLUdif or GLUave within 6 hours between the two groups. Multivariate Logistic regression analysis showed that APACHEⅡ score within 24 hours and GLUsd and GLUcv within 6 hours were independent risk factors of the short-term prognosis of septic shock patients [APACHEⅡ score: odds ratio ( OR) = 1.173, 95% confidence interval (95% CI) was 1.095-1.256, P = 0.000; GLUsd: OR = 1.465, 95% CI was 1.038-2.067, P = 0.030; GLUcv: OR = 1.089, 95% CI was 1.043-1.138, P = 0.000]. ROC curve analysis showed that GLUsd and GLUcv within 6 hours both had certain predictive value for the short-term prognosis of septic shock patients, the area under ROC curve (AUC) of GLUcv within 6 hours was higher than that of APACHEⅡ score (0.765 vs. 0.753), and AUC of GLUsd within 6 hours was close to APACHEⅡ score (0.629 vs. 0.753); and the diagnostic value of GLUsd combined with GLUcv within 6 hours was higher than the two respectively (AUC: 0.809 vs. 0.629, 0.765), the sensitivity was 97.8%, and the specificity was 66.7%. Conclusion:GLUsd combined with GLUcv within 6 hours can be used to estimate the short-term prognosis of septic shock patients.

6.
Article in Chinese | WPRIM | ID: wpr-882649

ABSTRACT

Objective:To investigate the predictive value of serum thyroid hormone in the short-term prognosis of patients with septic shock..Methods:The 133 patients with septic shock admitted to Intensive Care Unit (ICU) of Nanjing Hospital of Nanjing Medical University were enrolled. Data of patient’s general clinical information, acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), serum triiodothyronine ( T3 ), thyroxine (T4), free triiodothyronine (FT3) , free thyroxine (FT4) and thyroid stimulating hormone(TSH) in 24 h were collected, and the ratio of T3 to FT3 (T3/FT3) was calculated. The patients were divided into the survival group and death group according to the prognosis during ICU hospitalization. Univariate and multivariate analyses were used to analyze the prognostic factors of patients with septic shock. The receiver operating characteristic (ROC) curve and Kaplan-Meier analysis were plotted to evaluate the diagnostic efficacy of serum thyroid hormone for the short-term prognosis of patients with septic shock.Results:Compared to the survival group, FT3, T3 and T3/FT3 were significantly lower in the death group [1.73 (1.54, 2.52) vs. 1.32 (0.94, 1.54) pmol/L, 0.70 (0.56, 0.79) vs. 0.33 (0.25, 0.43) nmol/L, 318.18(299.44, 448.05) vs. 250.00 (192.31, 313.92), respectively; all P < 0.05 ]. The levels of serum T3 and FT3 were significantly correlated with the APACHEⅡ score in patients with septic shock (FT3: r = -0.25, P= 0.004; T3: r = - 0.24, P= 0.006). Binary Logistic regression analysis showed that FT3, T3 and T3/FT3 were independent risk factors of the short-term prognosis of patients with septic shock [FT3: OR = 6.533, 95% CI: 0.687 - 62.157, P = 0.012; T3: OR = 0.529, 95% CI: 0.372 - 0.975, P= 0.000; T3/FT3: OR = 1.719, 95% CI: 1.007 - 1.931, P= 0.002]. ROC curve analysis showed that FT3, T3 and T3/FT3 all had certain predictive value for the short-term prognosis of patients with septic shock, and the diagnostic value of T3 was the largest [AUC = 0.874, 95% CI: 0.794-0.954, P= 0.000]. The Kaplan-Meier curve showed a significantly higher survival rate in patients with T3 greater than 0.535 nmol/L than patients with T3 less than 0.535 nmol/L. Conclusions:The serum levels of thyroid hormone T3 and FT3 are closely related to the severity of septic shock. T3 is an effective ICU mortality during hospitalization prognostic indicator for patients with septic shock, which is better than FT3 and T3/FT3.

7.
Chinese Medical Journal ; (24): 757-764, 2021.
Article in English | WPRIM | ID: wpr-878064

ABSTRACT

Chronic obstructive pulmonary disease (COPD) has become the third-leading cause of death worldwide, which is a severe economic burden to the healthcare system. Chronic bronchitis is the most common condition that contributes to COPD, both locally and systemically. Neutrophilic inflammation predominates in the COPD airway wall and lumen. Logically, repression of neutrophilia is an essential fashion to COPD treatment. However, currently available anti-neutrophilic therapies provide little benefit in COPD patients and may have serious side effects. Thus, there is an urgent need to explore an effective and safe anti-neutrophilic approach that might delay progression of the disease. Sialic acid-binding immunoglobulin-like lectin (Siglec)-9 is a member of the Siglec cell surface immunoglobulin family. It is noteworthy that Siglec-9 is highly expressed on human neutrophils and monocytes. Ligation of Siglec-9 by chemical compounds or synthetic ligands induced apoptosis and autophagic-like cell death in human neutrophils. Furthermore, administration of antibody to Siglec-E, mouse functional ortholog of Siglec-9, restrained recruitment and activation of neutrophils in mouse models of airway inflammation in vivo. Given the critical role that neutrophils play in chronic bronchitis and emphysema, targeting Siglec-9 could be beneficial for the treatment of COPD, asthma, fibrosis, and related chronic inflammatory lung diseases.


Subject(s)
Animals , Asthma , Humans , Lung , Mice , N-Acetylneuraminic Acid , Neutrophils , Pulmonary Disease, Chronic Obstructive/drug therapy , Sialic Acid Binding Immunoglobulin-like Lectins
8.
Article in Chinese | WPRIM | ID: wpr-879562

ABSTRACT

OBJECTIVE@#To analyze the clinical phenotype and genetic basis for a Chinese pedigree affected with coagulation factor XI (FXI) deficiency.@*METHODS@#Activated partial thromboplastin time (APTT) and other blood coagulation factors, and activities of FXI:C and other relevant coagulation factors for a large Chinese pedigree including 6 patients from 3 generations were determined on a Stago automatic coagulometer. The FXI:Ag was determined with an ELISA method. All exons and flanking regions of the F11 gene were subjected to Sanger sequencing. ClustalX-2.1-win software was used to analyze the conservation of amino acids. Pathogenicity of the variants was predicted with online bioinformatics software including Mutation Taster and Swiss-Pdb Viewer.@*RESULTS@#The APTT of the proband was prolonged to 94.2 s. The FXI:C and FXI:Ag were decreased to 1% and 1.3%, respectively. The APTT of her father, mother, son and daughter was 42.1 s, 43.0 s, 42.5 s and 41.0 s, respectively. The FXI:C and FXI:Ag of them were almost halved compared with the normal values. The APTT, FXI:C and FXI:Ag of her husband were all normal. Genetic testing revealed that the proband has carried a heterozygous missense c.1103G>A (p.Gly350Glu) variant in exon 10 and a heterozygous missense c.1556G>A (p.Trp501stop) variant in exon 13 of the F11 gene. The father and daughter were heterozygous for the c.1103G>A variant, whilst the mother and son were heterozygous for the c.1556G>A variant. Both Gly350 and Trp501 are highly conserved among homologous species, and both variants were predicted to be "disease causing" by Mutation Taster. Protein modeling indicated there are two hydrogen bonds between Gly350 and Phe312 in the wild-type, while the p.Gly350Glu variant may add a hydrogen bond to Glu and Tyr351 and create steric resistance between the two, both may affect the structure and stability of protein.@*CONCLUSION@#The c.1103G>A and c.1556G>A compound heterozygous variants probably underlay the pathogenesis of congenital FXI deficiency in this pedigree.


Subject(s)
Exons/genetics , Factor XI/genetics , Factor XI Deficiency/genetics , Female , Heterozygote , Humans , Male , Mutation , Pedigree
9.
Article in Chinese | WPRIM | ID: wpr-879438

ABSTRACT

OBJECTIVE@#To explore the relationship between lumbar degenerative spondylolisthesis and T2WI high signal in the interspinous ligament in MRI in order to improve the understanding of the signal changes of the interspinous ligament.@*METHODS@#The clinical data of 43 patients with clinically diagnosed lumbar degenerative spondylolisthesis were collected from March 2018 to March 2020, there were 19 males and 24 females, aged 50 to 92 years with an average of 69 years old. Using picture archiving and communication systems (PACS) to access images and record the distribution and incidence of T2WI high signal in the interspinous ligament between the slipped and non-slipped segments. Using Spearman correlation analysis to explore the relationshipbetween the T2WI high signal of the interspinous ligament and the degree of lumbar spondylolisthesis.@*RESULTS@#Except for 8 ligaments that were not included in the statistical results due to poor image quality, 43 patients with a total of 207 lumbar vertebrae and interspinous ligaments were included in the study. According to the Meyerding classification method, 43 patients had a total of 48 segments with spondylolisthesis, 41 segments in grade Ⅰ and 7 segments in grade Ⅱ. There were 30 cases of MRI T2WI high signal in the interspinous ligament corresponding to spondylolisthesis segment, including 3 cases on L@*CONCLUSION@#In patients with degenerative lumbar spondylolisthesis, the MRI T2WI hyperintensity is more common in the interspinous ligament. The occurrence of T2WI high signal is positively correlated with the degree of spondylolisthesis, which should be payed enough attention in imaging diagnosis.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Ligaments, Articular , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Spondylolisthesis/diagnostic imaging
10.
Article in Chinese | WPRIM | ID: wpr-905384

ABSTRACT

Objective:To study the changes of brain motor control function in patients with complete spinal cord injury within three to six months. Methods:From January, 2017 to January, 2019, eleven inpatients with complete spinal cord injury and twelve healthy controls were screened with functional magnetic resonance imaging during attempted/executive movement (MA/ME) and motor imagery (MI). The involved area and activation were compared between the groups under tasks. Results:More areas were activated in the patients than in the controls as MA/ME, such as bilateral primary sensorimotor cortex, supplementary motor area, lateral globus pallidus, cerebellum, contralateral thalamus and putamen. During MI, the activation was more in the patients in ipsilateral primary motor cortex, supplementary motor area, dorsal premotor area, contralateral supplementary motor area, insular and basal ganglia. The patients induced more activation as MA than as MI in ipsilateral primary motor cortex, bilateral supplementary motor area and cingulate motor area, and contralateral cerebellum. Conclusion:The activation remains normal in primary motor cortex and supplementary motor area for subacute complete spinal cord injury patients when undergoing motor tasks, but some reorganization may occur in parietal lobe and cerebellum that involve in sensorimotor integration.

11.
Article in Chinese | WPRIM | ID: wpr-871905

ABSTRACT

Objective:To investigate the molecular characteristics, drug resistance rate and virulence genes harboring status of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) associated with skin and soft tissue infections (SSTIs), and provide epidemiological basis for clinical antibiotic usage and infection prevention and control. Methods:The Staphylococcus aureus associated with SSTIs in Quzhou People′s Hospital from 2014 to 2018 were retrospectively analyzed. A total of 72 CA-MRSA isolates were screened, and molecular typing was performed by multilocus sequence typing (MLST). K-B method and micro broth dilution method were used to analyze the antibiotic susceptibilities of those strains. The virulence genes screened including fibronectin binding protein genes (fnbA, fnbB),hemolysin genes (hla, hlb), enterotoxin genes (sec, seh) and leukocidin gene (PVL) were detected by polymerase chain reaction (PCR).Statistical analysis of differences between drug resistance rates and virulence genes carrier rates between ST59 and non-ST59 groups used were Chi-square test or Fisher exact test. Results:ST59 type was the main epidemic clone in skin and soft tissue infection CA-MRSA in Quzhou area with account for 55.56% (40/72). All isolates had higher resistance rates to erythromycin (90.28%, 65/72), clindamycin (68.06%, 49/72) and tetracycline (41.67%, 30/72). The nitrofurantoin, daptomycin and linezolid were all sensitive. The resistance rate to clindamycin of sequence type 59 (ST59) was (85.00%, 34/40). The resistance rate of ST59 to clindamycin was significantly higher than that of other clone types (χ 2=11.886, P<0.01). There was no significant difference in the resistance rates of other antibiotics. All 72 isolates exhibited carriage of virulence genes as follows, hla (97.22%, 70/72) , hlb (33.33%, 24/72) , fnbA (50.00%, 36/72) , fnbB (48.61%, 35/72) , PVL (63.89%, 46/72) , sec (4.17%, 3/72) , seh (4.17%, 3/72) . The carrier rate of PVL gene in ST59 type was (77.50%, 31/40). ST59 showed higher rates of PVL genes compared with other clone types (χ 2=7.227, P<0.01). Conclusions:The main clone of CA-MRSA associated with SSTIs in Quzhou was ST59, which was similar to other parts of the Country. The carrying rate of PVL gene of ST59 isolate was significantly higher than that of other isolates. CA-MRSA associated with SSTIs has a high resistance rate to erythromycin and clindamycin, which should not be used as the first choice in treatment.

12.
Chinese Journal of Urology ; (12): 303-308, 2020.
Article in Chinese | WPRIM | ID: wpr-869640

ABSTRACT

Objective:To evaluate the relationship between dyslipidemia and uric acid urolithiasis, and explore the risk factors of uric acid urolithiasis.Methods:93 patients with uric acid urolithiasis identified by stone composition analysis were retrospective analyzed from January 2014 to October 2019 were classified as uric acid urolithiasis group.Among them there were 77 men accounting for 82.8%, 16 women accounting for 17.2%, the median age is 64 years old.According to sex, age and other conditions, 321 patients with calcium oxalate urolithiasis in the same period were selected as calcium oxalate stone group. Among them there were 264 men accounting for 82.2%, 57 women accounting for 17.8%, the average age is 64 years old.While 306 non-stone people examined in hospital as control group in the same period who matched with age and gender. Among them there were 252 men accounting for 82.4%, 54 women accounting for 17.6%, the average age is 61 years old. There was no significant difference in age and sex ratio among the three groups. The body mass index (BMI) of uric acid urolithiasis group, calcium oxalate urolithiasis group and control group were significantly different( P<0.01). Serum uric acid, urine pH and blood lipids: triglyceride (TG), cholesterol (TC), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) were recorded in the three groups, and the correlation between the above indexes and stone composition was analyzed.The uric acid urolithiasis group was divided into hyperuricemia(HUA) group (n=41) and Non HUA group (n=52) according to serum uric acid, and 66 cases with HUA were selected in the control group. The dyslipidemia and urine pH levels of the above three groups were compared. The multivariate Logistic regression analysis was used to identify the independent risk factors associated with uric acid urolithiasis formation. Results:There were significant differences in TG level, incidence of hypertrigly-ceridemia, low HDL-cholesterolemia, high LDL-cholesterolemia, serum uric acid and urine pH between uric acid urolithiasis group and calcium oxalate urolithiasis group( P<0.05). Significant differences were seen in TG level, HDL-C level, incidence of hypertriglyceridemia and low HDL-cholesterolemia, serum uric acid and urine pH between uric acid urolithiasis group and control group.There was significant difference in urine pH between uric acid urolithiasis with and Non HUA group. Significant difference in the incidence of hypertriglyceridemia and low HDL-cholesterolemia were seen between uric acid urolithiasis with HUA group and HUA group.Multivariate Logistic regression analysis showed that obesity(odds ratio=1.68, P<0.001), hypertriglyceridemia(odds ratio=7.37, P=0.002), low HDL-cholesterolemia(odds ratio=10.46, P=0.001) and low urinary pH(odds ratio=0.10, P<0.001) were independent risk factors for uric acid urolithiasis. Conclusions:Dyslipidemia was more likely associated with uric acid urolithiasis. Obesity, hypertriglyceridemia, low HDL-cholesterolemia and low urinary pH are closely related to the occurrence of uric acid urolithiasis.

13.
Article in Chinese | WPRIM | ID: wpr-867907

ABSTRACT

Objective:To present our strategies and suggestions for management of acute hand injury during the epidemic of COVID-19.Methods:From January 1 to February 20, 2020, 78 patients with acute hand injury were admitted to the Department of Hand Surgery, Wuhan Fourth Hospital. They were 45 males and 33 females, aged from 21 to 69 years (mean, 43.2 years). Of them, 60 were treated from January 1 to 20, 2020, by medical staff under protection of class 1, and 18 from January 21 February 20, 2020, by medical staff under protection of class 2. The COVID-19 infection was recorded in the patients and medical staff as well. The measures taken and experience in control and prevention of 2019-nCoV infection during the epidemic were reviewed.Results:From January 1 to 20, 2020, 5 patients were diagnosed of COVID-19 infection, including 3 mild and 2 moderate cases, and 5 medical staff members were also diagnosed of COVID-19 infection, including 3 mild, one moderate and one severe cases. From January 21 to February 20, 2020, 2 patients were diagnosed of COVID-19 infection, including one mild and one moderate cases, but none of the medical staff was infected by COVID-19.Conclusions:During the epidemic of COVID-19, the front line medical staff may face a high risk of COVID-19 infection in the whole process of management of acute hand trauma. The risk of nosocomial COVID-19 infection can be reduced by complete pre-hospital examination, choice of proper anesthesia and surgical procedures, perioperative prevention measures for medical staff, improved postoperative ward management, and psychological counseling for the patients.

14.
Chinese Journal of Trauma ; (12): 143-147, 2020.
Article in Chinese | WPRIM | ID: wpr-867686

ABSTRACT

Objective:To investigate the value of high-resolution 3T MRI in the detection of triangular fibrocartilage complex (TFCC) injuries through a diagnostic test.Methods:A retrospective case series analysis was performed in 133 patients with ulnar wrist pain admitted in Beijing Jishuitan Hospital from January 2013 to April 2018. There were 68 males and 65 females, aged 14-69 years (mean 32.6 years). The patients was examined with the wrist MRI with consistent parameters and then received wrist arthroscopic detection or treatment. The TFCC injuries were classified as central injury, namely triangular fibrocartilage disc injury and peripheral injury, namely the tear of ulnar attachment, radial attachment, distal radioulnar ligaments and ulnocarpal ligaments. Take the results of wrist arthroscopy as the gold standard, the MRI and arthroscopic findings were compared and the sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were determined.Results:Wrist arthroscopy confirmed TFCC injuries in 122 patients, among which 72 patients were with central injury and 102 with peripheral injury. Meanwhile, TFCC injuries were diagnosed with MRI in 124 patients, among which 75 patients were central injury and 111 cases were peripheral injury. As for central injury, the sensitivity/specificity, positive/negative predictive value and positive/negative likelihood ratio of MRI were 0.972/0.918, 0.933/0.966 and 11.85/0.03, respectively; when the target pathology was peripheral injury, the sensitivity/specificity, positive/negative predictive value and positive/negative likelihood ratio of MRI were 0.882/0.323, 0.811/0.45 and 1.30/0.37, respectively.Conclusions:High-resolution 3T MRI is accurate in detection of central injury of TFCC, no matter the injury is traumatic or degenerated. In the diagnosis of peripheral injury of the TFCC, MRI can provide some help for its high sensitivity. However, the positive findings of MRI on peripheral structures should be cautious because of the poor specificity, and hence the results of history, physical examination and MRI should be considered together to attain an accurate diagnosis.

15.
Chinese Acupuncture & Moxibustion ; (12): 1173-1177, 2020.
Article in Chinese | WPRIM | ID: wpr-877582

ABSTRACT

OBJECTIVE@#To observe the effect of early acupoint electrical stimulation on the decline of lower limbs muscle strength in patients with intensive care unit-acquired weakness (ICU-AW) caused by septic shock.@*METHODS@#A total of 58 patients with ICU-AW caused by septic shock were randomly divided into an observation group (28 cases, 1 case dropped off ) and a control group (30 cases, 2 cases dropped off ). Patients in both groups received routine basic treatment. In the observation group, acupoint electric stimulation therapy was added at Huantiao (GB 30), Futu (ST 32), Zusanli (ST 36), Xuanzhong (GB 39) and Taichong (LR 3). Unilateral point with electrodes were applied, the SDZ-Ⅱ electronic instrument (discontinuous wave, frequency in 2 Hz, strength in 5 mA) was connected and changed to the other side after 30 min of unilateral treatment.The treatment was given 2 times daily, continued for 7 d or until the medical research council (MRC) score being 54 points or more. The changes of lower limb muscle strength MRC score, modified Rankin scale (MRS) score, bilateral quadriceps thickness and gastrocnemius pinnate angle of both groups were observed before treatment and on discharge. The time of admission to ICU, time of hospitalization, mortality during hospitalization, and mortality 28 d after discharge were compared between the two groups. The MRS scores of the two groups were followed up 28 d after discharge.@*RESULTS@#The MRC scores of lower limb muscle strength in the two groups on discharge were higher than those before treatment (@*CONCLUSION@#Early acupoint electrical stimulation can improve the lower extremity muscle decline in patients with ICU-AW caused by septic shock.


Subject(s)
Acupuncture Points , Electric Stimulation , Humans , Lower Extremity , Muscle Strength , Shock, Septic/therapy
16.
Article in Chinese | WPRIM | ID: wpr-905691

ABSTRACT

After retrieving the databases, as well as the official websites of institutes and administrations of occupational therapists, the qualifications, working conditions and career development in different countries, such as the United States, Canada, Australia, New Zealand and England, were collected and analyzed, which may provide reference frame for the development of the profession in China.

17.
Article in Chinese | WPRIM | ID: wpr-754734

ABSTRACT

Objective To explore the effectiveness of wide awake local anesthesia no tourniquet (WALANT) in arthroscopy for diagnosis and treatment of wrist injuries and conditions.Methods Between January 2012 and January 2016,WALANT approach was used in wrist arthroscopy for 22 patients with wrist injury or condition at Department of Hand Surgery,Beijing Jishuitan Hospital.They were 10 males and 12 females,aged from 19 to 56 years(average,34 years).Arthroscopic exploration was conducted in 7 cases,arthroscopic synovectomy in 6,dorsal wrist ganglionectomy in 3,triangular fibrocartilage complex (TFCC) debridement in 5 and TFCC repair in one.All the patients were anesthetized using portal site local anesthesia (PSLA) technique.Additional local infiltration around ulnar-sided wrist incisions was performed in 2 TFCC repairs.Bupivacaine was used for both techniques.The effects were evaluated using a ten-point visual analogue scale (VAS).Results Desired objectives were achieved in all patients.No operative complication was observed.Mild pain was noted in all the patients when local anesthetic was injected to the portal sites,with an average VAS score of 2.5 points (from 1 to 3 points).In the following arthroscopic procedures,most of the patients did not report any discomfort.Only one patient undergoing TFCC repair reported mild pain (VAS score of 3 points) during ulnar-carpal suture procedure.Conclusion The new WALANT technique is safe,time-saving,economical and capable of pain control during arthroscopy for numerous wrist injuries and conditions.

18.
Chinese Medical Journal ; (24): 2046-2052, 2019.
Article in English | WPRIM | ID: wpr-774661

ABSTRACT

BACKGROUND@#Deceleration capacity (DC) is a non-invasive marker for cardiac autonomic dysfunction; however, few studies have shown that the influence factors of cardiac autonomic dysfunction and the correlations between DC and stroke risk in paroxysmal atrial fibrillation (AF). We aimed to explore the influencing factors of abnormal DC and the relationships between DC and stroke risk in patients with paroxysmal AF.@*METHODS@#The study included hospitalized paroxysmal AF patients with DC measurements derived from 24-h Holter electrocardiography recordings taken between August 2015 and June 2016. Multivariable regression analysis was performed to evaluate the associations between correlated variables and abnormal DC values. The relationship between DC and ischemic stroke risk scores in patients with paroxysmal AF was analyzed.@*RESULTS@#We studied 259 hospitalized patients with paroxysmal AF (143 [55.2%] male, mean age 66.4 ± 12.0 years); 38 patients of them showed abnormal DC values. In the univariate analysis, age, hypertension, heart failure, and previous stroke/transient ischemic attack (TIA) were significantly associated with abnormal DC values. Among these factors, a history of previous stroke/TIA (odds ratio = 2.861, 95% confidence interval: 1.356-6.039) were independently associated with abnormal DC values in patients with paroxysmal AF. The abnormal DC group showed a higher stroke risk with the score of congestive heart failure, hypertension, age >75 years, diabetes mellitus, previous stroke and TIA (CHADS2) (2.25 ± 1.48 vs. 1.40 ± 1.34, t = -4.907, P = 0.001) and CHA2DS2-vascular disease, age 65-74 years and female category (VASc) (3.76 ± 1.95 vs. 2.71 ± 1.87, t = -4.847, P = 0.001) scores. Correlation analysis showed that DC was negatively correlated with CHADS2 scores (r = -0.290, P < 0.001) and CHA2DS2-VASc scores (r = -0.263, P < 0.001).@*CONCLUSIONS@#Lower DC is closely associated with previous stroke/TIA, and is also correlated negatively with higher stroke risk scores in patients with paroxysmal AF. It could be a potential indicator of stroke risk in paroxysmal AF patients.

19.
Article in Chinese | WPRIM | ID: wpr-745088

ABSTRACT

Objective To evaluate conventional wrist physical examination in detecting injury to the triangular fibrocartilage complex (TFCC).Methods A retrospective study was conducted of the 118 patients (119 wrists) who had been admitted from January 2013 to October 2017 to Hand Surgery Department,Beijing Jishuitan Hospital for wrist arthroscopic surgery.All of them underwent wrist physical examination preoperatively for conventional index tests for TFCC injury like ulnar fovea sign,piano-key test,distal ulnar ballottement test and ulnocarpal stress test.They were 68 males and 50 females with a mean age of 32 years.The results of physical examination were compared with the arthroscopic findings to calculate the sensitivity,specificity,positive/negative predictive value (PPV/NPV) and +/-likelihood ratio (LR) of each index test.In addition,we combined the results of any 2 tests to increase the capability of detecting peripheral TFCC injury.Results The diagnostic values of each index test were achieved by comparison between the results of physical examination and the arthroscopic findings:(1) ulnar fovea sign:sensitivity =0.648,specificity =0.742;(2) piano key test:sensitivity =0.817,specificity =0.735;(3) distal ulnar ballottement test:sensitivity =0.927,specificity =0.647;(4) ulnocarpal stress test:sensitivity =0.825,specificity =0.500.The combination of any 2 tests produced 3 new index tests,of which the most valuable combination was ulnar fovea sign & distal ulna ballottement test,with a sensitivity of 0.598,a specificity of 0.941,a PPV of 0.961and a + LR of 10.14,Conclusions The signs elicited in physical examination and special tests can be helpful in the diagnosis of TFCC injuries.However,as the value of any single test is not enough,we should clinically combine the results of ulna fovea sign and distal ulna ballottement test to increase the capability of detecting peripheral TFCC injury.

20.
Chinese Journal of Trauma ; (12): 241-246, 2019.
Article in Chinese | WPRIM | ID: wpr-745048

ABSTRACT

Objective To investigate the clinical efficacy of dry arthroscopy in the treatment of wrist joint injury. Methods A retrospective case series study was conducted to analyze the clinical data of 59 patients with wrist joint injuries admitted from January 2013 to January 2016. There were 48 males and 11 females, aged 15-69 years, with an average age of 34 years. Among the patients, there were 32 patients with old scaphoid fractures ( including delayed diagnosis and treatment of scaphoid fractures or scaphoid fracture nonunion) , 23 patients with intra articular fractures of distal radius, and four patients with chronic instability of lower ulnar radial joint. All patients were treated with dry arthroscopic surgery. During the operation, the operation time of bone grafting and the swelling degree of soft tissue around the joint which needed simultaneous incision were observed. Fracture healing, and joint stability were recorded after operation, and wrist function was evaluated by Mayo wrist function score. Results The average operation time of scaphoid bone grafting was 7 minutes. In patients with distal radius fractures requiring simultaneous incision and reconstruction of the lower ulnar radial ligament, there was no significant periarticular swelling, with normal anatomical layer and clear visual field. All patients were followed up for 6-28 months ( average 9 months) . All the old scaphoid fractures were healed, with the average healing time of 12. 6 weeks. All distal radius fractures were anatomically repositioned during operation. All patients with chronic instability of the lower ulnar radial joint were seen stable recovery of the joint, with negative impact test of the lower ulnar and radial joints. The Mayo wrist function score of all patients averaged 95 points. Conclusion Dry arthroscopic technique can improve the efficiency of bone grafting under wrist arthroscopy, reduce the swelling of soft tissue around the joint, maintain clear anatomical layers of soft tissue, promote fracture healing and improve wrist function, especially applicable for wrist arthroscopy with minimally invasive bone grafting and wrist incision at the same time.

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