BACKGROUND:There is always a controversy about nonsurgical and surgical repair of acute Achiles tendon rupture. Except retrospective analysis, there is a lack of high-level evidence-based medicine data.
OBJECTIVE:To systemicaly evaluate the clinical effectiveness of the nonsurgical versus surgical treatment for acute closed rupture of the Achiles tendon.
METHODS:The randomized controled trials about the nonsurgical versus surgical treatment for acute Achiles tendon rupture were searched in PubMed, EMbase, CBM, CNKI, Ovid, and WanFang Data by computer as wel as in relevant journals by hand, which were reported before February 2014. The Cochrane Library (Issue 1, 2014) was also retrieved. Two reviewers independently screened studies, extracted data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Then Meta-analysis was conducted using RevMan 5.2 Software.
RESULTS AND CONCLUSION:Nine randomized controled trials were included, and totaly 874 patients were involved, 441 cases in the nonsurgical group and 433 in the surgical group. The results of Meta-analysis showed that compared with the surgical group, the incidence of complications was lower [OR=0.41, 95%CI(0.26, 0.63), P< 0.000 1], but the rate of tendon re-rupture [OR=2.86, 95%CI(1.62, 5.02),P=0.000 2] and incidence of cicatricial adhesion [OR=0.07, 95%CI(0.03, 0.19),P < 0.000 1] were higher in the nonsurgical group. However, there were no significant differences between the two groups in patient satisfaction, superficial infection, motion recovery, and deep infection. Compared with the surgical treatment, the nonsurgical treatment can reduce the incidence of complications, but has a higher incidence of re-rupture. Because of sample-size and methodological quality restrictions, this conclusion needs further verification of large-sample, multicenter, and high-quality randomized controled trials.

Objective:To explore the feasibility of inguinal subcutaneous immunotherapy for allergic rhinitis ( AR ) in mice. Methods:36 female BALB/c mice were divided randomly into six groups( n=6 per group) including the control A,the model A, the treatment A groups,and the control B,the model B,the treatment B groups(inguinal subcutaneous immunotherapy for group A, cervical back subcutaneous immunotherapy for for group B). AR model was established with ovalbumin. At 25 to 55 days,ovalbumin im-munotherapy were performed in treatment groups,once two days,15 times totally. After intranasal rechallenge was performed at 56 to 62 days the AR symptom scores were documented. The eosinophils(EOS)in the nasal mucosa were measured by chromotropic acid 2R staining. Ovalbumin-specific IgE( OVA-sIgE) in the serum and expression of interferon-γ and interleukin-4 in the nasal lavage were measured by enzyme-linked immunosorbent assay meanwhile the ratio of interferon-γ and interleukin-4 was calc μlated. SPSS17. 0 software was used to analyze the data. Results:Before treatment ,the AR symptom scores of the model and treatment groups were more than 5. After treatment,the treatment A group were less than 5. The EOS count of the control A,model A,treatment A groups and the control B,model B, treatment B groups was 0. 78 ± 0. 31, 21. 60 ± 2. 90, 10. 43 ± 2. 56, 0. 83 ± 0. 46, 22. 44 ± 3. 39, 23. 40 ± 4. 24, respectively. The EOS count of the treatment A group was significantly lower than those in model A group ( P<0. 05 ) . There was no significant difference between treatment B and model B group ( P>0. 05 ) . OVA-sIgE expressed was negative in control groups and positive in other groups. The ratio of interferon-γ and interleukin-4 was 10. 75 ± 3. 38,10. 38 ± 3. 08,3. 02 ± 0. 69,2. 71 ± 0. 89,2. 52 ± 0. 30,5. 45±1. 41,respectively. The ratio in treatment A group was significantly higher than those in model A group(P<0. 05). There was no significant difference between treatment B and model B group ( P>0. 05 ) . Conclusion: Inguinal subcutaneous immunotherapy has a good effect on this disease. It spends short time ,has simple operation and good feasibility,which is a novel treatment method for AR in mice.

OBJECTIVE: To explore the changes of microRNAs in nasal mucosa after the specific immunotherapy (SIT) for allergic rhinitis (AR) in mice. METHOD: Female BALB/c mice, 6-8 weeks of age, were randomly divided into control group, model group and treatment group. AR model were established by intraperitoneal injection and intranasal challenge of ovalbumin and SIT was performed by inguinal subcutaneous injections. AR symptom scores were documented. The eosinophils (EOS) in the nasal mucosa were measured. Ovalbumin-specific IgE (OVA-sIgE) in the serum and expression of interferon-γ and interleukin-4 in the nasal lavage were measured by enzyme-linked immunosorbent assay meanwhile the ratio of interferon-γ and interleukin-4 was calculated. The microRNAs in the nasal mucosa were preliminary screened by microRNA gene microarray. Comparing with model group, the Fold changes of microRNA of the treatment group were ≥ 2.0 and the P < 0.05. MicroRNA target genes were predicted with GeneSpring 12.5 software. We took the intersection between genes in the signal pathway which associated with immune response,inflammation and target genes. The MEV-4-6-0 and Cytoscape_v2. 8. 2. software was applied to perform the cluster analysis and target gene regulatory networks maps. RESULT: The model of AR in mice and its SIT were successful. Comparing with the model group, the Fold changes of 15 microRNAs, of which 9 microRNAs were up-regulated and 6 microRNAs were down-regulated, were ≥ 2.0 in treatment group (P < 0.05). Cluste analysis showed clearly that microRNAs in the treatment group and model group respectively aggregated in two branches. The 15 microRNAs had 5302 target genes, of which, 451 genes were related more with SIT by the intersection. One microRNA can regulate many target genes, and one gene can also be affected by many microRNAs. Their synergistic effects may be involved in the mechanism of SIT. CONCLUSION The expressions of microRNAs are changed in nasal mucosa after SIT for AR in mice and we can speculate that microRNAs are involved in the process of SIT for AR. Bioinformatics methods can diminish the scope of target genes of microRNAs, which will help us studying the effect of changed microRNA on its relative target genes after SIT, and make us better understanding the mechanism of the disease and its SIT.
Administration, Intranasal ; Animals ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; immunology ; Female ; Immunoglobulin E ; blood ; Immunotherapy ; Interferon-gamma ; immunology ; Interleukin-4 ; immunology ; Mice ; Mice, Inbred BALB C ; MicroRNAs ; metabolism ; Nasal Mucosa ; drug effects ; metabolism ; Ovalbumin ; Rhinitis, Allergic ; therapy

BACKGROUND:Tranexamic acid is a synthetic anti-fibrinolytic drug, and can effectively control blood loss after total knee arthroplasty through vein. OBJECTIVE:To evaluate the effectiveness and safety of tranexamic acid in reducing blood loss after primary unilateral total knee arthroplasty. METHODS:From 2014 to 2015, 100 patients from the Department of Lower Limb, Sichuan Orthopaedic Hospital underwent primary unilateral total knee arthroplasty, and randomly divided into test group which used tranexamic acid and control group which used tranexamic acid, with 50 cases in each group. 1 g tranexamic acid was infused into the vein at 10 minutes before total knee arthroplasty in the test group, but tranexamic acid was not given in the control group. RESULTS AND CONCLUSION:The amount of total blood loss, postoperative wound drainage in 24 hours, and the amount of blood transfusion were significantly less in the test group than in the control group (P < 0.05). No significant differences in intraoperative blood loss and the number of patients receiving blood transfusion were found between the test and control groups. No significant difference in preoperative hemoglobin levels was detected before surgery, but hemoglobin levels were decreased after surgery between the two groups. Postoperative hemoglobin levels were apparently higher in the test group than in the control group after surgery. At 24 hours after surgery, no significant difference in coagulation was detectable between the two groups. At 6 days, double lower limb vein color Doppler ultrasound examination did not reveal deep vein thrombosis in both groups. These findings verify that treatment with tranexamic acid in the vein before primary unilateral total knee arthroplasty can evidently diminish the amount of perioperative blood loss and blood transfusion, reduce the risk and cost of blood transfusion, which is good for rehabilitation and does not increase the risk of deep vein thrombosis.

Objective To compare the effects of peripatellar peripheral nerve partially and totally depolarized in total knee arthroplasty (TKA). Methods 66 TKA patients were divided into partially depolarized group (A, 42 knees) and totally depolarized group (B, 38 knees). The scores of knee-joint, Feller and Visual Analogue Scale were recorded. Results There was no significant difference in all the scores between 2 groups before operation (P>0.05). All the scores improved after operation (P<0.05), however, there was still no significant difference between 2 groups (P>0.05). Conclusion Patellar peripheral nerve partially depolarization technique can reduce postoperative knee pain, which has the same effect with totally depolarization.

OBJECTIVE: To explore the effects of simultaneous multi-level surgery intervention on the changes of the oxidative stress and the cognitive function in young and middle-aged patients with moderate-severe OSAHS. METHOD: One hundred and sixteen young and middle-aged patients with moderate-severe OSAHS received simultaneous multi-level surgery. PSG,malondialdehyde (MDA), advanced oxidation protein products (AOPP) and 8-isoprostaneF2α (8-iso-PGF2α) were tested, together with the evaluation of the questionnaires of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE) and Epworth sleepiness scale (ESS) before and 6 months after surgery. RESULT: (1) The AHI, TS90% and LSaO₂ were all improved significantly 6 months after operation. No severe complications were observed in any patient. (2) The preoperative MoCA and MMSE scores were (23.52 ± 2.64) and (26.54 ± 1.07) respectively. The cognitive impairment were detected in OSAHS patients. MoCA was negatively correlated with AHI, TS90%, MDA, AOPP and 8-iso-PGF2a, while positively correlated with LSaO₂ (P < 0.05, r = -0.233, -0.190, -0.256, -0.247, -0.221 and 0.215, respectively). Cognitive impairment was mainly manifested as disorder in the visual space and execu- tive function, memory and delayed recall (mainly short-term memory). (3) MoCA and MMSE scores were both increased (P < 0.05) after the operation. MoCA showed negative correlations with MDA, AOPP, 8-iso-PGF2α, AHI and TS90%, and positive correlation with LSaO₂ (P < 0.05, r = -0.495, -0.463, -0.397, -0.332, -0.292 and 0.336, respectively). CONCLUSION Oxidative stress and cognitive dysfunction are closely related in young and middle-aged patients with Moderate-severe OSAHS. Oxidative stress may play an important role in cognitive function of young and middle-aged patients with Moderate-severe OSAHS. Multi-level surgery can improve oxidative stress so that to improve cognitive impairment.
Adult ; Cognition ; Cognition Disorders ; complications ; Humans ; Middle Aged ; Oxidative Stress ; Sleep Apnea, Obstructive ; surgery

OBJECTIVE: To explore a simple and accurate method for localization of upper airway obstruction in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and provide instructions for surgical treatment. METHOD: Fifty OSAHS patients confirmed by PSG underwent acoustic rhinometric and pharyngometric assessment by Eccovision. The parameters were recorded, including nasal minimal cross-sectional area (NMCA), distance of MCA from the nostril (DCAN), minimum cross-sectional area at the nasal valve(MCA), nasal resistance (NR) and nasal volume from 0 to 6 cm from the nostril (NCV), as well as pharyngeal cross-sectional area (CSA) and volume from 4.8 to 15.0 cm. The sensitivity and specificity of acoustic rhinometry and pharyngometry on localization of airway obstruction was determined by a comprehensive imaging and endoscopic study. RESULT: In 50 cases with severe OSAHS, NMCA, DCAN, MCA, NCV, NR were (0.61 +/- 0.35) cm2, (2.06 +/- 0.12) cm, (0.87 +/- 0.12) cm2, (9.24 +/- 2.31)cm3 and (0.51 +/- 0.32)kPa/(L x min), respectively. Pharyngeal CSA and volume were statistically significantly lower than that in control group (P < 0.01). The value of DCAN was (2.06 +/- 0.12) cm, (9.50 +/- 4.08) cm, (13.10 +/- 2.52) cm in type I II, III patient, respectively. Compared with the control group, the difference was statistically significant. CONCLUSION Acoustic rhinometry and pharyngometry is a simple and safe method in localization of airway obstruction in patients with OSAHS.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; physiopathology ; Nasopharynx ; physiopathology ; Rhinometry, Acoustic ; Sleep Apnea, Obstructive ; physiopathology ; Young Adult

Objective:To summarize the etiology, laboratory examinations and clinical features of rhabdomyolysis(RM)in children.Methods:The clinical data of children with RM admitted to the pediatric general ward at Third Hospital of Peking University from January 1st, 2010 to March 31st, 2021 were collected.The clinical characteristics, etiology distribution, laboratory examinations, treatments and prognosis of the children were analyzed.Results:A total of 24 children were included with 16 males and 8 females.The age ranged from 4 to 15 years old, with median age was 13years old.The etiology was exertional diseases in 14 cases(58.3%), non-exertional diseases in ten cases (41.7%, 7 cases of infection and 3 cases of other causes). The average age of exertional RM was(13.50±1.83)years, and that of non-exertional RM was(8.60±3.72)years.There was significant difference( t=3.848, P=0.002). The main clinical symptoms were muscle soreness, abnormal urine color and muscle weakness.Serum creatine kinase(CK)and serum myoglobin were significantly increased.The proportion of CK value moderate to severe increased of exercise RM children was significantly higher than that of non-exertional RM children( P=0.009). All children were treated with hydration and alkalization.Except for one case who died of critical primary disease, the other 23 children had good treatment response, and no rhabdomyolysis was found during the follow-up. Conclusion:The main causes of rhabdomyolysis in children are exercise and infection.Exertional RM is common in elder children.The increasing of CK level caused by exertional RM is more obvious.Active hydration and alkalization measures could avoid the occurrence of acute kidney injury.Most children with RM have good prognosis.

Objective: To explore the cross classification of tibial plateau fractures combined with avulsion fracture of medial femoral condyle. Methods: The 16 patients were retrospectively analysed as an observation group who had been treated at Department of Lower Limbs, Sichuan Orthopaedic Hospital for tibial plateau fracture and avulsion fracture of the medial condyle of the same femur from January 2015 to December 2018. They were 9 males and 7 females, aged from 27 to 78 years (average, 51.5 years). By the Schatzker classification, there were 2 cases of type Ⅰ, 8 cases of type Ⅱ, 3 cases of type Ⅲ and one case of type Ⅳ; by the cross classification, there were 10 cases of type Ⅰe, one case of type Ⅱe and 2 cases of type Ⅲe and 3 cases of type Ⅰv. The 332 patients were included as a control group who had been treated at the same department for simple tibial plateau fracture from January 2010 to December 2015. The imaging data of the 2 groups were compared to find out the charateristics of cross type distribution; the widened distance of the lateral tibial plateau, collapse depth of the tibial plateau, separation of avulsion fracture of medial femoral condyle, maximum clearance of the medial knee and eversion angle of the tibial plateau were investigated in the patients with cross types e and Ⅰv in the observation group. Results: In the observation group, the widened distance of the lateral tibial plateau averaged 7.18 mm, the collapse depth of the tibial plateau 8.74 mm, the separation of avulsion fracture of medial femoral condyle 3.44 mm, the maximum clearance of the medial knee 7.77 mm, and the eversion angle of the tibial plateau 87.03°. There was a significant difference in the cross type distribution of tibial plateau fractures between the 2 groups (P=0.002). In the observation group, the average widened distance of the lateral tibial platea for the 13 type e patients (8.49±4.26 mm)was significantly larger than that for the 3 type Ⅰv patients (1.51±2.11 mm) (t=2.706, P=0.017). Conclusion The cross classification of tibial plateau fractures with avulsion fracture of mediall condyle of the same femur may result mainly in types e and type Ⅰv. The widened distance of lateral tibial plateau helps distinction between types e and type Ⅰv.

Objective To investigate the application value of limited liquid resuscitation combined with continuous renal replacement therapy (CRRT) in treatment of severe acute pancreatitis (SAP) companied with abdominal compartment syndrome (ACS).Methods The retrospective cohort study was adopted.The clinical data of 67 patients with SAP companied with ACS who were admitted to the Fuling Center Hospital of Chongqing from January 2005 to December 2014 were collected.Among 67 patients,33 receiving conventional liquid resuscitation between January 2005 and December 2010 were allocated into the control group and 34 receiving limited liquid resuscitation combined with CRRT between January 2011 and December 2014 were allocated into the observation group.Observation indicators included:(1) required fluid volume and time of negative fluid balance in the 2 groups;(2) changes of pathological and physiological indicators after treatment in the 2 groups;(3)outcomes and prognosis of patients in the 2 groups.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using t test.Count data were analyzed using the chi-square test.Repeated measurement data were analyzed by repeated measures ANOVA.Results (1) Required fluid volume and time of negative fluid balance in the 2 groups:required fluid volumes at 6,24,48 and 72 hours after resuscitation were (2 449±339) mL,(4 820±757) mL,(9 428± 1 272) mL,(13 127± 1 565) mL in the control group and (2 360± 314) mL,(4 582±530) mL,(8 564± 970) mL,(11 470± 1 253) mL in the observation group,respectively,with a statistically significant difference in required fluid volume between the 2 groups (F=13.035,P＜0.05) and in required fluid volume at 48 and 72 hours between the 2 groups (t=3.132,4.794,P＜0.05).Time of negative fluid balance in the observation group and control group was (4.3± 1.7)days and (6.4 ±1.8)days,respectively,showing a statistically significant difference between the 2 groups (t =4.913,P＜0.05).(2) Changes of pathological and physiological indicators in the 2 groups after treatment:time factors:from 0 h to 168 h postoperatively,APACHE Ⅱ score,C-reaction protein (CRP),D-dimer,IAP,Bla and oxygenation index were changed from 20.9±4.1 to 13.9±2.6,from (167±39)mg/L to (55±17) mg/L,from (1 652±1 544) μg/L to (993±500)μg/L,from (23.4±3.4)cmH2O (1 cmH2O=0.098 kPa) to (21.4±2.9)cmH2O,from (4.6±1.6) mmol/L to (1.4±0.5)mmol/L,from (189±27) mmHg (1 mmHg =0.133 kPa) to (152±23)mmHg in the control group,and chaged from 21.5±5.1 to 11.0±2.8,from (168±36)mg/L to (44±19)mg/L,from (1 634±1 525) μg/L to (578±350) μg/L,from (23.2±2.5)cmH2O to (17.4±2.6)cmH2O,from (4.5±1.6)mmol/L to (0.8±0.3)mmol/L,from (188±26)mmHg to (196±25)mmHg in the observation group,respectively,showing gradual decreasing with time and statistically significant differences between the 2 groups (F =186.415,581.118,34.618,212.416,262.272,207.645,P＜0.05).Treatment factors:there were no significant differences in changing trends of APACHE Ⅱ score,D-dimer and Bla between the 2 groups (F=3.499,2.350,3.516,P＞0.05),and there were significant differences in changing trends of CRP,IAP and oxygenation index between the 2 groups (F=4.009,15.276,14.959,P＜0.05).Interaction effect between time factors and treatment factors:there were obviously interaction effects between time factors and treatment factors in APACHE Ⅱ score,CRP,IAP and oxygenation index (F=4.890,4.912,23.874,28.615,P＜0.05) and no interaction effects between time factors and treatment factors in D-dimer and Bla (F=2.803,1.920,P＞0.05).(3) Outcomes and prognosis of patients in the 2 groups:numbers of patients with surgery,local complications and infection and duration of hospital stay were 11,16,14,(46±17)days in the control group and 4,6,6,(36±14) days in the observation group,respectively,with statistically significant differences between the 2 groups (x2=4.484,7.221,4.910,t =2.433,P＜0.05).Mortality and hospital expenses were 24.2％ (8/33),(33± 18) x 104 yuan in the control group and 8.8％ (3/34),(27± 14)× 104 yuan in the observation group,respectively,with no statistically significant difference between the 2 groups (x2 =2.901,t =1.283,P＞ 0.05).Conclusion Limited liquid resuscitation combined with CRRT can effectively control IAP of patients with SAP companied with ACS and improve oxygenation index,meanwhile,it can also reduce number of patients with surgery,infection and local complications and duration of hospital stay.