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Objective: To explore the clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns. Methods: A retrospective observational study was conducted. From May 2018 to April 2021, 12 male patients with thumb destructive defects caused by electrical burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, aged 27 to 58 years, including 10 cases with degree Ⅲ thumb defect and 2 cases with degree Ⅳ thumb defect after thorough debridement. The thumb was reconstructed with free hallux-nail flap combined with composite tissue flap of the second phalangeal bone, joint, and tendon with skin island. The donor site of hallux-nail flap was covered with artificial dermis in the first stage and performed with continuous vacuum sealing drainage, and covered with medium-thickness skin graft from the groin site in the second stage. The donor site in the second toe was filled and fixed with iliac bone strips. The survival of reconstructed thumb was observed 1 week after the reconstruction surgery, the survival of skin graft in the donor site of hallux-nail flap was observed 2 weeks after skin grafting, and the callus formation of the reconstructed thumb phalanx and the second toe of the donor foot was observed by X-ray 6 weeks after the reconstruction surgery. During the follow-up, the shape of reconstructed thumb was observed and the sensory function was evaluated; the function of reconstructed thumb was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; whether the interphalangeal joints of the hallux and the second toe were stiff, the scar hyperplasia of the foot donor site, and whether the walking and standing functions of the donor feet were limited were observed. Results: One week after the reconstruction surgery, all the reconstructed thumbs of the patients survived. Two weeks after skin grafting, the skin grafts in the donor site of hallux-nail flap of 11 patients survived, while the skin graft in the donor site of hallux-nail flap of 1 patient was partially necrotic, which was healed completely after 10 days' dressing change. Six weeks after the reconstruction surgery, callus formation was observed in the reconstructed thumb and the second toe of the donor foot of 10 patients, the Kirschner wires were removed; while callus formation of the reconstructed thumb was poor in 2 patients, and the Kirschner wires were removed after 2 weeks of delay. During the follow-up of 6 to 24 months, the shape of reconstructed thumb was similar to that of the healthy thumb, the discrimination distance between the two points of the reconstructed thumb was 7 to 11 mm, and the functional evaluation results were excellent in 4 cases, good in 6 cases, and fair in 2 cases. The interphalangeal joints of the hallux and the second toe of the donor foot were stiff, mild scar hyperplasia was left in the donor site of foot, and the standing and walking functions of the donor foot were not significantly limited. Conclusions: The application of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns adopts the concept of reconstruction instead of repair to close the wound. It can restore the shape and function of the damaged thumb without causing great damage to the donor foot.
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Humans , Male , Burns, Electric/surgery , Cicatrix/surgery , Free Tissue Flaps , Hallux/surgery , Hyperplasia , Plastic Surgery Procedures/methods , Skin Transplantation/methods , Thumb/surgery , Toes/surgery , Treatment OutcomeABSTRACT
PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.
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Objective@#To investigate the clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage.@*Methods@#From April 2016 to July 2018, 68 patients with postpartum hemorrhage treated in the Maternal and Child Health Care Hospital of Tongxiang were randomly divided into two groups according to the random number table, with 34 patients in each group.The control group was treated with posterior pituitary injection.The observation group was treated with ergometrine maleate injection combined with posterior pituitary injection.The bleeding volume at different time points after treatment was compared between the two groups.The hemostasis time, the duration of uterine contraction, the extent of uterine decline, the duration of lochia and serum cytokines levels before and after treatment were compared.@*Results@#The bleeding amount at 0.5 h, 2 h, 24 h after administration in the observation group were (76.82±15.40) mL, (112.34±18.73) mL and (196.70±20.60) mL, respectively, which were significantly lower than those in the control group[(147.38±17.65), (198.49±19.37) mL, (283.74±21.56) mL](t=17.565, 18.643, 17.020, all P<0.05). The duration of contractions[(3.83±1.40) h] and the extent of uterine decline[(6.25±0.93) cm] in the observation group were significantly better than those in the control group[(1.92±0.59) h, (4.65±0.66) cm], and the hemostasis time[(21.29±3.60)min] and duration of lochia[(17.19±4.67)d] in the observation group were significantly shorter than those in the control group[(42.28±3.85) min, (24.28±6.11) d](t=23.220, 7.331, 8.181, 5.376, all P<0.05). After treatment, the levels of nitrogen monoxide (NO)[(91.22±6.23) μmol/L], nitric oxide synthase (NOS)[(24.56±2.46) μmol/L], brain natriuretic peptide (BNP)[(46.81±5.10)ng/L] in the observation group were lower than those in the control group[(98.63±7.51) μmol/L, (30.92±3.95) μmol/L, (90.35±4.66)ng/L], and the differences were statistically significant (t=4.428, 7.969, 36.750, all P<0.05).@*Conclusion@#The effect of ergometrine maleate injection combined with posterior pituitary injection on postpartum hemorrhage is effective, which can effectively control the amount of bleeding, shorten the time of hemostasis and promote postpartum recovery.
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Objective To investigate the clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage.Methods From April 2016 to July 2018, 68 patients with postpartum hemorrhage treated in the Maternal and Child Health Care Hospital of Tongxiang were randomly divided into two groups according to the random number table ,with 34 patients in each group .The control group was treated with posterior pituitary injection .The observation group was treated with ergometrine maleate injection combined with posterior pituitary injection .The bleeding volume at different time points after treatment was compared between the two groups .The hemostasis time, the duration of uterine contraction , the extent of uterine decline,the duration of lochia and serum cytokines levels before and after treatment were compared .Results The bleeding amount at 0.5 h,2 h,24 h after administration in the observation group were (76.82 ±15.40) mL,(112.34 ± 18.73) mL and (196.70 ±20.60) mL,respectively,which were significantly lower than those in the control group [(147.38 ±17.65),(198.49 ±19.37) mL,(283.74 ±21.56) mL](t=17.565,18.643,17.020,all P<0.05). The duration of contractions[(3.83 ±1.40) h] and the extent of uterine decline[(6.25 ±0.93) cm] in the observation group were significantly better than those in the control group [(1.92 ±0.59) h,(4.65 ±0.66) cm],and the hemostasis time[(21.29 ±3.60) min] and duration of lochia [(17.19 ±4.67) d] in the observation group were significantly shorter than those in the control group[(42.28 ±3.85) min,(24.28 ±6.11) d](t=23.220,7.331, 8.181,5.376,all P<0.05).After treatment,the levels of nitrogen monoxide (NO)[(91.22 ±6.23)μmol/L], nitric oxide synthase (NOS)[(24.56 ±2.46)μmol/L],brain natriuretic peptide (BNP)[(46.81 ±5.10)ng/L] in the observation group were lower than those in the control group [(98.63 ±7.51)μmol/L,(30.92 ±3.95)μmol/L, (90.35 ±4.66)ng/L],and the differences were statistically significant (t=4.428,7.969,36.750,all P<0.05). Conclusion The effect of ergometrine maleate injection combined with posterior pituitary injection on postpartum hemorrhage is effective , which can effectively control the amount of bleeding , shorten the time of hemostasis and promote postpartum recovery .
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OBJECTIVE@#To investigate the long-term effect of posterior lumbar pedicle screw fixation combined with isthmus bone grafting and fusion in young patients with spondylolysis.@*METHODS@#A retrospective study was carried out, consisting of 16 young patients with lumbar spondylolysis without spondylolisthesis treated by lumbar posterior pedicle screw fixation combined with isthmic bone grafting fusion from January 2006 to July 2014. There were 11 males and 5 females, aged from 18 to 21 years old, with an average age of 19.3 years old, and the course of disease ranged from 12 to 26 months, with an average of 22 months. All the patients suffered from lumbar pain and difficulty in getting out of bed. Preoperative CT confirmed 12 cases of L₅ isthmus fissure and 4 cases of L₄ isthmus fissure. Bone graft fusion was confirmed and internal fixation was removed after operation. Lumbar spondylolysis was evaluated by lumbago visual analogue scoring method at preoperative and postoperative time points. Lumbar isthmic fusion was evaluated by lumbar CT, and degeneration of fixed and adjacent segments of lumbar intervertebral disc was evaluated by lumbar MRI.@*RESULTS@#Of the 16 patients, 13 patients (26 sides) were followed up, with a mean duration of 96 months. The operation time ranged from 80 to 105 minutes, with an average of 95 minutes. The intraoperative bleeding volume ranged from 150 to 300 ml, with an average of 225 ml. All the patients were successfully operated without any complications related to the operation. VAS scores at each time point after operation were improved compared with those before operation(<0.01). Postoperative CT scans of lumbar spine showed osseous fusion at 6 to 14 months, with an average of 12 months. There were no changes of adjacent segment degeneration, fixed segment disc degeneration and protrusion on lumbar spine MRI, and no symptomatic recurrence or recurrent spondylolysis in the long term.@*CONCLUSIONS@#The posterior lumbar pedicle screw fixation combined with isthmic bone grafting and fusion is safe and effective in the treatment of young spondylolysis. The fusion rate is high and the interference of normal physiological range is reduced. The long-term effect is satisfactory.
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Adolescent , Female , Humans , Male , Young Adult , Bone Transplantation , Lumbar Vertebrae , Pedicle Screws , Retrospective Studies , Spinal Fusion , Spondylolysis , General Surgery , Treatment OutcomeABSTRACT
Objective:To investigate the effect of warmer intravenous infusion combined with local liquid dressing skin daub methods in short-term PN infusion patients with peripheral venous indwelling needle.Methods:Using the single blind random control method,150 PN patients from October 2015 to August 2016 were included.The control group was given the liquid dressing skin daub with 75 cases,and the observation group was given warmer intravenous infusion jointing local liquid dressing skin daub with 75 cases.To observe the incidence of phlebitis and the pain of the infusion catheter site with the infusion limb and the average maintain time of peripheral venous indwelling needle.Results:The incidence of phlebitis was significantly lower in the observation group than that in the control group (P ＜ 0.01) in two groups.The degree of infusion catheter pain with infusion limb pain wasless painful in the observation group than that in the control group (P ＜ 0.005) in two groups.The degree of catheter site pain after pulling out peripheral venous indwelling needle was less painful in the observation group than that in the control group(P ＜ 0.01) in two groups To compare the average maintain time of peripheral venous indwelling needle was (P ＜ 0.001)in two groups.Conclusion:Warmer intravenous infusion combined with liquid dressing skin daub can effectively prevent the occurrence of phlebitis in patients with peripheral venous indwelling needle PN infusion and improve the comfort.
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Objective To systemically evaluate the accuracy of CT and MR estimating whole liver volume with evidence based medicine methods.Method Published papers about whole liver volume estimation with CT or MR modality were searched in Cochrane library,MEDLINE,EMBASE,CMBdisc(China biology medicine disc) for English and Chinese abstracts.Inclusion criteria were formulated according to validity criteria for diagnostic research published by the Cochrane collaboration.Heterogeneity test of extracted data of Eligible papers was performed first to determine the appropriate statistical model used to pool the result.Finally,sensitivity and publish bias analysis was performed.Result Seventeen articles with 37 studies including 351 patients met the inclusion criteria.There was no heterogeneity between included studies (I2 =0％,Q =5.85,P =1).Fixed effect model was selected for the meta analysis and there was no statistically significant difference between true and radiological estimated whole liver volume (WMD =21.61 mL,95％ confidence interval:-6.33-49.57 mL,z =1.51,P =0.13).Sensitivity analysis revealed the result was robust which was not affected by excluding any of the included studies.Funnel plot and publish bias analysis showed no publish bias (t =-1.55,P=0.13).Conclusion CT and MR volume estimation is accurate for liver volume measurement,which provides important information for preoperative evaluation,postoperative monitoring and follow-up studies of other hepatic pathologies.aximum benefit to patients.
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OBJECTIVE: To observe the effect of a new compound methylamine irisolidone on cardiac function in rats with experiment myocardial infarction. METHODS: The male Wistar rats were randomly divided into 6 groups: control group, ischemia model group, methylamine irisolidone preconditioning group, pretreated with different dosages of methylamine irisolidone (200,100,50 mg · kg-1, respectively) and 200 mg · kg-1 puerain(positive control). Coronary artery ligation was used to induce the acute myocardial ischemia model. After 30 d administration of methylamine irisolidone, the heart function parameters,including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular systolic pressure (LVSP), maximal velocity of increase and decrease of left ventriclar pressure (dp/dtmax), were analyzed and myocardial histology was analyzed by hematoxylin-eosin staining. RESULTS: Compared with model group, methylamine irisolidone could improve the heart function of rats in AMI injury, increased the systolic pressure and diastolic pressure, decreased the heart rate(P < 0.01). The myocardial ultrastructure injury was alleviate. CONCLUSION: Methylamine irisolidone had cardioprotective effects on acute myocardial ischemia. The mechanism may be related to slow down heart rate, prolong diastolic, so that an increase in the endocardial blood supply.
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Objective: To investigate the expressions of Golgi matrix protein 130 (GM130), 14-3-3ζ and integrinβ3 in ovarian epithelial malignant tumor tissues and their clinical significance. Methods: The expressions of GM130, 14-3-3ζ and integrinβ3 in 49 ovarian epithelial malignant tumor tissues, 30 ovarian epithelial benign tumor tissues and 23 normal ovarian epithelial tissues were detected by immunohistochemistry. The expression levels of GM130, 14-3-3ζ and integrinβ3 mRNAs and proteins in ovarian epithelial malignant tumor tissues, ovarian epithelial benign tumor tissues and normal ovarian epithelial tissues were detected by RT-PCR and Western blotting, respectively. Results: The positive rates of GM130, 14-3-3ζ and integrinβ3 expressions in ovarian epithelial malignant tumor tissues were higher than those in the ovarian epithelial benign tumor tissues and normal ovarian epithelial tissues (P 0.05). The expression levels of GM130, 14-3-3ζ and integrinβ3 mRNAs and proteins in ovarian epithelial malignant tumor tissues were higher than those in the ovarian epithelial benign tumor tissues and the normal ovarian epithelial tissues (P < 0.05). Conclusion: The high expressions of GM130, 14-3-3ζ and integrinβ3 in ovarian epithelial malignant tumor may play an important role in malignant progression. GM130 may become a prognostic factor and a therapeutic target in patients with ovarian tumors. Copyright© 2014 by TUMOR.
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This paper is aimed to investigate the signal source and influential factors in signals of trans-esophageal pulse oxygen saturation (SeO2). The red light of the SeO2 probe was faced directly to the descending aorta (DA) of the mongrel dogs. The readings and waveform of SeO2 signals were recorded under following conditions: before and after DA was shield; before and after the blood supply of esophagus was cut off; under the different touch pressures between the SeO2 probe and the esophageal wall. The readings and waveform of SeO2 signals were also recorded respectively at both different esophageal depth and directions when mechanical ventilation was on and off. The tongue oxygen saturation (StO2) was recorded simultaneously as control. The waveform of SeO2 signals disappeared after DA was shield (P < 0.001). No significant difference was found in the SeO2 signals before and after the blood supply of esophagus was cut off (P > 0.05). Compared with the StO2 readings when the SeO2 probe was placed at different esophageal depth, the waldeyer ring, cervical area and thoracic inlet,the readings of SeOz significantly decreased (P < 0.05) while mechanical ventilation was on and off. However, there was no significant difference in the readings between SeO2 signals from DA, aortic arch (AA) and left subclavian artery and the StO2 signals recorded simultaneously. Mechanical ventilation had a remarkable effect on the SeO2 signals at different esophageal depth (P < 0.05), but the StO2 signals lay in its insensitivity to its influence. The readings of StO2 signals were significantly different from that of StO2 signals when the touch pressure between the SeO2 probe and the esophageal wall below 40 mmHg (P < 0.01). The directions of the optimum SeO2 signals acquired at different esophageal depth were not the same. The SeO2 signals were primarily derived from deeper arteries around the esophagus. All of Mechanical ventilation, location of the SeO2 probe in the esophagus and the touch pressure between the probe and esophageal wall can influence SeO2 signals.
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Animals , Dogs , Female , Male , Aorta, Thoracic , Physiology , Biosensing Techniques , Methods , Blood Gas Analysis , Methods , Esophagus , Oximetry , Methods , Oxygen , Blood , Signal Processing, Computer-AssistedABSTRACT
Objective To study the biological characteristics of arsenic resistance cell model chronic arsenic exposure human bone marrow mesenchymal stem cells (CAsE-hFBMSCs) and discuss the consequence of chronic arsenite exposure to human mesenchymal stem cells (hFBMSCs). Methods hFBMSCs cultivated under general conditions,hFBMSC cell survival rate was detected in 48 hours with arsenite toxicity test under different doses arsenic [0(control),0.25,0.50,1.00,2.00,4.00,8.00,20.00,40.00,80.00,120.00 μmol/L]of the fist 2-generation(P2). According to the test results,1.00 μmol/L sodium arsenite was chosen to stimulate hFBMSCs for 14 weeks as experimental group,simultaneous 0 μmol/L sodium arsenite as the control group. And then,the phenotype was detected by fluorescence-activated cell sorting,and the cell cycle by flow cytometry. Finally,the cell malignant transformation was detected by soft-agar assay. Results Arsenite low than 10 μmol/L promoted cell proliferation,but inhibited cell proliferation when exceeding 10 μmol/L. Half of the lethal dose (LC_(50)) in experimental and control groups were (89.42±0.64),(52.48±0.71)μmol/L. The difference between two groups was statistically significant(t = 123.89,P < 0.05). The phenotype of CAsE-hFBMSCs was CD29,CD90,CD166 positive and CD34,CD45 negative. The phenotype of CAsE-hFBMSCs was the same as the control. Comparing to control group[(8.44±0.45)%,(9.14μ0.14)%,(82.42±0.60)%],G2/M phage[(17.72±5.47)%]and S phage [(25.34±3.36)%]cell increased,G0/G1 phage[(56.96±8.83)%]cell decreased in P2 CAsE-hFBMSCs. The cell cycle became nearly the same as the control group after adaption. CAsE-hFBMSCs did not show clone formation in soft agar clone formation assay. Conclusion Long last and low level exposure to arsenite does not influence the biologic features of hFBMSCs.
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<p><b>OBJECTIVE</b>To investigate the impact of antihypertensive medication timing on degree and stability of blood pressure (BP) lowering in patients with moderate and severe essential hypertension.</p><p><b>METHODS</b>Ninety patients were randomly assigned to take Valsartan and Felodiping together in the morning (group A), Valsartan in the morning and Felodiping in the evening (group B) or Felodiping in the morning and Valsartan in the evening (group C, n = 30 each). The morning dosage was titrated if the goal blood pressure was not achieved. Ambulatory blood pressure monitoring (ABPM) was performed on the first and 14(th) day of medication.</p><p><b>RESULTS</b>The BP reductions during nighttime and twenty-four in group B and C hours were similar (P > 0.05) but were significant more than those in group A (P < 0.05). The smoothness indexes of mean systolic, mean arterial blood pressure during nighttime and twenty-four in group B and C were similar but significantly higher than that in group A (P < 0.05). The smoothness index of diastolic pressure at nighttime in group B and C was similar but significantly higher than that in group A (P < 0.05).</p><p><b>CONCLUSION</b>More significant and stable antihypertensive effects could be achieved by taking the two antihypertensive medications separately in the morning and at evening compared that taken the two drugs together in the morning.</p>
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Humans , Antihypertensive Agents , Blood Pressure , Drug Administration Schedule , Drug Therapy, Combination , Felodipine , Hypertension , Drug Therapy , Tetrazoles , Valine , ValsartanABSTRACT
Diabetes mellitus has become one of the diseases which threaten the heath of human being in the 21st century.A goal of research in diabetes is to find a way to increase the number of functional insulin-producing cells. Islet transplantation has been considered to be the most effective approach to cure type Ⅰ and part of type Ⅱ diabetes mellitus.This approach, however, is severely limited by an inadequate supply of donor islets available for transplantation.Moreover, recent progress of stem cells research has shown that stem cells may act as a new source of islet transplantation in diabetes mellitus treatment. Recent evidence indicates that Glucagon-Like PeptideⅠ(GLP-1) plays a very important role in targeted differentiation of stem cells into Insulin-Producing Cells and pancreatic development. GLP-1 is an intestine-derived insulinotropic hormone that stimulates glucose dependent insulin production and secretion. GLP-1 can induce differentiation of stem cells into insulin-producing cells, which is achieved by up regulation of PDX-1 expression.PDX-1 is a transcription factor critical for pancreatic development and endocrine cell neogenesis and a marker for pancreatic stem cells. These new findings suggest an approach to create Insulin-Producing cells in vitro by expanding stem/progenitor cells and then to convert them into Insulin-Producing cells by treatment with GLP-1. Thus GLP-1 may be a means by which to create Insulin-Producing cells ex vivo for transplantation into patients with insulinopenic type Ⅰ diabetes and severe forms of type Ⅱ diabetes. This article reviews recent progress about GLP-1 and targeted differentiation of stem cells induced by GLP-1.