目的：观察慢性酒精中毒所致震颤谵妄的临床特点及预后。方法：对32例慢性酒精中毒所致震颤谵妄患者的临床资料进行回顾性分析，探讨其临床特点及预后。结果：32例患者中，因应激方式不当饮酒者19例，平均饮酒年龄20.3±9.6年，平均每日摄入乙醇量276.4±21.9 g。因戒断而出现临床症状者15例。临床表现为多种精神症状和不同程度的意识障碍，伴有肢体震颤。头部CT扫描发现脑萎缩者30例。经治疗后症状痊愈者25人，好转者4人。结论：慢性酒精中毒所致震颤谵妄发作的病理生理机制尚不明了，但其发作与戒断关系密切，经积极干预可获得较满意的预后。
Objective To study the change in serum levels of soluble CD14, tumor necrosis factor-α, E-selectin, interleukin-10 and mean arterial pressure, as well as their relationship to infection during the pathophysiologic process in endotoxemia of rabbits. Methods Sixteen rabbits were randomly divided into two groups: group A, as a control group; group B, endotoxemia group. The model of rabbit with endotoxemia were used. Endotoxin at a dose of 1.5 mg/(kg·h) or 3 mg/(kg·h) was continuously infused through external jugular vein within 2 hours, 1 hour respectively. The change of levels of serum soluble CD14, tumor necrosis factor-α, interleukin-10 and E-selectin were observed at 0 (time before infusion of endotoxin), 30, 60, 120, 180, 240, 300 minutes, while mean arterial pressure was measured by polygraphy system. Results In the group B,there was an increase of content of soluble CD14,tumor necrosis factor-α,interleukin-10 and E-selectin following 30, 120 minutes respectively,and mean arterial pressure was lower than that of group A at same time points. Conclusion The results suggest that soluble CD14,tumor necrosis factor-α,interleukin-10 and E-selectin may play an important role during the change of infection and that these changes may be closely related with severe infection.
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.
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 crossclamp 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%). Twentynine 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 13260 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 perioperative protection of the renal function.
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 RTPCR 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.
Objective To investigate the biological mechanism about autologous peripheral blood stem cell transplantation （ABSCT） derived neovascularization to lead and perfect the effect of ischemic state tissue of secondary blood flow remodeling. Methods Forty-two patients with critical limbs ischemia and 42 limbs in all from Mar. 2005 to Dec. 2005 in Yunnan Provincial Center of Vascular Surgery were selected，who treated by endovascular repair and ABSCT at the first flow reconstruction and the secondary flow reconstruction，respectively. The preoperative and postoperative effect degrees of limbs regional blood flow from cutaneous covering，blood vessel，and blood were measured by multifunction monitoring device，dopplor ultrasound monitoring device，percutem oxygen partial pressure （TcPO2）monitoring device and digital subtraction angiography （DSA）. The follow-up time was in four year after ABSCT.Results After ABSCT， the pain，cold or cool，and rest pain of leg were relieved. The distance of intermittent claudication after ABSCT was longer than that before ABSCT 〔（1 600.3±310.1） m versus （520.3±160.6） m，F=5.84，P＜0.05〕. The foot pain and limbs insensible feeling easement rates were 100% after ABSCT. Compared with beforeABSCT，the objective effect indexes of limbs regional blood flow after ABSCT were significantly improved 〔skin temperature index：1.63±0.31 versus 1.22±0.23，F=4.69，P＜0.05； TcPO2： （37.61±9.52） mm Hg versus （30.63±4.54） mm Hg，F=5.72，P＜0.05；ankle-brachium index：0.93±0.23 versus 0.33±0.24，F=6.72，P＜0.05；photoplethysmography index：0.81±0.12 versus 0.23±0.05，F=5.68，P＜0.05；saturation of blood oxygen： （79.44±20.42）% versus （42.43±10.41）%，F=5.68，P＜0.05； DSA score：1.34±0.23 versus 0.21±0.03，F=4.89，P＜0.05〕. Conclusions The results bly suggest that the ABSCT can promote blood flow remodeling in limbs ischemia，and stem cells derived neovascularization can significantly offer effective and permanent blood flow perfusions to the ischemic statetissue，and this biological effect play an important role in the ischemic state tissue for secondary blood flow remodeling.
Objective To analyze the clinical features， common etiologies， prevention measurements of recurrent acute pancreatitis （AP）. Methods The clinical characteristics and imaging examination data of 43 patients with recurrent AP were analyzed retrospectively， which was compared with the results of 258 patients with primary AP. The recurrence etiologies were analyzed. Results There were no significant differences on the fever， jaundice， abdominal pain relief time， pancreatic local complications， and ratio of severe AP between two groups （P＞0.05）. Comparion of etiologies between recurrent AP and primary AP， cholecystitis and diet factor （alcoholic） had priority in patients with primary AP （P=0.038， P=0.006， respectively）， but the hyperlipidemic， duodenal nipple disease， and small stone in the common bile duct were the major etiologies in patients with recurrent AP （P=0.007， P=0.008， respectively）. No relapse was found within the follow up for 3 months to 2 years （the average time was 14.2 months）. Conclusion Find out the exact etiology and performe correct therapy are the key to the treatment and prevention of recurrent AP.
Stem cell transplantation is one of the main methods to treat thromboangiitis obliterans (TAO). In recent years, research on the treatment mechanism of stem cell transplantation has made some progress. The results of a number of stem cell clinical trials specifically for TAO have been published. Some new stem cell types have gradually been used in the clinic. There is no major dispute over security. In addition, research shows that the efficacy of stem cell transplantation is affected in many ways, and some factors have a certain predictive effect on the possibility of amputation after transplantation. This paper reviews the clinical research progress of stem cell transplantation for TAO, and aims to provide some basis for the better use of stem cell transplantation in the treatment of TAO.
ObjectiveTo investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. ConclusionThe soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.
ObjectiveTo analyze the effect of anal fistula clip (AFC) in the treatment of anal fistula, and to evaluate its safety. MethodsA historical cohort study method was conducted. Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected, of which 42 patients underwent the AFC treatment (AFC group), 41 patients underwent the endorectal advancement flap (ERAF) treatment (ERAF group). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of anus pain on postoperative day 1, 3, and 7, wound healing time, Wexner incontinence score of anal function on postoperative month 6, and clinical efficacy (healing and failure) were compared between the two groups. ResultsThe operation was successfully completed in both groups. The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group (P<0.05). No complications such as internal opening infection and bleeding occurred in the two groups. There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups (P>0.05). The median follow-up time was 22 months. There was no statistical difference in the wound healing time between the two groups (P>0.05). The Wexner score of anal function in the AFC group was lower than that in the ERAF group (P<0.05), and there was no statistical difference between after operation and before operation (Z=–1.751, P=0.089) in the AFC group, while that in the ERAF group after operation was higher than before operation (Z=–1.859, P=0.014). The healing rate had no statistical difference between the AFC group and ERAF group (85.7% versus 77.5%, χ2=0.925, P=0.336). Conclusion From the results of this study, the AFC is safe and effective in treatment of anal fistula, with the advantages of relatively simple operation, less bleeding during operation, lighter postoperative pain, and good protection of anal function.