Objective To explore the effect of the collateral ligaments and the plantar plate on the flexion of the metatarsophalangeal(MP) joints. Methods Twenty-four preserved human No.2-4 digits were obtained from embalmed cadaver feet, which were divided into 2 groups at random. In group A, the bilateral collateral ligaments were cut first, and then the plantar plate was sectioned. They were cut inopposite sequence in group B. Angle of the flexion of MP joint was observed in the same load after the bilateral collateral ligaments and the plantar plate were sectioned in different sequence.From 1994 to 2000,11 cases were used with this technic, including plantar section in 2 cases and both plantar section and bilateral collateral ligamentscut in 9 cases. Results The angle of flexion of the MP joint before operation in group A is 37.30±5.42°, it increased 11.29±2.36° and to 48.60±2.98° when the bilateral collateral ligaments were cut, and there was significant difference. Later the cut of the plantar plate increased another 5.30±1.59° and to 53.35±2.76°. Both have an increasing trend for the angle of flexion of the MP joint (Plt;0.01). While in group B, the angle of flexion of the MP joint before operation is 34.59±5.32°, it increased 6.29±2.98° and to 40.89±2.36° when the plantar plate were cut, laterthe cut of the bilateral collateral ligaments increased another 9.71±1.94° and to 50.60±2.01°. Both had an increasing trend for the angle of flexion ofthe MP joint (Plt;0.01). The bilateral collateral ligaments had more influence than the plantar plate (Plt;0.01). There was the same effect in different sequence (Pgt;0.05). In 2 cases with plantar section, the flexion angle of MP joint could achieve 15° to 45° in 2 monthes. The other 9 cases with both plantar section and bilateral collateral ligaments cut, the MP joint flexion achieved 10.3° to 58.4° in 26.3 months. Conclusion The flexion angle of the MP joint can be increasedby cutting the bilateral collateral ligaments and the plantar plate.
ObjectiveTo determine the effects of the management mode participated by doctors, nurses and patients on the safety of medical tubes for restlessness patients in the Neurosurgery Intensive Care Unit (NICU). MethodsA total of 133 restlessness patients treated between May 17 and November 22, 2013 were included in the study as control group, who were admitted to the NICU before application of the management mode participated by doctors, nurses and patients; another 119 restlessness patients treated between May 17 and November 22, 2014 were included in the study as research group, who were admitted to the NICU after application of the management mode participated by doctors, nurses and patients. Then we compared the accidental extubation situation between the two groups. ResultsThe accidental extubation rate of all kinds of medical tubes in the research group was lower than that in the control group, among which the extubation rate of urethral catheter (0.67% vs. 4.32%), gastric tube (2.26% vs. 10.14%), trachea cannula (1.08% vs. 7.84%), and arterial cannulation pipeline (1.12% vs. 6.93%) was significantly different between the two groups (P<0.05). ConclusionThe management mode participated by doctors, nurses and patients can effectively reduce the accidental extubation rate of medical tubes for restlessness patients, prevent the occurrence of adverse events and ensure the treatment and nursing safety in the NICU.
Periodontal disease is a common chronic infectious disease targeting the connective tissue supporting the dentition. In recent years, the research on periodontal disease and cerebral infarction has been increasing. However, the causal relationship between periodontal disease and cerebral infarction remains unclear. Periodontal disease may be associated with atherosclerosis, which is one of the major causes of cerebral infarction. Regular dental care can reduce the risk of cardiovascular disease. Therefore, investigating the above association and its underlying mechanisms is of great clinical significance, which may help clinicians to make appropriate treatment and prevention measures. In this paper, the research progress and possible mechanism of the relationship between periodontal disease and cerebral infarction were reviewed.
Ischemic stroke can lead to disruption in the oral ecology and an overgrowth of pathogenic bacteria, resulting in periodontal disease. Meanwhile, the aspiration and pulmonary infection resulted from dysphagia can increase the unfavorable prognosis. Some studies have found that there exist oral bacteria in the thrombus in myocardial infarction and ischemic stroke patients, showing that oral flora might be associated with thrombus and stroke-associated pneumonia. There are few high quality clinical studies or evidence-based guidelines. Priority should be given to high quality research that provides oral care standards, and incorporating oral care into future stroke pathways to improve the prognosis.
As a major disease that seriously endangers the health of Chinese residents, stroke has various triggering factors, among which infection is one of the initial factors. Previous studies have indicated a correlation of common oral infectious diseases such as periodontitis with the occurrence of stroke. However, there is a lack of effective integration of previous research on the induction of stroke by common oral infectious diseases. This article provides a comprehensive review of the relevant research on infectious diseases and stroke, with a particular focus on the progress related to periodontitis, gingivitis, dental caries, and pulpitis as triggers for stroke. It puts forward relevant recommendations for promoting oral health, so as to provide a theoretical basis for improving oral health literacy of Chinese residents and reducing the incidence of stroke and other major diseases.
ObjectiveTo understand the effect of programmed death-1 (PD-1) inhibitors on defective mismatch repair (dMMR) / microsatellite instability-high (MSI-H) advanced colorectal cancer (CRC). MethodThe literature of recent research relevant PD-1 inhibitors in the utility for patients with dMMR/MSI-H advanced CRC was reviewed and summarized. ResultsAt present, there were many studies exploring the utility of anti-PD-1 inhibitors for the treatment of dMMR/MSI-H advanced CRC (including locally advanced CRC and metastatic CRC), and some studies were still in trials. Studies had consistently shown that the use of PD-1 inhibitors in dMMR/MSI-H advanced CRC as first-line or subsequent therapy, as well as in the neoadjuvant setting, leading to significant survival benefits. These benefits were particularly notable in cases of dMMR/MSI-H metastatic CRC with concurrent BRAF/RAS mutations and in the context of neoadjuvant immunotherapy aimed at organ preservation in locally advanced dMMR/MSI-H CRC. Moreover, there were numerous studies exploring “dual immunotherapy”, and most studies found that its efficacy was superior to that of single immunotherapy. However, the more adverse events were reported by the “dual immunotherapy” compared to the single immunotherapy. ConclusionsOverall, based on results of the literature reviewed, PD-1 inhibitors have shown significant clinical benefits in dMMR/MSI-H advanced CRC, but there are still more issues that need to be further explored, such as discovering more first-line PD-1 inhibitors, overcoming drug resistance and adverse events. Future clinical practice should prioritize more precise individualized identification and the application of more effective combination therapy regimens to further optimize outcomes for patients with dMMR/MSI-H advanced CRC.
【Abstract】 Objective To evaluate the early result of tri ple Endobutton technique for reconstructing coracoclavicularligament of chronic complete acromioclavicular joint dislocations. Methods Between January 2009 and June 2010, 14 patients with chronic complete acromioclavicular joint dislocations were treated with tri ple Endobutton technique for reconstructing coracoclavicular ligament. There were 10 males and 4 females with a mean age of 38.5 years (range,26-52 years). Injury was caused by traffic accident in 7 cases,by falling in 5 cases，and by bruise in 2 cases. The average time was 47 days from injury to the operation (range,29-75 days). All patients had pain and activity restriction. The X-ray films showed complete dislocation of acromioclavicular joint. According to Allman’s type, all cases were classified as III degree complete dislocations. Results At postoperation, wound healed by first intention with no early complication of infection or neurovascular injury. All patients were followed up 18.3 months on average (range,13-30 months). Acromioclavicular joint subluxation occurred in 1 patient at 1 week after operation, and no redislocation or other complication occurred in the other patients. American Shoulder and Elbow Surgeons (ASES) score was 90.8 ± 4.1 at last follow-up, showing significant difference when compared with the preoperative score (65.3 ± 4.4) (t= —17.57，P=0.00); Constant-Murley score was 91.7 ± 3.9, showing significant difference when compared with preoperative one (71.5 ± 4.6) (t=—75.02，P=0.00). The definite answer in Simple Shoulder Test (SST) averaged 9.7 (range,7-12). Conclusion The tri ple Endobutton technique for reconstructing coracoclavicular ligament is an effective method in treatment of chronic complete acromioclavicular joint dislocations. The short-term results are satisfactory.
背景 研发随机对照试验报告规范 CONSORT 声明旨在帮助生物医学研究人员透明地报告随机对照试验（randomised controlled trials，RCTs）。我们已针对社会和心理干预措施制定了 CONSORT 2010 声明扩展版（CONSORT-SPI 2018），以帮助行为和社会科学家透明地报告这些研究。 方法 在对现有报告规范进行系统评价之后，我们进行了在线德尔菲流程（Delphi process）以优先考虑从系统评价中确定的 CONSORT-SPI 2018 清单的潜在条目。384 位国际参与者中有 321 位（84%）完成了 2 次调查。然后我们召开了由 31 位科学家、期刊编辑和研究资助者组成的共识会议（2014 年 3 月），最终确定 CONSORT-SPI 2018 检查清单和流程图的内容。 结果 CONSORT-SPI 2018 扩展了 CONSORT 2010 检查清单中的 9 个条目（包括亚条目在内的 14 个条目），增加了一个与利益相关方参与试验有关的新条目（包括 3 个亚条目），并修改了 CONSORT 2010 流程图。本解释与说明（E&E）文件是 CONSORT-SPI 2018 的用户手册，可帮助使用者更好地理解 CONSORT-SPI 2018。本文讨论了每个清单条目的含义和原理，并提供了完整及明晰的报告示例。 结论 CONSORT-SPI 2018 扩展版、解释与说明文件及 CONSORT 网站（www.consort-statement.org）是有助于改善社会和心理干预措施 RCTs 报告的有用资源。
背景 随机对照试验（randomized controlled trials，RCTs）常用于评估社会和心理干预措施的效果，这些结果亦常被用于制定决策。有关社会及心理干预措施试验结果的准确、完整和透明的报告，对了解针对这些干预措施的临床试验设计、实施、结果及这些结果的应用至关重要。然而，关于社会和心理干预措施的 RCT 报告质量仍不理想。CONSORT（consolidated standards of reporting trials）声明改善了生物医学领域 RCT 的报告质量，同样，行为和社会科学方面也需要类似的高质量报告规范。我们的目标是基于 RCT 报告规范 2010 年声明（Consolidated Standards of Reporting Trials 2010 Statement，CONSORT 2010）的官方扩展版，制定适用于社会和心理干预措施（social and psychological interventions，SPI）的 RCT 报告规范（CONSORT-SPI 2018）。 方法 我们遵循最佳方案制定报告规范的扩展版。首先，我们对现有报告规范进行了系统评价。随后，我们进行了有 384 位国际参与者参加的德尔菲在线调查。2014 年 3 月，我们举行了为期 3 天的共识会议，由 31 位专家参与，确定针对社会和心理干预措施的 RCT 报告的检查清单内容。专家们仔细讨论了先前与社会和心理干预措施 RCT 相关的研究和方法学问题。然后，投票决定对 CONSORT 2010 条目的修改或扩展。 结果 CONSORT-SPI 2018 检查清单扩展了 CONSORT 2010 的 25 个条目中的 9 个，包括：背景和目标、试验设计、受试者、干预措施、统计方法、受试者流程、基线数据、结果和估计及资助来源。此外，与会者还添加了一个与利益相关方参与度有关的新条目，此外，也修改了与受试者招募和及其后续维持相关的流程图。 结论 作者应使用 CONSORT-SPI 2018 来改善社会和心理干预相关的 RCT 的报告质量。期刊应修改编辑政策和程序，要求作者使用报告规范准备相关稿件，要求同行评议者使用报告规范评审相关稿件，以使读者能够评估研究的质量，评价研究结果的推广性，并重复有效的干预措施。