Objective:To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations.Methods:The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed.Results:The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes.Conclusions:NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.

The occurrence, development, and prognosis of burn is a complicated pathophysiological process involving many organs and systems. With the development of science and technology and update of treatment concept, more and more new materials, new equipments, and new methods are applied to the diagnosis and treatment of burn. Animals similar to humans in anatomical structure and physiological function are the ideal models for research of burn. Nowadays, animal models of burn have been developed to simulate different aspects of burn. These models provide important essential support for elucidating the pathophysiological mechanism of burns and exploring new therapeutic interventions and materials for human beings. Understanding the advantages and limitations of these animal models is essential for the research of burn.

Objective: To validate the clinical effect of three dimensional human body scanning system BurnCalc developed by our research team in the evaluation of burn wound area. Methods: A total of 48 burn patients treated in the outpatient department of our unit from January to June 2015, conforming to the study criteria, were enrolled in. For the first 12 patients, one wound on the limbs or torso was selected from each patient. The stability of the system was tested by 3 attending physicians using three dimensional human body scanning system BurnCalc to measure the area of wounds individually. For the following 36 patients, one wound was selected from each patient, including 12 wounds on limbs, front torso, and side torso, respectively. The area of wounds was measured by the same attending physician using transparency tracing method, National Institutes of Health (NIH) Image J method, and three dimensional human body scanning system BurnCalc, respectively. The time for getting information of 36 wounds by three methods was recorded by stopwatch. The stability among the testers was evaluated by the intra-class correlation coefficient (ICC). Data were processed with randomized blocks analysis of variance and Bonferroni test. Results: (1) Wound area of patients measured by three physicians using three dimensional human body scanning system BurnCalc was (122±95), (121±95), and (123±96) cm^2, respectively, and there was no statistically significant difference among them ( F=1.55, P>0.05). The ICC among 3 physicians was 0.999. (2) The wound area of limbs of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (84±50), (76±46), and (84±49) cm^2, respectively. There was no statistically significant difference in the wound area of limbs of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of limbs of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). There was no statistically significant difference in the wound area of front torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc (F=0.33, P>0.05). The wound area of side torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (169±88), (150±80), and (169±86) cm^2, respectively. There was no statistically significant difference in the wound area of side torso of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of side torso of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). (3) The time for getting information of wounds of patients by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (77±14), (10±3), and (9±3) s, respectively. The time for getting information of wounds of patients by transparency tracing method was longer than that by NIH Image J method and three dimensional human body scanning system BurnCalc (with P values below 0.05). The time for getting information of wounds of patients by three dimensional human body scanning system BurnCalc was close to that by NIH Image J method (P>0.05). Conclusions The three dimensional human body scanning system BurnCalc is stable and can accurately evaluate the wound area on limbs and torso of burn patients.

Objective To investigate the analgesic effects of inhaling 50% nitrous oxide on burn pediatric patients during and after dressing change. Methods A total of 120 burn pediatric patients received outpatient dressing and hospitalized from September 2012 to September 2014 were enrolled in our study, and they were all in accordance with the inclusion criteria. The 120 pediatric patients were divided into control group (n=30) treated with inhalation of oxygen during dressing change) and treatment group (n=90) treated with inhalation of 50% nitrous oxide during dressing change ) according to the computer-generated list of random number. The other treatments in control group and treatment group were the same. Before, during and after dressing change, degree of pain, heart rate, systolic blood pressure, diastolic blood pressure, oxygen saturation and adverse effects were observed at the same time points. Data were processed with analysis of chi-square test, covariance and Student′s t test. Results There were no significant differences between the two groups in levels of HR, SBP, DBP, and SpO2 before dressing change (t=0. 34, 0. 57, 0. 11, 0. 98, respectively;P>0. 05). Compared with those of control group, levels of HR, SBP, DBP, and SpO2 in treatment group were significantly ameliorated during dressing change (t=25. 96, 24. 11, 8. 37, 20. 29, respectively;P<0. 01). After dressing change, the levels of DBP in the two groups were close (t=1. 57,P>0. 05), but the levels of HR, SBP, and SpO2 showed statistical differences (t=5. 20, 8. 64, 3. 37, respectively;P<0. 01). Before dressing change, the pain scores were approximate between control group and treatment group (t=0. 18,P>0. 05). Compared with those in control group, the pain scores in treatment group during and after dressing change were (2. 82 ± 0.8) and (1.2 ±0. 84), which were significantly lower than those in the control group (t =23. 00, 4. 30, respectively;P<0. 01). There were no obvious adverse effects in two groups during and after dressing change. The results of the covariance analysis of pain scores during dressing change showed statistical differences ( F=867. 956,P <0. 01). Conclusions 50% nitrous oxide seems to have obvious analgesic effects on burns pediatric patients during dressing change, and it can be widely used.

OBJECTIVE: To systematically evaluate the efficiency and safety of total thyroidetomy (including near-total tyhroidectomy) versus subtotal thyroidectomy for multinodular goiter. METHODS: The literatures were searched from Cochrane Library, PubMed, Embase, Chinese Biological Medical Datebase, Chinese National Knowledge Infrastructure, and Chinese Science and Technology Journal Full-text Database as of November 2013. We included all randomizad controlled trials on total (including near-total) versus subtotal thyroidectomy in the treatment of multinodular goiter. The collecting of data and quality assessment were respectively completed by 2 researchers. RevMan5.1 software was used for Meta-analysis. RESULTS: We collected 7 literatures conforming to the standard, incuding 2 192 patients. The Metaanalysis outcomes showed that total thyroidectomy was associated with lower nodule recurrence rate (OR=0.13, 95% CI: 0.07-0.22, P<0.001) and higher in transient hypoparathyroidism rate (OR=2.33, 95% CI: 1.72-3.17, P<0.001). However, no statistical difference was seen comparing total and subtotal thyroidectomy in permanent recurrent laryngeal nerve paralysis rate (OR= 0.81, 95% CI: 0.24-2.74, P=0.74) and permanent hypoparathyroidism rate (OR=2.94, 95% CI: 0.48- 18.11, P=0.24). CONCLUSION Nodule recurrence rate of total thyroidectomy for multinodular goiter is lower than subtotal thyroidectomy and does not increase permanent complications.
Goiter, Nodular ; surgery ; Humans ; Hypoparathyroidism ; Randomized Controlled Trials as Topic ; Recurrence ; Thyroidectomy ; methods ; Vocal Cord Paralysis

BACKGROUND:Pedicle is the strongest bone structure for the connection between vertebrae and lamina, and the screw fixation through pedicle can provide reliable mechanical basis for the reconstruction of spinal stabilization.
OBJECTIVE:To analyzed the three-dimensional analogue measurement parameters of lumbar pedicle, in order to improve the accuracy and stability of the clinical application of pedicle screw fixation.
METHODS:The original CT data of the spine (L 1-L 5 ) related diseases patients who treated with pedicle screw were analyzed, and the three-dimensional multiplanar reconstruction imaging model was established with Mimics software. By the using of the Mimics software, the lumbar three-dimensional construction was conducted, and the screw length, diameter, transverse section angle and sagittal section angle were predicted, and then statistical y compared with the actual data of the patient postoperative.
RESULTS AND CONCLUSION:Case analysis showed that the position and the length of the screw were good without screw offset and fracture after internal fixation. There were no significant differences in the screw length, diameter, transverse section angle and sagittal section angle between the preoperative predicted parameters and the actual parameter after fixation (P>0.05), while the sagittal section angle of partial segments were smal er than the actual measure value (P<0.05). The lumbar three-dimensional reconstruction and simulation of pedicle screws placement through Mimics software can precisely guide the actual screw placement and improve the safety of pedicle screws placement.

BACKGROUND:Resection of femoral neck in the conventional total hip replacement greatly influences the equilibrium of forces jn the proximal fetour and causes disequilibrium of bone reconstruction,easily resulting in bone absorption,prosthesis loosening and dislocation.OBJECTIVE:To investigate the biocompatibility between materials and host in the total hip replacement with femoral neck preserved.DESIGN,TIME AND SETTING:A retrospective case analysis was performed in the Department of Orthopedics,the 180 Hospital of Chinese PLA between September 2000 and December 2006.PARTICIPANTS:Twenty-five patients.10 males,15 females,aged 47 years old(range 31-56 years old)were recruited for this study.Twelve patients suffered from femoral head necrosis-caused hip joint disease and osteoarthrosis(bilaterally affected in 5 patients),eight femoral head necrosis(femoral head necrosis subsequent to femoral neck fracture healing in 2 patients),three acetabular dysplasia necrosis of femoral head,and two infra-head femoral neck fracture nonunion.The course of disease averaged 6 years old ranging from 2-10 years.METHODS:Modified hip ioint posterior approach was used to expose the hip joint.Femoral head was resected from the femoral head-neck iuncture.Cartilago acetabularis was stripped and then artificial acetabulum was installed.Femoral proximal medullary cavity was expanded.Artificial femoral head was installed.Finally,all artificial joints were reduced.MAIN OUTCOME MEASURES:(1)Biocompatibility between prosthesis and host.(2)Function recovery of hip joint.RESULTS:All wounds were primarily healed.Patients were followed up for 0.5-6 years on average.Follow-up results demonstrated good hip joint motion and normal walking gait.X-ray showed well-positioned artificial hip joint,absence of prosthesis loosening and dislocation,as well as good femoral neck sclerotin.CONCLUSl0N:The preservation of femoral neck in total hip replacement is fit to the physiological compliance of proximal femar and prevents osteoporosis-induced prosthesis loosening and dislocation in the proximal femur.

BACKGROUND: Diabetes causes abnormal insulin like growth factor-1 (IGF-1) gene expression, which contributes to initiation and development of peripheral neuropathy.OBJECTIVE: To investigate the efficacy of a single dose of methylcabalamin on prevention of experimental diabetic neuropathy and the possible molecular mechanism of its involvement in IGF-1 gene expression.DESIGN: Completely randomized and controlled experiment.SETTING: Endocrinology Department of the First Affiliated Hospital of Nanjing Medical University.MATERIALS: The study was carried out in an Animal Center of Nanjing Medical University. Totally 80 male Sprague Dawley rats (sanitary degree)were randomly selected.METHODS: ① Totally 64 rats were chosen to be induced diabetic. They were injected intravenously with alloxan dissolved in saline solutions, at the dose of 240 mg/kg. ② Of 16 rats were chosen as normal control group who were injected intravenously with equivalent volume of saline solution. ③ Of 64 established diabetic rats were treated with daily subcutaneous injection of pork regular insulin in combination of protamine zinc insulin (2:1) then further divided into 2 groups as insulin-treatment diabetic control groups based on different blood glucose levels: group 1 with relatively better control of diabetes, group 2 with relatively worse control of diabetes, with 32 rats in each group. Totally 16 rats of each group were treated with methylcobalamin injection intramuscularly with 500 μg/kg body weight, thus correspondingly divided into insulin +methylcobalamin group 1 and insulin+methylcobalamin group 2. The remaining 16 rats of each group as respective insulin-treatment diabetic control groups were treated with equivalent volume of saline. ④ Initiate weight and end weight were measured at beginning of the experiment and after diabetic model was established. Glucose oxidase was used to detect glucose level. 1-deoxy-1-malin was used to detect fructose level. ⑤ Parameters were measured as follows: Sensory/motor nerve conduction velocity (SNCV, MNCV) and evoked potential amplitude (EPA) of sciatic nerves detected by evoked electromyogram; IGF-I mRNA by reverse-transcriptase polymerase chain reaction (RT-PCR); IGF-1 peptide by enzyme-linked immunosorbent assay (ELISA). ⑥ One-way analysis of variance was used to analyze the Significance of differences among groups.MAIN OUTCOME MEASURES: ① Tissue IGF-1 mRNA/ IGF-1 peptide, electrophysiological data of individual groups at different points of the experiment. ② Comparison between individual groups in glucose metabolic parameters and body weights at different points of the experiment.RESULTS: Three rats died for diabetic infection or other acute complications and only 77 rats were included in the final statistical analysis.① Body weight and glucose metabolic parameter changes: After diabetic model, glucose, fructose level and body weight change between methylcobalamin+insulin treated groups and insulin treated groups were not significant. ② IGF-1 mRNA/peptide changes: Tissue IGF-1 mRNA increased significantly in methylcobalamin + insulin treated groups than that in insulin treated groups, respectively (P ＜ 0.05-0.01). Two weeks after diabetic model was established, the sciatic tissue IGF-1 mRNA contents were obviously higher in methylcobalamin + insulin treated group 1 than that in insulin treated group 1 (P ＜ 0.05), but not significantly different from that in NC group; Similarly, tissue IGF-1 mRNA contents were obviously higher in methylcobalamin + insulin treated group 2 than that in insulin treated group 2 (P ＜ 0.05), but lower than that in NC group (P ＜ 0.01); Month 2, tissue IGF-1 contents in methylcobalamin+ insulin treated groups were lower signiiicantly than NC groups, but higher than insulin treated groups (P ＜ 0.05-0.01). By month 3, IGF-1 mRNA level in methylcobalamin+ insulin treated group 2 was not significantly different from that in insulin treated group 2. The IGF-1 peptide levels in nerve tissue changed approximately parallel to IGF-1 mRNA level over time course. ③ Nerve electrophysiological data changes: Month 2 and 3, SNCV, MNCV and EPA were significantly higher in methylcobal-amin+ insulin treated group 1 than in insulin treated group 1 (P ＜ 0.05);Month 2, SNCV and EPA were higher in methylcobalamin+ insulin treated group 2 than in insulin treated group 2 (P ＜ 0.05); Month 3, SNCV, MNCV and EPA were significantly lower in methylcobalamin + insulin treated group 2 than in control group (P ＜ 0.05-0.01), whereas no difference was observed between methylcobalamin + insulin treated group 2 and insulin treated group 2.CONCLUSION: ① Methylcobal has not effect on blood glucose. ②Methylcobal could prevent occurrence of experimental neuropathy through its effect on nerve IGF-1 gene expression of diabetic rats. ③ A better efficacy could be achieved by Methylcobal with a good control of blood glucose level in prevention of diabetic peripheral neuropathy.

OBJECTIVETo explore the role of insulin-like growth factor 1 (IGF-1) gene expression abnormality in neurotrophic causes of diabetic peripheral neurophathy.

METHODSDiabetes was induced in Sprague Dawley rats by alloxan. The parameters were measured as follows: IGF-1 mRNA by revere transcriptase-polymer chain reaction (RT-PCR); IGF-1 peptide by enzyme-linked immunosorbent assay (ELISA); electrophysiological parameters of nerves by evoked electromyogram; morphometric evaluation of sciatic nerves under light microscope and transmission electron microscope.

RESULTSDuring early diabetic stage, IGF-1 mRNA [(0.430+/-0.031) vs. (0.370+/-0.016), P<0.01, (0.430+/-0.031) vs. (0.280+/-0.010), P<0.001, respectively], IGF-1 peptide contents [(38.44+/-3.60) ng/mg vs. (30.06+/-2.41) ng/mg, P<0.01, (38.44+/-3.6) ng/mg vs. (3.71+/-2.70) ng/mg P<0.001, respectively] in sciatic nerve tissue reduced in diabetic rats with hyperglycemia and varied with severity of state when compared with non-diabetic control rats, and further gradually down-regulated in the diabetic rats with duration of diabetes [IGF-1 mRNA (0.320+/-0.021) to approximately (0.230+/-0.060); IGF-1 peptide (28.80+/-3.30) to approximately (19.51+/-1.80) ng/mg]. Furthermore, they correlated with nerve functional (sensory nerve conduction velocity: r=0.741, P<0.001; amplitude of evoked potential: r=0.716, P<0.001, respectively) and structural abnormality (axonal area r=0.81, P<0.001) of sciatic nerve. No difference was found in the above parameters between diabetic rats with euglycemia and non-diabetic control group.

CONCLUSIONIGF-1 gene expression in tissues was down-regulated from early diabetic stage, and varied with the severity and duration of diabetic state. The decrement in IGF-1 level might contribute to the initiation and development of diabetic neuropathy via autocrine or paracrine pathway.

Alloxan ; Animals ; Diabetes Mellitus, Experimental ; etiology ; metabolism ; Diabetic Neuropathies ; etiology ; metabolism ; Electrophysiology ; Evoked Potentials ; Insulin-Like Growth Factor I ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; physiopathology