Objective To analyze clinical manifestation,diagnosis and treatment of 8 patients with gas gangrene in Wenchuan earthquake.Methods Eight patients with gas gangrene in Wenchuan earthquake were selected for analysis on their clinical manifestations.We finally diagnosed gas gangrene based on patients'clinical manifestation and the cultured ciostridium in the focus of infection.All the patients were treated with antibiotics,repeated surgical debridement,hyperbaric oxygen and nutritional support.Results Most patients had no erepitation of the extremities but found gas in interstice of tissues identified by X-ray,B-ultrasound and CT scanning.Film preparation of efflusion of all patients showed clostridium and bacterial culture manifested mainly perfringens.Most patients were demonstrated to be with polyinfection.In addition,all patients were characterized by pitchy necrotic tissues,effusion,systemic decrease of red blood cells,increase of white blood cells and platelet.No death or amputation occurred under active combined therapy.Conciusions Earthquake induces mainly open trauma often combined with mixed infection,when gas gangrene is one of main special infections.The predominant combined therapies include utility of antibiotics and thorough surgical debridement,while hyperbaric oxygen and nutritional support are important and effective adjunctive therapies.

Objective To establish the UPLC fingerprint of Shuanghuanglian powder-injection. Methods Acquity UPLCTM BEH C18 Column (2.1 mm × 50 mm, 1.7 μm) was established;mobile phase was acetonitrile and 0.1%formic acid with gradient elution;the flow rate was 0.3 mL/min;the column temperature was 40 ℃. Characteristic spectrum cluster of 13 batches of Shuanghuanglian powder-injection were analyzed, and Chinese Medicine Chromatographic Fingerprint Evaluation System (2004 A) was used to evaluate their quality. Results UPLC fingerprint common mode of 13 batches of Shuanghuanglian powder-injection was established. There were total 16 common spectrum peaks in the reference for comparison, and three main peaks were identified with better separation. The 13 batchs had good consistency, and the process was stable. Conclusion The method is rapid, efficient and can be used for full control of the quality of Shuanghuanglian powder-injection.

ObjectiveTo employ the vascular endothelial growth factor (VEGF165) gene transfected rabbbit osteoplast to combine with the porous nano-hydrxyapatite crystal (n-HA)/polyam ide 66(/PA66) so as to evaluate the osteogenesis and rapid revascularization early after repair of the rabbit radius bone defects with the tissue-engineered bone (n-HA/PA66/osteoplast/VEGF165).MethodsThe animal models of bilateral radius bone defects were created in 56 New Zealand white rabbits that were then randomly divided into Group A and Group B.In Group A, the animals were implanted with n-HA/PA66on the left bone defects (Group Al) and with n-HA/PA66/VEGF165 composite materials on the right bone defects (Group A2). In Group B, the animals were implanted with n-HA/PA66/osteoplast/VEGF165 composite materials on the left side (Group B1) and with n-HA/PA66/osteoplast on the right side (Group B2).Gross, digital radiography, histological sections, vessel count and scanning electron microscopy (SEM) were performed at 2, 4, 8 and 12 weeks after operation.ResultsThe osteogenesis and revascularization in Group B1 was superior to that in the other groups at each time point, with statistical difference (P ＜0.05).The revascularization and osteogenesis in Groups B1 and B2 was far better than that in Groups A1 and A2, with no statistical difference between Group A1 and Group A2.ConclusionsThe new tissue-engineered bone (n-HA/PA66/osteoplast/VEGF165) has a perfect osteogenetic effect and can promote rapid revascularization and the bone healing in the early stage after repair of the bone defects.

Objective To investigate the changes of bone density,bone microstructure,bone BMP-2 expression in rats at early period of diabetes.Methods Thirty SPF 4-month-old male Wistar rats were randomly divided into 3 groups(n=10 in each group):A(fed with common forage as normal control group),B(fed with high-lipid forage and intraperitoneally injected with STZ to establish type 2 diabetes with insulin resistance),C(fed with common forage and intraperitoneally injected with STZ to establish type 2 diabetes with insulin secretion defaulting).The bone histomorphology,bone histomorphometry,bone BMP-2 expression were investigated 12 weeks later.Results As compared with group A,bone microstructure was of no obvious changes and bone BMP-2 expression was higher in group B(P

Objective To compare the effect of continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) on pain relief,rehabilitation efficacy,satisfaction degree following total knee arthroplasty (TKA) in an attempt to find a safe and effective analgesia at the stage of rehabilitation.Methods The records of 116 patients undergone unilateral TKA for osteoarthritis or rheumatoid arthritis of the knee were evaluated.The patients with preoperative American Society of Anesthesiology (ASA) score of 1 to 3 were randomized into CFNB group (58 cases) and PCIA group (58 cases) according to the random number table.Both operations were performed under ultrasound guidance.Postoperative visual analogue score (VAS),knee function,incidence of adverse reaction,and satisfaction degree were compared between the two groups.Results Regardless of the score at postoperative 4 and 12 hours,VAS between CFNB and PCIA groups revealed significant differences at postoperative 24 [(3.2±1.1)pointsvs (4.1 ±1.5)points],48 [(3.4±1.2)pointsvs (4.1 ±1.0) points] and 72 hours [(3.3 ± 1.2) points vs (4.0 ± 1.1) points] (all P ＜ 0.05).Time to achieve knee rehabilitation training objectives like straight leg raise,walking with crutches,and passive bending to 90° were similar between the two groups.Both groups achieved comparable knee function status with respect to Hospital for Special Surgery (HSS) score,Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score,and maximal knee flexion angle at postoperative 3 months.Postoperative nausea and vomit were significantly more frequent in PCIA group (24％) than in CFNB group (14％) (all P ＜O.05),but patients in both groups were satisfactory.Conclusion Ultrasound guided CFNB is an effective analgesic method during the early stage of TKA,for it can control pain,accelerate rehabilitation training and function recovery,reduce adverse reaction as well as improve patients' satisfaction.

Objective To analyze the clinical features of patients with open injuries combined with infections in Chinese Wenchuan earthquake and summarize the therapeutic experience. Methods An analysis was done on 54 patients with open injuries combined with infection transferred to our depart-ment from May 13, 2008 to June 10, 2008. Thorough debridement was performed based on general sup-porting management and anti-bacterial thempies done on the basis of results of bacteria culture and sus-ceptibility test. In the meantime, other managements including high-pressure oxygen therapy and external fixation were done for open fractures. Results Infection could be found in all open injuries, primarily combined infections with G+ coccus and G- bacillus or anaerobic. Moreover, most of the patients were infected by anaerobia. Of all, 1 patient with amputation received multiple debridement and repair because of severe infection of the amputation site and no death occurred. All patients recovered uneventfully, with sound wound healing, except for 2 patients. External fixation was stable and in good position. Conclu-sions The repeated and thorough debridement and the timely closure of wounds on the basis of energeti-cally anti-infection measures are key to diminishing the mortality rate and mutilation rate. Appropriate ad-junctive therapy can dramatically improve the curative effect.

Objective To discuss the treatment of acromioclavicular joint dislocation associated with clavicular distal end fracture and remedial means.Methods 28 cases of acromioclavicular joint dislocation associated with clavicular distal end fracture were treated with clavicular hook plate.28 patients included 4 cases of Allman's type Ⅰ,14 cases of type Ⅱ,10 cases of type Ⅲ.Classification of fracture included 9 traverse cases,14 oblique cases,3 comminuted cases,and 2 avulsion cases.There were 24 acute injury cases,4 obsolete injury cases.3 cases were open fractures.1 case was not successful by conservative management.After operation,early rehabilitation was emphasized and following-up was performed.The therapeutic effect was assessed with Karlsson standard.Results 28 patients were followed up for an average of 14.6 months(6～26 months).According to Karlsson standard:17 cases got A level,8 cases got B level,3 cases got C level.The rate of excellence was 89.3%.Conclusion Acromioclavicular joint dislocation associated with clavicular distal end fracture is not steady fracture and complicated with many ligaments avulsion often.Effective internal fixation on time and ligament repaired is necessary.

Objective To investigate the general information such as study motivation, study de-mand, and encountered difficulties of foreign medical postgraduates in China. Methods 45 medical post-graduates in Chongqing Medical University participated in this survey in February 2014. The questionnaire consisted of 19 questions, including study motivation, the reasons to learn in China, language proficiency, study expectation, satisfaction rate, and future career plan. In total, 45 questionnaires were handed out, and 42 (93%) were recovered. Results All respondents (42 persons) had already acquired medical license in their own countries. 45%of them (19 persons) had obtained bachelor’s degree in other university and were attracted by the reputation of Chongqing Medical University. 50% of respondents (21 persons) considered language barrier as the biggest problem in their learning process. 60%(25 persons) were generally satisfied with their postgraduate education in China. And lack of clinical practice opportunity was ranked as the No. 1 reason of dissatisfaction (54%, 23 persons). Conclusion Language barrier as well as lack of clinical practice opportunity is the biggest two problems encountered by foreign medical postgraduates in China. Although Chongqing Medical University has gained a lot of experience in foreign medical postgraduate education, improvements regarding training program and mentor selection should still be made.

Objective To characterize the viability and transgene expression of articular chon-drocytes cultured in 3-Dimensional scaffolds provided by four types of carriers.Methods Articular chondrocytes from rabbit knees were cultured and infected with adenovirus that could express green fluo-rescence protein (AdGFP) and GL3 luciferase (AdGL3-Luc).The viability and gene expression were determined with fluorescence microscopy and luciferase assays in four types of scaffolds;type I collagen sponge, fibrin glue, hyaluronan and open-cell polylactic acid (OPLA).Cartilage matrix production was assessed by Alcian blue staining.Results Articular chondrocytes of rabbits were effectively infected by AdGFP and exhibited sustained GFP expression.All the tested scaffolds supported the survival and gene expression of the infected chondrocytes.However, the highest transgene expression was observed in the OPLA carrier (P<0.01).Alcian blue-positive matrix materials were readily detected in OPLA cultures four weeks later.Conclusion OPLA supports the highest transgene expression and is the most conduc-tive scaffold for matrix production, suggesting that OPLA may be a suitable scaffold for cell-based gene therapy of articular cartilage repair.

In most cases of arthritic varus knees, stepwise osteophytes removal and medial soft tissue release could achieve satisfactory soft tissue balance during total knee arthroplasty. However, in some severe cases, conventional balancing techniques are not enough, necessitating other procedures like epicondylar osteotomy. To the best of our knowledge, no published article has reported the application of lateral epicondylar osteotomy in a severe varus knee. Here we reported a case of successful correction of a severe varus knee following lateral epicondylar osteotomy, and described its underlying rationale.
Aged ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Knee ; abnormalities ; Osteotomy ; methods