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Objective To analyze the influence of topographic anatomy on brachial plexus block anesthesia, and to provide reference for clinical research and application. Methods Total of 20 cadavers were selected and located through the modified method of inferior brachial plexus block of the coracoid process. The nerve blocking points were marked with blue dye, and the nerve concentration sites and marking points were dissected and exposed at the same time. The anatomical relationship between nerve concentration points and body surface markers were explored. Results The distances from the upper margin of the left centralization to the midpoint of the subclavian border, the inferior margin of the sternoclavicular joint, the shoulder peak and the inferior edge of the coracoid process were (3. 62±0. 24) cm, ( 10. 39± 0.25) cm, (6. 67 ±0.18) cm and (2. 80±0.19) cm, respectively. The distances from the upper edge of the right centralization to the midpoint of the subclavian border, the inferior margin of the sternoclavicular joint, the shoulder peak and the inferior edge of the coracoid process were (4. 24±0. 27) cm, (11. 10±0. 28) cm, (6. 35±0. 19) cm and (3. 03± 0. 15) cm, respectively. Conclusion The application of anatomy improves the accuracy of brachial plexus block, thus improves the effect of brachial plexus block anesthesia, and provides a powerful reference for clinical research and application.
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Objective: To summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers. Methods: Between January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 3.5 cm×2.5 cm to 10.5 cm×3.5 cm. All donor sites were directly sutured except that 1 case was recovered with free skin graft. Results: All flaps survived entirely except that 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm). Conclusion: Modified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved by using this flap to repair soft tissue defect of finger.
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Objective@#To investigate the clinical outcome of modified peeling method by divisional design in labia minora reduction in the treatment of labial hypertrophy.@*Methods@#From Feb 2015 to Oct 2017, 32 nympha hypertrophy patients underwent labia minora reduction by the modified peeling method with divisional design. The labia minora area was divided into medial and lateral divisions, from which the dermis and subcutaneous tissue were removed asymmetrically.@*Results@#The patients were followed up 1 to 6 months postoperatively. All incisions healed with excellent blood circulation of labia minora, except for 1 case with V-shaped dehiscence. All of the patients were satisfied with the eventual aesthetic appearance and the functional improvement.@*Conclusions@#The modified peeling method by divisional design in labia minora reduction is a safe and effective method with many advantages, such as nature contour, wide range of indications, fewer complications, and high satisfaction.
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Objective To establish the cardiac arrest (CA) model in rats by modified transcutaneous electrical stimulation on epicardium. Methods This study was performed in the Emergency Medicine laboratory in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. After 10 Sprague-Dawley male rats weighing 330-380 g were anesthetized, two acupuncture needles connected to the anode and cathode of a stimulator were transcutaneously inserted into the epicardium as electrodes. The puncture points were located quantitatively according to the anatomical structure of the rat chest. The electrical stimulation was maintained for 3 minutes to induce ventricular fibrillation(VF). Cardiopulmonary resuscitation (CPR) included chest compressions, intravenous adrenaline and defi brillation operated at 6 min after a period of nonintervention. Results CA was induced after the implement of the effective electrical stimulation in all ten rats in this experiment. The average current intensity to induce VF was (1.80 ± 0.59) mA, the average time to induce CA was (5.07 ± 2.37)s,the average time of the total electrical stimulation was(187.50 ± 12.75)s and the total time of CA was 6 min. At the end of the electrical stimulation, 9 rats presented VF and 1 rat showed pulseless electrical activity. The restoration of spontaneous circulation was achieved in all 10 rats. The average time of CPR was(190.90±68.60) s, the mean numbers of defi brillation were(1.20 ± 0.63) , and he average number of adrenaline application were (1.20 ± 0.42) times. Neither visible hemorrhage on epicardium nor gross pulmonary congestion was observed. Conclusions The modified transcutaneous electrical stimulation on epicardium to produce CA model in rats is an easily applicable and effective technique. This model may provide an alternative for experimental research of CPR.
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Objective To evaluate the clinical efficacy of modified thin anterolateral thigh flaps for recon-struction of hand and foot defects. Methods Between March, 2016 and September, 2017, 17 patients were recon-structed with modified thin anterolateral thigh flap. There were 6 cases for reconstruction of hand, and 3 of them were located in the back dorsal of hand defects. There were 11 cases for reconstruction of ankle and foot, and 5 of them were located in the dorsal of foot. The size of the flap was 5 cm×3 cm-33 cm×10 cm. The traditional perforator flap was elevated just above the deep fascial plane. The debulking procedures could follow before the pedicle was cut off. The modified method was that the flap was elevated from the superficial fascia and the plane between deep and superficial fat without intraoperative debulking procedures. Results Three flaps were eventually survived after secondary ex-ploratory operation caused by the hematoma. Two flaps had partial loss, 1 of which needed secondary skin grafting, and the other flap healed with additional intention. Followed-up period was 3-18 (average, 7) months . All flaps showed relatively good contour and the patients were satisfied with clinical outcomes. Conclusion It is a safe and reliable way that perforator flap can be elevated from the superficial fascia and the plane between deep and superficial fat. It can obtain a thin flap immediately and reduce donor-site morbidity without additional defatting and time-con-suming. The flap is soft with good contour. This technique is an ideal option for covering defects composed of dorsal of the hand or foot and the head and neck regions.
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Objective To investigate the effect and safety of endoscopic injection of tissue adhesive in a modified method combined with ligation for esophageal and gastric varices. Methods 60 patients with esophageal and gastric varices were randomly distributed to the treatment group (group A),who was treated with the modi-fied sandwich method(lauromacrogol -tissue adhesive-lauromacrogol)and combined with ligation for esophageal varices. The treatment group were compared with that 60 controls(group B),who was treated with the traditional sandwich method (lipiodol - tissue adhesive - lipiodol) and combined with ligation for esophageal varices. The hemostatic rate ,rebleeding rate ,improvement rate of gastric varices ,the rates of esophageal varices disappear-ance and complications were compared. Results The hemostasis rate were 98.32% and 96.41% between the two groups (P > 0.05). The improvement rate of gastric va rices (94.83% vs. 82.50%,P < 0.05) and the rate of esophageal varices disappearance(86.67% vs. 76.67%,P < 0.05)in the group A were both higher than those in the group B(49.57% vs. 41.23% ,P < 0.05). The amount of tissue adhesive in the group A was lower than that in the group B(2.47 ± 0.79 mL vs. 3.02 ± 0.68 mL ,P<0.05). The incidence of rebleeding rate ,fever ,transient bacteremia were equal between the two groups(P > 0.05),but the rate of chest and abodminal pain in the group A was higher than those in the group B (70.00% vs. 53.33%,P < 0.05). 1 patient in the group B had ectopic pulmonary embolism ,but improved after treatment. Conclusions Endoscopic injection of tissue adhesive in a modified method combined with ligation is effective and safe for esophageal and gastric varices ,and is worthy fur-ther investigation.
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Objective To investigate the effect and safety of endoscopic injection of tissue adhesive in a modified method combined with ligation for esophageal and gastric varices. Methods 60 patients with esophageal and gastric varices were randomly distributed to the treatment group (group A),who was treated with the modi-fied sandwich method(lauromacrogol -tissue adhesive-lauromacrogol)and combined with ligation for esophageal varices. The treatment group were compared with that 60 controls(group B),who was treated with the traditional sandwich method (lipiodol - tissue adhesive - lipiodol) and combined with ligation for esophageal varices. The hemostatic rate ,rebleeding rate ,improvement rate of gastric varices ,the rates of esophageal varices disappear-ance and complications were compared. Results The hemostasis rate were 98.32% and 96.41% between the two groups (P > 0.05). The improvement rate of gastric va rices (94.83% vs. 82.50%,P < 0.05) and the rate of esophageal varices disappearance(86.67% vs. 76.67%,P < 0.05)in the group A were both higher than those in the group B(49.57% vs. 41.23% ,P < 0.05). The amount of tissue adhesive in the group A was lower than that in the group B(2.47 ± 0.79 mL vs. 3.02 ± 0.68 mL ,P<0.05). The incidence of rebleeding rate ,fever ,transient bacteremia were equal between the two groups(P > 0.05),but the rate of chest and abodminal pain in the group A was higher than those in the group B (70.00% vs. 53.33%,P < 0.05). 1 patient in the group B had ectopic pulmonary embolism ,but improved after treatment. Conclusions Endoscopic injection of tissue adhesive in a modified method combined with ligation is effective and safe for esophageal and gastric varices ,and is worthy fur-ther investigation.
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Objective To assess the value of four different techniques of detecting the Mycobacterium tuberculosis (MTB) in bronchoalveolar lavage fluid (BALF) in the diagnosis of tracheobronchial tuberculosis. Methods A total of 98 patients diagnosed as tracheobronchial tuberculosis were selected from May 1,2013 to June 30,2016. The clinical data was analyzed retrospectively,and the positive rates of MTB of the 960 cultrue, the direct smears , the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were compared. Results The positive rates of the 960 cultrue,the direct smears,the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were 20.4%(20/98),15.3%(15/98),70.4%(69/98) and 74.5%(73/98),respectively. Among the four techniques ,the positive rates of the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were significantly higher than those of the 960 cultrue and the direct smears(P 0.05). Conclusions The modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay for detecting the MTB in BALF have high clinical value in the diagnosis of tracheobronchial tuberculosis.
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The purpose of this study was to derive a modified equation for contact lens method (CLM) in calculating post myopic laser refractive surgery corneal power. Methods: A total of 93 subjects who underwent myopic laser refractive surgery at IIUM Eye Specialist Clinic were recruited. The accuracy of postoperative corneal power using the standard CLM and newly-derived contact lens modified method (CLMmod) were compared to the standard comparison method ; the historical method (HM). The CLMmod equation was derived by adjusting postoperative corneal power of CLM according to amount of refractive change. Results: The mean postoperative corneal power using standard CLM was significantly higher than HM (mean difference: -0.24 D, p < 0.001). Fifty seven percent (n = 53 eyes) of the standard CLM results were within ±0.50 D of HM results. The difference between postoperative corneal power using standard CLM and HM increased significantly with the amount of refractive change (r = 0.835; p < 0.001). The mean postoperative corneal power of CLMmod showed that there was no statistical significant difference compared to the HM results (mean difference: 0.00 D, p= 0.964). Eighty eight percent (n = 82 eyes) of the CLMmod results were within ±0.50 D of HM results with improvement of 31% from the standard CLM results. Conclusion: The CLMmod equation provides more accurate calculation in determining post myopic laser refractive surgery corneal power. In near future, this modified equation can be used as an alternative equation to calculate postoperative corneal power when the preoperative data is unavailable.
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PURPOSE: The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. MATERIALS AND METHODS: Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. RESULTS: Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min+/-16 min vs. 1 h 36 min+/-19 min, p<0.01), immediate post-procedural pain (2.43+/-1.80 vs. 3.14+/-2.07, p<0.05), and post-procedure days until ambulation (3.95+/-1.13 days vs. 6.17+/-1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71+/-7.05 days vs. 13.86+/-3.7 days). CONCLUSION: Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Catheters, Indwelling , Peritoneal Dialysis/instrumentation , Retrospective Studies , Surgical Instruments , Treatment Outcome , Urinary Catheterization/instrumentationABSTRACT
Objective To assess feasibility and advantages of the improved endoscopic resection of duodenal major papillary.Methods A total of 56 cases were collected in Drum Tower Hospital from October 2007 to December 2012, which were diagnosed as duodenal major papillary adenoma or carcinoma in situ, where tumor didn't extend to the biliary or pancreatic duct by the endoscopic ultrasonography, intraductal ultrasonography or histology of biopsy specimens.The diameters of these adenoma ranged from 0.3 cm to 5.0 cm.Twenty-four lesions were resected by routine endoscopic method and 32 lesions were removed by modified endoscopic method.All patients underwent ERCP and biliary and/or pancreatic stents were placed.Results En bloc resection rate was significantly higher in modified group(87.5％ ,28/32) than that in routine group (60.9％, 14/23, P ＜ 0.05).There were no significant differences in complete resection rates (93.8％ ,30/32 VS 87.0％, 20/23;P ＞0.05), or in the amount and difficulty of pancreaticobiliary stenting(P ＞ 0.05)between modified group and routine group.Short-term complication occurrence in modified group was lower than that of the routine group(15.6％ ,5/32 VS 41.6％, 10/24, P ＜ 0.05), but long-term complication occurrence showed no significant difference.There was no significant difference in recurrence rate between two groups[7.1％ (2/28) VS 15.0％ (3/20) ,P ＞0.05].Conclusion Endoscopic resection of duodenal major papillary adenoma with a modified method shows more therapeutic effect.
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Milk pasteurization is a critical issue in the dairy industry, and failures in this process can affect final product safety. Scharer's enzymatic method is still traditionally used to verify pasteurization efficiency compliance, and it is based on screening for residual alkaline phosphatase in milk. Although several methods are used to quantify enzymatic activity to assess milk pasteurization efficiency, there is a small amount of published data regarding the use of these methods to quantify alkaline phosphatase in cheese. In this study, the Scharer's modified method was used to determine the levels of residual alkaline phosphatase in standard minas cheese, before and after 20 days of ripening. The cheeses were made using raw or pasteurized milk with the addition of different concentrations of raw milk (0; 0.05%; 0.10%; 0.20%; and 0.50%). In the fresh cheese samples, the method showed a sensitivity of only 0.50% with the addition of raw milk to the pasteurized milk used to make cheese. In addition, levels of up 0.20% of raw milk in pasteurized milk, the concentrations of phenol was inferior to 1μg phenol/g of dairy product which is the preconized indicator value for adequate pasteurization.
A pasteurização do leite é um ponto crítico na indústria de laticínios, e falhas nessa etapa comprometem a segurança do produto. O método enzimático de Scharer é tradicionalmente utilizado na verificação da eficiência da pasteurização e baseia-se na pesquisa da atividade de fosfatase alcalina residual em leite. Embora vários métodos estejam disponíveis para avaliar a eficiência da pasteurização, há um número reduzido de dados publicados baseados na quantificação da atividade da fosfatase alcalina em queijo. Neste estudo, o método modificado de Scharer foi utilizado para determinar os níveis de fosfatase alcalina residual em queijo minas padrão, antes e após 20 dias de maturação. Os queijos foram feitos com leite cru ou com leite pasteurizado com adição de diferentes concentrações de leite cru (0, 0,05%, 0,10%, 0,20% e 0,50%). Nas amostras de queijo fresco, o método apresentou sensibilidade apenas com 0,50% de adição de leite cru ao leite pasteurizado utilizado na fabricação de queijo. Em níveis de adição de até 0,20% de leite cru no leite pasteurizado, as concentrações de fenol se mostraram inferiores a 1μg de fenol/g de produto lácteo, que é o valor preconizado como indicador de pasteurização adequada.
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Animals , Spectrophotometry , Alkaline Phosphatase/chemistry , FoodABSTRACT
Objective To discuss the advantages and disadvantages of the iodized oil,diatrizoate and non-ionic iohexol used as contrast media in performing hysterosalpingography and to evaluate the modified hysterosalpingography in clinical practice.Methods Patients who were scheduled to receive hysterosalpingography were randomly selected and divided into three conventional groups:iodized oil group,diatrizoate group and iohexol group,with 100 cases in each group.Another 100 cases(modified group) were examined with modified hysterosalpingographic technique by using iohexol as contrast medium.During the procedure and after the hysterosalpingography all the patients were carefully observed.The image quality,the fallopian tube patent rate,the incidence of abdominal pain,clinical safety,etc.were documented and the results were compared among groups.The advantages of modified hysterosalpingographic technique were analyzed.Results No significant difference in image quality and the fallopian tube patent rate existed among the three conventional groups.The occurrence of abdominal pain in iohexol group was significantly lower than that in both iodized oil group and diatrizoate group(?2 = 10.54,P
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Objective To compare the graft function of 2 methods of kidney harvesting,the modified method of combined liver and kidney procurement and rapid en bloc kidney procurement. Methods The clinical data of 220 cadaveric renal transplantation recipients were collected(12 months follow-up),174 cases from en bloc kidney procurement and 46 from combined liver and kidney procurement.The average harvesting time,the incidence of renal vein injury,1 year kidney survival and incidence of acute rejection were compared between the two methods.Results In average harvesting time and incidence of renal vein injury,the en bloc kidney procurement were better than the method of combined liver and kidney procurement.However,the method of combined liver and kidney procurement was better than the en bloc kidney procurement in 1 year kidney survival,1 year incidence of acute rejection and average warm ischemia time.There was no difference in 1 year survival of patients and 24 h,1 week and 1 year graft function after transplantation. Conclusion Although the method of combined liver and kidney procurement is better than the en bloc kidney procurement in 1 year kidney survival and 1 year incidence of acute rejection,there is no difference between the 2 methods in 1 year survival of patients and graft function after transplantation.
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The establishment of a modified method to evaluate angiogenesis of rat rings in serum-free medium was investigated in this paper. The aorta rings of Wistar rats were embedded in fibrinogen gel in 48 well plates, and cultured in an optimized serum free medium MCDB131. Results indicated that new capillaries spouted on 4th day, and entered into growth phase from 6th day, and peaked on 13th day and remained unchanged thereafter.
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The Staining methods of PAS and Alcian blue may display the neutral and acidic mucus in many tissues, but are not ideal for the cells and tissues containing only weak acidic mucus. A modified method of Mayer's hematoxylin stain was used for staining gastric mucous neck cells with weak acid and the result was satisfactory. It ocmplements the PAS and Alcian blue staining methods.