Impact of Esophageal Motility on Microbiome Alterations in Symptomatic Gastroesophageal Reflux Disease Patients With Negative Endoscopy: Exploring the Role of Ineffective Esophageal Motility and Contraction Reserve

Background/Aims@#Ineffective esophageal motility (IEM) is common in patients with gastroesophageal reflux disease (GERD) and can be associated with poor esophageal contraction reserve on multiple rapid swallows. Alterations in the esophageal microbiome have been reported in GERD, but the relationship to presence or absence of contraction reserve in IEM patients has not been evaluated. We aim to investigate whether contraction reserve influences esophageal microbiome alterations in patients with GERD and IEM. @*Methods@#We prospectively enrolled GERD patients with normal endoscopy and evaluated esophageal motility and contraction reserve with multiple rapid swallows during high-resolution manometry. The esophageal mucosa was biopsied for DNA extraction and 16S ribosomal RNA gene V3-V4 (Illumina)/full-length (Pacbio) amplicon sequencing analysis. @*Results@#Among the 56 recruited patients, 20 had normal motility (NM), 19 had IEM with contraction reserve (IEM-R), and 17 had IEM without contraction reserve (IEM-NR). Esophageal microbiome analysis showed a significant decrease in microbial richness in patients with IEM-NR when compared to NM. The beta diversity revealed different microbiome profiles between patients with NM or IEM-R and IEM-NR (P = 0.037). Several esophageal bacterial taxa were characteristic in patients with IEM-NR, including reduced Prevotella spp.and Veillonella dispar, and enriched Fusobacterium nucleatum. In a microbiome-based random forest model for predicting IEM-NR, an area under the receiver operating characteristic curve of 0.81 was yielded. @*Conclusions@#In symptomatic GERD patients with normal endoscopic findings, the esophageal microbiome differs based on contraction reserve among IEM. Absent contraction reserve appears to alter the physiology and microbiota of the esophagus.

Study on correlation between serum vitamin D level and the curative effect after repair of rotator cuff tears / 中国骨伤

OBJECTIVE@#To investigate the correlation between serum vitamin D level and clinical outcomes after repair of rotator cuff tears.@*METHODS@#A total 122 patients who met the inclusion criteria and were followed up for 12 months from March 2018 to March 2020 were analyzed retrospectively, including 50 males and 72 females with an average age of(62.10±8.39) years old (ranged, 34 to 82 years old). All patients were divided into deficiency group(vitamin D<20 μg/L) and control group(vitamin D≥20 μg/L), including 62 cases in the deficiency group, with vitamin D (14.80±3.18) μg/L;60 cases in the control group, with vitamin D(25.17±5.64) μg/L. The two groups were compared in terms of age, gender, body mass index(BMI), tear size, degree of retraction, degree of fatty infiltration, injury factors, postoperative pain VAS score, postoperative shoulder joint function score, and re-tear rate. The age of all patients was divided into two categories:<60 years old and ≥60 years old;BMI was divided into <24 kg/m2 and ≥ 24 kg/m2;tear size was divided into ≤3 cm and >3 cm;retraction degree was divided into ≤2 cm and >2 cm;fat infiltration was divided into ≤2 grade and >2 grade;and the course of the disease was ≤3 months and >3 months. The correlation between Sugaya re-tear type and the variables listed above were analyzed and calculated.@*RESULTS@#There were no major complications such as joint infection, anchor withdrawal and revision surgery in any of the 122 patients who were followed up on. There were no statistical differences in age, gender, injury factor, BMI, tear size, degree of retraction, degree of fatty infiltration, and duration of disease between the two groups (P>0.05). The Constant-Murley scores, UCLA scores, and ASES scores of the two groups all improved considerably after surgery(P<0.05);however, there was no statistical differences in the postoperative shoulder function scores between the two groups (P>0.05). There was significant difference in VAS between the two groups 1 month and 3 months after operation, with vitamin D deficiency group scoring higher, and there was no significant differences 6 and 12 months after operation. Tear size(>3 cm), degree of retraction(>2 cm), degree of fatty infiltration(>2 degree) were all shown to be the independent risk factors for retear after surgery by Logistic regression analysis(P<0.05). The comparison between the two groups of patients using a 2×5 row list showed that the Sugaya classification of rotator cuff re-tear(grade Ⅰto Ⅴ) between the vitamin D deficiency group and the control group was statistically different(t=14.228, P=0.007). It was discovered that the Sugaya classification after surgery was statistically different between the two groups.@*CONCLUSION@#Vitamin D deficiency is not correlated with clinical function scores and re-tear rate, however it is associated with the early postoperative pain (1 and 3 months) and the quality of rotator cuff healing (Sugaya classification) after surgery.

Experiences and attitudes toward aesthetic procedures in East Asia: a cross-sectional survey of five geographical regions

Background@#The demand for aesthetic procedures continues to grow globally, particularly in East Asian countries. The popularity of specific aesthetic procedures varies, however, depending on the particular East Asian geographical region being studied. This study aimed to evaluate the experiences of and attitudes toward aesthetic procedures in five East Asian countries/regions, including China, Japan, South Korea, Hong Kong, and Taiwan. @*Methods@#To recruit participants, an online questionnaire was designed and distributed on social media networks between May 2015 and March 2016. The statistical analysis was conducted using SPSS software, version 22.0. @*Results@#A total of 3,088 people responded (approximately 600 in each country/region). Of these, 940 participants (47.8%) responded that they had experienced at least one aesthetic procedure in the past. Taiwan had the highest number of participants who had experienced at least one procedure (264/940, 41%), with primarily non-surgical experiences. Only in South Korea did surgical cosmetic experiences exceed non-surgical cosmetic experiences (55.9% vs. 44.1%). The popularity of particular procedures and the motivation for undergoing aesthetic procedures varied by country. @*Conclusions@#The popularity of aesthetic procedures continues to evolve. Similar trends were observed across the East Asian regions; however, each country had its unique demands and preferences. The information provided by this study can help aesthetic plastic surgeons further understand the patients in their corresponding region, customize their practice, and develop the requisite skills.

Hotspot Analysis of Traditional Drugs in Diabetes Treatment Literature / 中国结合医学杂志

OBJECTIVE@#To summarize current hotspots and predict the potential trends in traditional drugs of diabetes treatment for further research.@*METHODS@#Publications on the application of traditional drugs in diabetes treatment were searched from PubMed without language limits. Highly frequent MeSH terms were identified through Bibliographic Item Co-Occurrence Matrix Builder (BICOMB). Biclustering analysis results were visualized utilizing the gCLUTO software. Finally, a strategic diagram was generated.@*RESULTS@#Totally 2,386 relevant publications were obtained from PubMed on November 9th, 2018, and 69 highly frequent MeSH terms were identified. Biclustering analysis revealed that these highly frequent MeSH terms were classified into 7 clusters. After calculating the density and centrality of each cluster, strategy diagram was presented. Cluster 0 "Chinese medicine monomers such as antioxidant and hypoglycemic effects" was considered as the most potential research hotspot.@*CONCLUSIONS@#In this study, we found 7 topics related to the application of traditional drugs in diabetes treatment. The molecular mechanisms of Chinese medicine monomers in diabetes could become a potential hotspot with high centricity and low density.

Clinical observation of acupuncture at tendon blockage point of quadriceps femoris muscle belly for patella femoral arthritis / 中国针灸

OBJECTIVE@#To evaluate the clinical effect of acupuncture at tendon blockage point of quadriceps femoris muscle belly for mild to moderate patella femoral arthritis.@*METHODS@#A total of 76 patients with mild to moderate patella femoral arthritis were randomly divided into an observation group and a control group, 38 cases in each group. The patients in the observation group were treated with acupuncture at tendon blockage point of quadriceps femoris muscle belly, and the needles were stayed for 20 min each time for twice a week; while the patients in the control group were treated with sodium hyaluronate injection into articular cavity, once a week, and both groups were treated for 4 weeks. The pain symptoms and joint function of the patients were evaluated with pain visual analogue scale (VAS) score, tenderness value of the most obvious pain point in front of the knee, and Lysholm knee function score before and one week after treatment, and the clinical effect was observed.@*RESULTS@#After treatment, VAS scores, tenderness value of the most obvious pain point in front of the knee and Lysholm knee function scores of the two groups were improved compared with before treatment (<0.05); the improvement of VAS score and tenderness value of the most obvious pain point in front of the knee in the observation group was more obvious than that in the control group (<0.05). The total effective rate in the observation group was 94.7% (36/38), which was higher than 81.6% (31/38) in the control group (<0.05).@*CONCLUSION@#Acupuncture at tendon blockage point of quadriceps femoris muscle belly can relieve pain and improve the function of patella femoral joint for patients with patella femoral arthritis, and the clinical effect is better than that of sodium hyaluronate injected into articular cavity.

Construction and simulation mechanical analysis of dynamic knee joint finite element model based on CT image / 中国骨伤

OBJECTIVE@#To construct a dynamic knee joint finite element model based on CT image data and verify the validity of the model. To provide a simulation model and basic data for biomechanical research of the knee joint by further finite element analysis.@*METHODS@#The CT data of a healthy male knee joint was selected. With the help of Mimics 19.0 and Hypermesh 12.0 software, a high simulation finite element model of knee joint was established following steps, including geometric reconstruction, reverse engineering, meshing and material characterization. The dynamic knee flexion model was generated by determining the boundary conditions and torque loading, and the validity of themodel was confirmed. The biomechanical changes of the tibiofemoral and patellofemoral joints under different knee flexion angles were analyzed by applying the loads (500 N) to the finite element model during knee flexion.@*RESULTS@#A finite element model of knee joint was established based on CT images and anatomical characteristics. The model included three-dimensional elements such as bone, ligament, cartilage, meniscus and patellar retinaculum. The different finite element models of knee flexion states were produced by applying different torques after establishing boundary conditions. According to equivalent conditions (knee flexion 30 degrees, quadriceps tendon under 200 N stretch), the peak stress value of patella was 2.209 MPa and the average Mises stress was 1.132 MPa; the peak stress value of femoral trochlear was 1.405 MPa and the average Mises stress was 0.936 MPa. The validity of the model was proved by the difference between the model and previous studies of 1% to 13.5%. Dynamic model loading showed that the Mises stressof tibiofemoral joint decreased with the increase of knee flexion angle, while the Mises stress of patellofemoral joint was positively correlated with knee flexion angle. The Mises stress of cartilage stress planes at different knee flexion angles was significantly different(<0.05).@*CONCLUSION@#The finite element model established in this study is more comprehensive and can effectively simulate the biomechanical characteristics of dynamic knee joint, which provides support for further simulation mechanics researches of the knee joint.

Comparison of the efficacy and level of adherence for morning versus evening versus before bedtime administration of simvastatin in hypercholesterolemic patients

@#Background: Simvastatin is usually taken in the evening due to the circadian rhythm of hepatic cholesterol biosynthesis. The degree of reduction of low-density lipoprotein cholesterol (LDL-C) and the level of adherence to different administration time remained unknown in the Malaysian population. This study aims to investigate the effect of simvastatin on the percentage changes of lipid profile and the level of adherence to when simvastatin was instructed to be taken at different timing. Methods: Nine primary care health clinics across Malaysia participated in this study. 147 statin-naive subjects were selected through convenient sampling and randomised into one of the three arms (after breakfast, after dinner or before bedtime). Differences on percentage reduction of LDL-C from baseline and level of adherence among the three groups at week-16 were compared. The main outcomes measured in this study were the percentage change of lipid parameters and the percentage of high-adherence (MMAS=8) at week-16. Results: 59.2% of the patients were male. The mean age of the study population was 53.93± 10.85 years. Most of the patients were Malays (69.4%); followed by Indians (22.4%) and Chinese (8.2%). LDL-C decreased from 4.26 (Standard Deviation, SD1.01) to 2.36 (SD0.69)mmol/L at week-16 for patients taking simvastatin before bedtime; an absolute reduction of 44.95%.The differences of LDL-C percentage reduction between three arms were significantly different (p<0.001). The greatest LDL-C reduction was observed when simvastatin was taken before bedtime and revealed 56.2% patients with high-adherence at week-16. Conclusion: Simvastatin showed superior LDL-reduction and higher level of adherence when being instructed to be taken before bedtime

Effect of electroacupuncture on expression of stromal cell derived factor-1α in focal ischemic cerebral tissue of rats with cerebral ischemia/ reperfusion injury / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) of "Baihui" (GV20) and "Zusanli" (ST36) on the expression of stromal cell derived factor-1α (SDF-1α) and CD34 in ischemic cortex tissue of cerebral ische-mia /reperfusion injury (CI/RI) rats, so as to study its mechanisms underlying improving CI/RI. METHODS: Thirty male SD rats were equally and randomly divided into sham operation, model and EA groups (n=10 rats in each group). The CI/RI model was established by occlusion of the middle cerebral artery for 120 min, followed by reperfusion. EA (40 Hz, 1-2 mA) was applied to GV20 and left ST36 for 20 min, once daily for successive 14 days. The neurological deficit severity was assessed by using Longa's and colleagues' methods. The histopathological changes of the ischemic tissues were observed after H.E. staining and the expression of SDF-1α and CD34 in the ischemic cortex tissues was detected by immunohistochemistry. RESULTS: After modeling, the neurological deficit score, and the numbers of SDF-1α and CD34-positive cells in the ischemic cerebral cortex tissue were significantly increased in the model group (P<0.05). Following EA intervention, the increased neurological deficit score was reversed at the 3rd, 7th and 14th day, and the increased SDF-1α and CD34-positive cells were significantly further up-regulated in the EA group (P<0.05). H.E. staining showed tissue edema, widening of the intercellular space, cavitation-like changes, neuronal shrinkage, nuclear pyknosis with hyperchroma or even disappearance, and aggregation of inflammatory and neurogliocytes in the model group. These situations were relatively milder in the EA group. CONCLUSION: EA of GV20 and ST36 can improve neurological function of CI/RI rats, which may be associated with its effect in up-regulating the expression of SDF-1α and CD34 proteins in the ischemic cerebral cortex tissues.

Research of TCM synthetic rehabilitation on the recovery of wrist joint after distal radius fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate efficacy and advantages of the Traditional Chinese Medicine (TCM) synthetic rehabilitation therapy in the treatment of wrist dysfunction after distal radius fractures.</p><p><b>METHODS</b>From May 2014 to October 2015, 72 patients with distal radius fracture meeting standards were treated using central randomization system for clinical research. All the patients were divided into two groups: 36 patients in test group and 36 in control group. Sixty-nine cases were finished treatment and followed up in the end. The test group fell off 1 case, and the control group fell off 2 cases. The test group was given TCM synthetic rehabilitation (manipulative therapy, joint mobilization, soaking-washing with Chinese medicinal herbs, functional exercise), and the control group was given functional exercise as well as soaking-washing with Chinese medicinal herbs, 3 weeks for both. Five evaluation standards were used in this research, which were grip strength, patient-rated wrist evaluation (PRWE), Gartland and Werley wrist score, self-rating anxiety scale(SAS) and the overall curative effect evaluation. Before treatment(baseline), after 3 weeks of treatment and 3 months after fracture were the three points in time when collected the data.</p><p><b>RESULTS</b>After 3 weeks of treatment and 3 months after fracture, the test group had a significantly better results than those of control group in the PRWE, G-W wrist score and the overall curative effect evaluation(<0.05). In terms of grip strength recovery, after 3 weeks of treatment, the intergroup difference between the test group and the control group were statistically significant relative to the baseline regarding grip strength of ipsilateral wrist by group t-test(<0.05). However, the test group and the control group had no statistically significant relative to the baseline at 3 months after fracture in grip strength(<0.05). For the anxiety of patients, compared with the test group and control group at before and after rehabilitation treatment, the anxiety of both test group and control group cases was eased(<0.05). However, The degree of anxiety relief in test group and control group cases had no difference(>0.05).</p><p><b>CONCLUSIONS</b>The TCM synthetic rehabilitation therapy has better curative effects on the treatment of functional disability of wrist joints after distal radius fractures than the general therapy of soaking-washing with Chinese medicinal herbs and functional exercise.</p>

Clinical effects of rehabilitation exercise in the treatment of knee osteoarthritis based on the theory of "treating muscle for bone" / 中国骨伤

<p><b>OBJECTIVE</b>To study the efficacy and safety of voluntary rehabilitation exercise in the treatment of knee osteoarthritis, based on the traditional Chinese medicine theory of "treating muscle for bone".</p><p><b>METHODS</b>Ninety participants with early knee osteoarthritis were randomly divided into experimental group (=45) and control group (=45). Patients in experimental group were treated with voluntary rehabilitation exercise combined with isometric extension of quadriceps femoris. Patients in control group were treated with apparatus training combined with isometric extension of quadriceps femoris. The treatment course lasted for two weeks. Visual analogue scale (VAS), Lysholm score and total therapeutic effect were evaluated before and after treatments.</p><p><b>RESULTS</b>After two weeks of treatment, cure-remarkable-effective rate in experimental group (86.67%) was higher than that in control group (71.11%). The VAS scores and Lysholm scores were significantly improved in both two groups (<0.05). The results were significantly better in experimental group those in control group (<0.05). There were no serious adverse events.</p><p><b>CONCLUSIONS</b>Voluntary rehabilitation exercise combined with isometric extension of quadriceps femoris was effective and safe in the treatment of early knee osteoarthritis.</p>

Risk factors and countermeasures for ERCP related duodenal papilla hemorrhage / 中国内镜杂志

Objective To investigate the risk factors and countermeasures for endoscopic retrograde cholangiopancreatography (ERCP) related duodenal papilla hemorrhage. Methods Retrospective analysis was performed on the clinical data of 890 patients who underwent ERCP. According to whether the patients with ERCP related duodenal papilla hemorrhage, they were divided into the hemorrhage group and the non hemorrhage group. And the risk factors of duodenal papilla hemorrhage and their countermeasures were investigated. Results 51 patients had ERCP related duodenal papilla hemorrhage, and the overall incidence rate was 5.7%. Compared with the non hemorrhage group, the patients proportion of common bile duct stones was lower, but the cholangiocarcinoma and pancreatic head cancer were higher in the hemorrhage group (P < 0.05). The incidence of hypertension and duodenal diverticulum in the hemorrhage group were significantly higher than that in the non hemorrhage group (P < 0.05). Subgroup analysis showed that patients with stone diameter >2 cm, stone incarceration and the duodenal papilla into diverticulum in the hemorrhage group were significantly higher than that in the non hemorrhage group (P < 0.05). Conclusion Common bile duct stone diameter >2 cm, stone incarceration, malignant biliary and pancreatic cancer, hypertension and duodenal papilla into diverticulum were objective risk factors of ERCP related duodenal papilla hemorrhage, focus on prevention of bleeding. Endoscopic hemostasis was safe and effective.

Risk factors and countermeasures for ERCP related duodenal papilla hemorrhage / 中国内镜杂志

Objective To investigate the risk factors and countermeasures for endoscopic retrograde cholangiopancreatography (ERCP) related duodenal papilla hemorrhage. Methods Retrospective analysis was performed on the clinical data of 890 patients who underwent ERCP. According to whether the patients with ERCP related duodenal papilla hemorrhage, they were divided into the hemorrhage group and the non hemorrhage group. And the risk factors of duodenal papilla hemorrhage and their countermeasures were investigated. Results 51 patients had ERCP related duodenal papilla hemorrhage, and the overall incidence rate was 5.7%. Compared with the non hemorrhage group, the patients proportion of common bile duct stones was lower, but the cholangiocarcinoma and pancreatic head cancer were higher in the hemorrhage group (P < 0.05). The incidence of hypertension and duodenal diverticulum in the hemorrhage group were significantly higher than that in the non hemorrhage group (P < 0.05). Subgroup analysis showed that patients with stone diameter >2 cm, stone incarceration and the duodenal papilla into diverticulum in the hemorrhage group were significantly higher than that in the non hemorrhage group (P < 0.05). Conclusion Common bile duct stone diameter >2 cm, stone incarceration, malignant biliary and pancreatic cancer, hypertension and duodenal papilla into diverticulum were objective risk factors of ERCP related duodenal papilla hemorrhage, focus on prevention of bleeding. Endoscopic hemostasis was safe and effective.

Early detection of left ventricular global longitudinal peak strain in the diagnosis of high-risk coronary atherosclerotic heart disease in elderly patients: study protocol for a single-center diagnostic trial / 中国组织工程研究

BACKGROUND:Previous studies have demonstrated that tissue Doppler echocardiography and two-dimensional speckle tracking echocardiography are minimally invasive imaging methods used to screen for coronary atherosclerotic heart disease.However,they are not highly sensitive and specific for patients with suspected heart disease presenting with normal ventricular wall motion or for patients with early coronary heart disease.The newly emerging three-dimensional longitudinal strain imaging technology can overcome these shortcomings and has become a relatively mature technique for quantitative assessment of myocardial function.OBJECTIVE:To investigate the early diagnosis value of left ventricular global longitudinal peak strain (LVGLPS)measured by three-dimensional longitudinal strain imaging technology for high-risk coronary atherosclerotic heart disease.METHODS:This is a single-center,open-label,diagnostic trial.Three hundred elderly patients suspected of coronary atherosclerotic heart disease receiving treatment at the Department of Ultrasound Medicine,Taihe Hospital of China from January 2013 to January 2018 are included in this study.These patients will be divided into three groups:low-risk group (n=100;≥ 70％ diameter stenosis in one or two branches of the right main coronary artery and the left circumflex artery),high-risk group (n=100;≥ 50％ diameter stenosis in the left main coronary artery or ≥ 70％ diameter stenosis in the left anterior descending branch),and control group (n=100;＜50％ diameter stenosis in the main coronary arteries and all branches).All patients will undergo conventional echocardiography followed by three-dimensional longitudinal strain imaging to measure the LVGLPS.The LVGLPS will be compared among the three groups.The primary outcome measure is the sensitivity of the LVGLPS for prediction of coronary atherosclerotic heart disease.The secondary outcome measures are:the specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,and accuracy rate of the LVGLPS for prediction of coronary atherosclerotic heart disease;change in the LVGLPS;change in conventional echocardiography parameters;and change in the receiver operating characteristic curve for prediction of high-risk coronary atherosclerotic heart disease using the LVGLPS.This study will be performed in accordance with the Declaration of Helsinki.All patients have been informed of the study protocol and procedure and have provided written informed consent.This trial was approved by Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) with the approval No.2013(03) in January 2013.Participant recruitment and data collection began in January 2013 and will continue through December 2017.Outcome measure analysis will be performed and the trial will be completed in January 2018.Results will be disseminated through presentations at scientific meetings and publications in peer-reviewed journals.This trial was registered with ClinicalTrial.gov (identifier:ChiCTR-DDD-17012839).DISCUSSION:The findings from this study will help to confirm that three-dimensional longitudinal strain imaging technology is highly sensitive and specific for patients with abnormal coronary arteries with suspected coronary heart disease but who present with normal ventricular wall motion.The change in the LVGLPS contributes to early diagnosis of high-risk coronary atherosclerotic heart disease in elderly patients.This helps clinicians to diagnose early coronary heart disease and take timely strategies to avoid serious cardiovascular events as much as possible.

Minimal invasive elastic intramedullary nails and external fixation for treatment of comminuted closed fracture of tibia-fibula shaft / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical results of external fixation and AO titanium elastic intramedullary nailing for treatment of tibia-fibula comminuted closed fractures.</p><p><b>METHODS</b>From June 2010 to June 2012,58 patients with tibia-fibula comminuted closed fractures were treated with external fixation and AO titanium elastic intramedullary nailing, including 31 males and 27 females with an average age of 38.5 years old ranging from 21 to 57 years old. According to the system of AO Classification, the fractures were classified as type B1 in 9 cases,type B2 in 7 cases, type B3 in 10 cases, type Cl in 14 cases, type C2 in 12 cases,and type C3 in 6 cases. According to the system of Winquist-Hanson,the fractures' comminuted were classified as grade 1 in 23 cases, grade 2 in 17 cases, grade 3 in 12 cases, and grade 4 in 6 cases. According to the system of Johner-Wruhs, clinical results were compared between different type and grade groups by the time of last followed-up.</p><p><b>RESULTS</b>All 58 patients were followed up with an average time of 6.8 months (ranged from 18 to 36 weeks). All fractures had clinical healing with an average time of 28 weeks (ranged from 24 to 32 weeks). The total rate of good to excellent results was 91.4%. The rate of good to excellent in the group of grade 1 was higher than that of other grades. The complication rates and fracture healing time would increase respectively with higher Winquist-Hanson's grade. The complication rates in the group of type C3 was higher than that of other types, but the rate of good to excellent was lower than that of other types. The complication rates in the group of type B1 was lower than that of other types,but the rate of good to excellent was higher than that of other types.</p><p><b>CONCLUSION</b>Minimal invasiveusing AO titanium elastic intramedullary nailing combined with external fixation for treatment of tibia-fibula fractures especially for the multiple-segment,long spiral mild-to-moderate comminuted with hidden fracture can get satisfactory reduction and reliable fixation,it conformes to the principle of BO completely, protects the fracture end blood supply,reduces the external fixation time, has less skin soft tissue complications, postoperative function recovered satisfactorily.</p>

Thinking of therapeutic mechanism of small knife needle in treating closed myofascitis / 中国针灸

The authors investigated and discussed therapeutic mechanism of small knife needle in treating closed myofascitis on the basis of pathomechanism of modern medicine and acupuncture theory of TCM among numbers of clinical cases and experimental data. Therapeutic mechanism lies in 6 aspects: (1) Relieve the energy crisis of tenderness point on muscular fasciae; (2) Affect nervous system and reduce induction of harmful stimulating signal; (3) Inhibit aseptic inflammatory reaction on muscular fasciae; (4) Regulate dynamic equilibrium of soft tissue by cutting scar and releasing the conglutination; (5) Increase patients' regional threshold of feeling; (6) Reduce tension and pressure of soft tissue of tenderness point so as to relieve extrusion of nervus cutaneous.

Case-control study on the treatment of patients with scapular muscle fasciitis by Pizhen / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate and analyze the mechanism of Pizhen for the treatment of patients with scapular muscle fasciitis.</p><p><b>METHODS</b>One hundred and sixteen patients were divided into two groups according to random number table method, 58 cases in the treatment group and 58 cases in the control group. After treatment, 109 patients were followed up, and 7 patients lost follow-up (2 cases in the treatment group and 5 patients in the control group). In the treatment group, there were 15 males and 41 females, with a mean age of (28.02 +/- 4.85) years; the course of disease ranged from 0.25 to 3 years; and the patients were treated by Pizhen once a week,and 2 weeks were one treatment course. In the control group, there were 19 males and 34 females, with a mean age of (27.23 +/- 4.54) years old; the course of disease ranged from 0.25 to 1 year; and the patients were treated by acupuncture massage instrument, 20 minutes at a time,once a day for 2 weeks. Soft tissue displacement and banana area were tested by a soft tissue tension tester, pressure value was measured by pressure measuring instrument, and VAS was recorded by pain visual analog scale record.</p><p><b>RESULTS</b>There were significant differences in tissue displacement, banana area, pressure value and VAS between two groups before and after treatment. The tissue displacement and pressure value in the treatment group were higher than those in the control group,while banana area and VAS were lower than those in the control group. In the treatment group, 30 patients healed, 13 patients got marked improvement, 12 good and 1 poor;while 16 patients healed, 19 patients got marked improvement,11 good and 7 poor in the control group. The therapeutic effects in the treatment group was better than that in the control group.</p><p><b>CONCLUSION</b>Pizhen is an effective method to treat pain in patients with scapular muscle fasciitis by relaxing tendon of soft tissue around pain point of scapular and relaxing compress and stimulation of nerves.</p>

Vacuum sealing drainage and free coupling chain-link posterior tibial artery flap in the reconstruction of degloving injury of propodium / 中华整形外科杂志

<p><b>OBJECTIVE</b>To present the methods of vacuum sealing drainage and free coupling chain-link flap of posterior tibial artery flap and medial plantar flap in the reconstruction of degloving injury of propodium.</p><p><b>METHODS</b>From Oct. 2008 to Dec. 2011 five cases with degloving injury of propodium underwent debridement and vacuum sealing drainage on the first stage. Free chain-link flap of posterior tibial artery flap and medial plantar flap were applied to close the wound at the secondary stage. The nerve was included in the coupling flaps. The size of posterior tibial artery flap ranged from 14 cm x 10 cm to 11 cm x 8 cm,and the size of medial plantar flap ranged from 12 cm x 8 cm to 8 cm x 6 cm.</p><p><b>RESULTS</b>All flaps were survived with no vascular crisis. The flap sensation recovered to S3-S3 during the follow-up period of 6-21 months. The texture and appearance of flaps were satisfied. The plantar had not ulcer and corpus callosum.</p><p><b>CONCLUSION</b>Vacuum sealing drainage and free chain-link flap of posterior tibial artery flap and medial plantar flap with nerve are the ideal methods for the reconstruction of degloving injury of propodium.</p>

Clinical evaluation of stiletto needle for pain of knee osteoarthritis / 中国针灸

<p><b>OBJECTIVE</b>To objectively evaluate the clinical efficacy of stiletto needle for pain of knee osteoarthri tis (KOA), and analyze its function mechanism.</p><p><b>METHODS</b>Seventy-six cases of KOA (76 knees) were selected. Under the guide of Jingjin theory in TCM, stiletto needle was applied at pain point of Jingjin in extra-articular area to have a loose solution effect, 1 to 3 points were selected each time, 1 to 2 times of treatment were required. The results of tenderness measurement instrument was adopted as main evaluation index of joint pain, and all data of evaluation indices before and after the treatment were statistical analyzed.</p><p><b>RESULTS</b>There were significant differences in visual analogue scale (VAS) score, tenderness score, HSS function score and movement range of joint before and after the treatment (all P < 0.05). The effective rate of stiletto needle therapy was 89.5%. There was apparent regression trend between VAS score and tenderness score with Y (VAS) = 7.841-1.569 X (tenderness score) as its regressive equation.</p><p><b>CONCLUSION</b>The stiletto needle therapy is an effective method to relieve the pain of knee osteoarthritis, and its clinical efficacy evaluation could be more objective and digital with tenderness measurement instrument.</p>

Effects of glucose and insulin on the H9c2 (2-1) cell proliferation may be mediated through regulating glucose transporter 4 expression / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The change of glucose transporter 4 (GLUT4) expression could influence glucose uptake in the myocardial cells and then effect myocardial metabolism, which maybe one of the factor for the diabetes cardiovascular disease. This study aimed to explore the influence of glucose and insulin at different concentrations on H9c2 (2-1) cell proliferation and its GLUT4 expression in vitro, and evaluate the correlation between myocardial cells proliferation and GLUT4 expression. This might be helpful for understanding the relationship between glucose metabolism and cardiovascular disease.</p><p><b>METHODS</b>According to glucose concentrations in culture medium, cultured H9c2 rat myocardial cells were divided into five groups: control group (NC, glucose concentration 5.0 mmol/L), low glucose group (LG, glucose concentration 0.1 mmol/L), high glucose group 1 (HG1, glucose concentration 10 mmol/L), high glucose group 2 (HG2, glucose concentration 15 mmol/L), high glucose group 3 (HG3, glucose concentration 20 mmol/L). Then according to different insulin concentrations in culture medium, each group was further divided into two subgroups: normal insulin subgroup (INSc, insulin concentration 3.8 mU/L), high insulin subgroup (INSh, insulin concentration 7.6 mU/L). H9c2 (2-1) cells were cultured for 1, 2, 3 days, the proliferation of cells were assayed by cell counting Kit-8 assay, the expressions of GLUT4 mRNA and protein were detected with RT-PCR and Western Blotting technique, and the relation between myocardial cells proliferation and GLUT4 expression was evaluated.</p><p><b>RESULTS</b>Compared with NC group, cell proliferation (OD value) was lower in LG, HG2, HG3 group but higher in HG1 group on the second and the third day (P < 0.05). There was a negative correlation between OD value and the glucose level in HG1, HG2, HG3 groups (P < 0.05). OD value in INSc subgroups was lower than that in INSh subgroups (P < 0.05). GLUT4 mRNA was lower in LG, HG2, HG3 groups than that in NC group (P < 0.05). Compared with NC group, GLUT4 mRNA level in HG1 group was higher on the first day but lower on the second and third day (P < 0.05). In HG1, HG2 and HG3 groups, GLUT4 mRNA level had a negative correlation with the level of glucose (P < 0.05). GLUT4 mRNA in INSc subgroups was lower than that in INSh subgroups (P < 0.05). The expression of GLUT4 protein was similar to that of GLUT4 mRNA. There was a positive correlation between H9c2 cell proliferation and GLUT4 expression (P < 0.02).</p><p><b>CONCLUSIONS</b>Glucose levels could regulate glucose uptake in myocardial cells through influencing GLUT4 expression, and thus affected the cell proliferation and cell function. Insulin levels could affect the myocardial cell function by regulating GLUT4 expression. Effects of glucose and insulin on the myocardial cells proliferation might be mediated through regulating GLUT4 expression. There may be a mechanism of hyperglycemia pre-accommodation (HGPA) in myocardial cells mediated through regulation of GLUT4 expression.</p>