0.05).Conclusion Transpedicular fixation and verteb ral plasty of intracorporeal grafting combined with decompression is an alternative method in the treatment of thoracolu mbar burst fractures to restore the h eight of injured vertebra and preven t collapse of vertebral body postoperatively.[

Among all the road traffic injuries(RTI ),limb and spine fractures have a very high inci-dence.They can be caused by a variety of traumatogenic mechanisms,of whi ch crash is the most common.The distribution of types of fracture in RTI assumes a centrifugation-like p attern.Multiple fractures,homola teral limb injuries and violence-conducted in juries are common.The priority in RTI emergency is to treat serious concu rrent injuries and life-threatening comp lications.Only after the overall condition of the victim get stabilized can open injuries and fractures be treated ac tively.To treat victims of fracture s caused by RTI,especially those with a poor overall condition or an old age,appl ication of external fixation,espec ially a unilateral one,is a good consider-ation.And application of lockable i ntramedullary nailing to treat long tubular bone fractures has proved ve ry satisfactory.As for pelvis fractur es caused by RTI,external fixation c an be used initially while massive hemor-rhage resulted from the injury shoul d be treated vigorously.Internal fixation should be adopted as soon as th e vital signs get stabilized.To treat spine and spinal cord injuries,titanium a lloy is the first choice for fixation material.In most cases,anterior cervical fix ation and fusion with steel plate and screw is advisable for treatment of f ractures of cervical spine,while posterior i mmobilization with screw through pedicle of vertebra is usually suggested for treatment of fracture-dislocation of thoracolumbar vertebrae.

BACKGROUND: In subjects with different inflammatory and autoimmune diseases, soluble vascular cell adhesion molecule-1 (sVCAM-1) in sera increases, and its change may become an important monitoring index of immunological function, but its change rule has been unclear in acute cerebral infarction.OBJECTIVE: To observe the change of sVCAM-1 in sera of subjects with cerebral infarction and its clinical significance, and compare between the subjects with cerebral hemorrhage and normal population.DESIGN: A case controlled analysis.SETTING: Second Department of Brain, Research Institute of Surgery,Daping Hospital, Third Military Medical University of Chinese PLA.PARTICIPANTS: A total of 132 inpatients were selected from Second Department of Brain, Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA between May 2002 and April 2004. Among them, 89 subjects with cerebral infarction were classified into large infarction group (n=25,＞ 10 cm3), medium infarction group (n=31,4-10 cm3) and small infarction group (n=33, ＜ 4 cm3) respectively according to the size of infarct focus. There were 43 subjects in cerebral hemorrhage group, and 30 healthy persons were as normal control group.METHODS: Blood samples were isolated from subjects with cerebral infarction at hour 24, days 3, 7 and 14 after onset of the disease, while the blood samples were extracted from subjects with cerebral hemorrhage at hour24 and day 14 after the onset of the disease. 4 mL venous blood was obtained from the three groups. The serum concentration of sVCAM-1 was determined with double antibody sandwich method (DASM) in all the examinees.MAIN OUTCOME MEASURES: ①Dynamic change of the serum concentration of sVCAM-1 in the course of acute cerebral infarction, and compared with the other two groups. ②Comparison of the serum concentration of sVCAM-1 in different size of infarct focus. ③Change of the serum concentration of sVCAM-1 in acute cerebral infarction subjects complicated with infection.RESULTS: A total of 162 subjects were involved in the result analysis. ①The serum concentration of sVCAM-1 at the 24th hour after cerebral infarction was significantly higher in subjects with cerebral infarction than in subjects with cerebral hemorrhage group and normal control group [(1 184.5±68.3) ,(693.9±41.7), (576.1±39.8) μg/L,P＜0.01].Serum sVCAM-1 in the cerebral infarction subjects increased from the 24th hour to the 7th day after infarction gradually, while from the 7th day to the 14th day decreased gradually. However, the serum sVCAM-1 in the cerebral infarction subjects at day 14 was still markedly higher than that in the cerebral hemorrhage group and the normal control group (P ＜ 0.01 ). ②The serum concentration of sVCAM-1 was significantly higher in the large cerebral infarction group as compared with medium and small cerebral infarction groups [(1 217.4±59.3) ,(1 132.6±51.9) ,(983.7±54.2) μg/L,P ＜ 0.01]. ③The serum concentration of sVCAM-1 was significantly higher at days 3, 7and 14 in cerebral infarction subjects complicated with infection than in subjects without infection (P ＜ 0.01 ).CONCLUSION: The sVCAM-1 participates pathological change process of cerebral infarction, which can be regarded as monitoring index of cerebral infarction change. To block its production and expression can provide a new approach for improving the prognosis of cerebral infarction.

BACKGROUND: The number of dementia patients ceaselessly increases with the extension of the life expectancy and the ageing of the population; hence the survival rate of patients with post-stroke dementia(PSD) has become an important issue of public health. Although it is generally believed that dementia could shorten human life expectancy, there is rare report regarding the impact of PSD on the survival rate of the patients in developing countries.OBJECTIVE: To investigate the impacts of ischemic dementia on the survival rate of the patients to explore the risk factors that would affect the survival rate of patients after cerebral infarction(CI).DESIGN: A prospective randomized controlled study based on patients.SETTING: The second department of neurology of a field surgery institute in a military university hospital of Chinese PLA.PARTICIPANTS: Totally 619 cases of acute CI including 313 males and 306 females aged between 55 and 85 years old[mean of (70. 3 ±9.5) years old] were selected form the Department of Neurology of the Daping Hospital of the Third Military Medical University of Chinese PLA between 1st May 1998 and 28th December 1999.INTERVENTIONS: Data including human factor, vascular factor and CI characters of 619 cases of ischemic cerebral stroke were collected and they also received neuropsychological test. Dementia was diagnosed in CI patients at admission and 3 months after CI according to DSM-Ⅳ criteria. Two-year follow up was conducted for the analysis of survival rate in PSD patients and survival-correlated predicting factors.and survival rate in CI patientsRESULTS: Totally 146 total patients(23.6% ) were diagnosed as PSD at 3 month after CI, of which 39 cases were pre-stroke dementia and 107 cases were CI-correlated dementia. The survival rate of PSD patients was 49.3%after(19.4 ±8.3) months of follow-up. The survival rate of patients with CI-correlated dementia was 53.7% while the non-dementia patients was 92.0% after(21.3 ± 9.1 ) months of follow-up. There was significant correlation between PSD and survival rate as indicated by multifactor analysis ( RR = 4. 91, 95% CI = 3.85 - 13.49) . The rest predicting factors included age(RR=1. 12, 95% CI=1.06-1.18), BarthelIndex(BI, RR=1.63,95% CI=1.15-2.31), auricular fibrillation(AF, RR=1.47, 95%CI = 1.17 - 1.85) and CI history( RR = 2. 81, 95% CI = 1.53 - 5.16).CONCLUSION: Dementia could reduce the survival rate of CI patients and it could be set as a predicting factor for post-infarction survival rate.

Objective To explore the incidence rates of lower respiratory tract infections after general anes-thesia in the elderly orthopedics patients and to analyze the related risk factors.Methods A total of 45 patients with lower respiratory tract infections in 479 elderly orthope -dics patients who received general anesthesia were enrolled in the study.The bacterial identification and drug susceptibility testing were preformed after the collection of sputum specimens.The univariate factor analysis and multivariate logistic regression analysis were performed to identify the risk factors for the lower respiratory tract infections after general anesthesia,including the age,gender,smoking histo-ry,chronic respiratory diseases history,basic cardiovascular disease,diabetes,mental disease,and endotracheal tube type,anesthesia ventilation time,postoperative extubation time,and postoperative analgesia.Results Smoking history (Wald =5.058,OR =4.618),chronic respiratory diseases history(Wald =37.950,OR =20.507),mental disease (Wald =26.303,OR =75.644),endotrac heal tube type(Wald =9.035,OR =11.758),anesthesia(Wald =15.035, OR =20.163)and postoperative extubation time(Wald =14.243,OR =12.613)were identified as the risk factors for lower respiratory tract infections after general anesthesia in the elderly orthopedics patients (all P <0.05 ). Conclusion Risk factors should be intervened in elderly orthopedics patients who receive general anesthesia,and the antibiotics should be chosen on the basia of the drug susceptibility testing.

Neurogenic bowel is a syndrome that resulted from the denervation after spinal cord injury (SCI), and may influence the quality of life of SCI patients for the constipation and incontinence. It might be benefit of multidimensional bowel management including nu-trition, medicine and liquid, as well as stimulation, clyster etc. Surgery could be considered if necessary.

Protein arginine methyltransferases ( PRMTs) play crucial roles in the methylation of a series pro-tein substrates.PRMT5 is a type Ⅱ methyltransferase that symmetrically methylates arginine residues of histone and non-histone substrates, thereby regulating a variety of cellular processes through epigenetic control of target gene expression or post-translational modification of signaling molecules.Recently, accumulated evidence has suggested that PRMT5 may function as an oncogene.This review is aimed to summarize the oncogenic role of PRMT5 and its regulatory mechanisms in tumors.

Objective To evaluate the clinical effectiveness of minimally invasive external fixation in the treatment of intertrochanteric fractures of the femur in high-risk patients. Methods By using a monolateral external fixator with oblique pin-insertion, we treated 77 consecutive elderly patients (mean age, 71.3) with intertrochanteric fractures of the femur associated with at least one kind of severe systemic diseases from June 1996 to June 2004. Fractures included 70 cases of anterograde intertrochanteric fracture (According to the Evans classification, there were 5 cases of type Ⅰ fracture, 11 cases of type Ⅱ, 34 type ⅢA, 9 type ⅢB, and 11 type Ⅳ.) and 7 cases of retrograde intertrochanteric fracture. A total of 8 patients were combined with multiple injuries. Results A follow-up was made for 5~60 months (mean, 24.3 months). Complete bone union was achieved in all the patients within a period of 8~20 weeks (mean, 12 weeks). Postoperatively, no non-union or coxa vara occurred. According to the Harris hip scores, 49 patients were classified as “excellent” results, 21 as “good”, and 7 as “poor” (all of which were fatal cases), the “excellent-and-good” rate being 91%. Conclusions Minimally invasive external fixation is an alternative to open internal fixation in the management of intertrochanteric fractures in high-risk elderly patients, especially suitable to those with multiple injuries.

Objective To introduce the indications and surgical technique of pedicle subtraction osteotomy (PSO) for patients with rigid kyphotic scoliosis. Methods Fifty-eight consecutive patients (21 males, 37 females) with rigid kyphotic scoliosis were operated with PSO at the apical vertebra. The average age was 14.1 years (ranged from 4 to 27 years). Among them, 31 were congenital deformity while 26 with idiopathic scoliosis and 1 with neurofibromatosis scoliosis. 9 had previous surgery history. The average preoperative Cobb's angle of scoliosis and kyphosis was measured as 83.7? and 78.2? on standing films and as 71.1? and 76.3? on the distraction films. On the bending films, scoliosis and kyphosis were corrected by 12.4% and 23.8% respectively. The associated neurologic deficits were observed in 14 patients, bony or fibrous septum in the canal was found in 6 patients on the preoperative CT or MRI. All patients underwent pedicle subtraction osteotomy at the convex side of the apical vertebra with segmental pedicle screw fixation or Luque instrumentation. The level of osteotomy varied from T8 through L1. Results Most patients were improved in terms of pain and radiographic examinations. The average follow-up period were 26.7 months in 49 cases (ranged from 5 to 69 months). The average residual angle of scoliosis and kyphosis was 30.0? and 21.3? respectively. The average correction rate of scoliosis and kyphosis was 64.2% and 63.5% respectively. The complete neurologic recovery was obtained in 11 and partial recovery in 2 at three months postoperatively. One case showed no improvement 12 months after surgery. No patients developed severe complications while 2 had pneumonia(3.4%), 2 had superior mesenteric artery syndrome (3.4%) and 5 had temporary dysfunction of one or both lower extremity (8.6%). The loss of correction was 1.8% at one-year follow-up. Conclusion Pedicle subtraction osteotomy is a reliable technique for severe and rigid kyphotic scoliosis both in adolescents and adults, and for severe congenital deformities and revision surgery. With pedicle subtraction osteotomy at the apical vertebra and segmental pedicle screw fixation, the rigid deformities can be corrected in one-stage, neurovascular complications can be greatly reduced, both the spinal balance and stability can be restored. The patients is able to ambulate with a brace as early as three weeks after surgery.

AIM: To investigate the protective effects of berberine against liver injury induced by lipopolysaccharide in mice and the mechanisms underlying its protective effect.METHODS: The male mice were divided randomly into control,berberine group,LPS group and berberine treatment group.Mice were administered intragastrically with distilled water(0.01 mL/g) or(5 g/L) neutral sulfate berberine(0.01 mL/g) once a day for 5 days and injected intraperitoneally with normal saline or LPS(0.02(mL/g),28 mg/kg)at 1 h after gavage on day 5.Blood was collected for determining alanine aminotransferase(ALT) and aspartate aminotransferase(AST) activities,the content of tumor necrosis factors-?(TNF-?) at 10 h and 2 h after LPS or normal saline injection,respectively.Furthermore,the liver tissue was processed,and histological changes and ultrastructure in liver were observed with light and electron microscopy,malondialdehyde(MDA) content and superoxide dismutase(SOD) activity in liver were also detected.RESULTS: Both ALT and AST activities in serum in LPS group were higher than those in control and berberine treatment group.LPS increased the serum TNF-? content at 2 h after injection,which was reversed by berberine pretreatment.The histological examination showed that LPS caused severe hepatic cell edema,degeneration,apoptosis and even necrosis,and ultrastructure observation demonstrated that LPS induced mitochondrial swelling,condensation and margination of chromatin,irregular nuclear envelope in hepatocytes.The above pathological changes produced by LPS were attenuated by berberine pretreatment.Moreover,MDA contents in liver tissue were higher in LPS group than control and berberine treatment group,but there were no significant difference in SOD activity between berberine treatment and LPS group.CONCLUSION: Berberine has a protective effect on LPS-induced liver injury in mice,the mechanisms may be related to its decreasing the production of TNF-?,inhibiting lipid peroxidation and protecting mitochondria.