This paper introduces the structure and principle of a novel low-frequency electronic pulse therapeutic apparatus. Based on a novel single -chip microprocessor, the device can generate multiple special pulse signals and output bi -directional electronic pulse. At the same time, it can detect the impedance automatically and thus its security is improved.

BACKGROUND: There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE: To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondylolisthesis.METHODS: A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion.RESULTS AND CONCLUSION: Among 146 involved patients, 72 cases were treated with four pedicle screw fixation (short segments), while 74 cases with six pedicle screw fixation (long segments). Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5-14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability.

Pedicle screw loosening and axial dislocation are main reasons for spinal internal fixation failure. Screw loosening and dislocation is caused by screw extraction force,and the screw withdrawl force is related to screw diameter,screw thread design,bone density,and operation skills. Withdrawl intensity is increased with screw diameter and length. Pedicle screw stability can be decreased by osteoporosis. For osteoporotic patients,it is difficult to increase screw diameter alone,so polymethyl methacrylate bone cement is used to enhance screw stability and anti-flexion intensity. However,polymerization heat may induce tissue injury,and long-term stay may produce toxicity and exhibit cancerogenesis. Novel additive materials with good biocompatibility such as hydroxyapatite and calcium phosphate bone cement are gradually replacing polymethyl methacrylate bone cement. In addition,screw entrance point,direction and exact location during screw implantation can decrease pullout strength reducation caused by screw re-twisting and improve screw extraction intensity and stability.

Objective To investigate the level of urinary protein in type 2 diabetic patients with different glucose excursion and investigation the effect of the glucose excursion on early diabetic nephropathy.Methods Fifty-six type 2 diabetes patients were divided into two groups by the level of glycosylated hemoglobin(HbA1c),good glycemic.Patients in control group with HbA1c ＜ 7.0％ and patients in poor glycemic control group with HbA1c ＜ 7.0％.Microalbuminuria,urine transferring (UTRF),α1-microglobulin (α1-MG) and 32-microglobulin(32-MG) were measured.All the patients were monitored using the continuous glucose monitoring system (CGMS),and mean amplitude of glucose excursions (MAGE) were analyzed.Patients were divided into two groups by MAGE,one group's MAGE was lower than 3.9 mmol/L,and another group's MAGE was higher than 3.9 mmol/L.Urinary proteins were measured and analyzed in the two groups.Results In the poor glycemic control group,the levels of microalbuminuria,UTRF and albunin/ creatinine(A/C) rate were (81.28 ±44.13) mg/L,(4.54 ± 1.54) mg/L and (22.17 ± 14.52) mg/mmol significantly higher than that in the good glycemic control group((21.63 ± 10.16) mg/L,(2.48 ±0.29) mg/L and (2.05 ± 0.76) mg/mmol; t =4.758,5.360,4.805 ; P ＜ 0.05).Fasting C peptide in the poor glycemic control group was (1.01 ± 0.13) ng/ml,significant lower than that in the good glycemic control group ((1.51 ± 0.21) μg/L;t =4.826;P ＜0.05).The levels of A/C rate,α1-MG and β2-MG in the group with MAGE above 3.9 mmol/L significantly higher than those in the group with MAGE below 3.9 mmol/L(t =4.358,8.641,12.702;P ＜ 0.05).Conclusion Both persistent hyperglycemia and blood glucose variability could influent diabetic nephropathy.

A total of 64 patients with lumbar spondylolisthesis were enrolled from Department of Bone Surgery in the People's Hospital of Haian Province between January 2002 and December 2007, including 19 males and 45 females. They aged 26-73 years with a mean of 48.5 years. Their disease course was 1-15 years with a mean of 4 years. All patients complained about the repeated low back pain accompanied with lower limb radiating pain and intermittent claudication (50-300 m). Fifty-nine patients suffered from lumbar spondylolysis, including L3 Ⅰ degree in 3 cases, L4 Ⅰ degree in 31 cases,L4, Ⅱ degree in 13 cases, Ls Ⅰdegree in 9 cases and L5 Ⅱ degree in 3 cases. The remaining 5 cases were present with lumbar degenerative pseudo-spondylolysis. All patients were processed into whole laminectomy for decompression or vertebral canal decompression by fenestration, domestic vertebral internal fixation, reduction and interbody fusion. Fifty-five patients were followed up for an average of 3.1 years whereas 9 patients were lost. According to Steffee clinical effect grading, the curative effect was evaluated as excellent in 28 cases and good in 19 cases, the rate of excellence and good accounted for 85.5%. Within one week following bone graft, all patients were rechecked with X-ray plain film, 28 of them had shown complete reduction and 36 cases were present with part reduction. The fusion rate of interbody graft was 100%. These findings demonstrated that vertebral internal fixation system possesses a simple structure, convenient operation and solid fixation, resets the slipped vertebral body and significantly increases the fusion rate of vertebral graft.

Objective To investigate the assciation between hypertriglyceridemia and insulin resistance in type 2 diabetes (T2DM).Methods One hundred and forty-nine T2DM patients were divided into hypertriglyceridemia (n =88) and normal-triglyceridemia (n =61) groups according to triglyceridemia levels,waist circumference (WC),waist to height ratio (WHtR),fasting blood-glucose (FPG),glycosylated hemoglobin (HbA1 c),uric acid (UA),total cholesterol (TC),fasting insulin (FINS) and homeostatic model assessment for insulin resistance (HOMA-IR) levels were measured and compared between the two groups.Results Compared with the normal-triglyceridemia group,The levels of WC,WHtR,UA,TC,FINS and HOMA-IR of patients in the thypertri-glyceridemia group were significantly higher (Hypertriglyceridemia group:WC(89.51 ±10.31) cm,WHtR 0.55 ±0.06,UA(316.95 ±88.50) μmol/L,TC(5.74 ± 1.72) mmol/L,FINS (8.63 ± 4.91) μU/L,HOMA-IR 4.48 ± 3.14 ; Normal-triglyceridemia group:WC (86.31 ± 7.98) cm,WHtR 0.53 ± 0.05,Uric(275.48 ± 88.36) μmol/L,TC (5.15 ± 1.13) mmol/L,FINS (6.20 ± 3.89) μU/L,HOMA-IR 3.38 ± 2.76; t value were 2.133,2.315,2.815,2.349,2.364,2.221 ; P ＜ 0.05) ; HOMA-IR correlated positively with WC (r =0.233,P ＜ 0.01),WHtR(r =0.268,P ＜ 0.01),BMI (r =0.161,P ＜ 0.05),FPG(r=0.442,P ＜0.01),AST(r=0.169,P ＜0.0S),UA (r =0.907,P ＜0.01),TG(r =0.220,P ＜0.01)and FINS(r =0.907,P ＜0.01).Conclusion T2DM with hypertriglyceridemia increased insulin resistance.

Objective:To search, evaluate and summarize the best evidence summary of perioperative accelerated rehabilitation nursing for patients undergoing hip and knee arthroplasty, so as to provide reference for clinical perioperative nursing.Methods:Evidence-based nursing methods were used to search for relevant databases such as BMJ Best Practice, UpToDate, PubMed, CINAHL, and CNKI, etc.. The search period was from December 2010 to December 2022. Four researchers independently evaluated the quality of the guidelines, and two researchers independently evaluated the quality of expert consensus and system evaluation. Finally, the included literature was summarized.Results:A total of 12 pieces of literature, 3 guidelines, 5 expert consensus and 4 systematic reviews were included. From 13 aspects of preoperative education, preoperative optimization, anesthesia management, perioperative blood management, perioperative pain management, perioperative fluid management, perioperative temperature protection, infection prevention, thrombus prevention, postoperative nausea and vomiting, postoperative drainage, functional exercise, and perioperative rehabilitation promotion, 35 pieces of the best evidence for hip and knee replacement patients to accelerate rehabilitation nursing in the perioperative period was summarized.Conclusions:This study summarizes the best evidence of accelerated rehabilitation nursing in the perioperative period of hip and knee arthroplasty, aiming to build and standardize the accelerated rehabilitation nursing scheme in the perioperative period of hip and knee arthroplasty, so as to provide reference for clinical perioperative nursing.