【Abstract】 Objective To review the progress of autologous fat grafting of the face and outline different arguments in this field. Methods Recent literature concerning autologous fat grafting of the face was reviewed and analyzed. Results The applications and techniques for autologous fat grafting have been matured increasingly. It not only can adjust the proportion of facial contours, restore tissue volume, but also can improve the local skin texture. Reliable clinical results have achieved in facial augmentation and rejuvenation. Although there are arguments about donor site, harvesting technique, processing technique, and grafting technique, the basic principle is the same. Conclusion From the perspective of evidence-based medicine, clinicians are rich in clinical experience, but objective evidence is insufficient. So further researches should be carried to look for scientific evidences.
Objective To review progress of clinical application ofmorselized bone and to investigate relative exploration on it.Methods The recent articles on morselized bone in the field of clinicand experimental research were extensively reviewed, and relative examination of morselized bone referring to method and mechanism were investigated carefully.Results Morselized bone worked well clinically, especially inrevision ofartificial total hip joint, and it was proved effective with lots of advantages.Conclusion Morselized bone functions well clinically. Although its mechanism requires a further research, it still has a promising value in clinical application.
Objective To investigate the anatomic variations of the perforator vessels of anterolateral thigh (ALT) flap and the clinical indications. Methods From March 1985 to August 2004, the anterolateral thigh flapgraft was performed in 112 patients. The clinical data were analyzed. There were 67 males and 45 females, aging from 5 to 65 years with an average of 38.5 years. According to recipient site condition, four methods of flap harvesting were as follows:① 78 received free fasciocutaneous flaps;② 22 received free adipofascial flaps;③ 5 received pedicled island fasciocutaneous flaps; ④ 7 received pedicled reverse-flow island fasciocutaneous flaps. Facial, neck, breast, extremityjoint, plantar, and perineum defects were repaired and the effectiveness and donor site morbidity were evaluated. Results The blood supply of ALT flap came from the descending branch or transverse branch of the lateral circumflex femoralartery. The skin vessels were found to be septocutaneous perforators in 33% of flaps and to be musculocutaneous perforators in 77% of flaps. Of 112 flaps, 107 survived completely, the survival rate was 95.6% with little donor site morbidity. Conclusion ALT flap is a versatile softtissue flap. If refined to perforator flap, it can achieve better results in reconstructing defect and minimizing donor-site morbidity.
OBJECTIVE: To sum up the clinical results of bio-derived bone transplantation in orthopedics with tissue engineering technique. METHODS: From January 2000 to May 2002, 52 cases with various types of bone defect were treated with tissue engineered bone, which was constructed in vitro by allogeneous osteoblasts from periosteum (1 x 10(6)/ml) with bio-derived bone scaffold following 3 to 7 days co-culture. Among them, there were 7 cases of bone cyst, 22 cases of non-union or malunion of old fracture, 15 cases of fresh comminuted fracture of bone defect, 4 cases of spinal fracture and posterior route spinal fusion, 3 cases of bone implant of alveolar bone, 1 case of fusion of tarsotarsal joint. The total weight of tissue engineered bone was 349 g in all the cases, averaged 6.7 g in each case. RESULTS: All the cases were followed up after operation, averaged in 18.5 months. The wound in all the case healed by first intention, but 1 case with second intention. Bone union was completed within 3 to 4.5 months in 50 cases, but 2 cases of delayed union. Six cases were performed analysis of CD3, CD4, CD8, ICAM-1 and VCAM-1 before and after operation, and no obvious abnormities were observed. CONCLUSION: Bio-derived tissue engineered bone has good osteogenesis. No obvious rejection and other complications are observed in the clinical application.
Pulmonary hypertension (PH), characterized by diverse etiologies and intricate pathological mechanisms, is a complex cardiopulmonary vascular disorder featuring high morbidity and mortality. Percutaneous pulmonary artery denervation (PADN) represents an emerging interventional treatment method, which shows good prospects in the clinical practice of PH. The PADN has attained preliminary achievements in terms of safety and efficacy. Nevertheless, its long-term prognosis, the characteristics of the appropriate patient populations, and the optimization strategies combined with targeted pharmacotherapy remain to be further explored. This article reviews the current clinical applications of PADN as well as the challenges it confronts.
【摘要】目的探讨新型医患沟通范式的临床价值。方法分析新型医患沟通范式的基本文书和临床应用效果。结果自2002年1月2009年12月,新型医患沟通范式应用于9800余例住院患者,无1起医疗事故发生。结论新型医患沟通范式从形式上和内容上对患者知情权进行了充分的保障,对构建和谐医患关系具有重大价值。【Abstract】Objective To explore the clinical value of new doctorpatient communication paradigms. Methods The primary documents and clinical application results of new doctorpatient communication paradigms were analyzed in our study. Results We applied the new doctorpatient communication paradigms to more than 9800 patients of inpatient from January 2001 to December 2009. No medical negligence was observed. Conclusion The new doctorpatient communication paradigms can ensure the patient’s right of informed consent in form and in content. Its value to construct harmony doctorpatient relationship is great.
Objective To explore the clinical application of allogeneic bone transplantation. Methods Related literatures on clinical application of various allograft bone materials of the past 5 years were extensively reviewed. Results The allografts could be processed into various kinds of transplanting materials, such as small blocks, large segments, morselised or granular material, and bone ring, so that they could be applied to bone defect filling, prosthesis revision, limb preservation after tumor resection, and joint fusion. All these applications ended up with good clinical results. However, complications resulted in thestructural transplantation of large block bones could be overlooked. Conclusion The main advantage of bone allograft is that it can be integrated with host bone and be remodelled, so as to reconstruct bone structure and function. How to accelerate their integration and remodelling while exerting normal functions is the problem that requires solution.
To summarize the medium-term cl inical result of bio-derived bone transplantation in orthopedics with tissue engineering technique. Methods From December 2000 to June 2001, 10 cases of various types of bone defect were treated with tissue engineered bone, which was constructed in vitro by allogenous osteoblasts from periosteum (1 × 106/ mL) with bio-derived bone scaffold following 3 to 7 days co-culture. Six men and 4 women were involved in this study, aged from 14 to 70 years with a median of 42 years. Among them, there were 2 cases of bone cyst, 1 case of non-union of old fracture, 6 cases of fresh comminuted fracture with bone defect, and 1 case of chronic suppurative ostemyel itis. The total weight of tissue engineered bone was 3-15 g in all the cases, averaged 7.3 g in each case. Results The wound in all the case healed by first intention. For 7 year follow up, bone union was completed within 3.0 to 4.5 months in 9 cases, but loosening occurred and the graft was taken out 1 year after operation in 1 case. The X-ray films showed that 9 cases achieved union except one who received resection of the head of humerus. No obvious abnormities were observed, and the function of affected l imbs met daily l ife and work. Conclusion Bio-derived tissue engineered bone has good osteogenesis. No obvious rejection and other compl ications are observed in the cl inical appl ication.
Objective To observe therapeutical effect of recombinant human growth hormone (rhGH) on postoperative obstructive jaundice. Methods Fourtyeight patients were divided into two groups randomly: control group with 30 patients and rhGH group with 18 patients. After operation, subcutaneous injection of rhGH was administered 8 U/d for a week. At the same time, parenteral nutrition was given to both groups until the patients could eat and drink. Biochemistry examination, endotoxin, tumor necrosis factor, sIL-2R and nutritional status were all measured at following states: before operation 1, 7 and 14 days after operation. Results Body weights of rhGH group on the fourth day after operation and that of control group on the seventh day after operation increased, but the increasing tendency of rhGH group was more prominent than the control group. For blood sugar 7 days after operation, the level of rhGH group was higher than that of control group (P＜0.05). The level of serum albumin, transferrin, prealbumin in rhGH group was higher than that of control goup （P＜0.05）. Blood serum total bile acid,total cholesterol, low density lipoprotein,glutamicoxal acetic transaminase, transglutaminase, total bilirubin, endotoxin, tumor necrosis factor and sIL-2R were all decreased compared with control group (P＜0.01). However, no significant difference was observed in renal function and electrolute between the two groups.Conclusion An improvement of nutrition status and immunologic function can be observed in obstructive jaundice patients after the postoperative administration of rhGH.
ObjectiveTo investigate the effect of vascular interventional technique in arterial injuries of damage control surgery.MethodsA retrospective review was made on clinical data of 31 arterial injuries cases who received damage control surgery from March 2011 to June 2018. All cases underwent endovascular therapy for arterial injuries in No. 960 Hospital of Chinese People’s Liberation Army, and then the definitive operation was operated as soon as the vital signs became stable.ResultsThe surgery was successful in all patients, and the operation time was 43–100 min (average of 57 min), the intraoperative blood loss was 50–200 mL (average of 80 mL). Bleeding was successful controlled in 11 cases with covered stents, 9 cases with multiple overlapping bare stents, and 11 cases with spring coil, all cases with shock were improved immediately. There were no perioperative mortality or procedure-related complication occurred. All cases were discharged from hospital smoothly after two-phase surgery. All the patients were followed up for 6 to 24 months [(17±5) months]. Two patients with covered stent lumen stenosis less than 50% as showed by angiography, and no secondary treatment was required. In addition, blood flow patency was kept in the rest of artery, no bleeding occurred in injured artery. During the follow-up period, the collateral vessels of 9 patients treated with multi-layerbare stent overlapping technique were unobstructed. Stent migration, fracture or leakage was not found during the follow-up period. Patients recovered well after definitive surgery, they had good fracture healing with a disability rate of 0.ConclusionRational application of vascular interventional technique in damage control surgery is a safe and effective treatment method for arterial injuries combined with other traumas.