Objective To evaluate the therapeutic effect of botulinum toxin type A(BTX-A)injection in the treatment of spasmodic torticollis.Methods Sixty-four patients with spasmodic torticollis underwent the treatment of intramuscular injection of BTX-A in neck muscles.As a result,the efficiency of BTX-A therapy could be evaluated successfully.Results Considerable improvement of symptoms for the spasmodic torticollis patients was observed with BTX-A treatment.The average dose of BTX-A was(120.37 ±25.26) U.Injection points were 30.00 ± 4.85.The Tsui scores before treatment were (13.08 ±4.16) scores,and 2 weeks after treatment were (4.21 ± 2.63) scores.The Tsui scores showed a significant reduction after BTX-A injections (P <0.01).After treatment complete remission rate was 25.0% (16/64),significant improvement rate was 60.9% (39/64),partial improvement rate was 12.5% (8/64),invalid rate was 1.6%(1/64) and efficient rate was 85.9% (55/64).Duration of effect was (16.86-4.57) weeks.Patients who received repeated injections also had good response,with symptoms improved and dosage of BTX-A reduced.No serious adverse events happened in treatments.Conclusion BTX-A therapy is simple and effective in the treatment of spasmodic torticollis and should be considered as the first-choice treatment for the condition.

Objective To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis based on individual condition. Methods Twelve patients with intracranial venous sinus thrombosis were treated with endovascular management according to the severity and course of disease after they failed to respond to anticoagulant therapy. The clinical signs and symptoms,cerebrospinal fluid pressure and arteriovenous circulation time were observed and followed up (including MRV). Intravenous thrombolysis and mechanical thrombus maceration were carried out in all 12 patients,while intravenous thrombolysis, mechanical thrombus maceration in combination with intra-arterial thrombolysis were employed in 3. After the treatment, anticoagulant therapy was carried out for 6 months.The patients were followed up for 12 to 24 months. Results Of the twelve patients, clinical signs and symptoms included slight headache (2 cases), mild hemiplegia (1 case), ambiopia or blurred vision (3 cases). The cerebrospinal fluid pressure returned to under 26 cm H2O (1 cm H2O =0.098 kPa)following treatment from 28 to 38 cm H2O [ mean (32. 4 ±3.0) cm H2O] in preoperative measurement and the arteriovenous circulation time returned to below 10 s in all patients following treatment. Neither recurrence of thrombosis nor new symptoms of neurologic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation with the exception of a subcutaneous bleeding at the venopuncture site. Conclusion Endovascular treatment is effective and safe for patients with intracranial venous sinus thrombosis.

Objective To investigate the protective effects of Naoxintong capsule on cerebral ischemia-reperfusion injury in rats.Methods 45 SD rats were randomly divided into 5 groups: sham operation group (n=5), ischemia-reperfusion group (n=10), small dose of Naoxintong capsule group (n=10), large dose of Naoxintong capsule group (n=10), CoQ-10 group (n=10). The the cerebral ischemia-reperfusion model was established by occluding bilateral carotid arteries of animal. The moisture content and activity of ATPase in brain tissue of model rat were observed respectively at ischemia 30 min plus reperfusion 30 min and ischemia 30 min plus reperfusion 60 min.Results The activities of Na+-K+-ATPase, Ca2+-ATPase and Mg2+-ATPase decreased (P<0.01), contents of water in brain tissues increased (P<0.01) in the ischemia-reperfusion group, compared with the sham operation group. The activities of Na+-K+-ATPase, Ca2+-ATPase and Mg2+-ATPase increased (P<0.01), contents of water in brain tissues decreased (P<0.01) in the Naoxintong capsule group, compared with the ischemia-reperfusion group.Conclusion Naoxintong capsule can protect the brain tissue from ischemia-reperfusion injury.

Objective To investigate the correlation between FA value,ADC value and limb muscle strength score measured by magnetic resonance imaging in patients with ischemic stroke,aims to to analyze the clinical value of magnetic resonance imaging in limb muscle strength.Methods Twenty patients with acute cerebral infarction and treated from June 2015 to Junly 2016 were recruited from This hospital,and the simplified Fugl-Meyer motor function score was observed for all patients within 3 days.Tensor imaging examination was conducted to observe the distribution of nerve fiber bundles,FA value,ADC value changes.Results The FA value and ADC value of the infarct side were significantly different from those of the contralateral side(t=8.70,t=-18.70,P＜0.05);There were significant differences in FA value and ADC value between the infarcted ventricle hind limbs and the contralateral side of the infarcted ventricle(t=-5.16,t=-5.08,P＜0.05).The FA value of the infarcted ventral hind limbs had positive correlation with the simplified Fugl-Meyer motor function score(R=0.863,P=0.013).Conclusion FA value and ADC value of acute infarct and internal hindlimb are lower than FA value and ADC value of contralateral normal white matter.The FA value of internal capsule hind limbs is closely related to the simplified Fugl-Meyer motor function score.

Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo-rotic thoracolumbar fracture.Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob-served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi-sual analogue scale (VAS) and neurological function score (ASIA) of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured.Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P<0.05), but no significant differences existed on these parameters between 1 week post-operation and last follow-up (P>0.05).Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo-porosis, restore the height of fractured vertebra and reduce the compression of spinal canal, which will help the correction of spinal kyphosis and neurological function recovery. This method can well maintain long-term stability of internal fixation in osteoporosis and height of fractured vertebra, and significantly reduce the risks of long-term screw loosening and vertebral collapse.

Objective To investigate the effect of Rhodiola Rosae P. E on the expression of c-Fos and the apoptosis of neuronal in rat brain after ischemia/reperfusion (I/R) injury. Methods 120 Wistar rats were divided into sham group, model group and intervention group,subgrouped as 3 h, 6 h, 12 h, 24 h, and 48 h. The model and intervention groups underwent middle cerebral artery occlusion, and the latter accepted Rhodiola 0.672 g/kg daily for 15 d. They were assessed with Longa's score. The expression of c-Fos and apoptosis of neuronal were measured with immunohistochemistry and TUNEL. Results The expression of c-Fos in the ischemic area increased after cerebral ischemia/reperfusion (P<0.01), peaking at 24 h after injury, and decreased in the intervention group (P<0.01), with the decrease of neuron apoptosis and Longa's score (P<0.01). Conclusion Rhodiola protects the brain tissue against ischemia/reperfusion injury by inhibiting the expression of c-Fos and apoptosis in rats.

Objective To compare the biomechanical characteristics of new assembly of locking compression plate (NALCP) and locking compression plate (LCP) in internal fixation of femoral shaft comminuted fractures.Methods The preparation of a femoral shaft wedge fracture model (AO type 32-C2.1),six pairs of (12) femoral specimens were collected and divided into two groups randomly,with six in each group.The Group A was made up of the new assembly of locking compression plate fixation model (NALCP),and Group B the locking compression plate fixation model (LCP).The biomechanical properties of steel plates in two groups were tested by axial loading and torsional loading tests.The relative maximum displacement of fracture blocks in two groups on the X,Y and Z axes (the coronal axis was set as X axis,through the medial and lateral femur;the transverse axis was set as Z axis,through the femoral intercondylar fossa,perpendicular to the X axis;the sagittal axis was set as Y axis,perpendicular to the X and Z axis),the maximum strain,and the average strain of the steel plate were recorded.Strain distribution nephogram was produced,and the axial loading fatigue test results of Group A were recorded.Results Axial loading test:the relative maximum displacement of fracture in Group A on X,Y and Z axis were smaller than those in Group B (P ＜0.05 or 0.01);the main strain of Group A was greater than that of Group B (P ＜0.01);there was no significant difference in the average strain between Group A and Group B (P ＞ 0.05).Torsional loading test:The relative maximum displacement of fracture in Group A on X and Z axis was smaller than that of Group B (P ＜ 0.01);there was no statistically significant difference between the two groups on the Y axis (P ＞ 0.05);the main strain of plate in Group A was greater than that in Group B (P ＜ 0.01);there was no statistically significant difference in the average strain between Group A and Group B (P ＞ 0.05).There was no obvious difference in strain distribution between the two groups.In Group A,the fatigue test of axial cyclic loading was performed for 1 million times,and the NALCP was intact without deformation,loosening,or rupture.Conclusion NALCP can provide strong mechanical stability for comminuted femoral fracture.The design of bridge steel plate is reasonable,which can effectively avoid stress concentration,reduce the stress shielding of steel plate,and facilitate bone healing.

Objective:To compare minimally invasive percutaneous plate osteosynthesis (MIPPO) and open reduction and internal fixation via traditional lateral L-type approach (ORIF-LA) in the therapeutic effects concerning reduction and calcaneal alignment for Sanders Ⅲ/Ⅳ calcaneal fractures.Methods:A retrospective analysis was conducted of the 105 patients with calcaneal fracture who had been treated at Department of Foot and Ankle Surgery, Qilu Hospital from 2014.1 to 2018.2. Of them, 50 were treated with MIPPO (group A) and the other 55 with ORIF-LA (group B). The X-ray lateral and axial films, three-dimensional computed tomography (CT) of the calcaneal were taken pre-operatively and post-operatively to evaluate the reduction and calcaneal alignment. The American Orthopedic Foot Ankle (AOFAS) Ankle-Hind Foot Scale and Foot Function Index-Verbal Rating Scales (FFI-5pt) were adopted to assess the therapeutic effects. The postoperative complications of the two groups were compared.Results:All patients were followed up for 20-36 months (mean 24 months). The length of hospital stay and incision in group A was shorter than that in group B ( t=-11.276, -25.965, P<0.001). In group A and group B, the correction degrees of B?hler angle and Gissane angle were (34.49±3.81)°, (35.12±3.77)° and (-20.62±9.86)°, (-20.94±8.38)°, respectively ( P>0.05). Posterior calcaneal articular surface defects or steps in group A and group B were 1.55(1.12, 2.00)mm and 1.20(1.03, 1.60)mm, indicating that there was no significant difference in the reconstruction ability between the two groups ( P>0.05). There was no significant difference in VAS pain score between the two groups at 3 months after operation ( P>0.05), but group A was significantly lower than group B at 3 days after operation ( P<0.001). There was no significant difference in AOFAS and FFI-5pt scores between the two groups at 18 months after operation ( P>0.05). The complications of group A (6.0% incision infection, 2.0% incision area sensory disturbance, 2.0% foot stiffness) were lower than those of group B (16.36% incision infection, 14.55% incision area sensory disturbance, 10.9% foot stiffness) ( P<0.05). Conclusions:Compared with ORIF-LA, the MIPPO shows promising results in terms of reduction capacity and safety. Use of the MIPPO technique minimized the risk of postoperative wound complications and achieved superior functional outcomes compared with standard locking plate fixation via the extended lateral approach. MIPPO can be used as a choice for the treatment of calcaneal fracture.

Objective:To investigate the relationship between double mutations of myosin heavy chain gene (MYH6) p.Gly743Arg and p.Glu1389Lys and the cardiac phenotype.Methods:Patients carrying double mutations in the MYH6 gene p.Gly743Arg and p.Glu1389Lys were screened from 52 unrelated left ventricular hypertrophy (LVH) who were admitted to the Second Hospital of Chongqing Medical University from 2015 to 2020, and the genetic testing of peripheral blood of patients by second-generation whole-exome sequencing assay technology and genomic DNA of their family members Sanger sequencing was performed to validate the genomic DNA of the family members. The cardiac phenotype was evaluated by electrocardiogram, coronary computed tomography angiography (CTA), echocardiography, and cardiac magnetic resonance imaging (MRI) as adjuncts.Results:All whole-exome gene were detected in 52 unrelated patients with LVH, of which 1 patient (1.9%) had double mutations in MYH6 gene p.Gly743Arg and p.Glu1389Lys (proband). Two members of the maternal line of this patient carried p.Glu1389Lys mutation, but there was no obvious clinical phenotype. Two members of the paternal line carried p.Gly743Arg mutation and had obvious clinical phenotype of bradycardia, but there was no LVH. The male proband, aged 21 years old, presented with LVH and sinus bradycardia but no coronary artery stenosis on CTA before treatment, MRI showed that the left ventricular end diastolic diameter was 58 mm. After treatment with angiotensin receptor-enkephalinase inhibitor (ARNI), electrocardiogram showed that the heart rate increased significantly (from 43 bpm to 72 bpm). Echocardiography showed that the left ventricular end diastolic diameter decreased significantly (from 60 mm to 49 mm).Conclusions:The p.Glu1389Lys mutation of the MYH6 gene may not manifest the phenotype of heart disease. MYH6 gene p.Gly743Arg mutation may be manifested asymptomatic sinus bradycardia, but there is no LVH phenotype. The cardiac disease phenotype caused by the double mutations of p.Gly743Arg and p.Glu1389Lys in the MYH6 gene is more obvious. Asymptomatic LVH and sinus bradycardia can appear in adolescence, but the LVH phenotype can be reversed in a short period of time after ARNI treatment.

Objective To compare the stress and its distribution between our self-designed new assembly of locking compression plate (NALCP) of low elastic modulus versus conventional locking compression plate (LCP) in fixation of femoral comminuted fractures.Methods Six pairs of cadaveric femur were used to create models of middle femoral comminuted fracture.The femoral fracture models were fixated respectively by NALCP of Ti2448 with low elastic modulus (E =30 Gpa) (NALCP group) and conventional LCP of Ti-6Al-4V with high elastic modulus (E =110 Gpa) (LCP group).Axial and torsion loads were applied on the models in the 2 groups to simulate those on one leg when a person slowly walks.The relative maximum displacements on the X,Y and Z axes of fracture fragments,and the maximum and average strains of the plate were recorded in the 2 groups.Nephograms of strain distribution were made for the 2 groups.The results of fatigue test under axial loads were recorded for NALCP group.Results Both the axial and torsion loading tests showed significantly larger principal and average strains in NACLP group than in LCP group (P ＜ 0.05).However,there were no significant differences between the 2 groups in the relative maximum displacements of fracture fragments on X,Y or Z axis (P ＞ 0.05).The plate strain nephograms for the 2 groups showed consistent strain distributions.The plates in NALCP group survived 1,000,000 fatigue tests under axial loads,without any deformation,loosening or breakage.Conclusion As our NALCP of low elastic modulus may be better in stress transmission and distribution,it can effectively reduce the effect of stress-shielding and promote bone healing.