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Objective:To monitor the cerebral vascular blood flow parameters in the early stage of simulated acute exposure to high altitude hypoxia by transcranial color Doppler (TCCD), and to evaluate the change trend of cerebral hemodynamics and cerebrovascular reactivity.Methods:Sixty-four healthy volunteers were selected to observe the changes of peak systolic flow velocity(Vs), end diastolic flow velocity(Vd), mean flow velocity(Vm), resistance index (RI) and pulsatility index (PI) of middle cerebral artery (MCA) 30 minutes after they quickly entered the simulated altitude of 4 500 meters. Combined with breath holding test, breath holding index (BHI) was used to evaluate cerebrovascular reactivity (CVR), and subjects were divided into ≤30 years old group and >30 years old group, and the changes of CVR after hypoxia of the two groups were compared.Results:In the early stage of hypoxic environment, compared with baseline, SpO 2 decreased, heart rate increased, and blood flow velocity of middle cerebral artery(Vs, Vd, Vm) increased significantly, BHI showed a decreasing trend (all P<0.01). After hypoxia, the BHI rate of change in >30 years old was lower than that of the subjects ≤30 years old ( P<0.05). After breath holding, cerebral blood flow velocity increased significantly, PI and RI decreased significantly (all P<0.01). Conclusions:Cerebral blood flow is very sensitive to hypoxia. The application of TCCD technology can evaluate the trend of cerebral blood flow dynamics and cerebrovascular reserve capacity in real time and accurately, which is helpful to provide objective basis and research basis for the prevention and treatment of high altitude hypoxia.
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Objective:To evaluate the cerebral blood flow circulation time (CCT) by contrast-enhanced ultrasound, and to explore the change rule of CCT in different degree of intracranial pressure, so as to provide a new method for non-invasive monitoring of intracranial pressure.Methods:Ten patients with hemorrhagic stroke or acute craniocerebral trauma with increased intracranial pressure were selected from Tangdu Hospital, the Air Force Military Medical University from January to December 2019. Contrast-enhanced ultrasound was performed when the invasive intracranial pressure (iICP) increased (>20 mmHg, iICP increased group) and decreased to normal (≤20 mmHg, iICP normal group), CCT was measured and analyzed. The differences of CCTs between different iICP groups were compared and the relationship between CCT and iICP was analyzed.Results:①The CCT on the lesion sides of the same patients in the iICP increased group was significantly longer than in the iICP normal group[(9.34±2.58)s vs (6.48±1.91)s, P=0.002]. ②When iICP was increased in patients with hemorrhagic stroke or acute craniocerebral trauma, the CCTs of the diseased side and the non-pathological side were not statistically significant [(9.34±2.58)s vs (9.01±3.22)s, P=0.809]. ③Pearson correlation analysis and Spearman rank correlation analysis showed that there were no correlations between patient′s breathing, heart rate, carbon dioxide partial pressure, body temperature, GCS score and CCT (all P>0.05). Age, mean arterial pressure and CCT were moderately correlated ( r=0.518, 0.463 and P=0.023, 0.046, respectively). ④Logistic regression analysis showed that CCT was an independent risk factor related to intracranial hypertension( OR=0.7, 95% CI=0.47-0.95, P=0.036). The area under ROC curve (AUC) predicted by logistic regression was 0.750(0.588~0.912). Conclusions:Contrast-enhanced ultrasound noninvasive assessment of CCT can reflect the intracranial pressure in patients with hemorrhagic stroke or acute traumatic brain injury, and CCT has a predictive value for intracranial hypertension. When the patient has limited conditions for invasive intracranial pressure monitoring, or when the invasive monitoring probe is pulled out but still needs to evaluate intracranial pressure, the change of CCT can provide an effective reference for clinical diagnosis and treatment.
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Objective: To research lung infection related factors in proximal femoral fractures inpatient according to thehome page of its medical cases. Methods: The medical home pages of entire proximal femoral fracture cases from January1, 2003 to December 31 was extracted from the database of Chinese Academy of Traditional Chinese Medicine WangjingHospital. s medical information system. The information is verified and cleaned to build an Excel database with allavailable information. Logistic multivariate binary analysis was used to identify the related risk factors of pulmonaryinfection. The age of patients, the admission duration, chronic respiratory disease and using of traditional Chinese herbsare all closely related to pulmonary infection. Results: Logistic multivariate binary review found that the factors affectinglung infection were age, length of hospitalization days, chronic respiratory diseases, and whether to use of Chinese herbalmedicine. Conclusion: Under the premise conditions, patients with proximal femoral fractures should be allow to shortenthe length of time or early surgery. For elderly patients, and patients with chronic respiratory diseases, measures shouldbe taken as early as possible to prevent the onset of lung infection. The use of Chinese herbal medicine for prevention andtreatment of pulmonary infection is recommended, namely the combination of Traditional Chinese Medicine and westernmedicine in prevention and treatment of pulmonary infection.
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Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is a common magnetic resonance imaging findings in acute ischemic stroke due to severe stenosis or occlusion of large cerebral arteries.This article reviews the applications and related research of FVH in patients with acute ischemic stroke.
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Objective@#To determine the correlation of IgM deposition with clinic-pathological features and outcomes of IgA nephropathy patients.@*Methods@#A total of 1060 patients, who were diagnosed as IgA nephropathy by renal biopsies between 2001 and 2007 in Guangxing Hospital were enrolled. According to immunofluorescent test, patients were divided into patients with mesangial IgM deposition and patients without IgM deposition. Renal survival curves were assessed by Kaplan-Meier method. The effect of IgM deposition on outcomes of IgA nephropathy patients was examined by univariate and multivariable Cox proportional-hazards regression.@*Results@#Among 1060 IgA nephropathy patients, there were 750 patients with IgM deposition and 310 patients without IgM deposition. (1) Urinary protein and uric acid in patients with IgM deposition were significantly higher than those in patients without IgM deposition (all P<0.05). Other clinical indicators shown no statistical difference (all P>0.05). Moreover, IgM deposition patients had higher serum IgA, serum IgG and serum IgM (all P<0.05). (2) In pathological indicators, IgM deposition patients had more segmented sclerosis or adhesions (S1 of Oxford classification), activity lesions as inflammatory cell infiltration and mesangial proliferation, and chronic pathological changes as tubular atrophy, segmented glomerular damage than patients without IgM deposition (all P<0.05). (3) All patients were followed-up for a median of 89.7(61.8, 113.4) months, Kaplan-Meier analysis revealed that kidney survival rate was significantly lower in IgM deposition patients compared with patients without IgM deposition (Log-rank χ2=4.95, P=0.026). In a univariate Cox hazards regression mode, IgM deposition was a risk factor for poor prognosis of IgA nephropathy patients (HR=1.597, 95% CI 1.053-2.422, P=0.027). However, in a multivariable Cox analysis, IgM deposition shown no influence on outcomes of IgA nephropathy patients (HR=1.409, 95% CI 0.921-2.156, P=0.114).@*Conclusions@#IgA nephropathy patients with IgM deposition have higher urinary protein, and more serious pathological damage and immune fluorescence deposition. IgM deposition affects renal survival of IgA nephropathy, while IgM deposition is not an independent risk factor for prognosis of IgA nephropathy.
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BACKGROUND:Autologous island flap transplantation is the main therapy for burn scars. Floating and necrosis of transplanted flaps mainly impact the therapeutic effects. Dexamethasone has immunoregulatory function during trauma and stress process. OBJECTIVE:To investigate the effect of dexamethasone on immune balance of Th1/Th2 and prognosis in patients with burn scars undergoing autologous island flap transplantation. METHODS:Sixty-eight patients with burn scars undergoing transplantation of pedicled island flap were selected and randomly divided into control group and experimental group. Patients in the two groups were treated with negative pressure drainage under skin flap, infection prevention, improvement of microcirculation. After that, dexamethasone sodium phosphate (0.2 mg/kg) was immediately given in the experimental group, and the dose gradualy decreased after 3 days until drug withdrawal at 7 days. Levels of Th1, Th2, Th1/Th2 and interferon-γ, interleukin-4 were compared between the two groups before and 1 week after transplantation. In addition, incidence rates of skin flap necrosis, hemodynamic disorder, and effusion were compared between the two groups. RESULTS AND CONCLUSION:The levels of Th1, Th2, Th1/Th2, interferon-γ and interleukin-4 had no obvious differences between the two groups before flap transplantation. At 1 week after transplantation, the levels of Th1 and Th1/Th2 were higher, while the levels of Th2, interferon-γ and interleukin-4 were lower in the experimental group than the control group. Moreover, the incidence of complications was also lower in the experimental group than the control group. In conclude, dexamethasone can decrease the incidence of complications after island flap transplantation, which is maybe the result of adjusting immune balance of Th1/Th2.
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Objective To study the clinical efficacy of free anterolateral femoral skin flap on the repair of skin and subcutaneous soft tissue defects caused by excision of oversized malignant tumour in the skin. Methods A retrospective review was performed of free anterolateral femoral skin flap reconstructions for oversized malignant tumor cut on body surface since April 2007 to November 2010. There were 6 patients with head and limb squamous cell carcinoma because of bum scar and 3 patients with recurrence of dermatofibrosarcoma protuberans in wall of belly. The area of soft tissue defects ranged from 19 cm × 15 cm to 24 cm × 21 cm, and skin flaps was 20 cm × 16 cm to 25 cm × 22 cm in size. Three cases received radio therapy after operation. Results Nine flaps survived perfectly, one flap survived with partial necrosis and healed after changing dressings. No complications were observed in the donor site, including wound dehiscence, hernia and weakness. Follow-up survey of 12-24 months after the operation showed that the appearance and function in the repaired sites were normal, and norecurrence of the tumors. Conclusion Free transplantation of anterolateral femoral skin flap is relatively an ideal operative type for the repair of soft tissue defects caused by excision of oversized malignant tumour in the skin.
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Objective:To explore the relationship between the polymorphisms in gene FGFR1, FGF10, FGFI8 and the nonsyndromic cleft lip with or without cleft palate (NS CLP) in Chinese population. Methods: Genomic DNA was isolated from peripheral lymphocytes of 75 patients with NS CLP and their parents and 75 unimpaired healthy children. The polymorphisms in FGFRI gene rs13317, p. E467K, p. M3691 and p. S393S, FGF10 gene rs1448037 and FGFI8 gene rs4043716 were detected by applying three-dimensional (3-D) polyacrylamide gel microarray technology. The data were performed using statis-tical analysis : the genotype frequenc+ y and allele frequency between patients with NSCL/P and control subjects were performed. Haplotype relative risk (HRR) , family based association test (FBAT) , and transmission disequilibrium test (TDT) in nuclear family were performed. Results: There were no poly-morphism in FGFR1 gene p. E467K, p. M369I and p. $393S site, the corresponding base was all G. The polymorphisms of rs13317 and rs1448037 were detected and their genotype frequency and allele frequen-cy showed no significant difference between 75 patients with NSCL/P and 75 normal children. TDT, HRR and FBAT were also no significant differences. The genotype frequency of gene FGF18 rs4043716 showed significant difference, but allele frequency were no significant difference. TDT, HRR and FBAT were also no significant difference. Conclusion: Our studies suggest an association between gene FGF18 rs4043716 and the NS CLP in Chinese population, and no association among gene FGFR1 rs13317, p. FA67K, p. M3691, p. S393S and gene FGF10 rs1448037.