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Objective:To evaluate the risk factors related to the mid-term outcomes of hip preserving surgery for early stages osteonecrosis of the femoral head (ONFH) basing on China-Japan Friendship Hospital (CJFH) classification system.Methods:From June 2012 to September 2016, there were consecutive 325 patients (432 hips) were enrolled and divided into different preserving surgery groups, namely core decompression (CD) group 141 hips and "lightbulb" operation (LB) group 291 hips, respectively. Harris hip score (HHS) was used to evaluate the clinical outcomes. The progression of ONFH was observed by radiography. Clinical failure was defined as worsen of HHS and/or radiographic evaluation. Clinical endpoint events were marked as significant hip pain (HHS<70), and/or collapse of the femoral head requiring further interventions. Potential risk factors, including sex, age, etiology, the duration from symptom onset to treatment, preoperative CJFH type, ARCO stage and HHS, were analyzed using univariate risk analysis and Cox regression multivariate risk model.Results:The rate of hip failure was 47.5% (67/141) in CD group, including type C+M 13.0% (3/23), L1 38.1% (24/63), L2 82.4% (14/17) and L3 68.4% (26/38), respectively. There was significant difference in age (χ 2=3.887, P=0.049), type of CJFH (χ 2=40.943, P=0.000) in CD group. The Cox regression analysis revealed that age≥40 ( HR=2.325, 95% CI 1.398, 3.866, P=0.000), pre-HHS 70-80 ( HR=2.163, 95% CI 1.140, 4.105, P=0.018) and <70 ( HR=2.597, 95% CI 1.173, 5.749, P=0.019), type L2 ( HR=35.052, 95% CI 7.721, 159.133, P=0.000) and L3 ( HR=13.242, 95% CI 3.104, 56.491, P=0.000) were associated with failure of core decompression. The rate of hip failure was 36.4%(106/291) in LB group, including type C+M 33.3% (1/3), L1 31.3% (41/131), L2 84.6% (22/26) and L3 32.1% (42/131), respectively. There were significant differences in age (χ 2=8.437, P=0.004), pre-HHS (χ 2=19.737, P=0.000) and type of CJFH (χ 2=29.265, P=0.000) in LB group. The Cox regression analysis showed that poor pre-HHS ( HR=5.102, 95% CI 2.339, 11.129, P=0.000), type L2 ( HR=32.761, 95% CI 6.165, 43.507, P=0.000) were associated with failure of "lightbulb" preserving surgery. Conclusion:The results of hip preserving surgery for ONFH are associated with age, preoperative HHS and CJFH typing. The prognosis depends on the severity of symptoms, the residual of weight-bearing joint surface and lateral pillar of the femoral head.
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Diabetic foot is one of the serious complications of diabetic patients. It is caused by diabetes combined with different degrees of lower extremity vascular lesions and neuropathy, and the wound can not heal for a long time. The serious results can cause bone marrow infection, bone destruction, and have high disability and death rate. At present, there are various treatment methods for diabetic foot chronic wound. On the basis of internal medicine controlling blood sugar, anti infection, lowering blood lipid, improving microcirculation and nourishment nerve, the surgical method is adopted, including the debridement of the necrosis in a short time to prevent the infection from spreading; maggot biological debridement and ozone chemical debridement will promote the growth of granulation tissue while controlling infection. Skin grafting, skin flap transplantation, skin distraction closure can be used to repair soft tissue defects, or fat transplantation, platelet-rich plasma, and rich blood are used for the refractory wound after infection control. In patients with diabetic foot, the reconstruction of lower limb blood supply is beneficial to the recovery of chronic ischemic wounds. It is feasible to improve the blood supply of the lower extremities, improve the blood supply of the lower extremity artery bypass grafting, and improve the microcirculation of the peripheral vessels around the lower extremities. Lower extremity vascular bypass pressure perfusion therapy for vascular network expansion, tibia lateral moving technique for lower limb microcirculation reconstruction. For diabetic foot ulcer caused by peripheral neuropathy, such as Charcot foot, while the application of external fixator, total contact cast technology of affected foot for reducing treatment to promote wound healing; the preparation of orthopedic shoes can play a maximum protective effect on the healing of diabetic foot wound healing.
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Objective To explore the influence of singing therapy on anxiety and depression of patients with stable COPD.Methods Toally 56 COPD patients were divided into intervention group and control group according to random digit table.The control group was provided health education and mental nursing.On the base of treatment for the control group,the intervention group received singing therapy for 24 weeks.The anxiety and depression scale was to measure the anxiety and depression before and 24 weeks after intervention.Results There were no differences in HAD score and HAD-A score and HAD-D score between the groups before intervention (P＞0.05),but after intervention,the differences were significant in terms of the HAD score and HAD-A score and HAD-D score (P＜0.01).The scores of intervention group were significantly lower than those of the control group.For the scores,there was no difference in the control group between pre-and post-intervention (P＞0.05),but the scores after intervention were significantly lower than those before intervention in the intervention group (P＜0.001).Conclusion Singing therapy can effectively alleviate anxiety and depression of COPD patients at the stable state.
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BACKGROUND:Reducing the ischemia-reperfusion injury in the system of simulated in vivo physiological environment for amputated limbs, can extend the preservation time and improve the replantation success rate of amputated limb. OBJECTIVE:To investigate the effect of Mailuoning on the ischemia-reperfusion injury in the system of simulated in vivo physiological environment for amputated limbs. METHODS:The left hind legs harvested from 18 healthy adult male Bama mini-pigs were randomly divided into three groups:cold storage group, blood perfusion group, Mailuoning combined blood perfusion group, with six pigs in each group. After the left hind legs of each pig in al groups were amputated and stored at room temperature for 3 hours, the amputated legs were placed at 4 ℃, perfused with blood, or perfused with Mailuoning combined blood. After 6 hours of perfusion, the morphology of amputated limbs was observed under transmission electron microscope. The mRNA levels of apoptosis proteins Caspase3 and inflammatory factor interleukin-1βwere detected by real time fluorescent quantitative RT-PCR.RESULTS AND CONCLUSION:Transmission electron microscopy results showed that, the muscle fibers in blood perfusion group and Mailuoning combined blood perfusion group arranged more orderly and were more complete than cold storage group, the swel ing of mitochondria was lighter. In addition, the condition in Mailuoning combined blood perfusion group was better than in blood perfusion group. RT-PCR results showed that the expression of Caspase3 and interleukin-1βwas increased in al groups;at the same time, the expression level in blood perfusion group and Mailuoning combined blood perfusion group was significantly lower than those in cold storage group. Mailuoning combined blood perfusion group had s lower expression than blood perfusion group. In the system of simulated in vivo physiological environment for amputated limbs, Mailuoning can significantly reduce the ischemia/reperfusion injury of skeletal muscle cells and prolong the preservation time of amputated limbs.
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Aim The mechanism of basic fibroblast growth factor(bFGF)in mediating increase of intracellular free magnesium ([Mg2+]i) in human umbilical vein endothelial cells (HUVECs), and the relationship between Mg2+and angiogenesis were investigated in this study.Methods The change of[Mg2+]i in HUVECs were quantitatively detected in intracellular cation measurement system via loaded with the fluorescent magnesium indicator mag-fura-2. Endothelial cells were primarily acquired by infusion of collagen enzyme solutioninto the lumens of human umbilical veins and cultured in M199 with 0.2 fetal bovine serum. The role of bFGF in angiogenesis was observed in presence of 0,1 mmol?L-1 or 2 mmol?L-1 of extracellular Mg2+.Results bFGF dose-dependently increased [Mg2+]i, and there was not any significant difference among the groups of 0,1 mmol?L-1and 2 mmol?L-1 of extracellular Mg2+;similar results were obtained in groups done with Na+ and Ca2+. Pretreatment with bFGF receptor-2 (KDR) inhibitor (SU1498) blocked the increase of [Mg2+]i induced by bFGF.Unlike in the group of 0 mmol?L-1extracellular Mg2+,the apparent angiogeneses were observed in the groups of 1 mmol?L-1 and 2 mmol?L-1 extracellular Mg2+ in the presence of bFGF.bFGF-induced angiogenesis was significantly blocked with SU1498 in the presence of 1 mmol?L-1 extracelluar Mg2+.Conclusions These results suggest that the increase of [Mg2+]i by bFGF come from intracellular Mg2+ pools mediated by KDR-dependent signaling pathways,thereby resulting in the bFGF-induced angiogenesis.