ObjectiveTo investigate the hemostatic effect of fibrin sealant (FS) powder on severe wound surface and find out the minimum effective dosage.Methods1 cm2 round wound surface was made on the liver of New Zealand white rabbits. Different dosages of FS powder were administrated on the wound surface. Bleeding time and bleeding volume were examined to find out optimized dosage. Hemostatic effect of FS powder was observed and compared with chitin cotton, gelfoam and normal gauze.ResultsBleeding time (0.57±0.21 min)and bleeding volume (0.35±0.29 ml)of FS 10 mg/cm2 group were obviously different from FS 8 mg/cm2 group (P<0.05), not significantly different from FS 12 mg/cm2 group. FS 10 mg/cm2 group got the shortest bleeding time and the lowest bleeding volume, which was obviously different from chitin cotton, gelfoam and gauze groups (P<0.05～0.01).ConclusionThe hemostatic effect of FS powder is better than gelfoam, chitin cotton and gauze and its optimized dosage is 10 mg/cm2.

OBJECTIVETo discuss the pathological and clinical characteristics,methods of therapies and perioperative considerations of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis (AS).

METHODSThirteen patients with ankylosing spondylitis and cervicothoracic spinal fractures and dislocations were treated from January 2001 to March 2009, including 11 males and 2 females,aged varied from 33 to 60 years (mean 46) in 11 males and from 36 to 59 years (mean 47.5) in 2 females respectively. The symptom duration of AS was from 12 to 27 years (means 14.5 years). The chief complains were pain around cervical part and shoulder blades, some accompanied with decrease of motor power and sensation in upper or lower limbs. Spine radiographs revealed a displaced fracture of cervicothoracic spine. Laboratory examination presented positive results of HLA-B27 test. Fusion of fracture and ASIA neurological function grade variation were observed.

RESULTA total of 13 patients, who underwent operation, were followed up for 12 to 43 months(means 35.6 months). There were 6 patients were treated with anterior cervical discectomy and fusion, 4 with anterior cervical corpectomy and fusion, 1 with laminectomy and fusion and 2 with combined anterior and posterior stabilisation. The bone fusion were observed after reduction of fractures and dislocations ultimately. Twelve patients acquired an improved neurological status in different degrees, and only one suffered from persistent neurological impairment loss. The complications occurred in 5 cases during perioperation.

CONCLUSIONThis study suggests that most cervicothoracic spinal fractures and dislocations in patients with AS are extremely unstable and require operations. If operative method is proper and operative process accurate, either anterior,posterior or combined approach can achieve good spinal myeloid functional recovery with low rates of operative complications occurrence, under the guidence of imaging manifestation.

Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; diagnosis ; surgery ; Male ; Middle Aged ; Spinal Fractures ; diagnosis ; surgery ; Spondylitis, Ankylosing ; complications ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo design an animal model to study the facial transplantation of allografts in rabbits.

METHODSLivid blue rabbits and New Zealand white rabbits was applied as experiment animal, to harvest hemifacial composite-tissue flap based in the common external carotid artery with the branch of the external mandibular artery and auricularis magna artery, then allotransplantation was performed with the livid blue rabbits as recipient while new Zealand rabbits as donor, the immunosuppressive agent comprised ciclosporin, azamun and prednisone. 25 couples of rabbits were divided three groups. Group A, 5 couples of rabbits, no administered immunosuppressive agent and the artery anastomosis with end-to-end. Group B, 10 couples of rabbits, administered immunosuppressive agent and the artery anastomosis with end-to-end. Group C, 10 couples of rabbits, administered immunosuppressive agent and the artery anastomosis with end-to-side. Postoperative, to observe the survive ratio of animal and composite-tissue flap, verified the practicability of model further.

RESULTSThe blood supply of hemifacial composite-tissue flap is rich after allotransplantation. The survive ratio wasn't different with different procedure of the external carotid artery anastomosis.

CONCLUSIONSThis is a successful model of composite face flap transplantation in the rabbits.

Animals ; Facial Transplantation ; Models, Animal ; Rabbits ; Transplantation, Homologous

BACKGROUNDEarly studies showed that naloxone infusion decreases the incidence of morphine-related side effects from intravenous patient-controlled analgesia. This study aimed to determine whether naloxone preserved analgesia while minimizing side effects caused by intravenous tramadol administration.

METHODSEighty patients undergoing general anesthesia for cervical vertebrae surgery were randomly divided into four groups. All patients received 1 mg/kg tramadol 30 minutes before the end of surgery, followed by a continuous infusion with 0.3 mg x kg(-1) x h(-1) tramadol with no naloxone (group I, n = 20), 0.05 microg x kg(-1) x h(-1) naloxone (group II, n = 20), 0.1 microg x kg(-1) x h(-1) naloxone (group III, n = 20) and 0.2 microg x kg(-1) x h(-1) naloxone (group IV, n = 20). Visual analog scales (VAS) for pain during rest and cough, nausea five-point scale (NFPS) for nausea and vomiting, and ramsay sedation score (RSS) for sedation were assessed at 2, 6, 12, 24 and 48 hours postoperatively. Analgesia and side effects were evaluated by blinded observers.

RESULTSSeventy-eight patients were included in this study. The intravenous tramadol administration provided the satisfied analgesia. There was no significant difference in either resting or coughing VAS scores among naloxone groups and control group. Compared with control group, sedation was less in groups II, III, and IV at 6, 12, and 24 hours (P < 0.05); nausea was less in groups II, III and IV than group I at 2, 6, 12, 24 and 48 hours postoperatively (P < 0.05). The incidence of vomiting in the control group was 35% vs. 10% for the highest dose naloxone group (group IV) (P < 0.01).

CONCLUSIONA small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesic effects.

Analgesia, Patient-Controlled ; methods ; Analgesics, Opioid ; administration & dosage ; adverse effects ; therapeutic use ; Anesthesia, General ; methods ; Cervical Vertebrae ; surgery ; Female ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Naloxone ; administration & dosage ; adverse effects ; therapeutic use ; Narcotic Antagonists ; administration & dosage ; adverse effects ; therapeutic use ; Nausea ; chemically induced ; Tramadol ; administration & dosage ; adverse effects ; therapeutic use

OBJECTIVETo evaluate the clinical performance of careHPV16/18/45 DNA testing of cervical specimens as a triage testing for women with positive findings during the cervical cancer screening.

METHODSEligible women aged 25-65 years were enrolled from two high-risk communities in Yangcheng County,Shanxi Province.After providing written informed consent on a voluntary base,women underwent questionnaire-based interview,gynecological examination,and sample collection.Hybrid capture 2 technology(HC2),careHPV,Avantage HPV E6 test,and visual inspection with acetic acid(VIA)were conducted as the primary screening tests at the enrollment visit.Women with any positive finding were invited to receive a second VIA and colposcopy.careHPV16/18/45 was performed as a triage testing.Any visible lesion under colposcopy was directly biopsied.Women with pathology confirmed cervical intraepithelial neoplasia grade 2 and worse(CIN2+)were treated with standard procedures.

RESULTSFor the self-collected and doctor-collected samples,the application of careHPV16/18/45 as a triage testing decreased the colposcopy referral to 3.2% and 3.1%,respectively.Meanwhile,the sensitivity,specificity,and positive predictive value(PPV)for CIN2+were 50.0%,97.6%,and 26.7% for women with positive self-sampling careHPV results and 63.0%,97.9%,and 34.0% for women with positive doctor-sampling careHPV results.

CONCLUSIONcareHPV16/18/45 is promising as a triage testing among women with positive screening findings in low-resource settings.

Adult ; Aged ; Colposcopy ; DNA, Viral ; analysis ; Early Detection of Cancer ; methods ; Female ; Human papillomavirus 16 ; genetics ; isolation & purification ; Human papillomavirus 18 ; genetics ; isolation & purification ; Humans ; Mass Screening ; methods ; Middle Aged ; Uterine Cervical Neoplasms ; diagnosis ; virology ; Vaginal Smears

OBJECTIVETo study on needling safe depth of Fengfu (GV 16) with CT, so as to provide reference for safe needling depth of Fengfu (GV 16) in clinical acupuncture treatment.

METHODSForty-one adult volunteers were divided into 3 groups, a thin person group, a moderate person group and a fat person group according to Luo's indexes, and computer-aided tomography (CT) was used to measure the needling depth of Fengfu (GV 16).

RESULTSThe safe depths of perpendicular needling of Fengfu (GV 16) were different for persons of different somatotypes. The safe needling depth was (27.73 +/- 3.45) mm for the thin person group, (30.78 +/- 2.90) mm for the moderate person group, and (33.39 +/- 4.27) mm for the fat person group.

CONCLUSIONThe safe needling depth < or = the dangerous depth x 75% can be used for reference for the safe needling depth of Fengfu (GV 16) for different somatotypes persons.

Acupuncture Points ; Acupuncture Therapy ; Female ; Humans ; Male ; Neck ; Somatotypes ; Tomography, X-Ray Computed

BACKGROUND: In the clinic, 25%-35% heel pain is mostly caused by plantar fasciitis. Previous studies mainly focused on plantar fasciitis with heel pain caused by flat foot and the growth of calcaneus bone spur. There are no reports on other reasons for plantar fasciitis in large-sample studies. OBJECTIVE: Using the real-time shear wave elastography, CT scan and X-ray, the anatomic site and thickness of normal two-dimensional ultrasound standard flat plantar aponeurosis were identified to analyze the relationship between plantar elastic characteristics and plantar arch angle from non-weight-bearing to weight-bearing position so as to explore the correlation of plantar fasciitis with plantar elastics and plantar arch angle. METHODS: Fifty healthy volunteers (feet) were selected as the healthy control group. 100 cases of plantar fasciitis (one foot) were selected as the case group. Plantar arch angle from non-weight-bearing to weight-bearing position was obtained using X-ray and CT scan to identify anatomic site of plantar aponeurosis in both groups. Two-dimensional ultrasound and real-time shear wave elastography were utilized to obtain thickness and elastic modulus of plantar aponeurosis. RESULTS AND CONCLUSION: (1) From non-weight-bearing to weight-bearing, arch angle change value was (16.4±4.5)° in the healthy control group and (10.5±3.5)° in the case group. Significant differences in arch angle change were detected between the two groups (P <0.01). (2) Thickness of plantar fascia was obviously smaller in the healthy control group (2.4±0.3) mm than in the case group (3.5±0.9) mm. Elastic modulus of plantar fascia was obviously larger in the healthy control group (30.1±1.3) kPa than in the case group (9.1±1.2) kPa. Thickness of plantar fascia and elastic modulus of plantar fascia were significantly different between the two groups (P < 0.01). (3) In summary, real-time shear wave elastography combined with CT and X-ray images can investigate the morphological and elastic characteristics of the plantar aponeurosis from many aspects. Arch angle change is strongly associated with elastic modulus of plantar fascia. The decreased elastic modulus of plantar fascia is possibly one of the reasons for arch angle change from non-weight-bearing to weight-bearing conditions, and is probably one of reasons for plantar fasciitis with heel pain.

OBJECTIVETo study CXCR3 and CCR5 chemokine receptor expression in spleens of patients with primary immune thrombocytopenia (ITP) and its clinical significance.

METHODSThe splenectomy specimens from 10 ITP patients (ITP group) and 8 patients with traumatic splenic rupture (normal control group) were studied. Immunohistochemistry (IHC) was used to study the positive rate of CXCR3 and CCR5. Western blot was performed to detect CXCR3 and CCR5 protein expression, while real-time polymerase chain reaction (RT-PCR) was conducted to analyze their mRNA expression.

RESULTSThe positive rate of CXCR3 and CCR5 were both higher in ITP group (90% and 100%, respectively) than those in control group (75% and 87.5%, respectively)(P < 0.05). The differences were statistically significant (P < 0.05). Protein and mRNA level of CXCR3 in ITP group were 3.0 and 3.5 times as high as those in control group, respectively. Those of CCR5 in ITP group were 1.2 and 1.7 times as high as those in control group, respectively.

CONCLUSIONHigh expression of CXCR3 and CCR5 may play a part in the splenic immune disorders in patients with ITP.

Adolescent ; Adult ; Case-Control Studies ; Child ; Female ; Humans ; Male ; Middle Aged ; Receptors, CCR5 ; metabolism ; Receptors, CXCR3 ; metabolism ; Spleen ; metabolism ; Thrombocytopenia ; immunology ; metabolism ; Young Adult

BACKGROUNDAlthough heart transplantation has become a standard therapy for end-stage heart disease, there are few published studies regarding the use of transplant organs from marginal donors. Here we describe the clinical outcome we have obtained using marginal donor hearts.

METHODSWe analyzed 21 cases of orthotopic heart transplantation for end-stage heart disease performed in our department between September 2008 and July 2010. Of these patients, six received hearts from marginal donors and the remainder received standard-donor hearts. The two groups were compared in terms of both mortality and the incidence of perioperative complications such as infection, acute rejection, and right heart insufficiency.

RESULTSThe 1-year survival rate of both groups was 100%. Only one death was recorded in standard-donor group during follow-up. Patients who received marginal donor hearts (83%) experienced more early complications than did the standard-donor-heart group (13%), but the mortality of the two groups was the same. The duration of post-ICU stay was greater in the marginal donor group than in the standard-donor group, (35.5 ± 17.4) days and (21.7 ± 2.6) days, respectively (P < 0.05).

CONCLUSIONSThe use of marginal donor hearts increases the number of patients who can receive and benefit from transplants. However, it may introduce an increased risk of early complications, thus care should be taken both in the choice of patients who will receive marginal donor hearts and in the perioperative treatment of those for whom the procedure is performed.

Adult ; Antibodies, Monoclonal ; therapeutic use ; Female ; Heart Transplantation ; methods ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Methylprednisolone ; therapeutic use ; Middle Aged ; Recombinant Fusion Proteins ; therapeutic use ; Tissue Donors

Adolescent ; Adult ; Cardiac Surgical Procedures ; Child ; Child, Preschool ; Double Outlet Right Ventricle ; surgery ; Female ; Humans ; Infant ; Male