Objective To analyze, treatment of ipsilateral Pilon and calcaneal fractures (IPCF). Methods Injury causes included fallings in seven patients, traffic injury in two and impact injury in one, with ISS score of 5-22 points. There were seven patients with open injuries and 3 with close ones. Nine pa-tients had Ⅱ-Ⅲ degree of Pilon fractures according to the AO/OTA classification and six comminuted com-pression calcaneal fractures according to the Essex-Loprest classification. The Pilon fractures were fixed by cannulated nail, screw or Kirschner wire through open reduction in six patients including four fixed with ex-ternal fixators (the calcaneal fractures were fixed with percutaneous eannulated nail or Kirschner wire by poking reduction). The calcaneal fractures were fixed with only Kirschner wire through poking reduction in two patients and double fractures treated conservatively in two. Results The reduction of Pilon and cal-caneal fractures treated by operation were markedly improved in six patients, while there occurred angular deformity and joint surface introeession in the patients treated conservatively. The wound healing of soft tis-sue was sound in seven patients but unsatisfactory in the other three. The ankle-hind foot score was 82-94 points in four patients who were followed up. Conclusions IPCF is caused by the high energy force and characterized by severe injures of the soft tissues and the bone tissues at the distal tibia and calcaneua, for which limited internal fixation plus external fixation are suitable treatment choice.

OBJECTIVE:To investigate the effects of sevoflurane combined with remifentanil on intraoperative related indica-tors and quality of postoperative recovery in patients with general anesthesia. METHODS:52 patients with elective abdominal sur-gery were randomly divided into observation group and control group. All patients were treated with etomidate 0.3 mg/kg+atracuri-um 0.5 mg/kg+remifentanil 1μg/kg for anesthesia induction;then observation group was received sevoflurane by inhalation and con-trol group was propofol by infusion. The SBP,DBP,HR and BIS in 2 groups were recorded before anesthesia induction(T0),after anesthesia induction(T1),time of intubation(T2),skin incision(T3),10 minutes after establishing pneumoperitoneum(T4),end of pneumoperitoneum(T5) and extubation(T6),respectively. Operation and anesthesia duration,recovery time and extubation time, MMSE score and incidence of adverse reactions were recorded. RESULTS:SBP and HR in T6 and DBP in T4-6 in 2 groups were sig-nificantly higher than T0 of same group,BIS in T1-5 was significantly lower than T0,the differences were statistically significant(P<0.05),however,there was no significant difference between 2 groups (P>0.05). Recovery time and extubation time in observa-tion group were significantly lower than control group(P<0.05),there was no significant difference in the operation and anesthesia duration between 2 groups(P>0.05). MMSE scores in 2 groups were significantly lower than before after 0.5 h and 1 h of extuba-tion,and control group was lower than observation group(P<0.05 or P<0.01);MMSE scores in 2 groups were significantly high-er than 0.5 h and 1 h after extubation(P<0.05),however,there was no significant difference between 2 groups and before(P>0.05). There was no significant difference in the incidence of adverse reactions between 2 groups(P>0.05). CONCLUSIONS:Sevoflurane combined with remifentanil has satisfactory anesthesia,sevoflurane has better controllability,with good safety.

Objective: To study the e ects of Heying Anxin Fang on cardiac function and intracellular Ca2+ concentration in cadiocyte of chronic congestive heart failure rats. Methods: Animal models of heart failure were induced by subcutaneous injection of a large dose of ISO, and were randomly divided into model group, Shenmai injection group, captopril group, high, middle and low dosages of Heyinganxin Fang group and normal group with 9 in each group. To determine the indexes of LVSP, LVEDP, +dp/dtmax ,-dp/dtmax and heart weight, and determine Ca2+ concentration in cardiomyocytes by ow cytometer. Results: Compared with normal group, the indexes of heart weight, Ca2+ concentration and LVEDP in model group increased, but indexes of LVSP, +dp/dtmax, -dp/dtmax decreased obviously(P

Objective To evaluate the effect of sofren injection on acute lung injury (ALI) in septic mice.Methods Ninety-six pathogen-free made Kunming mice,aged 8-10 weeks,weighing 30-35 g,were divided into 4 groups (n =24 each) using a randon number table:sham operation group (group Sham),ALI group,vehicle group (group Vehicle) and sofren injection group (group Sofren).Sepsis was induced by cecal ligation and puncture.In Vehicle and Sofren groups,double distilled water and sofren injection 4 ml/kg were intraperitoneally injected,respectively,after the model was established,followed by repeated admninistration once every 12 h.At 12,24 and 48 h after operation,the animals were sacrificed and lungs were removed for mnicroscopic examination and for determination of wet to dry weight ratio (W/D ratio),malondialdehyde (MDA) content,superoxide dismutase (SOD) activity,and contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in lung tissues (by enzyme-linked immunosorbent assay).The lung injury score (LIS) was calculated after haematoxylin and eosin staining.Results Compared with group Sham,the LIS,W/D ratio and contents of MDA,TNF-α and IL-6 were significantly increased,and the SOD activity was decreased at each time point in ALI and Vehicle groups (P＜0.05).Compared with group ALI,the LIS,W/D ratio and contents of MDA,TNF-α and IL-6 were significantly decreased,and the SOD activity was increased at each time point in group Sofren (P＜0.05),and no significant change was found in each parameter mentioned above in group Vehicle (P＞0.05).Conclusion Sofren injection can attenuate ALI in septic mice.

Objective To investigate the clinical results and related key points of surgical treatment for Hawkins Ⅲ talus neck fractures.Methods From March 2005 to March 2010,26 patients with Hawkins Ⅲ talus neck fracture were treated and 21 of them were followed,including 13 males and 8 females,with an average age of 37.6 years.The fractures occurred on the left side in 11 patients and on the right side in 10patients.The mechanism of injury included high falling injury in 13 patients,traffic accident injury in 7 patients and rolling down injury in 1 patient.Five cases were closed fractures and 6 cases were open fractures.A bilateral approach,the medial and lateral approaches,was used to perform the operation with cannulated screw fixation in emergency.After external fixation in functional position for 6 weeks without loading,ankle joints were allowed to take exercise with hinge brace and to bear partially basing on plain radiograph 12-16weeks later.The weight-bearing should be adjusted with follow-up.Functional results were assessed according to AOFAS (American Orthupaedic Foot and Ankle Society,AOFAS)score.Results The average duration of follow-up was 36.6 months (range,6-60 months).All fractures gained union and the average union time was 4.5 months.The average AOFAS score was 78.6.There were 4 cases in excellent results,10 in good,5 in fair and 2 in poor.The overall excellent and good rate was 67.8％.Traumatic arthritis occurred in 13 cases and avascular necrosis in 5 cases.Conclusion The effect of surgical treatment for Hawkins Ⅲtalus neck fracture via a bilateral approach is satisfactory.

Objective To evaluate the clinical significance of sentinel lymph nodes biopsy (SLNB) in breast cancer patients after neoadjuvant chemotherapy. Methods SLNB was performed in sixty primary breast cancer patients after neoadjuvant chemotherapy using a combination of 99mTc- Rituximab and patent blue. SLN was examined by routine pathologic examination and immunohistochemistry. Routine axillary lymph node resection was performed after SLNB. Results The successful rate of SLNB was 95% (57/60). Twenty-three cases of SLN (40% ) were metastasis positive, including 18 positive cases detected by HE staining and 5 by immunohistochemistry. SLN was the only metastasis lymph nodes in 14 out of 23 cases. One case was of false negative metastasis by SLN. The sensitivity and accuracy of SLNB were 96% (23/24) and 98% (56/57), respectively. The specificity was 100% (33/33) , the false negative rate was 4. 3% (1/23) with the negative predictive value being 97% (36/37). The positive predictive value was 100% (24/24). Internal mammary sentinel lymph node lymphoscintigraphy were positive in 11 cases but all the cases were negative in metastases by pathologic examination. Conclusion The combination of isotope imaging agent and patent blue is suitable for primary breast carcinoma after neoadjuvant chemotherapy. Internal mammary sentinel lymph node biopsy is less clinically important.

Objective To investigate the effect of ulinastatin (UTI) preconditioning combined with ischemic preconditioning (IPC) on hepatic ischemia-reperfusion (IR) injury in rats and possible mechanism of action.Methods A total of 50 male Sprague-Dawley rats were randomly divided into sham-operation group,IR group,IPC group,UTI group,and UTI-IPC group (UCI group).Blood samples were collected from the inferior vena cava after surgery and liver tissue samples were also collected.The serum levels of aspartate aminotransferase (AST),alanine aminotransferase (ALT),and tumor necrosis factor-o (TNF-α),the levels of myeloperoxidase (MPO) and nuclear factor-kappa B (NF-κB) in the liver tissue,and wet/dry weight ratio were determined,and pathomorphological changes of the liver tissue were observed under a light microscope.A one-way analysis of variance was used for comparison of continuous data between groups,and the LSD-t-test was used for further comparison between two groups.Results The IR,IPC,UTI,and UCI groups had significantly higher serum levels of ALT,AST,and TNF-α,levels of MPO and NF-κB in the liver tissue,and wet/dry weight ratio than the sham-operation group (all P ＜ 0.05);the IPC,UTI,and UCI groups had significantly lower levels than the IR group (all P ＜ 0.05),the UTI group had significantly lower levels than the IPC group (all P ＜ 0.05),and the UCI group had significantly lower levels than the IPC and UTI groups (all P ＜ 0.05).Liver pathological examination showed that compared with the sham-operation group,the IR,IPC,UTI,and UCI groups had significantly greater liver injury (all P ＜0.05),while the IPC,UTI,and UCI groups had a significantly lower degree of liver injury than the IR group (all P ＜ 0.05),the UTI group had significantly slighter liver injury than the IPC group (P ＜ 0.05),and the UCI group had significantly slighter liver injury than the IPC and UTI groups (both P ＜ 0.05).Conclusion Both UTI and UCI have a protective effect against hepatic IR injury,and the combination of UTI and UCI significantly enhances such protective effect,possibly by inhibiting the expression of NF-κB,reducing the release of TNF-α and MPO,and alleviating liver inflammatory response.

Objective To establish the pathogenic gene loci on 8q23.3-24.1 and 10p15 in this benigh adult familial myoclonic epilepsy (BAFME) pedigree.Methods After obtaining informed consent, peripheral blood samples were obtained from 7 BAFME patients and 13 control individuals;amplified polymerase chain reaction (PCR) and short tandem repeat (STR) method were employed to conduct linkage analysis;five STRs on chromosomal segments 8q23.3-q24.1 and three STRs on chromosomal segments 10p1 5 were chosen at genetic distances appropriate.Results Negative signal was all obtained for 8q23.3-q24.1 and 10p15 (LOD scores less than-2 for these STRs, respectively;θ=0.0), excluding involvement of these regions in the BAFME pedigree analyzed.Conclusion STR linkage analysis of 8q23.3-q24.1 and 10p 15 does not support linkage to these regions, indicating that the pathogenic gene in the pedigree we studied is not in these chromosome segments.

Objective To observe the clinical effect of ulinastatin(UTI)combined with thymosin alpha 1(Tα1)in the treatment of septic shock.Methods A retrospective analysis was conducted on the clinical data of 88 patients with septic shock admitted to our hospital from June 2021 to October 2023.The patients were divided into UTI group and UTI+Tα1 group according to different treatment methods,with 44 patients in each group.The treatment effects,clinical indicators,microcirculatory perfusion indicators[central venous oxygen saturation(ScvO2),lactate(LAC),capillary refill time(CRT),mean arterial pressure(MAP)],Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,immune indicators,plas-ma and serum inflammatory indicators[soluble triggering receptor expressed on myeloid cells-1(sTREM-1),procalcitonin(PCT),interleukin(IL)-6,tumor necrosis factor-α(TNF-α)],and prognosis were compared between the two groups.Results After 7 days of treatment,the effective rate of treatment in the UTI+Tα1 group was higher than that in the UTI group(P＜0.05).The dura-tion of vasoactive drug use,mechanical ventilation time,ICU stay,and hospital stay were shorter in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 24 and 72 hours of treatment,ScvO2 and MAP gradually increased,LAC gradually decreased,and CRT gradually shortened in both groups(P＜0.05).After 24 hours of treatment,ScvO2 and MAP were higher,and CRT was shorter in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 72 hours of treatment,CRT was shorter,and MAP was higher in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 7 days of treatment,both APACHE Ⅱ and SOFA scores decreased in both groups compared to treatment before,and their scores were lower in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 7 days of treatment,the levels of CD3+and CD4+T lymphocytes increased in both groups compared to treatment before,and the levels were higher in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 7 days of treatment,the levels of sTREM-1,PCT,IL-6,and TNF-α decreased in both groups compared to treatment before,and the levels were lower in the UTI+Tα1 group than those in the UTI group(P＜0.05).After a 28-day follow-up,there was no sta-tistically significant difference in mortality between the two groups(P=0.398).Conclusion UTI combined with Tα1 can effectively promote the recovery of patients with septic shock,improve micro-circulatory perfusion,reduce plasma sTREM-1 and serum PCT levels,inhibit inflammatory responses,and improve prognosis.

Objective To observe the clinical effect of ulinastatin(UTI)combined with thymosin alpha 1(Tα1)in the treatment of septic shock.Methods A retrospective analysis was conducted on the clinical data of 88 patients with septic shock admitted to our hospital from June 2021 to October 2023.The patients were divided into UTI group and UTI+Tα1 group according to different treatment methods,with 44 patients in each group.The treatment effects,clinical indicators,microcirculatory perfusion indicators[central venous oxygen saturation(ScvO2),lactate(LAC),capillary refill time(CRT),mean arterial pressure(MAP)],Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,immune indicators,plas-ma and serum inflammatory indicators[soluble triggering receptor expressed on myeloid cells-1(sTREM-1),procalcitonin(PCT),interleukin(IL)-6,tumor necrosis factor-α(TNF-α)],and prognosis were compared between the two groups.Results After 7 days of treatment,the effective rate of treatment in the UTI+Tα1 group was higher than that in the UTI group(P＜0.05).The dura-tion of vasoactive drug use,mechanical ventilation time,ICU stay,and hospital stay were shorter in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 24 and 72 hours of treatment,ScvO2 and MAP gradually increased,LAC gradually decreased,and CRT gradually shortened in both groups(P＜0.05).After 24 hours of treatment,ScvO2 and MAP were higher,and CRT was shorter in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 72 hours of treatment,CRT was shorter,and MAP was higher in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 7 days of treatment,both APACHE Ⅱ and SOFA scores decreased in both groups compared to treatment before,and their scores were lower in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 7 days of treatment,the levels of CD3+and CD4+T lymphocytes increased in both groups compared to treatment before,and the levels were higher in the UTI+Tα1 group than those in the UTI group(P＜0.05).After 7 days of treatment,the levels of sTREM-1,PCT,IL-6,and TNF-α decreased in both groups compared to treatment before,and the levels were lower in the UTI+Tα1 group than those in the UTI group(P＜0.05).After a 28-day follow-up,there was no sta-tistically significant difference in mortality between the two groups(P=0.398).Conclusion UTI combined with Tα1 can effectively promote the recovery of patients with septic shock,improve micro-circulatory perfusion,reduce plasma sTREM-1 and serum PCT levels,inhibit inflammatory responses,and improve prognosis.