Establishing cleft services in developing countries: Complications of cleft lip and palate surgery in rural areas of Indonesia

BACKGROUND@#Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery.@*METHODS@#This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene.@*RESULTS@#In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05).@*CONCLUSIONS@#Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.

Clinic Efficacy and Action Mechanism of Promoting Repairment of Knee Osteoarthritis's Cartilage Corpuscle via Modified Duhuo Jisheng Mixture / 中国中医药信息杂志

Objective To discuss the clinic efficacy and its mechanism of action in promoting the cell proliferation of knee osteoarthritis's cartilage corpuscle via modified Duhuo Jisheng Mixture. Methods Totally 60 cases were divided into treatment group and control group by random number table method, with 30 cases in each group. Treatment group was given modified Duhuo Jisheng Mixture, 62.5 mL each time, twice a day, orally, and sulfoglycan sulfate capsules, 1 capsule a day, three times a day, orally; while control group was given diacerein capsules, 1 pill a day, twice a day, orally, and sulfoglycan sulfate capsules, the same as treatment group. Patients were required to do quadriceps muscle systolic and functional exercise, and keep warm. The treatment lasted for 6 weeks. VAS score and WOMAC of the two group were observed before and after treatment. IL-1, NO, Wnt5a, β-catenin, Sox9, Collagen Ⅱ in knee joint fluid were detected. Adverse reactions were monitored. Results Compared with pre-treatment, the contents of IL-1, NO, Wnt5a and β-catenin in two groups were reduces (P<0.05); while the contents of Sox9 and Collagen Ⅱ were raised (P<0.05). The VAS scores and WOMAC were reduced in two groups after treatment (P<0.05). There was no statistical significance between the two group in the above indexes (P>0.05). There were no obvious adverse reactions in both groups.Conclusion Modified Duhuo Jisheng Mixture can reduce inflammatory factors of the joint fluid and inhibit the Wnt signal pathway through regulating the expression of Sox9 and Collagen Ⅱ in the pathway, which can promote the cell proliferation of knee osteoarthritis's cartilage corpuscle and benefit the repairment of cartilage corpuscle in order to relieve pains and improve functions of knee joint.

Vacuum sealing drainage with anterolateral thigh perforator flap for repair foot soft tissue defect / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effect of vacuum sealing drainage(VSD) with anterolateral thigh perforator flap for repair foot soft tissue defect.</p><p><b>METHODS</b>From September 2014 to September 2016, 45 patients with foot soft tissue defect repaired by VSD with anterolateral thigh perforator flap, including 31 males and 14 females aged from 17 to 55 years with an average of 36 years old. Thirty patients were dorsal soft tissue defects, and 15 patients were plantar soft tissue defects. Sizes of soft tissue defect ranged from 7 cm×10 cm to 11 cm×18 cm, the wound was contaminated seriously and assisted with deep soft tissue exposure. Emergency surgical wound debridement with VSD treatment were performed, and wound surface was cleaned after 5 to 7 days, free anterolateral thigh flap were repaired. Sizes of flap ranged from 9 cm×12 cm to 13 cm×21 cm. Appropriate method was used to repair flap donor area.</p><p><b>RESULTS</b>All 45 free propeller flap were survived without skin edge necrosis, ulcerative infection. Forty patients were followed up from 3 to 24 months with an average of 13 months. Flap showed good color, beautiful appearance, good elasticity, soft texture, but without obvious bloated, the wood of leg healed well.</p><p><b>CONCLUSIONS</b>VSD with anterolateral thigh perforator flap for repair foot soft tissue defect could effective control wound soft tissue infection, receive reliable flap blood supply and skin flap could repaired at stage I. It is an effective method for repairing foot soft tissue defects.</p>

Cultivation of Traditional Chinese medicine thinking in tendon and muscle injury / 国际中医中药杂志

Traditional Chinese medicine thinking is the core method of diagnosis and treatment of traditional Chinese medicine. Thus, cultivating the clinical thinking of traditional Chinese medicine in the orthopeadics department has become the importance. TCM tendon and muscle injuries were well characterised by the TCM, becoming an important part of TCM orthopedics., The tendon and muscle injuries were used to explore the application and cultivation of traditional Chinese medicine thinking. This will help to improve the clinical curative effect, complement the modern Chinese medicine.

Improved mesenchymal stem cell survival in ischemic heart through electroacupuncture / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate whether electroacupuncture (EA) can promote cell survival and enhance heart function of mesenchymal stem cells (MSCs) therapy.</p><p><b>METHODS</b>MSCs were isolated from bone marrow and expanded in Minimum Essential Medium Alpha (α-MEM). MI was induced in 72 Sprague-Dawley (S-D) rats by ligation of the left anterior descending coronary artery (LAD) for 30 min and reperfusion. MI rats randomly received injection of 1×10(6) DiI-labeled MSCs alone (n =24, MSC group), or plus electroacupuncture (EA) at Neiguan (PC6, n=24, EA+MSC group), or saline (n =24, saline group). EA treatment was performed for 4 days. Another 24 rats were subjected to chest-open surgery without LAD occlusion and treatment (sham group). Three time points, 4, 14 and 28 days (n =8 for each group) were included in this study. The survival of transplanted MSCs and the protective gene expression were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot at day 4 and 14. Left ventricular remodeling, cardiac function, infarction area, fibrosis and capillary density were analyzed at day 28.</p><p><b>RESULTS</b>EA can enhance MSC survival (2.6-fold up) at day 4. Big capillary density was 53% higher in EA+MSC treated group than MSC alone group. Furthermore, the rats treated by EA reduced the fibrosis and had 36% smaller infarct size comparing to MSC alone. EA also attenuated left ventricular remodeling and enhanced the functional recovery of infarcted hearts at week 4.</p><p><b>CONCLUSION</b>EA at Neiguan acupoint can promote the stem cell survival and improve ischemic heart function. EA could become a useful approach in stem cell therapy for ischemia heart diseases.</p>

Effects of acupuncture on post-cesarean section pain / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Post-operation pain is a very subjective phenomenon. The aim of this study was to find out the effects of acupuncture or electro-acupuncture on post-cesarean pain.</p><p><b>METHODS</b>Sixty women, who had had spinal anesthesia during cesarean section at the Department of Obstetrics of China Medical University Hospital, were randomly assigned to the control group, the acupuncture group, and the electro-acupuncture group. After the operation, we applied subjects with acupuncture or electro-acupuncture on the bilateral acupuncture point, San Yin Jiao (Sp6), and the patient controlled analgesia (PCA). The first time of requesting morphine, the frequency of PCA demands in 24 hours, and the doses of PCA used were recorded double blindly. In addition, monitoring the subjects' vital signs, the opioid-related side effects, and the pain scores was done.</p><p><b>RESULTS</b>The results showed that the acupuncture group and the electro-acupuncture group could delay the time of requesting morphine up to 10 - 11 minutes when compared with the control group. The total dose of PCA used within the first 24 hours was 30% - 35% less in the acupuncture group and the electro-acupuncture group when compared with the control group, which was indicated in statistical significance. However, there was no significant difference between the acupuncture group and the electro-acupuncture group. The electro-acupuncture group's and the acupuncture group's pain scores were lower than the control group's within the first 2 hours. Both were statistically significant. However, two hours later, there were no significant differences of the visual analogue scale (VAS) scores between either of the treatment groups and the control group. Finally, the incidence of opioid-related side effects, such as dizziness, was less in the acupuncture group and electro-acupuncture group than in the control group.</p><p><b>CONCLUSIONS</b>This study shows that the application of acupuncture and electro-acupuncture could definitely delay the time of requesting pain relief medication after cesarean section and decrease the PCA doses used within the first 24 hours.</p>

Value of perioperative adjuvant therapy in liver transplantation for advanced hepatocellular carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the clinical value of perioperative adjuvant chemotherapy in prevention of tumor recurrence and improvement of patient survival after liver transplantation for advanced hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Twenty patients with advanced HCC (pTNM stages III and IV a) receiving liver transplantation with preoperative transcatheter arterial chemoembolization (TACE) and postoperative adjuvant chemotherapy (ADM+5-Fu+CDDP) were retrospectively reviewed in comparison with 16 patients receiving liver transplantation only for tumor recurrence, cumulative and tumor-free survivals. The feasibility and side-effects of the treatments were also studied.</p><p><b>RESULTS</b>The recurrence rate was lower in the perioperative treatment group than in non-treatment group (12/20, 60.0% vs 11/16, 87.5%, P<0.05). The 1- and 2-year overall survival rates were 70.8% and 47.1% for the chemotherapy group and 43.8% and 20.5% for the non-chemotherapy group respectively, showing significant differences between them (P<0.05). The 1- and 2-year tumor-free survival rates were 60.6%, 40.5% and 33.6%, 15.6% in the two groups, respectively, with also significant differences (P<0.05).</p><p><b>CONCLUSIONS</b>Perioperative adjuvant treatment may significantly decrease the likeliness of tumor recurrence and prolong the survival of patients with advanced HCC after liver transplantation. Chemotherapy with ADM+5-Fu+CDDP can be effective and safe with only mild side-effects.</p>