OBJECTIVETo examine the effects of the whey basic protein on bone metabolism of Sprague-Dawley (SD) rats and healthy mid-aged women.

METHODSForty-four female SD rats were randomized by weight into four groups of eleven rats each and fed 10 mg x kg BW(-1) x d(-1), 20 mg x kg BW(-1) x d(-1), 30 mg x kg BW(-1) x d(-1) of whey basic protein and control diet was given respectively by intragastrically injection for 90 days. Bone mineral density of femur was measured by dual-energy X-ray absorptiometry in vitro. Sixty-three health women [(37.9 +/- 4.3) years old] were randomly assigned to treatment with placebo, 30 mg whey basic protein per day or 60 mg whey basic protein per day for 24 weeks. The bone mineral density (BMD) of the lumbar vertebrae L2-LA, femoral neck and right calcaneus of each subject were measured by dual-energy X-ray absorptiometry (DXA) at 0 and the 24th week of treatment. Serum bone specific alkaline phosphatase and N-telopeptide (NTX) were measured at 0 and the 14th week.

RESULTSThe mean BMD value of the distal end of the femur in 10 mg x kg BW(-1) x d(-1) whey basic protein group was significantly higher than that of the control group at the end of the trail. But after treatment by doses of whey basic protein used in the study, there were no differences between the control group and others groups on bone mineral density in the human trail.

CONCLUSIONWhey basic protein should enhance the bone mineral density of the rats' femur and no obvious effect was detected in the human trail.

Adult ; Animals ; Bone Density ; drug effects ; Female ; Food, Formulated ; Humans ; Lactalbumin ; pharmacology ; Milk ; Milk Proteins ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Whey Proteins

Objective To evaluate the advantages and short term clinical results of arthroscopic release with radiofrequeney vaporization for knee joint stiffness.Methods Arthroscopic release with ra- diofrequency vaporization was done in 32 cases with knee joint stiffness resulted from various causes be- tween January 2002 and June 2005.According to degree of stiffness,32 cases were divided into three groups,ie,Group A(18 cases with suprapatellar bursa adhesions)treated with confectioning at suprapa- tellar bursa and lateral grooves;Group B(eight cases with joint compartment adhesions)managed with debridement at suprapatellar bursa and lateral groove and intereondyloid fossa,bending the knee with pressure and abscising the adhesion part in the joint compartment with radiofrequency vaporization;and Group C(six cases with most part of the joint adhered)treated by making small incision at the lateral or medial upper pole of the patellar as well as a space at the suprapatellar bursa by blunt dissection when it was difficult to insert arthroscope.After that,release combined with massage manipulation and thorough hemostasis by radiofrequency vaporization were carried out.There was no drainage after operation.Pas- sive and active flexion and extension exercises with pressure began two days after operation.Results Pre-operative limitation of flexion was 35?-75?that was increased to 115?-125?three weeks after opera- tion,with mean improvement of 78?in Group A.Pre-operative limitation of flexion was 40?-60?that was increased to 95?-120?three weeks after operation,with mean improvement of 72?in Group B.Pre-opera- tive limitation of flexion was 25?-45?that was increased to 90?-110?three weeks after operation,with mean improvement of 64?in Group C.No haematocele occurred postoperatively,with only slight swelling of the knee.Conclusion Arthroscopic release with radiofrequency vaporization for knee joint stiffness is characterized by less bleeding,minor trauma and reliable release and can be applicable especially for the eases with only adhesion at suprapatellar bursa,lateral groove or joint compartment.

BACKGROUNDAccurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer. Modalities that have been used to monitor response to neo-adjuvant chemotherapy (NAC) include physical examination (PE), ultrasound (US), and magnetic resonance imaging (MRI). The purpose of this study was to evaluate the accuracy of PE, US, and MRI in predicting the response to NAC in patients with breast cancer.

METHODSAccording to the response evaluation criteria in solid tumors guidelines, the largest unidimensional measurement of the tumor diameter evaluated by PE, US, and MRI before and after NAC was classified into four grades, including clinical complete response, clinical partial response, clinical progressive disease, clinical stable disease, and compared with the final histopathological examination.

RESULTSOf the 64 patients who received NAC, the pathologic complete response (pCR) was shown in 13 of 64 patients (20%). The sensitivity of PE, US, and MRI in predicting the major pathologic response was 73%, 75%, and 80%, respectively, and the specificity was 45%, 50%, and 50% respectively. For predicting a pCR, the sensitivity of PE, US, and MRI was 46%, 46%, and 39%, respectively, and the specificity was 65%, 98%, and 92% respectively.

CONCLUSIONSCompared with final pathologic findings, all these three clinical and imaging modalities tended to obviously underestimate the pCR rate. A more appropriate, universal, and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential.

Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Chemotherapy, Adjuvant ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Physical Examination ; Ultrasonography

Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.

OBJECTIVETo investigate the clinical relevant factors causing laryngeal stenosis after partial laryngectomy.

METHODSA retrospective study was carried out to review the history clinical data from 138 patients of partial laryngectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 1994 to October 2004. The clinical relevant factors causing laryngeal stenosis were included as follows: age, sex, TNM stage, tumor site, extension of thyroid cartilage defect, extension of larynx parenchyma defect, reconstruction method, laryngeal dilator, duration of using antibiotics, postoperative radiotherapy, lung infection, gastroesophageal reflux, diabetes. Multivariate stepwise logistic regression model was used for the analysis.

RESULTSOf 138 cases after partial laryngectomy, stenosis developed in 25 cases. The occurrence rate was 18.1%. In multivariate analysis, it was confirmed that the following factors correlated to laryngeal stenosis, i. e, extension of thyroid cartilage defect (chi2 = 4.323, P = 0.038), postoperative radiotherapy (chi2 = 6.002, P = 0.014), lung infection (chi2 = 4.220, P = 0.040), and gastroesophageal reflux (chi2 = 5.614, P = 0.018).

CONCLUSIONSThe clinical relevant factors causing laryngeal stenosis after partial laryngectomy were multiple. Statistical analysis showed that extension of thyroid cartilage defect, postoperative radiotherapy, lung infection and gastroesophageal reflux were the risk factors which may cause laryngeal stenosis.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Laryngectomy ; adverse effects ; Laryngostenosis ; etiology ; pathology ; Logistic Models ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Complications ; Retrospective Studies ; Risk Factors

COVID-19 ; Critical Care ; Humans ; Intensive Care Units ; SARS-CoV-2

INTRODUCTION: A second-tier rapid response team (RRT) is activated for patients who do not respond to first-tier measures. The premise of a tiered response is that first-tier responses by a ward team may identify and correct early states of deterioration or establish goals of care, thereby reducing unnecessary escalation of care to the RRT. Currently, utilisation and outcomes of tiered RRTs remain poorly described. METHODS: A prospective observational study of adult patients (age ≥18 years) who required RRT activations was conducted from February 2018 to December 2019. RESULTS: There were 951 consecutive RRT activations from 869 patients and 76.0% patients had a National Early Warning Score (NEWS) ≥5 at the time of RRT activation. The majority (79.8%) of patients required RRT interventions that included endotracheal intubation (12.7%), point-of-care ultrasound (17.0%), discussing goals of care (14.7%) and intensive care unit (ICU) admission (24.2%). Approximately 1 in 3 (36.6%) patients died during hospitalisation or within 30 days of RRT activation. In multivariate analysis, age ≥65 years, NEWS ≥7, ICU admission, longer hospitalisation days at RRT activation, Eastern Cooperative Oncology Group performance scores ≥3 (OR [odds ratio] 2.24, 95% CI [confidence interval] 1.45-3.46), metastatic cancer (OR 2.64, 95% CI 1.71-4.08) and haematological cancer (OR 2.78, 95% CI 1.84-4.19) were independently associated with mortality. CONCLUSION Critical care interventions and escalation of care are common with second-tier RRTs. This supports the need for dedicated teams with specialised critical care services. Poor functional status, metastatic and haematological cancer are significantly associated with mortality, independent of age, NEWS and ICU admission. These factors should be considered during triage and goals of care discussion.
Adolescent ; Adult ; Aged ; Critical Care ; Hospital Mortality ; Hospital Rapid Response Team ; Humans ; Prospective Studies ; Tertiary Care Centers

Background Accurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer.Modalities that have been used to monitor response to neo-adjuvant chemotherapy (NAC) include physical examination (PE),ultrasound (US),and magnetic resonance imaging (MRI).The purpose of this study was to evaluate the accuracy of PE,US,and MRI in predicting the response to NAC in patients with breast cancer.Methods According to the response evaluation criteria in solid tumors guidelines,the largest unidimensional measurement of the tumor diameter evaluated by PE,US,and MRI before and after NAC was classified into four grades,including clinical complete response,clinical partial response,clinical progressive disease,clinical stable disease,and compared with the final histopathological examination.Results Of the 64 patients who received NAC,the pathologic complete response (pCR) was shown in 13 of 64 patients (20％).The sensitivity of PE,US,and MRI in predicting the major pathologic response was 73％,75％,and 80％,respectively,and the specificity was 45％,50％,and 50％ respectively.For predicting a pCR,the sensitivity of PE,US,and MRI was 46％,46％,and 39％,respectively,and the specificity was 65％,98％,and 92％ respectively.Conclusions Compared with final pathologic findings,all these three clinical and imaging modalities tended to obviously underestimate the pCR rate.A more appropriate,universal,and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential.

BACKGROUNDSevere burn-blast combined injury is a great challenge to medical teams for its high mortality. The aim of this study was to elucidate the clinical characteristics of the injury and to present our clinical experiences on the treatment of such cases.

METHODSFive patients with severe burn-blast combined injuries were admitted to our hospital 77 hours post-injury on June 7, 2005. The burn extent ranged from 80% to 97% (89.6% +/- 7.2%) of TBSA (full-thickness burns 75% - 92% (83.4% +/- 7.3%)). All the patients were diagnosed as having blast injury and moderate or severe inhalation injury. Functions of the heart, liver, kidney, lung, pancreas and coagulation were observed. Autopsy samples of the heart, liver, and lungs were taken from the deceased. Comprehensive measures were taken during the treatment, including protection of organ dys function, use of antibiotics, early anticoagulant treatment, early closure of burn wounds, etc. All the data were analyzed statistically with t test.

RESULTSOne patient died of septic shock 23 hours after admission (four days after injury), the others survived. Dysfunction of the heart, liver, lungs, pancreas, and coagulation were found in all the patients on admission, and the functions were ameliorated after appropriate treatments.

CONCLUSIONSBurn-blast combined injury may cause multiple organ dysfunctions, especially coagulopathy. Proper judgment of patients' condition, energetic anticoagulant treatment, early closure of burn wounds, rational use of antibiotics, nutritional support, intensive insulin treatment, timely and effective support and protection of organ function are the most important contributory factors in successful treatment of burn-blast combined injuries.

Adult ; Anti-Bacterial Agents ; therapeutic use ; Blast Injuries ; complications ; physiopathology ; therapy ; Burns ; complications ; physiopathology ; therapy ; Humans ; Male ; Nutrition Therapy ; Psychotherapy ; Respiration

Objective:To observe the effect of Tongxie Yaofang on the expressions of colon serotonin transporter （SERT）， liver 5-hydroxytryptamine_2A receptor （5-HT_2AR） protein， serum 5-HT and inflammatory factors in ulcerative colitis （UC） model rats of liver stagnation and spleen deficiency， in order to explore the basis of syndrome of liver stagnation and spleen deficiency and the intervention mechanism of Tongxie Yaofang. Method:Fifty male SD rats were randomly divided into blank control group， model group， high， medium and low-dose Tongxie Yaofang group （10，5，2.5 g·kg^-1）， and salazosulacil group （0.3 g·kg^-1）. The ulcerative colitis model of liver depression and spleen deficiency was established by 2，4，6-trinitrobenzene sulfonic acid （TNBS）/ethanol solution enema + restraint stress + diet loss. After successful modeling， the samples were collected after 21 days of drug intervention. Htoxylin eosin （HE） staining and oil red staining were used to observe the pathological changes of colon and liver in each group. Serum interleukin-6 （IL-6）， IL-9， 5-HT and superoxide dismutase （SOD） were detected by enzyme linked immunosorbent assay （ELISA）. Protein expressions of SERT in the colons and 5-HT_2AR in liver of rats were detected by Western blot. Result:Compared with the normal group， obvious ulcers were formed in the colon and lipid droplets in the liver increased in the model group， serum levels of IL-6， IL-9 and 5-HT in the model group increased， while the level of SOD decreased （P<0.05）. The protein expression of SERT in colon decreased， whereas the protein expression of 5-HT_2AR in liver increased （P<0.05）. Compare with model group， the pathological damage of colon was improved， and the formation of lipid droplets in liver was reduced in high， medium-dose Tongxie Yaofang groups and sulfasalazine group. The serum levels of IL-6， IL-9 and 5-HT decreased， while the level of SOD increased in Tongxie Yaofang group and sulfasalazine group （P<0.05）. The protein expression of SERT in colon increased in high，low-dose Tongxie Yaofang groups and sulfasalazine group， and the protein expression of 5-HT_2AR in liver decreased in medium， low dose Tongxie Yaofang groups and sulfasalazine group （P<0.05）. Conclusion:Tongxie Yaofang may reduce the content of 5-HT， and regulate the intestinal motility and sensory system by up-regulating the expression of SERT in the colon， inhibit the expressions of IL-6，IL-9 and other inflammatory factors， and play an anti-inflammatory role， reduce the content of 5-HT and the expression of 5-HT_2AR in the liver， increase the level of SOD， regulate emotion and lipid metabolism in the liver， and then exert the intervention effect on ulcerative colitis with liver depression and spleen deficiency on the whole.