Objective To discuss the treatment and clinical outcome of open to the tarsometatarsal joint injury. Methods From April 2009 to April 2010,14 patients,10 males and 4 females,with open to the tarsometatarsal joint injury were treated in our department.They were 45 years old on average (from 21 to 67 years old).Five of them had the tarsometatarsal complex involved.According to Chiodo and Myerson's classification,all the injuries were of three-column type. Medial and lateral column shortening was respectively concomitant in 2 cases.Two patients had combined soft tissue defects and one patient degloved dorsal skin.A thorough debridement and Kirschner wire fixation following reduction were performed for all patients in the emergency room.A mini external fixator was applied in patients with medial or lateral column shortening.The degloved skin was thinned and grafted in situ,followed by vacuum sealing drainage (VSD) to cover the wound.The soft tissue defect was covered by VSD after debridement.All the patients had a definitive internal fixation after the soft tissue condition improved, and 3 of them had soft tissue coverage simultaneously.Functional outcomes were scored by American Orthopedic Foot Ankle Society (AOFAS) system. Results One patient with degloving injury had partial skin necrosis which was treated by debridement,definitive internal fixation and local flap transfer on the 13th day after emergency operation.A definitive internal fixation and skin graft were performed in 2 patients with soft tissue defects respectively on the 7th or 11th day post-operation.No wound infection or necrosis occurred in other patients.Twelve patients were followed up for an average period of 18 months (from 13 to 25 months).Solid union was obtained 12 weeks on average (from 10 to 16 weeks) after the secondary surgery.No flap necrosis,infection,nonunion or osteomyelitis occurred during the follow-up.Two patients had tarsometatarsal arthrodesis at the 12th or 14th month respectively due to severe pain and function limitation caused by post-traumatic arthritis.The mean AOFAS midfoot score at the last follow-up was 72 (from 61 to 89). ConclusionsAs tnanagement of open to the tarsometatarsal joint injury is a great challenge,surgeons must take soft tissue condition into consideration.Tenporary Kirschner wire fixation or in combination with external fixation after early thorough debridement,reduction and alignment restoration,followed by secondary definitive internal fixation until soft tissue condition improves is a safe and effective treatment strategy to decrease soft tissue complications and obtain stable fixation.

Objective To investigate the indications and efficacy of endovascular stenting for the treatment of thoracic aortic aneurysm.Methods From March 2005 to October 2008,21 patients with Stanford type B aortic dissection,5 cases of pseudoaneurysm,and 2 patient with intramural hematoma complicated with ulcer of the aortic wall were treated by endovascular stenting under general(2 cases) or local(26 cases) anesthesia in our hospital.Medtronic Talent stent was employed in 10 cases,Medtronic Valiant stent was used in 12,and microinvasive straight-type stent was used in 6 patients.Results The operation was completed successfully in all of the 28 cases.Angiography showed that the gaps in the aorta were closed without endoleak.No patient had chest pain or neurological complications.The patients were discharged in(4.5?1.1) days(range 3-7 days).Five patients developed fever after the operation and were cured by indomethacin in one month.One week after the surgery,in 21 cases,CT scan showed enlarged aortic dissection,improved blood supply,thrombus in the false lumen of the thoracic aorta,and a false lumen in the abdominal aorta.In the 5 cases with pseudoaneurysm,CT scan confirmed that the rupture was closed with thrombus being detected in the lumen.The aortic ulcers that were detected in the 2 cases,who had intramural hematoma,were covered by the stents.Of the patients,a follow-up of(21.3?10.2) months(range 1-40 months) was available in 23 patients,who had no complications during the period.Conclusions Endovascular stenting is a simple,safe and effective method for Stanford type B aortic dissection,pseudoaneurysm,and intramural hematoma,resulting in quick recovery,less complications,and short hospital stay.

[ ABSTRACT] AIM: To investigate whether L-carnitine ( LC) inhibits the eryptosis effect of uremic serum on erythrocytes.METHODS:Erythrocyte suspension (2%) was cultured and divided into 3 groups in vitro: control group ( C group) , uremic serum group ( U group, 30%uremic serum) , and uremic serum+LC group ( L group, 30%uremic serum+200 μmol/L LC) .Erythrocytes were collected at 24 h and 48 h.Eryptosis ( phosphatidylserine expression repre-sents eryptosis) was estimated by flow cytometry with Annexin V staining.The content of reactive oxygen species ( ROS) was also detected.Glutathione ( GSH) was measured by ELISA.RESULTS:Eryptosis in C group was increased as the in-cubating time extended.Eryptosis in U group was higher than that in C group, while that in L group was lower than that in U group.Meanwhile, ROS content was higher and GSH was lower in U group than those in C group.ROS content was low-er and GSH was higher in L group than those in C group.CONCLUSION:LC inhibits uremic serum-induced eryptosis by decreasing ROS and increasing GSH, thus attenuating oxidative stress.

e.

AimTo study the effects of aspirin (Asp) and verapamil(Ver)alone or in combination on mesenteric microcirculation of rats. MethodsAcute microcirculation disturbance(AMD) was produced by highmolecular weight dextran(Mr 480, 000) 360 mg· kg-1 iv. Arteriol and venul blood flow velocity and diameter (ABFV, VBFV, AD, VD) and blood flow state(BFS) were observed by intravital microcirculation method. Results Asp 2.5, 5 mg · kg-i, Ver 0.3, 0.6 mg · kg-1,Asp+ Ver(1 + 0.15), (2. 5+ 0. 3) mg· kg-1 iv significant increase ABFV by 11.1%, 31.3%, 18.7%,19.5%, 26.5%, 37.3%, VBFV by 12.5%, 5.7%, 2.5%, 3.7%, 30%, 34.7%,AD by 4.3%, 17.9%, 31.5%, 35%, 20%, 38.1% and VDby 2.2%,4.2%, 25%, 31.5%,5.8%,23.5%espectively, and got a raise in the number of capillaries and a marked improvement of BFS. Asp + Ver(1+0.15, 2.5+0.3) mg · kg-1 iv could reverse AMD. Conclusion Asp is superior to Ver in the increase of BFV, but Ver is superior to Asp in expansion of blood vessel. Asp in combination with Ver produces marked synergistic action and protection againist AMD.

An introduction to the Basic service module featuring holistic,full flow and seamless connection built by the hospital.Authors described their experiences in achieving homogenous clinical nursing care,and pointed out that integrating medical humanistic care into the daily nursing process,can improve doctor-patient relationship and patients satisfaction,thus raising medical service quality and efficiency.

Humans ; Jaw, Edentulous ; therapy ; Maxilla ; Prostheses and Implants

Objective To investigate the curative effect of bronchoalveolar lavage with fiberoptic bronchoscopy combined with vibration sputum drainage in the treatment of severe pneumonia patients undergoing mechanical ventilation (MV).Methods A prospective randomized controlled trial was conducted. 286 severe pneumonia patients undergoing MV admitted to intensive care unit (ICU) of Hunan People's Hospital from January 2014 to July 2016 were enrolled, and they were divided into control group and observation group according to random number table, with 143 patients in each group. Patients in both groups received sensitive antibiotics for anti-infection, etiological treatment, and calefacient and humidifying treatment. The patients in the control group received bronchoalveolar lavage with fiberoptic bronchoscopy, and those in the observation group received bronchoalveolar lavage combined with vibration sputum drainage. The parameters of respiratory function and inflammation before and after treatment, curative effect, and prognosis were compared between the two groups.Results ① There were no significant differences in respiratory function parameters between the two groups before treatment, 2 hours after treatment, the parameters were improved in both groups. Moreover, oxygenation index (PaO2/FiO2) in observation group was significantly higher than that of control group [mmHg (1 mmHg = 0.133 kPa): 379.1±20.2 vs. 351.8±24.7], and arterial partial pressure of carbon dioxide (PaCO2) and airway resistance (Raw) were significantly lower than those of the control group[PaCO2 (mmHg): 36.5±5.8 vs. 45.3±6.9, Raw (cmH2O, 1 cmH2O = 0.098 kPa): 12.9±0.6 vs. 13.1±0.8, allP < 0.01]. ② There were no significant differences in inflammation parameters between the two groups before treatment, 24 hours after intervention, which were significantly decreased in both groups. Moreover, white blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) in the observation group were significantly lower than those of the control group [WBC (×109/L): 8.2±1.7 vs. 12.8±3.7, PCT (μg/L): 15.4±2.4 vs. 21.8±3.1, CRP (mg/L): 37.1±6.1 vs. 67.2±7.2, allP < 0.01]. ③ Compared with the control group, the treatment efficiency of observation group was improved [95.1% (136/143) vs. 87.4% (125/143)], the quantity of sputum excretion was increased (mL: 49.2±12.5 vs. 36.9±11.0), duration of MV and length of ICU stay were significantly shortened (days: 6.4±3.6 vs. 9.4±2.1, 8.6±5.7 vs. 12.4±4.6, bothP < 0.01), however, there was no significantly statistical difference in 28-day mortality between control group and observation group [2.8% (4/143) vs. 2.1% (3/143),P > 0.05].Conclusion Compared with bronchoalveolar lavage with fiberoptic bronchoscopy alone, the treatment of bronchoalveolar lavage combined with vibration sputum drainage is more effective in sputum excretion for severe pneumonia patients undergoing MV, which could improve the respiratory function, reduce infection, shorten the duration of MV and the length of ICU stay, and improve the recovery.

Using Dachengqi Tang (DCQT) as a model, high performance liquid chromatography (HPLC) fingerprints were applied to optimize machine extracting process with the Box–Behnken experimental design. HPLC fingerprints were carried out to investigate the chemical ingredients of DCQT; synthetic weighing method based on analytic hierarchy process (AHP) and criteria importance through intercriteria correlation (CRITIC) was performed to calculate synthetic scores of fingerprints; using the mark ingredients contents and synthetic scores as indicators, the Box–Behnken design was carried out to optimize the process parameters of machine decocting process under high pressure for DCQT. Results of optimal process showed that the herb materials were soaked for 45 min and extracted with 9 folds volume of water in the decocting machine under the temperature of 140 1C till the pressure arrived at 0.25 MPa;then hot decoction was excreted to soak Dahuang and Mangxiao for 5 min. Finally, obtained solutions were mixed, filtrated and packed. It concluded that HPLC fingerprints combined with the Box–Behnken experimental design could be used to optimize extracting process of traditional Chinese medicine (TCM).

Objective To discuss the optimal retrieval time of the indwelling Gunther Tulip and Cook Celcet inferior vena cava filters (VCF). Methods During the period from March 2013 to April 2015 at Shengli Oilfield Central Hospital, the implantation of retrievable inferior vena cava filter was performed in 58 patients. Among the 58 patients, Gunther Tulip VCF was used in 13 and Cook Celcet VCF was employed in 31. Twenty-one patients followed the doctor's advice to receive retrieval procedure of VCF within three months after the implantation. Results Among the 21 patients, successful retrieval of VCF was obtained in 19. The mean indwelling time of Gunther Tulip VCF was 54.4 days, the longest time being 79.0 days. Gunther Tulip VCF was successfully removed in 3 patients and retrieval of VCF failed in 2 patients, with a retrieval success rate of 60%. The mean indwelling time of Cook Celcet VCF was 37.6 days, the longest time being 67.0 days. Cook Celcet VCF was successfully removed in 16 patients, with the success rate of retrieval being 100%. Conclusion Despite many VCFs that have been indwelled for a long time can be safely retrieved, retrieval procedure should be performed as early as possible in order to improve the retrieval success rate of VCF. It seems that the use of Cook Celcet VCF is a better choice although it is more expensive.