BACKGROUND:Previous clinical fol ow-up study showed that disc degeneration of adjacent segment after anterior cervical discectomy and fusion was faster than that of artificial cervical disc replacement. Compared with the anterior cervical discectomy and fusion, artificial cervical disc replacement can maintain a good range of motion of replacement segment. Further investigation should be taken to compare the difference between stress and fusion after replacement. OBJECTIVE:To compare the adjacent level discs loads between artificial cervical disc replacement and anterior cervical discectomy and fusion. METHODS:A healthy 30-year-old male volunteer was scanned with CT at the artificial cervical intervertebral disc and anterior cervical plate. Three-dimensional images were reconstructed with Mimics 10.01 and Geomagic Studio.v11 software. Above three-dimensional data were input into the Abaqus6.9 finite element analysis software for meshing, assignment, and stress analysis. Finite element method was used to simulate the stress changes of the adjacent segments after artificial cervical disc replacement and anterior cervical discectomy and fusion. RESULTS AND CONCLUSION:(1) Under the same preload, during anteflexion, posterior extension, and lateroflexion, the disc stress at adjacent segment was significantly larger after anterior cervical discectomy and fusion than normal disc. Compared with normal persons, no significant difference was detected in stress of adjacent segment at anteflexion, posterior extension, and lateroflexion after artificial cervical disc replacement. (2) Compared with artificial cervical disc replacement group, the stress of adjacent segment increased 10.3%-51.6%in the anterior cervical discectomy and fusion group. (3) Finite element analysis showed that the stress was larger in the anterior cervical discectomy and fusion group than in the artificial cervical disc replacement group. With prolonged fol ow-up, compared with the conventional anterior decompression and fusion, artificial cervical disc replacement can better play its protective effect on the adjacent intervertebral disc.

OBJECTIVETo study the influence of estradiol on histomorphology of skin flaps with ischemia reperfusion injury.

METHODS48 adult male Wistar rats aged 12-14 weeks old, were randomly divided into control group (group I), ischemia-reperfusion group (group II), saline group (group III), estradiol group (group IV). Superficial epigastric artery axial flap, 3 cm x 6 cm in size, was made in the left lower quadrant abdominal of each rat. Flap model with ischemia-reperfusion injury was established by using the nondestructive micro vascular clamp to clamp the superficial epigastric artery. The general condition of the flap was observed after operation. At 7 days after operation, the survival rate of the flap was detected, the flaps were harvested to receive histology and ultrastructural observation. The neutrophils level of the superficial epigastric vein were tested.

RESULTS7 days after operation, the survival rate of the flap in group IV was significantly higher than that in group II, III (P < 0.05). The neutrophils level in group IV was lower than that in group II, III (P < 0.05). The histological observation showed that the degree of tissue swelling and inflammatory exudation in group IV was more slight than that in group II, III. Presence of high neutrophils density were observed in group II, III, while slight inflammation and necrosis were observed in group IV. In group I, collagen fibers in flap are regularly arranged with no significant necrosis. Oganelles structure disappeared and apoptotic bodies were shown in group II and group III, even the lysosome could be seen in the cell. Collagen fibers in flap are regularly arranged with slight swelling and no obvious ultrastructural necrocytosis was seen in the cell of group IV.

CONCLUSIONThe estradiol can significantly increase flap survival rate by inhibiting neutrophils infiltration and improving the pathological changes of organization structure in flap.

Animals ; Epigastric Arteries ; Estradiol ; Leukocyte Count ; Male ; Necrosis ; Neutrophil Infiltration ; drug effects ; Neutrophils ; cytology ; drug effects ; Random Allocation ; Rats ; Rats, Wistar ; Reperfusion Injury ; etiology ; pathology ; Sodium Chloride ; Surgical Flaps ; blood supply ; pathology

Object To observe the effect of gypenosides (GP) on the DNA and RNA in cerebral cortex and hippocampus in vascular dementia rat. Methods Modified Pulsinelli 4 vessel occlusion (4 VO) method was used to establish the models of vascular dementia rat. The acridine orange (AO) method was applied to study the protective effect of GP on the DNA and RNA of cerebral cortex and hippocampus in vascular dementia rat. Results The fluorescent intensity from the DNA and RNA in cerebral cortex and hippocampus of vascular dementia rat is abated as compared with the normal control group. The fluorescent intensity from DNA and RNA of the treatment group administrated GP (200 mg/kg, ig) significantly intensified, as compared with that of non treatment group, and is similar to that of normal group. Conclusion The injury to the DNA and RNA in cerebral cortex and hippocampus in vascular dementia rat was obviously decreased by GP.

Objective To evaluate the relationship between changes in B-type natriuretic peptide(BNP) and cardiac troponin I(cTnI)levels and prognosis of critically ill patients with sepsis. Methods This study retrospectively reviewed the clinical data of 75 patients with severe sepsis and septic shock admitted into Emergency Intensive Care Unit(EICU)of the First Affiliated Hospital of Wenzhou Medical University in Zhejiang Province. According to the severity of the cases,they were divided into two groups:severe sepsis group(34 cases)and septic shock group(41 cases),and based on the difference in prognosis,they were divide into survivor group(32 cases) and non-survivor group(43 cases). Electrocardiogram(ECG)was performed within 24 hours after admission in all the patients. Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score and biochemical markers showing organ dysfunctions as BNP, cTnI, creatine kinase (CK), creatine kinase MB mass(CK-MB), and lactate were compared between severe sepsis and septic shock groups and between survivor and non-survivor groups. Results The septic shock group had significantly higher baseline BNP,cTnI,lactate and APACHE Ⅱscore and mortality rate than those in severe sepsis group〔BNP(μg/L):1.90(1.08,2.79)vs. 0.41(0.31,0.75),cTnI (μg/L):1.15(0.92,1.28)vs. 0.58(0.40,0.79),lactate(mmol/L):6.63±3.72 vs. 3.28±1.66,APACHEⅡscore:26.00(24.00,28.00)vs. 21.50(20.00,29.25),mortality rate:70.73%vs. 41.18%,P<0.05 or P<0.01〕. Compared with survivor group,the ages of non-survivor group were older with more males and higher BNP,cTnI,lactate and APACHEⅡscore〔males(cases):30 vs. 13,age(years old):66.49±14.97 vs. 58.19±17.05,BNP:1.60(0.62, 2.51)vs. 0.57(0.37,1.79),lactate:4.10(3.00,9.00)vs. 3.10(2.13,4.18),cTnI:1.02±0.49 vs. 0.62±0.37, APACHE Ⅱ score:28.00(25.00,30.00)vs. 21.00(20.00,25.75),P<0.05 or P<0.01〕. However,there were no statistically significant differences in the levels of CK and CK-MB between the above compared groups(both P>0.05). The patients' ECGs had no obvious changes. Conclusions High plasma BNP and cTnI levels in patients with sepsis may suggest myocardial damage and relatively bad prognosis. The examination of BNP and cTnI levels may help clinicians to early detect the high-risk patients with septic cardiac dysfunction and assess their prognoses.

Objective To study epidemiology, clinical findings, diagnosis and treatment of sepsis caused by Vibrio vulnificus. Method Patientss with Vibrio vulnificus sepsis were collected from 1995 to 2008. The medical records including epidemiological and clinical data were analyzed. Results The male-to-female ratio of 34cases was 4.7:1 and 76. 5% of these patients suffered from chronic liver disease. Most patients occurred from April to October with signs of abrupt fever, characteristic cutaneous lesions, hypotension and progressive multiple organ disfunction syndrome (MODS). The mortality was over 47.1% . The criteria proposed for early diagnosis of Vibrio vulnificus sepsis were abrupt onset with fever during the period from April to November, characteristic cutaneous lesions, such as the most commonly occurred haemorrhagic bullae on the extremities or even extensive necrosis of skin and muscular tissue, progressive hypotension or shock accompanied by MODS, pre-existing liver disease or chronic abuse of alcohol, and consumption of raw seafood or exposure to seawater within 12 week. Early administration of the third-generation cephalosporins with the quinolones in full dosage, aggressive wound debridement,appropriate dermoplasty and supportive care contribute to a better outcome. Conclusions Vibrio vulnificus sepsis progresses rapidly with high mortality. Early diagnosis, rapid treatment with prompt antibiotics and aggressive surgery treatment are very important to improve the outcome.

Objective To explore the surgical methods and clinical application effects of repairing hand soft tissue defect with free vascularized flaps based on the distal perforator of ulnar artery.Methods From March, 2001 to December, 2012 in our hospital, 90 patients with hand soft tissue defects were repaired by free vascularized flaps based on the distal perforator of ulnar artery, including 74 patients cases were repaired by Phase Ⅰ emergency surgery, 16 patients cases with scar contracture were repaired by Phase Ⅱ surgery.There were 34 cases were rebuild the sensory by repaired the continuity between the dorsal branch of the ulnar nerve and dorsal digital nerve or palmar digital nerve.The free vascularized flaps that used the emerging point of perforator of the ulnar artery as center of the flap was designed, which based on the distal perforator to repairing the hand soft tissue defect.Results All 89 patients postoperative flaps were survived.Necrosis was seen in 1 flap which was repaired by skin grafting.Follow-up ranged from 3 to 36 months with an average of 12 months.The appearance of flap was not clumsy, the quality was good.The sensation was S3-S3+ in 34 cases after nerve reconstruction surgery.The active and passive activity of 16 cases with scar contracture were improved significantly.The incision in 72 cases for direct suture were healed without scar contracture, 18 cases of skin grafts were all survived without contracture.Conclusion The free vascularized flaps based on the distal perforator of ulnar artery has constant perforating point, which can carry sensory nerves and leads to little donor site damage without major vascular injury.The flap serves as a simple approach to repair hand defects, and get satisfied skin flap appearance and texture, the fingers feel and function recovered well.

Objective To investigate the effect of resveratrol (Res) on paraquat (PQ)-induced acute lung injury (ALI) and mortality in mice and the mechanism of nuclear factor-κB (NF-κB) inflammatory pathway. Methods Sixty-eight healthy male ICR mice with grade SPF were enrolled, among them 20 mice were used for mortality observation (n = 10), and other 48 were used for determination of related parameters (n = 6). The mice were randomly divided into four group s: normal saline (NS) control group, Res control group, PQ group and PQ + Res group. The mice in the latter two groups were subdivided into 6, 24, 72 hours subgroups. The PQ poisoning model of mice was reproduced by one injection of 30 mg/kg PQ intraperitoneally. The mice in PQ + Res group were given 60 mg/kg Res intraperitoneally on the contralateral side after PQ injection. The mice were sacrificed at 6, 24, 72 hours after PQ poisoning, and lung tissue was harvested. The serum levels of tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-1β) were determined by enzyme linked immunosorbent assay (ELISA). The pathological changes in lung tissue were observed with electron microscopy. Apoptosis cells in the lung were identified by terminal dexynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) for the estimation of apoptosis rate. The protein expression of NF-κB p65 was determined by Western Blot. Results Compared with PQ group, the death number of mice at 48, 72, 96 hours in PQ + Res group was slightly decreased (0 vs. 2, 2 vs. 5, 4 vs. 6) but without statistically significant difference (all P > 0.05). Under electron microscope, the lung injury in PQ group was severer than that in NS control group, and Res was found to be able to alleviate the lung injury. Compared with NS control group [(2.45±0.61)%], the apoptosis rate at 6 hours in PQ group was significantly increased [(8.42±1.48)%], and peaked at 72 hours [(21.23±3.47)%]. Res could decrease the apoptosis rate after PQ poisoning [6 hours: (5.56±1.31)% vs. (8.42±1.48)%, 24 hours: (11.14±2.07)% vs. (16.88±2.96)%, 72 hours: (13.28±2.32)% vs. (21.23±3.47)%, all P < 0.05]. The serum levels of TNF-α, IL-6, and IL-1β, and NF-κB p65 in lung tissue were all markedly increased after PQ poisoning, and they were significantly decreased after Res intervention as compared with those of PQ group [TNF-α (ng/L): 2.62±0.29 vs. 4.06±0.74 at 6 hours, 3.98±0.41 vs. 6.79±0.80 at 24 hours, 5.06±0.75 vs. 11.00±0.75 at 72 hours; IL-6 (ng/L): 14.19±1.54 vs. 16.55±1.24 at 6 hours, 13.21±1.37 vs. 19.73±0.85 at 24 hours, 13.72±0.56 vs. 22.45±0.72 at 72 hours; IL-1β (ng/L): 8.54±1.64 vs. 12.59±0.66 at 6 hours, 10.15±0.29 vs. 16.24±1.03 at 24 hours, 16.14±0.70 vs. 19.55±0.56 at 72 hours; 6-hour NF-κB p65: (1.34±0.07) folds vs. (1.86±0.11) folds when the expression in NS control group was represented as 1, all P < 0.05]. Conclusions Res cannot lower the mortality in mice with PQ poisoning, but it seems to be able to attenuate PQ-induced ALI and cell apoptosis. The mechanism responsible for the latter maybe the inhibitive effect of Res on NF-κB p65 translocation and cytokines production.

Objective To compare the difference of the HBsAg detected results between the Roche cobas e601 electrochemilumi-nescence immunoassay instrument and the Abbott Architect i2000chemiluminescent microparticle immunoassay instrument.Methods The HBsAg positive specimens with the quantitation results of lower than 250IU/mL detected by the Abbott Architect i2000 were selected and simultaneously detected by the Roche cobas e601.The differences of detected results were compared and per-formed the linear correlation and analysis regression.Results 46 clinical specimens were detected.The detected results had best correlation between the two instruments by getting rid of 1 specimen with unconformable reactivity of detected results.15 speci-mens had the HBsAg detected result of 0.05-1.00 IU/mL by the Abbott Architect i2000,the linear regression equation was Y =17.49X+0.843(r=0.979);15 specimens had the HBsAg detected result of 1.1 -10.00 IU/mL IU/mL by the Abbott Architect i2000,the linear regression equation was Y =15.72X +21.06(r=0.952);15 specimens had the HBsAg detected result of 11 -250 IU/mL by the Abbott Architect i2000,the linear regression equation was Y =29.17X -129(r=1.000).Conclusion The detected results have better correlation between the two instruments and can be mutually converted by the formulas.

Objective To investigate clinical features,treatments and prognostic factors of the patients with necrotizing fasciitis caused by vibrio infections and thus provide reference for the early treatment and prognostic assessment.Methods A retrospective analysis was conducted on clinical data of 56 patients with vibrio necrotizing fasciitis admitted to the emergency center of our hospital from May 1995 to June 2011.The clinical characteristics and treatments of the patients were summarized,and differences of clinical factors between the survival group and death group were compared.The possible influencing factors for prognosis were also analyzed.Results The main clinical manifestations included fever (61％),shock (84％) and organ dysfunction,of which renal insufficiency (88％) was the most common,with case fatality of 43％.Early pathological changes of limbs were only local swelling and pain,while skin ecchymosis,tension blood blisters,necrosis and subcutaneous crepitation were the signs of advanced stage.Comprehensive treatment regime including early administration of sensitive antibiotics plus surgical incision and drainage and medicine support was given.A series of factors were significantly different between the survival and death groups including the duration from the presentation of symptoms to hospital admission (P ＜ 0.05 ),limb lesions involving the trunk (P ＜ 0.01 ),creatine kinase level (P ＜ 0.05 ),and emergency incision and drainage ( P ＜ 0.01 ).Conclusions The most prominent clinical manifestations of vibrio necrotizing fasciitis are rapidly progressive local symptoms and signs,and sharp deterioration of systemic conditions.Delayed visiting,severe local lesions,and failure to emergency surgery may be the factors for poor prognosis.