Multidisciplinary team strategy for treatment of diabetic foot / 中华普通外科杂志

Objective:To explore the team construction and treatment strategy of the Diabetic Foot-Multidisciplinary Team.Methods:The clinical data of 19 patients with severe ischemic diabetic foot treated by our Diabetic Foot-Multidisciplinary Team Center from Apr 2021 to Mar 2022 were collected, and the overall amputation rate, above-ankle major amputation rate, minor amputation rate and mortality, Diabetic Foot-Multidisciplinary Team consultation discipline participation rate and treatment participation degree were retrospectively analyzed.Results:Nineteen patients (15 males and 4 females) were enrolled, aged 26 to 94 (68.6±14.2). All were with severe ischemic diabetic foot ulcer:Rutherford grade 5 or up and dysfunction in 2 or more organs. Complications included arteriosclerosis obliterans of the lower extremities in 18 cases, heart diseases in 18, hypertension in 15, and renal insufficiencies in 10. The overall amputation rate was 36.8%, major amputation rate in 21.1%, minor amputation rate in 15.8%, and mortality rate was 15.8%. A total of 16 disciplines participated in Diabetic Foot-Multidisciplinary Team; the main participating disciplines were vascular surgery (19 times), endocrinology (12 times), and cardiology (11 times). The main treatment disciplines were vascular surgery (14 times), plastic surgery (3 times), and cardiology (2 times).Conclusion:For the diagnosis and treatment of diabetic foot, it is necessary to set up a multidisciplinary team as early as possible to control the causes of diabetic foot ulcer, prevent the recurrence of diabetic foot ulcer, reduce the mortality and amputation rate, and improve the quality of life of patients.

The clinical value analysis of MRN on diagnosis and treatment of lumbosacral nerve injury associated with sacral fractures / 中华骨科杂志

Objective:To discuss the clinical value of magnetic resonance neurography (MRN) on diagnosis and treatment of lumbosacral nerve injury associated with sacral fractures and analyze the characters of nerve injury which was caused by sacral fractures.Methods:The clinical data of 40 patients who had lumbosacral nerve injury associated with sacral fractures and accepted treatment in Tianjin hospital from August 2018 to December 2020 were collected based on inclusion and exclusion criteria. Twenty-four patients had unilateral sacral fractures (Tile C1) which included 16 Denis II type fractures and 8 Denis III type fractures. Sixteen patients had bilateral sacral fractures which were all Tile C3, U shaped and Denis II type sacral fractures. All patients had symptoms or signs of lumbosacral nerve injury, and accepted contrast-enhanced three-dimensional magnetic resonance neurography (CE-3D MRN) to diagnose the injury part and severity degree. The L 5-S 4 nerves were separated to three parts based on injured side and intraspinal type (IS), intraforaminal type (IF) and extraforaminal type (EF) location, and were judged the mild, medium or severe degree of nerve injury severity. Overall and pairwise Chi-square test was performed on the number of nerve injuries. Eleven patients accepted the operation of nerve dissection and exploration. The nerve injury part and severity were recorded under direct vision, and were statistically analyzed with CE-3D MRN outcome. Results:The outcome of 239 lumbosacral nerve injuries which had different part and severity were found by MRN, and all combined with sacral fractures of the same side. The nerves which ranked from largest to fewest according to injured numbers were L 5, S 1, S 2, S 3 and S 4. The statistical analysis showed that there were significant differences of injured nerve numbers except between S 1 and S 2, S 3 and S 4, and there were no significant difference of nerve injury part and severity degree between the direct visual judgement intraoperatively and preoperative CE-3D MRN examination. Conclusion:MRN can reveal the part and severity degree of lumbosacral nerve injury associated with sacral fracture clearly and accurately, which has important clinical value and should become the preferred examination of such injuries. The lumbosacral nerve injury has the most frequent features of S 1 and S 2, followed by L 5, and the least in S 3 and S 4.

Efficacy of combined local flaps in repair of larger defects in the nasal and perinasal region after Mohs micrographic surgery in 11 cases / 中华皮肤科杂志

Objective:To investigate efficacy and advantages of combined local flaps in repairing large defects in patients with nasal and perinasal non-melanoma skin cancers after Mohs micrographic surgery.Methods:From March 2018 to November 2020, 11 patients with nasal and perinasal non-melanoma skin cancers, who underwent Mohs micrographic surgery followed by repair with combined local flaps, were collected from Department of Dermatology, the Second Hospital of Hebei Medical University. According to the location and size of postoperative defects, flaps were designed based on the nasal aesthetic subunit principle. For large defects that could not be directly sutured or covered by a single local flap, 2 or 3 kinds of flaps were applied in combination, such as kite flap, modified diamond flap, nasolabial skin flap, bilobed skin flap, etc.Results:Among the 11 patients, 10 were diagnosed with basal cell carcinoma and 1 with squamous cell carcinoma, and the area of defects ranged from 2.0 cm × 2.3 cm to 2.7 cm × 3.6 cm. After Mohs micrographic surgery combined with local skin flap repair, all skin flaps survived well without blood supply obstruction, the texture, color and contour of the skin flaps were similar to those of the surrounding normal skin, and no obvious scars were formed. During the postoperative follow-up of 4 to 32 months, no recurrence of the tumors occurred, and the patients was satisfied with the appearance.Conclusion:To repair large defects using combined skin flaps of 2 or 3 kinds after Mohs micrographic surgery in patients with nasal and perinasal non-melanoma skin cancers can maintain the normal nasal or perinasal morphological structure and aesthetic appearance, and yield a satisfactory cosmetic effect.

Lamotrigine-induced drug eruptions / 中华皮肤科杂志

Lamotrigine is a new type of drug for the treatment of epilepsy, bipolar affective disorder and neuralgia. Drug eruptions are the common adverse reaction to lamotrigine, such as fixed drug eruption, acute generalized exanthematous pustulosis, toxic epidermal necrolysis, drug-induced hypersensitivity syndrome, etc. The pathogenesis of lamotrigine-induced drug eruptions includes immune and non-immune mechanisms. HLA alleles are related to drug eruptions caused by lamotrigine, and their relationship varies with the race of populations and type of drug eruptions. This review summarizes the etiology, pathogenesis and clinical characteristics of drug eruptions caused by lamotrigine, aiming to guide clinical treatment.

Evaluation of sequential application of epidermal growth factor receptor-tyrosine kinase inhibitor(EGFR-TKI) after chemotherapy in advanced non-small cell lung cancerpatients with EGFR-TKI acquired resistance / 中国医师进修杂志

Objective@#To explore the therapeutic efficacy and safety of chemotherapy sequential epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) for advanced non-small cell lung cancer (NSCLC) patients with EGFR-TKI acquired resistance.@*Methods@#The clinical features of 96 advanced NSCLC patients with EGFR mutation positive and EGFR-TKI acquired resistance from January 2013 to December 2016 were retrospectively reviewed. Forty-five patients who received chemotherapy sequential EGFR-TKI were enrolled in observation group, and another fifty-one who accepted chemotherapy alone were enrolled in control group. The objective response rates, disease control rates and adverse effects were compared between two groups.@*Results@#Compared with that of the control group, the objective response rate of the observation group was significantly higher [24.4% (11/45) vs.11.8% (6/51), P=0.037], the disease control rate was also significantly increased [77.8% (35/45) vs.52.9% (27/51), P=0.023], the progression free survival was obviously prolonged [(7.4 ± 2.0) months vs.(4.5 ± 1.2) months, P=0.029], the incidence of rash in adverse reactions was significantly increased [35.6% (16/45) vs. 7.8%(4/51), P=0.008]. There were no significant difference in the side effects between the two groups (P > 0.05).@*Conclusions@#Compared with chemotherapy alone, chemotherapy combined with sequential EGFR-TKI could bring better clinical efficacy for NSCLC patients with EGFR-TKI acquired resistance, and the adverse effects could be tolerated.

Clinical analysis of cranioplasty combined with shunt in the treatment of skull defect complicated with hydrocephalus after craniocerebral trauma / 中国神经精神疾病杂志

Objective To evaluate the clinical efficacy of ventricle -peritoneal or ventricle-atrial shunt in the treatment of skull defect with craniocerebral trauma combined with hydrocephalus in the same period. Methods Sixty-four patients with skull defect after craniocerebral trauma combined with hydrocephalus were randomly divided into observation group (n=32) and control group (n=32) The ventricle-peritoneal or ventricle-atrial shunt and skull repair were conducted simultaneously following surgical operation in observation group whereas ventricle-peritoneal or ventricle-atrial shunt and the skull defect were performed within 3 months and after 3 months following operation, respectively. The hydrocephalus symptoms, prognosis after three months ,clinical outcomes and the postoperative complications were evaluated. Results There was no significant difference in hydrocephalus symptoms between the observation group and control group (χ2=0.005,P>0.05). The GCS score, GOS score and neurological function score after three months were better than those before the treatment in these two groups (P<0.05). These functional parameters were significantly better in the observation group than in control group (P<0.05). The good rate in three months was significantly higher in the observation group than in control group (59.38％vs 31.25％,χ2=7.23, P<0.05). The incidence of complication was 6.25％(2/32) in the observation group, which was significantly lower than that in the control group (31.25％, 10/32) (χ2=7.13, P<0.05).Conclusion Cranioplasty combined with shunt in the treatment of skull defect complicated with craniocerebral trauma-associated hydrocephalus has low postoperative complications, good clinical prognosis and reliable efficacy, which is worthy of clinical application.

Clinical value of Xpert MTB/RIF in the early diagnosis of tuberculous meningitis / 国际检验医学杂志

Objective To investigate the clinical value of Xpert M TB/RIF in the early diagnosis of tuberculous meningitis (TBM ) .Methods Totally 130 patients with central nervous system infection in our hospital from February 2015 to December 2016 were divided into two groups ,65 cases of TBM patients as the TBM group ,65 cases of non TBM patients as the non TBM group . The CSF samples of all patients were respectively detected by acid fast staining ,Roche solid culture and Xpert MTB/RIF assay .The test results were compared .Results With clinical diagnosis as the gold standard ,the sensitivity of Xpert MTB/RIF to detection of TBM was 43 .08% and specificity was 100 .00% .The sensitivity of solid culture to detection of TBM was 58 .46% and specificity was 98 .46% .The sensitivity of acid fast staining to detection of TBM was 9 .23% and specificity was 100 .00% .Based on the re-sults of drug sensitivity test of traditional proportional method ,the sensitivity of Xpert M TB/RIF to detection of rifampin resistance was 88 .89% and specificity was 98 .35% .Conclusion Xpert M TB/RIF is a new diagnostic technique for detecting TBM and ri-fampin resistance in patients .It has the advantages of rapid ,direct ,reliable and high specificity and is worthy of clinical application .

Using T2 weighted magnetic resonance imaging and diffusion tensor imaging to predict functional outcomes for patients with cervical spondyiotic myelopathy / 中华物理医学与康复杂志

Objective To explore the value of quantitative T2 weighted magnetic resonance imaging (T2WI) and diffusion tensor imaging (DTI) parameters for predicting functional outcomes after surgery for cervical spondylotic myelopathy (CSM).Methods One hundred and forty CSM patients received T2WI and DTI before surgery at Tianjin Hospital between April 2014 and April 2016.They were then given systematic rehabilitation treatment after the surgery.The Japanese Orthopaedics Association (JOA) scoring system was applied to evaluate their neurological function before and after the surgery.According to the JOA recovery rate at 1-year follow-up,the patients were divided into a good recovery group (recovery rate≥ 50％) and a poor recovery group (recovery rate ＜50％).Maximum spinal cord compression (MSCC),signal change ratio (SCR),transverse area (TA),apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were compared between the two groups.Receiver operating characteristics (ROC) curves were used to measure the prognostic ability and determine the best cut-off value for each variable.The independent predictors of a poor recovery were estimated using univariate and multivariate analysis.Results ROC analysis showed that the area under the ROC curve (AUC) of MSCC was 0.593.For SCR it was 0.682.For the TA it was 0.706.For the ADC it was 0.719 and for FA it was 0.749.The respective cut-off values were 44％ compression,1.561,0.46 cm2,1.339×10-3 mm2/s and 0.386.FA had the largest AUC,followed by ADC,TA,SCR and MSCC.MSCC and SCR had low discrimination power (AUC＜0.7) in predicting a poor recovery,whereas TA,ADC and FA had moderate discrimination power (AUC 0.7-0.9).Logistic multivariate regression showed that a low JOA score,TA≤0.46 cm2 or FA≤0.386 were independent risk factors for a poor recovery.A predicting model built according to the results of the logistic regression analysis gave an AUC of 0.87,significantly better than that of the JOA score.With a cut-off value of 0.36,the sensitivity and specificity were 80％ and 77％ respectively.Conclusions Combining T2WI and DTI parameters with the JOA score may better predict the recovery of patients with CSM.The values can also provide references for making up rehabilitation plans.

The effect of PIM-1 silence on the growth of human prostate cancer xenograft tumor in nude mice / 天津医药

Objective To study the effect of PIM-1 gene silence by RNA interference (RNAi) on the growth of human prostate cancer xenograft tumor in nude mice. Methods The xenograft tumor model of human prostate cancer was established by injecting PC-3 cells in armpits of 12 nude mice. After modeling, the nude mice were randomly divided into three groups: interference plasmid group (injecting with RNAi recombinant plasmid), empty plasmid group and negative control group (liposome every), 4 mice in each group. Mice were injected every 2 days for 5 times. The tumor volumes of xenografts were measured during experiment, and the curve of tumor growth was drawn accordingly. The quality of tumor was measured, and the inhibitory rate of tumor was calculated at the end of the experiments. The expression levels of PIM-1, c-MYC mRNA and protein in xenograft tumors were detected by real-time PCR and Western blot assay, respectively. Furthermore, immunohistochemistry staining was used to verify the expression of PIM-1. Results The xenograft tumor model of human prostate cancer was established successfully. The volume of tumor was significantly decreased 6 days after the injection treatment in interference plasmid group than that of empty plasmid group and negative control group. The effect of suppressing tumor growth was remarkable. The expression levels of PIM-1 mRNA and protein were down-regulated significantly in interference plasmid group than those of other two groups. The immunohistochemical staining of PIM-1 showed the same changes. There was no significant difference in c-MYC protein level between the three groups. But interestingly, the c-MYC mRNA level was significantly decreased in interference plasmid group than that of other two groups. Conclusion The silence of PIM-1 gene by RNAi recombinant plasmid can result a significant growth suppression of the human prostate cancer xenograft tumors in nude mice. The expression of c-MYC gene is down-regulated at translation level in the therapeutic group concomitantly. PIM-1 may be a promising target of gene therapy for prostate cancer.

Efficacy of quadriceps femoris fasciculation induced by low-current nerve stimulation when used to assist ultrasound-guided lumbar plexus block / 中华麻醉学杂志

Objective To evaluate the efficacy of quadriceps femoris fasciculation induced by lowcurrent nerve stimulation when used to assist ultrasound-guided lumbar plexus block.Methods One hundred patients of both sexes,aged 18-45 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 50-85 kg,scheduled for elective unilateral knee arthroscopy,were selected and randomly divided into 2 groups (n =50 each) using a random number table:ultrasound assisted by nerve stimulator group (group SU) and ultrasound group (group U).The shamrock method was used to perform the ultrasound-guided lumbar plexus block in two groups.In group SU,the nerve stimulator with current 0.35 mA and frequency 1 Hz was used in the process of puncture,and 0.5％ ropivacaine 0.4 ml/kg was administrated when quadriceps femoris fasciculation was induced.In group U,when the tip of the nerve stimulating needle was located around the lumbar plexus,which was confirmed by ultrasound,0.5％ ropivacaine 0.4 ml/kg was administrated.The time of puncture,depth of needle insertion,onset time of block and effective block were recorded.Motor block was assessed using the modified knee score,and the development of complications was recorded within 24 h after block.Results Compared with group U,the onset time of block was significantly shortened,the rate of effective block was increased,the degree of motor block was aggravated (P＜0.05),and no significant change was found in the time of puncture or depth of needle insertion in group SU (P＞0.05).No complications were observed in two groups.Conclusion Low-current (0.35 mA) nerve stimulation-induced quadriceps femoris fasciculation when used to assist location can improve the efficacy of ultrasound-guided lumbar plexus block.

Clinical value of Xpert MTB/RIF in the early diagnosis of tuberculous meningitis / 国际检验医学杂志

Objective To investigate the clinical value of Xpert M TB/RIF in the early diagnosis of tuberculous meningitis (TBM ) .Methods Totally 130 patients with central nervous system infection in our hospital from February 2015 to December 2016 were divided into two groups ,65 cases of TBM patients as the TBM group ,65 cases of non TBM patients as the non TBM group . The CSF samples of all patients were respectively detected by acid fast staining ,Roche solid culture and Xpert MTB/RIF assay .The test results were compared .Results With clinical diagnosis as the gold standard ,the sensitivity of Xpert MTB/RIF to detection of TBM was 43 .08% and specificity was 100 .00% .The sensitivity of solid culture to detection of TBM was 58 .46% and specificity was 98 .46% .The sensitivity of acid fast staining to detection of TBM was 9 .23% and specificity was 100 .00% .Based on the re-sults of drug sensitivity test of traditional proportional method ,the sensitivity of Xpert M TB/RIF to detection of rifampin resistance was 88 .89% and specificity was 98 .35% .Conclusion Xpert M TB/RIF is a new diagnostic technique for detecting TBM and ri-fampin resistance in patients .It has the advantages of rapid ,direct ,reliable and high specificity and is worthy of clinical application .

Clinical value of water exchange colonoscopy / 中华消化内镜杂志

Objective To compare sedated water exchange and conventional colonoscopy in the recovery time,rates of reaching ileocecal valve and adenoma detection.Methods A total of 200 newly diagnosed patients undergoing colonoscopy with routine bowel preparation and propofol intravenous anesthesia were randomly divided into 2 groups:water exchange group (WE) and conventional group,100 patients in each group.The operations were performed by two experienced physicians.The recovery time,rates of reaching ileocecal valve and adenoma detection of each group were analyzed and compared after operation.Results The recovery times of patients in water exchange and conventional groups were 8.08±0.58 min and 12.34±0.72 min,respectively (F =2 147.33,P＜ 0.05).Rates of reaching ileocecal valve were 100.00％(100/100,WE group) and 96.00％ (96/100,conventional group),respectively(x2 =4.17,P＜0.05).Adenoma detection rates of whole colon were 43.00％ (43/100,WE group) and 29.00％ (29/100,conventional group) (x2=4.25,P＜0.05),of which small adenomas (＜ 1.0 cm) accounted for 83.96％ (89/106,WE group) and 70.59％ (48/68,conventional group) (x2 =4.43,P ＜ 0.05),respectively.Adenoma detection rates of proximal colon were 28.00％ (28/100,WE group) and 20.00％ (20/100,conventional group) (x2 =1.75,P＞ 0.05),of which small adenomas (＜ 1.0 cm) accounted for 90.41％ (66/73,WE group) and 74.47％ (35/47,conventional group) (x2 =5.45,P ＜ 0.05),respectively.Conclusion Water exchange colonoscopy can not only shorten the recovery time of patients,but also increase rates of reaching ileocecal valve and adenoma detection.

Effect of sodium arsenite on malignant transformation of human immortalized keratinocyte cell lines / 中国组织工程研究

BACKGROUND:Studies have found that sodium arsenite can cause the malignant transformation and tumorigenicity of HaCaT cels, but whether low concentrations of sodium arsenite can cause the malignant transformation is rarely reported. OBJECTIVE:To study the effect of sodium arsenite on the malignant transformation of human immortalized keratinocyte cel lines. METHODS:HaCaT cels were treated with different concentrations of sodium arsenite. MTT assay was used to determine the effect of sodium arsenite on HaCaT cel morphology and proliferation, flow cytometry used to detect the effect of sodium arsenite on HaCaT cel cycle, and soft agar colony formation experiments assay used to determine the effect of sodium arsenite on HaCaT cel colony formation capacity. RESULTS AND CONCLUSION: HaCaT cels grew wel when the concentration of sodium arsenite was 5 mol/L, but the cel growth was inhibited under intervention with 10 and 50 mol/L sodium arsenite. HaCaT cels treated with 0.1 mol/L sodium arsenite were passaged to the 20th generation, and cel morphology had no notable changes; cels at passage 25 exhibited enlarged size and multiple nucleoli, which had a continued proliferation trend. Compared with the primarily cultured cels, 0.1 mol/L sodium arsenite-treated HaCaT cels at passages 15 and 25 had an increased proportion at S phase and G2/M phase, with strengthened proliferation ability and increased colony-forming efficiency, and moreover, the proliferation ability and colony-forming efficiency of passage 25 cels were higher than those of passage 15 cels. These experimental data show that high concentrations of sodium arsenite reduce HaCaT cel viability, and low concentrations of sodium sulfite have a certain influence on the morphology, cel cycle, proliferation ability and colony-forming efficiency of HaCaT cels, and moreover, the proliferation ability and colony-forming efficiency of human immortalized keratinocytes wil be strengthened with the increase of passage.

Eukaryotic Expression and Immunogenic Research of Recombination Ebola Virus Membrane Protein Gp-Fc / 病毒学报

We used 293 cells to express the recombinant membrane protein of the Ebola virus. Then, the immunogenicity of the recombinant protein was studied by immunized BALB/c mice. According to the codon use frequency of humans, the gene encoding the extracellular domain of the Ebola virus membrane protein was optimized, synthesized, and inserted into the eukaryotic expression plasmid pXG-Fc to construct the human IgG Fc and Ebola GP fusion protein expression plasmid pXG-modGP-Fc. To achieve expression, the fusion protein expression vector was transfected into high-density 293 cells using transient transfection technology. The recombinant protein was purified by protein A affinity chromatography. BALB/c mice were immunized with the purified fusion protein, and serum antibody titers evaluated by an indirect enzyme-linked immunosorbent assay (ELISA). Purification and analyses of the protein revealed that the eukaryotic expression vector could express the recombinant protein GP-Fc effectively, and that the recombinant protein in the supernatant of the cell culture was present as a dimer. After immunization with the purified recombinant protein, a high titer of antigen-specific IgG could be detected in the serum of immunized mice by indirect ELISA, showing that the recombinant protein had good immunogenicity. These data suggest that we obtained a recombinant protein with good immunogenicity. Our study is the basis for development of a vaccine against the Ebola virus and for screening of monoclonal antibodies.

Neurologic function and expression of angiopoietin-1 and its receptor at recovery stage of cerebral hemorrhage after neural stem cell transplantation in rats / 中国组织工程研究

BACKGROUND:Recent studies have found that bone marrow mesenchymal stem cels that culturedin vitro for a long time can naturaly differentiate into neural stem cels, which then differentiate into neurons and glial cels, thereby providing a new therapeutic thinking for Parkinson’s disease, sequela of cerebral infarction, cerebelar atrophy and brain dysplasia. OBJECTIVE:To discuss the influence of neural stem cel transplantation on neurologic function of rats with cerebral hemorrhage at recovery stage and the relevant mechanism of action. METHODS: Sixty male Sprague-Dawley rats were randomly divided into normal group (n=18), cerebral hemorrhage group (n=21) and transplantation group (n=21). Cerebral hemorrhage models were established in the latter two groups using VII type colagen enzyme induction method. At 21 days of modeling, rats in the transplantation group were injected neural stem cels via the tail vein, and those in the other two groups received the same volume of normal saline. At 7, 14, 21 days after cel transplantation, modified adhesive removal test (MST) was employed to evaluate the neurologic function of rats, and then the rats were kiled. RT-PCR was used to detect angiopoietin-1 mRNA expression in the bleeding tissues, and western blot assay was employed to measure tyrosine kinase receptor-2 protein expression. RESULTS AND CONCLUSION:Compared with the normal group, the MST scores in the cerebral hemorrhage group and transplantation group were significantly decreased (P cerebral hemorrhage group > normal group, and there was a significant difference among the three groups (P< 0.05). These findings indicate that neural stem cel transplantation can effectively promote the neurologic recovery of rats with cerebral hemorrhage at recovery stage, and the concrete mechanism may be related to the increase of angiopoietin-1 mRNA and tyrosine kinase receptor-2 protein in the bleeding tissues.

Analysis on the changes of routine blood tests results after therapy of chlorpromazine, clozapine or perphenazine changed to risperidone in schizophrenic patients / 国际检验医学杂志

Objective To study the blood routine tests results change after therapy of chlorpromazine ,clozapine ,perphenazine changed to risperidone in schizophrenic patients .Methods 100 schizophrenic patients in the hospital from March 2014 to March 2015 for treatment were enrolled in the study ,who were treated with chlorpromazine ,clozapine or perphenazine respectively for one course ,and then the therapies were replace by risperdal .Results After treatment ,mean corpuscular volume was significantly grea‐ter ,the number of lymphocytes was significantly higher and intermediate cell number was significantly lower than that before treat‐ment ,the difference was statistically significant(P<0 .05) .Conclusion Leukocyte differentiation change and mean corpuscular vol‐ume increased obviously after therapy of chlorpromazine ,clozapine or perphenazine changed to risperidone in schizophrenic patients .

Closed-loop Titration of Propofol for General Anaesthesia in 20 Cases of the Laparoscopic Cholecystectomy / 医药导报

Objective To evaluate the feasibility of propofol infusion by a closed-loop system for the titration of anaesthetic in laparoscopic cholecystectomy guided by Bispectral Index ( BIS). Methods Forty patients subjected to laparoscopic cholecystectomy randomly allocated into two groups: the control group with opened-loop titratioin of propofol TCI induced at a target of 4 μg?mL-1 and aintained from 2 to 5 μg?mL-1 and the treatment group with closed-loop titration was performed using a proportional differential algorithm.For both groups,the BIS was set at 45-55.Remifentanil TCI was infused at a target of 4 ng?mL-1 and was maintained according to the situation.The change in medial arterial pressure(MAP),heart rate (HR) and BIS were recorded before anesthesia(t0 ),target BIS of 50(t1 ),at tracheal intubation(t2 ),during incision of skin (t3 ),5 min after the operation(t4 ),at t5 of gallbladder removing and at t6 of skin suturing.The dose of propofol was calculated. Results Haemodynamic data were similar between groups during the induction.But MAP was decreased significantly at t1 ,t3 ,t4 , t5 in the control compared with the treatment group (P<0.05).HR changes a lot at t5 in the control compared with the treatment (P<0.05).Total dose of propofol in the treatment group was statistically lower than that in the controls [(110.10± 8.34) vs (120.55±6.26) mg; (603.20±116.55) vs (759.50±116.37) mg,P<0.05)]. Conclusion Automated titration guided by BIS for propofol infusion is feasible without increase in haemodynamic adverse effects and is of less propofol consumption in the laparoscopic cholecystectomy.

Clinical value of the combination of carotid artery ultrasound and TCD in the evaluation of carotid artery stenosis stenting / 中国神经精神疾病杂志

Objective In order to examine the value of the combination of carotid artery ultrasound and Transcrani-al Doppler (TCD) in the evaluation of carotid artery stenosis stenting. Methods Seventy-one carotid stenosis cases con-firmed by digital subtraction angiography (DSA) who had cerebral ischemia symptoms and received stent implantation were reviewed. Carotid artery ultrasound and TCD were adopted to measure the vessel diameter, peak systolic velocity (PSV) of the narrow segment, PSV and pulsatility index (PI) of ipsilateral middle cerebral artery (MCA) before and after the treatment of intravascular stents, and a comparison analysis was made. Results Carotid stent implantation significant-ly improved the inner diameter, PSV of the narrow part, PSV and PI of the MCA on the stenotic side. Inner diameter of the narrow part was 3.13±0.83, 4.77±0.51 and 4.64±0.52 mm at before, one week and one year after the implantation, re-spectively (P<0.05). The PSV of the narrow part was 190.69±113.65, 86.15±30.52 and 90.28±29.79 cm/s at before, one week and one year after the implantation, respectively(P<0.05).PSV of the MCA on the stenotic side was 77.68±14.66, 115.62±22.32 and 108.89±20.29 cm/s at before, one week and one year after the implantation, respectively(P<0.05). PI of the MCA on the stenotic side was 0.81±0.01, 1.07±0.01 and 1.06±0.02 at before, one week and one year after the implantation, respectively (P<0.05). Conclusions The present study demonstrates that the combination of carotid artery ultrasound and TCD can quantitatively detect the vascular structural and hemodynamic improvements following the endo-vascular stenting, indicating that the combination of carotid artery ultrasound and TCD can be used for the accurate as-sessment and follow up of carotid artery stenting treatment.

Dentoalveolar and skeletal changes consequent to maxillary molar distalization with the modified pendulum appliance in classII malocclusion / 安徽医科大学学报

21 classII malocclusion adolescents (9 boys and 12 girls) were selected as the subjects, aged from 10.6 to 14.5 years, and the initial mean age was 12.8 years. All were treated with the modified Pendulum appli-ance. The duration for distalization of maxillary molars was from 3.2 to 5.7 months (4.3 months on average). Lat-eral cephalograms were obtained before and after distalization. Changes produced by the modified Pendulum appli-ance were analyzed with paired t tests. The mean space opening on lateral cephalograms was 7.31 mm, and maxil-lary first molar distalization accounted for 64.8% of the space,with a mean distal crown tipping of 18.64o. The rate of molar movement was 1.27 mm per month. The maxillary first molars intruded 0.69 mm,and the premolars extru-ded 1.02 mm. Lower anterior facial height increased 2.19 mm. The maxillary incisors had increased 3.39oof labial tipping and 1.13 mm of protrusion.

A comparative study of degree of the deltoid ligament injury based on X-ray and MRI after lateral malleolus fracture / 中华骨科杂志

Objective To investigate the value of X-ray and MRI in judging degree of the deltoid ligament injury after lateral malleolus fracture.Methods The data of X-ray and MRI of 41 patients with acute lateral malleolus fracture,excluding patients combined with medial malleolus fracture,were retrospectively analyzed.The medial clear space (MCS) was measured according to the mortise X-rays.The degree of injury of the superficial deltoid ligament and deep deltoid ligament was graded according to MRIs obtained from PACS (picture archiving and communication system) system.Moreover,the correlation between the width of the MCS and the degree of the deltoid ligament injury were statistically analyzed.The classification results of all patients according to the Lauge-Hansen classification based on X-rays and MRIs were recorded,respectively.Results A positive correlation was found between the width of the MCS and the degree of the deltoid ligament injury,and the optimal critical value of MCS was 7.85 mm for diagnosing complete rupture of the total deltoid ligament or the single rupture of the deep deltoid ligament,while 6.48mm for the complete rupture of the superficial deltoid ligament.Based on the MRIs,the accuracy of the results of Lauge-Hansen classification was 58.5％,and the accuracy for predicting the rupture of the deltoid ligament was 82.9％,however the degree of the deltoid ligament injury cannot be distinguished very well.Conclusion The deltoid ligament injury is common in acute lateral malleolus fracture,even though there is no medial malleolus fracture.The X-ray is still the prefenred choice for the evaluation of the ankle fracture; however the MRI is helpful in judging the degree of the deltoid ligament injury.