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Background Aluminum and fluoride are neurotoxic, and aluminum exposure alone is closely related to the overall cognitive function of operational workers. It is unclear about the effect of aluminum and fluoride interactions on cognitive function. Objective To evaluate a potential interaction effect of blood aluminum and urinary fluoride on the overall cognitive function of workers working in an aluminum plant. Methods Using cluster sampling, 230 workers in the electrolysis workshop of an aluminum group company in Shanxi Province were selected, and plasma aluminum concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) and urinary fluoride by ion-selective electrode. The study participants were divided into a low blood aluminum group and a high blood aluminum group according to the median (M) of blood aluminum concentration, and a low urinary fluoride group and a high urinary fluoride group by a predetermined cutoff point (2.160 mg·L−1). The Montreal Cognitive Assessment-Beijing (MoCA-BJ) was used to assess overall cognitive function of the workers. Logistic regression model was used to analyze the relationship between blood aluminum, urinary fluoride, and mild cognitive impairment (MCI), including multiplicative interaction analysis and correlation analysis; R language was used to fit an additive interaction model of blood aluminum and urinary fluoride on MCI and to calculate synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (API). Results Among the 230 operational workers, the median blood aluminum concentration (P25, P75) was 40.11 (25.16, 58.89) µg·L−1, and there were 104 cases of abnormal urinary fluoride, with an abnormality rate of 45.2%. There was a multiplicative interaction (OR=7.783, 95%CI: 1.377, 43.991) and no additive interaction (RERI=0.030, 95%CI: −0.498, 0.559; API=0.018, 95%CI: −0.279, 0.316; S=1.049, 95%CI: 0.519, 2.118) for the effect between blood aluminum and urinary fluoride on overall cognitive function of the workers. The logistic regression analysis showed that the risk of MCI was 12.105 (95%CI: 2.802, 52.287) times higher in workers with both high blood aluminum and high urinary fluoride than in those with low blood aluminum and low urinary fluoride, after adjusting for selected influencing factors. Conclusion Occupational exposure related high blood aluminum and high urinary fluoride are risk factors for cognitive dysfunction, and the coexistence of both indicators increases the risk of MCI in workers with occupational aluminum exposure, with a multiplicative interaction.
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Objective@#To examine the correlation between visuospatial construction ability and occupational aluminum exposure among aluminum workers, so as to provide the evidence for early protection of occupational injury among aluminum workers.@*Methods@#A total of 442 workers in an aluminum factory in Shanxi Province were selected using a cluster sampling method, and participants' demographic features and occupational history were collected. The blood aluminum concentration was measured using inductively coupled plasma mass spectrometry (ICP-MS), and the visuospatial construction ability was evaluated with the Cube Copying Test (CCT) of the Chinese version of the Montreal Cognitive Assessment (MoCA). The correlation between the visuospatial construction ability and blood aluminum concentration was examined using a multivariable logistic regression model.@*Results@#A total of 442 aluminum workers were enrolled, and all participants were male, with a mean age of (43.40±7.31) years, labor service duration of (23.64±8.35) years and a mean blood aluminum concentration of 33.87 µg/L. Of all participants, there were 206 workers with impaired visuospatial construction ability (46.61%), including 127 workers with blood aluminum concentrations of >33.87 µg/L (61.65%); 190 workers with educational duration of 6 to 9 years (92.23%), 118 electrolytic aluminum workers (57.28%), 114 workers with work shifts (55.34%), and 123 workers with a very good sleep quality (59.71%). Multivariable logistic regression analysis revealed that blood aluminum concentrations of >33.87 µg/L (OR=2.490, 95%CI: 1.531-4.052), educational duration of 6 years or more (OR: 0.075-0.246, 95%CI: 0.015-0.622), work type as a non-electrolytic aluminum worker (OR=0.838, 95%CI: 0.425-0.987), work shift (OR=1.179, 95%CI: 1.078-1.435) and a very good sleep quality (OR=0.104, 95%CI: 0.012-0.896) significantly correlated with impaired visuospatial construction ability among aluminum worker.@*Conclusion@#Impaired visuospatial construction ability correlates with occupational aluminum exposure among aluminum workers.
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OBJECTIVE: To explore the relationship between occupational aluminum exposure and fasting blood glucose level in workers. METHODS: A cluster sampling method was used to select 178 occupational aluminum-exposed workers as the exposure group, and 178 workers without occupational aluminum exposure as the control group in a large aluminum factory in Shanxi Province. Glucose oxidase method was used to measure the fasting blood glucose level, and inductively coupled plasma mass spectrometry was used to measure the plasma aluminum level in these workers. A generalized linear model was used to analyze the correlation between plasma aluminum exposure level and fasting blood glucose in these workers. RESULTS: The blood aluminum level of workers in the exposure group was higher than that of the control group [median: 39.58 vs 16.67 μg/L, P<0.01]. The fasting blood glucose level of workers in the exposure group was higher than that of the control group [(5.33±0.79) vs(5.15±0.41) mmol/L, P<0.01]. The results of the generalized linear model analysis showed that the blood aluminum level of workers was positively correlated with their fasting blood glucose level after adjusting for age, body mass index, smoking, drinking, exercise, family history of diabetes, and incidence of diabetes(P<0.05). There was a dose-response relationship between the blood aluminum level and fasting blood glucose level of workers in the groups of junior high school and below and high school(all P_(trend)<0.01). There was no correlation found between blood aluminum level and fasting blood glucose level in the group of college and above(P_(trend)>0.05). There was a dose-response relationship between the blood aluminum level and the fasting blood glucose level in the workers in the non-exercise group(P_(trend)<0.01). There was no correlation found between the blood aluminum level and the fasting blood glucose level in the exercise group(P_(trend)>0.05). CONCLUSION: The blood aluminum level of workers exposed to occupational aluminum is positively correlated with their fasting blood glucose level. Higher education level or exercise can moderately reduce the effect of blood aluminum level on fasting blood glucose.
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Objective@#To investigate and analyze the actual intake of protein and energy in adult patients with severe burns during post burn days (PBDs) 3 to 14.@*Methods@#Records of 52 adult patients with severe burns [37 males and 15 females, (37±9) years old], admitted to the Department of Plastic Surgery and Burns of Tianjin First Central Hospital from January 1st 2011 to December 31st 2017 and meeting the study inclusion criteria, were retrospectively analyzed. Nutrition intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations of patients during PBDs 3 to 14 were obtained from critical care records. During PBDs 3 to 7 and PBDs 8 to 14, the personal daily total energy intake and the ratio of it to energy target of patients were calculated and compared; the personal daily intake of carbohydrate, fat, and protein and calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake, and the ratios of non-protein calories to total nitrogen of patients were calculated and compared; the personal daily energy and protein intake of patients from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations were analyzed; the percentages of energy intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total energy intake, and the percentages of protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake of patients were calculated. Vomiting and diarrhea of patients during PBDs 3 to 7 and PBDs 8 to 14 were recorded. Levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, nitrogen balance values of patients on PBDs 7 and 14 were recorded or calculated. Data were processed with paired t test and chi-square test.@*Results@#(1) The personal daily total energy intake of patients during PBDs 3 to 7 and PBDs 8 to 14 were (8 696±573) and (11 980±1 259) kJ respectively, and ratios of them to energy target [(13 290±1 561) kJ] were 65.4% and 90.1% respectively. The personal daily total energy intake of patients during PBDs 3 to 7 was obviously lower than that during PBDs 8 to 14 (t=18.172, P<0.01). (2) The personal daily intake of carbohydrate, fat, and protein of patients during PBDs 8 to 14 were obviously higher than those during PBDs 3 to 7 (t=15.628, 22.231, 10.403, P<0.01). The personal daily calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake of patients were 56.8%, 25.1%, and 18.3% respectively during PBDs 3 to 7 and 54.2%, 27.0%, and 18.7% respectively during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy intake of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ2=0.185, P>0.05). The ratios of non-protein calories to total nitrogen (kJ∶g) of patients during PBDs 3 to 7 and PBDs 8 to 14 were 469∶ 1 and 456∶ 1 respectively. (3) The personal daily energy intake of patients from routes of oral diet and parenteral nutrition preparations during PBDs 8 to 14 [(4 394±978), (5 723±898) kJ] were obviously higher than those during PBDs 3 to 7 [(2 137±453), (4 855±825) kJ, t=26.516, 6.583, P<0.01], while the personal daily energy intake of patients from routes of enteral nutrition preparations during PBDs 8 to 14 was close to that during PBDs 3 to 7 (t=1.922, P>0.05). The constituent ratio of personal daily energy during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ2=4.100, P>0.05). The personal daily protein intake of patients from route of oral diet during PBDs 8 to 14 was (58±22) g, obviously higher than (25±6) g during PBDs 3 to 7 (t=14.514, P<0.01). The personal daily protein intake of patients from routes of enteral nutrition preparations and parenteral nutrition preparations during PBDs 8 to 14 was close to those during PBDs 3 to 7 (t=1.924, 1.110, P>0.05). The constituent ratio of personal daily protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake during PBDs 8 to 14 was close to that during PBDs 3 to 7 (χ2=5.634, P>0.05). (4) There were 3 patients with vomiting and 4 patients with diarrhea during PBDs 3 to 7, and 1 patient experienced both of them during PBDs 8 to 14. The levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, and nitrogen balance values of patients on PBDs 7 and 14 were (29±4) and (30±4) g/L, (132±42) and (171±48) mg/L, (7.4±2.8) and (6.7±2.8) mmol/L, (1.5±0.7) and (1.4±0.7) mmol/L, (30.5±4.3) and (34.5±2.2) g, -(25.1±2.6) and -(23.7±3.9) g, respectively.@*Conclusions@#The personal daily total energy intake of patients during PBDs 3 to 7 was lower than that during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14. Energy and protein intake were mostly derived from parenteral nutrition preparations during PBDs 3 to 7, while those during PBDs 8 to 14 were mainly derived from parenteral nutrition preparations and oral diet.
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Objective To investigate the changes of serum corticosterone and inflammatory factors in rats with different burn degrees. Methods One hundred and fifty male healthy Wistar rats were randomly divided into normal control group, moderate and severe burn hormone treatment groups, and moderate and severe burn physiological saline treatment groups, each group with 30 rats. After anesthesia, the rat models with burn Ⅱ,Ⅲ degrees of 30% back surface area were replicated; the burn, fluid infusion and steroid therapy were not carried out in the normal control group. After modeling, the moderate and severe burn hormone treatment groups were given intra-abdominal cavity injection of hydrocortisone 200 mg/d; while in the moderate and severe burn normal saline treatment groups, normal saline 4 mL·kg-1·d-1 was injected into the abdominal cavity. The dynamic changes of serum corticosterone, tumor necrosis factor-α(TNF-α), and interleukin-6 (IL-6) levels were detected at 1, 4, 12 hours and 1, 3 and 7 days after burn injury in each group. Results The levels of serum corticosterone at different time points after moderate and severe burn injury treatment were higher than those in normal control group, the degree of increase at 4 hours after injury in severe burn saline treatment group was more significant than that in moderate and severe burn hormone treatment groups and moderate burn saline treatment group (ng/L: 200.45±2.63 vs. 110.56±9.23, 146.02±3.28, 160.02±8.22). Except the level at 1 hour after injury in the moderate and severe burn hormone treatment groups, the TNF-αlevels in all the other groups at different time points were significantly higher than those in the normal control group (all P < 0.05); the IL-6 levels in various treatment groups were all higher than the IL-6 level in the normal control group, moreover, the increase degree on 1 day after injury in the severe burn saline treatment group was more obvious than the degrees in the moderate and severe burn hormone treatment groups and the moderate burn saline treatment group [TNF-α(ng/L): 39.78±4.30 vs. 15.99±1.40, 20.58±2.10, 25.98±1.60, IL-6(ng/L): 210.20±6.70 vs. 125.45±3.10, 149.81±4.20, 161.40±3.80, all P < 0.05]. Conclusion The burn stress may lead to the significant increase of serum corticosterone level in rats, and the stress dose of hydrocortisone has a certain regulatory effect on serum corticosterone and inflammatory factors in rats after different degrees of burn.
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Objective To report the technique and effect of robotic-assisted laparoscopic radical cystectomy (RARC) totally intracorporeal orthotopic ileal neobladder in female bladder cancer patient.Methods A consecutive series of 5 female patients with urothelial carcinoma of the bladder,who underwent RARC,bilateral pelvic lymph node dissection and intracorporeal orthotopic W-shaped ileal neobladder by an experienced robotic surgeon,were included in the retrospective study,from December 2017 to March 2018.Data were reviewed retrospectively.The patients aged 51-68 years old,with mean age 62.2 years,and BMI was 13.6-22.8 kg/m2,mean 18.1 kg/m2.The specimens were removed from the vagina.A 40 cm bowel segment with detubularisation was chosen for the W-shaped neobladder which was constructed manually.All patients resumed ambulation on postoperative 2 days and resumed oral feeding on postoperative day 3.The single-J stents and catheter were removed 12 days and 2 weeks after operation,respectively.Results All operation were performed successfully.The average operation time was 384.2 min (ranging 355-428 min) with mean estimated blood loss of 620 ml (ranging 150-1 800 ml).And the average number of dissected lymph nodes was 15 (ranging 10-20).The neobladder and urethra anastomotic leakage was observed in one patient who was healed after 2 weeks indwell catheter.Small bowel obstruction occurred in one case 3 weeks after operation and recovered after conservative treatment.The daytime urinary control was good,and 1 cases had urinary incontinence at night (follow up 4-7months,median:5.5months).No recurrence or metastasis was observed during routine follow-up.The imaging showed the good morphology of the upper urinary tract and the new bladder.Conclusions Our initial experience supports the feasibility and advantage of totally intracorporeal orthotopic W-shaped ileal neobladder following RARC in female patient with bladder cancer.It is worth to further verification in a large sample with longer follow-up.
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<p><b>OBJECTIVE</b>To observe and evaluate the clinical effects of improved scapula flap in repairing refractory wound.</p><p><b>METHODS</b>Ten patients, with refractory wounds (ranging from 11 cm×7 cm to 16 cm×15 cm) on face and extremities combined with bone and tendon exposure as a result of traffic injury, burns, or diabetic feet, were hospitalized from February 2008 to February 2013. The wounds were repaired with improved scapula flap ranging from 12 cm×8 cm to 17 cm×16 cm. Six of them were grafted directly; 4 of them were grafted with bridging. The vessel of flap was freed to the subscapular vessel and its thoraco-dorsal branch, forming the T-shape vessel pedicle with circumflex scapular vessel, and the vessels on two sides of vessel pedicle were anastomosed with vessels in recipient area. The donor sites were sutured directly or covered with autologous medium-thickness skin graft.</p><p><b>RESULTS</b>Nine flaps survived after surgery; the wounds were healed. Few blisters and exudation were observed at the distal end of one flap, which was cured after dressing change for 2 weeks. The pedicles of the bridge-like flap were divided 4-6 weeks after surgery. All the patients were followed up for 6 to 12 months. Slight swelling was observed in 2 flaps. The appearance and texture of the other 8 flaps were good, and the function of the recipient area recovered. No obvious hypertrophic scar was observed in donor site on the back, with normal function of shoulder joint and pulsation of named vessels.</p><p><b>CONCLUSIONS</b>Repairing refractory wounds with improved scapula flaps can result in good appearance, texture, and satisfactory function, which should be popularized in clinic.</p>
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Humans , Burns , General Surgery , Scapula , Skin Transplantation , Surgical Flaps , Treatment Outcome , Wound HealingABSTRACT
BACKGROUND: Tendon injury is a common injury in the department of hand surgery. The postoperative recovery of hand function is always affected by tendon adhesion after tendon repair. To prevent tendon adhesion, especially the adhesion after flexor tendon repair is always the key in the rehabilitation of hand surgery.OBJECTIVE: To investigate the impact of decimeter wave therapy on tendon adhesion and healing after flexor tendon repair.DESIGN: Randomized controlled study based on experimental animal SETTING: Provincial Institute of Orthopaedics.MATERIALS: The study was conducted in Hebei Provincial Institute of Orthopaedics from January 2001 to June 2003. Totally 28 Leghorn chickens were randomly divided into decimeter wave therapy group and operation control group.METHODS: The flexor digitorum profundus tendons of Leghorn chickens were transected and repaired. Decimeter wave therapy was applied to the toes on chickens of decimeter wave therapy group. Animals were executed at week 3 or 6 after operation for macroscopical observation and histological observation under optical and electron microscopes, and biomechanical analysis.MAIN OUTCOME MEASURES: Principle index: results of macroscopical observation and the observatory results under optical and electron microscope, and the results of biomechanics. Secondary index: results of the classification of tendon adhesion and healing.RESULTS: It could be seen under macroscopical and histological observation that the adhesion significantly reduced in decimeter wave therapy group. The protein synthesis of fibroblast was significantly more than that of the control group under electron microscope. As indicated by biomechanical analysis, the tendon gliding distance[ (5.37 ± 1.06) mm at week 3, (6.76 ± 1.52) mm at week 6]and the rehabilitative compliance( 1. 04 ± 0.65 at week 3)of decimeter wave therapy group were bigger than those of the control group respectively [ (4.43 ±1.03) mm, (5.33±1.27)mmand0.63±0.31](P ＜0.05), and the anti-tension strength of decimeter wave in therapy group (N, 26. 93 ± 4. 80,47. 12 ± 7.76) was significantly bigger than that of the control group respectively(21.29 ±4. 88 and 38.96 ±7.52) (P ＜0. 01).CONCLUSION: Decimeter wave therapy can effectively promote tendon healing and reduce tendon adhesions and provide prerequisites for early rehabilitative training after flexor tendon repair. Hence, it is an ideal assistance in the prevention of tendon adhesion.
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Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of anastomoses under the condition that perfect nerve anastomoses are ensured. PCMVβ plasmid containing cytomegalovirus promoter (CMV promoter) and Escherichia coli (E.coli) β-Galactosidase (β-Gal) structural gene (lacZ gene) was conducted. A soaked medical 8-0nylon suture was used to perform epineurial repair of rabbit sciatic nerve. In the control group a suture soaked in sucrose PBS was used, while in the experimental group a suture soaked in PCMVβ plasmid solution was applied. The sites of anastomoses of nerves by stages were taken out, and β-Gal histochemical staining was performed and β-Gal enzyme activity was assayed with 5-bromo-4-chloro-3-indolyl-β-D-galactoside. Results showed that the sites of anastomoses of nerves were taken out 2 days, 7 days, 14 days and 30 days respectively after the operation. The β-Gal histochemical stains at the sites of anastomoses showed no indigo positive cells at different stages in the control group, whereas displayed indigo positive cells in the experimental group. In the control group, no β-Gal enzyme activity was detected at different stages after operation, but in the experimental group, β-Gal enzyme activity could be detected from the 3rd day to the 30th day after operation. It was concluded that by using exogenous gene suture, exogenous gene could be transferred to the sites of peripheral nerve and expressed the exogenous gene expression products with bioactivity, which provided the feasibility of using gene therapy to accelerate the recovery of nerve function.
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Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of anastomoses under the condition that perfect nerve anastomoses are ensured. PCMVβ plasmid containing cytomegalovirus promoter (CMV promoter) and Escherichia coli (E.coli) β-Galactosidase (β-Gal) structural gene (lacZ gene) was conducted. A soaked medical 8-0nylon suture was used to perform epineurial repair of rabbit sciatic nerve. In the control group a suture soaked in sucrose PBS was used, while in the experimental group a suture soaked in PCMVβ plasmid solution was applied. The sites of anastomoses of nerves by stages were taken out, and β-Gal histochemical staining was performed and β-Gal enzyme activity was assayed with 5-bromo-4-chloro-3-indolyl-β-D-galactoside. Results showed that the sites of anastomoses of nerves were taken out 2 days, 7 days, 14 days and 30 days respectively after the operation. The β-Gal histochemical stains at the sites of anastomoses showed no indigo positive cells at different stages in the control group, whereas displayed indigo positive cells in the experimental group. In the control group, no β-Gal enzyme activity was detected at different stages after operation, but in the experimental group, β-Gal enzyme activity could be detected from the 3rd day to the 30th day after operation. It was concluded that by using exogenous gene suture, exogenous gene could be transferred to the sites of peripheral nerve and expressed the exogenous gene expression products with bioactivity, which provided the feasibility of using gene therapy to accelerate the recovery of nerve function.