Objective To explore the surgical techniques and effects of one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base.Methods The clinical data of 13 pediatric cases with one-stage reconstruction surgery for comminuted and depressed fractures of the frontal bone and anterior skull base were reviewed retrospectively,including 8 male and 5 female,aged from 4 to 14 years,with a mean age of 8 years.Admission Glasgow Coma Scale (GCS) was as follows:3 to 8 scores in 2 cases,9 to 11 scores in 4 cases,and 12 to 15 scores in 7 cases.The intraoperative one-stage osseous and vascular pedicle membranous reconstruction of frontal bone and anterior skull base had been performed in all patients.The periosteum-bone fragments-periosteum had been used in 4 cases whose bony defect diameter of anterior cranial fossa was over 1 cm,multimodality therapy were carried out postoperatively.The follow-ups were regularly executed after discharge.Results GCS at discharge was as follows:3 to 8 scores in 1 case,9 to 11 scores in 2 cases,and 12 to 15 scores in 10 cases.No significant difference was found in GCS between those on admission and at discharge(χ2=3.02,P>0.05).Eleven cases had a phenomenon of nasal hemorrhage and the duration was not exceeding 48 hours.No intracranial infection and cerebrospinal fluid leakage occurred in all patients.All patients received an acceptable appearance without obvious frontal depre-ssion or proptosis.Postoperative computed tomography image showed normal cranial volume,well reset of fracture pieces,no fracture pieces existing in intracerebral tissue,satisfactory hematoma evacuation,and orbital contents without compression.The complications like cerebrospinal fluid leakage,poor incision healing,brain abscess or mucous cyst had not been found in all patients from 3 months to 6 years follow-up period.Conclusions The one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base suggests a better prognosis,effectively less complications,which helps to avoid secondary surgery,but regular follow-ups are absolutely necessary.This procedure is worth applying and spreading to pediatric patients and medical institutions if necessary.

BACKGROUND: It has been proved that platelet activation is involved in the development of diabetic angiopathy. Glycoprotein (GP) Ib/IX/V complex is one of the main platelet membrane glycoproteins, and the receptor of both von Willebrand Factor and thrombin. It plays a key role in the process of platelet activation.OBJECTIVE: To observe the expression changes of GP Ib/IX/V complex and its component GP Ibα in patients with type 2 diabetes mellitus. DESIGN: Case-control study. SETTING: Department of Integrated Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.PARTICIPANTS: A total of 51 type 2 diabetic outpatients who visited Union Hospital were enrolled from December 2005 to January 2007. The diagnosis was based on the independent criteria from WHO in 1999. Of all the 51 patients, there were 23 females and 28 males, with a peripheral platelet count of over 50×109 L-1. All the subjects had no history of administrating drugs two weeks before the examination, which would potentially influence platelet count. According to disease controlling condition, the patients were assigned to well controlled patient (WCP) group (n = 25) and poorly controlled patient (PCP) group (n =26); and according to whether angiopathy was accompanied, diabetic patients were divided into vascular disease (VD) group (n =27) and non-vascular disease (NVD) group (n =24). Meanwhile 23 healthy subjects were enrolled as normal control group. Informed consents were obtained from subjects and their relatives. The experiments were approved by the ethical committee of Union Hospital.METHODS: Fasting venous blood was harvested from all the subjects' elbow on the early morning of visit day.①Biochemical analysis: Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and fasting plasma insulin (FINS) was measured by the Clinical Chemistry Department in Union Hospital.② Measurement of platelet membrane GP Ib/IX/V complex and its component GP Ibα: First, 3 mL cubital fasting blood was drawn from each subject and was anti-coagulated with 38 g/L natrium citricum. After that, all samples were fixed with 10 g/L paraform for 45 minutes. Then 50 μL well-fixed blood was added into the polystyrene tube, meanwhile 20 μL monoclonal antibody, such as CD42a-b-c-d and PE-labeled CD42b, was respectively mixed gently with the blood sample and incubated at room temperature in dark for 30 minutes. Next, 20 μL FITC-labeled rat IgG was mixed with the sample containing CD42a-b-c-d and incubated equally. In the end all blood samples were analyzed by FACS420 flow cytometry and the results were expressed as mean fluorescence intensity (MFI). ③ Platelet maximun aggregation rate (MAR) was detected according to reference.MAIN OUTCOME MEASURES: ①Biochemical indicators;②The expressions of GP Ib/IX/V complex and GP Ibα;③Platelet MAR.RESULTS: Fifty-one patients with type 2 diabetes mellitus and twenty-three healthy subjects were all involved in the result analysis.①There were significant differences in FINS in WCP group and PCP group compared with normal controls (P ＜ 0.01). FPG and HbA1c were significantly higher in PCP group compared with normal control group and WCP group (P ＜ 0.01).②Expressions of GP Ib/IX/V complex and GP Ibα were significantly lower in WCP group and PCP group compared with normal control group (P ＜ 0.01), significantly lower in PCP group than in WCP group (P ＜ 0.05), and also significantly lower in VD group and NVD group compared with normal control group (P ＜ 0.01). Moreover the expression of GP Ibα in VD group and NVD group was significantly lower than that of normal control group (P ＜ 0.05), and it also significantly decreased in VD group compared with NVD group (P ＜ 0.05). MFI of GP Ib/IX/V complex had an obvious negative correlation with FBG, HbA1c and FINS (r =-0.634, -0.573, -0.649, P ＜ 0.05), and GP Ibα MFI was obviously negatively correlated with FBG and HbA1c (r =-0.602, -0.543, P ＜ 0.05).③Platelet MAR of diabetic patients were remarkably higher than in healthy subjects (t =-3.852, P ＜ 0.01). Platelet MAR in PCP and VD groups were respectively higher than those in WCP and NVD groups (P ＜ 0.05). CONCLUSION: Platelet activation exists in the early stage of type 2 diabetes mellitus without diabetic angiopathy, and is more obvious after diabetic angiopathy. There is a positive correlation between platelet activation and blood glucose. As a receptor of thrombin and von Willebrand Factor, GP Ib/IX/V complex may be involved in the development of diabetic angiopathy.

BACKGROUND: After the damage of central nervous system, F-waves of electromyography is the valuable way for detecting tendon reflex and muscular tension below injured segment. The increase of spasm, stiffness and muscular tension induced by upper motor neuron injury can revoke change of F-waves.However, change of F-waves after spinal injury, and relationship between Fwaves and spasm of lower limb after injury are still unclear at present.OBJECTIVE: To analyze the correlation of minimal latency, occurrence rate and every index of dispersion-time degree of F-waves with post-injured spinal cord spasm in patients with spinal injury.DESIGN: Case-control observation.SETTING: Department of Rehabilitative Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.PARTICIPANTS: Totally 29 patients with traumatic spinal cord injury,who were hospitalized at Department of Rehabilitative Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology between June 2002 and March 2004, were selected as spinal injury group. Another 29 normal healthy volunteers were enrolled as normal control group in the same period. METHODS: Spasm level of both lower extremities in patients with spinal injury was graded with Ashworth scale to assess flexion of both coax, flexion of knee joint and Ashworth grade of dorsiflexion of ankle. F-waves was detected with Kepoint1.5 type EMG instrument produced by Denmark.Minimal latency, maximal latency and occurrence rate of F-waves of tibial nerve of both lower extremities were recorded. The discrete-time degree (difference value of maximal latency of F-waves and minimal latency of Fwaves) and mean occurrence rate of F-waves were calculated.MAIN OUTCOME MEASURES: The difference of each index between patients with spinal injury and normal persons was compared and the correlation of spasm with discrete-time degree, occurrence rate and minimal latency of F-waves in patients with spinal injury was analyzed.RESULTS: A total of 29 patients and 29 normal persons were involved in the result analysis. ①The discrete-time degree of F-waves in patients with spinal injury was higher than that in the normal persons, which had significant difference [(9.2±1.9), (6.7±1.0) ms, P ＜ 0.000 1]. ②The occurrence rate of F-waves in patients with spinal injury was lower than that in normal persons, which had significant difference [(84.5±6.2)%, (89.5 ±5.7)%, P ＜ 0.05]. ③The minimal latency of F-waves in patients with spinal injury was higher than that in normal persons, which had insignificant difference ( P ＞ 0.05). ④The discrete-time degree of F-waves in patients with spinal injury had positive correlation linearly with score of spasm Ashworth (r=0.790 31, P＜ 0.000 1). The occurrence rate of Fwaves in patients with spinal injury had positive correlation linearly with score of spasm Ashworth (r=0.742 03, P ＜ 0.000 1 ). The minimal latency of F-waves in patients with spinal injury had insignificant correlation with score of spasm Ashworth (r=0.081 68, P ＞ 0.05).CONCLUSION: The discrete-time degree and occurrence rate of F-waves can be used as sensitive index to evaluate electrophysiology in patients with spinal injury so as to assess the level of spasm in patients with spinal injury.

Animals ; Immune Tolerance ; Liver Transplantation ; immunology ; Male ; Rats ; Rats, Inbred Strains ; T-Lymphocyte Subsets

Adult ; Diagnostic Errors ; Female ; Humans ; Laryngitis ; diagnosis ; microbiology ; Male ; Middle Aged ; Mycoses ; diagnosis ; Pharyngitis ; diagnosis ; microbiology

To develop Students' Practical Ability according to the teaching requirement and culture aim of preventive medicine major,the teaching plan,teaching content,teaching methods,and experimental check-ing methods were explored and the experimental teaching pattern of medical microbiology adapted to pre-ventive medicine major was constructed.The investigation showed that the experimental teaching pattern helped to cultivate the students' operating ability,thinking of scientific research and ability of aggregate and solving analysis.Moreover,it helped to develop the students' co-operative consciousness and team spirit.It indicated that the new pattern was superior to the traditional experimental teaching.

BackgroundIron-containing foreign body trapped in the eyeball wall without affecting the opticus occurs occasionally in clinic. Operation always is performed in an attempt to avoid the deposition of rust in different tissues of the eye-balls. However,a few animal experimental studies showed that a small foreign body does not affect the retina and opticus in the period of three months. The question of whether surgery needs to be carried out is worth discussion. ObjectiveThe aim of this study was to evaluate the influence of posterior intrascleral iron foreign body on the rabbit retina and opticus. MethodsTwelve healthy adult Japan flap-eared white rabbits were randomly divided into two groups. Medium carbon iron with rust or without rust( size of 2. 0 mm × 1. 0 mm×0. 2 mm) were implanted into the posterior sclera of the left eye to create the animal model with iron foreign body in the eyeball wall. The cornea, anterior chamber, crystalline lens, vitreous and fundus of the rabbits were observed under a slit lamp microscope 1weekbeforeoperationand 1week, 2weeks, 1monthand 3months after operation.Flash electroretinogram(F-ERG) and flash visual evoked potential (F-VEP) were recorded at the time points mentioned above. All the rabbits were sacrificed and the eye balls were extracted at the end of the experiment, and the position of the iron foreign body was determined. The histopathological examinations of the retina and opticus were performed under the light microscope. This experiment complied with the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission. ResultsThere were no statistical differences for the a-wave amplitude of F-ERG among different time points( F =1. 885,P =0. 129 ) and different treatment groups ( F =1. 188, P =0. 340 ), as with the ERG b-wave amplitude ( time: F =2. 73, P =0. 064 ; group : F =1. 114, P =0. 367). The differences in the latencies of F-VEP N1-wave were insignificant among the different time points( F =1. 605, P =0. 263 ) as well as various groups ( F=1. 556, P =0.314 ), and those of F-VEP P1 -wave were not evidently changed ( time: F =2. 329, P =0. 092 ; group : F =2. 186, P =0. 103 ). No correlations were seen between the time factor and grouping factor ( P ＞ 0. 05 ). There was no apparent siderosis bulbi change during the follow-up duration. No morphological abnormality in the retina and optical nerve was found under the light microscope. At the end of the experiment,intrascleral iron foreign body was wrapped by surrounding tissue in a stable condition. Conclusions The small posterior intrascleral iron foreign body, whether it is oxidized or not, does not produce distinctive functional or pathological damage on retina and opticus in the short term.

Objective To explore the feasibility of implementing bedside nursing order in establishing excellent nursing model post.Methods Organization practices project taking charge by group,nursing order were assigned by responsible team leader.All orders was publicity at patients' bedside and were performed by responsible nurses and assistant nurses.The coincidence case in state of illness and nursing mesures,awareness in health education,nursing quality defective and patients' s satisfaction before and after implement were compared and the application ability in specialized knowledge were evaluated.Results The coincidence rate in state of illness and nursing mesures (1 501 vs 1 390),awareness in health education (1 511 vs 1 131) after implementation of nursing order was significantly higher than before implementation,there was statistics difference (x2 =21.849,133.150,respectively; P ＜ 0.01).The patients' s satisfaction showed a significant rise from 87.9％ to 93.3％ after implementation of bedside nursing order (x2 =25.036,P ＜ 0.01).Before implementation in nursing bedside order,the score of application ability in specialized knowledge among nurse were excellence (12),qualified nurses (51) and unqualified nurses (2) while the number was improved in excellence (66),qualified nurses (28) and unqualified nurses (1) respectively after implementation.There was statistics difference between before and after implementation (x2=16.951,P ＜ 0.01).Conclusions The implementation of bedside nursing order optimizes the utilization of the nursing human resource and contributes to the improvement of the quality of nursing service.

BACKGROUND/OBJECTIVES: Sonchus asper is used extensively as an herbal anti-inflammatory for treatment of bronchitis, asthma, wounds, burns, and cough; however, further investigation is needed in order to understand the underlying mechanism. To determine its mechanism of action, we examined the effects of an ethyl acetate fraction (EAF) of S. asper on nitric oxide (NO) production and prostaglandin-E2 levels in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. MATERIALS/METHODS: An in vitro culture of RAW264.7 macrophages was treated with LPS to induce inflammation. RESULTS: Treatment with EAF resulted in significant suppression of oxidative stress in RAW264.7 macrophages as demonstrated by increased endogenous superoxide dismutase (SOD) activity and intracellular glutathione levels, decreased generation of reactive oxygen species and lipid peroxidation, and restoration of the mitochondrial membrane potential. To confirm its anti-inflammatory effects, analysis of expression of inducible NO synthase, cyclooxygenase-2, tumor necrosis factor-alpha, and the anti-inflammatory cytokines IL-1beta and IL-6 was performed using semi-quantitative RT-PCR. EAF treatment resulted in significantly reduced dose-dependent expression of all of these factors, and enhanced expression of the antioxidants MnSOD and heme oxygenase-1. In addition, HPLC fingerprint results suggest that rutin, caffeic acid, and quercetin may be the active ingredients in EAF. CONCLUSIONS: Taken together, findings of this study imply that the anti-inflammatory effect of EAF on LPS-stimulated RAW264.7 cells is mediated by suppression of oxidative stress.
Antioxidants ; Asthma ; Bronchitis ; Burns ; Chromatography, High Pressure Liquid ; Cough ; Cyclooxygenase 2 ; Cytokines ; Dermatoglyphics ; Glutathione ; Heme Oxygenase-1 ; Inflammation ; Interleukin-6 ; Lipid Peroxidation ; Macrophages* ; Membrane Potential, Mitochondrial ; Nitric Oxide ; Nitric Oxide Synthase ; Oxidative Stress* ; Quercetin ; Reactive Oxygen Species ; Rutin ; Sonchus* ; Superoxide Dismutase ; Tumor Necrosis Factor-alpha ; Wounds and Injuries

BACKGROUNDCurrent knowledge about clinical and genetic risk factors for aspirin-induced gastric mucosal injury is not sufficient to prevent these gastric mucosal lesions.

METHODSWe recruited aspirin takers as the exposed group and healthy volunteers as the control group. The exposed group was categorized into two subgroups such as subgroup A as gastric mucosal injury diagnosed by gastroscopy, including erosion, ulcer or bleeding of the esophagus, stomach, or duodenum; subgroup B as no injury of the gastric mucosa was detected by gastroscopy. Clinical information was collected, and 53 single nucleotide polymorphisms were evaluated.

RESULTSAmong 385 participants, 234 were in the aspirin-exposed group. According to gastroscopy, 82 belonged to subgroup A, 91 belonged to subgroup B, and gastroscopic results of 61 participants were not available. Using the Chi-square test and logistic regression, we found that peptic ulcer history (odds ratio [OR] = 5.924, 95% confidence intervals [CI]: 2.115-16.592), dual anti-platelet medication (OR = 3.443, 95% CI: 1.154-10.271), current Helicobacter pylori infection (OR = 2.242, 95% CI: 1.032-4.870), male gender (OR = 2.211, 95% CI: 1.027-4.760), GG genotype of rs2243086 (OR = 4.516, 95% CI: 1.180-17.278), and AA genotype of rs1330344 (OR = 2.178, 95% CI: 1.016-4.669) were more frequent in subgroup A than subgroup B. In aspirin users who suffered from upper gastrointestinal bleeding, the frequency of the TT genotype of rs2238631 and TT genotype of rs2243100 was higher than in those without upper gastrointestinal bleeding.

CONCLUSIONSPeptic ulcer history, dual anti-platelet medication, H. pylori current infection, and male gender were possible clinical risk factors for aspirin-induced gastric mucosal injury. GG genotype of rs2243086 and AA genotype of rs1330344 were possible genetic risk factors. TT genotype of rs2238631 and TT genotype of rs2243100 may be risk factors for upper gastrointestinal bleeding in aspirin users.

Aged ; Aspirin ; adverse effects ; Female ; Gastric Mucosa ; drug effects ; injuries ; Genotype ; Helicobacter Infections ; physiopathology ; Humans ; Male ; Middle Aged ; Peptic Ulcer ; physiopathology ; Platelet Aggregation Inhibitors ; adverse effects ; Polymorphism, Single Nucleotide ; genetics ; Risk Factors