Objective:To investigate the biomechanical stabilities of different internal screw fixations for Sanders type ⅡB calcaneal fractures using finite element analysis.Methods:Based on the CT scan data of a male volunteer's calcaneus (26 years old, 173 cm tall, weighing 70 kg), a three-dimensional finite element model of the calcaneus was established using digital medical software such as Mimics 22.0, Geomagic 12.0, Solidworks 2019, and ANSYS Workbench 2022. A three-dimensional finite element model of Sanders type ⅡB calcaneal fracture was also established. The following 3 kinds of screws were used: ① longitudinal screws: from the calcaneal tuberosity to the anterior part; ② transverse screws: from the lateral wall of the calcaneus to the sustentaculum tali; ③ vertical screws: from the base of the calcaneus to the talar dome, perpendicular to the posterior articular surface. The scheme of screw configuration was as follows: the longitudinal screws were divided into the upper, middle, and lower groups based on their entry points from the upper, middle, and lower parts of the calcaneal tuberosity. Based on different configurations (double transverse screws + single vertical screw, single transverse screw + single vertical screw, double transverse screws without a vertical screw, and single transverse screw without a vertical screw) 4 subgroups were further subdivided, resulting in a total of 12 models (a, b, c, d, e, f, g, h, i, j, k, l). Forces of 420 N and 200 N were applied to the posterior and middle subtalar joints, respectively, to simulate the load on the calcaneus during single-leg standing in adults. In each model, total deformation displacement, relative displacement of the sustentaculum tali fracture gap, relative displacement of the anterior fracture gap, relative displacement of the articular surface fracture gap, peak stress at the fracture ends and peak screw stress were analyzed.Results:The total deformation displacement was the lowest in models i and j, while models k and l exhibited the highest deformation displacement. The maximum deformation values in the remaining models varied only slightly. The average relative displacement of the sustentaculum tali fracture gap was the lowest in the upper group (0.27 mm) and relatively higher in the lower group, with the greatest variation seen in models k and l. The average relative displacement of the anterior fracture gap was the smallest in the lower group (0.16 mm), with models i and k performing the best. The relative displacement of the articular surface fracture gap remained at a low level across all models. The upper group had the lowest average peak stress at the fracture ends (60.20 MPa), while the middle and lower groups had similar values (103.88 MPa and 99.76 MPa, respectively). The upper group had the lowest average screw stress peak value (222.77 MPa), whereas models k and l in the lower group had the highest stress peaks, reaching 331.48 MPa and 349.82 MPa, respectively.Conclusions:Model i (inferior longitudinal screw + double transverse screws + single vertical screw) can be recommended in clinic because it demonstrates balanced performance in displacement and stress and a notable advantage in reducing overall deformation displacement and anterior fracture gap displacement. As longitudinal, vertical, and transverse screws each play their distinct role in calcaneal fracture fixation, surgeons should select an appropriate screw configuration based on the patient's needs.

OBJECTIVE: To explore clinical rules based on the big data of the emergency department of the Second Affiliated Hospital of Guangzhou Medical University, and to establish an integrated platform for clinical research in emergency, which was finally applied to clinical practice. METHODS: Based on the hospital information system (HIS), laboratory information system (LIS), emergency specialty system, picture archiving and communication systems (PACS) and electronic medical record system of the Second Affiliated Hospital of Guangzhou Medical University, the structural and unstructured information of patients in the emergency department from March 2019 to April 2022 was extracted. By means of extraction and fusion, normalization and desensitization quality control, the database was established. In addition, data were extracted from the database for adult patients with pre screening triage level III and below who underwent emergency visits from March 2019 to April 2022, such as demographic characteristics, vital signs during pre screening triage, diagnosis and treatment characteristics, diagnosis and grading, time indicators, and outcome indicators, independent risk factors for poor prognosis in patients were analyzed. RESULTS: (1) The data of 338 681 patients in the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from March 2019 to April 2022 were extracted, including 15 modules, such as demographic information, triage information, visit information, green pass and rescue information, diagnosis information, medical record information, laboratory examination overview, laboratory information, examination information, microbiological information, medication information, treatment information, hospitalization information, chest pain management and stroke management. The database ensured data visualization and operability. (2) Total 140 868 patients with pre-examination and triage level III and below were recruited from the emergency department database. The gender, age, type of admission to the hospital, pulse, blood pressure, Glasgow coma scale (GCS) and other indicators of the patients were included. Taking emergency admission to operating room, emergency admission to intervention room, emergency admission to intensive care unit (ICU) or emergency death as poor prognosis, the poor prognosis prediction model for patients with pre-examination and triage level III and below was constructed. The receiver operator characteristic curve and forest map results showed that the model had good predictive efficiency and could be used in clinical practice to reduce the risk of insufficient emergency pre-examination and triage. CONCLUSIONS The establishment of high-quality clinical database based on big data in emergency department is conducive to mining the clinical value of big data, assisting clinical decision-making, and improving the quality of clinical diagnosis and treatment.
Adult ; Humans ; Big Data ; Emergency Service, Hospital ; Triage/methods* ; Intensive Care Units ; Hospitalization ; Retrospective Studies

To report a case of cutaneous metaplastic synovial cyst. A 14-year-old male patient presented with a cystic mass on the forehead for more than 6 months. Histopathological findings revealed an intradermal cystic structure with multiple intraluminal broad band-like villiform protuberances, which was lined with a membrane resembling hyperplastic synovium and composed of a variety of cellular structures; some areas of the cystic wall were covered with fibrin-like hyaline connective tissues, and some areas were highly cellularized and lined with multiple layers of epithelioid cells and spindle cells. Immunohistochemical study revealed diffuse expression of vimentin and positive staining for the histocyte marker CD68, but negative staining for cytokeratin and smooth muscle actin in epithelioid cells and spindle cells. According to the clinical manifestations and histopathological findings, the diagnosis of cutaneous metaplastic synovial cyst was confirmed.

A 44-year-old male patient presented with a subcutaneous nodule in the left little finger for 3 years. Skin examination showed a subcutaneous nodule with rubber-like hardness but no tenderness on palpation, measuring 0.4 cm × 0.4 cm in size at the dorsal distal aspect of the left little finger, and the movement of the distal interphalangeal joint was unrestricted. Postoperative histopathological examination revealed that the tumor contained abundant stroma consisting of variable fiberous, chondroid and myxoid materials; tumor cells were oval to short spindle-shaped with inconspicuous nucleoli but no mitosis; cells were arranged haphazardly or in small clusters. Immunohistochemical study showed positive staining for vimentin, CD34 and transcription factors ERG and SOX9, but negative staining for S100, P63, broad-spectrum cytokeratin AE1/AE3, epithelial membrane antigen, smooth muscle actin and desmin in tumor cells, and the Ki67 labeling index was below 1%. Finally, the patient was diagnosed with acral fibrochondromyxoid tumor.

Objective To evaluate the role of p38 MAPK signal transduction pathway in dexmedetomidine against neurotoxicity induced by bupivacaine.Methods Seventy-two adult male SD rats,successfully implanted with intrathecal catheter without complications,were randomly divided into 6 groups: control group (group C);p38MAPK inhibitor group(group SB);dexmedetomidine group (group D);bupivacaine group (group B);dexmedetomidine and bupivacaine group (group DB);p38MAPK inhibitor and bupivacaine group (group SBB).DMSO 20 μl were injected intrathecally in group C;p38MAPK inhibitor 30 μg and 5% bupivacaine were respectively injected intrathecally in group SB and B;group DB and SBB were respectivel pretreated with dexmedetomidine 75 μg/kg intraperitoneally and p38MAPK inhibitor 30 μg intrathecal injection 20 min before intrathecally injected 5% bupivacaine.Dexmedetomidine 75 μg/kg was injected intraperitoneally in group D.Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured before intrathecal catheter was implanted (T0),before intrathecal administration (T1) and at 4,8 and 12 h and on 1,2,3,4,5 and 6 days after intrathecal administration (T2-T10).At 24 h after intrathecal administration,6 rats were randomly chosen from each group and sacrificed.The lumbar segment (L4-5) of the spinal cord was removed for detecting neuronal apoptosis (by TUNEL) and phosporylated p38MAPK(p-p38MAPK) expression (by Western blot).Results Compared with T0,MWT was significantly increased and TWL was prolonged at T2-T9 in group B,MWT at T2-T7 was significantly increased and TWL at T2-T6 was prolonged in group DB,MWT was significantly increased and TWL was prolonged at T2-T5 in group SBB (P<0.05).Compared with group C,no significant difference was found in MWT,TWL,the apoptotic index and expression of p-p38MAPK in groups D and SB.MWT was significantly increased and TWL was prolonged at T2-T9 in group B,the apoptotic index and expression of p-p38MAPK were significantly increased in group B (P<0.05).Compared with group B,MWT and TWL at T2-T9,the apoptotic index and expression of p-p38MAPK were significantly decreased in groups DB and SBB (P<0.05).Conclusion Dexmedetomidine can inhibit spinal neurotoxicity induced by bupivacaine in rats via inhibiting apoptosis in spinal cord,and inhibition of p38 MAPK signal transduction pathway may be involved in the underlying mechanism.

OBJECTIVETo observe the effect difference between drug-spreading moxibustion and the oral administration of meloxicam for primary dysmenorrheal with cold stagnation and to explore its mechanism.

METHODSA total of 101 patients with primary dysmenorrheal were randomly assigned into a drug-moxibustion group(52 cases) and a western medication group(49 cases). Drug-spreading moxibustion was used on the lumbosacral acupoints area and then around lower abdominal five days before menstruation until the 3rd day of menstruation,once three days,while western medicine meloxicam was prescribed one day before menstruation,7.5 mg at a time,once a day and continuously for three days. The clinical effects after one course,namely three menstrual cycles,were compared between the two groups. Meanwhile,the resistance index(RI) and the pulsatility index (PI) of uterine artery and arcus arteriarum were examined through color Doppler ultrasound before and after treatment.

RESULTSAfter one-course treatment,the effective rate was 92.3%(48/52) in the drug-spreading moxibustion group,which was better than 67.3%(33/49) in the western medication group(<0.05). Also,all the RI and PI in the drug-spreading moxibustion group were obviously decreased than those before treatment(all<0.05),and the ones were superior to those of the western medication group(all<0.05),which showed no apparent decrease after treatment(all>0.05).

CONCLUSIONSDrug-spreading moxibustion can improve the symptoms of primary dysmenorrheal with cold-damp stagnation,and the effect is better than that of meloxicam. The mechanism may be related to improve the blood supply to the uterus.

Objective To observe the clinical efficacy of acupuncture-moxibustion plus bloodletting in treating chronic ankle sprain.Method Sixty-six patients with chronic ankle sprain were randomized into a treatment group and a control group, 33 in each group. The treatment group was intervened by acupuncture with distal points plus warm needling and bloodletting method in the topical area; the control group was by warm needling plus ultrashort wave applied to the topical area. The ankle joint symptom and sign score was evaluated before and after intervention, and the clinical efficacies were compared between the two groups.Result The recovery-markedly-effective rate in the treatment group was 51.6%, 74.2%, and 93.5% respectively after 1, 2, and 3 treatment courses, versus 26.7%, 46.7%, and 70.0% in the control group, and the between-group differences were statistically significant (P<0.05).Conclusion Acupuncture-moxibustion is an effective method in treating chronic ankle sprain.

This article is aimed to study the optimal process of preparation of Golden water-soluble gel, and to establish its quality control method. Taking the gel forming properties, stability, water loss rate, pH as investigation index, the best extraction process was screened by single factor and orthogonal test design. TLC method was used to identify the product of trichosanthin, rhubarb, and the content of paeoniflorin was determined by HPLC method. The optimal condition of preparation process is to use 1% carbomer as gel matrix, 10% glycerol as humectants, and 0.5%triethanolamine as pH modulators; trichosanthes and rhubarb could be detected by TLC method, with pH range 5.00 - 5.15. The linear range of paeoniflorin was 29.04-945.20μg·mL-1, the average recovery was 98.80%, and RSD was 2.91% (n=9). Golden gel forming process is simple and quality controllable with reliability and good stability.

This study was aimed to establish a separation method for neochlorogenic acid reference substances from Lonicera japonica. Refined neochlorogenic acid inL. japonica water extract was separated and concentrated by HPD200A macroporous resin, which was isolated and purified by medium-low-pressure preparative chromatography and determined by HPLC. The structure was identified by various spectroscopic data including ESI-MS,1H-NMR and13C-NMR. The results showed that the optimal purification technology conditions were as follows: washed with 5BV of water, collected elution, concentration, drying; neochlorogenic acid crude products were eluted with acetonitrile-0.5% formic acid solution (10:90) with the flow rate of 20 mL·min-1; and the detection wavelength was 326 nm. The contents of the prepared neochlorogenic acid reached to 98.86% and the yield was 89.1%. It was concluded that the method was effective for the preparation of neochlorogenic acid with high purity. It can be used to prepare the reference substances for quantitative analysis and content determination of Chinese materia medica.