Band II Research Articles

Application of muscular flap and induced membrane technique in the emergency treatment for limb salvage for Gustilo type III B and III C open fracture of lower leg

Objective To investigate the clinical effectivity of the muscular flap transposition and induced membrane technique in the emergency treatment for the limb salvage of Gustilo type III B/C open fracture of lower leg. Methods From July, 2015 to December, 2017, 10 cases of Gustilo type III B/C fracture of lower leg with bone defects were performed limb salvage surgery. Induced membrane technique was used to fill the bone defects in the emergency room. The gastrocnemius and/or soleus muscular flaps were transposed to cover the bone cement or exposed bone simultaneously in emergence treatment. After the wound healed completely, traditional bone grafting was used to repair the bone defects. There were 4 cases of Gustilo type III B and 6 cases of Gustilo type III C. The average length of bone defect was (5.25±1.70) cm ranging from 3.0 cm to 11.0 cm. The gastrocnemius medial head flaps were performed in 5 cases, the combined application with the gastrocnemius medial head flaps and the medial hemimuscular flaps of soleus were performed in 2 cases, and medial hemimuscular flaps of soleus were transposed in 3 cases. Results The wounds in 6 cases were healed at one stage, but 2 cases healed by dressing because the exudate after skin grafting. In 1 case, the cross-leg flap was used to cover the exposed bone cement due to the necrosis of soleus flap. The other 1 was performed the transposition of the lateral gastrocnemius flaps because the exposure of bone cement after the necrosis of the upper and lateral muscles in lower leg. In the second-stage, the bone defects were reconstructed by traditional bone grafting. The average healed time of bone was 7.2 months ranging from 5 months to 9 months. At the last followed-up time, all patients recovered their function of weight-bearing. The Paley's score of the adjacent joints: excellent in 8 cases and good in 2 cases. Conclusion The combination with induced membrane technique and local muscular flap transposition in emergency surgery is an effective method to limb salvage for the Gustilo type III B/C open fracture of lower leg. Key words: Gustilo type III, Gustilo type; Open fracture of lower leg; Induced membrane technique; Muscular flap; Emergency treatment

Optimization of the ultrasonic-microwave assisted enzymatic hydrolysis of freshwater mussel meat

In the present study, the Ultrasonic-Microwave (US-MW) technique was applied for assisting enzymatic hydrolysis of freshwater mussel meat. The operating parameters of enzymatic hydrolysis were investigated and the properties and qualities of the freshwater mussel hydrolysates were also analyzed. The considerable optimum conditions for enzymatic hydrolysis of mussel meat were ratio of liquid to material of 10.36:1, power of 360.52 W, processing time of 6.91 min, enzymolysis time of 4 h. Under these conditions, a degree of hydrolysis (DH) of 48.40% was obtained. The hydrolysates produced under optimum conditions, were characterized in terms of electrophoretic profile, amino acid composition and infrared spectrum analysis. SDS-PAGE profiles of the hydrolysates revealed that several protein bands were cleaved and several light myosin chains (25 kDa and 15 kDa, respectively) and peptides of molecular weight lower than 6.5 kDa were identified. The infrared spectrum absorption peak of amide band A and band III shifted after US-MW pre-treatment, which indicated that the N-H (hydrogen bonding) stretching vibration and triple helix structure of samples were affected. The essential amino acids in hydrolysates with or without US-MW pre-treatment were 36.62 mg/100 g and 33.40 mg/100 g. It was proved that US-MW assisted enzymatic hydrolysis is an effective technology to utilize freshwater mussel meat. Keywords: ultrasonic-microwave (US-MW), freshwater mussel meat, enzymatic hydrolysis, degree of hydrolysis (DH) DOI: 10.25165/j.ijabe.20181105.4104 Citation: Zhou Y J, Yi X L, Wang J Y, Yang Q, Wang S J. Optimization of the ultrasonic-microwave assisted enzymatic hydrolysis of freshwater mussel meat. Int J Agric & Biol Eng, 2018; 11(5): 236–242.

Clinical value of superior mesenteric vein (No.14v) lymph node dissection in D2 gastrectomy for locally advanced distal gastric cancer

To explore the value of superior mesenteric vein (No.14v) lymph node dissection in D2 gastrectomy for locally advanced distal gastric cancer. A retrospective cohort study was carried out. A total of 796 patients with locally advanced distal gastric cancer undergoing D2 gastrectomy at the Cancer Center of Guangzhou Medical University between 2002 and 2016 were enrolled. locally advanced distal gastric adenocarcinoma confirmed by postoperative pathology; adenocarcinoma located at or invaded into lower 1/3 stomach; lymphadenectomy was D2 or D2+; negative resection margin confirmed by pathology; no distal metastasis was found; preoperative neoadjuvant chemotherapy was not administrated. Patients with undefined group of lymph nodes by postoperative pathology and those who were died perioperatively were excluded. Among 796 patients, 293 underwent No.14v dissection (No.14vD+ group) and the other 503 patients did not undergo No.14v dissection (No.14vD- group). The 5-year overall survival was compared between the two groups. Therapeutic index of No.14v lymph nodes was calculated according to the following formula: therapeutic index=metastatic rate of No.14 lymph nodes (%) × 5-year survival rate of patients with No.14 lymph node metastasis(%) × 100. Meanwhile, stratified analyses based on pathological TNM staging were performed. There were no significant differences in age, gender, tumor size, Borrmann type, Lauren classification, histological type, surgical procedure, and number of harvested lymph node between two groups (all P>0.05). However, compared to No.14vD- group, No.14vD+ group had more advanced T staging (χ² =14.771, P=0.005) and TNM staging (χ² =18.339, P=0.003), and higher ratio of receiving adjuvant chemotherapy (χ² =4.205, P=0.040). The median follow-up period was 47 months. The 5-year survival rate in No.14vD+ and No.14vD- groups was 57.4% and 46.8% respectively without statistically significant difference (P=0.313). After adjusting for confounding factors, Cox proportional hazards model showed that No.14v lymphadenectomy was not an independent prognostic factor(HR=0.802, 95%CI: 0.545-1.186, P=0.124). Stratified analyses revealed that in all TNM stages, 5-year survival rates were not significantly different between two groups (all P>0.05). However, No.14v lymphadenectomy showed a tendency of survival benefit when the tumor staging after advancing to III A stage(III A: P=0.103; III B: P=0.085; III C: P=0.060). Five-year survival rates of No.14vD+ and No.14vD- groups in stage III A were 54.9% and 45.2%, in III B stage were 39.8% and 29.5%, in III C stage were 27.5% and 16.2%, respectively. After combining III A, III B and III C, the No.14vD+ group had a higher 5-year survival rate than No.14vD- group (39.2% vs. 27.7%, P=0.006). The No.14v metastasis rate in No14v+ group was 12.6%(37/293), including 0%(0/46), 2.5%(1/40), 4.9%(2/41), 15.7%(8/51), 20.8%(11/53) and 24.2%(15/62) in stages I B, II A, II B, III A, III B and III C respectively. The metastasis rate of No.14v lymph node in stage III patients was 20.5%(34/166). The 5-year survival rate of these 34 stage III patients with No.14v metastasis was 21.1%. The therapeutic index of No.14v lymph node in stage III patients was 4.3, which was comparable with 3.9 of No.9 and 4.9 of No.11p, even higher than 2.6 of No.1. Although No.14v lymphadenectomy can not improve the overall survival of patients with locally advanced distal gastric cancer, but it may significantly improve survival in those with stage III cancer. The therapeutic index of No.14v lymph node is similar to No.2 station lymph node in patients with stage III distal gastric cancer. Therefore No.14v lymph node should be included in D2 dissection.

SOFT ROT OF ONION BULBS CAUSED BY BURKHOLDERIA GLADIOLI PV. ALLIICOLA IN SLOVENIA

In 2012, growers of an indigenous onion (Allium cepa L.) cultivar from Northeastern Slovenia began noticing an increase of rotting onion bulbs both in the field and in storage. In some instances up to 30% of the bulbs were affected. Externally, the bulbs appeared healthy, but internal layers were found to have water-soaked and brown coloured lesions. We obtained samples from two different onion storage locations in spring of 2013 and isolated 27 morphologically distinct bacterial colonies on King’s medium B. The isolates were identified based on 16 S rDNA sequences (Bandi et al., 1994). An identical 16 S rDNA sequence (GenBank accession No. LT547718) was obtained from four isolates found at both storage locations and identified as a potential onion pathogen, Burkholderia gladioli based on high sequence similarity to other B. gladioli sequences (100 %) in the database. The strains of B. gladioli exhibited two different colony morphologies. One had a slightly wrinkled surface while the other was smooth. Both exhibited typical white-yellowish colour and released a yellow diffusive pigment into the medium. Pathogenicity of B. gladioli strains was evaluated on the onion bulbs by injecting a bacterial suspension into the bulb’s neck. Only B. gladioli strains caused a light brown rot development on the bulb’s internal layers after 6 to 12 days at 25oC. These results suggested the isolated B. gladioli strains belonged to the pathovar alliicola which was recently associated with extensive onion rotting in Poland (Kowalska et al., 2015). This is the first report and identification of Burkholderia gladioli pv. alliicola as a causative agent of soft rot on onion in Slovenia.

One-stage reconstruction of open fractures of leg, ankle and foot of Gustilo types III B and III C

Objective To explore one-stage reconstruction of open fractures of leg,ankle and foot of Gustilo types Ⅲ B and ⅢC.Methods From January 2001 to April 2012,160 open fractures of leg,ankle and foot of Gustilo types Ⅲ B and Ⅲ C were treated with one-stage reconstruction.They were 103 men and 57 women,with an average age of 36.3 years.There were 113 cases of tibial shaft fracture (type ⅢB in 91 and type ⅢC in 22),4 cases of tibial distal end fracture (ⅢB in 3 and type ⅢC in one),and 43 cases of ankle and foot fracture (ⅢB in 37 and type ⅢC in 6).Time from injury to surgery ranged from 3 to 37 hours,averaging 12.7 hours.After thorough debridement,crucial soft-tissue wounds were covered with surgical flaps,such as perforator flap,neurovascular flap,traditional axial skin or muscular flap and even local flap.The fractures were reduced and fixated definitively using external frames in 121 cases,plates in 20 cases,screws and/or K-wires in 14 cases,and intramedullary nails in 5 cases.Other limb reconstructions included neurovascular repair,transposition of the tendon and nerve,and joint stabilization of ankle and foot.Results Mean in-hospital time was 28.0 days (ranged from 9 to 76 days).Crucial wounds were repaired primarily.The limbs were savaged successfully in 159 cases while amputation was performed in one case of tibiofibular fracture of Gustilo type Ⅲ C 2 months after primary operation because of consistent and severe pain.Follow-ups ranged from 12 to 83 months (average,21.3 months).No severe or persistent infection occurred and bone union time ranged from 6 to 19 months (average,11.7 months) with satisfactory aesthetic and functional results.Conclusions One-stage reconstruction of open fractures of leg,ankle and foot of Gustilo types Ⅲ B and Ⅲ C with standard techniques of plastics and fracture management can significantly simplify the procedures and reduce complications.In addition,fresh wounds are easier to get repaired.Moreover,flap coverage of only crucial defects but not the whole wounds can minimize donor sacrifice and recipient bulking. Key words: Leg; Foot; Fractures, open; Surgical flaps; Microsurgery

Study on the angiographic classification of internal carotid artery paraclinoid aneurysms

Background There are a variety of nomenclatures and classification systems of paraclinoid aneurysms, most of which have been proposed for neurosurgical purpose. This article aims to develop an improved classification method which can be used during endovascular management on paraclinoid aneurysms and to summarize the main nomenclatures and classification systems of paraclinoid aneurysms. Methods One hundred and twenty-six patients with 142 saccular paraclinoid aneurysms, who were treated with endovascular embolization in our hospital during January 2009 to December 2011, were tried to be classified as Type Ⅰ (ophthalmic artery aneurysms) and Type Ⅱ (superior hypophyseal artery aneurysms). Each type was further divided into two subtypes according to their relative position to an imaginary bisector that separated ophthalmic artery and posterior communicating artery. Among the four subtypes, TypeⅠa and Ⅱa referred to aneurysms arising from internal carotid artery (ICA) proximal to the bisector, while TypeⅠ b and Ⅱ b referred to aneurysms arising from ICA distal to the bisector. Results All of the 142 paraclinoid aneurysms were classified successfully. According to our classification system, there were 45 aneurysms belonging to Type Ⅰ a, accounting for 31.69% (45/142), and 11 aneurysms belonging to TypeⅠb, accounting for 7.75% (11/142). Besides, 78 aneurysms were TypeⅡa, accounting for 54.93% (78/142), and 8 aneurysms were TypeⅡ b, accounting for 5.63% (8/142). Conclusion A number of classification systems have been proposed by different groups. It is important to choose suitable classification method in clinical practice, so as to formulate optimal treatment strategy.

Clinical study on the repairing of Gustilo III B and III C open tibia fractures by bone fixation and tissue flap

Objective To investigate the choice of methods and time on the treatment of Gustilo type 11I B and type m c open tibia fractures by bone fixation and tissue flap repairing. Methods The clinic data of 156 cases of Gustilo Ⅲ B and ⅢC open tibia fractures were retrospectively studied. There were 102 males and 34 females, with average age of 34 years（range 14 to 68 years）. Ninety-eight cases were classified as Gustilo type ⅢB and 38 cases were type Ⅲ C in degree. In all cases, one hundred and thirteen were treated with one- stage external fixation, ninteen cases were treated with secondary bone fixation. Sixty-seven cases of all wounds were repaired by one-stage vascular pedicle skin flap. Seven wounds were repaired by one-stage free flaps with vascular anastomosis. Sixty-two cases were secondary repaired by different flaps after defect tissue under VSD （vacuum-sealing-drainage） treatment by 1 to several weeks, which contains 9 free skin graft, eleven muscle flaps based on posterior tibial artery perforator, thirteen flaps based on fibial artery perforator, fourteen gastroc- nemius falps and 15 cross-leg flaps. Results Wound of all cases were healed wholly. Primary union oc- curred in 121 cases, twelve vases healed after bone grafting for segmental bone defect. Three cases with delayed union healed after reoperation for infection that caused osteomyelitis and sinus tract. The period of bone healing was form 5 to 12 months. Conclusion The treatment of Gustilo Ⅲ B and Ⅲ C open tibia fractures by one- stage or secondary bone fixation and tissue flap repairing get their advantages and disadvantages, but one-stage bone fixation and tissue flap repairing was better where appropriate. Key words: Tibia frartures ; Gustilo type; Bone fixation; Tissue flap

The Stress and Displacement Analysis of the Cut-Off Wall for the Deep Overburden Dam

The Duncan-Chang nonlinear constitutive model is used to carry out a three-dimensional finite element analysis of Xia Ban Di deep overburden dam with clay core. The regularities of the horizontal displacement, vertical stress and stress level for the cut-off wall are studied in this paper, and the paper provided reference for the dam stability and anti-seepage treatment of the cut-off wall with deep overburden.

An Analysis of Seepage Prevention Wall Behaviours of Deep Overburden Dam with Clay Core

The Duncan－Chang nonlinear constitutive model is used to carry out a three- dimensional finite element analysis of Xia Ban Di deep overburden dam with clay core (147.95m). The regularity of the change of stress and displacement with the change of material parameters under nine kinds of materials mix proportion is obtained and the optimum analysis result of stress and displacement for the seepage prevention wall is given in this paper.

"Reason Revisited: The Philosophy of Karl Jaspers," by Sebastian Samay, O.S.B.; and "Nietzsche-Studien," Band I, ed. M. Montinari, W. Müller-Lauter, and H. Wenzel

"Reason Revisited: The Philosophy of Karl Jaspers," by Sebastian Samay, O.S.B.; and "Nietzsche-Studien," Band I, ed. M. Montinari, W. Müller-Lauter, and H. Wenzel

Eskimo Prehistory, by Hans-Georg Bandi

Eskimo Prehistory, by Hans-Georg Bandi