ObjectiveTo explore the causes and management of the complications in diabetic foot treated with tibial transverse transport (TTT). MethodsBetween September 2015 and September 2019, 196 patients with diabetic foot were treated with TTT. There were 109 males and 87 females, with an average age of 67.6 years (range, 45-86 years). According to Wagner’s classification, there were 124 cases of grade 3, 62 cases of grade 4, and 10 cases of grade 5; the course of disease was 1-12 months, with an average of 2.6 months. All patients underwent the minimally invasive tibial osteotomy. The osteotomy site was the middle and lower tibia in 62 cases and the middle and upper tibia in 134 cases. The area of osteotomy was 20 cm2 in 83 cases and 7.5 cm2 in 113 cases. The osteotomy block was moved back and forth once in 92 cases and twice in 104 cases. The complications were recorded, including secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection. ResultsAmong 196 patients, 41 cases (20.9%) had complications. Nine cases (4.6%) had secondary fracture at tibial osteotomy, among which 6 cases (9.6%) of middle and lower segment osteotomies and 3 cases (2.2%) of middle and upper segment osteotomies. The incidence between the patients with different osteotomy sites was significant (χ2=5.354, P=0.021). The area of osteotomy was 20 cm2 in 5 cases (6.0%) and 7.5 cm2 in 4 cases (3.5%). There was no significant difference in the incidence between patients with different areas (χ2=0.457, P=0.499). Skin necrosis occurred in the osteotomy area in 12 cases (6.1%), all of which were moved back and forth once. There was a significant difference in the incidence between patients who were treated with transport once and twice (P=0.001). There were 18 cases (9.1%) with pin tract infection, including 12 cases (6.1%) with mild infection and 6 cases (3.0%) with severe infection. There was no significant difference in the incidence between the patients with mild and severe infections (P=0.107).ConclusionTTT is an effective method to treat diabetic foot, but there are complications such as secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection during transport. Preoperative evaluation of indication, standardization of osteotomy mode, size and position of osteotomy block, establishment of individualized removal plan, and strengthening of pin track nursing after operation can effectively reduce complications.
ObjectiveThe role of ferroptosis-related genes in the occurrence and development of lung injury caused by sepsis was investigated by bioinformatics methods, and the closely related genes were predicted. MethodsThe Dataset GSE154653 was downloaded from the gene expression database (GEO), and a total of 8 cases of microarray gene set were included in normal group and lipopolysaccharide (LPS)-induced sepsis lung tissue. The differential expression genes (DEGs) were screened out under conditions of |log2 FC|>1 and P.adj<0.05. Meanwhile, the selected DEGs were combined with the driver and suppressor genes of ferroptosis downloaded from the ferroptosis database (FerrDb) to obtain the differential genes associated with ferroptosis in sepsis (Fe-DEGs). These Fe-DEGs were further analyzed using R language, DAVID, and STRING online tools to identify GO-KEGG functions and pathways, and the construction of PPI network. Results The Bioinformatics approach screened out 3533 DEGs and intersected 53 key genes related to ferroptosis. The further biological process (BP) of GO enrichment analysis mainly involves the positive regulation of transcription, the positive regulation of RNA polymerase II promoter transcription, the cytokine mediated signaling pathway, and the positive regulation of angiogenesis. The molecular function (MF) mainly involves the same protein binding, transcriptional activation activity and REDOX enzyme activity. The pathways are enriched in iron death, HIF-1 signaling pathway and AGE-RAGE signaling pathway. Five key Fe-DEGs genes were screened by constructing PPI network, including CYBB, LCN2, HMOX1, TIMP1 and CDKN1A. Conclusion CYBB、LCN2、HMOX1、TIMP1 and CDKNIA genes may be key genes involved in ferroptosis of lung tissue caused by sepsis.
ObjectiveTo explore the clinical application and recent progress of preoperative liver function evaluation methods.MethodThe literatures about the studies of indexes of preoperative liver function evaluation were summarized and analyzed.ResultsSerological indexes could reflect liver function in many aspects; Indocyanine green clearance test, Child-Pugh and MELD scoring system could improve the accuracy of evaluating liver reserve function; Imaging examination and artificial intelligence (radiomics and deep learning) helped to diagnose the degree of liver fibrosis and accurately measure the volume of functional liver.ConclusionsEach method of preoperative liver function evaluation has certain limitation. It needs comprehensive analysis combined with a variety of evaluation indexes so as to objectively and accurately evaluate liver function and formulate an individualized diagnosis and treatment plan that furthest benefits patients.
ObjectiveTo explore the effects of different concentrations of sevoflurane on hyperoxia-induced lung injury in rat.MethodsThe 72 SD rats were randomly divided into control group C (n=12); sevoflurane inhalation group S, group S contains 5 subgroups (n=12) S0, S1.0, S1.5, S2.0, S2.5. Group C wasn’t given any treatment, rats in group S were inhaled 95% oxygen for 48 hours to establish a hyperoxia-induced lung injury model. then rats in each subgroup inhaled sevoflurane at different concentrations of 0%, 1.0%, 1.5%, 2.0% and 2.5% for 1 h respectively, rats in group C were breathe air freely. At the two time points which include inhaled 95% oxygen for 48 hours, and sevoflurane was inhaled for 1 h, blood was collected by the abdominal aorta, then arterial blood was used for blood gas analysis; using enzyme linked immunosorbent assay for the detection of serum tumor necrosis factor (TNF) -α and interleukin (IL) -8 and IL-6 concentration; HE staining was carried out in the right lung, and the pathological changes of lung tissue were observed under light microscope; Wet to dry ratio (W/D) of the left lung was taken.ResultsAfter inhalation of 95% oxygen for 48 hours (T1): compared with the group C, group S of arterial blood gas results suggested that the PaO2 value decreased, PaCO2 value increased. The degree of lung tissue injury and the pathological score, TNF-α, IL-8 and IL-6, W/D content increased significantly (P < 0.05), there was no significant difference between the S0 to S2.5 groups; After treatment with sevoflurane for 1 h (T2): compared with the group C, group S of arterial blood gas results suggested that the PaO2 value decreased, PaCO2 value increased. the degree of lung tissue injury and the pathological score, TNF-α, IL-8 and IL-6, W/D content increased significantly (P < 0.05); Compared with before sevoflurane treatment, the PaO2 value increased, PaCO2 value decreased, TNF-α, IL-8 and IL-6, W/D content decreased, pathological score decreased in group S1.0 to S2.5 (P <0.05), but there was no significant difference in group S0; After treatment with sevoflurane, compared with S2.0 group, the PaO2 value decreased, PaCO2 value increased, TNF-, IL-8 and IL-6, W/D content increased, pathological score increased in the group S1.0 and S1.5 (P < 0.05), but there was no significant difference in group S2.5.ConclusionSevoflurane can effectively reduce the degree of lung injury caused by hyperoxia in rats especially when the concentration is 2%.
Human chromosomes karyotyping is an important means to diagnose genetic diseases. Chromosome image type recognition is a key step in the karyotyping process. Accurate and efficient identification is of great significance for automatic chromosome karyotyping. In this paper, we propose a model named segmentally recalibrated dense convolutional network (SR-DenseNet). In each stage of the model, the dense connected network layers is used to extract the features of different abstract levels of chromosomes automatically, and then the concatenation of all the layers which extract different local features is recalibrated with squeeze-and-excitation (SE) block. SE blocks explicitly construct learnable structures for importance of the features. Then a model fusion method is proposed and an expert group of chromosome recognition models is constructed. On the public available Copenhagen chromosome recognition dataset (G-bands) the proposed model achieves error rate of only 1.60%, and with model fusion the error further drops to 0.99%. On the Padova chromosome dataset (Q-bands) the model gets the corresponding error rate of 6.67%, and with model fusion the error further drops to 5.98%. The experimental results show that the method proposed in this paper is effective and has the potential to realize the automation of chromosome type recognition.
ObjectiveTo summarize the mid-term follow-up results and postoperative aortic remodeling of treating blunt aortic injuries (BAI) with thoracic endovascular aortic repair (TEVAR).MethodsA retrospective study was conducted on BAI patients treated with TEVAR, who were admitted into the Department of Vascular Surgery in Zhongshan Hospital, Affiliated to Fudan University between September 2003 and December 2015. There were 15 males and 9 females at an average age of 45.6±14.0 years. The mechanism of BAI was mainly auto car crash. Totally 25 entry tears were detected and most of them were located at the aortic isthmus.ResultsTwenty-four BAI patients survived and eventually went through TEVAR. One patient died of pulmonary embolism 1 week post-TEVAR. Rate of technical success, clinical success and perioperative mortality was 100.0%, 95.8%, and 4.2%, respectively. Nineteen patients were followed up with a mean time of 35.1(13-87) months. All of them survived this period. Based on the follow-up imaging of CTA, 18 of them revealed no endoleak or stent migration, and 1 patient of transection still had perfusion of distal false lumen at the abdominal aorta. None of the aortic segments measured in this study showed expansion of ≥5 mm during follow-up. The aorta remodeled well in 94.7% of them.ConclusionTEVAR for treating BAI appears feasible with high rates of technical and clinical success rates. The mid-term follow-up results seems satisfying, but the long-term results are yet to be assessed with further follow-up.
【Abstract】 Objective To develop a new internal fixator Ni-Ti shape memory alloy scaphoid arc nail (NT-SAN)for fracture of the scaphoid waist and to test the biomechanical characteristics of NT-SAN so as to provide the biomechanicalproofs for cl inical appl ication. Methods According to the acquired measurements and anatomic features of the scaphoid in Chinese population, a special internal fixator—— NT-SAN was designed. The biomechanical intensity experiment: The 32 specimens of fractures of the waist of scaphoid were divided randomly into 4 groups (n =8). Reduction and internal fixation were carried out in each specimen, with Kirschner wires (Group A), with Kirschner wires stapl ing (Group B), with screw (Group C) and with NT-SAN (Group D). Their fixed strength was tested by a hydrol ic pressure biomechanical system AG-1. The biomechanical fatigue experiment: The models of 24 waist scaphoid fracture of adult upper l imbs specimens were made and randomly divided into 3 groups (n =8). Fracture was fixed with Kirschner wire stapl ing (Group E), with screw(Group F) and with NTSAN(Group G). Wrist joint was vertically pressured load of 98 N, palmar flexion and dorsal extension motion was simulated;the range of movement was from palmar flexion 5° to dorsal extension 30° and the frequency was 2 000 cycles. Displace data offragment were measured at every 500 cycles. Finally, the biomechanical features of NT-SAN were evaluated according to thetested data. NT-SAN was used to treated 1 patient with fracture of the waist of scaphoid, who was typed as Ⅱ b according to Herbert classification. Results The biomechanical tests showed that the traction forces were (15.18±3.55), (36.04±4.30),(64.88±11.62), (65.84±12.22) N and (20.28±12.09), (75.95±47.64), (120.91±26.68), (130.21±31.55) N when the displacements of the fracture l ines distracted in 1 mm/min were 1 mm and 2 mm; showing significant differences between Group D and groups A, B (P lt; 0.05), and showing no significant difference between Group D and Group C (P lt; 0.05). The biomechanical fatigue experiment showed that there were significant differences between Group G and groups E, F(P lt; 0.05) according to the measuredresults of the displacements of the fracture l ines. When wrist joint were circularly moved; showing significant differences between Group G and Group E(P lt; 0.05) after 500 circular movements, and showing significant differences between Group G and Group F(P lt; 0.05) after 1 500 circular movements according to the measured results of the “stage-shape” displacements in the fracture position. Incision healed by first intention and the X-ray films showed good NT-SAN fixation 3 months after followup.Conclusion The design of NT-SAN is in accordance with the anatomic features of the scaphoid. The fixed strength can meet the demand of the biomechanics and the range of fatigue strength can meet the demand of bony union.
Objective To study the diagnostic procedures and management of aortic stent graft infection. Methods Clinical data of 4 patients with aortic stent graft infection from 1998 to 2008 were analyzed retrospectively. Results Primary disease was thoracic endovascular aortic repair in 2 cases and endovascular aneurysm repair in another 2 cases. Constitutional symptoms and abscess information on imaging studies were presented in all patients. Salmonella choleraesuis was revealed in 2 cases. Surgical debridement, drainage and systematic antimicrobial therapies were given to 2 patients. The remaining 2 patients were managed with antimicrobial therapy only. During follow-up, there was no recurrence of infection. Conclusions Infection of aortic stent graft infection is a rare but potentially devastating complication. Radiologic studies can serve as important adjuncts in the diagnosis of endovascular graft infections. Several treatment options are available, some cases may be managed with conservative treatment.
Objective To investigate critical thinking disposition inventory on medical students to offer evidence for building a medical education model with core competency as guide, evidence-based medicine as carrier and lifelong learning as purpose. Methods Chinese Version of Critical Thinking Disposition Inventory was used to investigate the current status of critical thinking of 617 medical undergraduates and graduates of Sichuan University. Results The average total score was more than 280 points. Average total scores of medical students in different educational systems from high to low were 309 points (eight-year-program), 298 points (postgraduates), 287 points (seven-year-program) and 286 points (five-year-program), respectively. The scores of three items including “seek truth”, “systematicity” and “confidence” were lower than 40 points in students both of five-year-program and seven-year program. There was no significant difference in total scores and each item between genders and varied ages. Conclusion The main factors which influence critical thinking in medical students of China include education idea, teaching atmosphere, teaching methods and teaching evaluation system.
