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Objective To discuss the diagnostic value of a diagnostic strategy combining D-dimer and aortic dissection detection risk score (ADDRS) for patients with acute aortic dissection (AAD). Methods The clinical data of 750 patients with suspected AAD in emergency department of Zhongda Hospital Affiliated to Southeast University from January 2016 to January 2018 were retrospectively analyzed, including medical history, gender, age, chief complaint, physical examination, diagnostic imaging data and D-dimer levels on admission. ADDRS = 0 was defined as low risk group, ADDRS = 1 as medium risk group, ADDRS≤1 as non-high risk group,whereas ADDRS > 1 as high risk group. The clinical characteristics of AAD and non-AAD patients, ADDRS, D-dimer, and the diagnostic ability of D-dimer (the cutoff value of 500 μg/L) for AAD in different risk groups were observed. Results AAD was diagnosed in 79 of 750 (10.53%) patients. Of the 256 (34.13%) patients in low risk group, 5 patients were diagnosed with AAD. The medium risk group had 337 (44.93%) patients, including 44 cases with AAD. The high risk group had 157 (20.93%) patients, including 30 cases with AAD. In AAD patients, the proportion of male and hypertension, the incidence of ADDRS risk markers (including abrupt onset of pain, severe pain intensity, ripping or tearing pain, pulse deficit or systolic blood pressure differential of upper limb, focal neurological deficit, recent aortic manipulation, known thoracic aortic aneurysm) and the D-dimer levels in AAD group were significantly higher than those of non-AAD patients [male: 82.28% (65/79) vs. 59.76% (401/671), hypertension: 81.01% (64/79) vs. 41.43% (278/671), abrupt onset of pain: 78.48% (62/79) vs. 39.94% (268/671), severe pain intensity: 78.48% (62/79) vs. 50.52% (339/671), ripping or tearing pain: 32.91% (26/79) vs. 0.75% (5/671), pulse deficit or systolic blood pressure differential of upper limb: 15.19% (12/79) vs. 0.15% (1/671), focal neurological deficit: 7.59% (6/79) vs. 1.64% (11/671), recent aortic manipulation: 6.33% (5/79) vs. 0.30% (2/671), known thoracic aortic aneurysm: 15.19% (12/79) vs. 0.30% (2/671), D-dimer (μg/L): 1 160 (588, 3 340) vs 135 (56, 478), all P < 0.05], the proportion of diabetics was significantly lower than that of non-AAD patients [7.59% (6/79) vs. 18.78% (126/671), P < 0.05]. The positive predictive values of D-dimer for AAD diagnosis in the low risk group and the non-high-risk groups (including low and medium risk groups) were lower than that in the high risk group (8.62%, 26.32% vs. 40.91%), the negative predictive values of D-dimer were higher in the low risk group and non-high-risk groups than that in the high risk group (100.00%, 99.05% vs. 96.70%), missed diagnosis rates were higher than that in high risk group (0, 0.95%, vs. 3.30%). Conclusion In the high risk group, D-dimer≥500 μg/L is helpful for diagnosis of AAD; and in low risk group or non-high-risk group, D-dimer < 500 μg/L can efficiently and accurately exclude AAD.
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A total of 109 in patients with crayfish-related rhabdomyolysis were enrolled in our hospital from July to August 2016,including 31.2％(34/109)males and 68.8％ (75/109)females.The number of home-cooked crayfish accounted for 60.6％ (66/109).Main symptom was back pain 96.3％ (105/109).The misdiagnosis rate was 15.6％ (17/109).On day 1,2,3 after admission and the day before discharge,serum creatine kinase were 1 175(446,2 258)IU/L,3 710(2 137,8 875)IU/L,1 899(1 063,4595)IU/L and 317 (152,532)IU/L,respectively(P＜0.001).Serum myoglobin were (603±484)μg/L,(313±284)μg/L,(104±74)μg/L and (55 ± 20)μg/L,respectively(F=39.1,P＜0.001).Females were more susceptible to cra.crayfish-related rhabdomyolysis.Home-cooked crayfish is prone to induce rhabdomyolysis and easily to be misdiagnosed.Creatine kinase and myoglobin showed characteristic dynamic changes.
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Objective To compare the effectiveness and safety of different concentrations of elastin-like polypeptides (ELP) as novel submucosal injection material for endoscopic submucosal dissection.Methods Forty healthy New Zealand white rabbits were randomly divided into two groups (n=20).The first group by submucosal injection of different drugs were randomly divide into five groups (n=4).Four concentrations of 50 ku ELP (0.05,0.025,0.012 5,0.005 g/ml) were used separately in each group,while glycerin fructose was used for control group.Each solution (2 ml) was injected into the submucosa through the resected margin,the increase of mucosal thickness and surface changes were observed and recorded at 0,5,10,and 30 min.The subgroup by submucosal injection of different drugs were randomly divide into five groups (n=4).The injection pressure of each solution (2 ml) with the 25-gauge needle was calculated by a manometer,which was connected between the needle and syringe.Results The submucosal uplift heights in groups using the 0.05 g/ml ELP and 0.025 g/ml ELP injection were significantly thicker than that of glycerin fructose (P＜0.05),the 0.012 5 g/ml ELP and glycerin fructose injection showed no significant difference (P＞0.05),whereas the uplift height in glycerin fructose group was thicker than that of the 0.005 g/ml ELP (P＜0.05).The injection pressure correlated with the ELP concentration.The injection pressures of 0.05,0.025,0.012 5,0.005 g/ml ELP solutions were (332±36) kPa,(223±24) kPa,(174±22) kPa and (142±19) kPa,respectively,and that of glycerin fructose was (269±17) kPa.The 0.025 g/ml ELP solution was easily injected into the porcine stomach to create submucosal uplift.The injection pressure of the 0.025 g/ml ELP solution showed significantly lower value compared with that of glycerin fructose (P＜0.05).Conclusions ELP might be a promising agent for submucosal injection for endoscopic submucosal dissection (ESD),and 0.025 g/ml ELP might be efficient concentration for maintaining mucosal elevation,injection pressure and safety.
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Objective To determine the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia (VAP).Methods Clinical studies which were related to enhanced hand cleansing to the risk of VAP,which were published between July 1992 and June 2013 in English or Chinese were retrieved via computer and manual screening.Data were extracted according to appropriate inclusion and exclusion criteria and analyzed with RevMan 5.0 software.Results A total of 6 studies,all of which were performed with well controlled protocol,involving 28 461 mechanical ventilator days and 32 428 mechanical ventilator days were analyzed.The morbidity of VAP was 39.5 days per 1 000 mechanical ventilator days and 19.5 days per 1 000 mechanical ventilator days before and after enhanced hand cleaning,respectively.The methods of enhancing hand hygiene included feasible hand hygiene apparatus,long-term education,supervision and feedback,as well as increased hand cleaning compliance.All 6 eligible studies reported that enhanced hand washing lowered the risk of VAP,with risk reduction ranging from 29.8％ to 65.5％ with a mean reduction value of 50.6％.Meta analysis showed that enhanced hand cleaning could protect patients from VAP with odds ratio (OR) varying from 1.43 to 5.82 [pooled OR=2.23,95％ confidence interval (95％CI) 1.62-3.07,P＜0.000 01].It was showed in funnel chart that bias in the published articles was not significant.Conclusions Enhanced hand hygiene has an effect of prevention of VAP morbidity and is associated with lowered morbidity of VAP.However,the reliability of this conclusion is questionable because of poor quality of these studies.
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Objective To discuss the survivorship of rat mesenchymal stem cells (rMSCs) and the expression of human brain-derived neurotrophic factor (hBNDF) protein after transplantation of the hBDNF-modified rMSCs (hBDNF-rMSCs) to the adult rats with spinal cord injury (SCI) and discuss the effect of hBDNF-rMSCs on the apoptosis of rat neural cells. Methods A total of 240 adult male Sprague-Dawley rats were randomly divided into sham operation group,SCI group,hBDNF-rMSCs transplantation group and empty vector-rMSCs transplantation group,with60 rats in each group.The SCI model was established by using the modified Allen technique.At day 7 after modeling,an equal volume of hBDNFrMSCs suspension,empty vector-rMSCs suspension and phosphate buffered saline (PBS) were injected through the L4,5 subarachnoid space into the hBDNF-rMSCs group,empty vector-rMSCs group and SCI group,respectively.Then,the injured spinal cord tissues were obtained from each group at days 1,2,3,7 and 14 after transplantation to observe the viability and distribution of rMSCs with enhanced green fluorescent protein gene by fluorescent microscope,measure the expression of hBDNF protein by Western blot and detect the apoptosis of neural cells by TdT-mediated dUTP nick end labeling (TUNEL). Results Both hBDNF-rMSCs and empty vector-rMSCs groups showed green fluorescence expression of rMSCs.The hBDNF protein expression was observed in hBDNF-rMSCs group and changed with time,ie,the expression was detected at day 2 after transplantation,reached the highest level at day 7 and then decreased gradually.Among the hBDNF-rMSCs,empty vector-rMSCs and SCI groups,the number of TUNEL positive cells was the least in hBDNF-rMSCs group,followed by the empty vector-rMSCs group and the number was relatively more in SCI group at days 2,3,7 and 14 after transplantation,with significant differences among groups (P ＜ 0.05). Conclusions Transplantation of the hBDNF-modified rMSCs through subarachnoid approach are able to survive and assemble at the injured spinal cord area and express hBDNF protein.The hBDNF-modified rMSCs can inhibit the apoptosis of neural cells after SCI.
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Objective To investigate the effect of FK506 on the expression of axon guidance cue slit-2 after spinal cord injury(SCI)in rats.Methods A total of 75 adult Sprague-Dawley rats were randomly divided into three groups,ie,sham operation group,SCI group and FK506 treatment group.The SCI model was made by using the modified Allen's technique.Then,the rats were sacrificed and the spinal cord was removed at different time points(at days 1,3,7,14 and 28)for detection of the expression of slit-2 by means of reverse transcription polymerase chain reaction(RT-PCR)and immunohistochemistry.Results The expression of slit-2 changed with time.The expression of slit-2 could be detected at day 1 after SCI,reached the highest at day 7 and then decreased gradually,with higher expression level in the injury group compared with treatment group(P ＜ 0.05).Conclusion Following spinal cord injury,administration of FK506 can up-regulate the expression of slit-2 and may exert important effect on the guidance of the axon regeneration.
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Objective To observe the effect of FTY720 on the expressions of Bel-2 and Bax protein and explore the neuroproteetive effect of FTY720 on neuron after acute spinal cord injury in the rats.Methods A total of 75 SD rats were divided randomly into three groups,ie,the test group(treated with FTY720),the injury group(treated with normal saline)and the control group.The test and injury groups were impacted to create T10 spinal cord injury(SCI)by Allen's method.Both the mRNA and protein expressions of Bcl-2 and Bax in the injured spinal cord section were studied respectively with hematoxylin and eosin(HE)staining,immunohistochemical examination and reverse transcription polymerase chain reaction(RT-PCR)technique at different time points(at6 h,12 h,24 h,3 d and 7 d). Results The expressions of Bcl-2 and Bax in the test group and the injury group were higher than that in the control group at all time points.Meanwhile,at 12 h,24 h,3 d and 7 d,the mRNA and protein expressions of Bcl-2 in the test group were significantly higher than that in the injury group(P<0.05),while the mRNA and protein expressions of Bax in the test group were obviously lower than that in the injury group (P<0.05). Condusion Early administration of FTY720(0.5 mg/kg)after spinal cord injmy Canincrease the mRNA and protein expressions of Bcl-2,decrease the expression of Bax and inhibit neuron apoptosis in the injured spinal cord.
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Objectives To investigate the changes in the masseter muscle following osteotomy of the prominent mandibular angle using real-time three-dimensional (3D) ultrasonography, and to supply guidance for resection of the mandibular angle. Methods Real-time 3D ultrasonography was applied preand post-operatively (over a 6-month follow-up period) to 10 patients who underwent curved osteotomy with the following objectives: (1) to reconstruct the morphological changes of the masseter under different conditions; (2) to assess masseter muscle volume changes, and (3) to obtain the dynamic morphological changes of masseter during mouth opening and closing. Results The reconstructed 3D images revealed that longitudinal diameters of masseter muscle decreased and angle regions changed to be arc-shaped with significant thinning 6 months after operation. The mean volume of masseter muscle was (18. 222 ±3. 028) cm36 months post-operatively, compared with the pre-operation mass of (25. 480 ± 7. 113) cm3,the statistical difference was significant (P＜0.01). Transverse and longitudinal changes of the thickest masseter muscle section 6 months post-operatively were of no statistic difference (P＞0. 01) compared with pre-operation status during mouth opening and closing motions. Conclusion A certain extent of atrophy occurs primarily in the angle region of masseter muscle after mandibular angle ostectomy. However, these changes do not significantly impair masseter muscle function. Real-time 3D ultrasonography offers a novel, safe, and convenient technique for masseter muscle reconstruction and observation of masseter muscle movement.
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Objective To investigate the feasibility of using PLGA loaded with SD rats' mesenchymal stem cells(rMSCs) transfected with green fluorescent protein (GFP) gene as scaffolds for combinations of molecular, cellular, and tissue-level treatments of spinal cord tissue engineering. Methods rMSCs infected with lentiviral vectors (lv-GFP) were seeded onto PLGA at 8000 cell/cm2, rMSCs-GFP grown under similar conditions on tissue culture plastic as control. The morphology of rMSC-GFP was examined by fluorescence microscopic. The activity of MSCs was detected by MTT assay everyday. Cell cycle analysis was performed after a 3-day culture on PLGA using flow cytometry. The rMSCs-GFP seeded on PLGA was identified by FITC-anti CD34,CD90 and PE-anti CD44, CD106,CD45,CDllb at the third day. Results Fluorescence microscopic examination revealed adherence of the cells to the PLGA surface within 24 h of initial plating. After 3 days, GFP cells were spindle shaped. The difference disappeared at 7 days when cells under both conditions had become confluent Cells proliferated at the same rate on the PLGA surface compared to tissue culture plastic. And cell's cycle was unaffected by the transduction process and seeded on PLGA. Cells maintained their stem cell phenotype as judged by expression of CD90, CD44, CD106 markers,and absence of the hematopoietic marker CD45, CD34. This demonstrated that the transduction and the PLGA surface were not adversely affecting the cells. Conclusions MSCs are a good candidate for spinal cord tissue engineering. Cells continued to express green fluorescent protein(GFP)on a long-term basis,and are compatible with polymer surfaces. Morphology,viability,and growth kinetics were maintained when cells were grown on a poly-lactic-co-glycolic acid(PLGA)polymer scaffold. Therefore,they could make further efforts for combinations of molecular, cellular,and tissue-level treatments of spinal cord tissue engineering.
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Objective To investigate a new technique to increase the survival rate of free autogenous pellet fat graft. Methods Many methods were used to graft free autogenous fat, and the results compared to look for the best method for it. Results After 3 and 6 months, the volume rate in the treatment group and control group were 70%, 60% and 40%, and 30%. The times of fat injection were 2 and 4 . Conclusion Some vasodilators, low negative pressure and plasma can enhance the survival rate of free autogenous pellet fat graft.
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Objective To investigate the changes of the constitution and its ratio of collagen fiber in the process of masseter reattachment following different osteotomies of the prominent mandibular angle so as to offer guidance for the resection of mandibular angle. Methods Sixteen adult goats were randomized into four groups. In group A we performed unilateral curved osteotomy of the mandibular angle. In group B unilateral curved ostectomy was performed with partial masseter resection. In group C unilateral angle splitting ostectomy, while in group D unilateral dissection of the masseter muscle was conducted. The constitution and its ratio of collagen fiber in the interface were observed at 1-month, 2-month, 3-month, and 6-month after operation. Results On the changes of collagen fiber in the process of muscular reattachment, at 1-month post-operation, the constitution of collagen fiber (types Ⅰ and Ⅲ) in groups A and B were significantly different from that of control group (P<0.05). However, both groups C and D had no statistic difference from control group (P>0.05). At 2-month, 3-month and 6-month post-operation, those of all experimental groups had no statistic difference from control group. And with time, the percentage of collagen fiber type Ⅰ increased and type Ⅲ decreased gradually. Conclusion The recovery sequences of masseter muscle reattachment in this study are firstly group C, secondly group A and finally group B. It suggests that the recoveries of mastication and other oral activities are different. Group B turns out to be with a slow muscle reattachment. Thus, we recommend treating different kinds of mandibular hypertrophy with different ostectomies.
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Objective To investigate the methods of rectifying the excessive width of fold line and conglutination of the upper eyelid following blepharoplasty. Methods The width of double eyelid was redesigned, ranging from 6 mm to 8 mm. Then the scar of upper eyelid was excised about 1 mm to 2 mm, and the orbital septum fat flap, orbicularis oculi flap, infraorbicularis oculi fat flap and injection of lipochondria were utilized to fill the depression of upper eyelid. Results In our series, there were 20 eyelids of 16 cases receiving rectification. Orbital septum fat flap was used to correct 2 eye-lids, orbicularis oculi flap 4 eyelids, infraorbicularis oculi fat flap 10 eyelids and injection of lipochon-dria 4 cases. Among 12 eases of following-up, 10 of them were satisfied with the postoperative effects. The results were acceptable in other 2 cases. Conclusion It is a good approach to correct the excessive width of fold line and conglutination of the upper eyelid with local flaps, including the orbital septum fat flap, orbicularis oculi flap, infraorbicularis oculi fat flap and injection of lipochondria.
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Objective To investigate the changes of the masseter muscle following osteotomy of the prominent mandibular angle and to provide guidance for the resection of mandibular angle. Methods Ten goats were equally divided into two groups. In group A we performed unilateral curved osteotomy of the mandibular angle, and in group B we performed unilateral dissection of the masseter muscle. The cross section area (CSA) and the sarcomere length of masseter muscle were measured beore and after operation. Results (1) Cross section area (CSA) of masseter muscle fiber in curved ostectomy group decreased at 1,2, 3 and 6 months after operation in different extent. Comparing with the control group, the difference was statistically significant (P<0.01). CSA of masseter muscle fiber in dissection group decreased 1 month postoperatively, which had significantly statistic difference with control group (P<0.01). But, they had no significant difference with control group at 2, 3, and 6 months after operation (P>0.01). (2) Sarcomere length of masseter muscle in curved ostectomy group decreased in 1 week, 1 and 2 months after operation, which had significantly statistic difference with control group (P<0.01). At 3 months after operation, sarcomere length recovered to normal. In dissection group, sarcomere length decreased in 1 week and 1 month after operation, which had significantly statistic difference with control group (P<0.01). At 2 month after operation, it recovered to normal. Conclusion Certain extent of atrophy does happen to masseter muscle after mandibular angle ostectomy. Meanwhile, these changes do not significantly impair the function of masseter muscle. According to this, we suggest a simple mandibular angle ostectomy without partial resection of masseter muscle in case of mild to morderate mandibular angle hypertrophy. Doing so, we can not only achieve the cosmetic effect but also reduce the implications.
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Objective To explore the effect of botulinum toxin type A(BTXA)in the treatment of early hypertrophic scars(HTS).Methods BTXA was injected into and around the eady HTS,and then the modal and histological changes of the scars as well as the clinical reaction were observed in the patient.BTXA was also injected into muscle around the incision and effect on the cicatrization observed.Results Injection of BTXA could obviously alleviate ache and pruritus of eady HTS and could impel the atrophy and inteneration of eady HTS.Changes were found in paraffin-embedded tissue section by the hemetoxylin and eosin(HE)staining.Injection of BTXA into muscle around the cut could can reduce occurrence of HTS.Conclusion BTXA can help prevent the early HTS to a certain extent.The mechanism underlying this effect may be related to the reducing the tension around scars and proliferative activity,interfering with the signal transduction of small nerves,affecting the proliferation and apoptosis of fibroblasts and subsequently decreasing the collagen synthesis.
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[Objective]To investigate the effect of cryopreservation on the antigenicity of vascularized bone allotransplantation,and to observe the patency of the pedicle and the osteosis of bone allografts,in order to find out the dose of immunosuppressive agent.[Method]Forty-eight New Zealand rabbits were involved in the study.Of them 16 rabbits served as donors,and 32 hosts.Allotransplantation of cryopreserved radius diaphysis with the vascular pedicles were implanted to 8 rabbits and immunosuppressive agent(CsA 10 mg/kg/d) was administrated 4 weeks after transplantation(group A),similar cryopreserved grafts with the vascular pedicles were implanted to 8 rabbits and immunosuppressive agent(CsA 5mg/kg/d) was administrated 4 weeks after transplantation(group B),similar cryopreserved grafts with the vascular pedicles were implanted to 8 rabbits and immunosuppressive agent(CsA 2 mg/kg/d) was administrated 4 weeks after transplantation(group C),allotransplantation of cryopreserved radius diaphysis with a vascular pedicle was performed in 8 rabbits(group D),and 16 donors were group E.Immunological analysis was performed at 1 weeks.Radiography was taken for each graft at 2,4,8,12 weeks.And 12 weeks after operation,the patency of the pedicle was observed through ink infusing and histological studies were performed.[Result]There was no difference of IFN-? between group A and group B.However,the levels of IFN-? in groups A and B were lower than that in group C.[Conclusion]Cryopreservation could reduce the antigenicity of vascularized allotransplant graft.After transplantation,the reject response is decreased,patency and osteosis of bone allografts are better,and the dose of immunosuppressive agent are decreased.
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Objective To explore the new methods to fill local temporal depression or augment superciliary with autotissue graft.Methods Applying upper eyebrow perdicled dermis -fat petal to fill the local temporal depression or augment superciliary, accompanied with eyebrow lifting.Results Augmentation superciliary arch plasty with upper eyebrow perdicled dermis-fat petal was performed in 5 patients. All 5 patients' superciliary arch showed good shape and accompanied with no complications. Filling of local depression of temporal with derma-fat flap was performed in 6 patients, with dermis-fat flap and prosthesis was performed in 8 patients. 2 cases had hematoma. Conclusion Upper eyebrow perdicled dermis-fat petal as a material being ultilized to augment superciliary or to fill local temporal depression has advantages of better localization and more natural shape.[
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The thyroid allografts in rats were cultured for 48h in the conditions of hyperbaric oxygen (a mixture of 95% O2,5% CO2 pressurized at 2 atmospheres)and low pH(5.5 and 6.9).Uncultured and air cultured allografts were taken as control groups.The thyroid slices were transplanted under the kidney eapsulse of thyroidectomized recipients.By examining histological changes,detecting the serum T3 and T4 levels and five weeks body weight gain,the graft survival was cvaluated.Though the thyroids cultured in hyperbaric O2 were contaminated with the passenger leukocytes,the grafts had prolonged survival,suggesting this method might effectively diminish MHC immunogenicity to thyroid grafts.