OBJECTIVE: To describe a novel arthroscopic technique of modified tri-anchor double-pulley suture-bridge in repairing medium-sized supraspinatus tendon tears and evaluate the early effectiveness. METHODS: Between June 2021 and January 2024, 26 patients with medium-sized supraspinatus tendon tears who underwent arthroscopic modified tri-anchor double-pulley suture-bridge repair and met the selective criteria were included. There were 11 males and 15 females with an average age of 61.4 years (range, 43-74 years). Five patients had a significant history of trauma, while the remaining 21 patients had no apparent cause. The time from symptom onset to hospitalization was 3-25 months (mean, 7.9 months). The effectiveness was evaluated during follow-up, including the scores of University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), visual analogue scale (VAS), the range of forward flexion, abduction, external rotation, and internal rotation, and patient's satisfaction. Either MRI or ultrasound examination were used to evaluate structural integrity of the tendon. RESULTS: The operation time was 65-110 minutes (mean, 81.8 minutes). All patients were followed up 12-43 months (mean, 23.0 months). At 3 and 12 months after operation, the shoulder range of flexion, abduction, external rotation, and internal rotation, and the scores of VAS, UCLA, and ASES significantly improved when compared with those before operation ( P<0.05). The improvement was further observed at 12 months compared to 3 months ( P<0.05). At last follow-up, 13 patients were very satisfied with the effectiveness, 11 patients were satisfied, 1 was relatively satisfied, and 1 was dissatisfied. During follow-up, 15 patients underwent imaging examination and imaging reexamination showed that the re-tear rate of tendon was 6.6%(1/15). The remaining 11 patients refused imaging examination. Complications included partial anchor withdrawal in 1 case, shoulder stiffness in 5 cases, and mild pain in shoulder joint in 2 cases in physical activity or heavy physical activity. CONCLUSION Arthroscopic modified tri-anchor double-pulley suture-bridge technique is a novel surgical technique that uses double-loaded suture anchors as medial- and lateral-row anchors. In repairing medium-sized supraspinatus tendon tears, 6 sets of double-pulley suture-bridges can be created from one medial-row anchor; knotless medial-row can reduce re-tear rate of the tendon; good early effectiveness is obtained.
Humans ; Female ; Male ; Middle Aged ; Arthroscopy/methods* ; Adult ; Rotator Cuff Injuries/surgery* ; Aged ; Suture Techniques ; Treatment Outcome ; Suture Anchors ; Rotator Cuff/surgery* ; Range of Motion, Articular ; Tendon Injuries/surgery* ; Patient Satisfaction

OBJECTIVE: To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. METHODS: A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up. RESULTS: All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). CONCLUSION Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.
Male ; Female ; Humans ; Middle Aged ; Rotator Cuff/surgery* ; Rotator Cuff Injuries/surgery* ; Shoulder Pain ; Retrospective Studies ; Treatment Outcome ; Arthroscopy ; Shoulder Joint/surgery* ; Tendons/surgery* ; Range of Motion, Articular

Objective To evaluate the acceptability and effectiveness of different doses of midazolam oral solution in sedating infants during echocardiographic studies.Methods Two hundred and fourty patients aged 1 to 3 years who underwent echocardiographic study in sedation in our hospital were enrolled in this study.After recording the baseline data of all infants,they were randomly divided into four groups:0.3 mg·kg-1 midazolam oral solution group(M1 group),0.5 mg·kg-1 midazolam oral solution group(M2 group),0.7 mg·kg-1 midazolam oral solution group(M3 group)and 0.5 mL·kg-1 10%chloral hydrate administrated rectally group(C group),60 case per group,and the sedation was performed in the corresponding method of each group.The 5-point facial hedonic and Ramsay scales were used to evaluate acceptability and effectiveness in sedation.The onset time and duration time of sedation were recorded.Results Compared with the C group,the 5-point facial hedonic scale scores in M1,M2,and M3 groups increased during sedation(F=17.50,P<0.017).The onset time of sedation in the M1 and M2 groups was longer than that in the C group(P<0.017),and the duration time of sedation in the M1 and M2 groups was shorter than that in the C group(P<0.017).There was no significant difference in the onset time(P=0.85)and duration time(P=0.50)of sedation between the M3 and C groups.The onset time of sedation in the M1and M2groups was longer than that in the M3 group(P<0.017),and the duration time of sedation in the M1 and M2 groups were shorter than that in the M3 group(P<0.017).Conclusions The acceptability of infants with midazolam oral solution sedation under echocardiographic study was better than that of 10%chloral hydrate administrated rectally.There were fewer adverse reactions with the midazolam oral solution.The 0.7 mg·kg-1 midazolam oral solution had a rapid onset of sedation and definite effect.

Objective:To explore the research status, hotspots, and directions in traditional Chinese medicine treatment for postoperative gastrointestinal dysfunction both domestically and internationally.Methods:The bibliometric software CiteSpace 5.7.R5 was used to visually analyze literature published on the China National Knowledge Infrastructure and Web of Science core collection from establishment until 2022, and to draw the knowledge graph of authors, research institutions, and keywords.Results:After screening by two researchers, a total of 1 012 Chinese articles and 111 English articles were included. The analysis of annual publication volume showed that this field was showing an upward trend both domestically and internationally. The co-occurrence analysis of authors displayed that Hu Kaiwen and Jingwen Yang had the highest number of publications. Institutional co-occurrence analysis indicated that there were relatively few mature and influential teams formed domestically and internationally, and research institutions had limited cross-regional cooperation. Keyword clustering analysis revealed that the research hotspots mainly focused on integrated traditional Chinese and Western medicine nursing, clinical research, and traditional Chinese medicine external treatment methods.Conclusions:The research on the treatment of postoperative gastrointestinal dysfunction with traditional Chinese medicine is mainly concentrated in China, but there are few closely cooperating and stable research teams. Research in this field is still in its developmental stage both domestically and internationally, close cooperation between multiple institutions and authors is needed to form influential teams to conduct in-depth research on the mechanisms and principles of this field, making significant contributions to its development.

Objective:To explore the effect of core stability training on rehabilitation of patients after lumbar fusion.Methods:From June 2018 to December 2019, 90 patients with lumbar fusion admitted to Wuxi Second Hospital Affiliated to Nanjing Medical University were selected by convenience sampling. The patients were divided into control group and training group according to the method of random number table, with 45 cases in each group. The control group received routine postoperative rehabilitation nursing, while the training group carried out postoperative core stability training nursing. The rehabilitation effects of the two groups were observed.Results:The scores of Numerical Rating Scale (NRS) in the training group were lower than those in the control group at 2, 4, 12 and 24 weeks postoperatively, and the difference were statistical ( P<0.05) . The scores of Oswestry Disability Index (ODI) in the training group 12 and 24 weeks after operation were lower than those in the control group, with statistically significant differences ( P<0.05) . Conclusions:The core stability training nursing is helpful to improve the functional recovery after lumbar fusion, reduce the degree of postoperative pain, and then increase the rehabilitation effect of patients.

Hepatotoxicity is a common side effect for patients treated with gefitinib, but the related pathogenesis is unclear and lacks effective predictor and management strategies. A multi-omics approach integrating pharmacometabolomics, pharmacokinetics and pharmacogenomics was employed in non-small cell lung cancer patients to identify the effective predictor for gefitinib-induced hepatotoxicity and explore optional therapy substitution. Here, we found that patients with rs4946935 AA, located in Forkhead Box O3 (FOXO3) which is a well-known autophagic regulator, had a higher risk of hepatotoxicity than those with the GA or GG variant (OR = 18.020, 95%CI = 2.473 to 459.1784, P = 0.018) in a gefitinib-concentration dependent pattern. Furthermore, functional experiments identified that rs4946935_A impaired the expression of FOXO3 by inhibiting the promotor activity, increasing the threshold of autophagy initiation and inhibiting the autophagic activity which contributed to gefitinib-induced liver injury. In contrast, erlotinib-induced liver injury was independent on the variant and expression levels of FOXO3. This study reveals that FOXO3 mutation, leading to autophagic imbalance, plays important role in gefitinib-induced hepatotoxicity, especially for patients with high concentration of gefitinib. In conclusion, FOXO3 mutation is an effective predictor and erlotinib might be an appropriately and well-tolerated treatment option for patients carrying rs4946935 AA.

The general practitioners are facing a series of issues in aspect of medical humanities:incomprehensive humanity care,insufficient subjective components in medical records,low service efficiency particularly during heavy work load in outpatient service.To adapt the challenges,a general hospital in Shanxi province had explored a pathway to integrate the medical social work into patient care in general practice since 2017.The medical social workers jointed the general practice team,involved in outpatient service and patient education,generated humanity records to improve the humanistic care,and to promote doctor-patient communication.The general medical services were significantly improved after the program implementation in the hospital.

Objective: To observe the integration frequency of aadA2 resistance cassette at attI site of the integron under different concentration of streptomycin. Methods: Class 1 integron with known gene sequence was cloned into plasmid pACYC184 to produce recombinant plasmid pACIDA, meanwhile the integrase gene was cloned into plasmid pET28a to construct recombinant plasmid pETINT. These two recombinant plasmids were consecutively transformed into E. coli BL(DE3). These transformed bacteria was cultured in the LB medium at 37 ℃ overnight with addition of different concentration of streptomycin. The copy number of total integrons and the copy number of integrated aadA2 at attI site of integrons were determined by using real-time PCR. and the integration frequency is the result of the former divided by the latter. Results: The resulting frequencies were (1.97±0.24)×10^-3, (3.23±1.77)×10^-3, (3.27±0.67)×10^-3, 0.45±0.13 and 1.32±0.11, with respective streptomycin concentrations of 0, 20, 30, 40 and 50 μg/ml. The background frequency of integration without integrase overexpression was less than (1.75±0.33)×10^-7. Conclusion These findings indicate that antibiotic concentration significantly increase recombination frequency of aadA2 resistance cassette at attI site of the integron, catalyzed by integron integrase.(Chin J Lab Med, 2018, 41: 531-535)

Objective: To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population. Method: This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded. Any side effect associated with NCPAP were recorded. For categorical variables, comparisons were performed using Fisher test. Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables. The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis. Result: Totally 145 children were included, and 13 children were excluded due to incomplete data. One hundred and two children(77.3%)were ≤12 months; 91 children (68.9%) were from rural area. NCPAP ventilation was effective in 123 children, with a response rate of 93.2%, were all discharged with a better condition; it was ineffective in 9 children(6.8%), and they were all intubated and went on mechanical ventilation, 5 were discharged with a better condition, and 4 died after gaving up treatment. The gender, age, body weight, residence, main symptoms, main signs, imaging diagnosis, medications, partial pressure of oxygen(PaO₂), breath and heart rate before NCPAP treatment of two groups had no significant differences(allP>0.05). The rates of combining underlying diseases, trouble with feeding and cyanosis, and the partial pressure of carbon dioxide(PaCO₂ ) before NCPAP ventilation were higher in NCPAP ineffective group ((59±11 )vs.( 49±11) mmHg, 1 mmHg=0.133 kPa, t=-2.597, P=0.028); while the PaO₂/fraction of inspiration O₂ (FiO₂ ) before NCPAP was lower((150±37) vs. (207±63) mmHg, t=2.697, P=0.008). The breathing, heart rate and PaCO₂ of NCPAP effective group decreased significantly, while the PaO₂ and PaO₂/FiO₂ increased significantly after 2, 8, 24 h of NCPAP ventilation(all P=0.000). PaCO₂ in children with hypercapnia before NCPAP ventilation in NCPAP effective group decreased significantly ((48±9), (47±12), (45±11)vs.(58±7)mmHg, all P=0.000). All children tolerated well to NCPAP ventilation, and there were no severe side effects or complications associated with NCPAP ventilation. Conclusion NCPAP ventilation is safe and effectively improved the oxygenation and hypercapnia in infants with CAP. But it may not work well in children with underlying diseases, manifest as difficulty in feeding/cyanosis and extremely high PaCO₂ or low PaO₂/FiO₂, and they may need early intubation.

Background and objective Epidermal growth factor receptor (EGFR) and KRAS gene are important driver genes of non-small cell lung cancer (NSCLC).The studies are mainly focused on detection ofEGFR gene for advanced NSCLC,and the mutation feature of EGFR and KRAS gene in early NSCLC tissue is unknown.This study aims to investigate the mutations of EGFR and KRAS gene in NSCLC,and the relationship between the genotype and clinicopathologic features.Methods The hotspot mutations in EGFR and KRAS gene in 754 tissue samples of stage Ⅰ-Ⅲa NSCLC from Department of Pathology,Peking Union Medical College Hospital were detected by modified amplification refractory mutation system (ARMS) real-time PCR kit,and analyzed their correlation with clinical variables.Results The hotspot mutation rates in EGFR and KRAS were 34.5％ and 13.1％ respectively,and there were EGFR-KRAS double mutations in 3 samples.The mutation rate of EGFR was higher in females than that in males (39.5％ vs 29.4％,P=0.076),significantly increased in adenocarcinomas (38.7％) compared to that in the other forms of NSCLC (P＜0.01),but still lower than that reported in some Asian studies of advanced adenocarcinoma (-50％).Meanwhile,the mutation rate of KRAS was remarkably higher in males than that in females (16.6％ vs 9％,P=0.048),increased in adenocarcinomas compared to that in the other forms of NSCLC,but the difference was not significant (P=0.268).Samples harbored EGFR mutation were younger than those harbored KRAS mutation (P=0.031,5),and had significant difference in gender between the two groups (P＜0.01).Conclusion The mutation rate of EGFR in stag Ⅰ-Ⅲa NSCLC patients was lower than that in advanced NSCLC patients.And the percentage of the NSCLC patients with EGFRKRAS double mutations is 0.9％.