Objective To evaluate the treatment of unstable fractures of the distal end of the radius with external fixator.Methods 28 patients with unstable fractures of the distal end of the radius were treated with external fixators. 19 cases of them were fixed with K wires and bone graft was used in 4 patients with severe bone defect.Results The patients were followed up for an average period of 10.11 months. According to modified Mcbride grading, 25 patients showed excellent or good results with the excellent and good rate being 89.28% . Conclusion It is difficult to reduce unstable fracture of the distal end of the radius with close reduction. Redisplacement is frequent for plaster cast and is not reliable in maintaining reduction. These fractures should be treated with early open reduction. External fixation plus reasonable exercises taken after the operation is one of the good treatments and good results can be predicted. The most important factors affecting final outcome include radial shortening and reduction of articular surface.

Traction during reduction is essent ial for internal or external fixatio n of unstable distal radial fractures.Adequate and effective t raction is the key to the restoration of articular congruence,normal joint relation and the length of distal radius.The f orearm traction instrument develop ed by the authors is a simple,versatile and reliable device,from which stable,continuous and effective traction c an be expected during the surgery.The traction instrument is connected wi th the surgery-table before the operation.According to the needs of diff erent operations,many kinds of traction could be perfo rmed to support the operation.With t he help of the device,frac-ture reduction and fixation is signi ficantly improved during the surgery without excessively violent traction.The X-ray exposure and the operation hou rs can also be decreased as well.Over-traction or long-time violent traction could be avoided during the surgery.According to the author' s experience,the forearm traction i nstrument is an effective implemental device in the treatment of the unstable fractures of distal radius.[

Objective To summarize the outcome of volar approach for unstable distal radius fractures, as well as to explore and discuss the more prompt and efficient way with less complications. Methods Volar approach was used for unstable distal radius fractures in 129 cases (140 sides). This study involved 77 males and 52 females with an average age of 43.7 years (range, 15-76 years). According to the Coony universal classification, 36 sides were of type Ⅱ, 7 of type Ⅲ and 97 of type Ⅳ, which included 105 sides of fresh fracture and 35 old ones. Extra-articular reduction was performed under C-arm to restore the palm tilted angle and ulna deviated angle. For those with severe bone defect, artificial bone graft or auto-graft was applied. T-plates were fixed in 32 sides, T-plates with K-wires in 57, external fixators in 13, external fixators with K-wires in 38 respectively. Results The functional recovery was achieved at 3.8 months averagely after operation with a range of 2 to 6 months. The mean follow-up period was 23.6 months ( range, 12-40 months). 91 sides were rated as excellent, 38 as good, 10 fair and 1 poor. The long-term excellent-good rate was 92.1%. Conclusion The volar approach for unstable distal radius fractures has the following advantages: 1)less invasive without compromise to the bone and tendon sheath of distal radius; 2)The volar surface of radius is smooth , easier for plating; 3)no injury to the palmer ligaments and better for recovery; 4)better reduction; 5)avoidance of bone graft displacement; 6) shorten the operation time, less post-operative complication, earlier rehabilitation and faster functional recovery. The volar approach for unstable distal radius fractures is suitable either for internal or external fixation.

Object The quality of Panax quinquefolius L from different origins were assessed in accordance with the contents of total ginsenoside and ginsenoide Rb 1 of them Methods The contents of total ginsenoside were determined by UV spectrophotometry, and the contents of ginsenoside Rb 1 were determined by HPLC Results Among the seven commercially available samples, the sample from Canada gave the highest content of total ginsenoside and ginsenoside Rb 1, the second is the samples from Huairou, Beijing, China. Conclusion Contents of total ginsenoside of all the seven samples are more than 4%, while content's of ginsenoside Rb 1 are more than 1%. And the more content of total ginsenoside is, the more content of ginsenoside Rb 1 is

Objective To analyze the correlation between fluid equilibrium and oxygen index in patients at early stage (within 2 weeks) of severe acutepancreatitis (SAP),and to discuss the effects of fluid equilibrium after resuscitation on the prognosis.Methods A clinical study was conducted.Ninety-seven patients with SAP admitted into Shengjing Hospital of China Medical University directly or transferred into intensive care unit (ICU) in 24 hours after admission between March 201 1 to October 2013 were studied.Finally,65 patients were enrolled in statistical analysis,and those with termination of treatment prematurely were excluded.The patients received treatment protocol formulated by the same physician in ICU.Patients were divided into improved group and death group according to the outcome.The differences in fluid equilibrium on 1,2,3,7,14 days after admission of ICU between the two groups were compared.The correlation between fluid equilibrium and oxygen index was analyzed with curve fitting.Results Among 65 patients enrolled,53 of them were improved after intensive care and were transferred into ordinary wards.However,12 patients died in ICU.Patients in the improved group showed delayed positive fluid equilibrium,and some patients even showed negative fluid equilibrium.Patients in death group needed more fluid to achieve fluid equilibrium.There was a significant difference in the need of fluid to reach an equilibrium between improved group and death group [1 day:1 814.5 (905.2,2 152.8) vs.3 891.0 (2 524.2,5 714.5),Z=-3.303,P=0.001; 2 days:2 469.0 (1 456.0,3 696.0) vs.6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001 ; 3 days:3 234.0 (1 098.0,4 295.5) vs.9 533.5 (6 748.8,10 689.0),Z=-4.684,P＜0.001 ; 7 days:3 234.0 (1 033.0,5 162.0) vs.13 986.5 (8 045.8,14 518.0),Z=-4.718,P＜0.001 ; 14 days:3 234.0 (978.5,4 924.0) vs.13 436.5 (8 045.8,14 518.0),Z=-4.769,P＜0.001].There was no correlation between fluid equilibrium and oxygen index in improved patients within 3 days of ICU admission (R 2=0.000,P=0.827),and it fit the logistic curve in a relatively low level after 3 days of ICU admission (R 2=0.036,P＜0.001).Conclusions Early fluid resuscitation could help maintain hemodynamics stability in SAP patients.Those SAP patients who showed a negative equilibrium in early stage showed a better prognosis,and the fluid equilibrium and oxygen index in improved patients fit the logistic curve after 3 days of ICU admission.

ObjectiveTo systemically review the effects of timing of initiation of renal replacement therapy (RRT) on prognosis in septic patients with acute kidney injury (AKI).Methods A systematic search for randomized controlled trials (RCTs) and other clinical studies focused on comparing varied timing of initiation of RRT in septic AKI patients was performed in English or Chinese from PubMed, Web of Science, EMBASE, CNKI, Wanfang data, VIP from January 2000 to July 2014. Data screened were extracted with Cochrane systemically review method, and enrolled literature was collected for Meta analysis with RevMan 5.2 software. Total mortality, 28-day mortality, the total length of hospital stay and intensive care unit (ICU) stay in septic AKI patients with early or late initiation of RRT was analyzed. Funnel plots were drawn to detect publication bias.Results Five retrospective comparative studies with a total of 885 patients were enrolled. Random effect model in Meta analysis showed that there was no significant difference in total mortality between early RRT group and late RRT group [65.7% (226/344) vs. 68.7% (239/348), odds ratio (OR) = 0.71, 95% confidence interval (95%CI) = 0.38-1.31,P = 0.27]. The funnel plot demonstrated publication bias. Fixed effect model showed that there was significant difference in 28-day mortality between early RRT group and late RRT group [43.4% (66/152) vs. 55.3% (94/170),OR = 0.59, 95%CI = 0.36-0.94,P= 0.03]. The funnel plot demonstrated publication bias too. The data of total length of hospital stay and ICU stay could not be Meta-analyzed because of different data distribution, but no differences in total length of hospital stay and ICU stay between early and late RRT groups for septic AKI patients were found.ConclusionEarly RRT could reduce the 28-day mortality in patients with septic AKI compared with late RRT, but it did not lower the total mortality.

Objective\ To study the early diagnosis and treatment of the fracture of posterior medial tubercle of the talus (PMTT).Methods\ Five cases of PMTT fractures had been definitely diagnosed by CT scan. Subtalar joint were involved in three cases, open reduction and internal fixation (ORIF) had been adopted in 2;and 1 had been treated conservatively because of the refusal to surgery by the patient. Plaster cast fixation and excision of fragment was done respectively in one case. Results\ Four out of five cases had been correctly diagnosed and one had been misdiagnosed in the first visit.The mean follow up was 24 months. Non union combined with tenderness and numbness of the sole of the foot was found in the misdiagnosed case after 6 months. Excision of the fragment was carried out for this case and a satisfactory result had been achieved. Three of the other four cases was treated operatively with a good result and one were treated conservatively with a poor result. Conclusion\ The PMTT fractures are rarely seen and often misdiagnosed. Early diagnosis and correct treatment is important to eliminate the nonunion or tarsal tunnel syndrome.

0 05). CONCLUSIONS: This study suggested that there might be a close relationship between delayed preconditioning mediated by adenosine A 1 receptor agonist R-PIA and myocardial nuclear factor-kappa B binding activity and Mn-SOD protein expression.

Objective To investigate the protective effect of autophagy inducer rapamycin on acute kidney injury (AKI) induced by sepsis. Methods Twenty-four Sprague-Dawley (SD) male rats were randomly divided into sham group, caecal ligation and puncture (CLP) model group, and rapamycin treatment group (Rap treatment group), with 8 rats in each group. The septic AKI model was reproduced by CLP in rats, and rats in sham group were given appendix isolation without ligation and puncture. The rats in Rap treatment group were given 1.6 mg rapamycin by intraperitoneal injection immediately after model reproduction, and the rats in CLP model group were injected with an equal amount of normal saline. The rats in all groups were sacrificed after collecting peripheral blood specimen at 24 hours after model reproduction, and the levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were determined. The pathomorphology change in renal tissue was observed under light microscope after periodic acid Schiff (PAS) staining. Real-time polymerase chain reaction (real-time PCR, RT-PCR) was used to determine the mRNA expressions of renal tubular autophagy related molecules Atg-5 and Beclin-1. Western Blot was used to detect the expressions of renal tubular autophagy associated protein microtubule labeled protein 1 light chain 3-Ⅱ (LC3-Ⅱ) and Beclin-1 as well as apoptosis protein cytochrome C (Cyt C), Bax and Bcl-2. TdT-mediated dUTP nick-end labeling (TUNEL) assay was used to determine the renal tubular epithelial cell apoptosis. Results Rapamycin could alleviate pathomorphology changes in rats with septic AKI, and decrease the levels of BUN and SCr. Compared with sham group, the expressions of Atg-5, Beclin-1 and LC3-Ⅱ in CLP model group were significantly increased [Atg-5 mRNA (2-ΔΔCt): 2.34±0.04 vs. 1.00±0.03, Beclin-1 mRNA (2-ΔΔCt): 1.40±0.02 vs. 1.00±0.03, LC3-Ⅱ protein (gray value): 0.82±0.03 vs. 0.45±0.04, Beclin-1 protein (gray value): 0.59±0.06 vs. 0.29±0.03, all P < 0.01]. Rapamycin could further up-regulate the expressions of Atg-5, Beclin-1, and LC3 Ⅱ [Atg-5 mRNA (2-ΔΔCt): 3.28±0.19 vs. 2.34±0.04, Beclin-1 mRNA (2-ΔΔCt): 2.38±0.08 vs. 1.40±0.02, LC3-Ⅱ protein (gray value): 1.11±0.07 vs. 0.82±0.03, Beclin-1 protein (gray value): 0.85±0.05 vs. 0.59±0.06, all P < 0.01]. Compared with sham group, the apoptotic cells in CLP model group were increased significantly [(34.49±10.45)% vs. (2.78±1.40)%, P < 0.01], Cyt C and Bax protein expressions were significantly up-regulated (gray value: 0.87±0.02 vs. 0.46±0.03, 1.20±0.06 vs. 0.46±0.01, both P < 0.01), and Bcl-2 expression was significantly down-regulated (gray value: 0.64±0.02 vs. 1.33±0.09, P < 0.01). Rapamycin could effectively inhibit cell apoptosis [(15.44±5.50)% vs. (34.49±10.45)%, P < 0.01] and the protein expressions of Cyt C and Bax (gray value: 0.72±0.03 vs. 0.87±0.02, 0.84±0.03 vs. 1.20±0.06, both P < 0.01), and up-regulate the protein expression of Bcl-2 (gray value: 0.77±0.04 vs. 0.64±0.02, P < 0.01). Conclusion The protective effect of rapamycin on renal tissue of rat with AKI induced by sepsis was depended on cell apoptosis inhibition through inducing and promoting cell autophagy.