Objective To study the clinical characteristics and treatment of adult patients with tsutsugamushi disease in Nantong area,and to reduce the misdiagnosis and missed diagnosis.Methods Clinical data of 24 adult patients with tsutsugamushi disease who were admitted between 2010 and 2012 at Department of Emergency Medicine in Affiliated Hospital of Nantong University were reviewed retrospectively.The patients were 13 males and 11 females who were aged from 25 to 70 years old.Minocycline capsule was orally administrated as the mainstay of the therapy.Results All of the 24 cases of tsutsugamushi disease were presented with fever,predominantly with high fever.The body temperature of higher than 39 ℃ was recorded in 23 cases,and temperature of 38.0 ℃ to 38.9 ℃ was recorded in one case.Three cases complained with sore throat and cough,and 1 case with palpitation and chest distress.One eschar or ulcer was seen in 21 cases,2 eschars or ulcers only in 1 case.Twenty-one cases were presented with lymphadenopathy,11 cases with rash,3 cases with enlargement of the liver,and 4 cases with splenomegaly.The distribution of eschar or ulcer included inaxillary fossa,groin,external genitalia and crissum,waist,popliteal fossa,the lower edge of the female breast and skin folds of chest wall,the inside of the wrist,ankle,neck,retroauricular region,chest-back and the buttocks.The white blood cell count of (2.5-3.9) × 109/L in blood routine test was seen in 4 cases,(10.1-18.6) × 109/L in 3 cases.The blood platelet count was decreased in 1 case.Urinary protein was positive in 4 cases by urine routine examination.Blood biochemical examination revealed that elevated serum alanine aminotransferase was seen in 2 cases,elevated serum creatinine was in 1 case,mildly elevated cardiac troporin I was in 1 case,increased C-reactive protein was found in 19 cases.On Weil-Felix test,17 cases showed OXk titers of 1∶160-1∶320.Four cases showed an increase in overall lung markings,localized pulmonary infiltration shadow and even small pleural effusion on chest radiography.Electrocardiogram showed premature ventricular beats and slight ST segment changes in 2 patients.Oral minocycline showed obvious effect.Conclusions The clinical manifestations of tsutsugamushi disease can be variable.Multi organ dysfunction could be presented besides fever.The skin eschar and ulcer are the most pathognomonic for this disease and thus should be thoroughly examined for its presence to avoid misdiagnosis.

Rehabilitation therapeutics has become a popular specialty in colleges and universities in China. At present, 160 colleges and universities have set up rehabilitation therapeutics specialty, of which 73.75% are public colleges and 26.25% are private colleges (including independent colleges). The types of those colleges and universities are mainly concentrated on western medicine colleges (40.6%), traditional Chinese medicine colleges (18.1%) and comprehensive colleges (31.3%), with an imbalance in regional distribution between the east and west of China. Some problems are becoming prominent with the increase of the number of these colleges and universities, such as differences in discipline cultivation modes, compositions of colleges and universities, teaching quality, profession/industrial standards and distribution of rehabilitation education resources. In order to promote the healthy development of undergraduate education of rehabilitation therapeutics in colleges and universities in China, we should define the connotation and extension of rehabilitation therapeutics, establish the professional training mode of rehabilitation therapeutics with Chinese characteristics, classify the professional training objectives, strengthen the construction of teachers, formulate professional standards of rehabilitation therapeutics, and improve the uneven distribution of rehabilitation education resources.

Objective To know the antitumor effect and value of vinorelbine in chemotherapy with relapsed breast cancer.Methods To receive breast cancer tissue from primary and relapsed patients by surgery,then to obtain mammary cancer cells by collagenase.The antitumor effect of 5 chemotherapy drugs with breast cancer cells was measured by culture in vitro and MTT.Results With primary cancer cells from primary breast cancer,the antitumor effect of paclitaxel and docetaxel(sensitivity is 91.04%,92.54% respec- tively) is better than adriamycin,epirubicin and gemcitabine(sensitivity is 73.13%,74.63%,71.64% re- spectively;P

OBJECTIVE To observe the preventive effect on nosocomial infection by the herbal medicine Atractylodes chinensis disinfectant for air sterilization in cardiothoracic surgery.METHODS A.chinensis disinfectant and ultraviolet irradiation were used to disinfect the patients′ rooms of our cardiothoracic surgery department.The total number of germ and fungus in the indoor air before and after using the two methods were collected.The nosocomial infection rates of the same period were also studied.RESULTS A.chinensis disinfectant had strong effect on sterilization of indoor germs and fungi,and the sterilization rate was 92.7%.The comparison between A.chinensis disinfectant and ultraviolet irradiation showed significant difference in their disinfection effects,while no significant difference in their nosocomial infection rates.CONCLUSIONS The herbal medicine A.chinensis disinfectant can achieve good sterilization effect and prevent nosocomial infection.

OBJECTIVETo discuss the clinical effects and superiority of applying external fixation and bone transport to treat osteomyelitis and bone defect of femoral bone.

METHODSFrom August 2008 to December 2013,16 patients with osteomyelitis and bone defect of femoral bone were treated including 11 males and 5 females with an average age of 42 years old ranging from 13 to 62 years old. The average course of disease was 18 months ranging from 2 months to 4.5 years, and the average length of bone defect was 7.8 cm ranging from 4.5 to 15 cm. The bone defect of all cases were treated by external fixation and bone transport, the bone transport began at 1 week after operation, 1 mm per day and 4 times per day.

RESULTSAll patients were followed up for 10 to 36 months (means 22.5 months). One patient did not cooperate with treatment leads to the failure, then took the amputation. The remaining 15 cases of osteomyelitis were under control, including 12 cases of bone transport achieved one stage bone union, 3 cases achieved bone union via bone graft from iliac bone. The bone union time was 5 to 13 months(means 7.9 months). Thirteen patients almost obtained the same length of two lower extremities,2 patients had shortening of 1.5 to 2 cm. The time of moving the external fixation was from 6 to 16 months (means 9.3 months).

CONCLUSIONApplication of external fixation and bone transport is an effective method in treating the osteomyelitis and bone defect that can control the infection, eradicate wounds, and be the equalization of limb length.

Adolescent ; Adult ; Bone Transplantation ; External Fixators ; Female ; Femur ; surgery ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery

Objective To summarize the management of scrotal gangrene.Methods Totally,14 male patients (mean age,48 years;age range,27-74 years) with scrotal gangrene were treated from August 2003 to June 2005.Among these patients,scrotal gangrene was complicated by perianal and penile gangrene in 2 cases;by perianal,penile and inguinal gangrene in 10 cases;by perianal,penile,inguinal gangrene and abdominal subcutaneous gangrene in 2 cases.Three cases had concomitantly necrosis of the penis;and 5 ca- ses,orchitis.Bacterial cultures were performed in all 14 cases with the positive results.All patients underwent surgical treatment,including PhaseⅠincisions,aggressive debridement,drainage,irrigation,and scrotoplas- ty.After operation they received antibiotic therapy and supporting treatment.Three cases of penile necrosis underwent complete penis amputation and transplanting the urethra before the anus.Five cases of orchitis un- derwent unilateral orchiectomy.Two cases of abdominal gangrene underwent surgical subcutaneous treatment, including incision,aggressive debridement,drainage,and irrigation.Results Twelve cases undergoing scrotoplasty achieved PhaseⅠhealing.Two cases undergoing urethral fistulation recovered well.Ten cases of penile skin gangrene received penile dermatoplasty 1 month later,and then recovered.Two cases who had al- ready had AIDS died 2 or 3 d after operation.Conclusions The management of scrotal gangrene primarily consists of early and aggressive debridement,antibiotic therapy and supporting treatment.The PhaseⅠde- bridement and scrotoplasty as well as drainage are effective for the treatment of scrotal gangrene.

Objective To determine the effect of photochemotherapy on the expression of gelatinases. Methods Reverse transcription-polymerase chain reaction and gelatine zymography were employed to detect the effect of photochemotherapy on the expression and bioactivity of gelatinases at mRNA and protein levels respectively. Results Combination of ultraviolet A(UVA,0.8-2.0 J/cm2) and 8-methoxypsoralen(8-MOP,100 ng/mL) resulted in a decrease in the expression and bioactivity of gelatinases. Conclusion Photochemotherapy can inhibit the angiogenesis of endothelial cells through downregulating the expression and bioactivity of gelatinases.

Objective　To establish animal model for hypertrophic scar and study the characters of its morphology and collagen metabolism. Methods　A total of 64 round wounds (diameter of 6 mm each) with total skin loss were made on the ventral side of rabbit ear using a trephine. Morphology and collagen metabolism of scar wounds were studied at 14,21,35,70 and 98 days after operation, respectively. Results　There were 76% elevated scars developed (45/59 wounds) on the ventral side of rabbit ear at 21 days and 46% elevated scars disappeared (11/24) at 98 days after operation. There were numerous fibroblast proliferation and whorl-arranged collagen fibers at 21 and 35 days. The number of fibroblast decreased, but irregular-arranged fibers still presented in the elevated scars at 70 and 98 days after operation. Hydroxyproline content in elevated scars at 21 days was higher than that in normal skin (P<0.05), and at 35 days was 3 times as that in normal skin and at 98 days was also markedly higher than that in normal skin (P<0.05). Conclusion　Excessive deposition of collagen is a characteristic of hypertrophic scar in rabbits. The conversion of normal scarring to hypertrophic scarring in rabbits occurs at 14～21 days after operation. Both development and regression of hypertrophic scar in rabbit are quicker than that in human.

BackgroundPterygium is an ocular surface disease of abnormal cell proliferative kind and angiogenesis plays an important role in its development and recurrence.Several anti-angiogenic therapies have been used to treat pterygium,but there very few studtes for the in vivo observation of the microvessles in pterygium.ObjectiveThis study was to observe angiogenesis in pterygium with a high-resolution confocal microscope in vivo and to perform immunohistochemical study in vitro.MethodsA prospective case-controlled study was designed.Twenty eyes of 20 consecutive patients with primary pterygia and 20 age- and sex-matched patients with inner eye diseases and strabismus with normal conjunctiva were enrolled in this study.An in vivo confocal microscopy imaging system (Heidelberg Retina Tomograph Ⅱ Rostock Cornea Module) was used to collect microvascular pictures from the anterior part of pterygia and normal nasal conjunctiva of controls,and then immunochemistry was performed to examine the expression of CD31 in microvessel in vitro.The vascular density values were compared between these two groups.The correlation of vascular density values between in vivo Heidelberg Retina Tomograph and in vitro immunohistochemistry was calculated.Written informed consent was obtained from pationts before any examination and surgery.ResultsUnder the in vivo confocal microscope,the microvessel density was (8929±2993) μm/mm2 and (4202 ±692)μm/mm2,respectively,in pterygium and the normal conjunctiva group with a statistically significant difference between them (t =6.881,P＜0.01 ).Immunochemistry revealed that the expression of CD31 to measure vascular density was ( 21.00 ± 4.06/400 × field ) and ( 6.07 ± 1.75/400 × field ) in pterygium and the normal conjunctiva group,showing significant difference (t =12.312,P＜0.01 ).Positive correlations were found in the vascular density values between in vivo corneal laser confocal microscopy examination and in vitro immunochemistry examination in both the pterygium group and normal conjunctiva group (pterygium group:r=0.649,P＜0.01 ;normal conjunctiva group: r=0.572,P＜0.01 ) ConclusionsIn vivo confocal microscopy imaging is superior to in vitro immunochemistry in evaluating the microvessel of pterygium.The results of this study offer a new way index for further investigation of the biological behavior of pterygium and its mechanism.

OBJECTIVETo study short-term results and clinical application of Tri-lock BPS in total hip arthoplasty.

METHODSFrom May 2010 to July 2011, 32 hips in 31 patients (18 males and 13 females, ranging in age from 50 to 77 years old, with an average of 60.5 years old) were treated by total hip arthroplasty with Tri-lock BPS, including 8 patients with osteonecrosis (ON), 13 patients with fresh femoral neck fracture, 10 patients with developmental dysplasia of the hip (DDH). The therapeutic effects were evaluated by self assessment form, preoperative and postoperative Harris hip score, radiographs, Engh score and bone in growth of femoral side described by Gruen. Based on the short-term results,its design characteristic and clinical properties were analyzed.

RESULTSAll the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. All the patients were followed up with an average time of 12.2 months (ranged, 10 to 14 months). All the joints had good or excellent clinical results. The Harris score increased from preoperative 38.3 +/- 4.9 to 92.5 +/- 11.2 at the latest follow-up (t = 27.53, P < 0.01). Radiographically, the positions of the prostheses were normal,the average limbs length and femoral eccentricity recovered to normal. X-ray of the hips showed that the femoral stem prosthesis was in line with good initial fixed standard. At 3 months after surgery, X-ray of the hips showed that bone in growth in Gruen II and VI of femoral side.

CONCLUSIONShort-term results show that the design of Tri-lock BPS is more in line with human anatomy, and has the advantages in rapid recovery of hip function and retains more bone mass. It offers a newly valuable technology for the treatment of osteonecrosis, femoral neck fracture and DDH and so on.

Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Recovery of Function ; Tomography, X-Ray Computed ; Treatment Outcome