BACKGROUND:Healing time and plaster used in fixed position and fixed time are different between distal radius fractures and scaphoid fracture. When both fractures occur simultaneously, you cannot choose a fixed position and determine a fixed time. One-stage internal fixation for the distal radial fractures and scaphoid fractures simultaneously can obtain a good function. OBJECTIVE:To retrospectively analyze the effects of titanium locking compression plate and Herbert screw fixation for fresh unstable distal radial fractures with scaphoid fracture. METHODS:A total of 12 patients with fresh unstable distal radial fractures combined with scaphoid fracture were treated in the Shanxi Dayi Hospital from November 2011 to June 2014. Al cases received open reduction and locking compression plate fixation of the distal radius, open reduction of scaphoid fracture or percutaneous Herbert screw fixation. Fracture healing was observed during folow-up. At 6 months after treatment, wrist joint function was evaluated with modified McBride score. Range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength were measured. The distal radial shortening (difference in height of styloid process of radius and ulna), and angles of ulnar deviation and palmar tilt were measured with X-ray films. The data of healthy side and affected side were compared. RESULTS AND CONCLUSION:(1) 12 cases were folowed up for 6-24 months. (2) The distal radius and scaphoid fractures healed. The healing time of distal radius was 6-12 weeks, with an average of seven weeks. Healing time of scaphoid fracture was 3-6 months, with an average of 4.2 months. (3) Wrist score was evaluated using modified McBride scoring criteria at 6 months after treatment. There were excelent in 5 cases, good in 6 cases, and average in 1 case, with the excelent and good rate of 92%. (4) No significant difference in range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength, angles of ulnar deviation and palmar tilt, difference in height of styloid process of radius and ulna and modified McBride score was detected between healthy side and affected side (P > 0.05). (5) The median nerve injury in two patients was recovered within 6 months after postoperative exploration decompression. No complications appeared, such as infection, dorsal muscle tendon irritation symptoms, carpal tunnel syndrome, and internal fixation failure. (6) These findings confirm that fresh unstable distal radial fractures with scaphoid fractures can be treated with open reduction of the distal radius and locking plate fixation, open reduction of scaphoid bone or percutaneous Herbert screw fixation, with reliable fixation, high fracture healing rate, and good wrist function recovery rate; the repair effect is satisfactory.

Currently all military hospitals attach great importance to the management of state-owned assets.However,there still exist some problems,such as weak management consciousness,irregular assets disposing and loose connections between management and accounting.The author ventures some measures to strengthen management consciousness,organization establishment,accounting procedures and monitoring mechanism.

Objective To evaluate the effects of dexmedetomidine on the development of perioperative cardiovascular events in elderly patients.Methods Forty-eight patients of both sexes,aged 65-85 yr,with body mass index of 19.5-25.3 kg/m2,of American Society Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective abdomninal or lower limb surgery under general anesthesia,were divided into 2 groups (n =24 each) using a random number table:general anesthesia group (group G) and dexmedetomidine plus general anesthesia group (group D).In group D,dexmedetomidine was intravenously infused in a loading dose of 0.25 μg/kg over 10 min and then continuously infused at 0.2 μg · kg-1 · h-1 until 30 min before the end of surgery.The equal volume of normal saline was intravenously infused instead in group G.At 1 day before surgery and 1 and 2 days after surgery,dynamic electrocardiogram was used to monitor heart rate variability including standard deviation of normal-to-normal intervals,standard deviation of the average 5-min normal-to-normal intervals,and root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals.The development of intraoperative cardiovascular events and requirement for vasoactive drugs were recorded,and the development of cardiovascular events within 2 days after surgery was also recorded.Results Compared with group G,standard deviation of normal-to-normal intervals and standard deviation of the average 5-min normal-to-normal intervals at 1 and 2 days after surgery and root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals at 2 days after surgery were significantly increased,the total incidence of intraoperative cardiovascular events and requirement for vasoactive drugs were decreased,and the total incidence of cardiovascular events within 2 days after surgery was decreased in group D (P ＜0.05).Conclusion Dexmedetomidine can reduce the development of perioperative cardiovascular events in elderly patients.

Objective:To develop lipiodol-containing calcium alginate microspheres (LAMs) for embolization,and study the characterization for emoblization and the radiopacity. Methods:LAMs were prepared by dripping method. The preparation of LAMs was optimized by orthogonal experiment which involved effects of three factors (the volume ratio of lipiodol to the external aqueous solution,airflow rate,and the weight pushing the injector) at three levels on the responses to the size,polydisperse index and entrapment efficiency of LAMs. The morphology of LAMs was observed under microscope. The elasticity of LAMs was investigated by texture analyzer. The capability injected through catheter of LAMs was monitored by video spinning-drop tensionmeter. The radiopacity of LAMs was measured by X-ray imaging system after LAMs were injected into vas of a rat. Results:The optimal condition for preparation of LAMs was:the volume ratio of lipiodol to the external aqueous solution was 3∶ 10,airflow rate was 40 g/mL and the weight pushing the injector was 100 g. According to the optimized condition,LAMs were prepared and characterized. The mean diameter of LAMs was (493.9?42.6) ?m,the polydisperse index was 1.02 and the entrapment efficiency was (88.97?1.09)%. The LAMs were with round shape and smooth surface in view of photograph of microscope. The maximum average load was (1.09?0.18) N when LAMs were compressed to 60%. The LAMs were injected through catheter without much difficulty. The radiopacity of LAMs in rats was demonstrated to be visible under X-ray photography system. Conclusion:The radiopaque LAMs developed are suitable for the arterial embolization,with round shape,proper size,good elasticity,easy handling character and visible property under X-ray imaging. The radiopaque embolic agent is supposed to be useful for emoblization therapy.

Objective To explore the relationship of stromal derived factor 1α (SDF-1α) and CD44variant isoforms (CD44v6) with progress of multiple myeloma (MM). Methods Bone marrow mononuclear cells(MNCs) and bone marrow stromal cells (BMSCs) from 24 cases of MM patients (14 cases of untreated and relapsed and 10 cases of stable MM patients) and 15 cases of subjects were investigated as potential SDF-1αand CD44v6 product. The level of SDF-1α and CD44v6 of the conditioned media from MM patients and subjects were analyzed by ELISA. Results The level of SDF-1α and CD44v6 from MNCs in untreated and relapsed MM patients [(7232.41 ± 2644.97) pg/ml and (34.34 ± 13.20) ng/ml] were significantly higher than stable MM patients [(2315.49 ± 748.29) pg/ml and (15.69 ± 5.28) ng/ml] (t =6.25, t= 7.82, P ＜0.05) and 15 subjects [(1149.52 ± 636.06) pg/ml and (4.85 ± 3.62) ng/ml] (t= 4.60, t = 7.61, P＜ 0.05). The level of SDF-1α in stable MM patients was different from healthy subjects (P ＜0.05), but the level of CD44v6 in stable MM patients was not different from controls. The level of SDF-1α and CD44v6 in stable MM patients were significantly higher than health subjects (t = 2.99, t= 4.87, P ＜0.05). The level of SDF-1α was also detected from BMSCs of MM patients. When human MM cell lines U266 were adhered to BMSCs of 9 untreated and relapsed MM patients,and added rhIL-6 to it, there was significant increase of SDF-1α, compared with BMSCs in subjects and MM patients. The expression level of SDF-lα was correlated with the level of CD44v6 (r =0.51, P =0.03). Conclusion The increase of SDF-1α (may be produced by myeloma cells and BMSCs) and CD44v6 (may be produced by myeloma cells) activity is associated with the progress or pathogenesis of MM, and may be involved with tumor invasion. The completion of these processes in vivo may need participation of myeloma cells, BMSCs, IL-6,SDF-lα and CD44v6.

Objective To evaluate the bonding condition of hydroxyapatite (HA)/zirconia ( ZrO2 ) composite and bone interface and the ability of HA/ZrO2 in repair of bone defects.Methods Bone defect models were established in the lumbar vertebral body of 24 Beagle dogs and were implanted with HA/ZrO2 gradient composite (Group A ),HA/ZrO2 unilayer composite (Group B ),pure ZrO2 (Group C) and pure HA (Group D) successively.Dogs were sacrificed and lumbar vertebral specimens were harvested 6,12,16 weeks postoperatively and before the sacrifice at postoperative 6 and 12 weeks,the dogs were intramuscularly administered of quadracycline for fluorescence labeling.The interface bonding and repair of bone defects were observed through X-ray films,histomorphology and biomechanical test.Results The X-ray films displayed that the Group A achieved more formation of osteotylus and better repair of bone defects with the extension of the implantation period,followed by the Groups B and D and that the Group C had relatively worse results.Histomorphology study showed that the fluorescence labeling was enhanced gradually from 6 to 12 weeks in the Group A,with its growth from the edge of the implanted material to the inner part and its tight adhesion to the material,indicating active osteogenesis and massive bone formation.While the fluorescence labeling of the Groups B,C and D centered in the edge of implanted materials without presence in the material inner part.The mineralization rate of the four materials at 6 and 12 weeks had significant differences ( P ＜ 0.05).Synostosis rates at 6,12 and 16 weeks were the highest in the Group A,with the rate of up to (90.26 ±3.82) ％ at 16 weeks (P ＜0.05 ).Biomechanical test showed the maximum shear strengths at 6,12,16 weeks in the Group A were (2.64±0.16) MPa,(2.95 ±0.19) MPa and (3.45 ±0.23) MPa respectively (P＜0.05).Conclusion HA/ZrO2gradient biocomposite bonds well with the bone and possesses good repair ability for bone defects and hence is an ideal novel material for bone defect reconstruction.

Objective To establish an animal model for study on early oral fluid resuscitation of burn shock so as to provide experimental basis for oral fluid resuscitation of burn shock in wars, accidents or disasters. Methods Male Beagle dogs weighing 11-13 kg were used in the study and the carotis, jugular and duodenum were cannulated respectively for measurement of homodynamics, tissue perfusion and gastrointestinal function. Dogs were subjected to a 35% TBSA full thickness flame injury with 10-mi-nute anesthesia by intravenous injection of propofol 24 hours later, and then randomly and equally divided into two groups(8 dogs in each group) : no fluid resuscitation group (NR group) undergoing no treatment in the first 24 hours post burn and oral fluid resuscitation group ( OR group) undergoing gastric infusion of glucose electrolyte solution (GES) according to Parkland formula. From the second 24 hours post burn, animals in two groups were given delayed Ⅳ fluid resuscitation, and then intravenous nutritional support was initiated at the 72nd hour. The mean arterial pressures (MAP), cardiac output (CO), dp/dt max of left ventricular contractility (dp/dtmax) and plasma volume (PV) were monitored continuously. The pa-rameters of gastrointestinal tissue peffusion, the rates of gastric emptying and intestinal absorption of GES were determined, the morbidity was also recorded at the end of 5-day experiment. Results After 35% TBSA burn injury, MAP, CO,dp/dt max and PV dropped markedly and gastrointestinal tissue perfusion reduced obviously. CO and PV in OR group were significantly higher than those in NG group at 4, 8 and 24 hours after burn. Homodynamic parameters and gastrointestinal tissue perfusion in OR group were pro-moted to pre-injury level at 48 and 72 hours respectively, while homodynamic parameters in NR group did not return to pre-injury level till 72 hours, and gastrointestinal tissue perfusion kept lower than pre-injury till 120 hours post burn. Rates of gastric emptying and intestinal absorption of GES significantly reduced to the lowest level (42% and 37% of pre-injury) at about 4 hours post bum, but did not return to pre-in-jury level till eight hours post bum. Over five days, two out of eight dogs (25%) died in NG group but none in OR group. Conclusions The animal model can exactly simulate the actual circumstance, where oral resuscitation is superior to Ⅳ resuscitation in some aspects in treating early bum shock in wars, accidents and disasters, and provide practical and reliable method for measurement of homodynamic parameters, tissue perfusion, gastric emptying and intestinal absorptive function.

Objective To investigate the effect of carbachol on local gut inflammation during entetal resuscitation of rats with bum shock. Method Thirty-eight Wistar rats were subjected to 35%TBSA full thickness scald injury, and enteral fluid was infused into animal intestines via duodenal stomas 30 minutes post bum. The animals were randomly divided into four groups: no resuscitation (Control, n = 8), enteral resuscitation using either a glucose electrolyte solution (GES, n = 10) or GES plus carbachol (60 μg·kg-1,GES/CAR, n = 10), or carbachol alone (CAR, n = 10) .The volumeof GES infusion was based on the Parkland formula (4 ml· 1% TB-SA-1·Kg-1) - All animals were sacrificed 4 hours post bum, and specimens of jejunal tissue were collected to determine the levels of tumor necrosis factor (TNF)-α, nitric oxide (NO), nitric oxide synthase (NOS) and myeloperoxidase (MPO). Serum assays for plasma diamine oxidase (DAO) activities were also performed. Results There were no statistical differences in the intestinal levels of NOS, NO, TNF-α and MPO, and plasma OAO activities, between the GES group and the control group. Compared to the GES group, the GES/CAR group showed significantly lowered levels of intestinal NOS (1.276 ±0.391 vs. 1.818 ±0.436, P＜0.05), NO (0.925 ±0.402 vs. 1.561 ±0.190, P ＜ 0.05, TNF-α (0.87±0.13 vs. 1.94±0.47, P ＜0.01) and MPO (0.465 ±0.092 vs. 0.832±0.214, P＜0.05),and reduction in plasma DAO activites (0.732±0.192 vs. 1.381 ±0.564, P ＜0.05). The CAR group also showed significantly lowered levels of intestinal NOS, NO, TNF-α and MPO and reduced plasma DAO activites, compared to the GES group. Conclusions Theses results suggest that carbachol significantly inhibits the release of proinflammatory mediator and attenuates local inflammation in gut during enteral fluid resuscitation of rats in rats with bum shock. We postulate that carbachol may exert its and-inflammatory effects via the cholinergic anti-inflammatory pathway.

Objective To explore the efficacy of simultaneous reconstruction of composite tissue defects in two adjacent metacarpophalangeal joints of hand by split the 2nd toes.Methods From December 2006 to December 2011,the second toe composite flap pedicled with the dorsalis pedis artery-first,second metatarsal dorsal artery-dorsal artery were designed,and split it into the second metatarsophalangeal joint composite flap pedicled with the dorsalis pedis artery-first dorsal metatarsal artery-tibial artery and the proximal interphalangeal joint composite flap pedicled with dorsalis pedis artery-second dorsal metatarsal arteryfibular dorsal artery.Then they were used to repair composite tissue defects in two adjacent metacarpophalangeal joints of hand at the same time after reconstruction.Results This group includes 14 metacarpophalangeal joints of 7 cases,twelve joints was successful,two joints of 1 case to give up because the first dorsal metatarsal artery variation.At 6-24 months follow-up study in 12 out of 14 cases showed that there was no joint degeneration in X-ray manifestation and the recovering of joint function was satisfying.According to the function evaluation standard of reconstraction of thrumb and finger issued by Hand Surgery Society Chinese Medical Association,the excellent and good rate was 83.3％.Conclusion It is feasible to reconstruct of composite tissue defects in two adjacent metacarpophalangeal joints of hand at the same time by split the 2nd toes,and can effectively improve the functions of injury metacarpophalangeal joint.

Objective To improve detectable rate of gastric schwannoma by endoscopic ultrasonography (EUS). Method Clinical data and endoscopic ultrasonography (EUS) imaging features of 4 cases were retrospectively ana-lyzed which diagnosed as gastric schwannoma pathologically and immunohistochemically while diagnosed as gastric stromal tumor by EUS from May 2008 to June 2015 and reviewed the literature. Results 4 cases of gastric schwan-nomas are female and benign, all 4 lesions are solitary, 3 in gastric body, and 1 in fundus by endoscopic. By EUS, all lesions are originated from muscularis propria, hypoechoic change, even echoes and clear board without calcifica-tion or cystic changes. 2 cases have halo artifacts around the lesion. Literature review found that gastric schwannoma tended to occur in female, halo artifacts could be the feature of gastric schwannoma, calcification or cystic changes were rare in gastric schwannoma which were common in gastric stromal tumors. Conclusion It was difficult to distin-guish gastric schwannoma and gastric stromal tumors that originated from muscularis propria by EUS. For female patients with lesions originated from muscularis propria, originated from muscularis propria and occurred in gastric body, it was necessary to observe lesions whether there was being calcification or cystic and halo artifacts. Integrated all these performance, we should be in consideration of gastric stromal tumors, meanwhile, excluding the possibility of gastric schwannoma.