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With the rapid development of aging around the world， the incidence and prevalence of age-related dementia have increased significantly， leading to a huge burden on patients， families and society. So far， there are no drugs that can completely reverse degeneration of the nervous system. The core pathological mechanisms of dementia are not clear， and the occurrence and progression of degenerative diseases in the nervous system appears to be only rely on the prevention through lifestyle interventions. Among lifestyle interventions， a large amount of laboratory evidence and a small amount of epidemiological evidence suggest that time restricted feeding have excellent effects on preventing the occurrence and progression of degenerative diseases in the nervous system. However， due to the lack of evidence in human population， the application of time restricted feeding lacks scientific basis. By synthesizing the existing evidence， this review discussed the pathway network of time restricted feeding that antagonizes the nervous system degradation， suggesting that future studies should focus on population evidence and the combined effects of multiple effect pathways.
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Objective:To investigate the application of "three-dimensional knowledge-objective" teaching combined with immersive clinical experience in nursing practice teaching in the operating room of department of ophthalmology and otorhinolaryngology.Methods:A total of 86 nursing students who received practice teaching in the operating room of Department of Ophthalmology and Otorhinolaryngology in our hospital were selected as research subjects and were divided into control group and observation group using a simple random number table, with 43 students in each group. The students in the control group received traditional teaching, and those in the observation group received "three-dimensional knowledge-objective" teaching and immersive clinical experience. The two groups were assessed in terms of the effectiveness of classroom teaching, nursing quality score, and the score of the ability to handle nurse-patient dispute. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:After training, both groups had significant increases in the scores of basic nursing, specialized nursing, equipment management, equipment coordination ability, patrol coordination ability, and document recording ability and the total score of all dimensions, and the observation group had significantly higher scores than the control group ( P<0.05). After training, both groups had significant increases in the scores of dispute identification ability, the ability of emergency response to dispute, nurse-patient communication skills, the awareness of nursing laws and regulations, and psychological stress adjustment ability and the total score of all dimensions, and the observation group had significantly higher scores than the control group ( P<0.05). Conclusion:In the nursing practice teaching in the operating room of the department of ophthalmology and otorhinolaryngology, "three-dimensional knowledge-objective" teaching combined with immersive clinical experience can improve the effectiveness of classroom teaching, enhance nursing quality, and strengthen the ability to handle nurse-patient dispute.
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Objective:To analyze the clinical manifestations and laboratory features of brucellosis patients in order to provide help for clinical diagnosis.Methods:The medical records of confirmed brucellosis patients ( n=81) in Kunming Third People's Hospital from 2015 to 2019 were collected. The occupation, contact history, clinical manifestations, laboratory examination characteristics and treatment of the patients were retrospectively analyzed. Results:The 81 cases of brucellosis were mainly farmers (64 cases), most of who had a history of raising sheep or contacting sheep manure or secretions (71 cases). The clinical manifestations were fever (68 cases), low back pain (42 cases), joint pain (22 cases), including 72 cases in acute stage and 9 cases in chronic stage. Laboratory examination showed that liver function index total bilirubin (TB) and direct bilirubin (DB) were generally normal, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyltransferase (GGT) were increased in about half of the patients; high sensitivity C-reactive protein (HsCRP), procalcitonin (PCT), interleukin-6 (IL-6) and serum amyloid A (SAA) were increased in more than 80% of the patients, and erythrocyte sedimentation rate (ESR) was increased in 64.6% (42/65) of the patients. Doxycycline plus rifampicin was the first-line treatment program.Conclusion:The clinical manifestations of patients with brucellosis are diverse and atypical, and patients with nonspecific clinical manifestations such as fever should be combined with their occupation, contact history, indicators of infection detection, timely blood culture examination to make a clear diagnosis, and patients with abnormal liver function should pay attention to asking about occupation and contact history, so as to reduce misdiagnosis and mistreatment of brucellosis.
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Objective To evaluate biomechanical properties of the personalized titanium alloy short femoral prosthesis by finite element analysis. Methods Based on the validated femoral finite element model, the base of the femoral neck was simulated, and by inserting different short femoral prostheses, four total hip replacement (THR) models, namely, the SMF stem model (Model A), BE1 stem model (Model B), MINI stem model (Model C) and personalized stem model (Model D) were established, respectively. The same loads and constraints were applied to four groups of models, and the von Mises stress distribution and deformation were calculated and analyzed, so as to compare mechanical stability of each model. Results The deformation of all THR models was smaller than that of the femur model under physiological state. The deformation of Model B was close to that of Model C, and the deformation of Model A was close to that of Model D. The peak stress of Model C was higher than that of the other 3 models, reaching 9555 MPa. The overall stress trend was Model C > Model B > Model D> Model A > Model under physiological state. Conclusions The peak stress, stress distribution of personalized short femoral stem were similar to that of SMF stem, with reasonable stress distribution, small stress shielding of the proximal femur, minimum overall deformation and shear stress of the prosthesis, and its effectiveness and stability could meet the requirements of human biomechanics, which could provide references for joint surgeons and prosthesis researchers.
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Mushroom-derived cyathane-type diterpenes possess unusual chemical skeleton and diverse bioactivities. To efficiently supply bioactive cyathanes for deep studies and explore their structural diversity,
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Objective:To explore an effective treatment method for mycobacterial infection of multiple abscesses in the face and breast after autologous fat injection.Methods:Six patients with non-tuberculous mycobacterial infection after autologous fat injection in the face and chest were treated from June to September in 2018. All patients underwent preoperative ultrasound localization. The small incision was opened for debridement and the necrotic granular tissues were completely scraped. Vacuum aspiration therapy in the sinus was used to promote wound growth, in line with the standard anti-tuberculosis drug treatment.Results:All six patients in this group were being followed up for 10-14 months. The average follow-up time was 12 months. All the infected patients were recovered, and the appearance of the infected site was satisfied by the patients.Conclusions:Small incision debridement with vacuum aspiration therapy combined with a variety of anti-tuberculosis drugs can effectively treat non-tuberculous mycobacterial infection after autologous fat injection, and achieve good results.
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In recent years, in the absence of venous component, dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance have been defined as pure arterial malformation (PAM). It is extremely rare, and its etiology and treatment have not yet been fully elucidated. Here, we reported 2 cases of PAM with associated aneurysmal subarachnoid hemorrhage in this paper. Both patients had severe headache as the first symptom. Subarachnoid hemorrhage was found by CT and computed tomography angiography (CTA) and PAM with associated aneurysm was found by digital subtraction angiography (DSA). In view of the distribution of blood and the location of aneurysms, the aneurysm rupture was the most likely to be considered. Based on the involvement of the lesion in the distal blood supply, only the aneurysm was clamped during the operation. It used to be consider that PAM is safety, because of the presentation and natural history of previously reported cases. Through the cases we reported, we have doubted about "the benign natural history" and discussed its treatment. PAM can promote the formation of aneurysms and should be reviewed regularly. The surgical indications for PAM patients with aneurysm formation need to be further clarified. Management of PAM patients with ruptured aneurysm is the same as that of ruptured aneurysm. Whether there are indications needed to treat simple arterial malformations remains to be further elucidated with the multicenter, randomized controlled studies on this disease.
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Humans , Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Cerebral Angiography , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiologyABSTRACT
Objective:To investigate the efficacy and safety of magnesium aluminium carbonate, lansoprazole, amoxicillin and furazolidone in the treatment of Helicobacter pylori-related gastric ulcer.Methods:From March 2016 to December 2017, 120 patients with HP related gastric ulcer who met the inclusion criteria were enrolled in the digestive department of Linxi Hospital of Kailuan general hospital.They were divided into observation group and control group with random number table method, 60 cases in each group.The control group was given lansoprazole+ amoxicillin+ furazolidone triple therapy.On this basis, the observation group was added with magnesium aluminum carbonate.The clinical efficacy, clearance rate of Helicobacter pylori, the level of VEGF and EGF in gastric juice were compared between the two groups.Results:The total clinical effective rate of the observation group was 95.0% (57/60), which was significantly higher than that of the control group (83.3%) (50/60). The difference between the two groups was statistically significant (χ 2=4.23, P<0.05). The comprehensive symptom scores of the two groups decreased significantly with the treatment time (observation group: before treatment(9.6±2.2), treatment 2 weeks (5.5±1.5), treatment 4 weeks (4.3±1.2), treatment 6 weeks (3.1±0.8), control group (9.4±2.5), treatment 2 weeks (7.2±1.3), treatment 4 weeks (6.6±1.4), treatment 6 weeks (4.5±1.0)), and observation group syndrome scores There was significant difference between the two groups ( Finter-group=23.54, Pinter-group<0.05; Fintra-group=87.62, Pintra-group<0.05; Finteraction=8.47, Pinteraction<0.05). After treatment, VEGF level in gastric juice of the two groups increased significantly after treatment.In the observation group( (429.4±128.5) pg/ml )was significantly higher than that in the control group( (380.3±137.2) pg/ml, t=2.02, P<0.05). The EGF level in gastric juice of the two groups increased significantly after treatment.In the observation group( (658.1±164.0) pg/ml )was significantly higher than that in the control group ((583.5±135.1) pg/ml, t=2.72, P<0.05). The incidence of adverse reactions was 6.7% (4/60) in the observation group and 8.3% (5/60) in the control group.There was no significant difference (χ 2=0.12, P>0.05). Conclusion:The treatment of Helicobacter pylori related gastric ulcer with the combination of aluminum carbonate, lansoprazole, amoxicillin and furazolidone can obviously improve the clinical symptoms and promote the regeneration of ulcer mucosa.
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Objective@#To investigate the efficacy and safety of magnesium aluminium carbonate, lansoprazole, amoxicillin and furazolidone in the treatment of Helicobacter pylori-related gastric ulcer.@*Methods@#From March 2016 to December 2017, 120 patients with HP related gastric ulcer who met the inclusion criteria were enrolled in the digestive department of Linxi Hospital of Kailuan general hospital.They were divided into observation group and control group with random number table method, 60 cases in each group.The control group was given lansoprazole+ amoxicillin+ furazolidone triple therapy.On this basis, the observation group was added with magnesium aluminum carbonate.The clinical efficacy, clearance rate of Helicobacter pylori, the level of VEGF and EGF in gastric juice were compared between the two groups.@*Results@#The total clinical effective rate of the observation group was 95.0% (57/60), which was significantly higher than that of the control group (83.3%) (50/60). The difference between the two groups was statistically significant (χ2=4.23, P<0.05). The comprehensive symptom scores of the two groups decreased significantly with the treatment time (observation group: before treatment(9.6±2.2), treatment 2 weeks (5.5±1.5), treatment 4 weeks (4.3±1.2), treatment 6 weeks (3.1±0.8), control group (9.4±2.5), treatment 2 weeks (7.2±1.3), treatment 4 weeks (6.6±1.4), treatment 6 weeks (4.5±1.0)), and observation group syndrome scores There was significant difference between the two groups (Finter-group=23.54, Pinter-group<0.05; Fintra-group=87.62, Pintra-group<0.05; Finteraction=8.47, Pinteraction<0.05). After treatment, VEGF level in gastric juice of the two groups increased significantly after treatment.In the observation group( (429.4±128.5) pg/ml )was significantly higher than that in the control group( (380.3±137.2) pg/ml, t=2.02, P<0.05). The EGF level in gastric juice of the two groups increased significantly after treatment.In the observation group( (658.1±164.0) pg/ml )was significantly higher than that in the control group ((583.5±135.1) pg/ml, t=2.72, P<0.05). The incidence of adverse reactions was 6.7% (4/60) in the observation group and 8.3% (5/60) in the control group.There was no significant difference (χ2=0.12, P>0.05).@*Conclusion@#The treatment of Helicobacter pylori related gastric ulcer with the combination of aluminum carbonate, lansoprazole, amoxicillin and furazolidone can obviously improve the clinical symptoms and promote the regeneration of ulcer mucosa.
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Objective:To evaluate the efficacy and safety of adalimumab in the treatment of severe plaque psoriasis.Methods:From June 2018 to April 2019, 20 patients with severe plaque psoriasis were collected from Department of Dermatology, Henan Provincial People′s Hospital. After initial subcutaneous injection of adalimumab at a dose of 80 mg, these patients were subcutaneously injected with adalimumab at a dose of 40 mg at weeks 1, 3, 5, 7, 9 and 11. At weeks 4, 8 and 12, psoriasis area and severity index (PASI) was recorded, and changes in skin lesions were observed by reflectance confocal microscopy (RCM) . Adverse reactions were monitored during treatment.Results:At week 4, 12 patients achieved a 50% reduction in PASI (PASI50) ; at week 8, 14 achieved PASI75; at week 12, 20 patients achieved PASI75, of which 5 achieved PASI90 and 2 achieved PASI100. As RCM showed, the melanin content in the basal layer of skin lesions was lower compared with that of perilesional normal skin before treatment, gradually increased within 4 weeks, and nearly returned to normal at week 12. No infections, tumors or other related adverse reactions occurred in the 20 patients.Conclusion:Subcutaneous injection of adalimumab every other week is markedly effective in the treatment of severe psoriasis, with few related adverse reactions.
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Objective:To evaluate the short-term clinical efficacy and safety of secukinumab in the treatment of moderate to severe plaque psoriasis.Methods:Thirty-six patients with moderate to severe psoriasis, who visited Department of Dermatology, Henan Provincial People′s Hospital from June 2019 to November 2019, received subcutaneous injection of secukinumab at a dose of 300 mg once a week for 5 weeks, followed by once every 4 weeks. Psoriasis area and severity index (PASI) was recorded at weeks 4, 8 and 12, and adverse drug reactions were observed during the treatment.Results:All the 36 patients received the treatment for at least 12 weeks. At week 4, 8 patients achieved PASI75, including 3 achieving PASI90 and 1 achieving PASI100; at week 8, 26 achieved PASI75, of which 16 achieved PASI90 and 4 achieved PASI100; at week 12, 32 achieved PASI75, of which 26 achieved PASI90 and 8 achieved PASI100. No patients had serious adverse drug reactions, such as severe infections or malignancies. One patient developed abdominal pain and distension after subcutaneous injection in the abdomen, and the symptoms disappeared after 3 days; 1 patient developed tonsillitis followed by eczema-like lesions on the original psoriaitc lesions; suppurative lymphadenitis occurred in the neck of another patient.Conclusion:Secukinumab is markedly effective in the treatment of moderate to severe plaque psoriasis with few adverse effects, and is a new treatment option for patients with moderate to severe plaque psoriasis.
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Objective@#To study the effects of three different granular fats on proliferation, differentiation and migration of adipose-derived stem cells.@*Methods@#Ten patients were selected for lumbar liposuction. The adipose tissue was obtained with different sized side-hole fat aspiration devices: 10 ml of Macrofat (n=10), 10 ml of Microfat (n=10) and 10 ml of Nanofat (n=10). Enzyme digestion method was used to separate and extract adipose-derived stem cells(ADSCs). The differences of vascular matrix components in these 3 kinds of fat sources were analyzed. XTT assay was used to detect proliferation and growth ability. The migration ability of the cell injury model was observed in vitro, and the multi-directional differentiation ability was compared by the analysis of adipogenic and osteogenic induction. The experimental data were analyzed using SPSS 13.0 software. One-Way ANOVA was used to compare the difference of multiple groups. P<0.05 was considered as statistically significant.@*Results@#The detection of adipose-derived stem cells was by flow cytometry and it showed Macrofat, Microfat and Nanofat was(4.23±0.37)×105, (2.29±0.33)×105 and(1.56±0.16)×105. The content of fat-derived stem cells in Macrofat was the highest, followed by Microfat, and the content of Nanofat was the least (F=209.533, P<0.001). XTT assay showed that the proliferative ability of adipose-derived stem cells in the first two generations of Macrofat was the highest, followed by Microfat, while the proliferation of Nanofat was the lowest (the absorbance in 3 groups increased in a time-dependent manner). There was no significant difference in the proliferative capacity of the third generation of 3 groups (the absorbance of these 3 groups were compared at each time point). The cellular trauma model showed that the first generation of Macrofat-derived stem cells had the best migration ability, followed by Microfat, while the Nanofat had the weakest migration ability(Compared with the remaining area of wounds at 0 h, 12 h, 24 h point between the three groups, F=306.370, 1409.907, P<0.001). From the second generation, the migration ability of each group of ADSCs gradually self-repaired, and the migration ability at 12 h was similar to that of the first generation (F=11.410, P<0.001), but there was no significant difference in 24 h (F=0.070, P=0.933). Oil red O and alizarin red staining showed that the first generation of Macrofat and Microfat had better fat-forming and osteogenic differentiation ability than Nanofat(F=523.532, 620.022, P<0.001). However, there was no significant change after the second generation (F=2.144, 0.866, P=0.137, 0.432).@*Conclusions@#In the process of adipose tissue extraction of Nanofat, the production and activity of adipose-derived stem cells was impacted. However, in the process of culture and passage, the cell activity, proliferation ability, migration ability and differentiation ability can be achieved through self-repair, evenclose to the level of Macrofat or Microfat.
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Objective To determine the proper storage environment by comparing the activity of adipose-derived stem cell (ADSC) at 10％ PRP,10％ HS and 0.9％ NaCl.Methods ADSC was isolated and cultured.Then the ADSC was stored in 10％ PRP,10％ HS,and 0.9％ Nacl at room temperature (RT,about 26 ℃C) for 2 hours.After that the proliferation ability,survival rate and differentiation ability of the cells were detected.Finally storage media of ADSC was determined.Results Compared with 0.9％ NaCl,ADSC showed a better proliferation and higher differentiation ability at 10％ PRP and 10％ HS;besides,the survival rates of two groups were higher than the group of 0.9％Nacl.Among these groups,the survive rate of 10％ HS and 10％ PRP were 78.08％ and 75.68％ respectively,while it was 62.34％ in 0.9％ NaCl group.Conclusions 10％ HS is more suitable for short-term preservation of ADSC.
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Objective To investigate the effect of adipose-derived stem cells (ADSCs) on pho toaging skin after laser pretreatment with GaAlAs.Methods ADSCs were isolated from healthy wistar rats,ADSCs were isolated and cultured to establish an adipose-derived stem cell culture system.ADSCs were pretreated with GaAlAs laser at a wavelength of 650 nm 4 J/cm2.A rat model of pho toaging aging was established.Different doses of ADSCs and low energy laser ADSCs were pretreated with ADSCs for the treatment of photoaging skin,and the morphological changes of epidermis and dermis were observed before and after treatment with low energy laser pretreatment.Results When the concentration of ADSCs was 103/100 μl,there was no significant difference in epidermal thickness and dermal thickness between ADSCs treated group and GaAlAs pretreatment group (P＞0.05).The thickness of epidermis in the GaAlAs pretreatment group was significantly lower than that in the ADSCs group (P＜0.05) at 104/100 μl.When the concentration of ADSCs was 5 × 104/100 μl,the epidermal thickness of the GaAlAs pretreatment group decreased significantly and the thickness of the dermis increased significantly,which was significantly different from that of the ADSCs group (P ＜ 0.05).Conclusions GaAlAs laser pretreatment can enhance ADSCs anti-skin photoaging ability.
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Objective@#To evaluate the efficacy of gastric pull-up and complex laryngotracheal flap in reconstruction for circumferencial defects after resection of hypopharyngeal and cervical esophageal cancers.@*Methods@#A total of 163 cases (152 males, 11 females) with circumferencial defect after resection of hypopharyngeal and cervical esophageal cancers received reconstructive surgeries by gastric pull-up (42 cases) and complex laryngo-tracheal flaps (121 cases), of them 115 cases simultaneously underwent unilateral neck dissection and 20 cases had bilateral neck dissection. Postoperative radiotherapy was used in 67 cases, with a dosage of 40-60 Gy.@*Results@#There were 127 (77.9%) cases with positive metastatic lymph nodes. Of 42 patients with gastric pull-up reconstruction, 39 cases (92.8%) recovered the function of oral swallowing after operation, and 8 cases with cervical esophageal cancer recovered the functions of oral swallowing and speech after gastroesophageal anastomosis reconstruction. There were 3 (7.1%) cases died of surgery and 8 cases with surgical complications. Reconstruction of upper digestive tract with combined laryngotracheal flap was successful in all 121 cases, with recovered oral swallowing function after operation. No patient died of surgery but 24 cases had complications, mainly pharynx skin fistula or wound infection, which were cured by conservative treatments. The 1-, 3- and 5-year survival rates for 163 patients were 69.8%, 50.5% and 34.3%, respectively. The independent factors for prognosis included T4 (P<0.001) and N+ (P=0.042).@*Conclusions@#The complex of laryngotracheal flap with pectoralis major myocutaneous flap is suitable for most advanced hypopharyngeal cancer after resection of the tumor and reconstruction of circumferencial defect. It is simple technology, low and slight complication rate. The minority is not suitable for the application of pectoralis major myocutaneous flap can be used instead of free anterolateral thigh flap. Gastric pull-up for reconstruction of upper digestive tract is suitable for most patients with cervical esophageal cancer and hypopharyngeal carcinoma invading the cervical esophagus who are not suitable for laryngotracheal flap reconstruction, with good swallowing function after surgery. However, it is prudent to choose operative indications because of serious surgical trauma and risks for complications.
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Objective To observe the efficacy of oropharyngeal muscle exercise for relieving obstructive sleep apnea (OSAS) among stroke survivors.Methods Fifty stroke survivors with moderate OSAS were randomly divided into an observation group and a control group,each of 25.Both groups were given routine drugs and rehabilitation,while the observation group was additionally provided with oropharyngeal muscle exercises during the daytime for 20 minutes twice a day for6 weeks.The control group received deep breathing therapy.Before and after the 6 weeks of treatment,both groups were evaluated using polysomnography.Their sleep quality and daytime sleepiness were measured using the Pittsburgh sleep quality index and the Stanford sleepiness scale.Any changes in the patients' pharyngeal morphology after exercise were evaluated using MRI.Results After the oropharyngeal muscle exercises,the apnea hypoventilation index and minimum SaO2 ％,the snore index and sleep quality improved significantly.Daytime sleepiness was significantly relieved.Some structural remodeling of the pharyngeal airvay was observed by MRI,including significantly larger retropalatal distance and shorter length of the soft palate.The retropalatal distance was positively and correlated with the duration of exercise while the length of soft palate correlated negatively.Conclusion Exercising the oropharyngeal muscles is a promising alternative treatment for stroke survivors with moderate OSAS.It improves the morphology of the oropharynx to relieve obstruction during sleeping.
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Objective To evaluate the efficacy,bleeding profile and safety of low-dose levonorgestrel-releasing intrauterine system (LNG-IUS 8) in Chinese healthy women of childbearing age.Methods A multi-center,open-label,single-arm clinical trial conducted at 16 centres in China enrolled 773 healthy women of childbearing age (mean age 31.6 years old,range 18 to 40 years old),who demanded contraception,from April 2006 to June 2013.All women placed LNG-IUS 8 for 3 years and then been followed up at 3,6,9,12,18,24,30,36 months.The efficacy variables including pregnancy rate and expulsion rate were analyzed using life table,while observing adverse events (AE) to evaluate the safety.The bleeding profile happened during the study was assessed using 90-day reference intervals (World Health Organization criteria).Results Eight pregnancies occurred among 773 women,resulting in a overall Pearl index of 0.42 per 100 women years.The 3-year cumulative pregnancy rate was 0.37 per 100 women years and the 3-year cumulative expulsion rate was 1.99 per 100 women years.The number of women with bleeding/spotting reduced and the bleeding/spotting days declined over time.Totally 219 AE were reported related to LNG-IUS 8 placements.The most common AE were vaginal bleeding (8.2％,63/773)and the ovarian cyst (6.2％,52/773).LNG-IUS 8 had an improving effect on dysmenorrhea that the percentage of women with dysmenorrhea as well as the days of dysmenorrhea decreased over time.The percentage of women satisfied or very satisfied with LNG-IUS 8 was 87.2％ (622/713).Conclusion LNG-IUS 8 is highly effective and safe for Chinese healthy women of childbearing age.
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Objective To investigate the efficacy of flexor muscle disconnection combined with myocutaneous flap in the treatment of pressure ulcer in patients of ankylosing posture.Methods A retrospective case series study was conducted to analyze 15 patients with pressure ulcer at different body parts due to ankylosing posture after paraplegia admitted to the First Affiliated Hospital of Jinan University from January 2012 to July 2017.There were 10 males and five females,aged 40-78 years,with an average age of 68 years.The pressure ulcer ranged from 3 cm× 3 cm to 15 cm × 11 cm.The pressure ulcers were distributed at sacrococcygeal region in eight patients,macro-rotator in four,and ischial nodules in three.According to the size and position of pressure ulcer,different musculocutaneous flaps were selected,and high selective decompression of hip flexion and knee flexion was performed to ensure the tension free suture of the wound.After the operation,the negative pressure closed drainage (VSD) was given to maintain a proper posture for wound healing.The stitches were removed after the wound healed.The wound healing,pressure ulcer recurrence,flap texture,flap color,and donor site were observed,and patient satisfaction were also surveyed.Results All patients were followed up for 12-36 months,average 24 months.The pressure ulcer was healed in 12 patients after the first repair operation.In two nonunion cases,the unrelieved knee flexion and knee muscles led to high muscular tension and stiff joint,causing strong resistance during limb movement and strong flexor reflex.Two patients were healed after twice operation.In one patient,the incision was torn by the excessive flexion tension due to improper body position caused by the passive movement of the limb after operation,and the wound was healed after twice operation.All muscle flaps covered the wound and survived well,and the wounds were completely closed and healed with good shape,texture as well as elastic recovery.After the suture was removed18 days after surgery,the patients were discharged satisfactorily.The patients received conventional pressure ulcer care,and no new pressure ulcer was reported during the follow-up.The flap donor site was healed well after autologous skin repair.Conclusion For pressure ulcer in patients of ankylosing posture,flexor muscle disconnection combined with myocutaneous flap has notable effects in reducing tension and can accelerate wound healing and improve healing rate.
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The uncertain safety and effectiveness of test drugs and medical instruments in clinical trials might pose risks to the subjects, and pregnancy events emerging in clinical trials will increase the risks. At present, most of pregnancy events are recorded and reported as an adverse event, but due to their particularity, it is inappropriate to record and handle them with other adverse events. Pregnancy event closely is related to the interests of the sub-jects and the risk it might face, besides, it is also related to the interest and risk of their spouses and offspring. In order to handle pregnancy event, this paper elaborated responsibilities of researchers, sponsors and subjects accord-ing to the purpose of trials in three aspects, including experiment design, informed consent, and test expand, so that the interest of the subjects could get better protection.
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Objective To observe the clinical efficacy of Bushen-Qingxin decoction for the patients with premature ovarian failure (POF) with kidney deficiency type. Methods A total of 120 POF patients were randomly divided into the observation group and the control group. The observation group were treated with Bushen-Qingxin decoction. The control group were treated with hormone replacement therapy (HRT). After continuous treatment for 3 courses, the clinical efficacy, clinical symptoms and the levels of estrogen (E2), luteotropic hormone (LH), follicle-stimulating hormone (FSH) were comparedbefore and after treatment. Results The total effective rate in the observation group was 86.7% (52/60), and the control group was 60.0% (36/60). The difference was statistically significant (x2=9.588, P=0.002) between two groups. The symptoms aversion to cold, and cold limbs, depressed mood, night sweats were improved significantly better than those in the control group(x2=16.464,16.214,11.525,9.938,P<0.001).After treatment,the serum E2(88.32 ± 9.35 pmol/L vs. 62.10 ± 7.22 pmol/L, t=17.848) in the observation group was significantly higher than this in the control group,while the serum FSH(32.33 ± 4.60 U/L vs.46.82 ± 5.47 U/L,t=15.704),LH(24.80 ± 3.37 U/L vs.32.16 ± 4.02 U/L, t=10.868) in the observation group were significantly lower than those in the control group (P<0.01). In the follow-up of 3 months, the recurrence rate in the observation group was 3.8% (2/52), but 16.7% (6/36) in the control group. The difference was statistically significant between two groups (x2=4.231, P=0.040).Conclusions The Bushen-Qingxin decocation can significantly improve the clinical symptoms and restore ovarian function.The Bushen-Qingxin decocation is an effective method for the treatment of premature ovarian failure.