Discussion on the reference range of thromboelastogram in 916 healthy adults in Shenzhen area / 中国输血杂志

【Objective】 To determine the reference range of thromboelastogram(TEG) and establish a TEG feature for local population by measuring TEG parameters in healthy adults in Shenzhen comparing the difference between gender and age, and analyzing the reference data provided by reagent manufacturer. 【Methods】 A total of 916 healthy adults, aged between 19 to 59, who did their regular health checks in our hospital from September 2020 to August 2021 were selected. The TEG(from Lepu Medical Technology Co., Ltd.) was performed, and the clot reaction time(R), clot formation time(K), coagulation angle(α-Angle), maximum amplitude(MA), coagulation index(CI), fibrinolysis index LY30 and the estimated percent lysis (EPL) were analyzed. 【Results】 The reference ranges of TEG parameters, including R, K, α-Angle, MA, CI, LY30 and EPL, of 916 healthy adults from Shenzhen were 3.25~8.19 min, 0.66~3.18min, 47.70~76.56deg, 50.05~72.91mm, -4.3~3.4, 0~2.2% and 0~3%, respectively. The value of α-Angle, CI, K, LY30, MA and R didn’t all meet the given range provided by the manufacturer; some were exceeding and some inferior to. A total of 227 out of 916 individuals presented abnormal results, relative to the references, in at least one parameter, and 78 were diagnosed of abnormal coagulation based on the given reference range, with a specificity of 75.2%. 【Conclusion】 The reference range of TEG parameters of Shenzhen locals is significantly different from that provided by manufacturers. And it is imperative for local TEG laboratories to establish their own reference ranges according to age and gender groups based on local population characteristics.

Injured vertebra pedicle screw fixation and cross-segment pedicle screw fixation for thoracolumbar fracture：a meta-analysis / 中国组织工程研究

BACKGROUND:Thoracolumbar fracture becomes more in the clinic. The fixation manner of thoracolumbar fracture is controversial. Injured vertebra pedicle screw fixation or traditional cross-segment pedicle screw fixation are controversial and lack the support of evidence-based medicine. OBJECTIVE: To evaluate the outcomes of injured vertebra pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. METHODS: According to Cochrane system evaluation, the folowing databases were retrieved: National Library of Medicine database, China National Knowledge Infrastructure, Wanfang database and VIP database. Conference proceedings were searched by hand. The retrieval time ranged from 2005 to March 2015. Randomized controled trials were colected. Meta-analysis was performed by using Cochrane Colaboration Revman 4.2. RESULTS AND CONCLUSION: By screening, a total of 14 clinical controled trials were selected, including 956 patients. Meta-analysis results showed that postoperative Cobb angle was improved significantly in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=-2.72, 95%CI:-3.08--2.35,P < 0.01). Correction rate of the vertebral height was higher in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=7.45, 95%CI:6.94-7.97,P < 0.01). The failure rate was lower in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=0.12, 95%CI: 0.05- 0.27,P < 0.01). Results verify that postoperative Cobb angle improved significantly after the injured vertebrae pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. The height was obviously corrected and fewer complications were caused such as implant failure. The fixation effect was good.

Manifestation of dynamic contrast-enhanced CT of hepatic injury in rabbits / 中华创伤杂志

Objective To analyze the features of dynamic contrast-enhanced CT of blunt hepatic injury in rabbits. Methods The model of blunt hepatic injury was established in 40 New Zealand white rabbits with a steel ball falling down to the xiphoid process of the animals. Plain CT scan and dynamic contrast-enhanced CT scan (Hispeed spiral CT/2i, GE, America) of the liver were performed. Arterial,portal and balanced phases were respectively at 8-10 s, 35-40 s and 120-150 s after initiation of the contrast medium injection. The non-enhanced and enhanced images were compared in aspects of location and range of injury, tear of the liver capsule, active bleeding, involvement of the main hepatic veins and CT features of abdominal hemorrhage, which was further compared with the results of gross anatomy. Results The rate of plain CT scan was obviously lower than that of dynamic contrast-enhanced CT scan,which defined single tear in 13 patients, multiple lacerations in 18, liver subcapsular hematoma in seven,liver hematoma in nine, liver coated gap in 17, active bleeding in nine and main hepatic vein injury in five, with coincidence rates with the results of gross observation for 13/13,18/18,7/9,9/9,25/30,9/5and 5/4 respectively. According to Moore' s classification, CT/Laparotomy performed from grade Ⅰ to grade Ⅵ were 5/4 patients at grade Ⅰ , 15/13 at grade Ⅱ, 9/11 at grade, 5/6 at grade Ⅳ, 1/2 at grade Ⅴ, O at grade respectively. Conclusion Dynamic contrast-enhanced CT scan, especially at portal and balanced phases, is of great value for diagnoses of liver injuries and determination of injury severity.

Significance of multi-slice spiral CT in multi-plane and volume reconstruction of bone joint diseases / 中国组织工程研究

Following thin slice reconstruction by multi-slice spiral CT,the initial data were processed in workstation.Reconstruction methods include two-dimensional multi-plane reconstruction,contour reconstruction,three-dimensional surface shielding,maximum density projection and volume rendering technique.The key parameters of 64-slice spiral CT involve parameters of monitor,time resolution,space resolution,high tension generator and thermal capacity of sucker.Its performance is influenced by many parameters.A balance of monitor,high tension generator and sucker can improve CT time resolution and rendering range.Multi-slice spiral CT multiplanar reconstruction and three-dimensional reconstruction image as important supplement of axial images can directly display fracture condition,and best and rapidly present joint peripheral fracture,providing reliable evidence for surgical protocol.Postoperatively reconstructed images can clear display internal fixtor appearance,location and fracture reduction,and is significant for surgical protocol and prognosis evaluation.

Treatment of femoral fracture combined with ipsilateral acetabular fracture and femoral head dislocation / 中华创伤骨科杂志

Objective To discuss the treatment of femoral fracture combined with ipsilateral acetabular fracture and femoral head dislocation and the reasons for the misdiagnosis of the injury. Methods According to AO classification, there were 3 cases of type 32A, 2 of type 32B, and 1 of type 32C, who were treated with internal fixation of interlocking nails. There was 1 case of type 33C3, who was treated with femoral condyle supporting plate. There were 2 cases of type 31A2, who were treated with DHS. According to the Letournel classification, fracture of the acetabular posterior wall was found in 8 cases and fracture of the acetabular posterior column and wall in 1 case. All the cases of acetabular fracture were treated with internal fixation of titanium alloy reconstructive plates. Delayed diagnosis was found in 2 cases in this group. Results The 9 patients were followed up for 13 to 38 months (averaging 22.4 months). According to the American criteria, 8 cases was rated as excellent, and 1 case as good, with thd total excellent and good rate being 100%. Conclusions Femoral fractures combined with ipsilateral acetabular fracture and femoral head dislocation are a rare, complex and serious injury. They usually involve other organs, and are easy to be misdiagnosed. The surgeries should be done as early as possible. The internal fixation plays a key role in management of the fracture of acetabular.

CT and MRI manifestations of aggressive fibromatosis / 中华放射学杂志

Objective To discuss CT and MRI features of aggressive fibromatosis (AF), especially the characteristic signs of MRI, and to evaluate the value of MRI in diagnosing the disease. Methods The CT and MRI studies in 9 cases with pathologically proven AF were retrospectively analyzed. Results Among 9 cases with AF, one cases could not be discovered by CT and all cases could be discovered by MRI. Appearances of lesion were infiltrating in 7 cases and mass-like in 2 cases. All cases were without calcification and lipo-tissue in the lesion and without edema on adjacent muscle structures. A homogeneous density and high density was seen on CT plain scans and high density on contrast enhanced scans. On MRI scans, variable signal intensity was demonstrated on T 1WI, and high signal intensity on T 2WI, as well as increased signal intensity after contrast enhancement. The signal characteristics primarily reflected the underlying histologic composition of the lesions. Conclusion MRI is more excellent than CT in delineating the site, shape, and extent of these lesions. MRI is valuable in detecting and differentiating AF.