Objective To research the effect of perioperative thermal preservation on hemostatic function in elderly patients with laparoscopic rectal cancer resection.Methods Eighty-six elderly patients with laparoscopic rectal cancer resection with ASA Ⅰ-Ⅱ were randomly divided into control group (43 patients) and test group(43 patients).Control group was given routine operation,test group was given routine operation and thermal preservation.The nose pharynx temperature was monitored and recorded respectively on preanesthesia,30,60,90 min post-anesthesia and after operation.The level of prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),platelets (PLT),D-dimer(DD),fibrinogen (FBG),yon Willebrand factor (vWF) were detected on preanesthesia,30,60,90 min post-anesthesia and 24,48 h post-operation.Results The temperature in control group on 30,60,90 min pest-anesthesia and after operation [(36.1 ± 0.2),(36.0 + 0.1),(35.7 + 0.1),(35.6 ± 0.2) ℃] was significantly lower than that on preanesthesia [(36.8 ± 0.2) ℃] and the same time in test group [(36.8 ± 0.0),(36.7 ± 0.1),(36.7 +0.2),(36.8 ±0.2) ℃] (P ＜0.05).The level of PT,APTT and TT in control group on 30,60,90 min post-anesthesia and after operation were significantly longer than those on preanesthesia and the same time in test group (P ＜0.05).The level of PLT in control group after operation and on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group(P ＜ 0.05).The level of DD and vWF in control group on 24,48 h post-operation were significantly higher than preanesthesia and the same time in test group (P ＜ 0.05).The level of FBG in control group on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group (P ＜ 0.05).The hemostatic function had no significant change in test group (P ＞0.05).Conclusion The perioperative thermal preservation in elderly patients with laparoscopic rectal cancer resection can alleviate hemostatic function suppression and promote recovery.

Objective To evaluate the reason of failure of the interlocking nail.Methods From1998-2001, 72 patients with femur fractures were treated with the interlocking nail.Results 61 cases were followed-up,there were 5 breakages in the locking nail. The failure occurred after operation from 4～9 months.And 3 cases were at the middle of the nail.2 cases were at the first screw of the distal of the fracture.Conclusion The reason of breakage concluded open operation,too much separation of the periosteum,too early full weight bearing and unfit function exercise.

Objective To study the value of emergency angiography and interventional therapy in digestive tract hemorrhage. Methods 123 cases was performed with repeated angiography after perfusing vasodilator substance in those patients without bleeding signs in the first angiography. According to with or without bleeding during angiography, these cases were divided into group A (the patients is bleeding during angiography) and group B (the patients' stool bleeding examined were negative before angiography) for analysis. The patients with bleeding demonstrated angiographically had accepted the arterial embolization and/or infusion of vasoconstrictor substance later on. Results 90.8% patients of group A was found bleeding and 47.22% patients of group B was found bleeding on angiography. Bleeding was stopped immediately in all those patients with arterial embolization and 82.7% of those patients with vasoconstrictor substance infusion. Conclusions The detective rate of bleeding in active stage is greater than that of in resting stage on emergency angiography of patients with digestive tract hemorrhage ( P

Cerebral hemodynamic changes are an important pathophysiologic process for the occurrence and development of Moyamoya disease. Cerebral hemodynamic changes of Moyamoya disease have been a research focus. This article mainly reviews the cerebral hemodynamic parameters and detecting methods, characteristics of cerebral hemodynamic changes in patients with Moyamoya disease and their new progress.

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society (AOFAS) scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were followed up, with a mean 29.1 months (12-45 months). All the fractures were healed. The mean bone healing time was 13.3 weeks (11-16 weeks) and the mean time of total weight-bearing was 12.1 weeks (11-15 weeks). The ankle function score had improved from 29 (21-47) preoperatively to 81 (56-91)12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle with lateral malleolar malunion.

Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.

Objective To investigate the correlation between cognitive function and cerebral microbleeds (CMBs) in patients with small artery occlusive stroke (SAO).Methods The patients with SAO in Nanjing Stroke Registration Program were recruited from January 2011 to May 2011.The Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive evaluation.At the same time,conventional MRI sequences and susceptibility-weighted imaging (SWI) were used to detect CMBs.Results A total of 70 patients with SAO were included in the study,48 of them had abnormal MoCA scores ( ＜26 points) and 22 of them had normal MoCA scores (≥26).The age of patients (t =-2.237,P =0.023),years of education (t =2.297,P =0.029),history of hypertension (x2 =2.297,P =0.025 ),severity of white matter hyperintensities (Z =-3.263,P =0.001) and presence of CMBs (P =0.001) were associated with the abnormal MoCA scores in patients with SAO.Logistic regression analysis showed that after adjusting for age,sex,white matter lesions,hypertension,diabetes and coronary heart disease,the presence of CMBs (odds ratio 5.648,95％ confidence interval 1.105-28.869; P =0.038) was still an independent risk factor for abnormal MoCA scores.The more serious of CMBs,the lower the MoCA scores (r =- 0.532,P ＜ 0.001 ).In patients with CMBs,the cognitive domain,such as the total MoCA score (t =5.180,P ＜ 0.001 ),visuospatial/executive function (t =3.924,P ＜ 0.001 ) and attention (t =4.309,P ＜ 0.001 ) were impaired significantly.The CMBs at different parts resulted in cognitive impairment in the related fields.Conclusions The numbers of CMBs and their locations were closely associated with cognitive impairment in patients with SAO.

Objective To evaluate the clinical outcome of lateral malleolar's anatomical hook-plate in treating ankle fracture including distal fibular fracture. Methods Nineteen patients of ankle fracture including distal fibular fracture were treated from January 2006 to January 2009. There were 12 males and 7 females with an average age of 36 years (range, 18-72 years). The fractures were classified by Danis-Weber system. There were A type in 8 cases, B type in 11 cases. The average time of duration between injury and operation was 6 days (ranged from 6 hours to 16 days). The distal fibular fracture were treated with lateral malleolar's anatomical hook-plate. The medial malleolus was fixed with cancellous bone screw. The posterior malleolus was fixed with screw or plate according to the pattern of fracture. Results The mean follow-up period was 18.8 months with a range from 6 to 32 months. No obvious fracture line could be seen on the radiographs 4-6 weeks after operation. Bone healing was achieved in 10 cases 12 weeks after operation and in 9 cases 20 weeks after operation. All surgical incisions healed adequately. There were no instances of infection, instability of ankle and other complications. According to Mazur ankle joint scoring scale system, the fiual result was scored from 67 to 92 (average 86.3). There were excellent in 12 cases, good in 4, fair in 2,and poor in 1 case. The excellent and good rate was 84.2%. Conclusion The lateral malleolar's anatomical hook-plate represents a definite biomechanical superiority in treating fracture of the external malleolus, with advantage of restoring anatomic structure, joint activity effectively and firm fixation.

We investigated the development of an injectable, biodegradable hydrogel composite of poly(trimethylene carbonate)-F127-poly(trimethylene carbonate)(PTMC11-F127-PTMC11 )loaded with bone morphogenetic protein-2 (BMP-2) derived peptide P24 for ectopic bone formation in vivo and evaluated its release kinetics in vitro. Then we evaluated P24 peptide release kinetics from different concentration of PTMC11-F127-PTMC11 hydrogel in vitro using bicinchoninic acid (BCA)assay. P24/ PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine and ectopic bone formation of the implanted gel in vivo was detected by hematoxylin and eosin stain (HE). PTMC11-F127-PTMC11 hydrogel with concentration more than 20 percent showed sustained slow release for one month after the initial burst release. Bone trabeculae surround the P24/ PTMC11-F127-PTMC11 hydrogel was shown at the end of six weeks by hematoxylin and eosin stain. These results indicated that encapsulated bone morphogenetic protein (BMP-2) derived peptide P24 remained viable in vivo, thus suggesting the potential of PTMC11-F127-PT- MC11 composite hydrogels as part of a novel strategy for localized delivery of bioactive molecules.
Animals ; Biocompatible Materials ; chemistry ; Bone Morphogenetic Proteins ; pharmacology ; Bone and Bones ; drug effects ; Dioxanes ; chemistry ; Drug Delivery Systems ; Hydrogels ; chemistry ; Osteogenesis ; drug effects ; Peptides ; Prostheses and Implants ; Rats

Objective To evaluate the prognostic value of hyperintense vessel (HV) in patients with acute middle cerebral artery (MCA) occlusion.Methods Seventy-four consecutive patients with first ever stroke(48 male and 26 female,the mean age was (60.7 ± 15.3) years) in the territory of MCA,retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011,were enrolled assubjects.All subjects completed brain MRI,and MRA or DSA indicated proximal MCA occlusion.According to the location and extent of HV,all subjects were classified into 3 groups:without HV,proximal HV and distal HV.Clinical data were obtained and compared among patients with different grades of HV.Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke.Results HV was observed in 49 (66.2％ ) of the 74 enrolled patients.Among patients with HV,7 (9.4％ ) were classified as proximal HV and 42 ( 56.8％ ) as distal HV.Initial NIHSS score ( 11 ( 1 -22) ),10-day NIHSS score ( 13.5(4-25) ),infarction size ( ＞2/3:5 cases(6.8％ ) ),and 90-day mRSscore (3-6 scores:12 cases( 16.2％ )) were significantly lower in patients with distal HV than those without (15(6-25),Z=-3.544;7(0-22),Z=-4.461;20 cases(27.0％),x2 =20.916;27 cases (36.5％),x2 =22.689;all P＜0.01).The NIHSS score decreased from baseline to that on 10 days and the mRS score decreased from 10 days to that on 90 days in patients with distal HV was more than that in patients without distal HV. Multivariate analysis revealed that patients with older age ( OR =1.111,95％ CI 1.036-1.191,P=0.003),high infarction size (OR=3.679,95％ CI 1.35-10.025,P=0.011) worsened outcome,whereas distal HV (P =0.012,OR =0.131,95％ CI 0.027-0.638)improved outcome.Conclusion Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral artery occlusion.