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小隐静脉处理方法对逆行腓肠神经皮瓣移位成活率的影响

HINGED EXTERNAL FIXATOR WITH MINI-PLATE TO TREAT TERRIBLE TRIAD OF ELBOW

Objective To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow. Methods Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years (mean, 34 years). The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days (mean, 3.7 days). According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classification standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases. Results All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months (mean, 15 months). Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks (mean, 16 weeks). No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion (ROM) were 120-145° (mean, 135°) in flexion, 0-25° (mean, 10°) in extension, 50-90° (mean, 70°) in pronation, and 50-80° (mean, 60°) in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. Conclusion Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.

Analysis of Risk Factors for Acute Kidney Injury after Aortic Arch Replacement Surgery

Abstract： Objective To determine the risk factors for acute kidney injury (AKI) after thoracic aortic arch replacement surgery under deep hypothermic circulatory arrest (DHCA). Methods We retrospectively analyzed the clinical data of 139 patients who underwent thoracic aortic arch replacement surgery under DHCA between January 2004 and December 2008 in Beijing Anzhen Hospital Affiliated to Capital University of Medical Sciences. The patients were divided into two gro-ups according to whether AKI occurred after thoracic aortic arch replacement surgery. In the AKI gro-up (n=48), there were 39 males and 9 females with an age of 57.67±9.56 years. In the normal renal function gro-up (n=91), there were 69 males and 22 females with an age of 41.30±13.37 years. We observed the clinical data of the patients in both gro-ups, including left ventricular ejecting fraction (LVEF) before operation, diameter of the left ventricle, diameter of the ascending aorta, renal function, cardiopulmonary bypass time, aortic crossclamp time, and DHCA time. The risk factors for AKI and death after operation were evaluated by univariate analysis and stepwise logistic regression analysis. Results Among all the patients, AKI occurred in 48 (34.53%), 17 (12.23%) of whom underwent continuous renal replacement therapy (CRRT). Respiratory failure occurred in 27 patients (19.42%). Twentynine patients (20.86%) had cerebral complications, including temporary cerebral dysfunction in 26 patients and permanent cerebral dysfunction in 3 patients. In all the patients, 14 (10.07%) died, including 4 patients of heart failure, 9 patients of multiple organ failure, and 1 patient of cerebral infarction. There were 3 (3.30%)deaths in the normal renal function gro-up and 11 (22.92%) deaths in the AKI gro-up with a significant difference of mortality rate between the two gro-ups (P=0.011). A total of 118 patients were followed -up and 7 were lost. The follow-up time was from 5 to 56 months with an average time of 42 months. During the follow-up period, 7 patients died, including 3 patients of heart failure, 2 patients of cerebral apoplexy, and 2 patients of unknown reasons. The logistic regression analysis revealed that creatinine level was greater than 13260 μmol/L before operation (OR=1.042, P=0.021) and respiratory failure (OR=2.057, P=0.002) were independent determinants for AKI after the operation. Conclusion AKI is the most common complication of thoracic aortic arch replacement surgery under DHCA, and is the risk factor of mortality after the surgery. It is important to enhance perioperative protection of the renal function.

肾功能损伤分级在心脏术后肾脏替代治疗中的应用

摘要： 目的 探讨肾功能损伤分级(AKIN分级)在心脏术后肾脏替代治疗时机选择中的作用。 方法 2006年9月至2007年10月在我院首次行冠状动脉旁路移植术和/或心瓣膜手术100例患者中，根据AKIN分级，选取最高分级在2级、3级的患者，并结合是否接受肾脏替代治疗(RRT)将患者分为4组：A组：2级接受RRT治疗；B组：2级未接受RRT治疗；C组：3级接受RRT治疗；D组：3级未接受RRT治疗，记录4组患者临床资料和临床转归等。结果 4组患者术后肾功能均出现不同程度的损伤，血肌酐最高值分别为197.8±32.1 μmol/L，154.1±40.1 μmol/L，330.9±78.2 μmol/L和339.1±107.7 μmol/L，明显高于术前。4组患者住院病死率分别为16.7%、14.3%、52.2%和56.3%，C组患者住院病死率高于A组（χ2=5.487，P=0.019）和B组（χ2=11.036，P=0.001），D组患者住院病死率明显高于A组（χ2=5.812，P=0.016）和B组（χ2=11.003，P=0.001），其中以D组患者的病死率最高。结论 心脏术后患者肾功能损伤分级进入AKIN分级2级时接受RRT有可能改善其临床预后。

INFLUENCE OF EXPRESSION LEVELS OF EPIDERMAL GROWTH FACTOR AND KERATINOCYTE GROWTH FACTOR AFTER UNILATERAL PHRENECTOMY IN PIGLETS

Objective To investigate the different influence of the expression levels of the epidermal growth factor (EGF) and the keratinocyte growth factor (KGF) after the unilateral phrenectomy in piglets. Methods Thirty-six piglets were divided into 3 groups according to their ages during the operation (10 d,30 d,50 d). In each group, 6 piglets underwent the left cervical phrenectomy and 6 piglets were used as the shamoperation controls. The expression levels of EGF and KGF were determined by the real time quantitative RT-PCR at 2 weeks after operation.Results The melting curves of RTPCR showed that there was a single peark at the temperature of 80.0, 84.5 and 89.0℃ of EGF,KGF and GAPDH, respectively. In the experimental group, the expression levels of EGF were 3.53±0.36 and 1.73±0.29, and the expression levels of KGF were 4.71±0.42 and 2.77±0.29 in thepiglets undergiong the operation at their ages of 10 d and 30 d.Compared with the control group,the expression levels of EGF (4.60±0.41，2.18±0.24) and KGF(6.05±0.42，3.58±0.31) showed that there was a significant decrease postoperatively in the piglets undergoing the operation at their ages of 10 d and 30 d（P＜0.05）. However, there was no significant change in the piglets undergoing the operation at their ages of 50 d（P＞0.05）. The expression levels of EGF and KGF were significantly decreased with the lung development of the piglets（P＜0.05）. Conclusion The unilateral phrenectomy performed in the piglets younger than 30 d may cause abnormity of the EGF and KGF expression levels. The piglets older than 50 d may not cause a significant influence.

矩形皮瓣修复虎口瘢痕挛缩畸形

Preoperative Application of Budesonide Aerosol Inhalation in the Reduction of Respiratory Adverse Events during Pediatric Anesthesia Recovery

ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.

Mental Fatigue Electroencephalogram Signals Analysis Based on Singular System

In the present paper, the contribution of the largest principal component and the number of principal component needed for accumulative contribution 95% are selected as indices of electroencephalogram (EEG) in mental fatigue state in order to investigate the relationship between these parameters and mental fatigue. The experimental results showed that the contribution of the largest principal component of EEG signals increased in the prefrontal, frontal and central areas, while the number of principal component needed for accumulative contribution decreased by 95% with the increasing mental fatigue level. The parameters of singular system of EEG signals can be regarded as useful features for the estimation of mental fatigue and have larger application value in the study of mental fatigue.

Research Advances of Bone Metastasis in Breast Cancer

ObjectiveTo discuss related clinical research progress of bone metastasis of breast cancer. MethodThe literatures about bone metastases of breast cancer were researched and reviewed. ResultsAlthough there were so many related researches at home and abroad for bone metastasis of breast cancer,but the specific mechanism was still not fully elucidated.At present,the diagnostic method of bone metastasis of breast cancer included X-ray examination,bone scanning,computer tomography,magnetic resonance imaging,positron tomography,positron emission computed tomography,pathology biopsy,and detection of serum markers.In clinical treatment,the treatment consisted of systemic therapy and local therapy,but there was no uniform standard. ConclusionFor high incidence and serious influence on quality of life,bone metastasis of breast cancer needs to be studied further.

肝异位副脾误诊为右侧肾上腺占位性病变1例报道