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Objective:To investigate the therapeutic effect of the fibular head composite flaps for reconstruction of bone and skin defect at medial malleolus in children.Methods:A retrospective case series study was conducted to analyze 5 children (3 males and 2 females, aged 3-12 years) with internal malleolus and skin soft tissue defects admitted to the Yidu Central Hospital of Weifang between March 2010 and June 2018. The medial malleolus was defected (3 children at the right foot and 2 at the left foot) combined with skin defect around the medial malleolus. Dimension of skin defect was 3.0 cm×3.5 cm to 6.0 cm×10.5 cm, and of bone defect was 1.0 cm×1.0 cm to 2.0 cm×3.0 cm. The complex of the vascularized fibular head epiphysis was adopted to repair the defects at one stage. The donor sites were repaired with direct suture in 4 children and with skin graft in 1. Appearance, texture, elasticity and color of the flaps, length of lower limbs, ankle joint deformity, ankle joint range of motion, function of knee and ankle joint evaluated by using American Orthopedic Foot and Ankle Society (AOFAS) score and image change were observed. The flap donor area was evaluated for deformity, pain and sensory abnormality in the common peroneal nerve innervation area, and range of motion.Results:All the composite tissue flap survived with good blood circulation, and the wound healed by first intention. All children were followed up for 6-30 months (mean, 21 months). The appearance of the flap was good, and the texture, elasticity and color were similar to the surrounding area, without cicatricial contracture. The legs were the same length, and there was no deformity of the ankle joint. None had ankle joint deformity, with satisfactory loading and walking function. Comparison of ankle movement before and after operation showed significant differences: dorsal extension angle [(4.4±1.1)° vs. (13.2±2.4)°], plantar flexion angle [(12.4±1.8)° vs. (34.8±4.8)°] (both P< 0.05). Three children were graded as excellent and two good according to AOFAS score. X-ray showed that the gap between ankle acupoints and longitudinal development of the medial malleolus were almost synchronized with the healthy limbs. No signs of joint wear or early closure of epiphysis of medial malleolus was observed, and ossification center was obvious or showed gradually increase. The donor knee joint had normal flexion and extension function, without deformity, pain, or abnormal sensation in the common peroneal nerve innervation area. Conclusions:The complex of vascularized fibular head epiphysis and tissue flap can repair the bone and adjacent soft tissue defect of the medial malleolus in children at one stage, with good appearance recovery and ankle joint function recovery. The reconstructed medial malleolus can develop with the growth of children and has no effect on the function and feel of the knee joint in the donor area. It is a satisfactory method of reconstructing the traumatic defect of medial malleolus in children.
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Objective To study of short-term rehabilitation index and its relationship with medium-term function in male rectal cancer after laparoscopic surgery. Methods A retrospective analysis was made of 60 cases with rectal cancer who received laparoscopic radical resection in our hospital. In the observation group,the pelvic autonomic nerves were retained in 30 cases,and 30 cases in the control group were not retained. The levels of se-rum prealbumin(PA),C reactive protein(CRP),white blood cell count(WBC)and blood cortisol(Cor)were compared between the 2 groups. The independent influence factors of erectile and ejaculatory disorder were fol-lowed up at 6 months after operation. Results Postoperative exhaust time,defecation time,postoperative extuba-tion time,ambulation time,postoperative hospitalization time in the observation group were significantly shorter than those in the control group(P < 0.05). The level of serum CRP,WBC and Cor in the observation group was significantly lower than those of the control group at 3 d after operation,and the level of PA was significantly high-er than that of the control group(P < 0.05).The independent influence factors of erectile dysfunction were the level of PA and CRP at 3d after operation(P < 0.05).The independent influence factors of ejaculatory dysfunction were PA level at 3D after operation(P < 0.05). Conclusion Pelvic nerve protection in laparoscopic surgery is helpful to promote the postoperative recovery. High PA at short term after operation may be one of the medium-term protec-tion mechanisms for sexual function.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of wheat cellulose particles (testa triticum tricum purify, Fiberform) in the treatment of internal hemorrhoid.</p><p><b>METHODS</b>A multicenter randomized controlled clinical trial was adopted. From October 2015 to July 2016, 60 patients with internal hemorrhoid were enrolled from three medical centers, including Department of Anorectum, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Department of Anorectum, The Third Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Anorectum, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine. Enrollment criteria: Patients aging from 18 to 65 years old; being diagnosed with the second or third grade internal hemorrhoid; having good communication skills and being able to complete the records and follow-ups according to the research program requirements.</p><p><b>EXCLUSION CRITERIA</b>Patients combined with other anal diseases, or whose anus tube or rectum suffering occupying lesions; patients currently using other methods and defecation drugs in the treatment of their hemorrhoids; patients in pregnancy or with diseases of heart, liver, kidney or metabolic disorders; patients suffering from constipation due to other diseases and drugs, and long-term laxatives abusers. According to the random number table method, 60 patients were randomly divided into the combined treatment group [30 cases, wheat cellulose particles 1 bag each time, 2 times per day; Diosmin tablet 2 pills, 2 times per day] and the single treatment group [30 cases, Diosmin tablet 2 pills, 2 times per day]. The treatment courses for both groups were 7 days. According to the four-grade scoring method, the efficacy evaluation would be made on six indicators, which were the degree of hematochezia or bleeding, the degree of pain, hemorrhoid prolapse, the shapes and properties of stool, the defecation frequency and the defecation duration. The higher the score a participant got, the more severe the symptom was. The effectiveness was evaluated by the scoring reduction rate, and marked effectiveness and effectiveness were both found to be effective. Incidence of adverse events was compared between two groups before the treatment, and on postoperative 3-day and 7-day respectively.</p><p><b>RESULTS</b>There were no significant differences between two groups in gender, age, internal hemorrhoids gradings, disease course, and onset time as well as the baseline data, such as the degree of hematochezia or bleeding before the treatment, the degree of pain, hemorrhoid prolapse, the shapes and properties of stool, the defecation frequency and the defecation duration (all P>0.05). After the seven-day treatment, there was significant difference in effective rate between combination group and single group [96.7%(29/30) vs. 66.7%(20/30), Z=-4.376, P=0.000]. Meanwhile, the scores of combined group and single group in hematochezia or bleeding were 0(0, 1) and 0(0, 2) (Z=9.241, P=0.002); in shapes and properties of stool were 0(0, 1) and 0(0, 1) (Z=5.364, P=0.021); in defecation frequency were 0(0, 1) and 0(0, 2) (Z=7.552, P=0.006); and in defecation duration were 0(0, 1) and 0(0, 2) (Z=4.425, P=0.035), whose differences were all significant. The scores of pain degree and hemorrhoid prolapse of two groups also decreased, but the difference was not statistically significant (P>0.05). During the treatment, abdominal pain, diarrhea and other adverse reactions were not observed in participants of two groups.</p><p><b>CONCLUSION</b>Combination therapy of wheat cellulose particles (testa triticum tricum purify, Fiberform) can significantly improve the efficacy of internal hemorrhoid with safety and tolerance.</p>
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Objective To establish the item pool of quality of life questionnaire of Chinese medicine for postoperative patients with colorectal cancer;To conduct preliminary item screening. Methods With the guidance of Chinese culture background and TCM theory, systematic retrospective studies on medical records, interviews, TCM syndrome entries, and entries from EORTC QLQ-CR38 were used, and theoretical structure was extracted to form the primary item pool. Item selection and entry were optimized through the investigation, and the item pool was established through expert consultation. Results Item pool was composed of 70 entries, and the pre-questionnaire scale was formed. Conclusion Extraction of item pool ensures the reliability and scientificity of soft index, also has the characteristics of Chinese medicine.
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ObjectiveTo investigate the application of dexmedetomidine attenuating hemodynamic fluctuation in patients with cerebral aneurysm during anesthesia induction.Methods Sixty patients undergoing elective interventional procedure with cerebral aneurysm were divided into low dose of fentanyl group (group LF),high dose of fentanyl group (group HF),and low dose of fentanyl and dexmedetomidine combination group(group FD) by random digits table method with 20 cases each.Before induction of anesthesia,the patients in group FD received dexmedetomidine 1 μ g/kg for 10 minutes,and the others received 0.9％ sodium chloride with the same volume.During anesthesia induction,fentanyl 3 μ g/kg in group LF and group FD,and fentanyl 5 μ g/kg in group HF.Other anesthetics were equalized.Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were monitored and recorded at 3 min utes after lying on table (T0),before intubation (T1),immediately and 3 minutes after intubation (T2,T3).The differences between the maximum and the minimum of SBP,DBP and HR were calculated in these time points as fluctuation values,named as △SBP,△DBP and △HR.Results△SBP,△DBP and △HR in group FD [ (26.9 ± 14.8) mm Hg( 1 mm Hg =0.133 kPa),(10.7 ± 8.9) mm Hg,(12.5 ± 4.3 ) times/min ]were lower than those in group LF [ (40.4 ± 15.6) mm Hg,(20.3 ± 9.4) mm Hg,(30.1 ± 15.0) times/min ](P ＜ 0.05 ),as well as △SBP and △HR in group HF [ (29.8 ± 16.8 ) mm Hg,( 19.5 ± 7.4) times/min ]were lower than those in group LF(P ＜ 0.05).While △HR in group FD was lower than that in group HF (P ＜0.05).The usage of atropin in three group had no statistical significance during anesthesia induction (P =0.364),but more ephedrine was used in group HF than in group LF [30％(6/20) vs.5％(1/20),P=0.032 ].Conclusion Dexmedetomidine 1μ g/kg injected before anesthesia induction,which could prevent intubation reaction,blood pressure serious falling after intubation,and provide more stable hemodynamics,is particularly applicable for anesthesia induction in patients with cerebral aneurysm.
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@#Objective To evaluate the validity of Community Extremity Disability Assessment Schedule (CEDA) in community rehabilitation. Methods 313 patients with hemiplegia after stroke were divided into rehabilitation group and control group. The rehabilitation group received community-based rehabilitation (CBR) for 3 months, and was assessed with Community Extremity Disability Assessment Schedule before and 1 month, 2 months and 3 months after rehabilitation respectively. And it was compared with Fugl-Meyer Assessment (FMA). The control group received the same evaluation only. Results The scores of CEDA and FMA improved more in the rehabilitation group than in the control group 2 months after rehabilitation (P<0.01). The score of CEDA positively correlated with the FMA (r=0.643, P<0.01). Conclusion CEDA can be used to evaluate the efficacy of community rehabilitation.
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@# Objective To explore the effect of body-weight support treadmill training (BWSTT)on ambulatory capacity in individuals following incomplete spinal cord injury (ISCI).Methods 36 cases of incomplete SCI patients were divided randomly into control and BWSTT groups who were classified as ASIA C or D.All received comprehensive rehabilitation, and patients in BWSTT group also received BWSTT for 3 months when the physical condition was permitted.They were assessed before and after treatment.The evaluation items included measurement of ASIA lower-extremity motor assessment, functional independence measure (FIM) ambulatory function measure, 10meter ambulatory velocity and modified Barthel Index.Results The scores of ASIA lower-extremity motor assessment, FIM ambulatory function, the ambulatory 10-meter velocity in BWSTT group improved significantly when compared with the control group (P<0.05).The scores of modified Barthel Index were no difference between two groups before and after treatment (P<0.05).Conclusion BWSTT could improve ambulatory capacity for incomplete SCI patients
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Objective To investigate the effects of locomotor training on improving locomotor function after spinal cord injury(SCI)and the mechanism of spinal cord plasticity.Methods A model of complete thoracic cord transection was established using 84 adult female rats divided into sham,SCI and treadmill training(BWSTT) groups.The hind limb locomotor function of all the rats was evaluated.The fluorescence intensities due to (EphA4),vesicular glutamate transporter 2(VGluT2)and EphA4/VGluT2 double-positive neurons in the ventromedial area of the anterior horn of the lumbar COrd were detected using immunofluorescence double labeling and laser confocal microscopy.Results The rats in the BWSTT group showed better functional recovery in their hind limbs than those in the SCI group.BWSTT was correlated with markedly increased EphA4.VGIuT2 and EphA4/VGluT2 intensities in the ventromedial area.Conclusion BWSTT improves hind limb locomotor function in rats with thoracic cord transections by elevating the expression of EphA4/VGluT2,promoting neuronal plasticity in the lumbar anterior horn.
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@#Objective To observe the effects of comprehensive rehabilitation treatment on ambulation and balance function in patients with heavy brain injury when the starting time of rehabilitation was delayed.Methods Twelve heavy brain-injured patients received comprehensive rehabilitation treatment,including ambulation and balance training.They were evaluated with Fugl-Meyer Lower Extremity Assessment Scale,Functional Independence Measure(FIM)Ambulation Function Scale,Berg Balance Scale and Modified Barthel Index(MBI).One-way ANOVA was used to assess the functional status of patients during the course of treatment.Results After 3～6 months of treatment,All the scores of the assessment items above scales in all of the patients increased significantly compared with those at first evaluation(P<0.05).Conclusion The heavy brain-injured patients can still acquire contented ambulation and balance function after accepting comprehensive rehabilitation,though the starting time of rehabilitation is delayed.
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@#Objective To explore the effect of body-weight support treadmill training(BWSTT)on lower extremity muscle atrophy and ambulatory capacity in complete spinal cord injured(SCI)patients.Methods 20 patients with complete SCI at the thoracic level were divided into control and BWSTT group.They all received comprehensive rehabilitation,and patients in BWSTT group also received BWSTT for 3 months when the physical condition was permitted.They were assessed before and after treatment with measurement of thigh girth,ambulatory capacity measure of Functional Independence Measure(FIM),10 meters ambulatory velocity and activity of daily living(ADL)evaluation.Patients in BWSTT group also received middle thigh MRI examination before and after BWSTT.Results The muscles at the mid-thigh of the BWSTT group looked larger after BWSTT than before.The scores of FIM ambulatory function,the 10 miters ambulatory velocity of BWSTT group improved significantly when compared with that of the control group(P<0.05).The thigh girth and the scores of ADL were no different between these two groups before and after treatment(P<0.05).Conclusion BWSTT may ameliorate lower extremities skeletal muscle atrophy and improve ambulatory capacity for SCI patients.
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@# Skeletal muscle contractile properties are determined by their myosin heavy chain (MHC) expression profiles partly. Spinal cord injury induced the adaptation change in MHC isoform mRNAs and protein expression of skeletal muscle below the injured level, leading to the increased expression of fast and decreased expression of slow MHC isoforms. The adaptations in the MHC-mRNAs preceded the changes in proteins. The degree and velocity of MHC isoform adaptation were dependent on differenrt muscle and animal species. Short-term training could not induce the significant change of the transformation of MHC isoform, whereas long-term stepping training which emphasized load bearing could attenuate the MHC shift from slow toward faster isoforms.
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@# Skeletal muscle contractile properties are determined by their myosin heavy chain (MHC) expression profiles partly. Spinal cord injury induced the adaptation change in MHC isoform mRNAs and protein expression of skeletal muscle below the injured level, leading to the increased expression of fast and decreased expression of slow MHC isoforms. The adaptations in the MHC-mRNAs preceded the changes in proteins. The degree and velocity of MHC isoform adaptation were dependent on differenrt muscle and animal species. Short-term training could not induce the significant change of the transformation of MHC isoform, whereas long-term stepping training which emphasized load bearing could attenuate the MHC shift from slow toward faster isoforms.
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BACKGROUND: The rehabilitation outcome varies in stroke patients,and there are differences in the literatures about the influence of factors on the functional recovery in such patients.,OBJECTIVE: To evaluate the pre-rehabilitative and post-rehabilitative effects of stroke patients by functional independence measure (FIM) that is widely used, and analyze the influence of gender, age, motor and cognitive functions at admission, time interval from stroke onset to arrival at rehabilitative admission, comorbidity occurrence, laterality of lesion on the functional recovery of stroke patients.DESIGN: Before-after control observationSETTING: Center of Rehabilitation Medicine, Shandong Provincial Hospital; Faculty of Rehabilitation Medicine, Capital University of Medical SciencesPARTICIPANTS: From March 2000 to December 2002, 55 stroke patients were selected from Shandong Provincial Hospital. They were all first episode, and patients whose bilateral cerebral hemisphere were involved were excluded.METHODS: After the vital signs were steady, the stroke patients got through risk phase (31-75 days) and were treated with medicine improving microcirculation and providing neurotrophic factor for nerves. In addition, they accepted comprehensive rehabilitation training of Bobath technique, PNF technique and Rood method mainly, with 1-2 hours per day and five times per week.MAIN OUTCOME MEASURES: The patients were evaluated within 7days after admission and reassessed 3 days before discharge using FIM,including 18 items of motor and cognitive functions and 126 total scores (108-126 as elementarily or completely independent, 72-107 as mildly dependent, 54-71 as moderately dependent, 36-53 as severely dependent,18-35 as extremely or completely dependent). Multiple stepwise regression equation was applied to analyze the relation of above factors and functional recovery (increased value of FIM total score).RESULTS: Totally 55 patients were involved into the result analysis.①FIM total score of patients was significantly higher at discharge than at admission (93.8±12.0, 68.8±11.6, P ＜ 0.001), and motor function and cognitive function at discharge also increased compare with at admission (P ＜ 0.001).②Mean value of FIM motor score increased everyday was identical with that of total score (0.56±0.21, 0.59±0.21), and higher than mean value of cognitive score (0.03±0.03).Multiple stepwise regression analysis showed,scores of motor and cognitive status at admission, age, time interval from stroke onset to arrival at rehabilitative admission all affected the increased value of FIM total scores. No significant association between gender, comorbidity, laterality lesion of paralysis and functional recovery was observed (P ＞ 0.05). The most influential factors were orderly motor function,cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitation admission.CONCLUSION: Motor and cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitative admission have a no table relationship with functional recovery of stroke patients, especially motor function at admission is positively related. Thus we should not neglect the influence of these factors when conducting rehabilitative treatment.
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The present higher education curriculum gets adrift from the present modern anesthesiology development seriously.Clinical young doctors generally lack anaesthesia knowledge and first aid skill.It's impossible for them to gain anesthesiology knowledge and the skill through continuing medical education.We should adjust education curriculum to increase the teaching hours of anesthesiology course for clinical medicine undergraduate.
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Objective To observe the effects of comprehensive rehabilitation program on severe traumatic brain injury young patients when the time from injury to admission was delayed. Methods Eleven severe traumatic brain injury young patients received comprehensive rehabilitation program, including the neurodevelopmental techniques. They were evaluated with Functional Independence Measure (FIM) and Berg Balance Scale. One Way ANOVA was used to assess the functional status of patients during the course of treatment. Results After 6 to 12 months' treatment, the motor, cognitive and total scores of FIM and the Berg scores of all patients increased significantly ( P