ABSTRACT
Outer membrane vesicle (OMV), originating from the outermost membrane of cells, is the extracellular vesicles released by gram-negative bacteria, containing bacterial outer membrane components such as phospholipids, lipopolysaccharide (LPS), outer membrane protein, and bacterial-specific antigens. OMV plays an important role in bacterial physiology and pathogenesis, involving in biofilm formation, horizontal gene transfer, stress and inflammatory responses, and delivery of toxins and other biomolecules. It also plays a vital role in immune regulation and the establishment and maintenance of balanced intestinal microflora. This article provides an overview of the roles of OMV in bacterial infections and immune regulation and the potential application value of OMV in tumor-targeted therapy and new vaccine preparation in the hope to provide new ideas for the prevention and treatment of bacterial infections.
ABSTRACT
Objective:To explore the diagnostic efficacy difference and clinical diagnostic value of chronic lymphocytic leukemia flow (CLLflow) score and Moreau score (MS) in the diagnosis of chronic lymphocytic leukemia (CLL).Methods:According to the latest international and national diagnosis criteria for CLL, 133 patients with B-cell chronic lymphoproliferative diseases and uncertain immunophenotypes (B-CLPD), diagnosed by Zhengzhou Jinyu Comprehensive Haematological Pathology Diagnosis Centre from March 2020 to May 2021, were included in this study. Above patients were divided into the CLL group ( n=83) and non-CLL group ( n=50). The expression of clusters of differentiation (CD)5, CD10, CD20, CD19, κ light chain, λ light chain, FMC7, CD23, CD22, surface immunoglobulin M, CD200 and CD79 were detected by flow cytometry, and CLLflow score and MS score were calculated respectively according to the scoring rules. A fourfold table was used to compare the diagnostic efficacy of the two scoring systems, and the Kappa test and McNemar test were used to compare the consistency and superiority of the systems. Results:The rate of negative and positive CLLflow score were 4.8% (4/83) and 95.2% (79/83) in the CLL group and were 80.0% (40/50) and 20.0% (10/50) in the non-CLL group, and respectively (both P<0.001). The MS score (≤2, =3 and≥4) was 1.2% (1/83), 10.8% (9/83) and 88.0% (73/83) in the CLL group and was 86.0% (43/50), 14.0% (7/50) and 0 in the non-CLL group, there were significant statistical difference between the two groups ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the CLLflow score were 95.2% (79/83), 80.0% (40/50), 88.8% (79/89) and 90.9% (40/44), respectively and those of MS score were 98.8% (82/83), 86.0% (43/50), 92.1% (82/89) and 97.7% (43/44) respectively. The overall coincidence rate, positive and negative coincidence rate between the CLLflow score and MS score were 91.0% (121/133), 93.3% (83/89) and 86.4% (38/44) respectively. Besides, the McNeamr dominance test presented no significant difference ( P>0.05) and high consistency (Kappa=0.796) between the two scoring systems. With MS≤2 and MS≥4, the sensitivity and the specificity of the MS score were 100% (73/73) and 97.7% (43/44) respectively, and for the CLLflow score, the sensitivity and the specificity were 97.3% (71/73) and 86.4% (38/44) in this MS range. With MS = 3, the sensitivity and specificity of the MS score were 100% (9/9) and 0 (0/7), and CLLflow was 88.9% (8/9) and 57.1% (4/7). Conclusions:The diagnostic efficacy is similar and presents high consistency between the CLLflow score and MS score in CLL diagnosis. For CLL patients with MS = 3, the specificity of MS is relatively low, combined assessment with CLLflow score could improve the diagnosis efficacy for CLL in these patients.
ABSTRACT
Objective To evaluate the application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients.Methods The retrospective and descriptive study was conducted.The clinical data of 52 obese patients who underwent laparoscopic Roux-en-Y gastric bypass in the Third Medical Center of Chinese PLA General Hospital from March 2011 to February 2012 were collected.There were 24 males and 28 females,aged (43±9)years,with the range of 23-62 years.All the 52 patients underwent laparoscopic Roux-en-Y gastric bypass.Observation indicators:(1) surgical and postoperative conditions;(2) changes in anthropometric indices;(3) follow-up.Follow-up using outpatient examination was performed to detect complications of patients at 1,3,6,12 months after surgery up to February 2013.Measurement data with normal distribution were represented as Mean±SD,repeated measurement data were analyzed using repeated ANOVA.Count data were represented as absolute numbers.Results (1) Surgical and postoperative conditions:all the patients underwent laparoscopic Roux-en-Y gastric bypass successfully,without conversion to open surgery.The volume of intraoperative blood loss,operation time,and duration of hospital stay were (25± 11) mL,(78± 14) minutes,and (11±2) days.(2) Changes in anthropometric indices:the body mass index (BMI),fat mass,free fat mass,total abdominal fat volume (TAFV),total subcutaneous fat volume (TSFV),and total visceral fat volume (TVFV) of all the 52 patients were (31.8 ± 1.8)kg/m2,(39.4±4.1)kg,(50.2±6.0)kg,(l1 703±3 899)cm3,(7 418±2 969)cm3,and (4 314± 1 692)cm3 before surgery,(28.5±1.4)kg/m2,(33.0±1.1)kg,(49.7±4.6)kg,(11 016±3 713) cm3,(7 044± 2970)cm3,(3969±1 443)cm3 at 3 months after surgery,(27.1±1.7)kg/m2,(30.2±1.3)kg,(45.4± 3.1)kg,(9 406±4 452)cm3,(6 442±3 307)cm3,and (2 964±1 694) cm3 at 6 months after surgery,(24.4± 2.4)kg/m2,(32.6±1.1)kg,(48.6±2.7)kg,(7 612±3 029)cm3,(5 623±2 650)cm3,and (1 826±360) cm3 at 12 months after surgery,respectively,there were significant differences in the changes of these indices (F=130.2,30.3,4.9,25.6,11.9,16.5,P＜0.05).The BMI,fat mass,and TAFV at 3 months after surgery had significant differences compared with those before surgery (P＜0.05),but free fat mass,TSFV,and TVFV had no significant difference (P＞0.05).The BMI,fat mass,TAFV,and TVFV at 6 months after surgery had significant differences compared with those before surgery (P ＜ 0.05),but free fat mass and TSFV had no significant difference (P＞0.05).The BMI,fat mass,TAFV,TSFV,and TVFV at 12 months after surgery had significant differences compared with those before surgery (P＜0.05),but free fat mass had no significant difference (P＞ 0.05).(3) Follow-up:all the 52 patients have completed the follow-up after surgery and the remission number of obesity was 35.No complications such as anastomotic hemorrhage,obstruction,or anastomotic leakage occured in all the 52 patients.Conclusion Laparoscopic Roux-en-Y gastric bypass can reduce abdominal visceral fat significantly,while quantitative computed tomography can help to evaluate the distribution of abdominal visceral fat accurately.
ABSTRACT
Objective@#To evaluate the application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 52 obese patients who underwent laparoscopic Roux-en-Y gastric bypass in the Third Medical Center of Chinese PLA General Hospital from March 2011 to February 2012 were collected. There were 24 males and 28 females, aged (43±9)years, with the range of 23-62 years. All the 52 patients underwent laparoscopic Roux-en-Y gastric bypass. Observation indicators: (1) surgical and postoperative conditions; (2) changes in anthropometric indices; (3) follow-up. Follow-up using outpatient examination was performed to detect complications of patients at 1, 3, 6, 12 months after surgery up to February 2013. Measurement data with normal distribution were represented as Mean±SD, repeated measurement data were analyzed using repeated ANOVA. Count data were represented as absolute numbers.@*Results@#(1) Surgical and postoperative conditions: all the patients underwent laparoscopic Roux-en-Y gastric bypass successfully, without conversion to open surgery. The volume of intraoperative blood loss, operation time, and duration of hospital stay were (25±11)mL, (78±14)minutes, and (11±2)days. (2) Changes in anthropometric indices: the body mass index (BMI), fat mass, free fat mass, total abdominal fat volume (TAFV), total subcutaneous fat volume (TSFV), and total visceral fat volume (TVFV) of all the 52 patients were (31.8±1.8)kg/m2, (39.4±4.1)kg, (50.2±6.0)kg, (11 703±3 899)cm3, (7 418±2 969)cm3, and (4 314±1 692)cm3 before surgery, (28.5±1.4)kg/m2, (33.0±1.1)kg, (49.7±4.6)kg, (11 016±3 713)cm3, (7 044±2 970)cm3, (3 969±1 443)cm3 at 3 months after surgery, (27.1±1.7)kg/m2, (30.2±1.3)kg, (45.4±3.1)kg, (9 406±4 452)cm3, (6 442±3 307)cm3, and (2 964±1 694)cm3 at 6 months after surgery, (24.4±2.4)kg/m2, (32.6±1.1)kg, (48.6±2.7)kg, (7 612±3 029)cm3, (5 623±2 650)cm3, and (1 826±360)cm3 at 12 months after surgery, respectively, there were significant differences in the changes of these indices (F=130.2, 30.3, 4.9, 25.6, 11.9, 16.5, P<0.05). The BMI, fat mass, and TAFV at 3 months after surgery had significant differences compared with those before surgery (P<0.05), but free fat mass, TSFV, and TVFV had no significant difference (P>0.05). The BMI, fat mass, TAFV, and TVFV at 6 months after surgery had significant differences compared with those before surgery (P<0.05), but free fat mass and TSFV had no significant difference (P>0.05). The BMI, fat mass, TAFV, TSFV, and TVFV at 12 months after surgery had significant differences compared with those before surgery (P<0.05), but free fat mass had no significant difference (P>0.05). (3) Follow-up: all the 52 patients have completed the follow-up after surgery and the remission number of obesity was 35. No complications such as anastomotic hemorrhage, obstruction, or anastomotic leakage occured in all the 52 patients.@*Conclusion@#Laparoscopic Roux-en-Y gastric bypass can reduce abdominal visceral fat significantly, while quantitative computed tomography can help to evaluate the distribution of abdominal visceral fat accurately.
ABSTRACT
Objective@#To investigate the effect of X-ray fluoroscopy and CT guided technique in sacroiliac screw fixation for type Tile B or C sacrum pelvic fractures or dislocations.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 103 patients with type Tile B or C posterior pelvic ring fracture or dislocation admitted to the General Hospital from Northern Theater of PLA from January 2007 to December 2017. There were 58 males and 45 females, aged 28-69 years, with an average age of 43.8 years. Among the patients, 84 had normal sacrums while 19 had dysmorphic sacrums. The accuracy and placement time of two kinds of sacroiliac screw were compared by X-ray fluoroscopy (46 patients with normal sacroiliac screw placement and 11 with dysmorphic sacroiliac screw placement) or CT guidance (66 patients with normal sacroiliac screw placement and 18 with dysmorphic sacroiliac screw placement) were compared. Matta standard was used to evaluate the imageological healing and clinical prognosis 9 months after operation.@*Results@#In normal sacrum group, there was no statistical difference in placement accuracy between X-ray fluoroscopy [89%(41/46)] and CT guided technique [94%(62/66)](P>0.05). In dysmorphic sacrum group, the placement accuracy of CT guided technique [89%(17/18)] was significantly higher than that of X-ray fluoroscopy [55%(6/11)] (P<0.05). The screw placement time of X-ray fluoroscopy [(39.1±4.9)minutes] was significantly shorter than that of CT guided technique (54.7±3.8)minutes for normal sacrums (P<0.05), and there was no significant difference in terms of placement time by CT guided technique for dysmorphic sacrums (P>0.05). Nine months after operation, in normal sacrum group, the X-ray fluoroscopy had the excellent rate of 74% (34/46), good rate of 26% (12/46) for healing and the excellent rate of 83% (38/46), good rate of 17% (8/46) for clinical prognosis, showing no significant difference from those of CT guided technique [83%(55/66), 17%(11/66); 92%(61/66), 8%(5/66)] (P>0.05). In dysmorphic sacrum group 9 months after operation, the excellent and good rate of X-ray fluoroscopy [excellent 9%(1/11), good 64%(7/11)] was significantly lower than that of CT guided technique in terms of imageological healing [excellent 56%(10/18), good 39%(7/18)](P<0.05), while no significant difference was found in terms of clinical prognosis [excellent 55%(6/11), good 36%(4/11) vs. excellent 78%(14/18), good 22%(4/18)](P>0.05).@*Conclusions@#X-ray fluoroscopy for the fixation of type Tile B or C posterior ring fractures or dislocations of the normal sacrum takes much shorter time, although the comparable effect with CT guidance in aspects of placement accuracy and bone healing rate. For the dysmorphic sacrum, CT guidance allows more accurate screw placement and has better healing rate than X-ray fluoroscopy.
ABSTRACT
Objective To investigate the effect of X-ray fluoroscopy and CT guided technique in sacroiliac screw fixation for type Tile B or C sacrum pelvic fractures or dislocations.Methods A retrospective case control study was conducted to analyze the clinical data of 103 patients with type Tile B or C posterior pelvic ring fracture or dislocation admitted to the General Hospital from Northern Theater of PLA from January 2007 to December 2017.There were 58 males and 45 females,aged 28-69 years,with an average age of 43.8 years.Among the patients,84 had normal sacrums while 19 had dysmorphic sacrums.The accuracy and placement time of two kinds of sacroiliac screw were compared by X-ray fluoroscopy(46 patients with normal sacroiliac screw placement and 11 with dysmorphic sacroiliac screw placement)or CT guidance(66 patients with normal sacroiliac screw placement and 18 with dysmorphic sacroiliac screw placement)were compared.Matta standard was used evaluate the imagelogical healing and clinical prognosis 9 months after operation.Results In normal sacrum group,there was no statistical difference in placement accuracy between X-ray fluoroscopy [89％(41/46)] and CT guided technique [94％(62/66)](P＞0.05).In dysmorphic sacrum group,the placement accuracy of CT guided technique [89％(17/18)] was significantly higher than that of X-ray fluoroscopy [55％(6/11)](P＜0.05).The screw placement time of X-ray fluoroscopy [(39.1±4.9)minutes] was significantly shorter than that of CT guided technique(54.7±3.8)minutes for normal sacrums(P＜0.05),and there was no significant difference in terms of placement time by CT guided technique for dysmorphic sacrums(P＞ 0.05).Nine months after operation,in normal sacrum group,the X-ray fluoroscopy had the excellent rate of 74％(34/46),good rate of 26％(12/46)for healing and the excellent rate of 83％(38/46),good rate of 17％(8/46)for clinical prognosis,showing no significant difference from those of CT guided technique [83％(55/66),17％(11/66); 92％(61/66),8％(5/66)](P＞0.05).In dysmorphic sacrum group 9 months after operation,the excellent and good rate of X-ray fluoroscopy [excellent 9％(1/11),good 64％(7/11)] was significantly lower than that of CT guided technique in terms of imageological healing [excellent 56％(10/18),good 39％(7/18)](P＜0.05),while no signtficant difference was found in terms of clinical prognosis [excellent 55％(6/11),good 36％(4/11)vs excellent 78％(14/18),good 22％(4/18)](P＞0.05).Conclusions X-ray fluoroscopy for the fixation of type Tile B or C posterior ring fractures or dislocations of the normal sacrum takes much shorter time,although the comparable effect with CT guidance in aspects of placement accuracy and bone healing rate.For the dysmorphic sacrum,CT guidance allows more accurate screw placement and has better healing rate than X-ray fluoroscopy.
ABSTRACT
Objective To investigate the early clinical efficacy of Masquelet membrane induction technique in the treatment of traumatic long bone defects.Methods A retrospective case series study was conducted to analyze the clinical data of 41 patients with traumatic long bone defects admitted to the General Hospital of the Northern Theater Command from January 2012 to April 2017.There were 36 males and five females,aged 15-70 years,with an average of 38.2 years.There were 20 patients with bone defect at the femur,19 at the tibia,one at the fibula,and one at the ulna.All patients received staged treatment using the Masquelet membrane induction technique.In stage Ⅰ surgery,thorough debridement was first performed,and the secretions were taken for bacterial culture.The average bone defect length after debridement was 6.9 cm (2.0-18.5 cm).The bone defect was filled with antibiotic bone cement to induce the biofilm formation.If the postoperative bacterial culture showed positive results,debridement surgery was performed again.Stage Ⅱ surgery was performed after 6-12 weeks.The white blood cell count,C-reactive protein (CRP),procalcitonin (PCT),erythrocyte sedimentation rate (ESR) were measured before the operation.During the operation,bone biopsy was performed,and the bone cement placeholder was completely removed.The autologous cancellous bone and artificial bone were implanted in the bone defect areas,and the induced membrane was sutured.The healing time of bone defects was recorded,and the Paley fracture healing scoring criteria were used to evaluate the limb function.The complications were observed.The inflammatory markers were reviewed at the last follow-up.Results All patients were followed up for 7-36 months with an average of 13.6 months.A total of 37 patients obtained bone healing.The fracture healing rate of stage Ⅰ was 90％,and the healing time was 6-13 months,with an average of 9 months.According to the Paley fracture healing scoring criteria,the results were excellent in 25 patients,good in 10,and fair in two patients,with the excellent and good rate of 85％.In terms of complications,one patient with superficial infection recovered after dressing change,three patients had deep infection,of which one patient was treated with amputation and two received other treatments,and three patients were treated with membrane induction again because of bone resorption.At the last follow-up,there were significant differences between preoperative and postoperative White blood cell count,CRP,PCT and ESR(P ＜ 0.05).Conclusion For traumatic long bone defects,Masquelet membrane induction technique can promote fracture healing,restore limb function and reduce complications.
ABSTRACT
Objective: To explore the clinical effects upon gap nonunion of antibiotic-loaded bone cement spacer combined with membrane induction on infected bone defects
Methods: The data of 16 patients with infected bone defects admitted in General Hospital of Shenyang Military Area Command from January 2009 to January 2011 were analyzed retrospectively. There were 12 males and 4 females aged between 24-63 years age [average 43.1 +/- 9.7] who had received antibiotic laiden bone cement spacer treatment. Stage-1, debridement and anti-biotic treatment with intraoperative preparation of customized bone cement spacers [antibiotics and bone cement spacer[ with or without internal or external fixation Stage-2, removal of spacer and repair of bone defects using membrane-induced technique and internal fixation at bone defects site
Results: Sixteen patients were followed up for 39-98 months, [67.2 +/- 20.4] on average. All patients with infected bone defects were healed. X-ray showed that fractures had healed and the new bone formed at graft site was more radio opaque than that of adjacent bone segments. The healing time was 6 to 10 months, [7.4 +/- 1.1] on average. There was no recurrence of infection or deformity
Conclusion: The antibiotic-loaded cement spacer can control the local infection while maintaining the limb length and increasing the stability, reducing the contracture of bone and soft tissue, creating conditions for subsequent repair and reducing the infection rate of bone defects
ABSTRACT
Objective To explore the effect of social relationship quality intervention on blood pressure and mental state of patients after hypertensive hemorrhage. Methods From November 2014 to March 2016,48 patients with hypertensive intracerebral hemorrhage were assigned as control group and another 48 patients with the same disease in our hospitalfrom April 2016 to August 2017 as observation group:The former received routine nursing care and the latter was treated with social relationship quality intervention plus the routine nursing care.The blood pressure and mental states before intervention were compared with those 1 month after intervention. Result After intervention,the systolic and diastolic blood pressures in the observation group were significantly lower than those in the control group,and the scores on resilience,optimism and strength were all significantly higher than those in the control group (P<0.01, P<0.001). Conclusions The social relationship quality intervention is effective in the care to patients with hypertensive cerebral hemorrhage. It can effectively improve the clinical efficacy, reduce blood pressure and improve mental state, worthy of clinical application and promotion.
ABSTRACT
Objective To investigate the bacterial spectrum and drug resistance of bone infection after multiple hospitalizations.Methods A retrospective case series study was conducted on 95 patients with bone infection due to injuries admitted in the General Hospital of Shenyang Military Area from January 2009 to December 2016.There were 76 males and 34 females,with an average age of 47 years (range,17-94 years).Bacterial culture and drug sensitivity tests were performed in 246 specimens of the infection secretions and infected tissues.The bacterial species and drug resistance data of all the specimens were statistically analyzed.The numbers and ratios of Gram-positive bacteria and Gram negative bacteria were counted according to the changes of hospitalization frequency,and the changes of drug resistance of Staphylococcus aureus after repeated hospitalizations were also recorded.Results A total of 110 pathogenic bacteria were isolated,and mixed infection was found in 19％ of the bacteria.There were 61 Gram-positive bacteria (55.5％),including 35 Staphylococcus aureus [seven methicillin-resistant staphylococcus (MRSA) strains],accounting for 57％ of Gram-positive strains.Other Gram positive bacteria were mainly Enterococcus faecalis and Staphylococcus epidermidis.There were 48 Gram-negative bacteria (43.6％),including 12 Pseudomonas aeruginosa strains,accounting for 25％ of Gram-negative strains,nine Klebsiella pneumoniae strains,accounting for 19％ of the Gramnegative strains.Staphylococcus aureus had a resistance rate to penicillin of 82％,and the major Gram positive bacteria (Staphylococcus aureus,Enterococcus faecalis,Staphylococcus epidermidis) were all highly sensitive to vancomycin and linezolid.The major Gram-negative bacteria (Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii) were highly resistant to the second generation of cephalosporins and were sensitive to carbapenem antibiotics.In 95 bone infection patients,the ratio of Gram positive bacteria to Gram negative bacteria increased from 0.98 at the first admission to 3 after repeated hospitalizations,and the ratio change was statistically significant (P ＜0.05).After multiple hospitalizations,the drug resistance of Staphylococcus aureus to gentamicin,ciprofloxacin,levofloxacin,and tetracycline increased gradually.The resistance rate to penicillin was even up to 100％.Conclusions The mixed infection of bone infection is common,among which Staphylococcus aureus and Staphylococcus epidermidis are the main Gram-positive pathogenic bacteria,Pseudomonas aeruginosa and Klebsiella pneumoniae are the main Gram negative pathogenic bacteria.The proportion of Gram-positive bacteria infection increased after multiple hospitalizations and became the major pathogenic bacteria.Penicillin should be avoided in the treatment of Staphylococcus aureus infection in multiple hospitalizations,and gentamicin and ciprofloxacin should be used with caution.Vancomycin or linezolid which is more sensitive is a better option.
ABSTRACT
Objective To explore the clinical effect of Masquelet membrane induction technique combined with antibiotic coated intramedullary nail fixation in the treatment of lower limb large segment infected bone defects.Methods From June 2009 to August 2015,53 patients who have lower limb large segment infected bone defects were analyzed retrospectively,including 40 males and 13 females,aged from 23 to 61 years,with an average age of 36.2±8.4 years.37 cases were secondary to infection after fracture surgery,and 16 cases were caused by open fractures.There were 17 cases of femoral shaft defects and 36 cases of tibia diaphysis defects.All 53 cases were treated with Masquelet technique.The first stage was infection debridement,then bone defect was filled by bone cement mixed with sensitive or broad-spectrum antibiotics,and then temporary fixation was given.When the infection was controlled,debridement was given again and sensitive antibiotic bone cement was replaced to induce membrane,and antibiotic coated intramedullary nail was used for internal fixation.In the second stage,after intramedullary nailing internal fixation for 4-6 weeks,the bone cement occupying device was taken out and the autologous cancellous bone was planted in the induced membrane.Then the membrane was covered and sutured.The cure rate of infection,the time of bone healing and the related complications were observed.Results 53 patients were followed up for 24 to 63 months (with an average of 39±4.7 months).The length of tibia bone defect after debridement was 6-15 cm (average 8.7±4.9 cm).49 patients' infection were cured in 12 months after operation,and the bone defects were healed,with healing time of 5.3-9.7 months (mean 7.4±3.2 months).No refracture occurred.The healing time of tibia was 7.8±2.1 months,while the healing time of the femur was 7.2±3.9 months.1 case of femoral shaft defect had recurrence of infection 4 months after membrane induced bone grafting,and the first stage treatment was restarted which were debridement and implantation of sensitive antibiotic bone cement occupying device.After 6 weeks,the infection was controlled and the second stages continued.3 cases' s (2 cases of femoral shaft,1 case of tibial shaft) autologous cancellous bone were absorbed 3 to 6 months after operation,and no bone density increased in the bone defect area.The autologous cancellous bone was reimplanted and the bone defect was cured in 8 months.Conclusion Masquelet technology combined with antibiotic coated intramedullary nailing can effectively control infection and create a good biological and mechanical environment for bone defect repair.It has good clinical efficacy.
ABSTRACT
Objective To investigate the effects of melatonin on the changes of superoxide dismutase ( SOD ) , reactive oxygen species (ROS),and malondialdehyde(MDA) in N2A cells under hypoxia conditions.Methods Randomly divided the primary cultured neuroblasto-ma cells of mouse into the control group ,hypoxia group ,and MT treatment group .The MT treatment group were given melatonin 5μg/mL for 24 h to set up the treatment model .Rsbiotech of the hypoxia group and MT treatment group were given gaseous mixture of 95%N2 and 5%CO2 ,The ischemia hypoxia model of N 2A cells was set up with cells in the oxidative stress state and cultured for 24 hours at low concentra-tions of serum .The content of SOD , ROS, and MDA was measured respectively by xanthine oxidase , fluorogenic quantitative detection and thiobarbituric acid chromatometry .Results The expression of SOD in hypoxia group and MT treatment group were significantly decreased compared with that in control group(P<0.05).The level of SOD in MT treatment group significantly recovered compared with hypoxia group with singnificant difference (P<0.05).The expression of MDA and ROS in hypoxia group and MT treatment group were significantly in-creased compared with that in control group (P<0.05).The level of MDA and ROS in MT treatment group significantly recovered compared with hypoxia group with singnificant difference (P<0.05).Conclsion Melatonin provides a protective effect on the secondary damage of nerve cells with hypoxia ischemia .The possible mechanism is melatonin could play the role of free radical scavenging and up -regulate the ex-pression level of antioxidants .
ABSTRACT
Objective To discuss the clinical effects of arthroscopy combined with Brostrom repair in the treatment for chronic ankle instability talofibular ligament injury.Methods From January 2012 to June 2015,42 cases of chronic ankle instability in our hospital were performed modified Brostrom repair.All the cases were evaluated by AOFAS scoring system.Results All the patients were followed up for 9 to 17 months,an average of (12.7±3.5)months.At the last follow-up,all cases could participate in normal daily running training mission.Activity levels of 2 cases with cartilage injury had a decline than before.The others were able to attend the confrontational training.Postoperative AOFAS score(88.4±4.9) increased compared with preoperative score (43.3±7.8),the difference was significant(P<0.05).ConclusionThe curative effect of arthroscopy combined with Brostrom repair in treatment of chronic ankle instability talofibular ligament injury is satifactory.It can be helpful to the wounded rapid rehabilitation and good for the popularization and application in basic-level hospitals.
ABSTRACT
Objective To evaluate the clinical results of arthroscopic arthrolysis for the treatment of elbow stiffness.Methods Totally 34 cases with elbow stiffness caused by trauma who needed to undergo arthroscopic arthrolysis were selected from General Hospital of Shenyang Military Area Command from October 2014 to February 2016.Among them,3 cases were lost to follow-up,and the other 31 cases were included in the study.All the patients were performed arthroscopic arthrolysis.Removed the hyperplasia of osteophyte and girdle,cleaned the articular cavity,restored the smooth of articular surface,and released the joint capsular and ligament around the elbow joint during the operation.Manipulation release was used coordinate with analgesia and rehabilitation therapy after operation.Mayo scores of elbow were used for function evaluation and range of motion(ROM) was collected.Results Patients were followed-up from 9 months to 12 months,(10.4±1.5) months on average.Before the operation,the mean maximal flexion angle of the elbow was (87.6±5.9)°,the extension angle was (35.5±6.4)°,the pronation angle was (75.9±9.6)°,the rotational angle was (67.2±7.4)°,and it was (125.9±6.5)°,(5.0±1.9)°,(82.0±9.1)°,(81.0±7.0)°respectively after operation,and the differences before and after opreation were statistically significant (P<0.05).The Mayo scores was (61.9±7.6) preoperatively and (88.8±4.7) postoperatively,and the difference was statistically significant(P<0.05).Conclusion Arthroscopic arthrolysis has the advantages of clear operative field,minimal invasion and rapid recovery.It can effectively improve the elbow joint activity and arthroscopic arthrolysis is an effective surgical treatment for elbow stiffness.
ABSTRACT
Objective To investigate the clinical significance of serum interleukin-6(IL-6),C-reactive protein(CRP) and procalcitonin(PCT) in early diagnosis of postoperative infection after artificial femoral head replacement in rabbits.Methods Selected 64 healthy New Zealand white rabbits,and randomly divided them into the experimental group and the control group,with 32 cases in each group.All of the 64 rabbits underwent left femoral hip replacement.Rabbits in the experimental group were injected with staphylococcus aureus into the left hip joint immediately after artificial femoral head replacement,while rabbits in control group were injected with the same amount of saline.The changes of IL-6,CRP and PCT in synovial fluid of all rabbits were measured.Took synovial fluid and 3 pieces of synovial membrane to make bacterial culture 9 days after surgery.Results The bacterial culture of the experimental group was positive for staphylococcus aureus while it was negative in the control group.One day after surgery,the levels of IL-6,CRP and PCT in synovial fluid of two groups were significantly higher than those before operation(P0.05).The levels of IL-6,CRP and PCT in the synovial fluid of the experimental group were significantly higher than those of the control group at the 3rd,6th and 9th day after operation(P0.05),and IL-6 and CRP gradually restored preoperative level at 9th days after operation(P>0.05).The sensitivity and specificity of IL-6,CRP and PCT combined test were 96.9% and 90.6% respectively,which were significantly higher than those of individual indexes.Conclusion Combined detection of serum IL-6,CRP and PCT levels in the infection model of artificial femoral head replacement can provide some help for the early diagnosis of infection after clinical hip arthroplasty.
ABSTRACT
Objective To evaluate the curative effect of arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions.Methods Retrospectively analyzed the clinical data of 35 cases who were admitted into our hospital from June 2015 to October 2016 and underwent arthroscopic surgery for the treatment of first-time shoulder dislocation.All the 35 cases were combined with Bankart lesions,and the lacerated glenoid labrum were repaired with suture anchorsy.The postoperative ASES scroe and Rowe score were adopted for the final evaluation.Results All the 35 cases were followed up for 1 to 6 months,3 months averagely.All the patients had satisfactory shoulder function,with no shoulder dislocation occured again.The ASES score and Rowe score after surgery was better than that before surgery with statistically significant difference(P<0.05).Conclusion Arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions has many advantages such as mini-invasion,rapid recovery and satisfactory outcome in function and motion.
ABSTRACT
Objective To evaluate the clinical curative effect of Masquelet technique in treatment of infected single-bone defect of forearm.Methods The clinical data of 18 cases of forearm bone defect caused by bone infection in our department from January 2011 to June 2016 were retrospectively analyzed.All the patients received standard treatment of Masquelet technique with two stage.Radical debridement,bone defect filling with antibiotic PMMA bone cement, and internal fixation were accomplished at the first stage, and treatment of bone defect with autologous iliac bone graft were accomplished at the second stage after 6 to 8 weeks at the end of the first stage.The infection control,fracture healing and complications of the 18 patients were observed.Results There was no complications such as infection recurrence,bone resorption,plate screw loosening occured.The functional recovery of 18 cases in this group was evaluated according to the Anderson evaluation scale.The results were excellent in 9 cases,satisfactory in 6 cases,unsatisfactory in 3 cases,and no failure.The satisfactory rate was 83.33%.Conclusion Controlling infection with local release of antibiotics from PMMA bone cement implantation through Masquelet technique, inducing autogenous membrane structure in the bone defect area,and then transplanting autologous cancellous bone for bone defect reconstruction repair treatment are effective in the treatment of infected single-bone defect of forearm.
ABSTRACT
Objective To analyze the short-term clinical efficacy of the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis through total hip arthroplasty combined with internal fixation.Methods From January 2011 to June 2014 a total of 28 cases of ipsilateral femoral intertrochanteric fractures with femoral head necrosis were selected,and they were all treated with open reduction and greater trochanter plate fixation combined with total hip arthroplasty.The time of operation, amount of bleeding,time of bone healing of the greater trochanteric fracture,postoperative complications, rate of internal fixation device loosening,incidence of infection,and the Harris score of the hip joint before and after operation were recorded and statistically analyzed.Results The mean operative time was (174.0±27.1)min and the mean blood loss was (530.0±132.0)mL.There were 2 cases of deep venous thrombosis in the lower extremities,and there was no serious complications occured among the remaining cases.All patients were followed up for 12 to 24 months,averagely (16.3±7.0) months.All the 28 patients get bony union of the large trochanter,with the average healing time of (5.0±1.5) months.The preoperative Harris score was (28.0±7.1) points, while it was (86.5±5.3) points after the surgery, and the difference was statistically significant(t=-21.699,P=0.000).At the end of the follow-up,there was no internal fixation device loosening, no cable breakage,and no infection cases.Conclusion Total hip arthroplasty combined with internal fixation for the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis, especially the large trochanteric fractures, were of reliable fracture fixation, good initial stability and good joint function recovery.And it can maintain fracture stability and early recovery of joint function,so that intertrochanteric fractures and femoral head necrosis were treated simultaneously,and its recent clinical results were satisfactory.
ABSTRACT
Objective To investigate the preoperative diagnosis,surgical treatment and results of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).Methods We retrospectively analyzed the clinical data of 9 patients with ALCAPA who had undergone surgical treatment in Shanxi Children's Hospital from June 2010 to March 2014.Results There were 3 males and 6 females,aged from 4 months to 4 years old and 6 months,average age (1.14 ± 1.33)years,body weight from 5.6 to 18.0 kg,average weight(8.06 ± 3.99) kg.Echocardiography and spiral CT angiography were performed in all patients,one of which underwent cardiac catheter angiography.The cases of mitral regurgitation were mild in 2 cases,mild to moderate in 5 cases,and moderate to severe in 2 cases.Electrocardiogram showed abnormal Q wave,ST segment change and T wave inversion in lead Ⅰ,AVL and V4-6 in 9 cases.The X-ray sign was significant heart enlargement(C/T ratio 0.56-0.73,mean 0.61 ± 0.05).Echocardiography indicated ALCAPA,significant enlargement of left ventricle and decreased myocardial contractility(ejection fraction less than 50％).End diastolic diameter of left ventricle were more than 35 mm in 8 cases and aneurysm formation of left ventricular apex in 1 case.One case was confirmed ALCAPA by catheter angiography.Six cases had radioactive nuclide myocardial imaging,which showed different degree of myocardial infarction.All patients underwent reimplantation of left coronary artery into the aorta,mitral valvoplasty in 7 patients.One case died for low cardiac output syndrome.Others recovered and discharged.Postoperative complications included low cardiac output syndrome in 2 cases,pneumonia in 3 cases and supraventricular tachycardia in 1 case.During a followup of 3 months to 2 years,well development,good heart function,mitral valve regurgitation and ejection fraction improved in all case.Conclusion Echocardiography has important value in diagnosis of ALCAPA,which are confirmed by spiral CT angiography and catheter angiography.Preoperative nuclide examination for determinant of survival myocardium is helpful for surgery and prognosis.Reimplantation of left coronary artery into the aorta is the most ideal surgical procedure.
ABSTRACT
Objective To investigate the clinical efficacy of induced membrane technique for reconstruction of large tibia bone defects in adults.Methods From February 2010 to February 2014,28 cases with tibia bone defect (16 cases caused by traumatic,9 cases caused by chronic osteomyrlitis,and 3 cases caused by tumor resrction)were treated in our deparment.There were 21 males and 7 females,with a mean age of 36.7 years old.The mean bone loss after final debridement and tumor resrction was (6.2 ±2.6)cm,and the maximum length of bone loss was 16 cm in this series.All the patients were treated by induced membrane technique,and the healing rate,occurrence of complications and limb function were recorded.The bone union was assessed by Paley scores.Results The average duration of follow-up ranged from 12 to 37 months,averagely (23.4 ±4.7)months.The healing rate was 85.7% at a mean time of 5.2 months.According to the Paley scores,there were 20 cases of excellent,6 cases of good,2 cases of moderate.There were 2 patients with pin site infection,2 patients with deep infection re-quiring operative debridement,1 patient with superficial iliac incision infection,1 patient with nonunions of one ends of the bone gap,and 1 patient suffered the implant failure due to fullweight-bearing early.Conclusion The induced membrane technique is a valid option for the management of large tibia bone defects in adults caused by traumatic,tumor resection and removal of chronic osteomyelitis lesions,which sig-nificantly shorten treatment cycle,provide satisfactory results with minimal complications,and promote good recovery of limb function.