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Report a case sustained Gustilo type III C open fracture of the left humerus with brachial artery injury who has limb ischemia and wound infection after operation in June, 2014. To salvage the limb, performed cross limb vessel transfer to restore blood supply at one-stage. After multiple debridement, Flow-through flap transfer was performed for definitive reconstruction of the arterial injury and repair the wound in secondary stage. In the 3rd stage, cutting the pedicle of transposition vessels. Follow-up at 1 year after surgery, the patient's left upper limb had survived with limited movement and confirmed Flow-through the vessel reconstruction using CTA.
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The career development of young doctors is related to the future of medicine as a whole. Medicine is a subject that needs to be researched. Diagnosis and treatment work. The importance of scientific research for the development of medicine is self-evident. In addition to clinical work, young doctors need to take scientific research into account. We will provide the key elements in a road map of a successful scientific research for young doctors.
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Objective To investigate the preventive effects of emilia sonchifolia on experimental hepatic steatosis in rats and its molecular mechanism.Methods Seventy Sprague-Dawley (SD) rats were randomly divided into five groups: normal control, model, high dose emilia sonchifolia, low dose emilia sonchifolia groups and high dose emilia sonchifolia + phosphorylated extracellular signal regulated protein kinase 1/2 (pERK1/2) inhibitor (PD98059) group (PD group). In normal control group, the rats were fed with normal diet, and in the other four groups, the rats were fed with high fat and low protein diet combined with 30% carbon tetrachloride (CCl4) peanut oil 2 mL/kg subcutaneous injection, once every 3 days for consecutive 3 weeks to establish animal models with hepatic steatosis. In emilia sonchifolia high and low dose groups, 5.0 g/kg and 2.5 g/kg doses of emilia sonchifolia were given respectively by gavage, once a day. In PD group, after administration of emilia sonchifolia high dose by gavage once a day, additionally PD98059 0.3 mg/kg was injected through a tail vein, once a week. After 3 weeks, all rats were switched to normal diet and treatment continued as before. At the end of the 5th week, liver tissues were taken for pathological analyses. The serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total cholesterol (TC), and triglyceride (TG) were determinated by automatic biochenical analyzer. The positive cell count and protein expressions of sterol-regulatory element binding protein 1 (SREBP-1), pERK1/2, toll like receptor 4 (TLR4) and high mobility group box-1 protein (HMGB1) were tested by immunohistochemistry, Western Blot and flow cytometry. The levels of superoxide dismutase (SOD) and malonaldehyde (MDA) in liver cell homogenate were detected by hydroxylamine and TBA method.Results Compared with the model group, the lobular inflammation in high and low dose emilia sonchifolia groups and PD group was attenuated (1.50±0.53, 1.80±0.43, 1.20±0.42 vs. 2.30±0.48), and ALT, AST, TC, TG, SREBP-1, and MDA were significantly decreased, the decrease in high dose emilia sonchifolia group being the most significant [ALT (U/L): 51.91±6.95 vs. 66.50±12.15, AST (U/L): 125.70±5.62 vs. 147.10±10.52, TC (mmol/L): 1.79±1.04 vs. 2.81±1.08, TG (mmol/L): 0.87±0.55 vs. 1.17±0.67, SREBP-1: (30.60±5.56)% vs. (53.10±5.02)%, MDA (nmol/mg): 5.20±0.87 vs. 10.61±5.45,P 0.05]. While the above index values in PD group were close to those in high dose emilia sonchifolia group, showing that PD98059 had no impact on emilia sonchifolia's action.Conclusions Emilia sonchifolia can alleviate hepatic injury and attenuate lobular inflammation in rat experimental hepatic steatosis. Its mechanism is possibly related to the reduction of oxidative stress reaction, and SREBP-1 may be as a mediator involved in the action.
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Objective To analyze factors influencing β-blocker response rates of patients with portal hypertension and to explore the effect of nursing interference for increasing response rates with goal-directed nursing model. Methods 83 cases of portal hypertension were enrolled.Questionnaire about medical visiting behaviors and medication compliance were compared and analyzed after routine medication for 3 months.Bivariate and multivariate regression analysis were performed and related factors were used to establish a goal-directed nursing model for nursing interference guidance.52 non-response patients were randomly divided into the study group(27 cases)and the control group(25 cases).In the study group,compensation system and supportive-education according to Orem model were given,while the control group was given routine nursirng.Response rates and related factors were compared after 3 months of nursing intervention. Results Awareness of self-care responsibility,knowledge about the medication target,risk of sudden drug withdrawal,related medical knowledge,ability for pulse rate measurement and dose adjustment according to pulse rate changes were related to the response rates.Multivariate regression analysis showed that awareness of self-care responsibility,sudden drug withdrawal,utilization of social support and regular return visit were the independent factors.In the study group,ability for pulse rate measurement and dose adjustment acconding to pulse rate changes improved,phenomenon of sudden drug withdrawal declined and response rate increased,comparing with the control grpup. Conclusins For patients fail to respond to β-blockers,compliance behavior and medication compliance should be analyzed,and much attention should be paid to the education of the related medical knowledge,risk of sudden drug withdrawal and drag using targets.Goal-directed medel could be a guidance for nursing intervention to increase the response rates.
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Objective To discuss how to assess scientifically on the outcome of clinical application with peripheral nerve graft materials. Methods All Pubmed database from 1990 to 2010 were retrieved,and searched the English literatures about the application with peripheral nerve graft materials. The literatures consisted of original clinical research and review excluding animal experiments, repetitive research and irrelevant literatures. The clinical trials data of U.S. was also our target. The information about the safety and effectiveness of peripheral nerve graft materials and related statistical problems were discussed. Results Totally 1578 literatures were identified. Following reading titles and abstracts, we excluded some irrelevant articles. Finally 31 literatures and 2 issue of clinical research from clinical trial data of U.S. were included. After analysis on the literatures, we gained the following results: a remarkable degree of homogeneity among patients can be formed by setting the inclusion and exclusion criteria. For the assessment of proper digital nerve repair, Macknnon- Dellon evaluation is commonly applied, but for the composite nerve, BMRC evaluation is the main method and electromyography can be used as a secondary choice. The safety of peripheral nerve graft materials cannot be evaluated throughout one's life according to the current level of science and technology. It should be evaluated by long-term clinical observation. Randomized clinical trials with random grouping was a gold standard for clinical trials with a good balance and strong comparability. However, non-randomized controlled trials also have an important value. Conclusion It is impossible to make all affected factors homogeneity in a limited timespace conditions of clinical trial. However, we can try our best to keep factors homogeneity to maximum degree by setting the inclusion and exclusion criteria. The scientific assessment of outcome of peripheral nerve repair can be carried out with reasonable and internationally recognized nerve function evaluation methods, strict follow-up time and statistics programme meeting the clinical requirement.