Objective To investigate the outcome of the urethral realignment simultaneous internal fixation in treatment of pelvic fracture associated with posterior urethral disruption. Methods The study included 33 patients with pelvic fracture associated with posterior urethral disruption treated simultaneously by urethral realignment and internal fixation from December 2003 to August 2009. According to AO classification, two patients were with type A2 fracture, six with type B1 ,seven with type B2,five with type B3 ,six with type C1 ,four with type C2 and three with type C3. All the patients were found with complete posterior urethral disruption. Primary urethral realignment combined with emergency open reduction and internal fixation of pelvic fracture were performed in 12 patients. Due to unstable condition, 21 patients underwent primary suprapubic cystostomy and external fixation, sequentially delayed urethral realignment and internal fixation.Results The mean follow-up time of all patients was 37 months ( range, 3-63 months). Of all the patients, 25 patients (76%) regained good without urethral dialation or needed only short term urethral dilatation, and eight patients (24%) suffered from urethral stricture and needed further complex surgery. The incidences of urinary incontinence and erectile dysfunction were 6%(2/33) and 18% (6/33). The erectile dysfunction of two patients was ascribed to sacral nerve injury.At the final follow-up, the mean score was 90.3 points (range, 66-100) according to the Majeed' s scoring system, which showed that the result was excellent in 24 patients, good in eight and fair in one.Conclusions Urethral realignment and simultaneous internal fixation can attain good clinical results for pelvic fracture associated with posterior urethral disruption. It takes advantages of minor surgical trauma,short treatment cycle, good outcome and low complication rate.

ObjectiveTo investigate the results of open reduction with internal fixation for high anterior column fracture of acetabulum with intact true pelvic brim.MethodsFrom January 2006 to January 2010,12 patients suffered high anterior column fracture of acetabulum without involvement of true pelvic brim were identified.There were 9 males and 3 females,with the average of 35.6 years(range,29-46).The injury was caused by crush in 7 cases,smash of heavy object in 3 cases,and fall-down from height in 2 cases.These fractures were classified into three types:isolated high anterior column fracture of acetabulum without involvement of true pelvic brim,high anterior column fracture of acetabulum without involvement of true pelvic brim with posterior wall fracture of acetabulum and commminuted high anterior column fracture of acetabulum without involvement of true pelvic brim according to present and unpresent of posterior wall fracture.Five cases suffered isolated fracture and 2 cases associated smaller and nondisplacement fracture fragment of posterior wall were reduced and fixed by buttress plate of iliac crest and lag screw of anterior border of ilium through an iliofemoral approach; 4 cases with displacement posterior wall fracture of acetabulum were reduced and reconstructed by buttress plate and lag screws of through combinations of anterior and posterior approaches.One case suffered comminuted fracture were reduced and reconstructed by plates and screws of through extended iliofemoral approach.ResultsThe mean follow-up time of all patients was 26.7 months (range,14-37months).The quality of reduction was grade as anatomical in 8 patients,imperfect in 3,poor in 1 by Matta's score system.The fracture union was uneventful.There was nonunion and loss of internal fixation.At the final follow-up,the mean score was 16.8 (range,11-18),7 cases were graded as excellent,4 good,1 fair,according to modified Merle d'Aubigne and Postel score system.Heterotopic ossification and traumatic osteoarthritis were recorded in 1 patient.ConclusionGood clinical results can be achieved by anatomical reduction and rigid fixation through optimal approach.

Objective To investigate the malnutrition status among the elderly in age care institutions in Shanghai suburb and analyze its potential influential factors.Methods The MiniNutritional Assessment (MNA) was adopted to evaluate the nutritional status of the 190 elderly people in age care institutions.The dietary supply by the institution canteen and the quantity of residual food left by the malnourished elderly people were weighted.Results In the age care institutions,the malnutrition rate reached 23.7％,47.9％ of the elderly people were at the risk of malnutrition,and only 28.4％ of the elderly people were well nourished.Logistic regression analysis showed that the major influential factors for malnutrition in the elderly people were food intake ability,mobile capability,chewing and swallowing ability,ageing and mental Illness.The malnourished elderly people had the most residual meat and vegetables,and insufficiency of nutrient intake was the main cause for the malnutrition in the elderly people.Conclusions The elderly people in age care institutions in Shanghai suburb have the higher risk of malnutrition.The malnutrition occurs under influence of many factors,of which some are unavoidable,however,some factors like dietary factors can be changed to improve the nutritional status of the elderly people in age care institutions.

Objective To investigate the etiological characteristics of Streptococcus pyogenes that caused scarlet fever in different periods in Guangdong province.Methods 22 isolates from different periods were analyzed through emm typing,PCR detection for super antigen genes,antibiotic susceptibility test and pulsed-field gel electrophoresis (PFGE).Results All isolates were susceptible to cefotaxim,levofloxacin and penicillin.Streptococcus pyogenes isolated after the year 2000 were 100％ resistant to erythrocin and clindamycin,but the resistant rate for strains isolated before the year 2000 was 9.1％ (1/11).There were 3 emm types indentified from 22 isolates including emm12.0 (59.09％,13/22),emm6.0 (36.36％,8/22) and emm1.0 (4.55％,1/22),which were detected in the isolates from the year 1997 and 2011,from 1978 and 1986,and from 2008,respectively.The positive rates for speA,speB,speC,speF,speG,speH,smeZ,and ssa genes detected by PCR were 54.55％,100％,100％,100％,100％,54.55％,0％,and 86.36％ respectively.Among all strains,95.45％ of the isolates carried 6 superantigen genes simultaneously.Three clusters of 10 PFGE subtypes were identified in 22 isolates.Cluster Ⅰ consisted of all strains from 1997 and one strain from 2011.Cluster Ⅱ consisted of strains isolated from 1978 and 1986.Cluster Ⅲ consisted of nine strains from 2011 and one from 2008.Conclusion S.pyrogenes isolates in Guangdong province were susceptible to penicillin but resistant to erythrocin.emm 12.0 accounted for the majority of the three types and there was a high frequency of super antigen genes.

Objective To study the adsorption effect of activated charcoal suspension on paraquat (PQ) in gastrointestinal tract of beagles exposed to PQ.Methods Twenty healthy male beagles were randomly divided into experimental group and control group,with 6 beagles in each group.20％ PQ solution (a dose of 30 mg/kg) was prescribed through stomach for beagles in both groups.After exposure to PQ for 30 minutes,the beagles in experimental group were given activated charcoal suspension (1.0 g/kg of type Ⅰ activated charcoal powder mixed with 100 mL of normal saline) by gavage,while the control group was only given equal volume of normal saline.After exposure to PQ for 10 minutes,30 minutes,and 1,2,4,8,12,24,and 48 hours,blood was collected from hepatic portal veins and peripheral veins to detect the PQ concentration change in the plasma.The toxicokinetics software DAS 2.1.1 was applied to analyze PQ concentration and compare the change in toxicokinetics parameters between the both groups.The change in vital signs including heart rate (HR),respiratory rate (RR) and pulse oxygen saturation (SpO2) was dynamically monitored 10 minutes before exposure,4 hours and each day from the 1st to the 7th day after exposure.Results After exposure to PQ,the poison concentration in the plasma of hepatic portal veins and peripheral veins in the control group rose quickly and reached peak 4 hours later.It fell quickly at first,and fell slowly 8 hours later.But in the experimental group,the increase rate to the peak was significantly slow.Besides,PQ peak fell more obviously than that in the control group and it was about 50％ of the control group (μg/L:123.50 ± 11.67 vs.255.18 ± 12.29 in blood from hepatic portal veins,122.35± 11.72 vs.250.86± 11.15 in blood from peripheral veins).After 8 hours it fell much more quickly than that of the control group.After exposure to PQ for 48 hours,PQ concentration in the plasma was still lower than that of the control group (μg/L:0.53 ± 0.18 vs.15.98 ± 5.58 in blood from hepatic portal veins,0.31 ± 0.01 vs.15.03 ± 4.82 in blood from peripheral veins,both P ＜ 0.01).With the toxicokinetics analysis,compared with the control group,the maximum concentration (Cmax) and area under the curve (AUC) of PQ in the plasma of hepatic portal veins and peripheral veins in the experimental group were significantly decreased [Cmax (μg/L):125.07 ± 9.49 vs.255.18 ± 12.29 in blood from hepatic portal veins,123.38 ± 9.52 vs.250.86 ± 11.15 in blood from peripheral veins;AUC (mg· L-1· h-1):1.6±0.2vs.3.3 ± 0.4 in blood from hepatic portal veins,1.5 ± 0.2 vs.3.2 ± 0.3 in blood from peripheral veins],time to the peak (Tmax) of PQ was slowed (hours:5.3 ± 1.9 vs.4.0 ± 0.0 in blood from hepatic portal veins,4.7 ± 1.5 vs.4.0 ± 0.0 in blood from peripheral veins),and PQ plasma half-life (t1/2) and mean retention time (MRT) were significantly shortened [t1/2 (hours):3.8 ± 1.2 vs.15.4± 3.7 in blood from hepatic portal veins,3.5 ± 1.0 vs.15.5 ± 2.7 in blood from peripheral veins;MRT (hours):8.0± 1.5 vs.13.4± 1.2 in blood from hepatic portal veins,7.6± 1.3 vs.13.3± 1.2 in blood from peripheral veins;all P ＜ 0.01].After exposure to PQ,HR and RR in both the experimental group and the control group increased and reached to the peak about the 4th day and then the increase rate began to slow down gradually;SpO2slowed down gradually and reached to the valley about the 4th day and then it began to recover,but the change range of vital signs in the experimental group was smaller than that of the control group,and the parameters were significantly better than those of control group [4-day HR (bpm):134.50±3.00 vs.142.00±6.43,4-day RR (times/min):31.00±0.58 vs.34.33±0.94,4-day SpO2:0.900±0.006 vs.0.873±0.005,all P ＜ 0.05].Conclusion Activated charcoal administrated at 30 minutes after PQ poisoning can slow down the increase rate of PQ concentration in the plasma,decrease the peak concentration and has less influence on vital signs in beagles.

Objective To establish an animal model by placing one end of PICC in the hepatic portal vein of a beagle dog and leaving the other end out of its body.Methods Six Beagle dogs were given respiration anesthesia through orotracheal intubation.An incision was made through the right rectus abdominalis to locate the superior mesenteric vein (SMA) and the main hepatic portal vein.The left branch of SMA was separated and cut to put PICC into the main hepatic portal vein before being ligated and fixed.The other end of PICC was elicited through the right abdominal wall and passed beneath the skin to the back neck and fastened in case of movement.Results The anesthetic effect was good and all the operations were successful.The mean operation time was about an hour and the mean blood loss was about 15 ml.The incision healed 5-7 d after operation.Conclusion The establishment of the model can improve the effects of liver-targeting drugs,which can cut down the dosage,lower the cost of treatment and experiment and reduce the adverse effect of medicines.Through PICC,we can directly draw blood from the hepatic portal vein to measure the blood concentration before the first pass elimination.Then according to the concentration,we can calculate the absorption rate in the gastrointestinal tract,which can facilitate related experimental studies.

Paraquat (PQ) as a kind of sterile and herbicides, has effects of contact-kill and systemic action, which can be absorbed quickly by green plants and make them wither and die. Therefore, it is widely used in the agricultural production and occupies a large part in our country's pesticide market. PQ poisoning has become one of the most common pesticide poisoning in our country. PQ can be passivated when combining with soil, but it has great toxicity for human. There are still no specific antidotes for PQ poisoning at home and abroad, and the death rate of PQ oral poisoning is up to 95%. Clinically comprehensive treatment is adopted, including gastric lavage, intentional diarrhea, diuresis and blood perfusion. However, the therapeutic effect is not good and the case fatality rate keeps high. It has become one of the hot issues for emergency medicine study to search PQ's special efficiency measures. This paper briefly reviews PQ's poisoning mechanism and its clinical treatment progress to provide new exploration direction and treatment ideas for basic research and clinical treatment of PQ.

Objective To investigate the antimicrobial resistance pattern of non-typhoidal Salmonella isolated from diarrhea cases in Guangdong province,China.The multidrug-resistant strains were analyzed by pulsed field gel electrophoresis(PFGE) typing.Methods All the non-typhoidal Salmonella strains isolated between 2009 and 2011 were serotyped,then the antimicrobial resistance was detected by the disk diffusion method and molecular typed by PFGE.Results 91.76％ (256/279) S.typhimurium isolates were multiple resistant to 3 and more antimicrobials.Forty S.typhimurium isolates were multiple resistant to 9 and more antimicrobials and 3 out of which were multiple resistant to all the 12 antimicrobials in vitro.96.91％ (94/97) Salmonella I4,5,12:i:-isolates were multiple resistant to 3 and more antimicrobials.Nine Salmonella I4,5,12:i:- isolates were multiple resistant to 9 and more antimicrobials and I out of which was multiple resistant to all the 12 antimicrobials1 in vitro.47％ (47/100) S.enteritidis isolates were multiple resistant to 3 and more antimicrobials.Only 1 S.enteritidis isolates was multiple resistant to 9 and more antimicrobials.4.27％ (27/632) non-typhoidal Salmonella isolates was resistant to ciprofloxacin,including 17 S.typhimurium and 6 Salmonella 14,5,12:i:- isolates.Also,there were 3 1.96％ ( 202/632 ) non-typhoidal Salmonella isolates was intermediary to ciprofloxacin.The PFGE patterns of the predominant strains which were highly resistant and multidrug-resistant had different genotypes and demonstrated significant genetic diversity.Conclusion The situation about the multiple antimicrobial resistances of non-typhoidal Salmonella in Guangdong province has showed the prevalent problem.The PFGE types of the multiple drug-resistant strains prompted these strains were come from different clones.This requires that we continue to strengthen the resistance monitoring and control of the rational use of antibiotics.

Objective: To determine the scavenging effect and the change of metabolism of paraquat (PQ) using hemoperfusion (HP) once and twice within 12 hours after intoxication and explore the better scheme of HP. Methods: 18 beagles were randomly divided into 3 groups. Single HP group, Double HP group and Control group. Peripheral veins blood was collected at different times within 48 hours after exposure in each group. Toxin concentration was measured, analyzed and compared among 3 groups. Results: 6 hours after exposure, Single HP group and Double HP group has finished the first HP treatment, and the concentration of PQ was lower than that of the control group, the difference was statistically significant (P<0.05) . 10 hours after exposure, there was no statistical difference of toxin concentration among 3 groups (P>0.05) . 12 hours after exposure, Double HP group has finished the second HP treatment, the concentration of PQ was significantly lower than that of Single HP group and Control group (P<0.05) . 24 hours and 48 hours after exposure, there was no statistical difference of toxin concentration among 3 groups (P>0.05) . Statistical difference were not observed in toxicokinetical parameters among 3 groups (P>0.05) . Conclusion HP treatment once and twice within 12 hours after intoxication could effectively reduce the toxin concentration in the peripheral veins blood after HP for about 4 hours, then the toxin concentration would return to the same level as Control group quickly. It was suggested that at the beginning of poisoning, HP treatment once or twice could not significantly change the metabolism of paraquat.

Objective To investigate the serotypes, antimicrobial resistance, virulence genes and molecular characteristics of food-borne Vibrio parahaemolytieus isolated in Guangdong province in 2014.Methods Sixty V.parahaemolyticus strains were tested in this study.The serotyping and antibiotic resistance test were conducted, while the tdh and trh gens of the strains were detected with conventional PCR, and pulsed field gel electrophoresis (PFGE) and multiple locus sequence typing (MLST) were conducted too.Results The 60 strains belonged to 13 serotypes, the major serotypes included O3 : K6, O4: K8, O 1 : K36 and O4: KUT.The antibiotic resistance test indicated the isolates were highly resistant to ampicillin (100.0％), sulfonamides (43.3％) and cefalotin (28.3％).Up to 56.7％(34/60) of the strains were resistant to two or more antibiotics, and 2 strains showed resistance to three antibiotics.The virulence gene detection indicated that 63.3％ (38/60) of the strains carded tdh+trh-, while only 1 strain carried tdh+trh+.The 60 strains digested by Not I belonged to 48 different PFGE patterns and 3 clusters.The cluster B included the strains isolated from sporadic food borne cases with serotype of O3:K6 and similarity of 62.6％-100.0％.The cluster C included O4:K8 strains with the PFGE pattem similarity of 56.7％-62.5％.The MLST indicated that the 60 strains had 26 sequence types (STs).The ST-3 was predominant, including 33 strains (serotypes O3:K6 and O1 : K36).The four O4:K8 strains formed another predominant colony, which was different from ST-3.Conclusion The etiologic characteristics of V.parahaemolyticus varied, which might be one of the reasons for high incidence of food-bome V.parahaemolyticus infection in Guangdong.The molecular characteristics of O4: K8 strain were differem from the other predominant serotypes.Close attention should be paid to the possible outbreak caused by O4: K8 strain in this area.