ObjectiveThe total cavopulmonary connection (TCPC) offers a palliation for the hemodynamic derangements associated with congenital heart lesions characterized by a single functional ventricle, but it may cause acute hepatic injury because of the special physiology. The objective of this study was to characterize hepatic function and its relationship to cardiac function in children who had undergone the Fontan procedure. MethodsWe retrospectively analyzed 114 children who had undergone TCPC operation in Shanghai Children's Medical Center between January 2013 and March 2014. There were 65 males and 49 females with a median age of 3.8 years (range 2.5 to 13.2) and a median weight of 14.8 kg (range 12.0 to 33.0). The study cohort was further divided into three groups according to the Child-Pugh classification. The total scores were calculated regarding to ascite, bilirubin, albumin, and international normalized ratio (INR). The scores from 4 to 5 were classified in Child A group, from 6 to 8 classified in Child B group, from 9 to 11 classified in Child C group. Thirty-four patients met criteria for Child Class A, 53 patients for Child Class B, and 27 patients for Child Class C. The univariate analysis and multivariable logistic regression model were used to compare demographic, anatomic, and physiological variables among the three groups. ResultsWithin the study population, 80 patients of Child B group and Child C group met criteria for acute hepatic injury. Univariate risk factors for acute hepatic injury included longer total bypass time (P=0.044), longer aortic cross-clamping time (P=0.005), longer ventilation time (P=0.000), higher postoperative mean pulmonary arterial pressure (P=0.000), elevated N-terminal pro-brain natriuretic peptide (P=0.001), higher vasoactive inotropic score (P=0.000), lower mixed venous oxygen saturation (SvO2, P=0.000) and arterial oxygen saturation (P=0.001), higher incidence of arrhythmia (P=0.000), and low cardiac output syndrome (P=0.003), the need of peritoneal dialysis (P=0.000). In the multivariable logistic model, the need for peritoneal dialysis (OR=17.018, 95%CI 5.117-56.602) and the lower postoperative SvO2 (OR=0.922, 95%CI 0.871-0.976) were two independent risk factors for acute hepatic injury after the TCPC. ConclusionThe need for peritoneal dialysis and lower postoperative SvO2 may represent the compound effects of multiple risk factors including preoperative hemodynamic and a marked hepatic vascular inflammatory response to surgery and cardiopulmonary bypass, which in turn may mediate acute hepatic injury.
OBJECTIVE: To investigate the injury on isolated testes induced by ischemia/reperfusion(I/R), and the protective effect of Yisheng injection on the injury. METHODS: Twenty-six isolated cadaver testes contributed by 13 persons were preserved with 4 degrees C 250 ml hypertonic citrate alloxuric (HCA) solution and then reperfused with 37 degrees C 500 ml HCA. Solution of experimental group contained 500 micrograms/ml Yisheng injection. In simple cold preservation test, involving in 8 experimental and 8 control testes, a series of time points (6, 12, 18, 24, 36, 48, 60, 72 hours) were set to harvest. 10 testes (1 testis respectively on 6, 12, 18, 24 and 36 hours in experimental and control groups) were reperfused with 37 degrees C HCA for 6 and 12 hours. Histological and histochemical changes were observed. RESULTS: In the experimental testes, 4 degrees C cold preservation in 24 hours could not induce obvious pathologic changes. After 24 hours, changes such as swelling, vacuolar degeneration or detachment of endothelial cells (ECs), separation between basement membrane and seminiferous epithelium, mal-alignment of spermatogenous cell and edema of mesenchyme could be observed. In the testes preserved for 12 hours, the activity of lactic dehydrogenase(LDH) and succinic dehydrogenase (SDH) increased, then fallen after 24 hours. The activity of Nitric oxide synthetase(NOS) decreased after 18 hours. All changes were more obvious after following 37 degrees C reperfusion. In the control testes, swelling and vacuolar degeneration of ECs occurred on 12 hours cold preservation, and injury was worse along with the prolongation of cold preservation time. Pathologic changes of ECs, seminiferous epithelium and mesenchyme were serious after 37 degrees C reperfusion. CONCLUSION: 4 degrees C cold preservation in 24 hours can only cause mild ECs’ injury, and obvious abnormal testes’ histological profile can be observed beyond 24 hours. 37 degrees C reperfusion will make injury worse. Yisheng injection can keep isolated testes histologic structure well in 24 hours cold preservation, and it has protective effect on I/R injury.
ObjectiveTo explore the possible association between early injury assessment indexes and the length of stay (LOS) in first-line hospitals, in order to help the hospitals take advantage of resource effectively and transfer victims reasonably during earthquakes. MethodWe retrospectively analyzed the medical information of 3 576 traumatic patients injured in the Wenchuan Earthquake who were transferred to 242 first-line medical institutes between 14:28, May 12th and 14:30, May 19th in 2008. Three kinds of 15 variables were extracted for the analysis, including gender, age, heart or lung disease, pre-hospital time, head injury, trunk injury, open injury, crush injury, asphyxia, body temperature, heart rate, respiration, systolic blood pressure, diastolic blood pressure, and Glasgow coma score. Multiple stepwise linear regression analysis was performed to identify the factors associated with LOS. ResultsThe multiple linear regression analysis showed that age as well as other six factors affected LOS significantly (P<0.05). The partial regression coefficients of age, pre-hospital time, head injury, trunk injury, crush injury, complication of cardiac or pulmonary disease, and Glasgow coma score were -0.062, 0.157, 3.703, 4.111, 12.602, 14.762 and -1.312, respectively. ConclusionsEarthquake trauma patients with older age, long pre-hospital time, head injury, trunk injury, heart or lung disease, crush injury, and lower Glasgow coma score are at increased risk for extended LOS.
ObjectiveTo observe the efficacy of and influencing factors for kirschner wire limited internal fixation plus external fixation for patients with tarsometatarsal fracture dislocation. MethodsThe efficacy of kirschner wire limited internal fixation plus external fixation treatment for patients with tarsometatarsal fracture dislocation treated between January 2004 and June 2009 was retrospectively analyzed,and we also investigated the impact of surgery time and ligament damage on its long-term prognosis. ResultsTwenty patients were included,consisting of 16 male and 4 female patients,ranging from 15 to 57 years old.The mean time of follow-up was 24.5 months,ranging from 11 to 41 months.At the time of follow-up,there were 5%(1/20),10%(2/20),50%(10/20) and 35%(7/20) patients with AOFAS ankle-hindfoot score at 0~69,70~79,80~89 and 90-100,respectively;and the excellent rate was 85% in total.In this cohort,the acceptance rate of the results of treatment was 95% at discharging and 85% at the final follow-up,and the difference between the above two time-points was not statistically significant.In addition,patients with earlier surgery treatment and lower degree of ligament injury had better long-term prognosis. ConclusionFor patients with tarsometatarsal fracture dislocation,treatment with kirschner wire limited internal fixation plus external fixation can not only effectively restore joint function,but also has minimum surgical trauma,and it is an effective method for the treatment of tarsometatarsal joint injuries.
Between 1988 and 1994, 78 cases (183 tendons) of flexor tendon injuries of the hand were repaired by microsurgical techique. The patients were followed up from4 to 6 months. The results were assessed according to the grading method of TAM. In 36 cases, 78 tendons were repaired by microsurgical suture and the excellentgood rate reached 76.2 per cent and the other 42 cases, 105 tendons were repaired with biological memberane wrapped arround the anastomotic site following microsurgical suture, in which, 32 cases, 77 tendons were followed up and the excellentgood rate was 89.5 per cent. The curative effect between the two groups hadsignificant difference statistically (Plt;0.05). Those cases with a bad results were mainly those injuries occurred in Zone II which had very poor soft tissue condition of the palm and thoes old cases having extensive scar tissue formation surrounding the tendon bed.
Objective To explore the clinical significance of exposure the recurrent laryngeal nerve（RLN） for preventing the RLN injury in thyroidectomy. Methods The data of 1 723 patients with thyroid diseases undergoing total or subtotal thyroidectomy from September 2006 to August 2011 were retrospectively reviewed. RLN were exposed in 914 cases, 1 203 RLNs were exposed（exposed group）. RLN were unexposed in 809 cases, 1 013 sides were cut（unexposed group）. To compare RLN injury rate after operation and recovery of vocal cord in 6 months after operation between the two groups. Results In exposed group, 11 cases had RLN injury, the rate of RLN lesion was 0.91%. In unexposed group, 21 cases had RLN injury, the rate of RLN lesion was 2.07%. The differences between the two groups had statistical significance（P＜0.05）. When six months after operation, 0 case and 13 cases in exposed group and unexposed group respectively occurred permanent RLN injury, the differences between the two groups had statistical significance（P＜0.01）. Conclusion Exposure of RLN in total and subtotal thyroidectomy can significant avoid RLN injury, especially RLN permanent injury.
OBJECTIVE To observe the ultrastructural changes and number of satellite cells in different muscles with different denervation interval and investigate the mechanism of denervation atrophy. METHODS Muscles of different denervation interval were harvested, which were 6 biceps brachii and 6 abductor digiti minimi. The ultrastructure of the samples were observed under transmission electron microscope. The number of nucleus and satellite cells were counted to calculate the percentage content of satellite cells. RESULTS In early stage of denervation, the myofilament and sarcomere of the majority were well oriented. The nucleoli of some muscle cell nucleus were enlarged and pale. Vacuolarization was also seen in some mitochondria. There was no obvious proliferation of collagen fiber around myofibers. After denervation of half a year, rupture and disorientation of myofilament was seen. The nucleus became smaller, dark stained, and some of them were condensed. There was proliferation of fibroblasts, adipose cells and collagen fibers around myofibers. Motor endplate was not recognized one year after denervation. In the early stage of denervation, satellite cell percentage of the two muscles was relatively high. It then declined with time. One year after denervation, satellite cells were scarcely detected. Comparison of the curves for satellite cell declination in two muscles revealed that the declination of the abductor digiti minimi was faster than that of biceps brachii. Decrease of the former started 3 months after denervation, while the latter started after 6 months. CONCLUSION Disappearing of motor endplate and proliferation of collagen fibers are main factors that affect the treatment outcome in late cases. Decrease of satellite cell number is another cause. The correlation of less satellite cell in abductor digiti minimi and poorer recovery of hand intrinsic muscles indicates that increment of satellite cells in long-term denervated muscles may be one of the effective measures to improve treatment outcome.
ObjectiveTo quantitatively determine the levels of type Ⅰ and type Ⅱ collagen mRNA in the intervertebral disc cartilage endplate of injured animal model, and to clarify the cytological function of intervertebral disc chondrocytes during fibrosis repair after intervertebral disc injury.MethodsForty healthy New Zealand rabbits were randomly divided into fibrosus puncture group, upper cartilage endplate single puncture group, upper and lower cartilage endplate multiple puncture group, and sham group. Two experimental animals were randomly selected from each group on the 2nd day, and the 2nd, 8th, 12th, and 24th week after the animal modeling operation to obtain intervertebral disc specimens. The levels of type Ⅰ collagen and type Ⅱ collagen in cartilage endplate cells of the intervertebral disc were determined by reverse transcriptase polymerase chain reaction (PCR). RNA was extracted from the endplate of the intervertebral disc, and the RNA concentration and the ratio of RNA concentration to protein concentration were determined by nucleic acid analyzer. Reverse transcription was performed by Revertaid M-Mulv reverse transcriptase, type Ⅰ and type Ⅱ collagen primers were designed to establish a PCR reaction system, 2% agarose gel electrophoresis (120 V, 40 min) was prepared by using 0.5×TBE electrophoresis buffer. The amplification results were observed under ultraviolet light, and the gray values of different electrophoresis bands were determined.ResultsThe level of type Ⅰ collagen mRNA in each operation group showed a progressive increase after 8 weeks, and the magnitude of the increase was related to the degree of injury. The level of type Ⅱ collagen mRNA showed a transient increase in the fibrosis puncture group and the upper endplate single-puncture group in the first two weeks after the endplate punctures were completed, and then began to decline progressively; in the multiple puncture group, it showed a downward trend from the beginning of the operation. ConclusionsThe synthesis of type Ⅰ collagen in chondrocytes of the injured nucleus pulposus tissue continues to increase with time, while the synthesis of type Ⅱ collagen begin to decrease progressively after a small increase. The formation and change of type Ⅰ and type Ⅱ collagen in injured intervertebral disc chondrocytes are different from natural degeneration.
ObjectiveCurrently, simple triage and rapid transport (START) is widely used as a method to evaluate the severity of mass casualty events in a disaster. Modified physiological triage tool (MPTT) and modified physiological triage tool-24 (MPTT-24) are newly introduced triage methodologies that may offer improvements over START. However, the feasibility and accuracy of these two methods cannot be adequately assessed without sufficient data support, whether in earthquakes or other disasters. Our study aimed to analyze the value of the three triage methodologies in mass casualty events due to earthquakes.MethodsA total of 36 604 injured patients from the West China Hospital database were evaluated using START, MPTT and MPTT-24, respectively. The triage methodologies were then evaluated based on death and ICU acceptance, using the area under the receiver-operator curve (AUC). The sensitivity and specificity of the three methodologies were compared under different standards and correlations with the injury severity score (ISS) were analyzed. ResultsFor deaths, the AUCs for the triage methodologies were 0.711, 0.775 and 0.686 for START, MPTT, and MPTT-24, respectively. For ICU acceptance, the AUCs of the triage methodologies after correction for bias were 0.579, 0.618 and 0.603. The correlation coefficients of the triage methodologies and ISS score were 0.041, 0.087, and 0.115.ConclusionsMPTT is superior to START and MPTT-24 in the evaluation of critically ill patients in mass casualty events caused by earthquakes.
Drug addiction has been one of the serious social problems. The peripheral phlebitis caused by drug injection is common, but the occurrence of pseudoaneurysm with infection of femoral artery from injection injury was rarely reported in China. From January 1995 to March 1996, six cases of injury of femoral artery with infection from heroine injection were admitted. The characteristics of the injury were described. The therapeutic measures and details of attention to be needed were discussed. It was concluded that this type of injury was different from the injury caused in agricultural, industrial or traffic accidents. The treatment of choice depended upon the type of injury.