BACKGROUND:Craniotomy for severe traumatic brain injury is required to maintain the integrity of the dura mater. The artificial dura mater is now a common dural repair material, and looking for the ideal artificial dura mater is the exploring direction of neurosurgery.
OBJECTIVE:To explore the application of colagen sponge artificial dura in severe traumatic brain injury
METHODS:A retrospective analysis of 96 patients with severe head injury was performed, including 32 cases of the artificial dura with tightly suturing as the control group, and 64 cases of the artificial dura of colagen sponge without suturing as the experimental group. Operating time for hematoma clearance, blood loss, postoperative mechanical ventilation time, ICU monitoring time, the total number of hospitalized days as wel as time interval from hematoma clearance to cranioplasty, operative time for cranioplasty, blood loss, and Glasgow Coma Scale scores after dural damage and 6 months postoperatively in the two groups were measured.
RESULTS AND CONCLUSION:The same purpose was achieved in the two groups. The amount of bleeding during hematoma clearance, postoperative mechanical ventilation time, monitoring time in ICU, the total number of hospitalized days and Glasgow Coma Scale score of 6 months postoperatively showed no significant difference between the two groups (P> 0.05). But operative time for hematoma clearance and cranioplasty as wel as blood loss in the second operation were statisticaly significant between two groups (P< 0.05). The colagen sponge artificial dura in severe traumatic brain injury can fuly play a good role in reducing intracranial pressure, keeping brain functions, shortening operative time, and improving outcomes of patients, which has similar effects to tightly suturing the dura and creates favorable conditions for the folowing cranioplasty.

Objective:To survey the expression of MMP-1,MMP-2 of human periodontal ligament cells(HPDLCs)treated by tea polyphenols(TP)and lipopolysaccharide(LPS).Methods:HPDLCs were in vitro cultured in vitro and treated by TP(200 μg/ml) and /or LPS(100 μg/ml)for 24,48 and 72 h respectively,the secretion of MMP-1 and MMP-2 were examined by ELISA,MMP-1 and MMP-2 mRNA expression was examined by real-time PCR.Results:The secression and mRNA expression of MMP-1 and MMP-2 of HPDLCs increased by LPS treatment and significantly inhibited by TP at the different times.Conclusion:TP can inhibit the col-lagen degradation of HPDLCs mediated by LPS.

Objective To investigate the curative effect between liver resection combined with microwave ablation during operation and simple liver resection in the treatment of primary liver cancer.Methods From January 2005 to December 2013,a total of 84 patients diagnosed as primary liver cancer in our hospital were collected and divided into combination group(42 cases) and simple group(42 cases) according to the surgical method.Combination group were treated by combining liver resection with microwave ablation during operation,simple group by simple liver resection.Results The intraoperative blood loss for combination group was (323.9 ± 93.1) ml and simple group was (524.5 ± 119.2) ml,P ＜ 0.05.postoperative tumor recurrence rate for combination group was 14.2％ and simple group was 33.3％,P =0.040.1-,3-,and 5-year survival rate for combination group was 96.5％,67％ and 51％,and simple group was 84％,49.5％ and 36.5％,P =0.036.The differences of the above parameters between the two groups were statistically significant.The operation time for combination group was (177.7 ± 30.7) min and simple group was (165.1 ± 29.5) min,P =0.058.The postoperative hospital stay for combination group was (15.5 ± 3.7) d and simple group was (14.0 ± 4.0) d,P =0.068.The changes of ALT,AST,ALB,TBIL on the first postoperative day and the incidence of postoperative complications (including bile leakage,fever,pleural effusion,blooding,abdominal infection and some others) between the two groups had no statistical significances (P ＞ 0.05).Conclusion The curative effects of liver resection combined with microwave ablation during operation are superior to pure liver resection in the treatment of primary liver cancer.

Objective To explore the predictive value of microvessel density(MVD)and blood vessel invasion(BVI)in hepatic metastasis from early-stage rectal cancer.Methods MVD and BVI in the tumor tissue from 380 patients with stage I and II rectal cancer was determined by immunohistochemical S-P method with anti-CDIOS antibody and anti-CD34 antibody,respectively.Multinomial logistic regression was performed to analyze the predictive value of MVD and BVI in hepatic metastasis from early-stage rectal cancer.Results CD105 was expressed in newborn blood vessels,not in normal blood veseels.in the rectal cancer tissue.MVD was correlated with histological type and infiltration depth(P＜0.05).Besides histological type and infiltration depth,BVI was also correlated with histological grade.Multivariate analysis revealed that histological type,tumor infiltration depth,BVI,adjuvant therapy,and MDV were independent predictors of hepatic metastasis from rectal cancer.The risk of hepatic metastasis in patients with postive expression of either MVD or BVI or both were significant higher than that in patients with low expression of MVD and those without BVI expression[hazard ratio(95%CI),4.210(2.182-11.214)].Conclusion BVI and MVD are independent predictors of hepatic metastasis from stage I and II rectal cancer.Combined detection of MVD and BVI may help to predict the clinical outcome of patients with early-stage rectal cancer.

Background Researches showed that multifocal electroretinogram (mfERG) is able to assess the retinal function in the eyes with acute Vogt-Koyanagi-Harada ( VKH ) syndrome. But the mfERG characteristics of convalescence stage of VKH are still below clear. Objective Present study was to compare and follow up the variation process of visual acuity and mfERG in acute and recovery stages of VKH syndrome. Methods This was a clinic-based retrospective study. Visual acuity, mfERG and fundus fluorescence angiography ( FFA ) were recorded from 35 eyes of 18 acute VKH cases. The period of follow-up in recovery stage lasted about 18 months with the repetitive recording results for 4 times. Results In this study, the visual acuity range in acute stage VKH was 0. 01 to 1.0, and 91.4% (32/35 eyes) was below 0.6. Compared with normal control group, the visual acuity was significantly decreased (P＜0.01). The response densities (amplitudes) of N1 ,P1 waves of the first-order kernel were significantly lowed in all the 6 rings,and the implicit times of 1-4 rings of both waves were significantly prolonged in acute VKH eyes(P＜0. 05). The abnormalities of retinal function showed a regional difference at the posterior pole retina with the dominant change in the first ring,showing a cutting off78% in the P1 amplitude. The abnormal degree of mfERG was more serious as the the increase of retinal eccentricity. In 2 months of convalescence after glucocorticosteroids therapy,the range of visual acuity were 0. 1-1.2 ,and the amplitudes of N1, P1 of 1-2 rings were greatly elevated in comparison with acute on-set (P＜0. 05 ). However, there was still a remarkable difference in the amplitudes of from 1 through 6 rings,comparing with normal. The response density of P1 wave from whole recording region was only 44% of normal. Though the visual acuity was stable during the follow-up duration, a decreasing tendency in N1 and P1 amplitudes were seen. The implicit times of both wave shortened only in 1-3 rings in recovery stages of VKH (P＜0.05). Conclusion VKH syndrome cause serious damage of posterior retinal function.Macular region is the site with greater retinal functional lesion and restore before and after medication. This hardly recovery of retinal function can last over one and half year,even satisfied visual acuity is stable after proper treatment.

Background The pathological change of the anterior uveitis is the disruption of blood-aqueous barrier.Slit lamp examination appears to be limited for the evaluation of inflammatory response,and fluorescine angiography is an objective approach.However,there are few relative studies up to now in China.Objective Aim of this study was to observe the characteristics and assess the clinical applications of iris fluorescein angiography (IFA)in Chinese uveitis with brown iris.Methods Forty eyes of 40 normal subjects and 21 eyes of 13 patients with the anterior uveitis were collected in this study.IFA,slit-lamp examination and iris photograph were performed on the subjects.All individuals were informed consented at the initiation of this study.Results In normal eyes,fluorescence in iris vessels was blocked by the melanin pigment,but peripupillary weak fluorescent leakage was seen in the normal eyes with the age of ＞60 years old.The multiple patterns of fluorescence leakage were found in the patients suffered from uveitis of various etiologies although the negative slit-lamp finding,including the leakage of fluorescein around the pupillary margin and radial iris vessels in the eyes with mild diseases,transmitted fluorescence of regular iris vessels in the eyes with diffuse and local iris atrophy,and vascular tufts of the pupillary margin with coiled interwind tight clusters of thin vessels at the early phase in the eyes with dilated capillaries,microvascular anomalies and new vessel formation.The hyperfluorescence remained throughout the IFA duration.Conclusions IFA findings in uveitis vary depending on the topography,type and severity of inflammation.IFA has a good clinical applying value because of its objective assessment ability of the degree of the blood-aqueous barrier breakdown and iris neovascularization breakdown.It can exhibit the unvisible lesion under the slit-lamp and monitor the efficacy of medical theraphy in patients with active or quiescent uveitis.

Forty two general practice residents who participated in the standardized training in Suzhou Municipal Hospital from April to December 2022 were randomly divided into two groups with 21 in each group. The control group received the traditional teaching method, and the study group received additional training with a special management model for chronic obstructive pulmonary disease. After 3 months of training, the teaching effects were evaluated with the improved Mini Clinical Evaluation Exercise (Mini CEX) in two groups and the teaching satisfaction was also assessed. Compared with the control group, the study group showed significant better performance in outpatient service, including the treatment and rehabilitation planning ( t=3.82, P<0.001), humanistic care ( t=4.83, P<0.001), health education ( t=9.56, P<0.001), communication skills ( t=3.34, P=0.002), and overall performance ( t=3.13, P=0.003). The satisfaction of teaching in study group was also higher than that in the control group ( Z=-2.02, P=0.044). The study shows that incorporating the "specialized management of chronic obstructive pulmonary disease" model into the general practice standardized residency training can significantly improve the teaching effects.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Manipulation, Orthopedic ; Middle Aged ; Temporomandibular Joint Disorders ; therapy

BACKGROUND: The perioperative hemorrhage of knee surgeries is a difficulty in clinic, and the efficacy of tranexamic acid to reduce postoperative bleeding has attracted more attention, but choosing which administrations remains controversial. OBJECTIVE: To investigate the efficacy of tranexamic acid by intravenous injection or articular injection for reducing the perioperative hemorrhage of total knee arthroplasty. METHODS: Sixty patients undergoing unilateral total knee replacement were enrolled, and were then randomized into three groups (n=20 per group): no tranexamic acid administration (group A); intravenous dropping of 15 mg/kg tranexamic acid before tourniquet application plus 10 mg/kg tranexamic acid at 3 hours postoperatively (group B); articular injection of 50 mL saline diluted with 1 g tranexamic acid through a drainage tube (group C). Two-hour closure of drainage tube was performed in all patients. The postoperative dominant and hidden blood loss, blood transfusion rate, pulmonary embolism as well as lower extremity deep venous thrombosis were recorded. RESULTS AND CONCLUSION: (1) The dominant and hidden blood loss in the groups B and C were significantly less than those in the group A (P < 0.05); the dominant blood loss showed no significant difference between groups B and C (P > 0.05); the group B exhibited a significantly less hidden blood loss compared with group C (P < 0.05). (2) The blood transfusion rate in the groups B and C was significantly lower than that in the group A (P < 0.05). (3) No pulmonary embolism or lower extremity deep venous embolism occurred during 3-month follow-up. (4) That is to say, tranexamic acid can obviously reduce perioperative blood loss and blood transfusion rate without pulmonary embolism or lower extremity deep venous thrombosis, and intravenous administration exerts better clinical effectiveness.

To investigate the function of ALK3 gene, the gene regulation and the signaling pathway related to ventricular septum defect during heart development. The model mice with ALK3 gene knock-out via alpha-MHC-Cre/lox P system were bred. The mRNA expression level of control group was compared with that of experiment group and ALK3 downstream genes were screened using PCR-select cDNA subtraction microarray. The mRNA of control group was extracted from E11.5 normal mouse hearts, and that of experiment group, from E11.5 hearts of mice with alpha-MHC Cre(+/-) ALK3(F/+) genotype. It was found that the mice with ALK3 gene knock-out produced heart defects involving the interventricular septum. The platelet-activating factors acetylhydrolase and the transcription factor Pax-8 and so on, were down-regulated. However, the Protein Tyrosine Kinase (PTK) of Focal Adhesion Kinase (FAK) subfamily and beta subtype protein 14-3-3 were up-regulated in the alpha-MHC Cre(+/-) ALK3(F/-) mice. These data provide support that ALK3 gene played an important role during heart development. The platelet-activating factors acetylhydrolase and Pax-8 genes could be important ALK3 downstream genes in the BMP signaling pathway during interventricular septum development. PTK and beta subtype protein 14-3-3 might be regulatory factors in this pathway.
1-Alkyl-2-acetylglycerophosphocholine Esterase ; genetics ; metabolism ; 14-3-3 Proteins ; genetics ; metabolism ; Animals ; Bone Morphogenetic Protein Receptors, Type I ; genetics ; metabolism ; Genotype ; Heart Septal Defects, Ventricular ; genetics ; Mice ; Mice, Knockout ; Oligonucleotide Array Sequence Analysis ; PAX8 Transcription Factor ; Paired Box Transcription Factors ; genetics ; metabolism ; Protein-Tyrosine Kinases ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Signal Transduction ; genetics ; physiology