Efectividad de la crioterapia y la electroestimulación nerviosa transcutánea en deportistas con afecciones del sistema osteomioarticular / Effectiveness of cryotherapy and nervous transcutaneous electro stimulation in sportsmen with affections of the osteomyoarticular system

Introducción: El trauma grave constituye una de las principales causas de muerte y discapacidad. Si bien es una enfermedad muy heterogénea en cuanto a su origen, tipos lesionales y gravedad, existe gran incertidumbre en cuanto a su pronóstico. Objetivo: Evaluar la efectividad de la crioterapia y la electroestimulación nerviosa transcutánea para la disminución del dolor y el edema en deportistas con afecciones del sistema osteomioarticular. Métodos: Se realizó un estudio observacional, de corte descriptivo y retrospectivo, de 5 548 deportistas con afecciones del sistema osteomioarticular, que acudieron al Servicio de Rehabilitación Física del Estadio José Antonio Huelga de la provincia de Sancti Spíritus, entre noviembre de 2018 y diciembre de 2019, para recibir crioterapia y electroestimulación nerviosa transcutánea para la disminución del edema y el dolor. Entre las variables estudiadas figuraron: sexo, edad, tipo de deporte que practicaban, lesiones que presentaban, recuperación y tiempo de desaparición de los síntomas. Resultados: Predominaron el sexo masculino (66,83 %), el grupo etario de 8-21 años (57,33 %), el futbol y el atletismo como deportes con mayor número de afectados (23,08 y 22,85 %, respectivamente), así como los esquinces (56,54 %) y las fracturas (20,81 %) como lesiones principales. Conclusiones: La terapia aplicada resultó efectiva y segura para disminuir el edema y el dolor en los deportistas a causa de enfermedades traumáticas del sistema osteomioarticular.

Introduction: The serious trauma constitutes one of the main causes of death and disability. Although it is a very heterogeneous disease as for its origin, types of injure and seriousness, great uncertainty exists as for its prognosis. Objective: To evaluate the effectiveness of cryotherapy and the nervous transcutaneous electroestimulation for the decrease of pain and edema in sportsmen with affections of the osteomyoarticular system. Methods: An observational, descriptive and retrospective study of 5548 sportsmen with affections of the osteomyoarticular system was carried out, they went to the Physical Rehabilitation Service of the José Antonio Huelga Stadium in Sancti Spíritus, between November, 2018 and December, 2019, to receive cryotherapy and nervous transcutaneous electroestimulation for the decrease of edema and pain. Among the studied variables figured: sex, age, type of sport that they practiced, injure that presented recovery and time of disappearance of symptoms. Results: There was a prevalence of the male sex (66.83 %), the 18-21 age group (57.33 %), football and athletics as sports with a higher number of affected patients (23.08 and 22.85 %, respectively), as well as sprains (56.54 %) and fractures (20.81%) as main lesions. Conclusions: The applied therapy was effective and safe to diminish the edema and pain in sportsmen due to traumatic diseaes of the osteomyoarticular system.

One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator / 中华实用儿科临床杂志

Objective:To investigate the clinical effectiveness of one-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator.Methods:The data of 5 patients (2 males and 3 females) with angulation and shortening deformity in the lower extremity after epiphyseal injury of the distal femur were retrospectively analyzed.The patients underwent monorail external fixator assisted one-stage osteotomy correction of the distal femur and distraction osteogenesis of the middle and upper femur in Zhengzhou Orthopeadics Hospital from May 2017 to December 2019.The mean age was 13.6 years old (range: 10 to 17 years old). The affected limbs were shortened by 5.1 cm on average (range: 3.9 to 6.5 cm). The average angulation deformity of the distal femur was 24.9° (range: 17.0°to 30.5°). The mechanical lateral distal femoral angle (mLDFA), the mechanical posterior distal femoral angle (mPDFA), the mechanical axis deviation (MAD), the range of motion (ROM) of the knee, and the length of the lower limbs before surgery and at the final follow-up were measured and analyzed.Results:All patients were followed up for 22 months on average (range: 15 to 32 months). For all the 5 patients, the mechanical axis was well realigned, mLDFA, mPDFA, and MAD returned to normal range, and the length of the affected limb achieved the goal as planned before the surgery.Besides, the affected limbs were lengthened by 5.6 cm on average (range: 3.9 to 8.0 cm), and the median healing index was 35.6 d/cm (range: 29.0 to 45.0 d/cm). The bone callus in the distraction area and the osteotomy end were well healed at the final follow-up, as indicated by the X-ray results.At the end of the distraction period, the flexion ROM of the knee in all patients reached basically 90°.By the final follow-up, all patients had a normal knee ROM.No vascular or nerve injury, dislocation of hips or knee joints, re-fracture after disassembly, deep infection and other complications were observed in all patients.Conclusions:One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator is safe and feasible.The method requires no multiple operations and improves the tolerance of patients during the treatment period.

AnaIysis of chemotherapy drug-induced Iiver injury in chiIdren with acute IymphobIastic Ieukemia based on RUCAM scaIe / 中华实用儿科临床杂志

Objective To analezk thk charactkristics of drug-induckd livkr injure( DIFI)in childrkn with acutk lemphoblastic lkuckmia(LFF),so as to improvk thk phesician＇s undkrstanding of chkmothkrape DIFI,and to guidk clinical rational drug usk. Methods Onk hundrkd and forte-thrkk casks with LFF diagnoskd in thk Dkpartmknt of Hk-matologe and Oncologe in thk Pirst Lffiliatkd Hospital of Yhkngzhou Rnivkrsite from Januare 2012 to Dkckmbkr 2016 wkrk analezkd rktrospkctivkle. Baskd on DIFI diagnostic critkria and thk ARCLM scalk,thk casks with a scork of ≥3 points wkrk considkrkd to havk chkmothkrape DIFI. Groupkd be gkndkr,agk,immunoteping,risc and stagk of chkmo-thkrape,thk incidknck of DIFI was comparkd. Thk situation aftkr DIFI prkvkntion was comparkd bktwkkn two groups which was groupkd according to whkthkr thk application of hkpatoprotkctivk drugs. ResuIts Onk hundrkd and kight ca-sks(75. 52﹪)had DIFI,66 casks(61. 11﹪)showkd clinical manifkstations of livkr injure,and 42 casks(38. 89﹪) had no clinical semptoms. Lmong all thk casks 57. 41﹪(62 casks)wkrk mild livkr damagk,25﹪(27 casks)wkrk modkratk livkr injure and 17. 59﹪(19 casks)wkrk skvkrk livkr damagk. Thk clinical tepks which wkrk hkpatockllular accounting for 79. 63﹪(86 casks),cholkstatic 7. 41﹪(8 casks)and mixkd 12. 96﹪(14 casks). Malk wkrk 80 casks (79. 21﹪)and fkmalk 28 casks(66. 67﹪),but thk incidknck of DIFI bktwkkn diffkrknt gkndkr group had no statistical diffkrknck(χ2 ﹦2. 524,P﹦0. 112). Skvknte-fivk casks(77. 32﹪)wkrk ＜7 ekars agk and 33 casks(71. 74﹪)≥7 ekars agk,and thk incidknck of DIFI bktwkkn 2 groups was not statisticalle diffkrknt(χ2 ﹦0. 526,P﹦0. 468). Thkrk was no significant diffkrknck in T-LFF(8 casks,61. 54﹪)and B-LFF(100 casks,76. 92﹪)( χ2 ﹦0. 795,P﹦0. 372). Thk incidknck had significant diffkrknck in diffkrknt risc(P﹦0. 002). Thk incidknck of DIFI bktwkkn thk middlk risc group(60 casks,88. 24﹪)and standard risc(21 casks,58. 33﹪)had statistical diffkrknck( P ＜0. 05 ). Thk incidknck of DIFI bktwkkn thk middlk risc group and skvkrk risc(27 casks,69. 23﹪)had statistical diffkrknck( P﹦0. 015). Thk incidknck was diffkrknt in diffkrknt stagks of chkmothkrape(P＜0. 05). Thk incidknck of DIFI in induckd stagk was diffkrknt comparkd to othkr stagks(P＜0. 05). ARCLM scork ＞8 points accountkd for 21 casks(19. 45﹪), 6-8 points accountkd for 59 casks(54. 63﹪)and 3 -5 points accountkd for 28 casks(25. 92﹪). Eighte -nink patiknts(92. 71﹪)wkrk kffkctivk in thk hkpatoprotkctivk group and 8 patiknts(66. 67﹪)in thk no hkpatoprotkctivk thkrape group. Thk diffkrknck bktwkkn thk 2 groups was statisticalle significant(χ2 ﹦5. 317,P﹦0. 021). ConcIusions Thk clinical semptoms of drug-induckd livkr injure in childrkn with LFF chkmothkrape ark lacc of spkcificite. Thke ark mainle charactkrizkd be mild livkr injure. Thk clinical tepk of hkpatic injure is common in hkpatockllular. Thk ARCLM scork was mostle 6 to 8. Thkrk is no rklationship bktwkkn thk incidknck in LFF and gkndkr,agk,tepk of lkuck-mia. Thk incidknck with modkratk risc tepk is highkr than that of thk standard and high-risc tepk. Thk incidknck in induction rkmission stagk is highkst. Lpplication of hkpatoprotkctivk drugs is bknkficial to DIFI prognosis.

Desigualdades e implicaciones afectivas en mujeres autoras de lesión / Inequalities and affective involvement of female perpetrators of injury / Desigualdades e implicações afetivas em mulheres autoras de lesão

En este artículo se analiza la problemática específica de mujeres que cumplen condena por un delito de lesiones, en el contexto penal español. Fue abordado a través de una metodología cualitativa, realizando entrevistas en profundidad, procesadas en base a un análisis temático siguiendo criterios de organización de la Teoría Fundamentada. En sus resultados se destaca en el contexto previo al delito: la desigualdad con su pareja, posicionándose desde la sumisión a la exigencia de reciprocidad. Una vez condenadas, les repercute la implicación afectiva y su vulnerabilidad frente a la ruptura de vínculos significativos en su vida cotidiana. Se concluye incorporar el enfoque de género, enfatizando en un análisis crítico respecto del proceso e implicancias de la comisión del delito; así como la discusión de integrar nuevas categorías que intervengan en los discursos legales y políticas públicas respecto a la violencia en la pareja.

This article analyzes the specific problems of women who are serving sentences for the crime of injury, in Spanish criminal context. It was addressed through a qualitative methodology, conducting in depth interviews, processed based on a thematic analysis following criteria of organization of the Grounded Theory. Their results it stands out in the context prior to the crime: the inequality with their partner, positioning itself from submission to the requirement of reciprocity. Once condemned, condemn affects the affective implication and vulnerability in from of the rupture of significant links in their daily lives. The conclusion about the relevance of incorporating the gender approach, emphasizing a critical analysis about the process and implications of the crime, as well as the discussion of integrating new categories that intervene in legal speeches and public policies regarding violence in the couple.

Este artigo analisa a problemática específica de mulheres que cumprem condena por um delito de lesão, no contexto penal espanhol. O estudo foi feito através de metodologia qualitativa, realizando entrevistas em profundidade, processadas com base na análise temática seguindo critérios de organização da Teoria Fundamentada. Os resultados destacam, no contexto prévio do delito, a desigualdade no casal, posicionando-se desde uma submissão a exigência de reciprocidade. Uma vez condenadas, ressaltam a implicação afetiva e sua vulnerabilidade frente a ruptura de vínculos significativos na sua vida cotidiana. Conclui-se sobre a relevância de incorporar o enfoque de gênero, enfatizando uma análise crítica sobre o processo e as implicações no delito, assim como a discussão de integrar novas categorias que intervenham nos discursos legais e políticas públicas sobre a violência no casal.

Correlation between vascular endothelia injury factors and occupational hand-arm vibration disease / 中国职业医学

OBJECTIVE: To analyze the correlation between vascular endothelia injury factors and occupational hand-arm vibration disease( HAVD). METHODS: A judge sampling method was used to select 23 male patients with HAVD as the HAVD group,61 male workers who exposed to hand-arm vibration without HAVD as the vibration exposure group,64 male workers without hand-arm vibration exposure as the control group. The plasma levels of myosin light chain 2( MLC2),endothelin-1( ET-1) and vinculin( VCL) were detected by enzyme-linked immunosorbent assay. Logistic regression analysis was used to analyze the related indicators of HAVD for building the new multivariable model index Y. The indicators of HAVD were screened and judged by receiver operating characteristic( ROC) curves. RESULTS: There was significant difference in plasma levels of MLC2 among the three groups( P < 0. 05). The levels from high to low was as follows: HAVD group > vibration exposure group > control group. The plasma level of ET-1 in HAVD group was lower than that in the control group( P < 0. 05),but there was no significant difference between vibration exposure group and HAVD group( P > 0. 05). There was no significant difference among the three groups in the plasma level of VCL( P > 0. 05).The logistic regression analysis results showed that after adjusting confounding factors such as age,length of service,smoking,alcohol drinking and subjective symptoms,the higher MLC2 plasma level,the higher risk of HAVD( P < 0. 01),and the lower ET-1 plasma level,the higher risk of HAVD( P < 0. 05). According to ROC curve analysis,the area under the ROC curve( A_Z) value of the plasma levels of MLC2 and ET-1 were 0. 820 and 0. 524,respectively( P < 0. 01). The predictive probability index Y built with MLC2 and ET-1 by logistic regression model was used to judge the A_Z value of HAVD to be 0. 799( P < 0. 01). The A_Z values from high to low was as follows: MLC2 > Y> ET-1( P < 0. 01).CONCLUSION: The plasma levels of MLC2 and ET-1 are correlated with HAVD. The efficacy of MLC2 as a biomarker for screening HAVD is better than that of ET-1. No association was found between VCL and HAVD.

Clinical Significance of Combined Detection of Serum Retinal-binding Protein,Cystatin C and β2-micoglobuimin in Diagnosis of Early Renal Injures of Gestational Diabetes Mellitus / 现代检验医学杂志

Objective To study the diagnosis value of serum retinol binding protein (RBP),cystatin C(Cys C) and β2 microglobulin (β2-M) in early renal injures of gcstational diabetes mellitus (GDM) patients.Methods 85 case of GDM pregnant women admitted to Shiyan Maternal and Child Health-Care Hospital from Jan.2009 to Jan 2015 were chosen as research objects,and were divided into simple diabetes group (35 cases),micro proteinuria group (30 cases) and massive proteinuria group (20 cases) according to the urinary albumin excretion rate (UAER),while 30 cases of healthy pregnant women were recruited randomly during the same period as control group.The 24h urine protein,serum RBP and renal function indicators [blood urea nitrogen (BUN),creatinine (Ser),Cys C and β2 M],the positive rates of RBP,Cys C,β2-M and combined detection of RBP,Cys C,β2-M of the four groups were compared.Results The 24h urine protein in simple diabetes group,micro proteinuria group and massive proteinuria group were significantly higher than that in the control group (t=3.91～ 16.33,all P＜0.01),the difference between the 3 groups were statistically significant (t=6.78～ 16.94,all P＜0.01).The levels of BUN,Scr,Cys C,β2-M and RBP in micro proteinuria group and massive proteinuria group were significantly higher than those in control group and simple diabetic group (t=3.68 ～ 18.54,all P＜0.01),there were significant difference in above indexes between micro proteinurine group and massive proteinuria group (t=4.70～ 10.87,all P＜0.01).The positive rates of RBP,Cys C,β2-M and combined detection of RBP,Cys C and β2-M in micro proteinuria group and massive proteinuria group were significantly higher than those in control group and simple diabetic group (x2 =20.27～38.57,all P＜0.01).There was no significant difference in the positive rates between micro proteinuria group and massive proteinuria group (x2 =0.62～0.93,all P＞0.05).The positive rate of combined detection of the three indicators was higher than that of the single detection in the same group (x2=3.97～6.65,P＜0.05 or P＜0.01).Conclusion The detection of serum Cys C,RBP and β2-M has a high clinical value in the diagnosis of early renal damage in patients with GDM.The positive rate of combined detection of 3 indexes was higher than that of single index.

Respective Study on Acute Kidney Injure Induced by Vancomycin in Elderly Patients Evaluated by Serum Cys-C and Urine KIM-1 / 中国药师

Objective:To evaluate acute kidney injure ( AKI) induced by vancomycin in elderly patients by the determination of serum C ( Cys-C) , creatinine ( Cr) and urine kidney damage factor 1 ( KIM-1 ) in order to provide theoretical evidence for clinical pharmacists helping clinicians make individualized dosage regimen. Methods:A retrospective collection of 48 elderly patients admitted to ICU in our hospital from July 2016 to May 2017 treated with vancomycin for MRSA blood flow infection was carried out. The basic values of serum Cys-C, Cr and urine KIM-1 were determined before the treatment of vancomycin and 6, 12, 24h and 48h after the drug use. According to the AKI diagnostic criteria, the patients were divided into the AKI experimental group and the control group. The se-rum Cr, Cys-C and urine KIM-1 were compared between the groups after the drug use and the clinical diagnostic values of Cys-C and KIM-1 were assessed by the working characteristic curve ROC of the subjects. Results:Totally 32 cases (66. 67%) of patients were with AKI induced by vancomycin at 48h after the administration. Compared with that of the control group, the serum Cr, Cys-C and u-rine KIM-1 was significantly higher respectively at 48h, 24h and 12h after the drug use in the AKI experimental group, and the differ-ences between the groups were statistically significant(P<0. 05). Using serum Cys-C, Cr and urine KIM-1 as the AKI diagnosis, the number of AKI at 12h after the drug use had statistically significant difference (P<0. 05). The results of ROC curve analysis showed that the area under the KIM-1 curve of urine was 0. 797 with 95% confidence interval of 0. 647-0. 947), and the area under the serum Cys-c curve was 0. 582 with 95% confidence interval of 0. 364-0. 799. Conclusion: Compared with the traditional kidney damage markers Cr, serum Cys-C and urine KIM-1 can earlier predict renal function in elderly patients to provide reliable basis for early evalu-ation of renal function, which is helpful to the timely adjustment of vancomycin dosage regimen by clinicians assisted by clinical phar-macists for elderly patients.

Protective Effect of Sulfated Gastrodia Elata Polysaccharides on the Apoptosis of PC12 Cells Induced by Corticosterone / 中国药师

Objective: To investigate the protective effect of sulfated Gastrodia elata polysaccharides (GEPS) on the apoptosis of PC12 cells induced by corticosterone (CORT).Methods: After modifying GEP chemically, GEPS was obtained.PC12 cells were pretreated with GEPS (0, 250, 500 and 1 000 μg·ml-1) for 30 min before cultivating with CORT for 48 h.The cellular viability, lactate dehydrogenase (LDH) release and morphological observation were determined respectively by CCK-8 assay, LDH assay, inverted microscope and DAPI fluorescein stain method.Results: With the pretreatment of GEPS, the survival rate of PC12 cells increased significantly (P<0.05) in a dose-dependent manner.Compared with CORT injured group, GEPS attenuated the release of LDH with statistical significance (P<0.05), and LDH leakage decreased with the concentration of increase GEPS.Under an inverted microscope, PC12 cells incubated with CORT became shrinkage, and aggregated with decreased diopter and bad adhesion,and lots of cells floated.However, with the pretreatment of GEPS, the living status of PC12 cells improved markedly.Compared with CORT injured group, GEPS obviously reduced the apoptosis of PC12 cells.Conclusion: GEPS exhibits protective effects on the apoptosis of PC12 cells induced by CORT, while when compared with GEP, GEPS shows the similar effects.The other bioactivities of GEPS need further studies.

Clinical characteristics and prognosis of sepsis-associated liver injure in pediatric intensive care unit / 中国小儿急救医学

Objective To discuss the incidence,clinical characteristics of sepsis-associated liver injure in pediatric patients and risk factors that may affect the prognosis.Methods A retrospective analysis was made on the data of patients with sepsis-associated liver injure that had been hospitalized in Shanghai Children′s Hospital from January 2011 to December 2015.The cases were divided into the survival group and the death group.Logistic regression analysis was made to screen out risk factors of patients with sepsis-associated liver injure that influence the prognosis.Results The incidence of sepsis associated liver dysfunction was 9.7%(120/1242),the mortality rate was 35.8%(43/120).The most common focus of infection was respiratory tract infection(50.0%),followed by abdominal cavity infection(33.3%) and central nervous system infection(6.7%).The pathogenic microorganisms were mainly gram-negative bacilli(51.3%),followed by virus(26.5%) and gram-positive bacterium(17.7%).The main manifestations of the liver injure were elevated glutamic-pyruvic transaminase(117 cases,97.5%),prolonged prothrombin time(PT)(93 cases,77.5%),hypoproteinemia(83 cases,69.2%) and hyperbilirubinemia(70 cases,58.3%).The total bilirubin(TBIL),PT,activated partial thromboplastin time and total bile acid of the death group were higher than thoes of the survival group.Logistic regression analysis indicated that elevated TBIL(OR=2.937,95%CI 1.179-7.315,P=0.021) was the independent risk factor for death.The area under receiver operating characteristic curve for TBIL(cut off was 64.5μmol/L)was 0.736 with sensitivity 57.7% and specificity 84.8%.Conclusion The incidence rate of sepsis-associated liver injure among pediatric patient is high.Gram-negative bacilli are the main pathogenic microorganisms.This disease is manifested as the elevated glutamic-pyruvic transaminase,hypoproteinemia,prolonged PT and hyperbilirubinemia.Hyperbilirubinemia is the independent risk factor that influences the prognosis.

Particularidades del síndrome de dificultad respiratoria aguda en edades pediátricas / Particularities of the acute respiratory distress syndrome at pediatric ages

Desde las primeras descripciones del síndrome de dificultad respiratoria aguda los pediatras intensivistas reconocieron que posee particularidades que la hacen diferente en la población pediátrica. El objetivo de este trabajo es divulgar la definición específica en el modelo infantil, aunque existen similitudes en la fisiopatología del síndrome de dificultad respiratoria en adultos y niños. Se revisaron los conceptos vigentes sobre el síndrome de dificultad respiratoria aguda desde su descripción, a través de los diferentes consensos (desde el de 1994 hasta el de 2015) y se señalaron las recomendaciones en el tratamiento y seguimiento de esta entidad. Los tópicos que se trataron fueron: concepto; prevalencia y epidemiología; fisiopatología, severidad y enfermedades asociadas; soporte ventilatorio; tratamientos secundarios específicos sobre el pulmón; tratamientos concomitantes; monitoreo general y pulmonar; soporte ventilatorio no invasivo; terapia extracorpórea y el seguimiento a largo plazo. Las recomendaciones propuestas en la última conferencia de consenso para el tratamiento del síndrome de dificultad respiratoria en edades pediátricas permiten optimizar el tratamiento e identificar necesidades futuras de investigación del tema.

Since the first descriptions of the acute respiratory distress syndrome, the intensive service pediatrician admitted that it has some particularities that make it different in the pediatric population. The objective of this paper was to explain the specific definition in the infant model despite the similarities in the physiopathology of this syndrome in adults and children. The current concepts about the acute respiratory distress syndrome from its first description through the various consensuses about it (1994 to 2915) were reviewed, and the recommendations in terms of treatment and follow-up were also pointed out. The addressed topics were concept, prevalence and epidemiology, physiopathology, severity and associated diseases; ventilatory support, specific secondary treatments for the lung, concomitant treatments, general and pulmonary monitoring, non-invasive ventilatory support, extracorporeal therapy and long-term follow-up. The recommendations for the treatment of the respiratory distress syndrome at pediatric ages suggested by the last consensus conference allow optimizing the treatment and identifying future requirements for research on this subject.

Initial muscle-enclosing protection of large segment of exposed Achilles tendon and second stage repair of Achilles tendon rupture complicated with cutaneous defect:observation of 32 cases / 中国基层医药

Objective To discuss the methods and evaluate the effects of initial muscle-enclosing protection of large segment of exposed Achilles tendon and second stage repair of Achilles tendon rupture complicated with cuta-neous defect.Methods Among patients treated between August 2005 to April 2014 in our hospital,there were 32 patients,who were diagnosed with Achilles tendon rupture complicated with cutaneous defect.Of the 32 patients, there are 21 male and 11 female.Their ages range from 23 to 69,with an average age of 46.2 ±3.5.In all the patients described above,there are soft tissue contusion injuries and cutaneous defects on their posterior lower legs near the ankles,with the area of skin defects ranging from 3cm ×4cm to 5 ×12cm,and the Achilles tendons were ruptured, extracted,dissociated and completely uncovered.All patients were initially treated with triceps surae muscle-enclosing method to put aside and protect the large segment of exposed Achilles tendon.Later,the ruptured Achilles tendons were repaired,together with the transfer of skin flap to repair skin defects,at the second stage.The therapeutic effects were evaluated during postoperative follow-up periods.Results The mean follow-up period was 18 months,ranged from 11 to 32 months.According to the therapeutic effect evaluation standard of Arner-Lindholm,there were Excellent results in 22 patients,Good in 7 cases and Poor in 3 cases,with a combined excellent/good rate of 90.62%.Conclusion Initial muscle-enclosing protection of large segment of exposed Achilles tendon and second stage repair of Achilles tendon rupture complicated with cutaneous defect is advantageous to the function of patients with rapid recovery.

Application of a microvascular anastomotic coupling device in solitary upper extremi-ty artery injury repairs / 北京大学学报(医学版)

Objective:To investigate the outcomes of applying microvascular anastomotic coupling de-vices in solitary upper extremity artery injury repairs and to optimize parameters for optimal clinical out-come.Methods:From March to September 2013,19 injured arteries from 18 male patients who presen-ted at Department of Hand Surgery,Beijing Jishuitan Hospital with traumatic arterial lacerations of their upper extremities went through rapid repair procedures.COUPLER,a microvascular anastomotic coupling device was applied in these artery injury repair operations.The 19 repaired arteries included 3 brachial arteries,6 ulnar arteries and 10 radial arteries.After the procedures,all the 18 patients were then fol-lowed up by clinical specialists and examined with color doppler flow imaging for the effective recovery of artery circulation and upper extremities functionality.Results:The average time of artery repairs for all the 19 damaged arteries among the 18 patients was 278 s and the average follow-up time was (71.5 ± 40.9)d with the longest follow-up time as 116 d and shortest as 14 d.No patient returned to the opera-ting room after the procedures and after being dismissed from the hospital.None of the 18 cases were re-ported to have problems with circulation and thrombosis formation in their upper extremities.Color Doppler imaging showed that the arterial anastomotic site for all the 19 repaired arteries were unobstructed with artery blood spectrum at both ends.Three patients with radial artery repairs complained about mild pressure pain at the site of vascular anastomosis;while the other 15 patients all expressed satisfactory outcomes of the surgery and recovery.These evidences indicated that the outcomes of our initial evalua-tion for the solitary upper extremity artery injury repairs by using anastomotic coupling devices were posi-tive.Conclusion:Our observations have showed that microvascular anastomotic coupling devices can be used for repairing of solitary upper extremity artery injures.The procedures are quick,effective and safe. The clinical application of this microvascular anastomotic coupling device in artery injures is promising, however,additional evidences through further clinical investigation with more cases are warranted.

Biomechanical study on the impact injure of human mandible by finite element method / 实用口腔医学杂志

Objective:To investigate biomechanical changes of mandible in the impact injure simulated by finite element method (FEM).Methods:Mimics and Comsol software were used to build a FEM of human craniofacial bone based on CT scan data of a normal adult.LS-DYNA and Hypermesh software were used to simulate the impact with different quality,velocity and angulation pro-duced injures of human mandible,the biomechanical parameters of the mandible in the impact injury process were analysed.Results:A FEMof human maxillofacial bone was established,and the dynamic process of different impact force produced damage was simula-ted.Mandibular chin,angle and condylar neck was the stress concentrated area in the process of mandible injury.There was higher stress peak at the site which was closer to the impact position,the stress peak arrival time was also earlier.When the impactor with the same quality,the bigger the velocity,the greater the stress peak.When the impactor with the same velocity,the bigger the quali-ty,the greater the stress peak.When the impactor with the same velocity and quality,there was greater stress peak under the impact to mandible from angulation of 0 degree.Stress transfered to the surrounding bone from the impact position radially and gradually re-duced.The bone area with small cross-section was prone to high stress and more serious damage.Conclusion:The quality,the ve-locity,the impact angle and the impact site are the factors affecting the severity of impact injury.

Effect comparison of statins on myocardial injure and inflammatory factors in patients with unstable angina pectoris undergoing percutaneous coronary intervention / 重庆医学

Objective To compare the effect of atorvastatin and rosuvastatin on myocardial injure and inflammatory factors in patients with unstable angina pectoris(UAP)undergoing percutaneous coronary intervention(PCI).Methods Ninety six UAP pa-tients undergoing PCI were enrolled in the study and divided into two groups,patients were given atorvastatin(20 mg/d)or rosuv-astatin(20 mg/d)besides conventional treatment for 1 week before PCI.Datas were collected before medication,PCI and Twenty-four hours after PCI,including CK-MB,cTnI,hs-CRP,TNF-α,IL-6 and IL-10.Results Twenty-four hours after surgery,the PCI, CK-MB,cTnI,hs-CRP,TNF-α,IL-6 of rosuvastatin group were lower than those of atorvastatin group(P <0.05),but IL-10 of ro-suvastatin group was higher than that of atorvastatin group(P <0.05).Conclusion Rosuvastatin (20 mg/d)is better than atorvas-tatin (20 mg/d)in the efficacy of UAP patients undergoing PCI,which can reduce the level of myocardial injure and inflammatory factors effectively.

The effects of tumor necrosis factor-αand interleukin-6 on acute myocardial function lesion after the severe craniocerebral injury / 重庆医学

Objective To investigate the effects of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)on acute myocardial functional lesion after severe craniocerebral injury.Methods Sixty five examples with severe craniocerebral injury are collected in the 253th hospital of PLA from February in 2009 to May in 2012,of whom glasgow coma scale was low or equal to 8 points.They are examined creatine kinase-MB(CK-MB),cardiac troponin T(cTnT),TNF-αand IL-6 for correlative analysis while they are emer-gency treated at the same time.Results The myocardial function of the observe group examined results:CK-MB(198.63±37.72) U/L,cTnT(548.17±49.58)pg/mL;injury factors examined results:TNF-α(39.93± 18.88)ng/mL,IL-6(469.61 ±73.66)ng/mL.It both has evidently difference between the control group and the observe group and has obviously correlation between the my-ocardial function and injury factors of the observe group (P 0.911 4)and cTnT(r>0.942 1)had statistically significant difference.Conclusion TNF-αand IL-6 all participate in the process of the acute myocardial functional lesion after severe craniocerebral injury.The inchoate interference and treatment against TNF-αand IL-6 are possible to have inhibited the high expression of TNF-αand IL-6 in the blood and to improve the myocardial functional lesion after severe craniocerebral injury.

Evaluación de las secuelas intelectuales en niños con trauma craneoencefálico severo / Assessment of the intellectual sequelae observed in children with severe traumatic brain injury

INTRODUCCIÓN: el trauma craneoencefálico severo es una de las principales causas de hospitalización y mortalidad en niños mayores de un año. OBJETIVO: conocer y evaluar las secuelas intelectuales que provoca el traumatismo craneoencefálico severo en estos pacientes. MÉTODOS: se realizó un estudio prospectivo, longitudinal, descriptivo, cuyo universo estuvo constituido por 84 niños mayores de un año de edad con trauma craneoencefálico severo, en un periodo de inclusión desde 1998 a 2008, con un seguimiento de la rehabilitación motora hasta 5 años posterior a la inclusión (hasta 2013). Las variables a estudiar fueron: la edad, el sexo, las causas directas del accidente y las manifestaciones clínicas encontradas en el examen físico. Se determinó el coeficiente de inteligencia y seguimiento a la evolución en el tiempo a través de la escala de repercusiones de Glasgow. RESULTADOS: la causa fundamental de las lesiones craneoencefálicas fueron los accidentes. El sexo de mayor incidencia fue el masculino, y el grupo de edad, el comprendido entre 5-9 años. Se clasificó al 61 % de los pacientes como retrasados mentales moderados, el 32,2 % retrasados mentales leves y el 3,4 % retrasados mentales graves y profundos, respectivamente. Fallecieron 7 niños. La evaluación de la rehabilitación al año confirmó que el 76,6 % de los pacientes mantenían discapacidad severa, y a los 5 años solo el 29,9 % era incapaz de vivir independiente. CONCLUSIONES: los traumatismos craneoencefálicos severos provocan secuelas intelectuales graves en los niños, y no se logra una rehabilitación favorable hasta el año del egreso hospitalario. Los grupos más vulnerables a sufrir traumatismo craneoencefálico son los niños mayores de 5 años y del sexo masculino, y la causa fundamental que lo provocó fue, dentro de los accidentes, las caídas de altura.

INTRODUCTION: severe traumatic brain injury is one of the main causes of hospitalization and mortality in children aged over one year. OBJECTIVE: to identify and to assess the intellectual sequelae that severe traumatic brain injuries cause in these pediatric patients. METHODS: a prospective, longitudinal and descriptive study of 84 over one-year old children suffering severe traumatic brain injuries in the inclusion period of 1998 through 2008, with a follow-up motor rehabilitation up to 5 years (until 2013). The study variables were age, sex, direct causes of accident and clinical manifestations observed on the physical exam. The intelligence quotient and follow-up of progress in the course of time were determined according to the Glasgow Outcome Scale. RESULTS: accidents were the main cause of brain injuries. The most affected were boys and the 5 to 9 years-old group. Sixty one percent of these patients had moderate mental retardation, 32.2 % mild retardation and 3.4 % severe and deep retardation. Seven died. The assessment of the rehabilitative treatment one year after confirmed that 76.6 % of these children kept their severe disability and 5 year after, just 29.9 % of them were unable to manage themselves. CONCLUSIONS: severe traumatic brain injuries cause awful intellectual sequelae in children and favorable rehabilitation is not accomplished till one year of discharge from the hospital. The most vulnerable groups are over 5 years-old children and males, and the fundamental cause of these severe brain injuries were, among the accidents, falls from a high place.

Expression of stromal cell-derived factor 1 in the acute ischemia-reperfusion injury and its relationship with macrophages / 中华肾脏病杂志

Objective To observe the expression of stromal cell-derived factor 1 (SDF-1) in the kidney after ischemic reperfusion injury (IRI),and explore its relationship with macrophage during the IRI kidney.Methods A total of 28 healthy C57BL/6 male mice were used to establish renal IRI model by clamping both pedicles for 35 min followed by reperfusion.Kidney tissue samples were collected at indicated time points.Renal histological changes were estimated.The expression of SDF-1 was determined by immunohistochemistry,ELISA and real-time PCR.After the liposomal clodronate was injected intraperitoneally,the location of CD68 was observed by immunofluorescence.Renal histology and protein expression of SDF-1 were also detected.Results Compared with sham-operated group,classical tubular damage was found in IRI group,accompanied by a large number of inflammatory cells.The expression of total renal SDF-1 peaked on day 1 and decreased to control levels in the following days.SDF-1 in healthy kidney was localized at cortex,but spread to the corticomedullary area of the kidney during IRI.Compared with IRI groups,elimination of macrophage by injection of liposomal clodronate alleviated renal IRI and down-regulated the expressions of CD68 while up-regulating SDF-1.Conclusions SDF-1 expression is up-regulated in IRI kidney and is associated with macrophage.SDF-1 may play a role in the early phase of acute kidney injury and it may be a new marker in diagnosis of AKI.

Analyse selective non-operative management of closed splenic injuries in 98 cases / 重庆医学

Objective To discusses the methods of the case selection and monitoring and diagnosis and treatment to selective non-operative management of closed splenic injuries .Methods The clinical data and results of 98 cases from October 1999 to Octo-ber 2011 with closed splenic injuries managed non-operative treatment were analyzed retrospectively .Results There were 90 cases (91 .8% ) conservative successfully ,5 cases(5 .1% ) transit operation because hematoma increase and bleeding continuously during therapeutic observation and 2 cases(3 .1% ) died from multiple injuries merge infection and multiple organ failure .Conclusion Most of the closed splenic injuries below level Ⅱcan be treated by non-operative management ,the effect and prognosis determined by the reasonable case selection and monitoring conditions and diagnosis and treatment .

Evaluation of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy / 国际外科学杂志

Objective To evaluate of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy.Methods A retrospective analysis was performed for 60 patients with cholelithiasts concurrent with choledocholithiasis from May 2009 to April 2012,which were treated with endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST),and endoscopic nasobiliary drainage (ENBD),then three-dimensional spiral CT cholangiography(SCTC) was performed through endoscopic nasobiliary drainage (ENBD) tube,and the bile duct tree image of SCTC was evaluated,then laparoscopic cholecystectomy (LC) was carried out.Results Sixty cases were performed three-dimensional SCTC.The left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,and cholecyst bile duct was visible in 75％patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enteres into the common bile duct.Conclusion Three-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values to judge the structure of the bile duct tree and the configuration of cholecyst bile duct during operation,which can decrease the possibility of bile duct injure.