This paper analyzed the causes of peripheral nerve injury induced by acupoint injection, and proposed methods for prevention. These methods included emphasizing the physicochemical properties of medications and strengthening research on medication compatibility, classifying high-risk acupoints and establishing international standards for safe acupoint needling, standardizing clinical procedures for acupoint injection, and incorporating ultrasound technology when necessary to improve the accuracy and safety of the procedure. These strategies aimed to reduce the risk associated with the clinical application of acupoint injection.
Humans ; Peripheral Nerve Injuries/prevention & control* ; Ultrasonography ; Acupuncture Points ; Injections/adverse effects*

Background::An evidence gap still exists regarding the efficacy and safety of tegoprazan in patients with erosive esophagitis (EE) in China. This study aimed to verify the efficacy and safety of tegoprazan vs. esomeprazole in patients with EE in China. Methods::This study was a multicenter, randomized, double-blind, parallel, active-controlled, non-inferiority phase III trial of patients with EE randomized 1:1 to tegoprazan 50 mg/day vs. esomeprazole 40 mg/day. This study was conducted in 32 sites between October 24, 2018 and October 18, 2019. The primary endpoint was the cumulative endoscopic healing rate at week 8. The secondary endpoint included endoscopic healing rate at week 4, changes in the reflux disease questionnaire (RDQ) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and symptom improvement. Results::A total of 261 patients were randomized: 132 to the tegoprazan group and 129 to the esomeprazole group. The cumulative endoscopic healing rate at 8 weeks in the tegoprazan group was non-inferior to that of the esomeprazole group (91.1% vs. 92.8%, difference: -1.7%, 95% confidence interval [CI]: -8.5%, 5.0%, P = 0.008). There were no statistically significant differences in the changes in RDQ (total, severity, and frequency) and GERD-HRQL scores between the two groups (all P >0.05). The percentages of days without symptoms, including daytime and nighttime symptoms based on patients' diaries, were similar between the two groups (all P >0.05). In the tegoprazan and esomeprazole groups, 71.5% (93/130) and 61.7% (79/128) of the participants reported adverse events (AEs), 2.3% and 0 experienced serious AEs, while 70.0% and 60.2% had treatment-emergent AEs, respectively. Conclusion::Tegoprazan 50 mg/day demonstrated non-inferior efficacy in healing EE, symptom improvement, and quality of life, and it has similar tolerability compared with esomeprazole 40 mg/day.

Background::An evidence gap still exists regarding the efficacy and safety of tegoprazan in patients with erosive esophagitis (EE) in China. This study aimed to verify the efficacy and safety of tegoprazan vs. esomeprazole in patients with EE in China. Methods::This study was a multicenter, randomized, double-blind, parallel, active-controlled, non-inferiority phase III trial of patients with EE randomized 1:1 to tegoprazan 50 mg/day vs. esomeprazole 40 mg/day. This study was conducted in 32 sites between October 24, 2018 and October 18, 2019. The primary endpoint was the cumulative endoscopic healing rate at week 8. The secondary endpoint included endoscopic healing rate at week 4, changes in the reflux disease questionnaire (RDQ) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and symptom improvement. Results::A total of 261 patients were randomized: 132 to the tegoprazan group and 129 to the esomeprazole group. The cumulative endoscopic healing rate at 8 weeks in the tegoprazan group was non-inferior to that of the esomeprazole group (91.1% vs. 92.8%, difference: -1.7%, 95% confidence interval [CI]: -8.5%, 5.0%, P = 0.008). There were no statistically significant differences in the changes in RDQ (total, severity, and frequency) and GERD-HRQL scores between the two groups (all P >0.05). The percentages of days without symptoms, including daytime and nighttime symptoms based on patients' diaries, were similar between the two groups (all P >0.05). In the tegoprazan and esomeprazole groups, 71.5% (93/130) and 61.7% (79/128) of the participants reported adverse events (AEs), 2.3% and 0 experienced serious AEs, while 70.0% and 60.2% had treatment-emergent AEs, respectively. Conclusion::Tegoprazan 50 mg/day demonstrated non-inferior efficacy in healing EE, symptom improvement, and quality of life, and it has similar tolerability compared with esomeprazole 40 mg/day.

Objective:To observe the effects of ointment and massage on inflammation, oxidative stress and angiogenesis after skeletal muscle trauma, and to explore their mechanisms.Methods:Forty-two adult male Sprague-Dawley rats were randomly divided into a blank group ( n=6), an ointment and massage (O&M) group ( n=18) and a model group ( n=18). The blunt contusion model of gastrocnemius malformation was established in both the O&M and model groups using self-made percussion instruments. Two hours after successful modeling, the anti-inflammatory pain-relieving cream was applied to the injured area, and massaged evenly and gently for 5 minutes. That was repeated with an interval of 12 hours. No treatment was given to the model and blank groups. On the 1st, 3rd and 7th days after modeling, injured gastrocnemius muscles were resected after collecting abdominal blood. Hematoxylin-eosin (HE) staining and immunofluorescent (CD34) staining were applied, and serum superoxide dismutase (SOD) and malondialdehyde (MDA) contents were detected. Results:HE staining showed that at each time point the gastrocnemius muscle fibers of the model group were significantly more swollen and deformed, collapsed and dissolved than those of the blank group, with a large number of inflamed cells. The O&M group had better recovery, with more newly-generated muscle cells, less inflammatory infiltration and more normal cell shapes than the model group. Fluorescence was stronger in the O&M and model groups than in the blank group at each time point, with that of the O&M group significantly stronger than in the model group. The average SOD and MDA levels in the model and O&M groups were significantly higher than in the blank group, and on the 1st and 3rd days the O&M group′s average SOD level was significantly higher than the model group′s average, though by the 7th day there was no significant difference. The average MDA content of the O&M group was significantly lower than the model group′s average at each time point.Conclusion:Ointment and massage can effectively reduce the local inflammatory response and oxidative stress after a skeletal muscle injury. They can accelerate local angiogenesis, promoting the repair of damaged tissues.

Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.

Objective To evaluate the clinical outcomes of minimally invasive internal fixation for femoral intertrochanteric fracture in osteoporotic elderly patients. Methods A retrospective study was conducted in 112 patients using interan nail (IN) or trochanteric antegrade nail (TAN) for the management of intertrochanteric femoral fracture from January 2009 to September 2015 in our hospital. According to AO classification, there were 34 cases of type 31-A.1, and 61 cases of type 31-A.2, 17 cases of type 31-A.3. Clinical and radiological follow-up were available. Surgical and fluoroscopic time, length of hospital stay, blood loss, complications and hip functions were compared between two groups. Results A total of 78 patients meeting the criteria were evaluated at a mean follow-up of 15 months (range, 3-27 months). The IN was used in 41 patients and the TAN in 37 patients. Operative time, fluoroscopy time and blood loss showed significant difference between the IN group and TAN group (respectively, 58.9±6.9 vs. 75.6±5.9min; 2.70±0.47 vs. 4.40±0.47min; 107.6±6.7 vs. 127.8±6.8ml, P<0.05), suggesting that patients treated with the IN experienced shorter operative and fluoroscopy times, less blood loss and better hip function (73%) than those with TAN (65%, P<0.05). Rate of postoperative complications was lower in the IN group (4.9%) than in the TAN group (10.8%, P<0.05). There was no difference in hospital stay and fracture healing time between the two groups (P>0.05). Conclusions For minimally invasive treatment of unstable femoral intertrochanteric fractures, use of either the IN or TAN is clinically effective. However, IN presents more advantages (e.g., easy operation, reliable fixation, less bleeding, better clinical outcomes, and less complications). The use of IN is a suitable option for the treatment of unstable intertrochanteric fractures in osteoporotic elderly patients.

Objective To evaluate the efficacy and safety of embolization therapy with NBCA for intracranial arteriovenous fistula (AVF) in infants. Methods Four patients with cerebral arteriovenous fistula were reported, including 3 males and 1 female with nonspecific symptoms and signs, and the diagnosis was made by DSA. Three of them were treated by embolization therapy with NBCA. Results Three of the cases were treated by NBCA, neither death nor complication occurred. Conclusion Intracranial AVF is rare in childhood. Endovascular treatment with NBCA is effective and safe, but the long-term effect has to be comfirmed by follow-up study. (J Intervent Radiol, 2006, 15: 451-452)

BACKGROUND: At present, MRI is the key method to examine the hippocampal sclerosis of the patients with epilepsy. The main results are the abnormal signals of hippocampus, in addition, other symbols of MRI can also suggest the hippocampal sclerosis.OBJECTIVE: To study the significance and value of the loss of visualization of digitations of hippocampal head in diagnosis of hippocampal sclerosis through the analysis of MRI on patients with temporal lobe epilepsy.DESIGN: Non-randomized, blind procedure(data selection, result evaluation), blank controlled and clinical experiment.SETTING: Departments of radiology in two universities.PARTICIPANTS: Between September 1996 and December 2002, 18 patients with temporal lobe epilepsy were selected from the Department of Radiology,Xinhua Hospital Affiliated to Shanghai Second Medical University. Meanwhile,patients with headache were diagnosed with MRI. Eighteen healthy people,whose ages were matched, were as control group.METHODS: Among 18 patients, MRI of 16 patients and 18 people in the control group were performed with a GE 1.5T Horizon MR unit and another 2with a GE 1.5T Signa whole body MR unit. With the double blind procedure, whether the digitations of hippocampal head of 72 hippocampal heads of 36 people in both patient and control groups exist or not was recorded by two radiologists with knowledge of hippocampal dissection but without knowing the condition of clinical operation. The results were divided into 3 levels:loss, poorly visible and existing, and hippocampal atrophy and abnormal signals were also recorded.MAIN OUTCOME MEASURES: Image condition of digitations of head,size of hippocampal head and changes of signal.RESULTS: Of 18 patients with hippocampal sclerosis, the abnormal findings included smooth and the loss of visualization of digitations of hippocampal heads seen in 16 patients, poorly visible of digitations of hippocampal head in one patient, and existence of digitations of hippocampal head in one patient. Hippocampal atrophy and high signals on T2-weighted images and fluid-attenuated inversion recovery imaging were seen in all patients. The sensitivity of loss of digitations of hippocampal heads for diagnosis of hippocampal sclerosis was 88.9% (16/18), and the specificity was 100%.CONCLUSSION: The loss of visualization of digitations of hippocampal head is a sensitive indicator for the diagnosis of hippocampal sclerosis. Atrophic changes of hippocampus combining with the increase of T2-weighted signal can definitely diagnose the hippocampal sclerosis.

Objective To explore the significance and value of loss of digitations of hippocampal head in diagnosis of hippocampal sclerosis.Methods Eighteen patients with hippocampal sclerosis comfirmed by histopathological examination and 18 cases to be matched control group were examined by MRI . The digitations,atrophic change and abnormal signals of hippocampal head were evaluated retrospectively.Results Of 18 patients with hippocampal sclerosis, loss of digitations was seen in 16 cases, poorly visible in 1 case and exist in 1 case. The sclerotic hippocampal heads all had atrophic change and were hyperintensity on T_2-weighted and FLAIR MR imagings. No loss of digitations were seen in the opposite side of the hippocampal sclerosis and all hippocampal heads in control group.Conclusion The loss of digitations of hippocampal head is a sensitive indicator for the diagnosis of hippocampal sclerosis.

Objective To evaluate the methods and effect of balloon catheter dilation of benign esophageal stenosis in children. Methods 9 cases had an anastomotic stenosis after surgical correction of esophageal atresia; 11 cases of esophageal stenosis due to ingestion of caustics; one case had an lower esophageal stenosis after Nissen surgery and one case after gastroesophagoplasty. Age ranged from 17 days to 7 years. Each case had a barium esophagram before balloon dilation. The balloon size varied from 3 to 10 mm in diameter. Results 21 cases were successful after dilation of balloon catheter. There were no esophageal perforation and complications. The satisfactory results maintained from six months to thirty months. Conclusions Balloon catheter dilation is a simple、safe and reliable method for the treatment of benign esophageal strictures in children as the first choice.