OBJECTIVETo investigate therapeutic effects of vacuum sealing drainage (VSD) in the treatment of soft tissue defect combined with tendon and bone exposure.

METHODSFrom October 2007 to February 2011, 397 patients (412 feet) with open ankle fracture and dislocation combined with soft tissue defected were treated by VSD. There were 301 males and 96 females with an average age of 36 years (ranging age from 20 to 73 years). According to AO classification, 74 feet were type I, 211 feet were type II, 108 feet were type III and 19 feet were type IV. The mean time from injury to operation was 5.6 h ( 2 to 12 h). The mean treatment time of was 10 months (4 to 19 months).

RESULTSOne hundred and forty-one patients were primarily healed, 97 patients were sutured at stage II. Split-thick skin grafting was performed at stage II was performed in 103 patients; free flap transplantation was performed in 25 patients. Three of the 34 patients with infection were removed steel plate; Eviscerate flap coverage wound was performed in 14 patients caused by the first metatarsal bone exposure; Toe amputation were performed in 22 cases caused by toes necrosis. Tarsometatarasl joints perforators' surgery was performed in 10 patients with forefeet necrosis. Thirty hundred and six patients were followed up from 3 to 20 months (averaged 10 months). The wounds healed well.

CONCLUSIONVSD for soft tissue defects caused by ankle injury is a simple and effective method, but can not replace debridement and transfer flap.

Adult ; Aged ; Ankle Fractures ; Debridement ; Drainage ; methods ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Skin Transplantation ; Treatment Outcome ; Vacuum ; Young Adult

Objective To study the effects of CYP3A5 * 1 and CYP3A5 * 3 genotypes on tacrolimus dose requirement.Method We tested archival peripheral blood of 69 kidney recipients for CYP3A5 genotyping by polymerase chain reaction.The dose,blood concentrations and dose-normalized blood concentrations of tacrolimus were measured at 1st and 2nd month after the renal transplantation.Result There were 6 cases of CYP3A5 * 1/* 1 (8.7％),22 cases of CYP3A5 * 1/* 3 (31.9％),and 41 cases of CYP3A5 * 3/* 3 (59.4％).At 1st and 2nd month after the renal transplantation,the carriers of CYP3A5 * 1 genotype had a higher mean tacrolimus dose than CYP3A5 * 3/* 3 genotye (both P＜0.000 1),and those of CYP3A5 * 1 genotype had lower mean tacrolimus concentrations than CYP3A5 * 3/* 3 genotye (P=0.020 8,and P =0.019 1 respectively).Meanwhile,the carriers of CYP3A5 * 1 genotype had lower dose-normalized blood concentrations of tacrolimus than CYP3A5 * 3/* 3 genotye (P＜0.000 1) at 1st month after the renal transplantation,as well as at 2nd month after the renal transplantation (P =0.0191).Hepatic and renal function showed no significant effect on tacrolimus dose adjusted concentration at 1st and 2nd month after transplantation.Gender did not show a significant impact on tacrolimus dose.Conclusion CYP3A5 * 1 carriers needhigher tacrolimus dose than CYP3A5 * 3 homozygote to achieve the target blood concentration.CYP3A5 genotyping is a new approach for detecting tacrolimus dose requirement in kidney recipients.

Objective To understand the distribution of inhaled allergens throughout Hainan province and explore effective preventive measures against allergen by examining the serum allergen of patients with chronic rhinosinusitis (CRS), which will provide evidence for specific immunotherapy for treating CRS. Methods Three hundred and eighteen CRS patients underwent Phadiatop blood test by using the UniCAP 100 , a completely automatic autoanalyser. Allergen-specific IgE of 7 common allergens were tested and the concentration of total immunoglobulin E (TIgE) was collected and evaluated. Results The positive rates of the serum TIgE and inhaled allergens were 64.15% and 37.74% respectively. The incidences of the positive serum SIgE is 33.96%. Among the positive cases, 28.30% of the inhaled allergens were dermatophagoides pteronyssinus, 27.36% for tropical mites, 21.07% for dermatophagoides farinae, 13.52% for cockroach, 11. 64% for house dust, 7. 86% for cat dander and 0.63% for dog dander. The incidences of positive TIgE and SIgE were not significantly different between patients with nasal polyps and sinusitis only. Conclusions Dermatophagoides pteronyssinus, tropical mites and dermatophagoides farinae are the main inhaled allergens for CRS patients in Hainan.

Objective To study the association between house dust endotoxin levels and the airway responsiveness as well as allergen sensitization in adolescence in the urban and rural areas of Guangdong province.Methods Middle school students,aged 13-14,188 (male 109,female 79) from Guangzhou,129(male 70,female 59) from Conghua with positive responses,and 231 (male 125,female 106) and 307(male 145,female 162) of their respective reference students are selected from questionnaire prescreening.A detailed questionnaire,the lung function test,histamine bronchial provocation test,skin prick test and peripheral blood eosinophil count are undertaken.Seventy-six students from Guangzhou and 80 from Conghua were selected randomly for mattress dust sample collection to detect the levels of endotoxin.Results The prevalence of wheeze symptom,diagnosed asthma,nasal symptoms and allergic rhinitis of Guangzhou was significantly higher than that of Conghua (P＜0.0001),with 28.6％,27.7％,66.0％,46.4％ for Guangzhou respectively,and 5.0％,2.5％,31.0％,6.2％ for Conghua respectively.The positive rates of bronchial provocation test and skin sensitization against Dermatophagoides pteronyssinus(Der.p),D.farinae (Der.f),cat and dog allergen in the students of Guangzhou were significantly higher than that of Conghua (P＜0.0001).The positive rate of cockroach of Conghua was significantly higher than that of Guangzhou (P＜0.0001).The levels of endotoxin (amount,concentration and load) of samples from Conghua were significantly higher than that from Guangzhou (Conghua:6452 EU,10.95 EU/mg,1794 EU/m2 ;Guangzhou:1591 EU,6.45 EU/mg,508.80 EU/m2,respectively).PD20-FEV1 was correlated positively with endotoxin amount(r=0.174,P＜0.05).The diameters of the skin wheal size for Der.p and Der.f were correlated inversely with endotoxin amount and load (P＜0.001).Conclusion The prevalence of wheeze symptom,diagnosed asthma,nasal symptoms and allergic rhinitis in 13-14 year-old adolescent of Guangzhou was significantly higher than that of Conghua.Cockroach was the second major allergen of Conghua followed by house dust mite.The level of endotoxin was correlated positively with PD20-FEV1,but correlated inversely with skin sensitization to Def.p and Der.f.The study suggests that environmental endotoxin may have effect to protect children from developing allergic diseases.

Objective To campare the clinical efficacy of wrist-ankle acupuncture versus physical therapy in treating lumbar intervertebral disc herniation (LIDH).Method Fifty LIDH patients were randomized into a treatment group of 20 cases and a control group of 30 cases. The treatment group was intervened by wrist-ankle acupuncture, while the control group was by traction and interference electrotherapy. The short-form McGill Pain Questionnaire (SF-MPQ) and lumbar pain scoring system by Japanese Orthopedic Association (JOA) were compared before and after intervention.Result The SF-MPQ and JOA scores were significantly changed respectively after 5-day, 10-day, 15-day treatment as well as at the follow-up study in both groups (P<0.01). There were no significant differences between the two groups in comparing the SF-MPQ and JOA scores respectively after 5-day, 10-day, 15-day treatment as well as at the follow-up study (P>0.05).Conclusion Wrist-ankle acupuncture and physical therapy both are effective in treating LIDH, as they both can release the pain.

Objective To determine the variation of bone mineral density(BMD)and bone mineral content (BMC)in cadaveric lumbar vertebrae and investigate their significance in determining fracture modes and biomecha- nical properties.Methods The lumbar motion segments of the spines of 19 cadavers(mean age:56 years)were compressed to failure.The BMD and BMC of the cranial and caudal endplates were determined,along with the BMD and BMC of the upper and lower 1/3 transverse sub-endplate layers and the middle 1/3 transverse layer.The anteri- or,middle and posterior 1/3 vertical parts,anterior and posterior 1/2 vertical parts and the whole BMD and BMC were measured by using dual energy X-ray absorptiometry as well.All the data were analyzed statistically.Results Among the 19 segments,macrography after dissection revealed that 16 had been fractured,about 84.2%.The frac- ture always occurred in the centre or in the anterior part of the endplate.Within a vertebral body,the BMD and BMC of the cranial endplate were less than those of the caudal endplate,and the cranial 1/3 transverse layer and middle layer had lower BMD and BMC readings than the caudal layer.For the vertical region,from the anterior 1/3 to the posterior 1/3,or from the anterior 1/2 to the posterior 1/2,the BMD and BMC increased.For the endplate around the disc,the BMD of upper endplate was higher than that of the lower one,but the BMCs were equal.In one motion segment,the failure load correlated positively with BMD,and with the BMC of the endplate and the sub-endplate bone.Conclusion The variations in BMD and BMC within a vertebra and around a disc can explain why vertebral fractures are concentrated on the upper endplate,and why compressive fractures are always wedge-shaped.This un- derstanding can assist in the placement of inter-vertebral spacers.

0.05).In addition,in different medication intervals and the same total dosage(200 mg),there was no difference in the number of patients who reached ASAS20,ASAS50 anti BASDAI50 in both groups.The changes of other parameters were not observed.Conclusion Two dosages and different medication interval of rhTNFR-Fc have similiar efficacy onset time and maintenee period.Mean- while,at the same total dosage,there is no signifieant difference in therapeutic effect in the two dosage groups. However,50 mg(1/7 d)regimen has better compliance than 25 mg(1/3 d).

Objective To investigate the role of CD4~+CD25~+ Treg cells on the pathogenesis of ankylos- ing spondylitis(AS), and to study the machanism of tumor necrosis factor(TNF)-?blocker on the treatment of AS by detecting the number of CD4~+D25~+ Treg cells before and after the treatment. Methods The diagno- sis of 10 AS patients was made based on the 1984 modified New York criteria. The patients received subcuta- neou injection of recombinant human tumor necrosis factor receptor-Fc fusion protein(rhTNFR-Fc)(etaner- cept)50 mg weekly for 8 weeks and 10 heathy subjects were enrolled for control. The mononuclear cells were isolated from peripheral blood in beth patients and controls. The number of CD4~+CD25~+ T cells and CD4~+ CD25~(high)T cells and the expression of CTLA-4. were detected by flow cytometry. Results The proportion of CD4~+CD25~+ T cells(24?19)% in total CD4~+ T lymphocytes of peripheral blood and CD4~+CD25~(high)T/CD4~+ T (6?6)% from AS patients before treated with rhTNFR-Fc was higher than that in healthy volunteers and AS patients after treatment(P

OBJECTIVETo study the effect and mechanism of Ganbi decoction (GBD) in treating patients with antituberculotic agent caused liver injury (ATB-LI).

METHODSOne hundred and twenty-eight patients with ATB-LI were randomly assigned to the treated group (n = 66) and the control group (n = 62) with the envelop method. Meanwhile, 60 healthy persons were selected as the healthy control group. The treated group was treated by GBD one dose every day with the constituents modified depending on patients' symptoms, and the control group was treated with glucuronolactone tablets and inosine injection. One week was taken as one treatment course. The changes of clinical syndromes, physical signs, T-lymphycyte sub-groups and serum level of nitric oxide (NO) were observed before and after treatment and the recovery time of liver function was recorded. The outcome was compared with that in the healthy control group.

RESULTSIn the treated group, 28 patients (42.4%) were cured, 30 (45.5%) improved and 8 (12.1%) ineffectively cured, the total effective rate being 87.9% (58/66). In the control group, 17 patients (27.4%) were cured, 24 (38.7%) improved, and 21 (33.9%) ineffectively cured, the total effective rate being 66.1% (41/62). The total effective rate in the treated group was significantly higher than that in the control group (P < 0.05). Liver function was improved in both groups, recovery time in the treated group was 12.0 +/- 7.0 days, which was significantly shorter than that in the control group (16.0 +/- 8.0 days), showing significant difference between the two groups (P < 0.05). The levels of CD3, CD4 and CD8 were significantly higher and level of NO significantly lower in the two groups of patients than those in the healthy control group (P < 0.05), but these parameters were improved more significantly in the treated group after treatment, when compared with those before treatment or with those in the control group, all showing significant difference (P < 0.05).

CONCLUSIONGBD could prevent ATB-LI, and its mechanism could be by way of reducing NO production induced by endotoxin of macrophage and stimulating the proliferation of T-lymphycyte to elevate immunity.

Adult ; Aged ; Antitubercular Agents ; adverse effects ; Chemical and Drug Induced Liver Injury ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glucuronates ; therapeutic use ; Humans ; Inosine ; therapeutic use ; Liver Diseases ; drug therapy ; Liver Function Tests ; Male ; Middle Aged ; Nitric Oxide ; blood ; T-Lymphocyte Subsets ; Treatment Outcome

Erythrocytes ; metabolism ; Fatty Liver ; blood ; Female ; Hepatitis ; blood ; Humans ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Male ; Middle Aged ; Receptors, Complement 3b ; blood ; Thymosin ; therapeutic use ; Tumor Necrosis Factor-alpha ; metabolism