Objective To explore the clinical efficacy of ebridement and suturing combined with double vacuum sealing drainage (VSD) technology for the treatment of pressure ulcer. Methods Totally 32 patients of pressure ulcer (from July 2011 to October 2015) re-ceived debridement and suturing after infection control. Then F14 silicone ventricular drainage tube was placed in the wound for drainage while VSD was placed outside the wound. Both tubes inside and outside wound were connected to the central vacuum (20~40 kPa). Three days after the drainage,F14 silicone ventricular drainage tube was removed,and VSD material outside wound was replaced to continuous vacu-um treatment for another 3 to 4 days. Results All of 32 cases were healed up without hematoma,dead space and flap margin necrosis,inclu-ding 4 cases of poor healing,which were healed after active dressing. Conclusion Small area of the pressure ulcer can be closed up by de-bridement and suturing combined with double VSD technology,which is a simple operation with little injury and high clinical application value.

OBJECTIVE:To optimize the prescription and preparation of matrine liposomes.METHODS:The liposomes were prepared by the reverse-phase evaporation technique;the envelope efficiency and the diameter of matrine liposomes were taken as criteria,the prescription and preparation of the liposomes were optimized by orthogonal design.RESULTS:The best prescription consisted of egg phosphatidylcholin(80mg),the oil phase cholesterol(15mg),the water phase phosphate buffer so?lution(pH=7.0)and matrine(30mg);the best preparation technics was as follows:chloroform(30ml),ultrasonic time was10min rotary evaporating temperature at48℃.The liposomes had homogeneous shape with the particle size at250nm～750nm and the envelope efficiency of matrine liposomes at47.25%.CONCLUSION:The optimized formulation of martine liposomes is reasonable in prescription,practicable in technics,high in envelope efficiency and perfect in stability.

Objective Using Mental Practice as a training method to train students grasping skills of minimally invasive surgery(MIS),and analyze the change of mental practice in training grasping skills of MIS.Methods 36 students were randomly divided into mental practice training group (MPTG) ( n =12 ),conventional training group (CTG) ( n=12),control group (CG) ( n=11 ).Under the uniform appraisal standards and conditions,using different training methods to teach the grasping skills of MIS,and analyze the results statistically.Results MPTG' s pre-training test results ( 16.18 ± 5.73 ) and post-training test results (79.47 ± 22.05 ) were significantly different(P ＜ 0.001 ),post-training and two weeks later test results ( 89.32 ± 31.56) displayed no significant difference(P=0.283) ; CTG' s pre-training test results ( 17.47 ±8.33) and post-training test results (57.18± 21.83 ) were significantly different (P ＜ 0.001 ),post-training and two weeks later test results (42.27 ± 24.64)had significant difference(P=0.048) ; CG's pre-training test results ( 18.19 ± 4.74) and post-training test results (38.04 ± 19.13 ) were significantly different(P =0.003 ),post-training and two weeks later test results (23.71 ±15.71 ) had significant difference (P=0.034).Compared with MPTG in pre-training test,CTG (P=0.632) and CG (P =0.464) neither had significant difference,but in the post-training test,CTG (P =0.014) and CG (P ＜0.001 ) both had significant difference compared with MPTG.In the two weeks later test,CTG and CG both (P＜0.001 ) had significant difference compared with MPTG.Conclusion Mental practice training method can improve the pedormance of gasping skills of MIS significantly and better durability,improve the learning curve,easy to implement in teaching,easy to master students,it will be a new method of MIS skills training in the future.

Diabetic foot ulcer is a major complication of diabetes which is the most expensive and the most difficult to deal with and leads to a high rate of non-traumatic amputation.Diabetic foot osteomyelitis results from aggravation of diabetic foot ulcer.Unfortunately,the current therapeutic outcomes of diabetic foot osteomyelitis are still unsatisfactory because of its difficult diagnosis and special treatment protocols which are entirely different from those for conventional soft tissue infections.This paper summarizes the latest advances achieved in diagnosis and treatment of diabetic foot osteomyelitis.

OBJECTIVETo investigate the efficacy and safety of antiviral treatment in patients with hepatitis C virus (HCV) infection and decompensated cirrhosis and determine the effects of virological response on long-term prognosis.

METHODSSixty-six consecutive,interferon (IFN)-na(i)ve patients with HCV infection and decompensated cirrhosis were enrolled in this prospective study. All patients were given a 48-to 72-week course of IFN plus ribavirin (RBV) combined therapy,with a low accelerating dosage regimen using either:pegylated (PEG)-IFNa-2b at 1.0-1.5 mug/kg/week,PEG-IFNa-2a at 90-180 mug,or standard IFN-a-2b at 3MU,every other day.RBV was given at 800 to 1000 mg/day. All patients were routinely monitored for adverse drug reactions and virological response.Effects of treatments on patient survival were assessed by Kaplan-Meier analysis.

RESULTSAt the end of treatment,74.2% of patients were HCV RNA-negative,with 45.5% having achieved sustained virological response and 28.8% having relapsed;the remaining 25.7% of patients showed non-virological response (NVR). Among the patients with HCV genotype 1, 65.9% achieved end-of-treatment virological response (ETVR) and 34.1% achieved SVR;among the patients with HCV genotype 2,90.9% achieved ETVR and 68.2% achieved SVR. The positive and negative predictive values of early virological response (EVR) for ETVR were 95.7% and 75.0% respectively, and for SVR were 65.2% and 100% respectively. Compared with baseline,patients who achieved ETVR had better liver function,as evidenced by changes in levels of total bilirubin,alanine aminotransferase and albumin,as well as prothrombin activity and Child-Pugh score (t =4.564,11.486,2.303,2.699,3.694 respectively, all P less than 0.05).Compared with the NVR patients, the ETVR patients had lower risk of hepatic decompensation and hepatocellular carcinoma, and had improved survival (x2=18.756,6.992,7.580, respectively, all P less than 0.05).Twelve (18.2%) patients experienced serious adverse events,with 10 requiring premature treatment withdrawal and 2 dying.

CONCLUSIONAntiviral treatment for patients with HCV infection and decompensated cirrhosis using interferon in a low accelerating dosage regimen in combination with ribavirin is feasible.Patients who achieved ETVR had significantly improved long-term prognosis.

Alanine Transaminase ; Antiviral Agents ; therapeutic use ; Carcinoma, Hepatocellular ; Drug Therapy, Combination ; Genotype ; Hepacivirus ; genetics ; Hepatitis C ; diagnosis ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Kaplan-Meier Estimate ; Liver Cirrhosis ; drug therapy ; virology ; Liver Neoplasms ; Polyethylene Glycols ; therapeutic use ; Prospective Studies ; Recombinant Proteins ; therapeutic use ; Ribavirin ; therapeutic use ; Treatment Outcome

Objective:To compare the clinical effects on new bone formation and foot-ankle function between proximal tibial bone transport and distal tibial bone transport in the treatment of massive bone defects after tibial osteomyelitis debridement.Methods:From July 2012 to July 2017, 42 patients with chronic tibial osteomyelitis received bone transport surgery at Department of Orthopaedics, Nanfang Hospital.According to the Cierny-Mader classification for chronic osteomyelitis, all of them belonged to diffusive tibial osteomyelitis (type IV).Of them, 32 were treated by proximal tibial bone transport after tibial osteomyelitis debridement.In the proximal group, there were 27 males and 5 females, aged from 17 to 65 years and involving 20 left and 12 right sides. The other 10 cases received distal tibial bone transport. In the distal group, all of them were male, aged from 25 to 63 years and involving 6 left and 4 right sides. The 2 groups were compared in terms of external fixation index (EFI) and American Orthopaedic Foot & Ankle Society(AOFAS) Ankle and Hindfoot Scale.Results:There were no significant differences between the 2 groups in the preoperative general data such as gender, age or osteomyelitis site, indicating the 2 groups were comparable ( P>0.05). Both groups obtained complete follow-up. The proximal group was followed up for 590.1 d ± 287.3 d and the distal group for 615.6 d ± 130.6 d, showing no significant difference between groups ( P>0.05). In the proximal group 2 cases developed talipes equinovalgus after bone transport while in the distal group 3 cases did, and surgical intervention was needed for them. Surgical intervention was also carried out for16 cases of non-union at the docking site in the proximal group and for 2 ones in the distal group. The EFI was 76.2 d/cm±50.0 d/cm for the proximal group and 84.3 d/cm ± 59.9 d/cm for the distal group, showing no significant difference between groups ( P>0.05). The AOFAS scores were 81.4±10.1 for the proximal group and 60.0±5.9 for the distal group, showing a significant difference ( P<0.05). Conclusion:In the treatment of massive bone defects after tibial osteomyelitis debridement, no significant difference has been observed in the effect on bone formation between proximal tibial bone transport and distal tibial bone transport, but the former transport may have a less adverse effect on foot-ankle function.