OBJECTIVE: To compare the therapeutic effect of plum-blossom needle tapping at three meridians of wrist combined with rehabilitation training and simple rehabilitation training on wrist joint contracture after stroke. METHODS: A total of 72 patients with wrist joint contracture after stroke were randomized into an observation group and a control group, 36 cases in each one. In the control group, simple rehabilitation training was applied, 5 times a week, 3 weeks as one course and totally 3 courses were required. On the basis of the treatment in the control group, plum-blossom needle tapping at three meridians of wrist was adopted in the observation group. The tapping regions were wrist traveling parts of three meridians of hand, ranging from up 3 to below 1 of wrist crease, 3 times a week, 3 weeks as one course and totally 3 courses were required. The active range of motion (AROM) of active wrist extension, Fugl-Meyer score (FMA) and Barthel index (BI) score were observed before and after treatment in the two groups. RESULTS: The AROM, FMA scores and BI scores after treatment in the two groups were superior to before treatment (<0.05), and the improvements of 3 indexes in the observation group were superior to the control group (<0.05). CONCLUSION The therapeutic effect of plum-blossom needle tapping at three meridians of wrist combined with rehabilitation training is superior to simple rehabilitation training on wrist joint contracture after stroke.
Acupuncture Therapy ; Contracture ; etiology ; therapy ; Humans ; Meridians ; Stroke ; complications ; Stroke Rehabilitation ; Treatment Outcome ; Wrist ; Wrist Joint

Objective: To explore the feasibility of Sonography based Volume Computer Aided Display Heart (SonoVCADheart) in the display of the fetal ventricular outflow views, and compare diameters of fetal aorta (AO) and pulmonary artery (PA) measured by two-dimensional echocardiography (2DE) and SonoVCADheart. Methods: Eighty singleton fetuses in the second and third trimesters of pregnancy in January 2019 in Sir Run Run Shaw Hospital, Zhejiang University College of Medicine were enrolled. Conventional 2DE examinations were performed. The volume datasets were analyzed offline using the new automatic image processing software SonoVCADheart. The diameters of AO and PA were measured by 2DE and SonoVCADheart, respectively. Pearson correlation analysis was used to evaluate the correlation between the two methods. The consistency of the two methods was verified by Bland-Altman analysis, and he reliability of SonoVCADheart was assessed using the intraclass correlation coefficient (ICC). Results: Fetal ventricular outflow views were successfully obtained using SonoVCADheart in 73(91.2%) of 80 fetuses. There were good correlations between the two methods for measuring the diameters of AO and PA (r=0.953, 0.971; all P<0.001). The 95% agreement limits of AO and PA were (-0.669, 0.568)mm and (-0.632, 0.580)mm, respectively. ICC demonstrated that SonoVCADheart achieved great repeatability both between and within observers. Conclusions SonoVCADheart may have potentials for the quantitative evaluation of fetal ventricular outflow tracts with its good repeatability and reliability.

Objective: To explore the clinical value of magnetic resonance T₂-mapping imaging in the diagnosis of early intervertebral disc degeneration in obese people. Methods: From January 2018 to June 2019, 30 obese volunteers and 30 healthy volunteers with normal weight underwent T₂-mapping scan, while their routine MRI examination showed no abnormalities were slected.The T2 value of nucleus pulposus in both two groups were measured and compared. Results: The T2 values of nucleus pulposus of intervertebral disc of lumbar 1-2, lumbar 2-3, lumbar 3-4, lumbar 4-5 and lumbar 5-sacral 1 in the control group were (108.17±10.87)ms, (113.93±11.54)ms, (126.65±10.22)ms, (118.62±8.86)ms and (111.61±10.65)ms, respectively, which of nucleus pulposus in different segments was statistically significant(F=14.28, P<0.001). The T2 values of nucleus pulposus of intervertebral disc of lumbar 1-2, lumbar 2-3, lumbar 3-4, lumbar 4-5, lumbar 5-sacral 1 in the simple obesity group were (104.90±7.67)ms, (101.10±6.61)ms, (112.65±5.75)ms, (98.27±6.18)ms, (89.82±6.34)ms, respectively, , which of nucleus pulposus in different segments was statistically significant(F=49.52, P<0.001). There were statistically significant differences in the T2 values of nucleus pulposus of intervertebral disc of lumbar 2-3, lumbar 3-4, lumbar 4-5, lumbar 5-sacral 1 between the two groups(t=5.283, 6.535, 10.327, 9.626, all P<0.001). Conclusion Magnetic resonance T₂-mapping can detect early changes in tissue composition of intervertebral disc degeneration.Therefore, magnetic resonance T₂-mapping imaging technology can provide an important reference for the early diagnosis of intervertebral disc degeneration in obese people.

AIM: To investigate the therapeutic effect and safety of ranibizumab and conbercept on macular edema secondary to non-ischemic retinal vein occlusion.

METHODS: Totally 80 cases(80 macular edema eyes)with macular edema secondary to non-ischemic retinal vein occlusion patients enrolled into our hospital from March 2014 to May 2018 were collected into our study and randomly divided into the group A(40 cases)and the group B(40 cases). The patients in the group A and group B underwent ranibizumab and conbercept intravitreal injections, respectively. The intraocular pressure, central macular thickness(CMT), best corrected visual acuity(BCVA)and central macular volume(CMV), the number of injections and the occurrence of ocular complications before and after treatment of 2 groups were recorded and compared.

RESULTS: After treatment 2wk to 3mo, compared with the group A, the CMT, BCVA, CMV and the cases of intravitreal injections had decreased(P<0.05), meanwhile the visual acuity had increased in the group B(65% vs 38%, P<0.05), however, there was no significant difference in the incidence of complications between the two groups(5% vs 0%, P=0.999).

CONCLUSION: Compared with the ranibizumab, the conbercept has advantage in treatment of macular edema secondary to non-ischemic retinal vein occlusion by improving the visual acuity, reducing the CMT, CMV and the times of intravitreal injections.

Posterior internuclear ophthalmoplegia is a rare sign of pons infarction.Due to its mild clinical symptoms,it is easily misdiagnosed.In this article,we report a case of posterior internuclear ophthalmoplegia caused by pons infarction,discuss the causes of misdiagnosis and hope to attract the attention of doctors.By analyzing the clinical features of the case and reviewing the literatures,we try to differentiate the disease from multiple sclerosis,pons tumors and other diseases.The diagnosis was confirmed with thorough physical examination,laboratory test and imaging examination.Posterior internuclear ophthalmoplegia is a sign of pons infarction.

Objective To evaluate the application value of fetal heart echocardiography intelligent navigation (5D Heart) in the display of key diagnostic elements in five rapid screening fetal echocardiographic views.Methods Three hundred and eighty-four 3D volume datasets of 220 normal singleton fetuses in the second and third trimesters were acquired.After processing the datasets using 5D Heart,five rapid screening views were acquired,and 21 key diagnostic elements of the five cardiac diagnostic sections were graded.The 2 test was used to compare the difference in the key diagnostics elements of the five rapid screening views between 5D heart and the traditional technique.Pearson correlation was used to compare the detection rate of key diagnostic elements between 5D Heart technique and traditional two-dimensional echocardiography in normal fetuses and fetuses with congenital heart disease.The rank sum test was used to detect the consistency and reliability of the results.Results A total of 384 fetal volume datasets were obtained from 220 fetuses,of whom 317 heart volume datasets were available for analysis,with a success rate of 82.6％.There was no difference in the key diagnostic elements of the five rapid screening views between 5D heart and the traditional technique (x2=5.17,P=0.27).Compared with the abnormal fetal heart group (89.6％),the detection rate of diagnostic elements in the normal fetal heart group was 85.2％ (r=0.94,P=0.02).No significant differences were found when comparing the grading results of one observer in different periods of time,the grading results between two experienced doctors,or the grading results among the experienced doctor and one relatively inexperienced doctor (P ＞ 0.05).Conclusions Fetal cardiac ultrasound intelligent navigation technique has high reliability and repeatability in obtaining fetal rapid screening views and displaying fetal elemental diagnostic information.It has tremendous potential in standardized data collection and analysis of cardiac diagnostic sections in fetuses with congenial heart disease,as well as in training and teaching,remote medical consultation,and screening in primary hospitals.

Objective To explore the feasibility of smart-planes fetal heart ( S-planes FH ) in the display of the fetal ventricular outflow views ,and to compare diameters of fetal aorta ( AO) and pulmonary artery (PA) measured using two-dimensional echocardiography(2DE) and S-planes FH . Methods One hundred and eighty-five fetuses with gestational age of 17 - 36 weeks were enrolled . Each fetus had undergone conventional 2DE examination and the three-dimensional fetal cardiac volume datasets were obtained . The volume datasets were analyzed offline using S-planes FH . The diameters of AO and PA were measured by 2DE and S-planes FH ,respectively . Pearson correlation analysis was used to evaluate the correlation between the two methods for measuring the diameters of AO and PA . The consistency of the two methods was verified by Bland-Altman analysis . Results Fetal ventricular outflow views were successfully obtained using S-planes FH in 173 ( 93 .5％ ) cases of 185 fetuses whose ventricular outflow views were satisfactorily obtained by fetal 2DE . There were close correlations between the two methods in measuring the diameters of AO and PA ( r = 0 .84 , P = 0 .04; r = 0 .81 , P = 0 .00 ) . Bland-Altman analysis showed a close consistency between the two methods ,and their 95％ confidence intervals were ( -1 .17 ,1 .00) and ( -1 .79 ,1 .02) ,respectively . Conclusions There is a close consistency between S-planes FH and 2DE in measuring fetal AO and PA . S-planes FH may have potential for the evaluation of fetal ventricular outflow .

Objective    To explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy. Methods    The clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups. Results    Postoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001). Conclusion    Compared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.

Objective To study the influence of postnatal age and season of sample collection on congenital hypothyroidism (CH) screening and to determine the appropriate cut-off value. Method From January 2015 to December 2017, neonatal thyroid stimulating hormone (TSH) screening data in Guangzhou were retrospectively analysed. The infants were assigned into four groups according to sampling postnatal age:24～＜48 h, 48～＜72 h, 3～＜7＜d and≥7 d, and assigned into another four groups according to their birth seasons. Based on the data of 2015 and 2016, the cut-off value of TSH for hypothyroidism were adjusted. The data of 2017 were used to verify the accuracy of the adjusted cut-off value. The cut-off value was determined based on the receiver operating characteristic (ROC) curve and percentile method. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of the cut-off value were also calculated. Result A total of 459854 newborns were screened from 2015 to 2016. 7329 were positive in preliminary screening, 371 were still positive after recall for re-examination, and 318 were confirmed with CH eventually. The optimal TSH cut-off value calculated using ROC curve was 9 mIU/L, with a percentage of 98.7. The cut-off value with sampling time≥48 h was set to 9 mIU/L in spring, summer and autumn, and 10 mIU/L in winter. The cut-off of sampling time 24～＜48 h was set to 10 mIU/L in all seasons. The data of 264993 newborns screened in 2017 were verified using the adjusted cut-off value. The overall positive rate was reduced from 1.27％to 1.02％, and the PPV was increased from 6.07％to 7.58％without adding false negative cases. Conclusion Adjusting cut-off values of TSH for CH screening according to postnatal age and season can effectively reduce false positive rates.

To explore the effect of post-pyloric feeding by spiral nasoenteric tubes on ventilator-associated pneumonia (VAP) in neurocritical care patients. Methods A retrospective study was performed to analyze the clinical data of 175 neurocritical care adult patients with mechanical ventilation (MV) more than 48 hours, who were enrolled in three randomized controlled trials (RCT) conducted by Guangdong Provincial People's Hospital for post-pyloric tube placement between April 2012 to March 2019. The following patient clinical data were collected when patients were enrolled: gender, age, neurologic diagnosis, comorbidities, medication, endotracheal reintubation, bronchoscope treatment, the distal site of nasoenteric tubes, and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, Glasgow coma scale (GCS) score, and acute gastrointestinal injury (AGI) grade assessed. Patients were divided into VAP group and non-VAP group according to the occurrence of VAP, and the differences of each index between the two groups were compared. Then the influencing factors of P < 0.1 were included in multivariate Logistic regression analysis to identify the potential risk factors affecting the incidence of VAP. Furthermore, patients were divided into gastric feeding group and post-pyloric feeding group according to the distal site of nasoenteric tubes, and subgroup analysis was performed to evaluate the variety of VAP in patients with different tube sites and status. Results ① Forty-two patients occurred VAP in 175 MV patients, and the incidence of VAP was 24.0%. ② Univariate analysis showed the P value of post-pyloric feeding, APACHE Ⅱscore, GCS score and bronchoscope treatment were less than 0.1, and post-pyloric feeding and GCS score in VAP group were significantly lower than those in non-VAP group [post-pyloric feeding: 19.0% (8/42) vs. 36.8% (49/133), GCS:5 (3, 7) vs. 6 (4, 9), both P < 0.05]. Multivariate Logistic regression analysis indicated that post-pyloric feeding was independent protective factor [odds ratio (OR) = 0.360, 95% confidence internal (95%CI) = 0.151-0.857, P = 0.021] and bronchoscope treatment was the independent risk factor (OR = 2.210, 95%CI = 1.051-4.647, P = 0.036) for VAP. ③ The incidence of VAP was 28.8% (34/118), 0% (0/4), 8.3% (1/12), 26.7% (4/15), 22.2% (2/9) and 5.9% (1/17) respectively when tube tip in stomach, D1, D2, D3, D4 and jejunum confirmed by abdominal radiography. Post-pyloric feeding in each proportion seemed to present lower VAP rate compared with gastric feeding, however, no significant difference was found (all P > 0.05). ④ The incidence of VAP in post-pyloric feeding group was significantly lower than that in gastric feeding group [14.0% (8/57) vs. 28.8% (34/118), OR = 0.403, 95%CI = 0.173-0.941, P = 0.032]. Lower VAP rate appeared on patients with SOFA < 12 (OR = 0.392, 95%CI = 0.154-0.995, P = 0.044) and AGI grade ≥Ⅱ (OR =0.086, 95%CI = 0.011-0.705, P = 0.006) fed by post-pyloric route according to the result of subgroup analysis stratified by age, gender, APACHEⅡ score, SOFA score and AGI grade. Conclusion Post-pyloric feeding would decrease the incidence of VAP in neurocritical care patients on MV.