Objective To summarize the experience of vagina reconstruction with six kinds of axial pattern skin flaps Methods Six kinds of axial pattern skin flaps have been used for vagina reconstruction in 126 cases,including of hypogastric skin flap,thoraco umblical skin flap,labia minora skin flap,scrotal skin flap,penis skin flap and pudendal femoral skin flap Results All flaps were survived,but one case of necrosis occurred in hypogastric skin flap Conclusion The pudendal femoral skin flap is the first choice of flap for vagina reconstruction The advantages of this method are (1) the reconstructed vagina has good sensation and flexibility;(2)the linear scars of donor site are hidden and inconspicuous;(3)the flap is close to recipient site the procedure is simple

BACKGROUND:Knee joint is the most complicated structure of human body, and X-ray is often used to reflect the stenosis of knee compartment. However, radiographs are two-dimensional projection of three-dimensional joint structure. Thus, different joint shooting locations can impact the outcomes of measurement, and it is difficult to ensure the accuracy of repeated measurements. OBJECTIVE:To build three-dimensional model of knee compartment, measure the distance and volume, and provide the basis for subsequent models, biomechanics and relevant clinical studies. METHODS:Based on the principle of reverse engineering, using CT images of the knee joint and the software of Mimics, three-dimensional model of medial compartment knee structure was reconstructed. After the model was imported and smoothed, the medial and lateral compartment volumes were finaly calculated by the software of Geomagic Studio. RESULTS AND CONCLUSION: Three-dimensional model of the knee compartment, including femur, tibia and fibula, was successfuly structured by CT images. The models of knee and knee compartment could be observed at any angle or observed individualy, and could be measured. It was discovered that the volume of medial and lateral compartments of knee is close, although the joint space width of them is different, which ilustrates that the procedure can accurately reflect the degree of knee joint space width in the round by calculating the volume of medial and lateral compartments of knee joint through computer.

Objective Explore the reversibility and potential molecular mechanisms of pulmonary hypertension in pa-tients with complete transposition of the great arteries (cTGA) combined with ventricular septal defect (VSD) in comparison with those with simple VSD. Methods Twenty-four patients with pulmonary hypertension (mean pulmonary arterial pressure was greater than 30 mmHg) were enrolled in our study, in which 10 patients suffered from cTGA with VSD, and the rest 14 pa-tients suffered from simple VSD. Lung specimens were taken from the right middle lobe of lung before cardiopulmonary bypass. The extent of pulmonary hypertension was then graded according to the Heath-Edwards classification. ELISA was used to exam-ine the expression of eNOS, iNOS, ET-1, ET-AR, ET-BR, MMP-2, MMP-9 and TIMP in all the specimens. Results No statistically significant differences in age, height, weight, the size of VSD, and the pulmonary artery pressure before operation were found between the groups. The level of hemoglobin, aortic and pulmonary arterial oxygen saturation, and the reduction value of pulmonary arterial pressure after surgery were significantly higher in the cTGA patients than that in the simple VSD pa-tients (P < 0.05). All patients had grade 0 - Ⅱ Heath-Edwards changes in their lung biopsy samples. The expression of eNOS and MMP-2 was significantly lower in the TGA group than that in the simple VSD group [eNOS: (280.13 ± 101.92) ng/mg vs. (488.41±249.6) ng/mg, P<0.05; MMP-2:(31.68±15.36)ng/mg vs. (69.28±49.12)ng/mg, P<0.05]. There were no statistically significant differences between the two groups regarding the expression of iNOS, ET-1, ET-AR, ET-BR,MMP-9 or TIMP. Conclusion The imbalance of the NOS/ET system and the MMP/TIMP system involves in the development of pulmonary hypertension in patients with TGA combined with VCD. In patients with cTGA, the high oxygenation state in pul-monary circulation may decrease the expression of MMP2 and eNOS, and may affect the progress of pulmonary hypertension to a certain extent.

Objective To study the methodology and effect of auricle reconstruction with prefabricated expanded fascial flap in temporal and parietal area and skin flap in mastoid area, covered on the Medpor support. Methods Thirty cases of congenital vestigial auricle were involved in this study. The operations were divided into two stages: in the stage I,the temporal and parietal superficial fascia flap was cut with a vascular pedicle in the parietal and temporal superficial area, which was implanted under the skin of mastoid, and then both layers of those were expanded at the same time; in the stage II, this fascial skin flap was cut down and covered on the whole Medpor support to rebuild the man-made auricle. Results Thirty cases were successful after following-up for 6 months to 3 years. Their auricle shapes were vivid; their skin color was normal, and it had no any difference from all around skins, or no any appearance of the support. Conclusions With best understanding the biological characteristics of the Medpor support and choosing the suitable procedures and using the prefabricated expanded support, we could minimize the surgical complications in this operation. The results show that this procedure is satisfactory, without any necrosis of flap, swelling of contour, or appearance of the support. The combination of two flaps is the best method for the auricle reconstruction.

Objective To study the homology characteristics of clinicaly isolated and colonized linezolid(LZD)-resistant Enterococcus faecalis (E.faecalis) strains from a patient.Methods Ten E.faecalis strains (2 were isolated from urine specimens and 8 were from stool specimens) isolated from a patient with pulmonary infection were performed antimicrobial susceptibility testing, homology of E.faecalis was determined by pulsed-field gel electrophoresis (PFGE).Results Before and after patients received LZD therapy, 2 E.faecalis strains isolated form urine specimens were both resistant to LZD (MICs: 8 mg/mL, 16 mg/mL, respectively), among 8 strains from stool specimens (6 were isolated before therapy, and 2 were isolated after therapy), LZD susceptible, intermediate, and resistant strains were 4, 2, and 2 respectively(MICs: 0.25-12 mg/mL).10 strains of E.faecalis were homologous by PFGE typing.Conclusion In this case, the detection of E.faecalis from urinary tract and intestinal tract is homologous, which suggested that LZD-resistant Enterococcus may be colonized in vivo for a long time, and may be shift to cause bacterial infection.

OBJECTIVETo compare the effects of Atractylodes lancea from different producing area on collagen-induced arthritis (CIA) in rats.

METHODWistar rats were induced by type II bovine collagen. CIA rats were treated daily with oral administration of A. lancea from the geo-authentic and non-authentic producing area of Maoshan, Jiangsu province, and non-geo-authentic and non-authentic producing areas of Yingshan, Hubei province and Huayin, Shanxi province from day 7 after the day of the first immunization to day 35. Clinical symptoms as well as clinical scores and incidence were observed. All rats were sacrificed on day 35 after immunization to observe histopathologic and radiologic changes. Antibody to type II collagen in sera was measured by enzyme-linked immunosorbent assay (ELISA), the levels of pro-inflammatory cytokines tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), and interleukin-6 (IL-6) in sera and article-homogenated supernants by radiommunoassay, and inflammatory mediator of PGE2 in sera using ELISA.

RESULTA. lancea from Jiangsu province can ameliorate clinical symptom, reduce arthritis index and arthropathy of inflammatory joints, inhibit the production of IgG and IgM in sera, directly suppress the production of exogenous and endogenous cytokines of IL-1beta, TNFalpha and IL-6 and PGE2. A. lances from Hubei and Shanxi provinces can inhibit the production of IgM in sera, and A. lanceas from Hubei province also depress the production of IL-1beta in sera and IL-6 in supernants.

CONCLUSIONA. lancea from Jiangsu province is effective in CIA rats through inhibiting the production of pro-inflammatory cytokines and the inflammatory mediators.

Animals ; Arthritis, Experimental ; drug therapy ; immunology ; Atractylodes ; Cytokines ; blood ; Dinoprostone ; blood ; Male ; Phytotherapy ; Plant Extracts ; therapeutic use ; Rats ; Rats, Wistar

Objective To investigate the effects of same calorie intake of different enteral nutrition (EN) on blood glucose in patients with mechanical ventilation.Methods A total of 60 critically ill patients who were admitted to the Department of Intensive Care Unit (ICU) of Taizhou Combined Traditional Chinese and Western Medicine Hospital and received mechanical ventilation from January 2015 to January 2017 were selected. According to the random number table method, the patients were divided into a control group and a study group, 30cases in each group. The patients in the control group were given EN suspension (nutrison fibre), patients in the study group received EN emulsion (fresubin diabetes), on the first day, 1/3 standard calorie was supplied, if the patient had no any discomfort, on the second day 1/2 standard heat was given, from the third day to the tenth day they took the full amount and achieved complete EN (TEN).The fasting blood glucose (FBG), 2 hours postprandial blood glucose (2 h PBG) and glycated hemoglobin (HbA1) level before and after the EN for 10 days were observed, the gastrointestinal tolerance, dosage of insulin, inflammation related indexes, the incidence of ventilator associated pneumonia (VAP) and fatality were analyzed in the two groups.Results Compared with those before EN support, the FBG and 2 h PBG were decreased after the support for 10 days in both groups, the dosage of insulin used was decreased, and the degrees of decrease were more marked in the study group than those in the control group [FBG (mmol/L): 8.03±1.69 vs. 8.87±1.75, 2 h PBG (mmol/L): 8.25±1.98 vs. 10.43±2.34, dosage of insulin (U/d): 38.02±3.24 vs. 40.87±3.48, allP < 0.05], but there was no statistical significant difference in HbA1 level between the two groups [(7.36±1.53)% vs. (7.37±1.29)%,P > 0.05]. The incidence of gastrointestinal intolerance was lower in study group than that in control group [6.67% (2/30) vs. 10.0% (3/30)], but there was no statistical significant difference between the two groups (P > 0.05). Compared with those before EN support, the levels of γ-interferon (IFN-γ) were significantly increased (P < 0.05), while the tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-8) levels were significantly decreased after 10 days of EN support, but no statistical significant differences were found (allP > 0.05) between the two groups. During the treatment in the two groups, the incidence of VAP and mortality were relatively low, and there were no statistical significant differences were seen between the two groups (bothP > 0.05).Conclusions The blood glucose control of fresubin diabetes in patients with mechanical ventilation is superior to that of nutrison fibre, fresubin diabetes can reduce the dosage of insulin, decrease the levels of inflammatory factors and conducive to the prognosis of the patients.

Objective To study the preventive effects of prevention monitoring form for reducing enteral nutrition complications. Methods From January 2013 to December 2013, 58 patients were divided into control group which were used traditional nursing method. From January 2014 to December 2014, 61 cases were in intervention group undergoing prevention monitoring nursing method based on traditional nursing. We compared the differences between these two groups in body quality, C-reactive protein, albumin, prealbumin, complications and patient satisfaction before and after 10 d surgery. Results There were no differences between body quality, C-reactive protein, albumin, prealbumin in these two groups before surgery (P > 0. 05). Compared with the 10th day after surgery, there were significantly higher level of body quality, albumin, prealbumin in the intervention group than those of the control group (P<0. 05), while higher level C-reactive protein in the control group (P<0. 05). The incidences of abdominal pain, diarrhea, nausea, vomiting, gastric retention, reflux, aspiration and aspiration pneumonia, the proportion of blocking pipe were lower in the intervention group than the control group. Patient′s satisfaction rates were 98. 4% and 81. 0% in the intervention group and control group (P<0. 05). Conclusions Prevention monitoring form can decrease the rate of enteral nutrition complications, and improve nutrition, biochemical indexes and patients satisfaction.

Objective:To evaluate the effects of modified peroral endoscopic myotomy (POEM) on esophageal dynamics and clinical efficacy in achalasia (AC) patients.Methods:From January 2013 to December 2014, 51 patients diagnosed with AC and received modified POEM at The First Affiliated Hospital of Sun Yat-sen University were retrospectively enrolled. AC patients were classified as type Ⅰ, type Ⅱ and type Ⅲ according to Chicago classification. The changes of esophageal dynamics before and after the modified POEM were compared by high resolution manometry (HRM). The reflux after the operation was evaluated by 24-hour esophageal impedance-pH monitoring. The clinical symptoms and the quality of life of AC patients were assessed by impaction dysphagia questionnaire (IDQ), Eckardt scale and short-form 36 item health survey (SF-36). Paired t test, independent sample t test, Wilcoxon rank sum test and Pearson correlation analysis were used for statistical analysis. Results:At three months and one year after operation, lower esophageal sphincter pressure (LESP) and integrated relaxation pressure (IRP) were all lower than those before operation ((23.89±12.68) and (23.44±12.56) mmHg (1 mmHg=0.133 kPa) vs. (39.29±16.14) mmHg; (16.13±9.43) and (15.37±8.36) mmHg vs. (30.57±11.31) mmHg), and the differences were statistically significant ( t=7.520, 7.866, 7.641 and 8.909, all P<0.05). There were no statistically significant differences in LESP and IRP during the same period between patients with type Ⅰ AC and type Ⅱ AC (all P>0.05). The LESP of patients with partial esophageal peristalsis function recovered one year after operation was lower than that of patients with unrecovered esophageal peristalsis function ((15.38±4.54) mmHg vs. (25.65±13.19) mmHg), and the difference was statistically significant ( t=0.039, P<0.05). The proportions of pathologic acid reflux of AC patients at three months and one year after operation were 7.8%(4/51) and 2.0%(1/51), respectively. The IDQ and Eckardt scores of patients with AC at three months and one year after operation were both lower than those before operation (4 points, 0 points to 10 points and 4 points, 0 points to 11 points vs. 23 points, 18 points to 30 points; 2 points, 1 points to 3 points and 1 points, 0 points to 1 points vs. 5 points, 4 points to 5 points), and the differences were statistically significant ( Z=-6.036, -6.104, -5.971 and -6.209, all P<0.01). According to Eckardt score, the proportions of clinical remission at three months and one year after operation were higher than that before operation (98.0%, 50/51 and 100.0%, 51/51 vs. 19.6%, 10/51), and the differences were statistically significant ( χ2=64.76 and 68.56, both P<0.05). The SF-36 general health and social function scores at three months and one year after operation were both higher than those before operation (0.55 points, 0.45 points to 0.70 points and 0.55 points, 0.45 points to 0.70 points vs. 0.45 points, 0.30 points to 0.55 points; 0.88 points, 0.75 points to 1.00 points and 0.88 points, 0.75 points to 1.12 points vs. 0.75 points, 0.75 points to 1.00 points); and the differences were statistically significant ( Z=-4.439, -4.225, -2.123 and -2.320, all P<0.05); and the health change scores were lower than those before operation (3.00 points, 2.00 points to 3.00 points and 2.00 points, 1.00 points to 3.00 points vs. 4.00 points, 3.00 points to 4.00 points), and the differences were statistically significant ( Z=-4.827 and -4.841, both P<0.05). Before and after modified POEM, the changes of LESP were positively correlated with the changes of IRP ( r=0.624 and 0.592, both P<0.01). Conclusion:Modified POEM can significantly improve the symptoms and LES relaxation function of AC patients, with a low incidence of post-operative reflux.

Background: Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. Methods: Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. Conclusion The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.