Application of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose.@*METHODS@#The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm.@*RESULTS@#One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction.@*CONCLUSION@#The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.

Repair the large area soft tissue defect of forearm with free bilateral anterolateral thigh flaps in series / 中华显微外科杂志

Objective:To investigate the clinical effect of using free bilateral anterolateral thigh flaps(ALTF) in series to repair large area soft tissue defects of forearm.Methods:The clinical data of 11 patients with large soft tissue defects of forearm admitted in the Department of Plastic(Repair and Reconstruction) Surgery, Lishui Hospital of Zhejiang University from March 2014 to December 2021 were retrospectively analyzed, including 8 males and 3 females. Aged 36 to 68 years old, with an average of 48 years old. VSD treatment was performed after debridement, and until fresh removed 3 to 5 days after the operation. Until the wound was fresh. The wound was repaired with free bilateral ALTF in series until fresh. The size of the forearm wound was 18 cm×15 cm-28 cm×13 cm. The cut area of a single flap was 10 cm×8 cm-20 cm×13 cm. The series of bilateral flaps: One of the flaps was used as the proximal flap, and its vascular pedicle was anastomosed with the arteries and veins of the recipient area. The other flap was used as the distal flap, and the arteries and veins between the 2 ALTFs on both sides were anastomosed. The vascular pedicle beyond the distal flap was ligated or anastomosed to the distal end of the ulnar artery or the distal end of the radial artery. The flap and the surrounding skin of the recipient area were sutured immediately. The donor sites of the flap was closed directly. Periodic and regular outpatient follow-up was performed after operation and the clinical efficacy was analyzed.Results:All the flaps successfully survived after the surgery. The postoperative follow-up lasted for 6-18 months, 12 months in average. The flaps survived well with good soft texture, without swelling, the capillary reaction time was normal, without surface ulceration, in rosy colour and restored protective sensations. The hand function of the affected limb recovered well. The wound at donor sites healed well without complications. At the last follow-up, the hand function of the affected limb was evaluated by the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the result was 7 in excellent and 4 in good. The patients were satisfied with the flap and the therapeutic effect.Conclusion:The free bilateral ALTF in series can be used to repair a wound surface with large area, and the donor site can be closed at the same time. It is an effective method to repair large soft tissue defect of forearm.

Three patients with large area burns complicated by acute acalculous cholecystitis / 中华烧伤杂志

From April 2017 to April 2018, three male patients aged 46-71 years with large area burns were treated in our hospital. Acute acalculous cholecystitis (AAC) symptoms of the patients began to appear 15-81 days after injury. AAC was diagnosed 24-81 days after injury. Ultrasound-guided percutaneous transhepatic cholecystostomy was performed 26-82 days after injury. The symptoms subsided in 2 patients, and cholecystectomy was performed in 1 patient with gallbladder perforation 94 days after injury. The patients were cured and discharged 41-118 days after injury. No recurrence of cholecystitis occurred during 8-9 months of follow-up after discharge.

Treatment experience of large area cerebral infarction with portal vein pneumatosis / 中国中西医结合急救杂志

Acute cerebral infarction possesses the characteristics of high incidence, high disability rate and high mortality, especially in patients with large area cerebral infarction accompanied by a variety of chronic diseases,such as systemic hypertension, hyperglycemia, obesity, etc risk factors, their mortality will be much higher. Simultaneously, in the treatment of large area cerebral infarction, special attention should be paid on monitoring the disease situation changes of patients' electrolyte balance, digestive system and other systems; in this study, the experiences of treating a patient with large area cerebral infarction and occurrence of serious complications as portal vein pneumatosis, intestinal obstruction, etc in the course of disease were summarized.

A study on effect of Shenfu injection on early postoperative cognitive function and brain derived neurotrophic factor in patients with burns / 中国中西医结合急救杂志

Objective To investigate the effects of Shenfu injection on early post-operative cognitive dysfunction (POCD) and brain derived neurotrophic factor (BDNF) in patients with burns. Methods Fifty-six patients with burns and ready to receive surgical treatment of scars admitted to Affiliated Hospital of Southwest Medical University from July 2015 to January 2017 were enrolled, and they were divided into a control group and a Shenfu group by random number table, 28 cases in each group. The regimen of anesthesia induction before operation and anesthesia maintenance in the operation in two groups was the same, and the patients in Shenfu group received intravenous drip of Shenfu injection 40 mL at 0.5 hour before surgery. The Mini-mental State Examination Scale (MMSE) was used to evaluate the cognitive function after surgery, and MMSE score reduction of > 2 scores was recognized as cognitive impairment after operation;patient's pain degree was evaluated by using visual analogue scale (VAS); the levels of serum BDNF were detected by the enzyme-linked immunosorbent assay (ELISA) at 0.5 hour before operation, immediately after operation, and 12 hours, 1 day, 3 days after operation. Results The MMSE scores were significantly decreased in the two groups after surgery, but decreasing degree of the MMSE scores in Shenfu group were significantly slower than those of the control group (1 day after surgery was 22.8±2.9 vs. 20.5±3.2, 3 days after surgery was 25.6±3.1 vs. 23.2±3.0, both P < 0.05). The incidence of POCD in the Shenfu group was significantly lower than that of the control group [7.1% (2/28) vs. 42.9% (12/28), P < 0.05]. The VAS scores were significantly higher in the two groups after surgery, but there was no significant difference between the two groups at each time point (all P > 0.05). The serum BDNF levels were significantly increased in two groups at immediate post-operation and 12 hours after surgery compared with those 1 day before operation, in addition, the BDNF level in Shenfu group was obviously higher than that in the control group (mg/L: 13.5±4.2 vs. 9.9±3.3, 11.4±3.5 vs. 9.1±3.2, both P < 0.05), the serum BDNF levels in two groups returned to their preoperative levels on 1 day and 3 days after surgery (all P > 0.05). Conclusion The Shenfu injection can reduce the incidence of early POCD in patients with large area burns and its mechanism may be related to the increase of BNDF expression.

Efficacy Analysis of Edaravone Combined with Nimodipine in the Treatment of Acute Large Area Cerebral Infarction / 中国药房

OBJECTIVE:To investigate therapeutic efficacy and safety of edaravone and nimodipine in the treatment of acute large area cerebral infarction. METHODS:101 patients with acute large area cerebral infarction were analyzed retrospectively and divided into control group (53 cases) and observation group (48 cases) according to drug use. After admission,control group re-ceived routine treatment as relieving cerebral edema,anticoagulant and antiplatelet agglutination. Observation group was additional-ly given Edaravone injection 30 mg added into 0.9%Sodium chloride injection 100 mL intravenously,within 30 min,twice a day+Nimodipine injection 12 mg added into 0.9%Sodium chloride injection 500 mL intravenously,once a day,at dripping speed of 0.5μg/(kg·min),for 10 days,and then given Nimodipine tablet 60 mg orally instead,3 times a day,for 5 d,on the basis of control group. Treatment course of 2 groups lasted for 15 d. Clinical efficacies of 2 groups were observed as well as SpO2,hemoglobin (Hb),total hemoglobin (HBT),reduced hemoglobin (MHb),NIHSS score and the occurrence of ADR before and after treat-ment. RESULTS:Total response rate of observation group was significantly higher than that of control group,with statistical signifi-cance(P0.05). After treatment,the levels of SpO2,HBT and MHb in 2 groups were significantly higher than be-fore,and the observation group was significantly higher than the control group;NIHSS score of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group;Hb level of 2 groups were significantly low-er than before,with statistical significance(P0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:On the basis of conventional therapy,edara-vone combined with nimodipine in the treatment of acute large area cerebral infarction has significant therapeutic efficacy,can im-prove neurological impairment,but doesn't increase the occurrence of ADR.

Risk factors of hemorrhagic transformation in 335 patients with acute cerebral infarction / 重庆医学

Objective To investigate the risk factors of hemorrhagic transformation(HT) in patients with acute cerebral infarction(ACI).Methods A total of 335 patients with ACI from June 2013 to September 2016 was enrolled in this study,including 47 patients in hemorrhagic transform group(HT group) and 288 patients in non-hemorrhagic transformation group(NHT group).The general clinical situation,laboratory indexes,imaging features and treatment measures of the two groups were collected and compared,and then the risk factors of HT in the patients with ACI were analyzed by Logistic regression analysis.Results Univariate analysisshowed that there were significant differences between the two groups in the history of diabetes mellitus,hìstory of atrial fibrillation,NHISS score,systolic blood pressure at admission,fasting blood glucose,glycosylated hemoglobin,low density lipoprotein cholesterol,fibrinogen,infarct location,large area infarction and thrombolytic therapy(P＜0.05).Logistic regression analysis showed that history of atrial fibrillation(OR =2.703,95 ％ CI 1.169-6.250),high fasting blood glucose(OR =2.098,95 ％ CI 1.532-2.875),large area infarction(OR=9.999,95％CI 4.648-21.510) and thrombolytic therapy(OR=6.557,95％CI 1.954-22.003) were independent risk factors for HT.Conclusion The history of atrial fibrillation,high fasting blood glucose,large area infarction and thrombolytic therapy are the risk factors for HT in patients with ACI.Corresponding nursing measures should be arranged to facilitate the disease treatment.

Effect of enteral nutrition support on patients with large area burn / 现代临床护理

Objective To explore the experience of nursing patients with large area bum.Methods Thirty-one hospitalized patients with large area bums in our hospital during January 2012 to July 2013 were set as the control group,where fasting was done within 24 hours at admission and enteral nutrition was done after surviving shock phase.Another 31 patients with large area bums in the hospital during August 2013 to August 2015 were set as observation group,where short peptide enteral nutrition powder was administered within 24 hours at admission,followed by enteral nutrition was done after surviving shock phase.The two groups were compared in terms of nutrition indexes and intestinal complication rate before admission and 4 weeks after treatment.Result After enteral nutrition,the nutrition indexes in the observation group were all better than those the control group (P＜0.05) and the rates of complications on gastric retention and reflux,aspiration were insignificantly different between the two groups (P＞0.05);the rates of complication on abdominral pain and diarrhea were lower those of the control group (all P＜0.05).Conclusion For patients with large area bums,early enteral nutrition can better the nutrition and it is a safe therapy.

Clinical Observation of Edaravone Combined with Nimodipine in the Treatment of Acute Large Area Cere-bral Infarction / 中国药房

OBJECTIVE:To observe the efficacy and safety of edaravone combined with nimodipine in the treatment of acute large area cerebral infarction. METHODS:78 patients with acute large area cerebral infarction were randomly divided into control group (38 cases) and observation group (40 cases). Control group received aspirin platelet aggregation,reduced intracranial pres-sure,maintained water and electrolyte balance,decreased cerebral edema,Xuesetong for injection,Ginkgobiloba injection,lipid and blood pressurelowering,maintained blood sugar and other conventional treatment;observation group additionally received 30 mg Edaravone injection,adding into 100 ml 0.9% Sodium chloride injection by intravenous infusion (drip completed within 30 min),twice a day+12 mg Nimodipine injection,adding into 500 ml 0.9% Sodium chloride injection by intravenous infusion,once a day,with drip rate of 0.5-1 mg/h,for continuous 10 d,then received 40 mg Nimodipine tablet,orally,3 times a day. The treat-ment course for both groups was 15 d. Clinical efficacy,blood oxygen saturation (SpO2),hemoglobin (Hb),total hemoglobin (HbT),reduced hemoglobin(MHb)before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the incidence of adverse reac-tions was significantly lower tahn control group,the differences were statistically significant (P0.05). After treatment,the SpO2,HbT and MHb were significantly higher than before,and observation group was higher than control group,the differences were statistically signifi-cant(P0.05). CONCLUSIONS:Based on the conventional treatment,edaravone combined with nimodipine shows significant efficacy in the treatment of acute large area cerebral infarction,it can effectively recovery neuro-logical function damage and protect the brain tissue,which can reduce the incidence of adverse.

Specific technique system management in rescue of batches of patients with severe blast injury / 医学研究生学报

Objective It is a tough job to rescue batches of patients with severe blast injury .The article aimed to construct specific technique system management in the rescue of batches of patients with severe blast injury and evaluate its effects . Methods Retrospective analysis was made on 9 patients with severe blast injury who hospitalized simultaneously .According to the difficulties in the nursing process of treating severe blast injury such as management of respiratory tract , continuous renal replacement therapy , vascular access, nutritional supply, skin nursing, etc, specific technique system management was constructed to evaluate technical support key points at different phases , including personalized nursing scheme with disease progression , professional nursing instruction on key points of different phases from specialists as well as corresponding nursing decision and professional caring . Results Specific technique system management was applied in these 9 patients with severe blast injury .Only 1 patients developed ventilator related pneumonia when receiving mechanical ventilation and no procedure related complications occurred in the aspects of blood purification , skin management , vascular access and nutrition support .6 patients discharged from hospital after recovery . Conclusion Specific techniques and systemic management in batch treatment of severe bast injury patients could help collaborative nursing , improve the management of specific management and prevent complication .

Rapid measurement of 210Po in seafood with large area grid ionization chamber α spectrometry / 中华放射医学与防护杂志

Objective To develop a rapid and reliable method for determination of 210Po using large-area grid ionization chamber α spectrometry.Methods Samples were digested using a microwave digestion system.After preparation of sample source,the concentration of 210Po in clam was detected by large-area grid ionization chamber (φ 25 cm).209Po tracer was used to obtain the recovery.Results Large-area grid ionization chamber could achieve better counting and α spectrum resolution when the optimized thickness was 250 μg/cm2.By spiking 209Po tracer in clam,the minimum detectable activity was 9.870 × 10 4 Bq and the recovery of 210Po was 98％.Conclusions Compared with the traditional method,the developed method can avoid separation process,using less quantity of sample (0.2-0.5 g dry) and simplify the measurement process.This method may be has broad application prospects.

Effect of lattice silver wound repair dressings on large-area abrased wounds / 现代临床护理

Objective To observe the effect of lattice silver wound repair dressings on large-area abrased wounds . Methods A total of 60 patients with large-area skin abrasions were randomly divided into the observation group and the control group with 30 cases in each group. Both groups were treated with the same antibacterial treatment and nutritional support treatment. The control group received conventional general routine dressings and the observation group had the silver wound repair dressings every day. The two groups were compared in terms of the wound pain, wound infection rate, time for wound healing and scars of patients. Results The wound healing time in the observation group was significantly shortened (P<0.01). The scaring of the observation group was better than that in the control group (P<0.01). The pain degree and the exudation rate were both significantly lower in the observation group than those of the control group (P<0.01), and wound infection rate was lower than that of control group. Conclusions The lattice silver wound repair dressing can effectively promote the wound healing, shorten hospitalization duration, promote the patient recovery soon. It is simple and worthy of clinical popularization.

Effect of Mild Hypothermia on NSE and SOD in Serum of Patients with Large-area Cerebral Infarction / 中国康复理论与实践

@#ObjectiveTo investigate the effect of mild hypothermia on neuron specific enolase (NSE) and superoxide dismutase (SOD) in serum of patients with large-area cerebral infarction.Methods160 cases with large-area cerebral infarction were divided into the treatment group and control group with 80 cases in each group. Patients of the control group were treated with routine therapy. Those of the treatment group were added with mild hypothermia therapy (MHT). The scores of NIHSS were assessed and NSE and SOD in serum were examined before treatment and 7, 14 and 30 days after treatment in two groups.ResultsThe NIHSS score of the treatment group was significantly lower than that of the control group ( P<0.05), and NSE level decreased, SOD vitality increased in the treatment group. Other indexes such as respiratory, pulse, serum kalium and etc of two groups were not different ( P>0.05).ConclusionMHT can improve he nerve function of patients with large-area cerebral infarction recovering and improve prognosis.