OBJECTIVE: To investigate the surgical technique and effectiveness of tension band-assisted plate fixation combined with external fixator for volar marginal fractures of the distal radius. METHODS: A retrospective analysis was performed on the clinical data of 12 patients with volar marginal fractures of the distal radius treated by Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator between October 2018 and July 2023. The cohort included 9 males and 3 females, aged from 20 to 52 years (mean, 35.5 years). The injury causes included traffic accidents in 6 cases, falls from height in 3 cases, and fall in 3 cases. According to AO/Orthopaedic Trauma Association (AO/OTA), there were 1 case of type B2, 4 cases of type B3, 2 cases of type C1, 3 cases of type C2, and 2 cases of type C3. According to Fernandez classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ, and 5 cases of type Ⅴ. Associated injuries included radiocarpal joint dislocation or subluxation in 7 cases and median nerve injury in 2 cases. The time from injury to operation was 2-7 days (mean, 3.2 days). Postoperatively, functional outcomes were evaluated using the modified Mayo wrist score and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Grip strength was measured as the ratio to the unaffected side, and wrist range of motion (ROM) including dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was assessed. RESULTS: All procedures were successfully completed, with an operation time of 55-110 minutes (mean, 65 minutes). All patients were followed up 6-36 months (mean, 13.7 months). Surgical incisions healed by first intention, without complications such as vascular-nerve injury or infection. Bony union and articular congruency were attained in all patients, with a healing time of 3-5 months (mean, 3.8 months). During follow-up, 1 case of Kirschner wire migration occurred with no instances of infections, radiocarpal dislocations, internal fixation failures, or extensor pollicis longus tendon ruptures. At last follow-up, the modified Mayo wrist score ranged from 65 to 92 (mean, 80.8), the DASH score ranged from 7 to 15 (mean, 11.6), the grip strength was 65%-90% (mean, 78.2%) of the unaffected side; and wrist ROM was palmar flexion 60°-85° (mean, 77.4°), dorsiflexion 55°-80° (mean, 74.8°), radial deviation 10°-25° (mean, 18.8°), and ulnar deviation 15°-30° (mean, 24.5°). CONCLUSION Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator for volar marginal fractures of the distal radius is a simple method with reliable fixation, which can achieve satisfactory effectiveness.
Humans ; Male ; Adult ; Female ; Radius Fractures/diagnostic imaging* ; Retrospective Studies ; Middle Aged ; Bone Plates ; Bone Wires ; External Fixators ; Young Adult ; Fracture Fixation, Internal/instrumentation* ; Treatment Outcome ; Range of Motion, Articular ; Hand Strength ; Wrist Injuries/surgery*

Objective:To investigate the current status of polypharmacy among elderly outpatients with 4 types of chronic diseases such as hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease.Methods:A retrospective study was conducted on the drug use of elderly (≥65 years old) outpatients with hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease with data of Beijing Municipal Health Insurance Centre database from July 2017 to September 2017. The included patients had at least 1 of 4 types of chronic diseases. Polypharmacy was defined as ≥5 different types of medication at the first visit, and non-polypharmacy was defined as <5 types of medication. The number and severity of comorbidity were quantified using the Charlson Comorbidity Index (CCI), and the prognosis of patient was evaluated at 4 levels of 0, 1, 2, and ≥3 scores. The larger the value, the more severe the disease. Based on the Beers Criteria 2015, the potential inappropriate medication (PIM) was identified using the prescription review system of Puhua Health.Results:A total of 405 608 patients were included in this study, with a median age of 74 (65-107) years, and 204 219 patients (50.35%) were female. According to the type of medication used by patients, they were divided into polypharmacy group (113 594 cases, 28.01%) and non-polypharmacy group (292 014 cases, 71.99%). The CCI of the polypharmacy group was significantly higher than that of the non-polypharmacy group ( P<0.001). The proportion of patients with 0, 1, 2, and ≥3 scores in the polypharmacy group was significantly higher than that of the non-polypharmacy group, and the differences were statistically significant (all P<0.001). In terms of comorbidity, the proportions of patients among the 4 types of chronic diseases were higher in the polypharmacy group than in the non-polypharmacy group ( P<0.001). In terms of concomitant diseases, the proportion of patients with hyperlipidemia, cognitive impairment, heart failure, and osteoporosis in the polypharmacy group was higher than that in the non-polypharmacy group (all P<0.001). In terms of medical treatment behaviour, the median number of medical visits was higher in the polypharmacy group than in the non-polypharmacy group [2(1,3) vs. 1(1,2), P<0.001]. In terms of evaluating the unsuitability of medication, the proportion of patients with PIM in the polypharmacy group was higher than that in the non-polypharmacy group, including repeated medication [4.60% (5 227/113 594) vs. 1.64% (4 486/292 014)], contraindications [2.97% (3 376/113 594) vs. 1.13% (3 294/292 014)], interactions [6.51% (7 399/113 594) vs. 1.94% (5 658/292 014)], and lack of indications [22.39% (25 432/113 594) vs. 13.54% (39 543/292 014)], and the differences were all significant (all P<0.001). In terms of drug use categories, the top 5 most commonly prescribed drugs in the polypharmacy group were HMG-CoA reductase inhibitors (68 318 cases, 60.14%), dihydropyridines (60 951 cases, 53.66%), angiotensin receptor antagonists(45 050 cases, 39.66%), β-receptor blockers (25 675 cases, 22.60%) and sulfonylureas (16 023 cases, 14.11%). Conclusions:Polypharmacy is common in elderly patients with hypertension, diabetes mellitus, coronary artery disease, and cerebrovascular disease. The elderly patients with polypharmacy have a worse baseline status and more problems with PIM.

Objective:To investigate the current status of polypharmacy among elderly outpatients with 4 types of chronic diseases such as hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease.Methods:A retrospective study was conducted on the drug use of elderly (≥65 years old) outpatients with hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease with data of Beijing Municipal Health Insurance Centre database from July 2017 to September 2017. The included patients had at least 1 of 4 types of chronic diseases. Polypharmacy was defined as ≥5 different types of medication at the first visit, and non-polypharmacy was defined as <5 types of medication. The number and severity of comorbidity were quantified using the Charlson Comorbidity Index (CCI), and the prognosis of patient was evaluated at 4 levels of 0, 1, 2, and ≥3 scores. The larger the value, the more severe the disease. Based on the Beers Criteria 2015, the potential inappropriate medication (PIM) was identified using the prescription review system of Puhua Health.Results:A total of 405 608 patients were included in this study, with a median age of 74 (65-107) years, and 204 219 patients (50.35%) were female. According to the type of medication used by patients, they were divided into polypharmacy group (113 594 cases, 28.01%) and non-polypharmacy group (292 014 cases, 71.99%). The CCI of the polypharmacy group was significantly higher than that of the non-polypharmacy group ( P<0.001). The proportion of patients with 0, 1, 2, and ≥3 scores in the polypharmacy group was significantly higher than that of the non-polypharmacy group, and the differences were statistically significant (all P<0.001). In terms of comorbidity, the proportions of patients among the 4 types of chronic diseases were higher in the polypharmacy group than in the non-polypharmacy group ( P<0.001). In terms of concomitant diseases, the proportion of patients with hyperlipidemia, cognitive impairment, heart failure, and osteoporosis in the polypharmacy group was higher than that in the non-polypharmacy group (all P<0.001). In terms of medical treatment behaviour, the median number of medical visits was higher in the polypharmacy group than in the non-polypharmacy group [2(1,3) vs. 1(1,2), P<0.001]. In terms of evaluating the unsuitability of medication, the proportion of patients with PIM in the polypharmacy group was higher than that in the non-polypharmacy group, including repeated medication [4.60% (5 227/113 594) vs. 1.64% (4 486/292 014)], contraindications [2.97% (3 376/113 594) vs. 1.13% (3 294/292 014)], interactions [6.51% (7 399/113 594) vs. 1.94% (5 658/292 014)], and lack of indications [22.39% (25 432/113 594) vs. 13.54% (39 543/292 014)], and the differences were all significant (all P<0.001). In terms of drug use categories, the top 5 most commonly prescribed drugs in the polypharmacy group were HMG-CoA reductase inhibitors (68 318 cases, 60.14%), dihydropyridines (60 951 cases, 53.66%), angiotensin receptor antagonists(45 050 cases, 39.66%), β-receptor blockers (25 675 cases, 22.60%) and sulfonylureas (16 023 cases, 14.11%). Conclusions:Polypharmacy is common in elderly patients with hypertension, diabetes mellitus, coronary artery disease, and cerebrovascular disease. The elderly patients with polypharmacy have a worse baseline status and more problems with PIM.

Objective:To observe the expression of noggin mRNA in the hippocampus of rats with chronic cerebral hypoperfusion, and explore the effect of electroacupuncture (EA) at the " baihui" and " dazhui" acupoints on their learning and memory and on hippocampal neurogenesis.Methods:In total, 120 Sprague-Dawley rats had cerebral hypoperfusion induced by permanent bilateral ligation of the common carotid artery. The 104 successfully induced were divided at random into a model group and an EA group, each of 52. The EA group was given EA on the baihui and dazhui acupoints for 20 minutes daily for seven days followed by a two-day break. The output current was 1mA at 15Hz. No special treatment was given to the model group. After one, two, four and six weeks of treatment, 6 rats were given BrdU injections to observe the proliferation and differentiation of neural stem cells. Learning and memory were assessed using the Morris Water Maze. The expression of noggin mRNA and neurogenesis in the dentate gyrus of the hippocampus were measured using reverse-transcription polymerase chain reactions and immunohistochemistry.Results:After one, two and five weeks of intervention, the average learning and memory ability of the EA group were significantly better than those of the control group. The average expression of noggin mRNA was significantly higher in the EA group than in the model group at the same time points. Compared with the model group, there were more BrdU-positive cells in the hippocampal dentate gyrus in the EA group, and the number decreased with the prolongation of ischemia. Pearson correlation analysis showed that the levels of noggin mRNA in the hippocampus of both groups were positively correlated with their number of BrdU-positive cells. The correlation was stronger in the EA group than in the model group.Conclusions:Electroacupuncture can promote hippocampal neurogenesis in rats with chronic cerebral hypoperfusion by regulating the expression of hippocampal noggin mRNA, thereby improving their spatial learning and memory ability.

BACKGROUND AND PURPOSE: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis. This study aimed to explore the possible factors affecting the response to first-line treatments in patients with anti-NMDAR encephalitis. METHODS: We enrolled 29 patients who were diagnosed as anti-NMDAR encephalitis between January 1, 2015, and June 30, 2018. They were divided into the remission and nonremission groups according to their response to first-line treatments. The demographics, clinical manifestations, main ancillary examinations, follow-up treatments, and prognosis of patients were recorded. The symptoms reported on in this study occurred before treatments or during the course of first-line treatments. RESULTS: There were 18 patients (62.07%) in the remission group and 11 patients (37.93%) in the nonremission group. Compared to the remission group, a higher proportion of the patients in the nonremission group exhibited involuntary movements, decreased consciousness, central hypoventilation, lung infection, and hypoalbuminemia. The nonremission group had a high incidence of increased intracranial pressure and significant elevations of the neutrophil-to-lymphocyte ratio in peripheral blood (NLR), aspartate aminotransferase, and fibrinogen. Six patients (54.55%) in the nonremission group received second-line immunotherapy. Only one patient (3.45%) died, which was due to multiple-organ failure. CONCLUSIONS: Anti-NMDAR-encephalitis patients with more symptoms—especially involuntary movements, disturbance of consciousness, central hypoventilation, and accompanying hypoalbuminemia and pulmonary infection—may respond poorly to first-line treatments. Positive second-line immunotherapy therefore needs to be considered. Admission to an intensive-care unit, increased cerebrospinal fluid pressure, and increased NLR might be the significant factors affecting the response to first-line treatments.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Aspartate Aminotransferases ; Cerebrospinal Fluid Pressure ; Consciousness ; Demography ; Dyskinesias ; Encephalitis ; Fibrinogen ; Follow-Up Studies ; Humans ; Hypoalbuminemia ; Hypoventilation ; Immunotherapy ; Incidence ; Intracranial Pressure ; Lung ; Prognosis

Objective To evaluate the effect of intraperitoneal desferroxmine on the postoperative cognitive function of aged rats.Methods Twenty-four male Sprague-Dawley rats,aged 15-18 months,weighing 490-550 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),operation group (group O),and desferroxmine group (group D).Exploratory laparotomy was performed after anesthesia in O and D groups.In group D,desferroxmine was injected intraperitoneally (100 mg/kg per time,each time lasting for 12 h) for 7 consecutive days,starting from 7 days before operation,while the equal volume of normal saline (100 ml/kg) was given in group O.All the rats underwent Morris water maze test at 3 days after operation,and the escape latency and frequency of crossing the original platform were recorded.The rats were then sacrificed and the hippocampus was removed for detection of ferritin expression.Results Compared with group C,the escape latency was significantly prolonged,the frequency of crossing the original platform was decreased,and ferritin expression was up-regulated in group O,and no significant changes were found in each parameter mentioned above in group D.Compared with group O,the escape latency was significantly shortened,the frequency of crossing the original platform was increased,and ferritin expression was down-regulated in group D.Conclusion Intraperitoneal desferroxmine 100 mg/kg (injected for 7 consecutive days) before operation can improve the postoperative cognitive function of aged rats.

Objective To evaluate the effect of ulinastatin on brain injury induced by lipopolysaccharide (LPS) in mice.Methods Ninety adult male C57 mice,aged 3-4 months,weighing 200-300 g,were randomly divided into 3 groups (n =30 each) using a random number table:control group (C group),LPS group and ulinastatin group (U group).Group U received intraperitoneal injection of ulinastatin 10 000 U/kg,while group L received the equal volume of normal saline,and 10 min later brain injury was produced with LPS 1 μg/g injected into the cerebral ventricle.Ten animals were chosen and blood samples were taken for determination of plasma concentrations of S100β protein and neuron-specific enolase (NSE) at 1,3 and 7 days after LPS injection.Then the animals were sacrificed and hippocampal tissues were obtained for determination of interleukin-1β (IL-1 β) and tumor necrosis factor-α (TNF-α) contents and IL-1β mRNA and TNF-α mRNA expression.Results Compared with C group,the plasma concentrations of S100β protein and NSE and contents of IL-1β and TNF-α were significantly increased at 1,3 and 7 days after LPS injection,and IL-1β mRNA and TNF-α mRNA expression was up-regulated at 1 and 3 days after LPS injection in LPS and U groups.Compared with group LPS,the plasma concentrations of S100β protein and NSE and contents of IL-1β and TNF-α were significantly increased,and IL-1β mRNA and TNF-α mRNA expression was down-regulated at 1 and 3 days after LPS injection in group U.Conclusion Ulinastatin can attenuate brain injury induced by LPS in mice,and the mechanism is related to inhibited inflammatory responses.

Objective To study the effects of exercise on hemodynamic parameters and cardiovascular humoral factors in the elderly patients with hypertension. Methods The modified Bruce assessment (MBA) was employed in an essential hypertension (EH) group (group 1, n =34) composed by elderly EH patients and a control group (group 2, n =31) composed of normal subjects. Heart rate (HR),systolic and diastolic blood pressure (SBP、DBP), and the quantum and duration of exercise (QE, DE) were explored, while the serum concentrations of nitric oxide (NO), endothelin 1(ET1), atrial natriuretic factor (ANF) and AngiotensinⅡ(AngⅡ) were measured at 3 min before and after treatment. Results There were no significant differences between groups 1 and 2 with regard to HR, SBP, DBP, total DE and peak QE before and after treatment, in addition, at the peak of exercise ( P 0.05). Pretreatment SBP and DBP were significantly and positively correlated with those at the peak of and after treatment ( r =0.648,0.630, P