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Objective:Through meta-analysis, the association of three common adipokines (leptin, adiponectin, and chemerin) with bone nutrition of senile osteoporosis (SOP) in China was systematically evaluated.Methods:CNKI, CBM, VIP, Wanfang, PubMed, Web of Science, Embase, Cochrane Library, and other databases were searched for articles published from the establishment of the database to July 30, 2022. After literature screening, data extraction, and quality evaluation of the included studies were independently conducted by two researchers, a meta-analysis was performed using RevMan5.4 and Stata17.0 softwares.Results:A total of 13 studies in the Chinese population were included, including 897 patients with SOP and 673 elderly with normal bone mineral density . The results of the meta-analysis showed that compared with the control group, the serum leptin levels were significantly lower ( MD -2.64, 95% CI -4.04 to -1.23, P < 0.001), chemerin levels were significantly higher ( MD 25.23, 95% CI 14.57 to 35.90, P < 0.001), and adiponectin levels were not significantly different ( MD -0.55, 95% CI -2.26 to 1.17, P > 0.05) in SOP patients. After subgroup analysis according to the measurement method, leptin levels remained lower in SOP patients than in the control group. Conclusions:Compared with the control group, leptin levels were lower and chemerin levels were higher in SOP patients. Therefore, dysregulation of adipokines may play an important role in the occurrence and development of SOP, and regulation of adipokine levels and functions may play a role in the treatment of SOP and the improvement of bone nutrition as a nutritional intervention.
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Objective:To investigate the efficacy of free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve for repair of soft tissue defect in the foot and ankle.Methods:A retrospective case series study was made on clinical data of 9 patients with soft tissue defect in the foot and ankle admitted to 80th Group Military Hospital from December 2017 to December 2019. There were 8 males and 1 females, with the age of 28-63 years [(47.3±12.3)years] and the body mass index (BMI) of 16.7-27.8 kg/m 2 [(23.9±3.9)kg/m 2]. The size of soft tissue defect ranged from 10 cm×6 cm to 20 cm×12 cm. All patients were treated with the free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve. After debridement or tumor resection, a thin sensate flap was harvested by intra-adipose tissue dissection between the superficial and deep fat layers. The size of flap ranged from 13 cm×8 cm and 13 cm×10 cm. The thickness of the defatted flap ranged from 3-6 mm. The distance from the anterosuperior iliac spine to the point where the lateral cutaneous branch of the subcostal nerve crossed the iliac crest ranged from 7.5-10.0 cm. The flap survival, complications, and reoperation were observed after operation. The sensory recovery of the flap was evaluated using Tinel sign and nine-grid method including monofilament touch perception, vibration perception, pinprick perception, temperature perception, and static two-point discrimination test. The joint range of motion, and shoewear and walking problems were recorded. At the last follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to assess the affected foot and ankle. The injury at the donor site was detected as well. Results:All patients were followed up for 6-35 months [(21.1±10.1)months]. All flaps survived without infection or tumor reoccurrence. One patient developed ulceration, then surplus skin on the reconstructed heel was resected. One patient underwent flap debulking and removal of internal fixation. One or more sensory modalities within the nine areas in each flap could be detected at postoperative 3-6 months. The monofilament touch, vibration, pinprick, and temperature perception were presented in almost all regions of each flap at postoperative 12 months. However, only one patient in one region was noted with the static two-point discrimination, in which the distance of the two points was set as 25 mm. The range of ankle motion was slightly limited in 2 patients who underwent osseoligamentous complex reconstruction. All patients were able to wear normal shoes and walk without pain. At the last follow-up, the AOFAS ankle-hindfoot score ranged from 78 to 97 points [(86.4±7.4)points], significantly improved from preoperative 10-70 points [(44.2±18.4)points] ( P<0.01). No patients complained of pain at the donor site, but the widening linear scar was noted. Conclusion:For medium-sized soft tissue defect of the foot and ankle, the free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve can be defatted with the requirement and has advantages in defect site appearance, sensory restoration, wearing ordinary shoes, painless walking, good functional recovery, and minimal donor site morbidity.
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In recent years, the incidence of diabetes has been increasing gradually. The overall incidence of gastric cancer has been decreasing, but the number of new cases is still large. Which has become the two most important diseases threaten the survival and health of human being. This article reviewed recent studies on the correlation between diabetes and gastric cancer. The found that metabolic disorders might affect the incidence and mortality of gastric cancer, but there was no clear evidence that diabetes is a risk factor of gastric cancer. Therefore, more well-designed epidemiological studies are needed to confirm the relationship between diabetes and gastric cancer.
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<p><b>OBJECTIVE</b>To detect potential mutations in two neonates suspected for Cornelia de Lange syndrome (CdLS).</p><p><b>METHODS</b>Peripheral blood samples from the neonates and their parents were collected and analyzed for CdLS-related genes using targeted sequence capture and next-generation sequencing. Suspected mutations were confirmed by direct Sanger sequencing.</p><p><b>RESULTS</b>The neonates were found to respectively carry mutations c.7219C to T and p.D2339Lfs*4 of the NIPBL gene, among which the p.D2339Lfs*4 mutation has not been reported previously. No pathogenic mutation was found in other CdLS-related genes including NIPBL, SMC1A, SMC3, RAD21 and HDAC8.</p><p><b>CONCLUSION</b>The c.7219C to T and p.D2339Lfs*4 mutations of the NIPBL gene probably account for the disease in both patients.</p>
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Objective To summarize the computed tomography (CT) characteristics of primary hepatic angiosarcoma (PHA).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 9 PHA patients who were admitted to the Wenzhou Chinese Medicine Hospital (3 patients),Second Affiliated Hospital of Wenzhou Medical College (3 patients) and Wenzhou People's Hospital (3 patients) between January 2006 and June 2017 were collected.All 9 patients were fasting 8 hours before CT examination,and received screen scans without abdominal pressure.Scanning area was from dome of diaphragm to lower pole of the kidneys.Two associate senior doctors made images analysis.After preoperative examinations,patients selected whether or not to undergo treatment,resection,liver transplantation or chemotherapy + targeted therapy of monoclonal antibodies.Observation indicators:(1) plain scan appearances of CT;(2) enhanced scan appearances of CT;(3) results of pathological examinations;(4) follow-up and survival situations.Follow-up using outpatient,inpatient and imaging examinations was performed to detect tumor recurrence and stable condition up to December 2017.Results (1) Plain scan appearances of CT:9 patients showed solitary tumor,and tumors were respectively located in the left lobe (3 cases) and right lobe (6 cases) of the liver,including 5 with round tumors,3 with oval tumors and 1 with patchy tumor.The maximum diameter of tumor was 5.8-16.0 cm,with an average of 10.8 cm,including maximum diameter ＞ 6.0 cm in 8 patients.Tumors of 9 patients showed low-density shadow,and CT value was 32-46 HU,with an average of 41 HU,including homogeneous density in 3 patients and heterogeneous density in 6 patients;clear tumor boundary in 6 patients and unclear tumor boundary in 3 patients;tumor necrosis and cystolization in 4 patients,slightly strip-shaped high-density shadow in the center of tumor in 4 patients,and small patch-shaped intratunoral calcification in 1 patient.(2) Enhanced scan appearances of CT:① Arterial phase:tumors of 9 patients showed mild and moderate heterogeneous enhancements,with CT value of 63-76 HU and an average of 68 HU,including small patch-shaped or nodular enhancement in 3 patients and punetate or flocculent enhancement in the center of tumor in 6 patients.Tumors of 4 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma.Tumors of 5 patients showed mild enhancements,and tumor density was equal to or slightly less than that of normal liver parenehyma.② Portal vein phase:tumors of 9 patients showed mild and moderate,continuous and progressive enhancements,with a heterogeneous density,CT value of 56-71 HU and an average of 63 HU,including extended enhancement region in 3 patients,with a fusion and filling trend;small patch-shaped or nodular and lattice network-shaped enhancements of center and periphery of tumor in 6 patients,showing center filling and enhancement features of hepatic angiosarcoma.Tumors of 2 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma;tumors of 7 patients showed mild enhancements and tumor density was equal to or slightly less than that of normal liver parenchyma.③ Delayed phase:tumor enhancements of 9 patients slowly seceded,with CT value of 50-60 HU and an average of 53 HU,including density decreasing of periphery of tumor in 3 patients;partial fusion and center filling of enhancements in 6 patients,without enhancement in necrotic area.Tumor density was slightly higher than that of normal liver parenchyma in 2 patients,equal to that of normal liver parenchyma in 1 patient,and slightly less than that of normal liver parenchyma in 6 patients.(3) Results of pathological examinations:① Pathological examinations:cut surface of tumors showed grayish yellow and drab gray,and parts of surface were fish flesh shape,with internal bleeding and necrosis.Tumors were found in diffuse hyperplasia under microscopy,tumor tissues were made up of irregular and mutual matching lacuna vasorum,with infiltrating growths along hepatic sinus gap;hepatic angiosarcoma cells were spindle,round or irregular;there were slightly eosinophilia cytoplasm and deep chromatin of the nucleus,long-shaped or irregular nucleus,and different sizes of nucleolus.② Immunohistochemical staining:CD31 and CD34 were strongly positive,vimentin and Nestine were positive,and CK19,actin and creatine kinase were negative.(4) Follow-up and survival situations:of 9 patients,3 without treatment respectively died at 3,6 and 7 months;2 had recurrence at 4 and 5 months after tumor resection,with angiosarcoma invading right renal capsule,diaphragm and right pleural hemorrhage induced to haemothorax,and survived respectively for 13 and 15 months;2 respectively died of systemic metastasis at 4 and 8 months after liver transplantation;2 underwent chemotherapy + targeted therapy of monoclonal antibodies,and survived for 12 months.Conclusions CT appearances of PHA have certain characteristics.The plain scans of CT show heterogeneous low-density shadow,and enhanced scans of CT show small patch,punctate or nodular-shaped,continuous and progressive enhancements,with a clear boundary between tumor and liver parenchyma.
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Objective To investigate CT and MRI features of hepatoblastoma in adults.Methods CT and MRI findings of 8 cases of adult hepatoblastoma were retrospectively analyzed.Results (1) 75.0％ of the tumors was located in the right lobe of the liver and 25.0％ in the left lobe of the liver.(2) The maximum diameter of the tumor was averaged at (8.2±5.5)cm,and the maximum diameter of ＞ 5 cm was 62.5％.(3) Most tumors have a complete or incomplete false envelope,and the boundary is clear.(4) 75.0％ tumors were of necrocystic degeneration with calcification or bleeding in 25.0％ cases.(5) CT flat scan showing uniform low density or low density,MRI scanning T1WI was low signal,T2WI,T2WI fat suppression and DWI were high in parenchyma.(6) To strengthen substantial part in mild and moderate arterial uneven improved or ring slightly improved,portal venous phase continued mild reinforcement,delay slow exit accounted for 75.0％,reinforced psuedocapsule was mild.(7) The adjacent organs are under pressure deformation.(8) All patients underwent tumor resection and were followed up for 3 to 24 months.Conclusions CT and MRI characteristics of hepatblastoma in adult are specific and help improve the diagnostic accuracy of the disease.
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Objective To discuss the clinical value of bidirectional quantitative detection of MSCT in the diagnosis of diabetic lung injury.Methods From May 2016 to July 2017,120 patients with diabetes in Wenzhou Hospital of Traditional Chinese Medicine were selected as diabetic group,and 50 healthy people were selected as control group.The two groups received the pulmonary function test ( PFT) and the MSCT bidirectional quantitative detection,the test results of the two groups were analyzed.And the correlation of indicators of MSCT bidirectional detection and PFT detection indicators was analyzed.Results After examination,the maximum inspiratory lung volume (Vin),maximum expiratory volume (Vex),respiratory volume (EVvin,EVvex)-emphysema,EIvin (%),EIvex (%) in the diabetic group were (3 627.64 ±867.43)mL,(3 785.34 ±835.64)mL,(476.95 ±326.25)mL,(236.53 ±86.18)mL,(9.26 ±4.85)%,(4.11 ±2.58)%,respectively,which were significantly lower than those in the control group (t＝11.151,13.809,21.317,21.623,24.76,26.708,all P＜0.05).The Vin,Vex,EVvin,EVvex,EIvin(%),EIvex(%) in the patients with ≤5 years of diabetes were (3 627.64 ±867.43)mL,(3 785.34 ± 835.64)mL,(326.25 ±56.95) mL,(236.53 ±86.18) mL,(9.26 ±4.85)%,(4.11 ±2.58)%,respectively,which were significantly higher than those in the patients with ＞5-10 years of diabetes mellitus (t＝129.09,36.01,21.03,12.38,22.17,19.48,all P＜0.05).Conclusion MSCT bidirectional quantitative detection is of great signif-icance for patients with diabetes lung injury,and plays a significant role in clinical treatment.
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Objective To study the clinical effects of pulmonary recruitment maneuvers combined with pressure regulation volume control (PRVC) in the treatment of severe respiratory distress syndrome (RDS) in premature infants.Method From July 2015 to September 2016,preterm infants of grade Ⅲ-Ⅳ RDS who received PRVC treatment in neonatal department of Huai'an Maternal and Child Health Hospital were assigned into recruitment maneuver group and control group (without recruitment maneuver) using randon number table.The ventilator parameters were observed at 1,2,6,12,18 h and 24 h after ventilation.Recovery rate,duration of oxygen therapy and ventilation,duration of hospital stay,incidence of second dose of pulmonary surfactant and complications were compared between two groups.Result A total of 18 cases were included in recruitment maneuver group and 19 cases in control group.The recovery rate of recruitment maneuver group was higher than control group (16/18 vs.10/19).The duration of oxygen therapy [(6.6 ± 2.3) d vs.(11.8 ± 3.0) d],duration of ventilation [(4.1 ± 2.3) d vs.(6.4 ± 2.8) d],duration of hospital stay [(26.7 ± 7.0) d vs.(33.0 ± 8.4) d] in recruitment maneuver group were significantly shorter than control group (P ＜ 0.05).The proportion of bronchopulmonary dysplasia (1/18 vs.8/19),retinopathy of premature (1/18 vs.7/19),patent ductus arteriosus that require medication closure (1/18 vs.7/19)and incidence of second dose of pulmonary surfactant (2/18 vs.9/19) in recruitment maneuver group were significantly lower than control group (P ＜ 0.05).While the complication of air leak,necrotizing enteritis,Ⅲ-V grade intracranial hemorrhage showed no significant differences between the two groups (P ＞ 0.05).Conclusion Recruitment maneuvers combined with PRVC in treatment of severe RDS premature infants can improve recovery rate and oxygenation.It can also shorten the duration of oxygen therapy,ventilation and hospital stay.It can reduce the incidence of bronchopulmonary dysplasia and retinopathy of premature.It is worth spreading in clinical practice.reduce the incidence of bronchopuhmonary dysplasia and retinopathy.It is worthy of promotion.
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Maxillary sinusitis is a common condition in nose section. Traditional operations are always have more complications and easy to relapse, seriously affectting the quality of patient's life. The application of functional endoscopic sinus surgery (FESS) makes a qualitative progress on surgical treatment of maxillary sinusitis. In re- cent years, the researchs found that there are still unsatisfactories to long-term curative effect of some patients With the development of minimally invasive, people begin doubting its "functional". Recently, some new treat- merits have emerged in the world, but their safety and effectiveness needs further research. To seek for a better treatment, this article reviews the development and the existential problems of maxillary sinusitis surgery.
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Humans , Endoscopy , Maxillary Sinusitis , General Surgery , Nose , General Surgery , RecurrenceABSTRACT
Objective To reduce the incidence of the hypocapnia,the cutoff value of the end-tidal carbon dioxide partial pressure[Pet(CO2)] for predicting the hypocapnia so as to understand the suitable adjustment target and target range of the Pet(CO2) in preterm infants under mechanical ventilation.Methods From Jan.2012 to Oct.2013,96 cases of the preterm infants with respiratory distress syndrome(RDS) who needed mechanical support were selected from the Huaian Maternity and Child Health Care Hospital.Pet(CO2) value of each time point(1 h,24 h,48 h and 72 h after mechanical ventilation) were recorded,while radial artery blood was collected for blood gas analysis.The level of pa (CO2) ＜ 35 mmHg(1 mmHg =0.133 kPa) diagnosed hypocapnia;while the level of Pa (CO2) ＞ 60 mmHg was for diagnosing hypercapnia.The diagnostic cutoff and the suitable adjustment target and adjustment target range of the Pet(CO2) were confirmed by receiver operating characteristic (ROC) curve.Results The data from 381 arterial blood gas analysis results were gained,of which 151 times belonged to hypocapnia,and the rate was 39.6％,the other 230 cases were normal,and no case was of hypercapnia.The area under the ROC curve was 0.895,and the area of the standard error was 0.016.There was a statistical significance in Pet(CO2) value for the diagnosis of hypocapnia(P =0.000).The lower the value of Pet (CO2),the greater the likelihood of hypocapnia,and 95 ％ confidence interval area was 0.864-0.926.The Pet (CO2) optimal diagnostic cutoff value determined in accordance with Youden index was 30.5 mmHg.When Pet (CO2) among 41.5 mmHg,sensitivity was 100％.Conclusions Diagnostic cutoff value for forecasting hypocapnia is 30.5 mmHg.The suitable adjustment target of mechanical ventilation parameter adjustment is 41.5 mmHg for the Pet(CO2).The target range of mechanical ventilation parameter adjustment is 30.6-41.5 mmHg for the Pet(CO2).
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<p><b>OBJECTIVE</b>To understand the effect of lung recruitment maneuver (LRM) with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in preterm infants with respiratory distress syndrome (RDS) ventilated by proportional assist ventilation (PAV).</p><p><b>METHOD</b>From January 2012 to June 2013, thirty neonates with a diagnosis of RDS who required mechanical ventilation were divided randomly into LRM group (n=15, received an LRM and surport by PAV) and control group (n=15, only surport by PAV). There were no statistically significant differences in female (7 vs. 6); gestational age [(29.3±1.2) vs. (29.5±1.1) weeks]; body weight[(1,319±97) vs. (1,295±85) g]; Silverman Anderson(SA) score for babies at start of ventilation (7.3±1.2 vs. 6.9±1.4); initial FiO2 (0.54±0.12 vs. 0.50±0.10) between the two groups (all P>0.05). LRM entailed increments of 0.2 cmH2O (1 cmH2O=0.098 kPa) PEEP every 5 minutes, until fraction of inspired oxygen (FiO2)=0.25. Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve.When saturation of peripheral oxygen fell and FiO2 rose, we reincremented PEEP until SpO2 became stable. The related clinical indicators of the two group were observed.</p><p><b>RESULT</b>The doses of surfactant administered (1.1±0.3 vs. 1.5±0.5, P=0.027), Lowest FiO2 (0.29±0.05 vs. 0.39±0.06, P=0.000), time to lowest FiO2[ (103±18) vs. (368±138) min, P=0.000] and O2 dependency [(7.6±1.0) vs.( 8.8±1.3) days, P=0.021] in LRM group were lower than that in control group (all P<0.05). The maximum PEEP during the first 12 hours of life [(8.4±0.8) vs. (6.8±0.8) cmH2O, P=0.000] in LRM group were higher than that in control group (P<0.05). FiO2 levels progressively decreased (F=35.681, P=0.000) and a/AO2 Gradually increased (F=37.654, P=0.000). No adverse events and no significant differences in the outcomes were observed.</p><p><b>CONCLUSION</b>LRM can reduce the doses of pulmonary surfactant administered, time of the respiratory support and the oxygen therapy in preterm children with RDS.</p>
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Female , Humans , Infant, Newborn , Male , Infant, Premature , Interactive Ventilatory Support , Methods , Lung , Oxygen , Oxygen Inhalation Therapy , Positive-Pressure Respiration , Methods , Pulmonary Surfactants , Respiration , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Therapeutics , Tidal Volume , Treatment OutcomeABSTRACT
A total of 60 infants with severe persistent pulmonary hypertension (PPHN) at our NICU from January 2006 to December 2012 were divided into research group[(n =32,high-frequency oscillatory ventilation(HFOV) plus sildenafil)]and control group (n =28,HFOV only).Mean pulmonary arterial pulmonary arterial (MPAP),blood gas analysis,oxygenation index (OI),PO2 to fraction of inspired oxygen ratio (PO2/FiO2) before and after treatment were compared between two groups.After 3-day treatment,MPAP (mm Hg)(32 ±6) vs.(43 ±9)mm Hg,PCO2(mm Hg)(36 ±9) vs.(43 ±9),OI(56 ±22) vs.(85 ±21) in research group were significantly lower than those in control group(P ＜ 0.05) ; in comparison with control group,PO2(mm Hg) (89 ±15) vs.(72 ±22),PO2/FiO2(mm Hg) (223 ± 18) vs.(196 ±24) in research group were significantly higher(P ＜ 0.05).The time of ventilation use (d) (5.4 ± 1.3) vs.(6.3 ± 1.6) in research group was shorter than that of control group(P ＜0.05) while research group showed a higher clinical efficiency rate(％) (81.2 vs.50.0) (P ＜0.05).A combination of HFOV and sildenafil for severe PPHN can significantly reduce MPAP,shorten the duration of ventilation use and improve cure rate.
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Objective To evaluate the diagnosis and efficiency of nasal endoscopic surgery treatment for rhinogenous optic function damage (ROFD).Methods The clinical data of 36 patients (36eyes) with ROFD were retrospectively reviewed.All patients were operated on nasal sinus probing and open sinus surgery through transnasal endoscopic approach,and 10 patients underwent endoscopic optic nerve decompression.Results Seven patients had bilateral pansinusitis,9 patients had unilateral posterior ethmoidal sinusitis and sphenoiditis,8 patients had isolated sphenoiditis,8 patients had fungal sinusitis occured in the sphenoid sinus and unilateral posterior ethmoid sinus,3 patients had unilateral pyocyst and cyst of the sphenoid and ethmoid sinus,1 patient had frontal and ethmoidal sinusitis.All patients were confiemed by pathology after surgery.The visual acuity preoperative were as follows:3 eyes no light perception,10 eyes hand movement,11 eyes fingers counting less than 20 cm and 12 eyes were vision impaired in different degree.The visual acuity postoperative were as follows:3 eyes failed,13 eyes cured,20eyes improved from hand movement or fingers counting to fingers counting (30-60 cm).The efficiency rate was 91.7％(33/36).The other eye symptom was disappeared.Sinus epithelization was happened after surgery in all patients.Conclusions If the medicine expectant treatment is invalid,nasal sinus probing and open sinus surgery through transnasal endoscopic approach should be performed early in treatment of ROFD.Patients who suffered frnm severe visual damage and either unresponsive or intolerant to medical treatment should be administrated endoscopic sinus surgery including endoscopic optic nerve decompression.
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Objective To investigate the application and clinical outcomes of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps for the treatment of complex limb wound.Methods Data of 10 patients,who had undergone free tissue transfer of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps (iliac osteocutaneous flap,iliac crest flap and ilioinguinal flap) for the complex limb wound from March 2009 to January 2011,were retrospectively analyzed.There were 9 males and 1 female,aged from 21 to 57 years (average,39.7 years).Iliac osteocutaneous flap was used in 7 patients,iliac crest flap in 2 patients and ilioinguinal flap in 1 patient.The free tissue transfer was performed for hand reconstruction in 3 cases,foot reconstruction in 4 cases and leg reconstruction in 3 cases.The mean size of soft tissue defect was 20 cm × 9.7 cm.Results The mean size of the anterolateral thigh flap and the ilioinguinal flap was 17.8 cm×9.4 cm and 8.4 cm×4.5 cm,respectively.The mean volume of iliac crest was 5.4 cm×2.1 cm×0.8 cm,and the mean length of flow-through conduit was 10.5 cm.Except for the distal necrosis of iliac osteocutaneous flap in 1 case,which were treated by dressing change and skin grafting,the other flaps survived without complications.All patients were followed up for 6 to 36 months (average,12 months).The average bone union time was 3 months in the hand group,4 months in the foot group,and 4.5 months in the leg group.The disabilities of the arm,shoulder,and hand questionnaire score averaged 43,the mean Japanese Orthopaedic Association's foot rating scale was 71.3,and the mean Puno's functional score was 91.Donor site scars were mostly flat,pale and soft but widened in the thigh in 6 patients and in the ilioinguinal region in 3 patients,and numbness was reported in 2 patients.Conclusion In clinical situation that requires for coverage of complex and extensive limb defects,the free tissue transfer of anterolateral thigh perforator flap bridging superficial circumflex iliac artery flap is a better method,which can meet specific reconstructive demands with minimal donor site morbidity.However,a relative high risk has to be considered.
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Objective To evaluate the effects of valsartan and angiotensin-converting enzyme inhibitors on the excretion rate of urinary albumm(UAER) and the clearance of endogenous creatinine(Cr-C) in elderly patients.Methods 120 elderly patients with stage of the 2～3 class hypertension were included.The patients were divided into 3 groups,the valsartan group and the benazpril group and captopril group,the anti-hypertensive effects and UAER and Cr-C were determined before and after the treatment.Results No significantly different anti-hypertensive effects were observed in valsartan,benazpril and captopril.But the effects of UAER,Cr-C in valsartan group had significant changes compared with the other groups,and the three groups had significant differentiation(P
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Problems in metrology work in special hospital are elaborated,such as poor law awareness,repeated break-down of metrology equipment,etc.Improvement suggestions are put forward including emphasis on well-constituted metrology staff and adequate equipment purchase,cooperation in clinical departments,strengthening the management of metrology equipment at all levels,reinforcing the work function of the leading group in metrology management.This study is significant in supporting medical treatment and enhancing the hospital medical quality.
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Objective To understand the clinical characters and imaging features of Mirizzi syndrome.Methods All 15 patients were confirmed by operation , including 10 females and 5 males , aged 41～82 (mean age 65.1 years old). The course ranged from 4 days to 15 years. Among them, ERCP were performed in 8 patients, PTC in 2 patients, MRCP in 4 patients and CT in 3 patients.Results Cholangiography of Mirizzi syndrome revealed a broad, curvilinear impression on the common hepatic duct in the area where the cystic duct or gallbladder was in direct apposition, hepatic bile duct dilation above the level of the cystic duct. 6 cases were diagnosed to be Mirizzi syndrome preoperatively (3 cases in ERCP , 2 cases in PTC , 1 case in MRCP), 7 cases bile duct stone, 1 case bile duct dilation, 1 case normal. Conclusion Mirizzi syndrome is a rare disease . No pathognomonic features appear in either the history or the physical examination .Diagnosis requires a combination of ultrasonography , cholangiography (ERCP,PTC), CT and MRI .
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The nutritional support has become an important part of the management of pa- tients with severe head injury.Fifty- two cases were supported by early nutritional supplement.The result showed that themortality and morbidity were decreased.It is experienced that early nutritional support may reduce the loss of body protein and vis- ceral proteins,increase the function of cellu- lar immune system and promote the recov- ery of impaired nerves.
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Objective To study on imagination features of tumor thrombi in the portal vein of primary liver cancer (PLC). Methods We established a new type system of tumor thrombi, with Ⅰ 0 to Ⅳ, a total of 5 types and 8 sub-types in the portal vein of PLC based on normal intrahepatic portal vein anatomy and growing features of the tumor thrombi. The relationship between the types and the imaging diagnosis of 130 PLC cases with tumor thrombi in the portal vein was studied. Results 85%(110/130) cases of PLC with tumor thrombi in the portal vein belongs to type Ⅱ or Ⅲ when being first diagnosed in the hospital. The resectability rates for type Ⅰ, Ⅱ, Ⅲ, Ⅳ were 62%(5/8), 16%(10/62), 10%(5/48), 0 (0/12), respectively, and chemoembolization therapy (TACE) was given in 38%(3/8), 40%(25/62), 27%(13/48), 16%(2/12), respectively. Conclusions The new types of tumor thrombi are helpful for diagnosis and treatment of PLC with tumor thrombi in the portal vein.
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Objective To study the relationship between gastroesophageal varices and bleeding and portal venous tumor thrombi in patients with hepatocellular carcinoma(HCC). Methods From Jan. 2000 to Jan. 2003, 84 HCC patients with portal vein tumor thrombi were divided into Ⅰ～Ⅳ groups according to Ⅰ～Ⅳ types of tumor thrombi. The grade of gastroesophageal varices, the median survival time and the death cause for group Ⅰ～Ⅳ were retrospectively analyzed. Results Mild grade of gastroesophageal varices accounted for 64.7%, 6.0%, 85.7%,100%, respectively in group Ⅰ(n=17), Ⅱ(n=26),Ⅲ( n=35) and group Ⅳ(n=6),respectively. Severe varices were found in less than 5% in all four groups. The median survival periods were 10.1, 7.2, 5.7 and 3.0 months, respectively (P=0.0001). Most cases died from esophageal and gastric variceal bleeding and hepatic failure, with each accounting for about 50% of the mortality in all the 4 groups. Conclusions Portal venous tumor thrombi of HCC patients was not the major cause leading to esophageal and gastric varices and bleeding.