ObjectiveTo investigate the safety, feasibility, and efficacy of full repair strategy under small incision in the treatment of closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture.MethodsThe clinical data of 57 patients with closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture treated by full repair strategy (fracture, ligament, and cartilage repair) under small incision between January 2012 and January 2017 were retrospectively analyzed. There were 31 males and 26 females, with an average age of 41.1 years (range, 21-65 years). The causes of injury included traffic accident injury in 33 cases and falling injury in 24 cases. All of them were closed fractures, including 20 cases of medial malleolus fracture, 37 cases of complete medial malleolus but deep and shallow rupture of deltoid ligament. The average time from injury to admission was 9.6 hours (range, 3-34 hours). The quality of reduction of distal tibial articular surface (based on Ketz-Sanders standard), the reduction of tibiofibular syndesmosis (the anterior and posterior distances of distal tibiofibular syndesmosis and the lateral ankle twist angle measured by CT scan at 10 mm above the ankle joint line), and the fracture healing were evaluated. The medial clear space (MCS), tibiofibular clear space (TFCS), and distal fibular tip to lateral process of talus (DFTL) were measured on the X-ray films of ankle points. Before and after operation, the pain and functional improvement of ankle joint were evaluated by visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Association (AOFAS) score, and the activities of ankle dorsiflexion and plantar flexion were measured.ResultsThree cases with osteochondral lesions of the talus were found during operation and all were treated with microfracture techniques. Tournament paralysis occurred in 2 cases after anesthesia. The surgical incisions healed by first intention in all patients. All the 57 patients were followed up 24-84 months, with an average of 38.6 months. All patients achieved bone healing without bone nonunion and malunion at 12 months after operation. The reduction quality of distal tibial articular surface was excellent in 56 cases and good in 1 case at 3 months after operation, the excellent and good rate was 100%. There was no significant difference in the MCS, TFCS, DFTL, anterior distance of distal tibiofibular syndesmosis, posterior distance of distal tibiofibular syndesmosis, and lateral ankle twist angle between the affected and healthy sides at 12 months after operation (P>0.05). At last follow-up, the VAS score, AOFAS score, ankle dorsiflexion and plantar flexion activities of the affected side were significantly improved when compared with preoperative ones (P<0.05). Compared with the healthy side, there was no significant difference in ankle dorsiflexion and plantar flexion activities (P>0.05).ConclusionFull-repair strategy under small incisions for the treatment of Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture is effective and safe. It can not only reduce wound complications, but also improve the quality of joint reduction of the ankle joint and distal tibiofibular syndesmosis. Full repair of ligaments and cartilage can improve the internal fixation strength and joint stability of the ankle joint.
ObjectiveTo provide references for postoperative analgesia treatment for cirrhotic patients with bone fracture. MethodsOne elderly patient with liver cirrhosis and fracture was admitted to our hospital on July 9, 2013. We obtained medical evidences by searching databases and regulated the best treatment after evaluating the patient's comprehensive conditions. And then, the whole treatment strategy was fully implemented. Finally, the consequent results were evaluated. ResultsWe identified 22 relevant articles including one clinical guideline, three cochrane reviews, five systematic reviews, seven small sample randomized controlled trials, one high quality observational study, and five quantitative reviews. We found that opioid analgesics utilization combined with non-opioid analgesics could not only reduce the occurrence of opioid drug adverse reactions, but increase analgesia safety. Cox-2 inhibitors could be used as the first choice of non-opioid drugs due to the less adverse reaction and better analgesic effectiveness. ConclusionFor femur fracture patients with liver cirrhosis, treatment decision based on evidence-based medicine is more scientific, which can ensure maximum benefit for the patients.
Valvular heart disease is a structural or functional disease of the heart due to rheumatic fever, congenital malformation, infection, or trauma, resulting in abnormal cardiac hemodynamics and ultimately heart failure. Implantation of artificial heart valves has become the main way to treat heart valvular disease. Because the structure of the artificial heart valve plays a key role in the stress distribution and hemodynamic performance of the valve and stent, the geometric configuration of the artificial heart valve is constantly updated and improved during its development from mechanical valve to biological valve, which closely mimics the geometric characteristics of the normal natural heart valve. This article sums up the design process of geometric configuration of artificial heart valves and the influence of geometric configuration on the central disc stress and durability of artificial heart valves, analyzes the important parameters of geometric modeling for artificial heart valves, and discusses the development of the corresponding modeling method, to provide reference and new ideas for the biomimetic optimization design of artificial valves.
ObjectiveTo study the clinical significance of color Doppler ultrasound in the diagnosis of intussusception in children. MethodsWe retrospectively analyzed the color Doppler ultrasound results of 150 children with intussusception confirmed by X-ray air enema and surgery between January 2010 and December 2012. ResultsThe 150 children included 18 cases of necrosis, and 132 cases of simple edema; there were 122 cases of ileocecal intussusception, 22 cases of colon, and 6 of small intestine. Surgical treatment was performed for 30 cases, and 120 cases were treated with X-ray air enema reduction. Ultrasonic diagnosis was correct in 144 cases with an accurate rate of 96.0%; 6 cases were misdiagnosed, and misdiagnosis rate was 4.0%. ConclusionUltrasound in the diagnosis of children intussusception is simple, rapid, non-invasive, with no side-effects of radiation exposure, and selection of this method clinically has a very important significance.
目的探讨两种不同途径的营养方式对食管癌患者术后恢复的影响。 方法选取浙江省台州医院心胸外科2007～2011年63例食管癌患者术后的不同营养支持，分为肠内营养（enteral nutrition，EN）组（33例）和肠外营养（parenteral nutrition，PN）组（30例），比较两组的术后胃肠功能恢复、营养指标、并发症情况、住院费用、住院时间及肝功能等影响。 结果EN组与PN组的排气时间[（42.30±6.70）h vs.（60.60±15.60）h，P＜0.01]、住院时间[（15.40±6.55）d vs.（21.00±10.57）d，P＜0.01]、住院费用[（4.49 ±1.28）万元vs.（4.73 ±1.18）万元，P＜0.01]差异均有统计学意义。两组术后均无吻合口漏等严重并发症，两组术后白蛋白水平较术前有不同程度下降，术后肝功能PN组较EN组变化大，两组差异有统计学意义（P＜0.01）。 结论两种营养方式均能改善患者的术后营养状况，但肠内营养更符合生理特点、廉价，适应现代营养支持，较静脉营养有优势。
【摘要】 目的 通过检测临床确诊为慢性乙型肝炎患者血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、甲状腺激素T3、T4及促甲状腺素（TSH）含量，进一步探讨慢性乙型肝炎患者肝损情况与甲状腺分泌功能的关系。 方法 收集2009年1-4月79例确诊为慢性乙型肝炎患者（病例组）血清标本，分别检测其ALT、AST、甲状腺激素T3、T4及TSH含量。以同期健康体检者30例作为对照组。比较两组的差异及各指标间的相关性。 结果 病例组AST为（87±113） U/L、ALT为（135±241） U/L、AST/ALT为0.97±0.57、TSH为（1.63±1.29） mU/L、T3为（1.61±0.52）ng/mL、T4为（10.7±2.9） μg/dL，对照组分别为（23±5） U/L、 （18±5） U/L、1.31±0.26、（2.13±0.90） mU/L、（1.19±0.16） ng/mL和（8.6±0.9） μg/dL，两组各指标比较均有统计学差异（Plt;0.01）。所有指标均正常的共有6例（7.6%），有73例（92.4%）存在不同程度的指标异常；在68例AST/ALT比值降低的慢性乙型肝炎患者（93.2%）中，伴有单纯T4升高的有11例（16.2%），单纯T3升高的有4例（5.9%），T3、T4同时升高的有11例（16.2%），T3、T4同时升高且TSH降低的有2例（2.9%），1例T4升高且TSH降低（1.5%），1例仅TSH升高（1.5%）；在4例AST/ALT比值正常的慢性乙型肝炎患者（5.5%）中，有1例T3、T4同时升高且TSH降低，1例T3和T4同时升高，1例单纯T4升高，1例单纯TSH降低；有1例仅AST/ALT比值升高而其他项正常。 结论 慢性乙型肝炎患者除AST/ALT比值异常外，还同时伴有不同程度的甲状腺激素指标异常，其原因可能与慢性乙型肝炎应用干扰素治疗时甲状腺功能受损有关。【Abstract】 Objective To explore the relationship between liver damage and the secretion function of thyroid by detecting the serum alanine aminotransferase (ALT), aspartate aminotransferase(AST), T3, T4, and thyroid stimulating hormone (TSH) in patients with chronic hepatitis B. Methods The serum samples of 79 patients with chronic hepatitis B from January to April 2009 were collected, and the ALT, AST, T3, T4, and TSH concentrations were detected. Another 30 healthy subjects were selected as the control. The detected indexes were compared between the two groups. Results In the case group, the concentration of AST was (87±113)U/L, ALT was (135±241)U/L,AST/ALT was 0.97±0.57, TSH was (1.63±1.29) mU/L, T3 was (1.61±0.52) ng/mL, and T4 was (10.7±2.9) μg/dL; while in the control group, the concentrations of the items were (23±5) U/L, (18±5)U/L, 1.31±0.26, (2.13±0.90) mU/L, (1.19±0.16) ng/mL, and (8.6±0.9) μg/d L, respectively. The differences between the two groups were significant (Plt;0.01). Among the 79 case, 6 (7.6%) had a totally normal result, and 73(92.4%) had an abnormal result. There were 68 patients who had a low ratio of AST/ALT, among whom 11 (16.2%) had a simple T4 elevation, 4(5.9%) had a simple T3 elevation,11(16.2%) had an elevation of both T3 and T4, 2 (2.9%) had an elevation of both T3 and T4 and a depression of TSH, 1(1.5%) had an elevation of T4 and a depression of TSH, and 1 (1.5%) had a simple TSH elevation. There were 4 cases who had a normal ratio of AST/ALT, among whom 1 had an elevation of both T3 and T4 and a depression of TSH, 1 had an elevation of both T3 and T4, 1 had a simple T4 elevation, and 1 had a simple TSH depression. There was 1 case who had only an elevation of AST/ALT. Conclusion Most of the patients with chronic hepatitis B have an abnormal result of thyroid hormone together with the abnormal ratio of AST and ALT. The reason mainly lies in the damage of thyroid function by the usage of interferon for the therapy of chronic hepatitis B.
Biodegradable stents (BDSs) are the milestone in percutaneous coronary intervention(PCI). Biodegradable polymeric stents have received widespread attention due to their good biocompatibility, moderate degradation rate and degradation products without toxicity or side effects. However, due to the defects in mechanical properties of polymer materials, the clinical application of polymeric BDS has been affected. In this paper, the BDS geometric configuration design was analyzed to improve the radial strength, flexibility and reduce the shrinkage rate of biodegradable polymeric stents. And from the aspects of numerical simulation, in vitro experiment and animal experiment, the configuration design and mechanical properties of biodegradable polymeric stents were introduced in detail in order to provide further references for the development of biodegradable polymeric stents.
Due to their diverse types, complex causes, high incidence, and difficult treatment, lung diseases have become major killers threatening human life and health, and some lung diseases have a significant impact on alveolar morphology and histology. Numerical simulation of alveolar mechanical response, alveolar flow field information, multiphase flow, and material transport based on computational fluid dynamics is of great significance for lung disease diagnosis, clinical treatment, and in vitro experiments. Starting from the simplification and pathological differences of geometric and mechanical models, this paper analyzes and summarizes the conditions and application scenarios of the airflow dynamics calculation method in pulmonary alveoli, to provide a reference for further simulation and application of the alveolar region.
Objective To investigate the correlation of intracranial arachnoid cyst (IAC) with epilepsy and the possible mechanism of seizure induced by IAC. Methods Patients with IAC, who were treated in West China Hospital of Sichuan University between January 2009 and January 2019, were included and divided into IAC with epilepsy group and IAC without epilepsy group according to whether they were diagnosed with epilepsy. We collected the IAC location information of all subjects after the establishment of a three-dimensional spatial coordinate system of MRI images. Computational fluid dynamics technology was used to establish a blood vessel model in cyst area and perform hemodynamic analysis basing on contrast-enhanced CT images. Results A total of 72 patients were enrolled, including 24 in the IAC with epilepsy group and 48 in the IAC without epilepsy group. There was no significant difference between the two groups in terms of sex, age, IAC location, the volumes or the maximum diameters of IAC (P>0.05). Consecutive areas formed by the seven high-risk areas found in the IAC with epilepsy group were located in the temporal area. The seven high-risk areas were simultaneous IAC location in 5 patients in the IAC with epilepsy group and in 1 patient in the IAC without epilepsy group, and the difference was statistically significant (χ2=5.114, P=0.024). Comparison of the hemodynamic parameters between the two types of vascular models revealed similar pressure changes and blood pressure parameters, with lower blood flow and higher mean vascular wall shear stress in the IAC with epilepsy group. Conclusions IAC may cause epilepsy by increasing adjacent blood vessel stenosis and blood vessel wall shear stress through cyst space-occupying effect. The most common location of IAC with epilepsy is the temporal area. The occupying effect of IAC should be considered in the location of epileptogenic foci before surgery for IAC patients with epilepsy.