Calcaneus ; injuries ; surgery ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans

ObjectiveTo study the efficacy and safety of early endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy (EST) for patients with acute biliary pancreatitis.Methods420 patients who were admitted to our hospital for management of acute biliary pancreatitis were divided into early endoscopic therapy group (n=218 patients) and conservative therapy group (n=202 patients).The durations for complete disappearance of abdominal pain,decrease in serum and urine amylase levels to normal,liver function recovery time,white blood cell recovery time,and the mean duration and costs of hospitalizations were analyzed.ResultsIn the ERCP group,all patients received EST.The stones in 172 patients with choledocholithiasis were removed with dormia baskets or balloon catheters.In 20 patients with severe acute biliary pancreatitis,endoscopic pancreatic duct stents were inserted for drainage.The durations of complete disappearance of abdominal pain,decrease of serum and urine amylase values to normal,white blood cell recovery time,liver function recovery time,cost of hospitalization and duration of hospitalization were significantly shorter in the early ERCP group than the control group.The mortalities in the ERCP and the control groups were 8.0％ and 22.2％,respectively.Conclusions Early endoscopic management for patients with acute biliary pancreatitis was not only safe and efficacious,but the management helped to identify the underlying causes of pancreatitis and reduced the duration of hospital stay and expenses.

Objective To evaluate the diagnostic value of serum (1-3)-β-D-glucan detection for invasive fungal infection (IFI) in neonates. Methods Eighty-seven neonates who were suspected to be IFI cases in neonatal intensive care unit from May 2008 to January 2010 were enrolled into this study. All subjects had infection symptoms, while did no react to the antibiotics treatment. The diagnosis of IFI was made according to Invasive pulmonary fungal infection diagnostic criteria of children set by Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association and Invasive fungal infection diagnostic criteria for critical patients set by the Society of Critical Care Medicine, Chinese Medical Association. Circulating (1-3)-β-D-glucan levels were determined with GKT-5M set kinetic fungus detection kit. Levels of (1-3)-Β-D-glucan in IFI group and that in the control group were compared; optimal cut-off value was established with receiver operating characteristic (ROC) curve; and the sensitivity and specificity at the cut-off value of 20.0 pg/ml and optimal cut-off value were calculated and compared. Results Among the 87 suspected cases, 59 cases were not diagnosed as IFI and 28 cases were diagnosed as IFI finally. Five patients were confirmed to be IFI; seven cases were clinically diagnosed and 16 cases were still suspected IFI. Among the five confirmed cases, four cases were blood culture positive for Candida parapsilosis, one case Candida albicans positive and two cases both cerebrospinal fluid culture and blood culture positive for Candida albicans. The median levels of (1-3)-β-D-glucan of patients diagnosed as IFI (n=28) was 131.6 pg/ml(18.6-9999.0 pg/ml), which was higher than that of the patients without IFI (8.5 pg/ml, 5.0-34.6 pg/ml)(Z=-5.064, P<0.05). Area under ROC curve was 0.806 (95% CI: 0.725-0.886, P<0.05). The sensitivity (96.43% vs 69.49%) and specificity (72.22% vs 84.21%) for (1-3)-β-D-glucan were different as 20.0 pg/ml and 53.7 pg/ml were used as the cut-off values for diagnosing IFI. Conclusions (1-3)-β-D-glucan level could be used to diagnose IFI of neonates, but further studies are needed to evaluate false-positive rates and its cut-off value in IFI diagnosis.

Objective To evaluate the value of bypass graft in the treatment of critical lower limb ischemia with distal single outflow artery.Methods Forty-nine lower limbs in 42 patients with single outflow artery were collected and underwent arterial bypass graft.The operation methods included femoropopliteal artificial graft to single outflow artery with autograftand popliteal artery to calf vessel and so on.The results were analyzed finally.Results All of 42 patients,postoperative grafts occlusion occured in 1 case,the occlusion rate was 2.4％(1/42) and the success rate was 97.6％(41/42),1 case died of respiratory failure 4 d postoperatively,the mortality was 2.4％(1/42).The patency rate of graft was 100.0％(41/41) on discharge.Healing rate of foot ulcer was 33.3％ (11/33).Conclusions It's difficult to reconstruct blood flow for critical ischemic limb with single outflow artery,but good result is still expected by distal lower limb bypass graft.Distal bypass can provide a better nutritional support for the healing of foot ulcer and result in a lower limb salvage or lowering of amputation level.

OBJECTIVETo evaluate the functional outcomes of modified limited "L" incision beside the Achilles tendon with distraction bone block arthrodesis in treatment of subtalar osteoarthritis.

METHODSFrom March 2009 to September 2012, a total of 22 cases of old calcaneus fractures with subtalar osteoarthritis were treated with modified limited "L" incision and distraction bone block arthrodesis including 13 males and 9 females with a mean age of 35.3 years old (ranged 22 to 49). The mean time from calcaneal fracture was 21 months (ranged 11 to 32). According to the Stephens-Sanders classification, 16 cases were type II and 6 were type III. The modified-AOFAS ankle-hindfoot score was used for functional outcomes evaluation.

RESULTSThere was one incision necrosis and no infection, implant failure, bone-graft absorbed or talus necrosis was note at the follow-up time. A total of 21 cases were followed up for a mean time of 29 months (ranged from 18 to 46 months). All of the cases reached a bony union within 4 months postoperation. The mean modified-AOFAS ankle-hindfoot score was 82.6 points (ranged from 66 to 92 points),reached a significantly improvement in comparing with the mean preoperative score (50.8 points,ranged from 32 to 65 points, P < 0.01).

CONCLUSIONThe modified limited"L" incision beside the Achilles tendon with distraction bone block arthrodesis is an acceptable and alternative treatment method for subtalar osteoarthritis. This method is easy to use and with less complication. It can correct the main pathological changes and reach good functional outcomes.

Adult ; Arthrodesis ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Subtalar Joint ; surgery

Objective To investigate the ultrasonographic and pathological changes of peripheral pulmonary lesions in acquired immunodeficiency syndrome (AIDS) complicated with Penicillium marneffei pneumonia (PMP) and their clinical significance.Methods The ultrasonographic and pathological data of peripheral pulmonary lesions in 31 cases of AIDS complicated with PMP who were diagnosed in Fourth People's Hospital of Nanning were retrospectively reviewed.Results Among 31 cases of PMP,20 cases (64.5％) showed star-like diffuse sonogram,7 cases (22.6％) low solid echo and 4 cases (12.9 ％) black hole-like sonogram in ultrasonographic changes of peripheral pulmonary lesions.In pathological examination,Penicillium marneffei were seen in all samples:periodic acid-Schiff stain (PAS) and periodic acid-Schiff diastase stain (PAS-D) were all positive.Twenty four cases (77.4％) mainly showed infiltration of inflammatory cells,and 7 cases (22.6 ％) mainly showed necrosis and fibrous hyperplasia.Among 20 patients with star like diffuse sonogram,19 were mainly infiltration of inflammatory cells in pathological changes,and 19 were CD4+ T lymphocyte counts of 100-200/μL.Among 4 patients with black hole-like sonogram,all were necrosis in the central and hyperplasia in the peripheral in pathological changes,and CD4-T lymohocyte counts were all＜50/μL.Conclusions In AIDS patients complicated with PMP,ultrasonographic features were probably correlated with pathological changes in biopsy tissues and CD4-T lymphocyte counts.

Objective To explore the therapeutic strategy and clinical value of intraoperative chole-dochoscopy and electrohydraulic lithotripsy for refractory intrahepatic bile duct stones.Methods Liver pa-renchyma,intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 1 1 cases of refractory intrahepatic bile duct stones.Electrohydraulic lithotripsy and lithot-omy were performed to remove the stones and protect the liver parenchyma.If the stones could not be re-moved once,a secondary lithotripsy and lithotomy was performed through the fistula tract.Results All re-fractory calculi were crushed after one or two procedures and the clearance rate were 100%.No complica-tions occurred.Ten patients were followed up from 1 to 3 years except one.Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholic acid capsules in 1 to 2 years.Seven others showed no stone recurrence within follow-up time.Conclusion Intraoperative choledochoscopy and electro-hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma.The life quality of patients can be improved with low surgical risk and postoperative complications.

ObjectiveTo study the influence of Jiuqiang Naoliqing (JNQ) on the expression of calcitonin gene related peptide(CGRP)and Synapsin Ⅰ in brain of the spontaneous hypertension rats (SHR). MethodsThe rats were randomly divided into 4 groups: Wistar group, SHR group, lower dose of JNQ treated SHR group and higher dose of JNQ treated SHR group. The expression of CGRP and Synapsin Ⅰ in the dentate gyrus, CA1 subfield of hippocampus and cortex were determined by immunohistochemistry after treatment for 3 weeks. ResultsCompared with the Wistar group, the expression of CGRP and Synapsin Ⅰ in the dentate gyrus, CA1 subfield of hippocampus and cortex of SHR group significantly decreased. The treatment with lower dose of JNQ significantly enhanced the expression of CGRP in cortex(P<0.05 vs SHR).The treatment with higher dose of JNQ significantly enhanced not only the expression of CGRP in the dentate gyrus, CA1 subfield of hippocampus and cortex, but also that of Synapsin Ⅰ in the CA1 subfield of hippocampus selectively in comparison with SHR group. ConclusionJNQ may improve the micro circulation in brain by up regulating the expression of CGRP and enhance the modulating function of central nervous system by up regulating the expression of Synapsin Ⅰ in spontaneous hypertension rats.

ObjectiveTo observe the effect of Jiuqiang Naoliqing (JNQ) on the behavior of Kunming mice.MethodsSpontaneous movement, Morris Water Maze, Rotarod, anti caffeine test, sleeping time of pentobarbital sodium, subthreshold dose of pentobarbital sodium, and anti pentylene tetrazol test were adopted to evaluate the behavioral changes. ResultsCompared with the control group, the low dose of JNQ can increase spontaneous movement of the mice, the middle and high dose of JNQ can increase time on the rotating rods. JNQ can also increase sleeping time of pentobarbital sodium test and percent of falling asleep in subthreshold dose of pentobarbital sodium test, as well as antagonize caffeine's effect on mice. ConclusionJNQ can also do sedative and hypnotic effect on Kunming mice as well as improve their ability of balance and coordination.

ObjectiveTo characterize the neural progenitor cell in the human amnion mesenchyme and epithelial layer with specific mark proteins of neural stem cell.MethodsExpressions of specific mark proteins of neural stem cell including nestin, glial fibrillary acidic protein (GFAP), musashi-1, vimentin and PSA-NCAM in human amnion tissue and cultured amniotic cells were determined by immunohistochemistry and immunofluorescence staining.ResultsExpressions of pluripotent neural stem cell specific makers (nestin, musashi-1, vimentin and PSA-NCAM) were detected in the human amnion mesenchyme and epithelial layer. In addition, cultured amniotic cells were expressed several neural stem cell specific markers including nestin, GFAP and PSA-NCAM. Nestin+ and GFAP+ double positive cells were identified in the human amnion tissue and cultured amniotic cells by immunohistochemistry and immunofluorescence staining.ConclusionSpecific mark proteins of neural stem cell are expressed in human amnion tissue and cultured amniotic cells.