Objective To investigate role of reverse digital artery island flap combined with dig- ital nerve end to side anastomosis.Methods Reverse digital artery island flaps were used for recon- struction of 65 fingertip defects in 57cases,in which the restoration of the flap sense was attained via dig- ital nerve end to side anastomosis.Results After primary repair,all flaps survived,with good appear- ance and wear-resisting as well as satisfactory two-point discriminations.Conclusion Digital artery re- verse island flap combined with digital nerve end to side anastomosis is a simple and effective procedure for repair of finger defect.

OBJECTIVETo compare clinical efficacy of Zero-profile implant for anterior cervical discectomy and fusion and conventional titanium plate with cage internal fixation for the treatment of single segmental cervical intervertebral disc herniation.

METHODSFrom August 2011 to March 2014, clinical data of 139 patients with single cervical disc herniation treated with anterior cervical discectomy and interbody fusion with internal fixation were retrospectively analyzed. The patients were divided into two groups according to its operation method. There were 63 patients in group A which performed anterior discectomy and interbody fusion with Zero-profile;76 patients in group B which performed anterior cervical discectomy and cage plate internal fixation. JOA score and Odom functional rating between two groups were compared before and after operation. Videofluorographic swallowing study (VFSS) were used to evaluate thickness of prevertebral soft tissue. Bazaz dysphagia score were used to assess incidence of dysphagia. Postoperative AP X-ray and CT of cervical vertebra at 12 months were applied for evaluating bone graft fusion. Postoperative MRI was applied for evaluating the incidence of adjacent segment degeneration. Blood loss,operative time, preoperative and postoperative JOA score, Odom functional rating and VFSS score, Bazaz score, fusion rate between vertebral bodies and incidence of adjacent segment degeneration were compared between two groups.

RESULTSThere were no statistical meaning between two groups in JOA score, Odom functional rating before and after operation (P > 0.05); and no significant meaning in VFSS score between two groups before operation (P > 0.05); There were no significant difference in operative time and blood loss. There was statistical meaning in VFSS, Bazaz dysphagia score at 2 days, and 6 months after operation (P < 0.05). All patients obtained bone union at 1 year after operation, and no obvious meaning in fusion rate (P > 0.05). Eight patients (12.7%) in group A occurred adjacent segment degeneration and 19 patients (25%) in group B occurred adjacent segment degeneration, and there was significant meaning between two groups (P < 0.05).

CONCLUSIONBoth of Zero-profile implant for anterior cervical discectomy and fusion and conventional cage internal fixation for the treatment of single segmental cervical intervertebral disc herniation could obtain satisfied clinical results. While Zero-profile implant for anterior cervical discectomy and fusion has advantages of lower incidence of adjacent segment degeneration, and its mid and long term following-up results still further observation.

Adult ; Aged ; Bone Plates ; Case-Control Studies ; Cervical Vertebrae ; surgery ; Diskectomy ; Female ; Fracture Fixation, Internal ; Humans ; Intervertebral Disc ; surgery ; Intervertebral Disc Displacement ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

Objective To estimate the status of understanding hierarchical medical mode in chronic disease management among medical staff and residents in Xiamen .Methods The multi-stage sampling was used in the study to select 49 physicians from the tertiary hospitals , 58 general practitioners ( GPs ) and health managers from 5 community health services centers , and 499 residents from 5 communities in Xiamen.We conducted a face-to-face survey to estimate their basic information , recognition for hierarchical medical mode , and patients'willingness for community first contact care .The data was described by mean value of frequency and constituent ratio , the chi-square test or Fisher's exact test was used for comparison among groups .Logistic regression was performed to analyze the factors influencing the residents 'preference for treatment in community medical institutions . Results The physicians from tertiary hospitals or community health service centers were almost all familiar with Xiamen mode (91/107, 85%), and more than half of them knew about the hierarchical medical system (67/107, 62.6%), 86.9% (93/107) of them knew about the guide of hierarchical medical system , 58.9%(63/107) of them received the relative training before .The physicians from community had higher knowledge , more frequency training , more referral experiences and more effective evaluation than the physicians from hospitals (all P<0.05).In our study, 86.2%(344/399) of residents were willing to see doctors in community health centers and 77.9%(311/399) of them were willing to return to community health service centers from tertiary hospitals for disease convalescence or chronic disease management;53.6% (214/399) of residents preferred to utilize community first contact care when they got chronic diseases , and they were more satisfied with the consultation and diagnosis process in community .The residents who knew about the hierarchical medical system were more likely to utilize community first contact care and return to community for medical care . However, the female or the higher-income residents were less likely to see doctors in community .Patients who had experienced transfer to community or had higher satisfaction to community care were more willing to return from hospitals to community for disease convalescence .The mode showed that the system was more effective in measuring and controlling blood pressure or blood glucose for patients who joined the patients 'network than for those did not join.(P<0.05).Conclusion Medical staff are familiar with hierarchical medical system , and the residents are likely to use community health service as their first contact care in Xiamen.The utilization of community first contact care is influenced by sex , family income, previous experience, knowledge of the system , and satisfaction to the system of patients .

OBJECTIVETo explore the efficacy and safety of zero-profile implant for anterior cervical discectomy and fusion (ACDF) in treating single cervical disc herniation.

METHODSFrom August 2011 to June 2012,30 patients with single cervical disc herniation were treated with ACDF using zero-profile implant in one motion segment. There were 18 males and 12 females with a mean age of 55.3 years old (ranged, 36 to 68). Incidence of dysphagia, height of intervertebral space and condition of bone fusion were observed after operation. Spinal nerves function and clinical results were assessed according to Japanese Orthopaedic Association (JOA) score, Odom criteria.

RESULTSAll patients were followed up from 12 to 24 months with an average of 15.9 months. The mean intraoperative blood loss was (85.3 +/- 14.2) ml (70 to 120 ml) and operative time was (90.0 +/- 12.8) min (70 to 120 ml). Preoperative, postoperative at 3 months and 1 year, JOA score was 8.72 +/- 2.36 (5.0 to 13.0), 14.72 +/- 1.66 (11.5 to 17.0) and 15.65 +/- 1.03 (13.5 to 17.0), respectively. One year after operation, according Odom criteria to assess, 22 cases got excellent results, 7 good, 1 fair. All dysphagiaes vanished completely at 3 months after operation. The lost height of intervertebral space was (0.34 +/- 0.13) mm (0.1 to 0.6 mm) and (0.39 +/- 0.15) mm (0.2 to 0.7 mm) at 3, 12 months after operation, respectively. All patients obtained bone fusion at 1 year after operation.

CONCLUSIONThe zero-profile implant is a valid alternative to anterior cervical plate in treating single cervical disc herniation with ACDF, it has advantages of convenient procedure, satisfactory effect, lower incidence of postoperative dysphagia, reliable stability and less implant-related complications.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Diskectomy ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; surgery ; Male ; Middle Aged ; Prostheses and Implants ; Safety ; Spinal Fusion ; adverse effects ; Treatment Outcome

OBJECTIVETo investigate the selective strategy of the internal fixation methods in treating intertrochanteric femoral fracture by comparing the different methods.

METHODSData of 326 cases of intertrochanteric femoral fractures treated with different internal fixation methods were concluded. One hundred and sixty-five cases were treated with the dynamic hip screws (DHS group), 78 male, 87 female, age 38 to 98 years. One hundred and three cases were treated with the anatomical plates of proximal femur (AP group), 48 male, 55 female, age 39 to 89 years. Fifty-eight cases were treated with the fixation expandable proximal femoral nails (PFN group), 31 male, 27 female, age 41 to 92 years. According to Evans classification of intertrochanteric femoral fractures, fractures were divided into type I, II, III, IV and retro-intertrochanteric type. The cases of each type of three groups were DHS(12, 35, 61, 42, 15); AP(9, 23, 38, 25, 8); PFN (6, 13, 21, 13,5). Data of each group was collected for statistical analysis on the following aspects: operation time,blood loss, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function and the total complications.

RESULTSThe difference of operation time, blood loss, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function were of statistical significance (P < 0.01). In comparing with group DHS and AP, group PFN was of less operation time, blood loss, drainage, clinical healing time of fracture, but more fluoroscopy exposures, and the post-operative restored function of group PFN was more satisfied. The difference of operative complications were of no statistical significance (P = 0.05).

CONCLUSIONThe fixation expandable proximal femoral nail is a good choice for intertrochanteric femoral fracture.

Adult ; Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Hip Fractures ; surgery ; Humans ; Internal Fixators ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo compare the pituitary down-regulatory effects of the two gonadotropin-releasing hormone agonists Alarelin and Triptorelin in the long protocol of ovulation induction in in vitro fertilization and embryo transfer (IVF-ET).

METHODSWe included in this study 122 patients aged 24-39 years treated by IVF-ET for secondary infertility, with 10-20 pre-antral follicles and obstruction of the fallopian tube. Seventy-eight of them received Alarelin, and the other 44 Triptorelin. Comparative analyses were made on the pituitary down-regulatory effects of the two gonadotropin-releasing hormone agonists and the clinical outcomes of IVF-ET.

RESULTSNo premature LH surge and ovulation, nor severe hyperovarian stimulation syndrome was found in either group. There were no significant differences between the two groups in the mean dose and duration of gonodatropin treatment, the numbers of oocytes retrieved, mature oocytes and top-quality embryos, and the rates of 2PN, multi-sperm fertilization, cleavage, embryo transfer, embryo implantation, clinical pregnancy and early miscarriage (P > 0.05), but the rate of cancelled cycles was significantly higher in the Triptorelin than in the Alarelin group (P < 0.05).

CONCLUSIONAlarelin and Triptorelin can achieve similar pituitary down-regulatory effects and clinical outcomes in IVF-ET when used in the long protocol of ovulation induction.

Adult ; Embryo Transfer ; methods ; Female ; Fertilization in Vitro ; methods ; Gonadotropin-Releasing Hormone ; agonists ; analogs & derivatives ; pharmacology ; Humans ; Infertility, Female ; therapy ; Ovulation Induction ; methods ; Pituitary Gland ; drug effects ; Triptorelin Pamoate ; pharmacology

OBJECTIVETo investigate the multiplex ligation-dependent probe amplification (MLPA) technology in the detection of gene deletion and prenatal diagnosis of α-thalassaemia.

METHODSPhenotypes were analyzed by whole blood cell counting and hemoglobin component detection of peripheral blood samples from the subjects. The gene deletions and point mutations of α- thalassaemia were detected with regular gap-PCR and reverse dot blot (RDB) method. At last, the MLPA method was applied for detection of α-globin gene deletion. All the prenatal diagnosis samples were detected with both gap-PCR and MLPA method.

RESULTSα-thalassaemia phenotype was found in 75 samples from 1256 (628 couples) peripheral blood samples for pre-pregnancy or prenatal thalassemia gene screening. Among them, 71 samples carrying α-gene mutations and consistent with phenotypes were detected by routine methods. In the other 3 samples with no α-gene mutations detected and 1 sample with HbH phenotype but genotype of ﹣α(4.2)/αα were analyzed by MLPA and found each one samples of whole α-globin gene cluster deletion, respectively. Seventeen high risk couples were screened. Among the 17 prenatal diagnosis samples, 2 villus samples contaminated by exogenous DNA were confirmed by MLPA method.

CONCLUSIONMLPA is an effective complement for α-thalassaemia gene deletion detection. The molecular diagnosis strategy and process of gap-PCR combined with MLPA for α- thalassaemia gene deletion detection can prevent the missing of gene deletion, and false-positive or false-negative misdiagnosis of α-thalassaemia in prenatal diagnosis.

DNA Mutational Analysis ; Female ; Gene Deletion ; Genotype ; Humans ; Male ; Multigene Family ; Multiplex Polymerase Chain Reaction ; Phenotype ; Pregnancy ; Prenatal Diagnosis ; methods ; alpha-Thalassemia ; diagnosis ; genetics

OBJECTIVETo study the relationship of the incidence of bronchial dysplasia (bronchial anomalous origin and bronchial stenosis) with congenital heart disease.

METHODSA total of 185 children with congenital heart disease or bronchial dysplasia were enrolled. Bronchial dysplasia was identified by the 64-MSCT conventional scanning or thin slice scanning with three-dimensional reconstruction.

RESULTSForty-five children (25.3%) had coexisting bronchial dysplasia and congenital heart disease. The incidence rate of bronchial dysplasia in children with congenital heart disease associated with ventricular septal defect was higher than in those without ventricular septal defect (33.7% vs 15.0%; P<0.05). There were no significant differences in the incidence rate of bronchial dysplasia between the children with congenital heart disease who had a large vascular malformation and who did not.

CONCLUSIONSBronchial dysplasia often occurs in children with congenital heart disease. It is necessary to perform a tracheobronchial CT scanning with three-dimensional reconstruction to identify tracheobronchial dysplasia in children with congenital heart disease, especially associated with ventricular septal defect.

Adolescent ; Bronchi ; abnormalities ; embryology ; Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Infant ; Male ; Tomography, X-Ray Computed

Objective To explore the epidemiological status of abnormal glucose metabolism and its influential factors among middle and aged population with hypertension in Chengdu area. Methods In 2008, after adopting the methods of stratified cluster sampling, the authors investigated 4685 subjects of the middle and aged population between the age of 40-79 in Chengdu urban and rural area by checking blood pressure and oral glucose tolerance test (OGTY). Patients with previously known diabetes mellitus (DM) were only asked to perform fasting glucose and to carry out a questionnaire. Comparison of the prevalence rates of abnormal glucose metabolism in hypertensive and non-hypertensive subjects was carried out. The prevalence rates of isolated impaired glucose tolerance (I-IGT) and isolated postprandial hyperglycemia (IPH) among middle and aged subjects with hypertension were acquired and the influential factors of abnormal glucose metabolism among middle and aged subjects with hypertension were analyzed. Results The prevalence rate of abnormal glucose metabolism in the hypertensive subjects was obviously higher than that in the non-hypertensive subjects; without using OGTT, 72.9% of the pre-diubetic and 54. 4% of the new diagnosed DM patients would remain undiagnosed if fasting plasma glucose detection was used alone. Age, diabetic history of first degree relatives ,overweight or obesity were the risk factors for the development of abnormal glucose metabolism among middle and aged male subjects with hypertension in Chengdu area. Exercise training and high education level were the protective factors. Age, diabetic history of first degree relatives,abdominal obesity and hypertriglyceridemia were the risk factors for the development of abnormal glucose metabolism among middle and aged female subjects with hypertension in Chengdu area. Conclusions More than 50% of middle and aged subjects with hypertension in Chengdu area has accompanying abnormal glucose metabolism. OGTT easily discloses the abnormal status and should be a routine procedure in the diagnosis of pre-diabetes or DM in such population. Appropriate exercise, learning diabetes-related knowledge to take reasonable lifestyle, and intervention of metabolic factors such as overweight or obesity are advised. Abdominal obesity and hypertriglyceridemia play important roles in leading to abnormal glucose metabolism among middle and aged population with hypertension.

Objective To compare the efficacy of sublingual immunotherapy (SLIT) with standardized Dermatophagoides farinae drops in monosensitized and polysensitized patients with allergic rhinitis.Methods The efficacy of SLIT in 69 patients who were sensitized to house dust mites and treated with Dermatophagoides farinae drops for 1.5-2.0 year with complete clinical data were analyzed retrospectively.These patients had been divided into the monoallergen sensitized group and polyallergen sensitized group according to the results of skin prick tests.The total medication score (TMS) and the total nasal symptoms score (TNSS) were evaluated before and half an year,1.0 year and 1.5-2.0 years after SLIT treatment.Results After SLIT treatment for half an year,the TNSS in the monoallergen sensitized group (2.00 [1.00; 3.00]) was significantly lower than that in the polyallergen sensitized group (3.00 [2.00 ;4.00],Z =-2.851,P ＜ 0.05),this significant difference of TNSS between the two groups was also found after SLIT treatment for 1.0 year (0.00 [0.00 ; 1.00],2.00 [0.00 ; 3.00],Z =-2.590,P ＜0.05).Whereas,there was no significant difference between the two groups after 1.5-2.0 years'treatment refer to the TNSS (0.00 [0.00 ; 1.00],0.00 [0.00 ; 2.00],Z =-1.461,P ＞ 0.05).Half an year,1.0 year and 1.5-2.0 years after SLIT treatment,the TMS in both groups reduced significantly,with no significant difference between two groups (Z value was-0.777,-0.944,-0.907,all P ＞ 0.05).Conclusions SLIT with Dermatophagoides farinae drops is effective in monosensitized and polysensitized patients with allergic rhinitis.And equivalent efficacy could be achieved after 1.5-2.0 years.