Oral and external application of Chinese medicine combined with Ilizarov external fixator and the accordion technique for severe chronic osteomyelitis of the tibia / 国际中医中药杂志

Objective To evaluate the therapeutic effect of oral and external application of Chinese medicine combined with Ilizarov external fixator and the accordion technique for severe chronic osteomyelitis of the tibia.Methods A total of 78 patients with severe chronic osteomyelitis of the tibia were randomized into a routine treatment group and a combined treatment group, 39 in each group. All the patients in the two groups received external fixation by use of Ilizarov external fixator and the accordion technique. All the patients in the combined treatment group received oralGuyu decoction. The patients who had large wound received vacuum-sealing drainage in the routine treatment group, and vacuum-sealing drainage combined with external application ofShengji-Yuhong plaster in the combined treatment group. All the patients were treated for 8 weeks and followed up for 2 years. The time to wound healing and fracture healing, and the drainage time were compared between the two groups. Functional and radiologic findings were evaluated according to Paley's criteria. The functions of the knee joint and ankle joint were evaluated using the Hospital for Special Surgery (HSS) knee score and the scoring system of Baird and Jackson, respectively.Results The time to wound healing (17.33 ± 6.21 dvs. 22.27 ± 8.12 d;t=3.018,P=0.004) and the time to fracture healing (32.25 ± 6.02 weeks vs. 36.37 ± 7.75 weeks;t=2.623,P=0.011), and the drainage time (17.01 ± 4.66 dvs. 21.51 ± 5.23 d;t=4.012, P<0.001) in the combined treatment group were significantly shorter than those in the routine treatment group. According to Paley's criteria, the patients who achieved a score of excellent or good for fracture healing (84.6%vs. 53.8%;χ2=7.282,P=0.007) and function (92.3%vs. 66.7%;χ2=6.369,P=0.012) in the combined treatment group were significantly more than those in the routine treatment group. The scores of the HSS knee score (84.56 ± 7.42vs. 78.81 ± 5.33;t=3.391,P=0.002) and the scoring system of Baird and Jackson (85.01 ± 8.21vs. 79.21 ± 6.78;t=3.402,P=0.024) in the combined treatment group were significantly higher than those in the routine treatment group.Conclusion OralGuyu decoction and external application ofShengji-Yuhong plaster combined with Ilizarov external fixator and the accordion technique can promote recovery of the joint function, fracture healing and wound healing.

End-tidal carbon dioxide concentration monitoring in obstructive sleep apnea patients.

PURPOSE: The objective of this study was to investigate the end-tidal carbon dioxide concentration (ETco(2)) monitoring in obstructive sleep apnea (OSA) patients during sleep and to explore whether the ETco(2) value may explain a significant portion of the relationship between ETco(2) value and apnea/hypopnea index (AHI) and nocturnal oxygenation indices. MATERIALS AND METHODS: Thirty-eight consecutive patients underwent overnight polysomnography and were synchronously monitored for ETco(2) using an microstream capnometer. Mean and maximum values during wake time and different sleep stages were recorded. We grouped 38 OSA patients into 2 subgroups on the basis of their difference of mean total sleep time and wake time ETco(2) [(T - W) ETco(2)]; one group, 20 patients with (T - W) ETco(2) less than 0, and the other group,18 patients with (T - W) ETco(2) greater than 0. RESULTS: Group with (T - W) ETco(2) less than 0 patients exhibited higher AHI (mean ± SD, 68.58 ± 22.78 vs. 27.61 ± 19.44 events/h) and lower nocturnal oxygenation indices (minimum Sao(2), 67.85 ± 10.08 vs. 82.61% ± 6.07%; mean Sao(2), 91.29 ± 3.31 vs. 95.15% ± 1.88%) compared with the other group. CONCLUSIONS: In summary, the study provides preliminary data showing that ETco(2) potentially can be used in continuous monitoring of OSA patients. And, (T - W) ETco(2) can indicate the severity of OSA.

Detection of Mycobacterium tuberculosis and its L-forms in peripheral blood from tuberculosis and lung cancer patients / 中华检验医学杂志

Objectlve To evaluate the clinical value of the detection of Myeobacterium tuberculosis (MTB)and its L-forms(MTB-L)in pefipheral blood.Methods MTB and MTB-L in blood samples of 156 patients with tuberculosis and 147 patients with lung cancer were detected by hemolysis centrifugal drop Intensified Kinyoun's acid fast staining (IK) and hemolysis centrifugal culture with 42 healthy persons as controls.MTB DNA was detected by TaqMan-PCR technique in plasma mononuclear cells and whole blood from aforementioned groups.Results Among each groups detected by IK.the MTB positive rate was 1.3%(2/156),0.7%(1/147),and 0%(0/42)respectively.The positive rate of culture was 0.6%(1/156),0%(0/147),and 0%(0/42)respectively.MTB-L positive rate detected by IK was 41.0%(64/156),32.7%(48/147)and 7.2%(3/42).MTB-L positive rate detected by culture was 25.6%(40/156)and 39.5%(58/147).0%(0/42).MTB positive rate were significantly different from the MTB-L positive rate (P＜0.01).Among the 98 strains L-forms,81 strains were from human,17 strains were from bovis,and 44 strains were back to the ancestors.The positive rate of mononuclear ceHs and whole blood obtained from the tuberculosis group detected by TaqMan-PCR were 77.6%(121/156) and 68.6%(107/156)(P＜0.05).The positive rate of mononuclear cells and whole blood from lung cancer group were 59.2%(87/147)and 48.3%(52/147)(P＜0.05),which were higher than the plasma positive rate 12.2%(18/147)(P＜0.05).The result of individual bloed constituents (except for plasma) from two groups were significantly different from the control(P＜0.01).Conclusions MTB-L was found in the peripheral blood of the tuberculosis and lung cancer patients.Hemolysis centrifugal culture is a rapid,simple and reliable method for detecting MTB-L TaqMan-PCR showed the positive rate of MTB DNA in plasma and whole blood samples were significantly higher than that in the plasma.

The evaluation of quality of life for obstructive sleep apnea hypopnea syndrome in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#One of the objective of the study was to evaluate the reliability and validity of 18 items survey (OSA-18) which was made for disease specific quality of life in children with obstructive sleep apnea. The other was to explore whether OSA-18 could be used as a well appreciation method on OSAHS in children's quality of life before and after surgery.@*METHOD@#First, one hundred and twenty-two children's parents were interviewed with this survey scales and the survey scales was assessed by split-half reliability, retest reliability, internal consistency, construct validity and content validity. Second,OSA-18 was used to evaluate the QOL of 122 children within 4 weeks before PSG and in 6 to 12 months after operation.@*RESULT@#OSA-18 has a satisfactory internal consistency. Global Cronbach's alpha coefficient were 0.939. All domains and items Cronbach's alpha coefficients > 0.6; also has a well retest reliability, coefficient correlation of pearson equal 0. 619. Construct validity and content validity were satisfactory. The impact of pediatric OSAHS on QOL was moderate and severe in 77.05% patients pre-operation. However, it was only 28.69% after surgery. OSA-18 total scores, every domain and item score were significant decrease.@*CONCLUSION@#OSA-18 QOL survey had better reliability and validity, and was applicable for life quality assessment in OSAHS children. OSA-18 QOL survey could help clinical diagnosis of OSAHS in children and give quantitative evaluation for therapeutic measure.

Influence of obstructive sleep apnea hypopnea syndrome on the quality of life of the patients / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effects of obstructive sleep apnea hypopnea syndrome on the quality of life of the patients. METHODS The quality of life was assessed with the Medical Outcomes Study SF-36 Health Survey in 145 patients with OSAHS and 17 snorers without OSAHS. Excessive Daytime Sleepiness was assessed with Epworth Sleepiness Scale. Pearson linear correlation and stepwise multiple regression analysis were used to study the association between each domain score of SF-36 and patients information,PSG parameters,EDS scores. RESULTS Three domains of SF-36 correlated negatively with Body Mass Index. Four domains correlated negatively with EDS. Three domains and total score correlated significantly with the lowest oxygen saturation. Two domains correlated negatively with the longest time of apnea. AHI and the lowest oxygen saturation have a mild side effect on the quality of life. BMI and EDS score have significantly side effect on the quality of the life. CONCLUSION Comparing to the mild OSAHS patients and snorers without OSAHS,the severe OSAHS patients have worse quality of life. EDS score and BMI have a significantly side effect on the severe OSAHS patients. OSAHS has a side effect on the quality of life of the patients.

Experimental study on treatment of femoral head necrosis in rabbit with transplantation of bone marrow stromal cells / 中国矫形外科杂志

[Objective]To investigate the repairing effect and mechanism for treatment of femoral head necrosis on transplantation of bone marrow stromal cells.[Method]Twenty-four Newzland rabbits were divided into two groups randomly,Group A as core decompression group and Group B as Bone marrow stromal cells autograft group.Animal femoral head neorosis model was made by freezing method with liquid nitrogen.After freezing and drilling,The drilled necrotic cavities of Group A was implanted with gelatin sponge,while of Group B was with gelatin sponge combined by bone marrow stromal cells.Three animals in every group were sacrificed respectively at 2,4,6,8 weeks and subjected to radiograph and microscope examination.[Result](1)Radiograph examination:At 2 weeks,the drilled holes in Group A and B all presented low density images.At 4 weeks,the density in the drilled holes increased in group B and the density around the drilled holes increased in group A.At 8 weeks,sclerotic line formed around the drilled holes in Group A and trabeculae appeared in the drilled holes in group B.(2)Microscope examination:in group A,at 2 weeks,a few inflamatory cells appeared in the holes with many osteoblasts and ostoid appeared around the drilled holes.At 8 weeks,marrow formed in the drilled holes in group B,at 2 weeks,there were a large amount of osteoblasts in the drilled holes and some ostoid formed around thc drilled holes.At 4 weeks,the drilled holes were full of trabeculae.At 8 weeks,the trabeculae matured with the marrow appeared in the intertrabecular space.[Conclusion]Bone marrow stromal cells autografting may be an effective way to treat rabbit femoral head necrosis.

Determining the site of airway obstruction in obstructive sleep apnea with airway pressure measurements during sleep.

OBJECTIVE: To determine the site(s) of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) and their changes during sleep with upper airway (UA) pressure measurement; and to analyze the correspondence between the UA pressure measurement and polysomnography (PSG). METHOD: Thirty patients with OSAS underwent UA pressure measurement. The catheter with five solid-state ultraminiature sensors was inserted through the patients' upper airway to the esophagus. The sensors were located at the nasopharynx, oropharynx, tongue base, hypopharynx, and esophagus. The lower limit of UA obstruction was determined by relying on the observed pressure pattern. RESULT: 1) During inspiration, obstruction occurred associated with an increased negative inspiratory pressure inferior to the site of obstruction and a disappeared negative inspiratory pressure above the site of obstruction; 2) three patterns of obstruction were observed; 3) the site of obstruction was located at the site of the palate; 4) velopharyngeal obstruction and tongue-pharynx obstruction were all present; 5) nasopharyngeal obstruction velopharyngeal obstruction and tongue-pharynx obstruction were all present; and 6) peak inspiratory pressure differences between the normal breath and apnea were associated with the longest apnea interval (P <.05). CONCLUSION: UA pressure measurement can evaluate the site of obstruction in patients with OSAS and their changes during sleep. Peak inspiratory pressure differences between normal breath and apnea can show the severity of OSAS.