Objective To explore a safe,high efficiency and rapid approach for the repair of huge sacral pressure sores. Methods From 1993 to 2001,17 cases of huge sacral pressure sore were repaired using the pedicled upper part gluteus maximum myocutaneous flap .Results The outcome of repair in stage Ⅰ was satisfactory in all the cases during the followed-up period for 1～9 years,the size of the flap ranged from 16cm?10cm to 10cm?8cm,No recurrence was occurred,The function of gluteus in donor areas was keeped maximally. Conclusions The method is a good treatment for huge sacral pressure sores. It possesses the advantages of easiness to perform,rich blood supply,no necessity of free skin graft in the donor areas,less complications,high success rate. The treatment can be completed in one stage.It is worthy of popularization.

Objective To study the causes of misdiagnosis for differentiated thyroid carcinoma in teenager, the re-operative indication and style as well as the prevention of complication. Methods The clinical data of 36 cases of re-operative treatment for differentiated thyroid carcinoma in teenager from 1991 to 2002 were analyzed retrospectively.Results The incidence of residual cancer and cervical lymphnode metastasis in the patients was 38.9% and 30.5% respectively. The re-operative complications included 2 cases of hoarseness, and 3 cases of hand and foot spasm. Five-year and ten-year survival rates after reoperation were 90.4% and 88.9%, respectively. Conclusion Thyroid nodules in teenager should be guarded against malignancy. FNAB(Fine-Needle Aspiration Biopsy) is helpful for diagnosis before the operation, and pathological observation of frozen section during operation must be performed as routine examination. Choosing suitabel operative style could raise the operative excision rate and quality of life. The improved operation skill could reduce the operative complications.

Objective To find out the rate of deterioration of systemic lupus erythematosus (SLE) during pregnancy,the incidence of co-existing pregnancy induced hypertension (PIH) and the ways of antepartum treatment.Methods A retrospective analysis of the clinical data was performed in 19 cases of SLE with pregnancy from 1998 to 2003.Results SLE with pregnancy had an acute deterioration rate of 52.6% and incidence of co-existing PIH of 52.6% and 31.6%,which were related to patients'condition and remissions.Conclusion When SLE happens in pregnancy,it is more likely to get worse and complicated with PIH.It is necessary to enhance the antepartum monitoring and treatment for these patients.

Objective: To investigate the effects of "Songyou Yin" on the invasiveness of high metastatic human hepatocellular carcinoma (HCC) line MHCC97H and immune function of mouse and explore its action mechanism. Methods: The MHCC97H cells were treated with "Songyou Yin" at different concentrations (2, 4, and 8 mg/mL) for 48 h. The Boden chamber assay was applied to determine the tumor cell invasive potential and gelatin zymography was performed to detect activity of matrix metalloproteinase-2 (MMP-2). The nude mouse model hearing HCC xenograft with high metastatic potential was established for the in vivo study. Thirty C57BL/6 mice were randomized into intervention groups of C1, C2 and C3 with stepwise increased dosage of "Songyou Yin", and another two groups were regarded as negative and positive controls with 6 mice in each group. Forty Kunming mice were randomized into C1, C2, C3 and control groups with 10 mice in each group. The mice were administered "Songyou Yin" i. g. once daily for 7 consecutive days. After the mice were sacrificed the activities of natural killer cells were detected and the phagocytic function of abdominal cavity macrophages was observed. Results: The invasiveness of MHCC97 H cells in "Songyou Yin" groups (4 and 8 mg/mL) decreased significantly compared with the control group (P < 0.01), which was in accordance with the decreased MMP-2 activity. Moreover, "Songyou Yin" inhibited the growth of HCC in vivo. Cell-specific inhibitory ratio of NK cells was 24.6%, 27.1%, and 27.7% in C1, C2 and C3 groups; whereas phagocytic percentage of macrophages was significantly different from control group (P < 0.01). Conclusion: Chinese complex herb "Songyou Yin" inhibited the invasiveness of MHCC97H cell by suppressing MMP-2. Intragastric administration of "Songyou Yin" for 7 consecutive days enhanced the immune function of mice.

Objective To evaluate the effectiveness of mirror therapy in treating the upper limbs of patients with stroke.Methods The PUBMED,MEDLINE,EMbase,Cochrane Central Register of Controlled Trials (CENTRAL),ISI Web of Knowledge,OVID,CNKI,VIP and Wanfang Data databases were searched for reports of randomized controlled trials (RCTs) of mirror therapy in the treatment of the upper limbs of patients with stroke from the date of establishment of each database to April 2012.The bibliographies of the studies retrieved were also searched.Two independent researchers evaluated the included studies using the risk of bias provided by Cochrane Library.The extracted data were analyzed using RevMan 5.1 software and version 3.6 of the GRAED profiler.Results Reports of 9 trials were discovered.Meta-analysis showed that compared to the group that didn't have visual feedback,mirror therapy did not significantly increase Fugl-Meyer assessment (FMA) (Upper Limb) scores after 4 weeks of treatment compared with groups that did not have visual feedback.Mirror therapy also did not significantly increase average scores on the action research arm test (ARAT) after 6 weeks of treatment.Mirror therapy did,however,increase average Brunnstrom stage scores for the hand after 4 weeks of treatment and at a 6-month follow-up.Mirror therapy did not increase average scores on the modified Ashworth scale (MAS) after 4 weeks of treatment,but increased MAS scores were observed at a 6-month follow-up compared with a group which had no visual feedback.Mirror therapy increased functional independence measure (FIM) self-care scores after 4 weeks of treatment and at a 6-month follow-up,and it also increased modified Barthel index (MBI) scores after 4 weeks of treatment.In the GRADE system,the scores of Brunnstrom stages for the hand after 4 weeks of treatment were of moderate quality,but those scores and the MAS scores at the 6-month follow-up were of low quality.The FIM selfcare scores after 4 weeks and at the 6-month follow-up and the MBI scores measured after 4 weeks were of very low quality.Conclusion This evidence shows that mirror therapy can improve upper limb function and quality of daily life to some extent after stroke.However,because of the limitations of the previous studies such as poor quality,different end points,different rating scales and different courses of stroke,more high-quality,randomized,controlled trials with larger samples are needed to evaluate the effectiveness of mirror therapy in the rehabilitation of upper limb function after stroke.

OBJECTIVETo investigate the epidemiological characteristics of lower back pain of truck drivers in plateau areas with an analysis of the causes and evaluated the effects of the protective measures.

METHODSThe self-reported lower back symptom was investigated by questionnaire in 1,132 male drivers in plateau areas. Vibration of the driver lumbar back was measured real time with or without wearing corset. Study the effect of the special corset for drivers and the massage on back by self-control design of big sample intervention experiments.

RESULTSThe prevalence of lower back pain of drivers in plateau areas was 86.1%. High level of its prevalence is due to many factors. Special corset for drivers and massage on back by themselves can reduce the degree of the pain.

CONCLUSIONDriving in plateau areas is a special occupational work with high level of prevalence of lower back pain which can be prevented.

Automobile Driving ; Humans ; Low Back Pain ; epidemiology ; etiology ; prevention & control ; Male ; Occupational Diseases ; etiology ; prevention & control ; Prevalence ; Surveys and Questionnaires

Objective: To evaluate the safety and feasibility of treating de novo coronary lesions with paclitaxel-eluting balloon. Methods: This is a retrospective study, which enrolled 76 patients with 80 de novo coronary lesions treated with paclitaxel-eluting balloons(<30% residual stenosis and there was no blood flow limited dissection after pretreatment) from April 2015 to November 2016 in Guangdong general hospital. The data of basic characteristics,procedures,devices and follow-up information were retrieved and analyzed. The primary endpoint was the composite of cardiac death, recurrent myocardial infarction and target lesion revascularization. Results: (1)The age was (63.3±10.3) years. There were 68.4%(52/76) acute coronary syndrome patients, prevalence of type 2 diabetes was 36.8%(28/76), and 64.5%(49/76)patients with at least one high bleeding risk. (2)The lesion length was (17.4±7.6)mm, and the stenosis was (88.1±8.2)%.The reference vessel diameter≥2.75 mm accounted for 51.2% (41/80), and bifurcation stenosis accounted for 67.5%(54/80). (3)53.7%(43/80) lesions were pretreated with scoring balloon to optimize plaque modification. The paclitaxel-eluting balloon length and diameter were (22.3±5.5)mm and (2.74±0.52)mm.The residual stenosis was (12.3±10.3)%. Procedural success was 88.8%(71/80).Bail-out stenting rate was 5.0%(4/80). (4)The median follow-up duration was 12(6, 25) months. Primary endpoint occurred in 3 cases (3.9%), including 2 cardiac deaths(1 patient died of recurrent myocardial infarction, and 1 patient died of acute heart failure induced by severe mitral insufficiency), and one patient receivedtarget lesion revascularization. Conclusion In case of no more than 30% residual stenosis and no blood flow limited dissection after lesion pretreatment,it is safe and feasible to treat de novo coronary lesionsusing paclitaxel-eluting balloon.

BACKGROUNDThoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.

METHODSWe conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.

RESULTSPost endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.

CONCLUSIONSPCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.

Adult ; Aged ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; metabolism ; Vascular Surgical Procedures