RESUMEN
Objective:To explore the clinical efficacy of a retrograde pubic ramus intramedullary nail (RPRIN) in the treatment of anterior pelvic ring fractures.Methods:A retrospective study was conducted to analyze the 14 patients with anterior pelvic ring fracture who had been treated and followed up at Department of Traumatic Surgery, Tongji Hospital From June 2020 to February 2021. There were 10 males and 4 females with an age of (44.8±12.5) years. By the AO/OTA classification for pelvic fractures, 5 cases were type 61-A, 4 cases 61-B, and 5 cases type 61-C; by the Nakatani classification, 1 case belonged to unilateral zone Ⅰ fracture, 5 cases to unilateral zone Ⅱ fracture, 2 cases to unilateral zone Ⅲ fracture, 3 cases to right zone Ⅱ and left zone Ⅲ fracture, 2 cases to zone Ⅲ fracture on both left and right sides, and 1 case to zone Ⅱ fracture on both sides. The time from injury to operation was (7.8±1.8) days. All the anterior pelvic ring fractures were fixated with a RPRIN. The time and fluoroscopic frequency for placement of every single RPRIN, quality of fracture reduction, and pelvic function and incidence of postoperative complications at the last follow-up were recorded.Results:A total of 18 RPRINs were placed in the 14 patients. For placement of each RPRIN, the time was (35.9±8.6) min, and the fluoroscopic frequency (22.8±1.9) times. No complications such as infection occurred at any surgical incision after RPRIN placement. According to the Matta scoring, the quality of postoperative fracture reduction was assessed as excellent in 7 cases, as good in 5 cases and as fair in 2 cases. The 14 patients were followed up for (18.1+1.5) months. Their X-ray and CT images of the pelvis at the last follow-up showed that the fractures healed well and the intramedullary nails were placed in the cortical bone of the anterior ring of the pelvis. According to the Majeed scoring at the last follow-up, the pelvic function was assessed as excellent in 10 cases, as good in 3 cases and as fair in 1 case. One patient reported discomfort during squatting 2 months after operation but the symptom improved 3 months later without any special treatment. No patient experienced such complications as displacement or slippage of RPRIN, or pain at the insertion site.Conclusion:RPRIN is effective in the treatment of anterior pelvic ring fractures, showing advantages of small surgical incision, limited intraoperative fluoroscopy and short operation time.
RESUMEN
Objective:To investigate the clinical therapy of sacral osteotomy combined with lumbopelvic distraction triangular osteosynthesis for malunion and nonunion of type C longitudinally displaced sacral fracture.Methods:A retrospective study of 9 patients with malunion and nonunion of type C pelvic fractures who had been treated with sacral osteotomy combined with triangular osteosynthesis from April 2015 to January 2020 were analyzed. They were 5 men and 4 women, with an average age of 30.67±10.06 (range 14-45 years). AO/OTA classification at initial pelvic fracture, 8 cases were type C1.3 and one was type C3.3. The period from injury to surgery was 12.8±18.92 months (range 3-60 months). The cranial displacement of one side of the pelvis was 3.8±0.57 cm (range 2.5-4.1 cm). Sacral osteotomy and triangular osteosynthesis were used in all nine patients, combined with osteotomy or no osteotomy of the superior and inferior branches of the anterior ring pubis. The degree of longitudinal displacement of one side of the pelvis was assessed by making a vertical line gap between the acetabular apex on both sides and the central axis of the sacrum on the X-ray of the pelvis. The Majeed scoring and visual analogue scale (VAS) were evaluated preoperatively and at the last follow-up to assess the therapeutic effect of the patients.Results:In all 9 patients, except for 1 case of postoperative pelvic residual displacement 1.5 cm (preoperative 3.2 cm difference compared with the healthy side), the other 8 patients had a postoperative bilateral difference of 0.1-0.7 cm. All the patients were followed up for 12.00±9.95 months. At the last follow-up, the Majeed score of pelvic fracture increased from 44.0(33.5, 76.0) points preoperatively to 91.0(80.5, 92.5) points. The difference before and after operation was statistically significant ( Z=2.67, P<0.001), and the gait was significantly improved. And the VAS score for pain decreased from 6.00±1.41 points preoperatively to 1.22±0.97 points. The difference before and after operation was statistically significant ( t=8.73, P<0.001). None had complications like infection, plate broken, screw loosening, iatrogenic nerve or blood vessel injury, etc. Conclusion:Sacral osteotomy combined with lumbopelvic distraction triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fracture can correct pelvic deformity, prolong limb length, and reconstruct the stability of pelvic ring with good clinical results.
RESUMEN
Objective:To investigate clinical effects of lumbopelvic fixation and triangular osteosynthesis using sacral ala-iliac screws for the treatment of sacral fractures.Methods:The data of 12 patients with sacral fractures treated with lumbopelvic fixation and triangular osteosynthesis using sacral ala-iliac screws from December 2019 to June 2020 were retrospectively analyzed. There were 3 males and 9 females with an average age of 32.6±15.0 years (range, 13-52 years); causes of injury: 11 fall injuries and 1 traffic injury. The Denis classification of sacrum fracture: 4 cases of type II and 8 cases of type III. AO (Tile-Muller) classification: 4 cases of type C1.3, 8 cases of type C3.3; of the 8 cases of C3.3 fractures, Roy-Camille and Strange-Vognsen classification: 2 cases of type II, 6 cases of type III. According to the scoring system of Gibbons sacral nerve injury, there were 6 cases of scored 3 and 2 cases of scored 4; 4 cases of C1.3 fractures had no nerve injury. The time from injury to operation was 6 to 32 days, with an average of 19.3±9.2 days. After the vital signs were stabilized, laminectomy and decompression of sacral nerve roots, fracture reduction, lumbopelvic fixation and triangular osteosynthesis using sacral ala-ilac screws were performed. The fixation method of the anterior ring was determined according to the injury. The postoperative fracture reduction quality was evaluated according to Matta criteria. The clinical function and neurological function were evaluated according to the Majeed scoring system and Gibbons sacral nerve injury scoring system at the last follow-up.Results:Twelve patients were operated smoothly. 8 cases of C3.3 fractures were fixed by lumbopelvic fixation, of which 6 cases of U-shaped fractures were fixed by transverse rods due tolongitudinal separation displacement; Four cases of C1.3 used triangular osteosynthesis and transverse fixation in 3 cases with sacroiliac screws, and 1 case with sacral local plate. Six patients with anterior ring injury were fixed with steel plate in 4 cases, INFIX in 1 case and pubic branch screw in 1 case. All patients were followed up for 6 to 12 months, with an average of 7.3±1.7 months. Postoperative Matta standard evaluation: excellent in 7 cases; good in 4 cases; fair in 1 case. Majeed score at the last follow-up: excellent in 6 cases, good in 5 cases, and fair in 1 case. One of 2 cases of rectal and bladder dysfunction patients completely recovered, the other was found partial rupture of the nerve roots of sacrum 1 and 2 during operation, whose muscle strength below the calf was still reduced; 6 cases of preoperative muscle strength loss below the calf were significantly improved, among which 4 patients recovered completely, and 2 patients had lower limb sensory impairment; the Gibbons score improved by an average of 1.8±0.7 points (preoperative average 3.2 points, postoperative average 1.4 points). X-ray examinations were performed 3 to 6 months after the operation showed that the fractures were all healed. During the follow-up period, no complications such as fat liquefaction, infection, wound healing, and screw protrusion discomfort were found.1 case of S 2AI screw penetrated the outer plate of the ilium, and there was no pelvic tilt and unequal length deformity of the lower limbs. One patient took out the internal fixation 6 months after the operation due to lower back discomfort. At the last follow-up, all patients had no internal fractures or loss of fracture reduction. Conclusion:Lumbopelvic fixation and triangular osteosynthesis using sacral ala-iliac screws for the treatment of sacral fractures are reliable, with less trauma and lower incidence of complications; and the clinical results are satisfactory.
RESUMEN
BACKGROUND@#Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.@*METHODS@#Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis.@*RESULTS@#Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH.@*CONCLUSION@#This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.
Asunto(s)
Femenino , Humanos , Recién Nacido , Embarazo , Anestesia Raquidea/efectos adversos , Cesárea/efectos adversos , Coloides , Hipotensión/etiología , Incidencia , Vasoconstrictores/uso terapéuticoRESUMEN
Objective@#To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018. There were 48 males and 35 females, aged 21-84 years [(56.5±14.3)years]. The body mass index ranged from 19.8 to 43.1 kg/m2 [(27.6±6.5)kg/m2]. There were 26 patients with mainly craniocerebral injury, 15 with mainly thoracic injury, 28 with mainly abdominal injury, eight with mainly spinal injury and six with mainly pelvic fracture. The injury severity score (ISS) ranged from 24 to 66 points [(41.8±18.1)points]. All the patients received the axillary CVC based on Nickalls' landmarks. The left axillary vein was used as the puncture vein in 16 patients (left group), and the right axillary vein was used as the puncture vein in 67 patients (right group). A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group), while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group). The success rate of catheterization, pneumothorax, hematoma or artery injury, catheter ectopia, catheter-related infection and catheter-related thrombosis were recorded.@*Results@#A total of 80 patients were successfully intubated, with a success rate of 96%. Subgroup analysis showed that the success rate of right group was [97% (65/67)], slightly higher than that of the left group [94%(15/16)] , but the difference was not statistically significant (P>0.05). And the success rate of adjacent fracture group [94%(34/36)] was similar to that of non-adjacent fracture group [98%(46/47)], and the difference was not statistically significant (P>0.05). Complication incidences were as follows: hematoma or arterial injury [5%(4/83)], pneumothorax 2%(2/83), catheter-related thrombosis [12%(10/83)], and catheter ectopia [1%(1/83)]. No catheter-related infection was observed. Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury: 6% vs. 4%, pneumothorax: 0% vs. 3%; catheter ectopic: 0% vs. 1%; catheter-related thrombosis: 13% vs. 12%), and the difference was not statistically significant (P>0.05). The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury: 3% vs. 6%; pneumothorax: 3% vs. 2%; catheter ectopic: 0% vs. 2%; catheter-related thrombosis: 17% vs. 9%), and the difference was not statistically significant (P>0.05).@*Conclusions@#Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients. It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture. However, there still exists a high risk of catheter-related thrombosis, requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization.
RESUMEN
Objective To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients.Methods A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018.There were 48 males and 35 females,aged 21-84 years [(56.5 ±14.3)years].The body mass index ranged from 19.8 to 43.1 kg/m2 [(27.6 ± 6.5)kg/m2].There were 26 patients with mainly craniocerebral injury,15 with mainly thoracic injury,28 with mainly abdominal injury,eight with mainly spinal injury and six with mainly pelvic fracture.The injury severity score (ISS) ranged from 24 to 66 points [(41.8 ± 18.1)points].All the patients received the axillary CVC based on Nickalls' landmarks.The left axillary vein was used as the puncture vein in 16 patients (left group),and the right axillary vein was used as the puncture vein in 67 patients (right group).A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group),while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group).The success rate of catheterization,pneumothorax,hematoma or artery injury,catheter ectopia,catheter-related infection and catheter-related thrombosis were recorded.Results A total of 80 patients were successfully intubated,with a success rate of 96％.Subgroup analysis showed that the success rate of right group was [97％ (65/67)],slightly higher than that of the left group [94％ (15/16)],but the difference was not statistically significant (P ＞ 0.05).And the success rate of adjacent fracture group [94％ (34/36)] was similar to that of non-adjacent fracture group [98％ (46/47)],and the difference was not statistically significant (P ＞ 0.05).Complication incidences were as follows:hematoma or arterial injury [5％ (4/83)],pneumothorax 2％ (2/83),catheter-related thrombosis [12％ (10/83)],and catheter ectopia [1％ (1/83)].No catheterrelated infection was observed.Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury:6％ vs.4％,pneumothorax:0％ vs.3％;catheter ectopic:0％ vs.1％;catheter-related thrombosis:13％ vs.12％),and the difference was not statistically significant (P ＞ 0.05).The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury:3％ vs.6％;pneumothorax:3％ vs.2％;catheter ectopic:0％ vs.2％;catheter-related thrombosis:17％ vs.9％),and the difference was not statistically.significant (P ＞ 0.05).Conclusions Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients.It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture.However,there still exists a high risk of catheterrelated thrombosis,requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization.
RESUMEN
Objective To investigate diabetes-mediated changes in the neuromuscular pharmacodynamics of rocuronium in rats. Methods Diabetes mellitus was induced by a single injection of streptozotocin in rats.A total of 24 male SD rats were assigned to four groups using random number table:the normal control group,diabetic 2-week group,diabetic 4-week group,and diabetic 8-week group(6 rats per group).The sciatic nerve was stimulated in a rain-of-four(TOF)pattern,and the twitch tension changes in the tibialis anterior muscle were demonstrated by mechanomyography after intravenous injection of rocuronium in vivo.The time course characteristics of rocuronium,including onset time,and the recovery time from rocuronium injection to TOF ratio 75%(RT75%)and 90%(RT90%),were recorded,and half maximal inhibitory concentration(IC)values of rocuronium were determined using a four-parameter dose response curve. Results Compared with the normal controls,the diabetic rats had significantly prolonged onset time of rocuronium,while the RT75% and RT90% were decreased at all rocuronium doses(PConclusion Diabetes is associated with the rat skeletal muscle hyposensitivity to rocuronium,which is featured by prolonged onset time of rocuronium,decreased RT 75% and RT 90%,and right shift of the cumulative dose-response curve of rocuronium.
Asunto(s)
Animales , Masculino , Ratas , Diabetes Mellitus Experimental , Músculo Esquelético , Fármacos Neuromusculares no Despolarizantes , Farmacología , Distribución Aleatoria , Ratas Sprague-Dawley , Rocuronio , FarmacologíaRESUMEN
OBJECTIVE: To investigate the effects of a monomer purified from Paris Polyphylla (PP-22) on proliferation, apoptosis of human gastric carcinoma MGC803 cells and to study the sensitizing effect of PP-22 on the proliferation of MGC803 cells to chemo-therapeutic drugs 5-fluorouracil (5-Fu) or lobaplatin. METHODS: MTT assay and cell colone formation inhibitory assay were used to determine the inhibitory effect of PP-22 on human gastric carcinoma MGC803 cells. The sensitizing effects of PP-22 on MGC803 cells to chemotherapeutic drugs 5-Fu, lobaplatin were determined by MTT assay. The percentage of apoptotic cells and cell cycle distribution were determined by flow cytometry. The expression of cell apoptosis associated proteins were analyzed by Western blotting. RESULTS: MTT assay showed that PP-22 inhibited gastric carcinoma MGC803 cells proliferation in dose-dependent manner (r=0.90, P<0.05), but did not inhibit the growth of normal liver L02 cells at the same concentration. Cell colony formation inhibitory assay demonstrated that cell clones decreased with the increase of drug concentrations. The chemosensitivity of 5-Fu, or lobaplatin combined with PP-22 was improved compared with PP-22 group, respectively. PI staining analysis showed that the cell cycle was arrested at S phase. Western blotting detecting showed that the expression of Caspase-9, Caspase-3 were downregulated, the anti-apoptotic protein Bcl-2 is downregulated and pro-apoptotic protein Bak upregulated. CONCLUSION: PP-22 inhibits proliferation and induces apoptosis of MGC803 cells effectively and also sensitizes MGC803 cells to chemotherapeutic drugs.
RESUMEN
<p><b>BACKGROUND</b>It has been proved that sevoflurane postconditioning (SpostC) could protect the heart against myocardial ischemia/reperfusion injury, however, there has been few research focused on the electrophysiological effects of SpostC. The objective of the study was to investigate the effects of SpostC on action potential duration (APD) and L-type calcium current (I(Ca, L)) in isolated cardiomyocytes.</p><p><b>METHODS</b>Langendorff perfused SD rat hearts were randomly assigned to one of the time control (TC), ischemia/reperfusion (I/R, 25 minutes of ischemia followed by 30 minutes of reperfusion), and SpostC (postconditioned with 3% sevoflurane) groups. At the end of reperfusion, epicardial myocytes were dissociated enzymatically for patch clamp studies.</p><p><b>RESULTS</b>Sevoflurane directly prolonged APD and decreased peak I(Ca, L) densities in epicardial myocytes of the TC group (P < 0.05). I/R injury shortened APD and decreased peak I(Ca, L) densities in epicardial myocytes of the I/R group (P < 0.05). SpostC prolonged APD and increased peak I(Ca, L) densities in epicardial myocytes exposed to I/R injury (P < 0.05). SpostC decreased intracellular reactive oxygen species (ROS) levels, reduced the incidence of ventricular tachycardia and ventricular fibrillation, and decreased reperfusion arrhythmia scores compared with the I/R group (all P < 0.05).</p><p><b>CONCLUSIONS</b>SpostC attenuates APD shortening and I(Ca, L) suppression induced by I/R injury. The regulation of APD and I(Ca, L) by SpostC might be related with intracellular ROS modulation, which contributes to the alleviation of reperfusion ventricular arrhythmia.</p>
Asunto(s)
Animales , Ratas , Potenciales de Acción , Calcio , Metabolismo , Electrocardiografía , Éteres Metílicos , Usos Terapéuticos , Técnicas de Placa-Clamp , Pericardio , Metabolismo , Especies Reactivas de Oxígeno , Metabolismo , Daño por Reperfusión , Quimioterapia , MetabolismoRESUMEN
<p><b>OBJECTIVE</b>To search for and verify some common B cell epitopes in the core proteins of woodchuck hepatitis virus and human hepatitis B virus.</p><p><b>METHODS</b>Monoclonal antibodies against both core proteins of woodchuck hepatitis virus (WHV) and human hepatitis B virus (HBV) were prepared by inoculating Balb/c mice with denatured recombination WHV and HBV core proteins. ELISA and immunoblotting assays for WHcAg and HBcAg were carried out by using these antibodies. Immunohistochemistry was carried out with liver tissue sections of both WHV-infected woodchucks and chronic HBV-infected patients. The epitopes were mapped with the mouse mAbs (6D1 and 1H4) by using a panel of 24 16mer overlapping peptides covering the entire WHcAg. The amino acid sequences of WHcAg and HBcAg were compared.</p><p><b>RESULTS</b>Cross-reactions were observed between mAbs (6D1 and 1H4) and WHcAg and between Mabs and HBcAg/HBcAg in ELISA and immunoblotting assay. Liver tissue sections of both WHV-infected woodchucks and chronic HBV-infected patients could be stained specifically by mAbs. The epitopes were mapped at aa1-8 (6D1) and aa125-140 (1H4) of the core proteins of both WHV and HBV by using ELISA assay. WHcAg and HBcAg share similar amino acids sequences at aa1-8 and aa125-140 respectively.</p><p><b>CONCLUSION</b>The core proteins of woodchuck hepatitis virus and human hepatitis B virus share common linear B cell epitopes which span aa1-8 and aa125-140 respectively.</p>
Asunto(s)
Animales , Humanos , Ratones , Anticuerpos Monoclonales , Linfocitos B , Alergia e Inmunología , Línea Celular Tumoral , Reacciones Cruzadas , Epítopos de Linfocito B , Alergia e Inmunología , Antígenos del Núcleo de la Hepatitis B , Alergia e Inmunología , Virus de la Hepatitis B de la Marmota , Genética , Alergia e Inmunología , Virus de la Hepatitis B , Genética , Alergia e Inmunología , Marmota , Proteínas del Núcleo Viral , Alergia e InmunologíaRESUMEN
Objective To investigate the methods and clinical significance of breast cancer treated with photodynamic.Methods From June to December in 2005,photodynamic therapy was used in 12 cases confirmed intramammary lymph node metastasis before operation and 15 cases confirmed chest wall recur- rences by means of lymph node imaging.Results The intramammary lymph node metastasis whose diameter between 0.5～1.0cm measured by lymph node imaging preoperatively completely disappeared when rechecked 3 months postoperatively.Chest wall recurrence regions of breast cancer whose diameter less than 1.0 cm completely remitted.Conclusion Photodynamic therapy is helpful to eliminate the intramammary lymph node metastasis and to cure the postoperative chest wall recurrence of breast cancer.