Early diagnosis and treatment of trauma in knee joints accompanied with popliteal vascular injury.

OBJECTIVE: The objective of the present study was to investigate the early diagnosis and treatment of trauma in the knee joints accompanied with popliteal vascular injury. METHODS: Fifteen cases of patients with trauma in knee joints accompanied with popliteal vascular injury. These patients included 8 males and 6 females between the ages of 27 and 62, the average age being 39.2. Data of clinical symptoms and signs; blood oxygen saturation, color Doppler examination; vascular intervention by DSA angiography; and surgical operations were analyzed to clearly identify their role in early diagnosis and treatment. RESULTS: In the patient group for this study there were: 1 death case; 4 stage I amputation cases; 4 stage II amputation cases due to failure to salvage limbs; and 6 cases with patients who had successful limb salvage. The six cases of limb survival patients were followed up for 12 to 60 months, with an average follow up time of 28.3 months. The excellent rate of joint function of these patients with successful limb salvage was 83.3%. CONCLUSIONS: For patients with injured limbs, unclear dorsalis pedis artery palpation, decreased skin temperature, and decreased oxygen saturation of the toes, clinical manifestations combined with proper auxiliary inspection (such as color Doppler and blood vessel angiography of interventional DSA) enabled early diagnose of peripheral trauma in the knee joint accompanied with popliteal vascular injury.

An efficacy analysis of surgical timing and procedures for high-energy complex tibial plateau fractures.

OBJECTIVE: To identify the most effective treatment for application to high-energy complex plateau fractures. METHODS: 125 patients with closed high-energy complex tibial plateau fractures who had been surgically treated between 2003 and 2010 were reviewed retrospectively. Five procedure methods were studied (e.g. four open reduction and internal fixations, and close reduction via a minimal incision with hybrid external fixation) in five surgical timings, with a control group. The incidence of wound complications after operative treatment in the five surgical timings and the clinical effects of the five surgical procedure options were evaluated statistically. A postoperative follow-up ranging 26-110 months (mean, 36.5 months) was performed. RESULTS: Among the various groups, the respective overall wound complication incidences were 20.0%, 41.6%, 33.3%, 2.5%, and 16.7% within 4 hours, 4 hours to 3 days, 3-5 days, 5-8 days, and more than 8 days after injury. Failed fixation was clearly observed in Group 1 (23.1%, 6/26) and Group 5 (21.7%, 5/23) (P < 0.05). Significant differences were also found among Group 2 (92.6%), Group 3 (93.3%), and Group 5 (69.6%), in terms of the good and excellent rate of joint function according to the Rasmussen score (P < 0.05). CONCLUSION: The optimal surgical timing is within 4 hours after trauma, for which no obvious swelling was observed in the limbs. This is followed by surgical timing within 5-8 days, after which trauma showed only subsided limb swelling. Dual plating provides the best stabilization option, as it allows early joint mobilization, cartilage regeneration, and joint remodeling, thus decreasing the risk of joint stiffness. Hybrid external fixation may provide relative stability to maintain fracture alignment without the need for massive soft tissue dissection, and also minimizes blood loss and potential soft tissue complications.

[Prenatal screening and diagnosis of genetic deafness by microarray].

OBJECTIVE: To evaluate a microarray-based mutation screening method for genetic deafness and its application in prenatal diagnosis. METHODS: Mutation screening of common deafness genes was performed in pregnant women and volunteers spouses. Nine common mutations in four major deafness genes, GJB2, GJB3, SLC26A4 and mitochondrial 12S rRNA, were detected simultaneously by a microarray-based method. Genetic counseling was given based on their testing results. RESULTS: 5.11% of pregnant women carried at least one mutation. Among them, seven carried mutation in the mitochondria 12S rRNA gene and were offered aminoglycoside-induced ototoxicity warning. For other mutation carriers of GJB2 or SLC26A4 genes, additional mutation screening was performed in their husbands by direct sequencing. A total of 20 couples were at risk of giving birth to children with genetic deafness. Of five couples who selected to undergo prenatal diagnostic testing of the fetus, four were diagnosed as wild type or heterozygous for the tested genes and one as p.V37I/c.235delC compound heterozygous for GJB2. CONCLUSIONS: DNA microarray is a quick, easy and reliable method to screen mutations in genetic deafness genes. Application of this method in prenatal screening and diagnosis might effectively reduce the occurrence of genetic deafness.

[Mechanism of inhibitory effect of intravenous immunoglobulin on neonatal umbilical cord blood lymphocytes].

OBJECTIVE: The expression of CD25, CD45RA, CD45RO on umbilical cord blood mononuclear cells (CBMCs) and CD3(+) T lymphocytes was investigated to explore the mechanism of immunosuppressive effects of intravenous immunoglobulin on neonatal immune function. METHODS: Umbilical cord blood mononuclear cells and CD3(+) T lymphocytes isolated from 8 neonates were studied. The expression of CD25, CD45RA, CD45RO on umbilical cord blood mononuclear cells (CBMCs) and CD3(+) T lymphocytes induced with various stimuli of different combinations of IVIG and phytohemagglutinin (PHA) including (1) control group, (2) PHA activation group, (3) IVIG pre-inhibition group, (4) PHA pre-activation group, (5) PHA+IVIG group was measured with four-color immunofluorescence antibodies staining-flow cytometric technique. The results were also compared with peripheral blood mononuclear cells of 8 adults (PBMCs). RESULTS: IVIG inhibited the PHA-induced proliferation of CBMCs as reflected by the decreased expression of CD25 and CD45RO. The amounts of CD25(+) and CD4(+)CD45RO(+) CBMCs reached 77.52% +/- 2.31% and 64.29% +/- 3.09% after PHA use. But a decreased response in CD25(+) (7.66% +/- 1.20% and 7.78% +/- 1.46%) and CD4(+)CD45RO(+) CBMC (3.18% +/- 1.90% and 3.11% +/- 0.08%) was observed when IVIG was added in both IVIG pre-inhibition group and PHA+IVIG group. As compared with PBMCs, IVIG failed to induce the increase of the expression of CD45RA in CBMCs whereas CD45RA(+) PBMCs increased from 54.93% +/- 3.63% to 72.77% +/- 0.39% in IVIG pre-inhibition group. Moreover, IVIG inhibited the expression of CD25 and CD45RO on cord blood CD3(+) T lymphocytes no matter whether they were activated with PHA or not. The amounts of CD25(+) and CD4(+)CD45RO(+) CD3(+) T lymphocytes reached 97.92% +/- 2.19% and 80.41% +/- 5.57% after PHA use. But a decreased response in CD25(+) CBMCs (77.29% +/- 0.63%, 51.48% +/- 1.85% and 62.73% +/- 1.24%) and CD4(+)CD45RO(+) CD3(+) T lymphocytes (35.47% +/- 2.55%, 40.14% +/- 1.16% and 36.41% +/- 2.96%) was observed when IVIG was added in IVIG pre-inhibition group, PHA pre-activation group and PHA+IVIG group, and the degree of inhibition of IVIG on cord blood CD3(+) T lymphocytes was much lower than that of CBMCs. CONCLUSIONS: Cord blood T lymphocytes activation was inhibited by IVIG through the inhibition of CD25(+) CBMCs expression and the prevention of transformation from CD4(+)CD45RA(+) cells into CD4(+)CD45RO(+) cells. This IVIG-mediated suppression of activation in cord blood T cells may be derived from the indirect effect of other immune cells or molecules other than the direct effects on T cells. IVIG failed to induce the increase of expression of CD45RA in CBMCs, which may be related to the fact that majority of CBMCs were CD45RA(+) cells, but this may not rule out that the immunosuppressive effect of IVIG could be accomplished by the increase of CD45RA(+) cells in adult peripheral blood mononuclear cells. The suppressive effect of IVIG on CD4(+)CD45RO(+) T lymphocytes may account for its inhibitory effect on immunoglobulin production of neonates' B cells. Considering that naïve CD45RA(+) cells dominate in neonates and IVIG can inhibit transformation from CD4(+)CD45RA(+) cells into CD4(+)CD45RO(+) cells, it is recommended that IVIG should be used properly in neonates, otherwise it may deteriorate their poor immune function especially when it is used for prophylaxis or as a treatment of neonatal non-infectious diseases, and its immunosuppressive action will increase the susceptibility of neonates to infection.

[Reactivity and antigenic cross-reactivity of latex in children with allergic disorders].

OBJECTIVE: To explore the relationship between latex allergen and clinical presentation as well as allergenic cross-reactivity between latex and other allergens, to know the incidence of latex allergy in Chinese children and elucidate the allergenic cross-reactivity of latex with other allergens. METHODS: Totally 265 children with allergic disorders were assayed with 13 international standard allergen agents by means of SPT. RESULTS: In 79 children with latex allergenic SPT position, 53 were boys and 26 were girls with an average age of 5.6 years, and 14 cases had episodes occurred in winter, 14 cases in spring, 24 cases in summer, and 27 cases in autumn. Of them, 66 cases presented as asthma, 5 cases atopic skin disorders, 1 case anaphylactoid purpura, 1 case hives and 6 cases only had mild cough. Statistical analysis showed that the positive percentage of the latex SPT had no obvious relation with sex and age, but was higher in summers and autumns than in winters and springs (P < 0.01). Children with allergic symptoms had higher positive rate in latex allergenic SPT than those without them, that is, the positive percentage of the latex SPT significantly increased among children presenting with some allergic symptoms, such as asthma, hives and atopic skin disorders (P < 0.01). All the children with latex allergenic SPT position had cross-reactivity with acarid allergen, 62.0% approximately 43.0% with animal protein allergens including milk, cats, shrimp, dogs, eggs in the order of decreasing cross-reaction rate, and 10.1% - 3.8% with mold and plant farina allergens. But the cross-reactivity between latex and mold or tree farina I were not statistically significant. CONCLUSION: Thirty percent of the children with allergic disorders were latex allergenic SPT positive. Latex allergenic SPT positive results were significantly correlative to allergic clinical presentation and season, while were not relative to sex and age. The cross-reactivity of latex with acarid was most common, followed by animal protein allergens, while the cross-reactivity with mold and plant farina allergen was rare.