Pulmonary alveolar proteinosis (PAP) is a rare disease clinically, and at present no western medicine can effectively cure the disease. After the analysis of literatures related to Traditional Chinese Medicine (TCM) for treatment of the disease in the China National Knowledge Internet Database, it was discovered that the syndrome differentiation showed the disease closely associated with phlegm, blood stasis and yin deficiency. In this study, from view point of pulmonary gangrene TCM theory and treatment combined with PAP pathophysiological characteristics, it is emphasized that phlegm accumulation, blood stasis and yang deficiency are the key pathological manifestations of PAP, thus Yanghe decoction, Tounong powder, Kongxian pellet were used for treatment of one such case, the rational thinking in diagnosis and treatment of this patient being consistent with the idea learning western medicine for China use.

Objective:To evaluate the radiologic and clinical outcomes of supramalleolar dome osteotomy in the treatment of varus-type ankle arthritis.Methods:From June 2018 to December 2019, 13 patients with varus-type ankle arthritis underwent supramalleolar dome osteotomy at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. Of them, 13 (5 males and 8 females) were included in the study. Their average age at surgery was 47.2 years (range, from 16 to 65 years). By the modified Takakura staging for arthritis, 3 cases were stage 2, 4 cases stage 3a and 6 cases stage 3b. Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS), foot function index (FFI), visual analogue scale (VAS), Takakura staging, dorsal extension, plantar flexion, range of motion (ROM), tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT).Results:This cohort were followed up for 12 to 29 months (average, 17.2 months). At the last follow-up, AOFAS score (86.5±8.0), FFI (14.5±1.6), VAS score (1.5±1.0), Takakura staging (2.7±1.3), ROM (39.4°±8.0°), TAS (92.4°±6.0°), TT (3.7°±4.4°) were significantly improved than the preoperative values (68.3±14.4, 43.7±3.0, 4.2±1.4, 3.2±0.8, 43.3°±7.6°, 78.2°±8.3° and 7.0°±5.1°), and dorsal extension (10.9°±4.4°) was significantly smaller than the preoperative value (13.6°±5.1°) (all P<0.05). There were no significant differences between preoperation and the last follow-up in plantar flexion (29.7°±4.6° versus 28.5°±5.2°) or TLS (77.8°±4.5° versus 78.1°±5.3°) ( P>0.05). Conclusions:Supramalleolar dome osteotomy has shown promising short-term clinical efficacy in the treatment of varus-type ankle arthritis. It can significantly relieve pain, improve function, substantially correct deformity and retard progression of arthritis, but it may affect dorsal extension.

Phased array transducers are very attractive because the beam generated by the arrays can be electronically focused and steered. The present work characterizes far-field 2D properties of phased array system by functions that are deduced from rectangle source, rectangle line array and phased array based on point source. Results are presented for the distribution of ultrasound intensity on plane xoz and on x-axis by simulation using numerical calculation. It is shown that the shape of response of rectangle line array is modulated by the single array element. It is also demonstrated that the delay time of phased array is the key to steer the beam, sacrificing the value of main lobe and increasing the number of side lobes.
Computer Simulation ; Models, Theoretical ; Transducers ; Ultrasonics ; instrumentation ; methods

OBJECTIVE:To investigate off-label drug use of Ambroxol hydrochloride injection,and to provide reference for further evidence-based evaluation on rationality and standardized management of off-label drug use. METHODS:All medical orders for inpatients receiving Ambroxol hydrochloride injection were selected from 10 hospitals of Guangdong province during Apr. 2014 to Mar. 2015. Situation of drug use in different categories of departments was summarized,the incidence of off-label administation route and off-label dosage were analyzed;according to drug package inserts,prescription daily dose(PDD)and drug utilization in-dex(DUI)were calculated for each category of department,and the degree of off-label dosage was evaluated. RESULTS:A total of 761 821 person·day who used Ambroxol hydrochloride injection was included. Off-label drug use occurred in each category of departments,and the incidence of off-label drug use was 62.10%. The incidence of off-label administration route was 40.51%, mainly atomization inhalation;the incidence of it was the high-est in gynecology and obstetrics department(92.70%).The in-cidence of off-label dosage was 36.30%,and the incidence of it was the highest in cardiothoracic surgery department (85.36%). Departments whose PDDs were higher than the drug package inserts were cardiothoracic surgery department,ICU,surgical department,cardiovascular medicine department,emer-gency department,department of internal medicine and pediatrics department.CONCLUSIONS:Off-label drug use of Ambroxol hy-drochloride injection is common,and the effectiveness,safety and necessity remain controversial,which need to be proved by multi-center randomized controlled prospective trial.

Objective:To explore the short- and mid-term clinical outcomes of surgical treatment of chronic Lisfranc injuries.Methods:A retrospective analysis was conducted of the clinical and imaging data of the 19 patients with chronic Lisfranc injury who had been treated surgically from April 2013 to September 2020 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 13 males and 6 females, aged from 25 to 58 years (mean, 49 years). The median course of disease before operation was 24 months (from 3 to 312 months). All patients underwent fusion of the 1st, 2nd and 3rd tarsometatarsal joints (TMTJ) plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ by the same surgeon. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS) and Lublin score between pre-operation and the final follow-up and by Likert satisfaction scale and post-operative complications as well.Results:The 19 patients were followed up for (66.1±23.2) months (from 12 to 104 months). At the final follow-up, the AOFAS midfoot score was 87 (79, 90), the VAS score 1 (0, 2), and the Lublin score 70 (60, 75), all significantly improved compared with their preoperative corresponding values [51 (44, 63), 4 (4, 6) and 50 (40, 55), respectively] ( P<0.05). Sixteen patients were satisfied with their surgery. Fusion was not healed in 3 cases; plate breakage happened in one case but none of the cases had infection or other complications related to the skin or wound. Conclusion:Fusion of the 1st, 2nd and 3rd TMTJ plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ can lead to good short- and mid-term clinical outcomes in the surgical treatment of chronic Lisfranc injuries.

Objective:To evaluate the clinical and radiographic outcomes of tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach.Methods:From March 2018 to February 2021, 23 patients underwent tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach at the Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital.Of them, 15 were males and 8 females. Their average age at surgery was 54.4 years (range, from 28 to 72 years). There were 11 cases of traumatic arthritis, 2 cases of Charcot arthropathy, 6 cases of neurogenic equinovarus, 2 cases of traumatic equinovarus, and 2 cases of Kashin-Beck disease. Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS), visual analogue scale (VAS), foot function index (FFI), hindfoot alignment angle (HA), hindfoot alignment distance (HD), and hindfoot alignment ratio (HR). The tibia-foot angle on lateral weight-bearing and patient satisfaction at the last follow-up and postoperative complications were documented.Results:This cohort were followed up for an average of 24.7 months (from 12 to 48 months). The AOFAS ankle-hindfoot score (78.2 ± 9.2), VAS [2.0 (0.5, 2.0)], FFI [19.0 (10.5, 35.0)], HA (2.7° ± 5.8°), HD [(0.1 ± 0.8) cm] and HR [44.2 (36.4, 59.2)%] at the last follow-up were significantly improved than the preoperative values [43.4 ± 12.7, 4.0 (4.0, 6.0), 98.0 (60.0, 127.0), 22.0° ± 14.3°, (2.2 ± 1.6) cm and 86.0 (66.3, 100.0)%] (all P<0.05). The tibia-foot angle on lateral weight-bearing was 89.0° (87.1°, 90.4°) at the last follow-up. By the Likert scale, 17 cases were very satisfied with the surgery, 4 cases satisfied and 2 cases tolerate, giving a satisfaction rate of 91.3%(21/23). Infection occurred in one case and nonunion in one. Conclusion:Tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach yields good mid- to short-term clinical and radiographic outcomes, showing a strong capability to correct ankle and hindfoot varus and equinus.

Objective:To explore whether the deep deltoid ligament (DL) rupture affects the mid-term clinical efficacy of pronation-external rotation (PER) ankle fracture or not.Methods:A ret-rospective study was conducted to analyze the clinical data of 50 patients with ankle fracture of PER type Ⅲ or Ⅳ who had been treated at Department of Orthopedic Trauma, Beijing Jishuitan Hospital from January 2013 to December 2014.They were 37 males and 13 females with an average age of 30.2 years(from 16 to 68 years). According to their type of medial ankle injury, the patients were divided into 2 groups.The experimental group, consisting of 28 patients with deep DL rupture but no medial ankle fracture, did not undergo DL repair operation; the control group, consisting of 22 patients with supracollicular medial malleolar (SMM) fracture but no deep DL rupture, underwent open reduction and internal fixation (ORIF) for SMM.Both groups were treated with ORIF of fibular fracture in addition to syndesmosis screw fixation.The 2 groups were compared in terms of the medial malleolus space and distal tibiofibular space on the imaging exams at more than 6 months, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analog scale (VAS) pain scores at the mid-term follow-ups.Results:The differences between the 2 groups in gender, age and mode of concomitant subluxation or dislocation were statistically significant ( P<0.05), but there were no sig-nificant differences between the 2 groups in injury violence, height of fibular fracture line, presence of total dis-location, rate of posterior malleolus fracture, rate of posterior malleolus fixation, implant removal, or operation time ( P>0.05).Imaging exams were conducted for 38 patients at 6 or more months after surgery.The medial malleolus space was 3.7 mm and the distal tibiofibular space 4.5 mm for the 21 cases in the experimental group; the medial malleolus space was 3.4 mm and the distal tibiofibular space 4.4 mm for the 17 cases in the control group.The 3-year follow-up AOFAS scores of the experimental group and the control group were 98.3 and 94.6 respectively; VAS scores were 0.4 and 1.5; the 5-year follow-up AOFAS scores of the experimental group and the control group were 97.1 and 93.6 respectively,and VAS scores were 0.5 and 1.2 respectively.Logistic regression analysis of ordered multi-classification showed that the AOFAS and VAS scores at 3-year and 5-year follow-ups had no significant correlation with the deep DL rupture for the patients<45 years old( P>0.05).Patient age was correlated with the 5-year follow-up AOFAS scores ( P=0.021). Conclusion:In ankle fracture of PER type Ⅲ or Ⅳ treated with lateral malleolar and syndesmosis screw fixation, nonoperative treatment of the deep DL rupture may not influence the mid-term clinical efficacy for the patients less than 45 years old.

Objective:To analyze the clinical data of patients with end-stage ankle and hindfoot ar-thropathy who underwent tibiotalocalcaneal(TTC)arthrodesis by the same surgeon,explore the short-and mid-term clinical results,complications and functional improvement,and discuss the clinical progno-sis and precautions of TTC arthrodesis.Methods:Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020.In this study,23 males and 17 females were included,with an average age of(49.1±16.0)years.All the patients underwent unilateral surgery.The clinical characteristics,imaging manifestations,main diagno-sis and specific surgical techniques of the patients were recorded.The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and visual analogue scale(VAS)between pre-operation and at the last follow-up.The fusion healing time,symptom improvement(significant improvement,certain improvement,no improvement or deterioration)and postoperative complications were also recorded.Results:The median follow-up time was 38.0(26.3,58.8)months.The preoperative VAS score was 6.0(4.0,7.0),and the AOFAS score was 33.0(25.3,47.3).At the last follow-up,the median VAS score was 0(0,3.0),and the AOFAS score was 80.0(59.0,84.0).All the significantly improved compared with their preoperative corre-sponding values(P＜0.05).There was no wound necrosis or infection in the patients.One patient suf-fered from subtalar joint nonunion,which was syphilitic Charcot arthropathy.The median bony healing time of other patients was 15.0(12.0,20.0)weeks.Among the included patients,there were 25 cases with significant improvement in symptom compared with that preoperative,8 cases with certain improve-ment,4 cases with no improvement,and 3 cases with worse symptoms than that before operation.Con-clusion:TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot ar-thropathy.The function of most patients was improved postoperatively,with little impact on daily life.The causes of poor prognosis included toe stiffness,stress concentration in adjacent knee joints,nonunion and pain of unknown causes.

It is very important for epilepsy treatment to distinguish epileptic seizure and non-seizure. In this study, an automatic seizure detection algorithm based on dual density dual tree complex wavelet transform (DD-DT CWT) for intracranial electroencephalogram (iEEG) was proposed. The experimental data were collected from 15 719 competition data set up by the National Institutes of Health (NINDS) in Kaggle. The processed database consisted of 55 023 seizure epochs and 501 990 non-seizure epochs. Each epoch was 1 second long and contained 174 sampling points. Firstly, the signal was resampled. Then, DD-DT CWT was used for EEG signal processing. Four kinds of features include wavelet entropy, variance, energy and mean value were extracted from the signal. Finally, these features were sent to least squares-support vector machine (LS-SVM) for learning and classification. The appropriate decomposition level was selected by comparing the experimental results under different wavelet decomposition levels. The experimental results showed that the features selected in this paper were different between seizure and non-seizure. Among the eight patients, the average accuracy of three-level decomposition classification was 91.98%, the sensitivity was 90.15%, and the specificity was 93.81%. The work of this paper shows that our algorithm has excellent performance in the two classification of EEG signals of epileptic patients, and can detect the seizure period automatically and efficiently.
Algorithms ; Electroencephalography ; Epilepsy/diagnosis* ; Humans ; Seizures/diagnosis* ; Signal Processing, Computer-Assisted ; Support Vector Machine ; Wavelet Analysis

OBJECTIVE: To evaluate the early effectiveness of a new minimally invasive plate in the treatment of varus-type ankle arthritis. METHODS: A clinical data of 15 patients with varus-type ankle arthritis who met the selection criteria between March 2021 and October 2021 were retrospectively analyzed. All the patients were treated with medial open-wedge supramalleolar osteotomy and fibular osteotomy. The osteotomies were fixed with the new minimally invasive plate. There were 7 males and 8 females with an average age of 49.8 years (range, 16-71 years). The causes of ankle arthritis included post-fracture deformity in 1 case, sprain in 8 cases, and acquired clubfoot in 1 case; and 5 cases were without obvious factors. The disease duration ranged from 1 to 12 years, with an average of 4.1 years. Comparisons were made between pre-operation and the last follow-up in the Takakura staging, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, foot function index (FFI), visual analogue scale (VAS) score, tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT). RESULTS: All incisions healed by first intention. All patients were followed up 7-18 months (mean, 12.8 months). At last follow-up, the AOFAS ankle-hindfoot score, FFI, VAS score, and Takakura staging significantly improved when compared with the preoperative ones ( P<0.05). X-ray films showed that the osteotomy healed at 3 months after operation. At last follow-up, TAS significantly increased and TT decreased when compared with the preoperative ones ( P<0.05), and the difference in TLS between pre- and post-operation was not significant ( P>0.05). Complications included 1 case of intraoperative screw breakage and 2 cases of nerve injury of the affected foot. None of the patients complained of significant discomfort at the plate placement during follow-up, and no loosening of the internal fixator occurred. Eleven patients were very satisfied with the effeectiveness, while 4 were relatively satisfied. CONCLUSION The new minimally invasive plate for the varus-type ankle arthritis has good early effectiveness in relieving ankle pain, correcting deformity, improving limb alignment and ankle function, and reducing the incidence of postoperative incisional complications.
Female ; Humans ; Male ; Middle Aged ; Ankle ; Ankle Joint/surgery* ; Osteoarthritis/surgery* ; Retrospective Studies ; Tibia/surgery* ; Treatment Outcome ; Adolescent ; Young Adult ; Adult ; Aged