Objectives There is no clear consensus so far on which fixation method is most favorable for the tibial tunnel in anterior cruciate ligament reconstruction (ACLR). The purpose of this paper is to investigate the outcome of RigidFix cross pins fixation in the tibial tunnel and to explore the advantages of RigidFix applied both in the femoral and tibial tunnel with hamstring tendon graft in anterior cruciate ligament reconstruction. Methods This retrospective study included 53 patients (male/female, 45/8) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between January 2013 and December 2017 at our institute. The participants in group A ( n = 36) received anterior cruciate ligament reconstruction with RigidFix cross pins fixation in both femoral and tibial tunnels, while those in group B ( n = 17) with RigidFix cross pins fixation in the femoral tunnel and Interference screw fixation in the tibial tunnel. The visual analogue scale (VAS) score, International Knee Documentation Committee subjective knee form 2000 (IKDC2000) score, Lysholm knee scoring scale, Tegner activity score and the side‐to‐side difference were compared at 2 and 5 years postoperatively. The graft diameter, number of strands in graft and the average diameter of each strand were also compared between the two groups. The categorical parameters were analyzed by chi‐square test and the continuous variables conforming to a normal distribution were analyzed by Student's t ‐test. Results At 2 years postoperation, the VAS score (1.61 ± 0.55), side‐to‐side difference (1.50 ± 0.58) in group A were significantly lower than that in group B, and the IKDC2000 score (88.81 ± 3.88), Tegner activity score (6.14 ± 0.60) in group A were significantly higher than that in group B. At 5 years postoperation, the VAS score (1.64 ± 0.68), side‐to‐side difference (1.73 ± 0.63) in group A were significantly lower than that in group B, and the IKDC2000 score (89.09 ± 3.85), Tegner activity score (6.58 ± 0.94) in group A were slso significantly higher than that in group B. There was statistical difference in the change of the side‐to‐side difference between the two groups (group A vs. B, 0.22 ± 0.08 vs. 0.34 ± 0.11, p < 0.001). There were also statistical differences in the graft diameter (group A vs. B, 7.83 ± 0.74 vs. 7.41 ± 0.51, p = 0,038), number of strands in graft (5.67 ± 0.72 vs. 4.00 ± 0.00, p < 0.001) and the average diameter of each strand (1.41 ± 0.22 vs. 1.85 ± 0.13, p < 0.001) between the two groups. Conclusion RigidFix cross pins fixation in the tibial tunnel for anterior cruciate ligament reconstruction can achieve better 5‐year results when compared with the interference screw, and the hamstring tendon can be folded into a thicker graft when RigidFix cross pins were applied in both femoral and tibial tunnels.
Objective To analyze the experience of donation after citizens death,and investigate the questions in our country.Method The organs were obtained from 130 cases of organ donation in a single center,and the clinical data were analyzed retrospectively.Result From July 2011 to June 2014,there were 105 males and 25 females in the enrolled 130 donors,and the oldest age was 62 years and youngest one was only 10 months.130 donations included 15 cases of donation after brain death (DBD),73 cases of donation after cardiac death(DCD),and 42 cases of donation after brain death awaiting cardiac death(DBCD).In 73 cases of DCD,there were 66 cases of Maastricht category Ⅲ and 7 cases of Maastricht category Ⅴ.With these donated organs,122 cases of liver transplantations,228 cases of renal transplantations,12 cases of heart transplantation,2 cases of lung transplantations,6 cases of multivisceral transplantation and 4 cases of in vivo splitting liver transplantation were carried out successfully.Conclusion By strict screening and evaluation,the organs of donation after death can be utilized in clinical organ transplantation safely and effectively.
Key words:
Donors; Organ procurement; Organ donation; Organ transplantation
Good neurological outcome after cardiac arrest (CA) is hard to achieve for clinicians. Experimental and clinical evidence suggests that therapeutic mild hypothermia is beneficial. This study aimed to assess the effectiveness and safety of therapeutic mild hypothermia in patients successfully resuscitated from CA using a meta-analysis.We searched the MEDLINE (1966 to April 2012), OVID (1980 to April 2012), EMBASE (1980 to April 2012), Chinese bio-medical literature & retrieval system (CBM) (1978 to April 2012), Chinese medical current contents (CMCC) (1995 to April 2012), and Chinese medical academic conference (CMAC) (1994 to April 2012). Studies were included if 1) the study design was a randomized controlled trial (RCT); 2) the study population included patients successfully resuscitated from CA, and received either standard post-resuscitation care with normothermia or mild hypothermia; 3) the study provided data on good neurologic outcome and survival to hospital discharge. Relative risk (RR) and 95% confidence interval (CI) were used to pool the effect.The study included four RCTs with a total of 417 patients successfully resuscitated from CA. Compared to standard post-resuscitation care with normothermia, patients in the hypothermia group were more likely to have good neurologic outcome (RR=1.43, 95% CI 1.14-1.80, P=0.002) and were more likely to survive to hospital discharge (RR=1.32, 95% CI 1.08-1.63, P=0.008). There was no significant difference in adverse events between the normothermia and hypothermia groups (P>0.05), nor heterogeneity and publication bias.Therapeutic mild hypothermia improves neurologic outcome and survival in patients successfully resuscitated from CA.
Objective To summarize the experience of surgical resection of 58 hilar cholangiocarcinoma.Methods The clinical data of 58 patients with hilar cholangiocarcinoma surgically treated in our hospital from January 1995 to December 2004 were retrospectively analyzed.Results The 58 were divided into the radical resection group (n=22, 38.0 %) 、palliative resection group(n=26, 44.8 %) and external drainage group (n=10,17.2%) according to different kinds of treatments. None of patients died during operation. The postoperative total follow-up rate was 51.7%(30/58),and 11 cases were still survived,including 10 cased in the radical resection group,and 1 case in palliative resection group. There is statistical difference in survaval rate among 3 groups (One-Way-Anova, P0.01). In the 30 following cases, the maximum and minimum surviving time were 67 months and 28 days. Conclusion Resection group,especially radical resection group has good therapeutic effect in hilar cholangiocarcinoma.
Objective
To investigate the clinical efficacy and safety of alteplase thrombolysis in the treatment of patients with acute ischemic stroke.
Methods
42 patients with acute ischemic stroke were randomly divided into the control group and the study group.18 cases in the control group were treated by urokinase thrombolysis, and 24 cases in the study group were treated by alteplase thrombolysis.The clinical efficacy and safety were compared between the two groups.
Results
The total effective rate of the study group(91.7%) was higher than that of the control group(77.8%), and the difference was statistically significant(χ2=9.7, P<0.01). Compared with the control group, the total vascular patency rate was higher, the difference was statistically significant(χ2=97.6, P<0.01). The NIHSS score was lower in the two groups after treatment(t=10.158, 15.962, all P<0.05), and that in the study group was more lower, the difference between the two groups was statistically significant(t=10.564, P<0.05).
Conclusion
Alteplase thrombolysis in the treatment of acute ischemic stroke patients, thrombolytic therapy for patients, in the use of drugs within the time window patients can get good clinical curative effect, no more than drug use the most extensive restrictions rarely cause patients with intracranial hemorrhage, and being suitable for popularization and application.
Key words:
Stroke; Alteplase
Objective The research is engaged in developing an improved titanium skirt for keratoprosthesis, the aim of this study was to evaluate biocompatible of keratoprosthesis of novel design.Methods The pure titanium skirt for keratoprosthesis with three hands were first Sandblasted, and then bioactive hydroxyapatite coated on Sandblasted titanium for keratoprosthesis by a acid-alkali chemical treatment. A total of 18 New Zealand white rabbits and 18 alkali burned rabbit corneas were respectively divided into three groups (Group A, B and C;Group E, F and G) with simple random sampling methods.The modified titanium skirt was inserted into the corneal stroma of Group A and E, and then the control skirt was inserted into Group B and F. Group C and H did not insert skirt as surgery control. The interfacial biointegration of skirt/cornea were examined under light microscopy by HE,TEM and SEM. The transparent center was implanted to rabbit corneas with modified titanium skirt after 3 months. Results Dense hydroxyapatite coating was deposited on the Sandblasted specimens by an acid-alkali chemical treatment. The number of corneal fibroblasts increased significantly in Group A compared with Group B, The extracellular matrix deposited on the surface of modified titanium skirt was more dense and tight than that of control skirt.There was a significant difference in the shear force of skirt among groups A and B (t = 3.297, P < 0.05 ), E and F(t =4.237, P <0.05),and taking out the skirt in Group A and E were more difficulty than that in Group B and F after 3 months. The observation of the tissue sections of modified skirt inserted eyes revealed that there were cells and collagen-like fibres perpendicular to or at an angle to the rough interface and the cellular function was extremely active, in accordance with the results of TEM. Compared with healthy host tissue, skirt/cornea healing after alkali burn was impaired. Conclusions Hydroxyapatite modified Sandblasted titanium skirt for keratoprosthesis can promote the interfacial biointegration of skirt and host cornea, no matter in healthy cornea or diseased cornea (alkali burn cornea). Hydroxyapatite coating improved the bioactivity of titanium.
Key words:
Prostheses and implants; Titanium; Hydroxyapatites; Eye burns; Biocompatible materials
Objective
To investigate the correlation between the elastographic characteristics of liver and postoperative function of liver allografts.
Methods
Forty-eight cases of liver transplantation from The First Affiliated Hospital of Sun Yat-sen University were analyzed, Shear wave elastography (SWE) was performed before operation or at one week or one month post-operation.Liver function was evaluated by measuring alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), γ-glutamine transferase (GGT), albumin (ALB), alkaline phosphatase (ALP), prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR). Early allograft dysfunction (EAD) was also analyzed with reference to SWE among liver transplant recipients.
Results
SWE at one week after transplantation was significantly correlated with TBIL (r=0.525 6, P<0.01), APTT (r=0.668 3, P<0.000 1), PT (r=0.593 7, P=0.000 1), INR (r=0.609 6, P<0.000 1) and prealbumin (r=-0.464 1, P<0.01). However, no significant correlation was observed between pre-operative SWE and parameters of post-operative liver function.SWE in EAD patients was higher than that of patients without EAD (17.60±1.09 kPa vs.13.38±0.99 kPa, P<0.01). The optimal cut-off value of SWE at one week post-operation was 14.85 kPa.
Conclusion
Postoperative SWE is significantly correlated with postoperative liver function tests and EAD, suggesting SWE is a potential test for evaluating the quality of liver allografts.
Key words:
Ultrasonic examination; Shear wave elastography; Liver transplantation; Early allograft dysfunction
Abstract Background There is currently no reliable treatment for stump pain and phantom limb pain. Peripheral factors play a significant role in the pathophysiology of stump pain and phantom limb pain. Coblation technology is a relatively new technology that has shown promise in treating neuropathic pain. Case Report This report describes the use of coblation technology on femoral and sciatic nerve for stump pain and phantom limb pain. An ultrasound‐guided perineural infiltration anesthesia surrounding the neuroma was first performed and achieved approximately 60% stump pain relief that lasted for 2 hours, but no relief of the phantom limb pain. An ultrasound‐guided femoral and sciatic nerve block was performed to obtain longer pain relief. The patient reported approximately 80% pain relief in both stump pain and phantom limb pain that lasted for 40 hours. This finding suggested other factors in addition to the ultrasound‐detected neuroma in the residual limb generating pain for this patient. Coblation of femoral and sciatic nerves was performed. The stump pain was completely relieved immediately after operation. At 1, 3, and 6 months postoperative review, 80% relief of both stump and phantom limb pain was achieved. Overall activity was improved and there was no need for pain medications. The analgesic effect was stable during the 6‐month follow‐up period. Conclusion Our report suggests that coblation technology may be useful treatment for stump pain and phantom limb pain. Treatments focusing on peripheral nerves may be more effective than those focusing on the neuroma. This finding needs additional study for confirmation.
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