Objective To investigate the advantages of the external fixators used in the treatment of pelvic fracture. Methods From April 2002 to July 2008, 55 patients with unstable pelvic fracture were treated respectively with simple external fixators, external fixators plus traction and external fixators plus in-ternul fixation according to their different Tile classifications. Results Of this group, 51 cases were followed up for an average of 11 months, 2 cases died because of multi-injuries, and 2 cases were lost in the follow-up. All of the 51 patients obtained bony union. On average, it took 11 (6 to 14) weeks to achieve weight-bearing walking, and 12 (8 to 14) weeks to remove the external fixators for the patients. By Liu Li-ming's evaluation system, the good to excellent rate was up to 88.2%. Conclusions The pelvic fractures of Tile B1 and B2 can be treated with simple external fixators and those of Tile C with external fix-ators plus internal fixation or traction to achieve fracture reduction and stability of the pelvic ring. For the patients with multi-injuries, external fixators used in the emergency treatment can stabilize the pelvic ring, reduce blood loss and improve the success rate.

Objective To assess the clinical features of newly diagnosed primary Sjogren's syndrome (pSS). Methods Patients were diagnosed according to the international consensus criteria for Sjogren's Syndrome published in 2002. Clinical manifestations and laboratory tests of 86 pSS cases hospitalized in Nanjing Drum Tower Hospital in the past two years were reviewed. Results Among the 86 patients, 95.3% were female and the average disease onset age was 38.6 years. The median time from disease onset to diagnosis was 6 months. Dry mouth, dry eyes and arthralgia were the most common symptoms. Hematologic involvement was found to be prominent in these patients (69.8%). The incidence of abnormal liver function, interstitial lung disease and pulmonary arterial hypertension was 19.8%, 8.2% and 5.8% simultaneously. Younger patients (less than 18 years old) had lower frequency of dry mouth and dry eyes but higher ffrequency of fever and lymph nodes enlargement than the elderly patients (P<0.05). Patients with positive anti-SSA or anti-SSB antibodies had higher incidence of hematological changes as well as ESR than those with negative auto-antibodia. Elevated globulin/IgG and positive antinuclear antibody or rheumatoid factor (P< 0.05). Conclusion pSS is not always a benign disease. Some patients will develop vital organ damages very early and thus need to be identified and treated in time. It should not be overemphasize the importance of dry mouth and dry eyes for the diagnosis of pSS, especially in young patients. Those patients who have fever, high globulin level and positive rheumatoid factor of unknown origin should be screened for pSS.

This study is to evaluate the curative effect of repairing the flexor tendons defect in the fibroosseous sheath by transferring the near flexor digitorum superficial tendons. Thirty-two cases (39 fingers) with acute flexor tendon defect in Zone I were repaired by transferring the flexor digitorum superficial tendons. Early protected passive motion was advocated postoperatively. All cases were followed up for 11 to 23 months. The outcome of fingers were excellent in 24,good in 12 and fair in 3 by TAM score. The percentage of excellent and good outcome was 92. 3%. Microrepair of fresh flexor tendons defect in Zone II by transferring flexor digitorum superficial tendons combined with early protected passive motion can prevent the adhension of tendons effectively and restore finger function earlier.

Objective To analyze the prognostic factors and causes of death of patients with systemic lupus erythematosus (SLE).Methods A database with 319 patients were developed.They were newly diagnosed SLE in the Department of Rheumatology and Immunology,Affiliated Drum Tower Hospital of Nanjing University Medical School from 1999 to 2009.Normal distribution of measurement data was presented using mean±standard deviation.The skewed distribution of data was described by median(interquartile range).Using the rate or proportions,the character of classification data was also stated.Survival rate of SLE patients over time was studied by the Kaplan-Meier method,and prognostic factors were analyzed by COX proportional hazards model.Results The 5 year and 10-year survival rates was 96.2%, 88.7%, respectively Prognostic factors affecting survival included duration from onset to diagnosis, anemia, white blood cells in urine, low serum albumin,low C4 level,abnormal ECG and ultrasound echocardiography, pulmonary arterial hypertension (PAH) and systemic lupus erythematosus disease activity index (SLEDAI). However, PAH,duration from onset to diagnosis, low serum albumin were the independent poor prognostic factors and the relative risk and 95% confidence interval were 2.419 (1.052-5.564), 1.162 (1.043-1.294), 0.924 (0.873-0.978), respectively. Renal failure, pulmonary hypertension and infection were the main causes of death,followed by multiple organ failure and lupus encephalopathy. Conclusion PAH, duration from onset to diagnosis, low serum albumin are the important factors predicting poor prognosis. Early diagnosis, timely treatment of SLE organ damages and preventing complications are the key factors to improve the prognosis of patients with SLE.

Objective To explore the clinical efficacy of allogenic mesenchymal stem cells transplantation (MSCT) in patients with refractory polymyositis/dermatomyositis (PM/DM). Methods Bone marrow derived mesenchymal stem cells (BM-MSC) or umbilical cord derived mesenchymal stem cells (UC-MSC)were infused intravenously in 8 PM/DM patients. The clinical manifestations and laboratory parameters,including serum creatin in kinase (CK) and manual muscle test 8 (MMT8) score, were compared before and after MSCT. Staistically andlyzed by paired t-test. Results The eight patients were followed up for six to twelve months after MSCT. The level of serum CK decreased from (1681±430) to (886±248) U/L one week after MSCT (P＜0.05) and further decreased at week 2 (474±61) U/L, 1 month (293±89) U/L, 3 month (202±70) U/L and 6 month (175±46) U/L, respectively (all P＜0.05). MMT8 score increased to 1 month [(67±3) vs (45±14), P＜0.05], 3 month [(64±10) vs (45±14), P＜0.05], 6 month [(64±4) vs (45±14),P＜0.05] after MSCT. The dosage of glucocorticoid steroid were tapered in all patients 2 weeks after MSCT [(18±6) mg vs (34±15) mg, P＜0.05]. Clinical symptoms of interstitial pneumonia of both patients were relieved after MSCT, which was confirmed by the result of high resolution CT (HRCT) of the lung.The skin ulcers tended to be recovered after the transplantation in one DM patient. All patients did not develop transplantation related complications. Conclusion Allogenic MSCT is an effective and safe approach for the treatment of refractory PM/DM. However, extensive follow-up study is needed for long-term benefit evaluation.

Objective To explore the clinical efficacy and safety of umbilical cord derived mesenchymal stem cells transplantation(UC-MSCT)for patients with refractory systemic lupus erythematosus (SLE).Methods Twelve patients with refractory SLE were enrolled in this study.UC-MSCs(≥106/kg cell number)were infused intravenously for each patient. The clinical manifestations and laboratory parameters were compared before and after MSCT. Results The twelve patients were followed up for one to twenty-six months after MSCT.The systemic lupus erythematosus disease activity index(SLEDAI)score decreased from 18±4 to 10±4 one month after MSCT(n=12,P＜0.01)and then decreased to 7±4 at three month follow-up.Nine patients showed improvement of 24 h proteinuria[(2103±749)mg vs(3359±1248)mg,P＜0.01]one month after MSCT.Further improvement of 24 h proteinuria was observed in eight patients[(1427±616)mg vs(3342±1333)mg,P＜0.01]at three months post MSCT.Serum creatinine of five patients decreased significantly and ten patients showed an increase of serum albumin. Serum complement C3 increased in three patients and four patients showed obvious amelioration of hematological abnormalities. There was no transplantation related complications for all the patients. Conclusion UC-MSCT is effective and safe for refractory SLE,but further observation is required to evaluate its long term efficacy.

Objeefive To explore the clinical efficacy and safety of allogenic bone marrow derived mesenchymal stem cells transplantation(MSCT) in patients with refractory systemic lupus erythematosus(SLE).Methods Eleven patients with refractory SLE(nine females and two males aged from 16～41 years(mean 25±8).were entailed in the study.The infcIrmed consents which were approved by the Ethics Committee of the Affiliated Drum Tower Hospital of Naniing University Medical School were obtained from all participants.Bone marrow of healthy donors were obtained and the mesenchymal stem cells(MSC)were expanded in vitro.Each patient was infused MSC 1×106/kg body weight intravenously.Before MSCT.all patients were administrated with cvclophosphamide (CTX)800～1800 mg divided by two to three days.The clinical manifestations and laboratory tests were compared before and after MSCT.Results The eleven patients were followed up for one to thirteen months after MSCT.A11 patients did not develop transplantation related complications.The systemic lupus erythematosus disease activity index (SLEDAI)score decreased from 1 1.7±5.1 to 5.6±3.4 one month after MSCT(n=11,P＜0.01).Ufine protein excretion decreased from(1989+842)mg/24 h to(1118±700)mg/24 h one month after MSCT(n=10,P=0.02).Five patients were followed up for six months and their urine protein excretion decreased significantly [(522±151)mg/24 h vs (2478±797)rag/24 h.n=5.P＜0.01j.The serum albumin level of 5 patients with hypoalbuminemia increased gradually one month after MSCT [(28±6)g/L vs (32±7)g/L,n=5,P＜0.05].Serum complement C3 level increased from(0.50±0.12) g/L to(0.75±0.10)g/L (n=9.P＜0.01) and their anti-nuclear antibody (ANA) titer decreased one month after MSCT.In two patients with chronic renal failure.the serum creatinine decreased gradually.Conclusion Allogenic MSCT is an effective and safe approach for the treatment of refractory SLE.However.extensive follow-up study is needed for long-term benefit evaluation.

OBJECTIVETo investigate the clinical effect of the application of "compound anastomotic device" on the high-risk colorectal anastomosis in rectal cancer patients undergoing protective ileostomy.

METHODSA total of 116 rectal cancer patients undergoing surgical procedure and prophylactic ileostomy in Tongji Hospital (90 cases) and The Third People's Hospital of Jingdezhen City (26 cases) from May 2011 to October 2016 were prospectively enrolled in the study. Paralleled control study and random digital table were applied. Fifty-eight cases received the compound anastomotic device for protective ileostomy (anastomosis ring group) and 58 cases underwent traditional terminal ileostomy (traditional group). The compound device was mainly composed of Valtrac biodegradable anastomosis ring, drainage tube and condom. Operational procedure was as follows: Ileocecum was freed through incision following laparoscopic total mesorectal excision; Two intestinal ring-shape purses were made; Intestinal wall between purse string was cut and the compound anastomotic device was put into; The purse was tightened and anastomosis ring was closed; The compound device was embed and pull out through the Trocar hole in the right lower abdomen; Then the drainage tube was fixed to the abdominal wall and connected with a drainage bag or an outer pocket. Incidence of anastomotic leak, stoma-related complications, hospital stay and total cost of two groups were compared.

RESULTSThe general clinical data between two groups were not significantly different(all P>0.05). Stoma operation was performed successfully in all the patients of two groups. The stoma operation time was (34.6±13.8) min in anastomosis ring group and (25.8±14.0) min in traditional group with significant difference (t=2.123, P=0.035). Postoperative anastomotic leak occurred in 7 cases, including 3 cases with small fistula in traditional group and 4 cases in anastomosis ring group, of whom 1 case underwent left-low abdominal colonic stoma after necrotic intestine resection. All the patients were discharged within postoperative 7 to 37 days. In traditional group, 35 cases (60.3%) occurred stoma-related complications, the total hospitalization expenses was (65±28) thousand yuan, and the average hospital stay (including stoma reversion) was (23.6±11.8) days. In anastomosis ring group, 17 cases (29.3%) occurred stoma-related complications, the total hospitalization expense was (52±11) thousand Yuan, and the average hospital stay was (21.0±16.8) days. The incidence of anastomotic fistula and the hospital stay had no significant difference between two groups (all P>0.05). The stoma-related complication morbidity (χ=3.216, P=0.002) and the total hospitalization expenses (t=2.683, P=0.027) in anastomosis ring group were significantly lower than those in traditional group.

CONCLUSIONCompared with traditional ileostomy, the application of compound anastomotic device for protective ileostomy would be better to benefit the recovery of patients.