Objective To investigate the efficacy of external fixators in the treatment of unstable pelvic fractures( Tile B and Tile C ). Methods The different results of 78 patients who had been treated with or without external fixator were compared. Results In 38 cases who were treated without external fixator, the cure rate for hemorrhagic shock was 76%, the mortality 10.6%, and the average ISS score 11.6. In 40 cases who were treated with external fixator, the cure rate for hemorrhagic shock was 90%, the mortality 2.5%, and the average ISS score 9.8. Conclusion The treatment of unstable pelvic fracture with external fixator is simple and reliable, and can reduce the mortality significantly.

Objective To analyze the features of dynamic contrast-enhanced CT of blunt hepatic injury in rabbits. Methods The model of blunt hepatic injury was established in 40 New Zealand white rabbits with a steel ball falling down to the xiphoid process of the animals. Plain CT scan and dynamic contrast-enhanced CT scan (Hispeed spiral CT/2i, GE, America) of the liver were performed. Arterial,portal and balanced phases were respectively at 8-10 s, 35-40 s and 120-150 s after initiation of the contrast medium injection. The non-enhanced and enhanced images were compared in aspects of location and range of injury, tear of the liver capsule, active bleeding, involvement of the main hepatic veins and CT features of abdominal hemorrhage, which was further compared with the results of gross anatomy. Results The rate of plain CT scan was obviously lower than that of dynamic contrast-enhanced CT scan,which defined single tear in 13 patients, multiple lacerations in 18, liver subcapsular hematoma in seven,liver hematoma in nine, liver coated gap in 17, active bleeding in nine and main hepatic vein injury in five, with coincidence rates with the results of gross observation for 13/13,18/18,7/9,9/9,25/30,9/5and 5/4 respectively. According to Moore' s classification, CT/Laparotomy performed from grade Ⅰ to grade Ⅵ were 5/4 patients at grade Ⅰ , 15/13 at grade Ⅱ, 9/11 at grade, 5/6 at grade Ⅳ, 1/2 at grade Ⅴ, O at grade respectively. Conclusion Dynamic contrast-enhanced CT scan, especially at portal and balanced phases, is of great value for diagnoses of liver injuries and determination of injury severity.

Objective To discuss CT and MRI features of aggressive fibromatosis (AF), especially the characteristic signs of MRI, and to evaluate the value of MRI in diagnosing the disease. Methods The CT and MRI studies in 9 cases with pathologically proven AF were retrospectively analyzed. Results Among 9 cases with AF, one cases could not be discovered by CT and all cases could be discovered by MRI. Appearances of lesion were infiltrating in 7 cases and mass-like in 2 cases. All cases were without calcification and lipo-tissue in the lesion and without edema on adjacent muscle structures. A homogeneous density and high density was seen on CT plain scans and high density on contrast enhanced scans. On MRI scans, variable signal intensity was demonstrated on T 1WI, and high signal intensity on T 2WI, as well as increased signal intensity after contrast enhancement. The signal characteristics primarily reflected the underlying histologic composition of the lesions. Conclusion MRI is more excellent than CT in delineating the site, shape, and extent of these lesions. MRI is valuable in detecting and differentiating AF.

Objective To observe the effect of intermediate care on recurrence factors and recurrence rate of elderly patients with cerebral infarction.Methods Five Hundred and ninety-eight cases of acute cerebral stroke were divided into two groups,301 cases in the experimental group and 297 cases in the control group.After the acute stage,patients in the experimental group was included into the intermediate care unit.The experimental group was given comprehensive evaluation and multidisciplinary management,including the combination of traditional Chinese and Western medicine treatment,rehabilitation training and physical therapy,medication guidance,nursing and health education.After the acute stage of the disease,the control group patients were in the general ward.The course of treatment was 2 weeks.At baseline(t0),second weeks(t1),sixth months(t2)and twelfth months(t3),the blood pressure(SBP,DBP),fasting blood-glucose(FBG),blood lipid(TC,TG,LDL),serum homocysteine(Hcy)level and the recurrence rate of cerebral infarction in all two groups were observed.Results SBP at t1,t2 and t3 was lower than that at t0 in the experimental group,and the difference was statistically significant(P＜0.05).SBP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group(P＜0.05).DBP at t2 and t3 was lower than that at t0 in the experimental group,and the difference was statistically significant(P＜0.05).DP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group(P＜0.05).FBG at t1((5.34±0.76)mmol/L),t2(5.86±1.05)mmol/L)and t3(5.62±0.89)mmol/L)were lower than that at t0((7.27±2.34)mmol/L),and the difference was statistically significant(P＜0.05).FBG in the experimental group at t2 and t3 were lower than that in the control group((6.85±0.92)mmol/L,(6.36±1.03)mmol/L).There was significant difference between two groups(P＜0.05).TC at t1((4.86±0.85)mmol/L),t2((4.21±0.76)mmol/L)and t3((3.95±0.64)mmol/L)were lower than that at t0((5.56±1.06)mmol/L),and the difference was statistically significant(P＜0.05).TC in the experimental group at t2 and t3 was lower than that in the control group((5.06±0.93)mmol/L,(4.84±0.76)mmol/L).There was significant difference between two groups(P＜0.05).TG at t3((1.48±0.26)mmol/L)was lower than that at t0((1.86±1.31)mmol/L),and the difference was statistically significant(P＜0.05).TG in the experimental group at t3 was lower than that in the control group((1.71±0.66)mmol/L).There was significant difference between two groups(P＜0.05).LDL at t1((3.76±0.92)mmol/L),t2((3.09±0.62)mmol/L)and t3((2.59±0.51)mmol/L)were lower than that at t0((4.59±1.45)mmol/L),and the difference was statistically significant(P＜0.05).LDL in the experimental group at t2and t3 was lower than that in the control group((4.09±0.75)mmol/L,(4.12±0.64)mmol/L).There was significant difference between two groups(P＜0.05).Hcy at t1((14.16±3.17)μmol/L),t2((10.37±2.59)μmol/L)and t3((10.10±1.86)μmol/L)were lower than that at t0((23.62±5.62)μmol/L),and the difference was statistically significant(P＜0.05).Hcy in the experimental group at t2and t3 was lower than that in the control group((18.52±3.64)μmol/L,(16.37±2.75)μmol/L).There was significant difference between two groups(P＜0.05).The recurrence rate of cerebral infarction within 1 years was 4.7％(14/301)and 7.1％(21/297)in the experimental group and the control group.There was a decreasing tendency,but no statistical significance(P=0.208).Conclusion The intermediate care may affect the blood pressure,FBG,blood lipids,serum Hcy levels in elderly patients with cerebral infarction,so as to reduce the recurrence rate of cerebral infarction.

Objective To investigate the expression of apolipoprotein M in rats after renal transplantation and its role and action mechanism in acute rejection (AR).Methods The kidney transplantation model in rats were established.Male SD and Wistar rats were used as donors,and Wistar rats as recipients.Three groups were designated:control group (syngeneic transplantation,n =24,recipients were treated with normal saline i.p.); AR group (allogeneic transplantation,n =24,recipients were treated with normal saline i.p.); PDTC group [allogeneic transplantation,n =24,recipients were treated with NF-κB inhibitor-pyrrolidine dithiocarbamat (PDTC) i.p.].The renal grafts were drawn at day 1,3,5 and 7 post-transplantation,and the expression levels of NF-κB P65 and apoM protein were detected by using Western blotting,and those of apoM,perforin and granzyme B mRNA were by using real-time PCR.The correlation of apoM and NF-κB,apoM and perforin,and apoM and granzyme B was respectively analyzed.Results As compared with control group,the expression levels of apoM,perforin and granzyme B mRNA in AR and PDTC groups were dramatically up-regulated at each time point (P＜0.01),and those in PDTC group were significantly lower than those in AR group (P＜0.01).The expression levels of apoM and NF-κB protein in AR group were both distinctly higher than those in control group (P＜0.01),and those in PDTC group were markedly lower than those in AR group (P＜0.01).A significantly positive correlation was found between the expression of apoM and NF-κB protein (r =0.469,P＜0.05).And the expression of apoM mRNA was positively correlated to perforin and granzyme B mRNA (r =0.731,P＜0.01 ; r =0.514,P＜0.05).Conclusion The expression of apoM is obviously up-regulated in renal grafts of rats,which may take part in the pathogenesis of AR via NF-κB.

AIM: To clarify the relationship between expression of leukocyte iNOS-mRNA and pancreatic islet function in the diabetic rats induced by streptozocin(STZ). METHODS: Wistar rats were randomly divided into the control group ( n =10) and the diabetic group ( n =15). Expression of iNOS-mRNA in the peripheral blood leukocyte, liver and lung were detected with in situ hybridization and the blood sugar and insulin were also measured. RESULTS: It showed that the blood glucose content increased from (8 95?1 80) to (22 84?4 90) mmol?L -1 ,however, the plasma insulin content decreased from (81 76?20 12) to (58 92?18 20) mU?L -1 at the third day after the ? cell was disfunctioned by STZ injection. No expression of leukocyte iNOS-mRNA in normal rat was detected. The percent rate of positive cells were significantly increased in the rats with diabetes. CONCLUSION: The expression of leukocyte iNOS-mRNA is positively related to the damage of ? cells caused by STZ.

[Abstract] Objective: To evaluate the expression level of FOXD1 in glioma tissues of different grades, and to investigate the correlation between the expression of FOXD1 and the prognosis of glioma patients. Methods: The tumor tissues were collected from 40 glioma patients, who received surgical treatment in the neurosurgery department of the First Hospital of China Medical University from September 2014 to February 2015; Seven non-tumor tissues obtained from patients underwent internal decompression for traumatic brain injury were used as controls. The FOXD1 expression in glioma and non-tumor brain tissues was analyzed by qRT-PCR and IHC, and the correlations between clinical pathological features of glioma patients and FOXD1 expression level were analyzed. Furthermore, the Kaplan-Meier method was used to analyze the relationship between FOXD1 expression and survival time of patients. In addition, the expression of FOXD1 in glioma tissues and its relationship with patients’prognosis were confirmed by the data from GEO (GSE4290, GSE2223) and Rembrandt database. Results: qRT-PCR showed that the FOXD1 mRNA expression in glioma tissues of WHO grade IV was significantly higher than that of non-tumor brain tissues and glioma tissues of WHO grade II (P<0.01). German immunohistochemical score (GIS) was used to evaluate the immunohistochemical staining intensity, and the relationship between FOXD1 expression and clinical pathological features was analyzed. The results showed that FOXD1 in glioma tissues was related to WHO phathological grade level (χ2=11.73， P<0.01). There was statistically significant difference between the survival time of FOXD1 high expression group and FOXD1 low expression group (P=0.043). The data from GEO data base (GSE4290, GSE2223) and Rembrandt datasets showed that glioma tissues have a higher FOXD1 mRNA expression level than normal brain tissues, and the elevated expression of FOXD1 mRNA was negatively associated with the survival time of glioma patients. Conclusion: FOXD1 was highly expressed in glioma tissues, and the expression level of FOXD1 was increased as the pathological grade increases. The elevated expression of FOXD1 was related with the poor survival of glioma patients.

Objective: To compare the clinical efficacy of the preserving insertion point of the rectus abdominis-Pfannenstiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries. Methods: A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis-Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduction, postoperative functional and complications were compared between the two groups. Results: 43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P< 0.05). Intraoperative blood loss: 206.0±38.2 ml in the modified approach group and 252.4±46.1 ml in the traditional approach group (t=-3.560, P< 0.05). Postoperative hospital stay: 14.5±3.0 d in the modified approach group, and 20.0±4.4 d in the traditional approach group (t=-4.775, P< 0.05). Postoperative reduction was evaluated according to the Matta reduction criteria, among which 15 cases were excellent and 5 cases were good in the modified approach group; 17 cases were excellent and 6 cases were good in the traditional approach group. According to the Majeed score, the postoperative function of pelvic fracture was excellent in 10 cases, good in 7 cases, and acceptable in 3 cases, with an excellent and good rate of 85.0% (17/20). There were 11 excellent cases, 8 good cases and 4 fair cases in the traditional approach group, with an excellent and good rate of 82.6% (19/23). There was no statistically significant difference between the two groups (χ²=0.04, P >0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23). Conclusion Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis-Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time.