Heart failure is a global problem that occurs in 38 million patients worldwide, and the number is dramatically increasing in elderly society. Meanwhile, heart dysfunction is also the most common disease among hospitalized patients more than 65 years, especially in high-income countries. Approximately, one million patients are hospitalized because of heart failure in the world every year. Drug therapy is currently the most popular treatment for heart failure in clinic, however, the effects are limited. Therefore, exploring novel treatment strategies gradually becomes a focus not only in basic but also in clinical research.
ObjectiveBy comparing the mechanics of human auricular cartilage, polyurethane elastic material, and high density polyethylene material (Medpor), to produce theoretical proof on choosing optimal artificial auricular scaffold materials.MethodsThe experimental materials were divided into 3 groups with 6 samples in each: the auricular cartilage group (group A), the polyurethane elastic material group (group B), and the Medpor group (group C). With an Instron5967 mechanical testing machine, compression and tensile testing were performed to respectively measure values of compression parameters (including yield stress, yield load, elastic modulus, yield compressibility, compressibility within 2 MPa, and compression stress within 10% strain) and values of tensile parameters (including yield stress, yield load, elastic modulus, yield elongation, elongation within 2 MPa, tensile stress within 1% strain) for comparison.ResultsCompression testing: no obvious yield points were observed in the whole process in samples of group B, while obvious yield points were observed in samples of groups A and C. There was no significant difference between groups A and C with respect to yield stress and yield load (P>0.05); while the yield compressibility in group C was significantly lower than that in group A (P<0.05) and the elastic modulus in group C was significantly higher than that in group A (P<0.05). There was a significant difference with respect to compressibility within 2 MPa of materials among the 3 groups (P<0.05), the high, medium, and low values go to groups B, A, and C respectively. The compression stress within 10% strain in group C was significantly higher than that in groups A and B (P<0.05), and there was no significant difference between that in groups A and B (P>0.05). Tensile testing: the materials in group B had extremely high tensile strength. The yield stress in groups A and B was significantly higher than that in group C (P<0.05), and the elastic modulus and tensile stress within 1% strain were significantly lower than those in group C (P<0.05); but no significant difference was found between those in groups A and B (P>0.05). There was no significant difference with respect to yield load among the 3 groups (P>0.05); but there was significant difference with respect to yield elongation among the 3 groups (P<0.05), and the high, medium, and low values go to groups B, A, and C respectively. The elongation within 2 MPa in group B was significantly higher than that in groups A and C (P<0.05), and there was no significant difference between that in groups A and C (P>0.05).ConclusionCompared with the Medpor, the polyurethane elastic material is a more ideal artificial auricular scaffold material.
ObjectiveTo explore the effectiveness of keystone flap in repairing skin and soft tissue defects around joint.MethodsBetween March 2013 and December 2017, 10 patients of skin and soft tissue defects around the joint were repaired with keystone flaps. There were 6 males and 4 females. The age ranged from 17 to 72 years, with an average age of 57.5 years. The skin and soft tissue defects located around the joints, including 2 cases of hip joints, 4 cases of knee joints, 3 cases of elbow joints, and 1 case of wrist joint. The cause of skin and soft tissue defects included scar contracture in 3 cases, basal cell carcinoma in 3 cases, squamous-cell carcinoma in 3 cases, and dermatofibrosarcoma protuberant in 1 case. The area of defects ranged from 4 cm×3 cm to 11 cm×11 cm. The keystone flap was designed beside the wound, and the V-shaped flap was designed at the longer side of the fan-shaped flap. The area of flap ranged from 7 cm×3 cm to 35 cm×10 cm. The flap was constantly compressed by vacuum assisted closure after operation for 3-6 days.ResultsPrimary wound healing was achieved and the flaps survived. All patients were followed up 6-24 months (mean, 15 months). The texture and color of flap was similar to the adjacent area. The appearance and function of joint were satisfactory.ConclusionThe keystone flap is a feasible and efficient way to repair the wound around joint. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.
Massive cerebral infarction with malignant brain edema has poor prognosis with very high mortality, despite aggressive medical treatment. Surgical decompression is recommended by Chinese and international clinical guidelines for patients with massive cerebral infarction, however, there is no standardized diagnosis and treatment protocol in clinical practice. Following the principle of evidence-based medicine and based on the diagnosis and treatment norms of the participating hospitals of Severe Ischaemic Stroke Collaboration in recent years, we recommend this consensus statement of the standardized surgical decompression for malignant brain edema in massive cerebral infarction.