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The main clinical features of obsessive-compulsive disorder (OCD) are obsessions and/or compulsions. Due to its symptoms are heterogeneous and have a wide range of influences, OCD usually causes different degrees of damage to patients' social functions. Social cognition is the process of perceiving and judging the psychology and behavior of others or oneself. Its core is to understand the information processing process and the underlying mechanism of social psychological phenomena. Studies have shown that social cognitive deficits can affect an individual's social function. Therefore, many scholars believe that the social cognitive function of OCD patients are impaired. Through collecting and sorting out relevant literature, we find that OCD patients can’t perceive social cues accurately, and they have trouble recognizing their own emotions and those of others. In general, they are not prone to emotional response, that is, their ability of emotional experience is impaired, while because of their own emotional regulation dysfunction, they overreact to special events that can induce the obsession and/or compulsion.The patients have poor insight into the mental states of others.The researches on attributions of life events are dificient, so their characteristics of attribution styles are not yet clear.These findings provide a preliminary theoretical basis and reference for the specificity of social cognitive impairment in patients with OCD and for guiding clinical effective and precise intervention.
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Objective:To investigate the effect of conventional treatment plus long-term transcranial direct current stimulation (tDCS) on consciousness recovery in patients with minimally conscious state (MCS) after traumatic brain injury (TBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 60 patients with MCS after TBI admitted to Zhejiang Armed Police Corps Hospital from January 2019 to December 2020, including 38 males and 22 females, aged 19-60 years [(45.7±11.4)years]. Course of disease was 3-6 months [(4.6±0.9)months]. Of all, 30 patients received internal medicine, hyperbaric oxygen, rehabilitation and other conventional treatment (conventional treatment group), and 30 patients received tDCS stimulation on the basis of conventional treatment (tDCS treatment group). The tDCS stimulation contained 4 cycles for 28 days with each cycle lasting for 7 days (stimulation for 5 days, rest for 2 days). Coma recovery scale-revised (CRS-R) total score, brainstem auditory evoked potential (BAEP) score and clinical effictive rate (significantly effective+effective) were compared between the two groups before treatment, during 4 cycles of treatment and at 6 months and 12 months after treatment. Complications induced by tDCS were also evaluated.Results:There was no significant difference in CRS-R total score and BAEP score between the two groups before treatment (all P>0.05). CRS-R total score and BAEP score in tDCS treatment group were significantly higher than those in conventional treatment group during 4 cycles of treatment and at 6 months and 12 months after treatment (all P<0.05). CRS-R total score and BAEP score in both groups gradually increased during 4 cycles of treatment and at 6 months and 12 months after treatment (all P<0.05). The clinical effective rate in tDCS treatment group was 73% (22/30) when compared to 57% (17/30) in conventional treatment group ( P<0.05). In tDCS treatment group, 10 patients had local reversible slight redness at the cathodal position, while no other serious adverse effects, such as local burns, ulceration, exudation or epilepsy. Conclusion:Compared with conventional treatment, conventional treatment plus long-term tDCS can be more effective in improving the state of consciousness without serious adverse effects for MCS patients after TBI.
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Objective:To explore the clinical efficacy of periosteum-covered iliac crest autografts for treatment of severe osteochondral lesions of talus （OCLTs）.Methods:A retrospective case series study was used to analyze the clinical data of 26 patients with severe OCLTs treated at Zhejiang Armed Police Corps Hospital from January 2013 to October 2019. There were 21 males and 5 females，aged 17-49 years ［（36.3 ± 10.9）years］. All patients were treated using periosteum-covered iliac crest autografts. The visual analogue scale （VAS），American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and ankle joint range of motion （ROM） were assessed before operation，6 months after operation and at the last follow-up （≥ 12 months）. The area of talus injury with MRI at the same level was recorded before operation and at the last follow-up. The healing of talus and joint surface was detected with CT at the last follow-up. The healing of the incision and osteotomy site and complications were observed.Results:All patients were followed for 12 to 22 months［（15.1 ± 3.2）months］. The VAS was （2.4 ± 0.9）points and （1.7 ± 0.6）points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （5.4 ± 1.2）points （ P < 0.01）. Meanwhile，the VAS at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The AOFAS ankle-hindfoot score was （71.7 ± 7.8）points and （87.8 ± 6.2） points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （66.5 ± 7.5） points （ P < 0.01）. Meanwhile，the AOFAS ankle-hindfoot at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The ankle ROM was （58.4 ± 5.5）° and （70.0 ± 4.9）° at postoperative 6 months and at the last follow-up，significantly improved when compared to the preoperative （42.3 ± 8.1）° （ P < 0.01）. Meanwhile，the ankle ROM at the last follow-up was significantly improved when compared to that at postoperative 6 months （ P < 0.01）. The area of talus injury with MRI at the same level was 0.67（0.55，0.89）cm 2 at the last follow-up，significantly improved when compared to preoperative 2.64（1.98，3.68）cm 2 （ P < 0.01）. The transplantation had neither obvious defects nor joint surface steps based on CT findings. All surgical incisions were healed by first intention. There were no complications such as incision infection，skin necrosis，nonunion of osteotomy，malunion or severe ankle joint disorder except that 8 patients had residual local subchondral bone?marrow?edema-like?signal?and 2 patients showed delayed healing of medial malleolus osteotomy. Conclusion:For patients with severe OCLTs，periosteum-covered iliac crest autografts can effectively relieve ankle pain，improve ankle function，and reduce the area of injury.
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Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer. The systemic antitumor therapy of advanced NSCLC has undergone renovations of chemotherapy, targeted therapy and immunotherapy, which results in greatly improved survival for patients with advanced NSCLC. Immune checkpoint inhibitors (ICIs), especially targeting programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1), has changed the treatment paradigm of NSCLC. ICIs have become the standard treatment for advanced NSCLC without epidermal growth factor receptor(EGFR) mutation or anaplastic lymphomakinase(ALK) translocation in the first- or second-line setting, and for locally advanced NSCLC following concurrent radiotherapy and chemotherapy. ICIs are also promising in adjuvant/neoadjuvant therapy. More and more ICIs have been approved domestically for the treatment of NSCLC. Led by the NSCLC expert committee of Chinese Society of Clinical Oncology (CSCO), this consensus was developed and updated based on thoroughly reviewing domestic and foreign literatures, clinical trial data, systematic reviews, experts' discussion and the consensus(2019 version). This consensus will aid domestic clinicians in the treatment of NSCLC with ICIs. .
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Objective:To investigate the effect of nursing intervention on the incidence of agitation and negative emotion in patients undergoing general anesthesia recovery.Methods:Totally 120 patients with general anesthesia admitted to the Binzhou Central Hospital, Shandong Province from January 2017 to January 2019 were divided into the control group and the observation group by random digits table method with 60 cases each. Those in the control group was given routine nursing, the observation group was given integrated care. The incidence rate of agitation, conscious recovery time, the time of wake-up score≥4 and negative emotional changes in the two groups were compared.Results:The incidence of agitation in the observation group was 6.67% (4/60), which was lower than that in the control group (25.0%, 15/60). The difference was statistically significant ( χ2 value was 6.253, P<0.05). The conscious recovery time, the time of wake-up score≥4 was (1.05±0.39), (16.34±1.21) h, both were shorter than the control group (2.68±0.42), (23.12±1.03) h, the difference was statistically significant ( t value was 22.029, 33.050, P<0.01). The Kessler10 score of the observation group was 30.24±3.64,which was lower than that in the control group 24.84±2.35. The difference was statistically significant ( t value was 9.654, P<0.01). Conclusions:The operation room nursing intervention for patients with general anesthesia recovery can reduce the occurrence of agitation and reduce the negative emotion of patients, and the application effect is remarkable.
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Objective@#To investigate the effect of nursing intervention on the incidence of agitation and negative emotion in patients undergoing general anesthesia recovery.@*Methods@#Totally 120 patients with general anesthesia admitted to the Binzhou Central Hospital, Shandong Province from January 2017 to January 2019 were divided into the control group and the observation group by random digits table method with 60 cases each. Those in the control group was given routine nursing, the observation group was given integrated care. The incidence rate of agitation, conscious recovery time, the time of wake-up score≥4 and negative emotional changes in the two groups were compared.@*Results@#The incidence of agitation in the observation group was 6.67% (4/60), which was lower than that in the control group (25.0%, 15/60). The difference was statistically significant (χ2 value was 6.253, P<0.05). The conscious recovery time, the time of wake-up score≥4 was (1.05±0.39), (16.34±1.21) h, both were shorter than the control group (2.68±0.42), (23.12±1.03) h, the difference was statistically significant (t value was 22.029, 33.050, P<0.01). The Kessler10 score of the observation group was 30.24±3.64,which was lower than that in the control group 24.84±2.35. The difference was statistically significant (t value was 9.654, P<0.01).@*Conclusions@#The operation room nursing intervention for patients with general anesthesia recovery can reduce the occurrence of agitation and reduce the negative emotion of patients, and the application effect is remarkable.
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Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer, most NSCLC patients are at advanced stage at the time of diagnosis. For patients without sensitive driven-oncogene mutations, chemotherapy is still the main treatment at present, the overall prognosis is poor. Improving outcomes and obtaining long-term survival are the most urgent needs of patients with advanced NSCLC. In recent years, immunotherapy has developed rapidly. Immune checkpoint inhibitors (ICIs), especially targeting programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1), have made a breakthrough in the treatment of NSCLC, beneficial to patients' survival and changed the treatment pattern for NSCLC. It shows more and more important role in the treatment of NSCLC. Led by NSCLC expert committee of Chinese society of clinical oncology (CSCO), relevant experts in this field were organized. On the basis of referring to domestic and foreign literature, systematically evaluating the results of Chinese and foreign clinical trials, and combining the experiences of the experts, the experts group reached an agreement to develop this consensus. It will guide domestic counterparts for better application of ICIs to treat NSCLC.
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Objective@#To explore the excellent methods for aesthetic repair of the donor sites of flaps.@*Methods@#From January 2013 to March 2018, 120 patients (94 males and 26 females, aged from 3 to 60 years) were admitted to the Department of Burns of Beijing Jishuitan Hospital. Wounds areas after debridement or removing scar were ranged from 8.0 cm×3.5 cm to 24.0 cm×18.0 cm. Twenty patients with facial and neck scar were repaired with expanded flaps, including 4 scalp flaps, 8 supraclavicular flaps, 4 deltoid flaps, and 4 trapezius myocutaneous flaps. The flaps in ideal donor sites were selected to repair the wounds in 40 patients, including 20 cases of hand wounds or scars repaired with inguinal flaps, 10 children of foot skin defects or scars repaired with cross inguinal skin flap, 10 cases of knee joint wounds repaired with medial or lateral thigh flaps. The optimal flap design was used to repair wounds in 50 patients. Among the patients, wounds of 36 patients were repaired with relaying flaps, including donor sites of free anterolateral thigh flaps of 8 patients repaired with anteromedial thigh perforator flaps and donor sites of free anterolateral thigh flaps of 8 patients repaired with ilioinguinal flaps or superficial abdominal artery flaps, and donor sites of flaps of 20 patients repaired with peroneal perforator relaying flaps. Besides, wounds of 9 patients were repaired with free lobulated anterolateral thigh flaps, and wounds of 5 patients were repaired with modified V-Y propelling latissimus dorsi myocutaneous flaps. The donor sites of flaps were repaired with allogenic acellular dermal matrix combined with autologous split-thickness skin grafts in 10 cases. The areas of the flaps or myocutaneous flaps were ranged from 6.0 cm×4.0 cm to 30.0 cm×20.0 cm. The survival of flap, myocutaneous flap, or skin graft and the repair of donor site after operation and during follow-up were observed.@*Results@#Blood flow obstacle at 0.5 cm to the distal margin of the flap occurred in 1 patient repaired with expanded flap, which were healed after dressing change. Blood supply disorder occurred at the tip of the anteromedial thigh perforator flap of 1 patient repaired by optimal flap design, which were healed completely after second debridement and restitching. The other flaps or myocutaneous flaps survived well. The allogenic acellular dermal matrix and the autologous split-thickness skin graft survived with good color and texture. During follow-up of 3 months to 4 years, the donor sites of flaps had good appearance, only with linear scar and the function recovered well. The donor sites of skin grafts had no scar hyperplasia, only with scattered pigmentation.@*Conclusions@#According to the characteristics of donor sites of flaps, individualized and reasonable design before the operation such as pre-expanding of the flaps, selecting the ideal donor sites, optimization of the flap design or allogenic acellular dermal matrix combined with autologous split-thickness skin graft to repair donor sites of flaps can minimize the damage for function and appearance of donor sites of flaps and achieve aesthetic effects of donor sites of flaps.
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Objective@#To explore the clinical effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities after severe burns.@*Methods@#From January 2008 to January 2018, 72 patients (53 males and 19 females, aged 5 to 63 years) with hypertrophic scar contracture deformities and functional disorder in the large joints of extremities after severe burns were admitted to the Department of Burns of Beijing Jishuitan Hospital. Scar hyperplasia and contracture deformity were located at shoulder joints of 28 patients, elbow joints of 15 patients, hip joints of 7 patients, knee joints of 17 patients, and ankle joints of 5 patients. The wound area of patients after the scars were excised and released ranged from 7 cm×6 cm to 34 cm×12 cm. The wounds were repaired with corresponding unexpanded perforator flaps or expanded perforator flaps according to the joint location and existing soft tissue conditions. The size of flaps ranged from 7 cm×6 cm to 35 cm×14 cm. The donor sites of 51 patients were sutured directly; the donor sites of 21 patients were repaired by segmented grafts or mesh grafts. The adopted surgeries, the survival of flaps after surgery, and the functional recovery of the joints during follow-up were recorded.@*Results@#Among the 72 patients, 53 patients had perforator flap repairing surgery only; 19 patients had perforator flap repairing surgery and skin grafting. Among them, 12 patients had expanded perforator flaps, 60 patients had unexpanded perforator flaps. The perforator flaps were performed free transplantation in 9 patients, pedicled transplantation in 61 patients, and groin transplantation in 2 patients. At last, 67 flaps survived completely, while 5 flaps had distal-end necrosis which were healed after dressing change or skin grafting after debridement. During follow-up of 6 months to 3 years, the joint function of all the patients was obviously improved. The abduction angles of shoulder joints were over 110°; the hip, knee, and elbow joints could reach the straight position, and the flexion was normal; the foot drop deformity was corrected, and the appearance of flaps was good with obvious extension compared with the original state.@*Conclusions@#Perforator flaps are suitable for reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns. They can restore the joint function to the greatest extent as well as repair the wounds.
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Objective@#To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation.@*Methods@#From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. The wound area after thorough debridement ranged from 15 cm×11 cm to 35 cm×20 cm. Emergency surgery for reconstruction of the radial artery with saphenous vein graft under eschar was performed in 5 cases. The arteries of 36 patients (including 7 cases with simultaneous ulnar artery and radial artery reconstruction) were reconstructed with various forms of blood flow-through after debridement, among them, the radial artery of 13 cases, the ulnar artery of 8 cases, the brachial artery of 8 cases, and the femoral artery of 2 cases were reconstructed with saphenous vein graft; the radial artery of 3 cases and the ulnar artery of 7 cases were reconstructed with the descending branch of the lateral circumflex femoral artery graft; the radial artery of 2 cases were reconstructed with greater omentum vascular graft; the reflux vein of 3 cases with wrist and forearm annular electric burns were reconstructed with saphenous vein graft. According to the actual situation of the patients, 12 cases of latissimus dorsi myocutaneous flap, 6 cases of paraumbilical flap, 28 cases of anterolateral thigh flap, 10 cases of abdominal combined axial flap, 5 cases of greater omentum combined with flap and/or skin grafts were used to repair the wounds after debridement and cover the main wounds as much as possible. Some cases were filled with muscle flap in deep defect at the same time. The area of tissue flaps ranged from 10 cm×10 cm to 38 cm×22 cm. For particularly large wounds and annular wounds, the latissimus dorsi myocutaneous flap, the paraumbilical flap, the abdominal combined axial flap, and the greater omentum combined with flap and/or skin grafts were used more often. Donor sites of three patients were closed directly, and those of 58 patients were repaired with thin and medium split-thickness skin or mesh skin grafts. The outcome of limb salvage, flap survival, and follow-up of patients in this group were recorded.@*Results@#All the transplanted tissue flaps survived in 61 patients. Fifty-six patients had successful limb salvage, among them, 31 limbs were healed after primary surgery; 20 limbs with flap infection and tissue necrosis survived after debridement and flap sutured in situ; 5 limbs with flap infection, radial artery thrombosis, and hand blood supply crisis survived after debridement and radial artery reconstruction with saphenous vein graft. Five patients had limb salvage failure, among them, 3 patients with wrist electric burns had embolism on the distal end of the transplanted blood vessels, without condition of re-anastomosis, and the hands gradually necrotized; although the upper limb of one patient was salvaged at first, due to the extensive necrosis and infection at the distal radius and ulna and the existence of hand blood supply under flap, considering prognostic function and economic benefits, amputation was required by the patient; although the foot of one patient was salvaged at first, due to the repeated infection, sinus formation, extensive bone necrosis of foot under flap, dullness of sole and dysfunction in walking for a long time, amputation was required by the patient. During the follow-up of 6 months to 5 years, 56 patients had adequate blood supply in the salvaged limbs, satisfied appearance of flaps, and certain recovery of limb function.@*Conclusions@#Timely revascularization, early thorough debridement, and transplantation of large free tissue flap, combined tissue flap, or blood flow-through flap with rich blood supply are the basic factors to get better limb preservation and recovery of certain functions for patients with high voltage electric burns of limbs on the verge of amputation.
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Consciousness disorders are common in patients with severe traumatic brain injury ( sTBI) . There are some differences in the definitions of consciousness disorders in neurophysiology, neuropathology, neuroendocrinology, psychology and philosophy, which makes the evaluation and treatment of patients with consciousness disorders more complicated. The clinical multidisciplinary collaboration can make the assessment more accurate, so as to discover the residual consciousness of patients with consciousness disorder. In terms of treatment, sTBI patients are in critical condition and develop rapidly, accompanied by different systemic injuries and dysfunction of multiple systems, leading to long duration of consciousness disturbance and many complications. Neurosurgery, critical care medicine and rehabilitation medicine have their own advantages and disadvantages, and they have different clinical treatment decisions in handling patients with consciousness disorders. Therefore, multidisciplinary participation is needed in clinical treatment. Multidisciplinary collaboration can reduce the mortality, shorten hospitalization time, reduce hospitalization costs and improve the quality of life of patients with consciousness disorder after sTBI. The author discusses the value of multidisciplinary collaboration in the treatment of patients with post-sTBI consciousness disorder, in order to provide reference for improving clinical efficacy.
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Objective@#To study the outcome of perforator flap combined with mesh in repairing cicatricial abdominal hernia after deep burn.@*Methods@#From June 2000 to June 2016, 11 cases of cicatricial abdominal wall hernia after deep burn were treated. 8 cases were caused by electrical burn, 2 cases by stove burn and 1 case by molten iron burn. All of them were Ⅳ degree burn of abdominal wall. The overall treatment time was 1-11 years, with the average of 4.1 years. The hernias were 6 cm × 6 cm to 12 cm × 11 cm in size. The abdominal wall hernia was repaired following the process of scar excision, mesh and perforator flap transfer and defect repairment. 3 kinds of mesh materials were used, polypropylene mesh (n=7), composite mesh (n=2), and acellular allogenic dermis (n=2). The size of meshes ranged from 8 cm ×8 cm to 16 cm ×13 cm. Meanwhile, paraumbilical perforator flaps were used in 5 patients, and anterolateral thigh perforator flaps were 6. The flaps were 18 cm ×10 cm to 22 cm ×13 cm in size.@*Results@#All 11 cases of abdominal wall hernia were repaired. Follow-up period was 6 months to 2 years. There was no recurrence was found. The shape of the flap was satisfying.@*Conclusions@#The perforator flap combined with mesh is a good method to repair cicatricial abdominal wall hernia after deep burn.
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Objective To assess the pain of patients with disorders of consciousness(DOC) and e-valuate the reliability and validity of Chinese version of Nociception Coma Scale- revised ( NCS-R). Meth-ods Sixty-two patients with disorders of consciousness were assessed by NCS-R and the internal reliability, inter-rater reliability,test-retest reliability and concurrent validity was analyzed. Results Cronbach's alpha (α) of internal reliability was 0. 611, test-retest reliability for the NCS-R total scores by spearman was 0. 884. For the subscales,the reliability for the motor,verbal and facial subscale scores by Cronbach's kappa were 0. 856,0. 870 and 0. 856 respectively. Inter-rater reliability for the NCS-R total scores by spearman was 0. 662. For the subscales,the reliability for the motor,verbal and facial subscale scores by Cronbach's kappa were 0. 962,0. 867 and 0. 671 respectively. The spearman coefficient of concurrent validity was 0. 560 (all P<0. 01). Conclusion The NCS-R is a good valid scale and available for Chinese clinician and researchers to assess the pain of DOC patients.
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Objective To explore difference of neuropsychological tests between the remitted schizophrenia patients and the first-degree non-psychotic relatives of schizophrenia patients,and to explore the possible endophenotypes in cognitive function.Methods The MATRICSTM consensus cognitive battery was administered to 86 remittent schizophrenia patients (the patient group),86 first-degree non-psychotic relatives of schizophrenia patients (the relative group),and 86 healthy people (the control group).Results Compared with the control group,the patients group and the relative group showed poor performance on trail making test,brief assessment of cognition,hopkins verbal learning,mazes,category fluency,emotional intelligence test and continuous performance test (P＜0.05).There were significantly lower performances in the patient group than the relative groups on hopkins verbal learning,mazes,emotional intelligence test and continuous performance test (P＜0.05).Conclusion The remitted schizophrenia patients and their first-degree non-psychotic relatives have selective deficits in cognition function,among them,verbal leaning,attention/vigilance,reasoning and problem solving and social cognition may be potential endophenotypes for schizophrenia.
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Objective To examine the difference of neurological soft signs (NSS) among the remittent schizophrenia patients,first-degree non-psychotic relatives of schizophrenia patients and healthy controls.Methods The Cambridge Neurological Inventory (CNI) (the Chinese version) was administered to 86 remittent schizophrenia patients (patient group),86 first-degree non-psychotic relatives of schizophrenia patients (relative group) and 86 healthy controls (control group).Results Compared with relative group,NSS total-score,the subscore of motor coordination and sensory integration were significantly higher in patient group (P＜0.01).Compared with control group,NSS total-score,the subscore of motor coordination and sensory integration were significantly higher in patient group (P＜0.01).Compared with control group,NSS total-score and the subscore of motor coordination were significantly higher in relative group (P＜0.01).Conclusions The levels of NSS in remittent schizophrenia patients and their first-degree non-psychotic relatives are higher than normal control,and the patients have more NSS than their relatives.The motor coordination nay be a potential endophenotype for schizophrenia.
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Objective To acquire the source composition characters of the advanced students through analyzing the regional distribution of advanced students during the five years in a comprehensive hospital in Sichuan, so as to provide some references for improving the advanced studies influence of the hospital. Methods To conduct statistical analysis on the source information of advanced students of some hospital between January 2010 and 2014 December, and calculate the composition rate of each region by using Excel 2007. Results In these 5 years, the number of advanced students was increasing year by year from 2010 to 2014, and the sum number of advanced students was 7478. Among them, 5001 students came from Sichuan Province, accounting for 66.88％and 2477 students were from outside the province, account-ing for 33.12％. In Sichuan province, Chengdu had the highest proportion of advanced students (36.99％), and outside Sichuan Yunnan province had the highest proportion of advanced students (5.31％). Conclusion The hospital has extensive sources of advanced students. In order to further enhance the influence of further education in hospitals, it is necessary to stabilize the local students for further studies, expand the source of other places, and strengthen the connotation construction of further education.
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Obturators made of super soft liner thermosetting resin for 59 patients with fenestrated mandibular cyst were regulated according to cystic sizes.Cystic sizes and bone repair were detected by panoramic radiograph and CT 3,6 and 12 months after operation.In all patients,the cystic areas had higher bone mineral density than before,and cystic sizes dereased.32 patients had more than 50％ new bone formation in cystic areas,and cystic areas of 17 patients entirely disappeared without the need of secondary scale.
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Objective@#To explore the methods and effects of wound repair and functional reconstruction of high-voltage electrical burns in wrists.@*Methods@#From January 2009 to June 2016, 71 patients with high-voltage electrical burns in wrists were hospitalized, with 118 wrist wounds including 21 of type Ⅰ, 69 of type Ⅱ, 9 of type Ⅲ, and 19 of type Ⅳ. According to the wrist injuries, different surgical operations were performed. Forearm amputation was conducted in 20 wrists with necrosis in the distal end. On the basis of fasciotomy for decompression, early debridement was performed on the other 98 wrist wounds. After debridement, wounds with area ranging from 10 cm×7 cm to 30 cm×18 cm were repaired with tissue flaps with abundant blood supply. Thirty-two wounds were repaired with pedicled groin flaps, 11 wounds with pedicled paraumbilical flaps, 3 wounds with pedicled anterolateral thigh island flaps, 9 wounds with combined abdominal axial pattern flaps, 37 wounds with free skin flaps or myocutaneous flaps, and 6 wounds with flow-through descending branch of lateral femoral circumflex artery flaps, with tissue flap area ranging from 12 cm×8 cm to 34 cm×20 cm. Ulnar artery or radial artery vascular reconstruction was performed in 20 wrist wounds. Forty-one donor sites were sutured directly, while 14 were closed by thin split-thickness skin grafts from same-side thighs, and 43 were closed by thin split-thickness skin grafts from opposite-side thighs. Fifty-three wrist wounds were performed with tendon and nerve repair surgery, of which 20 were performed with simple tendon and nerve release surgery. Flexor digitorum profundus tendons and (or) flexor pollicis longus tendons were reconstructed with autologous or allogeneic tendon transplantation in 33 wrist wounds, and the median nerve was repaired with sural nerve graft in 21 wrist wounds. In 6 to 24 months after the last operation, tendon function of 53 wrist wounds which had tendon repair was evaluated with finger total active motion (TAM) method, while median nerve function of 21 wrist wounds which had median nerve repair was evaluated with integrate estimation method.@*Results@#(1) After forearm amputation, the incisions of 20 wrists with necrosis in the distal end were healed. (2) Among the 98 tissue flaps, 90 had good blood flow, while 8 had distal necrosis, of which 6 were healed after necrotic tissue removal and skin grafting, and two were sutured directly after debridement. Infection occurred under 7 flaps, of which 3 were healed by dressing change, and 4 were healed after second debridement. Twenty wrist wounds which had radial artery or ulnar artery repair had good blood supply of hand and amputation was avoided. During follow-up of 1 to 3 years, the incisions and flaps of patients who had tissue flap repair surgery healed well. (3) The excellent and good rate of TAM in each finger of the corresponding affected limbs of 53 wrist wounds which had tendon and nerve repair surgery was 51%. (4) Twenty wrists which had simple tendon and nerve release surgery were followed up for 1 to 2 years. The strength of muscle dominated by the median nerve was restored to grade Ⅴ in 1 wrist, grade Ⅳ in 3 wrists, and grade Ⅲ in 2 wrists. The strength of muscle dominated by the ulnar nerve was restored to grade Ⅳ in 3 wrists, with no recovery in other wrists. Sensory function examination showed grade S0 in 4 wrists, grade S1 in 2 wrists, grade S2 in 3 wrists, grade S3 in 8 wrists, and grade S4 in 3 wrists. Twenty-one wrists which had median nerve repair were followed up for 1 to 2 years. There was no recovery in muscle strength dominated by the median nerve. Sensory function examination showed grade S0 in 3 wrists, grade S1 in 5 wrists, grade S2 in 8 wrists, and grade S3 in 5 wrists.@*Conclusions@#It is a good method to sequentially conduct early fasciotomy for decompression, early debridement, vascular reconstruction, transplant of tissue flap with abundant blood supply, tendon and nerve repair in repairing electrical burn wounds of wrists, avoiding amputation, and reconstructing hand function according to the condition of electrical burns of wrists.
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Objective@#To investigate the effects of flap or myocutaneous flap combined with fascia lata or composite mesh on repairing wounds in abdomen of patients with severe high-voltage electrical burn.@*Methods@#From January 2010 to May 2017, 11 patients with severe high-voltage electrical burn in abdomen were hospitalized in our burn wards. In 3 hours to 7 days after burn, operation was performed when patients were in stable condition. After debridement, intestines with necrosis or perforation in 4 patients with peritoneal defects were resected and intestinal anastomosis was performed. The size of abdominal wounds after debridement ranged from 13 cm×9 cm to 41 cm×32 cm. Five patients were treated with rectus abdominis myocutaneous flap and size of which ranged from 14 cm×10 cm to 30 cm×17 cm. Among the above 5 patients, 4 patients with peritoneal defects used composite mesh of 25 cm×20 cm to enhance abdominal wall. Three patients were treated with tensor fascia lata myocutaneous flap, and size of the flap ranged from 24 cm×10 cm to 27 cm×13 cm. Three patients were treated with anterolateral thigh flap with fascia lata, and one of them was treated with the lobulated flap; size of the flap ranged from 18 cm×13 cm to 25 cm×15 cm. The later 6 patients used fascia lata of flap to enhance abdominal wall. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh.@*Results@#After operation, flaps or myocutaneous flaps of patients were survived, and strength of abdominal wall recovered. During follow-up of 6 month to 1 year, flaps or myocutaneous flaps were in good appearance, with no ankylenteron or abdominal wall hernia.@*Conclusions@#Flap or myocutaneous flap combined with fascia lata or composite mesh can achieve good effects on repairing severe high-voltage electrical burn wounds in abdomen.
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Objective@#To investigate the effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients.@*Methods@#From January 2014 to June 2016, 5 patients with high-voltage electrical burn of unilateral wrist were hospitalized in our burn ward, with extensive necrosis of skin soft tissue of burn wrist. Five patients were transferred to our burn ward 6 to 12 days post injury after undergoing emergency dermotomy of wrist to reduce tension in other hospitals. In 2 to 3 days after admission, operation was performed by two surgeon group at the same time, when patients′ general condition were stable. One group underwent debridement and the other group designed and dissected flap according to the range of skin soft tissue defect of wrist. Wrist wounds after debridement ranged from 15 cm×10 cm to 24 cm×15 cm. Three patients were treated with flow-through descending branch of lateral circumflex femoral artery flap and great saphenous vein for repairing wounds of wrist and reconstruction of ulnar and radial artery. Two patients were treated with flow-through descending branch of lateral circumflex femoral artery flap for repairing wounds of wrist and reconstruction of ulnar artery. The dissected flaps ranged from 16 cm×12 cm to 26 cm×16 cm and the length of bridging vessel ranged from 15 to 21 cm.@*Results@#The flow-through descending branch of lateral circumflex femoral artery flaps of five patients survived well. Wounds of 4 patients healed and wounds of 1 patient with infection under the flap on 3 days after operation healed after changing wound dressing and undergoing debridement for 2 weeks. After the operation, wrists and hands of 5 patients had adequate blood supply and ulnar and radial artery recovered patency. Follow-up of patients for 6 months to 1 year showed good flap appearance and adequate blood supply of burn hands.@*Conclusions@#The flow-through descending branch of lateral circumflex femoral artery flap can repair wrist wounds and recover blood supply of hands and it is a good method for repairing high-voltage electrical burns of wrist.