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【Objective】 To explore the value of thromboelastogram (TEG) in evaluating coagulation function of patients with liver cancer. 【Methods】 102 patients with liver cancer and 48 with hepatic hemangioma from Department of Hepatobiliary Surgery, Nanyang Central Hospital from August 2017 to September 2020 were retrospectively analyzed. TEG indicators (R, K, Angle, MA, CI, and G value) and routine coagulation indicators (Plt, PT, INR, APTT, FIB, and TT) of those patients and basic clinical data of liver cancer patients were collected, and the difference of detection parameters between the liver cancer group and liver hemangioma group was compared; The difference of TEG parameters in liver cancer patient subgroups was compared, and the correlation between TEG and routine coagulation tests in liver cancer patients was analyzed using Spearman rank correlation analysis. The sensitivity of the two detection methods in detecting the coagulation status of patients with liver cancer was compared. 【Results】 1) Compared with patients with hepatic hemangioma, Plts decreased significantly (166.6±108.824 vs 224.10±54.933, P<0.001), while PT, INR and APTT values increased significantly (13.12±2.052 vs 11.421±0.884, 1.156±0.191 vs 1.00±0.074, 29.977±5.333 vs 26.954±5.269, all P<0.05) in patients with liver cancer; MA and G values in patients with liver cancer were lower (56.991±11.574 vs 60.069±5.094, 7.667±4.682 vs 7.725±1.709, P<0.05); 2) Compared with newly diagnosed liver cancer patients, the Plt of re-diagnosed liver cancer patients decreased significantly(125.78±79.673 vs 188.86±116.437, P<0.05); the R and K value increased significantly (7.594±2.601 vs 6.058±1.739, 3.453±2.402 vs 2.438±1.990, all P<0.05), while the Angle, MA, CI and G value decreased significantly (53.897±12.288 vs 61.495±9.949, 53.556±11.407 vs 58.865±11.313, -3.494±4.253vs -0.836±3.180, 6.311±3.209 vs 8.406±5.191, all P<0.05); 3) There were significant differences in TEG parameters (R value excluded) between liver resection, transhepatic arterial chemoembolization and conservative treatment (P<0.05); 4) The R, K value of patients with liver cancer were negatively correlated with the Plt value, while the Angle, MA, CI, and G value were positively correlated with Plt value (P<0.001); the K value was negatively correlated with the Fib value, while the Angle, MA, CI, G value were positively correlated with Fib value (P<0.001); the R and K value were positively correlated with TT value, while the Angle and CI were negatively correlated with TT value (P<0.05); 5) The detection rate of hypocoagulability by TEG and routine coagulation testing was 18.63% (19/102) and 7.84%. 【Conclusion】 Compared with the newly diagnosed liver cancer patients, re-diagnosed liver cancer patients showed hypercoagulability. TEG can diagnose the coagulation abnormalties more sensitively, and help reduce the risk of bleeding.
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BACKGROUND: Adipose-derived mesenchymal stem cells (ADMSCs) can improve the liver function of rats with liver failure, which illustrates the important research value in the field of tissue engineering and cell transplantation.OBJECTIVE: To evaluate the therapeutic potential of human ADMSCs in heart failure rats and to discuss the possible biological mechanisms involved.METHODS: Heart failure rats were randomized into model and ADMSCs groups, which were given normal saline or DAPI-labeled human ADMSCs (3.0×106) via the tail vein. At 1, 3, 7 days after transplantation, we detected the biochemical indexes for liver function in rats. At 3 days after transplantation, the serum levels of cytokines, such as tumor necrosis factor α and interleukin-10, were detected, the histomorphological changes in the liver were observed by hematoxylin-eosin staining, and the protein expression of proliferating cell nuclear antigen was detected by western blot. RESULTS AND CONCLUSION: We found that human ADMSCs could migrate to the liver and lung tissues in rats after the transplantation via the tail vein. At 1 and 3 days after transplantation, the levels of serum alanine aminotransferase and aspartate aminotransferase were significantly reduced in the ADMSCs group as compared with the model group (P< 0.05); furthermore, the secretion of tumor necrosis factor α and interleukin-10 was significantly suppressed at 3 days after cell transplantation (P < 0.05). The results of hematoxylin-eosin staining indicated a significant improvement in liver degeneration and necrosis. The expression of proliferating cell nuclear antigen protein in the ADMSCs group was significantly up-regulated compared with the model group. To conclude, human ADMSCs can inhibit the inflammatory reaction and up-regulate the expression of proliferating cell nuclear antigen, to promote the regeneration of liver cells and he recovery of liver function.
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Objective The purpose of this study was to evaluate the hemodynamic effects of an extra-thoracic paraaortic counterpulsation device(ETPACD) with various capacities in an animal model with acute heart failure.Methods The acute heart failure model was successfully induced by snaring branch of anterior descending coronary artery in sheep(weighting 35-42 kg,n =8).The ETPACD is a single port,40 ml,60 ml and 80 ml stroke volume blood chamber designed to be connected to descending aorta through a valveless graft and placed extra-thorax.The hemodynamic indices of 40 ml,60 ml and 80 ml stroke volume were recorded respectively during counterpulsation assistance.Results 40 ml,60 ml and 80 ml ETPACD increased cardiac output 36.98％ (P =0.009),34.16％ (P =0.012) and 53.26％ (P =0.000) respectively,80 ml compared with 60 ml and 40 ml respectively P =0.001,P =0.005.And on diastolic mean aortic pressure 43.40％ (P =0.000)、63.20％ (P =0.000) and 78.76％ (P =0.000),80ml compared with 60ml and 40ml respectively P =0.329,P =0.025.The ETPACD (40 ml,60 ml and 80 ml) increased left carotid artery flow 45.19％ (P =0.007) 、61.51％ (P =0.001) and 81.50％(P=0.000),80 ml compared with 60ml and40 ml respectively P=0.016,P =0.000.Conclusion This study demonstrated that ETPACD (40 ml,60 ml and 80 ml) provided benefit of circulatory support in acute heart failure with better effect on hemodynamic parameters provided by 80 ml.Therefore,ETPACD with larger stroke volume may become a promising counterpulsation device for treatment of heart failure.
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Objective: To investigate echocardiography characteristics and clinical significance in patients with diastolic mitral regurgitation. Methods: A total of 15 patients with diastolic mitral regurgitation were studied including 1 patient with large volume of aortic regurgitation, 6 with atrial ifbrillation (AF), 2 with atrial lfutter, 1 with II° type I atrio-ventricular block (A-V block), 1 with II° type II A-V block and 4 with III° A-V block. The characteristics of mitral regurgitation were observed, the heart rates, left ventricular size were measured and left ventricular function was detected in all patients. Results: There was 1 large volume aortic regurgitation patient with diastolic mitral regurgitation occurred in slow iflling phase with less volume, it was less than positive velocity; 1 AF patient occurred in mid and late diastolic phase with less volume, it was obviously less than positive velocity; the rest 8 patients all occurred in mid and late diastolic phase, the velocity reached or surpassed to positive velocity. All 15 patients had slow heart rate, increased left heart, decreased left ventricular ejection fraction, tissue Doppler imaging showed that the early diastolic peak slowed down in mitral ring. There were 93% (14/15) patients having obvious systolic regurgitation. Conclusion: The time phase, quantity and velocity of diastolic mitral regurgitation have various characteristics, most of them associated with systolic regurgitation combining abnormal cardiac structure and function. Echocardiography provides important information for clinical treatment.
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To develop a standard defibrillation energy source which can output monophasic and biphasic de-fibrillation impulses and can display standard energy values. The storage capacitor was charged by single-end flyback transformator and discharged through the H bridge composed of insulated gate bipolar transistor (IGBT). Impulse voltage and current were collected by divider while discharging, and the energy value was calculated by STM32. The en-ergy value and waveform were displayed through the control module. The energy source could output both monophsic and biphasic waveforms, and the accuracy of displayed value was higher than ±2% or ±1 J. The standard defibrillation energy source can be used as standard device for defibrillator analyzer, and the metrological trace-ability system of defibrillation energy may come to be completed.
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BACKGROUND:Some studies have shown that the double-bundle posterior cruciate ligament reconstruction is not superior to the single-bundle posterior cruciate ligament reconstruction, and stil has some deficiencies difficult to overcome. Which is better, double-bundle reconstruction or single-bundle reconstruction? There is no uniform conclusion. OBJECTIVE:To perform a prospective cohort study on the clinical efficacy and safety of autologous single- and double-bundle posterior cruciate ligament reconstruction. METHODS:Totaly 81 patients with posterior cruciate ligament injury were randomly divided into single-bundle reconstruction group (n=41) and double-bundle reconstruction group (n=40). The knee stability, Lysholm score, Tegner score, hospital stay, operation time, fever days and number of puncture cases were compared between the two groups before and 24 months after reconstruction. RESULTS AND CONCLUSION:Compared with the single-bundle reconstruction group, the knee stability was significantly worse in the double-bundle reconstruction group (F=4.362,P=0.000); the operation time, hospital stay and number of puncture cases were also higher in the double-bundle reconstruction group (P 0.05). These findings indicate that both single- and double-bundle reconstruction under arthroscopy is safe and effective treatment for posterior cruciate ligament injury, but the double-bundle reconstruction is not recommended as the preferred surgical procedure because of longer time and larger trauma.
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Objective To investigate the anatomic structure of the Chinese people,develop the procedure of minimally invasive total hip arthroplasty through the anterolateral intermuscular approach and investigate its clinical outcome.Methods Three fresh adult cadavers(6 hips)were used for study of the anatomic construction of the anterolateral intermuscular approach in Chinese people.Sixteen patients were treated with minimally invasive total hip arthroplasty through anterolateral intermuscular approach.The clinical results and operation technique were recorded.Results The anterolateral intermuscular approach was a triangle muscular interval slightly parallel to the femur.The medial-superior angle of the triangle muscular interval consists of the anterior border of gluteus medius and tensor fascia lata muscle with juncture of muscles,where the inferior branch of superior gluteal nerve entered into tensor fascia lata muscle.The average incision length was 8.8 cm(7-10 cm),with mean blood loss of 350 ml(250-550 ml).The patients took out-of-bed activity 3-5 days after operations.During operations,anterior border injury in deep portion of the gluteus medius muscle was observed in seven patients and the injured muscles were trimed or repaired.All patients were followed up for 18-39 months(averaged 27.7 months).Most of the patients had excellent location of the phantoms,except that one acetabulum had a little pitch angle and two acetabulums had a little abduction angle.No complication was observed.The mean Harris scores of hip for all patients was increased from preoperative(39.1±6.7)points to(80.6±11.3)points on six month,(88.7±9.6)points on 12 month and(91.4±13.5)points on 24 months(11 patients).No patient suffered from gluteus medius muscle weakness during the follow-up.ConclusionAnterolateral intermuscular approach has the advantages of simple anatomic construction,small incision,little operative injury,muscle sparing and fast recovery without separate muscle or tendon and is suitable for the Chinese patients.Exact incision and special operative instruments should be emphasized to avoid the increase of acetabular pitch angle and abduction angle.
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Objective To evaluate the osteogenesis of a novel borosilicate glass materials combined with platelet-rich plasma in repairing segmental bone defects. Methods 36 New Zealand white rabbits which bilateral radius were resected into l.5cm bone defect, were divided into 4 groups averagely depending on implanted materials: group A (one side: D-Alk- 1B, another side: D-Alk- 1B +PRP), group B (one side:D-Alk- 1B +PRP, another side: β-TCP); group C (one side: β-TCP, another side: experimental bone defect),and group D(one side:D-Alk-1 B,another side :experimental bone defect). The specimens were examined after 4, 8,12 weeks; the osteogenesis was evaluated through gross observation, X-ray radiograph,histological examination,scanning electron microscope and Micro-CT. Results There were similar results about gross observation,X-ray radiograph ,histological examination. After 4, 8, 12 weeks ,D-Alk-1B materials, β-TCP and D-Alk-1 B + PRP group had better osteogenesis ability than the experimental control group (P ＜0.05); D-Alk-lB + PRP had the best performance, better than D-Alk-1B and β-TCP (P＜0.05); D-Alk-1B were similar to β-TCP (P＞0.05). D-Alk-1 B materials degradated faster than β-TCP materials, and the porous structure of the materials disappeared after degradation. D-Alk-1B materials intergrated with host's bone was better than β-TCP materials. Conclusion D-Alk-1B material have good biological activity, histocompatibility and biodegradation and simiar presence of bone formation compared withβ-TCP in the aspect of repairing the segmental bone defect, the combination of PRP and D-Alk-1 B strengthened osteogenesis in vivo.
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Objective To evaluate the expression of Srvivin mRNA in the occurrence and progress of prostate cancer.Methods The inhibitor of apoptosis gene Survivin mRNA in 45 prostate cancer cases and 30 benign prostatic hyperplasia(BPH) cases were detected by hybridization in situ technique.Results The average optical density of prostate cancer groups(0.4232±0.0085)was signifi cantly higher than BPH groups (0.3303±0.0834) (P=0.001 ).Among the different pathological grades [G1(0.3401±0.0474), G2 (0.4270±0.0074), G3 (0.4560±0.0883)],the difference was statistically significant in the expression of Survivin mRNA (P= 0.004).It was found that there was positive correlation between the transfer of lymph (0.4557±0.7921)and the expression of Survivin mRNA in prostate cancer(P=0.005 ).Conclusion Survivin mRNA is overexpression in prostate cancer.It presumed that Survivin participate in genesis,development of prostate cancer and closely correlated with prognosis.
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[Objective]To study and evaluate the result of the surgical treatment for arthroscopic reconstruction of anterior cruciate ligament(ACL) with double-bundle semitendinosus.[Method]Thirty-one cases who underwent surgical treatment of arthroscopic reconstruction of ACL with double-bundle semitendinosus during 1990～1998 were analyzed retrospectively.The mean follow up time was 127.36 months(98～168 months).Among them,11 case was simplicity ACL injury,15 cases associated with medial meniscus injury,8 cases combined with lateral meniscus injury,6 cases combined with medial collateral ligament injury,2 case combined with lateral collateral ligament injury.All the patients with medial collateral ligament injury were associated with medial meniscus injury.The analysis was performed on the symptom,physical sign,Lysholm score system and IKDC score pre and postoperation recently.[Result]All the patients had good clinical results with no click,locking,"give way",extra-extension pain,and floating patella test were negative.There were no other complications correlated with semitendinosus grafting.But mild pain were seen in 11 cases,Lachman test were positive in 3 cases,anterior drawer test were positive in 8 cases without complications of instability.The Lysholm score:preoperation was 49.62?8.22 and 76.60?7.68 in follow-up time(P
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[Objective]To discuss the clinical problems of meniscal transplantation based on 2 cases clinical practical results including the harvest and preserved methods of meniscal allograft,operative procedure,rehabilitation plan and side-effect,combining with literature review,so as to provide reference for further clinical practice and research.[Method]The meniscal allograft were perfumed with arthroscopic technique on 2 patients,younger than 50 years,suffering from severe meniscus tear or defect at the time of other procedures.The initial clinical results about relieving of symptoms,recovery of functions were evaluated after short time rehabilitations.[Result]There was no operative side-injury and signs of knee instability.The incisions healed well without exudation.The knee joint swelling disappeared in 6 weeks.Rejection reaction was not observed in all of laboratory tests.The VAS were 8,6 preoperatively and 3,2 postoperatively.The processes of rehabilitation were normal.[Conclusion]Considering the difficult in maintaining severe tear meniscus and the characteristics of immune evasion of meniscus,meniscal allograft may be expectable option in the future.Very many researches have provided theoretical base.The results of long-time following-up should be further observed and wany clinical problems need to be further solved.
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[Objective]To treat stenosing tenosynovitis by a kind of mini-invasion operation with endscopy assisted,and to observe the clinical results,and to discuss the problem of open and percutaneous A1 pulley release.[Method]Eleven cases,suffering from stenosing tenosynovitis,were treated by the technique of mini-invasion operation with endscopy assisted with a kind of special release knife.The clinical results was investigated and the operative methods was investigated.[Result]All of the patients showed relieving of symptoms of disfunction and trigger finger.There was no serious complication,such as injury of nerves,infection,wound ununion and hand disability.None recurrent case in the follow-up period of 6 to 36 months.[Conclusion]The method of miniinvasion surgical treatment of stenosing tenosynovitis by endscopical technique assisted is safe,effective and low-cost with few complications,which fit for treating stenosing tenosynovitis,specially for those patients with cortisone injection,diabetes and thumb stenosing tenosynovitis.
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[Objective]To investigate the surgical feasibility and efficiency with microendoscopy discectomy technique for the recurrent lumbar disc herniation.[Method]Ninteen cases underwent disc excision with different operative approaches,11 cases had undergone previous surgery with MED,7 cases with conventional approach,2 cases removing whole vertebrate plate approach,3 cases removing half vertebrate plate approach,2 cases with minor vertebrate plate window approach.There were 13 cases of ipsilateral protrusion and 2 cases of contralateral protrusion,3 cases of adjacent segment protrusion.All of these cases were revisioned by MED except for 1 case.[Result]Eighteen cases were finished by MED technique successfully except for 1 case which was changed to open operating.All cases were followed up from 6 months to 2.5 years,averaged 1.5 years.Postoperative JOA score was improved from preoperative average (9.61?3.40)? to average (26.17?2.60) ?,the rate of improvement final was 86.32%.In terms of Macnab scoring system,the satisfactory rate was 88.89%.[Conclusion]MED technique is an effective method for recurrent lumbar herniation,but the operator needs lots of experience in minimal invasive spine surgery.
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Objective To discuss the design of arthroscopic reconstruction of posterior cruciate ligament (PCL) with quadriceps tendon fixed by a patellar block and an allograft bone plug, and its clinical outcome. Methods Thirteen patients suffering from PCL injury were treated by the technique mentioned above. The connection between quadriceps tendon and superior patellar pole was preserved in the harvest process of quadriceps tendon. The femoral tunnel was made like a bottle neck, which was clogged with the patellar bone block. The quadriceps tendon strip was fixed by an allograft bone plug pressed into the tibial tunnel. Their functional recovery was evaluated by Lysholm scoring and IKDC(International Knee Documentation Committee) criteria. Results In the average follow-up period of 19 months, there were not any severe nerve or blood vessel lesions, or failures of transplanted ligament None of the patient complained of knee instability after the operation. The pain was relieved in most patients, but three complained of pain after knee movement A little calcification was found in the quadriceps tendon at the superior patellar pole one year after the operation in the X-ray of a patient There was significant difference in Lysholm scale between pre-operation and post-operation (P
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Objective To investigate clinical results of the treatment of posterior shoulder instability in a combined way of bone block procedure and posterior capsulorrhaphy. Methods The double contrast CT arthrography was performed for 5 patients suffering from posterior shoulder instability so as to detect the pathology. The treatments combining bone block procedure and posterior capsulorrhaphy were carried out according to the pathological conditions of bone and soft tissue. Results The double contrast CT arthrography showed posterior bone defects, posterior glenoid labrum tear and enlargement of posterior capsular cavity. After the bone block procedure and posterior capsulorrhaphy, no patients complained shoulder instability in the follow-up of 5 to 38 months. Conclusions Many pathological factors may induce posterior shoulder instability, which should be corrected by an appropriate operation rather than a “standard”method of operation. For patients involving several pathological factors, a combined operation may be needed in order to correct various pathological changes.
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<p><b>OBJECTIVE</b>To observe dynamic changes of intracellular calcium ([Ca(2+)]i) after spinal cord injury, and to study the relationship between the changes of [Ca(2+)]i and the functional damage of the spinal cord.</p><p><b>METHODS</b>The rats were subjected to a spinal cord contusion by using a modified Allen's method. The [Ca(2+)]i in the injured segment of the spinal cord was measured by the technique of La(3+) blockage and atomic absorption spectroscopy at 1, 4, 8, 24, 72, and 168 hours after injury. The motor function on the inclined plane was measured at the same time.</p><p><b>RESULTS</b>The spinal cord [Ca(2+)]i increased significantly (P<0.05 or P<0.01) aft er spinal cord injury. There was a significant correlation (P<0.05) between the changes of [Ca(2+)]i and the motor function.</p><p><b>CONCLUSIONS</b>[Ca(2+)]i overload may play an important role in the pathogenesis of spinal cord injury.</p>
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Animals , Male , Rats , Calcium , Metabolism , Linear Models , Rats, Wistar , Spectrophotometry, Atomic , Spinal Cord Injuries , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the characteristics of bone fractures from road traffic accidents and analyze their injury mechanisms so as to provide reference for the research and medical care of traffic trauma.</p><p><b>METHODS</b>Three hundred and six patients with fractures from road traffic accidents were included into this study. A total of 507 fractures were identified and the injury mechanism, location distribution and frequency were analyzed.</p><p><b>RESULTS</b>The most common location of fractures was the lower extremities, followed by the upper extremities, skull and maxillofacial region, and the rarest was the spine. A total of 56% of the patients suffered from multiple fractures. The fractures of the patella, femur and pelvis and the fractures of the olecranon, humerus and shoulder often happened simultaneously.</p><p><b>CONCLUSIONS</b>The injury mechanisms can be classified into four types: impact, incoordinate movement, stretch injury and crush and extrusion. The fractures from traffic accidents have the following characteristics: centrifugal distribution of the injuries, multiple fractures, force transmission and ipsilateral occurrence.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Accidents, Traffic , Chi-Square Distribution , China , Epidemiology , Fractures, Bone , Epidemiology , Injury Severity ScoreABSTRACT
Objective To investigate the pathological changes of bone in situ lengthening for the gunshot bone defect, and to discuss the practical feasibility and biological basis of bone lengthening in the conditions of periosteum damage. Methods The 38 canines were randomly distributed into two groups and sustained the same gunshot bone defect in the mid femoral diaphysis. In one group, the femur were stabilized with Bastiani external fixator and 2 weeks later the fractured limb with fixation were lengthened 2-4 times per day at a speed of 0.5-1 mm/d until the normal length was reached. The control group only had external fixation without lengthening. 3, 6 and 12 weeks after injury, the canines were given 99mTc MDP and got radionuclide examination under SPECT (ADAC company, USA.). Pathological and X ray observation were carried out at 1, 2 ,3 ,6 and 12 weeks respectively after injury for comparison between two groups. Results The X ray measurement showed that the length of callus distraction in the bone lengthening group increased by (2.82?0.94)cm and the relative lengthening of bone is 19.3% (15.8%-21.4% ), compared with normal femur on the same X ray film. The count of radionuclide increased gradually at the region of bone defect in the lengthening group. While in the fracture ends, no significant difference was found in the development pattern through each radionuclide observation phase between two groups. The main mode of osteogenesis was endochondral ossification and the bone defect area was enriched by chondrocyte in the bone lengthening group. Conclusion There are no obvious negative influence on bone turnover and local blood flow in the bone lengthening for gunshot bone defect. The remained periosteum and bone fragment under gunshot injury may have important role in the progression of osteogenesis. The neogenetic capillary provided not only blood supply for healing of bone but also source of osteocyte for bone lengthening in the case of the periosteum and blood circulation damaged with gunshot wound.
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To observe the local microcirculation changes in primary bone lengthening for gunshot bone defect treated by external fixators, the experimental study was carried out by using canine model of gunshot bone defect of extremities. 16 mongrel dogs were randomly divided into 2 groups, external fixators were used to distract early callus in one group and plaster was used for immobilization in the other group. The local microcirculation in the two groups was measured. The results showed: (1) Different from the normal fractures, the local blood flow of gunshot fractures was reduced in the first 3 days and then increased, at the 6th week it was close to the normal level. (2) There was no significant difference in the restoration of blood flow between the groups of external fixation and plaster immobilization. It is suggested that primary bone lengthening for gunshot bone defect by external fixators has no adverse effect on the restoration of the local blood flow.