OBJECTIVE: To observe the auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery. METHODS: A total of 64 patients with lumbar disc herniation who underwent percutaneous lateral transforaminal endoscope surgery were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with injection of 1% lidocaine for routine local infiltration anesthesia. The patients in the observation group were treated with wrist-ankle acupuncture at lower 5 area and lower 6 area for 30 min, 5 min before routine local infiltration anesthesia; immediately, 15 min, 30 min after insertion the left-right technique, up-down technique, and rotation technique were applied for six times, respectively. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO) and pain visual analogue scale (VAS) were compared between the two groups at the time points of intraoperative puncture (T), circular saw grinding (T), and placement of working channel (T). The intention of reoperation was recorded immediately after operation and 24 h after operation. The expectation and treatment credibility scale (ETCS) was used to evaluate the relationship between patients' expectation and efficacy 5 min before operation and immediately after operation. RESULTS: At T and T during the operation, the MAP and HR in the obserrvation group were lower than those in the control group, while SpO was higher than that in the control group (<0.05). At T, there was no significant difference of MAP, HR and SpO between the two groups (>0.05). At T, the peak VAS and average VAS in the observation group were lower than those in the control group (<0.05), but there was no significant difference at T and T (>0.05). The intention of reoperation in the observation group was higher than that in the control group both immediately after operation and 24 h after operation (<0.05). In the observation group, the scores of each item in ETCS immediately after operation were higher than those 5 min before operation (<0.05), while in the control group there was no significant difference between immediately after operation and 5 min before operation (>0.05). The scores of ETCS1, ETCS2 and ETCS3 immediately after operation in the observation group were higher than those in the control group (<0.05). CONCLUSION The wrist-ankle acupuncture has positive auxiliary analgesic effect on lumbago during transforaminal endoscope surgery, and strengthens the patients' confidence on the operation effect.

A 22-year-old man suffered from acute pulmonary hemorrhage and deteriorated renal function occurred within 3 days after traumatic brain injury. Mechanical ventilation cannot correct his severe hypoxemia, therefore, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated and finally resolved his hypoxemia. Concomitantly, continuous renal replacement therapy was performed to improve his kidney function. Although no anti-glomerular basement membrane (anti-GBM) antibody was detected in serum, Goodpasture's syndrome was considered. After treated with methylprednisolone pulse therapy and plasmapheresis, his renal function was significantly improved. ECMO was eventually discontinued after 60 hours of treatment and extubated on day 10. He was discharged home with normal pulmonary and renal functions.

Objective To evaluate the value of texture features derived from intravoxel incoherent motion (IVIM) parameters for differentiating pancreatic neuroendocrine tumor (pNET) from pancreatic adenocarcinoma (PAC).Methods Eighteen patients with pNET and 32 patients with PAC were retrospectively enrolled in this study. All patients underwent diffusion-weighted imaging with 10 b values used (from 0 to 800 s/mm ). Based on IVIM model, perfusion-related parameters including perfusion fraction (f), fast component of diffusion (D) and true diffusion parameter slow component of diffusion (D) were calculated on a voxel-by-voxel basis and reorganized into gray-encoded parametric maps. The mean value of each IVIM parameter and texture features [Angular Second Moment (ASM), Inverse Difference Moment (IDM), Correlation, Contrast and Entropy] values of IVIM parameters were measured. Independent sample t-test or Mann-Whitney U test were performed for the between-group comparison of quantitative data. Regression model was established by using binary logistic regression analysis, and receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency.Results The mean f value of the pNET group were significantly higher than that of the PAC group (27.0% vs. 19.0%, P = 0.001), while the mean values of D and D showed no significant differences between the two groups. All texture features (ASM, IDM, Correlation, Contrast and Entropy) of each IVIM parameter showed significant differences between the pNET and PAC groups (P=0.000-0.043). Binary logistic regression analysis showed that texture ASM of D and texture Correlation of D were considered as the specific imaging variables for the differential diagnosis of pNET and PAC. ROC analysis revealed that multiple texture features presented better diagnostic performance than IVIM parameters (AUC 0.849-0.899 vs. 0.526-0.776), and texture ASM of D combined with Correlation of D in the model of logistic regression had largest area under ROC curve for distinguishing pNET from PAC (AUC 0.934, cutoff 0.378, sensitivity 0.889, specificity 0.854).Conclusions Texture analysis of IVIM parameters could be an effective and noninvasive tool to differentiate pNET from PAC.
Adenocarcinoma ; diagnostic imaging ; Adult ; Aged ; Algorithms ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Male ; Middle Aged ; Motion ; Pancreatic Neoplasms ; diagnostic imaging ; Retrospective Studies

The study aims at investigating the grade standard and the quality characteristic of Pinelliae Rhizoma for commodity specification, which provides the reference for its grade standard formulation. 42 Pinelliae Rhizoma simples were collected from 5 medicinal materials markets and 2 producing areas. Based on the previous herbalogical study and market investigation, we combined with the data analysis to select the grading indicators using SPSS software for descriptive statistical analysis, analysis of variance, K-cluster analysis and correlation analysis. According to the actual production condition, we developed the grading standards of Pinelliae Rhizoma. Moreover, we compared the internal indicators(water, total ash, leachate and guanosine) of Pinelliae Rhizoma at various grade levels, and analyzed the correlation between appearance traits and internal indicators. The herbalogical study and market research found that the Pinelliae Rhizoma was better in large, solid and white. The results from descriptive and variance analysis showed that the appearance of Pinelliae Rhizoma was significantly different in weight per grain and grain number of 500 g. Referring to the 2015 Chinese Pharmacopoeia and the production practice, we use the length, weight per grain and grain number of 500 g as the classification index of Pinelliae Rhizoma. The results from correlation analysis showed that there was no significant correlation between the appearance of Pinelliae Rhizoma and the intrinsic quality index. In addition, we found there was no significant difference in the content of the intrinsic index except for the total ash and the extract. The current study established the classification index of the product specification and grade standard of Pinelliae Rhizoma with length, weight per grain and grain number of 500 g as the index, which can provide the basis for the classification of the product specification and grade of Pinelliae Rhizoma market.
Drugs, Chinese Herbal ; standards ; Pinellia ; chemistry ; Rhizome ; chemistry

OBJECTIVE: To explore clinical effects of ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures. METHODS: From January 2015 to March 2017, 20 patients with acute closed Achilles tendon rupture were treated by minimal traverse-cross technique repair with ultrasound guided. Among them, including 13 males and 7 females, aged from 28 to 49 years old with an average of(31.3 ±4.5) years old. All patients were single side injury. Fifteen patients on the left side and 5 patients were on the right side. The time from injury to operation ranged from 1 to 5 days with an average of (2.5±0.7) days. Operative time, postoperative complications were observed, and AOFAS score before and after operation at 12 months were compared. RESULTS: All patients were followed up for 12 to 27 months with an average of(15.2±4.9) months. Operative time ranged from 33 to 65 min with an average of(43.7±5.6) min. Incision of one patient were continued oozing and improved after changing dressings, other patients were healed at stage I. No sural nerve irritation symptoms and palindromic rapture of heel tendon occurred. AOFAS score was improved from 65.2±7.4 before operation to 97.7±4.7 after operation at 12 months (t=22.5, <0.01); 18 patients got excellent results and 2 good. CONCLUSIONS Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.
Achilles Tendon ; Adult ; Female ; Humans ; Male ; Middle Aged ; Rupture ; Sural Nerve ; Sutures ; Tendon Injuries ; Treatment Outcome

Objective To investigate the clinical value of preoperative lymphocyte-to-monocyte ratio(LMR)in evaluating the prognosis of patients with stage T1 non-muscle invasive bladder cancer(NMIBC).Methods A total of 215 patients with stage T1 NMIBC who underwent transurethral resection of bladder tumor were enrolled.Clinical data were collected.Patients were followed up and their disease-free survival(DFS)and overall survival(OS)were recorded.The receiver operating characteristic(ROC)curve of preoperative LMR in detecting patient prognosis was used to determine the optimal cut-off value for LMR.Patients were divided into low LMR group(LMR <3.86,=77)and high LMR group(LMR ≥ 3.86,=138).Kaplan-Meier survival curves were explored to compare cumulative DFS and OS rates in patients with different LMR levels,and COX proportional hazards regression model was used to analyze factors associated with DFS and OS.Results All these 215 patients with T1 stage NMIBC were followed up for 2-92 months,and the DFS rate was 59.07% and OS rate was 65.12%.Kaplan-Meier curves showed that the cumulative DFS rate(=4.784,=0.029)and cumulative OS rate(=7.146, =0.008)in the low LMR group were significantly lower than those in the high LMR group.Tumor size ≥ 3 cm(=1.398,95% :1.042-1.875,=0.025),pathological grade G3(=1.266,95% :1.026-1.563,=0.028),and LMR ≥ 3.86(=2.347,95% :1.080-5.101,=0.031)were independent factors associated with DFS in patients with stage T NMIBC.In addition,tumor size ≥ 3 cm(=1.228,95% :1.015-1.484,=0.034),pathological grade G3(=1.366,95% :1.017-1.834,=0.038),and LMR<3.86(=2.008,95% :1.052-3.832,=0.035)were independent factors associated with OS in patients with T1 stage NMIBC. Conclusion Preoperative LMR is an independent factor associated with patients' prognosis in T1 stage NIMBC.Patients with low LMR tend to have higher risk of NMIBC progression and death.
Disease-Free Survival ; Humans ; Lymphocytes ; cytology ; Monocytes ; cytology ; Prognosis ; Retrospective Studies ; Survival Rate ; Urinary Bladder Neoplasms ; diagnosis ; pathology

Bupleurum polysaccharides (BPs) is isolated from Bupleurum smithii var. parvifolium, a key traditional Chinese medicine. The study was to investigate the effects of BPs on diabetic kidney injury. After two intraperitoneal injections of streptozotozin (STZ) 100 mg·kg, renal injury in diabetic mice was induced and BPs was orally administrated at dosages of 30 and 60 mg·kg·d. The STZ injected mice developed renal function damage, renal inflammation and fibrosis known as diabetic kidney disease (DKD). BPs significantly reduced serum creatinine level and urinary albumin excretion rate, with the attenuated swelling of kidneys. BPs treatment obviously alleviated the pathological damage of renal tissue. The progression of renal injury in BPs treated mice was inhibited with less expression of type IV collagen (Col IV), fibronectin (FN) and α-smooth muscle actin (α-SMA). The inhibition of inflammation in kidney was associated with the reduced level of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). BPs administration suppressed the over-expression of toll like receptor 4 (TLR4) and high-mobility group box 1 (HMGB1) with lowered activity of nuclear factor kappa B (NF-κB) in renal tissue of diabetic mice. Oral administration of BPs effectively prevented the development ofrenal injury in diabetic mice. This study suggested that the protection provided by BPs might affect through the interruption of HMGB1-TLR4 pathway, leading to the inhibition of renal inflammation and fibrotic process.

BACKGROUND: With the wide application of the proximal closing wedge osteotomy in treatment of hallux valgus deformity, the metatarsal shortening and metatarsal elevation are constantly being mentioned. Scholars even think that the operation is complicated, the technical requirements are high, and the incidence of complications is high, and other osteotomy should be used instead. However, through literature research and clinical experience, it is found that the facts are not completely the case. OBJECTIVE: To perform geometric study of the plane and the physical model of the proximal closing wedge osteotomy so as to reasonably evaluate the effect of this technique on metatarsal shortening and metatarsal elevation. METHODS: The research was divided into four stages, in which the first three stages were plane geometric researches, with weight-bearing frontal image of the patient with hallux valgus as the research materials; the fourth one was solid geometric research, with plaster model of the first metatarsal bone as the research material. In research I (Stage I), the changes in 1/2 inter-metatarsal angle, length of the first metatarsal and distal metatarsal articular angle were learnt through angle adjustment after clipping when the distance from the wedge osteotomy vertex to medial border of the first tarsometatarsal joint was different (B, A, C, D respectively from the near to the distant, with a distance of 10 mm). In research II (Stage II), the changes in 1/2 inter-metatarsal angle, length of the first metatarsal and distal metatarsal articular angle were learnt through angle adjustment after clipping when the distance from the wedge osteotomy vertex to medial and lateral connection of the first tarsometatarsal joint was same, and the distance from the wedge osteotomy vertex to axis of the first metatarsal bone was different. In research III (Stage III), the changes in the above-mentioned research indexes were studied through angle adjustment after clipping when the wedge osteotomy vertex and wedge angle were fixed, but the proximal osteotomy line slope was different. Research IV (Stage IV) was the simulated osteotomy comparison, osteotomy perpendicular to metatarsal backbone or perpendicular to the horizontal plane was conducted on the model through plaster casting, and then osteotomy section was closed; the changes in elevation of the metatarsal head, 1/2 inter-metatarsal angle and length of the first metatarsal bone were measured. RESULTS AND CONCLUSION: (1) Results of plane geometry: The closer the wedge osteotomy vertex was to the proximal end, the larger the correction gained was and the smaller the changes in the distal metatarsal articular angle were, but the shortening was more obvious. Moreover, the closer the wedge osteotomy vertex was to the axis of the metatarsal bone, the smaller the shortening was; if only the proximal osteotomy line was different, the indices were the same. (2) Results of stereoscopic geometry: In the case of the same osteotomy angle, the cuneiform bone of the same angle was intercepted, and the degree of correction was obviously greater than that of the plane geometry. This should be related to the thickness of the osteotomy saw and the loss of bone mass caused by the osteotomy. The metatarsal bone was significantly higher after correction when perpendicular to the metatarsal stem compared with that perpendicular to the horizontal surface. In 1/2 inter-metatarsal angle, the difference between the two was only 1°. In metatarsal shortening, it was smaller when perpendicular to the metatarsal stem compared with that perpendicular to the horizontal surface. (3) In conclusion, a. the optimal wedge osteotomy vertex is not at the medial border of the joint but is 1 cm from the medial border of the joint; then, it will approach the axis of the metatarsal. In this way, good correction, steady fixation and further reduction of metatarsal shortening can be achieved. b. The optimal direction of the oscillating saw blade is perpendicular to horizontal plane; however, an approximately perpendicular position to the horizontal plane is acceptable. It does not affect the effect of orthopedics, and further reduces the metatarsal shortening. When the bony closure is closed, the distal end of the metatarsal bone is taken to avoid the elevation of the metatarsal bone with a 2 mm step with the proximal end. c. The angle selection of proximal osteotomy surface can be placed on the metatarsal stem according to the internal fixation condition, and it can also form an acute angle with the metatarsal stem, so that the effect of osteotomy will not be changed.

BACKGROUND: Skin-derived precursor cells play a regenerative role in wound healing, which can restore the physiological and aesthetic features of the skin by mitosis, proliferation and migration to the injury region. OBJECTIVE: To observe the structure of the mouse tail and the healing of the broken end, and then to investigate the correlation of these characteristics with the repair of skin trauma at the tail. METHODS: The tails of 2-day-old Kunming mice were cut off using ophthalmic microsurgical scissors to establish the mouse model of hair follicle regeneration in the tail. Regions in which the cells proliferated actively were determined. Wound healing samples were regularly taken, and embedded using OCT. Wound healing of the broken end was routinely observed by pathological staining. Cell proliferation was observed by immunofluorescence. Expression of AP-1 in the healing site was identified by immunofluorescent staining. RESULTS AND CONCLUSION: The structure of the mouse tail was complex, with rich blood supply. Good healing was observed in the broken end of the mouse tail. The cells in the hair follicles and dermal papillary layer showed active proliferation and mitosis, and thereby participated in wound repair and regeneration. Fluorescence staining results found that the positive expression of AP-1 was mainly concentrated in the epidermis and dermal papilla. These findings indicate that the epidermis and dermal papilla possess a strong ability to regenerate.

Objective To explore the value of intra-voxel incoherent motion diffusion weighted imaging(IVIM-DWI)in brain perfusion of early hypertensive patients. Methods Totally 36 hypertensive patients and 14 volunteers were recruited and scanned using routine MRI sequences including axial T2WI, T1WI, T2FLAIR, TOF-MRA and IVIM-DWI sequence. Perfusion-related diffusion coefficient (D*) values and perfusion fraction (f) values in various regions were measured separately.The independent sample t test was used to analyze the data.Results Compared with the volunteers,both D*values and f values in lenticular nucleus,thalamus,superior frontal gyrus,occipital lobe,genu of corpus callosum(CC)and posterior horns of periventricular WM, were found to be lower (P<0.05) in hypertensive patients. For other regions, there were no significant difference(P>0.05).Conclusion IVIM-DWI has the ability to detect subtle brain perfusion abnormalities at early stages of hypertension.It has an important value to the prevention and treatment of hypertensive encephalopathy.