Objective:To compare the clinical efficacy of anatomical reconstruction of coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation.Methods:Retrospective analysis was made on the data of 67 patients with acromioclavicular joint dislocation who received surgical treatment in the Department of Orthopaedics of the First Affiliated Hospital of Nanjing Medical University from June 2015 to January 2021. According to the surgical method, they were divided into reconstruction group (using the technique of anatomical reconstruction of coracoclavicular ligament at the original insertion point) and hook plate group (using the clavicular hook plate). There were 37 cases in the reconstruction group, including 26 males and 11 females, aged 47.2±9.6 years (range, 18-65 years), 13 cases on the left and 24 cases on the right. Among the 37 patients, 8 were sports injuries, 14 were falls, 11 were traffic accidents, and 4 were external force injuries. The average time from injury to surgery was 8.3±2.3 days. There were 30 cases in the hook plate group, including 24 males and 6 females, aged 47.4±9.7 years (range, 18-67 years), 12 cases on the left and 18 cases on the right. Among the 30 patients, 7 were sports injuries, 11 were falls, 9 were traffic accidents, and 3 were external force injuries. The average time from injury to surgery was 7.9±2.6 days. The surgical time, incision length, intraoperative bleeding, hospital stay, postoperative coracoclavicular separation ratio, and postoperative complications were compared between the two groups. Constant-Murley score and visual analog scale (VAS) were used to assess the shoulder joint function and pain degree of patients.Results:Both groups of patients were followed up, with a follow-up time of 12.3±0.4 months for the reconstruction group and 12.2±0.5 months for the hook plate group. The operation time (105.8±10.0 min), incision length [12.0 (11.0, 13.0) cm] and hospitalization time (6.8±2.1 d) in the reconstruction group were longer than those in the hook plate group [48.3±4.9 min, 10.0 (10.0, 11.0) cm, and 5.5±2.7 d], while the intraoperative blood loss (75.1±3.9 ml) was less than that in the hook plate group (90.3±6.3 ml), the differences were statistically significant ( P<0.05). The VAS [4.0 (3.0, 5.0), 3.0 (3.0, 3.0), 2.0 (1.0, 2.0) points] and Constant-Murley score (65.4±4.5, 84.9±2.5, 90.1±2.5 points) of the reconstruction group at 3 days, 3 months, and 12 months after surgery were better than those of the hook plate group [5.0 (4.0, 5.0), 4.0 (4.0, 4.0), 3.0 (3.0, 4.0) and 56.9±3.5, 79.6±4.0, 86.8±2.4 points], the difference was statistically significant ( P<0.05). At the last follow-up, there was a statistically significant difference in the separation ratio of coracoclavicular distance between the reconstruction group (0.12±0.08) and the hook plate group 0.22±0.15 ( t=3.25, P=0.002). There was no significant difference ( Z=-0.52, P=0.605) in the separation ratio of acromioclavicular distance [0.16 (0.05, 0.25) and 0.16 (0.04, 0.40)]. In the hook plate group, 6 cases had shoulder joint foreign body sensation and 2 cases had acromioclavicular joint redislocation (both Rockwood type III). Because the shoulder joint function did not affect their daily life, neither patient underwent secondary surgery. And no case of acromioclavicular joint redislocation occurred in the reconstruction group. Conclusion:Compared with the clavicular hook plate fixation, anatomic reconstruction of coracoclavicular ligament at the original insertion point in the treatment of acromioclavicular joint dislocation can reduce the pain of the shoulder joint earlier, which has the characteristics of small trauma, good effect, and reduces the steps of internal fixation removal, and has good clinical curative effect.

BACKGROUND: Shenyankangfu Tablet (SYKFT) is a Chinese patent medicine that has been used widely to decrease proteinuria and the progression of chronic kidney disease. OBJECTIVE: This trial compared the efficacy and safety of SYKFT, for the control of proteinuria in primary glomerulonephritis patients, against the standard drug, losartan potassium. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: This was a multicenter, double-blind, randomized, controlled clinical trial. Primary glomerulonephritis patients, aged 18-70 years, with blood pressure ≤ 140/90 mmHg, estimated glomerular filtration rate (eGFR) ≥ 45 mL/min per 1.73 m MAIN OUTCOME MEASURES: The primary outcome was change in the 24-hour proteinuria level, after 48 weeks of treatment. RESULTS: A total of 735 participants were enrolled. The percent decline of urine protein quantification in the SYKFT group after 48 weeks was 8.78% ± 2.56% (P = 0.006) more than that in the losartan 50 mg group, which was 0.51% ± 2.54% (P = 1.000) less than that in the losartan 100 mg group. Compared with the losartan potassium 50 mg group, the SYKFT plus losartan potassium 50 mg group had a 13.39% ± 2.49% (P < 0.001) greater reduction in urine protein level. Compared with the losartan potassium 100 mg group, the SYKFT plus losartan potassium 100 mg group had a 9.77% ± 2.52% (P = 0.001) greater reduction in urine protein. With a superiority threshold of 15%, neither was statistically significant. eGFR, serum creatinine and serum albumin from the baseline did not change statistically significant. The average change in TCM syndrome score between the patients who took SYKFT (-3.00 [-6.00, -2.00]) and who did not take SYKFT (-2.00 [-5.00, 0]) was statistically significant (P = 0.003). No obvious adverse reactions were observed in any group. CONCLUSION: SYKFT decreased the proteinuria and improved the TCM syndrome scores of primary glomerulonephritis patients, with no change in the rate of decrease in the eGFR. SYKFT plus losartan potassium therapy decreased proteinuria more than losartan potassium therapy alone. TRIAL REGISTRATION NUMBER NCT02063100 on ClinicalTrials.gov.

OBJECTIVE: To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province. METHODS: The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017. RESULTS: The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range: 0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%. The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r=-0.095, -0.151 respectively, P<0.01), positively correlated with death/withdrawal of care (r=0.196, P<0.01). CONCLUSIONS Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.
Anti-Bacterial Agents ; Birth Weight ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Surveys and Questionnaires

Objective To describe the trend of lung cancer mortality in Xuanwei City,Yunnan Province,from 1990 to 2016 and provide scientific evidence for the prevention and control of lung cancer in Xuanwei.Methods Mortality data from the 2nd(year 1990-1992)and 3rd(year 2004-2005)Retrospective Survey on Causes of Death,and the Routine Death Registration System(year 2011-2013 and 2014-2016)in Xuanwei were used in this study.We calibrated the missing report of the mortality data for the corresponding periods,calculated the crude mortality rates,standardized mortality rates and corresponding 95% of different types of lung cancers in the above four periods.Results The crude mortality rates of all lung cancers in Xuanwei for these four periods(1990-1992,2004-2005,2011-2013,and 2014-2016)were 34.0/100 000,89.8/100 000,102.3/100 000 and 87.2/100 000 respectively.The standardized morality rate of lung cancer remain high in Xuanwei although it has been decreasing since 2004.Morality rates of lung cancer for most age groups showed decreasing trends.The decrease has been statistically significant in the ≤ 40 year group since 2014.Except for Longchang,the standardized mortality rates have decreased in all other townships with high lung cancer prevalence.Conclusions Although the mortality rate of lung cancer remains high in Xuanwei,it has shown a decreasing trend since 2004.The decrease in lung cancer mortality in populations younger than 40 years is statistically significant.
China ; Humans ; Lung Neoplasms ; mortality ; Prevalence ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the factors associated with the occurrence of transplant renal artery stenosis (TRAS).

METHODSA retrospective analysis was conducted in 26 recipients who developed TRAS and 40 concurrent renal recipients without TRAS. We also conducted a nested case-control study in 14 patients with TRAS (TRAS-SD group) and another 14 non-TRAS recipients who received the allograft from the same donor (non-TRAS-SD group).

RESULTSCompared with those in the concurrent recipients without TRAS, acute rejection (AR) occurred at a significantly higher incidence (P=0.004) and the warm ischemia time (WIT) was significantly longer (P=0.015) and the level of high?density lipoprotein cholesterol (HDL--C) significantly lower (P=0.009) in the recipients with TRAS. Logistic regression analysis suggested that AR (P=0.007) and prolonged WIT (P=0.046) were risk factors of TRAS while HDL-C (P=0.022) was the protective factor against TRAS. In recent years early diagnosis of TRAS had been made in increasing cases, the interval from transplantation to TRAS diagnosis became shortened steadily, and the recipients tended to have higher estimated glomerular filtration rate at the time of TRAS diagnosis.

CONCLUSIONApart from the surgical technique, AR and prolonged WIT are also risk factors of TRAS while a high HDL-C level is the protective factor against TRAS. The improvement of the diagnostic accuracy by ultrasound is the primary factor contributing to the increased rate of early TRAS diagnosis in recent years.

We assessed the role of diabetes mellitus (DM) on treatment effects in drug-susceptible initial pulmonary tuberculosis (PTB) patients. A prospective study was conducted in eight provinces of China from October 2008 to December 2010. We enrolled 1,313 confirmed drug-susceptible initial PTB patients, and all subjects received the treatment regimen (2H3R3E3Z3/4H3R3) as recommended by the national guidelines. Of the 1,313 PTB patients, 157 (11.9%) had DM; these patients had more sputum smear-positive rates at the end of the second month [adjusted odds ratios (aOR) 2.829, 95% confidence intervals (CI) 1.783-4.490], and higher treatment failure (aOR 2.120, 95% CI 1.565-3.477) and death rates (aOR 1.536, 95% CI 1.011-2.628). DM was a contributing factor for culture-positive rates at the end of the second month and treatment failure and death of PTB patients, thus playing an unfavorable role in treatment effects of PTB.
Antitubercular Agents ; therapeutic use ; China ; epidemiology ; Diabetes Mellitus ; epidemiology ; therapy ; Female ; Humans ; Male ; Mycobacterium tuberculosis ; drug effects ; Tuberculosis, Pulmonary ; complications ; drug therapy ; epidemiology ; microbiology

The objective of this prospective study of the risks of treatment failure in patients with drug-susceptible pulmonary tuberculosis (PTB) was to provide reference data to help develop a disease control strategy. Participants were recruited in eight provinces of China from October 2008 to December 2010. A total of 1447 patients with drug-susceptible PTB and older than 15 years of age were enrolled. Demographic characteristics, bacteriological test results, and patient outcome, i.e., cure or treatment failure were recorded and compared using the chi-square or Fisher's exact tests. Multivariate logistic regression was used to identify factors associated with risk of treatment failure. Of the 1447 patients who were enrolled, 1349 patients (93.2%) were successfully treated and 98 (6.8%) failed treatment. Failure was significantly associated with age 365 years [odds ratio (OR)=2.522, 95% confidence interval (CI): (1.097-5.801)], retreatment [OR=2.365, 95% CI: (1.276-4.381)], missed medicine [OR=1.836, 95% CI: (1.020-3.306)], treatment not observed [OR=1.879 95% CI: (1.105-3.195)], and positive culture result after the first [OR=1.971, 95% CI: (1.080-3.597)] and second month [OR=4.659, 95% CI: (2.590-8.382)]. The risk factors associated with treatment failure were age 365 years, retreatment, missed medication, treatment not observed, and positive culture at the end of month 1 or month 2. These risk factors should be monitored during treatment and interventions carried out to reduce or prevent treatment failure and optimize treatment success.
Adolescent ; Adult ; Aged ; Antitubercular Agents ; therapeutic use ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium tuberculosis ; drug effects ; physiology ; Prospective Studies ; Retreatment ; Risk Factors ; Treatment Failure ; Tuberculosis, Multidrug-Resistant ; drug therapy ; epidemiology ; microbiology ; Tuberculosis, Pulmonary ; drug therapy ; epidemiology ; microbiology ; Young Adult

BACKGROUNDThe radiochemotherapy regimen concomitantly employing temozolomide (TMZ) chemotherapy and radiotherapy (RT) 4 weeks after surgery, followed by 6 cycles of TMZ is a common treatment for glioblastoma (GBM). However, its median overall survival (OS) is only 14.6 months. This study was to explore the effectiveness and safety of early TMZ chemotherapy between surgery and chemoradiotherapy plus the standard concomitant radiochemotherapy regimen.

METHODSA randomized, parallel group, open-label study of 99 newly diagnosed GBM patients was conducted at 10 independent Chinese neurosurgical departments from June 2008 to June 2012. Patients were treated with concomitant radiochemotherapy regimen plus early postsurgical temozolomide (early TMZ group) or standard concomitant radiochemotherapy regimen (control group). Overall response was assessed based on objective tumor assessments, administration of corticosteroid and neurological status test. Hematological, biochemical, laboratory, adverse event (AE), and neurological condition were measured for 24 months of follow-up. The primary efficacy endpoint of this study was overall survival (OS). The secondary endpoint was progression free survival (PFS).

RESULTSThe median OS time in the early TMZ group was 17.6 months, compared with 13.2 months in the control group (log-rank test P = 0.021). In addition, the OS rate in the early TMZ group was higher at 6, 12, and 18 months than in the control group, respectively (P < 0.05). The median PFS time was 8.7 months in the early TMZ group and 10.4 months in the control group (log-rank test P = 0.695). AEs occurred in 29 (55.8%) and 31(73.8%) patients respectively in early and control groups, including nausea (15.4% vs. 33.3%), vomiting (7.7% vs. 28.6%), fever (7.7% vs. 11.9%), and headache (3.8% vs. 23.8%). Only 30.8% and 33.3% were drug-related, respectively.

CONCLUSIONSAddition of TMZ chemotherapy in the early break of the standard concomitant radiochemotherapy regimen was well tolerated and significantly improved the OS of the GBM patients, compared with standard concomitant radiochemotherapy regimen. However, a larger randomized trial is warranted to verify these results.

Adult ; Aged ; Antineoplastic Agents, Alkylating ; therapeutic use ; Chemoradiotherapy ; methods ; Dacarbazine ; analogs & derivatives ; therapeutic use ; Glioblastoma ; drug therapy ; radiotherapy ; Humans ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVEThe prevalence of allergic asthma has been rising continually which is correlated with the increasingly closed living environment. House dust mites are the major sources of indoor aeroallergens which induce asthma in sensitized people. To monitor the seasonal variation of house dust mite (HDM)-allergens exposure level in the asthmatic children, which was evaluated to show its correlation with the level of asthma control, HDM allergic sensitization and fraction of exhaled nitric oxide, and to provide basic data for HDM environmental control.

METHODA total of 48 HDM-allergic asthmatic children were enrolled from the asthma clinic in the hospital from March 2011 to January 2012 (boys 34 and girls 14, aging from 3 to 14 years, mean age 8 years and 4 months) in the present study. Dust samples from mattresses, pillows, bedroom floor, living room floor and sofas were collected in each season within one year in the household of all the enrolled patients. The concentrations of Der p 1 and Der f 1 were measured by the enzyme-linked immunosorbent assay (ELISA). To record the Asthma Control Test (ACT) score or Children Asthma Control Test (C-ACT) score for each patient and to collect the data of doctor monitoring asthma control level each time when the patient was clinic visited. The concentration and its classification of the serum specific IgE to HDM was determined by fluoroenzyme-immunometric assay.

RESULTThe average concentration of Der f 1 of all dust samples was significantly higher than that of Der p 1 (0.13 µg/g vs 0.02 µg/g, P < 0.05). The concentrations of Der f 1 from mattresses, pillows and sofas dust samples were significantly higher than those from bedroom floor and living room floor dust samples (0.69 µg/g, 0.42 µg/g and 0.22 µg/g vs 0.07 µg/g and 0.07 µg/g, P < 0.05). The Der f 1 exposure level from mattress dusts in summer but no others was negatively correlated with asthma control level (r = -0.318, P = 0.036). The Der f 1 exposure level from any area dusts in summer and the Der p 1 exposure level from pillows dusts in autumn was negatively correlated with ACT/C-ACT score respectively. The Der f 1 from mattress dusts in winter was positively correlated with classification of sIgE to Der f 1. The Der p 1 exposure level from most areas in each season was positively correlated with classification of sIgE to Der f 1 and Der P 1.

CONCLUSIONDer f 1 was the predominant mite allergen in household dust and mainly came from mattresses, pillows and sofas. The role of the HDM allergen exposure level on the asthma control level and HDM allergic sensitization for the asthmatic children were depended on its area, season and HDM species, which suggested that the future assessment of clinical effect by the HDM environmental control should consider these factors.

Adolescent ; Air Pollution, Indoor ; adverse effects ; Animals ; Antigens, Dermatophagoides ; analysis ; Asthma ; diagnosis ; etiology ; immunology ; Child ; Child, Preschool ; Dust ; Environmental Exposure ; Enzyme-Linked Immunosorbent Assay ; Female ; Forced Expiratory Volume ; Humans ; Immunoglobulin E ; blood ; Male ; Pyroglyphidae ; immunology ; Risk Factors ; Seasons

Objective To investigate the distribution characteristics in the positive ratio distribution of serum allergen specific immunoglobulin E (sIgE) in atopic dermatitis children with multiple sensitization factors,which could help to assess the atopic condition and offer recommendation for the avoidance of allergens.Methods A total of 90 children with atopic dermatitis were enrolled(male 66,female 24,aged 0.3-16.1 years).All the patients were divided into 3 groups according to the patients' age:0-3 years old group (48 patients),4-7 years old group (31 patients),8-16 years old group (11 patients).The serum sIgE levels of 29 kinds of food and inhalation allergens in each patient were detected by the UniCAP 250 quantified IgE measurement system.Results The positive ratio of each food allergen in all the patients were as follows:55.6％ (50/90 cases) for egg white,42.2％ (38/90 cases) for milk,32.2％ (29/90 cases) for egg yolk,12.2％ (11/90 cases) for shrimp,11.1％ (10/90 cases) for crab,7.8％ (7/90 cases) for chicken,4.4％ (4/90 cases) for fish,54.4％ (49/90 cases) for wheat,37.8％ (34/90 cases) for peanut,34.4％ (31/90 cases) for soybean,33.3％ (30/90 cases) for tomato and 28.9％ (26/90 cases) for peach.The positive ratio of each inhalation allergen in all the patients were as follows:51.1％ (46/90 cases) for house dust,45.6％ (41/90 cases) for alternaria alternata,41.1％ (37/90 cases) for dermatophagoides pteronyssinus,40％ (36/90 cases) for dermatophagoides farinae,33.3％ (30/90 cases) for dog dander,28.9％ (26/90 cases) for cockroach,27.8％ (25/90 cases) for cat dander,21.9％ (19/90 cases) for blomia tropicalis,36.7％ (33/90 cases) for ambrosia elatior,34.4％ (31/90 cases) for white ash,32.2％ (29/90 cases) for london plane,32.2％ (29/90 cases) for artemisia vulgaris,31.1％ (28/90 cases) for common silver birch,27.8％ (25/90 cases) for willow,25.6％ (23/90 cases) for mountain juniper,25.6％ (23/90 cases) for humulus scandens and 25.6％ (23/90 cases) for chenopodium album.The positive ratios of sIgE for egg white,milk,egg yolk of patients in the 0-3 years old group were higher than those in the 4-7 years old group and 8-16 years old group (x2 =29.27,15.98,18.58,all P ＜ 0.05).The positive ratios of sIgE for dermatophagoides pteronyssinus,dermatophagoides farinae,blomia tropicalis,cat dander,mountain juniper,humulus scandens of patients in the 8-16 years old group were higher than those in the 0-3 years old group and 4-7 years old group (x2 =12.94,14.31,7.77,7.65,9.41,6.93,all P ＜ 0.05).The positive ratios of sIgE for food allergens and animal dander in the patients of diagnosed as atopic dermatitis alone were higher than those of diagnosed as atopic dermatitis combined with asthma or allergic rhinitis.The positive ratios of sIgE for common inhalation allergens in the patients diagnosed as atopic dermatitis alone were lower than those diagnosed as atopic dermatitis combined with asthma or allergic rhinitis.Conclusions Allergens such as animal protein,house dust,mites and molds are the main sensitization allergens for atopic dermatitis children with multiple sensitization factors.Atopic dermatitis children in 0-3 years old group often presented sensitiveto food allergens,while those in 8-16 years old group are more commonly sensitive to inhalation allergens.Patients diagnosed as atopic dermatitis alone are often presented sensitive to food allergens and animal dander,while those diagnosed with asthma or allergic rhinitis are more commonly sensitive to inhalant allergens.