OBJECTIVETo explore different regulatory effects of electroacupuncture (EA) at the same acupoint on the heart and the stomach.

METHODSEighty male SD rats were randomly divided into eight groups equally, i.e., the Neiguan (PC6) group, the Quchi (LI11) group, the Tianshu (ST25) group, the Danzhong (RN17) group, the Zusanli (ST36) group, the Sanyinjiao (SP6) group, the Xinshu (BL15) group, and the Weishu (BL21) group, 10 in each group. The regulatory effects of EA (2/15 Hz, 3 mA, 2 min) at different acupoints on the gastric motility (intragastric pressure) and the cardiac function (the left ventricular pressure) were observed. The mean values of effect of two-min pre-EA and after-EA were compared.

RESULTSCompared with the pre-EA in the same group, the left ventricular pressure decreased in the Neiguan (PC6) group, the Quchi (LI11) group, the Danzhong (RN17) group, the Sanyinjiao (SP6) group, and the Xinshu (BL15) group (P <0.05). The intragastric pressure increased in the Quchi (LI11) group, the Zusanli (ST36) group, the Sanyinjiao (SP6) group, and the Xinshu (BL15) group, while it decreased in the Tianshu (ST25) group, the Danzhong (RN17) group, and the Weishu (BL21) group (P <0.05). The difference of the left ventricular pressure was sequenced from high to low as Xinshu (BL15) >Danzhong (RN17) >Neiguan (PC6) >Sanyinjiao (SP6) >Quchi (LI11). The difference of the intragastric pressure was sequenced from high to low as Tianshu (ST25) >Weishu (BL21) > Xinshu (BL15) > Danzhong (RN17) > Zusanli (ST36) > Sanyinjiao (SP6) > Quchi (LI11).

CONCLUSIONSEA at the same acupoint (2/15 Hz, 3 mA) showed different regulatory effects on the heart and stomach. There existed some difference in the direction and size due to the acupoint location, meridians, dominant nerve segment or relating organs. A fixed effect direction to the specific target was also shown.

Acupuncture Points ; Animals ; Electroacupuncture ; Heart ; physiology ; Male ; Meridians ; Rats, Wistar ; Stomach ; physiology

Objective To explore a new peptide-based approach independent of HLA to generate antigen-specific CD+ CD8+T cells. Methods Peripheral blood mononuclear cells(PBMC) were stimula- ted for 6 h with IE-1 peptide pool. Then the activated IFN-γsecreting ceils were tested by immunomagnetic selection. And the selected cells were cultured with radio-inactivated PBMC in medium with 100 IU/ml IL-2 for 4 weeks. Results The generated T cell lines consisted of IE-1 specific CD4+ T (6.88%) and CD8+ T cells 92.99%, which demonstrated antigen-specific killing and cytokine secretion. Conclusion T ceils can be proliferated with this new procedure, and maintain its phenotype and antigen-specific function.

OBJECTIVETo explore the clinical effects of one-stage hemiarthroplasty in treating fresh subtrochanteric fracture combined with old femoral neck fracture.

METHODSFrom October 2003 to October 2013, 7 patients with fresh subtrochanteric fracture and old femoral neck fracture were treated with hemiarthroplasty in one stage. There were 5 males and 2 females, aged from 69 to 80 years old with an average of 74.5 years. According to the Garden classification, 2 cases were type IV and 5 cases were type V. According to the A0 classification of subtrochanteric fracture, all cases were type A1 (long oblique femoral subtrochanteric fractures). Biological coating long handle femoral prosthesis was used in the patients. The hip joint functions were assessed according to Charnley scoring system after all hemiarthroplasty.

RESULTSSeven patients were followed up from 12 to 24 months with an average of 18 months. There were 1 case with urinary system infection and 1 case with deep venous thrombosis. Of all, 5 cases recovered the walk ability at 6 months after operation and 2 cases could walk with the help of the crutch at 1 year after operation. According to Charnley scoring system to assess the hip joint function, the total Charnley scores reached 15.0±2.5, and 4 cases got an excellent results, 2 good, 1 fair.

CONCLUSIONArthroplasty through anterolateral approach can obtain satisfactory clinical effects in treating fresh subtrochanteric fracture combined with old femoral neck fracture, it has advantages of good joint stability, little pain, less complication, quickly recover, early activities on fields.

Aged ; Aged, 80 and over ; Arthroplasty ; methods ; Female ; Femoral Neck Fractures ; surgery ; Hip Fractures ; surgery ; Humans ; Male

Objective To explore the surgical method and curative effect of free vascularized fibular graft bridged vascu?lar pedicle by vein transplantation for infective long bone defect with or without soft tissue defect reconstruction. Methods From June 2008 to January 2014, 17 patients with infective long bone defect were treated, 11 male and 6 female, 1.5 to 55 years old and averaged 31.3 years. 8 cases in femur, 5 cases in tibia, 3 cases in humerus and 1 case in radius. Bone defect were 4 to 19 cm in length with an average of 9.4 cm. 8 cases with soft tissue defect, from 5.0 cm×3.0 cm to 17.0 cm×5.5 cm. Required adequate surgi?cal debridement, and vacuum sealing drainage (VSD) was used. Free vascularized fibular (skin) flap was designed and harvested . Artery and veins close to the health site were dissected, and bridged vascular pedicle of free vascularized fibular flap by autolo?gous vein transplantation with end to end anastomosis. The length free vascularized fibular graft was from 5 to 18 cm, with an aver?age of 9.6 cm. The free fibula flap ranged from 6.5 cm×4.0 cm to 18.0 cm×6.0 cm. Results All the 17 cases of fibular flap sur?vived, no vascular crisis happened. Post?operative wound primary healed in 11 cases, delayed 1 to 2 weeks to heal in 6 cases. Cal?lus was seen in the 6 to 8 weeks later. 15 cases were followed from 9 months to 6 years (averaged 30 months) while 2 cases were lost to follow?up. Bone defect primary healed in 13 cases, and the fibula graft unhealed in 2 cases, but healed again after a second operation. Fibula stress fracture occurred in one case at 7 months after grafting procedures and bone union was achieved 4 months after reapplying an external fixator. Infected bone defect healing time ranged from 4.2 to 9.8 months, averaged 5.9 months. Accord?ing to the Enneking score, 11 cases were excellent, good in 3 cases, one in fair. Excellent and Good rate was 93.3%. Conclusion Free vascularized fibular (skin) graft with vein bridged vascular pedicle can not only effectively repair infected bone and soft tissue defect, but also improve local blood supply and control infection, shorten the course of treatment, which is an effective treatment of infective long bone defects with or without soft tissue defects.

OBJECTIVE: To establish a SPE-HPLC method to determine the whole blood concentration of sirolimus.METHODS: The blood sample was treated on Waters OASIS SPE column in which a Supelcosil LC-18DB chromatographic column(250 mm?4.6 mm,5 ?m) was adopted and the temperature was set at 50 ℃.The mobile phase was a mixture of methanol and water(75∶25) at a flow rate of 1.5 mL?min-1.The UV detector was operated at 276 nm.RESULTS: The assay procedure was shown to produce linear calibration curves over the range 1.25～70 ng?mL-1 of sirolimus in blood(r=0.999 7).The limit of detection was 0.5 ng?mL-1.Within the range,the average recovery rate was(101.7?2.7)% and the extraction recovery rate was≥82.8%.The coefficients of variation within a day and between days did not exceed 4.0% and 5.4%,respectively.CONCLUSION: This method is found to be easy,convenient and precise for fast monitoring of plasma concentration of sirolimus.

Objective To introduce the transfer of anterolateral thigh flap with iliotibial tract in repair of massive skin and soft tissue defects of the forearm and reconstruction of extension or flexion of the forearm. Methods Eight cases of complicated raw wounds of the forearm were repaired with transfer of anterolateral thigh flap with iliotibial tract. Flexor tendons of 3 cases and extensor tendons of 5 cases were repaired with iliotibial tract. The axial vessel of the flap was used to rebuild blood supply of the hand. Results All the flaps survived completely. A follow-up ranging from 3 months to 2.5 years re- vealed that the reconstructed forearms were good in appearance and soft in texture and restored protective sensation. Affected limbs could perform extension or flexion. Total range of motion (TRM) of the hands was excellent in 6 cases and poor in 2. Conclusion Anterolateral thigh flap with iliotibial tract can not only repair soft tissue defects of the forearm, but also reconstruct the main extension or flexion of the forearm simultaneously.

Objective To analyze the possible reasons of failed surgical treatment of acetabular fractures. Methods Various methods were used for positive patient identification, including according to Matta's X-ray assessment and Merle d'Aubigne & Postel hip function score of clinical standards for classification of acetabular fracture reduction surgery were not satisfied or not carried out a reduction and fixation,the clinical evaluation of hip joint as a "bad", occurrence of femoral head subluxation or dislocation, femoral head necrosis and other serious complications. From February 2000 to February 2008, 22 patients including 14 males and 8 females with an average age of 38.6 years (range, 18-72 years) were considered as failed cases. Results 45.5% of these cases were posterior wall fractures which were not given any fixation, 27.3% of them were posterior column fractures which were not fixed, 13.6% of them whose reduction and fixation of anterior wall fractures were not satisfied, and 9.1% of them were anterior column fractures which needed fixation. One case should take open reduction and iternal fixation instead of THA. The rate of misdiagnosis and mistaken diagnosis were 90% if only X-ray evaluation was made and this rate decreased to 8.3% if computed tomography was taken. The rate of wrong selection of operative approach was 100% in 10 cases of misdiagnosis, and which was 58.3% in 12 cases of correct diagnosis. In the 5 patients with correct diagnosis and selection of operative approach, the reasons of failed surgical treatment were due to imperfect surgical skills in 3 cases, and inappropriate fixation patterns in 2 cases. Conclusion The causes of the failure of surgical treatment for acetabular fracture might include preoperative missed diagnosis and misdiagnose, inappropriate approach, and an unreasonable internal fixation with unskillful technique.

Objective To study the anatomy basis and biomechanical stability of euthyphoria reduction and percutaneous cannulated screw fixation for sacroiliac dislocation,and to evaluate the primary clinical efficacy of this method.Methods The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were measured on 12 adult cadavers (24 sides) fixed and preserved by formalin.Models of sacroiliac dislocation were made on six pelvic specimens of fresh cadavers.A comparison of stability was made on the six models between the fixation studied here and the traditional fixations by posterior percutaneous sacroiliac screws and by anterior sacroiliac joint plates.At the same time,17 patients with type C Tile fracture were treated with our method.The clinical efficacy was analyzed for the 17 patients.Results The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were 20.24?1.20mm,23.80?1.43mm,and 16.26?2.07 mm respectively. There was no statistically significant difference in stability between our method and the traditional fixation by posterior percutaneous sacroiliac screws,though ours seemed better.Follow-ups for the 17 cases averaged 2.2 years,re- vealing fine functional recovery in all according to Matta scoring.Conclusions Euthyphoria reduction and per- cutaneous cannulated screw fixation can lead to sufficient biomechanical stability for the sacroiliac joint and effec- tively avoid nervous injuries.In addition,our method is simple and clinically effective,It is recommendable for small and middle-sized hospitals.

Objective To explore the surgical technique and the efficacy of free descending genicular artery perforator flap without saphenous vein for tissue defect. Methods 18 cases of extremity tissue defect were involved in this study from Au?gust 2010 to April 2014, including 16 males and 2 females with an average age of 32.4 years (8 plantar or heel soft tissue defect, 10 back of hand or palm soft tissue defect). 2 old injury cases that had soft tissue defect after scar release were treated by free flaps and the other 16 were open injury with infection, among which 5 cases were combined with fractures or bone defect. Sizes of the skin and soft tissue defect were 2.0 cm × 8.0 cm to 9.0 cm × 12.0 cm. All wounds were treated by free descending genicular artery perforator flap from the contralateral limb. Medial femoral cutaneous nerve was kept in flaps as far as possible. The projection points of descending genicular artery perforator and saphenous vein were detected by Doppler, then the flaps were cut with reverse approach, and saphenous vein and saphenous nerve were preserved. Results All 18 flaps were survived and all cases were fol?lowed up for 3 to 30 months (average, 10.3 months). The flap sizes varied from 2.5 cm×9.0 cm-9.5 cm×13.0 cm. 2 cases with bone defect were healed 3 months later without infection, and the other 3 cases with fractures were healed 2-3 months after operation. The two point’s discrimination distance was 7.0-12.0 mm on the flap. The disabilities of the arm, shoulder, and hand question?naire score averaged 51, and the mean Japanese Orthopaedic Association's foot rating scale was 70.5. Most patients were satisfied with appearance of the recipient and donor sites, among which 5 cases had skin?graft on the donor sites, and the other 12 cases had small scars on the donor sites. Poor healing was detected in 1 case on the thigh which was healed 3 weeks later. There was no par?esthesia and rash on the donor sites. The mean distance between projection points of descending genicular artery perforator and sa?phenous vein was 3.7 cm. Conclusion Free descending genicular artery perforator flap without saphenous vein is an optimal therapy for the extremity tissue defect, which has the advantage of covert donor site, less invasion, less variation of perforator, and could recover the skin sense of recipient site.

Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. How-ever, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain un-clear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Meth-ods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease:im-proving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0%vs. 4.2%, respectively;P<0.001), including acute renal failure (21.4%vs. 0, respectively;P<0.001), and they increased with severity of AKI (P<0.001). The maximum levels of body tem-perature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR:1.023;95%CI:1.003–1.044;P=0.0238) and bilateral renal artery involvement (OR:19.076;95%CI:1.914–190.164;P=0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently oc-curred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.