Chinese medical soft indexes provided by the four diagnostic methods of traditional Chinese medicine (TCM) are the important basis for syndrome differentiation and treatment. Whereas, the difficulty in scientific measurement and objective evaluation of these soft indexes is intensified due to the complexity and nonlinearity of Chinese medical practice and thinking of diagnosis and treatment, as well as the subjectivity and complexity hold by the person, who plays as the host and the guest of practice and research. Referring to the knowledge and technique of sociology, psychology and statistics, it is tried, in this study, to probe in the basic processes for soft index dependent efficacy evaluation of TCM, and build its mode preliminarily, i.e. , standardization - screening and reconstruction - measurement - weighing and quantification - evaluation.
Diagnosis, Differential ; Humans ; Medicine, Chinese Traditional ; methods ; standards ; Outcome Assessment (Health Care) ; methods ; standards ; Research Design ; Surveys and Questionnaires

OBJECTIVETo study the common characters of sub-healthy people.

METHODSQuestionnaire of clinical epidemiological investigation was adopted in the sub-healthy people.

RESULTSThe commonest symptoms and their frequency in sub-healthy people were fatigue 78.7%, poor quality of sleep 73.4%, amnesia 59.9%, fatigue irrelievable after rest 59.1%, dry throat 59.0%, dizziness 58.6%, dry and xerotic eyes 58.3%, ache with distension eyes 57.8%, ache 56.4%, early awakening 52.7%, difficulty in falling asleep 52.5%, irritability 51.8%, etc. The commonest risk factors were lack of relaxation 60.4%, lack of physical exercise 58.0%, working with frequent extra shifts 56.7%, air pollution 56.2%, noise pollution 51.3%, etc. The commonest syndrome types in sub-healthy people were insufficiency of Pi-qi type 10.2%, Gan-qi stagnation and Pi deficiency type 10.1%, deficiency of Xin and Pi type 9.7 %, retention of dampness due to Pi-deficiency type 7.4% and qi deficiency type 4.2%, et al.

CONCLUSIONThe commonest symptoms in sub-healthy people are fatigue, poor quality of sleep, amnesia, irrelievable fatigue after taking rest, dry throat, dizziness, dry and xeritic eyes, ache with distension in eyes, ache, early awakening, difficulty in falling asleep, irritability, etc. The commonest risk factors are lack of relaxation and physical exercise, working with frequent shift, air and noise pollution. The commonest syndromes of sub-healthy people are insufficiency of Pi-qi type, Gan qi stagnation and Pi deficiency type, deficiency of Xin and Pi type, retention of dampness due to Pi deficiency type, qi deficiency type. These provides evidence for prevention and treatment of sub-health with TCM.

Adult ; China ; epidemiology ; Diagnosis, Differential ; Fatigue Syndrome, Chronic ; epidemiology ; Female ; Health Status ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Surveys and Questionnaires

OBJECTIVETo analyze the Chinese medicine (CM) syndrome pattern of patients with type 2 diabetes mellitus (DM2) and the relationship of CM patterns with the different blood glucose levels controlled and the incidences of diabetic chronic complications.

METHODSCM syndromes in 557 DM2 patients were sorted into 7 patterns, A: the Fei-Wei yin-deficiency with exuberant heat pattern; B: the Pi-qi deficiency pattern; C: the Shen-qi deficiency pattern; D: the Pi-Shen qi-deficiency pattern; E: the Gan-Shen yin-deficiency pattern; F: the both qi-yin deficiency pattern; and G: the both yin-yang deficiency pattern, the concurrent or accompanied excessive syndromes were not taken as the indication for sorting. The blood glucose level, duration of illness and incidence of diabetic chronic complications in patients of different patterns were compared.

RESULTSThe CM syndrome patterns commonly encountered in mostly of the 557 patients was pattern F (in 264 patients, accounting for 47.4%); the next was pattern C (95 patients, 17.1%) and E (92 patients, 16.5%). The concurrent syndromes appeared in most patients was blood stasis (501 patients, 89.9%), Gan-qi stagnation was the second (225 patients, 40.4%), and the portion of damp-heat syndrome was also rather large (180 patients, 32.3%). The duration of diabetes mellitus for patients with various patterns was significantly different (P < 0.01), the longest appeared in patients of pattern G, followed by pattern D, C, F, and E in sequence, and patients of pattern A and B had a rather shorter duration. Level of fasting blood glucose was rather higher in patients of pattern A, C, D, F, and G than in those of pattern B and E. Level of glycosylated hemoglobin in patients of pattern G was the highest and in pattern A the second, while in pattern B and E was rather lower. Incidences of diabetic chronic complications, including diabetic peripheral neuropathy, diabetic retinopathy, diabetic nephropathy, cerebral infarction, and atherosclerosis in patients of pattern A and B were lower than in those of other 5 patterns (P < 0.05); but the highest incidence of multiple chronic complications revealed in pattern D and G, and that of coronary heart disease revealed in pattern C and G, all showed significant different as compared with other patterns (P < 0.01).

CONCLUSIONThe most commonly encountered CM syndrome patterns in DM2 patients of early stage are pattern A and B; and those of middle stage are pattern C, D, E and F, various diabetic chronic complications may reveal in this stage; pattern G could be found in patients accompanied with multiple chronic complications and with uncontrolled blood glucose for a long time.

Adult ; Aged ; Aged, 80 and over ; China ; Diabetes Complications ; epidemiology ; Diabetes Mellitus, Type 2 ; classification ; diagnosis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Qi ; Yin Deficiency ; Young Adult

OBJECTIVETo summarize experience of using screws and cement to rebuild tibial bone defect in primary total knee arthroplasty (TKA) and to discuss the relationship between the number of required screws and the severity of tibial bone defects.

METHODSFrom July 2009 to May 2015, 34 patients (40 knees) with varus knees underwent TKA, and the screw and cement technique was used to rebuild medial tibia plateau during operation. There were 8 males (8 knees) and 26 females (32 knees), and the average age was (65.00 +/- 7.25) years old (ranged,55 to 82 years old). One to 6 screws were used in each case. Extension stems were used in 2 cases (4 and 5 screws was used respectively). The area percentages of the bone defects measured as defect area/tibia plateau area, depth of each defect, the number of screws needed in each case, were all used to determine the relationship between the number of screws and the area percentage in certain depth of bone defect by statistic methods, as well as the relationship between screw number and defect depth.

RESULTSAll the patients were followed up and the average duration was 24 months (ranged, 1 to 72 months). The average preoperative HSS score was 43.33 +/- 6.11 (ranged, 32 to 51 scores). Whereas the average postoperative HSS score was 92.15 +/- 4.64 (ranged,83 to 96 scores). The preoperative individual scores including pain, function, activity, nuscle strength, flexion deformity and stability were all improved compared with preoperation,and the differences were statistically significant. All the patients received normal alignment postoperatively, femoraltibial angle was improved from (167.00 +/- 6.39) degrees preoperatively to (175.00 +/- 2.69) degrees postoperatively, the tibial angle was improved from (78.09 +/- 4.51) degrees preoperatively to (88.75 +/- 1.24) degrees postoperatively. Both area percentage and depth of bone defect in a fitting Ologistic model had a significant statistical relationship with the screw number, and a rectangular coordinate system could be formed according to the relationship.

CONCLUSIONScrews and cement technique is a simple, safe and convenient method to rebuild tibial bone defects in primary TKA and its short-term and midterm effect are both reliable. During opera- tion, according to the rectangular coordinate system, the screw number needed in the operation can be inferred form th area and depth of tibia defect, which could have a guiding function in surgery.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; instrumentation ; methods ; Bone Screws ; utilization ; Female ; Fracture Fixation, Internal ; Humans ; Knee Injuries ; surgery ; Knee Joint ; surgery ; Male ; Middle Aged ; Tibia ; surgery

OBJECTIVETo compare differences between Crowe IV developmental dysplasia of the hip (DDH) with secondary acetabulum and Crowe IV DDH without secondary acetabulum,and determine whether it is necessary to divide Crowe IV DDH into two subtypes.

METHODSFrom June 2007 to May 2015,145 hips of 112 Crowe N patients who underwent total hip arthroplasty (THA) using S-ROM stem were divided into two groups: secondary acetabulum formaton group (group A) and no secondary acetabulum formaton group (group B). In group A,there were 12 females, 96 males,with an average age of (39.38 ± 11.19) years old. In group B, there were 2 females, 35 males, with an average age of (38.19 ± 10.92) years old. All the patients were evaluated by using Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up. The differences between two groups were compared on dislocation height, canal flare index (CFI), subtrochanteric shortening osteotomy (SSTO) usage, pre- and post-operation Harris scores, complications.

RESULTSThe dislocation height for group A was (4.74 ± 1.57) cm, while the dislocation height for group B was (3.12 ± 1.15) cm. Significantly difference was detected between two groups. The CFI for group A was 2.69 ± 0.68, while the CFI for group B was 3.42 ± 0.79, and the significantly difference was detected between two groups. Harris scores were totally improved from 58.18 ± 15.67 preoperatively to 91.20 ± 3.79 post-operatively and the difference was significant. Pre-operative Harris scores was 58.1 ± 15.3 in group A, 58.3 ± 16.9 in group B. Post-operative Harris scores was 91.0 ± 4.1 in group A, 91.0 ± 5.1 in group B. No significant difference was found on Harris scores between A and B preoperatively and post-operatively. Complications of 4 cases peri-prosthesis fracture, 4 cases dislocation and 4 cases nerve injury occur in group A; While only one case dislocation and one case nerve injury occur in group B. No statistical significance was detected.

CONCLUSIONCrowe IV DDH with secondary acetabulum is significantly different from Crowe IV DDH without secondary acetabulum on dislocation height and femoral morphology, which causes the different selections of surgical techniques (SSTO usage or not). These important differences in fundamental parameters indicate the necessity to further divide Crowe IV DDH into IVA and IVB two subtypes.

Adolescent ; Adult ; Aged ; Female ; Hip Dislocation, Congenital ; classification ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy

OBJECTIVETo study the effects of immunoglobulin on the neuronal expression of IL-1beta and IL-1ra and the neuronal death at hippocampus in rats with convulsion induced by pentylenetetrazol.

METHODSThe epilepsy model was established by injecting intraperitoneally pentylenetetrazol (PTZ) into Wistar rats. Forty-five rats were randomly divided into three groups, normal control group, PTZ plus intravenous immunoglobulin (PTZ-IVIG); PTZ plus normal saline (PTZ-NS). Neuronal death was assessed by light microscopy with the hematoxylin-eosin (HE) staining and with in situ terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL). IL-1beta and IL-1ra expressions were examined by histochemistry.

RESULTSThe ratio of IL-1beta/IL-1ra at hippocampal CA(1) region in PTZ-IVIG group (0.5 +/- 0.1) was significantly lower than that in PTZ-NS group (1.9 +/- 0.5, t = 12.9, P < 0.05). Apoptotic cell numbers at the hippocampal CA(1) region were significantly decreased in the PTZ-IVIG group, compared to PTZ-NS group (t = 27.1, P < 0.05). The numbers of positive cells were 16.4 +/- 3.3/1000 microm(2) in the former and 41.7 +/- 3.5/1000 microm(2) in the latter. Necrotic cell numbers at the hippocampal CA(1) region were significantly decreased in the PTZ-IVIG group (19.0 +/- 2.6/1000 microm(2)), compared to PTZ-NS group (42.3 +/- 4.9/1000 microm(2), t = 20.9, P < 0.05).

CONCLUSIONImmunoglobulin could inhibit neuronal death induced by convulsion and its possible mechanism might be the regulation of IL-1 system in neurons.

Animals ; Apoptosis ; Hippocampus ; drug effects ; immunology ; metabolism ; Immunoglobulins, Intravenous ; pharmacology ; Interleukin 1 Receptor Antagonist Protein ; metabolism ; Interleukin-1beta ; metabolism ; Neurons ; drug effects ; Pentylenetetrazole ; adverse effects ; Rats ; Rats, Wistar ; Seizures ; chemically induced ; immunology ; metabolism

OBJECTIVETo investigate influence of administration of Tujian decoction (Chinese herbal medicine) on protein kinase C (PKC) activity, renal function and structure in diabetic rat kidney.

METHODExperimental diabetic nephropathy model was induced by nephrectomy combined with streptozotocin (STZ) injection in sprague-dawley rat. Tujian decoction (20 g x kg(-1) x d(-1)) and Valsartan (20 mg x kg(-1) x d(-1)) were orally administrated respectively for 12 weeks. PKC activity was measured by [3H]phorbol 12, 13-dibutyrate ([3H]PDBu) binding assay. 24 h urine protein excretion (Upro) and renal pathological changes were observed.

RESULTIn 12th week, diabetic nephrectomized rats developed proteinuria, glomerulosclerosis, increased membrane PKC activity (mPKC), decreased cytosol PKC (cPKC), and increased ratio of mPKC and cPKC (M/C). Administration of Tujian decoction or Valsartan led to a reduction in proteinuria, structural injury, mPKC and M/C, and a recovery in cPKC.

CONCLUSIONTujian decoction possesses a renoprotective effect on diabetic nephrectomized rat, at least partially via the inhibition of PKC activation in renal cortex.

Animals ; Cuscuta ; chemistry ; Diabetes Mellitus, Experimental ; enzymology ; pathology ; Drug Combinations ; Drugs, Chinese Herbal ; isolation & purification ; pharmacology ; Euonymus ; chemistry ; Kidney Cortex ; enzymology ; Kidney Glomerulus ; pathology ; Male ; Plants, Medicinal ; chemistry ; Protective Agents ; pharmacology ; Protein Kinase C ; metabolism ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH).

METHODSFrom April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41.16±21.50) months ranging from 12 to 96 months. All the patients were evaluated by Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Harris scores, the incidence of complications such as ceramic fracture, squeaking, dislocation were observed.

RESULTSThe mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86(=0.017). Periprosthetic osteolysis was not deteced around any cup. No ceramic fracture occurred. There were 3 cases of revision surgery due to infection, losening of the stem and limb length discrepancy, respectively; 3 cases of dislocation occurred. Seventy-seven patients were recorded the gait and the hip mobility, the hip flexion of 69 patients were above 120 degrees.

CONCLUSIONSCeramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty.

OBJECTIVETo investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty.

METHODSFrom January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture. Primary THA reasons:12 cases for DDH(9 cases for Crowe IV), 5 cases for femoral neck fracture, 2 cases for necrosis of femoral head, 2 cases for proximal femoral deformity caused by early infection. The femur bone defects included Paprosky II in 11 cases, IIIa in 9, and IIIb in 1. Harris hip score , pain score and hip flexion were recorded before and after operation. The subjective satisfaction was recorded at the last follow-up.

RESULTSThe operation time and blood loss were 189 min(125 to 290 min) and 867 ml (200 to 2 000 ml). At the final followup, the pain score improved from (17.14±9.56) points preoperatively to (41.71±2.03) points (=11.42,=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (=9.73,=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(=15.33,=0.00). The degree of hip flexion increased from (93.10±27.27) points preoperatively to (121.90±16.62) points at the last follow-up (=4.59,=0.00). The mean subjective satisfaction was 9.48(10 points system), 14 of which were completely satisfactory. The last follow-up hip X-ray showed 21 cases of bone ingrowth, and other femoral stem without loosening or sinking sign significantly. There were 5 cases with bone anchor syndrome around proximal femoral cuff. There were 5 cases of proximal femur fracture, 3 cases of lesser trochanter fracture, 2 cases of greater trochanter fracture intra-operatively. Due to femoral canal stenosis, there were 4 cases of pre-tied wire at lesser trochanter to prevent fractures. There was 1 case of traumatic femoral fracture around stems with a distal oblique fracture, open reduction and locking plate fixation was performed. Other patients had no nerve stretch injury, dislocation, infection and lower limb deep vein thrombosis and other complications at the final follow-up.

CONCLUSIONSS-ROM prosthesis has satisfactory results in hip revision arthroplasty with Paprosky II and III femoral defects. Especially for patients with Crowe IV DDH and other proximal femoral deformities, it is possible to adapt to the medullary cavity morphology. Excellent initial stability, less complications and long-term biological fixation can be achieved with S-ROM in femur revision.

OBJECTIVETo study the complications and efficacy of self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement.

METHODSBetween January 2006 and July 2016, 265 patients (266 hips) received a self-made, antibiotic-loaded cement articulating spacer as part of a two-stage protocol. Among those patients, there were 143 males(144 hips) and 122 females(122 hips). The cement articulating spacers with vancomycin and two Steinman pins were made by a self-made mold system. Meanwhile, another antibiotic was added to the spacers according to the drug sensitivity test. Record if the infected prosthesis was removed, related complication with spacer(breakage and dislocation), Harris score, and control rate of infection.

RESULTSThe mean age of two-stage revision operation was(57.4±14.2) years. Thirty-nine patients(14.7%) used extended trochanteric osteotomy(ETO) to remove the infected prosthesis. And 38 patients occurred mentioned complications(14.3%). Spacer breakage occurred in 28 cases(10.5%) and dislocation occurred in 10 cases(3.8%). The mean follow-up time was(83.4±14.6) months. The Harris hip score was from 47.56±14.23 preoperatively to 86.43±12.84 at final follow-up(<0.05). The infection of 256 cases(96.6%) got control after revision operation. However, during postoperative follow-up, 4 cases occurred re-infection, and they were reoperated, and the infections obtained effective control after the operation. Thus total infection control rate was 95.1%(252/265).

CONCLUSIONSAntibiotic-loaded cement articulating spacer made by a self-made mold system is effective in controling infection caused by hip replacement. Related complication is less with spacer by a mould enclosing two Steinman pins. Using metallic internal fixation or allograft bone combined with spacer does not affect infection control.