The effect of fish oil on the basal left ventricular function and changes of left ventricular function induced by isoprenaline (ISO) was demonstrated in the study. The determination of cardiac performance in vivo showed that supplementation with fish oil (EPA and DMA,70%, 1. 4 mL/kg) had no significant effect on basal cardiac performance,while it could significantly inhibit the gains of +dp/dtmax,Vpm and HR induced by ISCK10 6 mol/L, 10 3 mol/L, 10 4 mol/L) introvenously. The result suggest that supplementation with fish oil have some effects on the function of B-adrenoceptors on rat myocardial membrane.

[Objective]To investigate the characteristics of fatal pulmonary embolism (PE) due to peri-operative orthopedic surgery and provide clinical recommendations for surgeons.[Method]Form September 2000 to September 2006,15 cases of fatal PE were treated.All cases were retrospectively analyzed,assessed and compared regard to specific risk factors,diagnostic process,treatment results and preventive measures.[Result]Orthopedic surgery may lead to proximal deep vein thrombosis (DVT),especially in patients with spinal cord injury,lower extremity or pelvic fracture.Fatal PE is surprisingly common and is not necessarily heralded by dramatic symptoms or signs associated with DVT,but can lead to substantial morbidity and mortality.So the preventive,diagnostic and therapeutic strategy of PE of orthopedic surgery is different form chronic PE.[Conclusion]The morbidity of fatal PE duo to peri-operative orthopedic surgery is insidious but serious.Thrombolytic treatment can improve the survival rate for patients with acute pulmonary embolism.

Effects of fish oil on B-adrenoceptors as well as the activity of adenylate cyclase (AC) on rat myocardial membrane were investigated. Supplementation with fish oil had no significant effect on basal activity of AC on myocardial membrane, whereas it could markedly inhibit the AC activity stimulated by isoproterenol (ISO). Radioligand binding assays showed that supplementation with fish oil had no effect on Bmax, and Kd, compared with saline control. However, supplementation with sheep oil could markedly reduce both the Ka and Bmax, compared with saline control. And the Ka value of sheep oil group was greatly decreased than that of fish oil group. The results suggested that supplementation with fish oil affected mainly on the activation of AC and not on B-adrenoceptor itself.

Objective To evaluate the role of membrane-bound complement regulatory protein expression in spinal cord dorsal horn in the development of neuropathic pain (NP) in rats.Methods Forty-eight male Sprague-Dawley rats,weighing 200-250 g,in which intrathecal catheters were successfully implanted without complications,were randomly divided into 4 groups (n =12 each):sham operation group (group S),group NP,normal saline group (group NS) and minocycline group (group M).NP was induced by chronic constrictive injury of the sciatic nerve in NP,NS and M groups.Minocycline 50 μg was injected intrathecally once a day for 7 consecutive days starting from 1 day before ligation of the sciatic nerve in M group,while the equal volume of normal saline was given in stead of minocycline in NS group.Mechanical pain threshold and thermal pain threshold were measured at 1 day before ligation of the sciatic nerve (baseline,T0) and 1,3,7 days after ligation of the sciatic nerve (T1-3).Then the rats were sacrificed at T3 and the lumbar segment (L4,5) of spinal cord was removed for determination of the expression of CD46,CD55,CD59 protein and mRNA in the dorsal horn of spinal cord by Western-blot and RT-PCR,respectively.Results Compared with S group,mechanical pain threshold and thermal pain threshold were significantly decreased at T1-3 and the expression of CD46,CD55 and CD59 protein and RNA was down-regulated at T3 in NP,NS and M groups (P ＜ 0.05).Compared with groups NS and NP,mechanical pain threshold and thermal pain threshold were significantly increased at T2.3 and the expression of CD46,CD55 and CD59 protein and RNA was up-regulated at T3 in M group (P ＜ 0.05).Conclusion The down-regulated expression of membrane-bound complement regulatory proteins in spinal cord dorsal horn and abnormal activation of the complement are involved in the development of NP in rats.

Posterior pilon fracture is a special and unique type of ankle fracture,and its injury mechanism and treatment principles are different from those of the trimalleolar fracture in the Lauge-Hansen classification,and also different from those described for the classic pilon fracture.The fractures have a low incidence and generally poor prognosis.The prevalence of posterior pilon fractures is 6.4％ of all trimalleolar fractures,and 5.6％ of all pilon fractures based on computed tomography images.The pathological features of posterior pilon fractures are different from those of the traditional ankle fracture and the classic pilon fracture,and it is very important to differentiate a posterior pilon fracture from the others.Because of the low incidence and high variation in fracture morphology,there is controversy over the practicable classification of posterior pilon fractures based on clinical features,such as injury mechanism,fracture classification and surgical approach.An ideal fracture classification system can reveal the injury mechanism and severity,guide the treatment,and predict prognosis.At present,no classification method is based on the injury mechanism,and none can summarize fracture morphology and guide treatment.The purpose of this study was to review the injury mechanism,clinical characteristics,classifications,treatments,and outcomes of posterior pilon fractures,to promote surgeons’ understanding of posterior pilon fracture and reduce perioperative complication.

Delirium is a common complication after elderly hip fracture, and is associated with high rates of mortality and morbidity. There is no enough attention for delirium compared to deep vein thrombosis, pulmonary embolism, heart failure, etc. This paper reviews the definition, diagnosis, incidence, prognosis, treatment and other aspects of delirium in order to better under?stand delirium clinically. Delirium is an acute mental disorder of consciousness, attention, perception, thinking ability, memory, mental activity, and emotion. It is characterized by the disorder of sleep or wakefulness, and these changes are difficult to explain by dementia. The confusion assessment method (confusion assessment method, CAM) is generally accepted as the current diagnos?tic tools for delirium, and mainly depends on the patient's consciousness and cognitive function. The mechanisms of delirium are unclear, and it is influenced by many factors, such as agedness, cognitive impairment, pain, sleep rhythm disorders, and theories mainly include neurotransmitter theory, the central inflammatory response theory, the theory of stress response, sleep wake cycle, et al. The delirium is difficult to explain by using single, liner factor, but is elaborated by many various factors. However, the influ?ences of delirium on outcome for hip fracture are unclear, and it is definite that these patients have poor functional recovery, poor independent living ability, longer time in bed, demand for more care. The prevention should be implemented as mainly measures for delirium. Elimination of risk factors, including correct hypoxia, reduce pain, avoid water electrolyte disorders, improve sleep rhythm, and avoid using of opioids should be tried. In addition, adequate analgesia and appropriate anesthesia should used, and some inappropriate drugs should be avoided. Multidisciplinary cooperation mode, including doctors from orthopedics, anesthesiolo?gy, and geriatric department should be conducted to reduce the incidence of delirium as far as possible. Once diagnosed, some measures should be applied, such as maintaining of airway patency, adequate nutritional support, correction of water and electro?lyte disorders, anemia and low serum albumin, to ensure adequate physical and mental support, and to create a good environment for the ward, as well as to remove the possible etiological factors, such as anemia, low protein acidosis and electrolyte disturbance.

Objective To investigate risk factors for postoperative delirium in elderly patients with hip fractures and determine whether the delirium can influence the outcome of hip fracture.Method A retrospective case control study was performed for 521 patients (≥60 years) with hip fractures treated surgically from January 2012 to December 2014.There were 170 males and 351 females, with the age of (79.3±8.3)years.Confusion assessment method (CAM) was applied to diagnose delirium after surgery, and the subjects were divided into delirium group (n=159) and control group (n=362) according to the presence of delirium.Univariate and multivariate analyses were performed to identify the riks factors for postoperative delirium, including age, gender, comorbidities, body mass index, American Society of Anesthesiologists (ASA) classification, type of fracture, haemoglobin, PaO2, albumen, type of anesthesia, type of anesthesia, amount of bleeding, time between admission to surgery, length of operation, type of operation and amount of blood transfusion.Perioperative complications and mortality within 1 year after operation were compared between the two groups.Results Univariate analysis revealed dementia, ASA classification, haemoglobin, PaO2, albumen, interval between admission to surgery, anesthesia method, operation time, and surgery methods were risk factors for postoperative delirium incidence (P<0.05).While multivariate analysis showed only dementia (OR=6.211, 95%CI 2.482-23.498), long interval between admission to surgery (OR=3.505, 95%CI 1.478-6.342), arthroplasty (OR=2.015, 95%CI 1.783-3.481), and PaO2≤60 mmHg (OR=2.766,95%CI 1.783-5.039) were the significant risk factors for postoperative delirium after hip surgery in the elderly.Incidences of lung infection, wound infection, cardiovascular events, cerebrovascular events and deep venous thrombosis in delirium group were higher than those in control group, but only incidences of lung infection and wound infection reached significant differences (P<0.05).Mortality in delirium group was higher than that in control group within 1 year after operation, but there was significant difference only within 3 months after operation (P<0.05).Conclusions Incidence of delirium is high after hip fracture surgery in the elderly.Dementia, long interval between admission to surgery, arthroplasty and PaO2≤60 mmHg are significant risk factors for postoperative delirium incidence, and the delirium patients are associated with high early mortality.

Objective Through investigating the clinicians’ scientific research level and weakness,we can carry out targeted clinical research training systematically,and then strengthen their utilization of clinical resources and data,and finally promote the transformation of scientific research resuits.Methods Filling and submitting the online questionnaires through WeChat,a popular chatting tool in China,physicians from 13 affiliated hospitals of a university in Shanghai have joined this research.Results 507 valid questionnaires have been received online:In terms of clinical research capacity,there seemed to be more barriers in the following issues:comprehension of the types and applications to design a clinical trial,formulation of the details including PICO elements(Patient-Intervention-Comparison-Outcome),methodological application including the category and principle of randomization,the category and principle of blind method and how to control the confounding elements and probable bias,and statistical problems in scientific research including discrimination of the different definition between FAS(Full Analysis Set) based on the principle of ITT(Intention-To-Treat) and PPS(Per-Protocol Set),how to write a standardized SAP(Statistical Analysis Plan) and how to calculate the sample size of a trial),and various management of clinical trials including data management,follow-up management,adverse event management and so on,and writing a protocol and a CRF (Case Report Form) in a standard and professional way.As for the needs for training,the top three topics were how to design a clinical research in a standardized style,how to practice the methodology and how to utilize the statistical skills into clinical trials.Conclusions Standardized design and writing of clinical trial protocols according to the CONSORT (Consolidated Standards of Reporting Trials) and SPIRIT (Standard Protocol Items:Recommendations for Interventional Trials),and the application of epidemiological and statistical methods are still short boards that most clinicians need to improve urgently,also are what they most concerned about at the same time.So it is necessary for physicians to receive systematic clinical research training to enhance their scientific research capacity.

Objective To evaluate the outcomes of surgical repair of typeⅢ pulmonary atresia with ventricular septal de-fect( PA/VSD) .Methods Retrospectively analyzed the clinical data of 98 patients with type Ⅲ PA/VSD who underwent sur-gical repair in the Department of Cardiovascular Surgery , Guangdong Cardiovascular Institute from September 2005 to December 2014.There were 54 males and 44 females at the mean age of(4.2 ±4.8) years and the mean weight of(13.2 ±10.0) kg. There were 67 patients in palliative repair group and 31 patients in radical repair group .There were 85 patients underwent on-pump operation including 9 beating heart cases.Results The mean bypass time was(121.2 ±49.4)min, the mean aorta cross-clamping time was(75.4 ±31.8) min.The overall postoperative mortality was 6.1%(6/98).For the survival patients, the mean ventilation time was(106.7 ±184.3) h, the mean ICU stay was(8.9 ±10.9) days and the mean hospital stay was (33.4 ±17.0)days.During follow-up period, 28 patients were underwent re-operation, the postoperative mortality was 7.1%(2/28).There were no differences in postoperative status between two groups.Conclusion The outcomes of surgical repair for type Ⅲ PA/VSD was good.Preoperative evaluation of the pulmonary development and MAPCAs were helpful for choosing surgical options.Re-operation was recommended to those appropriate patients.

Objective To investigate effects of ACUMED self-orientated elbow plate system in treatment of comminuted distal humeral fractures (type C) in adults.Methods Thirty-two adult cases of comminuted distal humeral fractures treated by open reduction and internal fixation with parallel dual plates from May 2009 to October 2010 were enrolled in the study.There were 17 males and 15 females,at average age of 60 years (range,21-85 years).All cases were subjected to closed fractures,involving left side in 15 cases and right side in 17.Besides,two cases had associated ulnar nerve injury.According to AO classification,there were 12 cases of type C1,12 of type C2 and eight of type C3 fractures.The time from injury to operation averaged 5.6 days.Distal humeri were exposed through posterior median incision of elbow and V shape osteotomy of olecroanon.Muscular contractile and relaxant functional exercise was taken within 24 hours postoperatively.Clinical results were assessed based on Mayo elbow performance score (MEPS) and X-ray films.Results X-ray films showed that all cases obtained primary bone healing in the follow-up (mean 12 months).Three cases of type C3 fractures had heterotopic ossification.All cases had no complications like infections or implant loosening postoperatively.Range of motion in elbow flexion and extension averaged 85° (range,8°-140°).MEPS was average 90 points (range,60-100 points),including excellent outcomes in 13 cases,good in 15,fair in one and poor in three,with excellence rate of 88％.Conclusion ACUMED parallel dual plate fixation technique based on stability theory of arch structure achieves solid fixation of adult comminuted distal humeral fractures,successfully reconstructs bone structure of distal humeri,and effectively restores elbow joint function in response to early rehabilitation exercise.