Simvastatin is a hypolipidemic drug that inhibits hydroxymethylglutaryl coenzyme A (HMGCoA) reductase to control elevated cholesterol,or hypercholesterolemia.Previous studies have shown that simvastatin may attenuate inflammation in ischemia-reperfusion injury and sepsis.Herein,we hypothesized that simvastatin may prevent rats from lipopolysaccharide (LPS)-induced septic shock.In our study,rats were divided into a saline group,an LPS group and an LPS plus simvastatin group.Male Sprague-Dawley (SD) rats were pretreated with simvastatin (1 mg/kg) for 30 min before the addition of LPS (8 mg/kg),with variations in left ventricular pressure recorded throughout.Ninety min after LPS injection,whole blood was collected from the inferior vena cava,and neutrophils were separated from the whole blood using separating medium.The neutrophils were then lysed for Western blotting to detect the levels of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1).In addition,mesentery microcirculations of inlet diameter,outlet diameter and blood flow rate were measured in all three groups.The results indicated that simvastatin significantly promoted heart systolic function and increased the level ofuPA while simultaneously inhibited the expression of PAI-1 as compared with LPS group.Moreover,simvastatin reversed the LPS-induced inhibition of mesentery microcirculation.Taken together,it was suggested that simvastatin can effectively protect the rats from LPS-induced septic shock.

OBJECTIVETo analyze the factors affecting the occurrence and severity of crush syndrome (CS) after crush injury (CI) in pediatric trauma victims in the Wenchuan earthquake.

METHODSMedical records of 98 patients who were transferred to our hospital were retrospectively reviewed. The risk factors, such as age, gender, time being besieged, type of injury, wound infection, hemodialysis, etc., which were assessed with T-test/chi(2)/Fisher's exact tests and logistic regression analysis for the occurrence of crush syndrome after crush injury. Possible risk factors influencing CS severity were analyzed.

RESULTSThere were 15 patients with CS, and all these cases were from 59 patients with extremities crush injury. The incidence of CS reached 15.3% in pediatric trauma victims after earthquake and 25.4% in extremities crush injury. Six risk factors were assessed with logistic regression analysis for three outcomes relating to crush syndrome, they are age, time being szeged and closed CI, whose log-odds ratio (log-OR) respectively was 1.049, 1.221, and 0.068 (P < 0.05 for all). And no correlation was found between CS and gender, upper or lower limbs injury or wound infection. There was no significant difference in wounds infection rate between patients with open injury and those who underwent CS fasciotomy (P = 0.754), but there was significant difference between those patients who underwent CS fasciotomy and those who underwent other operative incisions (P < 0.05). Wound infection had a significant association with severity of CS (P = 0.041) as compared with other factors such as age, gender, and time being szeged.

CONCLUSIONThe occurrence of crush syndrome is mainly because of extremities crush injury and also has significant relations with age, time being szeged and closed crush injury in children. Infection of incisional wound after CS fasciotomy is a risk factor for aggravation of CS.

Adolescent ; Child ; Child, Preschool ; China ; Crush Syndrome ; Disasters ; Earthquakes ; Female ; Humans ; Injury Severity Score ; Male ; Risk Factors

OBJECTIVETo study the surgical approach and curative effect of the "interlocking basket" technique in interventional therapy for longitudinal intracranial aneurysm.

METHODSThirty-eight Hunt and Hess Grade I-III patients with longitudinal intracranial aneurysm underwent interventional therapy using the "interlocking basket" technique. During the operation, the aneurysm was divided into two segments based on its length and occluded with two coils. The first coil with a transverse diameter matching that of the aneurysm was deployed to form a "basket", which was densely occluded, and a portion of this coil out of the "basket" was interlocked with the second coil to form another "basket" crossing the aneurysmal neck to prevent the coils from escaping till the neck of the aneurysm was densely occluded.

RESULTSThirty-five aneurysms (92.1%) were completely embolized, and 3 (7.9%) were 95% embolized. No coil escaping from the aneurysm neck or other complications occurred. Twenty-five patients were discharged with a GOS score of 5 (65.8%), 7 (18.4%) with a score of 4, and 6 (15.8%) had a score of 3. In the follow-up for 3-25 months after the embolization, angiography was performed in 28 cases, and recurrence was found in 2 cases (7.14%).

CONCLUSIONThe "interlocking basket" technique can increase the coil stability in longitudinal intracranial aneurysm and allows reliable block of the aneurysm neck and dense embolization of the aneurysm to improve the clinical outcomes of the patients.

Aged ; Embolization, Therapeutic ; methods ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo investigate the effect of the arthroscopic procedure on the patients with recurrent anterior shoulder dislocation.

METHODSFrom January 2001 to March 2006,52 patients with recurrent anterior shoulder dislocation were treated by arthroscopy. Among them 44 patients were followed up for 12 to 54 months(on average of 26 months). The data of the 44 patients was reviewed. Three evaluation systems, University of California at Los Angeles Shoulder Scores (UCLA), Simple Shoulder Test (SST) and Dawson, were used. The study evaluated the effect based on the Dawson system by the factors as: age, course of the disease, frequency of dislocation and relocation methods and the range of shoulder movement.

RESULTSThe ratio of recurrent dislocation after operation was 4.5%. Assessing through 3 evaluation systems, UCLA, SST and Dawson, results were similar: the follow-up evaluation were extraordinarily different from preoperative assessment, and the rating of good or excellent at the time of the final follow-up reached 91% higher. Based on the Dawson system, the evaluation results had no statistic diversity according to such factors as: age, course of the disease, frequency of dislocation and relocation methods.

CONCLUSIONSThe effects of arthroscopic surgery to the recurrent anterior shoulder dislocation are satisfied and evidence-proved. It is a good option for both common patients and athletes.

Adolescent ; Adult ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography ; Recurrence ; Retrospective Studies ; Shoulder Dislocation ; diagnostic imaging ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the posterior and superior compression test (PSCT) and weight-bearing on elbow test (WBE) on the diagnosis of superior labrum anterior to posterior (SLAP) lesion.

METHODSFrom July 2000 to March 2007, 4 clinical tests including O'Brien test, Crank test, PSCT and WBE were randomly performed on 207 patients (209 shoulders). Among the patients, 125 were males and 82 were females with the mean age of 39 years. All the patients underwent arthroscopic treatment by the same doctor. The arthroscopic diagnosis was considered as the golden standard. For each test, the parameters on clinical epidemiology were calculated, and the differences of detection rate between the physical tests and the arthroscopic examination were compared.

RESULTSThe parameters on clinical epidemiology of O'Brien test, Crank test, PSCT and WBE were comparable. The difference of detection rate between the physical tests and the arthroscopic examination was not statistically significant (P > 0.05). The detection rates of PSCT and WEB in the group of injury of posterior and superior labrum were statistically higher than the group of injury of anterior and superior labrum. The detection rate of PSCT in the group of simple SLAP lesion was relatively higher.

CONCLUSIONSCompared with O'Brien test and Crank test, the new PSCT and WBE have not only comparable clinical value in the diagnosis of SLAP lesion, but also the advantage in predicting the location of SLAP lesion. The detection rate of PSCT in the group of simple SLAP lesion is relatively higher, but the mechanism is to be determined.

Adolescent ; Adult ; Aged ; Arthroscopy ; Elbow Joint ; injuries ; physiopathology ; Exercise Test ; methods ; Female ; Humans ; Male ; Middle Aged ; Shoulder Dislocation ; diagnosis ; physiopathology ; Shoulder Joint ; injuries ; physiopathology ; Weight-Bearing

Objective To study the risk factors of intraprocedural re-rupture (IPR) of ruptured intracranial aneurysms, and the emergency management on this event and its efficacy. Methods The clinical data of 236 patients with ruptured intracranial aneurysms, admitted to our hospital from 2005 to 2009 and treated with embolization, were retrospectively analyzed; non-conditional logistic regression analysis was performed to analyze the risk factors of IPR of ruptured intracranial aneurysms. And the emergency management of IPR and its efficacy were concluded in 16 patients with IPR. Results The risk factors of IPR of ruptured intracranial aneurysms included small aneurysms with a diameter smaller than or equaling to 3.0 mm (OR=6.353, 95% CI: 1.266-31.894, P=0.025), aneurysms at distal part of Al and M1 segment of the anterior cerebral artery or middle cerebral artery (OR=35.449, 95% CI:3.053-411.642, P=0.004), atherosclerosis (OR=5.961, 95% CI: 1.215-29.260, P=0.028), mild vasospasm (OR=13.048, 95% CI: 1.220-139.574, P=0.034) and severe vasospasm (OR=14.826, 95% CI:1.871-117.488, P=0.011). Immediate reversal of heparin anticoagulation with protamine sulfate and rapid completion of coiling were performed in 16 patients (6.78%) occurred IPR. Emergent external ventricular drainage was performed in 12 patients having above Hunt-Hess grade Ⅲ:6 patients died; 1 was under persistent vegetative state and 9 fully recovered. Conclusion Small aneurysms, atherosclerosis,cerebral vasospasm and aneurysms at the distal part of Al or M1 segment may easily lead to IPR of ruptured intracranial aneurysms. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation, and emergent external ventricular drainage performed in severe patients are confirmed to be the keys, which can decrease the death rate and improve the prognosis.

OBJECTIVETo investigate the distribution and the drug resistance pattern of pathogenic bacteria isolated from pediatric cases suffering from wounds infection following the Wenchuan earthquake.

METHODSOf the ninety-eight injured children, 50 had wound infection diagnosed by clinical examination. Specimens for culture were collected from the fifty injured children and the results of bacterial identification and antibiotic resistance were retrospectively reviewed.

RESULTSIn the fifty injured children with wound infection, microbial growth was detected in 31 (62.0%) and 21 children suffered from mixed infections (the infection rate was 67.7%). Ninety-nine pathogens were isolated, gram positive bacteria accounted for 16.16% (16 strains), Gram negative bacteria accounted for 81.82% (81 strains), and fungus 2.02% (2 strains). Staphylococcus aureus (5 strains, 5.05%), Enterococcus faecalis (3 strains, 3.03%) and Enterococcus faecium (2 strains, 2.02%) were the primary Gram-positive bacteria identified and Gram-negative infections typically included Acinetobacter baumanii (27 strains, 27.27%), Enterobacter cloacae (18 strains, 18.18%) and Pseudomonas aeruginosa (13 strains, 13.13%). Acinetobacter baumanii was the most common organism isolated from wounds. Duration of being szeged and complications had a significant association with wound infection with Acinetobacter baumanii. Drug sensitivity tests displayed that the isolated bacteria were highly resistant to common antibiotics. One strain of Acinetobacter baumanii-calcoaceticus complex and six strains of Acinetobacter baumanii were resistant to all common antibiotics including imipenem/cilastatin. Vancomycin-resistant Gram-positive bacteria were not identified.

CONCLUSIONFollowing the Wenchuan earthquake disaster, wound infection profiles of pediatric patients were significantly different, Acinetobacter baumanii was the main common organism isolated from wounds in contrast to the previous low isolation rate. The isolated bacteria were highly and multiple drug resistant and it was difficult to treat. Knowing the distribution and the drug resistance pattern of pathogen is of paramount importance in guiding the clinical treatment.

Adolescent ; Child ; Child, Preschool ; Disasters ; Drug Resistance, Bacterial ; Earthquakes ; Female ; Gram-Negative Bacteria ; drug effects ; isolation & purification ; Gram-Positive Bacteria ; drug effects ; isolation & purification ; Humans ; Male ; Microbial Sensitivity Tests ; Wound Infection ; microbiology ; Wounds and Injuries ; microbiology

BACKGROUNDDifferent kinds of minimally invasive surgery (MIS) procedures have now been used in total knee arthroplasty (TKA). Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing (QS) procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients' vastus medialis and if the QS procedure had some advantages in patients' early recovery.

METHODSBetween February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees (15 men and 91 women, with a mean age of 65.1+/-7.4 years); osteoarthritis in 97 patients (91.5%) and rheumatoid arthritis in 9 patients (8.5%). MIS TKA was performed in 49 cases (MIS TKA group), while MIS-QS TKA in 57 cases (MIS-QS TKA group). During the operation, the type I, II and III insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery (HSS) scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded.

RESULTSThere was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 (0.9%) case with a type I insertion of the vastus medialis, 4 (3.8%) cases with type II insertions, 101 (95.3%) cases with type III insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was (53.3+/-12.4) minutes in the MIS TKA group and (64.1+/-15.1) minutes in the MIS-QS TKA group (P<0.001). In the MIS-QS TKA group, 1 patient had delayed healing of the partial skin incision (1.8%). No other complications were found in either group.

CONCLUSIONSAlthough most of the Chinese patients had type III insertions of the vastus medialis, the MIS-QS TKA procedure showed less injury to the quadriceps than the standard MIS TKA and this could contribute to the earlier recovery of the patients. But a shorter skin incision and more tension on the skin may also lead to more skin complications.

Aged ; Aged, 80 and over ; Anesthesia Recovery Period ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Quadriceps Muscle ; surgery ; Time Factors

Objective To investigate the effects of xuefuzhuyu injection on the expressions of the nuclear factor-кB(NF-кB)and inhibitor-кBα(1-кBα)in rat brain tissue after traumatic brain injury.Methods Eighty SD rats were randomly divided into sham-operative(n=20), model(n=20),hexadecadrol-treated(n=120)and xuefuzhuyu-treated(n=20)groups.Traumatic brain injury models were induced by free-fall.Sham-operative and model groups received intraperitoneal injection of 0.1 mL/(kg·d)normal saline;dexamethasone-treated group and xuefuzhuyu-treated group received intraperitoneal injection of 0.1 mg/(kg·d)dexamethasone and 4 mL/(kg·d)xuefuzhuyu injection immediately after the successful model inducement,respectively, and then, heir brain tissue samples were obtained at 6,24,48 and 96 h. Immunohistochemistry was employed to detect the protein expressions of NF-кB P65 and I-кBα in the traumatic brain tissue,and HE staining was performed to observe the brain structure.Results Increased protein expression of NF-кB P65 and decreased protein expression of I-кBα in the model group were found as compared to those in the sham-operative group at all time points(P<0.05);dexamethasone-treated and xuefuzhuyu-treated groups showed significantly lower protein expression of NF-кB and higher protein expression of I-кBα than the model group at all time points(P<0.05)and the effect of xuefuzhuyu injection was better than that of dexamethasone.The expressions of NF-кB and I-кBα were negatively correlated in the model group(r=-0.876.P=0.000). Conclusion Secondary injury caused by traumatic brain injury can be relieved by inhibiting the activation of NF-кB and increasing the expression of I-кBα, which are exactly the effects of xuefuzhuyu injection and dexamethasone,and xuefuzhuyu injection works better than dexamethasone.

Objective To explore the factors that may influence the prognosis of patients with multiple intracranial aneurysms (MIA) in subarachnoid hemorrhage (SAH). Methods A retrospective review was performed to analyze the medical records of 93 patients who had been managed in our department from January 2000 through January 2011 for MIA in SAH. Results The single factor analysis showed that the gender, preoperative Hunt-Hess grade, treatment protocol and a history of hypertension had significant influences on the prognosis of the patients (P＜0.05). The multiple linear regression analysis revealed that the preoperative Hunt-Hess grade and treatment protocol were 2 independent risk factors of the prognosis of the patients (P＜0.05). Conclusions The preoperative Hunt-Hess grade and the treatment protocol appear to be related to the prognosis of patients with MIA in SAH. Early diagnosis and treatment of ruptured aneurysms, as well as careful observation and proper intervention ofunruptured aneurysms,can result in a satisfactory prognosis in most patients with MIA in SAH.