Objective To investigate the clinical value of spiral CT in diagnosis of fracture of tibia plateau, to provide a reference for clinical treatment.Methods 50 cases of tibial plateau fracture were selected,they were diagnosed with X -ray and diagnostic multislice spiral CT three dimensional reconstruction scan respectively.The fracture type and so on of the two groups were compared.Results 50 patients were diagnosed as 14 cases of type Ⅰ, type Ⅱ 10 cases,Ⅲ type 6 cases,Ⅳ type 7 cases,Ⅴ type 5 cases,Ⅵ 8 cases,CT three -dimensional reconstruction diagnosis accuracy rate was 100.00%.X -ray diagnosis was accurate in 41 cases,diagnostic accuracy rate was 82.00%,the difference of two diagnostic ways was statistically significant (χ2 =8.657,P =0.000).All patients were not detected with significant artifacts,the line was good,the fracture line was blurred and visible fracture callus formation surgical outcome was good.Conclusion Spiral CT diagnosis in tibial plateau fracture has high accuracy,through clear and intuitive display morphological characteristics of the patients improves anatomical repair treatment,it is worthy of clinical application.

Objective To evaluate the effect of sevoflurane on left ventricular function in patients undergoing elective coronary artery bypass grafting (CABG) .Methods Thirty-five ASA Ⅱ or Ⅲ patients of both sexes (30 males, 5 females) aged 53-75 yr weighing 46-100 kg undergoing CABG were enrolled in this study. Transesophageal echocardiography (TEE) probe was placed. The TEE variables including cardiac index (CI), left ventricular short axis shortening (FS), left ventricular ejection fraction (LVEF), low propagation velocity ( Vp), E wave velocity (E) , A wave velocity ( A) , systolic wave velocity ( S) , diastolic wave velocity ( D), AR wave velocity, E/A ratio and S/D ratio were recorded before inhalation of sevoflurane (T_1 ) , and 5 min (T_2) and 15 rain ( T_3) after inhalation of sevoflurane after splitting of sternum, and before inhalation of sevoflurane (T_4 ), 5 min (T_5) and 15 min (T_6) after inhalation of sevoflurane after the closure of sternum. The end-tidal concentration of sevoflurane corresponded to 1 MAC. Anesthesia was induced with midazolam 0.05 nig/kg, sufentanil 0.5μg/kg and rocuronium 0.9 mg/kg and maintained with infusion of propofol at 4-6 mg·kg~(-1) ·h~(-1), remifentanil at 0.2-0.4μgkg~(-1)·h~(-1) and atracurium at 0.5 mg·kg~(-1)·h~(-1). The patients were mechanically ventilated after tracheal intubation (V_T 8 ml/kg, RR 12 bpm, I:E 1:2, FiO_2 70%-80% ) .Results (1) MAP and CI were significantly decreased at 5 and 15 min after sevoflurane inhalation. LVEF and FS were also decreased. (2) There was no significant change in diastolic function indexes after sevoflurane inhalation including E and A wave velocity, systolic wave velocity, diastolic wave velocity, E/A ratio and S/D ratio. (3) Cardiac function improved after CABG. CI, LVEF and FS were significantly increased after CABG as compared with preoperative values. Conclusion In patients undergoing elective CABG, sevoflurane (the end-tidal concentration corresponding to 1 MAC) can depress left ventricular systolic function but does not affect left ventricular diastolic function.

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp)control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic vs. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, < 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, > 140 mmHg, and by their hemoglobin Alc (HbAlc) level: tight control, < 6.5%; usual control, 6.5%-7.5%; or uncontrolled, > 7.5%, respectively. Results The mean CIMT was 8.20±0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 mm). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ± 0.08 mm, and 8.60±0.12 nun, respectively, P = 0.03) but not between glycemic control categories (8.20 ± 0.10 ram, 8.1 ± 0.08 mm, and 8.40 ± 0.14 mm, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR = 1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI)1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.

[Objective]To summarize the experiences of total hip replacement with cementless joint components in the treatment of osteoarthritis secondary to acetabular dysplasia in adults and to evaluate its early effect. [Method]From March 2000 to March 2007, thirty hips in 25 adult patients with osteoarthritis secondary to acetabular dysplasia undergoing total hip replacement with cementless joint components were included in this study. Of the patients, 5 were male and 20 were female.Their ages ranged from 35 to 55 years with an average age of 55 years. The patients mainly complained of pain and claudication. According to the Hartofilakidis classification , Semi-dislocation occurred in 21 hips and high-dislocation in 9 hips.Five patients underwent bilateral total hip replacements and twenty patients had unilateral total hip replacement.[Result]The duration of follow-up ranged from 8 months to 7 years ( average 3 years and 9 months ) . The average Harris score was increased from 36.09 to 88.21 points, They could take care of themselves and returned to their previous job. All the patients were pain-free and there was no sign of aseptic looseing or subsidence.[Conclusion]Total hip replacement with cementless joint components is an effective method for the treatment of osteoarthritis secondray to acetabular dysplasia in adults.The key point to the success for operation are appropriate cementless joint components, deepened medial wall of the acetabulum and improved the techniques of bone graft in the true acetabulum.

OBJECTIVE To investigate the risk factors,characteristics,measures of prevention and treatment of hospital fungal infection among maintenance hemodialysis patients.METHODS Clinical data of 128 maintenance hemodialysis patients between Jan 2002 and Dec 2006 were enrolled in this retrospective study of hospitalized infection cases.RESULTS During above period,36 infection episodes of 27 cases were occurred.The major infection site was lungs(69.4%).the Candida albicans was the main pathogen species(61.1%).The underlying and complicating diseases such as diabetes,chronic obstructive pulmonary disease and tumor,long antibiotics using,long hospitalization,poor nutrition status,inadequate hemodialysis,and venous indwelling catheter were the risk factors which led to fungal infection among maintenance hemodialysis patients.CONCLUSIONS The maintenance hemodialysis patients are easy to induce fungal infection.The C.albicans is the main pathogen species.The incidence of underlying diseases is rather high.Treatment of original diseases and complicating diseases,the standard using of antibiotics,adequate hemodialysis,the nutrition status and the reduction of the indwelling time of venous catheter are all the keys to decrease the fungal infection.

OBJECTIVE:To observe clinical efficacy and safety of Chaihu shugan powder combined with clonazepam in the treatment of liver qi stagnation type anxiety. METHODS:96 patients with liver qi stagnation type anxiety were randomly divided in-to observation group and control group,with 48 cases in each group. Control group was given Clonazepam tablet with initial dose of 0.5 mg,increasing to 4.0 mg gradually,tid;observation group was additionally given Chaihu shugan powder 300 ml,bid,on the basis of control group. Both groups were treated for 6 weeks. Clinical efficacy of 2 groups were observed,and HAMA and SAS were observed before and after treatment;the incidence of ADR were compared between 2 groups. RESULTS:The total effective rate of observation group(97.92%)was significantly higher than that of control group(83.33%),with statistical significance(P<0.05). There was no statistical significance in HAMA and SAS between 2 groups before treatment(P>0.05);HAMA and SAS of 2 groups decreased significantly 1,3 and 6 weeks after treatment,and the observation group was lower than the control group, with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Chaihu shugan powder combined with clonazepam is effective,improve patient anxiety and safe in the treatment of liver qi stagnation type anxiety.

ObjectiveTo determine ff the cardiac index (CI) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).MethodsForty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midasolam,sufentunil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.CI was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.ResultsBland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:CI (2.8 ± 0.6 ) L· min - 1 · m- 2,bias was 0.23 L* min- 1 · m - 2 and limit of agreement was ( - 0.57,1.02)L · min- 1 · m- 2,resulting in κ ＝ 0.546 and an overall percentage error of 28.6 ％.ConclusionCI values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.

Objective Bile acids (BA) facilitate cholesterol hepatic fibrosis. Although hepatic stellate cell (HSC) is one of the moot important cells during liver fibrogenesis, the effect of bile acids on HSC is rarely mentioned. Therefore,bile acids facilitate liver fibrosis through regulating activated HSC should be tested. Methods The amount of BrdU incor-poration was determined to assess the proliferation of HSC treated by bile acid. Wound-healing assay was used to determine the cellular motility. Meanwhile, the phoophorylation of p38 and JNK in HSC was detected by Western blotting. Results50 μmol/L GCDCA enhanced the HSC proliferation significantly (152.0% ± 7.1%, P < 0.05); 50 μmol/L GCDCA also induced phoophorylation of p38 and JNK (450.0% ± 12.2% of control in p38 (P < 0.01 ), 210.0% ± 15.2 % of control in JNK (P<0.05)). 50 μmol/L GCDCA aided wound healing (remaining wound area is 75.4% + 5.8% of original area, P<0.05), but this effect was inhibited by JNK (SP600125) or p38 (SB294002) inhibitor, respectively. Conclusions Bile acids enhance HSC proliferation and facilitate cellular motility through inducing phosphorylation of p38 and JNK, indicating bile acid aid liver fibrosis through regulation of p38 and JNK signaling.

BACKGROUND: Recent studies have proven the existence of the regeneration of central nervous tissue. But abjective results,such as lacked of neurogenesis after injury,also have been found in many experiments. The greatest difficulty in conventional brain transplantation or brain tissue transplantation has been the survival and development of the graft. Additionally,the stability of therapeutic effects and the rehabilitation of brain functions also need confirmation.OBJECTIVE: To investigate an approach to intrathecal injection of neural stem cells(NSCs) in stroke therapy,and observe therapeutic effects and side effects as well,so as to make the evaluation of the safety and feasibility.DESIGN: A confirmative before-after study based on stroke patients.SETTING: A neurology department in a municipal hospital and a microbiology and immunology department affiliated to a university hospital.PARTICIPANTS: From November 2002 to September 2003,26 stroke inpatients in the Neurology Department of Anyang Municipal People' s Hospital were selected. Of all the c ases,3 were diagnosed as acute cerebral hemorrhage,and the other 23 had been suffering strokes for durations ranging from 3months to 30 years,an average of (4.2 ± 6. 6) years. They were 20 male and 6female between the ages from 36 -72 years old,an average of(56.3 ± 12.7)years old. Fifteen of them were ischemic and 11 were hemorrhagic. Nineteen were associated with hypertension,2 with coronary heart disease,4 with diabetes and 4 associated with hyperlipodemia.INTERVENTIONS: On each of the 3 patients with acute cerebral hemorrhage (hematoma volume,35 - 40 mL),a microinvasive intracerebral hematoma puncture was performed,and then a suspension of NSCs were conducted to the stroke by a drainage tube. For the rest of the patients,suspensions were intrathecally administered into the subarachnoid and then flowed to the cerebral surface through cerebrospinal fluid(CSF) circulation. Afterwards,physical therapy(PT),occupational therapy (OT) and speech therapy(ST) were jointly applied to facilitate the rehabilitation of the stroke patients. Therapeutic effects was calculated according to the European stroke scale(ESS) and the Barthel Index(BI) . If ESS index went beyond or equal to 1 score,the case would be defined as effective; otherwise,it would be defined as not effective. Additionally,CT,MRI,EEG,chest x-ray,and blood biochemical variables were also measured.MAIN OUTCOMEMEASURES: Therapeutic effects and side effects were taken as main outcomemeasurements.RESULTS: Of the 23 patients who ntrathecal administration,19had positive therapeutic effect and 4 did not. Post-transplantation ESS was higher than that of pre-transplantation(54. 1 ±21.2 vs 51.4 ±21.1,t = 5.8,P = 0. 000 007 6),while post-transplantation BI also increased significantly as compared with that of pre-transplantation(41.1 ± 31.3 vs 36. 1 ± 32. 1,vasive intracerebral hematoma puncture had successful rehabilitation and regained self-care ability. Of all the patients,4 got a transitory fever and 2felt slight post-operation headache.CONCLUSION: Conclusion can be drawn from the study that stroke patients are ameliorated to various extents after neural stem cell transplantation which has no toxicity or side effects. It shows that neural stem cell transplantation is viable and feasible in improving the motor function and self-care ability in stroke patients.

Objective To study the curative effect of posterior diskoscope discectomy for adolescent lumbar disc herniation.Methods Eleven adolescent patients with lumbar disc herniation were treated with posterior diskoseope discectomy,the Japanese orthopaedic association (JOA) lower back pain score was observed and compared before operation and after operation 3,6,12 months.Results The JOA lower back pain score were (15.45 ± 2.73),(27.18 ± 2.08),(28.18 ± 1.25),(28.54 ± 1.21) scores before operation and after operation 3,6,12 months,there was statistical difference in JOA lower back pain score between before operation and after operation 3,6,12 months (P ＜ 0.01).The patients were followed up for 1-10 years,mean 7.9 years,excellent was in 8 cases,good was in 2 cases,general was in 1 case.Recurrence and iatrogenic lumbar instability were not found.Conclusions The posterior diskoscope discectomy with less trauma,less bleeding,faster recovery,and can achieve the same decompression objective with the traditional open surgical.So posterior diskoscope discectomy can be used as adolescent treatment of lumbar disc herniation.