Objective To explore the therapeutic effect of combining continuous venovenous hemofiltration (CVVH) with hemoperfusion (HP) on patients with septic shock.Methods A prospective study was conducted. Thirty-two patients with septic shock admitted to Changshu No.1 People's Hospital were enrolled, and they were divided into two groups according to random digits table. The observation group (17 cases) was given HP before CVVH, in the control group (15 cases), only CVVH treatment was carried out, and lasting for 5 days in both groups. The changes of pulse oxygen saturation (SpO2), central venous pressure (CVP), systemic vascular resistance index (SVRI), cardiac index (CI), extra-vascular lung water index (EVLWI) were observed before treatment and 5 days after treatment.Results Compared with those before treatment, the levels of SpO2, CVP, SVRI, CI were obviously elevated, and EVLWI was markedly decreased after treatment in two groups. Compared with those of control group, the degrees of improvement of above indicators in observation group were more prominent [SpO2: 0.966±0.035 vs. 0.939±0.036, CVP (mmHg, 1 mmHg = 0.133 kPa): 8.5±3.2 vs. 8.1±4.2, SVRI (kPa·s·L-1·m-2): 1 497.35±157.08 vs. 1 343.60±144.48, CI (mL·s-1·m-2): 120.36±15.34 vs. 106.69±12.33, EVLWI (mL/kg): 6.84±0.73 vs. 7.65±0.70, allP < 0.05].Conclusion Combing HP with CVVH for treatment of patients with septic shock can improve their prognosis more obviously than using CVVH alone.

Objective To review and evaluate the effect of one stage surgical correction of congenital heart disease with tracheal stenosis in infants.Methods Between August 2001 and December 2005,six infants with congenital heart disease with tracheal steno- sis were repaired at one stage operation.The age was 24 d～3 y[mean(13.16?12.03)months]and the weight was 4.2～10.0 kg [mean(7.98?2.03)kg].There were 3 patients with tetralogy of Fallot,1 with pulmonary atresia;2 with ventricular septal defect, 1 with coarctation of aorta;and 1 with pulmonary sling.The congenital heart disease were repaired underwent low temperature and car- diopulmonary bypass,and the tracheal stenosis were corrected simultancously.Results There was one death postoperative because of right and left branch stenosis.One patient with pulmonary sling died of granulation tissue on the patch 3 months after operation.All other 4 patients recovered uneventfully.These patients were followed up from 6 month to 4 years.There were no complications.CT scan shows that the tracheal anastomosis was patent without any stenosis.Conclusion One stage repair of congenital heart disease with tracheal stenosis in infants may have a satisfactory result.To deal with the tracheal stenosis is difficult,the operative methods de- pends on the length of stenosis.The principles of surgical methods consist of using autologous material,maintaining its contour and function of respiratory epithelium,and maintaining its growth.

Adult ; Aged ; Burns ; complications ; Female ; Glutathione ; therapeutic use ; Humans ; Liver ; physiopathology ; Liver Failure ; drug therapy ; physiopathology ; Male ; Middle Aged

The purpose of the present study was to explore whether substance P (SP) modulates the response mediated by GABAA receptors. Experiments were carried out on cultured hippocampal pyramidal neurons of rats. GABA-activated inward currents were recorded using the whole-cell-patch-clamp techique. The majority of the neurons examined (66/92, 72%) were sensitive to both GABA and SP. When the neurons were treated with SP prior to application of GABA, the GABA-activated current (IGABA) was inhibited markedly, which was concentration-dependent and could be blocked by spantide, an NK1 receptor antagonist. With 10－8, 10－7, 10－6 and 10－5 mol/L SP, IGABA was inhibited by 18%, 24.8%, 25.9% and 28% respectively. Intracellular application of H7, a potent inhibitor of PKC, abolished inhibition of IGABA by SP, suggesting that the inhibition of IGABA by SP may be a result of intracellular phosphorylation of the GABAA receptor.

OBJECTIVETo investigate the correlation between the pathological and image features of different subtypes of retroperitoneal liposarcoma.

METHODSPathological and image characteristics of 21 retroperitoneal liposarcomas were retrospectively analyzed comparing their different histopathological subtypes.

RESULTSThis series consisted of 11 well-differentiated, 4 myxoid, 3 round-cell, 2 pleomorphic and 1 dedifferentiated liposarcoma. Well-differentiated liposarcomas were predominantly composed of lipoma-like and sclerosing components. On CT and MRI image, the attenuation and signal intensity of lipoma-like components resembled those of fat, whereas the signal intensity of sclerosing components was similar to those of muscle. Unenhanced CT image of the myxoid subtype showed density resembling that of water. On contrast-enhanced CT image, it showed gradual reticular or sheet-like enhancement. The CT and MRI image appearance of the round cell and pleomorphic subtypes resembled those of nonfatty soft tissue masses with foci of necrosis. The dedifferentiated liposarcoma showed the image feature of a well-differentiated component clearing enhanced soft tissue mass.

CONCLUSIONDifferent subtypes of retroperitoneal liposarcoma show different CT and MRI features relating to their major histologic components. A good understanding of the relation between their radiological and pathological features is helpful to arrive at a correct diagnosis for retroperitoneal liposarcoma.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Liposarcoma ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retroperitoneal Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed

·AIM:To observe the clinical effect of bilateral oblique muscle weakening on the A - V patterns strabismus correction, and dose - response relationship between bilateral oblique muscle weakening and A-V syndrome degree.·METHODS: Totally 70 patients ( 70 eyes ) with A-V syndrome treated in our hospital from January 2012 to January 2016 were enrolled in this study, including 28 eyes of A sign and 42 eyes of V sign. All patients underwent bilateral oblique muscle reduction combined with horizontal rectus correction. The changes of the upper and lower strabismus were observed before and after operation, and the patients were followed up for 18mo. The successful rate of A-V sign and strabismus correction were observed and counted. In addition, the quantitative relationship between the degree of A-V and the degree of correction and the amount of residual after operation was compared and analyzed.·RESULTS: After operation, the oblique eye position angle difference of A - esotropia, A - exotropia, V -esotropia and V-exotropia were respectively -1. 98△ ± 3. 92△, -2. 25△± 4. 88△, 2. 96△± 5. 29△, 1. 91△± 4. 67△, the differences were significantly compared with preoperatively ( P < 0. 05 ). The reduce amount after operation were 25. 10△± 9. 79△, 24. 29△± 8. 63△, 23. 81△± 9. 24△, 22. 79△±8. 95△. After 18mo follow-up, the success rate of A sign correction was 96% ( 27/28 ) , and the successful rate of V sign correction was 93% ( 39/42 ) . A-V sign, the more the oblique angle before operation, the more the correction amount during the weakening of bilateral oblique muscle, and the postoperative oblique residual increased accordingly.·CONCLUSION: Bilateral oblique muscle weakening can effectively treat strabismus with A - V sign, and can significantly reduce the upper and lower ocular gradient. The upper and lower oblique angle of the A- V sign increase, and the corrected angle and residual volume increase with the quantitative relationship.

OBJECTIVETo summarize the clinical effect of avulsed skin replantation of hand and foot via vacuum sealing drainage (VSD) combing low temperature technique.

METHODSFrom March 2012 to October 2013,13 cases with avulsed skin replantation of hand foot using combined technique included 8 males and 5 females with an average age of 32 years old ranging from 18 to 62 years. The time from injury to hospital was 1 to 4 hours (2.4 hour in average). The reasons of injury included machine injury in 7 cases and rolling over by cars in 6 cases. The parts of injuried involved finger in 2 cases,back of the hand in 5 cases and dorsum of foot in 6 cases. The area of avulsed skin was 5 cm x 6 cm to 12 cm x 16 cm,tendon and bone exposure was found in 4 cases. VSD was operated in all patients and the avulsed skin was refrigerated in the temperature of -4 °C or -80 °C. After 4 days, the skin stored in the -4 °C was replanted to the wounded place in 5 cases and in 3 cases the skin was planted to the donor site of flap. The skin stored in the -80 °C was replanted in 4 cases after 7 or 8 days, 1 case after 45 days.

RESULTSOf the 13 cases, 1 case of degloved injury from lower leg to dorsal foot,the replanted skin was necrosis completely; 1 case of degloving injury with fourth finger,the skin which replanted after 45 days survived approximately 30%,cured after skin-graft many times. In the other cases, the survival area of replanted skin was more than 85%, all cured after dressing. According to the standard of skin survival area evaluation by Jia et al, 11 cases showed excellent, 1 showed medium and 1 showed inferior. There were no complication about grafted skin rupture after the skin survived in 11 patients,after 4 to 22 months follow-up, the resiliency of grafted skin showed good. Sensation recovery was measured by BMRC standard: 3 cases of S3, 5 cases of S3, 3 cases of S2.

CONCLUSIONVSD combining lower temperature technique in skin replantation provides time and space for wound preparation and treatment plan for the patients who need second surgery, especially for the large area skin degloving,this method could utilize the degloved skin efficiently, decrease the donor site area, alleviate the pain and financial burden,reduce the scar formation of donor site and impediment.

Adolescent ; Adult ; Cryopreservation ; methods ; Drainage ; instrumentation ; methods ; Female ; Foot Injuries ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Replantation ; Skin ; injuries ; Skin Transplantation ; Young Adult

OBJECTIVETo compare the clinical effects of different fixing methods for intertrochanteric fractures and make theoretical analysis.

METHODSFrom June 2003 to June 2007, 321 patients with intertrochanteric fractures, male 132 and female 189, ranging in age from 20 to 93 years with an average of 56.8 years, were treated with different fixation including Richard nail (142 cases), proximal femora nail (PFN, 94 cases) and external fixator (85 cases). The clinical data of all the patients were retrospectively analyzed, including the incidence of complications, joint function of hip (according Kudema modified Merli D'Aubigne criteria).

RESULTSAll patients were followed up from 10 months to 4 years with an average of 14 months. About the incidence of complications, there was significant difference between the external fixator group and the others two groups (P < 0.05); there was no significant difference between the Richard nail group and the PFN group (P > 0.05). There was significant difference in joint function of hip among three methods. PEN group was best than others two groups.

CONCLUSIONThere is the best clinical effects and lowest incidence of complications with PFN method, which is the better choice in treating intertrochanteric fractures.

Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Femur ; injuries ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; immunology ; Hip Fractures ; complications ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Young Adult

The study was purposed to investigate the significance of id4 gene promoter methylation in monitoring AML patients with complete remission (CR). Methylation specific-PCR (MS-PCR) were used to detect the status of promoter methylation of id4 gene in bone marrow samples from AML patients with CR who had accepted induction with DA or IA and 4 to 5 consolidation chemotherapy with Ara-C. The results showed that in the all 32 patients, 15 were found to show id4 promoter methylation and 7 out of the 15 were found relapsed or tendency to relapse in the following-up period. While all the 17 patients with id4 unmethylation were still in their CR status in the same period. In conclusion, id4 promoter methylation might be a predictor for relapse of AML patients with CR in certain degree.
DNA Methylation ; Humans ; Inhibitor of Differentiation Proteins ; genetics ; Leukemia, Myeloid, Acute ; genetics ; metabolism ; Neoplasm, Residual ; diagnosis ; genetics ; Promoter Regions, Genetic ; genetics

The aim of this study was to evaluate the significance of id4 gene promotor methylation detection in NHL patients. MS-PCR method was used to detect the status of id4 gene methylation in health donors and newly diagnosed NHL patients. The results indicated that the id4 gene was unmethylated in bone marrow samples from health donors. Among 18 newly diagnosed NHL patients, including one NHL patient with bone marrow cells involved, 4 patients were found in id4 gene methylation by MS-PCR. The 14 patients with id4 gene unmethylation were in their stable status and no bone marrow involvement were found by bone marrow biopsy during the 8-month follow-up. During the follow-up, the patient with both bone marrow involvement and id4 gene methylation turned to leukemia, in 2 out of the 3 patients with id4 gene methylation but without bone marrow involvement at diagnosis, the bone marrow involvement was found at last. It is concluded that the id4 gene methylation may be an indicator for MRD in NHL patients without bone marrow involvement.
Bone Marrow ; pathology ; DNA Methylation ; Humans ; Inhibitor of Differentiation Proteins ; genetics ; Lymphoma, Non-Hodgkin ; genetics ; pathology ; Promoter Regions, Genetic ; genetics