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OBJECTIVE：To study the relationship of polymorphism of clopidogrel absorption and metabolism related genes CYP2C19（* 2，* 3，* 17），ABCB1 C3435T and PON1 Q192R in patients with coronary heart disease in Xinjiang Uygur Autonomous Region ，and to explore the characteristics of population and combined diseases. METHODS ：A total of 1 126 patients with coronary heart disease who underwent clopidogrel absorption and metabolism related gene testing during hospitalization in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2020 were included as the study subjects. The gender，age，body mass index （BMI），nationality and the proportion of combined with hypertension and diabetes were compared among different CYP2C19 metabolic phenotypes and ABCB1 C3435T and PON1 Q192R genotypes. RESULTS ：Among 1 126 patients，1 126 had CYP2C19 * 2，* 3 and * 17 genotypes，1 109 had ABCB1 C3435T genotype and 1 123 had PON1 Q192R genotype. The distribution of each genotype was in line with Hardy-Weinberg balance （P＞0.05）. There were 66（5.86％）， com 459（40.76％），476（42.27％） and 125（11.10％）patients with CYP2C19 ultra-rapid metabolizer （UM）， extensive metabolizer（EM），intermediate metabolizer （IM）and poor metabolizer（PM），respectively. The proportion of patients with UM metabolism phenotype with BMI ＞24 was significantly higher than those of patients with IM and PM metabolism phenotypes （P＜0.05）. The proportion of Han nationality patients with UM metabolic phenotype was significantly lower than those of patients with EM ，IM and PM metabolic phenotypes （P＜0.05）；the proportion of Uygur nationality was significantly higher than that of patients with EM ，IM and PM metabolic phenotypes （P＜ 0.05）. There were 355，538 and 216 patients with ABCB1 C3435T wild-type（CC），heterozygous（CT）and mutant homozygous （TT）genotypes，respectively；the proportion of Han nationality in TT genotype patients was significantly lower than that in CC and CT genotype patients （P＜0.05），and the proportion of Uygur nationality was significantly higher than that in CC and CT genotype patients （P＜0.05）；the proportion of TT genotype patients with diabetes was significantly higher than that of patients with CT genotype （P＜0.05）. There were 365，519 and 239 patients with PON1 Q192R wild-type（GG），heterozygous（GA）and mutant homozygous （AA），respectively；the proportion of Han nationality in AA genotype patients was significantly lower than that in GG and GA genotype patients （P＜0.05），and the proportion of Uygur nationality was significantly higher than that of GG and GA genotype patients （P＜0.05）；the proportion of Han nationality and BMI ≤24 in patients with AA genotype were significantly lower than those with GA genotype （P＜0.05），and the proportion of Uygur nationality ，BMI＞24 and hypertension were significantly higher than those in GA genotype patients （P＜0.05）. CONCLUSIONS ：There are significant nationality differences among patients with different CYP2C19 metabolic phenotypes and ABCB1 C3435T and PON1 Q192R genotypes. In addition，patients with BMI ＞24 account for high proportion among CYP2C19 UM metabolism genotype ；patients with diabetes account for high proportion among ABCB1 C3435T TT genotype ；patients with BMI ＞24 and hypertension account for high proportion among PON1 Q192R AA genotype.
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Objective:To evaluate the promoting surgery incision healing effect of recombinant human acidic fibroblast growth fac-tor ( rh-aFGF) in the treatment of children with open fractures. Methods:A multicenter, randomized and controlled clinical trial was conducted to study the efficacy of rh-aFGF. Totally 120 cases of injured children (age<14y) were randomly divided into two groups, the treatment group (n=60) was given rh-aFGF washing during the operation and spraying after the operation, and the control group ( n=60) was treated with normal saline. Both groups were given traction, screw or Kirschner wire fixation. The healing time, healing status and delayed healing were observed and compared in the two groups. Results:Stage I healing rate, the complete healing time and delayed healing rate in the treatment group was 86. 6%, (20. 3 ± 5. 6)d and 3. 3%, respectively, while that in the control group was 56.7%, (23.4 ±6.2)d and 15.0%, respectively. The differences between the two groups were significant (P<0.05 or 0.01). Conclusion:Rh-aFGF can effectively promote wound healing and shorten the healing time. For all these positive aspects,rh-aFGF de-serves wider clinical application in postoperative rehabilitation after open fractures.
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Objective To explore the clinical application of the multi-network anatomical lavage on the treatment of chronic osteomyelitis after fracture surgery. Methods A retrospective analysis of 40 patients (41 sites) with chronic osteomyelitis after fracture surgery was performed from June 2006 to December 2008. There were 35 males and 5 females with an average of 42.7 years (range, 16-68). All 40 cases were treated with debridement, closing the cavity, and placing the multi-tube drainage network anatomical catheter lavage system. At the same time, sensitive antibiotics were used for 3 to 4 weeks. Rechecks were scheduled every 3 months after operation, including wound healing, X-ray presentation, ESR and C-reactive protein.Cure criteria depends on the conditions of the inflammation when the lavage treatment was over, and whether it relapsed six months after operation, including wound healing, systemic symptoms, ESR and C-reactive protein. Results Judged by the clinical outcomes when the lavage treatment was over and six months after operation, the effects were categorized into 3 levels, including excellent in 37 cases with primary wound healing, and without relapse six months later;, good in 2 with poor wound healing, the wound healed after a period of treatment without recurrence; poor in one with recurrent sinus infection and a prolonged unhealed wound, after another operation he was healed. 36 cases were treated with bone graft and internal fixation operation, and the fractures were healed after surgery, the fractures were healed directly in 4 cases without bone graft. The patients were followed up for an average of 43.2 months (range, 30-50) after operation, and none relapsed. Conclusion The multi-tube drainage network anatomical method is feasible and effective on the treatment of chronic osteomyelitis after fracture surgery with a high cure rate.
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BACKGROUND: Systemic administrations are widely used in preventing or curing bone infections, however, it accompanied by great adverse reactions and limited local blood drug levels. Therefore, local administration becomes a research focus, which aimed to explore a carrier possess good biocompatibility and slow-release antibiotics. OBJECTIVE: To explore the effect of calcium alginate gel compound vancomycin on prevention of bone infection, simultaneously, single drug was injected or implanted into models to compare the results.METHODS: A total of 60 healthy adult New Zealand white rabbits were prepared for osteomyelitis models by injecting Staphylococcus auraus to right tibiae medullaris, and randomly divided into systemic treatment, tricalcium phosphate and calcium alginate gel groups. After model preparation, rabbits in the systemic treatment group were intramuscular injected vancomycin (0.03 g, twice per day, for 4 successive days); in the triceicium phosphate group, 1 g tricalcium phosphate combined with 0.1 g vancomycin.was filled in the defects, sealed with bone wax. In the calcium alginate gel group, calcium alginate gel combined with vancomycin was implanted. Gross observation, radiological image and histological analysis were performed at weeks 4 and 8 after operation.RESULTS AND CONCLUSION: Local swelling and partial sinus were found in the systemic treatment and tricalcium phosphate groups after operation. The pathological slice showed that there were a large number of lymphocytes and some sequestrum in the systemic treatment and tricelcium phosphate groups. However, there was no manifestation of osteomyelitis in the calcium alginate gel group. The results suggested that calcium alginate gel compound vancomycin exhibit superior therapeutic effect on prevention of bone infection to local administration of calcium alginate gel combined with vancomycin or systemic application of vancomycin.
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[Objective]To study diagnosis and treatment of insidious infection after the internal fixation of long bone fracture.[Method]Thirteen patients with insidious infection after internal fixation of long bone fracture were treated with irrigation after debridment. Among the 13 cases 8 fractures were dislodged internal fixation and then were fixed with the external fixation. 5 fractures were remained the internal fixation and were instilled after debridment. All of the patients were given with antibiotics for 2～3 weeks after operation.[Result]All the 13 patients were followed up. The follow-ranged from 8 to 48 months with an average of 23.5 months. Among the thirteen patients 11 fractured-bone had bony union, one nonunion and one case had fistula, Infection relapsed in two patients.[Conclusion]Bone defects, fracture nonunion often occur on patients who have insidious infection after internal fixation of long bone fracture. These patients need to be operated. In slight infections fracture can be remained after debridement. Fractures with seriously infectious have to dislodge internal fixation and to be fixed with made according to its radiographic changes.
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[Objective]To discuss the causes and preventive measures about complications of iliac crest bone graft harvesting.[Method]From Jan.1990 to Jan.2005,828 patients with iliac crest bone graft harvesting were reviewed retrospectively,their complications were taken statistical analysis.[Result]Fifteen patients were found with superficial infections;10 deep infections;20 patients with superficial seromas and 10 patients with minor hematomas;4 deep hematomas;30 nerve injuries;3 vascular injuries,all 3 cases occurred secondary to harvesting of posterior iliac crest bone grafts;1 donor defect hernias,and 2 iliac wing fractures.[Conclusion]The causes of complications are incorrectly harvesting and rude operation.The preventive measures are that operators should know the anatomic characteristic of ilium and microinvasion.