Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.Th...Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.The patients were divided into observation group(n=15)and control group(n=40)according to received perioperative cranial ultrasound or not.The general data and surgical data were compared between groups,and ultrasonic data of observation group were analyzed.Results The proportions of good prognosis 1 and 6 months after operation in observation group were both higher than those in control group,while the incidence of cerebral infarction in observation group was lower than that in control group(all P<0.05).No significant difference of general data nor other surgical data was found between groups(all P>0.05).Acute encephalocele occurred in 1 case in observation group during operation,and cranial ultrasound accurately showed the contralateral secondary epidural hematoma.Increased intracranial pressure in different degrees were found in all 15 cases(15/15,100%)in observation group after operation with transcranial color coded Doppler(TCCD)or transcranial Doppler(TCD),while cerebral vascular spasm was observed in 5 cases(5/15,33.33%),among them 4 cases(4/5,80.00%)were diagnosed cerebral infarction based on CT examination.Conclusion Cranial ultrasound could be used to evaluate changes of sTBI in perioperative period and guide adjusting treatment strategy in time,being valuable for reducing risk of postoperative cerebral infarction and improving prognosis.展开更多
Background Different kinds of minimally invasive surgery （MIS） procedures have now been used in total knee arthroplasty （TKA）. Compared with traditional TKA procedure with a long skin incision, clinical studies sh...Background Different kinds of minimally invasive surgery （MIS） procedures have now been used in total knee arthroplasty （TKA）. Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing （QS） procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients＇ vastus medialis and if the QS procedure had some advantages in patients＇ early recovery. Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees （15 men and 91 women, with a mean age of 65.1±7.4 years）; osteoarthritis in 97 patients （91.5%） and rheumatoid arthritis in 9 patients （8.5%）. MIS TKA was performed in 49 cases （MIS TKA group）, while MIS-QS TKA in 57 cases （MIS-QS TKA group）. During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery （HSS） scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded. Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 （0.9%） case with a type Ⅰ insertion of the vastus medialis, 4 （3.8%） cases with type Ⅱ insertions, 101 （95.3%） cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was （53.3±12.4） minutes in the MIS TKA group and （64.1±15.1） minutes in the MIS-QS TKA group （P 〈0.001）. In the MIS-QS TKA group, 1 patient had delayed healing of the partial skin incision （1.8%）. No other complications were found in either group. Conclusions Although most of the Chinese patients had type Ⅲ insertions of the vastus medialis, the MIS-QS TKA procedure showed less injury to the quadriceps than the standard MIS TKA and this could contribute to the earlier recovery of of the patients. But a shorter-skin incision and more tension on the skin may also lead to more skin complications.展开更多
Background Successful lung transplantation has been limited by the scarcity of donors. Brain death （BD） donors are major source of lung transplantation. Whereas BD process induces acute lung injury and aggravates lu...Background Successful lung transplantation has been limited by the scarcity of donors. Brain death （BD） donors are major source of lung transplantation. Whereas BD process induces acute lung injury and aggravates lung ischemia reperfusion injury. Carbon monoxide （CO） inhalation at 50-500 parts per million （ppm） can ameliorate lung injury in several models. We examined in rats whether CO inhalation in BD donor would show favorable effects on lung grafts. Methods Rats were randomly divided into 4 groups. In sham group, donor rats received insertion of a balloon catheter into the cranial cavity, but the balloon was not inflated. In BD-only group, donor rats were ventilated with 40% oxygen after BD confirmation. In BD＋CO250 and BD＋CO500 groups, donor rats inhaled, after BD confirmation, 250 ppm or 500 ppm CO for 120 minutes prior to lung procurement, and orthotopic lung transplantation was performed. The rats were sacrificed 120 minutes after the lung transplantation by exsanguination, and their blood and lung graft samples were obtained. A total of 8 rats fulfilling the criteria were included in each group. Results The inhalation decreased the severity of lung injury in grafts from BD donors checked by histological examination. CO pretreatment reversed the aggravation of PaO2/FiO2 in recipients from BD donors. The CO inhalation down-regulated pro-inflammatory cytokines （TNF-α, IL-6） along with the increase of anti-inflammatory cytokine （IL-10） in recipient serum, and inhibited the activity of myeloperoxidase in grafts tissue. The inhalation significantly decreased cell apoptosis in lung grafts, inhibiting mRNA and protein expression of intercellular adhesion molecule-1 （ICAM-1） and caspase-3 in lung grafts. Further, the inhalation activated phosphorylation of p38 expression and inhibited phosphorylation of anti-extracellular signal-regulated kinase （ERK） expression in lung grafts. The effects of CO at 500 ppm were greater than those at 250 ppm. Conclusions CO exerts potent protective effects on lung grafts from BD donor, exhibiting anti-inflammatory and anti-apoptosis functions by modulating the mitogen-activated protein kinase （MAPK） signal transduction.展开更多
文摘Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.The patients were divided into observation group(n=15)and control group(n=40)according to received perioperative cranial ultrasound or not.The general data and surgical data were compared between groups,and ultrasonic data of observation group were analyzed.Results The proportions of good prognosis 1 and 6 months after operation in observation group were both higher than those in control group,while the incidence of cerebral infarction in observation group was lower than that in control group(all P<0.05).No significant difference of general data nor other surgical data was found between groups(all P>0.05).Acute encephalocele occurred in 1 case in observation group during operation,and cranial ultrasound accurately showed the contralateral secondary epidural hematoma.Increased intracranial pressure in different degrees were found in all 15 cases(15/15,100%)in observation group after operation with transcranial color coded Doppler(TCCD)or transcranial Doppler(TCD),while cerebral vascular spasm was observed in 5 cases(5/15,33.33%),among them 4 cases(4/5,80.00%)were diagnosed cerebral infarction based on CT examination.Conclusion Cranial ultrasound could be used to evaluate changes of sTBI in perioperative period and guide adjusting treatment strategy in time,being valuable for reducing risk of postoperative cerebral infarction and improving prognosis.
文摘Background Different kinds of minimally invasive surgery （MIS） procedures have now been used in total knee arthroplasty （TKA）. Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing （QS） procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients＇ vastus medialis and if the QS procedure had some advantages in patients＇ early recovery. Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees （15 men and 91 women, with a mean age of 65.1±7.4 years）; osteoarthritis in 97 patients （91.5%） and rheumatoid arthritis in 9 patients （8.5%）. MIS TKA was performed in 49 cases （MIS TKA group）, while MIS-QS TKA in 57 cases （MIS-QS TKA group）. During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery （HSS） scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded. Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 （0.9%） case with a type Ⅰ insertion of the vastus medialis, 4 （3.8%） cases with type Ⅱ insertions, 101 （95.3%） cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was （53.3±12.4） minutes in the MIS TKA group and （64.1±15.1） minutes in the MIS-QS TKA group （P 〈0.001）. In the MIS-QS TKA group, 1 patient had delayed healing of the partial skin incision （1.8%）. No other complications were found in either group. Conclusions Although most of the Chinese patients had type Ⅲ insertions of the vastus medialis, the MIS-QS TKA procedure showed less injury to the quadriceps than the standard MIS TKA and this could contribute to the earlier recovery of of the patients. But a shorter-skin incision and more tension on the skin may also lead to more skin complications.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 30571784）.Acknowledgements： The authors are grateful to JIN Di and GUO Yue-ping for their support and technical assistance, and professor Tsutomu Kobayashi for reviewing the manuscript.
文摘Background Successful lung transplantation has been limited by the scarcity of donors. Brain death （BD） donors are major source of lung transplantation. Whereas BD process induces acute lung injury and aggravates lung ischemia reperfusion injury. Carbon monoxide （CO） inhalation at 50-500 parts per million （ppm） can ameliorate lung injury in several models. We examined in rats whether CO inhalation in BD donor would show favorable effects on lung grafts. Methods Rats were randomly divided into 4 groups. In sham group, donor rats received insertion of a balloon catheter into the cranial cavity, but the balloon was not inflated. In BD-only group, donor rats were ventilated with 40% oxygen after BD confirmation. In BD＋CO250 and BD＋CO500 groups, donor rats inhaled, after BD confirmation, 250 ppm or 500 ppm CO for 120 minutes prior to lung procurement, and orthotopic lung transplantation was performed. The rats were sacrificed 120 minutes after the lung transplantation by exsanguination, and their blood and lung graft samples were obtained. A total of 8 rats fulfilling the criteria were included in each group. Results The inhalation decreased the severity of lung injury in grafts from BD donors checked by histological examination. CO pretreatment reversed the aggravation of PaO2/FiO2 in recipients from BD donors. The CO inhalation down-regulated pro-inflammatory cytokines （TNF-α, IL-6） along with the increase of anti-inflammatory cytokine （IL-10） in recipient serum, and inhibited the activity of myeloperoxidase in grafts tissue. The inhalation significantly decreased cell apoptosis in lung grafts, inhibiting mRNA and protein expression of intercellular adhesion molecule-1 （ICAM-1） and caspase-3 in lung grafts. Further, the inhalation activated phosphorylation of p38 expression and inhibited phosphorylation of anti-extracellular signal-regulated kinase （ERK） expression in lung grafts. The effects of CO at 500 ppm were greater than those at 250 ppm. Conclusions CO exerts potent protective effects on lung grafts from BD donor, exhibiting anti-inflammatory and anti-apoptosis functions by modulating the mitogen-activated protein kinase （MAPK） signal transduction.
