Objective To compare the clinical effect of continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) in the treatment of severe acute renal failure (ARF). Methods A hundred patients with severe ARF treated between May 2011 and December 2014 were chosen to be the study subjects. According to the order of admission, they were divided into control group and observation group with 50 patients in each. Patients of the control group underwent IHD, while those in the observation group underwent CRRT. Serum creatinine (Scr), blood urea nitrogen (BUN), endogenous creatinine clearance rate (Ccr), treatment effective rate and survival rate were compared between the two groups before and after the treatment. Results Scr, BUN and Ccr were all improved after treatment in both the two groups. However, Scr, BUN and Ccr in the observation group [(225.1±162.7) μmol/L, (14.2±9.3) mmol/L, (23.4±10.5) mL/min] were significantly better than those in the control group [(588.4±183.6) μmol/L, (29.1±10.4) mmol/L, (15.9±8.2) mL/min]. The treatment effective rate and patients’ survival rate in the observation group were respectively 60% and 70%, both significantly higher than those in the control group (40% and 52%) All the differences were significant (P<0.05). Conclusion CRRT is superior in the treatment of severe ARF with a higher survival rate of the patients, which is worthy of clinical promotion.
Objective To investigate the mass casualty triage system and its application, to provide evidence and advice for its future standardized use. Method Based on the principles and methods of systematic reviews, we searched MEDLINE (1950 to 2008), The Cochrane library (Issue 2, 2008) and CBM (from establishment to May 2008) to identify papers written in English of Chinese which described mass casualty triage systems or triage systems specific to the aftermath of earthquakes. We extracted information on name, grades, criteria, main characteristics and application of each triage system from the papers involving mass casualty triage systems. We also extracted information on setting, personnel performing the triage, grades, and characteristics from those papers describing any specific triage system for earthquake. We compared the colour of tags, codes and other materials used in different triage systems. Result We included 38 English and 6 Chinese papers. For mass casualty triage systems, we identified 7 primary triage methods with 4 grades.Three of these had relevant application reports. There were 6 secondary triage methods with 3-5 grades, and none had relevant application reports. Four tag methods were identified. Seven papers, 2 of which were published in China, reported specific secondary triage methods for earthquakes. Conclusion Based on the current evidence, there is no universally accepted mass casualty triage system with documented reliability and validity. No triage system has been developed specifically for the wounded in earthquakes. There are large differences between the triage methods for earthquake and other mass casualty incidents. Future research should focus on the development of a reliable and valid mass casualty triage system, aimed at maximizing the capacity for medical rescue.
Objective To assess the efficacy and safety of Lamiophlomis rotata (Benth) Kudo in treating bleeding, pain, and inflammation of different causes. Methods Based on the principles and methods of Cochrane systematic reviews, we searched CBM (from establishment to June 2008), CNKI (1980 to June 2008), MEDLINE (1966 to June 2008), and Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 2, 2008）to identify randomized controlled trials (RCTs) of Lamiophlomis rotata (Benth) Kudo. We assessed the risk of bias of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results We included 70 RCTs, of which there were 20 RCTs on bleeding, 10 RCTs on both bleeding and pain, 29 RCTs on pain, and 11 RCTs on inflammation. Most of the included studies were of low quality with a high risk of bias. ① Bleeding: We included 30 RCTs on bleeding. Meta-analysis showed that Lamiophlomis rotata (Benth) Kudo had a higher total effective rate of hemostasis compared with other hemostatics (OR 3.86, 95%CI 2.56 to 5.82) or the blank control group (OR 14.85, 95%CI 7.16 to 30.80). Patients in the Lamiophlomis rotata (Benth) Kudo group had less blood loss compared with other hemostatics or the blank control group and were associated with shorter duration of bleeding compared with the blank control group, but no statistical difference was noted when compared with other hemostatics. ② Pain: We included 37 RCTs on pain. Meta-analysis showed that Lamiophlomis rotata (Benth) Kudo had a higher total effective rate of analgesia compared with other paregorics (OR 3.01, 95%CI 2.23 to 4.06), the blank control group (OR 6.06, 95%CI 3.14 to 11.70), or placebo (OR 2.91, 95%CI 1.48 to 5.73). Patients in the Lamiophlomis rotata (Benth) Kudo group had lower pain score compared with the blank control group (MD -0.84, 95%CI -0.97 to -0.72). ③ Inflammation: We included 11 RCTs on inflammation. Meta-analysis showed that Lamiophlomis rotata (Benth) Kudo had a higher total effective rate of anti-inflammation compared with other antiinflammatory agents (OR 3.36, 95%CI 1.90 to 5.96). One RCT reported that Lamiophlomis rotata (Benth) Kudo could reduce joint swelling compared with other anti-inflammatory agents. ④ Safety: Twelve RCTs reported mild adverse effects in patients who received Lamiophlomis rotata (Benth) Kudo, such as mild nausea, diarrhea, and stomach discomfort, but no serious adverse effects were observed. Conclusion Current evidence demonstrates that Lamiophlomis rotata (Benth) Kudo is effective and safe in treating bleeding, pain, and inflammation. However, the results should be interpreted with caution because of the heterogeneity among the included studies and the high risk of bias. High quality RCTs with large samples are needed to further prove its effectiveness and safety.
【Abstract】 Objective To investigate the survival rate, voiding, sexual function after nerve-sparing surgery with extended systematic extraperitoneal lateral lymphadenectomy in lower rectal cancer. Methods Three hundreds and ninety-two cases with advanced lower rectal cancer who underwent nerve-sparing surgery with radical dissection from 1996 to 2000 were reviewed. Among them,173 cases only cleared in abdominal cavity,219 cases coupled with extraperitoneal lateral lymphadenectomy. Results The metastatic rate of lateral lymph node was 17.8%(39/219),the rate of non-modal foci of metastatic disease in lateral out of the abdominal cavity was 5.9%(13/219).Local recurrence rate, the abdominal cavity group was 16.2%（28/173）; the coupled group was 9.6%（21/219）， P＜0.05. Conclusion By contrast,abdominal cavity coupled with extraperitoneal lympadenectomy acted to cut down local recurrence and to elevate 5-year survival rate,the postoperative quality of life with voiding, sexual function appeared to be seriously affected, although the radical dissection are nerve-sparing surgery.
Facial complex regional pain syndrome (CRPS) is a CRPS that occurs around the periorbital and/or orofacial region, showing regional chronic pain accompanied by motor and autonomic nervous dysfunction. At present, the pathogenesis of CRPS is not clear, which may include inflammatory reaction, sympathetic nerve, spinal cord, supraspinal and other mechanisms. It is related to the hemisensory disturbances of CRPS, and closely associated with facial allodynia and migraine with trigeminal nerve. This article reviews the possible mechanisms of facial CRPS and connects the limb pain with facial pain, in order to provide some reference for the study of the pathogenesis of CRPS.
Objective To explore effectiveness of positive support reduction and internal fixation in the treatment of femoral neck fractures. Methods A clinical data of 74 patients with femoral neck fractures treated with hollow screw internal fixation between September 2017 and September 2021 was retrospectively analyzed. Based on the quality of fracture reduction, they were divided into positive support reduction group (group A, n=25), negative support reduction group (group B, n=21), and anatomical reduction group (group C, n=28). There was no significant difference in baseline data such as gender, age, cause of injury, disease duration, fracture side, Garden classification, and fracture line position classification between groups (P>0.05). The occurrence of complications such as early fixation failure, femoral neck shortening, non-union of fractures, and femoral head necrosis in three groups, as well as the Harris score of the hip joint were recorded and compared. Results All patients had primary healing of incisions after operation and were followed up more than 12 months. The follow-up time for groups A, B, and C was (21.1±5.7), (22.6±4.3), and (21.9±4.1) months, respectively; there was no significant difference between groups (P>0.05). There was no significant difference in the incidences of non-union of fractures, early internal fixation failure, and the femoral head necrosis between groups (P>0.05). The incidence and length of femoral neck shortening, and the hip Harris score at last follow-up in groups A and C were all superior to those in the group B, with significant difference (P<0.05). There was no significant difference in the above indicators between groups A and C (P>0.05). Conclusion Positive support reduction can provide a good biomechanical environment for the healing of femoral neck fractures, thereby achieving a higher fracture healing rate, reducing the occurrence of femoral neck shortening, minimizing the function of hip joint, and achieving effectiveness similar to anatomical reduction.
ObjectiveTo explore the effects of cryopreservation on the cell survival rate, cell viability, early apoptosis, migration ability, and tendon-related marker expression of tendon-derived stem cells (TDSCs) in rat patellar tendons.MethodsThe patellar tendon tissues were harvested from 12 4-month-old male Sprague Dawley rats; 12 patellar tendon tissues from 6 rats were cryopreserved (the experimental group), and the other 12 patellar tendon tissues were not treated (the control group). The patellar tendons were digested with 0.3% type I collagenase to obtain nucleated cells. The survival rate of nucleated cells was detected by trypan blue exclusion assay, and colony-forming ability by crystal violet staining. TDSCs were isolated and cultured to passage 3 (P3). The cell viability of TDSCs was detected by Alamar Blue method, the early apoptosis by Annexin V-FITC/PI assay, the cell migration ability by Transwell method, and the mRNA expressions of tendon-related markers [collagen type I (Col1α1), scleraxis (Scx), and tenomodulin (Tnmd)] by real-time quantitative PCR.ResultsThe survival rate of nucleated cells was 91.00%±3.63% in the control group, and was 61.65%±4.76% in the experimental group, showing significant difference (t=12.010, P=0.000). The formation of the primary nucleated cell clones was observed in 2 groups. At 12 days, the number of colonies forming of the experimental group [(8.41±0.33)/1 000 nucleated cells] was significantly lower than that of the control group [(15.19±0.47)/1 000 nucleated cells] (t=28.910, P=0.000). The percentage of TDSCs in the active nucleated cells in the experimental group (1.37%±0.09%) was significantly lower than that in the control group (1.67%±0.10%) (t=5.508, P=0.003). The growth trend of TDSCs (P3) in the 2 groups was consistent within 14 days. There was no significant difference in absorbance (A) value between 2 groups at each time point (P>0.05). The early apoptotic rate of TDSCs was 1.67%±0.06% in the experimental group and was 1.63%±0.06% in the control group, showing no significant difference (t=0.707, P=0.519). Under microscope, TDSCs adhered to the lower chamber of the Transwell chamber; the number of cells was 445.00±9.70 in the experimental group and was 451.50±12.66 in the control group, showing no significant difference (t=0.998, P=0.342). The relative mRNA expressions of Col1α1, Scx, and Tnmd were 3.498±0.065, 0.062±0.002, and (4.211±0.211)×10–5 in the experimental group and were 3.499±0.113, 0.062±0.001, and (4.341±0.274)×10–5 in the con-trol group, showing no significant difference (t=0.013, P=0.991; t=0.042, P=0.969; t=0.653, P=0.549).ConclusionThe survival rate of nucleated cells in cryopreserved rat tendon tissues is lower, but a large number of active TDSCs, and its cell viability, early apoptosis rate, migration ability in vitro, and cell tenogenic differentiation ability are remained.
Objective To investigate the effect of functional exercises at different time and different immobilization positions on the functional recovery of elbow joint with type C distal humeral fractures. Methods A total of 120 patients with type C distal humeral fractures admitted to the hospital between June 2013 and July 2015 were included in the study. They were randomly allocated to 3 groups, 40 patients in each group. Group A: functional exercises began immediately after the operation; Group B: the affected elbow was fixed at 90° flexion for 1 week and then began functional exercises after 1 week of immobilization; Group C: the affected elbow was fixed at 30° extension for 1 week and then began functional exercises after 1 week of immobilization. There was no significant difference in gender, age, fracture pattern, fracture side, injury time, and surgical approach between groups (P>0.05). Results In groups A and B, 1 case had incision redness and swelling respectively, and the other incisions healed by first intention. Five patients occurred myositis ossificans in group A, 4 cases in group B, and 5 cases in group C. The incidence of complications in groups A, B, and C was 15.0% (6/40), 12.5% (5/40), and 12.5% (5/40), respectively. There was no significant difference between groups (χ2=0.144, P=0.930). All patients were followed up 6-25 months, with an average of 9.8 months. At 2 weeks after operation, the Mayo elbow joint function score of group A was significantly higher than those of groups B and C (P<0.05), and the visual analogue scale (VAS) of group A was significantly lower than those of groups B and C (P<0.05). There was no significant difference between groups B and C (P>0.05). At 6 months after operation, there was no significant difference in Mayo elbow joint function score and VAS score between groups (P>0.05). At 2 weeks and 6 months after operation, the flexion and extension activities of elbow joint in groups A and C were better than that in group B (P<0.05), and there was no significant difference between groups A and C (P>0.05). There was no significant difference in forearm rotation between groups (P>0.05). All fractures of 3 groups achieved clinical healing, and there was no significant difference in healing time between groups (P>0.05). Conclusion Early functional exercises can relieve pain and obtain better elbow flexion and extesion activities after operation. The elbow joint fixed at 30° extension is better than at 90° flexion in elbow flexion and extension activitis.
ObjectiveTo explore the application value of damage control in intra-abdominal sepsis. MethodsThe related literatures were searched by searching literatures with " damage control” " damage control resuscitation” damage control surgery”, and " intra-abdominal sepsis”, to made an review. Results Despite significant advances in management and treatment, mortality from intra-abdominal sepsis remained still high. Due to its unique anatomic and microbial environment, initial operation could not completely remove the source of infection and avoid complications. Therefore, it was becoming increasingly popular to utilize a damage control strategy with abbreviated laparotomy and planned reoperations. ConclusionsDamage control is characterized by staged treatment, and is widely accepted used to manage intra-abdominal sepsis.
Pain is one of the common complications of most diseases. Due to the unknown mechanism of pain, its treatment has been controversial. Repeated peripheral magnetic stimulation for pain has the advantages of non-invasiveness, painlessness, and well-targeted. However, the parameters of repeated peripheral magnetic stimulation for pain are not uniform due to various factors such as frequency, location of action, and coil type. In this paper, the parameters and efficacy of repeated peripheral magnetic stimulation for various kinds of pain such as acute and chronic low back pain, myofascial pain, migraine, peripheral neuralgia and post-traumatic pain are described, in order to providea theoretical basis for future research. In addition, the mechanism of repeated peripheral magnetic stimulation for pain has not been known, and this article will briefly summarize and explain on this.