Objective This article provides a reform operative method for repairing non union in proximal or middle ulna Methods According to anatomical stady of recurrent interosseous artery from both blood supply and biology strength designs the transposition of proximal ulna periosteal bone flap, combining external fixator to repair non union in ulna Results Twelve cases of non union in proximal or middle ulna were treated by this means, these results were encouraging Conclusions Periosteal bone flap based on recurrent interosseous artery has a stable position, reliable blood supply and no injuring main vessel Moreover external fixator has many advanture, such as steady fixation, rarely damage, simply operation, function train early to prevent producing stiff joint, activate fracture with physiological force, Both can prompt the healing of fracture, It is an efficient method to cure non union in proximal or middle ulna

Objective To describe the method and the clinical effect of the transplantation of cutaneous iliac flap and external fixation for the repair of the defect of tibia and soft tissue of the leg. Methods Between May 1998 and May 2001, 22 tibial fractures associated with bone and soft tissue defects of the leg were treated with Bastiani external fixation device and transplantation of the groin osteocutaneous flap with the deep circumflex iliac vessels. There were 15 males and 7 females with the the age ranged from 16 to 58 years and an average of 37 years. The follow-up period ranged from 5 to 36 months, with an average of 25. 5 months. Results All the osteocutaneous flaps survived completely after operation; the defects were repaired at one setting; the external fixation apparatuses were steady and the fracture healed smoothly. The bone graft healed with the host bone in three to six months. The recovery of function of the limb were satisfactory. There were no major complicaton in this series. Conclusion The groin osteocutaneous flap with the deep circumflex iliac vessels can be used to repair the bone and soft tissue defects in the tibia at one setting. The external fixation device provides a convenient condition for bone graft and prevents the stress protection effect.

Objective:To explore the clinical effect of hyperbaric oxygen plus magnetic stimulation and Xingnaojing injection on the coma patients with severe brain injury.Methods:120 coma patients with severe brain injury who were treated in our hospital from September 2011 to March,2016 were enrolled in the present study.According to different therapies,they were divided into the observation group (55 cases) and control group (65 cases).Both groups received conventional therapy and Xingnaojing injection,on the the basis of which,the control group received the Hyperbaric Oxygen therapy,while the observation group received Magnetic Stimulation on the basis of control group.The GCS,level of inflammatory factors,clinical prognosis as well as memory function were compared between the two groups.Results:After the therapy,the GCS score of both groups were obviously increased and that of observation group was significantly higher than control group (P＜0.05);the serum level ofCRP,TNF-oα,IL-6 levels were significantly decreased compared with those before therapy,and those of observation group were obviously lower than the control group (P＜0.05);the total effective rate of ob servation group was 94.55％ (52/55),which was equivalent to the control group (89.23％,P＞0.05);the long term memory,short term memory,instantaneous memory and memory quotient of observation group were significantly higher than those of the control group.Conclusion:Hyperbaric oxygen plus magnetic stimulation and Xingnaojing injectionon was effective on the coma patients with severe brain injury,it could down-regulate the inflammatory response,promote awake and recovery of memory function.

Object To investigate and compare the scavenging effect of Cordyceps growing in different environment on hydroxyl radical. Methods 10-Phennanthroline-Fe 2+ oxidative assay was used to observe the effect of scavenging hydroxyl radical from H_2O_2/Fe 2+ system by the aquenous extracts of Cordyceps. Results Cordyceps from Naqu of Xizang,northwest Yunnan,and northwest Sichuan all showed us the significant effect on scavenging of hydroxyl radical produced from Fenton Reaction. The biggest values of MDR among Cordyceps specimens from various microecological environment surpassed that among specimens of Naqu of Xizang,northwest Yunnan,and northwest of Sichuan. Conclusion The aquenous extracts of Cordyceps could scavenge the hydroxyl radical from Fenton Reaction. The microecological environment for Cordyceps growing has an significant effect on its scavenging action.

Objective: To evaluate the clinical result of atlantoaxial reduction and fixation guided by the intraoperative CT.Methods: Sixteen cases were retrospectively studied, including seven males and nine females, with the mean age of 49.9 years.Twelve cases were diagnosed as chronic atlantoaxial instability or dislocation, while four cases as acute odontoid fracture and dislocation.Among the sixteen cases, fourteen underwent atlantoaxial fusion, while two underwent temporary atlantoaxial fixation without fusion.The intraoperative CT was used in the setting of: 1.Evaluating the atlantoaxial reduction before the screw insertion;2.Guiding the C1 and C2 pedicle drilling (two cases using additional three-dimensional printing drilling template);3.Evaluating the position of the screws and reduction after the atlantoaxial fixation.In addition, three-dimensional drilling template combined with intraoperative CT was used in two cases.CT scanning frequency was calculated.To evaluate the accuracy rate of screw fixation under the intraoperative CT, 19 cases without the intraoperative CT were studied as the control group.Results: Averaged CT scanning frequency was 1.4 times (Once in eleven cases, twice in four and three times in one).Among the sixteen cases, mal-positioned C1 screws were found and revised in two cases.No spinal cord injury or vertebral artery injury occurred.The follow-up ranged from three to ten months, with the mean of 6.7 months.Fourteen cases achieved solid osseous fusion, and two with temporary fixation had odontoid fracture union.Anatomic reduction was achieved in all the cases.Eleven cases with preoperative myelopathy had postoperative improvement and their mean JOA scores improved from 12.1 to 14.4.To the last follow-up, no hardware complications were found including screw broken, rod broken or fixation loosening.All the screws of intraoperative CT group had good positions.For 19 cases of the control group, there were two cases of mal-positioned screws (10.5%).Conclusion: Advantages of atlantoaxial reduction and fixation guided by the intraoperative CT included: improving the accuracy of the atlantoaxial screws, exactly evaluating the reduction of the atlantoaxial joint, immediately discovering the mal-positioned screws and avoiding the revision surgery.A good clinical result was found in the preliminary study.

[Objective]This study was aimed to evaluate treatment outcomes and toxicity of continuous-infusion EPOCH regimen for NK/T-cell lymphoma(NK/TCL).[Methods]From June 2003 to June 2008,34 patients including 30 nasal NK/TCL (88.2%)and 4 nasal type NK/TCL(11.8%)received doxorubicin,vincfistine,etoposide over 96 hours infusion with bolus eyelophosphamide and oral predinisone(EPOCH)chemotherapy as first-line treatment.Median cycles of EPOCH administered were 2.5(1-6 cycles).Additional involved field radiation therapy(IFRT)was administered to patients with localized nasal focus after chemotherapy.[Results]Among 34 patients,33 were eligible for response evaluation.The response rate(RR)was 60.6% (20/33)with complete remission(CR)rate of 45.5%(15/33).The RR of patients with nasal NK/TCL was 66.7%(20/30)with CR rate of 50%(15/30).Only one of the 3 nasal type NK/TCL patients achieved stable disease(SD),the other 2 had progressive disease(PD)during chemotherapy.After a median follow-up of 22(2-68)months,the estimated 3-year overall survival rate(OS)was 52.2%.For patients with nasal NK/TCL,the estimated median survival time was not reached,the 3-year OS was 59.4%.For patients with nasal type NK/TCL,the estimated median survival time was only 7 months.The CR rate was 75.0% for localized nasal NK/TCL who received initial EPOCH chemotherapy followed IFRT with the 3-year OS of 75.0%.Major adverse effect was myelosuppression.The incidence of grade Ⅲ～Ⅳ neutropenia was 30.9%.No treatment-related mortality occurred.[Conclusions]EPOCH regiment was effective and well tolerant for nasal NK/TCL.Combined EPOCH chemotherapy followed by IFRT produced promising outcome for patients with localized disease.However,patients with nasal type NK/TCL responded poorly and more efficacious treatment strategies are urgently needed.

STUDY DESIGN: A retrospective clinical review. PURPOSE: To investigate the difference in clinical manifestations and severity between polymicrobial and monomicrobial infections after spinal surgery. OVERVIEW OF LITERATURE: Surgical site infections (SSIs) after spinal surgery are a major diagnostic and therapeutic challenge for spinal surgeons. Polymicrobial infections after spinal surgery seem to result in poorer outcomes than monomicrobial infections because of complementary resistance to antibiotics. However, comparison of the clinical manifestations and severity between polymicrobial and monomicrobial infections are limited. METHODS: Sixty-seven patients with SSIs after spinal surgery were studied: 20 patients with polymicrobial infections and 47 with monomicrobial infections. Pathogenic bacteria identified were counted and classified. Age, sex, and body mass index were compared between the two groups to identify homogeneity. The groups were compared for clinical manifestations by surgical site, postoperative time to infection, infection site, incisional drainage, incisional swelling, incisional pain, neurological signs, temperature, white blood cell count, and the percentage of neutrophils. Finally, the groups were compared for severity by hospital stay, number of rehospitalizations, number of debridements, duration of antibiotics administration, number of antibiotics administered, and implant removal. RESULTS: Polymicrobial infections comprised 29.9% of SSIs after spinal surgery, and most polymicrobial infections (70.0%) were caused by two species of bacteria only. There was no difference between the groups in terms of clinical manifestations and severity. In total, 96 bacterial strains were isolated from the spinal wounds: 60 strains were gram-positive and 36 were gram-negative pathogenic bacteria. Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Enterobacter cloacae were cultured in order of the frequency of appearance. CONCLUSIONS: Most polymicrobial infections were caused by two bacterial species after spinal surgery. There was no difference in clinical manifestations or severity between polymicrobial and monomicrobial infections.
Anti-Bacterial Agents ; Bacteria ; Body Mass Index ; Coinfection ; Debridement ; Drainage ; Enterobacter cloacae ; Escherichia coli ; Humans ; Length of Stay ; Leukocyte Count ; Neutrophils ; Postoperative Complications ; Retrospective Studies* ; Spine ; Staphylococcus aureus ; Staphylococcus epidermidis ; Surgeons ; Surgical Wound Infection ; Wounds and Injuries

Objective To explore the mechanism of resveratrol in alleviating neuroinflammation after cerebral ischemia-reperfusion injury by inhibiting Toll like receptor 4 (TLR4) signaling pathway. MethodsSixty adult male SD rats were randomly divided into sham-operated group, cerebral ischemia-reperfusion injury group, and resveratrol treatment group (n=20). Rat models of transient middle cerebral artery occlusion (MCAO) in the latter two groups were prepared by modified thread embolization method; reperfusion was performed after 2 h of occlusion, and 20 mg/kg normal saline or resveratrol via tail vein injection was given 15 min before model preparation and one min before reperfusion, respectively. At 72 h after MACO, neurological severity scale (NSS) was applied to evaluate the neurological functions of rats. Enzyme linked immunosorbent assay was performed to detect the expressions of pro-inflammatory cytokines interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-αand anti-inflammatory cytokines IL-4, IL-10, and transforming growth factor (TGF)-β. Reverse transcription-polymerase chain reaction was performed to detect the mRNA expressions of M1 signature markersIL-1βandCD32and M2 signature markersCD206andArginase-1. Western blotting was used to detect the expressions of TLR4 signaling molecules TLR4, myeloid differentiation protein 88 (MyD88), tumor necrosis factor receptor-associated factor 6 (TRAF6), IL-1 receptor associated kinase 1 (IRAK1) and nuclear factor (NF)-κB.ResultsAs compared with those in the sham-operated group, rats in the cerebral ischemia-reperfusion injury group had significantly decreased NSS scores, significantly elevated levels of IL-1β, IL-6, TNF-α, IL-4, IL-10, and TGF-βin the damaged brain tissues, significantly elevated mRNA expression levels ofIL-1β,CD32,CD206, andArginase-1, and significantly elevated protein expression levels of TLR4, MyD88, TRAF6, IRAK1 and NF-κB (P<0.05). As compared with rats in the cerebral ischemia-reperfusion injury group, rats in the resveratrol treatment group had significantly decreased NSS scores, significantly decreased levels of IL-1β, IL-6, and TNF-α, significantly elevated levels of IL-4, IL-10, and TGF-βin the damaged brain tissues, significantly deceased mRNA expression levels ofIL-1βandCD32, significantly elevated mRNA expression levels of CD206andArginase-1, and significantly decreased protein expression levels of TLR4, MyD88, TRAF6, IRAK1 and NF-κB (P<0.05).ConclusionResveratrol inhibits microglia M1-type polarization and promotes M2-type polarization after cerebral ischemia reperfusion by inhibiting TLR4 signaling pathway, which further reduces neuroinflammation and neurological deficits.

Objeetive To explore the clinical application value of new modified paracalculous ureteral catheter in ureteroscopic holmium laser lithotripsy for the treatment of large middle and lower ureteral stone.Methods From January 2014 to January 2017,86 patients with unilateral middle and lower ureteral large stone were treated in Jingzhou Central Hospital.By adopted to random digital table,86 patients were randomly separated into two groups,all of whom were treated with ureteroscopic holmium laser lithotripsy.Forty-three cases were underwent new modified laser lithotripsy with ureteral catheter inserted beneath the stone.Normal saline was injected continuously through the catheter during lithotripsy procedure (modified lithotripsy group).Forty-three cases were underwent direct ureteroscopic holmium laser lithotripsy (direct lithotripsy group).The outcome data were compared between the two groups,such as the operation time,stone clearance rate,ureteral perforation,transit to open surgery,postoperative urinary sepsis,perirenal hematoma,ureterostenosis and other complications.Measurement data were expressed as ((x) ± s),and t test was used for comparison between groups.Results All the patients in the modified lithotripsy group were completed successfully without ureteral perforation,rupture,loss of lithotripsy channel,transit to open surgery,perirenal hematoma,and urinary sepsis and so on.In the direct lithotripsy group,there were 5 cases of ureteral perforation,4 cases of lithotripsy channel loss,6 cases of transit to open surgery,2 cases of perirenal hematoma,1 case of urinary sepsis.The operation time of the two groups was (39.5 ± 7.2) min and (47.2 ± 11.6) min,respectively,t =-4.975,P =0.001.Stone clearance rate was 100％,91.1％.The patients in both groups received an average of 1 year out-patient follow-up.There were 3 cases of mild ureterostenosis in the modified lithotripsy group,which were not re-operated.In the direct lithotripsy group,there were 5 cases of mild ureterostenosis,and 2 cases of severe ureterostenosis,which were re-operated.Conclusion It is safe and effective to use the new modified paracalculous uteteral catheter in the ureteroscopic holmium laser lithotripsy of large middle and lower ureteral stone,which can shorten the total operation time and reduce the occurrence of complications.It has a higher clinical value.

Objective To grope for an ideal immune strategy in grown-ups via comparison of immunological effects under 4 different vaccination schemes.Methods Study population was selected by stratified random cluster sampling.A total of 4 different vaccination proposals,including Strategy A (3 doses,10 μg,administrated repeatedly into the unilateral deltoid muscle at 0-1-6 months),Strategy B (2 doses,20 μg,administrated into the bilateral deltoid muscles simultaneously),Strategy C (3 doses,10 μ g,administrated repeatedly into the unilateral deltoid muscle at 0-1-2 months) and Strategy D (2 doses,10 μg,administrated to the bilateral deltoid muscles at the same time),were conducted in Liangzhou,Minqin Gulang,and the Tianzhu Tibetan Autonomic county respectively,in Wuwei city,Gansu province.Under 4 different strategies,post-vaccination immunological effectiveness was evaluated when blood samples of participants collected in the eighth months,post-first injection and in the third year,and tested by enzyme-linked immunoassays and electro-chemiluminescence immunoassay.Chi-squared test and Fisher exact test were used to evaluate the immumological differences between the 4 strategies.Wilcoxon's signed rank test and Kruskal-Waillis H test were conducted to compare the differences of the geometric mean titers (GMTs) of antibody against HBV surface antigen (anti-HBs) titers.Results A total of 1 621 eligible participants aged 16 to 60 years old,were recruited for the study.Numbers of administration and gender were testified as the presuming factors for influencing immune effectiveness.The vaccination completion rates were 53.97％ and 79.82％ in Strategy A and C,respectively,and the difference statistically significant (P＜0.05).In the first year,the protective antibody sero-conversion rates (standardization rate) were 89.21％,54.88％,92.11％,and 41.63％,in Strategy A,B,C and D,respectively,and the significant statistically differences emerged (P＜0.05) if Strategy B,C and D were compared with Strategy A (as the gold standard).Over a 3-year follow-up period,the levels of GMTs on protective antibody declined from 179.2 IU/L,51.6 IU/L,277.1 IU/L and 10.1 IU/L to 61.3 IU/L,21.2 IU/L,31.8 IU/L and 6.0 IU/L in Strategy A,B,C and D,respectively,and the differences of declination on GMTs showed statistically significant differences (P＜0.05) when compared within or between the 4 strategies.Conclusion The 0-1-2 months' prophylactic schedules (Strategy C) seemed superior to the others,in terms of effectively inducing the protective antibody,with shorter duration of vaccination,persisting longer immunity and having higher rate of completive vaccination,so is worth to be recommended as a feasible immune programme for adults,especially for migrants from the rural regions.