Objective To elucidate the new concept and theory of neurorestoratology. Methods With the review of the development course and important research works in the field of neurorestoratology during the 20th century, especially recent 30 years, the regularity summary, science and technology philosophy induction, and theory distillation were carried out in this article. Results The new discipl ine system was brought forward as follows: ① Definition: neurorestoratology was asub-discipl ine of neuroscience which studies neural regeneration, neural structural repair of replacement, eruroplasticity and neuromodulation. The core purpose was to promote neural functional recovery of all neural degenerative diseases and damages. ② One central task and two basic points: to recover neurological function was the central research task all the time and the two basic points were the precl inical (basic) neurorestoration and the cl inical neurorestoration. ③ Four rationale of the discipl ine: l imited renovation, relearning, insufficient reserve, and l ifelong reinforcement. ④ Five major factors of neurorestoratology (5N’s dogma): neuroregeneration, neurorepair, neuroplasticity, neuromodulation, neurorehabil itation. “Neuroprotection” appeared to be included in the broad definition. ⑤ Four-step rule of neurorestoratology: structural neurorestoration, signal neurorestoration, rehabil itative neurorestoration, and functional neurorestoration. ⑥ Emphasize that translational medicine from lab to bed in neurorestoration. Conclusion The discipl ine of neurorestoratology has the vast development prospectand will be sure to increase the rapid progress of the basic and cl inical restorative neuroscience.
ObjectiveTo compare the recent efficiency and toxicity reactions of pemetrexed plus cisplatin and paclitaxel plus cisplatin for advanced lung adenocarcinoma. MethodsOne hundred and twenty-four patients with advanced lung adenocarcinoma treated in our hospital between January 2009 and December 2012 were divided into pemetrexed plus cisplatin group (group PP, n=63) and paclitaxel plus cisplatin group (group TP, n=61). The effect was evaluated after two courses of treatment, and the toxicity reactions were evaluated every course. ResultsThe objective response rate, disease control rate and progression-free survival in group PP and TP were respectively 58.7% vs 37.7%, 74.6% vs 52.5%, and 6.1 months vs 4.5 months, with significant differences (P<0.05). The incidence of nausea and vomiting, and white blood cell decrease (neutropenia) in group PP were significantly lower than that in group TP (χ2=16.164, P<0.001; χ2=9.469, P=0.002). There were no significant differences in incidence of thrombocytopenia, anemia and hepatic function damage (χ2=0.098, P=0.755; χ2=0.267, P=0.606; χ2=0.006, P=0.973). ConclusionPemetrexed plus cisplatin shows obviously superior effects and fewer side effects on advanced lung adenocarcinoma compared with paclitaxel plus cisplatin regime.
New functional evaluation methods for coronary artery lesions have received widespread attention at home and abroad. As a new functional evaluation technique, the clinical value of quantitative flow ratio (QFR) in the accuracy and feasibility of diagnosing myocardial ischemia caused by coronary artery stenosis has been confirmed in many clinical trials. Compared with the traditional gold standard fractional flow reserve (FFR) for diagnosing coronary artery stenosis, QFR has the advantages of simple operation, time-saving and low cost. This article reviews the comparison of the diagnostic accuracy of FFR and QFR and the progress of clinical research, aiming to explore whether QFR may replace FFR as a functional evaluation method of coronary artery disease and guide clinical blood circulation reconstruction.
OBJECTIVE: To study the morphological character of long head of triceps muscle for clinical application in reconstruction of shoulder abduction. METHODS: Forty-four upper extremities of fixed human adult cadavers were carefully dissected. The origins and the pedicles of blood vessels and nerves of long head of triceps muscle, as well as the maximum available size of the muscles, were measured. Six cases of clinical application of long head of triceps muscle for reconstruction of shoulder abduction were followed up for 3 to 11 months. RESULTS: The origins in the dorsal side of long head of triceps muscle were muscular and the ventral side were tendinous, which was 7.6 to 13.3 cm in length and 1.6 to 3.4 cm in width. The distance from the origin to the neurovascular pedicle was 5.7 to 11.4 cm. The radial nerve, which innervated the muscles, could be dissected for 2.9 to 11.8 cm in length. The blood supplies to the triceps muscle were from humeral artery (43.2%), 1.0 to 6.0 cm in length and 1.6 to 2.4 mm in diameter, and from humeral profundus artery (45.5%), 1.5 to 4.4 cm in length and 0.9 to 2.4 mm in diameter, if the vessel was separated to the humeral artery, the length was 1.5 to 6.3 cm. The neurovascular pedicles were multiple branched. In the 6 cases of clinical application of the triceps muscles, the operated shoulder could abduct from 5 degrees preoperatively (0 degree to 10 degrees) to 77.3 degrees (50 degrees to 90 degrees) postoperatively. CONCLUSION: In accordance to the anatomical character of the triceps muscles, the long head of triceps muscle is a suitable choice for reconstruction of shoulder abduction with optimistic outcomes.
ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=−3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
In 2019, the American Wilderness Medical Society updated and released a new version of the practice guidelines based on the practice guidelines for the prevention and treatment of acute altitude illness first published in 2010 and updated in 2014. This article interprets the guidelines, focusing on effective measures to prevent and treat different forms of acute altitude illness, as well as suggestions for specific methods to manage the disease, with a view to providing help for clinicians in better practice.
ObjectiveTo evaluate the effectiveness of the modified intramedullary fixation with two Kirschner wires for extra-articular fracture of the proximal phalangeal base. MethodsBetween June 2012 and November 2015, 18 cases (18 fingers) of fresh extra-articular fracture of the proximal phalangeal base were treated, including 16 males and 2 females with an average age of 31 years (range, 21-57 years). The causes included strike injury in 10 cases, fall injury in 4 cases, mechanical injury in 1 case, twist injury in 1 case, crush injury in 1 case, and cutting injury in 1 case. The injured fingers were little finger in 16 cases, ring finger in 1 case, and index finger in 1 case. Of the 18 cases, 17 had closed fractures and 1 had open fracture. X-ray film showed transverse fracture in 14 cases and transverse-oblique fracture in 4 cases. The time between injury and operation was 3 hours to 4 days (mean, 2 days). After anatomical reduction, two Kirschner wires were used for intramedullary fixation. Functional exercises were done at 2 days after operation. The Kirschner wires were removed at 4 weeks after operation. ResultsAll the wounds healed by first intention. There were no deformation, loosening or breakage of Kirschner wires, and pin tract infection. Postoperative X-ray films showed anatomical reduction of fracture in all cases; no re-displacement happened, and clinical healing was obtained at 4 weeks; bony union was obtained at 8 weeks. All patients were followed up 6-12 months with an average of 8 months. There was no pain in the metacarpophalangeal joint; the range of motion was (88.1±2.3)° at 3 months after operation, showing no significant difference when compared with normal side [(88.8±2.6)°] (t=1.73, P=0.10). The finger flexion and extension were normal; according to the criteria of total active motion of finger, the results were excellent in all cases. ConclusionThe technique of modified intramedullary fixation with two Kirschner wires for extra-articular fractures of the proximal phalangeal base has the merits of convenient operation, little injury, reliable fixation, and excellent effectiveness. This technique is conducive to the recovery of hand function due to the early functional exercises.