Functional recovery of denervated muscle by neurotization using nerve guidance channels

Tissue‐engineered muscle has been proposed as a means of repairing volumetric muscle defects to restore anatomical and functional recovery. We have previously demonstrated that denervated muscle, which is analogous to engineered muscle construct, can be reinnervated by direct transplantation of host nerve (neurotization) in a rat model. However, the use of this approach is not possible if the length of host nerve is inadequate and cannot be mobilized to the insertion site of the engineered muscle. In this study we investigated whether neurotization coupled with nerve guidance channels would increase the regeneration of neuromuscular junctions (NMJs) in completely denervated muscle and encourage neurofunctional recovery. Seventy‐two Lewis rats were evaluated in three groups, a normal control group (n = 8), a denervated group (n = 32) and a neurotization coupled with nerve guidance group (n = 32). Neurofunctional behaviour and histological evaluations were performed at 4, 8, 12 and 20 weeks postoperatively. Extensor postural thrust (EPT) and compound muscle action potential (CMAP) amplitude were significantly improved in the nerve guidance group when compared with the denervated group, even though these values were different from those of the normal control group at 20 weeks postoperation. Regeneration of axons and NMJs was demonstrated histologically in the nerve guidance group. Neurotization coupled with nerve guidance channels leads to regeneration of axons and NMJs in completely denervated muscle. To our knowledge, this is the first report to show that nerve guidance can allow re‐innervation in denervated muscle containing long‐gap nerve injuries. Copyright © 2013 John Wiley & Sons, Ltd.     

B-Lynch缝合术治疗8例剖宫产后出血体会

目的探讨B-Lynch缝合术治疗剖宫产后出血的效果。方法对8例剖宫产后出血患者采用B-Lynch缝合术治疗,回顾性分析患者的病历资料。结果 8例患者均经B-Lynch缝合术成功止血,无1例因血液循环不良或再出血手术或子宫切除。子宫复旧、月经复潮时间无异常。结论剖宫产后子宫收缩乏力性出血药物治疗无效时,B-Lynch缝合术操作简单易行,止血效果可靠,尤其适合在基层医院开展。     

术中保温护理对人工髋关节置换术患者凝血功能及术后苏醒的影响

目的:探讨术中采用保温护理对人工髋关节置换术患者凝血功能及术后苏醒的影响,降低手术风险。方法:将60例患者随机分为观察组30例和对照组30例,均给予常规护理措施,观察组加用保温护理,观察记录两组术中输液量、出血量及手术时间,围术期低体温发生率,术后复苏情况及凝血功能等。结果:观察组术中输液量、出血量和手术时间与对照组相似,差异无统计学意义(P>0.05)。观察组低体温发生率6.67%、寒战发生率6.67%,对照组低体温发生率33.33%、寒战发生率46.67%,差异有统计学意义(P>0.05)。观察组气管拔管时间、完全清醒时间和麻醉恢复室滞留时间均短于对照组,差异有统计学意义(P>0.05)。手术前,两组患者凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(FIB)指标检测结果相似,差异无统计学意义(P>0.05);手术结束时观察组PT、TT、APTT和FIB指标检测结果与手术前相似,差异无统计学意义(P>0.05),而对照组与手术前比较变化显著,差异有统计学意义(P>0.05)。结论:保温护理可以有效降低人工髋关节置换术患者低体温及寒战发生率,促进麻醉复苏,提高苏醒质量,保护凝血功能。     

Effects of enteral nutrition support combined with enhanced recovery after surgery on the nutritional status,immune function,and prognosis of patients with esophageal cancer after Ivor-Lewis operation

BackgroundEsophageal cancer (EC) with a high incidence of malnutrition is a highly malignant digestive tract tumor. We investigated the effect of enteral nutrition (EN) support combined with enhanced recovery after surgery (ERAS) on the nutritional status, immune function, and prognosis of patients with EC after Ivor-Lewis operation.MethodsOne hundred patients were randomly divided into the observation group (n=42) and the control group (n=58). The patients in observation group were treated with EN combined with ERAS intervention after Ivor-Lewis operation, and the patients in control group were treated with conventional postoperative EN intervention. The situation of operation, nutritional status, immune function recovery and prognosis between the two groups were compared.ResultsThere was no statistically significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). The chest tube removal time and oral feeding time of the observation group after operation were shorter than those of the control group (P<0.05). After intervention, serum albumin (ALB), transferrin (TF), pre-albumin (PA) and hemoglobin (Hb) levels in both groups were significantly decreased. These indexes were significantly higher in the observation group than in the control group (P<0.05). There were no significant changes in the levels of immunoglobulin (Ig) A, IgG, and IgM, or the numbers of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ T cells in the observation group before and after intervention (P>0.05); however those indexes were significantly decreased in the control group after the intervention (P<0.05). Interestingly, the levels of IgA, IgM, IgG, CD3⁺ T cells, CD4⁺ T cells and CD4⁺/CD8⁺ T cells in the observation group were significantly higher than those in the control group after intervention (P<0.05). The incidence of pulmonary infection in the observation group was significantly lower than that in the control group. The postoperative exhaust time, postoperative defecation time and postoperative hospital stay were shorter in the observation group than in the control group (P<0.05). There was no significant difference in hospitalization cost between the two groups (P>0.05).ConclusionsEN combined with ERAS was more beneficial to the improvement of nutritional status and immune function recovery of patients with EC after Ivor-Lewis operation. It also shortened the length of hospital stay.     

Preliminary trial in treatment of postpartum endometritis with intrauterine application of hyperimmune serum in dairy cows

ObjectiveTo evaluate the efficacy of hyperimmune serum (HS) in treatment of postpartum endometritis.MethodsIn a field trial, cows with vaginal discharge, 25–35 d in milk were randomly assigned to three treatment groups. In group 1 (n=42), cows received an intrauterine treatment with 50 mL HS. HS was produced against Arcanobacterium pyogenes and Escherichia coli that had already been isolated from the Iranian dairy farms. In group 2 (n=39), cows were treated with one intrauterine infusion of 5 g oxytetracycline (OTC). In group 3 (n=65), cows affected with endometritis were treated with 0.5 mg cloprostenol (PG). Group 4 (n=89) included clinically healthy cows as control (HC) group without any treatment in groups HS, OTC and PG; all cows were re-examined 39–49 d in milk.ReultsCure rate after treatment defined as the absence of vaginal discharge at the re-examination, was 64.3%, 61.5% and 72.3% in HS, OTC and PG groups, respectively (P>0.05). Cows categorized as E1 and E2 showed higher cure rate and reproductive performance measures than E3 cows in both treatment groups but their differences were not significant. Conception rate to all services for cows with endometritis (category E1, E2 and E3) was 52.9% in HS group, 57.1% in OTC and in PG 62.1% compared to 66.7% in HC (P>0.05). The difference in the conception rate between the HS and HC group was not significant.ConclusionsWe suggest that HS could be the no antibiotic alternative treatment choice for postpartum endometritis in dairy cattle.