Impact of β-glucan on the Fecal Water Genotoxicity of Polypectomized Patients

The aim of the study was to determine the effect of β-glucan on the cytotoxicity and genotoxicity of polypectomized patient's fecal water (FW). Polypectomized volunteers (n = 69) were randomly assigned to consume bread with or without β-glucan, for 3 months. FW was collected at the beginning (t = 0), the 30th and 90th day and 2 wk after the intervention. Cytotoxicity and genotoxicity were estimated on Caco-2 cells, using trypan blue exclusion test and comet assay, respectively. Gastrointestinal symptoms were recorded and subjects kept a 3-day food diary at baseline and after completion. Trypan blue exclusion test revealed cell survival of approximately 87% after incubation with FW. The FW samples showed 49% genotoxicity at the baseline. Genotoxicity in the intervention group decreased during the trial reaching statistical significance on the 90th day compared to control. An increase was noticed 2 wk after the trial, but it still remained significantly lower compared to control. Group-specific analysis for β-glucan also revealed significant decrease in the genotoxicity on the 90th day compared to baseline. β-glucan ingestion in polypectomized patients significantly decreased the genotoxicity of their FW. Our findings suggest that β-glucan consumption could possibly provide protection against colon cancer development.     

Severe lumbar spinal stenosis combined with Guillain-Barré syndrome: A case report

BACKGROUNDGuillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARYA 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSIONGBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.     

12-year survival analysis of 322 Hintegra total ankle arthroplasties from an independent center

Background and purpose — Total ankle arthroplasties (TAAs) have larger revision rates than hip and knee implants. We examined the survival rates of our primary TAAs, and what different factors, including the cause of arthritis, affect the success and/or revision rate.Patients and methods — From 2004 to 2016, 322 primary Hintegra TAAs were implanted: the 2nd generation implant from 2004 until mid-2007 and the 3rd generation from late 2007 to 2016. A Cox proportional hazards model evaluated sex, age, primary diagnosis, and implant generation, pre- and postoperative angles and implant position as risk factors for revision.Results — 60 implants (19%) were revised, the majority (n = 34) due to loosening. The 5-year survival rate (95% CI) was 75% (69–82) and the 10-year survival rate was 68% (60–77). There was a reduced risk of revision, per degree of increased postoperative medial distal tibial angle at 0.84 (0.72–0.98) and preoperative talus angle at 0.95 (0.90–1.00), indicating that varus ankles may have a larger revision rate. Generation of implant, sex, primary diagnosis, and most pre- and postoperative radiological angles did not statistically affect revision risk.Interpretation — Our revision rates are slightly above registry rates and well above those of the developer. Most were revised due to loosening; no difference was demonstrated with the 2 generations of implant used. Learning curve and a low threshold for revision could explain the high revision rate.

Arthritis in the ankle often develops earlier than in the hip or knee, and 70% have a traumatic etiology (Saltzman et al. 2005, Brown et al. 2006). Total ankle arthroplasty (TAA) can be indicated for severe arthritis in the ankle joint, but the anatomical preconditions, like a small surface area and high stress from compression and torque (Bouguecha et al. 2011, Kakkar and Siddique 2011), makes it less durable than hip and knee prosthetics. The Hintegra TAA, a 3-component mobile bearing, uncemented implant (Hintermann et al. 2004) is widely used and results from the development center demonstrate survival rates of 94% and 84% after 5 and 10 years’ follow-up (Barg et al. 2013). This is considerably more than the survival rates from national registries. Labek et al. (2011) demonstrated that development centers report only half of the revision rate that can be found in the few existing national registers. In a systematic review of primary Agility total ankle arthroplasty (DePuy Synthes Orthopedics, Warsaw, IN, USA), the author (Roukis 2012) found that the incidence of complications increased from 7% to 12%, in studies where the inventor was excluded. Similar results were found by Prissel and Roukis (2013), who found an increased incidence of complications from 6% to 13% in studies where the inventor or faculty consultants were excluded. These studies indicated the risk of selection (inventor) and publication (conflict of interest) bias.Planning and surgical technique, including significant experience, are mandatory for a successful outcome. The better result from development centers may reflect, besides the above-mentioned bias, that there is a long learning curve and that the indication for revision surgery varies.We examined the survival rates of primary Hintegra TAAs performed at Hvidovre Hospital, with revision rate as outcome. We report primary diagnosis for primary TAA and examine whether sex, generation of the implant, preoperative angles and implant position affect the revision rate.     

基于仝小林院士脏腑风湿理论探讨新型冠状病毒肺炎康复期的中药治疗

仝小林院士将新型冠状病毒肺炎定名为"寒湿疫"，并以此理论为基础制定了初期、中期、重症期及恢复期的中医治疗方案，同时基于仝院士学术理论体系中的"脏腑风湿"理论，根据恢复期 "余毒未清，正虚邪恋"的病机特点，探讨其符合具备脏腑风湿行成3个基本要素：即外受寒湿裹挟戾气为必要外因；脏腑内虚为重要基础；邪疫伏留胶着，正邪交争为致病关键。故在辨证施治中可应用脏腑风湿理论以调理脾胃，化湿透邪，补益肺脾，顾护阳气，养阴生津。     

单侧外固定治疗重度Pilon骨折的临床疗效探究

目的探讨单侧外固定治疗重度Pilon骨折的临床疗效。方法回顾性分析2017年6月-2018年12月南京中大医院江北院区骨科收治的重度Pilon骨折患者100例,男性54例,女性46例;年龄18~65岁,平均35.5岁;Ruedi-AllgowerⅡ型39例,Ⅲ型61例。按照不同固定方法分为常规固定组和单侧外固定组,各50例,比较两组患者住院时间、完全负重下地时间、骨折愈合时间,评价治疗前及治疗后3个月踝关节活动度、踝关节功能恢复情况、疼痛程度,并统计患者的治疗效果及并发症发生情况。结果单侧外固定组住院时间、完全负重下地时间、骨折愈合时间分别为(16.50±1.50)d、(132.56±10.25)d、(14.16±0.69)周,均短于常规固定组(19.25±2.35)d、(198.65±16.58)d、(17.58±1.50)周(t/P=6.975/0.001、23.970/0.001、14.650/0.001)。治疗后3个月,单侧外固定组踝关节Mazur评分为(85.67±6.59)分,显著高于常规固定组(62.78±3.45)分,VAS评分为(2.23±0.36)分,低于常规固定组(4.59±0.89)分(t/P=21.760/0.001、17.380/0.001);单侧外固定组患者踝关节活动度分别为(17.29±0.16)°、(28.36±1.23)°、(19.68±0.16)°、(16.89±2.12)°,均高于常规固定组(10.62±1.25)°、(21.57±2.58)°、(14.36±1.62)°、(14.25±0.57)°(t/P=37.430/0.001、16.800/0.001、23.110/0.001、8.503/0.001)。单侧外固定组治疗优良率为90.00%,显著高于常规固定组74.00%(χ^2/P=4.336/0.037)。单侧外固定组总并发症发生率为4.00%,显著低于常规固定组的18.00%(χ^2/P=5.005/0.025)。结论单侧外固定支架治疗重度Pilon骨折可有效减轻患者疼痛症状,提高患者踝关节活动度,恢复患者功能,治疗效果显著,安全性较高。     

镇江市护士分层培训及分层进阶现况分析

目的调查镇江市各医院护士分层培训及分层进阶的方法及现状。方法2018年4—5月间采用自行设计的调查问卷,对全市医院的护理人员进行随机抽样调查。结果调查显示镇江市96.45%的护士受医院分层培训及分层进阶这一模式的管理。其中N1占16.77%,N2占29.5%,N3占41.9%,N4占8.7%,其他占3.11%。有24.53%的护士对医院目前的分层培训方式感到满意并认为无需改进,40.99%的护士表示满意,但需要改进,29.19%的护士表示基本满意,需要改进,5.28%的护士表示不满意需要较大改进。95.82%的医院科室对不用层级的护士有不同的核心能力要求并根据不同核心能力要求进行培训。结论护士分层培训几分层进阶这一管理模式在镇江各医院都有体现,但各医院实行的方式有较大差异,配套的管理方式也有待完善。     

Interleukin-11 Overexpression and M2 Macrophage Density are Associated with Angiogenic Activity in Proliferative Diabetic Retinopathy

ABSTRACT

Purpose

To investigate the expression of IL-11 and its receptor IL-11Rα and to quantify density of CD163⁺ M2 macrophages in proliferative diabetic retinopathy (PDR).     

经9次核酸检测终确诊的新型冠状病毒肺炎患者1例分析

目前新型冠状病毒肺炎(COVID-19)疫情在全球蔓延,形势严峻,并对全球公共卫生事业构成巨大挑战,快速准确的诊断COVID-19对疫情的防控有重要意义。本文报道1例COVID-19患者的调查和确诊过程,以对COVID-19确诊和疫情防控提供有价值的参考。患者为赴渝务工于2020年1月23日返乡人员,在渝期间,其同工地的一同事确诊为COVID-19,之后该工地接连有另外8位同事被确诊。患者返乡后2月2日被当地疫情防控单位采取医学隔离。患者于隔离后不久出现咳嗽,阵发性,干咳为主,偶可咳出黄色痰液等COVID-19相关临床症状,遂被当地新型冠状病毒肺炎定点医疗单位收治,后经市级新型冠状病毒肺炎诊治专家组远程视频会诊转入四川大学华西医院资阳医院。患者先后经历9次核酸检测,在前8次核酸检测均为阴性的情况下,于第9次核酸检测结果为阳性,2月21日最终确诊为新型冠状病毒肺炎。     

半夏白术天麻汤治疗眩晕高血压病举隅

高血压病是我国发病率较高的疾病之一,西医治疗以长期服用降压药物为主要治疗方式,但常因依从性差的原因导致血压控制不佳,而用中医辨证治疗对于首次发现高血压的患者,可明显有效地降低高血压的发病率。高血压病在中医学中属"眩晕",在临床中常常会用半夏白术天麻汤来治疗眩晕,本文通过跟师医案及临床收集介绍半夏白术天麻汤治疗高血压眩晕临证方药的运用。