Objective To report the clinic experience of tr eatment of severe pelvic fracture in order to improve the early diagnosis and operation of the injury.Methods We retrospectively studied the clin ic data of106patients admitted to our hospita l for severe pelvic fracture from Apr il 1994to May 2002.Results The main causes for pelvic fracture were traffic accident injury(69cases,65.1%)and falling accident injury(31cases,29.3%).87cases were in the survival group,and 19cases in the death group,with t he mortality of about 17.9%.In the death group,10di ed from hemorrhagic shock,4of severe cerebral injury,3from MOF,and 2from ARDS.32cases with pelvic f ractures were treated by opening red uction and internal fixation,91.7%of which achieved good results.Conclusion In the treatment of severe pelvic fra ctures,prehospital emergency care is very important.Complicated severe injuries should be treated pr omptly and pelvic fractures be fixed with internal fixation as soon as possibl e.

BACKGROUND: The free border of meniscus is avascular portion, for which, it is not susceptible for the meniscus to be cured naturally after injury. Therefore, it is necessary to induce fibrous tissue healing probably under certain situation.OBJECTIVE: To adopt tissue engineered cartilage and fibrin adhesive to treat meniscus injury in avascular portion and compare the results.DESIGN: Randomized group division and blank control experiment was designed.SETTING: Animal Laboratory of a Shenzhen Second People's Hospital.green-purplish-blue adult rabbits were selected, randomized into 3 groups,12 rabbits in each, named blank control, fibrin adhesive group(FA group)and tissue engineered cartilage group(TE-C group).METHODS: The experiment was performed in Animal Laboratory of Shenzhen Second People's Hospital from September 2003 to March 2004.Ten baby rabbits borne in 3 to 5 days were sacrificed to collect fibrochondrocytes for culture so as to prepare tissue engineered cartilage containing 12 × 108 L-1chondrocytes. Thirty-six adult rabbits were prepared into the injured model in avascular portion of meniscus (0. 7 × 0. 3) cm with full-thickness laceration. In blank control, no any filler was applied for management; in FA group, fibrin adhesive was infused in laceration; and in TE-C group, tissue engineered cartilage was infused in laceration. Four animals of each of 3 groups were sacrificed in the 2nd, 6th and 12th weeks after operation. Eight menisci were collected in each group each time for gross morphological observation and histological examination.MAIN OUTCOME MEASURES: Gross morphological observation and histological examination in injured meniscus model of rabbit.logical observation in injured meniscus model of rabbit: In blank control, the splits in meniscus were not been healed and tissue filler was not apparent. In FA and TE-C groups, the splits had been filled up with tissue fillers comblank control, 2 to 12 weeks after operation, there was chondrocyte proliferation presented on the border of splits. In FA group, 12 weeks after operation, on the defect border, there were many fibroblastic cells that closely adhered to adjacent tissue, resulting in scar tissue healing. In TE-C group,12 weeks after operation, cartilage cavities and capsule were apparent in the defect and chondrocftes were in cell condensation.CONCLUSION: Tissue engineered cartilage is survived in the acceptors, resulting in fibrocartilaginous healing and specific biological label of chondrocytes. But the remarkable difference presents in collagen arrangement among the repaired tissue, adjacent normal meniscus tissue and normal cartilage.

Objective To compare clinical outcomes of double-bundle and single-bundle in individualized arthroscopic anatomical reconstruction of anterior cruciate ligament (ACL) . Methods The clinical data of 117 patients were reviewed who had received double-bundle or single-bundle arthroscopic ACL reconstruction from March 2007 through September 2009 in our hospital and had undergone complete follow-up. Of them, 35 cases had single-bundle ACL reconstruction and 82 double-bundle reconstruction. In the single-bundle group(group A), there were 31 men and 4 women, aged 28. 6 ±5. 1 years. In the double-bundle group(group B), there were 73 men and 9 women, aged 27. 6 ±5. 4 years. The 2 groups were comparable in the preoperative demographic data ( P > 0. 05). To evaluate the outcomes, Lachman and Pivot Shift exams , KT-2000, Lysholm and IKDC (International Knee Documentation Committee) scores, were adopted. Results The 117 patients received a mean follow-up of 15 months (from 11 to 25 months). The Lachman test showed 88. 6% (31/35) were normal in group A and 95. 1% (78/82) were normal in group B.The pivot-shift test showed 88. 6%(31/35) were normal in group A and 96. 3% (79/82) were normal in group B. Group A had a mean Lysholm score of 93. 4 ± 8. 2 and group B a mean Lysholm score of 93. 7 ±7. 0. There were no significant differences between the 2 groups in the above indexes ( P > 0. 05). By IKDC score, 71. 4% (25/135) were normal in group A and 93. 9% (77/82) were normal in group B. The KT-2000 test showed a mean of 1. 4 ± 0. 6 mm in group A and a mean of 1. 1 ± 0. 5 mm in group B. These 2 values were significantly different between the 2 groups ( P < 0. 05). Conclusions The individualized arthroscopic double-bundle anatomical reconstruction of ACL can maximally restore the anteroposterior and rotational stability. Arrangement of the ACL insertion site on the femoral and tibial side, three-portal technique and ruler application are keys for individualized anatomical double-bundle ACL reconstruction.

Objective To discuss the strategies for diagnosis and treatment of severe pelvic fracture. Methods 38 patients with severe fracture of pelvis circle and different complications were studied in this paper from May, 1997 to June, 2005. 28 cases underwent emergency treatment for shock, 31 cases had internal fixation, and 14 cases received operative procedures for their complications. Results All the 38 cases survived. The integrity of the pelvic circle was restored in patients with unstable pelvic fracture. Most of the patients were back to their former work. Conclusions In treatment of severe pelvic fractures, the hemorrhagic shock and other complications endangering life should be promptly treated, and restoration of the integrity of the pelvic circle is the most important step.

BACKGROUND: Schwann cell derived neurotrophic factor, which is isolated and purified from the kytoplasm of Schwann cell with the relative molecular mass of 58000, is a kind of neurotrophic substance possessing obvious neurotrophic activity. It can be against neurovirulent substance of nitrogen monoxidum.OBJECTIVE:To create root avulsion animal models and observe the protective effects of Schwann cell derived neurotrophic factor (SDNF) on motoneurons of spinal anterior horn from spinal root avulsion induced cell death.DESIGN: Repeated observation and measure.SETTING: Third Department of Orthopaedics, Second People's Hospital of Shenzhen; Department of Micro-surgery , First Hospital Affiliated to Sun Yat-sen University.MATERIALS: This experiment was conducted at the Experimental Animal Center of Medical College of Sun Yat-sen University from March to May 2003. Twenty Sprague-Dawley rats with the age of 3-4 months, of clean degree, were selected and divided randomly into experimental group of Schwann cell derived neurotrophic factor and control group of normal saline with 10 rats in each group. The right side was injured, and the left side was intact served as normal control side.METHODS : ①A rat model of C6,7 spinal root avulsion induced motoneuron degeneration was established. ② A small piece of gelfoam presoaked in 40 μL SDNF solutions (1 g/L) was placed in contact with the injured spinal cord in the animals of the experimental group. Normal saline was added as the same way as above in the animals of the control group. ③ A silica pipe was put on the surface of gleform, one end of the silica was sutured to the glefoam , and the other end wasfixed subcutaneously with vaselinum. Local intramuscular injection of penicillinum was performed on the wound following closing the incision. All rats received an injection (20 μL) of either SDNF or normal saline solution at the lesion site through the silica pipe sutured to the glefoam once a week after the surgery. All the animals were killed by the end of the third weeks. ④The spinal region of C6,7 level was dissected out for observing survival rate and morphological change of motoneurons of spinal anterior horn as well as the expression of nitricoxide synthase(NOS).MAIN OUTCOME MEASURES: ① Survival and morphological change of spinal motor neurons. ②Change of nitricoxide synthase expression of spinal motor neurons.RESULTS: Totally 20 rats were enrolled in the experiment, and all of them entered the stage of result analysis. ① Survival and morphological changeof spinal motor neurons: 68.6% motoneurons of injured side of the control group died at 3 weeks after surgery. The survival rate was 31.4%,which was significantly lower than that of the intact side (P ＜ 0.01), and the survived neurons was shrinked significantly; the death rate of spinal motor neurons of injured side of experimental group was decreased by 35%as compared with control group (P＞ 0.05). The survival rate was 66.4%,and the survived neuron body was increased, similar to the intact side (P ＞ 0.05). ② Change of nitricoxide synthase expression of spinal motor neurons: In normal spinal cord, NOS positive neurons were shown in dorsal horn, surrounding the central canal and in the intermediolateral column.NOS was not seen in the anterior horn motonurons. At the end of the third week after C6,7 spinal root avulsion, increased NOS expression was not found at the injured side in the Schwann cell derived neurotrophic factor group and the intact side in the control side, while the significantly increased NOS expression of spinal motoneurons was found at the injured side of the control group.CONCLUSION: Degeneration of spinal motoneuron and increased expression of NOS can be induced by spinal root avulsion. SDNF has a significant effect in protecting spinal motoneurons from spinal root avulsion induced cell death and inhibiting the expression of NOS. These results suggest that the effects .of SDNF on motoneuron survival may be achieved by modifying the expression of certain cellular molecule such as NOS.

BACKGROUND: Schwann cell-derived neurotrophic factor is a bioactive protein isolated and purified from the kytoplasm of Schwann cell. It can obviously maintain the survival of spinal cord anterior horn motor neuron and promote the regeneration of peripheral nerve.OBJECTIVE: To observe the protective effect of Schwann cell-derived neurotrophic factor on the high injury of peripheral nerve-induced apoptosis of sensory neurons in spinal dorsal root ganglia.DESIGN: Randomized and controlled animal experiment.SETTING: Shenzhen Second People's Hospital.MATERIALS: Totally 30 3-week-old SD infant rats, of clean grade and either gender, were used in this experiment. They were randomly divided into neurotrophic factor group and control group with 15 rats in each one.Left sides of the animals in both two groups were set as normal sides and right sides as injured sides.METHODS: This experiment was carried out at the Experimental Animal Center, Medical College of Sun Yat-sen University from May 2003 to July 2003. ① L4.5 nerve root high-mutilation animal models were developed on the rats in two groups. Proximal nerve stump was connected with silicone tube. According to grouping, 60 mg/L Schwann cell-derived neurotrophic factors and 20 μL normal saline were injected into the silicone tubes respectively. Two ends of silicone tube were enveloped with vaseline.② Sample collecting was conducted at postoperative 4 weeks, survival rate and morphological change of sensory neurons in dorsal root ganglia of injured nerve was observed.MAIN OUTCOME MEASURES: ① Gross observation of sciatic nerve regeneration at injured side of the rats in two groups ② Survival of sensory neurons in dorsal root ganglia ③ Morphological change of sensory neurons in dorsal root ganglia.RESULTS: All the 30 rats entered the stage of result analysis. ① Gross observation of sciatic nerve regeneration: In the neurotrophic factor group,nerve new born axon grew along silicone tube, with 1cm in length; there were few and thin newborn axons in control group with 0.8 cm in length.② Survival of neuron in dorsal root ganglia of the rats in two groups: There was little fibrous tissue proliferation in the dorsal root ganglion in neurotrophic factor group. The loss of neurons was not obvious and the survival rate was 91.8%. Obvious fibrous tissue proliferation appeared in the dorsal root ganglia in control group, and a great many neurons were lost with the survival rate of 58.6%. Survival rate of neurons was 33.2% higher in neurotrophic factor group than in control group (P ＜ 0.01 ). ③ Morphological change of neurons in dorsal root ganglia: The diameter and area of neurons in dorsal root ganglia were significantly lower in control group than in neu rotrophic factor group and normal side [(21.8±1.4) μm,(373.1±50.9) μm2 vs (24.8±1.1) μm, (482.8±42.2) μm2 and (24.5±1.3) μm, (471.5±51.4) μm2,P ＜ 0.01], while there were no significant difference in diameter and area of neurons between neurotrophic factor group and normal side(P ＞ 0.05).CONCLUSION: Schwann cell-derived neurotrophic factors have obvious neurotrophic bioactivity for sensory neurons in the injured dorsal root ganglia.

BACKGROUND:Ginsenoside can promote wisdom,prevent aging,protect cortical motor neurons,resist cell apoptosis,but the mechanisms are unclear.OBJECTIVE:To observe the effect of Ginsenoside Rb1 and Rg1 on nerve growth factor expression in Schwann cells.DESIGN,TIME AND SETTING:The in vitro cytological study was performed at the Second People's Hospital of Shenzhen City from March to June 2004.MATERIALS:Fresh adult ex vivo nerve was obtained from limbs that were dissociated by trauma and could not be reimplanted at the Second People's Hospital of Shenzhen City.Ginsenoside Rb1 and Rg1 was supplied by the Norman Bethune University of Medical Sciences.METHODS:Epineurium was removed and cut into 1.0-2.0 mm blocks.Schwann cells were isolated by enzyme digestion.Following removing fibroblasts by double 30-minute differential attachment,Schwann cells with above 95% purity rate were harvested,and then incubated on a 96-well culture plate coated with polylysine (105 cells/well).Schwann cells in the Ginsenoside Rb1 group were subjected to 20 uL of Ginsenoside Rb1 at 10,20,40,60,80 ug.Schwann cells in the Ginsenoside Rg1 group underwent 20 uL of Ginsenoside Rg1 at 10,20,40,60,80 ug.Schwann cells in the control group were treated with 20 uL of phosphate buffered saline.MAIN OUTCOME MEASURES:Nerve growth factor expression rate was determined in Schwann cells by using flow cytometry.RESULTS:Nerve growth factor expression rate in Schwann cells was significantly increased in the Ginsenoside Rb1 and Ginsenoside Rg1 groups compared with the control group at 48 hours following incubation (P ＜ 0.05),in a dose-dependent fashion.Nerve growth factor expression rate peaked when Ginsenoside Rb1 and Ginsenoside Rg1 were 60 mg/L.No significant difference in nerve growth factor expression rate was detected between the Ginsenoside Rb1 and Ginsenoside Rg1 groups (P ＞0.05).CONCLUSION:Ginsenoside Rb1 and Rg1 has potential of promoting the recovery of damaged peripheral nerve by increasing Schwann cell producing and secreting nerve growth factor.

ObjectiveTo investigate the effect of high volume hemofiltration (HVHF) combined with mechanical ventilation (MV) on seawater respiratory distress syndrome (SW-RDS) canine models.MethodsTen nomal hybrid dogs were randomly assigned into two groups:MV group(MV group,n=5),all the animals only received MV after establishing model successfully; HVHF combined with MV group (HVHF+MV group,n=5),all were received HVHF plus MV after establishing model successfully.Both groups were observed for 4 hours.Mean arterial pressure (MAP),heart rate (HR),central venous pressure(CVP),arterial blood gas and venous plasma osmotic pressure were detected at baseline,0 min(model establishment),60 min,120 min,180 min,240min after treatment.Venous blood was collected to detect inflammatory mediators (IL-8,IL-6,TNF-α)at baseline,0 min,120 min,240 min after treatment.The lung pathology was examined at the end of the experiment.Results(1)All the animals were suvival after four hous of treatment in both groups. (2)Pattial pressure ofoxygen(PaO2) and O2 saturation(SaO2) rised after four hours of treatment in both groups(P＜0.05), and HVHF+MV group was better than MV group.After 4 hours of treatment,pH,actual bicarbonate (AB),bases excess(BE) in HVHF+MV group were significantly better than those in MV group(P＜0.05),recovering to the baseline values.(3)MAP,HR,CVP were stable during the four hours of treatment,and compared with 0 min,there was no significant differences after 4 hours of treatment in bothgroups. There were no significant differemces at the same time of treatment in both groups. (4)Plasma osmotic pressure were stable during the four hours of treatment,and compared with 0 min,there was no significant difference in MV group.But in HVHF+MV group,osmotic pressure was significantly higher after 4 hours of treatment than that at the same time in MV group(P＜0.05),and compared with 0 min and 180 min,those were higher too(P＜0.01). (5)Compared with those at the same time in MV group,plasma inflammatory mediators (IL-8,IL-6,TNF-α) were significantly decreased after 4 hours of treatment in HVHF+MV group(P＜0.01).After 4 hours of treatment IL-8,TNF-α in MV group were higher than those at the same time in 0 min (P＜0.05).(6)Compared with those in MV group,there were less infiltration of neutrophils,edema and injury of alveolar epithelium from pulmonary pathology.ConclusionsHVHF combined with MV can significantly improve hypoxemia and correct acidosis of SW-RDS model in canines.HVHF can effectively clear plasma inflammatory mediators and redundant water,improve pulmonary pathology changes.HVHF has no impact on MAP,HR and CVP of SW-RDS.

Background: Transjugular intrahepatic portasystemic shunt (TIPS) is widely used for reducing portal hypertension. Post-TIPS anticoagulant treatment is controversial because of lack of obligatory evidence. Aims: To systematically review the effect of anticoagulant treatment on patients with liver cirrhosis after TIPS. Methods: Randomized controlled trials (RCTs) of liver cirrhosis patients after TIPS with anticoagulant treatment (anticoagulant treatment group) or without anticoagulant treatment/placebo (control group) were retrieved from PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CBM and VIP databases in March 2020. Meta-analysis was conducted by RevMan 5.3. Results: Three RCTs involving 157 liver cirrhosis patients were enrolled. These studies mainly reported the effects of anticoagulant treatment on gastrointestinal rebleeding, stent patency, mortality and incidence of hepatic encephalopathy (HE). Meta-analysis revealed that no significant differences in total gastrointestinal bleeding rate (OR=1.04, 95% CI: 0.25-4.38, P=0.96), variceal bleeding rate (OR=1.04, 95% CI: 0.14-7.68, P=0.97), stent stenosis (OR=1.88, 95% CI: 0.73-4.79, P=0.19), occlusion (OR=0.07, 95% CI: 0.00-1.44, P=0.09), shunt dysfunction (OR=0.67, 95% CI: 0.10-4.29, P=0.67), mortality (OR=2.12, 95% CI: 0.06-72.77, P=0.68) and incidence of HE (OR=1.18, 95% CI: 0.45-3.06, P=0.74) were found between anticoagulant treatment group and control group. Conclusions: Post-TIPS anticoagulant treatment is safe and without increasing the rate of gastrointestinal rebleeding, mortality and incidence of HE. However, anticoagulant treatment does not further improve the stent patency. Therefore, anticoagulant treatment appears to be unnecessary in patients with liver cirrhosis after TIPS.

Humans ; Transcatheter Aortic Valve Replacement ; Aortic Valve/surgery* ; Heart Valve Prosthesis Implantation ; Renal Dialysis ; Aortic Valve Stenosis/surgery* ; Treatment Outcome ; Heart Valve Prosthesis