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ObjectiveTo develop basic training courses for family doctor teams for people with disabilities. MethodsUtilizing the methods and theories of the World Health Organization (WHO) rehabilitation competency framework (RCF), and referring to the WHO universal health coverage global competency framework, the rehabilitation competency characteristics of family doctor teams for people with disabilities in community settings were analyzed, and a basic training course system for these teams based on the RCF was developed. Results and ConclusionBased on RCF, a competency framework for family doctor teams serving people with disabilities has been constructed. The objectives, content and training course system for basic rehabilitation training has been established.
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Objective:To compare the clinical effects robot navigation assisted and conventional proximal femoral nail antirotation (PFNA) implantation and fixation in the treatment of elderly femoral trochanteric fractures.Methods:A total of 86 elderly patients with tuberosity fracture of the femur were admitted as research samples from January to March in 2022 in the Department of Trauma Orthopaedic, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University, including 37 males and 49 females, who aged from 63 to 92 years, with an average age of (79.6 ± 6.9) years. All patients were treated with intramedullary nails (PFNA), 32 with dimensity robotic-assisted therapy (robot group) and 54 with traditional methods (conventional group). The length of incision, the number of intraoperative fluoroscopy, the amount of intraoperative blood loss, and the operation time were recorded. The occurrence of postoperative complications in the two groups was observed. The rate of excellent hip Harris score at 3 month after surgery was compared between the two groups. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)], and was conducted by Chi-square test or Fisher exact probability between groups. Results:All patients were followed up for 9 to 12 months, with an average of (10.6 ± 0.9) months. The incision length and tip apex distance (TAD) of the robot group were (3.40±0.82) cm and (21.85±1.44) mm, which were smaller than (4.82±0.75) cm and (26.83±1.75) mm in the conventional group ( P<0.05 for all). The number of intraoperative fluoroscopy and guide needle adjustment [(14.53±3.26) and 0 times] in the robot group were less than those in the conventional group [(20.67±4.84) and (2.83±1.42)] ( P<0.05). The intraoperative blood loss and drainage rate of the robot group were (87.03±9.41) and (46.40±8.91) mL, which were smaller than that of the conventional group [(110.00±12.52) and (69.62±10.22) mL] ( P<0.05). There was no significant difference in the number of days of hospitalization and operation time between the two groups ( P>0.05). The postoperative complication rate in the robot group was 9.4%, which was lower than that in conventional group (42.6%), and the difference was statistically significant ( χ2=11.88, P=0.036). The excellent rate of postoperative hip joint function in the robot group was 75.0%, and the conventional group was 66.7%, and there was no significant difference between the two groups ( χ2=0.66, P=0.416). Conclusion:Robot-assisted navigation downward PFNA surgery can have good clinical effect in the treatment of femoral tuberosity fracture in the elderly, which can reduce the number of surgical incisions and intraoperative fluoroscopy, and reduce the incidence of postoperative complications, which is helpful to achieve minimally invasive surgery and rapid recovery of elderly patients with femoral tuberosity fracture.
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Objective:To investigate the iodine intake and iodine nutritional status of pregnant women in different water iodine areas of Tianjin, and to provide a basis for formulating appropriate intervention measures in high water iodine areas.Methods:From January to September 2016, 90, 91 and 71 pregnant women were randomly selected as research subjects in different water iodine areas in Tianjin (water iodine ≤150, > 150 - 300 and > 300 μg/L) via the random sampling method. Samples of salt, drinking water and urine were collected from pregnant women. A semi-quantitative food frequency questionnaire was used to investigate the intake of 12 kinds of food eating by pregnant women in the past year. Salt iodine content was determined by direct titration, water iodine content was determined by ceric sulfate catalytic spectrophotometry, and urinary iodine was determined by arsenic-cerium catalytic spectrophotometry.Results:There was no statistically significant difference in salt iodine intake among pregnant women in different water iodine areas ( H = 2.29, P = 0.318); the difference in drinking water iodine intake (7.50, 282.60, 544.35 μg/d) was statistically significant ( H = 223.31, P < 0.001), and further pairwise comparison found that the differences were statistically significant ( P < 0.001); the difference in food iodine intake was not statistically significant ( H = 2.19, P = 0.334). With the increase of water iodine content in various regions, the contribution rate of drinking water iodine intake gradually increased. The medians of urinary iodine in pregnant women in different water iodine areas were 113.50, 180.55 and 268.55 μg/L, respectively, and there was a positive correlation between urine iodine content and total iodine intake ( rs = 0.31, P < 0.001). Conclusions:The iodine nutrition level of pregnant women in areas with water iodine ≤150 μg/L is insufficient (< 150 μg/L), so the consumption rate of iodized salt should be increased to prevent the occurrence of iodine deficiency disorders. The iodine nutrition level of pregnant women in areas with water iodine > 300 μg/L exceeds the appropriate amount (250 - 499 μg/L), pregnant women should control the intake of foods with high iodine content and take measures to improve water as soon as possible to reduce iodine.
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Objective:To observe the postoperative complications and revision rates of robot arm-assisted unicompartment arthroplasty by means of a meta-analysis.Methods:Relevant databases including Cochrane Library, PubMed, EMBASE, Wanfang, VIP, CNKI, and Web of Science were searched by computer for high-quality studies on complications and revision rates after robot arm-assisted unicompartment arthroplasty in both English and Chinese from the database establishment date to March 2021. The quality of the studies retrieved was evaluated. Relevant data including postoperative complications, infection, pain, prosthesis loosening, and revision were extracted for a meta-analysis using STATA 15.0 software.Results:A total of 16 studies were included, including one randomized controlled study, 6 case-control studies and 9 cohort studies. By the methodological index for non-randomized studies (MINORS), 7 studies scored 14 points, 3 studies 13 points, one study 12 points, 4 studies 11 points, and one study 10 points. Meta analysis showed that the total rate of complications was 2% (95% CI: 1%to 4%) . Three studies used NAVIO robot, 7 studies MAKO robot, one study NAVIO and MAKO robots, and one study Acrobot robot. Since just one study used Acrobot robot, only MAKO and NAVIO robots were included for the subgroup analysis which showed that the postoperative complication rates for NAVIO and MAKO robots were 4.0% (95% CI: -2% to 10%) and 3% (95% CI: 1% to 5%) , respectively. The incidence of postoperative pain was 0.2% (95% CI: 0.1% to 0.3%), the incidence of postoperative infection 0.5% (95% CI: 0.3% to 0.8%), the incidence of postoperative prosthesis loosening 0.5% (95% CI: 0.3% to 0.8%), and the revision rate 2% (95% CI: 1% to 2%). According to the subgroup analysis of NAVIO and MAKO robots, their revision rates were 4% (95% CI: 2% to 7%) and 2% (95% CI: 1% to 2%), respectively. Conclusion:The clinical efficacy of robot arm-assisted unicompartment arthroplasty is good, for the complications in the patients are limited and the long-term survival rate of the prosthesis is excellent.
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The S1 protein of the infectious bronchitis virus (IBV) is a major structural protein that induces the production of the virus-neutralization antibodies. The monoclonal antibody against the IBV M41 S1 protein was used as a target for biopanning. After three rounds of biopanning, randomly selected phages bound to the monoclonal antibody. Sequence analysis showed that the dominant sequence was SFYDFEMQGFFI. Indirect competitive enzymelinked immunosorbent assay showed that SFYDFEMQGFFI is a mimotope of the S1 protein that was predicted by PepSurf. The mimotope may provide information for further structural and functional analyses of the S1 protein.
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The S1 protein of the infectious bronchitis virus (IBV) is a major structural protein that induces the production of the virus-neutralization antibodies. The monoclonal antibody against the IBV M41 S1 protein was used as a target for biopanning. After three rounds of biopanning, randomly selected phages bound to the monoclonal antibody. Sequence analysis showed that the dominant sequence was SFYDFEMQGFFI. Indirect competitive enzymelinked immunosorbent assay showed that SFYDFEMQGFFI is a mimotope of the S1 protein that was predicted by PepSurf. The mimotope may provide information for further structural and functional analyses of the S1 protein.
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Objective:To study the influence of anticoagulation timing on incidence of perioperative deep venous thrombosis (DVT) in elderly patients with hip fracture.Methods:A retrospective analysis was made of the 179 elderly patients with hip fracture who had been admitted to Department of Orthopedics and Traumaology, Hong-Hui Hospital from July 2017 to December 2018. They were 78 males and 101 females, aged from 62 to 91 years (mean, 79.5 years). There were 79 femoral neck fractures and 100 intertrochanteric fractures, 109 of which were treated by internal fixation and 70 by hip replacement. The patients were divided into 3 groups depending on the timing of anticoagulation after injury. In group 1 of 74 cases, anticoagulation started <24 h after injury; in group 2 of 36 cases, anticoagulation started 24 to 48 h after injury; in group 3 of 69 cases, anticoagulation started >48 h after injury. Anticoagulation continued until 12 h before surgery in all patients but was resumed 8 to 12 h after surgery. The 3 groups were compared in incidence of perioperative DVT.Results:The 3 groups were comparable due to insignificant differences between them in their pre-operative general data ( P>0.05). DVT occurred perioperatively in 84 patients, yielding an incidence of 46.9% (84/179). The incidences of perioperative DVT were 27.0% (20/74), 47.2% (17/36) and 68.1% (47/69) in groups 1, 2 and 3, respectively, showing significant differences ( χ2=24.206, P<0.001), between any 2 groups ( P<0.05). Conclusion:Since the earlier anticoagulation starts after injury the lower incidence of perioperative DVT in elderly patients with hip fracture, early standardized prophylactic anticoagulation after injury can effectively reduce incidence of perioperative DVT.
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Objective:To observe the functional remodeling of the default mode network (DMN) of patients with post-stroke cognitive impairment (PSCI) in response to transcranial direct current stimulation (tDCS) and to explore the mechanisms involved.Methods:Eighteen PSCI patients and twenty healthy controls were enrolled. The PSCI patients were given 20 minutes of tDCS at 2.0mA on the dorsolateral prefrontal cortex every weekday for four weeks. The subjects were scanned using resting state functional magnetic resonance imaging before and after the intervention to explore any functional changes in the DMN. Montreal cognitive assessment (MoCA) scoring was performed before and after the treatment.Results:Compared to the healthy controls, the cognitively impaired patients showed significant abnormalities in the DMN on admission, including decreased functinal connection (FC) in the posterior cingulate cortex and/or precuneus (PCC/PCu), as well as increased FC in the medial prefrontal cortex (MPFC) and left hippocampus. After the treatment, a significant improvement in the PSCI patients′ average MoCA score was observed. The average FC of the PCC/PCu had also increased significantly, while that of the left hippocampus had decreased significantly, on average. The FC in the PCC/PCu after tDCS was found to be positively related to the MoCA score measured at 4 weeks after admission.Conclusions:PSCI patients show functional abnormalities in the DMN. tDCS applied to their dorsolateral prefrontal cortex can significantly improve their average MoCA scores, which may be related to the increasing FC of the PCC/PCu.
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Objective To study the iodine nutritional status in the key population in Tianjin before and after the implementation of the new standards of iodized salt content, and to provide a scientific basis for iodine supplementation. Methods According to the method of population proportion sampling, the family edible salt samples, the urinary iodine and goiter of children aged 8-10 years and the urinary iodine level of pregnant women were investigated before the adjustment of salt iodine content (2005, 2011) and after the adjustment (2014, 2017). The results were compared and analyzed. Results The median of salt iodine after the adjustment (26.05mg/kg) was significantly lower than that of before (30.20mg/kg, Z=12.867, P2=221.916, 309.405, 540.148, respectively, P 2=0.196, P=0.658). After stratified analysis based on salt iodine content, it was found that among children who took iodized salt and qualified iodized salt, the median urine iodine after adjustment was lower than that before adjustment, and the difference was statistically significant (Z=2.726, 2.742, all P2=4.769, P=0.029). Conclusion After adjusting the salt iodine content in Tianjin, children's iodine nutrition was optimized from a higher level to an appropriate level, and thyroid goiter rate of children remained at low level. The iodine nutrition of pregnant women was slightly lower than adequate level, but the proportion of pregnant women at the adequate level increased. The new standard of iodine salt was appropriate, but the proportion of children with urine iodine <100μg/L increased, which needs to be monitored. At the same time, the iodized salt coverage rate and the qualified iodized salt consumption rate did not reach the elimination standard of iodine deficiency diseases, and the supervision of the salt industry market should be strengthened.
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Objective:To explore the efficacy of our novel reduction technique in the surgical treatment of complicated tibial plateau fractures.Methods:From May 2016 to September 2018, 50 fractures of tibial plateau (Schatzker types Ⅴ and Ⅵ) were treated at Department of Orthopaedics and Traumatology, Hong Hui Hospital. They were 34 males and 16 females, aged from 27 to 56 years (average, 42.3 years). They were divided into 2 groups according to the reduction techniques. In the group of novel reduction ( n=23), bone fragments were reduced one by one from the distal to the proximal until the compression fracture was reduced and fixated. In the conventional reduction group ( n=27), the articular surface was reduced first before fixation of articular fragments with distal ends of tibial fracture. The 2 groups were compared in terms of intraoperative bleeding, operation time, tibial plateau angle (TPA) on the knee anteroposterior X-ray film taken on the second day after operation, and rate of acceptable TPA (±5°). Results:There were no significant differences between the 2 groups in general preoperative data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in either operation time (2.7 h ± 0.4 h versus 3.0 h ± 0.6 h) or intraoperative bleeding (215 mL ± 56 mL versus 221 mL ± 52 mL) ( P>0.05). The novel reduction group had a significantly higher rate of acceptable TPA [78.2% (18/23)] than the conventional reduction group [48.1%(13/27)]( P<0.05). Conclusion:In the surgical treatment of complicated tibial plateau fractures, compared with conventional reduction technique, our novel reduction technique can increase the rate of acceptable reduction but not operation time nor intraoperative bleeding.
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Objective:To explore the clinical efficacy of proximal femoral anatomical locking plate and autogenous iliac graft for failed primary internal fixation in treatment of femoral intertrochanteric fracture.Methods:A retrospective analysis was conducted of the 29 patients with femoral intertrochanteric fracture who had been treated after failed primary internal fixation at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital between January 2014 and March 2017. They were 17 men and 12 women, aged from 35 to 83 years (mean, 68.7 years). Their primary internal fixation involved dynamic hip screw in 12 cases, proximal femoral locking plate in 13 cases, and intramedullary nail in 4 cases. The causes for their internal fixation failure included head cutting in 8 cases, fracture nonunion in 10 cases, plate or screw breakage in 6 cases, intramedullary nail breakage in 3 cases, and hip varus in 2 cases. Their revision surgery was performed with anatomical proximal femoral locking plate and autogenous iliac bone graft. Their fracture union time, and visual analogue scale (VAS), hip Harris score, SF-36 health survey scale and complications at the final follow-ups were recorded.Results:All the 29 patients were followed up for 12 to 24 months (18 months on average). Bony union was eventually achieved in all the 29 patients after an average time of 4.5 months (from 3 to 7 months). There were no such complications as nonunion, re-fracture or internal fixation failure. The VAS pain score at the final follow-up(4.6±1.6) was significantly lower than that before surgery(7.1±2.1), and the Harris hip score(85.2±8.2) and SF-36 score(75.9±15.5) at the final follow-up were significantly higher than those before surgery (48.0±12.7 and 48.7±18.8) (all P<0.05). According to their hip Harris scores at the final follow-ups, the therapeutic efficacy was rated as excellent in 9 cases, as good in 15 cases and as poor in one, yielding an excellent and good rate of 82.8%. Conclusion:For patients with femoral intertrochanteric fracture whose primary internal fixation has failed, especially those with fine femoral head and neck and hip joint, proximal femoral anatomic locking plate and autogenous iliac bone graft can result in satisfactory clinical efficacy.
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Objective:To report our experience in the admission and perioperative management of 88 patients with lower extremity fracture in a mildly affected area in the epidemic of COVID-19.Methods:A retrospective analysis was conducted of the 88 patients with 97 lower extremity fractures who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine from 23rd January, 2020 to 22nd February, 2020. They were 43 males and 45 females, aged from 15 to 95 years (average, 65.5 years). The patients underwent screening for COVID-19 infection before admission. Their fractures were located at the femoral neck in 33 cases and at the femoral trochanter in 26. Open reduction and internal fixation was performed for 29 cases, internal fixation with proximal femoral nail anti-rotation (PFNA) for 25 and hip replacement for 28. The time from injury to admission, time from admission to surgery, operation time, fracture reduction, hospital stay, and perioperative deep venous thrombosis (DVT) of lower limbs were recorded. COVID-19 infection was observed in the medical staff and patients as well.Results:All the 88 patients were COVID-19 negative in the screening before admission. The time from injury to admission averaged 4.5 days, the time from admission to surgery 3.7 days and hospital stay 6.6 days. The prostheses were all well located in the 28 patients undergoing hip replacement. The rate of functional and anatomic reduction was 94.2%(65/69) in the 69 patients undergoing internal fixation. Peri-operatively, DVT occurred in 25 cases (28.4%). High temperature was observed in 7 patients within 3 days after operation, which was diagnosed as absorption fever. No medical staff or patients were infected by COVID-19.Conclusion:In the epidemic of COVID-19, orthopedic surgeons in a medical institute in a mildly affected area can still provide effective and safe medical services for fracture patients and reduce nosocomial infection, as long as they comprehend the diagnosis and treatment guidelines for the epidemic, strictly screen the patients accordingly, stick to operative indications, protect against possible infection cautiously, and carry out the procedures in a standard manner.
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Posterior tibial slope (PTS) is used to describe the sagittal alignment of the tibial plateau of the knee. As its values indicate the steepness or gentleness of the tibial platform, it is an important basis for knee surgery, such as total knee replacement (TKA), anterior cruciate ligament/posterior cruciate ligament reconstruction (RACL/RPCL) and tibia high-level osteotomy (HTO), and affects the indication and efficacy of knee surgery. Since there has been no consensus description of PTS at present in clinical practice in China, this paper intends to discuss PTS from perspectives of epidemiology, measurement, its influence on knee joint activity, relationship between subchondral bone and knee ligament, and its significance in various knee joint operations. This review hopes to contribute to the knee surgery after the surgeons have a comprehensive understanding of the clinical significance and applications of PTS.
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Posterior tibial slope (PTS) is used to describe the sagittal alignment of the tibial plateau of the knee.As its values indicate the steepness or gentleness of the tibial platform,it is an important basis for knee surgery,such as total knee replacement (TKA),anterior cruciate ligament/posterior cruciate ligament reconstruction (RACL/RPCL) and tibia high-level osteotomy (HTO),and affects the indication and efficacy of knee surgery.Since there has been no consensus description of PTS at present in clinical practice in China,this paper intends to discuss PTS from perspectives of epidemiology,measurement,its influence on knee joint activity,relationship between subchondral bone and knee ligament,and its significance in various knee joint operations.This review hopes to contribute to the knee surgery after the surgeons have a comprehensive understanding of the clinical significance and applications of PTS.
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Objective To explore the predictive significance of platelet changes on deep venous thrombosis of the lower limbs after total knee replacement,and to guide the early clinical prediction and prevent the occurrence of thrombotic events.Methods A retrospective study was conducted of the 50 patients who had been treated by total knee arthroplasty for degenerative knee osteoarthropathy from January 2016 to June 2018 in the Department of Orthopedics and Traumaology,Xi'an Jiangtong University Medical College Red Cross Hospital.There were 10 males and 40 females,aged from 47 to 80 years (average age 65.1 years).According to the results of B ultrasound examination of the lower extremities,the patients were divided into the non embolic group (24 cases) and the embolic group (26 cases).The platelet counts and hemoglobin levels of the two groups were recorded before and after operation,and their respective differences were calculated.The difference of hemoglobin difference between the two groups was analyzed.At the same time,the difference of platelet count and total knee joint were examined.Whether the deep venous thrombosis of the lower extremity after replacement was statistically significant.If there was no statistical difference in the difference in hemoglobin between the two groups,and the difference in platelet count was statistically significant,the ROC curve was made to determine the optimal screening point.If obeying the normal distribution and the homogeneity of the variance,an independent sample t test was performed on the platelet count difference and the hemoglobin amount difference between the two groups,and the dose data in accordance with the normal distribution was expressed as (Mean ±SD).Results The difference of platelet count was (30.4 ± 14.8) ×109/L in thrombosis group and (53.5 ± 15.2) × 109/L in thrombosis group.The difference of platelet count between the two groups had statistical significance (P ＜ 0.001).The best screening point of platelet count difference was 34.0 × 109/L.The difference of hemoglobin count between thrombosis group and thrombosis group was (20.8 ± 9.3) g/L and (24.0 ± 10.7) g/L,there was no significant difference in hemoglobin between the two groups (P ＞ 0.05).Conclusions Preoperative and postoperative platelet count difference can effectively predict the incidence of lower extremity deep venous thrombosis after total knee arthroplasty.When the platelet count difference before surgery ≥34.0 × 109/L,early prevention of deep venous thrombosis should be avoided.The formation of the occurrence.
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Objective To investigate the diagnostic value of enhanced MR subtracted venography (MRsV)in iliac vein stenosis. Methods 21 patients were recruited for unilateral venous circulation disorders,and they were all performed two kinds of MR venography,including time of flight (TOF)and MRsV.All raw data were reconstructed and maximum intensity proj ection (MIP)images were gained after post-processing in workstation.The image quality and diagnostic accuracy were evaluated by two experienced radiologists.All the results were analyzed,with P<0.05.Results 18 patients were enrolled in our study with good image quality,including 10 cases of unilateral iliac venous thrombosis,1 case of iliac venous stenosis infiltrated by tumor recurrence,3 cases of IVCS and 4 cases without iliac venous thrombosis.The sensitivity and specificity of MRsV-MIP were higher than TOF-MIP (100% vs 92.3%,100% vs 75%,respectively). There was significant difference in diagnostic accuracy between MRsV-MIP and TOF-MIP(χ2=4.827 2,P=0.028 0).Conclusion MRsV demonstrates better image quality and diagnostic performance than TOF in evaluation of iliac vein stenosis.MRsV has greater potential in providing the differential diagnosis evidence in venous stenosis.It could be established as an independent iliac venous imaging method.
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Objective@#To explore the effects of endoplasmic reticulum stress-induced apoptosis in thyroid injury of rats caused by excessive fluoride intake.@*Methods@#All 40 Wistar rats were randomly divided into four groups, control group, low fluoride group, medium fluoride group and high fluoride group. The rats in control group were fed with tap water (fluoride concentration=0.344 mg/L) and the experimental rats were fed with the water contaminated fluoride with the dose of 5, 10 and 20 mg/L. 10 rats (female: male=1∶1) in each group were sacrificed after 8 months of exposure through drinking water. The contents of urine fluoride were detected by fluorine ion selective electrode method. Morphology of thyroid was observed through light microscope and apoptosis in thyroid were detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. The mRNA and protein expressions of glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP) were analyzed by RT-PCR and immunohistochemistry respectively, and results were compared among groups.@*Results@#The contents of urine fluoride in all fluoride treated groups were separately (4.74±1.88), (7.70±2.82) and (10.50±2.92) mg/L, which were gradually higher than that of control group (2.23±0.54) mg/L (P<0.05). Morphological changes were found in thyroid tissues of fluoride treated groups, thyroid follicular hyperplasia or even no cavity cell clusters were observed. Apoptosis in thyroid were notably increased in fluoride treated groups. The mRNA expression levels of GRP78 in all fluoride treated groups were separately 1.30±0.42, 1.39±0.29 and 1.50±0.27, which were significantly higher than that of control group (0.93±0.24) (P<0.05). And the mRNA expression levels of CHOP in medium and high fluoride groups were separately 1.17±0.29 and 1.30±0.26, which were significantly higher than that of control group (0.91±0.20) (P<0.05). The protein expression levels of GRP78 and CHOP in medium and high fluoride groups were respectively 29.68±4.04, 29.90±3.74 and 4.05±1.62, 4.44±1.81, which were significantly higher than those in the control group (separately 23.80±6.36, 2.27±0.89) (P<0.05).@*Conclusion@#Excessive-fluoride intake can induce thyroid injury, and endoplasmic reticulum stress-induced apoptosis might be involved in the injury.
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Objective To evaluate the value of MRI diagnosis in Stewart-Treves syndrome(STS).Methods The 48 STS nodules proved by pathology were retrospectively studied,which compared the MRI findings and pathological results.Results All nodules were solid and more than 4 mm in diameter.According to the expression of D2-40 and CD31,all nodules were divided into two types.The 47 nodules were divided into STS type I(hemangiosarcoma).The MRI findings showed slightly low signal on T1 WI and slightly high signal on T2 WI,while were higher than the muscular signal.Additionally,all nodules of STS type I were remarkably enhanced.The 1 mass-like-shape cases wsa divided into STS type Ⅱb (mixed lymphangiosarcoma).The MRI findings showed heterogeneous signal on both T1 WI and T2 WI,in which the high signal was leading.And the enhancement showed the low-level inhomogeneous signal.Conclusion MRI could be a valuable tool for the diagnosis in STS because of the characteristic signal on MRI.And if combined with the history of chronic upper limb lymphedema,the diagnostic accuracy could be improved before surgery.
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The distal radioulnar joint (DRUJ) is one of the most important joints connecting hand and forearm,playing an important role in maintaining normal rotation of the hand and forearm and stability of the wrist.Serious DRUJ dislocation can lead to functional limitation of the forearm and wrist.DRUJ displacement is not uncommon clinically,but often missed.It is usually associated with a distal radioulnar fracture,with an incidence ranging from 10％ to 19％.Without correct and effective diagnosis and treatment,it will lead to chronic pain,dysfunction and other complications.There are various treatments for DRUJ displacement,like initiative splint fixation,percutaneous fixation with kirschner wire,soft tissue reconstruction,joint fusion and joint replacement at the end-stage,and arthroscopic techniques as well which are increasingly popular in recent years.All these treatments ease the patients' pain to a certain extent,but also bring about complications of different severities.Currently,reconstruction of the DRUJ stability using elastic suspension system may be a new treatment alternative in the future because it has gradually attracted the attention from experts.
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Objective To compare the effects of tetracaine or lidocaine anesthesia effect on urethral agita-tion in thoracoscopic male patients during recovery period. Method One hundred and twenty male adults(18 ~60 yr),ASA physical status I and II undergoing elective thoracoscopic surgery ,were randomly divided into three groups of 30 cases in each one. The control group received paraffin oil lubrication catheterization after general anes-thesia induction,whereas the experimental groups received tetracaine gel or lidocaine gel 3~5 g in urethral surface anesthesia before catheterization. Intra-operatively ,urinary catherization was performed with a 16 Fr Foley′s cathe-ter,and a balloon was inflated with 10 mL distilled water. The CRBD was assessed at 0,1,and 12 h after patient′s arrival in the post-anaesthesia care unit. Severity of CRBD was graded as none,mild,moderate and severe. Data were analysed by one-way ANOVA and Fisher′s exact test. P < 0.05 was considered significant. Results Inci-dence and severity of CRBD was reduced in the experimental groups compared with the control group(P < 0.05). Postoperative pain as assessed by visual analogue scale and Richer-SAS was also reduced in the experimental group compared with the control group. Furthermore,in the tetracaine group,catheter-related complaint had less discom-fort than that in the lidocaine group. Conclusion Lidocaine and tetracaine surface anesthesia can significantly reduce catheter-related bladder discomfort after induction ,and tetracaine mucilage lasts for a longer time and less discomfort.