Correlation between acoustic radiation force impulse imaging and reserve function of liver / 中华超声影像学杂志

Objective:To investigate the correlation between acoustic radiation force impulse imaging(ARFI) and reserve function of liver and the feasibility of liver reserve function assessment by ARFI.Methods:According to the inclusion criteria, 74 patients were screened and 71 patients were finally enrolled from Henan Province People′s Hospital during June 2017 and June 2019. The portal vein diameter (D PV), spleen length (L SP) were measured by two-dimensional ultrasound. The liver shear wave velocity (LSWV) and spleen shear wave velocity (SSWV) were measured by ARFI. Serological markers were checked, and the indocyanine green (ICG)15-minute retention rate (ICG R15) was measured by excretion test. The patients were divided into ICG R15<10% group and ICG R15≥10% group, the difference of the measurements between two groups were calculated, the correlations of the measurements and ICG R15 were analyzed. LSWV diagnostic performance for liver reserve function was evaluated by the ROC curve. Results:There were significant differences in LSWV, D PV, SSWV, L SP, aspartate transaminase(AST), alkaline phosphatase(ALP), y-glutamyl transpeptidase(γ-GGT) and albumin (ALB) between ICG R15<10% group and ICG≥10% group( P<0.05), but no significant differences in other measurements( P>0.05). The correlations between ICG R15 and LSWV( r=0.673, P<0.001), D PV( r=0.355, P<0.05), SSWV( r=0.384, P<0.05), L SP( r=0.403, P<0.001), ALP( r s=0.245, P<0.05) and ALB( r s=-0.390, P<0.05) were statistically significant. The ROC curve showed high diagnostic performance for liver reserve function assessment by LSWV. The area under the ROC curve was 0.903 (95% CI=0.810-0.961, P<0.01), and the cut-off value was 2.15 m/s (sensitivity 84.6%, specificity 86.7%). Conclusions:The LSWV can evaluate the reserve function and it is a useful supplement to the ICG excretion experiment.

Clinical application of H-shaped decalcified bone in spinal posterior approach surgery / 第三军医大学学报

Objective To observe the effect of H shaped decalcified bone grafting on spinal fusion and anti conglutination by posterior approach and to evaluate its values in the application in spinal posterior approach surgery. Methods Total laminectomy was performed on 23 cases of severe spinal stenosis and 31 cases of intraspinal tumor for decompression. Thorough decompression of the nerve roots was performed on the former following total laminectomy while exploration and excision of the neoplasm were done on the latter. Then, H shaped decalcified bone grafts were inlaid between spinous processes and transverse processes to cover the lamina defection and overlap the adjacent segments in all cases. At last, the spinal internal fixation or plaster external fixation were used to stabilize vertebral segments according to the economic status of patients. The average time of follow up was 21 months (18～31 months). Results All patients got successful segmental spinal fusion within 8 months. Clinical symptoms were obviously alleviated in 43 cases at the end of follow up but symptoms recurred 12 months after operation in other 11 cases(all were tumor patients). Conclusion H shaped decalcified bone graft is valuable in spinal fusion and anti conglutination in spinal posterior approach surgery.

Microsurgical repair at early stage for soft tissue defect of limbs wounded by modern firearm / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore an early stage repair method for soft tissue defect of limbs of modern firearm wound, and to improve treating result.</p><p><b>METHODS</b>Defects of the hind limbs of dogs were repaired with skin, muscle and myocutaneous flaps.</p><p><b>RESULTS</b>Wounds healed within 2 weeks in the experimental group except one that healed in 3 weeks because of infection. Limb function was close to normal. The treatment result was better in the experimental group than the control.</p><p><b>CONCLUSIONS</b>Skin, muscle and myocutaneous flaps can cover soft tissue defect at an early stage, prevent and reduce infection, promote the healing and recovery of combined injury, reduce the time of treatment and disability rate.</p>

Surgical management and its therapeutic effect of gunshot wounded femor al arteries immered in seawater in rabbits / 第三军医大学学报

Objective　To investigate the surgical management of a gun shot wound of blood vessels and immersied, and evaluate its primary effect. Methods　100 rabbits were divided randomly into simple wounded group(SWG,n=50) and seawater immersion group(SIG,n=50).F emoral arteries were impacted by 0.38 gram steel spheres with velocity of 600 ～800 meters per second fired by 7.62 mm rifle. Animals in SIG were immersed in artificial seawater (pH 8.2～8.4, salinity 25.4,temperature 21℃) for 60 min, o f which those in SWG were spared. Grossly injuried artery was excised and restor ation of blood flow was reconstructed by end-to-end anastomosis or reversed au togenous venous grafting or cryopreserved arterial allografting. At 24 h,7,1 4,21 days after operation, blood flow was examined by Doppler ultrasonic detecti on and part of anastomotic sites and graft were collected for pathological obser vation. Results　In completely transected injury, the patency in SIG was 80.00%,while that in SWG was 86.67% in the first 3 weeks. In arterial c ontused injury ,patency in SIG was 86.67%,and that in SWG was 82.35% at the same time. Thrombosis occurred mostly in the first postoperative week. Atypical endo thelial cells were found at the anastomosis sites in the first postoperative week, and the anastomosis sites were lined with endothelium in 3 weeks postopera tively. Conclusion　Early curative effect could be obtained. Whe n grossly injuried artery is excised and followed by a routine surgical procedur e in the treating gunshot wounds immersed in seawater.

An experimental study peripheral nerve regeneration through NGF · HAMM grafts in rats / 中华显微外科杂志

Objective To determine the effect of peripheral nerve regeneration through NGF ·HAMM (Nerve growth factor and Human Ammion membrane Matrix) grafts. MethodsA 1.2 cm defect of the left sciatic nerve were made and then repaired randomly by means of autogenous nerve bridging (group N),NGF · HAMM microporous conduit bridging (group NH) or HAMM microporous conduit bridging (group H) in 60 adult Wistar rats. There were 20 animals in every group. At 1,2 and 3months post operation,the following items as qualitative histology,quatitative histomorphometry,electrophysiology and functional assessments of end-organ reconnection were determined. ResultsAt 2and 3 months post operation,Motor nerve conduction velocity (MNCV) of the nerve repaired with HAMM were lower than that of the nerve repaired with autograft and NGF · HAMM. At 3 months post operation,there was no significant difference between NH group and N group in nerve conduction velocity (P>0. 05). At 2 and 3 months post operation,both NGF · HAMM conduit and nerve autograft groups showed more nerve fibers,bigger axon diameter and thicker meylin sheaths than H group.Conclution The combination of HAMM and NGF world enhance nerve regeneration and myeliogeny,as well as could cooperatively promote the functional recovery of injured nerves and limbs. Our results indicate that the NGF · HAMM microporous conduit is a promising tool for use as a nerve guide tube in peripheral nerve regeneration.

Biomechanical experiment and clinical report of modified patellectomy for polar fracture of the patella / 中华创伤杂志(英文版)

OBJECTIVE: To study the influence of polar patel-lectomy and the site of reanchored the patellar tendon on femoral quadriceps extensing force. METHODS: The experiment was designed by using 5 lower limbs of cadavers for extracorporal biodynamic test. The maximal fixing force of the double stainless steel wire (0.4 mm in diameter) reanchoring the patellar ligament to the patellar cortical edge was measured. Clinically 21 patients with polar fractures were treated by removing the small fragments and reanchoring the patellar ligament to the cortical edge of the patella using the wires. RESULTS: Resection of the lower 1/4 part of the patella and the patellar ligament reanchored to cortical edge of the patella would not increase femoral quadriceps contracting force arm. But if the patellar tendon reanchored near the joint surface, much more extending force would be needed than the former (P<0.001). The maximal fixing force of the wires is 67.4 kg (60.9-72.5 kg). All the patients using this modified procedure gained satisfactory functional recovery. CONCLUSIONS: The modified partial patellecomy is a simple and effective procedure for choice.