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BACKGROUND:Numerous scholars have previously researched certain greater tuberosity fractures and the procedures used to treat them.Few researchers,however,have studied the comminuted split fracture of the greater tuberosity of the humerus(Liu-Gang type IV)with rotator cuff tear in great detail. OBJECTIVE:To compare the clinical therapeutic effect of open repair position modified calcaneal plate combined with suture anchors and proximal humeral internal locking system(PHILOS)plate in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV). METHODS:Case data of 30 patients with comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)from May 2012 to May 2022 were retrospectively analyzed.They were divided into the modified calcaneal plate combined with suture anchor group(group A)and the PHILOS with#2 Johnson group(group B),with 15 cases in each group.Intraoperative blood loss,surgical time,and incision length of all patients were recorded.Pain visual analog scale score,Constant-Murley score,as well as shoulder joint abduction,forward flexion,external rotation,and dorsal expansion activities during the last follow-up(>1 year)were evaluated. RESULTS AND CONCLUSION:(1)The surgical incision length and operation time were shorter,and blood loss was less in group A than those in group B(P<0.05).(2)No significant difference in visual analog scale score and Constant-Murley score was detected between the two groups(P>0.05).(3)During the last follow-up,forward flexion in group A was better than that in group B(P<0.05).No significant difference in abduction,external rotation,and dorsal expansion was determined between group A and group B(P>0.05).(4)In terms of complications,there was 1 case of shoulder joint pain and discomfort in group A(7%),2 cases of subacromial impingement syndrome,2 cases of upward movement of nodules,and 2 cases of shoulder joint pain(40%)in group B.There were significant differences in complication rates between the two groups(P=0.031).(5)In summary,the modified calcaneal plate combined with suture anchors in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)could better restore the forward flexion function of the shoulder joint and has a small incision,less blood loss,shorter operation time and fewer complications.
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Background@#Previous literatures suggest that the prognosis of Kienböck’s disease might be favorable despite no surgery if it is diagnosed in late age, but the evidence is not clear. The aim of this study was to determine the radiographic and clinical progression of Kienböck’s disease diagnosed at more than 50 years of age. @*Methods@#Data of 27 patients diagnosed with Kienböck’s disease at more than 50 years of age between 2000 and 2016 were investigated. During the study period, no treatment, either surgical or nonsurgical, was applied. We explained to the patients that the affected lunate was not expected to collapse further if found late in age. Annual visits were recommended, through which radiographic and clinical observation was made. We assessed changes in Stahl index and radioscaphoid angle between the initial assessment and the final follow-up, and clinical assessment was made using pain in visual analog scale (VAS) and Dornan’s criteria. @*Results@#Initially, 2 patients were in Lichtman stage 1, 6 in stage 2, 5 in stage 3A, 11 in stage 3B, and 3 in stage 4. Radiographic follow-up of at least 5 years (mean, 7.8 years) was made in 14 patients, whose Stahl index and radioscaphoid angle did not differ significantly from their initial measurements. Arthritic appearance was not found, and progression in the Lichtman stage was detected in 1 lunate, from 3A to 3B. Despite no surgical treatment for an average of 7.5 years (range, 5.0–15.7 years) of observation period in the 27 patients, average pain in VAS improved from 3.5 (range, 1–7) to 0.8 (range, 0–2), with excellent or good clinical status by Dornan’s criteria. @*Conclusions@#Our study suggests that Kienböck’s disease diagnosed at more than 50 years of age can follow a benign natural course in radiographic and clinical aspects. Therefore, surgical interventions should be considered carefully in this age group.
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@#Objective To investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach. Methods The clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed. Results All patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points. Conclusion Single utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.
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@#Objective To investigate the effects of robotic versus thoracoscopic lobectomy on body trauma and lymphocyte subsets in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 120 patients with NSCLC who underwent lobectomy in the same operation group at the same period were collected and divided into a robot group (n=60) and a thoracoscope group (n=60) according to different surgical methods. The operation time, intraoperative blood loss, postoperative drainage time, drainage volume, postoperative hospital stay, complication rate, pain visual analogue scale (VAS) and other perioperative indicators were recorded in the two groups. Inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6) and lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) levels were measured before and 1 d, 3 d after surgery. The effects of the two surgical methods on the body trauma and lymphocyte subsets were compared. Results The operation time, intraoperative blood loss, postoperative drainage time, drainage volume and VAS of the robot group were lower than those of the thoracoscope group, and the differences were statistically significant (P<0.05). On the 1st day after surgery, IL-6 of the thoracoscope group was higher than that of the robot group, while CD3+, CD4+ and CD8+ were lower than those of the robot group, with statistically significant differences (P<0.05). Conclusion Compared with thoracoscopic lobectomy, robotic lobectomy has less trauma, less inflammatory response, faster recovery, less inhibitory effect on lymphocyte subsets, and has clinical advantages.
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Background@#The accessory tendon of the extensor hallucis longus (ATEHL) muscle is a common abnormal structure, and its clinical significance remains debatable. In this study, we provide the incidence of the ATEHL and characterize its morphological types in Asian cadavers and investigate its clinical applications. @*Methods@#The tendons from 50 adult cadaveric feet, fixed in 10% formalin, were analyzed. We measured the length and width of both the ATEHL and the extensor hallucis brevis (EHB). @*Results@#All dissected specimens had an ATEHL. The first metatarsophalangeal joint was surrounded by an accessory tendon that inserted onto the joint capsule and the dorsal base of the proximal phalanx. We classified the ATEHL into 3 types based on their directions. Differences in ATEHL type based on sex were not statistically significant. @*Conclusions@#We found an ATEHL in all cadaveric specimens in this study. We surmise that the ATEHL acts as an antagonist with the EHB when the toe is extending, which might help prevent the occurrence of hallux valgus deformity.
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Background@#The accessory tendon of the extensor hallucis longus (ATEHL) muscle is a common abnormal structure, and its clinical significance remains debatable. In this study, we provide the incidence of the ATEHL and characterize its morphological types in Asian cadavers and investigate its clinical applications. @*Methods@#The tendons from 50 adult cadaveric feet, fixed in 10% formalin, were analyzed. We measured the length and width of both the ATEHL and the extensor hallucis brevis (EHB). @*Results@#All dissected specimens had an ATEHL. The first metatarsophalangeal joint was surrounded by an accessory tendon that inserted onto the joint capsule and the dorsal base of the proximal phalanx. We classified the ATEHL into 3 types based on their directions. Differences in ATEHL type based on sex were not statistically significant. @*Conclusions@#We found an ATEHL in all cadaveric specimens in this study. We surmise that the ATEHL acts as an antagonist with the EHB when the toe is extending, which might help prevent the occurrence of hallux valgus deformity.
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Objective:To summarize the experience of robotic and thoracoscopic segmentectomy in Daping Hospital, Army Medical University, and comparison analysis the clinical application value for early-stage lung cancer.Methods:A retrospective cohort study was conducted to continuously enroll 190 patients, 100 who received robotic(33 males and 67 females, median age of 51 years)and 90 who received VATS(34 males and 56 females, median age of 54 years), who underwent segmentectomy between June 2018 and October 2019. Perioperative outcomes(the operation time, intraoperative blood loss, postoperative thoracic drainage volume and time, pain score, complications, postoperative hospital stay and survival and mortality) were compared.Results:All the patients successfully completed the surgery and recovered from hospital, with no perioperative death.The baseline characteristics(sex, age, clinical symptoms, smoking status, underlying disease, tumor size, pathological type) and type of segmentectomy were comparable. There was significant difference in operative time[120(interquartile range, IQR 60-225)min vs. 155( IQR 75-330)min, P<0.001], blood loss[30( IQR 20-400) ml vs. 100( IQR 20-1 600) ml, P<0.001] between the robotic and VATS groups, respectively. But there was no significant difference in postoperative thoracic drainagevolume[4( IQR 1-15) days vs. 4( IQR 2-29) days, P=0.547], postoperative thoracic time[755( IQR 200-3 980)ml vs. 815( IQR 280-3 920)ml, P=0.902], pain score[2.33( IQR 0.88-4.75) points vs. 3.13( IQR 0.95-5.29)points, P=0.199], complications[7.4%(14/190) vs. 6.3%(12/190), P=0.303], postoperative hospital stay[7( IQR 3-19) days vs. 6( IQR 4-21) days, P=0.405] , number of lymph nodes[(4.83±3.18) vs.(6.15±4.1), P=0.255] between the robotic and VATS groups, respectively. The follow-up time was 6.5( IQR 1-26) months in the two groups, without recurrence, metastasis or death. Conclusion:Robotic lung segmentectomy is safe and feasible. This approach might lead to a better in operative time and blood loss. The short-term efficacy is similar with thoracoscopy, and the long-term efficacy needs further follow-up time.
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@#Objective To evaluate the feasibility and clinical value of robot-assisted lobectomy through anterior approach. Methods We retrospectively analyzed the clinical data of 180 patients who underwent robot-assisted lobectomy through anterior approach in our hospital between April 2017 and February 2018. There were 97 males and 83 females, aged 59.5 (32.0-83.0) years. The clinical effects were analyzed. Results One patient was transferred to thoracotomy due to tumor invasion of adjacent blood vessels and injury to the blood vessels, and there was no perioperative death. There were 8.5 (1.0-35.0) dissected lymph nodes for each patient. The median operation time was 120 (50-360) min, including robot Docking time 5 (1-23) min and robot operation time 65 (7-270) min. The median blood loss was 50 (5-1 500) mL, 132 (73.3%) patients had malignant tumors and median drainage time was 5 (2-30) d. The mean postoperative pain score was 3.4±0.7 points and the postoperative hospital time was 8 (2-32) d. At the median follow-up of 24 months, 11 patients developed recurrence and metastasis, and 3 died. Conclusion Robot-assisted lobectomy through anterior approach is a safe and convenient operation method, which is worthy of clinical application.
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@#Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in robotic lung segmentectomy. Methods A non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020. 3D-CTBA was performed before operations in 53 patients [a 3D-CTBA group, including 18 males, 35 females, with a median age of 52 (26-69) years] and not performed in the other 69 patients [a traditional group, including 23 males, 46 females, with a median age of 48 (30-76) years]. The clinical data of the patients were compared between the two groups. Results All the patients were successfully completed the surgery and recovered from hospital, with no perioperative death. The baseline characteristics of the patients were not significantly different between the two groups (P>0.05). No significant difference was found in the operative time [120 (70-185) min vs. 120 (45-225) min, P=0.801], blood loss [50 (20-300) mL vs. 30 (20-400) mL, P=0.778], complications rate (17.0% vs. 11.6%, P=0.162), postoperative hospital stay [7 (4-19) d vs. 7 (3-20) d, P=0.388] between the two groups. In the 3D-CTBA group, 5 (9.4%) patients did not find nodules after segmentectomy, and only 1 (1.9%) of them needed lobectomy, but in the traditional group, 8 (11.6%) patients did not find nodules and had to carry out lobectomy, the difference was statistically significant (P<0.05). The follow-up time was 10 (1-26) months, and during this period, there was no recurrence, metastasis or death in the two groups. Conclusion 3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations, and reducing wrong resections in segmentectomy, without increasing the operation time, blood loss and complications. It is safe and effective in anatomical lung segmentectomy.
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Human exhaled gases contain thousands of trace amounts of trace volatile organic compounds (VOCs), some of which are endogenous substance and can be detected as potential biomarkers for disease. Acetone, the second highest VOCs in human exhaled gases, has been widely used in non-invasive diagnosis and monitoring of diabetes. At present, more than 30 independent studies have been undertaken on the range of breath acetone concentration and its influencing factors, and the quantitative relationship between blood glucose and glycosylated hemoglobin in diabetic patients. However, there are still many challenges in the application of breath acetone as a clinical regulatory parameter for diabetes. In this paper, the research status and progress in the breath acetone and analysis method were reviewed, and the existing problems in diabetes diagnosis and monitoring were discussed. Besides, the future development prospects were analyzed with the present technical level.
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Objective To evaluate the safety and efficacy of endoscopic submucosal tunnel dissection (ESTD) for esophageal submucosal tumors (SMTs). Methods A meta-analysis was performed on 18 related studies of ESTD on the treatment of esophageal SMTs retrieving from Chinese and English databases. Complete resection rate and en bloc resection rate were extracted for efficacy, and the complication rate, recurrence rate and death were used to evaluate safety. Results Complete resection rate was reported in all studies, and the pooled complete resection rate was 97. 5%(95%CI: 95. 4%-98. 6%). There were 9 studies that reported en bloc resection rate, and the pooled en bloc resection rate was 95. 9%(95%CI:90. 1%-98. 3%). Subcutaneous emphysema, mediastinal emphysema, pneumothorax, pneumoper-itoneum and perforation were reported in all 18 studies. The pooled prevalence of air leakage symptoms was 11. 3%(95%CI: 7. 0%-17. 6%) for subcutaneous emphysema and pneumomediastinum, 3. 6%( 95%CI:2. 1%-6. 2%) for pneumothorax and 3. 2%( 95%CI: 1. 9%-5. 4%) for pneumoperitoneum. Additionally, the pooled prevalence of perforation was 4. 9%(95%CI: 3. 1%-7. 8%).Intraoperative bleeding was reported in 2 studies, and the pooled incidence of bleeding was 3. 7%(95%CI: 2. 1%-6. 4%). During the follow-up of the 18 studies, no death was reported, and only 2 cases of recurrence were reported in one study. Conclusion ESTD is safe and effective for esophageal SMTs.
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Objective To study the concentration distribution of acetone in fasting exhaled breath in diabetic patients and healthy subjects,to explore the effect of individual indexes on the concentration of acetone in fasting exhaled breath,and to study the role of individual indexes of fasting exhaled breath acetone in diabetes screening.Methods The acetone concentration measurements of fasting exhaled breath were performed on 265 healthy subjects,39 patients with type 1 diabetes (T1D),and 300 patients with type 2 diabetes (T2D) using real-time online respiratory acetone analyzer based on cavity ring-down spectroscopy (CRDS).SPSS 19.0 software was used to eliminate outliers,and relevant statistical analysis was carried out with the corresponding gender,age,height,body mass,body mass index (BMI) and blood glucose concentration (BGL).The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of fasting breath acetone concentration for diabetes diagnosing.Results The mean fasting breath acetone concentration in T1D patients was (2.24±1.43)×10-6 was significantly higher than (1.43±0.55)×10-6 in healthy subjects and (1.41±0.73)×10-6 in T2D patients,and the differences were statistically significant (all P＜0.05).The average fasting breath acetone concentration in male diabetic patients was higher than that in female patients.The mean fasting breath acetone concentration was positively correlated with age (R=0.31,P＜0.01) in healthy subjects,was positively correlated with BMI (R=0.33,P＜0.05) in T1D patients,and was positively correlated with height (R=0.18,P＜0.01) in T2D patients.The area under the ROC curve for the diagnosis of T1D by fasting breath acetone concentration was 0.853 with a sensitivity of 71.9％ and specificity of 87.4％ (P＜0.01),and for the diagnosis of T2D was 0.528 with a sensitivity of 54.1％ and specificity of 55.0％ (P＞0.05).Conclusions The detection of fasting breath acetone concentration is meaningful for T1D diagnosing,but has a low accuracy for T2D diagnosing (no statistically significant).
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<p><b>OBJECTIVE</b>To characterize the proteomic profiles of joint synovial tissue in normal rats and rats with rheumatoid arthritis (RA) and identify the proteins related with the occurrence of RA to explore the pathogenesis of RA.</p><p><b>METHODS</b>SD rat models of RA were established using Mtb (heat-killed Mycobacterium tuberculosis H37Ra). Two-dimensional gel electrophoresis proteomics technology was employed to analyze the difference in synovial tissue protein profiles between RA model rats and normal rats, and two of the differentially expressed proteins were verified with Western blotting and fluorescence quantitative PCR.</p><p><b>RESULTS</b>Comparison of the two-dimensional gel electrophoresis patterns from the model rats and normal rats showed 4 up-regulated and 4 down-regulated proteins by 2 folds in the RA model rats. Western blotting and fluorescent quantitative PCR of 2 of the 8 proteins yielded consistent results with those by proteomics analysis.</p><p><b>CONCLUSION</b>Arthritis synovial lesions in RA represent very complex pathological processes involving a variety of proteins, and these differentially expressed proteins may contribute to the progression of RA.</p>
Asunto(s)
Animales , Ratas , Artritis Reumatoide , Metabolismo , Western Blotting , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Electroforesis en Gel Bidimensional , Reacción en Cadena de la Polimerasa , Proteínas , Proteómica , Ratas Sprague-Dawley , Membrana Sinovial , Metabolismo , Patología , Regulación hacia ArribaRESUMEN
Objective To investigate the curative effect of racecadotril granules on acute rotaviral enteritis in infants. Methods 100 infants with acute rotaviral enteritis were divided into combined treatment group(group A:50)cases and smecta group(B group:50 cases) ;Group B was given to basis of conventional therapy,but Group A received conventional therapy combined with clothing racecadotril particles. The efficacy and adverse reactions were observed.Results The time of improvement of vomiting,fever and diarrhea in A group was significantly shorter than the B group(t =2. 245,2. 298,2. 301, all P ＜ 0.05); The total effective rate 92. 0% in A group were higher than the B group 74. 0% after treatment 3d(x~2 = 3.987, P ＜ 0.05). The average course of treatment in A group (5.5 ± 0. 9) d was lower than the B group(7. 0 ± 1.1)d(t =7.17,P＜0.01). Conclusion Racecadotril is an effective and safe drug in treating rotaviral enteritis in infants.
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BackgroundThe aim of this review was to evaluate the efficacy and safety of antibiotic agents in children with COVID-19, as well as to introduce the present situation of antibiotics use and bacterial coinfections in COVID-19 patients. MethodsWe searched Cochrane library, Medline, Embase, Web of Science, CBM, Wanfang Data and CNKI from their inception to March 31, 2020. In addition, we searched related studies on COVID-19 published before March 31, 2020 through Google Scholar. We evaluated the risk of bias of included studies, and synthesized the results using a qualitative synthesis. ResultsSix studies met our inclusion criteria. Five studies on SARS showed an overall risk of death of 7.2% to 20.0%. One study of SARS patients who used macrolides, quinolones or beta lactamases showed that the mean duration of hospital stay was 14.2, 13.8 and 16.2 days, respectively, and their average duration of fever was 14.3, 14.0 and 16.2 days, respectively. One cohort study on MERS indicated that macrolide therapy was not associated with a significant reduction in 90-day mortality (adjusted odds ratio [OR] 0.84, 95% confidence interval [CI] 0.47-1.51, P = 0.56) and improvement in MERS-CoV RNA clearance (adjusted hazard ratio [HR] 0.88, 95% CI 0.47, -1.64], P = 0.68). According to the findings of 33 studies, the proportion of antibiotics use ranged from 19.4% to 100.0% in children and 13.2% to 100.0% in adults, despite the lack of etiological evidence. The most commonly used antibiotics in adults were quinolones, cephalosporins and macrolides and in children meropenem and linezolid. ConclusionsThe benefits of antibiotic agents for adults with SARS or MERS were questionable in the absence of bacterial coinfections. There is no evidence to support the use of antibiotic agents for children with COVID-19 in the absence of bacterial coinfection.