Objective To investigate the clinical curative effect of Modified Gualou Xiebai Banxia Decoction in the treatment of stable angina pectoris(SAP)with internal resistance of phlegm and turbidity and its effect on gut microbiota.Methods The clinical data of 72 cases of SAP patients with phlegm turbidity and internal resistance type in our hospital were selected for prospective study,sorted according to the order of admission,and divided into control group and observer by random number table method,with 36 cases in each group.The control group was given standardized western medicine treatment,and the observation group was given the addition of Modified Gualou Xiebai Banxia Decoction on the basis of the control group.The clinical efficacy and gut microbiota composition of the two groups of patients were compared.Results After treatment,the clinical efficacy of the observation group was better than that of the control group(P<0.05);there was no significant difference in the ECG efficacy between the two groups(P>0.05).Based on 16S rDNA technology,at the phylum and genus levels,there was no difference in the abundance of Bacteroidota,Bacteroides and Faecalibacterium(P>0.05).After treatment,the abundance of Bacteroidota in the observation group increased more significantly than that in the control group(P<0.05).Conclusion Modified Gualou Xiebai Banxia Decoction can effectively improve the clinical efficacy of SAP patients with phlegm-turbid internal resistance by regulating gut microbiota,which provides new inspiration for the further development of Gualou Xiebai Banxia Decoction.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Objective:To compare the clinical effect of circular external fixator and intramedullary nail in treatment of tibial segmental fractures.Methods:A retrospective case control study was performed on clinical data of 43 patients with segmental tibial fractures treated from January 2006 to December 2012 in Tianjin Hospital. There were 31 males and 12 females with age range of 20-60 years［（35.9±9.6）years］. All fractures were classified as type 42C2 using the AO/OTA classification. A total of 21 patients treated with circular external fixator（circular fixator group）and 22 patients were treated with intramedullary nail（intramedullary nail group）. The condition of vascular and neural injuries，methods of fracture reduction，time of full weight bearing，bone healing time and infection rate were compared between the two groups. The proximal tibial medial angle，proximal tibial posterior angle，IOWA knee and ankle joint score，range of motion of flexion of keen joint and range of motion of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last follow-up.Results:All patients were followed up for 12- 48 months［（19.6±2.1）months］. There were no vascular and neural injuries or other severe complications in both groups. All 21 patients in circular fixator group underwent closed reduction but 3 patients in intramellary nail group were treated by open reduction. The time of full weight bearing was（12.9±2.8）days and in circular fixator group and（75.1±8.0）days in intramedullary nail group（ P<0.05），with bone healing time for（7.0±1.0）months and（8.2±1.4）months，respectively（ P<0.05）. There was no deep infection in both groups. In circular fixator group and intramedullary nail group，the proximal tibial medial angle was（86.7±1.5）° and（93.5±1.7）°（ P<0.05），while the proximal tibial posterior angle was（82.1±1.8）°and（75.1±2.7）°（ P<0.05）. No significant differences were found between the two groups at the last follow-up concerning IOWA knee and joint score，range of motion of flexion of keen joint and range of motion of plantar flexion of ankle joint（ P>0.05）. The range of motion of dorsal flexion of ankle joint in intramedullary nail group was（30.9±3.0）°，better than（21.2±2.2）° in circular fixator group（ P<0.05）. Conclusion:For segmental tibial fractures，cirlular external fixation is superior to intromedullary nail in aspects of completely close reduction，early full weight bearing and early bone healing and alignment.

OBJECTIVE：To systematically evaluate the efficacy and safety of Kuanxiong aerosol in the treatment of coronary heart disease angina ，and to provide evidence-based reference for climical drug use . METHODS ：Retrieved from Cochrane Library，PubMed，Embase，CKNI，Wanfang data ，VIP，and CBM ，randomized controlled trials （RCTs）about Kuanxiong aerosol （trial group ）versus nitroglycerin （control group ）in the treatment of coronary heart disease angina were collected during the inception to Mar. 20th，2020. After literature screening and data extraction ，quality assessment was performed using the bias risk assessment tool recommended by the Cochrane System Evaluator Manual 5.1.0. Meta-analysis was performed by using Rev Man 5.3 statistical software. Sensitivity analysis was conducted for the stability of the result ，and trial sequential analysis （TSA）was performed by using TSA 0.9 software. RESULTS ：A total of 11 RCTs were included ，with a total of 1 847 cases. Meta-analysis showed that improvement rate of angina pectoris （within 3 min）[RR＝1.11，95％CI（1.02，1.22），P＝0.02] and total response rate of angina pectoris （within 5 min）[RR＝1.04，95％ CI（1.01，1.07），P＝0.01] in trial group were significantly higher than control group；the incidence of ADR [RR＝0.44，95％CI（0.35，0.57），P＜0.000 01] in trial group was significantly lower than control group. There was no statistical significance in total response rate of ECG [RR＝1.02，95％CI（0.97，1.09），P＝0.42] or the level of NO after treatment [SMD ＝－0.08，95％CI（－0.61，0.45），P＝0.76] between 2 groups. The results of sensitiv ity analysis and TSA showed that the efficacy evidence of Kuanxiong aerosol in the treatment of coronary heart disease pectoris was not accurate ，but the evidence of safety was accurate. CONCLUSIONS ：Kuanxiong aerosol can improve the efficacy in patients with coronary heart disease angina ，and the safety is better ，but the conclusions of efficacy needs to be further confirmed by enlarging sample size.

Objective:To investigate the accuracy and postoperative efficacy of fluoroscopy and CT in measuring the mounting parameters of Taylor Spatial Frame.Methods:Data of patients with peripheral knee deformities who were treated by Taylor Spatial Frame from June 2006 to December 2017 were retrospectively analyzed. According to different measurement methods of mounting parameters, they were divided into fluoroscopy group (mounting parameters were obtained by intraoperative fluoroscopy) and CT group (mounting parameters were obtained by postoperative CT). There were 33 patients (35 segments) in the fluoroscopy group, 23 males (23 segments) and 10 females (12 segments), with an average age of 36.4±11.6 years old. In CT group, there were 30 patients, 19 males and 11 females, with an average age of 36.9±13.8 years. There were 22 cases (24 segments) of high tibial osteotomy, 5 cases (5 segments) of distal femur osteotomy, and 6 cases (6 segments) of both distal femur and high tibial osteotomy. Operation time, external fixation time, the number of electronic prescription and deformity correction time, mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), mechanical lateral distal femoral angle (mLDFA), range of motion (ROM) andhospital for special surgery (HSS) knee functional scores were compared between the two groups.Results:All the 63 patients were followed up for 21.9 months (range, 12-60 months). In fluoroscopy group, operating time was 100.9±9.1 min, electronic prescription number 1.4±0.6, and deformity correction time was 19.4±3.6 days. In CT group, operating time was 79.2±10.8 min, electronic prescription number 1.2±0.4, and deformity correction time was 16.0±4.4 days. The difference of the above indexes between the two groups was statistically significant ( t=8.803, 2.042, 3.440, all P < 0.05). In the fluoroscopy group, the external fixation time was 4.8±0.9 months; MAD was 4.3±2.1 mm; MPTA was 88.5°±1.9°; mLDFA was knee 89.2°; ROM was 122.4°±3.9° and HSS score was 90.0±3.6. In CT group, the external fixation time was 4.6±0.9 months; MAD was 4.0±1.9 mm; MPTA was 87.8°±1.7°; mLDFA was knee 88.6°; ROM was 122.7°±3.4° and HSS score was 91.1±2.9. There was no statistically significant difference in the above indexes between the two groups (all P >0.05). In the fluoroscopy group, 22 segmental deformities were corrected by one electronic prescription, and 13 segmental deformities were corrected by two or more electronic prescriptions. In CT group, 25 segmental deformities were corrected by one electronic prescription, and 5 segmental deformities were corrected by two electronic prescriptions. There was no incision infection and no neurovascular injury in the two groups. Conclusion:Both fluoroscopy and CT scan can obtain the mounting parameters of the Taylor Spatial Frame, and the results of correction of the peripheral deformities of the knee joint are satisfactory. However, CT measurement of the mounting parameters is more accurate which could achieve shorter operation time, and less times of electronic prescriptions.

Objective To investigate the clinical outcomes of combined Ilizarov technique with tendon transfer for the treatment of rigid equinovarus foot deformity.Methods A retrospective analysis was performed on the clinical data of 11 patients (14 feet) with rigid equinovarus foot deformity who were treated by Ilizarov technique combined with tendon transfer without additional bony procedures from August 2015 to February 2018.The average age was 21.6 years old (range,12-36 years old) and 6 patients were males and 5 patients were females.According to Dimeglio classification,8 feet were grade Ⅱ and 6 feet were grade Ⅲ.Seven patients (10 feet) were treated with external fixator and tendon transfer simultaneously.Four patients (4 feet) underwent staging surgery,in which Achilles tendon lengthening,plantar fascia lysis and slow correction of deformity with external fixator were performed as the first stage operation,followed by the second stage tendon transfer.The average interval between the two operations was 26.5 days (range,20-32 days).The lateral tibiotalar angle on load-bearing ankle radiographs and tibiocalcaneal angle on Saltzman view radiographs were measured after operation,and compared with that before operation.Functional evaluation was performed by The American Orthopaedic Foot and Ankle Society (AOFAS) and Ankle Hind foot Scale.Quality of life assessment was assessed by the MOS 36-Item Short Form Health Survey (SF-36) Scale.The excellent and good rate of operation was evaluated by the International Clubfoot Study Group (ICFSG) scoring system.Results All patients were followed up for 6 months to 36 months with an average of 20 months.All cases achieved effective correction.There were no neurovascular complications in this group of patients.The preoperative ankle range of motion in dorsiflexion was-19.9°± 14.8°,and plantar flexion 38.5°± 12.8°.At the latest follow-up,the mean dorsiflexion increased to 2.7°± 1.6° and the plantar flexion decreased to 21.0°±9.2°.Preoperative Dimeglio classification included 8 feet in grade Ⅱ,6 feet in grade Ⅲ.At the latest follow-up,there were 13 feet in grade Ⅰ and 1 foot in grade Ⅱ.The tibiotalar angle was 122.2°± 16.6° before surgery and 100.8°±4.8° at the latest follow-up.The tibiocalcaneal angle of the Saltzman view was-25.2°±9.2° before surgery and-3.7°±2.8° at the latest follow-up.The mean preoperative AOFAS score increased from 63.9± 12.7 to 85.2±9.7,with statistically significant difference (t=14.87,P＜ 0.05).The average SF-36 score increased from 50.1±8.4 to 63.7±8.1,with statistically significant difference (t=4.10,P＜ 0.05).At the latest follow-up,the average ICFSG score was 6.6 (range,3-16).According to the classification of ICFSG score,there were 7 feet excellent,6 feet good,and Ⅰ foot fair,with an excellent and good rate of 92.9％ (13/14).Conclusion Ilizarov technique combined with tendon transfer could achieve successful correction of rigid equinovarus foot deformity with satisfactory short-term results.

Objective To evaluate the clinical effects of the Ilizarov method combined with two kinds of reversed neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot.Methods Data of 21 cases of posttraumatic equinus with soft tissue defects on ankle and foot who were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer from June 2006 to January 2018 were retrospectively analyzed.There were 17 males and 4 females,aged from 26 to 65 years,with an average age of 43.9 years.The soft tissue defect dimensions ranged from 6 cm×5 cm to 10 cm×9 cm,and the time from the initial trauma to the operation ranged from 2.5 to 240.0 months.The mean preoperative equinus contracture was-38.9° (range,-25° to-66°),and total ankle range of motion (ROM) was 7.1° (range,0°-18°).All cases were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer.Two weeks after the flap transfer,distraction of the Ilizarov fixator was initiated to gradually correct the equinus foot.The flap survival was observed in the postoperative period,and the International Club Foot Study Group (ICFSG) score was collected at the latest follow-up.The criteria were used to assess the morphological and functional outcome.Results A total of 21 resversed flaps were transferred,including 15 sural neurocutaneous flaps and 6 saphenous neurocutaneous flaps.The sizes of flaps were from 7 cm±6 cm to 11 cm± 10 cm.Among them,17 patients underwent primary flap transfer,and 4 patients underwent a delayed second-stage procedure 2 weeks after primary surgery.The 4 delayed flaps contain 3 sural neurocutaneous flaps and 1 saphenous neurocutaneous flap.All 21 patients were followed up and the average periodof follow-up was 20.3 months (range,8-96 months).Among the 21 flaps,19 survived completely.Although marginal necrosis was observed in 2 cases,these wounds healed after subsequent debridement and dressing change treatment.No major complication was seen,but superficial pin tract infection was present in 4 cases who then received dressing change and oral antibiotic.Deformities were corrected,and ankle motion had increased significantly.The mean ankle activity at the latest follow up was 22° (range,8°-38°),and postoperative ICFSG score at the latest follow-up was 5.67±3.09,which significantly reduced compared with preoperative one (30.81 ±3.63).The difference was statistically significant (t=32.815,P=0.035).The results were excellent in 13 feet,good in 7,and fair in 1,with the excellent and good rate of 95.24％ (20/21).The local infections were cured without recurrence at operative site.Equinus deformities were corrected,and the latest follow-up results showed that all patients walked normally without recurrence.Conclusion Ilizarov method combined with reversed sural and saphenous neurocutaneous island flap can improve the limb function and the flap can survival with good clinical effect.

Objective To study the clinical characteristics and prognosis of cerebral infarction combined with metabolic syndrome.Methods From July 1,2015 to March 31,2017,250 patients with cerebral infarction combined with metabolic syndrome in four comprehensive hospital in Zhongshan city were studied.The blood pressure,blood lipid,blood sugar,waist circumference,neurological deficit and disability were analyzed before and after treatment. Meanwhile,the neurological function and disability degree of blood pressure,blood lipid,blood sugar,waist circumfer-ence and non qualified patients were compared.Results After treatment for two weeks,three months and six months, the systolic blood pressure [(132.21±11.25)mmHg,(126.37 ±10.26)mmHg,(122.29 ±11.12)mmHg], diastolic blood pressure [(90.12 ±5.21)mmHg,(84.16 ±4.11)mmHg,(82.23 ±3.10)mmHg],triglycerides [(1.81±0.24)mmol/L,(1.64 ±0.35)mmol/L,(1.51±0.25)mmol/L],high －density lipoprotein cholesterol [(1.01±0.31)mmol/L,(1.08 ±0.36 )mmol/L,(1.19 ±0.34 )mmol/L],fasting plasma glucose [(6.26 ± 0.56)mmol/L,(6.10 ±0.34)mmol/L,(5.59 ±0.34)mmol/L],two－hour postprandial blood glucose [(8.36 ± 1.12)mmol/L,(7.34 ±1.10)mmol/L,(7.05 ±0.26)mmol/L],neurological deficit scores [(31.26 ±1.16)points, (26.58 ±1.05)points,(21.10 ±0.34)points],disability scores [(3.26 ±0.34)points,(2.10 ±0.25)points, (0.59 ±0.20)points]were better than those before treatment (F＝5.10,5.23,5.45,4.89,4.21,4.20,4.26,4.58, P＝0.02,0.04,0.02,0.03,0.01,0.02,0.02,0.03).After treatment for three months and six months,the waist circ-umference [(82.21±5.10)cm,(81.23 ±4.16)cm]were less than before treatment (F＝5.26,P＝0.03).After treatment,the compliance rate of blood pressure,blood lipids,blood glucose,waist circumference was 79.20%,and the not met rate was 20.80%.The neurological deficit score [(17.25 ±1.26)points]and disability score[(0.34 ± 0.12)points]were lower than those who did not meet standard(t＝29.64,17.44,P＝0.01,0.01).Conclusion High blood pressure,high blood lipid and high blood sugar are the main clinical characteristics of patients with cerebral infarction combined with metabolic syndrome,and relieving the symptoms of＂three high＂can improve the prognosis.

Objective To investigate the prevalence of chronic non-communicable diseases among farmers,land less peasants and urban population in a certain area of Anhui Province,to explore the relationship between the lifestyles of landless peasants and their chronic non-communicable diseases.Methods A total of 761 valid questionnaires were collected by cross-sectional epidemiological study,including 119 farmers,259 landless peasants and 383 urban groups.The enumeration data was analyzed by x2 test and the measurement data analyzed by variance.The risk of chronic non-communicable diseases in each group was analyzed by Logistic regressions.Results General demographic characteristics showed that there were differences in three groups of people in the respects of drinking,eating habits and physical activity and other lifestyles (all P ＜ 0.05).Logistic regression analysis showed that the onset risk of hypertension and overweight obesity in the famer group and the landless peasant group was lower than that in the urban group,but higher than that in the peasant group.After adjusting for confounding factors,the prevalence of hypertension in the farmer group (OR =0.20,95％ CI:0.12-0.33) and the lost land group (OR =0.65,95％ CI:0.44-0.95) was lower than that in the urban group,the overweight obesity in the farmer group (OR =0.44,95％ CI:0.27-0.74) and the lost land group(OR =0.67,95％ CI:0.47-0.96) was lower than that in the urban group.The incidence of atherosclerosis in the farmer group (OR =2.48,95 ％ CI:1.45-4.23) and the lost land group(OR =2.00,95％ CI:1.33-3.02) was higher than that in the urban group.Conclusions The living style of landless peasants is different from those of rural group and urban group,and the incidence of hypertension and overweight obesity is higher than that of farmers.We should take interventions against chronic non-communicable diseases in landless peasants.

Objective To observe the phosphorylation level and nuclear translocation of signal transducer and activator of transcription factor-3 (STAT3) in hippocampal neurons induced by oxygen and glucose deprivation in vitro and discuss the dynamic changes of STAT3 signal pathway in an in vitro cell model of brain hypoxia and ischemia.Methods Hippocampal neurons from newly born SD rats (within 24 hours from birth) were cultured with DMEM/F12 for nine days,and then were transferred to oxygen and glucose deprivation environment for four hours to establish experimental cell models.The distribution of phosphorylated STAT3 (p-STAT3) in the hippocampal neurons in different groups was observed under laser scanning confocal microscope after immunofluorescence staining.Expression intensity of p-STAT3 at different time points after oxygen and glucose deprivation in the hippocampal neurons was detected by Western blotting.Results Expression of p-STAT3 was unobvious in the nucleus of the control group,but it was observed in the nucleus of the model group one hour after modeling,and peaked at three hour.Expression levels of p-STAT3 in the hippocampal neurons at each time point between the two groups showed significant difference (P ＜ 0.05).Conclusion Oxygen and glucose deprivation induces noticeable up-regulation of p-STAT3 in the hippocampal neuronal nucleus,which indicates the overactivation of signal transduction pathway of STAT3.