Objective To investigate the efficacy and safety of Ningdong granule on Obsessive-compulsive disorder (OCD) associated with Tourette's syndrome (TS).Methods Thirty-six patients with OCD associated with TS were randomly divided into 2 groups.18 patients in the treatment group were treated with ND granule,and 18 patients in the control group were treated with fluoxetine,the initial dose of fluoxetine was 10 mg/d,and maximum dose was 60 mg/d.All of the participants with history of medication had to be medication-free for≥ 1 weeks prior to the study.The severity of tics and OCD were evaluated at baseline and at end point (8 w),with Yale Global Tic Severity Scale (YGTSS)and Yale-Brown Obsessive Compulsive Scale (Y-BOCS),the contents of 5-HT in serum were measured by ELISA.Side-effects were evaluated according to an adverse event chart produced by this study team.Results The effective rate of treating tics in treatment group was 88.89％ (16/18),and in control group was 77.78％ (14/18).The effective rate of treating OCD in treatment group was 83.33％ (15/18),and in control group was 88.89％ (16/18).The differences in the aspects between treatment group and control group were not significant (P＞0.05).Compared with YGTSS scores [the treatment group was (27.28 ± 8.10),the control group was (29.17 ± 7.53)] and Y-BOCS scores [the treatment group was (22.72 ± 6.75),the control group was (23.17 ± 6.12)] at baseline,the scores YGTSS scores [the treatment group was (12.72±5.20),the control group was (15.50±5.39)] and Y-BOCS scores [the treatment group was (1250± 4.38),the control group was (12.22±4.31)] of both two groups at end point reduced significantly (P＜0.01),but the difference between the two groups was not significant (P＞0.05).The contents of serum 5-HT in the two groups were significantly raised after treatment [the treatment group was (86.05±24.26 vs 66.00±19.63) ng/ml,P=0.01),the control group was (91.16±26.07 vs 67.52±21.18) ng/ml,P＜0.01].Only one subject reported adverse reactions in the treatment group,while 6 subjects experienced adverse reactions in the control group,but no difference was shown in comparison of the aspect between the treatment group and the control group (P＞0.05).Conclusion ND granule with tiapride could improve the syndrome of tics and OCD associated with TS.ND granule with tiapride and fluoxetine with tiapride showed similar efficacy and safety for OCD with TS.

Objective To investigate Aβ42 and P-tau levels in cerebrospinal fluid (CSF) of patients with mild cognitive impairment (MCI). Methods CSF of 25 cases of MCI and 14 cases of cognitively normal (CN) were investigated. The CSF levels of Aβ42 and P-tau were detected by ELISA method. Correlation analysis was used to analyze the correlation between P-tau level and MMSE score in MCI. Results The CSF level of Aβ 42 was higher and P-tau was lower in MCI than CN group(P<0.05). P-tau level in MCI was also negatively correlated with MMSE score (P<0.05). Conclusion Aβ42 and P-tau levels in CSF may be valuable biological markers in the diagnosis of MCI. P-tau level in CSF of MCI may be related to the severity of cognitive impairment.

Objective To investigate the effect of Ningdong granule on 5-hydroxytryptamine metabolism and 5-HT2AR of Tourette’s Syndrome(TS) rat models. Methods 32 SD rats were divided into 4 groups randomly, the control group, the model (Apo) group, the low dosage NDG (NGL) group, and the high dosage (NGH) group. TS rat models were induced by intraperitoneal injection (i.p.) with Apo (2 mg/kg) in the experimental groups last 4 weeks. Rats in the control group were injected with normal saline (0.9%) (3 ml/kg, i.p.). Then, the rats were treated by intragastric administration (i.g.) with ND granular at 1.8g/(kg?d)in NGL group, with ND granular at 3.6 g/(kg?d)in NGH group, with distilled water at equal Volume in Control group and Apo group respectively for 12 successive weeks. Analysis the striatum 5-HT2AR protein expression by Immunohistochemical method;Determination of the content of 5-HT and 5-HIAA in striatum by Enzyme linked immunosorbent assay (ELISA). Results The level of 5-HT and 5-HT2AR protein expression in the model group [(1.98±0.14)ng/ml and(143.10±8.01)], compared with the control group[(1.78±0.10)ng/ml and(127.43±6.72)], was up-regulated (P<0.01 or 0.05). The levels of 5-HT and 5-HT2AR protein expression in NGH group[(2.20±0.14)ng/ml and(166.33±9.21)ng/ml] were further up-regulated, and the levels of 5-HIAA in NDH group [(0.58±0.08) ng/ml] became lower, compared with the control group(P<0.01 or 0.05). Conclusion Activity of 5-HT system enhanced in Apo-induced TS rat model. However, the enhanced activity may still be relatively insufficient. The mechanism of ND granulear treating TS was associated with depression of the 5-HT metabolism, up-regulation expression of 5-HT2AR, and improving the activity insufficient of 5-HT system.

Objective To investigate the outcome between endoscopically assisted and routine anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome.Methods From Februray 2008 to June 2010, forty-four patients with cubital tunnel syndrome were treated with routine anterior subcutaneous transposition (routine group,28 cases) and endoscopically assisted anterior subcutaneous transposition (endoscope group,16 cases).The operate time,drug administration,scar and postoperative hospital stay were compared.The patients were followed 1-12 month postoperatively,postoperative time back to work and function of ulner nerve were recorded.Results The results of endoscope group were as follows: operative time was (67.20 ± 19.69)min; postoperative scar length was (1.5％ ± 0.58) cm; rate of administration of anodyne was 6.3％; postoperative hospital stay was (2.4％ ± 1.42) days; postoperative time back to work,(14.6 ± 4.69)days; the results of open surgery group were as follows:operative time (62.8％ ± 11.06) min; postoperative scar length was (8.7％ ± 1.42) cm; rate of administration of anodyne was 42.8％; postoperative hospital stay was (5.7％ ± 2.53) days; postoperative time back to work was (29.40 ± 8.75) days; all differences of the results were significant between two groups (P ＜ 0.05).According to function of ulner nerve scoring system,one year postoperatively, excellent or good results were 82.14％ in routine group and 81.25％ in endoscope group,no significant difference between two groups (P ＞ 0.05). Conclusion Compared with routine anterior transposition of the ulnar nerve,endoscopically assisted anterior transposition has the following advantages: smaller incision and less tissue damage,less postoperative pain and sooner returning to work.And similar outcome was achieved from the two group.

OBJECTIVETo study the classification and individualized treatment of the terminal phalanx of thumb duplication.

METHODSFrom Apr. 2003 to Dec. 2012, 76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied. Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb, we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb), Type B(asymmetry and no deviation), Type C(asymmetry and deviation), Type D (symmetry and no deviation) and Type E(symmetry and deviation). Different surgical procedures were selected according to different types. Simple excision of the smaller thumb was adopted for Type A case. Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B. Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint, as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C. The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D. The classical Bilhaut-Cloquet procedure, or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E. The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand.

RESULTSAccording to our new classification standard, there were 3 cases with Type A duplicated thumbs, 36 with Type B, 13 with Type C, 15 with Type D, 10 with Type E. All the 76 patients underwent the individualized surgical treatment. The patients were followed up for 6-60 months. According to the evaluation form, excellent results were achieved in 66 thumbs, good in 9 thumbs and fair in 2 thumbs.

CONCLUSIONSThe new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication. Individualized therapy, including basic and repeated surgical procedure could be adopted for each type with satisfactory results.

Child ; Collateral Ligaments ; surgery ; Finger Phalanges ; surgery ; Humans ; Orthopedic Procedures ; methods ; Osteotomy ; methods ; Polydactyly ; classification ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Thumb ; abnormalities

Objective To investigate the characteristics of TCM syndromes of Tourette syndrome (TS) to find out the basis for its TCM treatment. Methods Based on the preliminary studies,the TCM syndrome scale of TS is designed to investigate the general data,main symptoms and syndromes of 126 cases of TS children to find out the frequency of each syndrome. Results Of the 126 TS cases,97 were males,accounting for 77%; the average age was 8.31 years; and 32 had a positive family history,accountting for 25.4%. In the tic behavior,the facial twitching and limb twitching occupied 91.6% of the muscular stereotyped tic. In the vocal behavior,the throat and nasal sound occupied 42.1%. In the accompanied symptoms,the inattention occupied 69.8%. In the personality offset,the willfulness occupied 49.2%,irritable hyperactivity occupied 78.6%,and silence occupied 7.1%. More than 50% of the patients had red or dark red tongue with thick or sticky coating. Nearly 70% of them had string-taut or rolling pulse. As for the syndromes,heart-liver deficiency with deficiency wind stirred up,and liver-kidney yin deficiency with yang hyperactivity stirring up wind were common,being 41.3% and 34.1% respectively. Conclusion TS takes the heart-liver deficiency with deficiency wind stirred up and liver-kidney yin deficiency with yang hyperactivity stirring up wind as the common syndromes. The basic treating principle is enriching yin and reducing yang,and smoothing the liver to stop wind. At the same time,reinforcing the spleen and nourishing the heart,and dissolving phlegm and enlightening the brain should be applied for treatment.

Objective To investigate the necessity and feasibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly.Methods From February 2007 to January 2015,we collected the patients with radial polydactyly,whose nail width or thumb girth was less than 80％ of contralateral side.Among them,some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb.In these cases,an island compound flap,which was based on proper palmar digital artery (PPDA) in radial thumb and contained nail,part distal phalanx and skin,combining with ulnar side of ulnar thumb was used to reconstruct a new thumb.Only the patients with a smaller thumb girth were treated by an island flap to augment the thumb size.There were 26 patients,including 29 sides.Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery(PPA) and PPDA.Appearances were evaluated by Wang -Gao scoring system and functions were evaluated by Tata scoring system.Results There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands:both thumbs only had one PPDA;the main thumb had two while the extra thumb still had one.The former was responsible in 82.76％ (24 hands).All cases were operated according to preoperative design using an island compound flap.26 hands in 23 patients were followed up more than 6 months.Flap results included survival in 22 patients,tension vesicle in 2 patients and tip necrosis in 2 patients.The incision was infected in one patient with the treatment of changing dressing regularly.The function results were excellent in 21 patients,good in 4,fair in 1.Aesthetic results were excellent in 13 patients,good in 4 and fair in 1.Conclusions There is always one developed PDAA in extra thumb,which can be used to design a flap.The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs.Using an axial or island flap to reconstruct a new thumb can not only change the appearance,but also make the reconstructed thumb acquire two sets of blood supply and nerve system.

Objective To investigate the necessity and feasibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly.Methods From February 2007 to January 2015,we collected the patients with radial polydactyly,whose nail width or thumb girth was less than 80％ of contralateral side.Among them,some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb.In these cases,an island compound flap,which was based on proper palmar digital artery (PPDA) in radial thumb and contained nail,part distal phalanx and skin,combining with ulnar side of ulnar thumb was used to reconstruct a new thumb.Only the patients with a smaller thumb girth were treated by an island flap to augment the thumb size.There were 26 patients,including 29 sides.Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery(PPA) and PPDA.Appearances were evaluated by Wang -Gao scoring system and functions were evaluated by Tata scoring system.Results There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands:both thumbs only had one PPDA;the main thumb had two while the extra thumb still had one.The former was responsible in 82.76％ (24 hands).All cases were operated according to preoperative design using an island compound flap.26 hands in 23 patients were followed up more than 6 months.Flap results included survival in 22 patients,tension vesicle in 2 patients and tip necrosis in 2 patients.The incision was infected in one patient with the treatment of changing dressing regularly.The function results were excellent in 21 patients,good in 4,fair in 1.Aesthetic results were excellent in 13 patients,good in 4 and fair in 1.Conclusions There is always one developed PDAA in extra thumb,which can be used to design a flap.The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs.Using an axial or island flap to reconstruct a new thumb can not only change the appearance,but also make the reconstructed thumb acquire two sets of blood supply and nerve system.

Objective To explore the relationship between individual difference in heparin sensitivity and postoperative bleeding,and lay the foundation for individualized heparin anticoagulant strategy. Methods A total of 120 patients undergoing cardiopulmonary bypass were enrolled in this study. Activated clotting time(ACT)of whole blood was established,and 2.5 mg/kg first heparin was given to the sternum.The value of ACT was measured after five minutes.The patients were divided into 3 groups according to the results of the first measured heparin.If the ACT value did not meet the transfer requirements,heparin 0.5 mg/kg was added,and the amount of bleeding was recorded. The general information of patients,blood transfusion and drainage and other information 24 hours postoperatively were recorded. Results Drainage volume 24 hours after the operation in 3 groups was statistically significant(P < 0.05). Drainage volume 24 hours after the operation in group with ACT>750 s and group with ACT<480 s was significantly higher than that in group with ACT ranging from 480 s to 750 s but the difference be-tween the group with ACT < 480 s and the group with ACT > 750 s was not statistically significant(P > 0.05). Conclusions Heparin sensitivity is associated with postoperative bleeding in patients with cardiopulmonary by-pass surgery,and patients with ACT ranging from 480 s to750 s have the lowest amount of bleeding.

Objective: To discuss the therapeutic effect of using tibial island flap of second toe for the treatment of fibular hallux flap donor site defect. Methods: From March 2012 to April 2015, 18 tibial island flaps of second toe were transferred to repair donor site defect on fibular hallux that can not sutured directly, and the subsequent donor site wound on the second toe were sutured. Results: On an average of 13 months follow-up, all 18 flaps survived with primary healing. Texture and appearance of the tibial island flaps were satisfactory; The flaps had good sensory recovery, S3⁺ in 14 patients and S4 in 4 patients. Severe contracture of the first toe web were not observed. The donor site of second toe got good recovery with normal activity of interphalangeal joint. Conclusions The tibial island flap of second toe is a good option for treatment of the defect on fibular hallux flap donor site. Meanwhile, it also meets the requirement of " donor site care" .