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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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At present, the experimental examination of medical morphology courses in most medical colleges and universities still adopt traditional specimen examination or PPT examination, and there are many disadvantages. This paper introduces how to build a system with B/S architecture based on the local area network, and how to set up an examination system to realize the functions of user management, online examination database updating, free examination paper formation, examination running and automatic marking. Through its application in Chengdu Medical College in recent years, the medical morphology online picture exam system has effectively promoted the reform of the examination methods, the style of study and the effect of experimental teaching. However, there are still some problems, such as high investment cost and limited examination room.
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At present, the experimental examination of medical morphology courses in most medical colleges and universities still adopt traditional specimen examination or PPT examination, and there are many disadvantages. This paper introduces how to build a system with B/S architecture based on the local area network, and how to set up an examination system to realize the functions of user management, online examination database updating, free examination paper formation, examination running and automatic marking. Through its application in our school in recent years, the medical morphology online picture exam system has effectively promoted the reform of the examination methods, the style of study and the effect of experimental teaching. However, there are still some problems, such as high investment cost and limited examination room.
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Objective:To study the application of students as standardized patients in orthopedical practice teaching of foreign medical students.Methods:A total of 116 students who received Surgical practice teaching in Affiliated Renhe Hospital of China Three Gorges University from January 2014 to December 2017 were randomly divided into two groups. Bedside teaching model was adopted in the control group ( n=58) to help the interns manage the in-patients under the guidance of the teacher. Additional teaching using standardized patients was applied 1 to 2 times per week in the experimental group ( n=58) on the basis of control group. After the teaching, practical test and assessment survey were adopted to evaluate the effectiveness of teaching. SPSS 13.0 was used to analyze the data by t-test. Results:The scores of the practical test of the experimental group were significantly higher than those of control group, such as history taking [(15.23±3.15) vs. (13.56±3.54), P=0.008], physical examination [(17.24±4.23) vs. (10.32±3.75), P=0.000], and basic skill [(17.32±2.58) vs. (13.22±3.65), P=0.000]. The assessment survey showed that learning motivation [(8.25±1.04) vs. (4.82±0.93), P=0.000], and communication ability [(6.22±1.12) vs. (5.59±0.89), P=0.001] of the experimental group were effectively improved than those of the control group. Conclusion:The teaching mode using standardized patients can effectively improve the learning motivation and clinical practical skills of foreign medical students, as well as the teaching quality.
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Nonunion is the interruption of fracture healing process for a variety of reasons.The cause of the disease is different,and the treatment method is also different.Non-infective nonunion is that there are no local infection factors when nonunion occurs after wound and fracture,and it is most common in all nouunion.However,it is still a difficult problem for clinical orthopaedics.With the development of medical technology orthopaedics attach great importance to this kind of nonunion and study it deeply,its incidence is getting lower and lower.Despite brilliant results,the treatment for this kind of nonunion remains tricky.The treatment of non-infective nonunion can be divided into conservative treatment and surgical treatment,and the latter is still the main treatment.This article gives a systematic review of the treatment of non-infective nonunion.
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Clinical medicine is a practical, highly skilled natural science. Solid clinical skills are the cornerstone of medical students' growth and development. According to the change of medical education environment, the tension of doctor-patient relationship and the lack of practical ability, we build a set allround , systematic clinical practice teaching system based on practice curriculum teaching , centralized practice teaching, social practice teaching, practice skills assessment and practice skills competition. The research and practice of the system not only promotes teachers' and student's emphasis on the training of clinical practical skills but also improves student's clinical practice skills, strengthen teachers' clinical skills teaching ability, and boost the construction of clinical skills experimental center.
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Objective To investigate the clinical efficacy of bone grafts containing bone morphogenetic protein 2 (Bone Conduction) treating of nonunion of femoral fracture after intramedullary nailing.Methods The clinical data of 49 patients with nonunion of femoral fracture after intramedullary nailing from August 2008 to August 2016 were analyzed retrospectively.They were divided into experimental group and control group according to different bone grafting methods.The experimental group (n =23) was treated with Bone Conduction combined with allograft bone grafting.The control group (n =26) was treated with autogenous bone grafting.The autogenous bone was taken from the ipsilateral ilium.The two groups were compared operative time,intraoperative blood loss,postoperative wound complications,hospitalization time,postoperative visual analog scale,mean image healing time and the score for distal femoral fractures after the operation.All patients were followed up for 12 to 24 months.Follow-up methods were divided into telephone follow-up and outpatient follow-up.The patients were followed up for outpatients before fracture healing.The patients were followed up by telephone after fracture healing.The healing time of fracture,the flexion and extension activities of the knee joint at 9 months after operation were recorded.SPSS19.0 statistical software was used to analyze the data.Measurement data were expressed as ((x) ±s).The independent sample t test was adopted in measurement data and the counting data was tested by Chi-squared test.Result In the experimental group,operative time was (138.7 ± 34.6) minutes,intraoperative blood loss was (315.4 ± 52.8) ml,postoperative wound complications was 0 case,hospitalization time was (8 ± 3) days,postoperative visual analog scale was 5 scores,but in the control group,operative time was (170.5 ± 32.5) minutes,intraoperative blood loss was (367.2 ± 56.4) ml,postoperative wound complications was 3 cases,hospitalization time was (13 ± 2) days,postoperative visual analog scale was 8 scores.There were significant differences between the two groups,P ＜0.05.All patients who followed up for 12-24 months were recovered,with an average follow-up of 15 months.Mean image healing time in the experimental group and control group was separately(4.9± 2.5) months,(5.2 ± 2.8) months.The excellent and good rates ofthe score for distal femoral fractures 9 months after the operation was separately 95.7％,96.2％,there was no significant difference between the two groups,P ＞ 0.05.Conclusions Bone graft material containing bone morphogenetic protein 2 (Bone Conduction) has the advantages of simple operation,less trauma,less complications,high osteogenic activity and good bone graft effect are equalled with iliac bone graft,the bone graft material containing bone morphogene protein is an effective method to treat nonunion of femoral fracture after intramedullary nail.
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Bacillus subtilis is Gram-positive aerobic bacterium and widely used as a heterologous protein expression host because of its safety and high protein secretion property. However, comparing to Escherichia coli, the low transformation efficiency limits the application of B. subtilis as a host cell for directed evolution of heterologous enzymes. Therefore, we optimized the competent cell preparation conditions for conventional plasmid, including the alteration of the medium, the concentration of inducer, the plasmid type, and other parameters. Compared with the original LB medium, YN medium improved the transformation efficiency by about 4 folds. The transformation efficiency enhanced by about 2 folds under induction with 1.5% xylose for 2 h. In addition, with plasmids prepared from E. coli GM272 strain the transformation efficiency increased by about 3 folds. Combining all these findings, the transformation efficiency of pDG1730 plasmid under the optimized conditions could reach 10⁶ CFU/μg, which was 2 orders of magnitude higher than that the original. Our findings provide references for directed evolution of enzymes and metabolic engineering in Bacillus subtilis.
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BACKGROUND:During fracture healing, in addition to the need for appropriate biomechanical environment, the role of cytokines is also increasingly attracted attention. OBJECTIVE:To study the effect of nerve growth factor and alpha-lipoic acid on fracture healing in rat models of femoral fracture. METHODS:Sprague-Dawley rat models of femoral fracture were established. Seventy-two rats were randomly divided into three groups. In the control group, rats were intramuscularly injected with physiological saline. In the nerve growth factor group, rats were intramuscularly injected with nerve growth factor 200 ng/kg, once a day. In the combined therapy group, rats were intramuscularly injected with nerve growth factor 200 ng/kg and oral y taken alpha-lipoic acid 25 mg/kg, once a day. At 1, 2 and 3 weeks after administration, bony cal us volume was measured. Enzyme linked immunosorbent assay was used to measure serum bone morphogenetic protein-2 levels. Western blot assay was utilized to detect bone morphogenetic protein-2 protein expression at the broken end of fracture. Semi-quantitative RT-PCR was applied to examine vascular endothelial growth factor mRNA expression. RESULTS AND CONCLUSION:(1) At 1 week after administration, no significant difference in bony cal us volume was detected among the three groups. Serum bone morphogenetic protein-2 level, bone morphogenetic protein-2 protein expression, and vascular endothelial growth factor mRNA expression were significantly higher in the nerve growth factor group and combined therapy group compared with the control group (P<0.05), but no significant difference was found between the two groups. (2) At 2 weeks after administration, the amount of cal us, serum bone morphogenetic protein-2 levels, bone morphogenetic protein-2 protein expression, and vascular endothelial growth factor mRNA levels were significantly higher in the nerve growth factor group and combined therapy group compared with the control group (P<0.05). Above expression levels were higher in the combined therapy group than in the nerve growth factor group (P<0.05). (3) At 3 weeks after administration, serum bone morphogenetic protein-2 levels, bone morphogenetic protein-2 protein expression, and vascular endothelial growth factor mRNA levels were significantly decreased in the nerve growth factor group. However, above expression levels were stil high in the combined therapy group, and significantly higher than in the nerve growth factor group (P<0.05). (4) These results indicate that nerve growth factor combined with alpha-lipoic acid had better effects on the fracture healing compared with the nerve growth factor alone.
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Objective To investigate the effects and mechanisms of hypoxia on the contraction of mesen-teric arteries induced by phenylephrine (PE) in guinea pig. Methods Pressure myograph system was used to study the effects of 20, 40 and 60 min hypoxia (mixed with 95% CO2 and 5% O2) on the constriction induced by PE in acutely separated mesenteric artery (300 ~ 400 μm) of guinea pig. Results PE (0.1 ~ 100 μmol/L) caused the contractions of the mesenteric arteries in guinea pig in a concentration-dependent way . Hypoxia de creased the pH value of perfusion fluid from 7.4 to 6.3. Hypoxia significantly inhibited PE-induced vasocon-striction, and the inhibition was hard to recover after reoxygenation. Hypoxia inhibited PE-induced vasoconstric-tion in a time-dependent way , with the inhibition rate reduced in the sequence of inhibition duration of 60 , 40 and 20 min. When its value was decreased to 6.3 , the perfusion fluid even inhibited PE-induced vasoconstric tion. Conclusion Hypoxia can inhibit PE-induced vasoconstriction in the mesenteric arteries of guinea pig in a time-dependent way. The mechanism may have something to do with the change of pH.
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Objective To investigate the change of connexin (Cx) in mesenteric artery (MA) and aorta of spontaneously hyper‐tensive rats (SHR) and normotensive rats .Methods Quantitative RT‐PCR and Werstern blot technique were used to compare the difference in the expression of Cx37 and Cx40 mRNA and protein in MA and aorta of SHR and normotensive rats .Results The level of Cx37 mRNA expression in MA from SHR was decreased compared with that of the normotensive rats (P0 .05) .The expression of Cx37 protein in MA from SHR was decreased compared with that of the normotensive rats (P0 .05) . Conclusion Hypertension may could decrease gap junctional communication in cells of MA and aorta from SHR by the downregu‐lation of the expression of Cx37 and/or Cx40 .
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Objective To evaluate the clinical effect and safety of transurethral enucleation of prostate with the bipolar plasma kinetic technique(PKEP)in the treatment of benign prostate hyperplasia (BPH)more than 80 mL.Methods The data from the 116 patients who underwent the PKEP were analyzed retrospectively.The clinical parameters include operation time,blood loss, postoperative catheter retention time,postoperative complication rates,the differences of the clinical parameters pre-and postopera-tively were compared,include maximum urine flow rate(Qmax),residual urine(RU),international prostate symptoms score(IPSS), and quality of life(QOL).Results Mean operation time was (87.46±25.01)min,Mean blood loss was (129.15±44.35)mL.Mean resected tissue weight was (77.67±19.56)g.No patient had the transurethral resection syndrome(TURS),All cases were followed up for 3 to 6 months,the clinical parameters pre-and postoperatively was respectively:Qmax(6.04±2.37)mL/s vs.(17.85±2.55) mL/s;RU(116.25±53.18)mL vs.(8.85±7.66)mL;IPSS(25.06±4.23)vs.(5.90± 1.91);QOL(4.85 ±0.65)vs.(1.71± 0.54).Conclusion The transurethral enucleation of prostate with the bipolar PKEP resects the proliferated prostate cleanly,had lesser bleeding and complication rates,had advantages of high safety,and satisfactory efficacy for the treatment of BPH more than 80 mL.
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Objective To investigate the influence of flufenamic acid (FFA) on gap junction intercellular communication in vascu-lar smooth muscle cells(VSMC) in situ of acutely isolated arteriole segments .Methods Whole-cell patch clamp recordings were used to study the effects of FFA on membrane input capacitance (Cinput ) ,membrane input conductance(Ginput ) or membrane input re-sistance(Rinput ) of VSMCs embedded in arteriole segments .Results FFA concentration-dependently and reversibly suppressed Ginput or increased Rinput ,with an IC50 of 56 and 33μmol/L in acutely isolated mesenteric artery(MA) and brain artery(BA) segments re-spectively .There was not significant difference between MA and BA (P> 0 .05) .After application of FFA (≥ 300 μmol/L) ,the Cinput ,Ginput and Rinput of the in situ cells were very close to the respective dispersed cell in MA and BA .Conclusion FFA is a reversi-ble gap junction blocker ,achieving a complete electrical isolation of the recorded VSMC at ≥300 μmol/L .FFA suggesting a homo-geneous property of the gap junctions between MA and BA .
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Objective To establish the L929 cell line with high expression of asporin ,and to study the effect of asporin on the expressions of TGF- β1 and Col2α1 in mouse fibroblast L929. Methods Asporin cDNA was amplified from mouse mandible tissue by RT-PCR,then was inserted into the eukaryotic expression plasmid pcDNA3.1(-). The recombinant plasmid pcDNA3.1(-)-ASPNIII was transfected into the mouse fibroblast cell line L929, followed by G418 treatment. RT-PCR and Western blot assays were used to screen the stable, asporin high expressing L929 cell line.The effect of overexpression of asporin on the regulations of TGF-β1 and Col2α1 was further studied. Results The stable, aspori high expressing n L929 cell linewas successfully established. Results of RT-PCR and Western blot assays showed that overexpression of asporin could effectively inhibit the expressions of TGF-β1 and Col2α1. Conclusion Enforced expression of asporin can inhibit the expression of TGF-β1 and Col2α1 in L929 cells.
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‘Student-centered’ teaching model is the needs of higher medical education.In the process of education,we carried out comprehensive and systematic reforms by satisfying students' needs and improving students' ability as the main line.These reforms included change of teaching methods (the basic theory combined with clinical knowledge),increase of innovative experiments and change of evaluation system.These results showed that students were interested in these reforms,the innovation abilities of students were improved and students could pay more attention to the process of learning.
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Objective: To investigate the differentially expressed genes in osteosarcoma cell lines with various metastatic potentialities, and to screen for new candidate genes related to metastasis of osteosarcomas. Methods: The total RNAs of a lowly metastatic and a highly metastatic osteosarcoma cell lines (M6 and M8) were extracted. Differentially expressed genes in the two osteosarcoma cell lines were studied by cDNA microarray. The hybridization signals were scanned with a Generation Ⅲ array scanner and analyzed by Imagequant 5.0 software. Typical differentially expressed genes were further verified by real-time quantitative PCR. Results: There were 330 differentially expressed genes between M6 and M8 cells. In the high-metastasis M8 cells, 178 genes were up-regulated and 152 genes were down-regulated compared to the low-metastasis M6 cells, with 43 extremely up-regulated and 49 extremely down-regulated. The differentially expressed genes were mainly associated with cell proliferation, indicating these genes might be related to the inhibition of M6 cells. Other differentially expressed genes included those associated with the regulation of gene expression and signal transduction, indicating these genes might be correlated with tumor metastasis. Conclusion: cDNA microarray shows an advantage in identifying genes associated with metastasis of osteosarcoma. In M8 subset of MG63 osteosarcoma cells,43 genes are up-regulated and 49 genes are down-regulated, which may be related with metastasis of osteosarcoma.
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OBJECTIVE: To investigate the effect of balloon kyphoplasty combined with bone cement on the treatment osteoporotic vertebral fracture.METHODS: A total of 58 aged patients with single osteoporotic vertebral compression fracture (58 vertebral bodies) were treated with balloon kyphoplasty. The fracture always occurred at T_8-L_4 segment of vertebral body in particular at T_(10)-L_2 segment of thoracic waist. By local anesthesia, lateral or bilateral pedicle of vertebral arch was punctured to injection bone cement under C-arm fluoroscopy.RESULTS: Bone cement leakage occurred in 8 cases, including leakage along posterior longitudinal ligament into adjacent posterior margin of vertebral body (n=1), external edge of vertebral body (n=6), and subcutaneous tissue (n=1); however, all the patients did not have clinical symptoms. C-arm fluoroscopy showed that height of vertebral body was increased, and rachiokyphosis was improved after treatment. Pain was obviously improved, and the easement rate of pain was 100%. There was significant difference in visual simulation score, angle degree of rachiokyphosis, and living activity scale before and 6 months after treatment (P < 0.05), but there was no significant difference between 6 months after treatment and following up stopping (P>0.05).CONCLUSION: Balloon kyphoplasty can significantly ease pain caused by osteoporotic spinal fractures and tumor metastatic spinal fractures and can partially restore vertebral body height and kyphosis deformity, there is conducive to improving spinal function and improving the quality of life.
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AIM: To investigate the effects of Shuguan Capsule on myocardial blood flow (MBF) and myocardial oxygen consumption (MOC) in anesthetized dogs. METHODS: Coronary blood flow (CBF) of twenty-five thoracotomized dogs was detected by electromagnetic flow meter and the MBF was calculated. While the oxygen content in the artery (AO2 ) and in the coronary venous sinus (VO2) was determined with blood oxygen analysis.Moreover, the other cardiac hemodynamic parameters, such as heart rate (HR), femoral arterial blood pressure (BP), were observed by physiological polygraph. RESULTS: It was found that Shuguan Capsule (48.5 mg/kg and 194 mg/kg) could significantly increase the MBF, and then decease the coronary artery resistance. Furthermore, Shuguan Capsule could also lower the AO2, but increase the VO2, which led to the decreased MOC. CONCLUSION: Shuguan Capsule exhibits the effects to keep the balance between blood supply and oxygen consumption in the heart by modulating the coronary resistance and by reducing MOC in dogs.
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Pedicle screw instrumentation has become the standard stabilization of the posterior lumbar spine.Loosening due to osteoporosis is the common reason for failure.Bone cement augmentation is regarded as an efficient way to enhance screw strength in osteoporotic bones.In this review,a brief introduction to the recent advances in researches on the biomechanics of the bone-screw interface,the pedicle screw augmentation technique and the materials of bone cement is presented.The paper emphasizes the significance of studies on the augmentation indications,vicariousness activity in osteoporosis sclerotin and the strength.
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Objective To explore the surgical types in fractures of the proximal femur by internal fixation. Methods One hundred and three cases of femoral peritrochanteric fracture underwent operation were studied retrospectively. According to AO classification, the cases of each type were treated by four methods of internal fixation: the cannulated compression screw, dynamic hip screw (DHS), anatomical plate and proximal femoral nail (PFN). Results All patients were followed up from 6 to 40 months. All fractures were healed. Complications occurred in 9 patients, including aseptic necrosis of the femoral head in 2, coax magna in 7. According to Sanders standard of function of joint, the final effect was satisfactory. Conclusion It is important to select different surgical types according the different peritrochanteric fracture separately.