AIM: To investigate the clinical effect and stability of biological amnion membrane coverage combined with corneal bandage lens for patients with chemical burns of ocular surface.METHODS: Retrospective study. The clinical data of 49 cases(49 eyes)of patients with chemical burns of ocular surface treated in our hospital between December 2018 and August 2021 were collected. They were divided into the biological amnion membrane coverage group and the biological amnion membrane coverage combined with corneal bandage lens group according to the surgical method. The loss time of biological amniotic membrane, postoperative pain score, repair rate and time of ocular surface, visual acuity and complications were compared between the two groups.RESULTS: The ocular pain scores of the two groups were 2.208±0.758(the biological amnion membrane coverage group)and 2.063±0.800(the biological amnion membrane coverage combined with corneal bandage lens group)at 1d after surgery, respectively(P>0.05). But at the 3d and 7d after surgery, pain scores were 1.844±0.762 and 1.150±0.582, 1.684±0.820 and 0.750±0.514, respectively(all P<0.05). The loss time of biological amniotic membrane in the biological amnion membrane coverage combined with corneal bandage lens group was 10.75±2.63d, which was longer than that in the biological amnion membrane coverage group(7.60±2.22d; P<0.05). Moreover, it has better ocular surface repair effect than the biological amnion membrane coverage group. At 6mo after operation, visual acuity in the two groups was 0.30(0.10, 0.55)and 0.30(0.20, 0.58), respectively(P>0.05). Additionally, there was no differences in the complications of both groups(P>0.05).CONCLUSION:Biological amnion membrane coverage has effective treatment effects on patients with chemical burns of ocular surface, and it can delay the loss time of biological amniotic membrane, increase repair rate of ocular surface and alleviate postoperative discomfort if combined with corneal bandage lens.

Hydrofluoric acid is a highly dangerous and toxic inorganic acid, which is widely used in industrial fields and daily life. The risk of hydrofluoric acid burns is related to hydrofluoric acid mass fraction, duration of exposure to hydrofluoric acid, burn area, burn depth, and burn site, etc. Hydrofluoric acid has strong toxicity and tissue penetration ability. A small area of hydrofluoric acid burns can cause death in a short time. Therefore, improving the understanding of the mechanism of hydrofluoric acid burns and learning how to treat hydrofluoric acid burns in different sites can further improve the cure rate of hydrofluoric acid burns.
Burns, Chemical/therapy* ; Calcium Gluconate ; Humans ; Hydrofluoric Acid/adverse effects*

Objective: To explore the epidemiological characteristics and treatment outcomes of patients with hydrofluoric acid burns in hands. Methods: A retrospective observational study was conducted. The medical records of 229 patients with hydrofluoric acid burns in hands who were admitted to Zhejiang Quhua Hospital from January 2008 to December 2020 and met the inclusion criteria were collected. The following statistical data of patients were collected, including gender, age, type of affiliated enterprise, hydrofluoric acid mass fraction, injury site, total burn area, prehospital time, length of hospital stay, length of wound healing, whether hypocalcemia and hypomagnesemia occurred or not on admission, whether surgery intervention was performed or not, and whether scar sequelae occurred or not. Single factor and multivariate logistic regression analysis were used to screen out the risk factors impacting surgery intervention and scar sequelae of all the patients and patients whose hydrofluoric acid mass fraction was known. Single factor and multivariate linear regression analysis were used to screen out the risk factors impacting the length of wound healing of all the patients and patients whose hydrofluoric acid mass fraction was known. Results: The 229 patients included 206 males and 23 females, with the majority aged 30 to 50 years (139 patients). The type of affiliated enterprise of majority patients was non-fluorine chemical enterprise. The hydrofluoric acid mass fraction was known in only 91 patients, mainly medium. The majority injury site was in the middle and end of finger. The total burn area was below or equal to 1% total body surface area. The prehospital time was 19 (9, 29) h. The length of hospital stay was 2 (1, 7) d. The length of wound healing was 12 (8, 18) d. The proportions of hypocalcemia and hypomagnesemia were 0.9% (2/229) and 1.3% (3/229) on admission, respectively. Thirty-six patients had surgeries and 83 patients had scar sequelae. In 229 patients, single factor logistic regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting surgery intervention (with odds ratio values of 7.86 and 51.35, respectively, 95% confidence intervals of 1.83-33.76 and 11.89-221.78, respectively, P<0.01) and scar sequelae of patients (with odds ratio values of 3.62 and 27.40, respectively, 95% confidence intervals of 1.76-7.43 and 13.25-56.68, respectively, P<0.01); multivariate logistic regression analysis showed that prehospital time was the independent risks factor impacting surgery intervention and scar sequelae of patients (with odds ratio values of 43.00 and 24.55, respectively, 95% confidence intervals of 9.89-187.03 and 11.78-51.16, respectively, P<0.01); single factor linear regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting the length of wound healing of patients (with β values of 6.16 and 12.83, respectively, 95% confidence intervals of 3.38-8.93 and 10.72-14.93, respectively, P<0.01); multivariate linear regression analysis showed that both type of affiliated enterprise and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of 2.81 and 12.16, respectively, 95% confidence intervals of 0.50-5.13 and 10.00-14.31, respectively, P<0.05 or P<0.01). In 91 patients whose hydrofluoric acid mass fraction was known, single factor logistic regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting surgery intervention of patients (with odds ratio values of 9.10, 11.25, 10.69, and 0.04, respectively, 95% confidence intervals of 1.15-72.25, 1.39-90.93, 1.32-86.59, and 0.01-0.19, respectively, P<0.05 or P<0.01), type of affiliated enterprise, hydrofluoric acid mass fraction, and prehospital time were all the factors impacting scar sequelae of patients (with odds ratio values of 0.32, 0.21, and 36.80, respectively, 95% confidence intervals of 0.11-0.92, 0.06-0.73, and 11.03-122.79, respectively, P<0.05 or P<0.01); multivariate logistic regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting surgery intervention of patients (with odds ratio values of 11.51 and 0.04, respectively, 95% confidence intervals of 1.22-108.26 and 0.01-0.25, respectively, P<0.05 or P<0.01), prehospital time was the independent risk factor impacting scar sequelae of patients (odds ratio=37.71, with 95% confidence interval of 9.97-142.69, P<0.01); single factor linear regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting the length of wound healing of patients (with β values of 7.12, -5.63, -9.74, and 13.50, respectively, 95% confidence intervals of 2.43-11.81, -10.59--0.68, -14.78--4.70, and 10.14-16.86, respectively, P<0.05 or P<0.01); multivariate linear regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of -5.84 and 0.09, respectively, 95% confidence intervals of -10.59--1.08 and 0.05-0.12, respectively, P<0.05 or P<0.01). Conclusions: The majority of patients with hydrofluoric acid burns in hands are young and middle-aged males. Type of affiliated enterprise, hydrofluoric acid mass fraction and prehospital time are the risk factors that affect the treatment outcomes of patients with hydrofluoric acid burns in hands.
Adult ; Body Surface Area ; Burns ; Female ; Humans ; Hydrofluoric Acid/adverse effects* ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To analyze the value of procalcitonin (PCT) in the diagnosis of perioperative infection associated with implants in patients with primary hip arthroplasty. METHODS: A retrospective study was conducted on 150 patients who underwent primary hip arthroplasty from June 2018 to June 2020, including 86 males and 64 females, aged from 47 to 77 years old with an average of (57.04±7.43) years. All patients with primary hip arthroplasty were divided into infection group and non infection group according to whether there was infection after operation. Blood samples were collected from the elbow vein before operation (D0) and on the 4, 6, 8 days after operation(D4, D6 and D8) respectively to detect the serum PCT level and white blood cell count (WBC) level. RESULTS: Among 150 patients with primary hip arthroplasty, 34 patients with postoperative infection were in the infection group, and 116 patients without postoperative infection were in the noninfection group. In the infection group, there were 19 cases of superficial surgical site infection(55.88%, 19/34), 9 cases of urinary tract infection (26.47%, 9/34), and 6 cases of pneumonia(17.65%, 6/34). After bacterial culture in the infection group, there were 9 cases of Staphylococcus aureus, 3 cases of Escherichia coli, 3 cases of Staphylococcus epidermidis, 3 cases of Streptococcus constellation, 3 cases of Candida albicans, 6 cases of Klebsiella pneumoniae, 2 cases of Escherichia coli and Streptococcus agalactis, 3 cases of coagulase invisible staphylococcus and Burkholderia cepacia, 2 cases of Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa. There was no significant difference in PCT levels between two groups in D0(P=0.081), D4(P=0.069) and D6(P=0.093), but there was significant difference in D8(P=0.007). There was no significant difference in WBC between two groups at any time point(P>0.05). The results of receiver operating characteristic curve(ROC) showed that the AUC of PCT diagnosis was 0.978[95%CI(0.933, 1.022)] and that of WBC was 0.562[95%CI(0.398, 0.726)], PCT was an important predictor of infection after primary hip arthroplasty(AUC>0.9). When the critical value was 0.526 ng/ml, the sensitivity and specificity of PCT diagnosis are 36% and 100%, respectively, WBC was not a significant predictor of infection after primary hip arthroplasty (0.59/L, the sensitivity and specificity were 64% and 44%, respectively. CONCLUSION PCT has a high specificity for perioperative infection in patients with primary hip replacement, and it is a promising diagnostic index for infection.
Male ; Female ; Humans ; Middle Aged ; Aged ; Procalcitonin ; Calcitonin ; Arthroplasty, Replacement, Hip/adverse effects* ; Protein Precursors ; Retrospective Studies ; C-Reactive Protein/analysis* ; Calcitonin Gene-Related Peptide ; Escherichia coli

Objective: To investigate the clinical characteristics of patients with hydrofluoric acid (HF) burns. Methods: Clinical data of 316 patients with HF burns admitted to Zhejiang Quhua Hospital from January 2004 to December 2016 were retrospectively analyzed. Patients were divided into non and mild poisoning group (NMP, n=157), moderate poisoning group (MP, n=120), and severe and fatal poisoning group (SFP, n=39) based on the severity of poisoning. Occurrences of hypocalcemia, hypomagnesemia, hypokalemia, and hyperkalemia of patients within 24 hours after admission were recorded. Values of emergency urinary fluoride of patients on admission were recorded. Values of urinary fluoride of patients admitted to hospital in 4 hours post injury in groups MP and SFP at post injury hour 4, 12, and 24 and on post injury day 2, 3, 4, 5, 6, and 7 were also recorded. Electrocardiographic abnormalities of patients within 24 hours after admission were recorded. Data were processed with chi-square test, Kruskal-Wallis H test, and Mann-Whitney U test. Results: (1) Hypocalcemia, hypomagnesemia, and hypokalemia occurred in some patients in each of the three groups, but no patient had hyperkalemia. Taking serum calcium namely total serum calcium as reference, the incidence rate of hypocalcemia of patients in group NMP was close to that in group MP (χ²=0.05, P>0.05). The incidence rate of hypocalcemia of patients in group SFP was significantly higher than that in group NMP or group MP (χ²=10.53, 7.92, P<0.01). The incidence rates of hypokalemia in the three groups were close (χ²=0.63, P>0.05). Taking serum ionized calcium as reference, the incidence ratio of hypocalcemia of patients in group NMP was close to that in group MP (χ²=0.01, P>0.05), while there were statistically significant differences in incidence ratio of hypocalcemia of patients between group SFP and each of group NMP and group MP (χ²=4.66, 4.47, P<0.05). Taking serum calcium as reference, the incidence rate of hypocalcemia of patients was 7.3% (23/316). Taking serum ionized calcium as reference, the incidence rate of hypocalcemia of patients was 60.0% (42/70), which was significantly higher than that of taking serum calcium as reference (χ²=113.74, P<0.01). The incidence rates of hypomagnesemia of patients in groups MP and NMP were close (χ²=0.02, P>0.05). The incidence rate of hypomagnesemia of patients in group SFP was significantly higher than that in group NMP or group MP (χ²=14.69, 9.94, P<0.01). (2) The urinary fluoride levels were tested in 288 patients, with the value of emergency urinary fluoride of patients on admission 0.2-590.0 mg/L. The values of urinary fluoride of 202 patients were above the normal value. The values of emergency urinary fluoride of patients in groups NMP, MP, and SFP were 2.15 (1.11, 4.30), 5.89 (1.72, 14.25), and 36.0 (13.2, 103.2) mg/L, respectively. The values of emergency urinary fluoride of patients in groups MP and SFP were significantly higher than the value in group NMP (χ²=23.28, 66.03, P<0.01). The value of emergency urinary fluoride of patients in group SFP was significantly higher than that in group MP (χ²=39.23, P<0.01). The value of urinary fluoride of 33 patients admitted to hospital within 4 hours post injury in groups MP and SFP reached the top at 4 hours post injury and then gradually declined, which returned to normal on about 5 days post injury. The values of urinary fluoride of patients in group SFP at 4, 12, and 24 hours post injury and on 2, 3, 4, 5, 6, and 7 days post injury were significantly higher than those in group MP (Z=-4.28, -4.15, -3.81, -4.21, -2.48, -2.06, -2.31, -2.68, -3.03, P<0.05 or P<0.01). (3) Twenty-seven patients had electrocardiographic abnormality. There were 12 patients with T wave changes (the most common), 8 patients with ST-T changes, 6 patients with ventricular arrhythmias, 6 patients with conduction block, and 1 patient with broadened QRS waveform. There was no patient with prolonged Q-T interval. The ratios of patients with the above electrocardiographic abnormalities in group SFP were higher than those in group NMP and group MP. Conclusions Clinical manifestations of patients with HF burn are hypocalcemia, hypomagnesemia, hypokalemia, and electrocardiographic abnormality. In addition to routine serum electrolyte and electrocardiogram monitoring, the levels of serum ionized calcium and urinary fluoride can be helpful to evaluate the severity of illness of the patients.

Objective: To retrospectively explore the effects of modified dosage of calcium gluconate (CG) on the patients with hydrofluoric acid burns not in hands or feet. Methods: One hundred and sixty patients with hydrofluoric acid burns not in hands or feet were hospitalized in our burn ward from January 2004 to December 2017. Based on the dosage of CG at different admission time, 76 patients hospitalized from January 2004 to December 2012 were included in traditional group, and 84 patients hospitalized from January 2013 to December 2017 were included in modified group. For patients in the two groups, subcutaneous injection of CG solution at one time was immediately conducted on admission in topical treatment. In traditional group, the injection was CG solution with mass concentration of 100 g/L. For wounds of superficial partial-thickness and above degree, CG solution was prescribed at the dosage of 50 mg/cm². Wounds of superficial-thickness or mass fraction of hydrofluoric acid less than 20.0% did not receive injection. In modified group, the mass concentration of CG solution for injection was diluted with normal saline to 25 g/L. For wounds of deep partial-thickness and above degree, CG solution was prescribed at the dosage of (50×mass fraction of hydrofluoric acid) mg/cm². For wounds of superficial partial-thickness, CG solution was prescribed at the dosage of (25×mass fraction of hydrofluoric acid) mg/cm². For wounds of superficial-thickness, CG solution was prescribed at the dosage of 2.5 mg/cm². For systemic treatment, the injection velocity of CG solution via venous access was adjusted according to the level of serum calcium namely total serum calcium of patients in traditional group. In modified group, serum ionized calcium was additionally detected through automatic blood gas analyzer by the bed to regulate the injection velocity of CG via venous access. The incidence rate of hypercalcemia and mortality of patients after treatment in the two groups, and the situation about treatment of survivors in the two groups were analyzed. Data were processed with chi-square test, Fisher′s exact probability test, t test, and Mann-Whitney U test. Results: (1) After treatment, 9 patients (11.8%) had hypercalcemia, while the other 67 patients (88.2%) did not have hypercalcemia in traditional group. Two patients (2.4%) had hypercalcemia, while the other 82 patients (97.6%) did not have hypercalcemia in modified group. The incidence rate of hypercalcemia of patients in traditional group was significantly higher than that in modified group (χ²=5.579, P=0.02). (2) There were two deaths (2.6%) and 74 survivors (97.4%) in traditional group, while there were two deaths (2.4%) and 82 survivors (97.6%) in modified group. The mortalities of patients in the two groups were close (P>0.05). (3) The ratios of eschar excision and skin grafting and hyperplastic scar formation, wound healing time, and ratio of esophageal scar stenosis of survivors in the two groups were close (χ²=0.002, 0.054, Z=0.66, P>0.05). Conclusions Hydrofluoric acid is highly dangerous. The early management of patients with hydrofluoric acid burns emphasizing specialized dosage of CG for treatment can be helpful to reduce incidence of complications and improve the safety of treatment.

OBJECTIVETo explore the clinical effect of subtotal vertebrectomy, decompression and strut grafting in treating thoracolumbar burst fractures through posterolateral approach via posterior midline incision.

METHODSFrom May 2005 to July 2008, 14 patients with thoracolumbar burst fractures were treated with subtotal vertebrectomy, decompression and strut grafting through posterolateral approach via posterior midline incision. There were 9 males and 5 females, ranging in age from 24 to 68 years, with an average of 42.3 years. All patients were single segment fractures, of them, T11 was in 1 case, T12 in 5, L1 in 5 and L2 in 3. According to AO classification in spinal fracture, type A3 was in 5 cases, B1 in 3, B2 in 3, C1 in 2, C2 in 1. According to the ASIA classification in neurological function, grade A was in 3 cases, B in 3, C in 5, D in 2, E in 1. The height of anterior border vertebral body, volume of spinal canal and neurological function were analyzed by X-ray films, CT scanning and ASIA classification preoperative, postoperative and at final follow-up.

RESULTSOperative time was from 3.5 to 5.5 hours with the mean of 4.0 hours; bleeding during operation was from 800 to 2 600 ml with the mean of 1 300 ml. Two cases with nerve root injury recovered without special handling after 3-6 months; 1 case with leakage of cerebrospinal fluid restored through lumbar cerebrospinal fluid drainage; 1 case with pleura tear healed through closed thoracic drainage. No iatrogenic vascular injury or infection was found. The follow-up time was from 8 to 36 months with the mean of 16.5 months. All patients had neurofunctional recovery at different degree, except that 3 patients in grade A. The height of anterior border vetebral body restored from (42.25 +/- 11.87)% preoperatively to (94.38 +/- 3.08)% postoperatively, and (92.87 +/- 3.32)% at final follow-up (P<0.05); volume of spinal canal (the actual volume of spinal canal/normal volume of spine canal) increased from (45.63 +/- 6.88)% preoperatively to (95.26 +/- 3.31)% postoperatively, and (96.13 +/- 2.56)% at final follow-up (P<0.05). Cobb angle were corrected from (25.64 +/- 4.40) degrees preoperatively to (5.80 +/- 1.14) degrees postoperatively; Cobb angle lost from 0 degrees to 6 degrees at final follow-up with (8.10 +/- 2.65) degrees. All patients obtained complete bony fusion without pseudarthrosis formation at final follow-up.

CONCLUSIONSubtotal vertebrectomy decompression and strut grafting through posterolateral approach via posterior midline incision is an effective and safe method in treating thoracolumbar burst fracture, which can restored height of intervertebral body, volume of spinal canal and physiological flexion of spinal column, and retain spinal permanent stability.

Adult ; Aged ; Bone Transplantation ; methods ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; injuries ; physiopathology ; surgery ; transplantation ; Male ; Middle Aged ; Recovery of Function ; Spinal Fractures ; physiopathology ; surgery ; Thoracic Injuries ; physiopathology ; surgery ; Young Adult

OBJECTIVETo identify the active material of anti-hepatic fibrosis from Amydae Carapax.

METHODSMembrane separation technology was adopted to screen active fraction in Amydae Carapax, and the active components were isolated from the active fraction using gel chromatography and high performance liquid chromatography. The purified active components in Amydae Carapax were further analyzed using 4700 series time-of-flight mass spectrometer.

RESULTSProteins and peptides of Amydae Carapax with molecular weight less than 6000 were proved to have biological activity. 8 components (Bj1-Bj8) were isolated from the active fraction. Bj4, Bj6 and Bj7 were screened as active components. Bj7 was further purified, resulting in 7 components (Bj701-Bj707). Bj704 and Bj707 showed significant biological activity. Mass spectrometry showed three molecular ion peaks with highest abundance, i.e. m/e 526, 542 and 572, i.e. m/e 526, 542 and 572, in Bj707 -A The amino acid sequences of above three peptide compounds were NDDY (Asn-Asp-Asp-Tyr), NPNPT (Asn-Pro-Asn-Pro-Thr), and HGRFG (His-Gly-Arg-Phe-Gly), respectively. And M572 was the most abandunt components.

CONCLUSIONThree active peptide compounds of anti-hepatic fibrosis of Amydae Carapax were identified.

Animals ; Cell Line ; Humans ; Liver Cirrhosis ; Medicine, Chinese Traditional ; Tissue Extracts ; isolation & purification ; pharmacology

OBJECTIVETo compare the effects of different kind of methods in the management of hydrofluoric acid burn in early postburn stage in rabbits.

METHODSThirty-three rabbits were inflicted with burn by 55% of hydrofluoric acid covering 5% TBSA, and were randomly divided into 3 groups, i.e. A (n = 13, with 5 ml.kg(-1).h(-1)of isotonic saline intravenous infusion), B (n = 10, with isotonic saline and 50 g/L of calcium gluconate infusion in dose of 20 mg/kg at different time points), and C (n = 10, with the same treatment as B group, and with excision of burn wound at 0.5 post burn hour) groups. The serum levels of fluorine and calcium were determined before and after various postburn hours, and the mortality rate was statistically analyzed.

RESULTS(1) The serum level of fluorine in A (8.37 +/- 2.62 mg/L) and B (8.59 +/- 2.25 mg/L) groups reached the peak value at 1 postburn hour (PBH), which was 107 times higher than that before the burn injury. The serum level of fluorine in B group was significantly lower than that in A group at 24 PBH (P < 0.05), while that in C group declined to (6.20 +/- 0.23) mg/L, which was obviously lower than that in A and B groups (P < 0.01). (2) The serum calcium level declined after burns, reaching the lowest level at 8 to 12 PBH. and began to increase at 24 PBH. Compared with normal calcium value, the serum level of calcium in A, B and C groups declined to as much as 46%, 32% and 26%, respectively. Statistically significant difference was found between C and B groups (P < 0.01). (3) The mortality rate in the three groups within 72 PBH were 30.8%, 12.5% and 0.0%, respectively.

CONCLUSIONEarly removal of burn area and calcium supplementation could help quickly decrease blood fluorine, reverse the fatal hypocalcemia and the multiple systemic toxic injury in rabbits inflicted with hydrofluoric acid injury.

Animals ; Burns, Chemical ; drug therapy ; surgery ; Calcium ; blood ; Calcium Gluconate ; therapeutic use ; Disease Models, Animal ; Elective Surgical Procedures ; Fluorine ; blood ; Hydrofluoric Acid ; adverse effects ; Rabbits ; Random Allocation ; Skin Transplantation ; Wound Healing

Adult ; Aged ; Diagnostic Errors ; Female ; Hamartoma ; diagnosis ; Humans ; Liver ; pathology ; Liver Diseases ; diagnosis ; Liver Neoplasms ; diagnosis ; Male