Objective To remedy the general defects of external fixator such as poor stability,complexed operation,strong stress shielding and bad extension function. Methods A total of 102 patients with limb shaft fracture were treated with the self-made external fixation and the curative effect observed. There were 84 males and 18 females aged at 5-78 years. Of all, 76 cases had tibial and fibular fractures, 10 femoral shaft fractures (children), 4 intertrochanteric or subtrochanteric fractures, 7 ulnar or radial fractures and 5 humeral shaft fractures. Results All patients got good results through a all-course observation, among which 76 cases with tibial and fibular fractures were followed up for 3 months to one year. Furthermore, the mean substantial bone healing time was only 3.5 months. The joint functions of the knee and the ankle recovered synchronously, with an overall excellence rate of 93.4%. No displacement of the fractured part or further fracture occurred. Conclusions The structure and function of the self-made external fixation accord with the demanding of current external fixator in orthopaedics.

Objective To investigate the effect of all-trans retinoic acid(atRA) on the urinary TGF?_1 excretion and glomerular lesion of diabetic rats at early stage.Methods SD rats were randomly assigned into 3 groups: atRA treated group,diabetic control group and normal control group.Streptozotocin(STZ)-induced early diabetic male SD rat were used.The atRA treated group were treated with daily subcutaneous injections atRA of 10mg/kg for 7 days(n=6),and then the excretion of urinary protein and TGF?_1 and NO level of plasma,urine and renal tissue were measured,and pathological changes of their kidneys were observed.Results The diabetic control rats showed increased urinary excretion of protein and TGF?_1 and NO level of plasma,urine and renal tissue and deposit of glomerular matrix,while atRA prevented these changes.Conclusion AtRA can prevent the development of diabetic nephropathy,which is relevant with the inhibition of secretion of TGF?_1 and NO.

Objective To investigate the effect of at-RA in macrophage accumulation in tubulointerstitium of rats with renal tubulointerstitial fibrosis.Methods Unilateral ureteral obstructive(UUO) rat animal models were used for the study.40 SD rats were randomly divided into 5 groups: sham group,UUO group,benazepril group,low-dose at-RA groups and high-dose at-RA groups.The rats were under intragastric administration by benazepril(10mg/(kg?d)) in benazepril group,and by(at-RA)(10mg/(kg?d)) in low-dose at-RA group and 20mg/(kg?d) in high-dose at-RA group and by sodium chloride in tales doses in sham group and UUO group from the day before the operation to 14 day after operation.Immunohistochemistry staining of CD68 and Col Ⅲ was used to define the macrophage accumulation and expression of interstitial Col Ⅲ.The degree of tubulointerstitial damage was scored by HE and Masson staining.Results Tubulointerstitial macrophage infiltration were all significantly reduced by(at-RA) or benazepril treatment.They also improved the histological changes of UUO rats and inhibited interstitial colⅢ deposition.Conclusion Reduction of interstitial macrophage infiltration may be an important event by which(at-RA) or benazepril prevents renal injury caused by UUO.

BACKGROUND:Many studies have confirmed that recombinant human bone morphogenetic protein 2 plays a very important role in bone formation and fracture healing, but recombinant human bone morphogenetic protein 2 alone implanted is prone to diffusion and degradation, which is unable to play a persistent role in new bone formation. OBJECTIVE:To explore the effect of recombinant human bone morphogenetic protein 2 composite bone in the rabbit lumbar fusion. METHODS:Thirty New Zealand white rabbits were selected to make posterior lumbar intertransverse fusion models, and then were randomly divided into three groups, in which, L5-6 intertransverse implantation of autologous iliac bone, al ogeneic bone and recombinant human bone morphogenetic protein 2 composite bone (recombinant human bone morphogenetic protein 2 and al ogeneic bone complex) was done respectively. At 6 weeks after implantation, gross observation, X-ray examination and histological observation were performed. RESULTS AND CONCLUSION:Fusion rate and percentage of new bone area were higher in the composite bone group than the autologous iliac bone and al ogeneic bone groups (P<0.05);the tensile strength was lower in the al ogeneic bone group than the other two groups (P<0.05), but there was no difference between these two groups except the al ogeneic bone group. X-ray films showed cal us formation in the implanted region of the three groups. In the autologous iliac bone group, a large amount of cartilage tissues formed along with a smal amount of bone trabeculae and a certain amount of woven bones. In the al ogeneic bone group, the implant was covered with a large amount of fibrous tissues, bone island was seen and there was also a smal amount of bone trabeculae and cartilage tissues. In the composite bone group, a great amount of bone trabeculae and cartilage tissues were visible to form woven bone and cortical bone. These findings indicate that the recombinant human bone morphogenetic protein 2 composite bone can obtain good effect in the rabbit lumbar fusion.

Objective To evaluation the efficacy of dexmedetomidine mixed with dezocine and levobupivacaine for patient-controlled epidural analgesia (PCEA) after cesarean section.Methods A total of 300 patients, aged 23-35 yr, with body mass index of 24-28 kg/m2 , of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective cesarean section under epidural anesthesia, were randomly divided into 3 groups (n =100 each) according to the random number table: morphine and levobupivacaine group (ML group), dezocine and levobupivacaine group (DL group), and dexmedetomidine, dezocine and levobupivacaine group (DDL group).In group ML, the loading dose included morphine 2 mg + levobupivacaine 10 mg + 5 ml normal saline, and PCEA solution contained morphine 5 mg + levobupivacaine 150 mg + normal saline 100 ml.In group DL, the loading dose included dezocine 3 mg+ levobupivacaine 10 mg+ normal saline 5 ml, and PCEA solution contained dezocine 15 mg + levobupivacaine 150 mg + normal saline 100 ml.In group DDL, the loading dose included dezocine 2 mg+ levobupivacaine 10 mg + dexmedetomidine 0.5 μg/kg + normal saline 5 ml, and PCEA solution contained dezocine 7.5 mg+ levobupivacaine 150 mg + dexmedetomidine 1.5 μ g/kg + normal saline 100 ml.At 10 min before the end of operation, the loading dose was given via the epidural catheter, and the PCEA pump was connected and set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Analgesia was maintained until 42 h after operation.Visual analog scale score was main-tained ≤ 3, and (or) visual analog scale for fatigue score ≤ 2.When PCEA failed, morphine 2 mg was injected epidurally as rescue analgesic.At 4, 8, 24 and 42 h after operation, the modified Bromage score and Ramsay sedation score were recorded, and patients' satisfaction with analgesia was evaluated.The occurrence of epidural analgesia-related adverse reactions was recorded.Results The consumption of PCEA solution and requirement for rescue analgesics were significantly lower in group ML than in group DL.Compared with group ML, Ramsay sedation score was significantly decreased at 4 and 8 h after operation, the degree of patients' satisfaction with analgesia was increased, and the incidence of nausea, vomiting, dizziness and pruritus was decreased in DL and DDL groups, and the incidence of urinary retention was decreased in group DDL.The degree of patients' satisfaction with analgesia was significantly higher, and the incidence of dizziness and urinary retention was lower in DDL group than in group DL.No patients developed epidural analgesia-relatcd hypotension, bradycardia, or respiratory depression in the three groups.Conclusion The efficacy of dexmedetomidine mixed with dezocine and levobupivacaine is good when used for PCEA after cesarean section, and the adverse reactions are fewer.

BACKGROUND:Posterior maleolar fracture is an important factor affecting the prognosis of ankle fractures. Posterior maleolar fracture often caused by high energy trauma. Using what kind of fixation and fixation materials biomechanics, and how to embed has become a current research hotspot. OBJECTIVE:To compare the clinical outcomes of different fixation materials on posterior maleolar fracture, and analyze the effect of different fixation methods on biomechanical outcome of posterior maleolar fracture fixation, so as to provide a basis and reference of selecting the best fixation for the clinical treatment of ankle fracture. METHODS: The relevant literature included by PubMed database and the China National Knowledge database from the year of 1976 to 2015 were retrieved by the first author through computer. English key words are “Ankle fracture; internal fixation; biomechanics; biocompatibility”, Chinese language search terms are “posterior maleolar fracture; internal fixation; biomechanics; biocompatibility”. Summarize the most commonly used metal fixation materials and absorbable content materials. The clinical commonly used metal fixation materials including bone plate and screws, absorbable fixation materials such as biodegradable material polylactic acid, polyethylene plastic ester, polylactide gum ester, etc. The biomechanical properties were analyzed. RESULTS AND CONCLUSION: The new locking screw can withstand more buckling and shear force. Lag screw has a tapping action, and the puling was stronger after tapping, but for patients with osteoporosis, the pressure effect of screw on fracture fragments was limited, the strength was not enough, at this time, locking plate should be used. Locking plate has a greater stability and higher confrontational feature to bending stress, less likely to pul out. Steel coupling screw provides better stability. To avoid secondary removing of the fixation, stress protection after fixation and other shortcomings after the metal material fixation fracture healing, the strength of the absorbable fixation material made by biodegradable material polylactic acid, polyvinyl acetate glue and polypropylene plastic ester after high temperature and pressure processing was increased. Absorbable fixation material may overcome the adverse effects associated with metal fixation, such as imageological examination, secondary implant removal. These results show that the mechanical properties of the absorbable screws are more closer to human bone, no surrounding bone vulnerability due to stress shields, no osteoporosis occurs, and can degrade in the body, but its fixation strength is stil less than the traditional fixed screw and bone plate. We should choose a suitable fixation material according to the forces of fracture site and the size of the fracture fragments.

Objective To investigate the application of MRI in evaluation of the traumatic temporomandibular joint (TMJ) injury induced by type Ⅵ condylar fracture. MethodsMRI was performed in TMJs in 18 patients with type Ⅵ condylar fractures at days 3-14 post-injury and the MRI findings were analyzed. ResultsMRI findings of 18 patients with traumatic TMJ injury with 19 sides of type Ⅵ condylar fractures showed 15 sides of TMJ disk displacement,nine sides of capsule tear,16 sides of retrodiscal tissue tear (double-plate area) and 19 sides of joint effusion change. Conclusions MRI is very important in the diagnosis and evaluation of traumatic TMJ injury,since it can clearly display the TMJ injuries in type Ⅵ condylar fractures.Therefore,the clinical application of MRI is beneficial for selection of the therapeutic schedules.

Objective: The characteristics and differences of the general notice between the Chinese Pharmacopoeia and the Japanese Pharmacopoeia were investigated to provide references and suggestions for the compilation of the Chinese Pharmacopoeia.
Methods: From the perspective of frame structure and main contents, the general notice between the Chinese Pharmacopoeia and the Japanese Pharmacopoeia was compared.
Results: Each volume of the Chinese Pharmacopoeia had its general notice, including 34 to 48 items and 10 to 12 chapters based on different varieties collected in each volume. The Japanese Pharmacopoeia had 49 items not arranged by chapters. There are many differences on the general notice between the Chinese Pharmacopoeia and the Japanese Pharmacopoeia, such as the definitions and expressions of names, determination of appearance, revision rules, risk assessment and quality control conception. The framework of the general notice in the Chinese Pharmacopoeia was clear, the content was specific and the operation was friendly. The term description of the general notice in the Japanese Pharmacopoeia was concise, and some terms need to be implemented under the guidance of professional knowledge.
Conclusion: In light of comparative study, every volume’s general notice of the Chinese Pharmacopoeia has its own characteristics. By integrating advanced analytical technique, combining the requirements with laws and regulations, and optimizing content and terms, all volume’s general notice could be explored to be coordinated and unified.

Objective To compare the curative effect of tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids in the treatment of patients with stage Ⅲ to Ⅳ hemorrhoids.Methods The patients with stage Ⅲ to Ⅳ hemorrhoids who underwent prolapse and hemorrhoids or tissue-selecting therapy stapler surgery in the department of General Surgery,Shanghai Ninth People's Hospital and Xinhua Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Chongming Branch,from Jan.2013 to Jun.2014 were accepted and allocated to prolapse and hemorrhoids or tissue-selecting therapy stapler group.The peri-operative parameters about operative time,blood loss,postoperative hospital stay and the time required to return to normal activity were compared by t test,The postoperative complications including pain assessment and the incidence of postoperative bleeding,urine retention,faecal urgency,fecal incontinence,anal stenosis,rectovaginal fistula and recurrence rate were compared by t test and chi-square test.Rank sum test was used to compare the recurrence rate and patient's satisfaction between the two groups.Results The operation time,intraoperative bleeding volum,postoperative hospital stay and the time required to return to normal activity in the procedure for prolapse and hemorrhoids group were signifcantly higher than those in the tissue-selecting therapy stapler group (P =0.021,P =0.003,P =0.001,P ＜0.001).The pain score of procedure for prolapse and hemorrhoids group were all higher than those of the tissue-selecting therapy stapler group in the first post-operative defecation and in post-operative 24 hours and 72 hours (all P ＜ 0.001).The incidence of faecal urgency of the procedure for prolapse and hemorrhoids group in post-operative 1 month (18.6％) was higher than that of the tissue-selecting therapy stapler group (6.6％) (P =0.036).There were no statistically significant differences in the incidence of postoperative bleeding,urinary retention,recurrence rate and patient's satisfaction between two group (P ＞ 0.05).Conclusion Tissue-selecting therapy stapler was superior to the procedure for prolapse and hemorrhoids in operation time,intraoperative blood loss,postoperative pain and the incidence of faecal urgency.Long-term results demonstrate that tissue-selecting therapy stapler and prolapse and hemorrhoids have similar effectiveness.

As a novel fungal type Ⅲ polyketide synthase, CsyB from Aspergillus oryzae can sequentially accept one molecular short chain fatty acyl CoA as start unit, one molecular malonyl-CoA and one molecular acetoacetyl-CoA as extend unit to produce the short chain csypyrone B1-3. On the basis of crystal structure of CsyB, a fatty acyl CoA binding tunnel of a length of about 16 Å is located in its active center that is proposed to accept diversified start units. In order to examine the substrate diversity of CsyB, CsyB gene was introduced and expressed in Escherichia coli that contained a number of precursors of long chain fatty acyl CoA in vivo. The results of HPLC revealed that a series of long chain csypyrone derivatives were detected in the recombinant strain in comparison with the control strain. These new csypyrone compounds were preliminarily analyzed by UV-visible spectroscopy and LC-HRMS. Three hydroxylated csypyrones were intensively determined by 1D and 2D NMR experiments, especially the position of the hydroxyl group in these compounds. These results demonstrate that CsyB exhibits a broad substrate specificity, which not only can accept the long chain saturated or unsaturated fatty acyl CoA as substrate, but also accept hydroxylated long chain fatty acyl CoA.