Objective: To systematically evaluate the clinical effects of Maxing Shigan Decoction (MXSGD), a compound traditional Chinese herbal medicine, combined with Western medicine on pneumonia in children. Methods: In this study, the relative trials published from 1994 to 2008 were searched in Chongqing Weipu Database, Chinese Journal Full-text Database, Wanfang database, Chinese Biomedical Literature Database and other electronic database by using the method of Cochrane systematic review. At the same time the information from related journals, professional data and network were hand-searched. The methodological quality of the included trials was assessed by two evaluators, and homogeneous evaluation by meta-analysis was performed. Statistical analysis of clinical data was performed by using RevMan 4.2.7 software provided by the Cochrane Collaboration. Results: A total of 146 reports were found, while only eight randomized controlled trials met the inclusion criteria. The methodology quality of the reports included in the study was evaluated by the Jadad scale, and the specific random method, allocation concealment, blinding and intention-to-treat analysis were not described in all of the eight trial reports. As MXSGD combined with Western medicine group (treatment group) was compared with Western medicine group (control group), the meta-analysis indicated that the odds ratio for the total effective rate was 4.06, and the 95% confidence interval was from 2.63 to 6.27. MXSGD combined with Western medicine was good at increasing the total effective rate as compared with Western medicine, and the difference was statistically significant (P<0.000 01). Conclusion: MXSGD combined with Western medicine can improve clinical symptoms and increase the total effective rate of the patients with pneumonia in children. However, its clinical effects should be further identified by high quality, multicenter and randomized controlled trials with large-scale design.

Objective To compare the effect of sacroiliac anterior papilionaceous plate (SAPP) and the traditional reconstruction plate for the treatment of sacroiliac joint disruption.Methods 11 consecutive patients with sacroiliac joint disruption associated with pelvic fracture enrolled in our hospital.Detailed physical examination,X-rays,CT and FAST were performed before surgery.11 patients underwent SAPP fixation.Of the 11 patients,there were 5 males and 6 females.Their average age was 39.6 years.12 patients enrolled in last year as control group underwent reconstruction plate.There were 7 males and 5 females in this group.Their average age was 39.1 years.Operation time,blood loss,placing time of SAPP were recorded.X-ray films were performed after surgery to evaluate reduction condition by Matta criteria.X-ray films and Majeed outcome were performed in follow up.Results According to Tile classification,there were 13 Type B and 10 Type C.For SAPP group,operation time was (100.9±32.1) min,blood loss (998.8±365.7)ml,Placing time of SAPP was (6.6±3.2) min.For control group,operation time was (110.8±29.6) min,blood loss was (136.0±279.3) ml,placing time of reconstruction plate was (15.4±1.1) min.According to Matta criteria,8 cases were rated as excellent,11 as good,3 as fair,and 1 as poor.Lumbosacral nerve injury occurred in 1 case,lateral femoral cutaneous nerve injury in 7,and massive blood loss in 2 cases.No posterior infection occurred.Compared with control group,SAPP group experienced shorter placing time,and less blood loss in type B pelvic fracture.Conclusion As a new instrument,SAPP could be well applied in the treatment of sacroiliac disruption.Compared with reconstructed plate,SAPP obviously shortens placing time and facilitated placing procedure,and does not increase blood loss,neurological risk and infection rate and does not need different incision and reduction method.

Objective To compare the efficiency of the pelvic packing and the angioembolization for controlling pelvic fracture hemorrhoea.Methods Data of 43 consecutive patients with pelvic fracture hemorrhoea who were enrolled in our hospital from April 2004 to April 2012 were retrospectively analyzed.There were 26 patients who had undergone pelvic packing,including 15 men and 11 women with an average age of 41.6 years (packing group).The causes of the fractures included road accident injury (12 cases),falling injury (8 cases) and the bruise injury caused by heavy object (6 cases).According to the Tile classification,there were 16 cases of type B and 10 cases of type C.There were 4 cases with open pelvic fractures and 5 associated with the abdomen trauma.There were 17 patients who had undergone angioembolization,including 10 men and 7 women,with an average age of 39.2 years (angio group).The causes included road accident injury (9 cases),falling injury (5 cases) and the bruise injury caused by heavy object (3 cases).There were 2 cases of type A,11 cases of type B and 4 cases of type C.The ISS,operation time,blood transfusion and the complication were all recorded respectively.Results For the packing group,the average ISS was 52.4± 15.3,and the operation time was 42.0±2.1 min.The blood transfusion was 15.0±4.7 U before the surgery and 6.0±1.6 U in the first 24 h after the surgery.The mean ICU stay was (8.0±3.6)d.And for the angio group,the average ISS was 40.6±12.4,and the operation time was 86.0±3.6 min.The blood transfusion before the surgery was 13.0±5.4 U vs.10.0±2.1 U in the first 24 h after the surgery,and the ICU stay was 11.0± 1.8 d.2 cases in the packing group underwent repacking and 6 cases in the angio group had received second angioembolization.Five cases died in the packing group but no one died of the hemorrhoea while 4 cases died in the angio group with one died of the hemorrhoea.There were 3 cases in the packing group suffering the deep infection while 1 suffered the superficial infection in the angio group.Conclusion The efficiency of the pelvic packing is higher than the angioembolization because of its shorter operation time and ICU stay,more effective blood control,less blood transfusion after surgery,and lower postoperative mortality.It is very suitable for the application at the local hospital and the national conditions nowadays.

BACKGROUND:Percutaneous hol ow screw under X-Ray fluoroscopy has been shown to treat fracture of acetabulum of the pelvis, but the time of internal fixation was long, and the amount of radiation exposure to the patients and physicians was large.
OBJECTIVE:To test the application of the ISO-C3D METHODS:Thirty-one patients with fracture of the acetabulum were treated with percutaneous hol ow screw under a fluoroscopy-based ISO-C computerized navigational system for fracture of acetabulum. 3D computerized navigational system. The interval from injury to operation was 4 to 13 days. Al patients were fol owed up for one year.
RESULTS AND CONCLUSION:The average bleeding volume during operation was only 18 mL, except that the bleeding volume of only one patient, who suffered from the sacroiliacjoint injury and received open reduction and internal fixation, was up to 300 mL. The total number of screws used in the operation was 42, among which 24 were screws for acetabular anterior column fracture and 18 for posterior column fracture. Al screws were implanted once precisely. The average time of internal fixation was 59 minutes, and the mean time for fluoroscopy was 39 seconds. The 31 patients were pain-free one week after the operation and no complication (infection, vascular nerve injury or implant breakage) was noted post-operatively. When the fol ow-up ended, radiography revealed fracture union with satisfactory screw fixation (no screw breakage or loosening). According to Matta functional scoring, results were excellent in 23 cases, good in 8 cases, with an excellent and good rate of 100%. According to Majeed functional scoring, the results were excellent in 22 cases, good in 6 cases and average in 3 cases, with an excellent and good rate of 90%. These results indicated that ISO-C3D computerized navigational system can supply stable internal fixation without an increase of complication.

Objective To evaluate the role of phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway in mild head hypothermia-induced reduction of global cerebral ischemiareperfusion (I/R) injury in rats.Methods Sixty male Sprague-Dawley rats,weighing 250-280 g,were randomly divided into 5 groups (n=12 each) using a random number table:sham operation group (group S),group I/R,mild hypothermia + I/R group (group H),mild hypothermia + I/R + solvent control group (group DM),and mild hypothermia + I/R + PI3K inhibitor LY294002 group (group LY).Global cerebral I/R was induced by modified four-vessel occlusion method described by Pulsinelli.In H group,when the hippocampal temperature was decreased to 33℃ using nasopharyngeal cooling,the bilateral common carotid arteries were occluded for 15 min followed by reperfusion,and hippocampal hypothermia was maintained at 32.5-33.5 ℃ for 1 h.In DM and LY groups,DMSO and LY294002 5 μl were injected into the left ventricle,respectively,and 20 min later the other procedures were similar to those previously described in group H.At 8 h of reperfusion,6 rats were sacrificed,and hippocampal specimens were obtained to detect the expression of pFoxO3a,Bcl-2 and Bax (by immuno-histochemistry).The expression of phosphor-Akt (p-Akt) was determined by Western blot.Results Compared with group S,the expression of p-Akt,pFoxO3a and Bcl-2 was significantly up-regulated in I/R,H and DM groups,the expression of Bcl-2 was down-regulated,and the ratio of Bcl-2/Bax was increased in H and DM groups,and the ratio of Bcl-2/Bax was decreased in I/R and LY groups.Compared with group I/R,the expression of p-Akt,pFoxO3a and Bcl-2 was significantly up-regulated,the expression of Bcl-2 was down-regulated,and the ratio of Bcl-2/ Bax was increased in H and DM groups.Compared with H and DM groups,the expression of p-Akt,pFoxO3a and Bcl-2 was down-regulated,the expression of Bax was up-regulated,and the ratio of Bcl-2/ Bax was decreased in group LY.Conclusion PI3K/Akt signaling pathway is involved in reduction of global cerebral I/R injury by mild head hypothermia in rats.

Objective To evaluate the clinical results of minimally invasive surgery for open tibial plateau fractures using minimally open reduction and Hybrid external fixation.Methods From January 2011 through January 2015,9 complicated open tibial plateau fractures were treated with Hybrid external fixation.They were 6 males and 3 females,with an average age of 33.8 years (range,from 18 to 53 years).According to the Schatzker classification,there were 5 cases of type Ⅴ and 4 ones of type Ⅵ.According to the Gustilo classification,there were 5 cases of type Ⅱ,3 ones of type Ⅲ A and one of type Ⅲ B.All the patients were treated with Hybrid external fixation with or without minimally open reduction.Results The average operation time was 185.6 minutes (from 140 to 240 minutes).The average time for hospital stay was 18.4 days (from 10 to 45 days).The patients were followed up for an average of 15.6 months (from 6 to 36 months).All the 9 fractures got united after an average time of 4.3 months (from 3 to 7 months).The external fixation was removed after confirmation of fracture union.According to Merchant scores,the clinical results were evaluated as excellent in 4 cases,as good in 3,as fair in one and as poor in one.The knee joint was stable in each case.Pin tract infection was observed in one and wire loosening in one.Conclusion Hybrid external fixation with or without minimally open reduction is a safe and feasible surgical method which avoids massive soft tissue dissection for complicated open tibial plateau fractures.

Objective To evaluate the short and mid-term effects of fixing comminuted posterior acetabular wall fractures with structural autologous iliac bone graft combined with mini screws.Methods From January 2010 to January 2014,29 patients with comminuted posterior acetabular wall fracture were treated by structural autologous iliac bone graf combined with mini screws.They were 21 males and 8 females,with a mean age of 44.2 years (range,from 22 to 58 years).The mean time form injury to operation was 7.8 days (range,from 1 to 25 days).The operations were performed through the Kocher-Langenbeck approach,with the patients in the lying position on the uninjured side.The fragments were reduced and fixed by mini screws and the ischemic ones were removed.Structural autologous iliac bone graft was used to reconstruct the posterior wall of acetabulum before a reconstruction plate was applied to compress and maintain it.The functional outcomes were evaluated by the modified Merle d'Aubigne and Postel clinical grading system at the last follow-ups.The radiographs were graded according to the Matta criteria.Results By the Matta criteria,10 cases achieved excellent reduction,16 good reduction,and 3 poor reduction,giving a good to excellent rate of 89.7％.Of this series,29 patients were followed up for 31.5 months on average (range,from 12 to 48 months).By the modified Merle d'Aubigne and Postel criteria,the functional recovery was rated as excellent in 16 cases,good in 9,fair in 3 and poor in one,giving a good to excellent rate of 86.2％.Two cases developed femoral head necrosis according to the magnetic resonance imaging 18 months postoperation.Three patients developed traumatic arthritis two years postoperation.Five patients developed heterotopic ossification postoperation,with no obvious clinical symptoms.Two patient with injury to the sciatic nerve recovered 4 months postoperation.Conclusions Structural autologous iliac graft combined with mini screws can reconstruct the integrity and stability of the fractured acetabular posterior wall,avoiding osteonecrosis of the acetabulum.This surgical technique is effective and safe in treatment of comminuted fracture of the acetabular posterior wall.

Objective To evaluate 3D printing used in the treatment of complex acetabular fractures.Methods Between January 2009 and December 2013,121 patients with complex acetabular fracture were treated at our department.3D printing was used in surgical planning in 53 of them,including 36 males and 17 females with an average age of 41.2 ± 10.4 years (3D group).The other 68 patients received conventional surgery without use of 3D printing,including 42 males and 26 females with an average age of 42.6 ± 8.9 years (conventional group).By the Judet-Letournel classification system,there were respectively 7 and 9 T-type fractures,4 and 6 posterior column with posterior wall fractures,21 and 28 transverse and posterior wall fractures,5 and 6 anterior with the second half transverse fractures,and 16 and 19 double column fractures.Surgical time,blood loss,transfusion,fluoroscopy times and complications were recorded in the 2 groups.At the final follow-ups,the clinical results were assessed by Merle D'Aubigné & Postel scoring and the radiographic results were assessed by Matta records.The 2 groups were similar in preoperative demographic data (P ＞ 0.05).Results In the 3D and conventional groups,respectively,surgical time was 3.5 ±O.9 hours versus 4.5 ± 1.1 hours,blood loss was 1,200.2 ±232.8 mL versus 1,550.4 ±211.6 mL,transfusion was 8.9 ± 3.8 U versus 12.3 ± 2.9 U,and fluoroscopy times were 8.7 ± 2.1 versus 11.9 ± 2.4.The differences between the 2 groups were statistically significant (P ＜ 0.05).The 3D and conventional groups were respectively followed up for 20.3 and 37.8 months on average.All the acetabular fractures healed.The time from surgery to full-weight-bearing walking averaged 3.5 months.Iatrogenic ischiadic nerve injury occurred in 5 and 7 cases and superficial infection in 3 and 5 cases in the 3D and conventional groups,respectively.No iatrogenic vascular injury,nonunion,or implant failure occurred in the 2 groups.By the Merle D' Aubigné & Postel records,the excellent and good rate was 64.2％ (34/53) in the 3D group versus 64.7％ (44/68) in the conventional group.By the Matta records,the excellent and good rate was 73.6％ (39/53) in the 3D group versus 75.0％ (51/68) in the conventional group.The differences were not statistically significant (P ＞ 0.05).Conclusion Since 3D printing can contribute to better preoperative plan,it helps to lead to more accurate operation,shorter surgical time,and enhanced perioperative safety.

Objective To compare the effect of ISO-C3D navigation and conventional C-arm fluoroscopy in iliosacral screws insertion for treatment of posterior pelvic ring injuries.Methods Sixty-five patients with posterior pelvic ring injuries managed by minimally invasive percutaneous iliosacral screws from June 2006 to January 2012 were reviewed.There were 37 males and 28 females,at age range of 18-63 years (mean 35.9 years).Pelvic fracture classification based on Tile system was type B1 in 10 cases,type B2 in 15,type B3 in nine,type C1 in 18 and type C2 in 13.Patients were divided into ISO-C3D navigation group (Group A,n =35) and C-arm fluoroscopy group (Group B,n =30) according to the difference in intraoperative fluoroscopy methods.Intraoperative fluoroscopy time,time cost in inserting a screw,patient satisfaction rate for bone reduction,bone union time and excellent-good rate of postoperative function were recorded.Results Eighty cannulated screws were inserted for the 65 patients.Average fluoroscopy time and time cost in inserting a screw were shorter in Group A than in Group B (P ＜0.01),but there was no statistical difference between the two gronps in patient satisfaction rate for bone reduction.No patient presented with infection,vascular nerve injury or other complications.Follow-up was 6-24 months (mean 12.7 months) for all the patients.Functional recovery showed no statistical difference between the two groups at postoperative 6 months.All fractures were healed and no delayed union or nonunion happened.Conclusion As compared with conventional C-arm fluoroscopy,computer-navigated surgery can reduce fluoroscopy time and improve screw insertion accuracy.

Objective To evaluate the effect of local mild hypothermia on the expression of phosphatase and tensin homolog deleted on chromo-some ten (PTEN) protein during global cerebral ischemia-reperfusion (I/R) in rats.Methods One hundred and eight healthy adult male Wistar rats,weighing 230-280 g,were randomly divided into 3 groups (n =36 each) using a random number table:sham operation group (group S),cerebral I/R group (group I/R) and mild hypothermia cerebral I/R group (group HI/R).Global cerebral I/R was induced by 4-vessel occlusion method described by Pulsinelli.Bilateral vertebral arteries were permanently occluded by cauterization,and bilateral carotid arteries were occluded for 15 min.Nasopharyngeal cooling was applied and the nasopharyngeal temperature was reduced to 32.5-33.5 ℃ and maintained at this level for 1 h.When the nasopharyngeal temperature was reduced to 32.5-33.5 ℃,the bilateral carotid arteries were clamped in group HI/ R.Six rats were chosen to be anesthetized and sacrificed immediately before ischemia and at 4,8,12,24 and 72 h of reperfusion.Hippocampal specimens were obtained to detect the expression of phosphorylated PTEN (pPTEN),Bcl-2 and Bax protein (by immunohistochemistry) in hippocampal CA1 region,contents of S100B protein (by ELISA) and MDA (by thiobarbituric acid method),and activity of SOD (by xanthine oxidase method).Results Compared with group S,the expression of p-PTEN and Bcl-2 protein,ratio of Bcl-2/Bax protein and activity of SOD were significantly decreased,and the expression of Bax protein and contents of MDA and S100B protein were increased after reperfusion in group I/R (P ＜ 0.05),and the ratio of Bcl-2/Bax protein was decreased,and there was no significant difference in the expression of p-PTEN,Bcl-2 and Bax protein,activity of SOD and contents of MDA and S100B protein after reperfusion in group HI/R (P ＞ 0.05).Compared with group I/R,the expression of p-PTEN and Bcl-2 protein,Bcl-2/Bax ratio and activity of SOD were significantly increased and the expression of Bax protein and content of MDA and S100B protein were decreased after reperfusion in group HI/R (P ＜ 0.05).Conclusion The mechanism by which local mild hypothermia reduces cerebral damage is related to inhibition of activation of PTEN protein in the brain tissues during global cerebral I/R in rats.