Objective To evaluate the treatment outcome of nerve fascicle transfer for treatment of flexor elbow Method Fifty two cases of brachial plexus injury were involved The function of elbow joint was restored by using fascicle nerve transfer from part of median nerve, ulnar nerve, thoracodorsal nerve and contralateral C 7, to the muscular branch of the biceps Results There was no significant adverse effects of the donor function following partial nerve resection Twenty six patients had biceps strength M 4 and flexed elbow joint more than 90 degree Conclusion Partial nerve fascicle transfer to the nerve branches of biceps from the donor nerve can provide sufficient nerve fibers to reinnervate biceps

ObjectiveTo evaluate the influence of the resected prostate tissue volume (RPV) on the improvement of International Prostate Symptom Score (IPSS), quality of life (QOL), and voiding function after transurethral resection of the prostate (TURP).

METHODSThis study included 82 men with benign prostatic hyperplasia treated by TURP. Before and three months after TURP, we obtained the IPSS, QOL score, post-voiding residual urine volume (PVR), and maximum urinary flow rate (Qmax) from the patients. We measured the total prostate volume (TPV) and transition zone volume (TZV) by transrectal ultrasound preoperatively and investigate the influence of the RPV, RPV/TZV ratio, and RPV/TPV ratio on the efficiency of TURP.

RESULTSAt three months after TURP, the mean Qmax increased by 9.27 ml/s, IPSS decreased by 15.86, QOL score increased by 3.47, PVR decreased by 87.1 ml, and 72.0% of the patients felt satisfied with the surgical results. There was no statistically significant difference in RPV between the patients satisfied and those dissatisfied with the results. Both the RPV/TPV and RPV/TZV ratios significantly increased in the satisfaction group as compared with the dissatisfaction group (P=0.002 and P=0.004). The areas under the ROC curve for the RPV/TPV and RPV/TZV ratios were 0.793 (P=0.001) and 0.687 (P=0.009), respectively.

CONCLUSIONSRPV is closely related to the short-term outcomes of TURP, and the ratios of RPV/TPV and RPV/TZV may be used as new markers to predict the outcomes of TURP.

Aged ; Humans ; Male ; Middle Aged ; Organ Size ; Patient Satisfaction ; Postoperative Period ; Prostate ; diagnostic imaging ; pathology ; surgery ; Prostatic Hyperplasia ; diagnostic imaging ; pathology ; surgery ; Quality of Life ; Transurethral Resection of Prostate ; Treatment Outcome ; Ultrasonography ; Urination ; physiology

Objective To investigate the expression and effects of endothelin-1 (ET-1) in cerebral vessels of scalded rats. MethodHistological method was used to observe the alteration of histological structure of basilar artery in 8 scalded rats. Reverse transcription polymerase chain reaction(RT-PCR) was performed to examine expression of ET-1 mRNA;Western blotting to analyse expression of endothelin-1;radioimmunoassay to measure ET-1 levels;R3espectively, of cerebral basilar artery in 48 scalded rats. ResultVascular pathohistological changes were observed in cerebral basilar artery after rats were scalded;ET-1, ET-1 mRNA expression and ET-1 levels of basilar artery in scald 6 hours, 12 hours and 24 hours group were obviously higher than that of control group. Conclusion Scald may cause an increases of ET-1 expression in basilar artery, and elevated ET-1 expression may relate to the pathogenesis of cerebral vascular injury in scalded rats.

Objective To measure the femoral head-neck ratio among Chinese adults in Nanjing to explore its clinical significance. Methods 468 Chinese without hip symptoms were chosen randomly. There were 313 males and 155 females. 13 cases were less than 20 years old, 88 cases were from 21 to 30 years old, 123 cases were from 31 to 40 years old, 104 cases were from 41 to 50 years old, 102 cases were from 51 to 60 years old, 24 cases were from 61 to 70 years old, 14 cases were more than 71 years old. The mean age was 42.4 years old (ranged from 17 to 82 years old). The maximum diameter of the femoral head and the minimum vertical diameter of femoral neck length on both sides were measured by Digimizer software in the standard anteroposterior pelvis film. The femoral head-neck ratio (FHNR) was calculated and compared with that of the western. Results The normal FHNR of Chinese in Nanjing was 1.48 ± 0.09 (1.33-1.69). FHNR was 1.46±0.09 in Chinese aged less than 20 years old. It was 1.48±0.09 in Chinese aged from 21 to 30 years, and 1.47±0.10 in those aged 31-40 years, 1.46±0.09 in 41-50 years, 1.49±0.10 in 51-60 years,1.48±0.08 in 61-70 years, 1.49±0.10 in those more than 71 years. There was no difference between male and female, the left and right side or the different age groups. There was no difference between the western and Chinese in Nanjing. Conclusion FHNR measurement has not variation with regard to sex, age and side. It may be useful to understand some kind of the hip diseases.

Objective To compare the RIFLE and AKIN diagnosis criteria for acute kidney injury ( AKI) in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery from January 2004 to June 2007 were retrospectively evaluated. RIFLE and AKIN criteria were employed for the diagnosis and staging of AKI which occurred 7 d after cardiac surgery. The diagnosis sensitivity and precision for prediction of hospital mortality were compared between these two criteria. Results One thousand and fifty-six patients were included in this study. There was no significant difference between the prevalence of AKI after cardiac surgery diagnosed by RIFLE criteria and that diagnosed by AKIN criteria (29.55% vs 31.06%, P>0.05). There was no significant difference between the total hospital mortality and the hospital mortality of each stage of AKI diagnosed by RIFLE criteria and those diagnosed by AKIN criteria ( P > 0. 05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by AKIN criteria and those diagnosed by RIFLE criteria. The area under the ROC curve for hospital mortality was 0. 856 for RIFLE and 0.865 for AKIN in all patients (P<0.001). Conclusion Compared to RIFLE criteria, AKIN criteria do not improve the sensitivity of diagnosis and predictive ability of hospital mortality of AKI after cardiac surgery.

Objective To investigate the long-term prognosis and possible risk factors of acute kidney injury(AKI)following cardiac surgeries. Methods Clinical data of 941 patients undergoing open heart surgery from January 2004 to June 2007 were retrospectively analyzed.Survival and renal function of above patients were informed through telephone or clinic follow-up till February 2010.Long-term survival was analyzed using risk-adjusted Cox proportional hazards regression model. Results Of the 941 patients after cardiac surgery,275(29.2%)developed AKI and 666(70.8%)did not.Survival was worse in patients with AKI(67.8%vs 85.6%,P<0.01)and was proportional to its severity (AKIN 1,2 and 3 stages:70.7%,62.3%and 58.6%,P<0.01).Although 90.5% of patients had complete renal recovery after AKI at discharge of hospital,they still had an increased risk for death during follow-up compared with patients without AKI (69.6% vs 85.6%,P<0.01).In the Cox proportional hazards regression model,age(HR=2.238),anemia (HR=1.625),prolonged operation time (HR=1.153),AKI severity (HR=1.473)were independent risk factors for long-term prognosis after cardiac surgery.At the end of the follow-up,patients with AKI had statistically higher Scr than non-AKI patients(107.6 μmol/L vs 83.0 μmol/L,P=0.014),and among those AKI patients,34.0%progressed into CKD 3-5 stages,34.8%developed double serum creatinine. Conclusions AKI is a risk factor for the long-term prognosis of cardiac surgery.Patients with complete renal recovery after AKI still has an increased risk for death and poor renal function compared with patients without AKI.

Objective To investigate the clinical characteristics of twice-weekly hemodialysis patients.Methods Data were collected from Shanghai Renal Registry.A total of 1288 patients undergoing regular hemodialysis (HD) with dialysis adequacy index and other biochemical parameters in Shanghai in January 2007 were enrolled into the cohort study with 2 years follow-up.Clinical characteristics and outcome of twice-weekly HD patients were analyzed as compared with thrice-weekly HD patients.Results Compared with patients on thrice-weekly HD,the twice-weekly HD patients were significantly younger and had significantly shorter HD vintage,smaller body surface area,longer HD session time,higher single-pool Kt/V (spKt/V) and serum albumin but lower weekly Kt/V (P＜0.05).There was no statistical difference in ultrafiltration volume between two groups.Kaplan-Meier survival analysis indicated that both groups had similar two-year survival.Multivariate Cox regression analysis showed that age,body mass index,serum albumin and weekly Kt/V were predictors of patient mortality.Conclusion It is acceptable for some hemodialys patients with twice-weekly HD,and close monitor of dialysis adequacy and volume status is necessary for this therapy model.

Objective To assess the symptoms of patients due to indwelling double ureteral stent and their impact on quality of life. Methods Sixty patients were assessed by the specific questionnaire. Average time of indwelling stent was 21.4 d. All patients finished the special questionnaire when the stent was removed by cystoscope, including specific urinary symptoms, IPSS (international prostate symptom score), VAS (visual analogic scale) and QOL (quality of life). To assess the pain feeling, the patients were divided into 3 groups by varied methods of anesthesia, including local anesthesia, balance anesthesia and general anesthesia. Results Insertion or removal of ureteral stents with local anesthesia provoked pain in 11 of 12 (91%) patients and 8 of 10 (80%) patients in balance anesthesia group. But 38 patients of general anesthesia group did not feel any pain when inserting stents. In 54 of 60 (90%) patients, the indwelling catheter provoked one or several urinary symptoms: nocturia (70%), frequency (65%), urgency (60%), tenesmus (58%), dysuria (52%), hematuria (35 % ) and incontinence (30 %). 75 % of the patients experienced pain, in the flank and lower abdomen. 29 (48 %) patients were found to be unsatisfied with their quality of life due to the indwelling stent. Among them, 18 (62%) patients demonstrated that the provoked overactive bladder symptoms were the main influence factor of QOL, compared with 5(17 %) patients complaining pain feeling. Conclusions Urinary symptoms and pain associated with indwelling double J ureteral stents could interfere the daily activities and 50 % of patients were found reduced quality of life. Overactive bladder symptoms were the main influence of QOL during the time of indwelling stent.

Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years (range, 3 months to 56 years). The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%(22/425). The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner's sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route.

Objective To evaluate the nutritional status in maintenance hemodialysis patients using objective score of nutrition on dialysis.Methods Patients on maintenance hemodialysis were randomly selected and divided into three groups based on objective score of nutrition on dialysis:normal nutritional status group,moderate nutritional status group,and low nutritional status group.Logistic regression analysis was performed to identify factors of malnutrition.Furthermore,the results were compared with those of subjective global assessment.Results Totally 75 patients(male:female =1.13∶1)with a mean age of(54.90 ± 12.10)years and a mean vintage of (85.37 ± 54.17)months were enrolled.As determined by objective score of nutrition on dialysis,15 patients (20％)were divided into normal nutritional status group,42(56％)into moderate nutritional status group,and 18(24％)into low nutritional status group.Compared with the normal nutritional status group,the low nutritional status group had significantly different body mass index[(19.81 ± 2.22)vs(23.90 ± 2.44)kg/m2,P =0.030]and dry weight[(50.85 ± 7.60)vs(59.94 ± 10.89)kg,P =0.020].In addition,compared with normal nutritional status group,the moderate nutritional status group and low nutritional status group had significantly different total cholesterol[(4.60 ± 0.84)and(3.73 ± 0.68)mmol/L vs(5.71 ± 1.64)mmol/L,P =0.011,P =0.000],normalized protein catabolic rate[1.17 and 1.15 g/(kg · d)vs 1.45 g/(kg · d),P =0.030,P =0.010],triceps skinfold thickness[(1.44±0.77)and(1.00±0.41)cmvs(1.80±0.63)cm,P=0.032,P=0.020],mid-ann circumference[(24.85±1.48)and(21.66±1.48)cmvs(24.99 ±2.30)cm,P=0.046,P =0.037].Logistic regression analysis indicated C-reactive protein(OR =12.482,95％ CI =0.190-130.928,P =0.035)and normalized protein catabolic rate(OR =0.128,95％ CI =0.022-0.736,P =0.021)were significantly correlated with malnutrition.Conclusion Malnutrition is common in hemodialysis patients,with inflammation and low protein intake being its independent factors.