Objective:To explore the consistency of MRI fast field echo resembling a CT using restricted echo-spacing (FRACTURE) and CT in the evaluation of knee and ankle bone changes.Methods:From November 2020 to November 2021, seventeen patients who underwent CT and MRI FRACTURE examinations of knee joint or ankle joint in the First Affiliated Hospital of Dalian Medical University were retrospectively collected, including 14 patients with knee joint examinations and 3 patients with ankle joint examinations. According to the number of joint components, 80 components were included, including 14 for femur and patella, 17 for tibia and fibula, and 3 for talus, scaphoid, medial cuneiform, medial cuneiform, lateral cuneiform and calcaneus, respectively. The fracture, hyperosteogeny, and bone destruction of the joint bones were evaluated by two observers using CT and FRACTURE images, respectively. Kappa test was used to analyze the consistency of CT and FRACTURE images between observers in the evaluation of joint bone lesions.Results:The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by CT and FRACTURE images were 0.925 (0.823-1.027), 0.905 (0.799-1.011) and 0.895(0.752-1.038) respectively for observer 1, and were 0.963 (0.892-1.034), 0.933 (0.843-1.023) and 0.886 (0.731-1.041) respectively for observer 2. The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by observers 1 and 2 via CT images were 1.000 (1.000-1.000), 0.937(0.851-1.023) and 0.945 (0.839-1.051) respectively, and that by FRACTURE images were 0.962 (0.888-1.036), 0.966 (0.899-1.033) and 0.836 (0.656-1.016) respectively.Conclusion:For the evaluation of fracture, hyperosteogeny, and bone destruction of knee joint and ankle joint, MRI FRACTURE sequence is highly consistent with CT.

Objective:To detect serum levels of vitamin A (Vit A), vitamin D(Vit D)25-hydroxy vitamin D[25-(OH)D] and vitamin E(Vit E) in children aged 0-6 years in Tibetan Plateau of Garzi Prefecture, thus providing references for physical examinations and prevention of 4 key diseases (rickets, malnutrition anemia, pneumonia and diarrhea) in children in plateau areas by relevant government departments.Methods:A total of 2 122 children who participated in physical examination in 12 townships of Xiangcheng County and 14 townships of Daocheng County, Garzi Tibetan Autonomous Prefecture, Sichuan Province from April 2017 to April 2019 with 0-6 years old were recruited for surveying physical measurements and collection of venous blood.Serum Vit A and Vit E levels were detected by high performance liquid chromatography.Serum levels of 25-(OH)D were detected by high performance liquid chromatography tandem mass spectrometry.The relationship between Vit A, Vit E and 25-(OH)D levels with the gender, age, seasonal change and altitude was analyzed.Results:The serum Vit A level, subclinical Vit A deficiency rate and marginal vitamin A deficiency rate were(1.05±0.27) μmol/L, 8.15%(173/2 122 cases) and 45.99%(976/2 122 cases), respectively in 2 122 children with 0-6 years old.There were significant differences in the serum Vit A level, the subclinical Vit A deficiency rate and the marginal vitamin A deficiency rate in children with different ages, seasons and altitudes (all P<0.05). The serum level of 25-(OH)D and 25-(OH)D deficiency rate insufficient rate were (24.65±6.45) ng/L, 6.03%(128/2 122 cases) and 16.59%(352/2 122 cases), respectively.There were significant differences in the serum level of 25-(OH)D, 25-(OH)D deficiency rate and 25-(OH)D insufficient rate in children with different ages and seasons (all P<0.05). The mean serum Vit E level, Vit E deficiency rate and Vit E insufficient rate were (7.81±1.74) mg/L, 2.78%(59/2 122 cases) and 29.59%(628/2 122 cases), respectively.There were significant differences in serum Vit E level, Vit E deficiency rate and Vit E insufficient rate in children with different ages and seasons (all P<0.05). The mean serum levels of Vit A and Vit D remained the lowest before the age of 1 year, and their deficiencies at this age were the most significant.The mean serum level of Vit E remained the lowest in >1-2 years old, and its deficiency and insufficient at this age were the most significant.Vit A, D and E levels were significantly affected by seasonal changes, which were significantly higher in the summer than in the spring, autumn and winter.In addition, Vit A and 25-(OH)D were significantly affected by the altitude, which were the lowest above 4 km altitude. Conclusions:The overall serum levels of Vit A, 25-(OH) D and E in children with 0-6 years old in Tibetan Plateau areas of Ganzi Prefecture are lower than those in plain areas.Vit A, 25-(OH) D and Vit E levels significantly differed in the age, season and altitude, which are related to the lack of local resources, insufficient maternal nutrition during pregnancy and insufficient intake after birth, as well as temperature and light caused by changes in local seasons and altitude.Therefore, it is necessary to make reasonable supplements during pregnancy to prevent vitamin deficiency.

Objective:To investigate the clinical outcomes of open reduction and cannulated screw fixation directly via the anterior approach for femoral neck fracture of Garden type Ⅳ which is difficultly reducible in young and middle-aged patients.Methods:Forty patients aged younger than 65 years old were treated by open reduction and cannulated screw fixation directly via the anterior approach for femoral neck fractures which were difficulty reducible at Department of Orthopaedics, Mindong Hospital from March 2015 to October 2017. They were 28 males and 12 females, aged from 22 to 62 years (mean, 49.2 years). All the fractures were type Ⅳ by the Garden classification. The time from injury to operation averaged 3.2 d (range, from 1 to 6 d). Their postoperative fracture nonunion and femoral head necrosis were recorded. The reduction quality and hip function were evaluated using Garden reduction index and Harris hip scores.Results:All the 40 patients were followed up for 11 to 44 months (mean, 22.3 months). Nonunion occurred in one patient who had to accept secondary artificial hip replacement. No avascular necrosis of the femoral head occurred in any patients. The anteroposterior Garden reduction indexes at 2 d after surgery and at the last follow-up for the 40 patients were respectively 156.97°±1.40° and 157.07°±1.47°, showing no significant difference( t=-0.302, P=0.765); so were the lateral Garden reduction indexes (171.82°±4.48° and 172.10°±4.27°) ( t=-2.333, P=0.817). The Harris hip scores at the final follow-up for the hip ranged from 77 to 98 (average, 92); 31 cases were rated as excellent, 6 as good, 2 as fair and one as poor, giving an excellent to good rate of 92.5%. Conclusion:In the treatment of femoral neck fracture of Garden type Ⅳ which is difficultly reducible in young and middle-aged patients, if closed reduction has failed, open reduction and cannulated screw fixation directly via the anterior approach can achieve satisfactory short-term outcomes because it facilitates fracture reduction and fixation under direct vision, promotes fracture union and reduces avascular necrosis of the femoral head.

A 34-year-old female patient presented with itchy nodules on the left posterior ear for 7 years.Skin examination showed clustered light-red or brown-black nodules measuring about 4 cm × 5 cm in size on the left posterior auricle,as well as from the posterior sulcus of the auricle to the anterior border of the hair line on the posterior auricle.Histopathological examination of the skin lesion revealed epidermal hyperkeratosis,proliferation of a lot of small blood vessels in the dermis,swelling vascular endothelial cells with enlarged nuclei and eosinophilic cytoplasm bulging into vascular cavity,and perivascular infiltration of lymphocytes and many eosinophils.The patient was diagnosed with angiolymphoid hyperplasia with eosinophilia.After extended surgical resection,a skin graft from the left lower abdomen was used to repair the defect.After the surgery,the flap survived well,and the appearance of the auricle was improved.No recurrence was observed during 1 year of follow-up.

OBJECTIVETo investigate the feasibility of endoscopic metallic stent as a bridge to elective laparoscopic surgery in patients with malignant colorectal obstruction.

METHODSClinical data of 63 patients with obstructive colorectal cancer who underwent endoscopic metallic stent insertion under radiologic monitoring at the Longyan First Hospital between June 2012 and August 2016 were analyzed retrospectively. After complete remission of the obstruction, all the patients received multi-disciplinary team (MDT) evaluation to make the further treatment strategy. The subsequent surgery included open and laparoscopic procedures, and the short-term efficacy of these two procedures was compared.

RESULTSThere were 30 male and 33 female patients with age of 30 to 90 (mean 67) years, including 3 cases of ascending colon cancer, 4 cases of transverse colon cancer, 12 cases of descending colon cancer, 26 cases of sigmoid cancer, and 19 cases of rectal cancer. Only one patient (1.6%) developed sigmoid perforation at 3 hours after stent placement, and underwent emergency laparotomy with Hartmann procedure. The remaining 62 patients had bowel movements. After MDT evaluation, 10 patients (16.1%) were treated with palliative chemotherapy because they were unfit for surgery or for diffuse distant metastases. A total of 52 patients underwent radical surgery after a mean interval from stent insertion of 10 days (7-20 days), including open (n=18, including two cases with conversion to open surgery) and laparoscopy (n=34). The baseline data between open and laparoscopy groups were similar (all P>0.05). Primary anastomosis was successfully performed in all the patients without preventive stoma. Compared to open group, laparoscopy group had faster bowel movement [(2.88±1.06) d vs. (4.05±2.43) d, P=0.022] and shorter postoperative hospital stay [(7.85±0.96) d vs. (9.82±4.41) d, P=0.002]. There were no statistically significant differences in operative time, intraoperative blood loss, number of harvested lymph node, and postoperative complication rate between two groups (all P>0.05).

CONCLUSIONSEndoscopic metallic stent placement can effectively remove malignant colorectal obstruction, and thus enables surgeons to perform an elective radical surgery, avoiding emergency surgery with stoma and unnecessary surgery for patients with distant metastasis. In the era of enhanced recovery after surgery, the endoscopic metallic stent placement combined with laparoscopic procedures, as a less invasive alternative, is effective and safe.

Objective To investigate the clinical effect of mild hypothermia on neonatal bilirubin encephalopathy, and the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and amplitude integrated electroencephalogram (aEEG) for diagnosis and evaluation of curative effect. Methods From May, 2013 to December, 2014, 29 newborns with bilirubin encephalopathy were divided into conventional group (n=15) and mild hypothermia group (n=14). The conventional group received conventional therapy, and the other group received mild hypothermia in addition. The aEEG and neuron-specific enolase (NSE) were measured before and after treatment, as well as the glucose metabolism rate with 18F-FDG PET/CT after treatment. Results The NSE was lower after treatment in both groups (t>9.670, P<0.001), and was lower in the mild hypothermia group than in the conventional group (F=46.146, P<0.001). After treatment, sleep-wake cycle (SWC), epileptiform activity and the degree of abnormality were obviously improved (P<0.05), and were better in the mild hypothermia group than in the conventional group (P<0.05). The cerebral glucose metabolism rate was significantly better in the mild hypo-thermia group than in the conventional group (t>2.943, P<0.01). The cerebral glucose metabolism rate was negatively correlated with aEEG and NSE (r>0.640, P<0.05). Conclusion Mild hypothermia therapy could further promote the energy metabolism of brain cells in neonatal bilirubin encephalopathy. 18F-FDG PET/CT and aEEG can be used for early diagnosis and therapeutic evaluation.

OBJECTIVE:To offer the literature basis for clinical safe drug use by literature research about ADR induced by Yishen juanbi pill. METHODS:Using“Yishen juanbi pill”as searching word,related literatures about ADR induced by Yishen juanbi pill were collected from CNKI,and then the occurrence of ADR was summarized and analyzed. RESULTS:A total of 15 literatures were included,involving 58 patients. Primary disease were mainly rheumatoid arthritis (28 cases,48.28%);organs/systems involved in ADR were digestive system (77 cases, 76.24%). Main clinical manifestations were epigastric discomfort, pernicious vomiting,diarrhea,etc. No obvious ADR was found. ADR-inducing dose was mainly 8 g,tid(47 cases,92.16%);ADR-inducing drug combination were two-drug combination (33 cases,56.90%). Fifty-eighe cases of ADR were recovered after treatment,and main treatment was drug withdrawal or symptomatic treatment. CONCLUSIONS:Although Yishen juanbi pill may induce ADR,those ADR can disappear spontaneously after drug withdrawal or the symptoms are recovered after symptomatic treatment. Yishen juanbi pill is a relatively safe Chinese patent medicine of anti-inflammatory,but ADR monitoring should be strengthened during application.

Jingui Yaolue is a part ofTreatise on Cold-Attack and Miscellaneous Diseases. Because of the archaic words, students lost the interest on it. So it became the questions that how to make students interested in learning theJingui Yaolue and to make traditional Chinese medicine(TCM) classical guide clinical treatment. Thus, a try has been made to teach the TCM classic in the clinical practice apprentice setting rather than the classrooms. Here, some experiences about apprentice teaching in clinical practice of Jingui Yaolue were shared.

Objective To evaluate the efficacy and safety of Shuangyi Qushi Tongluo Capsules (SQTC) for the treatment of knee osteoarthritis (KOA).Methods A multi-center,randomized,parallel-controlled trial was carried out in 240 cases of KOA patients.The patients were divided into trial group (N =120) and control group (N =120),which was given SQTC,Xianlinggubao capsules respectively for 8 weeks.Before treatment,and 2,4 and 8 weeks after treatment,we recorded the scores of clinical symptoms and traditional Chinese medical syndromes,Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores and knee function scores.After treatment,the clinical efficacy and adverse reaction were observed.Results (1) After treatment for 8 weeks,the clinical efficacy of the trial group was superior to that of the control group (P ＜ 0.05).(2) The trial group had better effect on improving the visual analogue scale (VAS) scores of knee pain,VAS scores of limitation of motion and time for morning stiffness than the control group after treatment for 8 weeks(P ＜ 0.05 or P ＜ 0.01).(3) After treatment for 4 and 8 weeks,the trial group had better effect on improving scores of traditional Chinese medical syndromes,WOMAC scores and Japanese Orthopedic Association(JOA) scores than the control group (P ＜ 0.05 or P ＜ 0.01).(4) Before and after treatment,the results of blood,urine and stool routine examination,liver and kidney function,and electrocardiography showed no significant changes.Conclusion SQTC are effective and safe in treating KOA,and can start an effect shortly.

Objective To investigate the association of silent information regulator 1 (SIRT1) polymorphisms with intracerebral hemorrhage (ICH) susceptibility.Methods From September 1,2013 to May 30,2017,Han ethnic 201 ICH patients and 203 controls from South China were enrolled in this study.Genotyping and sequencing ofSIRT1 polymorphisms (rs7069102,rs2273773 and rs7895833) were performed by PCR-restriction fragment length polymorphism (PCR-RFLP).The correlation of SIRT1 polymorphisms with ICH was analyzed.Results (1) The rs7895833 A allele frequency distribution was significantly higher and the rs7895833 GG+AG gene frequency distribution was significantly lower in the ICH group than those in the control group (P＜0.05);the rs7069102 C allele frequency distribution was lower and the GG+CG gene frequency distribution was higher in the ICH group than those in the control group,without significant differences (P＞0.05).(2) Logistic regression analysis indicated rs7895833 AA genotype carriers had increased risk for ICH (OR:1.57,95％CI:1.14-2.18,P=0.006).(3) As compared with patients with rs2273773 TT genotype,patients with CC and CT genotypes had significantly higher high-density lipoprotein cholesterol level (P＜0.05);there were no associations between rs2273773/rs7069102 and ICH.Conclusion SIRT1 rs7895833 is significantly associated with ICH susceptibility;rs2273773 genotypes affect plasma high-density lipoprotein cholesterol level in the Chinese Han ethnic population.