Development of a database for war wound / 军事医学

Objective To develop a war wound database that is capable of data acquisition , audit, storage, query and statistical analysis,and can be used to record wounds, diagnosis,treatment and outcomes.Methods Based on requirement analysis and database design , the basic structure and function of this database system were determined before we developed this database system by Java on Oracle 11g.Results The database had eight data modules , including basic information , wounded information , wound conditions , first aid and treatment information , medication information , surgical information , medical evacuation , and operational background .The database management system ( DBMS ) was established , and the functions were ensured .Conclusion The records of war wound in the databases are highly continuous , timely, and standardized .They can adapt to the language of medical support research and war wound treatment research .

Risk factors of perioperative heart failure in elderly patients with femoral shaft fracture / 中国骨伤

<p><b>OBJECTIVE</b>To study the risk factors of perioperative heart failure in the elderly patients with femoral shaft fracture by the regression analysis, so as to provide relevant clinical reference.</p><p><b>METHODS</b>From July 2012 to April 2017, 143 elderly patients with femoral shaft fracture who underwent surgical treatment in our hospital were retrospectively studied. Among them, 25 patients with perioperative heart failure included 10 males and 15 females with a mean age of (77.2±12.5) years old; 118 patients without heart failure included 54 males and 64 females with a mean age of (71.1±10.6) years old. The data of the time from injury to operation, hypertension history, heart disease history, disturbance of consciousness, preoperative renal function, operation method, operation time, anesthesia mode, perioperative fluid volume difference, perioperative pain score, postoperative hemoglobin were collected and recorded. The various factors of the two groups were compared, and a multiple factor Logistic regression analysis was performed on the meaningful results in order to identify the independent risk factors.</p><p><b>RESULTS</b>Univariate analysis showed that age, heart disease history, preoperative renal function and perioperative fluid volume had statistical difference between the two groups(<0.05). Multivariate analysis showed that the independent risk factors of perioperative heart failure were age[=0.016,=2.789(1.208, 6.439)], heart disease history[=0.011,=2.878(1.269, 6.527)], preoperative renal function[=0.043,=2.410(1.027, 5.654)], the perioperative fluid volume difference[=0.022,=4.215(1.230, 14.439)].</p><p><b>CONCLUSIONS</b>The age, heart disease history, preoperative renal function and perioperative fluid balance are the risk factors of perioperative heart failure in elderly patients with femoral fracture. During the perioperative period, we should pay full attention to and evaluate the hazards of these risk factors and adopt effective and effective prevention and treatment measures.</p>

Suture anchor for acute injuries of medial collateral ligament of knee at degree III / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate clinical efficacy of suture anchors in treating acute injuries of medial collateral ligament (MCL) of knee at degree III.</p><p><b>METHODS</b>Twenty-seven patients with degree III acute MCL injuries of knee were treated with suture anchors from January 2007 to June 2011. There were 15 males and 12 females, aged from 19 to 56 (averaged 32.6) years old. The time from injury to operation was 3 to 10 days, averaged 6 days. Symptoms and physical signs before and after treatment were observed, Lysholm scoring were used to evluated clinical efficacy.</p><p><b>RESULTS</b>All patients were followed up from 16 to 30 months with an average of 21.6 months. The stability of knee joints was good in all patients. Abduction stress test was negative when the knee joint was straightened at 0 degrees and flexed at 30 degrees. The average degree of flexed knee (67.00 +/- 5.80) degrees preoperatively was lower than that of postoperatively (136.50 +/- 6.30) degrees at 1 year. According to Lysholm scoring, preoperative scores ranged from 30 to 43 points, averaged 36.46 +/- 1.48; 1 year after operation ranged from 87 to 100 with an average of 91.50 +/- 3.80 and higher than postoperative. Twenty patients got an excellent results, 5 good and 2 fair.</p><p><b>CONCLUSION</b>Suture anchors in treating acute injuries of medial collateral ligament of knee at degree III has following advantages: small range of tissue dissection, easy to operate, reliable fixation and less complications.</p>

Clinical apprehension on application of Tri-lock BPS total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study short-term results and clinical application of Tri-lock BPS in total hip arthoplasty.</p><p><b>METHODS</b>From May 2010 to July 2011, 32 hips in 31 patients (18 males and 13 females, ranging in age from 50 to 77 years old, with an average of 60.5 years old) were treated by total hip arthroplasty with Tri-lock BPS, including 8 patients with osteonecrosis (ON), 13 patients with fresh femoral neck fracture, 10 patients with developmental dysplasia of the hip (DDH). The therapeutic effects were evaluated by self assessment form, preoperative and postoperative Harris hip score, radiographs, Engh score and bone in growth of femoral side described by Gruen. Based on the short-term results,its design characteristic and clinical properties were analyzed.</p><p><b>RESULTS</b>All the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. All the patients were followed up with an average time of 12.2 months (ranged, 10 to 14 months). All the joints had good or excellent clinical results. The Harris score increased from preoperative 38.3 +/- 4.9 to 92.5 +/- 11.2 at the latest follow-up (t = 27.53, P < 0.01). Radiographically, the positions of the prostheses were normal,the average limbs length and femoral eccentricity recovered to normal. X-ray of the hips showed that the femoral stem prosthesis was in line with good initial fixed standard. At 3 months after surgery, X-ray of the hips showed that bone in growth in Gruen II and VI of femoral side.</p><p><b>CONCLUSION</b>Short-term results show that the design of Tri-lock BPS is more in line with human anatomy, and has the advantages in rapid recovery of hip function and retains more bone mass. It offers a newly valuable technology for the treatment of osteonecrosis, femoral neck fracture and DDH and so on.</p>

Clinical study on the effects of the femoral attachment site of grafts and the tunnel angle on the function of knee joint after anterior cruciate ligament reconstruction / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of the attachment site of grafts and the tunnel angle on the function of knee joint after anterior cruciate ligament reconstruction.</p><p><b>METHODS</b>From January 2006 to May 2009, 47 patients(32 males and 15 females, ranging in age from 19 to 51 years old, with an average of 35.3 years old) were treated with single-bundle reconstruction of anterior cruciate ligament. Several indexes were measured at the latest follow-up as follow: attachment sites of graft on the femoral condyle were recorded, the femoral tunnel angles on coronal and sagittal planes were measured on postoperative X-ray films. According to the IKDC score, these patients were divided into two groups. In the first group, 38 patients were found the IKDC score more than 90 at the latest follow-up, and in the second group 9 patients were found IKDC score less than 90. By comparing the two groups, the relation of the indexes and postoperative function of knee was analyzed.</p><p><b>RESULTS</b>The IKDC which was more than 90 at the latest follow-up was found in 38 patients, whose femoral attachments site of ACL was positioned at (29.73 +/- 4.31)% (ranged from 16.21% to 53.82%) from the posterior end of Blumensaat's line. IKDC which was less than 90 was found in 9 patients, whose femoral attachments site of ACL was positioned at (46.61 +/- 3.43)% (ranged from 27.18% to 72.34%). There was significant difference between the two groups (P = -0.000 7). The IKDC more than 90 at the latest follow-up was found in 38 patients,whose femoral tunnel angle on coronal plane was (49.5 +/- 4.72) degrees (ranged from 33 degrees to 67 degrees) and on sagittal plane was (31.3 +/- 5.12) degrees (ranged from 11 degrees to 45 degrees) were significantly less than those whose IKDC less than 90 at the latest follow-up on coronal plane was (67.6 +/- 3.09) degrees (ranged from 41 degrees to 81 degrees) and on sagittal plane was (41.2 +/- 5.69) degrees (ranged from 23 degrees to 56 degrees) (P = 0.000 7, P = -0.000 8).</p><p><b>CONCLUSION</b>There is close relation between the attachment site of grafts and the tunnel angle with the function of knee, so in anterior cruciate ligament should be anatomic reconstructed with the anterior medial approach.</p>

Treatment of adolescent clavicular fracture with titanium elastic nails / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the feasibility and clinical effects of titanium elastic nails (TEN) for adolescent clavicular fracture.</p><p><b>METHODS</b>From October 2008 to November 2009, 17 adolescent patients with clavicular fracture were treated with internal fixation, including 11 males and 5 females who ranged in age from 12 to 18 years (mean 15.3 years). The mean time from injury to surgery was 3.5 days (2-7 days). Constant function score before surgery and that 3 months after surgery and shoulder ROM before surgery and that 2 months after surgery were compared. Fracture reduction and healing were followed up by X-rays to analyze internal fixation with the TEN technique.</p><p><b>RESULTS</b>All patients were followed up for a mean of 6.5 months (range 3-8 months), during which no infection, TEN fracture or skin bursting was observed. The Constant score rose from preoperative (45.3 +/- 6.1) to (85.6 +/- 4.3) at 3-month follow up (t = 22.164, P < 0.01),and the shoulder activity degree at 2-week follow up was improved obviosly from preoperative (P < 0.01). X-ray at 12-16 weeks after surgery showed good bone healing and recovery of shoulder function.</p><p><b>CONCLUSION</b>Internal fixation with TEN in the treatment of adolescent clavicular fracture is safe, minimally invasive,reliable and cosmetic. This technique provides a liable ption for the treatment of adolescent clavicular fractire</p>

The cup safe-zone and optimum combination of the acetabular and femoral anteversions that fulfills the desired range of motion of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To investigate safe range of acetabular prosthesis angle and the optimum combination of cup and neck in the range of activities of daily living (ADL).</p><p><b>METHODS</b>A three-dimensional generic parametric and kinematic simulation module of THA was developed. Range of motion (ROM) of flexion > or = 110 degrees, internal-rotation > or = 30 degrees at 90 degrees flexion, extension > or = 30 degrees and external rotation > or = 40 degrees were defined as the normal criteria for desired ROM for activities of daily living (ADL), and ROM of flexion > or = 120 degrees, internal-rotation > or = 45 degrees at 90 degrees flexion, extension > or = 30 degrees and external rotation > or = 40 degrees as the severe criteria. The range of the changes in the general head-neck ratios (GR), the femoral neck anteversion (FA), the operative anteversion (OA) and operative inclination (OI) of the cup component were 2-2.92, 0 degrees-30 degrees, 0 degrees-70 degrees, 10 degrees-60 degrees respectively. For the collodiaphyseal angle (CCD) of 135 degrees, the corresponding OA related to the OI which every 5 degrees was calculated, and described using dots and lines in a coordinate system in which OI of acetabular cup was the horizontal ordinate and OA of acetabular cup was the vertical ordinate. All data was analyzed by SAS 6.12 software.</p><p><b>RESULTS</b>Large GR greatly increased the size of safe range and it was recommended that GR be more than 2.37 when the CCD-angle was 135 degrees as it further increases the size of safezone. The size of cup safety range of the severe criteria was smaller than normal criteria. When the CCD-angle was 135 degrees, the optimum relationship between OA of acetabular and FA of the normal criteria and the severe criteria can be estimated by the formula: Y1=-0.816X1 + 39.76 (R2=0.993), Y2=-0.873X2 + 47.04 (R2=0.999) respectively.</p><p><b>CONCLUSION</b>Large GR greatly increases the size of safe-zone and it is recommended that GR be more than 2.37, so it extends the acceptable range of error that clinicians cannot avoid it completely. The larger range of the hip motion, the smaller size of the cup safe-zone,but can retrieve by increase the GR. The OA is negative with FA.</p>

Effects of diazoxide on the mitochondrial ultrastructure and permeability in donor rat myocardium / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To investigate the effect of diazoxide (DE) on the myocardial ultrastructure and opening of maitochondrial permeability transition pore (MPTP) in donor rat heart suffered from long-term hypothermic preservation.</p><p><b>METHODS</b>The Langendorff model of isolated rat heart was used. The hearts were stored in 4 degrees C Celsior solution containing different concentration of DE (15, 30, or 45 micromol/L) for 9 h followed by 60 min of reperfusion. The recovery of rate-pressure product (RPP) was observed. The opening of MPTP and myocardial mitochondria ultrastructure were also evaluated.</p><p><b>RESULTS</b>(1) As compared with the celsior solution preserved group, DE (30 micromol/L) increased recovery of RPP during reperfusion and inhibited the opening of MPTP. DE also alleviated the myocardial mitochondrial ultrastucture damage induced by long-term hypothermic preservation. (2) The above effects of DE were attenuated by a mitoK(ATP) channel inhibitor 5-hydroxydecanoate and a MPTP opener atractyloside.</p><p><b>CONCLUSION</b>In the donor rat heart, DE protects myocardial mitochondria ultrastructure against long-term hypothermic preservation injury via inhibiting the opening of MPIP.</p>

COX-2 inhibitor nimesulide protects rat heart against oxidative stress by improving endothelial function and enhancing NO production / 生理学报

Since a cyclooxygenase 2 (COX-2) inhibitor can reduce infarct size and improve contractility in ischemic myocardium, the aim of the present study was to explore whether COX-2 inhibitor nimesulide could protect myocardial function against oxidative stress injury in rat hearts, and to investigate the underlying mechanisms. The isolated rat hearts perfused by Langendorff method were exposed to 140 mumol/L of H2O2, and the cardiac contractility was measured. Then, the responses of coronary arteries, precontracted with U-46619, to the endothelium-dependent vasodilator serotonin (5-HT) and the endothelium-independent vasodilator sodium nitroprusside (SNP) were evaluated. The results were as follows: (1) In hearts exposed to H2O2 for 20 min, the left ventricular developed pressure [LVDP, (54.8 +/- 4.0)%] and maximal rate of rise/fall of ventricular pressure [+/-dp/dt(max), (50.8 +/- 3.1)% and (46.2 +/- 2.9) %] were reduced compared with that in the control group (100%). After pretreatment with nimesulide (5 mumol/L) for 10 min before H2O2 perfusion, LVDP and +/-dp/dt(max) were enhanced to (79.9 +/- 2.8)%, (80.3 +/- 2.6)% and (81.4 +/- 2.6)%, respectively (P<0.01), and this was partially abolished by the nitric oxide synthase (NOS) inhibitor L-NAME [(60.2 +/- 2.1)%, (63.9 +/- 2.4)% and (63.1 +/- 2.9)%, respectively, P<0.01]. (2) The vasodilatation induced by 5-HT and SNP in H2O2-treated group was significantly less than that in the control group. Pretreatment with nimesulide for 10 min antagonized the decrease of endothelium-dependent vasodilatation in H2O2-treated group [(-22.2 +/- 4.2) % vs (-6.0 +/- 2.5) %, P<0.01], but had no effect on the decline of endothelium-independent vasodilatation [(-2.0 +/- 1.8)% vs (-7.0 +/- 3.5) %, P>0.05]. (3) Pretreatment with nimesulide for 10 min increased the NO production in H2O2-treated hearts [(2.63 +/- 0.40) vs (1.36 +/- 0.23) nmol/g protein, P<0.05], and this was inhibited by L-NAME. (4) Pretreatment with the selective COX-1 inhibitor piroxicam had no effect on LVDP and +/-dp/dt(max) in isolated hearts exposed to H2O2, but the left ventricular end diastolic pressure (LVEDP) was much higher than that in the group treated with H2O2 alone. Piroxicam did not influence the coronary resistance in H2O2-treated rat hearts. These data suggest that the COX-2 inhibitor nimesulide improves myocardial function in rat hearts suffering from oxidative stress, and this may be through an improvement in endothelium-dependent arterial relaxation and an enhancement of NO production in rat heart.