Objective:To evaluate the early clinical outcomes of modified suspended fixation with triple plates and double beams through a limited incision in the treatment of acroxoclavicular dislocation.Methods:A retrospective study was conducted to analyze the 23 patients with acromioclavicular dislocation who had been treated at Department of Orthopedics, The People's Hospital of Northern Jiangsu from June 2021 to August 2023 by modified suspended fixation with triple plates and double beams through a limited incision. There were 9 males and 14 females with an age of (52.2±10.6) years. The incision length, operation time, intraoperative bleeding and complications were recorded. The visual analogue scale (VAS) pain score, Constant-Murley shoulder score, American Shoulder and Elbow Surgeons (ASES) score, range of shoulder motion (anterior flexion, abduction, lateral rotation) were recorded and compared between preoperation and the last follow-up. The coracoclavicular distance (CCD), clavicle tract width and coracoid tract width were measured and compared between postoperative day 2 and the last follow-up.Results:The patients were followed up for 12 (12, 16) months. The incision length was 5 (4, 5) cm, the operation time 50 (40, 60) min, and the intraoperative bleeding 30 (20, 30) mL. No such complications occurred as incision infection, fracture, or failure of internal fixation. The VAS pain score, Constant-Murley shoulder score, ASES score, anterior flexion, abduction and lateral rotation of the shoulder at the last follow-up were, respectively, 0 (0, 0) point, (92.8±4.9) points, (90.4±5.7) points, 175 °(170°, 180°), 175°(170°, 175°), and 85°(80°, 85°), significantly improved compared with the preoperative values [6 (5, 6) points, (40.4±7.2) points, (39.3±7.1) points, 85°(80°, 85°), 85°(80°, 90°), and 35°(35°, 40°)] ( P<0.05). The CCD was (6.1±1.3) mm at postoperative day 2 and (7.5±1.7) mm at the last follow-up, showing a significant difference ( P<0.05). Compared with postoperative day 2, the CCD widening at the last follow-up was <4mm in all patients, giving an excellent rate of 100% (23/23). The medial clavicle tract widening and the medial coracoid tract widening at the last follow-up were both <2 mm in all patients, giving an excellent rate of 100% (23/23). The lateral clavicle tract widening at the last follow-up was >2 mm in 2 patients, giving an excellent rate of 91% (21/23). Conclusions:In the treatment of acroxoclavicular dislocation, our modified suspended fixation with triple plates and double beams through a limited incision can lead to reliable reduction fixation and good recovery of shoulder function, showing advantages of short surgical time, easy surgical operation, high safety, and minimal postoperative widening of bone tracts.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

High performance liquid chromatography (HPLC) is currently the mainstream technology for detecting hemoglobin. Glycated hemoglobin (HbA1c) is a gold indicator for diagnosing diabetes, however, the accuracy of HbA1c test is affected by thalassemia factor hemoglobin F (HbF)/hemoglobin A2 (HbA2) and variant hemoglobin during HPLC analysis. In this study, a new anti-interference hemoglobin analysis system of HPLC is proposed. In this system, the high-pressure three-gradient elution method was improved, and the particle size and sieve plate aperture in the high-pressure chromatography column and the structure of the double-plunger reciprocating series high-pressure pump were optimized. The system could diagnose both HbA1c and thalassemia factor HbF/HbA2 and variant hemoglobin, and the performance of the system was anti-interference and stable. It is expected to achieve industrialization. In this study, the HbA1c and thalassemia factor HbF/HbA2 detection performance was compared between this system and the world's first-line brand products such as Tosoh G8, Bio-Rad Ⅶ and D10 glycosylated hemoglobin analysis system. The results showed that the linear correlation between this system and the world-class system was good. The system is the first domestic hemoglobin analysis system by HPLC for screening of HbA1c and thalassemia factor HbF/HbA2 rapidly and accurately.
Chromatography, High Pressure Liquid ; Fetal Hemoglobin/analysis* ; Glycated Hemoglobin A/analysis* ; Hemoglobin A2/analysis* ; Hemoglobins

Objective To explore the accuracy of fluid responsiveness assessment by variability of peripheral arterial peak velocity and variability of inferior vena cava diameter (ΔIVC) in patients with septic shock. Methods A prospective study was conducted. The patients with septic shock undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Beijing Electric Power Hospital from January 2016 to December 2017 were enrolled. According to sepsis bundles of septic shock, volume expansion (VE) was conducted. The increase in cardiac index (ΔCI) after VE ≥ 10% was defined as liquid reaction positive (responsive group), ΔCI < 10% was defined as the liquid reaction negative (non-responsive group). The hemodynamic parameters [central venous pressure (CVP), intrathoracic blood volume index (ITBVI), stroke volume variation (SVV), ΔIVC, variability of carotid Doppler peak velocity (ΔCDPV), and variability of brachial artery peak velocity (ΔVpeak-BA)] before and after VE were monitored. The correlations between the hemodynamic parameters and ΔCI were explored by Pearson correlation analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of all hemodynamic parameters on fluid responsiveness. Results During the study, 74 patients with septic shock were included, of whom 9 were excluded because of peripheral artery stenosis, recurrent arrhythmia or abdominal distension influencing the ultrasound examination, and 65 patients were finally enrolled in the analysis. There were 31 patients in the responsive group and 34 in the non-responsive group. SVV, ΔIVC, ΔCDPV and ΔVpeak-BA before VE in responsive group were significantly higher than those of the non-responsive group [SVV: (12.3±2.4)% vs. (9.2±2.1)%, ΔIVC: (22.3±5.3)% vs. (15.5±3.7)%, ΔCDPV: (15.3±3.3)% vs. (10.3±2.4)%, ΔVpeak-BA: (14.5±3.3)% vs. (9.6±2.3)%, all P < 0.05]. There was no significant difference in CVP [mmHg (1 mmHg = 0.133 kPa): 7.5±2.5 vs. 8.2±2.6] or ITBVI (mL/m2: 875.2±173.2 vs. 853.2±192.0) between the responsive group and non-responsive group (both P > 0.05). There was no significant difference in hemodynamic parameter after VE between the two groups. Correlation analysis showed that SVV, ΔIVC, ΔCDPV, and ΔVpeak-BA before VE showed significant linearity correlation with ΔCI (r value was 0.832, 0.813, 0.854, and 0.814, respectively, all P < 0.05), but no correlation was found between CVP and ΔCI (r = -0.342, P > 0.05) as well as ITBVI and ΔCI (r = -0.338, P > 0.05). ROC curve analysis showed that the area under ROC curve (AUC) of SVV, ΔIVC, ΔCDPV, and ΔVpeak-BA before VE for predicting fluid responsiveness was 0.857, 0.826, 0.906, and 0.866, respectively, which was significantly higher than that of CVP (AUC = 0.611) and ITBVI (AUC = 0.679). When the optimal cut-off value of SVV for predicting fluid responsiveness was 11.5%, the sensitivity was 70.4%, and the specificity was 94.7%. When the optimal cut-off value of ΔIVC was 20.5%, the sensitivity was 60.3%, and the specificity was 89.7%. When the optimal cut-off value of ΔCDPV was 13.0%, the sensitivity was 75.2%, and the specificity was 94.9%. When the optimal cut-off value of ΔVpeak-BA was 12.7%, the sensitivity was 64.8%, and the specificity was 89.7%. Conclusions Ultrasound assessment of ΔIVC, ΔCDPV, and ΔVpeak-BA could predict fluid responsiveness in patients with septic shock receiving mechanical ventilation. ΔCDPV had the highest predictive value among these parameters.

Objective: To investigation HER2 status in gastric adenocarcinoma of Chinese and contributing factors to the HER2 expression. Methods: HER2 status of 40 842 gastric adenocarcinomas and clinical data were retrospectively collected from 23 hospitals dated from 2013 to 2016. The association between HER2 positivity and clinicopathologic features was analyzed. Results: Of the 40 842 patients the median age was 62 years, the male female ratio was 2.6∶1.0. The rate of HER2 positivity was 8.8% (3 577/40 842). HER2 expression was related to the tissue type, tumor location, Lauren classification and tumor differentiation (P values: 0.009, 0.001, <0.01 and <0.01, respectively). Different HER2 expression status was observed between primary and recurrent tumors in 7.6% (48/635) cases. The rates of HER2 positivity ranged from 2% to 10% among different institutions. The rates of HER2 FISH amplification were dramatically different among the 23 hospitals (0-100%) with an average rate of 10% (810/8 156) in patients with HER2 IHC 2+ . Conclusions HER2 expression is associated with clinicopathologic characteristics. HER2 re-assessment of tumor tissue and use of in situ hybridization techniques increase HER2 positivity. The current retrospective study should reflect the HER2 status in gastric adenocarcinoma of Chinese patients.

Objective: To investigate the expression of BRCA-associated protein 1 (BAP1) in malignant mesothelioma, non-small cell lung cancer and carcinosarcoma, and its application in the differential diagnosis. Methods: Twenty-two cases of malignant mesothelioma including 17 epithelioid type, 2 sarcomatoid type and 3 biphasic type were collected.As the study control, 80 non-small cell lung cancers infringement pleural membrane(including 40 lung adenocarcinomas and 40 lung squamous cell carcinomas) and 15 carcinosarcomas were included. BAP1 expression was detected using immunohistochemical method. A differential diagnosis antibody panel, including calretinin, WT1, CK5/6, D2-40, CAM5.2, CEA, TTF1, Napsin A, p63 and p40 was tested in all cases. Results: All 80 cases of non-small cell lung cancer and 15 cases of carcinosarcoma were BAP1 positive. In contrast, 64% (14/22) of malignant mesotheliomas lost BAP1 expression (P<0.01). Addition of BAP1 to the mesothelioma marker panel, the diagnostic accuracy of malignant mesothelioma was enhanced to 93%. Focal expression of BAP1 in tumors suggested multiclonal evolution of mesothelioma. Conclusions Loss of BAP1 expression helps to confirm the diagnosis of malignant mesothelioma whereas all non-small cell lung cancer expresses BAP1. It is therefore recommended that BAP1 can be used in conjunction with other immunohistochemical markers to improve the diagnostic accuracy of malignant mesothelioma.

Objective To explore the curative effectiveness of comprehensive voice training methods on teachers' voice disorders patients by using subjective and objective assessment. Methods Forty-seven teachers' voice disorders patients suffering from voice symptoms without organic disease and complete follow-up data as the research object were treated with a three-month comprehensive voice training program. Training content included relieving laryngeal muscle tension, improving the throat vocal cord movement and reconstruction methods of pronunciation. The use of voice acoustic analysis and voice handicap index(VHI) were compared before and after training. Results The jitter and shimmer were significantly decreased after comprehensive voice training from 1.06(0.79,1.38)％and 2.71(2.16,3.24)％to 0.78 (0.59, 0.99)％ and 1.64(1.03,2.45)％, the differences were significant (Z=3.249,-4.121, P<0.05). Maximum phonation time and dysphonia severity index were significantly increased obviously from (9.87 ± 2.61)s and-2.23±0.75 to (12.81±1.97)s and-0.43±1.65 respectively, the differences were significant (t=-6.057,-5.273, P<0.05). After the training, the VHI score of voice disorder index decreased from (37.41±4.96)points to (26.31± 4.29) points after the comprehensive voice training. In addition to emotional function, the difference was statistically significant(t=12.715, 5.881, 11.483, P<0.05). Conclusions Voice training can reduce the degree of voice disorders effectively, increase the power of the respiratory system, therefore improve the voice quality of teachers with voice disorders. The subjective and objective combination assessment can evaluate the quality of the patient′s voice more thoroughly and evaluate the clinical efficacy of voice training further.

Objective To compare suture bridge and single row techniques in repair of rotator cuff tears in a rabbit model.Methods Seventy-six mature male New Zealand white rabbits were used in this study.The 12-month old rabbits,weighing from 2.5 to 3.0 kg (average,2.8 kg),were made models of full-thickness rotator cuff tear by cutting off at the foot print the supraspinatus tendon.The models were randomly divided into 2 even groups (n =38 each).Their right shoulders were repaired by suture bridge and single row techniques respectively in the 2 groups,with their left shoulders untreated as controls.The rabbits were then sacrificed at the 2nd,4th and 8th weeks after surgery for histological comparisons of healing under microscopy.Biomechanical comparisons were made at the 8th week to analyze advantages and disadvantages of the two methods.Results At 2,4 and 8 weeks postoperatively,there were no significant differences between the anterior and middle 1/3 zones of bone-tendon junction regarding cartilage growth or collagen fiber morphology in the suture bridge group,while the cartilage growth and collagen fiber morphology in the middle 1/3 zone of bone-tendon junction were significantly more mature than in the anterior 1/3 zone in the single row group.At the 8th postoperative week,the load to failure in the suture bridge group (134.59 ± 17.69 N) was significantly higher than that in the single row group (72.23 ± 12.08 N) (P ＜ 0.05),but remained significantly lower than that in the control group (192.61 ± 9.42 N) (P ＜ 0.05).Conclusion The suture bridge technique is a feasible and reliable method for repair of rotator cuff tear and has a better healing effect than the single row technique.

ObjectiveTo investigate the clinical curative effect of traditional Chinese medicineKuiyu decoction combined with quadruple therapy for peptic ulcer (PU).MethodsThis study was a randomized controlled trial. 82 patients with PU and conformed to the indusive criteria were randomly divided into a control group and a treatment group by the random number table method, with 41 cases in each group. The control group was treated with quadruple therapy, while the treatment group was treated with traditional Chinese medicineKuiyu decoction based on the treatment of the control group. Integral change of main symptoms before and after treatment and the level changes of serum motilin (MTL), somatostatin (SS) of the two groups before and after treatment were compared and clinical total effective rate was evaluated.ResultsThe total effective rate was 95.1% (39/41) in the treatment group and 80.5% (33/41) in the control group. There was statistical difference between the two groups(χ2=4.100,P=0.043). Stomach pain (0.58 ± 0.21vs.0.73 ± 0.28,t=2.744), gasteremphraxis (0.35 ± 0.12vs.0.43 ± 0.14,t=2.778), sour regurgitation integral (0.28 ± 0.09vs.0.34 ± 0.11,t=2.703) and serum MTL level (358.5 ± 81.3 pg/mlvs.422.8 ± 86.9 pg/ml,t=3.460) in the treatment group were lower than those in the control group (P<0.01);the serum SS level (87.5 ± 18.7 pg/mlvs.73.8 ± 17.9 pg/ml,t=3.389) in the treatment group was higher than that in the control group(P<0.01).ConclusionsTraditional Chinese medicineKuiyu decoction combined with quadruple therapy for the patients with PU can promote SS secretion through decreasing MTL, so it can improve the clinical effect.

Objective:To analyze survival in patients with advanced oral cancer from prospective clinical trials. Methods:From 2008 to 2010, 256 patients with oral cancer at clinical stage III/IVA were randomly categorized into two groups. Patients in the experi-mental group received neo-adjuvant chemotherapy, surgery, and post-operative radiation, and patients in the control group underwent surgery and post-operative radiation. All patients were routinely followed-up after treatments. Survival was analyzed using Kaplan–Meier method and log-rank test, and differences were considered statistically significant at P value lower than 0.05. Results: Each group was composed of 128 patients. With the median follow-up period of 60 months, the 5-year overall survival rate was 61.7%and the disease-free survival rate was 53.9%. The overall survival rate (P=0.350) and the disease-free survival rate (P=0.160) were not sig-nificantly different between the experimental and control groups. Patients with positive pathological response to neo-adjuvant chemo-therapy exhibited significantly improved overall survival (P＜0.05). Conclusion:Radical surgery should be emphasized to improve the prognosis of oral cancer. Functional reconstruction could also improve the quality of life and survival of patients. Despite that neo-adju-vant chemotherapy could not improve the survival of patients with advanced oral cancer in entirety, it could benefit patients exhibiting positive treatment responses.