ObjectiveTo investigate the predictive value of N-terminal pro-brain natriuretic peptide(NT-proBNP) level on the capacity load of patients with maintenance hemodialysis (MHD).MethodsOne hundred and twenty patients undergoing MHD were divided into two groups according to blood pressure levels:bad blood pressure control group with 72 patients and good blood pressure control group with 48 patients.NT-proBNP levels were detected before and after dialysis,and cardiothoracic ratio,left ventricular mass index ( LVMI ),swelling index,number of occurrences of low blood volume and ultrafiltration volume were measured and compared between two groups.The correlation between NT-proBNP and the above indicators was analyzed.ResultsThe systolic blood pressure,diastolic blood pressure,NT-proBNP before dialysis,cardiothoracic ratio,LVMI,swelling index and number of occurrences of low blood volume in bad blood pressure control group respectively were (159.7±18.2) mm Hg (1 mm Hg =0.133 kPa),(95.3±14.8) mm Hg,(11 837.13±1374.26) ng/L,0.61±0.12,(174.36±21.35) g/m2,2.93±1.72,12cases/week,while the indicators in good blood pressure control group were ( 131.6±17.3) mm Hg,(86.5±13.2) mm Hg,(7649.54±1106.18) ng/L,0.52±0.11,( 151.83±18.94) g/m2,1.02±1.48,26 cases/sweek.There were significant differences between two groups (P ＜ 0.01 ).It was showed that NT-proBNP difference between before and after dialysis had significant positive correlation with ultrafiltration volume(P＜ 0.05).NT-proBNP before dialysis had a significant positive correlation with systolic blood pressure,diastolic blood pressure,cardiothoracic ratio,LVMI and swelling index (P ＜ 0.05 or ＜ 0.01 ),while had obvious negative correlation with the number of occurrences of low blood volume(P ＜ 0.01 ).ConclusionsNT-proBNP level of MHD patients has close correlation with blood pressure,cardiothoracic ratio,swelling index,number of occurrences of low blood volume and ultrafiltration volume.Detecting the level of NT-proBNP can better evaluate the changes of blood volume in dialysis patients,adjust dialysis prescription in time,and ensure the adequacy of dialysis.It has important significance to improve the quality of life of MHD patients.

Objective To assess the efficacy of combining vestibular rehabilitation with cognitive behavioral therapy in treating chronic subjective dizziness ( CSD) and the associated anxiety. Methods A total of 98 anxious CSD patients were randomly divided into an experimental group ( n=50) and a control group ( n=48) . All of the pa-tients′scores on the Hamilton anxiety scale ( HAMA) were no less than 14 and their scores on the Hamilton depres-sion scale ( HAMD) were less than 18. Systematic vestibular rehabilitation was given to the patients in the control group, while this was combined with cognitive behavioral therapy for the patients in the experimental group. All pa-tients were evaluated using a dizziness handicap inventory ( DHI) and the HAMA before treatment and in the 4th and 8th week of the treatment. Results Before the treatment there was no significant difference between the 2 groups in any of the assessments. After 3 weeks of treatment, the average HAMA score, DHI total score and its factor scores had decreased significantly. Four weeks later, the average HAMA score, DHI total score and its factor scores for som-atization, emotion and function had improved significantly in both groups compared with before treatment and the scores after 3 weeks. After 3 and 7 weeks of treatment, the average HAMA score, DHI total score and its factor scores of the experimental group were significantly lower than those of the control group. Conclusion Cognitive behavioral therapy amplifies the effects of vestibular rehabilitation in treating persons with CSD, in part by significantly relieving their anxiety.

BACKGROUND:Keloids are the result of abnormal post-traumatic skin restoration, which are characterized with overgrowth and progressive enlargement, invasion of adjacent normal skin tissue, extension beyond the scope of the original wound. Given the high recurrence, treatment with surgery alone is meaningless and, therefore, comprehensive treatment of surgery and other approaches is required. OBJECTIVE:To explore the clinical curative effect of local injection after timely removal of auricle keloid core. METHODS:Twenty patients with auricle keloid were enroled. After keloid core excision, the time interval within the incision scar tissue injection of fluorouracil or triamcinolone acetonide add lidocaine or monotherapy was gradualy lengthened, and if necessary the proper amount of compound betamethasone was added according to scar conditions. The injection dose was adjusted timely based on the regression of scar. The treatment effect was observed for 12 to 24 months. RESULTS AND CONCLUSION: Of 36 auricle keloids from 20 patients, the comprehensive treatment was effective in 1 keloid, and other 35 keloids were cured. The effective rate was 100%, the completely cured rate was 97.2% and the excelent rate was 2.8%. These findings indicate that minimaly invasive excision of keloid core and the epithelial flap coverage combined with 5-fluorouracil and corticosteroid injection is a safe and effective method to treat auricle keloids.

Objective To investigate the effects of host factors and hepatitis B virus (HBV) factors on interferon treatment in patients with chronic hepatitis B(CHB). Methods Polymerase chain reaction sequence specific primers (PCR SSP) technology was used to determine human leukocyte antigen (HLA) DR and DQ alleles in 32 patients with CHB. Serum HBV DNA level was quantified by a PCR assay with a low limit of detection of 1000 copies/ml. HBV genotypes, precore(A 1896 ) and core promoter(T 1762 A 1764 ) mutations was determined by PCR restriction fragment length polymorphism(PCR RFLP) analysis. Results The frequency of HLA DRB1*14 allele was higher in 10 responders to IFN treatment than in 22 non responders(20.0% v.s. 2.3%, relative risk(RR)=10.750, P =0.030); whereas that of HLA DQB1*07 is lower(10.0% v.s. 38.6%, RR=0.176, P =0.022). Pretreatment serum HBV DNA level in 10 responders was lower than that in 22 non responders (6.71?1.06 v.s. 7.59?0.56log 10 copies/ml, P =0.030). Patients with HBV genotype B infection had a higher response rate to IFN than those with HBV genotype C infection(53.8% v.s. 15.8%, P =0.049). Pretreatment serum ALT level, presences of A 1896 mutation and T 1762 A 1764 mutations had no difference between responders and non responders. Logistic multivariate analysis identified low pretreatment HBV DNA level(RR=0.212, P =0.034), presence of A 1896 mutation(RR=0.063, P =0.049) and HLA DQB1*07(RR=13.358, P =0.045) as independent factors associated with IFN antiviral response. Conclusions Low load of pretreatment serum HBV DNA and T 1762 A 1764 mutation in HBV genome or HBV of genotype B are associated with the response rate to IFN treatment in patients with CHB.

BACKGROUND: There are many reasons for poor function after knee arthroplasty. Leg length discrepancy is one of them. The extent of influence on the function of knee joint after arthroplasty has not been fully studied. OBJECTIVE: To analyze the change degree, possible influencing factors and functional changes of leg length discrepancy in patients after total knee arthroplasty. METHODS: Totally 107 patients (124 knees), including 23 males and 84 females, were included from October 2016 to September 2018, who entered the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University for total knee arthroplasty. There were 90 cases of unilateral total knee arthroplasty (90 knees) and 17 cases of bilateral total knee arthroplasty (34 knees). Three cases (6 knees) of bilateral total knee arthroplasty received separate treatment with an interval of more than 6 months, and entered the unilateral knee group. Therefore, there were 93 cases (96 knees) in the unilateral knee group, and 14 cases (28 knees) in the bilateral knee group. Patients signed the informed consent. This study was approved by the Hospital Ethics Committee. At preoperative and postoperative 10 days and 6 months, full length anteroposterior radiographs were taken, and the length of the lower limb and hip-knee-ankle angle were measured and recorded. Angle of knee flexion contracture was measured and the hospital for special surgery knee score was recorded. RESULTS AND CONCLUSION: (1) The length of patients' lower limbs was increased by the correction of deformities after total knee arthroplasty. The length of lower limbs 10 days after surgery was longer than that at 6 months after surgery. The lower limbs of 70.2% of the patients were increased 10 days after total knee arthroplasty, and 79.0% of the patients were increased 6 months after total knee arthroplasty. At 10 days and 6 months postoperatively, the postoperative corrected flexion contracture angles were positively correlated with the change of postoperative lower limb length. (3) Limb lengthening on the operative side was positively correlated with increased hospital for special surgery knee score after surgery. (4) The incidence of leg length discrepancy before and after surgery was almost equal: 45.1 % preoperatively, 55.3% 10 days postoperatively, and 46.0% 6 months postoperatively. (5) The leg length discrepancy preoperatively and 6 months postoperatively was influenced by the difference of deformities between the pair of limbs. Preoperative influencing factors were the difference of hip-knee-ankle angle and flexion contracture of both lower limbs. The difference value of flexion contracture of both lower limbs was the factor affecting the leg length discrepancy 6 months after surgery. Leg length discrepancy before surgery and 6 months after surgery was affecting the difference of hospital for special surgery knee score between lower limbs.

OBJECTIVETo study the anatomy basis for the clinical application of the adjacent horn shaped perforator fasciocutaneous flap for the reconstruction of small and medium-sized defects in the trunk area.

METHODS(1) Ten adult antiseptic cadavers (20 sides) were perfused with red latex. The skin blood supply, line of the blood vessels, branches in accordance with the distribution and crossing were observed. (2) Fifteen cases with defects in the trunk were treated with the adjacent horn shaped perforator fasciocutaneous flaps. The defects size ranged from 5 cm x 5 cm to 13 cm x 13 cm with the size of the flaps ranging from 10 cm x 6 cm to 35 cm x 15 cm.

RESULTSThe trunk skin is supplied by mainly 17 groups arteries such as thyrocervical trunk, internal thoracic artery, posterior intercostal arteries, superior epigastric artery, arteria epigastrica inferior, lumbar arteries, and so on. The perforators (diameter > 0.5 mm) numbers are about 20, 40, 24, 6, on the chest, abdomen and perineum, upper back, waist, respectively. All the flaps survived completely with primary healing both on donor and recipient sites. The flaps color, texture, function and appearance were satisfactory during the follow-up period of 1-24 months.

CONCLUSIONSThe adjacent horn shaped perforator fasciocutaneous flap should be designed flexibly. The defects in the donor sites could be closed directly without skin graft. It is an effective, easy and ideal method for the reconstruction of large defects in the trunk.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Perforator Flap ; Skin Transplantation ; Torso ; surgery ; Young Adult

This paper was to explore the effect of blood oxygen saturation (SO2) on oxidative damages of erythrocytes under the condition of oxidative stress. Keeping SO2 of cultured erythrocytes in vitro at the states of 0.3, 0.5, 0.7, 0.9 and 0.98, respectively, we induced oxidative stress by tert-buthylhydroperoxide (BHP, 0.15 mmol/L of final concentration). After incubation, antioxidant capacity was assessed by measuring content of reduced glutathin hormone (GSH) in erythrocytes. Methemoglobin (MetHb) content, lipid peroxidation (thiobarbituric acid-reactive substances, TBARS) and denatured globin-chains on the plasma membrane were measured to assess the extent of oxidative damages. The results showed that in the presence of BHP, GSH contents increased from 0.3 to 0.98 groups; MetHb, TBARS and globin-chains levels all dropped with the rise of SO2. In conclusion, antioxidant capacity and oxidative damages of erythrocytes are closely related to SO2, declined SO2 could promote oxidative damages of erythrocytes.
Cells, Cultured ; Erythrocytes ; cytology ; metabolism ; physiology ; Glutathione ; blood ; Humans ; Methemoglobin ; metabolism ; Oxidative Stress ; drug effects ; Oximetry ; methods ; Oxygen ; blood ; Thiobarbituric Acid Reactive Substances ; metabolism ; tert-Butylhydroperoxide ; toxicity

Objective To evaluate the technique and clinical results of the modular fluted tapered stems for treating periprosthetic femoral fractures in revision hip arthroplasty.Methods From August 2007 to February 2014,fourteen patients (14hips) with periprosthetic femoral fractures underwent revision hip arthroplasty with modular fluted tapered stem.A retrospective analysis was performed involving all patients who were followed-up more than 2 years.The subjects consisted of 4 males and 10 females with mean age of 73.4±6.6 years (range,62-82 years) at the time of revision.All patients were unilateral with 8 left hips and 6 right hips.The status of primary arthroplasty was bipolar hemiarthroplasty in 3 patients and total hip arthroplasty in 11 patients.Nine cases were with cemented stems,5 cases with uncemented stems.The interval from primary hip arthroplasty to revision surgery ranged from 40 to 163 months,with an average of 120.9±31.9 months.Eight cases with Vancouver type B3 periprosthetic femoral fracture were found preoperatively,6 cases with aseptic loosening and bone deficiency occurred periprosthetic femoral fracture during the operation.Based on the Paprosky classification system for femoral bone deficiency:type ⅢA in 8 hips,type ⅢB in 5 hips,type Ⅳ in 1 hip.Both the femoral and the acetabular components were revised in 9 patients.All femoral fractures were treated with cable fixation,and the cortical allograft struts were used to augment femoral bone stock in 7 patients.The patients were followed up at 6 weeks,3 months,6 months,9 months,12 months and annually thereafter.Harris Hip Score System and radiographic examination was used to evaluate the clinical results,including fracture union,implant stability,bone stock,hip joint function and postoperative complications.Results The mean duration of follow-up was 62.1 ±22.2 months (range,30-96 months).The mean times of fracture union were 6.2±2.5 months (range,3-12 months).The Harris Hip Score improved from 29.6± 10.3 preoperatively to 86.3±4.2 postoperatively (t=-21.6,P=0.00).Thirteen cases (93％,13/14) had the stem subsidence of 4.9±2.5 mm (range,0-9 mm).Thirteen cases (93％,13/14) were presented with femoral bony restoration.Two cases showed incorporation of the allograft in 7 patients.One patient developed deep venous thrombosis of lower limbs,and one suffered from subcutaneous hematomas after surgery.There was no infection,aseptic loosening,dislocation or periprosthetic fracture complications at the followup.Conclusion The short-medium term results of the modular fluted tapered prosthesis applied in periprosthetic femoral fractures are encouraging in revision hip arthroplasty.The present technology can provide reliable primary stability and can tolerate minimal subsidence postoperatively.

In order to remove the endotoxin from the blood of endotoxemia patients, we prepared a new adsorbent with heparin space arm and polymyxin B (PMB) ligand. The carrier of chloromethyl polystyrene resin was activated and heparin space arm was grafted, and then PMB ligand was immobilized onto adsorbent with glutaraldehyde. We employed in vitro FITC-lipopolysaccharide (FITC-LPS) static adsorption to characterize the adsorption properties on the adsorbent, and conducted in vitro lipopolysaccharide (LPS) static adsorption to measure quantitavely the adsorption capacity and rate, and then evaluated the blood compatibility. The in vitro static adsorption indicated that the adsorbent had the removal rate of LPS above 70% with the adsorption equilibrium time for 2 hours. Blood compatibility experiment showed that the adsorbent had little negative effects on blood cells and plasma protein, and their adsorption rates were less than 10% for hemocytes and 20% for plasma protein respectively. This adsorbent exhibited high selectivity, high adsorption capacity and good biocompatibility, and presented a promising clinical application in the treatment of endotoxemia.
Adsorption ; Endotoxemia ; therapy ; Endotoxins ; isolation & purification ; Hemofiltration ; instrumentation ; methods ; Heparin ; chemistry ; Humans ; Ion Exchange Resins ; chemistry ; Ligands ; Polymyxin B ; chemistry ; Sorption Detoxification ; methods

Objective To study the treatment of femoral intertrochanteric fractures by reduction without a traction table in a special position and fixation with proximal femoral nail antirotation (PFNA).Methods From May 2016 to May 2017,34 patients with femoral intertrochanteric fracture were treated with PFNA.They were 20 men and 14 women,from 36 to 89 years of age (average,69.9 years).The left side was affected in 15 cases and the right side in 19.By AO classification,there were 10 cases of type AO 31-A1,13 ones of type 31-A2,and 11 ones of type 3 l-A3.Two cases were complicated with other fractures,and 5 with internal system disease,3 of whom had more than 2 concomitant diseases.Preoperative deep venous thrombosis was found in 2 cases.Surgery was performed for them between 2 and 8 days after injury (average,3.7 days).Reduction was performed in a special position without a traction table.The duration of anesthesia,operation time,intraoperative hemorrhage,postoperative complications and hip function by Harris scores were recorded.Results For the 34 patients,the anesthesia time ranged from 57 to 85 min (average,67.5 min),the operation time ranged from 28 to 65 min (average,40.9 min),and the intraoperative hemorrhage from 80 to 150 mL (average,110.6 mL).They received effective follow-up for 6 to 12 months (average,8.4 months).All the fractures healed after 6 to 12 months(average,7.2 months).No failure of internal fixation was observed during follow-ups.By the Harris scores at the final follow-up,the function of the affected hip was rated as excellent in 9 cases,as good in 21 and as fair in 4,giving an excellent to good rate of 88.2％.Conclusion In the treatment of femoral intertrochanteric fractures,reduction without a traction table in a special position and PFNA fixation may reduce anesthesia time,leading to satisfactory clinical outcomes.