ObjectiveTo investigate the effectiveness of using a sensory prefabricated flap to repair the heel avulsion injury. MethodsBetween August 2012 and August 2013, 6 cases of heel avulsion injury were treated. There were 4 males and 2 females, aged 16-54 years (mean, 29 years). The causes were crush injury in 4 cases and wheel twist injury in 2 cases. The injury to admission time was 2-6 hours (mean, 4 hours). The size of skin avulsion ranged from 5 cm×3 cm to 15 cm×8 cm. Avulsion skin had no replanted condition. At one stage operation, the avulsed heel skin soft tissue was made the full thickness skin graft which was fostered on the anterolateral thigh with lateral circumflex femoral artery perforator, and the lateral femoral cutaneous nerve was put beneath the skin to prefabricate the prefabricated flap; at two stage operation, the prefabricated skin flap pedicled with lateral circumflex femoral artery was used to repair the wound, and the lateral femoral nerve was anastomosed with the calcaneal nerve to reconstruct the feeling. ResultsSix prefabricated flaps all survived, and re-plantation flaps survived after operation. The wounds healed by first intention at donor site and recipient site. The patients were followed up 1-2 years (mean, 1.5 years). The flaps had satisfactory appearance and soft texture. At 1 year after operation, the sensation of the flaps was S3, with two-point discrimination of 22-27 mm (mean, 24.3 mm). According to ZHANG Ming's evaluation standards, the results were excellent in 5 cases, and good in 1 case. The patients could walk normally or with weight-bearing; only linear scar formed at the donor site. ConclusionFor patients with heel soft tissue avulsion injury without replantation qualification, a sensory prefabricated flap by the avulsed heel skin soft tissue can transplanted to repair the heel defect. Satisfactory effectiveness can be obtained in heel appearance and function recovery.
Objective To assess the effects and safety of vasodilators for sudden sensorineurial hearing loss (SSHL). Search strategy Electronic databases: MEDLINE from 1966, EMBASE from 1974, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database from 1989. Hand search: Five kinds of Chinese otolaryngology journals were searched. Literature references were checked intensively. Selection criteria Randomized controlled trials comparing vasodilators with placebo or other drugs in patients with SSHL. Data collection and analysis At least two reviewers independently assessed trials quality and extracted data. Main results Thirteen trials with 1 155 patients were eligible and included in the systematic review. Ten of the trials were from developed countries and them were from P. R. China. None of the four trials showed that the effects of vasodilators were better than placebo for SSHL. None of the seven trials showed that the effects of one kind of vasodilators were better than that of the other vasodilators. Two trials showed that other drugs, such as batroxobin and hypaque,were probably better than some vasodilators (dextran, papaverine, 654-2, danshen). Eight trials reported the side effects of vasodilators, such as pruritus, allergy, etc. Reviewers’ conclusions Base on the systematic review of current eligible randomized controlled trials, there is no evidence to prove that vasodilator therapy is better than placebo or other therapies for SSHL, or the effects of one kind of vasodilator are better than that of the other vasodilators. We can’t draw a reliable conclusion about the effects of vasodilators for SSHL at the moment. And we must pay attention to their potential adverse reactions.
Objective To investigate the relationship between graded spinal cord ischemia/reperfusion injury and somatosensory evoked potentials(SEP),neurologic function score（NFS）and the histopathological changes of spinal cord. Methods Forty rabbits were randomized and equally divided into 4 groups: shamoperation group, ischemia for 30min, 45min and 60min groups. The spinal cord ischemiareperfusion injury model was created by occlusion of the abdominal aorta in rabbits. SEP was monitored before ischemia,5,10minutes after ischemia, 15, 30 minutes, 1,2, 24 and 48 hours after reperfusion. NFS was evaluated at 6,12,24 and 48 hours after reperfusion.The pathological changes of spinal cord were observed after reperfusion 48 hours. Results The pathological characters with mild,moderate and severe spinal cord ischemia/reperfusion injury could be simulated by declamping after 30， 45 and 60 minutes infrarenal aorta crossclamping. SEP amplitude returned to normal after reperfusion 15 minutes（Pgt;0.05）and SEP latency returned to normal after reperfusion 30 minutes（Pgt;0.05）during mild spinal cord ischemia/reperfusion injury.SEP amplitude returned to normal after reperfusion 30 minutes（Pgt;0.05）and SEP latency returned to normal after reperfusion 60 minutes（Pgt;0.05）during moderate spinal cord ischemia/reperfusion injury. SEP latency increased and SEP amplitude decreased during severe spinal cord ischemia/reperfusion injury,compared with other groups, there were significant differences in SEP latency and SEP amplitude by clamping the infrarenal aorta for 60min（Plt;0.01）. With graded spinal cord ischemia/reperfusion injury, compared with shamoperation group, spinal cord ischemiareperfusion groups had significant differences in NFS（Plt;0.01）. Conclusion SEP is much quicker in the recovery of amplitude than latency during spinal cord ischemia/reperfusion. SEP is a sensitive and accurate index for spinal cord function during ischemia/reperfusion injury. SEP monitoring spinal cord ischemia/reperfusion injury during operation provides experimental basis for clinical application.
OBJECTIVE: To investigate the characteristics and the pathologic classification of electrical-injury nerve using somatosensory evoked potential(SEP) technique. METHODS: SEP were detected and evaluated in 12 cases with electrical-injury nerve during operation, electrical stimulation was commenced from distal side of nerve where the structure of nerve looks normal under operating microscope, up to proximal side until evoking out a stable SEP predeterminate virtual value. Pathological examination and the following functional evaluation were compared with the values of SEP. RESULTS: At the site of nerve looking normal under operating microscope, perineurium appears normal or slightly thicken. But there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular. Vessel plexus is not seen. At SEP stabilizely evoked site, nervous construction is normal, there are visible interfascicular vessel plexus and connective tissue appears loose. Comparing SEP values with pathological section, amplitude and latency of SEP is positively correlative with the quality of nerve. Eight cases repaired with SEP technique to select the anastomosis site for nerve transplantation were followed up, two-point discrimination reached grade III (America hand surgery association criterion) within 62.5% cases. CONCLUSION: SEP technique is valuable method for functional evaluation of electrical- injury nerve which has a complicated pathology. The pathology of electrical-injury nerve can be classified into 4 types, type A: fibrosis of nerve; type B: nerve looking normal under operation microscope, perineurium appears thicken, and there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular, vessel plexus is rarely to see; type C: nerve looks normal, lymphocyte infiltration exists and it is obvious that there are many physalis-like, retrogressive construction in the section; type D: nervous construction is normal, there are visible interfascicular vessel plexus, and connective tissue appears loose, SEP always can be stably evoked.
Injury of dorsal root ganglia (DRG) may cause sensory and motor dysfunction. In order to investigate the changes of somato-sensory evoked potential (SEP) and histological characteristics of DRG in different causes and different periods of injury, fifty-two rabbits were chosed to build the models. The rabbits were divided into 4 groups: Control group (n = 4); mechanical compressing group (n = 16); inflammatory injury group (n = 16); and treatment group (2% lidocaine with hydroprednisone was administered locally, n = 16). After one to eight weeks, SEP was determined and samples of DRG were obtained to observe the histological and ultrastructural changes every week. The result showed that the gap junction of microvascular endothelium in DRG had been destroyed by the mechanical compression was the major cause of the vessel permeability increasing. The increasing of endothelial pinocytic vesicles transportation and widening of endothelial gap junction were the main causes of inflammatory irritation of DRG. The local infiltration with 2% lidocaine and hydroprednisone could obviously ameliorate inflammatory injury in DRG.
ObjectiveTo investigate the influence and management of blood pressure on intraoperative cortex somatosensory evoked potential (CSEP) in the surgery of severe scoliosis. MethodsFrom June 2009 to March 2012, CSEP monitoring during surgery of severe scoliosis were performed on 43 patients, in whom 4 had abnormal CSEP while blood pressure decline. There were 2 males and 21 females. The average age was 16.1 years. The average preoperative Cobb angle was 96.1° (88.7-107.5°). Latency and amplitude of cortical potentials were observed with the value of the latency extension more than 10% and peak amplitude reduction more than 50% defined as abnormality. The arterial blood pressure (ABP) was used to evaluate the intraoperative blood pressure. ResultThe incidence rate of bilateral CSEP wave abnormalities after blood pressure decline was 9.3% in the surgery of severe scoliosis. One case of CSEP abnormality occurred during the installing of pedicle screws; two cases during the Smith-Petersen osteotomy, and one case during the bone graft after correction. With the ABP dropping to about 92/57 mm Hg (1 mm Hg=0.133 kPa), the amplitude decreased 80% in 24-33 minutes. After the ABP increased to 113/75 mm Hg by treatment, the index was backed up normally in 5-10 minutes. There was no neurological complication after surgery. ConclusionA high incidence rate and significantly decreased amplitude of CSEP abnormality after blood pressure decline in the surgery of severe scoliosis are found. Intraoperative stable blood pressure should be maintained for patients with severe scoliosis. When the amplitude of CSEP decreases followed with blood pressure decline, blood pressure should be actively corrected by treatment, so that the CSEP may get back to normal as soon as possible.
Non-drug treatment of hypertension has become a research hotspot, which might overcome the heavy economic burden and side effects of drug treatment for the patients. Because of the good treatment effect and convenient operation, a new treatment based on slow breathing training is increasingly becoming a kind of physical therapy for hypertension. This paper explains the principle of hypertension treatment based on slow breathing training method, and introduces the overall structure of the portable blood pressure controlling instrument, including breathing detection circuit, the core control module, audio module, memory module and man-machine interaction module. We give a brief introduction to the instrument and the software in this paper. The prototype testing results showed that the treatment had a significant effect on controlling the blood pressure.
A non-linear rectification based on immune genetic algorithm (IGA) is proposed in this paper, for the shortcoming of the non-linearity rectification. This algorithm introducing the biologic immune mechanism into the genetic algorithm can restrain the disadvantages that the poor precision, slow convergence speed and early maturity of the genetic algorithm. Computer simulations indicated that the algorithm not only keeps population diversity, but also increases the convergent speed, precision and the stability greatly. The results have shown the correctness and effectiveness of the method.
Plantar pressure distribution can reflect the force of several key points on foot while standing and walking. A comprehensive understanding of the plantar pressure distribution makes great sense in the following aspects:the understanding of the normal foot biomechanics and function, clinical diagnosis, measurement of disease extent, postoperative efficacy evaluation, and rehabilitation research. A simple plantar pressure measurement device was designed in this study. This paper uses FlexiForce flexible sensor to pickup plantar pressure signal and USB A/D board to do data acquisition. The data are transferred into a laptop and processed by a VB-based software which can display, remember and replay the data. We chose patients with hallux valgus and normal people to measure the pressure distribution and make contrast analysis of plantar pressure with this device. It can be concluded that people with hallux valgus have higher pressure on the second metatarsophalangeal joint and the distribution move outward. The plantar pressure of patients postoperative could be greatly improved compared to the preoperative. The function of this device has been confirmed.
A new urine analysis core module based on high performance 32-bit microprocessor and high precision color sensor was presented. A novel optical structure and a specific circuit were applied to improve measurement precision and temperature was used to compensate for results in this core module. The information of urine test peice, such as all original data and color RGB value, reflectivity, semi-quantitative level, etc. can be output. The results showed that the measuring precision was about 95% or above with ideal stability and reliability using this presented core module, which can be conveniently applied in various urine analyzers, and can greatly decrease the cost of urine analyzers in development and production.