A wound diagnosis and treatment mode with integrated medical care for repair of chronic infectious wounds plus bone exposure at lower extremities / 中华创伤骨科杂志

Objective:To evaluate a wound diagnosis and treatment mode with integrated medical care in the repair of chronic infectious wounds plus bone exposure at lower extremities.Methods:A retrospective analysis was conducted of the 64 patients with chronic infectious wound plus bone exposure at the lower 1/3 of the leg who had been admitted to Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University from January 2019 to December 2021. The patients were divided into 2 groups according to the wound diagnosis and treatment mode. In the observation group of 31 patients subjected to the wound diagnosis and treatment mode with integrated medical care led by specialist nurses, there were 24 males and 7 females with an age of (53.6±12.4) years, the wound was located at the tibial side in 15 cases and at the fibular side in 16 cases, the wound areas averaged [28.27 (23.56, 37.70) cm 2], and the time from injury to treatment was (27.3±4.1) d. Evaluation of the patient's condition, wound diagnosis and formulation of treatment protocols were performed jointly by a doctor-nurse team after the patients were admitted, and continuous diagnosis and treatment of the wounds were carried out mainly by specialist nurses during the doctors' follow-up. In the control group of 33 patients subjected to the conventional wound diagnosis and treatment mode led by doctors, there were 25 males and 8 females with an age of (51.3±14.3) years, the wound was located at the tibial side in 17 cases and at the fibular side in 16 cases, the wound areas averaged [27.49 (17.84, 40.45) cm 2], and the time from injury to treatment was (27.6±4.0) d. The 2 groups were compared in the wound healing rate, wound recurrence rate, hospitalization time and patients' satisfaction. Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The observation group achieved a significantly higher wound healing rate within 1 month after treatment [83.87% (26/31)] than the control group [60.61% (20/33)], a significantly lower wound recurrence rate within 6 months after treatment [0% (0/31)] than the control group [18.18% (6/33)], significantly shorter hospitalization time [18.0 (15.1, 20.9) d] than the control group [26.8 (18.4, 40.1) d], and significantly higher patients' satisfaction [50 (50, 50) points] than the control group [50 (42, 50) points] (all P<0.05). Conclusion:In the repair of chronic infectious wounds plus bone exposure at lower extremities, the wound diagnosis and treatment mode with integrated medical care led by specialist nurses may result in a higher wound healing rate, a lower wound recurrence rate, a shorter hospital stay and higher patients' satisfaction than the conventional wound diagnosis and treatment mode led by doctors.

Therapeutic effect of exposed bone cement in treatment of infectious bone and soft tissue defect / 中华显微外科杂志

Objective:To evaluate the therapeutic effect of exposed bone cement in treatment of infectious bone and soft tissue defect by comparison with routine bone cement therapy.Methods:A retrospective analysis was carried out in 27 patients who had been treated from January 2016 to January 2020. Of the 27 patients, 12 were treated by exposed bone cement filling for bone defect at the first stage, followed by flap and bone grafting at the second stage. Other 15 patients were treated by routine bone cement filling and flap repair at the first stage, followed by bone grafting at the second stage. Regular dressing change was carried out after surgery. All patients entered follow-up by out-patient review for wound condition and X-ray. Infection rate of bone and soft tissue, time of bone union, flap survive rate and complication were compared between the 2 groups.Results:The follow-up lased for 9-24(16.5±3.9 ) months. The bone defects were all healed. The treatment time of bone defects in the group of exposed bone cement was 25-34(28.5±2.8) weeks. The treatment time of bone defect in the routine cement group was 25-36(29.6±3.4 )weeks. There was no statistical difference between the 2 groups( P<0.05). Two cases in each group had failed in infection control after bone cement implantation. With further debridement, cleaning and other treatment, the infection was under control. All flaps in the 2 groups survived. In the group of exposed bone cement, there were 3 flaps splitting, 2 hemorrhage(effusion) and 1 partial flap necrosis, In the routine bone cement group, there were 4 wound dehiscence, 8 hemorrhage(effusion) and 3 partial flaps necrosis. There was no significant difference in flap complications between the 2 groups( P>0.05). The healing of bone defect was evaluated by Samantha X-ray score, the scores of the 2 groups were 5.41±0.67 and 5.40±0.63, respectively, with no statistical significance. The Paley's approach was used to grade the bone healing and the function of adjacent joints. Paley bone defect healing evaluation results weve all excellent. Joint function assessment were as follow: in the group of exposed bone cement, 6 cases were excellent and 3 were good; in routine bone cement group: 6 cases were in excellent and 5 in good. There was no significant statistical difference. Conclusion:Compared with a routine bone cement treatment, the exposed bone cement in the treatment of infectious bone defects saw a fewer flap splitting and fewer hemorrhage/effusion, without an increase in bone and soft tissue infection. This procedure could be considered for further trials in the treatment of a composite defects of infected bone and soft tissue.

VEGF-C/VEGFR-3/iNOS Signaling in Osteosarcoma MG63 Cells Mediates Stimulatory Effects on Human Umbilical Vein Endothelial Cell Proliferation / 中国医学科学杂志(英文版)

Objective To assess the effects of vascular endothelial growth factor-C (VEGF-C)/vascular endothelial growth factor receptor-3 (VEGFR-3) signaling on nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) expression in human osteosarcoma MG63 cells and the subsequent impact on the proliferation of human umbilical vein endothelial cells (HUVECs). MethodsMG63 cells were treated with VEGF-C alone (VEGF-C group), VEGF-C + iNOS inhibitor aminoguanidine (AG; AG group), and VEGF-C + VEGFR-3 inhibitor MAZ51 (MAZ51 group); untreated MG63 cells were used as controls. NO production was evaluated by a colorimetric method involving nitrate reductase. Meanwhile, mRNA and protein levels of iNOS were examined by reverse transcription polymerase chain reaction (RT-PCR) and Western blot. To explore the effect of VEGF-C/VEGFR-3/iNOS signaling of MG63 cells on proliferation of HUVECs, we set up six groups: HUVECs, HUVECs+MG63, HUVECs+VEGF-C, HUVECs+MG63+VEGF-C, HUVECs+MG63+VEGF-C+AG, and HUVECs+MG63+VEGF-C+MAZ51 groups. The proliferation of HUVEC cells was assessed by Cell Counting Kit-8 (CCK-8), 5-ethynyl-2'-deoxyuridine (EdU) incorporation assay, and proliferating cell nuclear antigen (PCNA) expression quantitation. ResultsVEGF-C treatment enhanced iNOS expression at both gene and protein levels (mRNA: LSD-

Effect of Adjuvant Therapy of Huayu Pills on Neurological Recovery of Patients with Acute Cerebral Infarction / 中国实验方剂学杂志

Objective:To observe the effects of adjuvant therapy of Huayu pills on neurological recovery of patients with acute cerebral infarction (ACI) and syndrome of Qi deficiency and blood stasis, and to investigate its mechanism of action for antioxidation, anti-inflammation and improvement of microcirculation. Method:One hundred and forty patients were randomly divided into control group (70 cases) and observation group (70 cases) by random number table. During the study period, there were 3 drop-out cases, 2 excluded cases, and 65 completed cases in the control group. There were 1 drop-out cases, 4 excluded case, and 65 completed cases in the observation group. Western medicine was given in both groups. Patients in control group additionally got oral administration of Xiaoshuang Tongluo tablets, 6 tablets/time, 3 times/day. The patients in observation group got oral administration of Huayu pills, 5 g/time, 2 times/days. The treatment course was 4 weeks in both groups. Before the treatment, and at the second and fourth week after treatment, scores of national institute of health stroke scale (NIHSS) were graded. Before and after treatment, scores of functional independent measures (FIM) scale, fugl-meyer assessment of motor function (FMA), Qi deficiency and blood stasis syndrome were graded. Disability/mortality and safety were discussed after treatment. Levels of the whole blood viscosity (BV), plasma viscosity (PV), platelet aggregation rate (PAG), fibrinogen (FIB), P-selectin (CD62p), D-dimer (D-D), superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), lipid peroxide (PLO), homocysteine (Hcy), tumor necrosis factor -α (TNF-α), serum cystatin C (Cys-C) and hypersensitive C-reactive protein (hs-CRP) were detected both before and after treatment. Result:In the analysis of rank sum test, clinical efficacy in observation group was better than that in control group (Z=2.131, P<0.05). At the second and fourth week after treatment, scores of NIHSS, Qi deficiency and blood stasis, as well as levels of NO, PLO, MDA, Hcy, Cys-C, hs-CRP, TNF-α, BV, PV, PAG, FIB, CD62 p and D-D in observation group were lower than those in control group (P<0.01), while levels of FIM, FMA and SOD were all higher than those in control group (P<0.01). Conclusion:Based on the comprehensive treatment of Western medicine, adjuvant therapy of Huayu pills can improve the degree of nerve function defect, improve the ability of exercise and daily life, reduce the degree of disability, improve the microcirculation and hemorheology, reduce the inflammatory reaction, eliminate oxygen free radicals, and relieve the oxidative stress injury in patients with ACI and Qi deficiency and blood stasis syndrome, and the clinical efficacy is better than that of Western medicine alone.

Preliminary experience of management and standardised procedure of department of trauma and microsurgery during the outbreak of COVID-19 / 中华显微外科杂志

Objective:To summarize the preliminary experience in ward management, medical protection, standardised diagnosis and treatment procedures in trauma microsurgery during the outbreak of COVID-19.Methods:Taking an example from the Department of Trauma and Microsurgery at Zhongnan Hospital of Wuhan University, the orthopedic patients and medical staff with COVID-19 admitted from Decemberm 31, 2019 to March 1, 2020, in-cluding clinical diagnosis and confirmed cases, were analyzed retrospectively. General information, including age, gen- der, basic diseases, contact history, symptoms, lung CT and prognosis, were collected and analysed preliminarily. On January 20, 2020, the COVID-19 outbreak was confirmed as "human to human transmission". COVID-19 infection of patients and medical staff in the wards were analysed, through the update of protection awareness and control measures. Department management, medical protection and standardized control procedures of trauma microsurgery were explored.Results:Five cases with clinical diagnosis or confirmed COVID-19 were included. One was inpatient and the rest 4 were medical staff, aged 25-81 years, 3 with confirmed and 2 with clinical diagnosis of COVID-19. After the treatment by specialists from Department of Infectious Disease and Department of Respiratory Disease, 4 of infected persons were cured and 1 died. Since January 20, 2020, when it was clear that the virus transmitted to people, there was no new case of infection among the medical staff and inpatients after the multidisciplinary collaboration in the ward prevention and control procedures were standardized and took in action.Conclusion:The spread of the COVID-19 can be effectively controlled by standardised diagnosis and treatment procedurs in the word of trauma microsurgery.

Study on the effect of hydraulic delivery vertebroplasty on vertebral morphology and bone cement diffusion / 中国骨伤

OBJECTIVE@#To evaluate the effect of different bone cement injection methods during percutaneous vertebroplasty(PVP) on vertebral morphology and cement diffusion.@*METHODS@#The clinical data of 52 patients with single-segment osteoporotic vertebral compression fracture treated from January 2016 to December 2017 were retrospectively analyzed. The patients were divided into hydraumatic group (28 cases) and pusher group (24 cases) according to bone cement injection method during PVP. By comparing visual analogue scale(VAS), height of anterior vertebral body, compression ratio, kyphosis angle before and after operation and analyzing filling ratio of bone cement in the first 1/3, median line and back 1/3 of the vertebral body in lateral X-rays and the conditions of bone cement diffusion in AP X-rays were to evaluate the effect of different bone cement injection methods on vertebral morphology and cement diffusion.@*RESULTS@#Postoperative VAS was obviously improved in all patients and hydraumatic group was better than pusher group(0.05). There was no significant difference in filling ratio of bone cement in the first 1/3 and median line of the vertebral body by lateral X-ray films between two groups(>0.05), but in the back 1/3 of the vertebral body filling ratio of bone cement in hydraumatic group was better than in pusher group(<0.05). The distribution of bone cement from AP X-ray films were more significant in hydraumatic group(<0.05).@*CONCLUSIONS@#Hydraulic delivery vertebroplasty (HDVP) has better clinical efficacy and it can guarantee sufficient distribution of bone cement into the fractured vertebra and preferably restore the morphology of vertebral body, which is worthy of clinical application.

Application of enhanced recovery after surgery in colorectal surgery in municipal hospitals / 肿瘤研究与临床

Objective To analyze the feasibility and safety of enhanced recovery after surgery (ERAS) in colorectal surgery in municipal hospitals. Methods The clinical data of patients with colorectal cancer in Zhangzhou Affiliated Hospital of Fujian Medical University from June 2016 to December 2018 were retrospectively analyzed. A total of 50 patients who underwent laparoscopic surgery combined with ERAS in the perioperative period were selected as the ERAS group, and 50 patients who underwent laparoscopic surgery combined with conventional methods in the perioperative period were treated as the control group. The general data were compared in the two groups, including age, gender, body mass index and the tumor site. The postoperative recovery was compared including fart time, defecation time, total fluid food intake time, nutritional indexes, postoperative leaving hospital time. And the postoperative complications were also compared, including wound infection, lung infection, anastomotic fistula, abdominal infection as well as the urinary infection. Results The first fart time and total fluid food intake time in the ERAS group were earlier than those in the control group [(1.5±0.5) d vs. (2.1±0.8) d, (2.2± 0.8) d vs. (3.4±1.6) d], and the differences were statistically significant (t= 4.907, t= 4.604, both P< 0.01). The albumin and hemoglobin in the ERAS group were higher than those in the control group [(32.7 ±3.1) g/L vs. (30.9 ±2.1) g/L, t= -3.188, P= 0.002;(115±3) g/L vs. (103±16) g/L, t= -3.916, P< 0.01], and the postoperative hospital stay in the ERAS group was shorter than that in the control group, and the difference was statistically significant [(7.2±1.2) d vs. (9.5± 3.6) d;t=4.095, P=0.001]. And the incidence of postoperative complications in the ERAS group was lower than that in the control group, and the differences were statistically significant [14％ (7/50) vs. 38％ (19/50),χ2 = 7.484, P= 0.008]. Conclusions ERAS combined with laparoscopic colorectal cancer surgery can accelerate the postoperative rehabilitation, shorten the length of hospital stay, and reduce postoperative complications. It has high feasibility and safety in the application of colorectal surgery in municipal hospitals, but the individualized treatment must be taken into consideration.

Application of enhanced recovery after surgery in colorectal surgery in municipal hospitals / 肿瘤研究与临床

Objective@#To analyze the feasibility and safety of enhanced recovery after surgery (ERAS) in colorectal surgery in municipal hospitals.@*Methods@#The clinical data of patients with colorectal cancer in Zhangzhou Affiliated Hospital of Fujian Medical University from June 2016 to December 2018 were retrospectively analyzed. A total of 50 patients who underwent laparoscopic surgery combined with ERAS in the perioperative period were selected as the ERAS group, and 50 patients who underwent laparoscopic surgery combined with conventional methods in the perioperative period were treated as the control group. The general data were compared in the two groups, including age, gender, body mass index and the tumor site. The postoperative recovery was compared including fart time, defecation time, total fluid food intake time, nutritional indexes, postoperative leaving hospital time. And the postoperative complications were also compared, including wound infection, lung infection, anastomotic fistula, abdominal infection as well as the urinary infection.@*Results@#The first fart time and total fluid food intake time in the ERAS group were earlier than those in the control group [(1.5±0.5) d vs. (2.1±0.8) d, (2.2± 0.8) d vs. (3.4±1.6) d], and the differences were statistically significant (t = 4.907, t = 4.604, both P < 0.01). The albumin and hemoglobin in the ERAS group were higher than those in the control group [(32.7±3.1) g/L vs. (30.9±2.1) g/L, t = -3.188, P = 0.002; (115±3) g/L vs. (103± 16) g/L, t = -3.916, P < 0.01], and the postoperative hospital stay in the ERAS group was shorter than that in the control group, and the difference was statistically significant [(7.2±1.2) d vs. (9.5±3.6) d; t = 4.095, P = 0.001]. And the incidence of postoperative complications in the ERAS group was lower than that in the control group, and the differences were statistically significant [14% (7/50) vs. 38% (19/50), χ2 = 7.484, P = 0.008].@*Conclusions@#ERAS combined with laparoscopic colorectal cancer surgery can accelerate the postoperative rehabilitation, shorten the length of hospital stay, and reduce postoperative complications. It has high feasibility and safety in the application of colorectal surgery in municipal hospitals, but the individualized treatment must be taken into consideration.

Clinical Observation of Acupuncture plus Medication in Treating Chronic Pelvic Inflammatory Disease / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture plus medication in treating chronic pelvic inflammatory disease. Method By using the random number table, sixty-eight patients with chronic pelvic inflammatory disease were randomized into an acupuncture-medication group of 34 cases and a medication group of 34 cases. The clinical efficacies were compared after 2 courses of treatment, and the symptoms and body signs scores and syndrome score of traditional Chinese medicine (TCM) were also compared. Result There was a significant difference in comparing the therapeutic efficacy between the acupuncture-medication group and the medication group (P<0.05). After the treatment, the symptoms and body signs scores and TCM syndrome score dropped significantly in both groups (P<0.05), indicating that the two groups both had improvement in the symptoms, body signs and TCM syndrome; there were significant between-group differences in comparing the score differences in the symptoms and body signs scores and TCM syndrome score after the treatment (P<0.05), and the acupuncture-medication group was higher than the medication group. Conclusion Acupuncture plus medication can better ameliorate the symptoms and body signs and TCM syndrome in chronic pelvic inflammatory disease.

Effect comparison of anterograde and reverse digital artery island flap in repairing of fingertip defects / 局解手术学杂志

Objective To evaluate the clinical effect of anterograde and reverse digital artery island flap in treatment of wound repairing for fingertip defects.Methods From January 2015 to December 2016,there were 35 patients with fingertip defects underwent surgical treat-ment in our hospital,including 14 cases underwent surgery with anterograde digital artery island flap(anterograde group)and 21 cases under-went surgery with reverse digital artery island flap(reverse group).The anterograde group used proper palmar digital artery and nerve as the pedicle of flap,then took forward the finger pulp flap to the injured site.The reverse flap from the dorsal of one side of finger was harvested for coverage of the distal phalanx.Results All the flaps of the 35 cases were survived.In the anterograde group,reflux obstacle of vein appeared in 1 case,and it was cured with scarification procedures.In the reverse group,there were 3 cases of vascular crisis.After dressing release and partial remove of the stitching,2 cases of them return to normal.The other 1 case suffered from flap edge necrosis,and then the wound healed after dressing change.The operation time of anterograde group was(107.5 ±18.4)min and it was(139.5 ±18.0)min in the reverse group, which showed significant difference between the two groups(P<0.05).All the 35 cases were followed up for 6 to 12 months,with an average of 8.5 months.At the last follow-up,it showed that patients in both of the two groups had ruddy color,good texture and no significant bloated flap appearance.In the anterograde group,the sensory function of 12 patients restored to S4 and 2 patients restored to S3.Meanwhile,in re-verse group,5 patients restored to S3,12 patients restored to S2, and 4 patients restored to S1.The two-points discrimination of the antero-grade group was(4.22 ±0.67)mm,and it was(7.04 ±1.25)mm in the reverse group,which was significantly different(P<0.05).The in-terphalangeal joint motion was(102.67 ±7.35)°at the distal end and(64.46 ±8.37)°at the proximal end in anterograde group.And it was (100.64 ±10.29)°and(60.81 ±10.80)°respectively in the reverse group,with no significant difference between the two groups (P>0.05).The excellent and good rate was 92.8%in the anterograde group and 80.9%in the reverse group by the criteria for functional evaluation,and there was no statistically significant difference(P>0.05).Conclusion For fingertip defects(IshikawaⅠ~Ⅲ)treated by anterograde digital artery island flap or reverse digital artery island flap both can obtained good clinical efficacy.But it has shorter operation time and better sensory recovery with anterograde digital artery island flap repairing.

Injured vertebra pedicle screww fixation versus short-segment pedicle instrumentation for thoracolumbar fracture:a meta-analysis / 中国组织工程研究

BACKGROUND: Posterior internal fixation is one of the most common methods for thoracolumbar fractures. There is a lack of systematic evaluation about the efficacy of injured vertebra pedicle screw fixation(IVPSF)versus short-segment pedicle instrumentation (SSPI) for thoracolumbar fracture. OBJECTIVE: To compare the clinical outcomes of IVPSF and SSPI for single thoracolumbar fracture through a METHODS: A computer-based on-line research of PubMed, Medline, Embase, Cochrane Library, CNKI, and WanFang databases was performed for the studies regarding IVPSF versus SSPI for thoracolumbar fracture from 1990 to 2016. meta-analysis. The randomized controlled trials and cohort studies were collected based on the strict criteria of inclusion and exclusion. A meta-analysis was conducted on Revman5.3 sofeware. RESULTS AND CONCLUSION: (1) Eleven articles were enrolled, including 5 English and 6 Chinese ones, involving 689 patients (328 cases for IVPSF and 361 cases for SSPI). (2) The meta-analysis indicated that the operation time, blood loss and mean hospital stay showed no significant differences between two groups. IVPSF showed more effective than SSPI in the kyphotic angle correction and anterior vertebral height recovery at postoperation and 1-5 years of follow-up. Moreover, the incidence of postoperative fixation failure in IVPSF was lower than that in SSPI. (3) These findings suggest that IVPSF that reduces the postoperative fixation failure rate for thoracolumbar fractures provides better kyphosis correction and restoration of anterior vertebral height at post-operation and 1-5 years of follow-up.

Anatomical and preclinical study of repair of cervical tracheal wall defects with vascularized pectoralis major tendon flaps / 中华显微外科杂志

Objective To provide an anatomical basis for repairing the defect of cervical tracheal wall with vascularized pectoralis major tendon flaps.Methods Thirty-two lateral thoracic necrotomies were studied for the following aspects.Measurement of pectoralis major tendons' length,width and thickness.Anatomy of thoracoacromialartery,pectoral branches:origin,distribution.Measurement of length of pedicle,rotated radius of flaps and length from recipient site.An imitative operation was undergone on a specimen of corpse.One patient was undergone the operation of repairing the 3.0 cm × 1.5 cm defect of anterior cervical trachea wall,accompanying with incision infection,with pectoralis major tendon flap.Results Length of pectoralis major tendon:(22.9 ± 0.9)mm.Width of tendon:(51.0± 2.4)mm.Thickness of tendon:(5.81± 1.35)mm.Length of pedicle:(89.3 ± 5.3) mm.The radius of pedicle pectoralis major myotendinous flap:(121.7± 8.2)mm.The distance from pivot point of flap to central point of recipient:(96.5 ± 8.9)mm.Patient possessed normal pronunciation,good appearance and no emphysema at 5 months' follow-up.Tracheal lumen,measured 2.6 cm in the anteroposterior dimension and 1.8 cm in the lateral dimension,showed no recurrence of obvious stenosis in cervical computed tomography at 3 month postoperatively.Conclusion Pedicle pectoralis major tendon flaps,originated from thoracoacromial artery pectoral branches can repair cervical tracheal wall defects effectively.

Efficacy observation on chrondromalacia patellae treated with fire needling technique at high stress points / 中国针灸

<p><b>OBJECTIVE</b>To compare the clinical efficacy differences between fire needling technique of filiform needle at high stress points and regular acupuncture on chrondromalacia patellae so as to provide the better therapy for the treatment of this disease.</p><p><b>METHODS</b>Sixty cases of chrondromalacia patellae were randomized into a fire needling group (28 cases) and a routine acupuncture group (32 cases). In the fire needling group, 5 to 6 high stress points were localized according to the symptoms, palpation and imaging condition and were stimulated with fire needling technique of filiform needle. The treatment was given once every two days, 5 treatments made one session. In the routine acupuncture group, the regular acupuncture was applied at Dubi (ST 35), Xiguan (LR 7), Yanglingquan (GB 34), Yinlingquan (SP 9), Zusanli (ST 36), etc. The treatment was given once every day, 5 treatments made one session. Lysholm score, VSA score, patella title angle (PTA) and lateral patella angle (LPA) of the affected knees before and after treatment, as well as the clinical efficacy after treatment were observed in the two groups.</p><p><b>RESULTS</b>After treatment, Lysholm score, VSA score, PTA and LPA were all improved apparently in the two groups (all P < 0.01). After the treatments, the improvements in Lysholm score, VSA score, PTA and LPA in the fire needling group were more obvious than those in the routine acupuncture group (all P < 0.05). The effective rate was 92.9% (26/28) in the fire needling group, better than 87.5% (28/32) in the routine acupuncture group (P < 0.01).</p><p><b>CONCLUSION</b>The fire needling technique of filiform needle at the high stress points relieves the clinical symptoms of chrondromalacia patellae and recovers the biodynamical structure of patellae.</p>

Influence on microstructure of dental zirconia ceramics prepared by two-step sintering / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the microstructure of dental zirconia ceramics prepared by two-step sintering.</p><p><b>METHODS</b>Nanostructured zirconia powder was dry compacted, cold isostatic pressed, and pre-sintered. The pre-sintered discs were cut processed into samples. Conventional sintering, single-step sintering, and two-step sintering were carried out, and density and grain size of the samples were measured. Afterward, T1 and/or T2 of two-step sintering ranges were measured. Effects on microstructure of different routes, which consisted of two-step sintering and conventional sintering were discussed. The influence of T1 and/or T2 on density and grain size were analyzed as well.</p><p><b>RESULTS</b>The range of T1 was between 1450 degrees C and 1550 degrees C, and the range of T2 was between 1250 degrees C and 1350 degrees C. Compared with conventional sintering, finer microstructure of higher density and smaller grain could be obtained by two-step sintering. Grain growth was dependent on T1, whereas density was not much related with T1. However, density was dependent on T2, and grain size was minimally influenced.</p><p><b>CONCLUSION</b>Two-step sintering could ensure a sintering body with high density and small grain, which is good for optimizing the microstructure of dental zirconia ceramics.</p>

The role of toll like receptor-4 signal pathways activation in ischemia-reperfusion injury of island skin flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To determine the role of toll like receptor-4 signal pathways activation in ischemia-reperfusion injury of island skin flap.</p><p><b>METHODS</b>A totol of 50 adult male SD rats were randomized into 3 groups: sham-operated group (n=10), ischemia/reperfusion group (n=20) and TLR4 inhibitor-eritoran tetrasodium (E5564)-treated group (n=20). The inguinal island skin flaps models were set up. A bolus of E5564 (5 mg/kg) was infused intravenously 60 min before reper fusionm. TLR4 binding activity in flap tissue was analyzed at 1, 2, 4 and 6 h of reperfusion by immunohistochemical technique and flaps were assessed histologically at 6 h of reperfusion. The viability of flaps was assessed 7 days postoperatively.</p><p><b>RESULTS</b>Exprerssion TLR4 in skin flap tissue was significantly increased in I/R group, compared with E5564-treated group. Immunohistochemical exam showed TLR4 mainly expressed in skin flap vessel wall and PMN membrane. Marked neutrophil infiltration and edema was observed in I/R group, while less neutrophil infiltration was observed in E5564-treated group. In the E5564-treated group, the survival of flaps was (80.31 +/- 11.63)%, which was significantly greater than that in the I/R group (51.70 +/- 7.62)% (P < 0.01).</p><p><b>CONCLUSION</b>After ischemia-reperfusion injury in rats, the expression of TLR4 increased in the skin flap tissue with excessive neutrophil infiltration. Administration of E5564 can significantly improve flap survival by regulating the early activation of TLR4 and suppressing neutrophil infiltration within the flap.</p>

Clinical application of free anterolateral thigh flap in the reconstruction of oromaxillo-facial defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the possibility and practicality of using free anterolateral thigh flap to repair defects of oromaxillo-facial region.</p><p><b>METHODS</b>One hundred and seventy-two patients underwent anterolateral thigh flap (ALP) reconstruction from Jan. 2007 to Dec. 2008. The size of the defect ranges from 4 cm x 4 cm to 10 cm x 25 cm. One hundred and six flaps were used for tongue reconstruction, 14 flaps for buccal reconstruction, 15 flaps for mouth floor reconstruction, 1 flap for lower lip and mental region reconstruction, 6 flaps for hard and soft palate reconstruction, 3 flap for maxillary part reconstruction, 18 flaps for submaxilla part reconstruction, 2 flaps for pharynx oralis reconstruction, 3 flaps for repairing large-area defect of facial, 1 flap for repairing neck and shoulder region and 3 flaps for repairing defect of Infratemporal fossa. Of these flaps, 151 were musculocutaneous flaps, 13 were fasciocutaneous flaps and 8 were chimeric flaps.</p><p><b>RESULTS</b>The success rate reaches 98.3% (169 of 172). Postoperatively, 4 cases encountered vascular crisis, 1 of which survived completely with successful vessel exploration, 3 cases with partial necrosis; and 3 cases with complete necrosis. One case with bleeding after operation. Six cases with parotid fluidly and parotid fistula, 8 cases with mouth floor fistula, 6 cases with infection, 3 cases with infection and partial necrosis on the lateral thigh. All patients achieved acceptable contour, appearance and function.</p><p><b>CONCLUSION</b>Free anterolateral thigh flap can repair kinds of complicated defects on oromaxillo-facial region.</p>

The chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for reconstruction of oromaxillary soft tissue defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the application of the chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for large and complicated oromaxillary soft tissue defect.</p><p><b>METHODS</b>Based on the anatomic study of descending branches and cutaneous perforators of lateral circumflex femoral artery, the perforator vessels were found and used as flap pedicle. The perforator flap was made as chimeric flap for repairing the oromaxillary soft tissue defect in 8 cases. The chimeric perforator flaps were divided into three types as anterolateral thigh flaps and anteromedial thigh flaps, anterolateral thigh flaps and rectus femoris perforator flaps, and anterolateral thigh flaps and anterolateral thigh flaps.</p><p><b>RESULTS</b>All the 16 flaps in 8 cases survived completely with no complication. The wounds in donor sites were all primarily closed with no skin graft. The patients were followed up for 1-9 months with good functional and esthetic results. There was no morbidity in donor sites.</p><p><b>CONCLUSIONS</b>The chimeric perforator flap has a large tissue volume for large and complicated oromaxillary defect. There is no need for extra donor site and extra blood vessel anastomosis.</p>

Operative strategy of atlantoaxial instability / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the operative strategy and therapeutic outcomes of the atlantoaxial instability.</p><p><b>METHODS</b>Clinical data of 29 patients with atlantoaxial instability were retrospectively analyzed. There were 27 males and 2 females. The mean age was 33 years old with a range from 18 to 54 years. There were fracture of anterior arch of atlas accompanied with ligamentum transversum rupture in 5 cases, odontiod fracture in 7 cases, Hangman fracture in 6 cases, dysplasia of atlas and axis in 10 cases, ankylosing spondylitis in 1 case. The clinical and imaging manifestation of atlantoaxial instability were found in all patients. The symptoms and physical signs of superior cervical spinal cord disease or cervical spinal injury were found in 18 cases. The patients were treated with simple modified Magerl method (7 cases), cannutated screw fixation(6 cases), resection of C2,3 disc throuth the anterior approach and fusion with Zephir titanium plate (4 cases), percutaneous pedicle screw fixation of C2 (2 cases), release and reduction through anterior oropharynx (LRAO) combined with modified Magerl method (4 cases), LRAO and atlas lateral mass screw and plate fixation through posterior approach (3 cases), cervical occipital fusion through C2 pedicle (3 cases).</p><p><b>RESULTS</b>All patients were followed up with an average time of 17.2 months ranging from 11 to 38 months. All patients obtained anatomical reduction and bone healing. Using Odom standard to evaluation for 18 cases with spinal injury before operation, the results were excellent in 9 cases,good in 7,fair in 2. No injury of vertebral artery, nerve root, spinal cord, infection of incisional wound, breaking or loosening of internal fixatir were found in the study.</p><p><b>CONCLUSION</b>Identifying the causes of atlantoaxial instability, rational plan of operation can get satisfactory clinical results.</p>

Blood-letting puncture at 12 Jing-well points of the hand combined with fuming and washing with Chinese herb lotion for treatment of edema of the affected limb in patients of hemiplegia after stroke / 中国针灸

<p><b>OBJECTIVE</b>To search for a therapy for edema of the affected limb in patients of hemiplegia after stroke.</p><p><b>METHODS</b>Eighty patients were randomly divided into a treatment group and a control group, 40 cases in each group. The treatment group were treated by blood-letting puncture at 12 Jing-well points of the hand combined with fuming and washing with herbal lotion, and the control group were treated by oral administration of diuretic. The therapeutic effect was observed after treatment for 10 days.</p><p><b>RESULTS</b>The total effective rate was 85.0% in the treatment group and 70.0% in the control group with a significant difference between the two groups (P < 0.05). The cumulative score of symptoms of edema, improvement of skin pitting, damp and cool sensation, the function of limbs and the total score in the treatment group were better than the control group (P < 0.05); the cumulative score of TCM syndrome after treatment, improvement of the symptoms of limb flaccid paralysis, shortness of breath, weakness, dark-pale tongue proper and the total cumulative score were better than the control group (P < 0.05).</p><p><b>CONCLUSION</b>Blood-letting puncture at 12 Jing-well points of the hand combined with fuming and washing with Chinese herbal lotion is effective for edema of the affected limb in patients of hemiplegia after stroke.</p>