Arthroplasty, Replacement ; Elbow Joint ; injuries ; surgery ; Humans ; Joint Instability ; therapy ; Tennis Elbow ; therapy

Objective To explore the risk factors,the distribution of etiology and drug resistance status of patients with early infection (3 months) after liver transplantation,and to provide reference for clinical diagnosis and treatment.Methods The clinical data of 112 recipients from February 2014 to December 2015 were collected,and logistic regression analysis was performed on the risk factors of early postoperative infection in liver transplant patients.The independent risk factors of infection after liver transplantation were screened out.At the same time,the results of pathogen culture and drug sensitivity test were statistically described.Results The independent risk factors for infection at 3th month after liver transplantation included the operative time ≥600 min [P =0.003,odds ratio (OR) =9.996,95 ％ confidence interval (95 ％ CI),2.221-44.981],intensive care unit (ICU) ≥6 days (P =0.010,OR =6.306,95％ CI =1.563-25.437),Child-Pugh grade of C (P =0.023,OR =6.298,95％ CI =1.294-30.659).Of the 112 liver transplant recipients,59 had an infection (52.68％),and 168 stains of pathogens were isolated.The positive rate of the specimens was highest in sputum,followed by bile,ascites,drainage and catheter end,blood,deep vein catheter,middle urinary,pleural effusion and peripherally inserted central catheter (PICC).The detectable rate of gram-negative bacteria,gram-positive bacteria,fungi and viruses was 46.43％ (78 strains),29.76％ (50 strains),18.45％ (31 strains),and 5.36％ (9 strains) respectively.Infection occurred mainly within 1 month after surgery,accounting for about 80.36％ (135 strains),especially at 1st week after surgery,accounting for about 34.52％ (58 strains).Gram-positive bacteria had a higher drug resistance rate,including penicillins,macrolides,aminoglycosides,quinolones,linamides,etc.especially in the highest rate of Enterococcus faeciurr.Gram-negative bacteria were individualized based on the different strains of the bacteria,and they were relatively low in the resistance of the carbapene.Conclusion Infection is one of the most common complications after liver transplantation.To reduce the incidence of infection after liver transplantation,efforts should be made to shorten the duration of operation and ICU stay time,improve the basic nutritional status of recipients,and enhance monitoring of the recipient's infection after liver transplantation,to further increase the survival rate of postoperative liver transplantation recipients and improve the quality of life.

AIMTo elucidate the independent or combined effects of endothelin-1 (ET-1) and prostaglandin F2alpha (PGF2alpha) on cardiomyocytes and investigate the relationship between hypertrophy and apoptosis of cardiomyocytes.

METHODSCultured neonatal rat cardiomyocytes were stained with FITC-conjugated phalloidin and eosin to detect the cardiomyocyte hypertrophy evidenced by increased sarcomeric structure and cell size. Cardiomyocytes were stained with Hoechst 33258 to detect apoptotic nuclei showing features of condensation and fragmentation.

RESULTSCardiomyocyte hypertrophy induced by ET-1 or PGF2, shown a dose dependent effect. The area of cardiomyocytes treated by 10 nmol/L or 100 nmol/L of ET-1 for 24 h increased 68% or 84% as compared with control, respectively. The area of cardiomyocytes exposed to 10 nmol/L or 100 nmol/L of PGF2alpha for 24 h increased 28% or 106% as compared with control, respectively. The ET-1 and PGF2alpha had a synergic effect on cardiomyocyte hypertrophy, but not superimposed effect. The area of cardiomyocytes increased 80%, 122%, 96%, and 199% in 10 nmol/L ET-1 plus 10 nmol/L PGF2, 10 nmol/L ET-1 plus 100 nmol/L PGF2alpha, 100 nmol/L ET-1 plus 10 nmol/L PGF2alpha, and 100 nmol/L ET-1 plus 100 nmol/L PGF2alpha group, respectively. There were no changes in apoptotic rate of cardiomyocytes treated by ET-1 or PGF2alpha alone for 48 h. The apoptotic rate of cardiomyocytes also didn't increase in ET-1 plus PGF2alpha treatment for 24 h groups, but significantly increased in ET-1 plus PGF2alpha treatment for 48 h groups. ET-1 or PGF2alpha could induce an increase in apoptotic rate of hypertrophic cardiomyocytes. There was a positive relationship between hypertrophic extent and apoptotic rate in cardiomyocytes.

CONCLUSIONThe cardiomyocytes treated by ET-1 or PGF2alpha alone only show hypertrophy, but treatment of ET-1 plus PGF2alpha for 48 h induces apoptosis of cardiomyocytes.

Animals ; Apoptosis ; drug effects ; Cells, Cultured ; Dinoprost ; administration & dosage ; pharmacology ; Dose-Response Relationship, Drug ; Endothelin-1 ; administration & dosage ; pharmacology ; Myocytes, Cardiac ; cytology ; drug effects ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo explore clinical effects of three nonparallel screws in treating femoral neck fractures.

METHODSFrom September 2008 and May 2009, 29 patients were treated, including 12 males and 17 females with an average age of 52 years (ranged from 27 to 62 years). Before operation, according to Garden classification system, 2 cases were Garden type II (undisplaced fracture), 18 cases were Garden type III (partial displaced fracture) and 9 cases were Garden type IV (complete displaced fracture). After fracture reduction in operation, Pauwels classification system was used to classify the type, and 12 cases were type II, 17 cases were type III Closed reduction and internal fixation with three non-parallel screws were used to treat. The surgery X-ray and follow-up X-ray were compared to observe whether femoral neck abbreviate and screw exit appeare. Harris scoring was used to evaluate function.

RESULTSAll patients were followed-up from 34 to 44 months with an average of 38 months. The mean time of bone union was 7 (ranged, 3 to 12) months. Nonunion occured in 4 cases with Garden IV, and femoral head necrosis occurred in 2 cases. For Harris scoring, two cases with nondisplaced fracture were 100. Among 27 cases with displaced fractures, 23 cases achieved bone union without femoral head necrosis, average Harris scale was 91.35 +/- 8.00, and the average Harris scale of 4 cases with bone nonunion was 61.23 +/- 5.12. For all but one, there was no femoral neck crispation after bone union.

CONCLUSIONNonparallel screws for femoral neck fractures can effectively control abbreviation and screw tail exit after fracture healing.

Adult ; Bone Screws ; Female ; Femoral Neck Fractures ; diagnostic imaging ; surgery ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the effect and complication of surgical treatment for Pilon fracture using the posterolateral approach.

METHODSFrom August 2009 to March 2011, 15 patients with Pilon fractures (2 in B3,13 in C) and with a separate displaced posterior malleolar fragment was treated in two-stage: the first stage management was on stabiliztion of the soft tissue envelope with temporary external fixator of spanning arthritis, and the second stage management was open reduction and internal fixation with posterolateral approach and anteromedial or anteralateral approach.

RESULTSAll patients were followed-up for 12 to 17 months (14.2 months in average). Thirteen of the 15 fractures healed, but 2 fractures needed autologous bone graft procedure duo to nonuion. There was no wound complication related to poterolateral incion. Fourteen fractures had less than 2 mm of incongruity of distal tibia joint. According to Baired-Jackson criteria, the results were excellent in 2 cases, good in 7, fair in 4, and poor in 2.

CONCLUSIONThe posterolateral approach offers direct visualization for the reduction and fixation of the fibula and posterior distal fragment of the tibia Pilon fractures, faciliate the management of this difficult fracture pattern.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; surgery

Cardiac hypertrophy is an adaptive process to an increased hemodynamic overload. However, the adaption may lead to the fragility of myocardium facing pathological stimuli. In the present study, experiments were designed to explore the susceptibility of hypertrophic myocardiocytes to apoptotic stimuli and the role of protein kinase Cdelta (PKCdelta) during the transition from hypertrophy to apoptosis. Endothelin-1 (ET-1)-treated cardiomyocytes were used as model of cardiac hypertrophy. Angiotensin II (Ang II) was used as an apoptotic stimulus. Cell surface area was measured to determine the extent of hypertrophy. The apoptotic rate in cardiomyocytes was detected by Hoechst 33258. (1) Cell surface area was increased by 42.5% and 67.3% following 1 nmol/L and 10 nmol/L ET-1 treatment, respectively, as compared with serum-free cultured myocytes. So the mildly and moderately hypertrophic myocyte models were set up. (2) Apoptotic rates in serum-free cultured, mildly and moderately hypertrophic myocytes after Ang II treatment were (15.54+/-1.32) %, (20.65+/-1.40) % and (29.33+/-3.52) %, respectively. It is suggested that hypertrophic myocytes are more susceptive to apoptotic stimulus. (3) Rottlerin, a specific inhibitor of PKCdelta depressed apoptotic rates induced by Ang II to (15.88+/-2.25) % in mildly hypertrophic myocytes and to (15.01+/-1.37) % in moderately hypertrophic myocytes; but rottlerin did not affect apoptotic rate induced by Ang II in serum-free cultured myocytes. These results suggest that inhibition of PKCdelta can reduce Ang II-induced apoptosis of hypertrophic cardiomyocytes and that PKCdelta is possibly involved in the apoptotic process of hypertrophic cardiomyocytes.
Angiotensin II ; pharmacology ; Animals ; Animals, Newborn ; Apoptosis ; drug effects ; physiology ; Cardiomegaly ; pathology ; physiopathology ; Cell Enlargement ; drug effects ; Endothelin-1 ; pharmacology ; Heart Failure ; physiopathology ; Myocytes, Cardiac ; cytology ; pathology ; Primary Cell Culture ; Protein Kinase C-delta ; physiology ; Rats ; Rats, Sprague-Dawley

Objective To investigate the dynamic changes of transcription profiles of mouse thymus gene expression in different times after 6 Gy γ-irradiation.Methods High-flux cDNA microarray technique was used irradiation,the numbers and types of differentially expressed genes were gradually decreased,for instance,the induced differential expression genes were involved in cell cycle,immunity and stress,apeptosis,signal transduction,transcription regulation,DNA synthesis and recombination,cystoskeleton,ion channel and transportation,metabolism,protein translation and synthesis,development and cell differentiation,etc.correlated cell cycle(3 up-regulating:Cyclin G,Anxal,Fgf1 and 2 down-regulating:Cdc2a,Cdc25b),5 genes correlated immune stress(4 up-regulating:IL-18,Casp1,IL-15,IL-7 and 1 down-regulating:Cd28),7 genes correlated apoptosis(4 up-regulating:Caspl,Anxal,Perp,IL-7 and 3 down-regulating:Pten,Api5 and Fas).Conclusions After 6 Gy irradiation,differentially expressed genes in mouse thymus is not only involved in many targets,levels and pathways,but also displayed an obvious difference in times.This reveals the regular pattern of differential expression genes in the process of injury and reconstitution in moderate dose irradiated mouse thymus.

Objective To analyze the incidence and risk factors of colorectal adenomatous polyps (CAP) in recipients after liver transplantation. Methods Seventy-seven liver transplant recipients and 231 individuals undergoing colonoscopy during physical examination were recruited in this study. The incidence of CAP and pathological examination results were analyzed. Clinical data of liver transplant recipients were collected. According to the incidence of CAP, liver transplant recipients were divided into the CAP group (n=28) and non-CAP group (n=49). The risk factors of CAP after liver transplantation were identified. Results The 5-year cumulative incidence rates of colorectal polyps in liver transplant recipients and physical examination individuals were 43% and 34%, and 29% and 23% for the 5-year cumulative incidence rates of CAP, with no significant differences (both P > 0.05). Among all liver transplant recipients, 65 polyps were detected. The quantity of polyps in 1 case was excessively high and not counted. Multiple polyps were identified in certain recipients. Five polyps were not prepared for pathological examination due to small size. Pathological examination of 60 polyps demonstrated 25 inflammatory polyps, 33 CAP (8 complicated with low-grade intraepithelial neoplasia and 3 complicated with high-grade intraepithelial neoplasia), and 2 well-differentiated adenocarcinoma. Cox model analysis prompted that use of ciclosporine after liver transplantation was an independent risk factor for CAP in the recipients. Conclusions The risk of CAP is slightly elevated after liver transplantation. Postoperative use of ciclosporine is an independent risk factor for CAP in recipients after liver transplantation. Colonoscopy should be emphasized in the recipients after liver transplantation.

OBJECTIVETo introduce a new way of treatment for elbow stiffness and instability.

METHODS30 cases of elbow trauma were treated with mobile hinged Orthofix elbow fixator, 26 of them were followed up. There are 15 male patients and 11 female patients. The average age is 32.6 years old. The 26 injured elbows involved 12 cases on left side and 14 cases on right side; Sixteen cases on the dominant side and 10 cases on the non-dominant side. Sixteen cases had elbow stiffness, 5 cases had acute radial head fracture and posterior dislocation of the elbow, 3 of cases had Monteggia's fracture dislocation, and 2 cases had neglected posterior dislocation of the elbow.

RESULTSThe average follow up time was 6 months (3 - 12 month). The mean time of fixation with fixator was 8.5 weeks (6 - 11 weeks). The mean ROM of the 16 cases of elbow stiffness was (37.5 +/- 0.8) degrees before operation, and (96.5 +/- 0.6) degrees operation, with a significant difference (P < 0.05). The mean Mayo elbow score was (69.5 +/- 1.7) before operation, compared with (82.8 +/- 1.6) after operation, with a significant difference (< 0.05). For the other 10 cases (5 cases with acute radial head fracture and posterior dislocation of the elbow, 3 cases with Monteggia's fracture dislocation, 2 cases with neglected posterior dislocation of the elbow), the average ROM of the elbow flexion-extension was 95 degrees (65 degrees - 150 degrees ); The average range of flexion was 117 degrees; the average loss of extension was 22 degrees; the average pronation was 76 degrees (20 degrees - 90 degrees ), the average supination was 75 degrees (15 degrees - 90 degrees ). Nine of the cases achieved anatomic reduction and proved by X-ray. The mean Mayo elbow score was 84 (49 - 96). Three cases were rated excellent, 4 good, 2 fair and 1 poor. The rate of excellent and good was 70% (7/10). Nine cases had no pain or mild pain, and did not need analgesic. Eight cases returned to their former work, 5 of the cases had complications.

CONCLUSIONSThe mobile hinged elbow external fixator have following advantages: (1) distraction of the articular space and enhance fracture healing; (2) allow early movement of the elbow during healing; (3) provide stable environment for the healing after arthrolysis and reconstruction. Mobile hinged elbow external fixator can achieve successful result in the treatment of elbow stiffness or unstable fracture dislocation of elbow.

Adolescent ; Adult ; Aged ; Elbow Joint ; injuries ; surgery ; External Fixators ; Female ; Follow-Up Studies ; Fracture Fixation ; methods ; Humans ; Joint Dislocations ; complications ; surgery ; Joint Instability ; surgery ; Male ; Middle Aged ; Monteggia's Fracture ; complications ; surgery ; Radius Fractures ; complications ; surgery ; Treatment Outcome

OBJECTIVETo report the method and result of open arthrolysis of patients who suffered from severe post-traumatic elbow stiffness.

METHODSOf the 12 patients, there were 9 male and 3 female, average age of 32 years old (16 - 47 years). Primary injury included 7 simple fractures, 1 simple dislocation, 2 fracture dislocations and 2 soft tissue injury. The averaged time of immobilization after injury was 3.3 weeks (0 - 8 weeks). The averaged time between injury and open arthrolysis was 6.4 months (1 - 14 months). Before open arthrolysis, the mean arc of total motion was 33.8 degrees (0 degrees - 80 degrees ). Three patients suffered from forearm rotation deficiency. Posterior approach was used for 4 patients, medial approach for 2 patients and both medial and lateral approach for 6 patients. tissues were resected, which hindered the motion of the elbow and perform proximal radioulnar joint arthrolysis for some patients. After arthrolysis, the arc of elbow motion could reach 0 degrees - 140 degrees , and for the patients who suffered from forearm rotation deficiency, pronation 80 degrees and supination 90 degrees were gotten. Ulnar nerve transposition was not a routine. The patients began active and active-assisted elbow and forearm movement the first day after operation. Indomethacin was taken the first day after open arthrolysis routinely.

RESULTSTwelve patients were followed up for 14 - 18 months (averaged 15.8 months). At the latest follow-up, the mean arc of total motion was 120.8 degrees (100 degrees - 140 degrees ). Nine patients recovered the functional arc of 30 degrees - 130 degrees , and 10 patients extended to less than 10 degrees , and 4 patients could extend to 0 degrees . As for the 3 patients who suffered forearm rotation deficiency, the forearm rotation improved. The mean Mayo elbow performance score was 70.4 (50 - 90) before open arthrolysis, and 98.8 (85 - 100) after open arthrolysis. No patient was found to have signs of heterotopic ossification.

CONCLUSIONSFor the treatment of post-traumatic stiff elbow, with careful open arthrolysis and early active and active-assisted exercise we can get good results.

Adolescent ; Adult ; Elbow Joint ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; etiology ; surgery ; Male ; Middle Aged ; Motion Therapy, Continuous Passive ; Range of Motion, Articular ; Treatment Outcome