AIM: To investigate the distribution in mice and pharmacokinetics in rabbits of fraction Ⅲ isolated from Naja naja atra venom. METHODS: Fraction Ⅲ was labelled with [~(125)Ⅰ] by chloramine-T method. The drug concentration in blood was determined by a radionuclide tracing kinetic methods. The distribution of [~(125)Ⅰ]-fraction Ⅲ in mice was determined based on the ratio of the relative incorporation of radioactivity in tissues to that in blood. RESULTS: In two and four hours after intravenous injection of fraction Ⅲ in mice, the organs in which the ratio of the radioactivity incorporation was bigger than 1 were liver, kidney, lung, heart and muscle, whth the maximun in kidney. After intravenous injection of fraction Ⅲ, with dosages of 75, 150 and 300 ?g/kg, respectively, the T_(1/2)?, T_(1/2)? and T_(1/2)? were 39.6-42.5 min, 16.8-17.3 h and 21.7-22.1 h, respectively. There was no significant difference between the different dosages. CONCLUSION: Fraction Ⅲ was mostly found in kidney, followed by liver and lung after intravenous administration in mice. The pharmacokinetics is in accordance with the feature of three atrioventricular modle. The AUC is in direct proportion to the dosage. It suggests that the distribution and clearance of the drug is a grade 1 linear kinetic process. [

Objective To investigate the relationship among the late-life depression ( LLD ) , cognitive function and white matter lesions ( WML) , after excluding vascular risk factors and brain atrophy.Methods The depression and cognition status of 277 patients were assessed using a variety of neurological scales, and the actually enrolled patients were divided into LLD group ( 77 cases ) and the non-depressed group (103 cases).The independent samples t test and multivariate Logistic regression were used to analyze independent risk factors for depressive symptoms with the model Ⅰ of controlling age , sex, years of education and the model Ⅱof controlling age, sex, years of education, high blood pressure, diabetes and coronary heart disease.Under the premise of controlling mode Ⅱand brain atrophy , partial correlation was used to analyze the correlations of depressive symptoms and cognitive function and WML , and the correlation between depressive symptoms and cognitive items.Results The results showed that the proportion of high blood pressure (90.9%vs 74.7%, χ2 =6.342,P=0.046), cognitive scores (19.23 ±7.05 vs 22.99 ± 6.71, t=3.343,P=0.001), WML level 2 proportion (65.1% vs 34.9%, χ2 =7.373,P=0.025) and temporal lobe atrophy of hippocampal sulcus ratio (0.24 ±0.03 vs 0.22 ±0.03, t=-2.041,P=0.044) had statistically significant difference between the two groups.Multivariate Logistic regression showed that cognitive function was an independent risk factor for depression ( OR=1.63,95% CI 1.01 -2.80, P=0.030).Controlling for all risk factors , partial correlation analysis showed that depressive symptoms were correlated with cognitive function ( r=-0.239,P=0.004) and WML ( r=0.222,P=0.008) and the atrophy of temporal lobe and hippocampus ( r=0.173, P=0.040 ).Under the model Ⅱ, depressive symptoms correlated with attention (r=-0.175, P=0.040), memories (r=-0.140, P=0.050) and drawing clock test ( r=-0.186, P=0.029 ).Conclusions Excluding vascular risk factorts , brain atrophy and WML , cognitive impairment has significant correlation with depressive symptoms.Vascular risk factors are involved in the occurrence of depression , and WML may be the severity of cognitive impairment reserve marker.LLD patients showed hippocampal atrophy similar with early AD , manifesting the cognitive feature of memory and executive dysfunction and attention disorder .

Objective To investigate the value of the B-mode ultrasound method for muscle recovery after transplantation.Methods From January,2009 to January,2014,35 patients of functioning free gracilis muscle transplantation for brachial plexus injury were involved.Using B-mode ultrasound to determine the cross-sectional area (CSA) of transplanted gracilismuscle at rest and contraction state.The contraction ratio (CR) and the muscle bulk ratio (MBR) was calculated based on the CSA.Then the CR and MBR were analysised statistically with manual muscle strength and joint range of motion (ROM) to investigate the correlation.Results The followed-up time was 8-24 months,averaged of 22.4 months.The CR of the transplated muscle was (1.23±0.15),which was significantly correlated with muscle strength and joint ROM (P＜0.01,r=0.872,r=0.847,respectively).CR of transplanted muscle with or larger than M4 was greater than that of less than M4 [CR were (1.35±0.10),(1.09±0.06),respectively],and the difference was statistically significant (P＜0.05).The MBR was greater than 1 in 17 cases,and less than 1 in 18 cases.There was no significant correlation between MBR and muscle strength and ROM (P＞0.05).There was no statistically significant difference in muscle strength and ROM between patients with MBR greater than 1 and those with MBR less than 1 (P=0.054,P=0.284,respectively).Conclusion The transplanted muscle recovery can be quantitatively reflected by the CR.CR enlargement of the transplanted gracilis muscle indicated a better recovery of muscle contraction function.MBR is not suitable for evaluating function recovery of transplanted muscles.

Objective:To investigate the clinical effect of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fracture.Methods:Clinical data of 58 patients suffering from old osteoporotic vertebral bodies with endplate fractures from January 2018 to January 2020 were analyzed retrospectively. All patients had a single vertebral body fracture and were treated with bilateral injection of bone cement with percutaneous kyphoplasty (PKP). According to the shape of the puncture device, the patients were divided into a curved needle group and a ordinary group. There were 28 cases in the curved needle group, including 7 males and 21 females, aged 60-84 years old, with an average age of 71.8±7.8 years. The distribution of vertebral bodies with fractures: T 11 3 cases, T 12 5 cases, L 1 6 cases, L 2 5 cases, L 3 3 cases, L 4 4 cases, and L 5 2 cases. In the ordinary group, there were 30 cases, 8 males and 22 females, with an average age of 73.2±8.4 years (range, 61-88 years). The vertebral body distribution of fracture: T 11 3 cases, T 12 5 cases, L 1 7 cases, L 2 4 cases, L 3 4 cases, L 4 5 cases, and L 5 2 cases. The surgery time, amount of bone cement injection, and bone cement leakage rate were compared between the two groups, as well as the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 week, 6 months, and 1 year after surgery. Preoperative and postoperative vertebral midpoint height and kyphosis Cobb angle were measured. Results:All patients were followed up for 12-24 months, with an average of 14.7±2.9 months. The bone cement leakage rate in curved needle group (18%, 5/28) was lower than that in ordinary group (23%, 7/30), but there was no significant statistical difference (χ 2=0.27, P=0.607). The amount of bone cement injection and surgery time in curved needle group (5.0±0.5 ml, 55.2±6.9 min) were significantly higher than those in ordinary group (3.4±0.6 ml, 42.9±3.6 min, P<0.05) . The scores of VAS (2.3±1.0, 2.6±1.5) and ODI (27.5%±9.7%, 28.7%±11.3%) in curved needle group were lower than those in ordinary group (2.7±1.0, 4.5±1.1 and 31.8%±10.5%, 43.1%±13.4%) at 6 months after surgery and at the last follow-up after surgery. In the curved needle group, the Cobb angle was 25.5°±3.5° preoperatively, 18.4°±1.6° postoperatively, and 20.5°±4.9°at the last follow-up. The height of the vertebral body was 14.2±1.9 mm before surgery, 21.5±2.2 mm after surgery, and 20.1±3.6 mm at the last follow-up. Compared with the preoperative results, the kyphosis Cobb angle decreased and the height of the fractured vertebral body increased at the last follow-up, and the differences were statistically significant ( P<0.05). In the ordinary group, the Cobb angle was 24.4°±3.6° preoperatively, 23.1°±4.0° postoperatively, and 27.8°±2.9° at the last follow-up. The height of the vertebral body was 14.5±1.8 mm before surgery, 15.4±2.0 mm after surgery, and 12.7±1.0 mm at the last follow-up. At the last follow-up, the kyphosis Cobb angle increased and the height of the fractured vertebral body decreased compared with preoperative and postoperative 1 week, and the differences were statistically significant ( P<0.05). At 1 week after surgery, 6 months after surgery and the last follow-up, the Cobb angle of curved needle group was lower than that of ordinary group ( P<0.05), the height of vertebral body was higher than that of ordinary group ( P<0.05). Conclusion:Flexible application of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fractures can effectively increase the riveting force of bone cement in the vertebral body, restore the height of endplate, and reduce the occurrence of kyphosis and chronic low back pain.

Objective:To explore the clinical technique and method of reconstruction large soft tissue defect of plantar by skin soft tissue dilatation combined with thigh cross leg flap to improve the weight-bearing function of plantar standing.Methods:From February 2015 to June 2019, 8 cases with plantar soft tissue defects were repaired with cross leg flap expanded from the healthy side of the thigh. Right foot in 4 cases, left foot in 3 cases and bilateral in 1 case. There were 5 males and 3 females. Ages ranged from 16 to 56, with an average age of 31. Clinical features: scar ulcer in 4 cases, bone-sticking scar in 4 cases, bone exposure in 1 case. After debridement, the area of skin and soft tissue defect was 9 cm×16 cm-12 cm×29 cm, the area of harvest expanded flap was 11 cm×18 cm-14 cm×30 cm. All flaps were fixed by cross-leg with pedicle. The pedicle division were performed one month after the skin flap transmission.Results:Of the 9 flaps transferred, 8 survived, 1 died in the distal part of the flap and was repaired by secondary expanded flap, and the donor site healed in linear scar stage. After 6-24 months follow-up, the plantar flap was in good shape and could walk with weight-bearing, without ulceration, and the protective tactile sensation was gradually restored in 12 months.Conclusions:The large-area soft tissue defect of plantar was repaired with the expanded cross leg flap in the healthy thigh, which also provide sufficient thickness of soft tissue to increase the ability of bearing weight and wearing resistance of the sole. It is a good alternative method to repair large area soft tissue defect of plantar under the condition of limited transfer of perforator flap and free flap.

Objective:To explore the clinical technique and method of reconstruction large soft tissue defect of plantar by skin soft tissue dilatation combined with thigh cross leg flap to improve the weight-bearing function of plantar standing.Methods:From February 2015 to June 2019, 8 cases with plantar soft tissue defects were repaired with cross leg flap expanded from the healthy side of the thigh. Right foot in 4 cases, left foot in 3 cases and bilateral in 1 case. There were 5 males and 3 females. Ages ranged from 16 to 56, with an average age of 31. Clinical features: scar ulcer in 4 cases, bone-sticking scar in 4 cases, bone exposure in 1 case. After debridement, the area of skin and soft tissue defect was 9 cm×16 cm-12 cm×29 cm, the area of harvest expanded flap was 11 cm×18 cm-14 cm×30 cm. All flaps were fixed by cross-leg with pedicle. The pedicle division were performed one month after the skin flap transmission.Results:Of the 9 flaps transferred, 8 survived, 1 died in the distal part of the flap and was repaired by secondary expanded flap, and the donor site healed in linear scar stage. After 6-24 months follow-up, the plantar flap was in good shape and could walk with weight-bearing, without ulceration, and the protective tactile sensation was gradually restored in 12 months.Conclusions:The large-area soft tissue defect of plantar was repaired with the expanded cross leg flap in the healthy thigh, which also provide sufficient thickness of soft tissue to increase the ability of bearing weight and wearing resistance of the sole. It is a good alternative method to repair large area soft tissue defect of plantar under the condition of limited transfer of perforator flap and free flap.

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.