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Objective:To explore the clinical application of three-dimensional CT angiography (3D-CTA) in repair of limb wounds with free lateral thoracic perforator flaps.Methods:A retrospective study was conducted to analyze the clinical data of 61 patients with limb soft tissue defects who had been treated at The Third Department of Orthopedics, Xingtai General Hospital of North China Medical and Health Group from January 2018 to September 2022. There were 37 males and 24 females with an age of (43.9±12.0) years. Thirty-three left and 28 right sides were injured. Soft tissue defects ranged from 4.0 cm × 3.0 cm to 17.0 cm × 8.0 cm, and flap areas from 5.0 cm × 4.0 cm to 18.0 cm × 9.0 cm. The patients were divided into 2 groups according to the different preoperative vascular exploration methods: an ultrasound group of 30 cases subjected to ultrasound Doppler examination and a 3D-CTA group of 31 cases subjected to 3D-CTA examination. The preoperative findings were compared with those of intraoperative exploration in the 2 groups. The operation time, flap survival rate, patient satisfaction with trauma repair, sensory recovery of the flap area, and the excellent and good rate of the donor area were also compared between the 2 groups.Results:The differences in preoperative general data between the 2 groups were not statistically significant, indicating the 2 groups were comparable ( P>0.05). In the ultrasound group, the inraoperative classification of the lateral thoracic perforator flaps showed a low concordance with preoperative classification (Kappa coefficient of 0.104, P=0.088). In the 3D-CTA group, the classification of lateral thoracic perforator flaps was consistent with the preoperative 3D-CTA examination (Kappa coefficient of 1.00, P<0.001). The preoperative measurements in the 3D-CTA group found that the diameter at the origin of the lateral thoracic artery was (1.2±0.3) mm, the vascular pedicle length (8.1±2.1) cm, and the diameter at the perforator exit (0.6±0.2) mm; the preoperative surface positioning at the perforator exit found that the perforator exit was (1.6±0.3) cm above the horizontal line of the subscapular angle and (5.3±1.4) cm outside the vertical line of the subscapular angle. These measurements were similar to the intraoperative ones [(1.1±0.3) mm, (8.3±2.4) cm, (0.7±0.2) mm, (1.5±0.4) cm, and (5.2±1.5) cm], showing no significant differences ( P>0.05). In contrast, the preoperative measurements of the above indexes in the ultrasound group did not coincide with the actual intraoperative measurements, and the differences were all statistically significant ( P<0.05). The operation time, flap survival rate, rate of patient satisfaction with wound repair, rate of sensory recovery in the flap area, and the excellence and good rate of the donor area in the 3D-CTA group were (52.9±16.7) min, 100.0% (31/31), 96.8% (30/31), 83.9% (26/31), and 87.1% (27/31), respectively, which were significantly better than those in the ultrasound group [(76.3±21.4) min, 86.7% (26/30), 76.7% (23/30), 60.0% (18/30), 63.3% (20/30)] ( P<0.05). Conclusions:As preoperative 3D-CTA examination can clarify the types and anatomical characteristics of the lateral thoracic artery and its perforators, it helps the design and harvest of the lateral thoracic perforator flaps. Compared with the ultrasound Doppler examination, preoperative 3D-CTA examination shortens operation time, raises survival rate of the flaps, and facilitates recovery of the appearance and function of the limb wounds, and leads to little impact on the donor site.
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Autologous ozonized blood transfusion (AOBT) is a therapeutic method that mixes blood with medical ozone in vitro and then reinfuses it into the body. It has been widely used in the auxiliary treatment of ischemia, hypoxia, autoimmune diseases and cancer. The mechanism of ozone therapy is still unclear, and no unified standard for the concentration, frequency and course of AOBT treatment has been established. This article aims to review the mechanism and clinical application of AOBT.
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【Objective】 To investigate the efficacy of autologous ozoneized blood transfusion(AOBT) in improving consciousness and motor function in convalescent stroke patients. 【Methods】 A total of 44 patients who were diagnosed as convalescent cerebral apoplexy and received treatment in Rehabilitation Department of our hospital from August 2016 to September 2021 were randomly divided into the experimental group and control group by blind method. The experimental group (n=22) received general rehabilitation training (such as exercises, occupational therapy, acupuncture and transcranial magnetic stimulation) plus AOBT (200 mL venous phlebotomy at the median elbow), once every 2 to 3 days and 12 occasions as a course of treatment; the control group solely recieved general rehabilitation training. The consciousness (GCS score) and ability of daily living (Barthel index score) score of the two groups before and after treatment were statistically compared, and Ueda motor function grade, Brunnstrom stage and muscle tone grade were observed and evaluated. 【Results】 After the treatment, the experimental group and the control were compared as follows: 1) the GCS score and Barthel score was 14.82±0.39 vs 12.41±2.52, 61.14±12.24 vs 52.05±11.72(P<0.05); 2) The recovery rate of motor function was 95.45% (21/22) vs 63.64% (14/22) (P<0.05); 3) The total recovery rate of muscle tone was 90.91% (20/22) vs 63.64% (14/22) (P<0.05). 【Conclusion】 AOBT, with somewhat high safety and effectiveness, can improve the state of consciousness, motor function and muscle tone in convalescent patients with stroke.
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Objective:To analyze the effectiveness of indocyanine green angiography in monitoring blood perfusion of free perforator flap during repair surgery of limb soft tissue defect.Methods:A retrospective case series study was conducted to analyze the clinical data of 26 patients who underwent free perforator flap repair of soft tissue defects in the limbs in Xingtai General Hospital of North China Medical and Health Group from August 2019 to October 2022. The patients included 21 males and 5 females, aged 20-59 years [(39.5±4.1)years]. The wound size ranged from 2.0 cm×5.0 cm to 12.0 cm×16.0 cm. The time from injury to surgery was 5-30 days [(16.2±1.9)days]. During the surgery, indocyanine green angiography was used to evaluate the blood perfusion in the flap area after the free perforator flap was completely cut but before the vascular pedicle was not cut off, and immediately after the free perforator flap was anastomosed with the recipient area′s blood vessels and sutured with surrounding tissues. Consistency testing was performed on the degree of blood perfusion of the skin flap displayed by two indocyanine green angiography tests to determine whether the anastomosis of the skin flap was unobstructed after transplantation. On 14 days after surgery, the second indocyanine green angiography technique was applied to measure the survival of flaps in patients with sufficient blood perfusion. The difference between the poor blood perfusion in the flap arearevealed by indocyanine green angiography technique and the actual necrosis occurrence in this part was compared. The sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of indocyanine green angiography were calculated for evaluating blood perfusion in the flap area.Results:All the patients were followed up for 14-21 days [(17.4±3.5)days]. Two indocyanine green angiography tests showed strong consistency in blood perfusion in the flap area, with no statistically significant difference (Kappa coefficients of 1.00, P<0.01). All the patients had unobstructed anastomosis after flap transplantation. On 14 days after surgery, the second indocyanine green angiography test showed all skin flap areas as grade 1 in 11 patients, with the worst developed areas as grade 2 in 7 patients, grade 3 in 5, and grade 4 in 3. All the flaps survived in the 18 patients with flaps showing grade 1 development and the worst part showing grade 2 development; among the 8 patients with the worst developed areas being grade 3 and grade 4, 5 patients were found with skin flap necrosis (full thickness or superficial) in the areas with poor blood supply, and the skin flap survived well in 3 patients. Indocyanine green angiography in evaluating blood perfusion in the flap area showed the sensitivity of 100% (95% CI 0.46, 1.00), the specificity of 85.71% (95% CI 0.63, 0.96), the accuracy of 88.46% (95% CI 0.76, 1.00), the negative predictive value of 100% (95% CI 0.78, 1.00), and the positive predictive value of 62.50% (95% CI 0.26, 0.90). Conclusion:Indocyanine green angiography has good real-time imaging effect, with high sensitivity, specificity and accuracy, making it an objective method for monitoring the blood flow status of skin flaps and predicting skin flap necrosis.
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【Objective】 To explore the perioperative blood management in patients with pancreatic pseudocyst combiend with coagulation factor Ⅴ(FⅤ) deficiency. 【Methods】 Preoperative: In order to determine the effect of cryoprecipitated antihemophilic factor and fresh frozen plasma (FFP) on the elevation level of factor Ⅴ, we alternately infused cryoprecipitate and FFP in the resting state. TEG, coagulation function and coagulation factor activity were monitored before and 1 h, 24 h and 48 h after infusion, and intraoperative and postoperative blood transfusion strategies were formulated. FFP 600 mL and cryoprecipitate 10 U were supplemented preoperatively. Intraoperative: The operation procedure was performed for 7 hours with an infusion of 600 mL FFP without significant bleeding. Postoperative: FFP was infused. 【Results】 Preoperative: The coagulation factor Ⅴ activity on pre-operation was 1.9% and 1.8%. After alternating infusion cryoprecipitate 10 U and FFP 1 200 mL, the FⅤactivity increased to 5.1% and 6.0%, respectively. There was no significant difference in TEG parameters, PT and ATPP results were decreased to varying degrees. Intraoperative: The operation was successful without obvious bleeding. Postoperative: FFP 500 mL was infused 2 h after operation, and FFP 250-500 mL was injected daily from 1 to 7 days after surgery. No significant bleeding was observed in the wound, the results of TEG, PT, APTT and hemoglobin (Hb) did not change significantly compared with those before surgery. The patient was discharged successfully 12 days after surgery. The genetic test results showed that he had inherited coagulation factor Ⅴ deficiency, which was a compound heterozygous variation. 【Conclusion】 Perioperative blood management in patients with FⅤ deficiency combined with surgical disease, requiring pre-transfusion evaluation and post-transfusion evaluation in combination with laboratory investigations and clinical manifestations, cryoprecipitate and fresh frozen plasma can be effective in supplementing coagulation factors. The TEG seems to be better than the Seven items of coagulation function in judging the clotting status of patients with FⅤ deficiency.
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Autologous ozonized blood transfusion(AOBT) is a therapy of re-transfusion of 100-200 mL of autologous blood after shaking and agitation with appropriate amount of oxygen-ozone in vitro. The oxidation of blood through the strong oxidation of ozone can enhance the non-specific immune response of the body, regulate the internal environment and promote health. This therapy has been increasingly applied in clinical practice, while no unified standard for the operation process in terms of ozone concentration, treatment frequency and treatment course had been established. This operation process of AOBT is primarily explored in order to standardize the operation process and ensure its safety and efficacy.
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Granulocyte is granular leukocytes in blood, which play an important role in anti-infection treatment and cancer-killing activity. In clinical, allogeneic granulocyte transfusion can be applied for anti-infection treatment when the patients are seriously infected but the antibiotic treatment is ineffective, especially the WBC counts are extremely low. Recently, some progress has been made in the researches about treating cancer with granulocyte infusion. It is possible to use allogeneic granulocyte infusion with high killing activity to treat the certain types of cancers.
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Platelets concentrates play a vital role in the maintenance of normal hemostatic activity and the integrity of blood vessel wall. Accordingly, for patients with low platelet counts (thrombocytopenia) or dysfunction, platelet transfusion can be of significant value in preventing and treating hemorrhage. In recent years, various studies have proved that platelets also play a very important role on anti-inflammation and improvement of cell and tissue growth and repair in regeneration processes. Platelets with the natural source of various growth factors can help in wound healing and proliferation. At present, autologous platelet-rich plasma and platelet gel are also widely used in the treatment of clinical patients. Therefore, the non-transfusion therapy of allogeneic platelet concentrate and alternatives such as platelet rich plasma, platelet gel and dry platelet (freeze-dried platelet) should be applied on patients in the near future.
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【Objective】 To investigate the clinical efficacy and safety of centrifugal plasma separation combined with plasma adsorption in the treatment of hypertriglyceridemia. 【Methods】 The data of 42 patients with hypertriglyceridemia from February 2019 to October 2020 were retrospectively collected and analyzed. The patients were treated with plasma component exchange by centrifugal plasma separation combined with plasma adsorption (PA) lipid-lowering therapy. The plasma was separated by an automatic blood cell separator, and was then adsorbed by membrane plasma component absorber. Conditions for plasma component exchange were sodium citrate as anticoagulant, the whole blood flow rate at (30~80) mL/min, the plasma circulation volume 2 500 mL, the treatment time 2 h, and the discarded plasma 200 mL. The treatment was performed once every two weeks, twice in total, and the efficacy was evaluated 6 weeks later. The changes of serum total protein (TP), blood lipid indexes and hemorheology indexes before and after treatment were observed, and the adverse reactions during treatment were recorded. 【Results】 The effective rate of 42 patients after treatment was 95.24%. The values of TP, TC, TG and LDL-C decreased significantly (82.53±6.37 vs 74.26±5.91, 7.46±1.83 vs 3.88±1.06, 5.91±2.16 vs 2.20±1.13, 4.23±1.02 vs 3.17±0.85) while HDL-C increased significantly(0.92±0.15 vs 1.23±0.26) after the treatment (P<0.05). After the treatment, the levels of whole blood high-cut viscosity, whole blood low-cut viscosity, plasma viscosity, hematocrit and fibrinogen decreased significantly (7.53±1.21 vs 5.16±0.88, 18.27±3.15 vs 12.04±2.32, 2.46±0.37 vs 1.68±0.29, 52.24±5.31 vs 32.53±4.42, 4.28±0.76 vs 3.14±0.45)(P<0.05). The incidence of adverse reactions was 14.3%, and no serious adverse reactions were observed. 【Conclusion】 The centrifugal plasma separation combined with plasma adsorption in the treatment of hypertriglyceridemia is safe and effective.
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【Objective】 To explore the quality of autologous platelet-rich plasma prepared by manual and automatic method and to study the clinical injection therapeutic effects in patient with knee arthritis. 【Methods】 28 patients with knee arthritis in Orthopedics Department of our hospital were enrolled. PRP was prepared manually in 12 patients and automatically in 16. The whole blood of 50~70 mL was drawn from 12 patients and prepared into PRP of 10 mL manually by centrifugation. The 20~30 mL PRP was collected by automatic apheresis. Plt, RBC, WBC and other related indexes of PRP were detected after collection. Among the 28 patients, 12 in the manual group received injection twice, while 16 in the automatic group 4 episodes, with an interval of 15~20 days. The treatment effect was evaluated after the last treatment. 【Results】 The PRP prepared by two methods can both reach the required quality standard of platelet counts..The patient′s pain symptoms relieved significantly after injection treatment and the effect was remarkable. There was no significant difference in clinical efficacy between the two groups. 【Conclusion】 The PRP prepared by manual and automatic methods can be used for injection treatment for patient with knee arthritis. The clinical therapeutic effects were good and worth promotion and application.
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【Objective】 To explore the effect of allogeneic platelet gel on hemostasis and repair of vascular anastomoses and wounds in patients with giant aortic aneurysms during surgery. 【Methods】 One adult dose of allogeneic platelets, applied as platelet rich plasma (PRP), was prepared as platelet gel (PG) (about 220 mL) for spraying or smearing at the vascular anastomosis and thoracic wound during the surgery of giant aortic aneurysms. 【Results】 The gel formation was presented about 30 seconds after spraying or smearing with PG on the anastomotic and wound surface. The hemostatic effect is good, with less postoperative drainage fluid from pericardium and mediastinum than usual, and the ICU stay was 4 days. 【Conclusion】 Allogeneic platelets as a source of PRP to prepare PG may be applied to obtain the clotting and healing during surgical operation.
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OBJECTIVE To study the current situation and problems of military blood emergency support and nosocomial infections,and find out countermeasures.METHODS The current situations and problems of military blood emergency support and nosocomial infections management system were analyzed,especially paying attentions to those parts including selecting blood donors,blood collection,storage,transport and distribution.RESULTS There were a lot of shortcomings existed in the blood infection factors control and management on blood emergency support;many measures should be taken to elovate the level of blood emergency,and reduce the risk of blood infection.CONCLUSIONS Improving and reforming the management system of blood emergency support in army,and maximatily reducing the risk of blood infection are important.
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Objective To study the effects of aircraft, railway and highway transportations on the quality of red cell suspension.Methods Red cell suspensions from aircraft, railway and highway transportations were randomly selected, 10 units each, and stored for about 20 days as test groups, Another 10 unites of red cell suspensions were collected and stored for 20 days to serve as the control group. Biochemical indicators, including lactic dehydrogenase(LDH), Na+, K+ and Cl-were tested by automatic biochemistry analyzer. Free hemoglobin (FHb) was measured by chromatometry of 3 wavelengths. PO2 was detected by blood gas analyzer. The rate of red blood anaerobic glycolysis and osmotic fragility were also tested. The microstructure of red blood cells (RBCs) was observed by scanning electron microscope.Results The rates of anaerobic glycolysis of aircraft and railway transported red cell suspensions were (42.9?5.6)% and (42.2?3.1)%, respectively, significantly lower than those of highway transportation and the control group, which were (60.4?5.9)% and (70.1?7.8)%, respectively. FHb concentrations in erythrocyte suspension from aircraft and railway transportations were (1.37?0.31) mg/ml and (1.28?0.41) mg/ml, respectively, significantly higher than those of the highway transportation and the control group, which were (0.37?0.05) mg/ml and (0.31?0.03) mg/ml, respectively. LDH level and Na+ concentrations in erythrocyte suspension from aircraft and railway transportations were significantly higher than those from highway transportation and the control group. PO2 was decreased significantly in red cell suspension from aircraft transportation, and the osmotic fragility was increased. K+ was increased significantly in red cell suspension from railway transportation. Cl-was not changed. The aircraft and railway transported RBCs showed agglutination, spherical changes and ragged edges. Many thorn RBCs could be found in these samples. The morphology of RBCs after highway transportation had normal shape , but a few were spherical and ragged at edges. The RBCs of the control group was in double-faced concave disc shape and equably suspended.Conclusion The quality of red cell suspension is closely related to the different ways of transportation. Under certain circumstances, the quality of red cell suspension from highway transportation is superior to that from aircraft and railway transportations.
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0.05). Levels of TGF-?1 and PDGF in microparticle platelet frozen powder were higher than those in fresh platelet(P
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Objective: To explore the mechanism of congestive heart failure (CHF) by observing the effects of Tingli Shengmai Decoction on myocardial fibrosis and expression of TGF-?1 of rats with CHF. Methods: The CHF animal models were duplicated by the abdomen arteriarctia method, and 60 male wistar rats were randomly divided into the sham-operation group, the model group, the high-dose of Tingli Shengmai Decoction group, the low-dose of Tingli Shengmai Decoction group and the positive medicine (Xinbaowan) control group. After 4 weeks common fed, every group rats were given a certain dose of distilled water or medicine. After 8 weeks, hemodynamic parameters were detected, MASSON staining was used in the study of collagen type in left ventricular interstitial tissue, collagen volume fraction (CVF) were measured by image analysis, and expression of TGF-?1 in myocardium were evaluated by immunohistochemical staining. Results: Compared with the sham-operated group, CVF of model control group increased significantly (P
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Objective To explore the conditions for construction of human-to-swine hematopoietic chimera and its specific immune tolerance.Methods The human cord blood CD34+ cells (5?105/Kg) were transplanted to neonatal swine through intraperitoneal injections. The experimental swine, injected with human SCF (50ng/Kg.3d) and EPO (100U/Kg. 3d) simultaneously, and swine without injection were defined as transplantation group 1 and group 2, respectively. The swine, injected with saline, were taken as the control group. Peripheral blood (PB) was collected on day 10, 20, 30, 40, 50, and 60 after injection. The human CD71+cells in the chimera PB were quantitated by FACS and the genus-antibodies of PB were detected by blood group gel card. Results The percentage of human CD71+ cells in PB of transplantation group 1 was significantly higher than that of group 2 (P
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Objective To explore the method of chemical synth esis of L-alanyl-L-glutamine dipeptide. Methods L-alanyl-L -glutamine dipeptide was prepared by condensation and ammoniation reaction of L -glutamine and 2-D-chloropropionyl chloride. The physico-chemical properties of this dipeptide were identified with melting point determination, amino acid analysis, elements analysis and MS and its purity was determined with HPLC. Results This dipeptide was confirmed good in quality by physico-chem ical determination. Conclusion Dipeptide synthetized by this me thod is simple, convenient and with good guality.
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Objective To investigate the changes of leukocyte derived cytokines,IL 1?,IL 6,IL 8,and TNF ?,in platelets concentrates (PCs) during storage,and to study the effect of leukodepletion on cytokine concentration in PCs and the incidence rate of febrile non hemolytic transfusion reaction (FNHTR).Methods 8 bags of apheresed PCs from 8 voluntary donors were each divided into two identical portions (A and B).Group A underwent leukocyte filtration,while group B did not.Then both groups were stored at 22℃ for 5 days.The levels of cytokines (pg/ml),white blood cell (WBC) count and platelet count in both groups were tested on the day 0,3 and 5 during storage.In clinic,240 patients were randomly divided into two groups with 120 in each group to receive non filtered or filtered PCs (1 bag/patient).The incidence of FNHTR was investigated.Paired t test and ? 2 test were used in data analysis. Results There was a significant positive correlation between the content of WBC in PCs and the level of cytokines.On the 5th day of storage,residual WBC in leukoreduced PCs were less than 1?10 6/PC,the levels of cytokines remained the same as those on 0;however,WBC in non filtered PCs was (351?81)?10 6/PC,and the levels of IL 1??IL 6?IL 8 and TNF ? were 105.0pg/ml,269.0pg/ml,1840pg/ml and 42.0pg/ml respectively and increased 18 ( P
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Subcutaneous injection of 1.0 mg/kg cadmium chloride in 0.8% solution was given to rabbits weighing 1.7~2.5kg 3 times a week for 10 weeks.An equal volume of normal saline was injected to the rabbits of the control group.Blood specimen from the auricle vein and 24-hour-urine of every rabbit were collected once a week.Ten weeks later the renal cortex of the rabbits WES resected,processed routinely and examined under optical microscopy,The level of guanidinoacetic acid (GAA) of the serum and urine was determined with HPLC.It was found that the serum level of GAA increased after 3 weeks of cadmium administration while urinary excretion of GAA increased slightly in the first week and decreased significantly in the second week of cadmium injection and thereafter.
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The changes of the activities of serum CK,LDH,HBKH and AST of 11 soldiers having stayed in simulated 3500m and 4500m were observed.It was found that the activities were significantly increased in the order of CK,LDH and HBDH because of hypoxia but the changes of AST was of no statistical significance.CK/LDH ratio and pulse rate showed similar charges to serum enzymes but the changes of arterial oxygen saturation and working efficiency were the opposite to those of serum enzymes.These findings suggest that serum CK and LDH are the indicators of choice to evaluate human reactions to high altitude.