Transferring fascicles of obturator nerve restoring vesical branch of pelvic nerve to treat the micturition function of patients caused by sacral plexus injury / 中华骨科杂志

Objective To explore the feasibility of transferring of the obturator nerve onto the vesical branch of pelvic nerve with direct anastomosis,in order to restore the automatic micturition function of patients with bilateral lower sacral plexus injury (S2-S4).Methods Data of five patients (4 males and 1 female) with bilateral lower sacral plexus injury who had surgery from May to July 2018 were retrospectively analyzed.The average age was 26 years old (range,23-30 years old) and the average delay from injury to operation was 10.2 months (range,7-14 months).Three patients suffered with fell off injury and two patients had car accident injury.All patients presented with continence and the urodynamics revealed flaccid neuropathic bladder with neurogenic adynamia of detrusor muscle.The vesical branch of pelvic nerve was dissected between the bladder and the ureter where it entered the bladder neck from backward to forward almost vertically.The obturator nerve was dissected along the pelvic sidewall,and the comparable bundle branch of obturator nerve was transferred onto the vesical branch of pelvic nerve with direct anastomosis.The diameter and freed length of pelvic nerve and the fascicles of the obturator nerve were measured intraoperatively,and the cutaneous sensation of medial thigh and the muscle strength of hip adduction were evaluated postoperatively.Results The surgery was performed through the traditional abdominal paramedian approach in 3 patients and through the pararectus approach in 2 patients.The vesical branch of pelvic nerve in all five patients could be revealed clearly and there was enough operative space for nerve transferring.The surgery was successful in all five patients without any complication.The donor nerves were anterior branch of obturator nerve in 2 patients,posterior branch of obturator nerve in 1 patient,2/3 fascicles of anterior branch of obturator nerve in 1 patient and 2/3 fascicles of posterior branch of obturator nerve in 1 patient.The average length and diameter of freed fascicles of obturator nerve were 2.28 cm (range,1.9-2.6 cm) and 1.36 mm (range,1.2-1.5 mm).The average length and diameter of pelvic nerve were 2.46 cm (range,2.2-2.7 cm) and 1.2 mm (range,1.1-1.3 mm).The vesical branch of pelvic nerve and the bundle branch of the obturator never were comparable and anastomosed free of tension.The sensation of medial aspect of thigh was almost normal and the muscle strength of hip adduction was M4 postoperatively.Conclusion The vesical branch of pelvic nerve can be well exposed via pararectus approach.Transferring of the fascicles of obturator nerve onto the vesical branch of pelvic nerve is feasible and safe.

Application of FOCUS-PDCA Cycle Management in Reducing the Incidence of Irrational Medical Orders of Parenteral Nutrition / 中国药房

OBJECTIVE:To reduce the incidence of irrational medical orders for parenteral nutrition,and promote the rational use of parenteral nutrition. METHODS:The medical orders for parenteral nutrition of the first quarter of 2016 in general surgery de-partment of our hospital were collected,and the number and types of its irrational medical orders were summed up. Then FO-CUS-PDCA(Find-organize-clarify-understand-select-plan-do-check-act)cycle management was adopted to analyze and improve the existing problems in issuing medical orders for parenteral nutrition. The improved(the third quarter of 2016)medical orders for par-enteral nutrition were collected,the number and types of its irrational medical orders were summed up,and management effect was evaluated. RESULTS:Establishing nutrition support group,strengthening the training and communication of medical staff,adding prescription evaluation module for parenteral nutrition in hospital information system and a number of measures had made the inci-dence of irrational medical orders for parenteral nutrition in general surgery department declined from 48.25%(1433/2970)before improvement to 5.67%(120/2118)after improvement. The incidences of cation excess,inappropriate selection of drugs and inap-propriate compatibility in irrational types were 0. CONCLUSIONS:FOCUS-PDCA cycle management can reduce the irrational rate of medical orders for parenteral nutrition and promote the rational use of parenteral nutrition in hospital.

Applications and effect evaluations of continued nursing care in functional rehabilitation after limbs intra-articular fracture operation / 中国实用护理杂志

Objective To explore the influences of continued nursing care on the recovery of intra-articular fractures of joint function of limbs and the quality of life after operation. Methods A total of 493 intra-articular fracture of limbs postoperative patients,who were discharged from our department from January 2015 to December 2016,were randomly divided into observation group and reference group.After operation,the reference group used self-management mode to practice joint functional exercise,while the observation group uses continued nursing mode to guide physical therapy to recover joint functions.After they discharged 12 weeks,we compared these two groups of patients with satisfaction of nursing care,joint function recovery and quality of life. Results After 12 weeks of operation, in observation group, the patients' joint function recovery rate was close to 79.27%(195/246), which was significantly higher than the rates 55.47%(137/247)in reference group,the difference was statistically significant(χ2=32.947,P<0.01). Respectively, the physiological function score,vigor score, mental health score, physiology role score, body pain score, health condition score, social function score and health score of the observation group in the quality of life assessment were (72.66 ± 4.41), (89.27 ± 4.10), (93.01 ± 3.05), (88.03 ± 3.19), (91.68±3.99),(76.78±4.86),(79.11±4.68),(85.57±7.07).The scores of control groups were(65.71±3.41),(64.02±4.51),(61.43±4.29),(66.49±4.52),(64.24±4.30),(62.02±6.24),(62.94±4.50),(65.02±7.72).The comparative difference of the two groups has statistical significance (t=12.48- 60.15, P<0.05). Meanwhile,in the satisfaction rate of nursing care,the great satisfaction rate of observation group(70.73%, 174/246) was much higher than reference group (37.65%, 93/247), the difference was statistically significant (χ2=59.789, P<0.01). Conclusion Offered outside continued nursing care to the intra-articular fracture of limbs postoperative patients can effectively improve the joint function of patients,their qualities of life and can considerably increase satisfaction of nursing care. Thus,it should to be clinically promoted.

Applied anatomy study of posterior approach via sacrectomy for reaching the deep intrapelvic sacral plexus / 中华外科杂志

Objective@#To observe the possibility of posterior approach via sacrectomy for reaching intrapelvic sacral plexus and expose the deep intrapelvic origin of sciatic nerve from sacral plexus in order to perform nerve graft.@*Methods@#Five adult cadaver specimens were used in the study with prone position in May 2012. Cut off the gluteus maximus along the origins and lift to the lateral side, the piriformis was lay beneath. The sciatic nerve and the inferior gluteal nerve pierced from the infrapiriformis foramen in the operative field. Excise the origin of the piriformis via sacrectomy with osteotome and the length and width of the insertion on sacrum were measured. The piriformis was resected and then the sacral nerve roots beneath were exposed. The S2-S4 sacral nerve roots and the deep intrapelvic origin of sciatic nerve from sacral plexus were revealed after carefully dissecting. From July 2012 to June 2016, nine patients with lumbosacral plexus injury were performed surgery through the posterior approach in Department of Hand Surgery, Beijing Jishuitan Hospital.There were 6 male and 3 female patients, with a mean age of 29 years. All patients were diagnosed as upper and lower sacral plexus injury, in one of them combing with contralateral lower sacral plexus injury. The average time from injury to operation was 8.3 months.@*Results@#The length and width of the piriformis insertion on sacrum were (3.44±0.15) cm and (2.42±0.11) cm, respectively. The deep intrapelvic origin of sciatic nerve from sacral plexus in all nine patients can be revealed clearly and there was enough operative space that nerve transfer or graft can be performed through the posterior approach via sacrectomy. The total blood loss during operation was (1 822±1 523) ml.@*Conclusion@#The piriformis and part of sacrum it attached can be resected safely through the posterior approach and the deep intrapelvic sacral plexus and the origin of sciatic nerve can be well exposed.

The influence of probucol combined with atorvastatin on plasma levels of oxidative low density lipoprotein and lipoprotein-associated phospholipase A2 in patients with acute coronary syndrome after percutaneous coronary intervention / 天津医药

Objective To evaluate the effects of probucol combined with atorvastatin medication on blood levels of oxidized low-density lipoprotein (ox-LDL), lipoprotein-associated phospholipase A2 (Lp-PLA2), and the correlation of their changes in patients with acute coronary syndrome (ACS) undergoing percutaneous poronary intervention (PCI). Methods A total of 97 patients with ACS and undergoing PCI were randomly divided into two groups according to the date of admission:single medication group (n=42),the patients were taken atorvastatin 20 mg/d; and combined medication group (n=55),the patients were taken atorvastatin 20 mg/d with probucol 500 mg/d. The plasma levels of ox-LDL and Lp-PLA2 were measured in both groups before and 6-8 weeks after the medication. Then the results were compared and analyzed between two groups. Results (1) Before treatment there were no significant differences in levels of ox-LDL and Lp-PLA2 between two groups (P>0.05). After the treatment, the ox-LDL level was significantly decreased in combined medication group (P<0.01). After the treatment, the levels of Lp-PLA2 were significantly decreased than those before treatment in both groups (P<0.01). Compared with single medication group, levels of ox-LDL and Lp-PLA2 were significantly lower in combined medication group (P < 0.01). (2) After treatment, the absolute value of Lp-PLA2 decline (ΔLp-PLA2) was positively correlated with the absolute value of ox-LDL decline (Δox-LDL) in combined medication group (r=0.314, P=0.020). Conclusion Probucol combined with statin therapy can reduce ox-LDL and Lp-PLA2 levels, and with a positive correlation between them. Probucol can further decrease the level of Lp-PLA2 by inhibiting ox-LDL production, which may be one of the mechanisms of its anti-atherosclerosis.

A proteomic analysis of effects ofβ-elemene on human gastric cancer cell line SGC7901 / 西安交通大学学报(医学版)

Objective To investigate the effect of β-elemene on SGC7901 gastric cancer cell line and the potential proteins involved. Methods Human SGC7901 gastric cancer cells were treated with different concentrations ofβ-elemene.Cell viability was assessed.A proteomic method,isobaric tags for relative and absolute quantitation (iTRAQ),was employed to detect the proteins altered by β-elemene.Protein expression was validated by Western blot.Results β-elemene inhibited the viability of SGC7901 gastric cancer cells in a dose-dependent manner.Altogether,147 upregulated proteins and 86 downregulated proteins were identified in response to β-elemene treatment in SGC7901 gastric cancer cell line.Among them,the expressions of p21-activated protein kinase-interacting protein 1 (PAK1IP1 ),Bcl-2-associated transcription factor 1 (BTF)and topoisomerase 2-alpha (TOPIIα)were validated by Western blot and the trends were consistent with iTRAQ results.Top pathways involved inβ-elemene treatment in SGC7901 gastric cancer cell line included ribosome signaling,peroxisome proliferator-activated receptors (PPARs)signaling pathway,regulation of actin cytoskeleton,phagosome,biosynthesis and metabolism of some amino acids.Conclusion Our results suggest a promising therapeutic role of β-elemene for gastric cancer.The differentially expressed proteins give us better insights into the potential mechanisms involved in gastric cancer treatment using β-elemene.

Effects of ω-3 polyunsaturated fatty acids on the proliferation of human gastric cancer cell line AGS / 西安交通大学学报(医学版)

ABSTRACT:Objective To investigate the effects of ω-3 polyunsaturated fatty acids on the proliferation of human gastric cancer cell line AGS and the possible mechanisms.Methods Human gastric cancer line AGS and human microvascular epithelial cell HMEC-1 were treated with different concentrations of docosdhexaenoic acid (DHA)and eicosapentaenoic acid (EPA).The inhibition of cell proliferation was evaluated by MTT assay and cell morphology.Flow cytometry was used to detect the cell cycle change.The expressions of mitochondrial respiratory membrane protein complex Ⅰ,Ⅱ and V were analyzed with Western blot.Results DHA and EPA could markedly inhibit the proliferation of AGS in significant time-dependent and concentration-dependent manners (P 0.05).Conclusion ω-3 PUFAs can selectively inhibit the growth and proliferation of human gastric cancer cell line AGS.These effects may be as-sociated with arresting cell cycle in G0/G1 phase and inhibiting the energy metabolism of AGS cells.

The effect of combination of docosahexaenoic acid and 5-fluorouracil on the proliferation of human gastric cancer cell line AGS and the expression of mitochondrial respiratory membrane protein complexes / 西安交通大学学报(医学版)

Objective To investigate the inhibitory effects of docosahexaenoic acid (DHA)and 5-fluorouracil (5-FU)in combination on human gastric cancer cell line AGS in vitro .Methods Human gastric cancer line AGS was treated with different concentrations of DHA and 5-FU alone or in combination.The inhibition of cell proliferation was evaluated by MTT assay.Dose of median (IC50 )of drugs (alone or in combination)and the combination index (CI)were calculated using the median-effect equation and the combination index equation of Chou-Talalay.Flow cytometry was used to detect the cell cycle distribution.The expression of mitochondrial respiratory membrane protein complex in AGS cells was analyzed with Western blot.Results DHA and 5-FU alone or in combination could markedly suppress the proliferation of AGS in significantly time-dependent and dose-dependent manners (P <0.05).IC50 values with DHA or 5-FU administered for 24 h and 48 h were 5 1.60 μg/mL (DHA:24 h),34.82 μg/mL (DHA:48 h),45.90 μg/mL (5-FU:24 h),and 1 6.86 μg/mL (5-FU:48 h), respectively.DHA remarkably strengthened the inhibitory effect of 5-FU and decreased IC50 of 5-FU by 3.56 -2.1 5 folds.The combination of DHA and 5-FU showed synergism.Flow cytometry showed that AGS cells treated with DHA and 5-FU were arrested in G0/G1 phase and the proportion of AGS cells in G0/G1 phase increased compared with that in the control group,DHA group and 5-FU group,while the proportion of the cells in S phase decreased significantly (P < 0.05 ).Western blot showed after treatment with DHA and 5-FU for 48 h,the expression of mitochondrial respiratory membrane protein complex was significantly decreased compared with control group,DHA group and 5-FU group (P <0.05).Conclusion DHA could act synergistically with 5-FU in inhibiting the growth of gastric carcinoma cells,and meanwhile decrease the dose of 5-FU.The mechanism may be associated with cell cycle arrest in G0/G1 phase and interference in the energy metabolism of AGS cells due to inhibition of the expression of mitochondrial oxidative respiratory chain complexes by the two compounds.

Nano-collagen artificial bone for alveolar ridge preservation in the Kazakh from Xinjiang Tacheng Region / 中国组织工程研究

BACKGROUND:It is an important issue of alveolar ridge preservation after tooth extraction. Because of the limited treatment and geographical conditions, lack of awareness of oral health, many local people in frontier areas in Xinjiang have poor alveolar ridge that is not of timely repair after tooth extraction. Thus, it is important to find a suitable local and efficient way to save the residual ridge, which has a more practical clinical value. OBJECTIVE:To investigate the feasibility of nano-colagen artificial bone used for alveolar ridge preservation in the Kazakh in Xinjiang Tacheng Region, China. METHODS: Sixty-eight Kazakh patients with bilateral extraction from Tacheng region, Xingjiang Uygur Autonomous Region, China were selected in a self-controled trial. According to the principle of a minimum alocation imbalance index, the experimental side and control side of extraction patients were confirmed. In the experimental side, nano-colagen artificial bone was implanted; while, conventional treatment was done in the control side. Multi-slice spiral CT was used to scan the regions of extraction interest to measure the relative gray value of alveolar bone mineral density immediately and 3 months after implantation. RESULTS AND CONCLUSION:Immediately after implantation, tooth extraction sockets were visible on CT images both in the experimental and control sides; but after 3 months, the extraction sockets became unclear on the CT images, and CT values were close to those of the surrounding alveolar process, but bone tissues were ful of the bone graft area in the experimental side. The alveolar bone mineral density was higher in the experimental side than the control side at 3 months after implantation. These findings indicate that the nano-colagen artificial bone has good clinical achievement in alveolar ridge preservation in the Kazakh in Xinjiang Tacheng Region.

The diagnosis and treatment of suprascapular nerve combined with axillary nerve injuries following the shoulder trauma / 中华骨科杂志

Objective To expore the effect of nerve repair for patients with traumatic suprascapular nerve combined with axillary nerve injuries.Methods Data of 13 cases with traumatic suprascapular nerve combined axillary nerve injuries treated by surgery from June 2003 to September 2011 were retrospectively analyzed.All the cases were males,and the average age was 28 years old.There were 2 cases of neck of scapula fracture combined with clavicle fracture,3 of floating shoulder injury,1 of humerus neck fracture combined with glenoid cavity fracture,3 of clavicle fracture,1 of acromion fracture,2 of shoulder blade fracture and 1 of atlanto-axial vertebral fractures.All the 13 cases performed isolated lost of the function of shoulder abduction and external rotation completely,and the muscle strength of deltoid,the supraspinatus and infraspinatus was M0.The electrophysiological examination showed complete denervation of axillary nerve and suprascapular nerve.The suprascapular nerve was broken in 10 cases in which 6 cases were repaired by 1 band sural nerve graft and 1 case was repaired by 1 band superficial cervical plexus,and 3 cases were irreparable because of the distal avulsion injury from the target muscle,and 3 cases were performed with neurolysis.The axillary nerve ruptured in 12 cases,in which 10 cases was repaired by 2-3 bands sural nerve graft,and fascicles selected from the median nerve were used to neurotize axillary nerve in 2 cases.The neurolysis of axillary nerve was performed at the quadrilateral space in 1 case.10 of the 13 cases had both the suprascapular nerve and axillary nerve ruptured.Results 13 cases were followed up,the follow up period was 36 to 134 months.In 7 cases,the functional recovery of shoulder abduction were 180° and the average external rotation was 56° and the muscle strength of deltoid attained M4.In 5 cases,the average shoulder abduction was 38°;the range of external rotation was-40°-30°,and the muscle strength of deltoid achieved M4 in 1 case,M3 in 2,M2 in 2.There was no improvement in 1 case.Conclusion The suprascapular nerve associated axillary nerve injury should be suspected in the patients with isolated lost the function of shoulder abduction and extemal rotation completely.Repair of axillary nerve and suprascapular nerve by nerve graft simultaneously could achieve good outcome,and early surgery should be conducted.

An assessment of labial bone mass after immediate implant or delayed implant placement in esthetic zone / 中华医学美学美容杂志

Objective To evaluate the alteration of labial bone mass one year after immediate implant or delayed implant placement in esthetic zone.Methods From June 2009 to June 2012,22 patients with 11 immediate implant and 11 delayed implant in the maxillary anterior region were followed up.CBCT images were obtained immediately after surgery and one year after implant placement,the horizontal and vertical alterations of the labial bone were evaluated by image analysis software.Results The 1-year vertical reduction of labial bone after immediate implant placement was statistically significant (P＜0.05),and no significant difference in delayed implant (P＞0.05).The 1-year horizontal reduction of labial bone was statistically significant at coronal and middle of implant,without significant difference at apical of implant.Conclusions Immediate implant can not stop the physical absorption of labial alveolar ridge,and the study can provide reference to achieve esthetics in the anterior region.

Expression of α-B crystalline in triple-negative breast cancer and its significance in targeted therapy / 中国肿瘤临床

Objective: To investigate the expression of α-B crystalline in triple-negative breast cancer (TNBC) and discuss its role in the prognosis and targeted therapy of TNBC by analyzing the correlation amongα-B crystalline and the clinico-pathological indi-ces of breast cancer. Methods:Immunohistochemistry SP assay was used to determineα-B crystalline expression in paraffin-embedded specimens of 30 cases of TNBC and 50 cases of non-TNBC tissues. The differences in protein expressions among tissues were com-pared, and correlation analysis was performed to determine the relationship between protein expression and clinico-pathological indi-ces. Results:The positive expression rate ofα-B crystalline was 66.67%in TNBC (20/30) and 42.00%in non-TNBC (21/50), which in-dicates that the expression is significantly higher in TNBC than in the non-TNBC tissues (χ2=4.566, P0.05), but exhibits a differ-ence in terms of lymph node metastasis and the number of metastasized lymph nodes [P53, Ki67 (P0.05). Conclusion:Significant differences were found inα-B crystalline expression between TNBC and non-TNBC.α-B crystalline is highly expressed in TNBC tissues, and the expression is signif-icantly higher in TNBC tissues than that in non-TNBC tissues.α-B crystalline is associated with poor prognosis of breast cancer. Conse-quently, the overexpression ofα-B crystalline in TNBC may be a reason for unfavorable TNBC prognosis.

The clinical research of restoring the global upper limber function in traumatic total brachial plexus avulsion injuries / 中华骨科杂志

Objective To observe the outcomes of the modified multiple nerve transfer s combined with the late hand function reconstruction to restore the active pick-up function of the paralyzed upper extremity in patients with total brachial plexus avulsion injuries (TBPAI).Methods 33 patients suffered with TBPAI firstly underwent multiple nerve transfers,which including accessory nerve transfers to neurotize the suprascapular nerve to recover the shoulder abduction,contralateral C7 (CC7) nerve transfers via the modified pre-spinal route with direct coaptation to restore lower trunk function and the musculocutaneous nerve was also neurotized by the transferred CC7 nerve via a cutaneous nerve graft to restore the function of elbow flexion,as well as the phrenic nerve transfers to neurotize the posterior division of lower trunk to restore the function of elbow and finger extension.The patients with muscle recovery were selected to perform the hand function reconstruction at the second stage for restoring the active pick-up function.The patients were chosen as followcriterias:the degree of shoulder abduction attained 30°or more,the motor power of elbow,wrist,and finger flexion attained grade M4 or more,elbow and finger extension attained M3 or more.The methods of hand function reconstruction included wrist fusion and flexor carpal ulnaris opponensplasty,in addition to palmar capsulodesis of the metacarpophalangeal joint.Results The mean follow up was 41±7.7 (range,36-73 months) after the first procedure of multiple nerve transfers,the muscle strength of elbow and finger and wrist flexion attained M 4 as well as the elbow and finger extension achieved M3 or more in 10 patients,all of 10 patients achieved 40°-80°shoulder abduction.8 out of 10 patients had performed the second surgical procedure for hand functional reconstruction.6 of them had successfully recovered the active pick-up function.Conclusions The newly designed procedure of multiple nerve transfers could effectively restore the function of shoulder abduction,elbow,wrist,and finger flexion,as well as elbows and finger extension in patients with TBPAI,combined with the hand functional reconstruction,active pick-up function could be successfully reconstructed.

Surgical treatment of shoulder joint posterior dislocation secondary to internal rotation contractnre deformity in brachial plexus birth palsy / 中华显微外科杂志

ObjectiveTo observe the functional recovery of shoulder joint and the reduction of posterior dislocated humeral head in children with shoulder joint internal rotation contracture and humeral head posterior dislocation secondary to brachial plexus birth palsy treated by a modified surgical procedure through the anterior combined posterior approach of the shoulder. MethodsNinteen patients,ranging in age from 2.5 to 8.5 years (average 5 years),suffered posterior dislocation of the shoulder joint secondary to internal rotation contracture in brachial plexus birth palsy. The gleno-humeral joint deformity was confirmed by X-ray and CT examination and classified as type Ⅳ in 15 eases and typeⅤin 4 cases according to the modified water's criteria.The surgical procedure was as follows:the contracture soft tissue around the anterior of shoulder joint was released firstly through the anterior approach, and the posterior-inferior capsule of the shoulder was exposed and separated with the pseudoglenoid through the posterior approach,the humeral head was reduced by external rotation the arm,then the posterior-inferior capsule was retighten.A plaster cast was used to fix the shoulder at the neutral position of 0° for 4 weeks. ResultsAfter 12 to 36 months follow up(average of 20 months), the Mallet score of the shoulder was from 11.4 ± 1.7 (range 7-16)preoperative to 15.5 ± 1.8(range 13-19) postoperative,the difference was significantly (P ＜ 0.05).The central relocation of humeral head was achieved in 16 patients, but the humeral head was still dislocated to posterior in 3 cases.ConclusionsThe posterior-inferior capsule was separated with the pseudo-glenoid and retighten through the posterior approach,and reduction of the humeral head by soft tissue releaseing through the anterior approach can recover the concentric relationship of gleno-humeral joint and improve the function of shoulder joint with posterior dislocation secondary to internal rotated contracture deformity in brachial plexus birth palsy.

Clinical typing of lumbosacral plexus nerve root injury caused by trauma / 中华骨科杂志

ObjectiveTo classify the type of lumbosacral plexus nerve root injury.MethodsFrom November 2004 to August 2011,36 patients suffered with lumbarsacral plexus nerve root injury underwent surgical exploration in our department.There were 24 males and 12 females,aged from 7 to 49 years(average,29.5 years).By inductively analyzing the location and amount of nerve root injury,preoperative clinical manifestations and results of physical examination,the clinical typing of lumbarsacral plexus nerve root injury was made.ResultsLumbosacral plexus nerve root injury was classified into 6 types:total lumbosacral plexus nerve root injury (4 cases),lumbar plexus and upper sacral plexus nerve root injury (6 cases),sacral plexus nerve root injury (9 cases),upper sacral plexus nerve root injury (11 cases),lower sacral plexus nerve root injury(4 cases) and lumbar plexus injury(2 cases).There were 19 patients with total lumbosacral plexus nerve root injury,lumbar plexus and upper sacral plexus nerve root injury or sacral plexus nerve root injury,among which 73.7％(14/19) nerve root injury located in the spinal canal and all of them were nerve root avulsion or rupture.There were 17 patients with upper sacral plexus nerve root injury,lower sacral plexus nerve root injury or lumbar plexus nerve root injury,among which 64.7％ (11/17) nerve root injury located in intro-pelvic or pelvic sacral foramina,and all of them were distraction injury.ConclusionThis clinical typing is useful for the accurate diagnosis of lumbosacral plexus nerve root injury.In addition,it is also beneficial for judging the location and characteristics of nerve root injury.

Medium term follow-up of phrenic nerve transfer to the posterior division of lower trunk to recover elbow and finger extension in patients with brachial plexus root avulsion / 中华骨科杂志

Objective To observe effect of phrenic nerve transter to the posterior division ot lower trunk (PDLT) for recovering elbow and finger extension in patients with brachial plexus root avulsion.Methods From June 2005 to December 2008,43 patients with brachial plexus root avulsion were treated with phrenic nerve transfer to PDLT to recover elbow and finger extension.There were 36 males and 7 females,aged from 4 to 44 years (average,23.5±9.9 years).The interval from injury to operation ranged from 1 to 12months (average,3.7±1.9 months).There were 32 cases of total nerve roots avulsion,5 cases of middle and lower trunk avulsion accompanied with upper trunk normal or partial injury,and 6 cases of C6 to T1 nerve root avulsion accompanied with C5 nerve root rupture or partial injury.The normal function of the phrenic nerve in the injured side should be proved preoperatively by radiographic and electromyographic examination.The entire brachial plexus in injured side was exposed through the combined incision.The posterior division of lower trunk was identified and severed as proximal as possible,and the posterior cord and radial nerve were dissociated distally until to the level of midpoint of humerus.Then the branches of the posterior cord except the radial nerve were sectioned.Direct anastomosis of the phrenic nerve and PDLT was performed in 33 patients,and indirect anastomosis through bridge grafting using sural nerve was performed in remaining 10 cases.Results All patients were followed up for 36 to 73 months (average,39.7±7.l months).The percentage of muscle strength ≥grade 3 in elbow,finger and thumb extension was 81.6％,41.9％ and 39.5％,respectively.Conclusion Satisfactory functional recovery of elbow extension had been achieved after the phrenic nerve transfer to the PDLT in patients with brachial nerve root avulsion injury,however,the functional recovery of finger and thumb extension was not as satisfactory as anticipated.

Speech Therapy for Early Cleft Palate Postoperative Children / 中国康复理论与实践

@#Objective To study the early language development for children with cleft lip and palate. Methods 105 non-intellectual and hearing impairment children who has done cleft palate operation, accepted one-to-one treatment mode for speech rehabilitation, once or twice a week, 30~45 min each time. Results The speech articulation of all the children improved (P<0.001). Conclusion Early surgery can restore the palatopharyngeal closure function and get better voice as soon as possible.

Application of diffused optical tomography with ultrasonography in differential diagnosis of breast neoplasms / 中华超声影像学杂志

Objective To explore the value of diffused optical tomography(DOT)with ultrasonography (US)in differential diagnosis of breast benign from malignant neoplasms.Methods One hundred ard twenty-three breast neoplasms from 113 patients were checked use the optical tomography image ultrasonography(OPTIMUS).The diagnosis results of the system were compared with pathological study.Two-dimensional ultrasound features in breast neoplasms were digitalizated,and HBT and SO_2 were detected by DOT.At last,synthesis diagnostic index(SDI)was obtained by both US and DOT.Statistic process was carried out in sensitivity,specificity,and the rate of accuracy respectively by US,DOT and OPTIMUS system.Results Among breast neoplasms of 123 mass studied pathologically,78 of them were benign and the rest were malignant.HBT in benign lesions(153.02±105.78)was significantly less than malignant lesions(232.95±78.22),SO_2 in benign lesions(1.0332±0.1641)was significantly elevated compared with malignant lesions(0.8794±0.1814),SDI in benign lesions(147.26±53.76)was significantly less than malignant lesions(243.98±57.27),significant differences were found between the two groups(P＜0.05).The sensitivity of differential diagnosis of breast neoplasms by the OPTIMUS system was 93.33%,the specificity was 83.33%,and the rate of accuracy was 86.99%.Conclusions OPTIMUS can improve the specificity and the rate of early diagnosis.

Prevention and management of the complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury / 中华骨科杂志

Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years (range, 3 months to 56 years). The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%(22/425). The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner's sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route.

Genotype and Drug Resistance of ?-Lactamases in Escherichia coli / 中华医院感染学杂志

OBJECTIVE To study the antibiotic sensitivities and characterization of ?-lacamase activity and the antibiotic resistance mechanisms.METHODS The extended-spectrum ?-lactamases were detected.Agar dilution method was used to determine the minimum inhibitory concentration(MIC)of severel antibiotics.The plasmids of clinical isolates were cloned into competent cells(K-12).RESULTS Isoelectric focusing(IEF):The last 5 clinical isolates have all got an activity at a high pH 9 which could be presumptively identified as AmpC.The last two clinical isolates had a weak activity with pH of about 8.0,which belonged to SHV type ?-lactamases.All the isolates had a group of activities at the lower pH range of the gel(pH5).These could be presumptively identified as TEM ?-lactamases.CONCLUSIONS The data suggest that each isolate clearly originate from the same population but possess mutations that leads to antibiotic resistance.The combinations of mutations in same isolates suggest that an earlier strain have infected other compartments and become the founder for later antibiotic resistant variants.