Objective To compare the clinical effect of the treatment for calcaneal fracture by percutaneous reduction combined with Ilizarov stent and open reduction and internal fixation.Methods Data of 35 patients with closed calcaneal fractures from June 2012 to January 2014 were respectively analyzed.13 cases were fixed with poking reduction and Ilizarov support.Among them,there were 9 males and 4 females,aging from 20 to 51 years old (average,34.46± 10.21 years);Sanders type Ⅱ fractures in 2,type Ⅲ in 8 and type ⅣV in 3;Tscheme-Gotzen 2 degree of soft tissue injury in 9 and 3 degree in 4.22 cases were treated with open reduction and internal fixation.Among them,there were 15 males and 7 females,aging from 18 to 60 years old (average,33.59±12.07 years);Sanders type Ⅱ fractures in 3,type Ⅲ in 15,type ⅣV in 4;Tscheme-Gotzen 0 degree of soft tissue injury in 13 and 1 degree in 9.Results There was no significant difference in the anatomic parameters between the two groups before operation.Postoperative calcaneal B(o)hler angle of stent group (27.77°±2.86°) was less than that of the plate group (30.45°±3.45°),and Gissane angle of stent group (131.23°±3.92°) was larger than that of the plate group (127.82°±4.65°);axis angle of stent group (19.23°±2.20°) was less than that of the plate group (22.64°±5.14°);calcaneal width of stent group (33.61±3.43 mm) was less than plate group (36.05±3.26 mm),and the difference have statistical significance.The calcaneal length of the stent group (63.23±5.67 mm) was smaller than that in the plate group (63.59±4.58 mm),but there was no significant difference.The time from the injury to surgery in stent group (4.77±0.83 d) was less than that in the plate group (6.68± 1.84 d),the blood loss of stent group (45.00±6.04 ml) was significantly less than that of the plate group (292.95±43.66 ml).The fracture healing time of stent group (9.31± 1.38 week)was less than that of the steel plate group (9.82± 1.40 week),but there was no significant difference.About limb function American Orthopaedic Foot and Ankle Society (AOFAS) score,7 cases in the stent group were excellent,3 cases good,1 cases fair,2 cases poor;and 9 cases of the plate group were excellent,7 cases good,3 cases fair,3 cases poor,there was no significant difference.Conclusion For the Sanders Ⅱ / Ⅲ type calcaneal fractures and Sanders type ⅣV patients associated with soft tissue damage which are not suitable for open reduction and internal fixation in short term,Ilizarov technique is a good option.

Objective:To observe clinical and pathological features of pancreatic solid-pseudopapillary tumor ( SPPT) , and to find some useful immunohistochemical methods for its differential diagnosis.Methods: The clinical features of 14 SPPT patients were obtained. Each case underwent microscopic observation and immunohistochemical staining. The primary antibodies were CgA, Syn, E-cadherin, β-catenin and Cyclin Dl. These results were compared with 5 pancreatic well-differentiated tumors and well-differentiated carcinomas ( WET/WEC). Results: SPPT mainly involved young women, and the head of pancreas was the commonest location. Tumors were always in solid and cystic gross appearance.Although the tumor' s borderlines seemed clear, focal infiltrations could often be identified. The histological features of SPPT were similar in some aspects to those of WET/WEC, especially the solid pattern of WET/WEC. Both of them could express CgA and Syn. But all SPPTs lost E-cadherin membranous signals, and even had some nuclear signals (5/14) , while all WET/WECs remained the same staining pattern with normal pancreas cells, β-catenin positive signals in SPPTs were located both in nuclei and plas mas. WET/WECs' positive signals were all in membranes and plasmas, but negative ones in nuclei. Perinuclear dot-like signals could also be seen in the majority cells, which were similar to normal islet cells' staining pattern. SPPTs' nuclear positive rates of Cyclin Dl were usually more than 70% (12/14). WET/WECs' rates were all lower than 30%. Conclusion: Comprehensive analysis of patients'clinical, pathological features and immunohistoehemistry results, including E-cadherin, β-catenin and Cyclin Dl, was helpful to the diagnosis of SPPT and its differential diagnosis of WET/WEC.

To study the chemical constituents from the root of Berchemia lineata (L.) DC., nine compounds were isolated from the EtOAc extract by using silica gel, RP-C18 silica gel column chromatography and preparative HPLC. Based on the spectroscopic analysis, their structures were identified as 5-hydroxy-7-(2'-hydroxypropyl)-2-methyl-chromone (1), (-)-(1'R, 2'S)-erythro-5-hydroxy-7-(1', 2'-dihydroxypropyl)-2-methyl-chromone (2), naringenin (3), eriodictyol (4), (+)-aromadendrin (5), (+)-taxifolin (6), (+)-catechin (7), (+)-epigallocatechin (8) and quercetin (9). Among them, compound 2 is a new chromone derivative. Compound 1 is a known chromone derivative and isolated from this genus for the first time. Compounds 3-9 are known flavonoids and isolated from this plant for the first time.

Objective To evaluate the value of MRI diffusion tensor imaging (DTI) on diagnosis of traumatic brain injury(TBI). Methods Twenty two patients with TBI 1 to 7 days post-injury and 14 healthy controls were studied with DTI and conventional MRI. The fractional anisotropy (FA) was quantified from different regions of interest (ROI) including the genu of corpus callosum (CC), the splenium of CC, the genu of internal capsule (IC) and the posterior limb of IC bilaterally. The FA value of the same ROI was compared between TBI group and control group, and FA value of the lesion side was compared with the mirror healthy side in TBI group. Correlations between the FA and Glasgow coma scale (GCS) in TBI patients were analyzed with Pearson linear correlation. Results Compared with control group, the FA value decreased significantly in each ROI (P<0.01). Compared with the healthy side, FA value was also significantly lower in lesion side in TBI group (P<0.01). The FA value in all the sites were not correlated with GCS in TBI group (P>0.01).Conclusion DTI is sensitive for detecting the acute traumatic injury of white matter and evaluate the degree of injury. It offers the possibility to diagnose TBI earlier and accurately.

200 papers on nerve root type cervical spondylosis treated with Chinese medicine were retrieved and 38 papers with complete diagnostic criteria and medical statistics were included for study. The results showed acupuncture, massage, and herbal therapy were three common methods and have their own advantage, but systemic, standardized and normative treatment program was lack. In the meantime of treating nerve root type cervical spondylosis, prevention should also be paid attention. The treatment, prevention and exercise on the whole therapeutic idea should be established, which has far-reaching significance.

Objective To observe the clinical effects of ultra-sound guided lumbar plexus and sciatic plexus nerve block combined with general anesthesia on elderly patients undergoing hip replace-ment surgery.Methods Eighty elderly patients scheduled for unilateral hip replacement surgery were randomly divided to lumbar plexus and sciatic plexus nerve block combined with general anesthesia group (group N)and general anesthesia group (group G).The airways of all the patients were con-trolled by laryngeal mask airway (LMA)in both groups.The bispectral index (BIS)of patients in both groups was maintained in the range of 45-55.The dosage of sulfentanyl,visual analogue scale (VAS)at 2,4,8 and 24 h after surgery,and the dosage of patient controlled analgesia (PCA)drugs were recorded.The period from end of surgery to extubation,off-bed activity and discharged from hospital,mortality in 30 days after surgery were recorded.Meanwhile,postoperative delirium (POD) and postoperative cognitive dysfunction (POCD),and severe cardiovascular and pulmonary complica-tions were evaluated.Results No patient died in 30 days after surgery in both two groups.One patient suffered from severe pulmonary infection in group G.The dosage of sulfentanyl of group N was less than the value of group G (P <0.05),the periods from end of surgery to extubation,off-bed activity and discharged from hospital of group N were shorter than those in group G (P <0.05 ).The VAS scores and incidence of POD and POCD in group N were lower than those in group G (P < 0.01 ). Conclusion In elderly patients undergoing hip replacement surgery,ultrasound-guided lumbar plexus and sciatic plexus nerve block combined with general anesthesia could help reduce usage of opioids during operation,offer better analgesia effect,shorten the period of off-bed activity and discharged from hospital and reduce incidence of POD and POCD in elderly patients.

Objective To evaluate changes of regional cerebral metabolism by proton MR spectroscopy (~1H-MRS) in patients with minimal hepatic encephalopathy (MHE) and to correlate these changes with the neuropsychological test. Methods Fifty-four patients with cirrhosis including nine patients with hepatic encephalopathy (HE),23 patients with MHE,22 patients without HE and 13 controls underwent neuropsychological tests and ~1H-MRS scanning. The volumes of interest included occipital gray matter and left parietal white matter regions. Ratio of spectral peak areas of N-acetylaspartate (NAA),choline (Cho),myo-inositol (mI),and glutamine/glutamate (Glx) relative to creatine (Cr) were acquired. Statistical analysis was conducted using independent t test and one-way analysis of variance. The results of different groups were compared by using the nonparametric Mann-Whitney U test with Bonferroni correction. Correlations among the ~1H-MRS ratios, the grade of HE, neuropsychological test and ammonia data were calculated with Spearman correlation test. Results The ratios of NAA/Cr,Cho/Cr,mI/Cr,Glx/Cr of the occipital gray matter and left parietal white matter regions in patients with cirrhosis are 1.55±0.12,0.48±0.10,0.42±0.14,2.52±0.48 and 1.73±0.17,0.75±0.16,0.42±0.16,2.75±0.59respectively,and they are 1.53±0.10,0.48±0.09,0.51±0.11,2.20±0.39 and 1.69±0.15,0.82±0.14,0.53±0.12,2.40±0.40 in patients without HE,1.58±0.13,0.48±0.08,0.38±0.13,2.62±0.39 and 1.78±0.18,0.74±0.14,0.38±0.15,2.84±0.58 in patients with MHE,1.54±0.12,0.50±0.13,0.29±0.07,3.04±0.31 and 1.70±0.19,0.62±0.16,0.29±0.07,3.37±0.38 inpatients with HE.Compared with controls, decreased mI/Cr and Cho/Cr ratios and elevated Glx/Cr ratios were found in patients with cirrhosis (t=3.196,9.394,-6.527,P＜0.01,occipital gray matter. t=5.592,9.717,-6.681,P＜0.01,left parietal white matter＝ and in subgroup of patients without HE, with MHE and HE (F=5.097,25.896,20.204,P＜0.01,occipital gray matter.F=16.435,28.660,21.283,P＜0.01,left parietal white matter).Significant difference in these metabolic alterations was also found among the different groups of cirrhosis especially the ratios of Glx/Cr in occipital gray matter and left parietal white matter (P＜0.0084).The ratios of mI/Cr also significantly altered between patients without HE and with MHE (P＜0.0084).There was a significant negative correlation between the ratios of Cho/Cr,mI/Cr and the grade of HE (P＜0.01＝ and a significant positive correlation between the ratios of Glx/Cr and the grade of HE (r=0.709,P＜0.01,occipital gray matter; r=0.720,P＜0.01,left parietal white matter＝.NCT-A and DST of controls is (49±8) s and 39±6.They are (134±37),(83±26),(64±22) second and 15±2,25±9,35±8 in patients with HE,MHE and without HE respectively.The metabolic alterations of Cho/Cr,mI/Cr,Glx/Cr correlated significantly with neurepsychological tests in all subjects (P＜0.01＝.There was a significant positive and a negative correlation between the ratios of Glx/Cr and the data of NCT-A and DST respectively (r=0.570,-0.642,occipital gray matter; r=0.541,-0.632,left parietal white matter).The metabolic alterations of Glx/Cr had no correlation with ammonia data as well as other metabolic alterations.Conclusions ~1H-MRS study shows cerebral metabolic alterations of gray and white matter in patients with cirrhosis,especially the reduction in mI/Cr ratio and increase in Glx/Cr ratio. These changes correlate well with the neuropsychological tests and may be useful in predicting the presence of MHE.

Objective To explore the effect of low constant direct current (LCDC) in the medullary cavity on repairing of rabbit radial defect as to evaluate its clinical value. Methods DBX was put into the segmental osteoperiosteum defect of rabbit bilateral radius. The rabbits were divided into 2 groups: group A (subject group) with the defects stimulated by LCDC and group B (control group) with the defects left untreated. In week 2,5 and 9, 4 animals from each group were put into death, and the radius was taken for study using photograph, electron microscope, histological & morphologic technique, and the contents of the Calcium (Ca) and ALP were determined. Results Compared with group B, the healing of group A was better. The contents of Ca and ALP increased obviously in week 2 (P

Objective To introduce the treatment of intraarticular calcaneal fractures with poor soft tissue using poking reduction combined with Ilizarov methods. Methods From September 2007 to September 2009,11 patients with the intraarticular calcaneal fractures were treated with poking reduction combined with Ilizarov methods,including 10 males and 1 female at average age of 33.6 years(range,21-50 years).Four patients had the left calcaneal fractures and seven with the right ones.According to Sander classification,there were seven patients with type II fractures,three with type III fractures and one with type IV fracture.The various extents of heel soft tissue injury were emerged in all the patients.Before operation,B(o)hler angle was 0°-12°(average 8°)and Gissane angle 70°-95°(average 80°).According to AO classification of close soft tissue injury,there were three patients with type IC2,six with type IC3,one with type IC5 and one with open soft tissue injury.The collapse of the articular surface was recovered by Steinmann pin which passed through the lateral calcaneal tubercle.The medial and lateral fracture fragments were corrected by using the tensed olive wires.The heighat and width were maintained by using the Ilizarov external fixation. Results The mean duration of follow-up was 13.3 months (range,6-20 months).All fractures were healed after mean duration for 8.1 weeks(range,7-10weeks).The postoperative B(o)hler angle was 20°-45°(average 33°)and Gissane angle 100°-118°(average 107°).According to Maryland Foot Score system,the result of postoperative function was excellent in seven patients,good in three and fair in one,with excellence rate of 91%. Conclusions For the intraarticular calcaneal fractures,the poking reduction combined with Ilizarov method is able to recover and maintain the normal calcaneal height and width and reduce postoperative wound infections and many other complications.specially for Sanders II or III with severe soft tissue injury in the open or closed calcaneal fractures.Master of surgical indications and operating poims can attain satisfactory clinical efficacy.

Objective To discuss the operative methods, timing and outcomes of severe open Pilon fractures. Methods From April 2003 to July 2008, 21 patients with open Pilon fractures were admitted. All the patients were type C fracture according to AO/OTA classification, including 17 cases of type C2 and 4 cases of type C3. According to Gustilo classification, there were 18 cases of type Ⅱ, 2 cases of type ⅢA, 1 case of type ⅢB. The patients were treated in two different ways: one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with transarticular external fixation of the ankle (19 cases),which included 16 cases of Gustilo Ⅱ AO/OTA C2, 2 cases of type Gustilo Ⅱ AO/OTA C3 and 1 case of type Gustilo ⅢA AO/OTA C2. Formal open reconstruction of the articular surface by plating and external fixation was performed when the condition of soft tissue had improved (2 cases), which included 1 cases of type Gustilo ⅢA AO/OTA C3 and 1 cases of type Gustilo Ⅲ B AO/OTA C3. Results All the patients were followed up from 6 to 48 months, with the mean of 24 months. The outcome of reduction was evaluated by the Burwell-Charnley score. Anatomical reduction was found in 6 cases, function reduction was in 14 cases and poor reduction was 1 case. The heal-time ranged from 2.5 to 11 months, with the mean of 4.7 months. The delayed union occurred in 2 cases. The rate of delayed union was 9.5%. Two patients experienced skin superficial necrosis. There were superficial infection in 2 cases and deep infection in 1 case. The infection rate was 14.3%. Eight cases experienced early traumatic arthritis. The incidence of this complication was 38.1%.According to American Orthopedic Foot Ankle Society (AOFAS) scale for ankle joint, the result of the treatment was 66-94, with an average of 85.2. Conclusion It is important to have the optimal timing of surgery and reliable fixation according to fracture classification, the condition of soft tissue and time after injury. It is the key to evaluate the condition of soft tissue and protect the blood supply.