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Objective To study biomechanical effects of cannulated screws at different fixation angles on posterior malleolus fracture based on finite element method, so as to determine the best fixation method of cannulatedscrew. Methods The finite element model of ankle joint, including tibia, fibula, astragalus, corresponding cartilage and ligaments was reconstructed using CT images, and 1 / 2 posterior malleolus fracture model was established on the basis of verifying its validity. The biomechanical effects of cannulated screw fixation on posterior malleolus fracture fixation model were analyzed. Results Compared with 0°,5°,10°,20° fixation model, the 15° fixation model had the smallest displacement. The screw stress of 15° fixation model was lower than that of 5°, 10°, 20° fixation model, and higher than that of 0° fixation model. But when the screw fixation angle was 0°, the peak contact pressure of ankle joint was much larger than that of normal ankle joint, which was easy to cause traumatic osteoarthritis. Conclusions Cannulated screw is safe and effective for treating posterior malleolus fracture which is less than 1 / 2 fragment size. The displacement and stress of the model are different at different fixation angles of screws. When the fixation angle of screw is 15°, the biomechanical stability is the best, which can be used to guide clinical operation.
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ObjectiveTo characterize the chemical constituents of Dayuanyin based on ultra-performance liquid chromatography-quadrupole/electrostatic field orbitrap mass spectrometry(UPLC-Q-Exactive Orbitrap MS). MethodThe detection was performed on a Thermo Acclaim™ RSLC 120 C18 column(2.1 mm×100 mm, 2.2 μm), the mobile phase was acetonitrile(A)-0.1% formic acid aqueous solution(B) for gradient elution (0-7.5 min, 10%-19%A; 7.5-12 min, 19%-22.5%A; 12-23 min, 22.5%-27%A; 23-27 min, 27%-56%A; 27-35 min, 56%-84%A; 35-36 min, 84%-90%A), the flow rate was 0.3 mL·min-1, and the column temperature was 30 ℃. The data were collected in the positive and negative ion modes by heated electrospray ionization(HESI), and the detection range was m/z 80-1 200. Combining the retention time of the reference substance, fragment ions, databases such as PubChem and related literature, Xcalibur 3.0 was used to identify the chemical constituents of Dayuanyin. ResultA total of 161 compounds were identified, including 14 alkaloids, 60 flavonoids, 16 terpenoids, 26 saponins, 18 phenylpropanoids, 16 organic acids and 11 others. ConclusionThe established method can effectively and quickly identify the chemical components in Dayuanyin, and clarify its chemical composition, which can provide a basis for the development of compound preparations of this famous classical formula.
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The self-health management level of patients with coronary heart disease depends largely on their health literacy level. The theory of health ecology believes that the factors affecting individual health are multi-level. Based on the perspective of health ecology, this paper analyzed the influencing factors of health literacy of patients with coronary heart disease from five aspects: personal characteristics, behavior, interpersonal network, living and working conditions, environmental policies, so as to provide a basis for formulating targeted and systematic strategies for improving the health literacy of patients with coronary heart disease in the future.
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This paper focused on the research progress of the assessment methods of carers′ fall concern for the elderly. The content of this review included the definition of carers′ fall concern, and the advantages and disadvantages of various assessment method of carers′ fall concern for the caregivers to the elderly, such as qualitative interviews, questionnaires, and scales. Through this review, the authors hoped to provide a reference for selecting or developing a localized carers′ fall concern assessment tool.
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O'Sullivan-Mcleod syndrome is a very rare variant of MND with a good prognosis. Its clinical feature is distal lower motor neuron syndrome of both upper limbs, and there is no effective treatment at present. We reported a case of O'Sullivan-Mcleod syndrome in this paper.The patient exhibited with middle-aged progressive distal muscle weakness and atrophy of both upper limbs, without sensory, cognitive or behavioral impairment and without pyramidal tract sign. Laboratory examination, imaging and genetic tests showed no obvious abnormalities. EMG revealed neurogenic damage to the small muscles of both hands. Now we retrospectively analyzed the clinical features of a patient with O'Sullivan-McLeod syndrome, and data from 18 cases for comparative analysis, in order to improve its understanding by clinicians.
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The immune checkpoint blockade therapy has profoundly revolutionized the field of cancer immunotherapy. However, despite great promise for a variety of cancers, the efficacy of immune checkpoint inhibitors is still low in colorectal cancer (CRC). This is mainly due to the immunosuppressive feature of the tumor microenvironment (TME). Emerging evidence reveals that certain chemotherapeutic drugs induce immunogenic cell death (ICD), demonstrating great potential for remodeling the immunosuppressive TME. In this study, the potential of ginsenoside Rg3 (Rg3) as an ICD inducer against CRC cells was confirmed using in vitro and in vivo experimental approaches. The ICD efficacy of Rg3 could be significantly enhanced by quercetin (QTN) that elicited reactive oxygen species (ROS). To ameliorate in vivo delivery barriers associated with chemotherapeutic drugs, a folate (FA)-targeted polyethylene glycol (PEG)-modified amphiphilic cyclodextrin nanoparticle (NP) was developed for co-encapsulation of Rg3 and QTN. The resultant nanoformulation (CD-PEG-FA.Rg3.QTN) significantly prolonged blood circulation and enhanced tumor targeting in an orthotopic CRC mouse model, resulting in the conversion of immunosuppressive TME. Furthermore, the CD-PEG-FA.Rg3.QTN achieved significantly longer survival of animals in combination with Anti-PD-L1. The study provides a promising strategy for the treatment of CRC.
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Objective:To identify the risk factors of cognitive dysfunction in patients with atrial fibrillation and to establish a risk prediction model.Methods:The convenience sampling method was used to evaluate 260 patients with atrial fibrillation who were hospitalized in the Department of Cardiology of the Affiliated Hospital of Jining Medical College from January to December 2020. The cognitive function of the patients was evaluated with the Montreal Cognitive Function Assessment Scale (MoCA). Univariate analysis was used to screen the independent variables that had influence on the occurrence of cognitive dysfunction, and the statistically significant variables were included in the multivariate Logistic regression model. According to the regression coefficients of statistically significant variables, a line map was drawn to construct the risk prediction model of cognitive dysfunction in patients with atrial fibrillation.Results:There were 209 cases with cognitive impairment and 51 cases without cognitive impairment. Univariate analysis showed that sex, age, smoking history, drinking history, education level, free thyroxine, hemoglobin, D-dimer and BMI ( χ2 values were 4.08-18.83, t values were -6.04-2.94, Z=-2.76) were significantly different between the patients with or without cognitive dysfunction. The results of multivariate Logistic regression analysis showed that age ( OR values were 1.13), education level ( OR=0.01-0.05), quit smoking history ( OR=0.36), drinking history ( OR=0.35) and free thyroxine( OR=1.14) had significantly statistical significance ( P<0.05). The area under ROC curve (AUC) = 0.878 and AUC>0.8, this model had good clinical prediction ability. Conclusions:The construction of cognitive dysfunction risk prediction model for patients with atrial fibrillation can prevent or intervene high risk factors in advance, facilitate clinical use, and provide data support for the improvement of cognitive function in patients with atrial fibrillation.
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OBJECTIVE To prepare Neuritic acid oral emulsion ,to optimize its formulation and preparation technology ,and to investigate its stability. METHODS Neuritic acid oral emulsion was prepared by mechanical method. On the basis of single factor experiment ,the appearance ,centrifugal stability ,centrifugal stability constant (Ke)and particle size of the emulsion as indexes,the formulation was optimized by orthogonal design ,taking the dosage of oleic acid ,octylphenol polyoxyethylene ether-10 and propylene glycol as factors ,the preparation technology was optimized by taking emulsification temperature ,shear time,pressure of high-pressure homogenization and cycle times of high-pressure homogenization as factors. The content of neuritic acid was determined by high performance liquid chromatography. The stability of Neuritic acid oral emulsion was investigated by high temperature test ,accelerated test and long-term test. RESULTS The optimal formulation and preparation technology were as follows:neuritic acid of 1 g,oleic acid of 5% ,octylphenol polyoxyethylene ether- 10 of 4% ,propylene glycol of 2% , emulsification temperature of 60 ℃ ,shear time of 2 min,homogenization pressure of 40 MPa and cycle times of twice. After three experiments ,the average particle size of Neuritic acid oral emulsion was 158.05 nm(RSD=1.58%,n=3),the average Ke was 0.39(RSD=1.49%,n=3),and the appearance was uniform milky white ,there was no stratification. The results of high temperature test showed that Neuritic acid oral emulsion was prone to stratification in high temperature environment ,and the content of neuritic acid increased. The results of accelerated test and long-term test showed that there was no significant change in the appearance or the content of neuritic acid when Neuritic acid oral emulsion was placed at room temperature for 6 months. CONCLUSIONS The formulation and preparation technology are stable and feasible ,and can be used for the preparation of Neuritic acid oral emulsion. Neuritic acid oral emulsion should not be placed in high temperature environment. It has good stability at room temperature for 6 months.
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Refeeding syndrome (RFS) is a potentially fatal complication of clinical nutritional therapy. Patients in intensive care unit (ICU) consuming nutrients under high stress and high metabolism are more likely to develop RFS, which is closely related to the poor prognosis and higher mortality. However, due to the lack of characteristic clinical manifestations of RFS and the incomplete evaluation of risk factors, there are few reports on the related research of RFS risk prediction model, and it is easily ignored by clinicians. The key to prevention and treatment is to clarify the risk factors of RFS in ICU patients, early identify high-risk patients and initiate intervention. In this paper, the diagnostic criteria, current domestic and abroad situation, risk prediction indexes and preventive therapy of RFS are reviewed. It provides a reference for constructing an RFS risk prediction model that is in line with our national conditions, in order to improve the ability of medical staff to early identify RFS and improve the survival rate of ICU patients.
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Objective:To investigate the effects of seven-step exercise rehabilitation combined with elastic resistance training on functional fitness and cardiovascular adverse events in patients with coronary heart disease (CHD).Methods:116 patients with CHD in our hospital from March 2017 to March 2019 were selected for prospective study, and they were divided into observation group ( n=58) and control group ( n=58) according to the order of admission time. The control group was given routine intervention, and the observation group was given seven step exercise rehabilitation combined with elastic band resistance training on the basis of the control group. The intervention satisfaction, incidence of cardiovascular adverse events, functional physical fitness indexes, cardiac function [left ventricular ejection fraction (LVEF), cardiac stroke volume (SV), cardiac index (CI)] and activities of daily living (BI) were compared between the two groups. Results:After intervention, the aerobic endurance, limb flexibility, lower extremity muscle strength and upper limb muscle strength were better than those in the control group ( P<0.05). After intervention, the LVEF, CI, SV, daily behavior, physiology and daily activities scores in the observation group were higher were higher than those of the control group ( P<0.05) . The intervention satisfaction of the observation group was 94.83%(55/58) , higher than that of the control group 79.31%(46/58) ( P<0.05); the incidence of cardiovascular adverse events in the observation group was 5.17%(3/58) and 10.34%(6/58) of the control group, with no statistically significant difference ( P>0.05). Conclusions:Seven-step exercise rehabilitation combined with elastic band resistance training can effectively improve the functional fitness and heart function of CHD patients, improve daily living ability and intervention satisfaction, and prevent cardiovascular adverse events.
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Objective:To evaluate the effect of gender on neuromuscular blockade of rocuronium in epileptics.Methods:Forty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 18-59 yr, with body mass index of 18.5-24.0 kg/m 2, scheduled for elective surgery for treatment of epilepsy under general anesthesia, were divided into 2 groups ( n=20 each) according to gender: male group (group M) and female group (group F). Neuromuscular conduction function was monitored with a muscle relaxation monitor.Ulnar nerve was stimulated in TOF mode (frequency 2 Hz, wave width 0.2 ms, stimulation current 70 mA and interval 12 s). Rocuronium 0.8 mg/kg was injected intravenously during anesthesia induction, and endotracheal intubation was performed when T l reached maximum inhibition.The conditions of endotracheal intubation were evaluated by the modified method.When T 1 recovered to 25% during operation, rocuronium 0.15 mg/kg was intravenously injected.Sugammadex sodium 2 mg/kg was injected intravenously when T 1 recovered to 50% after surgery.The onset time (T onset), peak time (T peak), 10% recovery time (T 10%), 10%-25% recovery time (T 10%-25%), 25%-50% recovery time (T 25%-50%), 50%-75% recovery time (T 50%-75%) and 75%-90% recovery time (T 75%-90%) of rocuronium were recorded.Peripheral venous blood samples (3 ml) were collected when T 1 recovered to 25% and 75%, and the concentration of rocuronium was detected by liquid chromatography-tandem mass spectrum.The consumption of rocuronium per unit of weight per minute was calculated. Results:There was no significant difference between the two groups in terms of T onset, T peak, T 10%, T 10%-25%, T 25%-50%, T 50%-75%, T 75%-90%, endotracheal intubation conditions, blood concentration of rocuronium at varied time points, or consumption of rocuronium per unit of weight per minute ( P>0.05). Conclusion:Gender exerts no effect on the neuromuscular blockade of rocuronium in epileptics.
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Intravitreal injection of anti-VEGF drugs has gradually become the first-line treatment for diabetic retinopathy (DR). However, diabetic macular edema (DME) caused by DR blood-retinal barrier damage is less sensitive to anti-VEGF drugs.Therefore, it is necessary to find supplementary drugs or alternative drugs that can effectively protect the structure of the blood vessel wall. Melatonin is a hormone mainly secreted by the pineal gland, which can play a number of functions in the human body such as regulating biological rhythms, scavenging free radicals, and anti-inflammatory. In recent years, studies have shown that melatonin can improve neuronal degeneration and protect blood vessel structure through multiple mechanisms in retinopathy. In terms of its protective effect on the retinal capillary structure, melatonin can improve the damage of early DR endothelial cells and pericytes through anti-oxidative stress, anti-inflammatory, and inhibiting cell apoptosis so as to protect the integrity of the blood-retinal barrier structure. It suggests that melatonin may provide new ideas for the prevention and treatment of DR, especially with DME.
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Objective@#Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province.@*Methods@#A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data.@*Results@#The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05).@*Conclusions@#The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.
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Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.
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Objective To better understand the clinical features and the diagnosis of TAFRO syndrome.Methods The clinical data of a patient were analyzed and the related literatures were reviewed.Results A 51-year-old male characterized by fever,edema of the legs,serous cavity effusion,throm-bocyto-penia,and renal dysfunction;Kidney biopsy suggested a diagnosis of endocapillary proliferative glomerulon-ephritis and thrombotic microangiopathy.The pathology of lymph node biopsy supported the diagnosis of Castleman disease.After administering with glucocorticoids and supportive platelet transfusion,the clinical symptoms relieved.Conclusion Symptoms of patients with TAFRO syndrome are variable.The diagnosis relies on history and pathological examination.Currently,glucocorticoids can be used as first line therapy.TAFRO syndrome should be thoroughly investigated for differentiating with other diseases.
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Objective To investigate the current status of application of the Confusion assessment method for the Intensive Care Unit (Cam-ICU),and to explore its influencing factors.Methods A total of 300 patients admitted to were enrolled.The researchers and nurses used Cam-ICU to assess patients' delirium,respectively,and the differences in deliriun assessment were analyzed.Results For delirium assessment,the Kappa value was 0.546 between the researchers and nurses.The consensus rate was 17.6% for hypoactive delirium,and 77.8% for hyperactive delirium in 44 delirium patients.Logistic regression analysis showed that APACHE Ⅱ score,RASS score and delirium type were influencing factors of accurate assessment of delirium.Conclusion The consistence of assessment of delirium by ICU nurses is generally good,but the accuracy of assessment of hypoactive delirium is the worst.
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Purpose The mean pulmonary artery (MPAP) has been widely used as an important parameter to diagnose and evaluate pulmonary hypertension (PH).The purpose of this paper is to compare the efficacy of two methods in evaluating PH,including estimating pulmonary artery systolic pressure (PASP) using Doppler ultrasonography to measure tricuspid regurgitation (TR) velocity,and directly using the peak velocity of TR.Materiasl and Methods From January 2012 to June 2013,eighty patients with left-to-right shunt congenital heart diseases (CHD) planned for closure procedure in Tangdu Hospital of the Fourth Military Medical University and the General Hospital of Shenyang Military region were included in this prospective study,who underwent right heart catheterization to measure pulmonary artery pressure,and underwent Doppler ultrasonography to measure the peak velocity ofTR.Results Using catheter-measured MPAP of≥ 25 mmHg as diagnostic reference,the false positive rate was 62.96%,and the false negative rate 0% when the estimated PASP of >30 mmHg determined by TR method was used to diagnose PH.There was high diagnostic agreement when peak velocity of TR was used to diagnose PH.When 320 cm/s and 340 crn/s were used as diagnostic cutoff values,false positive rates were 14.81% and 7.41%,and false negative rates were 15.91% and 20.45%,respectively.Conclusion In patients with left-to-right shunt CHD,peak velocity of TR measured on echocardiography can be used to diagnose PH which overcomes the high false positive rate in estimation method.It is more suitable to diagnose PH when the MPAP is used as the diagnostic criterion.
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Objective To investigate the feasibility of VTQ value of spleen in noninvasive assessment of staging of liver fibrosis in patients with hepatitis B.Methods VTQ values of spleen were measured in 56 patients with hepatitis B by using ARFI technique and liver biopsy was performed.The patients were then grouped according to the stages of liver fibrosis stage.The results were analyzed by the intergroup comparison,Pearson Correlation analysis,and receiver operating characteristic curve (ROC curve).Results There was positive association of the VTQ value with the stages of liver fibrosis,whose correlation coefficient was 0.83 (P < 0.05);There was no significant difference between the spleen VTQ value and the liver fibrosis S1 and SO (P > 0.05),whereas there were significant differences among other groups (P < 0.05).The area under the ROC curve was 0.95,the cut-off value was 2.79m/s,and the specificity and sensitivity were 81.8% and 91.7% respectively.Conclusions The VTQ value measured by ARFI technique has a better value in noninvasive diagnosis of stages of hepatitis B liver fibrosis.
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Objective To evaluate the feasibility of real-time threedimensional transesophageal echocardiography (RT3D TEE) in Carpentier's classification of patients with mitral regurgitation (MR).Methods Totally 124 patients with MR were divided into type Ⅰ—Ⅲ type according to Carpentier's classification,and the cases and methods of operation were followed up.Results In all of the 124 patients,9 cases were Carpentier's type Ⅰ,including 8 cases of atrial fibrillation,1 case of mitral valve cleft;102 patients were type Ⅱ,including pure mitral valve prolapse in 16 cases,mitral valve prolapse with chordae rupture in 80 cases,infective endocarditis in 6 cases;13 cases were type Ⅲ,including Ⅲa type rheumatic heart disease in 8 cases,Ⅲ b type of left ventricular systolic dysfunction in 5 cases.Totally 101 cases underwent MR surgery,including mitral valve plasty in 83 cases and valve replacement in 18 cases.Conclusion RT3D TEE is feasible and accurate in defining different types of MR,and it is useful to make management decisions and select the appropriate surgical strategy.
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Objective To investigate the association between rs7744 polymorphism in the 3'?untranslated region(3'?UTR)of myeloid differen?tiation factor 88(MyD88)gene and the risk and severity of coronary artery disease(CAD)in a North Chinese Han population. Methods The CAD and control groups consisted of 540 patients and 270 subjects,respectively. The genotypes of rs7744 were detected by polymerase chain reac?tion?restriction fragment length polymorphism(PCR?RFLP),and clinical data were collected. Results The distributions of MyD88 rs7744 were in HWE(P>0.1). In the<50?year?old age group,a lower risk of CAD was observed for subjects carrying the variant AG genotype in comparison to subjects carrying the wild AA genotype(OR=0.38,95%CI:0.17-0.93,P=0.029). The MyD88 rs7744 polymorphism was also related to the modified Gensini score(P=0.011),which was lower in subjects carrying the variant GG genotype than the wild AA genotype(5.23±3.85 vs 7.49± 4.96). Conclusion Our results revealed that MyD88 rs7744 polymorphism in the 3'?UTR is correlated with the risk and severity of CAD.