Objective　To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. Methods　Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm×5.0 cm to 4.5 cm ×11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm ×8 cm to 12 cm×25 cm. Results　All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. Conclusion　The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.

OBJECTIVE:To establish a method for the content determination of calceolarioside A in the Leaves of Fraxi-nus mandschurica. METHODS:HPCE was performed on the capillary of uncoated fused silica capillary,buffer solution of borate buffered saline(20 mmol/L,pH 9.3),separation voltage of 20 KV by pressure injection(injection pressure was 50 bar with 3 s), detection wavelength was 350 nm,and column temperature was 30 ℃. RESULTS:The linear range of calceolarioside A was 50-250μg/ml(r=0.999 7);RSDs of precision,stability and reproducibility tests were less than 3%,recovery was 97.48%-102.08%(RSD=1.12,n=6). CONCLUSIONS:The method is simple,good reproducibility,and can be used for the content determination of calceolarioside A in the Leaves of F. mandschurica.

OBJECTIVETo investigate relations between milk consumption and lactose intolerance (LI) in adults and to explore the effect of milk consumption on lactase activity.

METHODSTotal of 182 subjects aged 20-70 years were recruited and interviewed by questionnaires, and their accumulative cow's milk intake (AMI) was calculated. LI was evaluated by hydrogen breath test (HBT).

RESULTSA negative correlation was found between AMI and severity of observed LI symptom (r=-0.2884; P<0.05). Binary logistic regression analysis showed a negative correlation between LI and duration and frequency of milk consumption (OR, 0.317 and 0.465, respectively; both P<0.05) and a positive correlation between LI and amount of milk consumed per sitting (OR, 6.337; P<0.05).

CONCLUSIONLI is related to various milk consumption behaviors. Most Chinese adults with LI may tolerate moderate milk consumption <160 mL.

Adult ; Animals ; Breath Tests ; China ; epidemiology ; Drinking Behavior ; Humans ; Hydrogen ; Lactase ; metabolism ; Lactose ; Lactose Intolerance ; diagnosis ; epidemiology ; prevention & control ; Milk ; Prevalence

OBJECTIVETo investigate the antiatherogenic effect and possible mechanisms of the extracts of Radix Salviae Miltiorrhizae (RSM) or Fructus Crataegi (FC), as well as their interaction.

METHODWistar rats were randomly divided into 2 groups: normal group and model group. The atherosclerotic model rats were injected VD3 and ovalbumin, while fed with high cholesterol diet. After the model was determined successfully, all model rats were divided into normal group, model group, Xuezhikang group, RSM group, FC group, mixture of RSM and FC group. Each group was given the corresponding drugs for 4 weeks. After 12 weeks, blood serum were analyzed for total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C), superoxide dismutase ( SOD), malondialdehyde (MDA) and nitric oxide (NO). And the blood plasma also analyzed for levels of endothelin (ET), 6-keto prostaglandin F1alpha (6-keto-PGF1alpha), thromboxane B2 (TXB2), C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-alpha) and so on. At last, the pathological observation of aorta was carried out.

RESULTCompared with those in model group, the TC, TG, LDL-C, ET, TXB2 and MDA levels and TXB2/PGF1alpha ratio were reduced, while the HDL-C, the serum SOD, No and 6-keto-PGF1alpha level were raised in the intervention groups. Although the levels of CRP, IL-6 and IL-8 were lower than model group, there was no obvious effect on the releasing of TNF-alpha.

CONCLUSIONRSM and FC could inhibit the atherogenesis formation and development, which might be due to regulating the lipid metabolism, enhancing the antioxidation, and reducing the release of inflammatory factors.

Animals ; Atherosclerosis ; prevention & control ; C-Reactive Protein ; analysis ; Crataegus ; Disease Models, Animal ; Interleukin-6 ; blood ; Lipid Peroxidation ; drug effects ; Lipids ; blood ; Male ; Plant Extracts ; therapeutic use ; Rats ; Rats, Wistar ; Salvia miltiorrhiza

Objective To evaluate the prevalence of full thickness rotator cuff tear in patients with proximal humeral fractures,and the relationships between different risk factors.Methods Data of 113 patients with proximal humeral fractures from January 2014 to January 2016 who underwent surgical treatment were retrospectively analyzed.The general characteristics of patients (age,sex,cause of injury) were recorded and the rotator cuff was evaluated preoperatively on MRI and explored intra-operatively.We calculated and compared the incidence rate of age,sex in patients with and without rotator cuff tear.And the incidence rate of rotator cuff tear in different types of fracture according to Neer classification was calculated.Results The full thickness ro tator cuff tear were indentified in 28 patients (24.8％),and 21 of them had been confirmed by MRI preoperatively.Statistical significant difference was found between patients with rotator cuff tear group (average of 75.11± 10.89 years old) and without rotator cuff tear group (64.68± 13.43) for the age of the patient.Full thickness rotator cuff tear was most common in Neer 3 GT fracture (33.3％,8/54),followed by Neer 2 GT (26.67％,4/15) and Neer 2 SN (17.65,6/34),however,no full thickness rotator was found in Neer 4 type fracture.There were 4 patients with total rotator cuff tear who had symptom of shoulder before the operation.The other 24 patients had no symptom of shoulder.Conclusion Patient age was found as a risk factor for full thickness rotator cuff tear in humeral proximal fractures with the rate of 24.8％.Full thickness rotator cuff tear was most common in Neer 3 GT fracture.

Objective:To study the predictive value of BAT score for the prognosis of patients with spontaneous intracerebral hemorrhage (sICH).Methods:A retrospective analysis of 93 sICH patients in the Emergency Department of the Second Affiliated Hospital of Wannan Medical College from January 2018 to December 2020 was conducted, and the patients were classified into the good prognosis group ( n=34) and the poor prognosis group ( n=59) according to the Glasgow Outcome Score (GOS) 3 months after the discharge. Clinical data such as basic data of patients, admission vital signs, laboratory indicators, National Institute of Health stroke scale (NIHSS) score and BAT score and other clinical data of the two groups were compared. Multivariate logistic regression was used to analyze the risk factors affecting poor prognosis of sICH patients. The receiver operating characteristic (ROC) curve was drawn to analyze predictive value of BAT score for poor prognosis of sICH patients. Results:The admission systolic blood pressure, white blood cell count, hypertension complications, emergency BAT score and NIHSS score of patients in the poor prognosis group were significantly higher than those in the good prognosis group ( P<0.05). Multivariate logistic regression analysis indicated that the admission systolic blood pressure ( OR=1.024, 95% CI: 1.002~1.046, P=0.035) and emergency BAT score ( OR=2.640, 95% CI: 1.445-4.825, P=0.002) could accurately predict the poor prognosis of sICH patients. ROC curve analysis showed that the area under ROC curve (AUC) of BAT score was 0.792, the sensitivity was 79.3%, and the specificity was 76.5%. The AUC of systolic blood pressure for predicting poor prognosis of sICH patients was 0.701, and the sensitivity was 55.2%, and the specificity was 88.2%. The AUC of BAT score combined with systolic blood pressure for predicting poor prognosis of sICH patients was 0.835. Conclusions:BAT score and admission systolic blood pressure could more accurately predict poor prognosis of sICH patients. The combination of them had a higher efficacy in predicting poor prognosis of sICH patients after 3 months.

Objective:To evaluate the differential diagnostic efficacy of a predictive model of breast imaging reporting and data system (BI-RADS) classification combined with mammography radiomics classifier for various X-ray phenotype of breast lesions.Methods:A retrospective analysis was performed on 2 055 female patients who underwent mammography examination and were confirmed by pathology from May 2013 to August 2020 in Zhongda Hospital, Southeast University. Breast lesion was classified into mass or non-mass according to the fifth edition of BI-RADS. The mass was further divided into small mass (maximum diameter ≤ 2 cm) and large mass (maximum diameter>2 cm), the non-mass was further divided into asymmetric, calcification and structural distortions. By manually segmenting the region of interest of the lesion, the radiomics features were extracted and the model was constructed. Receiver operating characteristic curve and area under the curve (AUC) were used to assess the diagnostic efficacy of the BI-RADS classification, the radiomics model and the combined model for various phenotypes of breast lesions. Differences among the AUC were analyzed by the DeLong test.Results:The AUCs based on the BI-RADS classification, the radiomics model and the combined model were 0.924±0.006, 0.827±0.009 and 0.947±0.005 respectively. Compared with BI-RADS classification and the radiomics model, AUC of the combined model was the highest, and the differences were statistically significant ( Z=9.29, 14.94, P<0.001). For large mass, small mass and non-mass, combined model (AUC=0.958±0.007, 0.933±0.013, 0.939±0.008) showed the best performance when compared to the BI-RADS classification (AUC=0.937±0.010, 0.896±0.020, 0.916±0.011; Z=5.32, 3.90, 5.08, P<0.001) or the radiomics model (AUC=0.872±0.012, 0.851±0.021, 0.758±0.016; Z=7.86, 4.53, 12.13, P<0.001). The AUC of the combined model for benign and malignant asymmetric breast lesions (0.897±0.017) was higher than that of the BI-RADS classification (AUC=0.866±0.020, Z=4.27, P<0.001) and the radiomics model (AUC=0.633±0.029, Z=7.44, P<0.001); however, the AUC of the combined model for benign and malignant calcification and structural distortion of breast lesions (0.971±0.010, 0.811±0.057, respectively) was only higher than that of the radiomics model (AUC=0.827±0.021, 0.586±0.075, Z=7.40, 3.15, P<0.001), and there was no significant difference with the BI-RADS classification (AUC=0.959±0.012, 0.800±0.061, Z=1.87, 0.39, P>0.05). Conclusion:The combined model shows better differential diagnostic performance, which is valued in the clinical application.

Objective:To investigate the long-term effect of open reduction and internal fixation and one stage rotator cuff repair in treatment of proximal humeral fractures combined with rotator cuff tear.Methods:A retrospective case series study was performed on clinical data of 40 patients with proximal humeral fractures combined with rotator cuff tear admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2012 to December 2015. There were 24 males and 16 females, aged 52-93 years [(72.5±10.2)years]. According to Neer classification, there were 7 patients with two-part proximal humerus fractures, 27 with three-part proximal humerus fractures and 6 with four-part proximal humerus fractures. All patients received open reduction and internal fixation using locking plates and one stage rotator cuff repair. Functional shoulder exercises were carried out after operation. Fracture healing and wound healing were observed postoperatively. Shoulder active motion, visual analogue score (VAS) and University of California at Los Angeles (UCLA) shoulder rating scale were assessed and compared before operation and at the last follow-up.Results:All patients were followed up for 4.5-8.5 years [(6.2±1.2)years]. All wounds and fractures healed without infection or nonunion. At the last follow-up, the active forward elevation of affected shoulder was 100°-150° [(121.8±15.8)°], the external rotation with the shoulder in neutral position was 30°-80° [(47.0±15.9)°], the external rotation with the shoulder abduction was 60°-80° [(73. 5±6.2)°], the internal rotation with the shoulder abduction was 60°-80° [(70.5±7.1)°], showing significant differences compared to preoperative 30°-60° [(44.8±11.1)°], 0°-30° [(12.0±10.4)°], 0°-30° [(13.8±7.7)°], 30°-60° [(47.0±8.5)°], respectively (all P<0.01). The VAS was 1 (0, 1)points at the last follow-up, and was 6(5, 6)points before operation ( P<0.01). The UCLA shoulder rating scale was 28-35 points [(31.0±2.3)points] at the last follow-up, compared with preoperative 8-11 points [(10.3±0.8)points] ( P<0.01), and rated as excellent in 10 patients, good in 23 and poor in 7, with the excellent-good rate of 83%. Conclusion:For patients with proximal humeral fractures combined with rotator cuff tear, open reduction and internal fixation and one stage rotator cuff repair can significantly restore the shoulder motion, relieve the pain and recovery shoulder function, and the long-term therapeutic effect is satisfactory.

Objective To conduct a cross-sectional study on sleep and periodontal conditions,and further analyze the correlation be-tween sleep disorders and the progression of periodontitis.Methods A total of 100 patients who visited the Department of Stomatology at Nanjing First Hospital from June 2022 to October 2023 and met the inclusion criteria were selected.According to the 2018 Interna-tional New Classification of Periodontitis and Implant Periodontitis,patients were divided into stages Ⅰ-Ⅳ of periodontitis.General patient information was recorded.A Pittsburgh sleep quality index(PSQI)questionnaire survey was conducted to understand the patient's sleep status,and routine periodontal examinations were conducted to record probing depth(PD),periodontal attachment level(AL),bleeding index(BI),and blood routine tests were used to measure white blood cell count.The correlation between sleep disor-ders and periodontitis was statistically analyzed.Results The average PSQI score of all patients was(7.01±3.17)points,with an average PD of(3.52±0.67)mm,an average AL of(3.84±1.58)mm,and an average BI of(3.15±1.26).Among them,patients with stage Ⅳ periodontitis had the highest PSQI score.The white blood cell count of patients with stage Ⅲ and Ⅳ periodontitis was higher than that of patients with stage Ⅰ and Ⅱ(P<0.05),and the white blood cell count of patients with sleep disorders and periodontitis was higher than that of patients with periodontitis without sleep disorders(P<0.000 1).Using PSQI score as the independent variable and periodontitis stage as the dependent variable,after adjusting for age,gender,smoking,brushing frequency,and white blood cell count,regression analysis showed an OR of 1.480 2(95％CI:1.248 5-1.755 0).Conclusion There is a correlation between sleep disorders and periodontitis,and sleep disorders can promote the occurrence and development of periodontal tissue inflammation.

Objective: To investigate the clinical efficacy of arthroscopic irrigation combined with surgical debridement in the treatment of shoulder infection after arthroscopic rotator cuff repair. Methods: Data of 4 post-operative infected patients [(male 3 cases, female 1 case; 55 years (51-61 years)] after arthroscopic rotator cuff repair who underwent arthroscopic irrigation combined with surgical debridement from January 2016 to June 2019 were retrospectively analyzed. Less than 1 month after surgery, swelling, pain in the surgical area occurred and all patients had fever, abscess and sinus. Hematology and radiology were conducted immediately after admission. Antibiotic treatment was applied, and adjusted according to the culture results timely. All patients underwent arthroscopic irrigation combined with surgical debridement. Antibiotics continued accordingly after the operation. Blood routine, erythrocyte sedimentation rate, C-reactive protein, X-ray, etc. were rechecked regularly to evaluate the symptomatic relief of the infection and prognosis. Visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function during the pre-operative and post-operative follow-up period. Results: The surgery was successfully completed in all 4 patients. One was treated with VSD for vacuum suction and the wound was closed one week later. The results of microbial culture showed that 2 cases were Mycobacterium tuberculosis positive, 1 case Pseudomonas aeruginosa positive, and 1 case was Staphylococcus aureus positive. After treatment, the shoulder sinuses of all patients were healed, without swelling, pain, etc. The follow-up time was 3, 4, 32, and 33 months, respectively. There was no recurrence of infection until the latest follow-up. The joint mobility and scores were better than the situation of preoperative. The VAS score and ASES score of 2 patients with early debridement (< 1 month duration of infected symptoms) were respectively improved significantly from 5 and 40, 6 and 23 before operation to 1 and 80, 1 and 73 respectively at the latest follow up. The VAS score and ASES score of other 2 patients (> 6 months duration of infected symptoms) were respectively improved from 6 and 28, 6 and 32 to 1 and 62, 2 and 65 respectively. All patients were satisfied with the results. Conclusion Early arthroscopic irrigation combined with surgical debridement is an effective method to treat the post-operative infections after arthroscopic rotator cuff repair.