Objective To discuss the early clinical management of the pa tients with traumatic hemipelvectomy. Methods A case was reported and literature reviewed. Results The patient was a 4-year-old boy who incurred a left groin and proximal thigh crush with nearly complete transection of this extremity and arrived at our hospital 7 hours after injury. After the vital signs were stabili zed with reasonable wound care and 2 hours of fluid resuscitation, the patient r eceived a thorough debridement and the hip disarticulation and fixation of pubic symphysis. The postoperative course was relatively smooth. While the successful treatments of this patient corresponded to the experiences in the literature, s pecial considerations regarding this severe injury were discussed. Conclusion Im mediate prehospital hemostasis by local pressure, rapid transport, aggressive in itial resuscitation, early recognition of the severity and prompt decision to co mplete the amputation, and attention to details in the rehabilitation phase are necessary for successful management of these patients.

While the basic concept of saving life and decreasing disability h as not changed in the management of polytrauma, the timing and strategies of tre atment have been gradually modified. Damage control is one of the new strategies , and its application in orthopedic traumatology is known as damage control orth opedics. Damage control orthopedics involves formalized three stages in the mana gement of fractures of long bones and pelvis. Stage 1 consists of temporary fixa tion of the unstable fractures and hemostasis. Stage 2 comprises resuscitation, warming, oxygen delivery and administration of coagulation factors to the patien t in the intensive care unit. In Stage 3 definitive fixation is done for the fra cture. Indications of damage control orthopedics: for patients with polytrauma w hose conditions are unstable or in extremis the damage control strategy is recom mended. For the borderline patients early total care may be applied, but the sur gery should be performed with great caution. It has to be converted to the damag e control strategy if conditions of the patient deteriorate during the operation . Since damage control orthopedics is an evolving practice, further work is need ed to enhance its effectiveness and to reduce the incidence of ARDS and MOF.

Modern Chinese Orthopaedic traumatology has stemmed from the orthopaed ics of Traditional Chinese Medicine(TMC)and western orthopaedics.On the one hand,with a long history and its unique system of theory and treatment,TMC orthopaedics h as made a great con-tribution to the development of modern Chinese orthopaedic traumatology.On the other hand,the introduction and development of western medicine have dramatically pro moted the development of modern Chinese orthopaedic traumatology.Modern Chinese surgeons of orthopaedic trauma have accomplished numerous successful f irst cases in the world since 1950s an d have thus expanded their professional influence.At pr esent,the Chinese orthopaedic trau ma community has grown much stronger and established its ow n academic associations and journals.More and more de-partments of orthopaedic traumatology have been successively establis hed as an independent en-tity in large and middle-sized hospi tals in China.So far,the Chinese orthopaedic trauma com-munity,on the whole,has reached the international level,but there are q uite a lot to be improved in the aspect of treatment.To end the backwardness,in the future Chinese orthopaedic trauma community should make great efforts in education of orthopedists on comp rehensive knowledge,establishment of formal profession al training system,national standardization of orthopaedic procedures in clinical diagnosis an d treatment,active membership of re lative international aca-demic associations and increasing p rofessional exchanges with international counterparts,as well as in research and development of operative techniques and fixators.All these will be the main strategies and developmental trends in the future for Chinese orthopaed ic traumatology. [

Objective To assess the impact of preoperative ureteral stenting on outcome of flexible ureteroscopic lithotripsy . Methods The clinic data of flexible ureteroscope lithotripsy were analyzed retrospectively .All 52 eligible patients were divided into three group :goup A(no preoperative ureteral stenting );group B (preoperative ureteral stenting for 3-10 days);group C(preopera‐tive ureteral stenting for two weeks or more ) .The application of ureteral access sheath ,operation time ,stone free rates ,hospital stays ,complications were compared among the three groups .Results There were no significant differences in aging ,gender ,stone size , distribution ,average hospitalization days ,postoperative complications among the three groups (P>0 .05) .There were significantly differ‐ences between group A and group B ,group C(P<0 .05) ,and there were no difference between group B and group C (P>0 .05) on the suc‐cess rate of indwelling ureteral access sheath ,average operation time ,stone free rate .Conclusion Preoperative ureteral stenting could en‐hance the success rate of indwelling ureteral access sheath ,shorten the operation time ,improve the stone free rate .There was similar out‐come of flexible ureteroscopic lithotripsy between preoperative ureteral stenting for 3-10 days and two weeks or more .

Objective To study the cytopathogenic effect of epidemic hemorrhagic fever with renal syndrome virus (HFRSV) on renal tubular cells(RTC). Methods Human fetal renal tubular cells (HFRTC) were cultured in vitro. HFRTC infected or not infected by HFRSV were observed by using trypan-blue stain and transmission electron microscopy(TEM). Viral-mRNA was detected by in situ molecular hybridization. Results (1) HFRSV could directly infected HFRTC: (2)The death rate of HFRTC in the infection group was significantly higher than that in the control grou 1 to 4 weeks after infection; (3) Injuries of cell membrane and cell organs after infection with HFRSV were significantly earlier and more severe as compared to control by means of TEM. Conclusion HFRSV can directly damage renal tubular cells (RTC ), which contributes to the pathogenesis of hemorrhagic fever with renal syndrome (HFRS).

Objective To compare the effect and safety of digital flexible ureteroscopic lithotripsy and per-cutaneous nephrolithotomy for renal calculi. Methods Clinic data of 105 cases with kidney stones were analyzed retrospectively, including 53 cases with digital flexible ureteroscopic lithotripsy (group A) and 52 with minimally invasive percutaneous nephrolithotomy (group B). The operative time, intraoperative blood loss, stone-free rate, complications, average hospitalization time were compared. Results There were no significant differences in age, gender, stone size, stone surface area, average operative time, stone-free rate and complications between two groups. Significant differences were found between group A and group B in terms of intraoperative blood loss and average hospitalization time. Conclusions Digital flexible ureteroscopic lithotripsy has similar effect as minimally invasive percutaneous nephrolithotomy for the treatment of kidney stones about 20 mm in terms of average operative time, stone-free rate, and complications, but excels minimally invasive percutaneous nephrolithotomy in intraopera-tive blood loss and average hospitalization time. Digital flexible ureteroscopic lithotripsy can be the first choice for the treatment of kidney stones about 20 mm.

Objective To analyze and explore the value of the mutislice spiral CT (MSCT) scanning,its reconstructive technology and MRI scanning for applying to the identifying diagnosis of new and old vertebral compresion fracture.Methods One hundred and sixty-seven cases with the new and old vertebral compresion fracture who have 189 vertebrae in total were examined using the MSCT scanning,their imaging information were postprocessed with 2D and 3D reconstruction at the work station.Thirty-four patients with overall 43 vertebrae were carried out by MRI scanning and their images were compared with those of MSCT.Results They had the highest proportion of vertebrae in L1 with accounting for 27.68% (31/112) and 35.06% (27/77) among the patients with new and old vertebral compresion fracture,respectively.The next was T12,L2 and T11.There were statistically significant differences between new and old cases in such appearance as fracture line clear and sharp(102 and 21),contusion and hemorrhage of spinal cord(15 and 0),parenchyma shadow beside vertebrae(103 and 11),appendant fracture(26 and 5),organ's lacerated wound around vertebral body(30 and 0),discus intervertebrales vacuum(10 and 36),derangement and hardening of vertebral bone trabecularism(29 and 51) (P＜0.01).Twenty-six vertebrae with the uneven low T1 WI signal,27 vertebrae with the T2 WI fat-suppresion irregular high signal were demonstrated in MRI scanning among 27 vertebrae of 21 cases with new vertebral compresion fracture.While 16 vertebrae with the T1WI and T2WI signals were the same as those of the normal vertebrae,16 vertebrae were the T2WI fat-suppresion low signal among 13 cases with old vertebral compresion fracture.Conclusions The MSCT plays an important role in identifying diagnosis for the most of the patients with the new and old vertebral compresion fracture, while MRI scanning may reflect the pathophysiological characteristics in diagnosis of the spinal cord and the ligament lesion.Therefore,the MSCT and MRI scanning should be integrated to be used to enhance remarkably the accurate rate of the diagnosis.

Objective To explore the impact of cardio cerebral vascular diseases (CVD) on life expectancy among residents in Shandong Province,develop effective preventive measures for the high-risk population and provide guidance for the health care resource allocation.Methods Based on the death monitoring data of the disease in Shandong Province in 2012,we calculated the crude mortality and standardized the mortality rate of the disease.We designed life tables with all causes of death and with eliminating causes of CVD death and analysed life expectancy with and without them examined.Results In 2012,crude mortality rate of CVD was 320.16/100 000 (SMR 252.85/100 000) in Shandong Province.The death rate of CVD was of 46.30％ of all deaths reported by monitoring system.The mortality rate of CVD in male and female were 332.99/100 000 and 307.02/100 000,respectively.The mortality rate of CVD in rural and urban areas were 341.84/100 000 and 267.28/100 000,respectively.The mortality of CVD increased with age and growed rapidly after the age of 60.Life expectancy of urban and rural areas was 79.20 years and 78.14 years,respectively.After eliminating causes of CVD death,life expectancy for eliminating causes of CVD death in urban and rural areas increased 8.51 years and 10.02 years,respectively.Life expectancy for eliminating causes of CVD death in male and female increased 8.02 years and 11.10 years,respectively.Conclusions Life expectancy of urban and rural areas,the male and female for eliminating causes of CVD death than that of all causes of death were greatly extended.Reducing the death caused by CVD to increase health life expectancy have important public health significance.

Objective To investigate the effects of quiet respiratory intrathoracic pressure changes on ventricular dimensions and left ventricular systolic function,and to further verify our newly proposed hypothesis of the mechanism of respiratory effects on hemodynamics.Methods Twenty healthy volunteers aged 18 to 40 years average(24?7) years were included.The respiratory curve and electrocardiogram were simultaneously recorded.The interventricular septum movement,ventricular dimensions and ventricular systolic excursions were recorded by two-dimensional and M-mode echocardiography during quiet respiration.The respiratory variations of the above parameters were derived,and the parameters for assessing ventricular systolic function were calculated.Results With quiet respiration,the interventricular septum moved towards the left ventricle on inspiration,and then towards the right ventricle on expiration.The right ventricular diastolic dimension increased significantly on inspiration compared with those on expiration.The opposite changes occurred with left ventricular diastolic dimensions.The left ventricular posterior wall systolic excursion and the left ventricular stroke volume significantly increased during expiration compared with those during inspiration.No significant differences were found in left ventricular ejection fraction and fractional shortening between inspiration and expiration.Conclusions The respiratory intrathoracic pressure change is one of the factors influencing the reciprocal changes of the left and right ventricular parameters related to ventricular dimensions and systolic function.

Objective To investigate the biological behavior and expression of intergrin-linked kinase (ILK) after exposure to transforming growth factor beta 2 (TGF-β32) in human Tenon fibroblasts (HTFs).Methods The primary ceils of HTFs were cultured by tissue attached culture method and identified by immunofluorescence analysis with Vimentin and keratin.The proliferation levels of HTFs induced by different concentrations of TGF-β2 were analyzed by MTT.The α-smooth muscle actin (α-SMA) and ILK mRNA expression were analyzed by quantitative Real-time PCR.The protein expression of α-SMA,ILK and E-cadherin were analyzed by Western Blot,and the protein expression of α-SMA and E-cadherin were also analyzed by immunofluorescence staining.Results MTT analysis showed that the optical density levels of 5.0 μg · L-1 and 10.0 μg · L-1 TGF-β2 were significantly higher than those of 0.1 μg · L 1,1.0 μg · L-1 and the control after exposure for 48 hours and 72 hours,and all these optical density levels were significantly higher than that for 24 hours (all P ＜0.05).The expression of α-SMA and ILK mRNA increased significantly when cells were treated with 5.0 μg · L-1 TGF-β2 for 48 hours in comparison with the control group (all P ＜ 0.05).The protein of α-SMA,ILK and E-cadherin were expressed both in TGF-β2 treated groups and control group,and TGF-β2 up-regulated the expression of them.There were significant differences when compared with the control group (all P ＜ 0.05).Immunofluorescent staining showed that α-SMA and E-cadherin were detected in TGF-β2 treated groups.α-SMA expressed in cytoplasm,while E-cadherin both in cytoplasm and nucleus.Conclusion TGF-β2 can induce the proliferation,transdifferentiation and adhesion of HTFs,and up-regulate the expression of ILK in vitro,suggests that ILK may play a role in the process of scar formation after glaucoma filtration surgery.