Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:To explore the clinical effect on reconstruction of the soft tissue defects after resection of mucous cysts of distal interphalangeal joint (DIP) with transfer of the flap of dorsal branch of proper palmar digital artery.Methods:From September 2021 to September 2023, 8 patients (8 digits) with mucous cysts on DIP were treated in the Department of Hand and Microsurgery, the Affiliated Hospital of Binzhou Medical University. All 8 cases were females, aged 55-65 years old, with an average age of 60 years old. The cyst was located in the thumb in 1 case, in the index finger in 3 cases, in the middle finger in 3 cases, and in the ring finger in 1 case. After extensive resection of the mucous cysts, the size of soft tissue defects was at 0.8 cm×0.6 cm-1.7 cm×0.9 cm. Pedicled with the dorsal branch of proper palmar digital artery, the flaps adjacent to the defects were designed to cover the wounds. The size of the flaps was 1.2 cm×1.0 cm-2.0 cm×1.2 cm. Donor sites of the flap were covered by the full thickness skin grafts of medial upper arm. The postoperative follow-up was conducted by the combination of outpatient revisits and telephone reviews to observe the survival of the flap, and the functional recovery was evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:All flaps survived well after surgery. Postoperative follow-up ranged from 4 to 12 months, with a mean of 10 months. At the final follow-up, there was no recurrence of mucous cyst and all symptoms disappeared. All flaps healed well, with good appearance, soft texture and without obvious difference in colour from the surrounding skin. All skin grafts healed in one stage. The range of motion of the affected DIP was 0°-70°, and the TPD was at 7-8 mm, both caused no impact on daily life. The outcomes were excellent according to the evaluation criteria set by the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Conclusion:The flap pedicled with dorsal branch of proper palmar digital artery has obvious advantages with less damage and simple operation in the treatment of a mucous cyst of DIP. It is an ideal surgical procedure.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:The nasal swell body（NSB） consists of the nasal septal cartilage, nasal bone, and swollen soft tissue, all of which are visible during endoscopic and imaging examinations. Although the function of the NSB remains uncertain, there is evidence to suggest that it plays a vital role in regulating nasal airflow and filtering inhaled air. Based on anatomical and histological evidence, it is hypothesized that the NSB is indispensable in these processes. This study aims to investigate the impact of NSB on nasal aerodynamics and the deposition of allergen particles under physiological conditions. Methods:The three-dimensional （3D） nasal models were reconstructed from computed tomography （CT） scans of the paranasal sinus and nasal cavity in 30 healthy adult volunteers from Northwest China, providing basis for the construction of models without NSB following virtual NSB-removal surgery. To analyze the distribution of airflow in the nasal cavity, nasal resistance, heating and humidification efficiency, and pollen particle deposition rate at various anatomical sites, we employed the computed fluid dynamics（CFD） method for numerical simulation and quantitative analysis. In addition, we created fully transparent segmented nasal cavity models through 3D printing, which were used to conduct bionic experiments to measure nasal resistance and allergen particle deposition. Results:①The average width and length of the NSB in healthy adults in Northwest China were （12.85±1.74） mm and （28.30±1.92） mm, respectively. ②After NSB removal, there was no significant change in total nasal resistance, and cross-sectional airflow velocity remained essentially unaltered except for a decrease in topical airflow velocity in the NSB plane. ③There was no discernible difference in the nasal heating and humidification function following the removal of the NSB; ④After NSB removal, the deposition fraction（DF） of Artemisia pollen in the nasal septum decreased, and the DFs post-and pre-NSB removal were（22.79±6.61）% vs （30.70±12.27）%, respectively; the DF in the lower airway increased, and the DFs post-and pre-NSB removal were（24.12±6.59）% vs （17.00±5.57）%, respectively. Conclusion:This study is the first to explore the effects of NSB on nasal airflow, heating and humidification, and allergen particle deposition in a healthy population. After NSB removal from the healthy nasal cavities: ①nasal airflow distribution was mildly altered while nasal resistance showed no significantly changed; ②nasal heating and humidification were not significantly changed; ③the nasal septum's ability to filter out Artemisia pollen was diminished, which could lead to increased deposition of Artemisia pollen in the lower airway.
Adult ; Humans ; Cross-Sectional Studies ; Nasal Cavity/surgery* ; Allergens ; Pollen ; Artemisia ; Hydrodynamics

Objective:To construct a clinical predictive model of severe adenovirus pneumonia(SAP)in children using random forest and verify it.Methods:The clinical, laboratory and imaging data of 542 children with adenovirus pneumonia treated in Tianjin Children′s Hospital from January 2019 to January 2021 were analyzed retrospectively.The research object was randomly divided into training dataset and validation dataset(8∶2).The training dataset screened the predictors of SAP of pneumonia through random forest and established a prediction model, and the prediction model was expressed visually by the nomogram.In the validation dataset, the receiver operating characteristic curve(ROC)and sensitivity, specificity, error rate and confusion matrix were used to validate it.Results:A total of 439 children were in the training dataset, and 187 cases(42.60%)of the training data was divided as severe type.A total of 103 children were in validation dataset, and 44 cases(42.71%)of the validation dataset was divided as severe type.The percentage of monocytes(M%), PLT, AST, IL-6, the peak of body temperature, pulmonary inflammation of the consolidation and patchy shadowing were independent predictors of SAP in children.The area under the ROC curve of the training dataset and the validation dataset was 0.95(95% CI: 0.92~0.98)and 0.92(95% CI: 0.82~0.99), respectively.The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the training dataset were 0.994, 1.000, 0.987, 0.998, 1.000 and in validation dataset were 0.752, 0.990, 0.514, 0.945 and 0.857, respectively. Conclusion:The predictive model has good discriminant ability, and the early clinical and hematological indexes are helpful to improve the identification and screening of SAP in children.

Objective To investigate the effect of combination therapy of Gabapentin and Cobamamide in treatment of painful diabetic neuropathy (PDN).Methods A total of 96 patients with type 2 diabetes (T2DM) and PDN were enrolled in this study and randomly divided into control group (Con,n=32),Cobamamide group,(n=32),and Gabapentin+Cobamamide group,(n=32).FPG and HbA1c were actively controlled in each group.Con group was treated with vitamin B1.Clinical and biochemical data of all the subjects were collected.The degree of pain was assessed by visual analogue scale (VAS).The changes of median nerve,peroneal nerve motor nerve conduction velocity (MNCV),and sensory nerve conduction velocity (SNCV) were evaluated by EMG assessment.The assessment of sleep quality was done by Pittsburgh sleep quality index scale (PSQI).Results There was no significant differences of baseline MNCV,SNCV and the degree of pain among the three groups (P>0.05).After treatment,all the above index were improved in both Cobamamide group and Gabapentin+Cobamamide group.MNCV and SNCV were higher in Gabapentin+Cobamamide group than in Cobamamide group (P<0.05).There were no significantly improvement of MNCV and SNCV in Con group (P>0.05).Conclusion The combination therapy of Gabapentin and adenosine cobalt amine could reduce pain,improve nerve conduction velocity,and improve the quality of sleep.

Objective:To assess the characteristics change of sleep architecture in drug naive patients with schizophrenia,compared with healthy control.Methods:The key words including schizophrenia and sleep architecture (or sleep structure or sleep disturbance or polysomnogram and so on) were used to search literatures in MEDLINE,Embase,Springer,PsychINFO,google scholar,Wanfang data,published from 1980 to 2015.Fifteen studies that compared sleep architecture in drug naive patients with schizophrenia and healthy control were included.Literature quality evaluation was performed with the Newcastle-Ottawa Scale.The meta-analysis was performed by using Stata13.0 software.Results:Compared to healthy control,the total sleep time decreased (P ＜ 0.01),the sleep latency increased (P ＜ 0.01),the sleep efficiency decreased (P ＜ 0.01),and the rapid-eye-movemem (REM) sleep latency increased (P ＜ 0.01) significantly in drug naive patients with schizophrenia.The proportion of stage1 was increased,and the proportions of stage4 and slow wave sleep stage were decreased,the differences between case and control were statistically significant.Conclusion:In the control of drug effects,patients with schizophrenia may have poorer sleep quality of be poorer than healthy controls,such as the decreased total sleep time,specifically slow wave sleep,prolonged sleep latency and decreased sleep efficiency.

Objective To investigate the expression of Toll-like receptor 4 (TLR4),and explore its relationship with neurological function after fluid percussion brain injury in rats.Methods 56 adult rats were randomly divided into traumatic brain injury group(TBI group,n=48) and sham operation group(SO group,n=8).The experimental models were established.The water content of edematous brain and the expression of TLR4 were measured with dry-wet measure,immunohistochemistry and Western Blot at 1 h,6 h,12 h,24 h,3 d,7 d after shock respectively.Results Compared with SO group,neuronal function score decreased in TBI group from 6 h(3.86±0.42),reached to the lowest level at 24 h(2.65±0.32),and gradually rose at 3rd day (3.25±0.17).TLR4 immunoreactive expression increased from 6 h,reached its maxmum at 24 h,lasted to 3rd day,and then began to drop at 7th day.The linear regression analysis indicated that expression of TLR4 had negative correlation with change of neuronal function score (r 1 =-0.824,r w =-0.867,P＜0.05).Conclusion TLR4 expression is upregulated following fluid percussion injury in rats and involved in neurological function impairment by inducing secondary inflammatory brain injury.

Objective To investigate the change of serum CD62p of coronary heart disease (CHD) patients after different doses of clopidogrel administration.Methods One hundred and ninety-one patients with CHD were selected as our subjects.Of which,95 cases were with SAP and 66 cases were with non ST segment elevation acute coronary syndrome (NST-ACS).SAP patients were randomly given clopidogrel at dose of 75 mg/d or 150 mg/d and served as A and B groups.NST-ACS patients were randomly given 300 mg clopidogrel,then randomly divided into C and D groups with sequentially taking clopidogrel at dose of 75 mg/d or 150 mg/d respectively.Thirty healthy peoples were served as E group without drug intervention.Concentrations of serum CD62p were detected by Elisa before taking clopidogrel,24 h and the fifty day of after taking clopidogrel.Results (1) Before taking clopidogrel,the serum concentrations of CD62p in CHD patients were higher (A group:(7.62 ± 2.99) ng/L,B group:(8.48 ± 3.13) ng/L,C group:(9.50 ± 3.32) ng/L,D group:(10.22 ± 5.14) ng/L than that of healthy control group ((5.49 ± 1.99) ng/L,P ＜ 0.05).The Serum CD62p levels in SAP patients were lower than that of NST-ACS patients (P ＜ 0.05).(2)The serum concentrations of CD62p in A and B groups at before taking clopidogrel were (7.62 ±2.99) ng/L and (8.48 ±3.13) ng/L respectively,higher than that four days after taking clopidogrel ((6.79 ± 2.51) ng/L,(6.37 ± 1.80) ng/L;t =2.390,4.520;P ＜0.05 or P ＜0.01).There was no statistical significant difference between A and B groups(P ＞0.05).(3) In C and D groups,the serum CD62p at before taking clopidogrel were (9.50 ±3.32) ng/L and (10.22 ±5.14) ng/L,higher than that after taking clopidogrel for four days ((8.21 ± 2.62) ng/L,(8.17 ± 2.37) ng/L; t =2.084,2.157 ; P ＜ 0.05).No significant difference was seen between C and D groups (P ＞ 0.05).Conclusion The serum CD62p in patients with CHD was higher than that in the healthy control.Clopidogrel administration can decrease serum CD62p in CHD patients.

Objective To investigate the expression of inflanmatory cytokines such as interlukin-1β (IL-1 β),interlukin-6 (IL-6),tumor necrosis factor-α (TNF-α) and intercelluar adhesion molecule-1 (ICAM-1),and explore their relationships with neuronal function score after fluid percussion brain injury in rats.Methods The experimental models were established in 48 adult rats.The water content of edematous brain and the expression of IL-Iβ,IL-6,TNF-α and ICAM-1 were measured with dry-wet measure,immunohistochemistry at 6 h,12 h,24 h,3 d,7 d after operation respectively.Results Compared with animals of shame operation (SO) group,neuronal function score decreased in TBI group from 6h (3.78±0.84),reached to the lowest level at 24h (2.65±0.32),and gradually increased at 3d (4.75±0.71).IL-6,IL-1β,TNF-α and ICAM-limmunoreactive expression increased from 6h,reached its maxmum at 24h,lasted to 3th day,and began to decrease at 7d.The linear regression analysis indicated that expression of IL-1β,IL-6,TNF-α and ICAM-1 had negative correlations with change of neuronal function score(r=-0.912,r=-0.892,r=-0.794,r=-0.887 respectively,P＜0.05).Conclusion IL-6,IL-1β,TNF-α and ICAM-1 expression is upregulated following fluid percussion injury in rats,and shows negative correlations with neuronal function score.The possible mechanisms is that inflammatory cytokines are involved in nerve function impairment by inducing secondary brain injury.