Objective To introduce a modified replantation for thumb rotating avulsion amputation,and to evaluate its short term clinical outcome.Methods From January 2007 to July 2009,7 patients with thumb rotating avulsion amputation underwent replantation,including 6 males and 1 female,aged from 21 to 47 years (average,28.3 years).The amputation level of each thumb was metacarpophalangeal joint.During operation,fusion of metacarpophalangeal joint was performed according to injury degree of soft tissue; interphalangeal joint of the thumb was fixed in 15 degrees of flexion by sewing flexor pollicis longus muscle tendon and extensor pollicis longus muscle tendon to tendon sheath or soft tissue; the superficial vein harvested from ipsilateral forearm was used to bridge the dorsal carpal branch of radial artery and the ulnar palmacollateral artery of the thumb; direct anastomoses of dorsal veins were performed in 6 cases and venous transplantation in 1 case; and bilateral nerves were transferred to the back of the first metacarpal and anastomosed to the superficial branch of the radial nerve.Results All 7 replanted thumbs survived completely.Arterial crisis occurred in 1 case after operation,which was cured after operative and medication treatment.The follow-up period ranged from 3 to 24 months.The appearance and opposition function of replanted thumbs were satisfactory and the sensation of fingertip recovered to S4 in 4 cases and to S3 in 3 cases.The two point discrimination ranged from 8 to 12 mm.Conclusion Because bridging the dorsal carpal branch of radial artery and the ulnar palmar collateral artery of the thumb with a superficial vein harvested from ipsilateral forearm to reconstruct blood supply of the thumb is available and easy to be performed,this modified replantation is an ideal way to repair thumb rotating avulsion amputation.

Objective To report a case of toxic epidermal necrolysis associated with geotrichosis due to Geotrichum silvicola. Methods The exudates from the body surface, blood and urine of the patient were examined by microscopy and simultaneously inoculated onto the Sabouraud dextrose agar (SDA) medium. The isolate was examined by microscopy, PCR which amplified the D1/D2 domain of 26S rDNA, and gene sequencing. Homologous sequences were searched in the GenBank/EMBL/DDBJ/PD nucleotide sequence library, and the genetic relationship was analyzed with the genealogical tree. Results Microscopy of pus from the abscess on the dorsa of left hand revealed a lot of spores and a few hyphae, which were not observed in the blood or urine specimens. Meanwhile, whitish colonies were grown in all the three successive cultures of blood and urine specimens, rather than the exudates on the body surface. After itraconazole and garlicin were administered for one week, both microscopic exam and fungus culture were negative. Microscopic exam of the isolate showed arthrospores arranged in chains, budding spores and a few of hyphae. It was found that there was a one-base difference between our isolate (Hebei-1) and the isolate from kerion -like eruptions (Changzheng-1), and a four-base difference between our isolate and the reference Geotrichum silvicola strain as well, in the D1/D2 domain of 26S rDNA. This isolate was identified to be most close to Changzheng-1 in the phylogenetic tree. Conclusion The patient with toxic epidermal necrolysis is associated with geotrichosis due to Geotrichum silvicola.

PURPOSE: We performed a meta-analysis to evaluate the efficacy and safety of mirabegron add-on therapy to solifenacin for patients with overactive bladder (OAB). METHODS: We conducted a systematic literature review to identify all randomized, double-blind, controlled trials (RCTs) of this combination (mirabegron and solifenacin) for OAB. Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched. A manual search was also performed to investigate relevant references from the retrieved studies. RESULTS: Four publications describing 5 RCTs that compared combination therapy with solifenacin, including a total of 3,309 patients, were analyzed. The mean number of micturitions per 24 hours (mean difference [MD], -0.45; 95% confidence interval [CI], -0.65 to -0.26; P < 0.00001), number of episodes of incontinence per 24 hours (MD, -0.71; 95% CI, -0.14 to -0.02; P=0.04), volume voided per micturition, and number of urgency episodes per 24 hours demonstrated that combination therapy was more effective than solifenacin therapy alone. Safety assessments, including common treatment-emergent adverse events (odds ratio, 1.09; 95% CI, 0.95–1.27; P=0.23) and discontinuations due to adverse events (P=0.30), demonstrated that the combination therapy was well tolerated. CONCLUSIONS: This meta-analysis suggests that mirabegron therapy as an add-on to solifenacin provides a satisfactory therapeutic effect for OAB symptoms with a low occurrence of side effects.
Humans ; Solifenacin Succinate* ; Urinary Bladder, Overactive* ; Urination

Objective To determine the risk factors for imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in neonatal intensive care unit (NICU).Methods One hundred and eighty-eight Pseudomonas aeruginosa infected children (confirmed by pathogenic examination) in the NICU of Maternal and Child Health Hospital of Guangdong from January 1,2008 to December 31,2011,were chosen as the objects of study,and were divided into two groups.The first group included 73 children that had been isolated with IRPA strains(IRPA group),and the second group included 115 children that only had imipenem-sensitive Pseudo monas aeruginosa (ISPA) strains (ISPA group).Chi-square test or t-test was applied.The risk factors were investigated by univariate or multivariate Logistic regression analysis.Results Data from univariate analysis showed that the gestational age and birth weight of neonates were lower than those in ISPA group [(34.0±3.5) weeks vs (35.6±2.8)weeks,t=3.413,P＜0.01; (1848.1±276.4) g vs (2110.7±345.6) g,t=5.472,P＜0.01].There were more neonates with gestational age ≤ 32 weeks [67.1％ (49/73) vs 45.2 ％ (52/115)],birth weight ＜1500 g [73.9％ (54/73) vs 33.0％(38/115)],small for gestational age [68.5％ (50/73) vs 29.6％ (34/115)],receiving imipenem [72.6％ (53/73) vs 27.0％ (31/115)] or the third generation cephalosporins [65.8％ (48/73) vs 33.0％ (38/115)] two weeks before the isolation of Pseudomonas aeruginosa,and mechanical ventilation [78.1％ (57/73) vs 61.7 ％ (71/115)],deep vein catheterization [83.6％(61/73) vs 65.2％(75/115)] in the IRPA group than in the ISPA group (all P＜0.05 or 0.01).The multivariate Logistic regression analysis revealed that imipenem treatment within two weeks before the isolation of Pseudomonas aeruginosa (OR=6.409; 95％ CI:1.926-21.333,P =0.002) was an independent risk factor.Conclusions IRPA infection in NICU hospitalized infants is strongly related to their gestational age and birth weight.History of imipenem administration could be an independent risk factor.

Objective To evaluate the prophylatic effect of recombinant human erythropoietin (rhEPO) on bronchopulmonary dysplasia (BPD) of preterm infants. Methods One hundred and fifty-five infants who were born at 26-29+6 weeks of gestation in Department of Neonatology, Guangdong Women and Children Hospital from January 1, 2009 to December 31, 2010 were randomly assigned to rhEPO-treated group (n=78) and control group (n=77) on admission. Randomization was stratified according to gestational age (26 or 27 weeks and 28 or 29 weeks). rhEPO-treated group was given the rhEPO at 300 U/kg, but none for the control group. Forty-eight hours after birth, rhEPO was injected subcutaneously every other day, three times a week for 4 weeks. The supportive care was same in the two groups. The outcomes at 36 weeks gestation included:(1) mortality of the infants;(2) incidence and severity of BPD;(3) rates of the complications, such as pneumonia, sepsis, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), and retinopathy of prematurity (ROP) ; and (4) duration of oxygen and ventilation support. Mann-Whitney U, χ2, Fisher's exact or t test were used for statistical analysis. Results The incidence of BPD in rhEPO-treated group was lower than in the control group [18.6%(11/59) vs 36.8%(25/68),χ2=5.107,P=0.030), but there was no difference in the severity of BPD (P>0.05). There was no significant difference in the mortality rate between the two groups [12.8%(10/78)vs 7.8%(6/77), P>0.05]. The duration of the mechanical ventilation and oxygen therapy was shorter in rhEPO-treated group than in the control group [oxygen therapy:166.4(138.9-198.1) h vs 288.9(287.4-312.9)h, U=361.000;mechanical ventilation:80.5(67.7-95.1) h vs 150.4(148.9-151.9) h, U=88.000;both P<0.05]. There were no significant differences between the two groups in the rates of the complications, including pneumonia, sepsis, NEC, IVH, PDA and ROP, in preterm infants during hospitalization (all P>0.05). Conclusion Prophylatic treatment of rhEPO in preterm infants could decrease the incidence of BPD, and reduce the duration of the mechanical ventilation and oxygen therapy, but without increasing any side effects.

Objective To explore the diagnosis value of joint detection of microalbumin(mALB) ,α1-Microglolin(α1-M ) and N-acety-β-D-glucosaminidase(NAG) in the diabetes and hypertension patients with early injury of kidney .Methods Sample were col-lected from July 2013 to January 2014 ,including 63 diabetic cases(diabetic group) ,58 patients with hypertension(hypertension group) and 64 health controls(control group) ,then the levels of urinary mALB ,α1-M were detected by immunoturbidimetry ,urina-ry NAG activity was assessed by endpoint colorimetric assay .Results The levels of urinary mALB ,α1-M and NAG in diabetic group and hypertension group were higher than those in control group(P<0 .05) .The positive rates of three indices single detected were less than 50 .0% ,the positive rates of any two indices joint detected were more than 50 .0% ,the positive rate of three indices joint detected was more than 70 .0% .Conclusion The method of urinary mALB ,α1-M and NAG joint detected is sensitive and reli-able for diagnosing of the early injury of kidney .

Objective To study the factors which influence the dose distribution of brachytherapy in cervical cancer. Methods Ninety-five patients with cervical cancer Ⅱ - Ⅲ b received fundamental radiation therapy including brachytherapy in our department from Aug. 2004 to Nov. 2005. The deviation of isodose curve of brachytherapy was based on A-B reference system, and the deviation of dose was defined by measuring in a practical standard body model. Results The factors influencing isodose offset significantly were parametrial infiltrating degree, and anatomy factor of cervical cancer and operating skill. The degree of isodose offset could not be lowered with the increased frequency of brachytherapy. Conclusion Making simulation in cervical brachythecapy is necessary not only for the identification of the deviation of isodose curve but also for adjusting the dose distribution and revising the plan of radiotherapy.

Objective By exploring the alteration of tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor-1 (PAI-l) in plasma in Kawasaki disease (KD) patients to identify the pathophysiological mechanism of vascular damage and to detect the relationship between fibrinolytic system function and coronary artery lesion complications in Kawasaki disease patients. Method Plasma levels of t-PA, PAI-1 antigen were measured by enzyme-linked immunosorbent assay. Patients with KD were grouped into acute phase group, recovery phase group patients with coronary artery lesion group and non-coronary artery lesion group. Results Plasma t-PA and PAI-1 in acute phase and recovery phase groups were significantly higher than those in the healthy group (P

Objective To investigate the efficacy and prognostic factors of non-small cell lung cancer (NSCLC) leptomeningeal metastasis (LM) patients undergoing treatment with epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs).Methods The clinical data of 30 patients with NSCLC- LM were retrospectively analyzed, including the basic situation, survival time, clinical characteristics,pathological type,differentiation degree and treatment method.The median survival time (MOS) was calculated by Kaplan-Meier method. The log-rank test was used to analyze the prognostic single factors.The Cox regression model was used to analyze the multivariate factors. Results The log-rank test result showed that sex,pathological type,differentiation degree and EGFR-TKIs treatment were the influencing factors of MOS(P<0.05).The multivariate analysis result showed that sex,pathological type, differentiation degree and EGFR-TKIs treatment were the independent influencing factors of prognosis in NSCLC-LM patients (P<0.05), and the female gender (RR = 0.090, 95% CI 0.048 -0.140),adenocarcinoma(RR=0.108,95% CI 0.073-0.134),well differentiation(RR=0.112,95% CI 0.076 - 0.141), using EGFR-TKIs treatment (RR = 0.042, 95% CI 0.012 - 0.074) were significant predictors of a good prognosis. Conclusions The female gender, well differentiation, adenocarcinoma and EGFR-TKIs treatments are significant predictors of a good prognosis. EGFR-TKIs can prolong the survival time of patients with NSCLC-LM,and it is recommended for a clinical treatment for patients with NSCLC-LM.