Objective To study the clinical characteristics of mulifocal motor neuropathy. Methods Patients records in China Biological Medicine Database (CBM-disc 1980-2005)and WanFang Database were searched. Demographic data, clinical manifestations, electrophysiology, and laboratory findings on multifocal motor neuropathy were analyzed. Results Of the total 80 patients, 61 cases were males, and 19 were females. A single limb weakness began in all the patients. Weakness was usually accentuated distally(95.3%), accompanied by muscle amyotrophy(76.3%) and fasciculation(46.3%). Reflexes were reduced (96.4%). Sensory impairment and cranial involvement were rare. 92.1% of the patients showed conduction block of motor nerve. Results Of the total 80 patients, 61 cases were males, and 19 were females. A single limb weakness began in all the patients. Weakness was usually accentuated distally(95.3%), accompanied by muscle amyotrophy(76.3%) and fasciculation(46.3%). Reflexes were reduced (96.4%). Sensory impairment and cranial involvement were rare. 92.1% of the patients showed conduction block of motor nerve. Conclusions Clinical features about multifocal motor neuropathy are a single distal limb weakness, muscle amyotrophy, and conduction block of motor nerve. MMN should be differentiated from motor neuron disease and chronic inflammatory demyelinating polyneuropathy.
Objective To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors. Methods The cl inical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009. Of 82 patients, 65 were male and 17 were female, aged 26-72 years (mean, 38 years).Fractures were caused by traffic accident in 62 cases, by crush in 13 cases, and by fall ing from height in 7 cases. The time from injury to admission was 30 minutes to 12 days (median, 7.6 hours) in 70 cases, 12 cases were transferred because poor result after 34-67 days of conservative treatment. According to Judet classification, there were 24 cases of posterior wall fracture, 3 cases of posterior column fracture, 1 case of anterior wall fracture, 2 cases of anterior column fracture, 6 cases of transverse fracture, 16 cases of transverse and posterior wall fracture, 4 cases of posterior column and posterior wall fracture, 5 cases of T-type fracture, 3 cases of anterior and posterior hemitransverse fracture, and 18 cases of complete both-column fracture; 24 cases combined with dislocation of the hip. During operation, Kocher-Langenbeck approach was used in 49 cases, anterior il ioinguinal approach in 19 cases, and the combination of anterior and posterior approaches in 14 cases. Reconstructive plate (74 cases) and hollow lag screw (8 cases) internal fixation were used. The function of the hip was evaluated according to the modified Merled’Aubigne- Postel hip score system postoperatively. According to fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hi p dislocation and time of reduction, operative approach, deep vein thrombosis (DVT), and heterotopic ossification (HO), the patients were divided into the groups and the results were compared. Results Accordancewith the Matta X-ray evaluation criteria, anatomic reduction was achieved in 21 cases, good reduction in 37 cases, fair reduction in 16 cases, and poor reduction in 8 cases, and the excellent and good rate was 71%. All the cases were followed up 12-52 months mean, 34 months). Iatrogenic sciatic nerve injury occurred in 8 cases, infection in 3 cases, HO in 16 cases, DVT in 3 cases, hip posttraumatic arthritis in 12 cases, and avascular necrosis of the femoral head in 9 cases. X-ray examination showed that 80 cases achieved fracture union at 10-24 weeks after operation (mean, 14 weeks) and 2 cases had fracture delayed union at 10 months and 12 months after operation. According to the modified Merled’Aubigne-Postel hip score system, the function of the hip was rated as excellent in 26 cases, good in 32, fair in 20, and poor in 4 at 6 months after operation; the excellent and good rate was 71%. The affecting factors of cl inical results of acetabular fractures were fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation and time of reduction (P lt; 0.05). However the operative approach, DVT, and HO were not affecting factor of the acetabular fractures (P gt; 0.05). Conclusion Operative treatment of acetabular fractures has a satisfying therapeutic effect. Fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation, and time of reduction are risk factors affecting postoperative results.
The dynamic changeS of density of epidermal melanocytes in the full-thickness autografts of skinon guinea pigs were investigated by means of histochamical and autoradiographic techniques at variousjntervals during 3 months peried potoperatively,It was found that the increase of epidermalmelaneeytes was accompanied by hyperpigmentation of the skin grafts. Meanwhils,the amount of 3H-TdR taken by the melanocytes was increased. The results showed that the melanocytes poitive to Dopabecame...
Objective To explore the correlation between the quantitative and qualitative features of CT images and the invasiveness of pulmonary ground-glass nodules, providing reference value for preoperative planning of patients with ground-glass nodules. MethodsThe patients with ground-glass nodules who underwent surgical treatment and were diagnosed with pulmonary adenocarcinoma from September 2020 to July 2022 at the Third Affiliated Hospital of Kunming Medical University were collected. Based on the pathological diagnosis results, they were divided into two groups: a non-invasive adenocarcinoma group with in situ and minimally invasive adenocarcinoma, and an invasive adenocarcinoma group. Imaging features were collected, and a univariate logistic regression analysis was conducted on the clinical and imaging data of the patients. Variables with statistical difference were selected for multivariate logistic regression analysis to establish a predictive model of invasive adenocarcinoma based on independent risk factors. Finally, the sensitivity and specificity were calculated based on the Youden index. Results A total of 555 patients were collected. The were 310 patients in the non-invasive adenocarcinoma group, including 235 females and 75 males, with a meadian age of 49 (43, 58) years, and 245 patients in the invasive adenocarcinoma group, including 163 females and 82 males, with a meadian age of 53 (46, 61) years. The binary logistic regression analysis showed that the maximum diameter (OR=4.707, 95%CI 2.060 to 10.758), consolidation/tumor ratio (CTR, OR=1.027, 95%CI 1.011 to 1.043), maximum CT value (OR=1.025, 95%CI 1.004 to 1.047), mean CT value (OR=1.035, 95%CI 1.008 to 1.063), spiculation sign (OR=2.055, 95%CI 1.148 to 3.679), and vascular convergence sign (OR=2.508, 95%CI 1.345 to 4.676) were independent risk factors for the occurrence of invasive adenocarcinoma (P<0.05). Based on the independent predictive factors, a predictive model of invasive adenocarcinoma was constructed. The formula for the model prediction was: Logit(P)=–1.293+1.549×maximum diameter of lesion+0.026×CTR+0.025×maximum CT value+0.034×mean CT value+0.72×spiculation sign+0.919×vascular convergence sign. The area under the receiver operating characteristic curve of the model was 0.910 (95%CI 0.885 to 0.934), indicating that the model had good discrimination ability. The calibration curve showed that the predictive model had good calibration, and the decision analysis curve showed that the model had good clinical utility. Conclusion The predictive model combining quantitative and qualitative features of CT has a good predictive ability for the invasiveness of ground-glass nodules. Its predictive performance is higher than any single indicator.
To understand the reason of hyperpigmentation following full-thickness skin autograft, 54 guinea pigs were selected as skin autograft models. The changes of density of epidermal keratinocyte (KC) and the amount and distribution of melanin in the epidermal KC were observed by histological, histochemical and autoradiographic techniques. The results showed: (1) The histological changes of KC were in fact a wound-repair process; (2) The increased melanin in KC coordinated with "multi-overlapping screen" effect, a result of multiple layers of "supranuclear cap", was the direct cause of hyperpigmentation of the graft and (3) The hydrolytic disturbance of melanin in KC and the longer life span of the KC were probably the important reasons for the increase of melanin in the epidermis.
Objective To quantitatively evaluate the changes of choroidal biomarkers in patients with central serous chorioretinopathy (CSC) and preliminarily explore its pathogenesis. MethodsClinical cross-sectional study. From July 2021 to December 2022, 74 eyes of 65 patients with CSC (CSC group) confirmed by ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 46 patients (51 eyes) were male, 19 patients (23 eyes) were female. The duration from the onset of symptoms to the time of treatment was less than or equal to 3 months. A control group consisted of 40 healthy volunteers (74 eyes) matched in age and gender. Among them, 26 patients (50 eyes) were male, and 14 patients (24 eyes) were female. Using VG200D from Microimaging (Henan) Technology Co., Ltd., macular scanning source light coherence tomography angiography was performed, with scanning range 6 mm × 6 mm. According to the division of the diabetes retinopathy treatment research group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, namely, the central area with a diameter of 1 mm, the macular area with a diameter of 1-3 mm, and the surrounding area of the fovea with a diameter of 3-6 mm. The device comes with software to record the three-dimensional choroidal vascular index (CVI), choroidal vascular volume (CVV), perfusion area of the choroidal capillary layer (CFA), choroidal thickness (CT), and three-dimensional CVI, CVV, and CT in the upper, temporal, lower, and subnasal quadrants within 6 mm of the fovea. Quantitative data between the two groups were compared using an independent sample t-test. Qualitative data comparison line χ2 inspection. The value of receiver operating curve (ROC) analysis in predicting the occurrence of CSC, including CVI, CVV, CFA, and CT. ResultsCompared with the control group, the CVI (t=3.133, 4.814), CVV (t=7.504, 9.248), and CT (t=10.557, 10.760) in the central and macular regions of the affected eyes in the CSC group significantly increased, while the CFA (t=－8.206, －5.065) significantly decreased, with statistically significant differences (P＜0.05); CVI (t=7.129), CVV (t=10.020), and CT (t=10.488) significantly increased within 6 mm of the central fovea, while CFA (t=－2.548) significantly decreased, with statistically significant differences (P＜0.05). The CVI (t=4.980, 4.201, 4.716, 8.491), CVV (t=9.014, 7.156, 7.719, 10.730), and CT (t=10.077, 8.700, 8.960, 11.704) in the upper, temporal, lower, and lower nasal quadrants within 6 mm of the central fovea were significantly increased, with statistically significant differences (P＜0.05). In the CSC group, the maximum CVI and CVV were (0.39±0.10)% and (1.09±0.42) mm3, respectively, on the nasal side of the affected eye. Upper CT was (476.02±100.89) μm. The nasal side CVI, CVV, and CT have the largest changes. The ROC curve analysis results showed that the area under the curve of CT, CVV, and CVI within 6 mm of the central region, macular region, and fovea was over than 0.5. Subcentral CT was the most specific for the diagnosis of CSC. ConclusionChoroidal biomarkers CVI, CVV, and CT in CSC patients increase, while CFA decreases. Central CT is the most specific for the diagnosis of CSC.
Objective To evaluate the effect of tissue engineered skin with isogeneic cells on repairing skin defects in inbred rat model so as to provide relevant evidences for the clinical application. Methods The skins of newborn inbred F344 rats were harvested and treated with Dispase trypsin to isolate the epidermal cells. The skins of adult Sprague Dawley rats were obtained and treated with hypertonic sodium-SDS-trypsin to prepare the acellular dermal matrix. The tissue engineered skin was reconstructed by submerging culturing and air-liquid interface culturing in vitro. The full-thickness skin defects of 1.5 cm × 1.5 cm in size were prepared along the dorsal both sides of 36 adult inbred F344 rats, and 72 defects were repaired with tissue engineered skin in experimental group (n=24), with allogeneic acellular dermal matrix in negative control group (n=24), and with autologous full-thickness skin in positive control group (n=24). Finally the gross observation, the survival rate, wound contraction rate, and histological observation were used to evaluate the effect. Results The wound healed by first intension at 4 weeks postoperatively in the experimental group; the grafts connected with the adjacent tissue tightly and had normal appearance. At 4 weeks after operation, the survival rate of the graft was 0 in the negative control group; the survival rates were 62.5% (15/24) in the experimental group and 91.7% (22/24) in the positive control group, showing significant difference between 2 groups (χ2=5.779, P=0.016). The wound contraction rates of the experimental group and positive control group were significantly lower than that of the negative control group (P lt; 0.05), but no significant difference was found between the experimental group and positive control group (P gt; 0.05). Histological observation showed that slight inflammation reaction appeared at 1 week postoperatively in the experimental group; the regeneration of the blood vessel and the proliferation of the fibroblasts in dermis and the gradual maturation of epidermis were observed at 2 weeks, and new collagen deposition and collagen remodeling in the dermis of the graft were found at 4 weeks postoperatively. Conclusion The tissue engineered skin is able to repair full-thickness skin defect of rats effectively, it has similar effect to the autologous full-thickness skin in preventing the wound contraction and promoting the wound healing, which provides experimental evidences for the clinical application.
ObjectiveTo evaluate the safety and effectiveness of total hip arthroplasty (THA) in patients with hypothyroidism.MethodsSixty-three patients with hypothyroidism (hypothyroidism group) and 63 euthyroid patients without history of thyroid disease (control group) who underwent primary unilateral THA between November 2009 and November 2018 were enrolled in this retrospective case control study. There was no significant difference between the two groups in gender, age, body mass index, hip side, reason for THA, American Society of Anesthesiology (ASA) classification, preoperative hemoglobin (Hb) level, and preoperative Harris score (P>0.05). The perioperative thyroid stimulating hormone (TSH) and thyroxine (T4) levels, the hypothyroidism-related and other complications during hospitalization, the decrease in Hb, perioperative total blood loss, blood transfusion rate, length of hospital stays, and 90 days readmissions rate in the two groups were recorded and evaluated. The periprosthetic joint infection, aseptic loosening of the prosthesis, and hip Harris score during follow-up were recorded.ResultsThe differences in the TSH and T4 of hypothyroidism group between pre- and 3 days post-operation were significant (P>0.05) and no hypothyroidism-related complications occurred after THA. The decrease in Hb and perioperative total blood loss in the hypothyroidism group were significantly higher than those in the control group (P<0.05), but there was no significant difference between the two groups in terms of transfusion rate, length of hospital stays, and 90 days readmission rates (P>0.05). No significant difference in the rate of complications (liver dysfunction, heart failure, pulmonary infection, urinary infection, and wound complication) between the two groups was found (P>0.05) except for the rate of intramuscular vein thrombosis which was significantly lower in the hypothyroidism group, and the rate of postoperative anemia which was significantly higher in the hypothyroidism group (P<0.05). The two groups were followed up 1.0-9.9 years (mean, 6.5 years). At last follow-up, Harris score in both groups were significantly higher than those before operation (P<0.05). An increase of 39.5±12.3 in hypothyroidism group and 41.3±9.3 in control group were recorded, but no significant difference was found between the two groups (t=0.958, P=0.340). During the follow-up, 1 case of periprosthetic joint infection occurred in the hypothyroidism group, no loosening or revision was found in the control group.ConclusionWith the serum TSH controlled within 0.5-3.0 mU/L and T4 at normal level preoperatively, as well as the application of multiple blood management, hypothyroid patients can safely go through THA perioperative period and effectively improve joint function, quality of life, and obtain good mid-term effectiveness.
Objective To investigate the short-term effectiveness of Swanson artificial joint replacement in treating post-traumatic metacarpophalangeal joint stiffness. Methods Between August 2007 and May 2010, 11 cases (13 fingers) of metacarpophalangeal joint stiffness with soft tissue defects underwent Swanson artificial joint replacement. There were 7 males (9 fingers) and 4 females (4 fingers), aged 43 to 65 years with an average of 49 years. The involved fingers included 4 thumbs, 4 index fingers, 3 middle fingers, and 2 ring fingers. The types of injury included open and crush injury in 8 fingers, fracture of the metacarpophalangeal joint in 3 fingers, metacarpophalangeal joint severing in 2 fingers. The time from joint stiffness to hospitalization was 12 to 48 weeks (mean, 24 weeks). The joint activity was (136.82 ± 28.96)°. According to total active motion (TAM) assessment, included good in 1 finger, fair in 6 fingers, and poor in 6 fingers before operation. The activities of daily living were assessed by Sollerman score, which was 45.64 ± 11.04. The X-ray films and CT scan showed traumatic arthritis of the metacarpophalangeal joint. Results The incision healed by first intention. All patients were followed up 12 to 34 months (mean, 24.1 months). At last follow-up, the joint activity was (194.64 ± 28.86)°, showing significant difference when compared with preoperative value (t=25.214, P=0.000). According to TAM assessment, including excellent in 1 finger, good in 4 fingers, fair in 7 fingers, and poor in 1 finger. The Sollerman score was 67.45 ± 8.20 postoperatively, showing significant difference when compared with the preoperative score (t=10.470, P=0.000). X-ray examination showed no prosthesis fracture, periprosthetic fracture, or joint dislocation occurred at last follow-up. Conclusion Swanson artificial joint replacement can be appl ied to treat posttraumatic metacarpophalangeal joint stiffness, which can improve the joint activity and has satisfactory short-term effectiveness.
ObjectiveTo systematically review the effects of the promotion of appropriate health technology in China and provide reference for improving the promotion of appropriate health technologies. MethodsDatabases including CBM, VIP, CNKI and WanFang Data were searched for studies about the appropriate health technology in China from inception to August 2014. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies by the evaluation criteria for descriptive studies of MAStARI, an assessment tool developed by JBI Evidence-Based Health Care Center. And then, qualitative descriptive analysis method was used to comprehensively analyze the data from four aspects: medical institutions, regulators, technology promotion medical staff and patients. ResultsA total of 23 cross-sectional studies and one before-after study were included. The results of qualitative analysis showed that: 1) the technology utilization rate of appropriate health technology extension institutions was more than 70%, the number of outpatients of township and village organizations increased significantly than that of the county level institutions; 2) director of technology extension and managers of hospital were in favor of the promotion of appropriate technology for its good effectiveness, safety, lower medical costs, and skill improvement of medical staff; 3) medical staff mastered the appropriate health technology, they were willing to promote appropriate technology and spoke highly of it for its safety, feasibility and economic effect, and improved their level of technology; 4) in patients' opinion, the appropriate technology reduced the disease course and cost, they spoke highly of it for its acceptance, efficacy and safety. ConclusionCurrent evidence shows that the promotion of appropriate health technology has achieved good effects. The satisfaction of medical institutions, managers, health service staff and patient is high, but these research results are of poor quality, mostly subjective evaluation, lack of scientific, rational, objective and consistent evaluation criteria, which cannot be used as evaluation evidence for the promotion of appropriate health technology.