[A comparative study of vancomycin loaded bone cement in the treatment of Wagner Ⅱ-Ⅳ diabetic foot]

OBJECTIVE

To investigate the clinical effect of vancomycin bone cement in the treatment of diabetic foot ulcer (DFU) ruptured Wagner gradeⅡ-Ⅳ.

METHODS

From March 2019 to April 2021, 32 patients with Wagner gradeⅡ-Ⅳ diabetic foot were divided into vacuum sealing drainage (VSD) group and bone cement group according to different treatment methods. There were 16 cases in VSD group, 8 males and 8 females;the age ranged from 66 to 81 (70.50±7.20) years, and the course of disease ranged from 8 to 40 (27.56±8.55) months;Wagner gradeⅡin 2 cases, grade Ⅲin 7 cases and grade Ⅳin 7 cases;debridement and VSD were used. There were 16 cases in the bone cement group, 9 males and 7 females;the age ranged from 63 to 79 (69.56±7.29) years, and the course of disease ranged from 11 to 39(22.75±11.43) months;Wagner gradeⅡ in 2 cases, grade Ⅲin 5 cases and grade Ⅳ in 9 cases;vancomycin loaded bone cement was used for treatment. The types of bacteria, negative time of bacterial culture, skin healing time, hospital stay, operation times and complications were observed and compared between two groups.

RESULTS

All patients were followed up for 3 to 6 (4.00±1.07) months. The bacterial negative time, skin healing time and hospital stay in bone cement group were significantly lower than those in VSD group (P<0.05). The median number of operations in both groups was 2, and there was no significant difference (P>0.05). According to the analysis of pathogens in two groups, there were 13 cases of G⁺ patients, 14 cases of G^- patients and 5 cases of mixed bacteria. The number of G⁺, G^- and mixed bacteria in bone cement group was 6, 7 and 3 cases respectively, and the number of G⁺, G^- and mixed bacteria in VSD group was 7, 7 and 2 cases respectively. The wounds of 32 patientsin two groups healed completely without complications.

CONCLUSION

Vancomycin loaded bone cement is effective in the treatment of Wagner grade Ⅱ-Ⅳ diabetic foot ulceration wounds. It can reduce the length of hospital stay, shorten the healing time of skin and kill pathogens as soon as possible. It is one of the effective methods to treat Wagner gradeⅡ-Ⅳdiabetic foot ulceration.

[Clinical effect of minimally invasive technique on the treatment of osteoporotic humeral shaft fractures in elderly patients with locking plates]

OBJECTIVE

To explore the clinical effect of minimally invasive technique combined with locking plates for the treatment of osteoporotic humeral shaft fractures in elderly patients.

METHODS

From July 2012 to December 2016, 26 patients were treated by minimally invasive technique combined with the locking plate for osteoporotic humeral shaft fractures, including 10 males and 16 females, ranging in age from 61 to 81 years old, with an average of 70.3 years old. The T-score of mean bone density was -2.74. All 26 patients had closed fractures, including 6 cases of type A, 7 cases of type B and 13 cases of type C. All patients were followed up for 12 months after surgery, and the Constant shoulder joint score and Mayo elbow score were calculated before surgery and 12 months after surgery.

RESULTS

All 26 patients were followed up, and the duration ranged from 12 to 16 months, with an average of 13.2 months. All fractures healed within 16 weeks, with an average healing time of 14.3 weeks. The average Constant shoulder joint score before surgery and 12 months after surgery was 54.61±2.09, 88.50±2.47. The average score of Mayo elbow joint before surgery and 12 months after surgery was 58.19±2.74, 90.30±2.16.

CONCLUSIONS

The shoulder and elbow joint function of elderly patients with osteoporotic humeral fractrues treated with minimally invasive technology combined with locking plate recovered well postoperatively. It is an effective method for the treatment of osteoporotic humeral shaft fractures in elderly patients.

[Modified Metaizeau's technique for the treatment of radial neck fractures of Judet III or IV in children]

OBJECTIVE

To explore the clinical effect of modified Metaizeau's technique for radial neck fractures of Judet II or IV in children, summarizing the value of clinical application.

METHODS

From May 2014 to March 2017, 32 children of Judet III or IV radial neck fractures were treated with percutaneous Kirschner wire poking reduction and closed reduction with elastic intramedullary nailing fixation, including 21 boys and 11 girls, aged from 5.7 to 10.6 years old with a mean of 7.2 years old. The modified An-Morrey functional rating index were used to evaluate elbow range of motion, myodynamia, stability, and pain preoperatively and 1 year postoperatively in all the patients.

RESULTS

All patients were available for an average follow-up from 12 to 15 months. No complications such as incision infection, wire or nail tail irritation and avascular necrosis of radial head and epiphyses was occurred. The fracture achieved solid healing at 8 to 10 weeks after operation. The modified An and Morrey functional score improved from 58.69±5.80 before operation to 99.13±1.79 at 1 year after operation, there was obvious difference of scores between preoperative and postoperative at 1 year.

CONCLUSIONS

Modified Metaizeau's technique is a reliable and good treatment for Judet III or IV radial neck fractures in children, which has advantages of few complication, minimal invasion, quick fracture union and good recovery of elbow joint.

[Clinical application of blocking screws and rooting technique in the treatment of distal tibial fracture with interlocking intramedullary nail]

OBJECTIVE

To introduce the clinical method of blocking screws and rooting technique in the treatment of distal tibial fracture with interlocking intramedullary nails.

METHODS

From June 2006 to March 2011, 26 patients with distal tibial fracture were treated with interlocking intramedullary nails using blocking screws and rooting technique, included 18 males and 8 females with an average age of 46.2 years old ranging from 24 to 64 years. According to AO classification: 10 cases of type A1, 4 cases of type A2, 8 cases of type B1, 4 cases of type B2. The average distance of the fractures end to the ankle joint was 85 mm ranging from 55 to 125 mm, the mean time between injured and operation was 4.5 days. The patients were evaluated with pain, range of motion, walking.

RESULTS

All cases were followed-up for 6 to 22 months (averaged 15 months). According to Iowa ankle joint grading system,the score was improved from preoperative (66.8 +/- 8.2) to postoperative (94.6 +/- 4.8). All fractures had united, and got satisfactory reduction and stable fixation with no complications had happen such as breakage of screw.

CONCLUSION

Fixation with interlocking intramedullary nail using blocking screws and rooting technique in treating distal tibial fracture, is a safe and effective technique for the improvement of stability.

Glycerol-enhanced mini-polyacrylamide gel electrophoresis for the separation of differentially expressed DNA fragments in cDNA representational difference analysis

Representational difference analysis (RDA) is a widely used technique in molecular biology. However, in practice, its efficiency depends on a rapid and reliable separation of the RDA fragments prior to cloning. To achieve this, we have compared and combined the separation efficiencies of conventional and MetaPhor agarose gel electrophoresis (MAGE) with a glycerol-enhanced mini-polyacrylamide gel electrophoresis (PAGE) system (Gem-PAGE). As anticipated, MetaPhor agarose provided significantly improved resolution over conventional agarose electrophoresis, but the latter remains useful to rapidly confirm the presence of RDA-enriched difference products and direct the concentration of MetaPhor agarose subsequently used for further fragment separation. Additional improvements in resolution were possible by using the Gem-PAGE system. The effect of glycerol on band definition of PAGE was most noticeable as the acrylamide to glycerol ratio (A:G) approached 1:2. Gels in which the A:G ratio was significantly above or below this resulted in both poor morphology and impaired resolution of the bands. By exploiting sequentially agarose-based and Gem-PAGE electrophoresis, the goal in RDA of "one band one product" is now realizable.

A novel speech controller for radio amateurs with a vision impairment

This paper describes a portable speech controller system for persons with a vision impairment to adjust the channel frequency of a radio set via speech commands. The speech commands are recognized on a general-purpose digital signal processor using a hidden Markov model (HMM), and are used to remotely control radio channel changes.

Effects of intracranial hypertension on steady and pulsatile haemodynamics in dogs

1. Intracranial hypertension (ICH) tends to elicit various cardiovascular changes. Previous studies on the haemodynamic responses to ICH have been confined mainly to measurements of arterial pressure (AP), cardiac output (CO) and total peripheral resistance (TPR). In the present study, we used the technique of arterial impedance analysis for a complete assessment of steady and pulsatile haemodynamics in ICH. 2. In anaesthetized dogs, aortic pressure and flow waves were obtained with high-fidelity Millar sensors. The pressure and flow waves were subjected to Fourier transformation (frequency analysis) for an analysis of impedance spectra. Intracranial pressure (ICP) was elevated by inflation of an epidural balloon. At an ICP of 50 mmHg, the changes in steady and pulsatile haemodynamics were slight. 3. Haemodynamic changes became evident at an ICP of 100 mmHg. The mean AP was elevated by 31 mmHg (+32%) and heart rate (HR) was reduced by 25 b.p.m. (-18%). There was also a significant decrease in CO by 27% and large increase in TPR by 82%. With respect to pulsatile haemodynamics, an elevation of ICP to 100 mmHg caused significant increases in characteristic impedance by 45% and wave reflection by 53%. Arterial compliance was reduced by 50%. The ventricular oscillatory work was increased without a significant change in steady work. 4. The results indicate that ICH causes constriction of resistance vessels to affect AP and TPR. Because the pulsatile haemodynamics reflect mainly the Windkessel functions, ICH also induces stiffness of the large vessels to affect arterial impedance, pulse wave reflection and ventricular oscillatory work.

Hemodynamic and neurohumoral changes after abdominal aortic constriction in rats

Cardiac after-load, neurohumoral reaction and the secondary cardiac hypertrophy were studied in six groups of Sprague-Dawley (SD) rats with abdominal aortic constriction. We found that abdominal aortic constriction above the renal arteries decreased the heart rate and cardiac output, and increased the pulse pressure. These abnormalities would return to normal after constriction ended. Captopril, propranolol and prazosin could reduce the increase of pulse pressure but still had decreased in cardiac output of rats with abdominal constriction. Aortic constriction also increased the aortic impedance and cardiac load but decreased aortic compliance. These changes could also be lessened by captopril, propranolol and prazosin. We have confirmed that aortic constriction can induce secondary cardiac hypertrophy, but the pathogenesis might be due to multiple factors.

ATP-sensitive potassium-channel-opening activity of CL-065, a 3-[(substituted-carbonyl)amino]-2H-1-benzopyran, in the rat

The pharmacological activity of CL-065 (trans-3-acetamido-2,2-dimethyl-4-hydroxy-3,4-dihydro-2H-1-benzopyran-6- carbonitrite) was investigated in anaesthetized spontaneously hypertensive rats (SHR) and isolated thoracic aorta of Sprague-Dawley rats. The intravenous administration of CL-065 [0.1-2.0 mg kg(-1)] to anaesthetized SHR induced a dose-dependent reduction of mean arterial pressure (MAP) with maximum effect approximately 5 min after injection and which persisted for over 3 h. CL-065 also induced a reflex tachycardia which seemed to parallel the time course of the hypotensive effect. The hypotensive effect of CL-065 was blocked by pretreatment with glibenclamide [5 mg kg(-1), i.v.], a specific ATP-sensitive potassium (KATP) channel blocker. Moreover, CL-065 (0.01-10 microM) resulted in dose-dependent vasodilatory effects on phenylephrine (0.3 microM)-induced vasoconstriction in isolated thoracic aorta. The vasorelaxation elicited by CL-065 was antagonized competitively by pretreatment with glibenclamide (0.1-1.0 microM; pA2 = 6.90+/-0.09; slope = 1.03+/-0.18). Similarly, the other two KATP-channel openers cromakalim (1.0 nM-1.0 microM) and nicorandil (0.1-30 microM) also induced vasorelaxation in thoracic aorta. The EC50 of cromakalim, CL-065 and nicorandil (i.e. the doses having half the maximum effect) were approximately 0.083, 0.17, and 4.5 microM, respectively, for phenylephrine (0.3 microM)-induced vasoconstriction in isolated thoracic aorta. Moreover, increased extracellular potassium levels (20-60 mM) resulted in concentration-dependent attenuation of the vasodilator effect of CL-065. In conclusion, CL-065 induces a depressor effect via activation of KATP channels.

Acute effects of nitric oxide blockade with L-NAME on arterial haemodynamics in the rat

1. We employed the technique of impedance spectral analysis to investigate the role of endogenous nitric oxide (NO) in the regulation of steady and pulsatile haemodynamics in Wistar Kyoto rat (WKY). 2. A total of 12 WKYs was anaesthetized with pentobarbitol sodium (40 mg kg-1, i.p.) and artificially ventilated with an animal respirator. The aortic pressure wave was monitored with a high fidelity Millar sensor, and aortic flow wave with an electromagnetic flow probe. The pressure and flow waves were subjected to Fourier transform for the analysis of impedance spectra. 3. The baseline cardiovascular parameters were mean arterial pressure (APm) 95 +/- 9 mmHg, heart rate (HR) 338 +/- 9 b.p.m., stroke volume (SV) 0.23 +/- 0.01 ml, cardiac output (CO) 77.8 +/- 1.6 ml min-1, total peripheral resistance (TPR) 98 +/- 11 (x10(3)) dyne s cm-5, characteristic impedance (Zc) 2046 +/- 141 dyne s cm-5, arterial compliance at mean AP (Cm) 3.78 +/- 0.22 microliters mmHg-1 and backward pulse wave (Pb) 12.9 +/- 0.6 mmHg. 4. An NO synthase inhibitor, NG-nitro-L-arginine monomethyl ester (L-NAME) was administered at graded intravenous doses. This agent caused dose-dependent increases in AP and TPR with decreases in HR. At an accumulative dose of 10 mg kg-1, APm was increased by 29 +/- 3 mmHg (+31%) and TPR by 49 +/- 6 (x10(3)) dyne s cm-5 (+50%), while HR was reduced by 37 +/- 5 b.p.m. (-11%) and CO by 10.4 +/- 0.8 ml min-1 (-14%). The pulsatile haemodynamics including Zc and Pb were slightly increased by 14-15%. Cm was decreased by 1.09 microliters mmHg-1 (-29%). L-NAME also did not significantly affect the ventricular work including the steady, oscillatory and total work. 5. Aminoguanidine, a specific inhibitor for inducible NO synthase (iNOS), in dose 10-60 mg kg-1 i.v. did not alter the AP, HR and other parameters. The result indicated that blockade of constitutive NOS, but not iNOS is involved in these changes. 6. Angiotensin II (Ang) in various infusion doses was used to produce a profile of AP increase similar to that caused by L-NAME. Ang remarkably increased Zc, while TPR was moderately elevated. The pattern of haemodynamic changes was different from that following L-NAME. 7. The results suggest that blockade of the endogenous NO affects predominantly the arterial pressure and peripheral resistance. The Windkessel functions such as arterial impedance and pulse wave reflection are slightly increased. Ventricular works are not significantly altered.

Endogenous nitric oxide on arterial hemodynamics: a comparison between normotensive and hypertensive rats

Endogenous nitric oxide (NO) plays an important role in maintaining a vasodilator tone. In the present study, we compared the effects of NO blockade on the steady and pulsatile components of arterial hemodynamics between spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto strain (WKY), 22-26 wk of age. In the first series of experiments, various doses (1-30 mg/kg i.v.) of N(G)-nitro-L-arginine methyl ester (L-NAME) were administered to block the NO release in anesthetized WKY and SHR. In both WKY and SHR, L-NAME caused a dose-dependent increase in arterial pressure (AP) with a decrease in heart rate (HR). The maximal effects of L-NAME on AP and HR occurred at a dose of 10 mg/kg. Both the AP increase and HR decrease were higher in SHR (AP, +38 +/- 4 mmHg; HR, -49 +/- 5 beats/min) than WKY (AP, +22 +/- 3 mmHg; HR, -33 +/- 5 beat/min). In other series, the technique of impedance spectral analysis was employed to investigate the effects of L-NAME (10 mg/kg i.v.) on the arterial hemodynamics. The aortic pressure and flow waves were recorded and subjected to Fourier transform for the analysis of impedance spectra. Both in WKY (n = 12) and in SHR (n = 12), L-NAME significantly increased AP and total peripheral resistance (TPR). The pulsatile and frequency-dependent hemodynamics including characteristic impedance, wave reflection, and ventricular work were only slightly altered. Despite higher resting values of AP and TPR in SHR (mean AP, 154 +/- 7 mmHg; mean TPR, 204 +/- 17 x 10(3) dyn x s x cm(-5)) than WKY (mean AP, 94 +/- 6 mmHg; mean TPR, 98 +/- 12 x 10(3) dyn x s x cm(-5)), the magnitudes of AP and TPR increments after NO blockade were significantly higher in SHR (AP, +37 +/- 3 mmHg; TPR, +124 +/- 16 x 10(3) dyn x s x cm(-5)) than in WKY (AP, +24 +/- 3 mmHg; TPR, +45 +/- 7 x 10(3) dyn x s x cm(-5)). The continuous formation of endogenous NO affects predominantly the AP and peripheral resistance in both WKY and SHR. The windkessel functions, such as impedance spectra, pulse-wave reflection, and ventricular work, are less affected after NO blockade. In addition, the effects of NO release on the AP and TPR appear to be enhanced in rats with established hypertension.

The effect of glycolic acid on the treatment of acne in Asian skin

BACKGROUND

Glycolic acid has become important and popular for treating acne.

OBJECTIVE

To evaluate the efficacy and safety of serial glycolic acid peels with glycolic acid home care products on facial acne lesions and other associated skin problems.

METHODS

We collected 40 Asian candidates with moderate to moderately severe acne. They were divided into two groups according to the degree of greasiness of their facial skin. The two groups' members were treated with four series of 35% and 50% glycolic acid peels, respectively. They also used 15% glycolic acid home care products during this study period. The improvement of acne as well as other associated problems were assessed by both the physicians and the patient themselves.

RESULTS

Significant resolution of comedones, papules, and pustules was found. The skin texture of each candidate was dramatically rejuvenated. Consistent and repetitive treatment with glycolic acid was needed for the apparent improvement of acne scars and cystic lesions. The follicular pores also became comparatively smaller. Furthermore, most of the candidates had much brighter and lighter looking skin. Only small percentage of patients (5.6%) developed side effects.

CONCLUSION

Glycolic acid has considerable therapeutic value for acne with minimal side effects even in Asian skin. It may be an ideal adjunctive treatment of acne.

The correlation of cardiac mass with arterial haemodynamics of resistive and capacitive load in rats with normotension and established hypertension

In hypertensive animals and humans, cardiac hypertrophy may occur as a consequence of an external load on the heart. Several studies have suggested that the non-pulsatile components of arterial haemodynamics, such as arterial pressure and vascular resistance, do not adequately represent the ventricular afterload and are not well correlated with the degree of cardiac hypertrophy (CH). The present study was undertaken to analyse the correlation between the degree of CH and various haemodynamic parameters in the spontaneously hypertensive rat (SHR) with established hypertension. A total of 36 SHRs (6-8 months) with a tail-cuff pressure above 190 mm Hg were used. Control data were obtained from 32 age-matched normotensive Wistar Kyoto rats (WKY). Animals were anaesthetized with pentobarbitone sodium (40 mg/kg i.p.) and artificially ventilated with a respirator. A Millar catheter with a high-fidelity pressure sensor was used to record the aortic pressure and an electromagnetic flow transducer to monitor the aortic flow. The pressure and flow signals were subjected to Fourier transformation for the analysis of the arterial impedance spectrum. The left ventricular weight-to-body weight ratio (LVW/BW) was taken as a measure of the degree of CH. The measured haemodynamic parameters in these anaesthetized, open-chest SHRs were systolic pressure (SP) (mean +/- SE) 172 +/- 4 mm Hg, diastolic pressure (DP), 120 +/- 3 mm Hg, pulse pressure (PP) 52 +/- 2 mm Hg, peripheral resistance (Rp) 344,032 +/- 8,012 dyne.s.cm-5, characteristic impedance (Zc) 6,442 +/- 313 dyne.s.cm-5, the impedance modulus at the first harmonic (Z1) 26,611 +/- 1,061 dyne.s.cm-5, mean arterial compliance (Cm) 0.87 +/- 0.04 microliter/mm Hg and LVW/BW 3.092 +/- 0.026 mg/g.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of left ventricular functional status using thermodynamic indices

Conventional methods to assess cardiac contractility have been focused on the mechanical properties of the myocardium. Many of these have suffered from theoretical and practical drawbacks. In this study, we have attempted to evaluate the left ventricular contractile status using the thermodynamic principle and compared these indices with the conventional index (dP/dt). A total of 8 mongrel dogs were anesthetized and artificially ventilated. A Millar catheter with high-fidelity multiple sensors was inserted into the aorta to record the simultaneous changes in aortic flow and pressure waves. Cardiac inotropy was increased by graded doses (2-32 micrograms/kg/min) of dobutamine. Angiotensin injection (100-300 micrograms) to achieve a blood pressure elevation of 30 mmHg was employed for afterload augmentation. Preload was increased by rapid infusion of 6% dextran solution (20 ml/kg). Several thermodynamic parameters were calculated at steady state during the control period and after drug interventions. These included power-averaged rate of power density generation (ARPD), peak ejection rate of change of power (PREP), energy-averaged power density (APD) and frequency-normalized ARPD (FARPD). PREP and APD were unchanged by afterload increment while FARPD, ARPD and dP/dt decreased significantly with an increase in afterload, ARPD was highly sensitive to an increased preload (p < 0.001), and PREP was also changed significantly by an increase in preload. dP/dt was boarderlinely affected by Dextran infusion (p = 0.05), and APD was independent of preload (P > 0.05). Inotropic stimulation increased ARPD, PREP, APD, FARPD and dP/dt by 139.0 +/- 48.0%, 98.0 +/- 51.4%, 74.0 +/- 49.7%, 60.0 +/- 30.4% and 44.6 +/- 10.4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction of snake venom cardiotoxin (a membrane-disruptive polypeptide) with human erythrocytes

The action of 7.2 microM cardiotoxin on 0.25% human erythrocytes in a plasma extender solution was studied by the interaction of toxin with intact red blood cells and subsequent hemolysis of the cells. The binding of toxin to cells was completed within 10 min, whereas the membrane rigidity was weakened in a non-lytic period for about 25 min. The toxin molecules bound almost exclusively to the membrane. The bound toxin could not be liberated with either 0.5% Triton X-100 or 0.1 N NaOH. The degree of binding was slightly reduced in the presence of 10 mM mono- and divalent inorganic salts. The action of toxin might weaken the in situ association of several proteins that are linked with band 3 protein of the membrane, thus making the cells fragile and altering the shape of the cell to a smooth sphere.

Membrane disintegration and hemolysis of human erythrocytes by snake venom cardiotoxin (a membrane-disruptive polypeptide)

The action of 7.2 microM cardiotoxin on 0.25% (v/v) human erythrocytes in plasma extender solution was studied by osmotic fragility and hemolysis. The toxin loosened the membrane rigidity without lysis for about 25 min and then the cells hemolyzed for about 6 h at 37 degrees. The membrane was not perturbed at 15 degrees. The hemolysis of cells was optimal at 37 degrees and virtually stopped below 20 degrees. Both events could be suppressed by adding inorganic salts or toxin antibody. Once the membrane was loosened, the addition of phospholipase A2 would potentiate the disintegration of erythrocytes. In contrast, hemolysis of erythrocytes by (Lys)n lacked a non-lytic period and was temperature independent and insensitive towards salts and phospholipase A2.

Free vascularised bone graft using microvascular technique

The authors investigated 212 dried human fibulae to find out the length, the circumference and the entry points of nutrient artery to the fibula. Angiography of six freshly amputated limbs was studied to show the relationship of the posterior tibial artery and peroneal artery. Seven clinical cases of free vascularised fibula graft are reported. The length of the fibula graft varies from 10 cm to 20 cm. A postoperative 113M-In EDTMP examination revealed the blood supply to the grafted fibula was adequate. The bony healing and functional restoration of the extremities proved to be satisfactory.