Facial Paralysis ; complications ; Granulomatosis with Polyangiitis ; complications ; Humans ; Male ; Young Adult

Put forward opinions and suggestions about characteristics of the new era of medical disputes pre -vention treatment through the analysis of a hospital in the past five years occurred in 44 medical disputes .We must fo-cus on innovation and long -term mechanism to prevent medical malpractice , medical malpractice to further improve the prevention, comprehensive mechanism , and continuously improve the effectiveness of medical dispute processing services.

ObjectiveTo evaluate and compare long-term clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with remnant preservation versus remnant resection.MethodsFrom October 1999 to May 2005,standard ACL reconstruction with autogenous quadrupled hamstring tendons under arthroscopy using remnant resection with transtibial techniques was conducted in 87 patients.From June 2005 to May 2010,ACL reconstruction with autogenous quadrupled hamstring tendons using outside-in bone tunnel establishment and remnant preservation was performed in 221 patients.Only the patients who underwent simple ACL reconstruction together with more than three years follow-up records were enrolled in the study,including 66 patients in remnant preservation group and 39in remnant resection group.ResultsPatients of both groups were all followed up for 36-60 months,which showed insignificant difference between groups ( P ＞ 0.05).Compared with the preoperative data,the latest follow up data demonstrated satisfactory outcomes in both groups.The two groups showed no significant differences regarding the preoperative data including age and gender distribution,average time from injury to surgery,joint instability extent and functional score of the affected knee ( P ＞ 0.05 ).There was no statistical difference in regards of the thigh muscle atrophy and Lachman test between groups ( P ＞0.05).However,the remnant preservation group was superior to the remnant resection group in aspects of the range of motion of the affected knee,Lysholm score,stability in anterior drawer test,stability in pivot shift test and international knee documentation committee (IKDC) grade ( all P ＜ 0.05 ). ConclusionCompared with standard ACL reconstruction using remnant resection with transtibial techniques,the ACL reconstruction using outside-in bone tunnel establishment and remnant preservation has better longterm clinical outcomes including stability and function of the affected knee.

Objective To provide the reference basis for reducing the occurrence of nutritional risk by analyzing possible risk factors for nutritional risk status and investigating the relationship between preoperative nutritional risk status and prognosis.Methods We retrospectively analyzed the clinical data of 894 patients(nutritional risk group of 491 cases,non-nutritional risk group of 403 cases) with esophageal cancer resection.The univariate analysis was used to analyze the relationships between nutritional risk status with postoperative complications and length of hospitalization.And the multiple Logistic regression model analysis was applied to analyze the risk factors of nutritional risk status.Results The nutritional risk group had a higher rate of postoperative complications (33.60 ％ vs.19.60 ％,U =-3.429,P =0.001),higher incidence of serious complications (23.01％ vs.8.68％,U =-3.611,P =0.000) and longer hospital stays [(37.20 ± 13.89) days vs.(31.69 ± 13.49) days,t =4.124,P =0.000] than that of non-nutritional risk group.The results of the multiple logistic regression analysis showed that the preoperative nutritional risk factors were associated with the patients' age (OR =1.58,95％ CI:1.101-2.268),number of symptoms entries(OR =7.97,95 ％ CI:6.071-10.463),symptom severity (OR =0.26,95％ CI:0.186 -0.385),and dietary intake (OR =0.62,95 ％ CI:0.482-0.813),P ＜ 0.05 for all.Conclusion The older patients with more severe symptoms and poor diet are more likely to suffer from nutritional risk.Prolonged hospital stay and postoperative complications easily happen in patients with nutritional risk.So patients with preoperative nutritional risk should be given timely and effective nutrition intervention measures,in order to reduce postoperative complications and length of hospitalization.

OBJECTIVETo observe the effect of Hydroxy Safflower Yellow A (HSYA) on the expression of osteogenic markers, such as alkaline phosphatase, Cbf(alpha)l and type I collagen, and explore the mechanism of HSYA in the prevention and treatment of glucocorticoid-induced ischemic necrosis of femoral head.

METHODSFifteen healthy and adult New Zealand white rabbits were collected and weighted 0.9 to 1.3 kg. The rabbits were injected abdominally with anesthetic drugs, then received marrow cavity puncture of tibia and anterior superior iliac spine to get bone marrow blood. Rabbits bone marrow mesenchymal stem cells (BMSCs) were separated from the bone marrow blood, cultured in vitro and passaged. The 3rd generation of BMSCs which had good growth condition were randomly divided into blank group, model group and HSYA groups with different doses. The BMSCs in model group were treated with high dose of dexamethasone to induce adipogenic differentiation of cells cultured in vitro, and inhibit osteogenic differentiation. The BMSCs in HSYA groups received high dose of dexamethasone and different concentrations of HSYA simultaneously. The blank group received not any special handling. After a week,the expressions of alkaline phosphatase, Cbf(alpha)l and type I collagen mRNA were detected.

RESULTSThe alkaline phosphatase activity was significantly decreased in BMSCs of the model group as compared with the blank group (P < 0.01), and the expression of Cbf(alpha)l and type I collagen mRNA were also decreased significantly (P<0.01). The alkaline phosphatase activity was significantly increased in BMSCs of each HSYA group as compared with the model group (P < 0.05 or P < 0.01), and the expression of Cbf(alpha)l and type I collagen mRNA were also increased significantly (P < 0.05 or P < 0.01).

CONCLUSIONThe mechanism of HSYA may be related to the effect of antagonism to the reduced osteogenic differentiation induced by glucocorticoid.

Alkaline Phosphatase ; genetics ; metabolism ; Animals ; Bone Marrow Cells ; cytology ; drug effects ; metabolism ; Cell Differentiation ; drug effects ; Cells, Cultured ; Chalcone ; analogs & derivatives ; chemistry ; pharmacology ; Collagen Type I ; genetics ; metabolism ; Core Binding Factor alpha Subunits ; genetics ; metabolism ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Female ; Glucocorticoids ; pharmacology ; Male ; Mesenchymal Stromal Cells ; cytology ; drug effects ; metabolism ; Osteogenesis ; drug effects ; Rabbits

OBJECTIVE:To systematically review the difference of phlebitis induced by Alprostadil injection with different ad-ministration routes,and to provide evidence-based reference for clinical rational use. METHODS:Retrieved from PubMed,EM-Base,Cochrane Library,CBM,CJFD,VIP and Wanfang database,RCTs about phlebitis induced by Alprostadil injection with dif-ferent administration routes were collected. Meta-analysis was conducted by Rev Man 5.2 statistical software after literature screen-ing,data extraction and quality evaluation according to Cochrane System Evaluator's Manual 5.1.0. RESULTS:A total of 20 RCTs were included,involving 2562 patients. The results of Meta-analysis showed that the incidence of phlebitis induced by intravenous injection was significantly higher than that induced by intravenous dripping [OR=4.11,95%CI(1.59,10.67),P=0.004] and intrave-nous pump [OR=3.50,95%CI(1.50,8.16),P=0.004]. The incidence of phlebitis induced by general apparatus infusion was signifi-cantly higher than that induced by fine filtering infusion [OR=0.03,95%CI(0.01,0.08),P<0.001],with statistical significance. CONCLUSIONS:The incidence of phlebitis induced by low-concentration of Alprostadil injection or fine filtering infusion is low-er,and that of intravenous injection is higher.

Objective To investigate the temporal expression patterns of the related transcription factors and target genes in cardiomyocyte hypertrophy,and provide valuable clues for further researches on cardiomyocyte hypertrophy.Methods Isoproterenol (ISO) was used to induce ventricular myocytes hypertrophy in neonatal mice.The survival rate of cardiomyocyte was detected by CCK-8,and the average diameters and surface areas of cells were measured by computer photograph analysis system.The mRNA and protein expression levels of related genes were respectively measured by RT-PCR and Western blotting.Results The model of cardiomyocyte hypertrophy stimulated by ISO was constructed successfully.The expression levels of GATA4,MEF2C,GATA5,BNP and ANP increased 24 hours after ISO treatment,the expression levels of P300,α-MHC and TBX5 increased 12 hours after ISO treatment,and of SRF and β-MHC mRNA increased 6 hours after ISO treatment (P＜0.05).The expression levels of GATA4,α-MHC,β-MHC,SRF and P300 mRNA increased firstly,and then decreased in cardiomyocytes induced by ISO.The expression levels of GATA4,SRF,α-MHC,β-MHC and P300 mRNA were still higher than normal (P＜0.05),but of MEF2C decreased to normal (P＞0.0S) 72 hours after ISO treatment.The expression levels continuously elevated of GATA5,TBX5,ANP and BNP mRNA than that of controls (P＜0.05),while no fluctuation was found in NKX2.5 mRNA expression (P＞0.05).The expression of GATA4 protein increased,while of HEY2 protein decreased 48 hours after ISO treatment (P＜0.05).Conclusions In hypertrophic cardiomyocytes,the expression pattern of MEF2C is similar to,but the patterns of GATA5,GATA4,TBX5 and SRF are different with that in the development of heart,implying these genes are important during the process from compensatory stage to decompensation stage.The expression patterns of GATA4,MEF2C and SRF are similar to that of acetylase P300,implying the temporal expressions could be regulated by P300 in cardiomyocyte hypertrophy.

Objective To investigate whether the percutaneous ethanol injection (PEI)under sedation and analgesia can in-crease the energy deposition and curative efficiency of the high intensity focused ultrsound(HIFU)in treating unresectable middle and advanced stages of primary liver cancer.Methods Thirty-six cases of clinically diagnosed unresectable middle and advanced sta-ges of primary liver cancer were randomly divided into the PEI+ HIFU group(combination group,n = 23)and the simple HIFU group (HIFU group,n=13);10mL of the mixture of 99.7% ethanol and iodized oil (9:1)was given by intratumoral injection at 30 min before ablation in the PEI+HIFU group,while 0.9% physiological saline 10mL was replaced in the simple HIFU group.The ablation energy efficiency factor(EEF)and irradiation time were compared between the two groups.Results The ablation EEF in the PEI+HIFU group and the simple HIFU group were (13.82+4.26)J/mm3 and (25.63+6.31)J/mm3 respectively,the PEI+HIFU group was significantly lower than the simple HIFU group (P <0.05);the irradiation time were (1 468.28+253.21)s and (2 352.56+463.34)s respectively;which in the PEI+ HIFU group was significantly shortened (P <0.05).Conclusion PEI can enhance the HIFU ablation energy deposition and improve the efficiency of HIFU for treating unresectable primary liver cancer.

Objective To explore the clinical characteristics and outcome of correction with Ilizarov fixator for the knee deformities.Methods From May 2003 to April 2010,21 patients (22 knees) underwent knee deformity correction with Ilizarov fixator,including 12 males and 9 females with an average age of 20.3 years (range,8-48).Causes of the deformities included poliomyelitis in 4,burn in 2,osteomyelitis in 2,trauma in 9,Blount diseases in 2,and multiple osteochondromatosis in 2.Five patients had fixed flexion contracture due to soft tissue,they were corrected through a combination of Ilizarov's frame crossover the joint with a pair of hinges by gradual posterior distraction.Eight patients (9 limbs) had one way bony deformities and 7 patients had complex deformations.The frame with 4 hinge-posts was used for correction by restoring the alignment firstly,and then gradual lengthening to correct bone shortening.Additionally,an overlay frame of the above mentioned combinations was applied for correction of bony deformity combined with soft tissue contracture for 1 patient.Results The average time in frame was 22.3 weeks (range,12-36).At the time of removing frame,satisfactory alignment was achieved in all of the affected knees,and solid bony healing was obtained in osteotomy or bone lengthening area in 16 patients (17 limbs) with bony correction.All patients were followed up for an average of 32.1 months (range,6-86).The range of motion was improved from 102.14°±49.36° preoperatively to 126.90°±24.31° at the final follow-up.Additionally,the Japanese Orthopaedic Association knee score was also increased from 50.24±23.64 before operation to 85.71±10.52 at the final follow-up.All of them were able to walk without crutches,deal with daily life independently.Only 2 patients with the range of motion of the knee less than 90° were not able to squat.Conclusion Ilizarov fixator has advantages of minimal intervention to local tissue in operation and nimble adjustment at any time,and disadvantages related to a longer time in frame.