BACKGROUND: If it is feasible to realize the controllable urination by establishing artificial abdomen-bladder reflex arc basing on remained somatic-reflection below the paralyzed level.OBJECTIVE:To establish an artificial abdomen-bladder reflex arc in canines abdomen to resume the bladder dysfunction due to spinal cord injury.DESIGN:Bilateral comparative observing study with experimental animal as subjects.SETTING:At the Research Institute of Surgery,Third Military Medical University of Chinese PLA.MATERIALS:This study was carried out at the Research Institute of Surgery of Daping Hospital,Third Military Medical University of Chinese PLA from April 2002 to December 2004.Six adult male canines were adopted with body mass of 10-12 Kg.INTERVENTIONS:This is achieved by intradural microanastomosis of the proximal end of right T12 ventral root and the distal end of right S2 ventral root,as well as the distal end of right S2 dorsal root and Ti2 dosal root by end-to-side microanastomosis. After axonal regeneration,the abdomenspinal cord center-bladder new artificial bladder reflex pathway was established,hereby inducing urinating by right abdominal stimulation. The bladder func-tion was assessed with electrophysiological examination and detrusor elec-tromyograms at postoperative 9 months,which was compared with the left controls.MIAN OUTCOME MEASURES: l①Electrophysiological examination.②Bladder contracting function.RESULTS:Data from six canines were analyzed statistically without loss.①Evoked potentials from the anastomosized distal site could be detected by the stimulation (115 mV,1.0 ms)at the right T12 dorsal root in all six canines before and after the spinal cord transaction at the T12 segment level,which was similar to the left side in shape and amplitude.② After paraplegia for 48 hours ,bladder contraction was very quickly initiated by a series of stimuli(1 000 mV, 10 Hz, 2 s) at the right T12 dorsal root with the new reflex arc and the evoked bladder pressure increased to 61% of control side,and to 51% of control side by stimulation at the right abdomen.CONCLUSION:The new bladder artificial autonomic reflex arc is established basing on the somatic reflex at the level higher than the injured con-secutive spinal cord and provides afferent passages for the transduction of bladder sensory,showing satisfactory function of conducting motor excitation. Reconstruction of the bladder autonomic reflex arc by intradural microanastomosis results in bladder contraction,and contributes to controllable urination of canines.

The expressions of NF-κB and PPARγ were increased in adipose tissue of insulin resistant rats.The angiotensin receptor blocker decreased NF-κB protein expression by 21%,increased PPARγ protein expression by 28%and diminished adipocyte size,suggesting that these findings may be involved in the improvement of obesity-induced inflammation and insulin resisitance.

Objective To explore operative indications,methods and effect of one stage total hip arthroplasty(THA)in treatment of acetabular fractures.Methods One stage total hip arthroplasty (THA)was carried out in 11 patients with acetabular fractures including 10 males and one female(at mean age of 42.4 years)8-37 days(mean24 days)after injury.There were anterior column fractures in three patients,posterior wall fracture in one,posterior column fracture in two,posterior column fracture combined with posterior wall fracture in two,transverse fracture in one,transverse fracture combined with posterior wall fracture in one and two-column fracture in one.Fresh acetabular fractures were first fixed with reconstruction plate or screws to restore shape of acestbular wall;then,granule or bulk of resected femoral head were implanted into acetabulum posterior to placement of acetabular cup prosthesis.While for old acetabular fractures,the resected femoral head was first implanted on acetabular superior wall and posterior wall and then acetabular cup prosthesis was placed.Results Follow-up for 6-45 months (mean 28 months)showed obdous improvement of hip joint function,with average Harris score of 78 points and average active degree of 95°.X-ray film presented loosening of acetabulum and osteolysis in one patient.All patients began weight bearing three months after operation,with no dislocation of joint prosthesis.Conclusions Under strict control of indications,one stage THA can be done for patients who miss operative reduction due to obvious acetabular fracture dislocation and severe articular cartilage injury.Stable aeetabular cup may beget satisfactory short-term clinical results.

Objective To evaluate the role of mangled extremity severity score(MESS)in res-ervation and amputation of crush lower limbs in earthquake. Methods There were 122 patients with crush lower limb injuries,with MESS≥8 points in 34 patients who were primarily amputated,M ESS 5-7points in 19 who were principally preserved and MESS＜5 points in 69 who were preserved by means of debridement,external fixators,plast splints and vaeuum sealing drainage technique.Results All pa-tients were survived.with amputation rate of 29.5%. Conclusion MESS is an important reference for evaluation of reservation and amputation of crush limb injuries caused by earthquake.

BACKGROUND: Idiopathic scoliosis is a common spinal deformity in teenagers, which is managed mainly by orthomorphia. However, due to great trauma, long operative duration and large blood loss, a great amount of blood transfusion is needed during the surgery. Allogeneic blood transfusion should be reduced in order to release blood insufficient, decline blood transfusion expense, as well as avoid transfusion diseases. OBJECTIVE: To investigate the value of controlled hypotension combined with autotransfusion in idiopathic scoliosis orthomorphia.METHODS: Intraoperative controlled hypotension was performed during posterior orthomorphia surgery on all the 46 cases of idiopathic scoliosis, 17 cases in which were served as the control group, who underwent allogeneic blood transfusion without autotransfusion, while the other 29 cases were served as the experimental group, who underwent autotransfusion that including reinfusion of preoperative deposited autologous blood and intra-operative salvaged autologous blood. The blood loss volume and transfusion status in two groups were observed. RESULTS AND CONCLUSION: Blood loss volume in the control group was 400-1 000 (867±161) mL, and that in the experimental group was 350-1400 (842±376) mL, There was no marked difference between the two groups (P > 0.05). The volume of allogeneic blood transfusion in the control group was 500-1 800 (845±332) mL, which was greater than that in the experimental group [0-1 300(423±237) mL] (P < 0.01). The results suggested that controlled hypotension reduces intraoperative bleeding, and postoperative autotransfusion minimizes the need of allogeneic blood transfusion.

BACKGROUND: Vascular injuries of the extremitiesy are frequently concomitant with vascular defects and are usually repaired by autologous vessel grafting. However, the source of autologous vessels is limited and the preparation of them is traumatic.OBJECTIVE: To retrospectively evaluate the extremity-preserving efficacy of vascular prosthesis grafting in repairing major vascular injuries of the extremities in 29 cases.DESIGN: A retrospective study.SETTING: Department of Orthopedics and Traumatic Surgery, Center for Battle Wound and Trauma of Chinese PLA, Research Institute of Surgery,Daping Hospital, Third Military Medical University of Chinese PLA.PARTICIPANTS: We selected 29 patients with major vascular injuries of the extremities repaired by vascular prosthesis grafting who received the treatment at the Department of Orthopedics and Traumatic Surgery of the Center for Battle Wound and Trauma of the Chinese PLA of the Research Institute of Surgery of, Daping Hospital of the Third Military Medical University of Chinese PLA between January 1989 and December 2000. There were 23 males and 6 females. Injury sites: 9 cases were at subclavian artery, 6 at axillary artery, 2 at brachial artery, 10 at femoral artery, 1 at femoral vein and 1 at popliteal artery. 11 of these 29 cases (37.9%) were complicated with shock, 8 with fractures and dislocations, 5 with peripheral nerve injuries and 3 with infections.METHODS: The vascular prosthesis was anastomosed end to end with the trimmed culprit vessels. As for the 3 cases with infective arterial injuries,the vessels were placed away from the infected region and were bridged together in a non-inf1ammatory region and then muscles or musculo-cutaneous flaps were used to cover the infected regions.The functions of the extremities of the patients were evaluated according to MAS at week 2 and 1 year after the operation.MAIN OUTCOME MEASURES: The vascular patency rate and the extremity-preserving outcomes..RESULTS: All 29 patients entered the stage of result analysis. Extremitypreserving efficacy: All the patients who underwent vascular prosthesis grafting had their extremities preserved. Only 1 patient had the late sequelae of ulcers in the foot sole due to extended extremity ischemia and nerve damage. The rate of 2-week patency rate of the grafted vessels was 100% and the 1-year rate of patency was 96.5%, as revealed by Doppler blood stream scanning. The excellent and good rate of the function of extremity was 89%.CONCLUSION: Vascular prosthesis grafting is the one of the methods for repairing the major vascular injuries so as to preserve the extremities and their functions.

Objective Developing an index system to evaluate the community teaching bases of general practice, for the purpose of identifying and completing at least one demonstration teaching base for general practice in each city in 2010. Methods Initial building of the index system by means of Delphi method and experts interview, followed by selection of experts for consultation, statistical analysis on the results of letter inquiries, and rounded up by the establishment of the index system for evaluation in the end. Results The recovery rates of a two-round Delphi questionnaire response are 94.12% and 100.00%respectively. Expert's authority degrees of five indexes are all over 0.8, which suggests high expert's authority. The average coordination coefficient of two-round Delphi experts consultation is 0.262and 0.534 respectively, showing good experts coordination. In the end, the study established four first-class indexes, ten second-class indexes, 41 third-class indexes and five additional indexes. Conclusions The index system is established in view of the current development of community teaching bases. It focuses on evaluating teachers, the teaching process and base's function. The evaluation system provides reference for selecting demonstration community teaching bases of general practice.

Objective To set up a three-dimensional finite element model (FEM) to investigate biomechanics of point contact locking plate (PC-LP) fixating femoral shaft fractures. Methods One intact fresh adult cadaveric femur was scanned by CT at 1 mm interval. Then, the data of CT were utilized to establish three-dimensional FEM by using software Mimics and PRO/E and simulate the different clini-cal loading conditions. The changes of theoretical stress of femur and PC-LP were analyzed under flexion, axial compression and torsion loads. Results (1) Under four-point bending load, the distribution of femur stress was in uniformity, with the largest stress of the PC-LP focused on the edge. (2) Under axial compression load of 250 N, the largest stress of the femur was focused on the screw holes on beth distal ends, with the largest stress of the PC-LP focused on the middle screw holes. (3) Under the torsion load cused on the middlepart and the middle screw holes. Conclusions Under the four-point bending, ax-ial compression and torsion loads, the distribution of femur stress is in uniformity, when the largest stress of the PC-LP focuses on edge or the middle screw holes, while that of the PC-LP on two screw holes of proximal or distal ends.

Objective To provide better emergency and patient services in well-equipped comprehensive hospitals, the organization and wisdom therapeutic strategy are of great importance for the recovery of injured patients from the earthquake zone. Method From 12 May 2008, following the 8.0 Magnitude earthquake in Wenchuan county of Sichuan Province, six Chongqing hospitals with third class in grade A were involved in the rescue of the injured patients with great effort. A total of 533 patients were retreated and followed up from quake zone. All the patients were scored with ISS and AIS system. The profiles of the patients examined, operated and clinical infection investigation were documented. Results Of 533 patients, the number of the patients whose ISS is below 16 is 456 (83.6%), the number between 16 and 25 is 65 (12.2%), and the humor above 25 is 12 (2.3%). The patients were classfled based on their fracture parts as follows: head and neck (n = 42), face (n = 7), chest (n = 114), abdominal and cavitas pelvis (n =81), limb and pelvis (n =314), body surface (n =205), with 180 single fracture site, 139 of them being two combined fracture sites, and 114 of them being above three combined fracture sites. Thirty-two of the patients were suffered from amputation. The number of patients suffered from crushing syndrome reached 21, with 281 surgical operations in hospitals. Seventy-nine patients were suffered from infections including 87.3% of pre-hespital infections. The results from bacteria culture and antibiotic susceptibility showed that the infected bacteria mainly involved in Escherichia coli, Staphylococcus anreus, Staphylococcus haemolyticns, Klebsiella pneumoniae, Baumanii, Aerobacter cloacae, Pseudomonas aeruginosa, C type chain coccus, Bacillus aerogenes capsulatus. The antibiotic susceptibility to diverse bacteria has no obvious changes and exists partial overlapping, and infected patients should be given the treatment of cephalosporin, macrolide antibiotic and so on. Conclusions For the emergency conditions after the catastrophe, the comprehensive hospitals must be prepared to meet large quantities of severe trauma and infection therapy. The scientific selection of antibiotics in the combinative therapy is of great importance to the enhancement of early specific treatment, prevention of severe trauma complications and rehabilitation of patients.

BACKGROUNDCatheter-directed thrombolysis (CDT) has been a mainstay in treating deep venous thrombosis (DVT). However, the optimal dosage of a thrombolytic agent is still controversial. The goal of this study was to evaluate the safety and efficacy of low dosage urokinase with CDT for DVT.

METHODSA retrospective analysis was performed using data from a total of 427 patients with DVT treated with CDT in our single center between July 2009 and December 2012. Early efficacy of thrombolysis was assessed with a thrombus score based on daily venography. The therapeutic safety was evaluated by adverse events. A venography or duplex ultrasound was performed to assess the outcome at 6 months, 1 year and 2 years postoperatively.

RESULTSThe mean total dose of 3.34 (standard deviation [SD] 1.38) million units of urokinase was administered during a mean of 5.18 (SD 2.28) days. Prior to discharge, Grade III (complete lysis) was achieved in 154 (36%) patients; Grade II (50-99% lysis) in 222 (52%); and Grade I (50% lysis) in 51 (12%). The major complications included one intracranial hemorrhage, one hematochezia, five gross hematuria, and one pulmonary embolism. Moreover, no death occurred in the study.

CONCLUSIONSTreatment of low-dose catheter-directed thrombosis is an efficacious and safe therapeutic approach in patients with DVT offering good long-term outcomes and minimal complications.

Adolescent ; Adult ; Aged ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; administration & dosage ; adverse effects ; therapeutic use ; Venous Thrombosis ; drug therapy ; Young Adult