To study the characteristic of the metacarpal fracture and the forensic investigation of severity of the injury.52 cases with metacarpal fracture were reviewed.The incidence and the location as well as the patterns of fracture were analyzed.The severity of the fracture were different with different mechanism.

Objective In order to explore the quantification of forensic medical determination to the tooth drop by boxing injury, we study the torensic clinical comparison between this kind of injury and periodontopathy, and study the characteristics of this kind of injury. Method Form the peri-odontopathy group by 65 cases of periodontopathy tooth drop by boxing injury and regular group by 65 cases of normal tooth drop by boxing injury, and analyze the data by statistical Chi-square test. Results Comparing to the regular group, the periodontopathy group has outstanding differences on age, the injury of buccal parenchyma, the type and number of tooth dropped, tooth broken and fracture of den to-alveolar. There is inverse ratio between the injury intensity and the determination of injury degree. Conclusion There is misunderstanding on determination of injury degree of periodontopathy tooth drop by boxing injury. It is necessary to use the injury degree of influence when we determine the above-mentioned injury.

Objective To discuss Buyang-huanwu decoction preventing the formation of lower limb deep vein thrombosis (DVT) after major orthopedic surgery.Methods 60 patients were randomly divided into a treatment group and a control group.The treatment group was treated with oral liquid of Buyang-huanwu,twice a day; while the control group was treated with 5000IU of low molecular heparin through subcutaneous injection,once daily.Prothrombin time (PT),activated partial thromboplatin time (APTT),fibrinogen (FIB),D-dimer,lower limb deep vein color B ultrasonic and the wound flow changes after 48 hours were observed at 1st,7th,and 14th day after medication.Results ①)Comparison on the incidence of DVT:The incidence of DVT in the treatment group was higher than the control group at 7th day after medication,this incidence turn to equal in the two groups at the 14th day after medication,while at the end of therapy,the incidence of DVT in the treatment group was lower than the control group with significant difference (P＜0.05).②Comparison on D-dimer changes:D-dimer at the 1st and 14th day were (0.782 ± 0.472) mg/1 and (0.320 ± 0.102) mg/1 in the treatment group and (0.720±0.421)mg/1 and (0.417 ± 0.217) mg/l in the control group.Comparing with the same group before treatment [the treatment group was(0.548±0.245)mg/1; the control group was (0.560±0.195) mg/l],D-dimer was increased at the 1 st day with obvious difference (P＜ 0.05),but reduced at the 14th day,without statistical difference (P＞0.05).Conclusion Buyang-huanwu decoction did not show good effects as low molecular heparin at the beginning of the treatment,but the its whole therapeutic effects and safety was better in treating lower limb deep vein thrombosis after major orthopedic surgery.

AIM: To explore the therapeutic effect of malleolus radialis implantation with vascularized periosteal flap for disunion of carpal navicular fracture, and investigate the characteristics of tissue implantation. METHODS: Thirty-two patients with disunion in carpal navicular fracture were selected from Jiangyin People's Hospital from January 2000 to January 2006, with the informed consents of all the patients. They were treated with implantation of malleolus radialis with vascularized periosteal flap, fixed with plaster cast for 8-10 weeks. Therapeutic effect was evaluated as: ①excellent: normal activity of carpal joints, without soreness sense, fracture line disappeared by X ray;②fine: uncomfortable activity of carpal joints, with slight limitations, fracture line disappeared by X ray. RESULTS: ①All 32 cases of the disunion in carpal navicular fracture were synostosis displayed by X ray.②There were 23 cases followed up for 3-12 months, 7 cases for 13-24 months, and 2 cases for 25-36 months. Carpal joints function achieved the standard of the uninjured side, without pain or affection on daily life.③The therapeutic effect was excellent in 22 cases, fine in 10 cases, and good rate was 100%. CONCLUSION: Implantation of malleolus radialis with vascularized periosteal flap is an effective way to treat the disunion of carpal navicular fracture.

Objective To investigate the clinical effects of vitrectomy combined with cataract surgery in the treatment of proliferative diabetic retinopathy (PDR V-VI stage).Methods A total of 80 patients with proliferative diabetic retinopathy from January 2012 to January 2014 were divided into the single group and the combined group according to the surgical method.Patients of the single group were treated by vitrectomy while patients of the combined group were treated by vitrectomy combined with cataract surgery.The incidence of retinal reattachment,postoperative vision and surgical complications between the two groups were compared.Results Compared with the single group,the incidence of retinal reattachment was higher in combined group (P ＜ 0.05).The postoperative vision improvement was better than that in single group,the difference was significant (P ＜ 0.05).And the surgical complications in combined group was less than that in single group,the difference was significant (P ＜ 0.05).Conclusion Vitrectomy combined with cataract surgery in the treatment of proliferative diabetic retinopathy has a better clinical effect which is safe and reliable,and it can improve the rate of retinal reattachment and reduce surgical complications.

Objective To investigate the clinical value of GFR, microalbuminuria (mAlb), serum β2-microglobulin (MG) and cystatin C (CysC) for the evaluation of renal function in patients with DN.Methods A total of 150 patients with type 2 DM diagnosed by WHO standard (1999) from December 2012 to December 2015 were retrospectively analyzed.Thirty-three kidney transplantation donors during the same time were chosen as the control group.The urine mAlb, Cr, albumin/Cr ratio(ACR) and SCr, serum β2-MG, CysC, urea, uric acid(UA), fasting blood glucose (FBG), hemoglobin A lc (HbA1c) and C-reactive protein (CRP) were measured.99Tcm-DTPA renal dynamic imaging was performed.The Gates method was used to calculate GFR, and the modification of diet in renal disease (MDRD) method was used to calculate the estimated GFR (eGFR).The relative equation between GFR and eGFR was studied.The clinical stages of renal function in type 2 DM patients were evaluated by Mogenesen standard method.Two-sample t test was used for data analysis.ROC curve analysis was performed to study the diagnostic value of GFR in DN.Results The patients were divided into merely type 2 DM group, early stage DN (Ⅰ, Ⅱ, Ⅲ), and clinical DN(Ⅳ) groups by Mogenesen standard method.GFR and eGFR in the DNⅠstage were higher than those of the merely type 2 DM group (t values:-7.502,-3.629, both P<0.01), and GFR and eGFR decreased with the increased stage of DN.However, serum UA, CRP, FBG and HbA1c, SCr, urea, β2-MG, CysC, mAlb and ACR increased when the stage of DN was higher.GFR and eGFR showed a linear correlation, with the regression equation of y=0.957x+6.823.AUC of ROC in patients with DN Ⅰ was 0.989.With the cutoff value of 125.09 ml/min, the sensitivity and specificity was 96.2%(25/26) and 98.4%(122/124) respectively in diagnosis of DNⅠ.Between high UA and normal UA groups, FBG and HbA1c were not significantly different (t values:-1.010,-1.034, both P>0.05), but the renal function indicators were different (t values:-5.090-2.209, all P<0.01).Compared with the normal CRP group, the FBG, HbA1c and renal function indicators were statistically different in high CRP group (t values:-6.114-7.386, all P<0.01).Conclusions GFR and eGFR show a linear relationship in type 2 DM.GFR is a sensitive, specific diagnostic index in DN Ⅰ period.β2-MG, CysC, mAlb and ACR are conducive to the early diagnosis of DN.High UA is an independent risk factor for the onset of DN, and high CRP is an inflammatory damage factor in DN.

BACKGROUND:Single fracture or colapse of the posterolateral tibial plateau fractures is relatively rare in the clinical work. Rational choice of surgical approach and internal fixation for posterolateral plateau fracture is significant to restore the lower limb force line, maintain the joint stability and obtain good biocompatibility.
OBJECTIVE:To compare the stability and biocompatibility of Carlson posterolateral and posterior midline approaches for the treatment of posterolateral tibial plateau fractures with “T” shaped locking plate.
METHODS:From July 2011 to July 2014, 43 patients with posterolateral tibial plateau fractures, who were treated in the Affiliated Hospital of Jining Medical University, were retrospectively analyzed. Al patients were assigned to two groups according to approaches. In the Carlson posterolateral approach group, 22 cases received “T”-shaped plate insertion by Carlson posterolateral approach. In the posterior midline approach group, 21 cases received “T”-shaped plate insertion by posterior midline approach. After repair, perioperative data, fixation effects and knee function score were compared and analyzed between both groups.
RESULTS AND CONCLUSION:(1) 43 cases (43 knees) of posterolateral tibial plateau fractures were folowed up strictly. (2) No significant difference in operation time, fracture healing time, total load time, Hospital for Special Surgery score at 12 months postoperatively, tibial plateau angle and posterior slope angle immediately and 12 months postoperatively was detected between both groups (P > 0.05). (3) Significant differences in fracture exposure, blood loss, and excelent and good rate of Rasmussen at 12 months postoperatively were identified in both groups. Moreover, above indexes were better in the Carlson posterolateral approach group than in the posterior midline approach group (P< 0.05). (4) These findings confirmed that for a single fracture or colapse of the posterolateral tibial plateau fractures, two kinds of surgical approaches can achieve ful and direct exposure. Carlson posterolateral approach has good repair effect, fixation effect and biocompatibility.

Background: Myoclonic epilepsy with ragged-red fi bers (MERRF) is a type of mitochondrial encephalomyopathy, clinical experience with the antiepileptic treatment for myoclonus in MERRF is still limited. Myoclonus appears to be intractable, and some antiepileptic drugs may change the blood lactate level. Objective: In this study, we report on two patients, a girl and her mother, both with MERRF in a Chinese family. We aimed to study their myoclonus attack, response to AEDs and blood lactate level. Methods: The diagnosis was based on muscle biopsies and a genetic test. We recorded their myoclonus and detected alterations of blood lactate when the patients received antiepileptic drugs. Results: The patients displayed substantial differences in their responses to antiepileptic drugs. The mother exhibited a good response to valproic acid, although valproic acid is not recommended for mitochondrial disease; however, her daughter was refractory to many antiepileptic drugs until she received a combination treatment of levetiracetam and topiramate. We did not fi nd valproic acid, levetiracetam or topiramate affected the blood lactate levels. Conclusion: These fi ndings imply that not all MERRF patients are resistant to antiepileptic drugs, and for those who are intractable, combination treatment involving levetiracetam and topiramate may be effective for treating myoclonus in MERRF and does not worsen lactic acidosis.

Objective To compare the noxious stimulations induced by insertion of Proseai laryngeal mask airway(PLMA)and classic laryngeal mask airway(CLMA)in children.Methods Forty-seven ASA Ⅰ or Ⅱ children,aged 3-12 yr and undergoing surgery under general anesthesia,were randomly divided into 2 groups:PLMA group(group P,n =23)and CLMA group(group C,n =24).General anesthesia was induced with target-controlled infusion(TCI)of propofol.When the effect-site concentration of propofol was equal to the plasma concentration predetermined.PLMA or CLMA insertion was attempted.The target plasma concentration of propofol was predetermined according to Dixon's up-down method,with 0.2 μg/ml as a step size.The initial target plasma concentration of propofol was 6 μg/ml and 4.4 μg/ml for groups P and C,respectively.The preedetermined target plasma concentration of propofol and the satisfaction of insertion conditions for each child were recorded.Results The 50％ effective concentration(EC50)of propofol to achieve satisfied condition of PLMA and CLMA insertion were 5.87(95％ CI,5.62-6.11)and 4.53(95％ C1,4.38-4.69)μg/nl,respectively,and the difference was significant(P ＜ 0.01).Conclusion The noxious stimulation induced by insertion of PLMA in children aged 3-12 years is stronger than that of CLMA.

Objective To investigate the effect of injection of air into the epidural space on the subarachnoid puncture during the combined spinal-epidural anesthesia (CSEA) .Methods Two hundred and ten ASA Ⅰ or Ⅱ parturients who were at full term with a singleton fetus, aged 20-42 yr, weighing 57-82 kg (height 152-170cm) , undergoing cesarean section under CSEA, were randomly divided into 3 groups ( n = 70 each) : hanging drop technique group (group Ⅰ ) and injection of small volume of air group (group Ⅱ ) and injection of large volume of air group ( group Ⅲ ) . The epidural space was indentified using hanging drop technique in group Ⅰ and using loss of resistance to air technique in Ⅱ and Ⅲ groups. Injection of air was stopped as soon as the clear loss of resistance identified the epidural space in group Ⅱ , whereas all 4 ml of air was injected in group Ⅲ . After the epidural space was confirmed at L3,4 interspace, a 25-gauge spinal needle protruding 14 mm beyond the 18-gauge epidural needle was introduced through the epidural needle. Subarachnoid placement was confirmed by backflow of cerebrospinal fluid (CSF) . If no backflow of CSF was observed, the spinal needle was withdrawn and an epidural catheter was inserted through the epidural needle to perform epidural anesthesia. Successful subarachnoid puncture, failures to observe backflow of CSF and adverse reactions were recorded. Results The three groups were comparable with respect to age, height, body weight and gestation weeks. The success rate of subarachnoid puncture was 91% ,93% and 79% in Ⅰ ,Ⅱ and Ⅲ groups respectively, and it was significantly higher in Ⅰ and Ⅱ groups than in group Ⅲ ( P < 0.05) . There was no significant difference in the success rate of subarachnoid puncture between Ⅰand Ⅱ groups ( P > 0.05) . Bilateral segmental analgesia presented in all cases who received only epidural anesthesia after no backflow of CSF was observed, and the expected analgesia also presented in all cases in whom back flow of CSF was observed. No adverse reactions occurred. Conclusion Injection of air into the epidural space is related to the success of subarachnoid puncture during CSEA and injection of a large volume of air lowers the success rate.