BACKGROUND:Avulsion fractures of the tibial attachment of the posterior cruciate ligament have been repaired using open reduction and rivet fixation, hol ow screw fixation, or arthroscopic reconstruction of the posterior cruciate ligament. These methods ignore the importance of early tension reconstruction of the posterior cruciate ligament, so their efficacies are uncertain. Determining the optimal fixation method and how best to restore knee stability remain controversial. OBJECTIVE:To observe the stability of new bone fixation plate for the repair of avulsion fracture of the tibial attachment of the posterior cruciate ligament. METHODS/DESIGN:We wil conduct a prospective, single-center, self-control ed, clinical trial at the Cangzhou Central Hospital, Hebei Province, China. Fracture fragments and the injured posterior cruciate ligament wil be exposed in 20 patients with avulsion fracture of the tibial attachment of the posterior cruciate ligament through a posterior approach and open reduction. The posterior cruciate ligament wil be reconstructed with a new type of bone plate. Al patients wil be fol owed for 3 and 12 months. Primary outcome:The Hospital for Special Surgery knee score wil be used to evaluate knee function preoperatively and 3 and 12 months postoperatively. Secondary outcomes:Lysholm Knee Scoring Scale, X-ray, computed tomography, and magnetic resonance imaging wil be used to assess knee morphology preoperatively and 3 and 12 months postoperatively. Patient satisfaction wil also be assessed at 3 and 12 months postoperatively. The study protaol was registered at clinicaltrials.gov.NCT03059368. The study protocol has been approved by the Ethics Committee of Cangzhou Central Hospital of China. Al protocols wil be conducted in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent wil be provided by al participants. DISCUSSION:This trial wil evaluate a newly-designed plate fixation device for early tension reconstruction of the posterior cruciate ligament to repair avulsion fractures of the tibial attachment of the posterior cruciate ligament and restore knee stability. This trial wil verify the plate's efficacy, provide an experimental basis for treating avulsion fractures of the tibial attachment of the posterior cruciate ligament, and provide a method of maximizing knee stability.

Aromatic Chinese herbs has been used to prevent plague since ancient times, and traditional Chinese medicine has unique advantages in the prevention and treatment of epidemic disease. Corona virus disease 2019 (COVID-19) is rampant, and the National Health Commission of the People's Republic of China issued guidelines which recommends integrated treatment plans of traditional Chinese and Western medicine. According to the traditional Chinese medicine treatment plan in the National COVID-19 Diagnosis and Treatment Plan (Trial Seventh Edition) of the National Health Commission, Chinese patent medicines or prescriptions containing more aromatic Chinese herbs are selected for prevention and treatment during the period of medical observation, clinical treatment and recovery of confirmed patients. Some local health committees or traditional Chinese medicine administrations also recommend a variety of other ways to use aromatic traditional Chinese herbs (external fumigation, moxibustion, wearing sachet, etc.) to prevent and cure COVID-19. The efficacy of "fragrance repels filth and reinforces vital qi" of aromatic Chinese herbs plays a positive role in the prevention and treatment of COVID-19. It has become a consensus to use aromatic Chinese herbs to interfere with the occurrence and development of COVID-19. The unique properties, chemical composition and action mechanism of aromatic Chinese herbs are worthy of extensive and in-depth experimental and clinical research, which can provide reference for the follow-up treatment of novel coronavirus and the development of corresponding drugs. Based on the theory of traditional Chinese medicine, this paper discusses the role of aromatic Chinese herbs in the prevention and treatment of COVID-19, and speculates the possible mechanism of its function, in order to provide a basis for attaching importance to the prevention and treatment of COVID-19.

To evaluate therapeutic efficacy and safety of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection in the treatment of chronic obstructive pulmonary diseases (COPD). All clinical trial databases were retrieved from PubMed, EMBase, ClinicalTrials, Cochrane Library, CNKI, CBM, VIP, and Wanfang. Data were searched from inception to February 2018, randomized controlled trials (RCTs) by Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with chemotherapy (experimental group) compared with conventional therapy (control group) in the treatment of COPD were included. All included studies were critically appraised by two independent reviewers according to the cochrane systematic review method and using Revman 5.3 Software and State 12.0 for Meta-analysis. There were 16 RCTs were included in the evaluation and screening of selected articles with a total of 1 259 patients. The Meta-analysis showed that the total clinical efficacy of the patients in the experimental group after treatment was significantly better than that in the control group [OR = 4.67, 95% CI (3.03, 7.19), P < 0.000 01]; The improvement of forced expiratory volume in one second (FEV1) was significantly better than control group [SMD = 1.43, 95% CI (1.14, 1.72), P < 0.000 01]; Forced vital capacity (FVC) was significantly better than control group [SMD = 1.53, 95% CI (1.17, 1.90), P < 0.000 01]; FEV1/FVC was significantly better than control group [SMD = 1.12, 95% CI (0.90, 1.34), P < 0.000 01]; FEV1 in the percentage of the predicted value forced vital capacity (FVC) was significantly better than control group [SMD = 0.62, 95% CI (0.31, 0.93), P < 0.000 1] and the blood gas index of PaO2 was significantly higher than control group [MD= 9.7, 95% CI (7.92, 11.65), P < 0.000 01]; PaCO2 was significantly lower than control group [SMD =-1.51, 95% CI (-1.90, -1.12), P < 0.000 01]; SaO2 was significantly higher than control group [SMD = 0.94, 95% CI (0.48, 1.40), P < 0.000 1]. For the treatment of chronic obstructive pulmonary disease, Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with chemotherapy can significantly improve the lung function of patients, but the conclusions of the study still need to be confirmed by more high-quality clinical trials.

Objective: To provide a scientific basis for the modern identification of Panax japonicus and ensure the clinical efficacy and medication accuracy, the molecular identification of P. japonicus and its related species or adulterants was carried out. Methods: ITS2 sequences of P. japonicus were amplified and sequenced directionally. ITS2 sequences of related species and adulterants were downloaded from GenBank. Cutting with ITS2 database, the final dataset consisted of 102 sequences from 24 species. DAMBE program was also implemented to detect substitution saturation of ITS2 sequences. MEGA 6.06 software was utilized for sequence alignment, calculating GC content, analyzing variation sites, estimating intra-specific and inter-specific genetic distances, and finally building NJ tree. Moreover, the secondary structure of ITS2 was predicted by using the ITS2 database. Results: The length of ITS2 sequences from P. japonicas was 230 bp and GC content was 63.7%. The average genetic distance analysis, NJ tree, and secondary structure characteristics of the ITS2 sequences showed that there were great differences between P japonicus and its non-identical adulterants or partial related species (P. stipuleanatus, P. pseudoginseng, P. trifolius, P. vietnamensis var. fuscidiscus, and P. vietnamensis). Howerer, the application of such method for the identification of P. japonicus and partial closely related species (P. quinquefolius, P. ginseng, P. notoginseng, P. japonicus var. major, P. japonicus var. bipinnatifidus, P. assamicus, P. variabilis, and P. japonicus var. angustifolius) had certain limitation. Conclusion: The ITS2 sequence can be used as one of the DNA barcodings for the identification of P. japonicus and its non-identical adulterants at high identification rate, however, its versatility of identification between P japonicus and related species needs to be further verified. Our study provides the basis for the identification of inter-specific genetic and affinity relationship of P. japonicas and its related species, the distinguishment between P. japonicas and non-identical adulterants, and the clinical safety of P japonicas.

AIM: To explore the characteristics of astigmatism in preschool children before, during and after the COVID-19 epidemic, so as to provide a reference for further prevention and control of children's vision.METHODS: In the consecutive four years from January 2018 to December 2021, a retrospective analysis of vision data was conducted on 2 273 preschool children(4 546 eyes)younger than 4 years old who participated in children's vision screening test in Baiyun district, Guangzhou. They were divided into 1-year old group(ages<1-year old, 420 cases), 2-year old group(1-year ≤ ages <2-year, 543 cases), 3-year old group(2-year ≤ages <3-year, 614 cases), and 4-year old group(3-year ≤ ages<4-year, 696 cases)according to ages. The analysis included astigmatic degrees of children's eyes as well as their conditions of astigmatism.RESULTS: In 2018, the astigmatic degrees of the both eyes of 1-year-old group were higher than those of other groups(P<0.05). The binocular astigmatic degrees of the preschool children in four groups were obviously higher in 2020 than 2019(P<0.05), while they were significantly decreased in 2021 when compared with 2020(P<0.05). From 2019 to 2020, the increase of astigmatic degrees of the right eye is more considerable than the left eye of preschool children in those four groups(P<0.001). Furthermore, the morbidity of astigmatism basically echoes with the changing tendency of astigmatic degrees from 2018 to 2021.CONCLUSIONS: Preschool children in Baiyun district, Guangzhou, have the highest degree of astigmatism and the fastest progression rate within 1 year old. Before COVID-19 epidemic, the changes in astigmatism and prevalence were relatively stable; during COVID-19 epidemic, the astigmatism and prevalence increased significantly and the astigmatic degrees of right eye increased more than that of the left eye; after the normalization of epidemic prevention and control, the astigmatism and prevalence decreased significantly.

BACKGROUNDWhile echocardiography has been a pivotal screening test in pulmonary arterial hypertension (PAH), the presence of structural cardiac defects may affect the ability to reliably predict pulmonary artery pressures (PAPs). This study sought to evaluate the accuracy of Doppler echocardiography (DE) for estimating PAPs in adult atrial septal defect (ASD) patients with PAH.

METHODSA prospective study was carried out to compare the echocardiographic assessment of PAP with the same pressures obtained by right heart catheterization (RHC) in adult ASD patients with PAH who underwent simultaneous DE and RHC. Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of PAPs.

RESULTSTwo hundred and fifty-seven patients were included in the study. A significant overestimation of the systolic pulmonary arterial pressure (sPAP) and mean pulmonary artery pressure (mPAP) was reported by echocardiography compared with those by catheterization ((81.8 ± 26.9) mmHg vs. (72.9 ± 26.9) mmHg, P < 0.01; (51.9 ± 16.4) mmHg vs. (41.4 ± 17.2) mmHg, P < 0.01, respectively). Twenty-one percent (55/257) of the patients had PAH when estimated by echocardiography whereas showed normal results in the subsequent catheterization test. Using Bland-Altman analytic methods, the bias for the echocardiographic assessment of the sPAP was 9.1 mmHg with 95% limits of agreement ranging from -24.4 to 42.6 mmHg. For mPAP measurement, the bias was 10.5 mmHg with 95% limits of agreement ranging from -12.4 to 33.4 mmHg. On multiple linear regression analysis, age, gender, body surface area, ASDs' diameter, PVR, diastolic blood pressure, and echocardiographic assessment of right atrial pressure (RAP) explained 68.8% of the total variability in the model (r(2) = 0.688, P < 0.01).

CONCLUSIONInaccuracy was frequently reported in Doppler echocardiographic assessment of the PAP in adult ASD patients with PAH and was often associated with age, gender, body surface area, ASDs' diameter, pulmonary vascular resistance, diastolic blood pressure and echocardiographic estimation of RAP.

Adolescent ; Adult ; Aged ; Echocardiography, Doppler ; methods ; Female ; Heart Septal Defects, Atrial ; diagnosis ; Humans ; Hypertension, Pulmonary ; diagnosis ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Artery ; pathology ; Young Adult

BackgroundThe excess volume of contrast media (CM) is a marker of a more severe coronary culprit lesion and longer intervention duration in patients undergoing cardiac procedures. However, it is unclear whether the contrast volume is directly correlated with worse clinical outcomes. The aim of this study was to investigate the association between contrast dose and the incidence of 1-year major adverse cardiac and cerebrovascular events (MACCE) and all-cause bleeding events in patients undergoing cardiac catheterization and coronary angiography (CAG).

MethodsWe prospectively enrolled 10,961 consecutive patients diagnosed with coronary heart disease expecting CAG from 2012 to 2013. The study population was pursued with a follow-up duration of 1 year. The predictive value of contrast volume, divided into quartiles, for the risk of MACCE and all-cause bleeding events was assessed using logistic regression analysis.

ResultsThe cumulative incidence of 1-year MACCE was 8.65%, which was directly associated with increasing contrast volume. In particular, MACCE was observed in 7.16%, 7.89%, 9.31%, and 11.73% of cases in the contrast volume quartile Q1 (≤100 ml), Q2 (101-140 ml), Q3 (141-200 ml), and Q4 (>200 ml), respectively (P < 0.001). Moreover, the incidence of 1-year all-cause bleeding events was noted in 4.70%, 5.93%, 7.28%, and 8.21% of patients in Q1, Q2, Q3, and Q4, respectively (P < 0.001). The survival analysis showed that the 1-year MACCE rate was higher in patients using greater CM volume during the CAG. CM volume used >140 ml was associated with the occurrence of 1-year MACCE, and the incidence was dramatically elevated in patients exceeding a contrast volume of 200 ml (P = 0.007).

ConclusionOur data suggested that higher contrast volume was significantly correlated with an increased risk of MACCE and all-cause bleeding events in patients undergoing cardiac catheterization.

Trial RegistrationClinicalTrials.gov, NCT01735305; https://clinicaltrials.gov/ct2/show/NCT01735305?id=NCT017353057rank=1.

Objective: To detect the CHRNA7 gene mutation and polymorphism in Southern Han Chinese patients with nocturnal frontal lobe epilepsy (NFLE). Methods: Blood samples were collected from 215 Southern Han Chinese patients with NFLE and 200 healthy Southern Han Chinese control subjects. Genomic DNA was extracted, and CHRNA7 whole genome exons were amplified by the polymerase chain reaction and subjected to Sanger sequencing. Results: No CHRNA7 gene mutation was detected in all of the NFLE patients. However, five single nucleotide polymorphisms (SNPs) in sporadic cases were found, located in exons 5, 6, and 7 of the CHRNA7 gene. Among them, c.690G>A and c.698A>G are known SNPs, while c.370G>A, c.654C>T, and c.497-498delTG were newly discovered SNPs. These SNPs were also found in some of the healthy controls. Conclusions: No CHRNA7 gene mutation was identified in Southern Han Chinese patients with NFLE. The CHRNA7 gene is probably not responsible for NFLE in this population.

Objective To discuss the clinical significance of internal fixation through anterolaterel and posteromedial approaches in the treatment of closed sagittal Pilon fractures of Topliss classification and compare the effects of the two approaches.Methods The study involved 57 patients with closed sagittal Pilon fractures treated with open reduction and internal fixation from 2007 to 2010,including 29 patients treated through anterolateral approach (Group A) and 28 through posteromedial approach (Group B).All patients were with closed fractures,and all surgery time windows were 10-19 days.The two groups were compared in aspects of gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window,operation time,intra-operative blood loss,ambulation time,infection and necrosis rate of skin and soft tissue,length of stay,ankle joint function recovery after internal fixation,and intra-operative X-ray reduction.Results All patients were followed up for 12-26 months (mean,20 months) except for one patient in the Group A,with total follow-up rate of 98％.The two groups showed no significant differences regarding the gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window selection,operation time,intra-operative blood loss,and ambulation time (P ＞0.05).While,the infection and necrosis incidence of skin and soft tissue,and the hospital stay we re significantly lower and shorter in the Group A than that in the Group B (P ＜ 0.05 ).Two patients in the Group A were complicated with toe extensor tendon adhesion,which was released by removing the fixation.Fifteen patients had wound infection during hospitalization,including three patients in the Group A and 12 in the Group B,but they were all cured after treatments like dressing.Fifteen patients were treated with stage Ⅰ allogeneic bone graft and 11 with autologous iliac bone graft.All the patients obtained bone union.Conclusions Topliss classification of closed sagittal Pilon fractures has clear clinical significance in surgical plan selection and operative procedures.Both of the anterolateral and posteromedial approaches can achieve good effects in the treatment of closed sagittal Pilon fractures due to high energy injury.However,the anterolateral approach is relatively a better choice,for it brings in a lower incidence of infection and necrosis of skin and soft tissue and a shorter length of hospital stay.

BACKGROUND:Dynamic hip screws have been considered as a classic method for intertrochanteric fracture. However, migration of the hip screw resulting in cut-out of the femoral head remains the most common mechanical failure, which requires secondary surgery. OBJECTIVE:On the basis of the traditional dynamic hip screw, we modified the lag screw, designed new internal fixation system as cemented dynamic hip screws to explore the feasibility and the biomechanical properties for the treatment of osteoporotic intertrochanteric fracture. METHODS:A total of 24 hip samples were harvested from fresh cadavers with osteoporosis. Bone density was measured. According to the standards, the specimens were made into intertrochanteric fracture models of AO31-A1 type. Of each specimen, one side implanted with cemented dynamic hip screws served as experimental group, and another side implanted with traditional dynamic hip screw served as control group. Axial compression, twisting and fatigue load biomechanics were tested. Their biomechanical functions were compared. RESULTS AND CONCLUSION:Stress intensity, axial stiffness and horizontal shear stiffness were higher in the experimental group than in the control group (P<0.05). At torsion angle of 3°, torsional moment was higher in the experimental group than in the control group (P<0.05). Fatigue load was higher in the experimental group than in the control group (P<0.05). Results suggested that cemented dynamic hip screw internal fixation system in the treatment of senile osteoporotic intertrochanteric fracture can effectively enhance the hip screw holding force and prevent femoral cutting. Biomechanical property, stiffness, endurance resistance and stability of cemented dynamic hip screw are better than traditional dynamic hip screw.