ObjectiveTo probe plasma calcitonin gene related peptide (CGRP) levels during thrombolytic therapy in patients with iliofemoral venous thrombosis in order to investigate its regularity of the alteration and its clinical significance.MethodsFifty patients with acute iliofemoral venous thrombosis and 30 patients with chronic iliofemoral venous thrombosis were given urokinase and prostaglandin E1 from veins for 15 days. The CGRP levels were determined by radioimmunoassay before treatment and on the 6th hour, 1st day, 3rd day, 7th day, 14th day, 30th day after treatment.ResultsThe plasma CGRP levels were increased in patients with acute iliofemoral venous thrombosis compared with the contrast ones. The CGRP levels in serious group was lower than those in mild group. However, the CGRP levels of 30 chronic patients and 12 patients who received the second course of thrombolysis as on effective were not different from those of contrast ones. The plasma CGRP levels were increased at the 6th hour,reached the peak at the 3th day and returned to normal at the 14th day after thrombolytic therapy in acute group which just consistent with the therapeutic effectiveness.ConclusionIt is helpful to judge whether the thrombolytic therapy is effective and the illness has come to chronic stage according to the levels of plasma CGRP in patients with iliofemoral venous thrombosis.
Acute kidney injury (AKI) is a complication with high morbidity and mortality after cardiac surgery. In order to predict the incidence of AKI after cardiac surgery, many risk prediction models have been established worldwide. We made a detailed introduction to the composing features, clinical application and predictive capability of 14 commonly used models. Among the 14 risk prediction models, age, congestive heart failure, hypertension, left ventricular ejection fraction, diabetes, cardiac valve surgery, coronary artery bypass grafting (CABG) combined with cardiac valve surgery, emergency surgery, preoperative creatinine, preoperative estimated glomerular filtration rate (eGFR), preoperative New York Heart Association (NYHA) score>Ⅱ, previous cardiac surgery, cadiopulmonary bypass (CPB) time and low cardiac output syndrome (LCOS) are included in many risks prediction models (>3 times). In comparison to Mehta and SRI models, Cleveland risk prediction model shows the best discrimination for the prediction of renal replacement therapy (RRT)-AKI and AKI in the European. However, in Chinese population, the predictive ability of the above three risk prediction models for RRT-AKI and AKI is poor.
ObjectivesTo systematically review the efficacy of hypothermia intervention on adult severe craniocerebral injury.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of hypothermia intervention on severe craniocerebral injury from the establishment of the database to July 2nd, 2020.Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 25 RCTs involving 2 949 patients were included. The results of meta-analysis showed that the mortality of hypothermia intervention group was lower than that of normal body temperature group (RR=0.72, 95%CI 0.58 to 0.89, P=0.003), and the prognosis of hypothermia intervention group was better than that of normal body temperature group (RR=1.29, 95%CI 1.15 to 1.46, P<0.000 1).ConclusionsCurrent evidence shows that the hypothermia intervention has a lower mortality rate and a higher prognosis rate in the treatment of adult severe brain injury. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate therapeutic effect of tile shape perineal stapled prolapse resection in treatment of rectal prolapse. Methods The clinical data of 31 patients with rectal prolapse underwent tile shape perineal stapled prolapse resection in the Renmin Hospital of Wuhan University from December 2013 to August 2015 were retrospectively analyzed. All the patients with rectal prolapse were performed the tile shape perineal stapled prolapse resection with general anesthesia and (or) epidural anesthesia. The prolapse was completely pulled out and then axially cut open with a linear stapler in the lithotomy position. Finally, the prolapse was resected stepwise with the curved stapler at the prolapse’s uptake. Results There were 8 males and 23 females in the 31 patients. The age was (65.8±3.2) years old. There were 14 patients with Ⅱ degree and 17 patients with Ⅲ degree prolapses. The median course was 5.8 years. The 31 patients were followed up for 0.5–7.0 months. Of 31 cases, the 24 cases were cured and 7 cases were better. It was found out that there was a significant difference between the number of axially cut open with a linear stapler and the weight of specimen (P<0.05). And there was a significant difference between the number of axially cut open with a linear stapler and the recurrence (P<0.05) too. When the number of axially cut open with a linear stapler were 4 for Ⅱ degree and 3 for Ⅲ degree, the treatment had been proved to be the highest efficacy. Conclusions Preliminary results of limited cases in this study show that tile shape perineal stapled prolapse resection is safe and effective in treatment of rectal prolapsed. Key of operation is that prolapse is completely pulled out and then axially cut open with a linear stapler at some o’clock for 2–4 points and rectal valves are formed. Prolapsed is resected stepwise with curved stapler at prolapse’s uptake. When number of axially cut open with a linear stapler are 4 for Ⅱ degree and 3 for Ⅲ degree, it could achieve the best therapeutic effect.
Objective To explore the biomechanic effects of multi ple freeze-thaw on human allograft tendons. Methods Thirty tendons (24 flexor digitorum superficial is tendons and 6 flexor poll icis longus tendons) were harvested from 3 fresh cadaver donors and were divided into 6 groups randomly (fresh group; 1 cycle, 2 cycle, 3 cycle, 5 cycle, and 10 cycle freeze-thaw groups). There was 4 flexor digitorum superficial is tendons and 1 flexor poll icis longus tendon in each group. The structural and mechanical properties as well as viscoelastic change were estimated. Results The results of the structural and mechanical properties in 1 cycle, 2 cycle, and 3 cycle freeze-thaw groups were similar to that of the fresh group (P gt;0.05). The tendons in 5 cycle and 10 cycle freeze-thaw groups showed a significantly lower ultimate load and maximum stress when compared with those of fresh group (P lt; 0.05), but there was no significant difference in maximum tensile or maximum strain (P gt; 0.05). Moreover, the tendons in 5 cycle and 10 cycle freeze-thaw groups had a significant increase in viscoelastic properties when compared with fresh group (P lt; 0.05). Conclusion In the cryopreservation of tendon allografts, the cycle of freeze-thaw should not exceed 3 times. Multiple cycle freeze-thaw will weaken the biomechanical properties of tendon allografts, which make grafts easier to fatigue or even rupture.
Objective To investigate the cl inical outcomes of lumbar spondylol isthesis associated with lumbar spinal stenosis through decompressive laminectomy, spondylol ithesis reduction system (SRS) internal fixation, single posteriolateralVigor Spacer threaded fusion cages and intertransverse process arthrodesis bone grafting. Methods From June 2002 to June 2006, 58 cases of lumbar spondylol isthesis were treated with decompressive laminectomy, fixed by SRS instrumentation, posterior installed with interbody Vigor Spacer Cage and bone grafted between intertransverse process arthrodesis. There were 47 males and 11 females, aged 32-66 years old (45.8 on average). The course of disease was 3 months to 7 years, with an medium course of 25 months. Accoding to the Meyerding standard, 38 cases were classified as degree I and 20 as degree II. Spondylol isthesis between L4 and L5 covered 21 cases and between L5 and S1 covered 37 cases. There were 44 cases of lumbar spondylol isthesis and 14 of degenerative lumbar spondylol isthesis. The intervertebral height was 1.5-10.5 mm with the average of 5.1 mm. Results All patients’ incisions obtained heal ing by first intension after operation. The operation time was 50-90 minutes with an average of 65 minutes. The blood loss was 200-500 mL with an average of 250 mL. The patients were followed up for 10-38 months with an average of 23.6 months. According to the Macrab criteria, 54 cases were excellent, 3 good, 1 fair and the choiceness rate was 98.3%. According to the Meyerding classification, 38 cases of degree I and 19 out of 20 cases of degree II obtained complete reduction, and the rate of complete reduction was 98.3%. There were 57 (98.3%) cases which fused well 3-6 months after operation. The intervertebral height resumed to 9.6-12.5 mm with an average of 11.6 mm, and no intervertebral height loss was found. Conclusion The treatment of lumbar spondylol isthesis with decompressive laminectomy, SRS internal fixation, single posteriorolateral Vigor Spacer threaded fusion cage and bone grafting has excellent cl inical results and stable reduction.
ObjectiveTo investigate the effectiveness of sliding trochanteric osteotomy (STO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods Between July 2016 and April 2021, 52 patients (57 hips) with Crowe type Ⅳ DDH who underwent primary THA were enrolled according to inclusion criteria. There were 5 males and 47 females with a median age of 51 years (range, 18-76 years). There were 47 cases of single hip and 5 cases of bilateral hips. The leg length discrepancy (LLD) was 50.50 (44.00, 55.00) mm, visual analogue scale (VAS) score was 8.0 (6.0, 9.0), and Harris score was 58.0±5.0 before operation. Trendelenburg sign was positive in 46 patients (46 hips). All patients underwent STO and THA using Wagner-cone stem. The operation time, intraoperative blood loss, blood transfusion volume, Trendelenburg sign, and related complications were observed. During follow-up, VAS and Harris scores were recorded to evaluate the hip pain and function. X-ray film was used to measure the LLD and observe the bone union situations. Results The operation time was 90-125 minutes (mean, 105 minutes). Introperative blood loss was 420-800 mL (mean, 640 mL). Ten patients underwent blood transfusion and the amount of allogeneic blood transfusion was 2-4 U (mean, 3 U). All incisions healed by first intention after operation. All patients were followed up 4-60 months (median, 24 months). At last follow-up, LLD was 6.00 (4.00, 7.75) mm, showing significant difference when compared with that before operation (Z=−6.278, P=0.000). After operation, 51 hips (89.5%) achieved bone union at the osteotomy site, 4 hips (7.0%) had fibrous union, and 2 hips (3.5%) had nonunion. The healing time of osteotomy was 3-12 months, with an average of 6 months. At last follow-up, the VAS score was 3.0 (2.0, 5.0) and the Harris score was 85.0±6.0. The differences between pre- and post-operation were significant (Z=−6.176, P=0.000; t=−25.285, P=0.000). Trendelenburg sign remained positive in 4 patients (4 hips) at last follow-up and the difference was significant when compared with preoperative (χ2=67.947, P=0.000). One patient had a medial femoral cortical fracture when Wagner-cone stem was implanted during operation, and 2 patients had early symptoms of sciatic nerve palsy after operation, and no other related complications occurred. Conclusion For Crowe type Ⅳ DDH patients, STO applied in THA can reduce the resected bone mass, provide better exposure of hip as well as improve function of hip abductor muscle. Wagner-cone stem is recommended.