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ObjectiveTo observe the effect of comprehensive intervention on the incidence of lactation galactostasis in communities from the perspective of preventive medicine， so as to prevent the occurrence of the mammary ducts obstruction disease. MethodsA total of 400 women in the early stage of pregnancy were selected from four communities. Those in two communities were set up as the intervention group. Comprehensive intervention for the prevention and treatment of mammary ducts obstruction disease during pregnancy and "Six-step recanalization manual therapy" practical guidance were conducted on the intervention group. The pregnant women from the other two communities were the control group， who received no intervention or guidance training. The two groups were followed up at 1 month， 3 months and 5 months postpartum， and the occurrence of mammary ducts obstruction disease was investigated and interventions were carried out. ResultsThe incidence of galactostasis in the intervention group was 26.0%， 10.6% and 5.1%， respectively at 1， 3 and 5 months after delivery， and the incidence of galactostasis in the control group was 38.0%， 22.2% and 8.3%， respectively. The incidence of galactostasis at 1 month and3 months after delivery was statistically different （P<0.05）， while the incidence of galactostasis 5 months after delivery was not statistically different （P>0.05）. The protection rates of comprehensive intervention on galactostasis were 31.58%， 52.25% and 38.55%， respectively. ConclusionPublicity and education work of prevention and control of the mammary ducts obstruction disease and "Six-step recanalization manual therapy" practical guidance can effectively reduce the occurrence of plugged mammary ducts， and therefore should be promoted.
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Lower leg lengthening has a history of more than 100 years. However, serious complications occurred in the early stage due to the immature device and technical conditions. The emergence of Ilizarov technology making limb lengthening is a kind of controlled operation. Based on the "Ilizarov effect", the results of limb regeneration and lengthening were obtained by slow, stable and continuous distraction of living tissues. The regeneration of bone and soft tissue is like limb development in children. Currently, the traditional Ilizarov external fixation is still the dominated method for leg lengthening. The Chinese Ilizarov external fixator and the lower leg Achilles tendon elastic lengthening external fixator are the representatives of domestic application. Other limb lengthening methods, including computer hexapod assisted orthopedic surgery (CHAOS), lengthening over nail (LON), lengthening and then nailing (LATN) and intramedullary nail lengthening system, have not been developed in China. Percutaneous transverse osteotomy at 5-6 cm below the tibial plateau is a common osteotomy method in China. This method can maximize the retention of periosteum and intramedullary blood circulation. Limb lengthening more than 4 cm is recommended by leg Achilles tendon elastic synchronous lengthening fixator with calcaneal wire fixation. Following the principle of tension-stress, the lengthening is carried out slowly. Further, the lengthening device is removed step by step according to the principle of dynamic adjustment of fixed stiffness.
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Objective:To investigate surgical methods and clinical effects of tibial pseudarthrosis due to neurofibromatosis type I (NF1) in adult using Ilizarov technique combined with intramedullary nail.Methods:A total of 12 adult with tibial pseudarthrosis due to NF1 treated by Ilizarov technique combined with intramedullary nail from October 2009 to December 2017 were retrospectively included. There were 6 males and 6 females with an average age of 27±8.3 years (range 17-44). All cases presented severe anterior arch in varus or valgus deformity with shortening in an average of 10.8±3.7 cm (range 5.6-16.5 cm). The in-volved levels were at the middle and lower part of tibia. All cases suffered from more than one treatment with failed surgery. One male patient with 5 times of unsuccessful operations. There were 4 cases with severe limping gait and 8 cases with walking with the help of brace (or single crutch) preoperatively. Regarding the family history, seven cases were inherited by father and 5 cases by mother. During surgery, the part of tibial pseudarthrosis and thickened fibrous tissue surroundings like periosteal were removed. The contracture achilles tendon was elongated in open way, and intramedullary nailing cross the ankle joint was applied when the tibial medullary cavity opened. Further, iliac bone grafting and proximal tibial osteotomy were performed with Ilizarov fixator application finally. The tibia was lengthened at a rate of 0.5-1 mm/d at 7 days postoperatively. The healing rate of pseudarthrosis and the length and alignment of limb were evaluated by X-ray routinely. The lower limb function and complications were assessed by self-made table for lower limb deformity correction and functional reconstruction.Results:All patients were followed up for 31-80 months with an average of 47.6±14.7 months. Bone union of pseudarthrosis in all cases was eventually achieved. The tibia was lengthened 5-12 cm with an average of 8.4±2.5 cm. There were 9 cases underwent second surgeries to promote bone healing and to correct residual deformities. The external fixator was used for 25-37 months with an average of 31.5±3.7 months. There was no complication, including neurovascular injury, severe soft tissue or bone infection affecting the clinical effects. All intramedullary nails were not removed finally. The limb function and gait in full weight bearing in 12 patients recovered at the latest follow-up. The evaluation score was 2.4±0.3 (range 2.1-2.8), of which 9 cases were excellent 3 were good. Thus, the excellent and good rate was 100%.Conclusion:The satisfactory clinical effects, including angular deformity correction, pseudarthrosis healing and short limb lengthening, can be achieved in adult with tibial pseudarthrosis due to NF1 by using the combination method of Ilizarov technique and intramedullary nail. However, the treatment duration could be longer.
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Objective: To explore the effectiveness of the first-stage debridement and Ilizarov metatarsal bone lengthening in treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head. Methods: Between January 2015 and October 2018, 8 cases (9 feet, 11 sites) of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head were treated by first-stage debridement and Ilizarov metatarsal bone lengthening. There were 3 males (4 feet, 5 sites) and 5 females (5 feet, 6 sites), with an average age of 57.5 years (range, 44-65 years). According to diabetic foot Wagner grade, 6 cases (7 feet) were grade 3 and 2 cases (2 feet) were grade 4. The chronic osteomyelitis located at left foot in 4 cases, right foot in 3 cases, and bilateral feet in 1 case. The duration of chronic osteomyelitis was 1-5 years (mean, 3.1 years). The chronic osteomyelitis site was the 1st metatarsal head in 3 feet, the 3rd metatarsal head in 1 foot, the 4th metatarsal head in 1 foot, and the 5th metatarsal head in 6 feet. Two patients had chronic osteomyelitis at 2 sites on 1 foot. The length of lengthened metatarsal bone, lengthening time, and the time of wearing external fixation frame were recorded, and the external fixation frame index was calculated. The healing conditions of foot ulcer and lengthening bone segment were observed, the healing time was recorded, and the healing index of lengthening bone was calculated. The ankle function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) score criteria. Results: All patients were followed up 9-26 months with an average of 15.0 months. Except pin tract infection during the bone lengthening period, there was no complications such as skin necrosis and vascular or nerve injury occurred during treatment. The length of lengthened metatarsal bone was 12-35 mm with an average of 20.5 mm; the metatarsal bone lengthening time were 21-84 days with an average of 57.8 days. The average time of wearing external fixation frame was 14.6 weeks (range, 10.4-21.1 weeks) and the external fixation frame index was 54.3 days/cm (range, 42.9-59.2 days/cm). The ulcer wound healed with an average healing time of 30.5 days (range, 19-70 days) and no ulcer recurrence was observed during follow-up. Bone healing was obtained in all bone lengthening segments, and the average healing index was 42.5 days/cm (range, 37-51 days/cm). The average AOFAS score was 91.7 (range, 87-95); 5 feet were excellent and 4 feet were good. The excellent and good rate was 100%. Conclusion: The metatarsal bone lengthening under Ilizarov law of tension-stress after debridement can promote diabetic foot ulcers healing and reconstructing the length of metatarsal to retain the function of metatarsal load and avoid amputation. This is an effective method for the treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.
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The Soviet Union orthopedic doctor Ilizarov invented the ring external fixator which could be assembled into more than 800 configurations, and created a new minimally invasive external fixation technology system called Ilizarov technology which was different from the western classical orthopedic technique. The theoretical basis of this technique is to imitate nature, by controlling and transforming the stress of life movement in vitro, to cure the complex trauma fracture, bone and soft tissue defect, infection and severe deformity of limbs, and to save some endangered amputation complex trauma and limb deformity. From theoretical guidance, surgical indications, medical models and postoperative management, it differs from the modern technique of internal fixation (AO) fracture treatment theory in trauma orthopedics. It can achieve fracture reduction and fixation by the most minimally invasive or even bloodless operation, and control bone growth in vitro. It can not only complete the fixation requirements of most fractures in trauma orthopedics, but also solve complex problems such as bone nonunion, bone defect, soft tissue defect of limbs and associated malformation without bone graft and loss of bone length. Ilizarov technology was introduced into China mainland for more than 30 years, but the application of this technology in the field of orthopaedics in China is still not extensively spreaded because of many reasons, In this article, the authors review the application of Ilizarov technology in the field of trauma orthopedics in China for domestic Orthopaedic surgeon to better understand this technology.
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Objective: To explore the effectiveness of Ilizarov external fixation without bone graft in the treatment of atrophic femoral shaft nonunion. Methods: The clinical data of 12 patients with atrophic femoral shaft nonunion admitted between October 2010 and January 2017 were retrospectively analyzed. There were 8 males and 4 females, aged from 24 to 61 years, with an average age of 41.7 years. The nonunion sites located in the middle and upper femur in 7 cases and in the distal femur or supracondylar in 5 cases. The disease duration ranged from 1 to 9 years, with an average of 3.7 years. Previous operations ranged from 1 to 9 times, with an average of 2.8 times. The original fixator was removed, the fracture end of nonunion was debrided, and Ilizarov external fixator was installed. In patients with the length of bone defect less than 4 cm, direct compression fixation was performed during operation; in patients with limb shortening more than 2.5 cm, proximal femoral osteotomy and bone lengthening components were required to prepare limb lengthening after operation; all patients did not receive bone graft. The wearing time of external fixator, clinical bone healing time of nonunion fracture end, and complications were recorded. The effectiveness was evaluated by Paley's nonunion evaluation criteria. Results: All patients were followed up 24-50 months, with an average of 30 months. Bony union was achieved in all 12 cases with a healing time of 6.0-23.5 months (mean, 11.5 months). The wearing time of external fixator ranged from 7 to 25 months, with an average of 13.5 months. At last follow-up, according to Paley's nonunion evaluation criteria, the results were excellent in 6 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 83.3%. Sagittal angulation deformity of femur more than 7° occurred in 4 cases, with no significant effect on knee extension function, and no special treatment such as osteotomy was performed. Two patients had shorter limbs (>2.5 cm) after operation and were replaced by high shoes; 4 patients with trans-knee fixation lost knee joint mobility of 10-30° after operation; 10 cases of needle tract infection occurred, of which 4 cases with infection and loosening of fixed needle were replaced and re-fixed after needle extraction, the remaining 6 cases of infection without loosening of fixed needle were controlled by local dressing change, needle nursing, and oral cephalosporin anti-inflammatory drugs. No complications such as deep infection and vascular nerve injury occurred. Conclusion: Ilizarov external fixation has a high healing rate for atrophic femoral shaft nonunion, which is relatively minimally invasive and can avoid bone grafting. Its preliminary effectiveness is exact, and it is also effective for patients who have experienced multiple failed operations. It is necessary to pay attention to the nursing and rehabilitation training after external fixation.
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Objective To understand the status of fluoride content in brick tea (pressed tea) in China,and conduct health risk assessment according to the situation of drinking brick tea in fluorosis areas.Methods Twenty national designated brick tea manufacturers were selected to collect 1-5 varieties of brick tea samples of mainstream varieties with large production volume and large sales volume.If low-fluoride brick tea was produced,an additional sample would be collected to determine the fluoride content of tea.The retrospective analysis method was used to collect the monitoring data of brick tea-type fluorosis in the whole country in 2017,and analyze the use of brick tea in the residents of the brick tea-type fluorosis areas in six provinces (regions) of Inner Mongolia,Sichuan,Gansu,Ningxia,Xinjiang and Qinghai.According to the fluoride content of brick tea,combined with daily average consumption data of brick tea in the brick tea-type fluorosis areas,daily average brick tea intake,and hazard quotient of the daily average brick tea fluoride and the standard recommended fluoride intake were calculated.A health risk assessment was conducted based on the hazard quotient (hazard quotient ＞ 1 indicated a health risk).Through the total fluoride intake standard of the Chinese population,the safe consumption of brick tea with different fluoride content was simulated by using the value of the hazard quotient.The tea fluoride was measured by an ion selective electrode method.Results A total of 54 samples were collected,of which 49 were brick tea samples and 5 were low-fluoride brick tea samples.The geometric mean of the fluoride content of 49 brick tea samples was 460 mg/kg,the median was 430 mg/kg,and the range was 102-1 797 mg/kg.There were 14 samples with a fluoride content ＜ 300 mg/kg,accounting for 28.6％.The average fluoride content of 5 low-fluoride brick teasampleswas 193 mg/kg,ranging from 102 to 290 mg/kg.Forty-nine brick tea samples were distributed in 5 provinces,the fluoride content of brick tea was the lowest in Yunnan,128 mg/kg;the highest in Hubei,712 mg/kg.The lowest fluoride content of brick tea in different varieties was Tuo tea,130 mg/kg,and the highest was Jinjian tea,745 mg/kg.There were 1 000 households drinking brick tea in the brick tea-type fluorosis areas in 6 provinces,73.9％ (739/1 000) of households drinking the products of the national assigned brick tea manufacturers;a total of 1 000 brick tea samples were collected,and the geometric mean of brick tea fluoride content was 551 mg/kg,and only 17.5％ (175/1 000) of brick tea had a fluoride content ＜ 300 mg/kg.Compared with the national standards and the standards of World Health Organization,hazard quotient of agriculture,animal husbandry,semi-pastoral industry,urban residents through the brick tea fluoride was 0.34,1.38,0.75,and 0.21,respectively;0.29,1.21,0.66,and 0.19,respectively.Animal husbandry hada health risk through drinking brick tea among them.According to the health standard of total fluoride intake in China,when drinking brick tea with fluoride contents of 300,430,460 and 500 mg/kg,the safe consumption of brick tea for school-age children was 2.9,2.0,1.9 and 1.8 kg,respectively,and for adult was 4.3,3.0,2.8 and 2.6 kg,respectively.Conclusions Brick tea has high fluoride content,and percent of qualified brick tea is low and few of low-fluoride brick tea are consumed.There is a health risk in the animal husbandry who has a large amount of brick tea.
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Objective The amyloid β-protein precursor contains a domain highly homologous to Kunitz-type serine protease inhibitors. We have successfully established and characterized the recombinant human rhKD/APP in vitro. The aim of this study is to investigate the potential neuroprotective role of rhKD/APP on cerebral ischemia/reperfusion injury in rats. Methods Rats pretreated with rhKD/APP (4, 8, 16 mg/kg) were subjected to prepare models of cerebral ischemia/reperfusion (I/R) injury and those rats treated with Nimodipine were used as positive control. Comparison of the scores of neurological deficits, TTC-stained infarct volume and cerebral water content between the groups was performed. The activities of SOD, Na+-K+-ATPase and the content of MDA in the cortex tissues were measured and the activities of serum myeloperoxidase ( MPO) enzyme were also compared. The expressions of adhesion molecules ( ICAM-1 and E-selectin) were compared by immunohistochemistry. End-labeling of nuclear DNA fragmentation (TUNEL) and qualification of caspase-3, Bcl-2 and Bax were also employed to evaluate the local apoptosis in cortex tissues. Results By pretreatment with the rhKD/APP at three doses, cerebral infarct volume, water content and neurological deficits were all reduced. The activities of SOD, and Na+-K+-ATPase were increased, the contents of MDA were decreased in the cortex tissues, and the serum MPO activity was reduced. The expressions of adhesion molecules were downregulated and the apoptotic signaling of neurons were inhibited. All the changes induced by rhKD/APP treatment in the ischemia/reperfusion injury models showed statistical significance compared with the control rats. However, no significant difference was shown between the rhKD/APP group and Nimodipine group excepted for the reduced MPO in sera. Conclusions The result of this study suggest that rhKD/APP has neuroprotective effect on the cerebral ischemia/reperfusion injury through inhibiting multiple signaling pathways and is promising to be a potential neuroprotective drug.
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Objective@#To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs.@*Methods@#A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on.@*Results@#All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on.@*Conclusions@#The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical, economical, adjustable, universal and portable. The domestic external fixator could meet the clinical demand for fixation of the osteotomy end of the limbs, the correction of the deformity, the repair of the defects and the limb lengthening.
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Objective To investigate the clinical effects differences of two kinds of D2 lymphadenectomy in the treatment of patients with advanced gastric cancer including open operation and laparoscopy operation.Methods 90 patients with advanced gastric cancer were chosen in recent years in our hospital and were randomly divided into both group including group A (45 patients)with D2 lymphadenectomy by open operation and group B (45 patients) with D2 lymphadenectomy by laparoscopy operation;and the clinical indicators in peri-operation period,the dissec-tion number of lymph node,survival rate in 1 year with follow-up and postoperative complication incidence of both groups were compared.Results The clinical indicators in peri-operation period of group B was significantly better than that of group A (t=2.13,2.56,1.98,1.96,1.94,2.05,2.10,all P0.05).The postoperative complication incidence of group A and group B were separately 20.00% and 8.89%,the postoperative complication incidence of group B was significantly lower than that of group A (χ2 =9.44,P<0.05).Conclusion Compared with D2 lymph-adenectomy by open operation,D2 lymphadenectomy by laparoscopy operation in treatment of patients with advanced gastric cancer can efficiently decrease the degree of surgical trauma,accelerate the process of recovering after opera-tion,and be helpful to reduce the risk of postoperative complications.
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Objective To analyze the causes of the complications in the treatment of limb deformities with the Ilizarov technique and to discuss the management and prevention of these complications.Methods From January 2000 to October 2010,846 patients with limb deformities (16 upper limbs and 830 lower limbs) who had been treated with Ilizarov technique were retrospectively analyzed,including 508 males and 338 females with an average age of 25.7 years (range,1.2-72).Statistical analysis was used to compare the type,severity,treatment methods and results of complications.Results Postoperative follow-up lasted for 6 to 30 months,with an average of 18 months.There were 81 cases of pin tract infections,36 cases of restricted joint movements,6 cases of skin thermal damage,7 cases of nerves and vessels injury,8 cases of bone delayed union,2 cases of osteofascial compartment syndrome,7 cases of dislocation,5 cases of fixed needle breakage,8 cases of secondary joint deformities,5 cases of serious osteoporosis,6 cases of skin eruption,4 cases of femoral fractures near to proximal external fixator,3 cases of subsequent fracture after external fixator dismantled,11 cases of deformity recurrence and 1 case of the others.Combining with anti-infection,functional training,physiotherapy,and the second operation therapy and so on,a permanent disability was finally left in 13 patients.Conclusion If the Ilizarov technique was used improperly,there would be multiple complications during the preoperative preparation,surgical procedures and postoperative management.Effective preventive measures should be taken,such as following the principle of the Ilizarov technique,standardizing operation procedures,strictly postoperative observation,correcting postoperative rehabilitation exercise guidance,regular follow-up radiography and postoperative adaptability dynamic adjustment of the external technique.
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To investigate the effects of platycodin D in combination with different active ingredients of Chinese herbs under different therapeutic principles on proliferation and invasion of 4T1 and MDA-MB-231 breast cancer cell lines.
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To explore the inhibitory effects and to investigate the mechanisms of combined treatment of osthole, psoralen with aconitine on human breast cancer cell line MDA-MB-231BO.
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OBJECTIVE To evaluate the effectiveness of applying neuronal stem cells to bridging a 10mm long facial nerve defect in rabbits using a tissue engineered artificial nerve. METHODS Thirty-six Japanese white rabbits were randomly divided into three groups of 12. Group A: chitosan guidance channels with collagen protein sponge were filled with neuronal stem cells and NGF; Group B: chitosan guidance channels with collagen protein sponge were filled with NGF; Group C: autograft nerve. A series of examinations were performed, including electrophsiological methods, histological staining of nerve, Brdu and S100 immunohistochemical staining, at 12 weeks after operation. RESULTS At 12 weeks after operation, all examination results from Group A were better than from Group B(P0.05). CONCLUSION Neuronal stem cells can be used as seeding cells in peripheral nerve tissue engineering for repairing 10mm facial nerve defects.
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BACKGROUND: The selection of carrier plays an essential role in the research of applying tissue-engineering to fix the peripheral nerves. An ideal carrier would be one that is similar to extracellular matrix and that it has biocompatibility with in vivo cells.OBJECTIVE: To evaluate the biocompatibility of hippocampal neural stem cells with collagen and gelatin sponge in vitro and to probe into the feasibility of using the materials as biomaterial scaffold in peripheral nerve tissue engineering.DESIGN: A randomized and controlled trial.SETTING: Department of Otorhinolaryngology of the First Affiliated Hospital of Zhengzhou University; Department of Anatomy of the School of Basic Medical Sciences of Zhengzhou University.MATERIALS: The experiment was carried out from July to December 2005 at the Laboratory of Neurobiology of the Department of Anatomy of the School College of Basic Medical Sciences of Zhengzhou University.Twelve New born (＜ 24 hours) clean grade guinea pigs of either gender with a body mass of 50-70 g, were provided by the Experimental Animals Center of Zhengzhou University School of Medicine.METHODS: The new born (＜ 24 hours) guinea pigs were anesthetized intraperitoneally with 10 g/L chloral hydrate and sterilized in 0.75 volume fraction of alcohol. Hippocampal tissue was resected from the brain under a surgical microscope. Hippocampus neural stem cells were cultured in vitro. The cultured cells of two generations were suspended at a density of 1 ×1010L-1 and respectively combined with collagen and gelatin sponge.The number of cells was counted and histological changes were observed under an inverted phase microscope and scanning electron microscope after 7 days, and the adhesion rate of the two materials to the cells were measured.MAIN OUTCOME MEASURES: ①Growth of the neural stem cells and their adhesion to the collagen and gelatin sponge were observed and the total number of the cells and adhesion rate with carrier were measured. ②The morphological changes of differentiation cells by immunocytochemical staining.RESULTS: ①Hippocampus neural stem cells could grew on the collagen and gelatin sponge and attached to them gradually. The adsorption rate of collagen was higher than thai of gelatin sponge (37.17 % and 14.87 %,x2=4.819,P ＜ 0.05). ② There was no significant difference in the total number of the cells in the control group, collagen group and gelatin sponge group [(53.17±3.5)×104,(53.25±2.6)×104, (52.04±4.05)×104,F=0.233,P ＞ 0.05].CONCLUSION: Two biomaterials (collagen and glutin sponge), especially collagen, have good biocompatibility with hippocampus neural stem cells from the guinea pigs and can be used safely as scaffold materials in peripheral nerve tissue engineering.