Protective effect of pre-perfusion with improved St.Thomas solution on skeletal muscle ischemia-reperfusion injury in dogs / 中华显微外科杂志

Objective:To explore the protective effect and mechanism of improved St. Thomas solution on canine skeletal muscle ischemia-reperfusion injury (IRI).Methods:Between March 2021 and September 2021, in the experimental operating room at the Air Force Hospital of the PLA Eastern Theater Command, 16 Beagles were randomly divided into control group, IRI group, IRI+NS group, and improved St. Thomas group, 4 in each group. The canine skeletal muscle IRI model was established, and the canine vital signs were monitored by pre-perfusion with improved St. Thomas perfusate [potassium chloride (KCl), magnesium sulfate (MgSO 4), and NaHCO 3 (pH adjusted)]. The pathological damage of canine skeletal muscle was explored by hematoxylin eosin (HE) staining, electron microscope detection and tissue wet/dry weight ratio, and blood vessel density. Hypoxia performances were detected by labeling blood vessels and hypoxia-inducible factor-1α (HIF-1α). The IRI model of L6 rat myoblasts was established, and the components of St. Thomas perfusion solution were pre incubated to explore the effect on the inhibition of cell proliferation. And by detecting reduced nicotinamide adenine dinucleotide phosphate (NADPH), F2 isoprostane (F2-isoprostane), interleukin 1β(IL-1β), tumour necrosis factor alpha (TNF-α), myeloperoxide enzyme (MPO), glutathione peroxidase (GSH-Px), etc. to explore its protective mechanism. Statistical software SPSS 23.0 was used for statistical analysis, A P<0.05 was set as statistically significant. Results:In the improved St. Thomas group, the vital signs of the dogs were relatively stable, the amount of maintained dopamine was less, the histopathological structure of the gastrocnemius muscle tended to be intact, the swelling of tissue cells and mitochondria was significantly relieved, and the tissue wet/dry weight ratio was less than that in the IRI group ( P=0.046). Pre-incubated with therapeutic doses of MgSO 4 or NaHCO 3, the proliferation rate of L6 cells was higher than that of IRI group ( P<0.01, P=0.005), NADPH ( P=0.004, P=0.001), F2-isoprostane ( P<0.01, P=0.01), IL-1β ( P=0.02, P=0.015), TNF-α ( P<0.01, P<0.01), MPO ( P<0.01, P<0.01) were all lower than those in the IRI group, except GSH-Px that was higher than what in the IRI group ( P<0.01). Conclusion:Pre-perfusion of the improved St. Thomas solution can stabilise the vital signs of dogs in a short period of time. The solution can improve the state of skeletal muscle cells, improve tissue hypoxia, and reduce the damage of skeletal muscle tissue cells through anti-inflammatory and anti-oxidative stress.

Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury / 世界急诊医学杂志（英文）

BACKGROUND@# Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.@*METHODS@# In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.@*RESULTS@# Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups.@*CONCLUSION@# Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

Ten years retrospective study of using primary microsurgery technology to treat patients with severe lower extremities injury / 中华显微外科杂志

Objective To clarify the role of microsurgery in limb salvage procedure and its efficiency in long-term functional results through a retrospective review of patients who sustained severe injury of lower extremities and had been treated Shanghai 6th people's hospital, in recent 10 years. Methods Patients who sustained severe injury of lower extremities and treated with microsurgical techniques in January, 2006 to January, 2016 were studied. Patients' general information, classification of open fracture, and MESS were noted. The enrolled patients were divided into two groups (group A: primary microsurgical reconstruction;group B: non-microsurgical reconstruction ) according to whether primary microsurgical reconstruction was performed or not. Each group were also further divided into sub-group according to preoperative MESS (MESS<7 and MESS≥7). The reconstruction methods, hospitalization days, op-eration times, postoperative complications, as well as the SIP were then recorded for each groups. The differences of these data among each groups were analyzed and compared. Results The main objection was patient with Gustilo grade III open fracture, totally 548 patients were admitted, with 312 males and 236 females. The main age was 35.6 years old. The main etiology was road traffic accident (79.7％). There were 211 patients (38.5％) in group A, and 337 patients (61.5％) in group B. In group A, there were 37 patients in subgroup one (MESS<7), and 174 patients in sub-group two (MESS≥7). The rate of delayed amputation was 2.8％, while the complication rate was 11.8％. In group B, there were 181 patients in subgroup one(MESS<7), and 156 patients in subgroup two (MESS≥7). The rate of delayed amputation was 4.0％, while the complication rate was 13.3％. In long-term survey, the average VAS score of group B was higher than that of group A, but no significant difference was noted. The average VAS scores in 2 year postopera-tively in the subgroups (MESS≥7) were higher than those in the other subgroups (MESS<7). The results of SIP scores were similar with VAS scores in two groups. Conclusion The techniques of microsurgery has been promoting the successful rates and outcomes for limb salvage procedure over the recent decades. Meanwhile, the current evaluating system for se-vere limb injury needs to be updated to meet the demands of ever-developing limb salvage techniques.

Analysis of lower limb injuries in collegiate American football team: a 2-year prospective study / 体力科学

Collegiate American football injuries for two year seasons in Japanese Kansai Division I team were analyzed using injury rates (IR) per 1000 athlete-exposures (1000AE: one athlete-exposure was defined as a player participating in one game or one practice.), especially focusing on lower limb injuries. The overall game injury rate (GIR: 38.3) was significantly higher than practice injury rate (PIR: 13.1) (X²=12.355, p < 0.05). The difference between GIR in 2008 season (50.8) and in 2007 season (25.7) was significant (X²=8.235, p < 0.05). The lower extremity injuries approximately occupied 60% of all injuries, especially GIRs of both ankle inversion sprains (3.8) and anterior cruciate ligament (ACL: 3.3) injuries being much higher. PIR in this study was higher than the rates of collegiate American football teams in the U.S.A., especially PIRs of knee ligament injuries (ACL and medial collateral ligament injuries) and ankle sprains (inversion and eversion sprains) being much higher. Regarding the occurrence of injury, GIR with contact in ACL injuries (2.8) and GIR without contact in ankle inversion sprains (2.4) were the highest. It is also necessary to change practice plans and circumstances so that the PIR of knee and ankle injuries could be reduced. Research is needed on injury prevention for knee and ankle injuries in the games and practices.

A study of lower limb injuries in aerobic dance instructors / 体力科学

The purpose of this study was to investigate the injurious influence of aerobic dancing on the lower limbs injuries. Subjects were personally interviewed about exercise hours and the intensity of their classes, together with experience of injury, and their body configurations, alignments, ranges of motion, and muscular strengths were measured. EMG during aerobic dance exercise was measured in subjects with knee Q angles over and under 20 degrees.<BR>The incidence of lower limb injury was 64.3%, and the most frequent injury was shin splint. The injured individuals had significantly more high-intensity classes than normal. As to body configuration, the width in patella per femur was significantly lower and the value of patellar ligament per height was significantly higher in the injured than in the normal subjects. The range of motion of hip external rotation in the injured was significantly smaller than that in the normal subjects. EMG discharge of the vastus medialis in the injured with a knee Q angle of over 20 degrees was markedly greater than that in normal subjects with an angle of less than 20 degrees.