Diagnosis and treatment of duodenal perforation caused by oral excessive ibuprofen in children / 中国小儿急救医学

Objective To summarize the etiology,diagnosis and treatment of three cases of duodenal perforation. Methods The data of 3 cases of children with duodenal perforation in our hospital from September 14,2016 to June 20,2017 were retrospectively analyzed. The causes,clinical features and treatment of children's duodenal perforation were summarized. Results A total of 2 males and 1 females aged 2 years,3 years and 5 years were included in the 3 cases. All 3 cases had fever history of upper respiratory tract infection before onset. Acute abdominal pain occurred after oral administration of ibuprofen several times,and all the abdominal plain films prompted pneumoperitoneum. Three cases of perforation sites were duodenal anterior wall,diameter were 0. 5-1 cm. Two cases of small amount of pneumoperitoneum were explored and repaired the duodenal perforation by 3D laparoscopic,1 case underwent laparotomy to repair the duodenal perforation due to a large number of liquid pneumoperitoneum and severe shock. Repair of 3 cases were covered with omentum. Three cases were all cured without anastomotic fistula, ulcer, adhesive intestinal obstruction or other complications. Followed-up in the department of gastroenterology,3 cases had no Helico-bacter pylori infection. Conclusion Repeatedly oral administration of ibuprofen can cause duodenal perfora-tion in children in the short term. Once the digestive tract perforation confirmed,emergency surgical explora-tion is needed. Laparoscopic repair of duodenum perforation is safe and effective and may have a faster recov-ery. We can choose exploratory laparotomy if conditions are not allowed.

Diagnosis and Treatment of Mesenteric Cyst in Children / 现代医院

Objective To summarize the diagnosis and surgical treatment of mesenteric cyst in children.Methods The clinical records of mesenteric cyst cases from January 2011 to December 2015 were reviewed retrospectively.The diagnosis and treatment options were analyzed, and the prognosis of laparoscopic surgery and laparotomy was compared.Results The main clinical symptoms included abdominal mass, abdominal pain, and abdominal distension.Abdominal ultrasound and/or CT scan were the diagnostic tools in all cases.Traditional laparotomy was performed in 14 cases, while laparoscopy in 7 cases (1 case switched to laparotomy).2 cases had emergency surgery due to acute abdomen, laparotomy and laparoscopy in each case.Simple cyst resections were completed in 14 cases, of which 2 cases with a small amount of residual in the mesenteric root.Intestinal resection and anastomosis were required in other 7 cases.The average time of hospital stay for laparotomy group was 12 days, and 10.14 days for laparoscopy group.There was no significant difference.All patients were discharged without postoperative complications.With 1-4 years follow-up, there was no recurrence.Conclusion The operation for mesenteric cysts depends on the relationship between the cyst and the adjacent bowel or organs, and the overall outcome is favorable.The selective use of laparoscopy will benefit more children.

Efficacy and safety of tranexamic acid for treating perioperative bleeding during PFNA internal fixation in elderly femoral intertrochanteric fracture / 重庆医学

Objective To evaluate the effect of preoperative intravenous drip of tranexamic acid(TXA) on perioperative bleeding in proximal femoral nail anti-rotation(PFNA) operation of elderly intertrochanteric fracture.Methods A total of 115 elderly patient with intertrochanteric fracture undergoing PFNA internal fixation were selected and divided into the treatment group(58 cases) and control group (57 cases).The treatment group was intravenously dripped with 20mg/kg TXA before operation,while the control group had no special treatment.Hemoglobin (Hb) and hematocrit(Hct) were recorded before operation and on postoperative 1,3 d.The total amounts of perioperative blood loss were calculated by using the Gross equation and Nadler equation.The blood transfusion rate and thromboembolic complications occurrence situation in the two groups were performed the statistics.Results The total amounts of perioperative blood loss were (872.21±312.53) mL in the treatment group and (1 162.41±368.64) mL in the control group,the difference was statistically significant(P0.05).Conclusion Preoperatively intravenous drip of 20mg/kg TXA in PFNA internal fixation of elderly intertrochanteric fracture can effectively decrease perioperative blood loss without increasing the risk of thrombus formation.

Comparsion of minimally invasive percutaneous osteosynthesis and supercutaneous plating with closed reduction in treatment of distal tibial comminuted fractures / 局解手术学杂志

Astract:Objective To compare the clinical efficacy of minimally invasive percutaneous osteosynthesis and supercutaneous plating with closed reduction in the treatment of distal tibial comminuted fractures. Methods A total of 40 patients with close distal tibial comminuted fractures in our hospital from April 2012 to April 2014 were divided into minimally invasive percutaneous osteosynthesis group and external fixation group. External fixation group were treated by supercutaneous plating,while the minimally invasive percutaneous osteosynthesis group were treated by minimally invasive percutaneous osteosynthesis. And the operative duration,hospital stay,the time of weight loading and frac-ture healing,postoperative complications and function of ankle were compared between the two groups. Results In the supercutaneous plating group,the operative duration was (60. 17 ± 5. 64) minutes,the hospital stay was (8. 651 ± 2. 21) days,the time of weight loading was (49.26 ±9.85)days,the time of fracture healing was (13.82 ±4.23)weeks,the incidence of postoperative complications was 5.00%,and the excellent and good rates was 95. 00%. In the minimally invasive percutaneous osteosynthesis group,the operative duration was (74. 64 ± 6. 82)minutes,the hospital stay was (18. 22 ± 2. 32)days,the time of weight loading was (57. 56 ± 11. 32)days,the time of fracture healing was (17. 47 ± 2. 31)weeks,the incidence of postoperative complications was 25. 00%,and the excellent and good rates was 80. 00%. There were significant differences in operative duration(χ2 =9. 922,P=0. 007),hospital stay(χ2 =10. 48,P=0. 015),time of weight loading (χ2 =14. 618,P=0. 001) and fracture healing(χ2 =40. 16,P=0. 000) between the two groups. The AOFSA score of supercutaneous plating group was (89. 1 ± 3. 9)point,compared with (90. 5 ± 4. 1)point of minimally invasive percutaneous osteosynthesis group,and the difference was statistically significant(χ2 =0. 463,P=0. 793). Conclusion Distal tibial fractures may be treated successfully with minimally invasive plate osteosynthesis or supercutaneous plating. However,supercutaneous plating offers multiple advantages in terms of mean operative dura-tion,hospital stay,the time of weight loading and fracture healing.

Correlation between blood pressure variability and cognitive impairment in patients with acute ischemic stroke / 国际脑血管病杂志

ObjectiveToinvestigatethecorrelationbetweenbloodpressurevariabilityandcognitive impairment in ischemic stroke. Methods The inpatients with acute ischemic stroke were enroled. The demographic and clinical data were colected. The coefficient of variation of blood pressure within 7 days after onset w as calculated. Montreal Cognitive Assessment w as used to evaluate the cognitive function at three month after onset. Multivariate logistic regression analysis w as used to identify the relationship betw een the coefficient of variation of blood pressure w ithin 7 days and the cognitive impairment at 3 months after onset. Results A total of 708 patients w ith acute ischemic stroke w ere enrol ed in the study. At 3-month folow-up, 510 patients (72.0%) had cognitive impairment and 198 (28.0%) had normal cognitive function. The coefficient of variation for systolic blood pressure ( 8.3 ±1.2 vs.8.7 ±1.4; t= -3.299, P=0.001) and coefficient of variation for diastolic blood pressure ( 7.8 ±1.3 vs.8.0 ±1.5; t= -2.529, P=0.012) in the cognitive impairment group w ere significantly higher than those in the normal cognitive function group. With the first quintile as a reference, after adjusting other confounding factors, multivariate logistic regression analysis show ed that cognitive impairment at 3 months after onset w as significantly associated w ith coefficient of variation for systolic blood pressure. The odds ratios and 95 % confidence intervals for the 2-5 quantile groups w ere 2.33 (1.18-4.6), 2.31 (1.15-4.66), 2.70 (1.29-5.65), and 4.82 (1.92-12.1), respectively ( al P<0.05 ). Conclusion Systolic blood pressure variability in the acute phase of ischemic stroke is associated w ith cognitive impairment.

Application of virtual simulation surgery in lumbar spinal metastases / 局解手术学杂志

Objective Through the exploration of virtual simulation surgery to find a way to treat lumbar spinal metastases. Methods Based on 64 row spiral CT continuous 2-dimensional images of lumbar segments, normal lumbar vertebral, destruction of disease, abdominal aorta and kidneys were reconstructed by the Mimics software. 3D visualization structure was contemplated by anterior lesions clear, titanium mesh of bone cement support, and posterior pedicle screw fixation. Results The three-dimensional reconstruction distinctly displayed the structures of lumbar and its adjacent organs, and the entire virtual simulation surgery was intuitive. Conclusion The application of virtual simulation surgery ensures more accurate 3D model of lumbar establishment and its adjacent organs, and it provides an objective basis for in-dividualized treatment programs.

Application of prone-straddle position for transvaginal hysteromyomectomy in the posterior wall of the uterus / 局解手术学杂志

Objective To discuss the safety and advantages of prone-straddle position applied in transvaginal hysteromyomectomy of the posterior wall of the uterus. Methods The clinical data of patients who were admitted into our hospital from March 2013 to Janaury 2015 and received transvaginal hysteromyomectomy were retrospectively analyzed. They were divided into group A ( prone-straddle position, 30 cases) and group B (traditional lithotomy position,24 cases). The exposure of operative field, convenience of operation, time of the placement, time of operation, patient satisfaction, as well as patients’ heart rate, blood pressure, and oxyhemoglobin saturation were observed and ana-lyzed. Results Compared with the lithotomy position, there were significant differences in the time of the placement and the time of opera-tion in the patients treated by prone-straddle position. The patients with prone-straddle position cooperated well, and there was no obvious discomfort. Their vital signs were stable during the operation. The operative field during prone-straddle position exposed better and it was more convenient which make the operation became easier for both the operators and nurses. Conclusion Prone-straddle position applied in transvaginal hysteromyomectomy of the posterior wall of the uterus is safe and practicable, and it is valuable for clinical application.

Relationship between microalbuminuria and severity of acute ischemic stroke and outcomes / 国际脑血管病杂志

Objective To investigate the relationship between microalbuminuria (MAU) and the risk factor for acute ischemic stroke,the severity of the disease and outcomes.Methods A total of 156 consecutive patients with acute ischemic stroke were enrolled prospectively.They were randomly divided into either an MAU positive group (≥ 30 mg/g) or an MAU negative group (＜ 30 mg/g) according to urinary albumin/creatinine ratio (UACR).They were also randomly divided into either a good outcome group (0-2) or a poor outcome group (＞2) according to the modified Rankin scale (mRS) scores.The various demographic and clinical data were compared,and the poor outcome of acute ischemic stroke and the independent factors of positive MAU were analyzes.Results A total of 156 patients with acute ischemic stroke were enrolled,including 84 males and 72 female; aged 53 to 78 years (mean 65.4 ± 6.2); the time from onset to admission was 1.5 to 28 h; 94 patients had good outcomes,62 had poor outcomes,and no one died; MAU was positive in 76 patients and MAU was negative in 80 ones.Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 1.992,95％ confidence interval [CI] 1.108-2.374; P =0.015),complicated with diabetes (OR 2.497,95％ CI 1.177-5.298; P =0.017) and atrial fibrilhtion (OR 2.338,95％ CI 1.062-5.148; P =0.035),high serum homocysteine (Hcy) level (OR 2.541,95％ CI 1.073-6.02; P =0.047) and UACR (OR 2.130,95％ CI 1.396-3.017; P =0.001),MAU positive (OR 3.291,95％ CI 1.681-6.444; P =0.001),high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 9.196,95％ CI 2.828-19.815; P＜ 0.001) were the independent risk factors for poor outcomes in patients with acute ischemic stroke.There were significant differences in the proportion of the patients complicated with diabetes (P =0.038) and fasting blood glucose level (P =0.025),serum Hey level (P =0.022),and carotid intima-media thickness (IMT) (P =0.019) between the MAU positive group and the MAU negative group.The proportion of anterior circulation infarction was lower (P =0.033),the rates of the baseline NIHSS score (P =0.003) and poor outcome were higher in the MAU positive group (P ＜ 0.001).Multivariate logistic regression analysis showed that increased diabetes (OR 2.237,95％ CI 1.036-4.829; P =0.040) and fasting blood glucose (OR 1.223,95％ CI 1.145-1.673; P =0.027),the increased Hey level (OR 2.542,95％ CI 1.047-6.612; P=0.025),carotid artery IMT (OR 1.295,95％ CI 1.106-1.362; P =0.023) and baseline NIHSS score (OR1.206,95％ CI 1.044-1.219; P =0.023) were correlated independently with the positive MAU in patients with acute ischemic stroke.Conclusions Positive MAU is one of the independent risk factors for poor outcomes of acute ischemic stroke,it is closely associated with some risk factors for acute ischemic stroke,and it has a significant impact on the severity of acute ischemic stroke and outcomes.

Clinical analysis for suture of sacral ligament and pubovaginalis fascia plus sacrospinous ligament fixation in treatment of 32 cases with pelvic organ prolapse / 局解手术学杂志

Objective To discuss the clinical value of the suture of sacral ligament and pubovaginalis fascia plus sacrospinous ligament fixation in the treatment of moderate and severe pelvic organ prolapse ( POP) . Methods Thirty-two cases with moderate or severe POP,who were treated by the suture of sacral ligament and pubovaginalis fascia besides sacrospinous ligament fixation,were retrospectively analyzed. Results The locations of POP in the 32 patients were mainly in the anterior and middle pelvis cavity. The degree of uterine prolapse was not less than POP-Q Ⅲ phase. The anterior and/or posterior vaginal walls were also prolapsed. The patients were treated by the transvaginal panhysterectomy,vaginal wall neoplasty,sacrospinous ligament fixation and the suture of sacral ligament and pubovaginalis fascia. Those with stress incontinence were also treated with urethral posterior ligament plication. The operation time was 60~120 min,and the hemorrhage vol-ume was 100~300 mL. There were no severe complications or recurrence in all patients. Conclusion The suture of sacral ligament and pubovaginalis fascia could greatly reduce the hazard rate of the recurrence of anterior pelvic organ defects in POP patients treated by sacrospi-nous ligament fixation. The suture operation could strengthen the anterior pelvis cavity,and was proven to be simple,secure and effective. Therefore,the operation is valuable to be used in clinical application.

Autologous bone-marrow stem-cell transplantation for nonunion of tibia fracture / 局解手术学杂志

Objective To investigate the effect of the percutaneous autologous bone marrow stem cell transplantation for the treatment of nonunion of tibial fracture. Methods From 2007 to 2011,the data of 11 patients with tibial nonunion who received autologous bone marrow stem cell transplantation was analyzed retrospectively. Taking bone marrow,examine,isolation,cultivation and expansion marrow mesenchymal stem cells( MSCs) ,and then marrow needle was inserted into the site of the nonunion under the X-ray,the MSCs were injected into the site of nonunion. Compression bandage was applied after operation. X-rays following-up were reviewed. Results All 11 patients were followed up from 4~27 months,with average of 13 months,X-ray showed:fracture healed well,no adverse events happen. Conclusion Satisfactory out-come can be obtained by percutaneous autologous bone marrow stem cell transplantation in treatment of tibial nonunion. Clinical application value is high,especially to patients who had suffered from severe skin and soft tissue injury with keloids healed.

Innate immune recognition of the pathogenic parasites by toll-like receptors / 生物工程学报

Toll-like receptors (TLRs) have emerged as major receptor components of pattern-recognition receptors (PRRs), which are responsible for the recognition of pathogen-associated molecular patterns (PAMPs)-derived pathogenic parasites. This recognition triggers the secretion of a large amount of type I interferons (IFNs), inflammatory cytokines, and chemokines and maturation of immune cells, for effective host defense by eradicating infectious parasites. Both the myeloid differentiation factor 88 (MyD88) and the TIR domain containing the adaptor molecule (TRIF) are involved in these signaling pathways. Here, we review the latest findings on the recognition of the pathogenic parasites and activation of corresponding signaling pathways through TLRs, with special emphasis on the recognition of pathogenic protozoan and helminthes. By highlighting recent progress in these areas, we hope to provide references in future studies not only for the complexity of host-parasite interactions but also for the prevention of the pathogenic parasite infections.

Laparoscopy in the diagnosis and treatment of Meckel's diverticulum in children:Report of 16 cases / 中国微创外科杂志

Objective To explore the utilization of laparoscopy in the diagnosis and treatment of Meckel’s diverticulum in children. Methods A total of 16 children with Meckel’s diverticulum underwent laparoscopic procedures between June 1999 and February 2003. With the help of celioscopy, the focus of the intestines is detected and pulled out through the umbilical port. The wedge resection of diverticulum or enterectomy with anastomosis was then performed. Results The operative time was 75 ～ 150 min, with a mean of 92 min. The patients began to take food on the third postoperative day. No operative complications occurred. The postoperative hospital stay was 5～7 d, with a mean of 5.8 d. Follow-up for 4～44 months (mean, 19.4 months) in the 16 patients showed no intestinal adhesion. Conclusions Laparoscopy is safe and effective in the diagnosis and treatment of Meckel’s diverticulum.

Relationship between levels of serum matrix metalloproteinases and brain edema and neurologic impairment in patients with intracerebral hemorrhage / 临床神经病学杂志

Objective To investigate the relationship between levels of serum matrix metalloproteinases(MMPs)and brain edema and neurologic impairment in patients with intracerebral hemorrhage(ICH).Methods The levels of serum MMP-9 and MMP-2 in 31 patients with ICH were tested with ELISA for at 1 d,3 d,7 d and 2 weeks after onset.The volumes of hematoma and its peripheral edema were evaluated by CT,the neurologic impairment was evaluated by NIHSS at 1 d and 14 d after onset.Results Levels of serum MMP-9 and MMP-2 were significant higher in ICH group at each time point after onset than those in normal control group(allP

Expression of c-fos gene in brain tissue and change of focal cerebral blood flow after experimental intracerebral hemorrhage in rats / 临床神经病学杂志

Objective To explore the expression of c-fos gene at early stage and changes of focal cerebral blood flow (CBF) in brain tissue after intracerebral hemorrhage(ICH) in rats.Methods The rat models with ICH were made by Nath improvement method;fos protein in brain tissue and the expression of c-fos mRNA were measured by immunohistochemistry and RT-PCR method;its focal cerebral blood flow (CBF) was measured by hydrogen clearing method.Results The expression of fos protein was found at 1 h after ICH in the ipsilateral basal ganglia after ICH,it peaked at 3 h;c-fos mRNA peaked at 1 h after ICH,and had still expression of higher level after 3 h;cBF was reduced at 1 h after ICH,and returned to the level of the control group by 3 h and maintained to 24 h after ICH,and then appeared the reduction of CBF during 24 h again.Conclusion The increase and long induction expression of c-fos gene were showed in brain tissue of hematoma periperal zone and contralateral cortex one.Although focal CBF reduced after ICH in rats,it wasn't consistent with the expression of c-fos gene.