Objective To explore the treatment of fractures of symphysiolysis /superior and inferior ramus of pubis and sacrum. Methods We treated 11 cases of fractures of symphysiolysis / superior and inferior ramus of pubis and sacrum with pubic symphysis double plate +sacrum rods, and analyzed the clinical results of the operation. Results All the 11 cases were followed up for a period of 6 months to 2 years. 2 cases had numbness of perineum and foot drop which were cured with posterior tibial muscle tendon translocation. 1 case had chronic pain in sacroiliac region, and needed antalgica occasionally. The others had a satisfactory recovery. Conclusion For fracture of symphysiolysis /superior and inferior ramus of pubis and sacrum, pubic symphysis double plate +sacrum rods can get a good clinical result.

Objective To explore the efficacy of temporary occlusion of abdominal aorta in the treatment of massive bleeding after pelvic fracture.Methods From May 2003 to May 2010,temporary occlusion of abdominal aorta was performed for 23 patients with massive bleeding after pelvic fracture.There are 15 male and 8 female patients with a mean age of 32 years (range,17-62 years).The mechanisms of injury included traffic accidents in 17 cases,falls in 4,engine injury in 1 and crash injury in 1 case.According to AO classification,4 cases were of type B2,4 of type B3,2 of type B3,1 of type C1,4 of type C2,and 12 of type C3.After aorta occlusion,the internal iliac vessel was ligated and the bleeding sites were tamponed.The fractures of pelvis were reduced.External fixation was used in 17 cases and screws and plates were used to fixation in 6 cases.Results All cases were rescued successfully.The average volume of blood transfusion was 4000 ml (range,1500-8500 ml).Intraoperative self-blood transfusion was performed in 14 patients.The average volume of self-blood transfusion was 1500 ml (range,700-5000 ml).Twenty-one patients were followed;the duration of follow-up was 26 months (range,5-36 months).The functional results were excellent in 11 cases,good in 4,fair in 3 and poor in 2 according to Majeed scores system.Complications included 2 cases of infection,1 of lower limb deep venous thrombosis,1 of malreduction of sacroiliac joint,and 1 of malunion of pelvic fracture.No complication was found due to the aorta occlusion or the internal iliac vessel ligation.Conclusion Temporary occlusion of abdominal aorta was an efficient and quick method in the treatment of massive bleeding after pelvic fracture.

Objective To investigate the clinical value of gauze packing for haemodynamically unstable pelvic fracture.Methods Between January 2006 and January 2014,gauze packing was used to treat haemodynamically unstable pelvic fracture in 42 patients consisting of 23 males and the 19 females aged 34.2 years (range,18 to 54 years).AO classification of the fracture was type B1 in 9,B2 in 5,B3 in 3,C1 in 13,C2 in 4,and C3 in 8 patients.All the patients were diagnosed with hypovolemic shock upon admission with the systolic pressure of (75.4 ± 4.3) mmHg and heart rate of (126.5 ± 12.4) beats/ min.Injury severity score (ISS) was (38.7 ± 6.2)points.Anti-shock treatment,internal or external fixation of pelvic ring,and gauze packing were performed immediately to control the hemorrhage following pelvic fracture.Results Systolic pressure was (95.2 ± 4.6) mmHg and mean heart rate was declined to (85.4 ± 13.2)beats/min after pelvis volume control and gauze packing,with significant differences compared to these preoperatively (P ＜ 0.05).Red blood cell transfusion before internal or external fixation and gauze packing was (15.0 ± 2.4) units versus (8.3 ± 1.5) units within the first postoperative 24 hours (P ＜ 0.05).Twenty-four out of the 42 patients underwent temporary abdominal aorta occlusion.Six patients died postoperatively with the death rate of 14％.Mean time of removing the packing gauze was (51.4 ± 10.3) hours (range,24-168 hours).Conclusion Anti-shock treatment with concurrent gauze packing and pelvis volume control is effective to arrest the massive hemorrhage in hemodynamically unstable pelvic fracture.

This experiment was designed to search and identify the active principle as well as the optimal proportion of water-soluble extractives of traditional Chinese medicine (water-soluble extractives) Liqi Huoxue medicinals com-patibility (Qixue Bingzhi Fang-CWQB) in the prevention and treatment of atherosclerosis (As) by optimal uniform design method. The water-soluble extractives of CWQB were divided into 6 sections (A, B, C, D, E, F) through macroporous resin. The effect intensity and step of every component were compared through its effect on blood fat level, platelet aggregation, inflammatory factors, vascular endothelial growth factor (VEGF) and so on among hyper-lipoidemia rat models. The pharmacological experimental results and statistical analysis showed that CWQB water-soluble extractives of component D (mainly is paeoniflorin, accounted for 49.12%), component E (mainly is total flavonoids, accounted for 30.0%) compatibility had better effects on decreasing blood fat and triglyceride (TG). Com-pared with the model group, there was significant difference (P < 0.01). It also had inhibiting effect on endothelin (ET) and maximum platelet aggregation rate (P < 0.01). The component F (mainly is total acids, accounted for 32.7%) had inhibiting effect on serum IL-6 and IL-8 (P< 0.01). It was concluded that different compatibility of wa-ter-soluble extractives of CWQB can be applied to different targets or steps of the body. The active principle extrac-tives include main component of paeoniflorin, flavonoids and total acids. The best proportion is about 1:1:1.

Objective: To understand the coincidence rate of adjustable and non adjustable desks and chairs in primary and secondary schools in Shanghai, so as to provide a reference for the effective management of desks and chairs in schools. Methods: Stratified random cluster sampling was applied to measure 1 091 sets of desks and chairs in 33 classrooms of 7 primary and secondary schools in 4 districts of Shanghai including Huangpu, Hongkou, Yangpu and Jiading districts. The height examination data of seated students in the same semester were also collected to evaluate the matching type of functional size of desks and chairs and students height according to Functional Sizes and Technical Requirements of Chairs and Tables for Educational Institutions. Results: The matching coincidence rate of desk and chair distribution in primary and secondary schools was 22.5%, and the matching coincidence rates of primary, middle and high schools were 11.7%, 27.1% and 40.9% respectively ( χ 2=83.23, P <0.01); the matching coincidence rate of adjustable desks and chairs (28.2%) was significantly higher than that of fixed (18.2%) ( χ 2=14.49, P <0.01). The type of distribution of desks and chairs that do not correspond to national standards, from elementary school to high school, showing a trend of high desks with high chairs, low desks with high chairs to high desks with low chairs. Conclusion The coincidence rate of desk and chair distribution in primary and secondary schools is low, and the adjustable desks and chairs has improved the problems to a certain extent, but has not significantly improved the coincidence rate. It is necessary to further explore the effective management mode in the use of adjustable desks and chairs and improve the current situation of the use of desks and chairs in schools.

BACKGROUNDPelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature. The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.

METHODSWe retrospectively reviewed the records of pelvic fractures in elderly patients (age ≥55 years) who were treated in our department from September 1997 to May 2010.

RESULTSA total of 40 elderly patients with pelvic fractures were identified. Their mean age was 65.8 years (range 55-87 years). About 68% (n = 27) were men. The average Injury Severity Score (ISS) was 17.8 (range 6-45). Twelve (30%) patients required blood transfusion (mean 10 units) during the first 24 hours. The fractures were most frequently due to falling from a standing position (48%). Almost half (48%) were grade I breaks. Associated injuries were present in 70% (n = 28) of patients, and 65% (n = 26) had medical co-morbidities. Altogether, 29 patients (73%) underwent non-surgical management of their pelvic fracture. The average hospital stay was 25 days. There were five in-hospital deaths and one death 10 months after discharge. High ISSs (>25) were associated with increased in-hospital mortality (P = 0.018). At the final assessment (mean follow-up 15 months), 52% of the surviving patients had experienced decreased self-sufficiency.

CONCLUSIONSPelvic fractures in elderly patients result in high morbidity and mortality rates. A high ISS (>25) can be used to identify a patient at high risk. We recommend aggressive resuscitation and intensive care for that patient. For patients with an unstable pelvic or displaced acetabular fracture (≥2 mm) who can endure surgery, open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.

Aged ; Aged, 80 and over ; Blood Transfusion ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; etiology ; surgery ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies

Objective: To study the effects of Phellodendron amurense on herpes simplex virus 1 (HSV-1) and cytokines, and to explore the mechanism of Phellodendron amurense inhibiting HSV-1 virus through multiple channels. Methods: Viruses were inoculated into medicine treated HeLa cells. The proliferation of virus was observed by fluorescence microscopy. The transcriptional levels of glycoprotein gD and functional protein US1 on the surface of virus envelope were detected by quantitative (q) PCR. After incubating HeLa cells for 24 h, qPCR was used to detect the expression of intrinsic immune factors such as IP-10, IL-12, IFN-gamma and transcription factor NF-kappa B (P65). The expression and nuclear location of NF-kappa B (P65) protein were detected by immunofluorescence. Results: Fluorescence showed that the proliferation of virus decreased significantly at 8 and 40 ng/ml (P<0.01), and the transcription levels of viral protein gD and US1 decreased (P<0.05). After incubation for 24 hours, the transcription levels of IP-10, IL-12 and IFN-gamma in HeLa cells increased significantly (P<0.01). The transcription level of transcription factor NF-kappa B (P65) also increased (P<0.05), and immunofluorescence showed that the nuclear penetration rate of p65 subunit of NF-kappa B (P65) in each group increased (P<0.05). Conclusions Phellodendron amurense extract can inhibit HSV-1 by inhibiting the transcription of viral functional protein and promoting the expression of cellular immune factors.