This paper reviews the advances concerning the diagnosis and treatment of carpal collapse. Systematic study on carpal collapse was launched only two decades ago. The improved roentgenologic diagnosis has deepened our understanding of the disorder. Its classification has helped doctors conduct objective follow ups of the progress and prognosis of the disease. And the related biomechanical research has made clear mechanism of the collapse which can serve as an important basis for choice of operative methods. The various partial carpal arthrodesis, of which the commonest is four corner arthrodesis, and proximal row carpectomy are proved to be effective in relieving most symptoms and ending the continuation of collapse, so they have become major treatment methods for the disease. But operative methods have to be chosen in the light of detailed conditions of radiocarpal and midcarpal joints. The silicon arthroplasty has been abandoned due to its serious complications.

Objective:To study the X-ray manifestations of distraction osteogenesis in tibial bone transfer, put for-ward the classification and formulate the standard treatment protocols.Methods:Data of 42 cases among 321 cases with dysplasia of distraction osteogenesis who had tibial bone transfer from January 2012 to December 2018 were retrospectively analyzed. There were 27 males and 15 females aged from 4-65 years old, with an average of 33.1 years. The dysplasia sites were 26 cases of proximal tibia, 3 cases of tibial shaft and 13 cases of distal tibia. The length of tibial defect ranged from 3.5 cm to 21.7 cm, with an average of 6.7 cm. The main management protocol included systemic assessment, local assessment, fixator adjusting stimulation and surgical intervention. The fixator adjusting stimulation included transport slowing, transport stopping, transport backing, and accordion techniques. The main surgical intervention was second site osteotomy and bone grafting. According to the X-films, the dysplasia of the tibia transport can be divided into four types: longitudinal defect; transverse defect; insect erosion defect; full-length defect. External fixation index (EFI) was used to evaluate the healing and mineralization of distraction osteogenesis. The limb function was evaluated by Paley method.Results:All 42 cases were followed up for 33.71 ± 11.7 months (range, 24-72 months). The types of dysplasia were as follows: 25 cases (59.5%) of longitudinal defects, 8 cases (19.0%) of transverse defect, 2 cases (4.8%) of insect erosion defect, and 7 cases (16.7%) of full-length defects. After the treatment, except for 2 cases of amputation, all the dysplasia healed and the patients recovered limb walking. External fixation index of 40 cases was 1.55-2.83 months/cm, with an average of 1.76 months/cm. According to Paley evaluation method, 27 cases were excellent, 10 cases good, 1 case fair, and 2 cases poor, thus the excellent and good rate was 92.5% (37/40). The complications after treatment included: nail tract infection (3 cases), axial displacement of transferred segment (4 cases), clubfoot (2 cases), and amputation (2 cases). The total incidence of complications was 26.2% (11/42), which was symptomatically treated.Conclusion:The X-film manifestations of dysplasia at the osteotomy site in tibial bone transport can be divided into four types: longitudinal defect, transverse defect, insect erosion defect, and full-length defect. The different types were treated by general and local evaluation, frame adjustment stimulation and surgical intervention. The remedial results of the dysplasia were excellent.

Objective To explore the clinical significance on power spectra assay of heart rate (HRPSA) to cardiovascular autonomic nervous system function in patients with interictal epilepsy.Methods HRPSA of 48 patients with epilepsy and 31 healthy controls were assessed in the study. their heart rate variability(HRV) was analysed.Results HRV was significantly reduced in patients with interictal epilepsy, especially in the patients received carbamazepine treatment.Conclusion The cardiovascular autonomic nervous system function exists disturbance in patients with interictal epilepsy,especially in the patients received carbamazepine treatment.

AIM: To isolate,identify and screen active compounds of simplitied formula of Danggui Shaoyao Power(poria,Rhizoma Atracty-lodis Macrocephalae,and Radix Angeliae Sinensis). METHODS: Compounds in the fraction of CO_2 supercritical fluid extraction(SFE-CO_2) were isolated by silica gel chromatography and detected the protective effect on KCl-induced PC12 cell damage. RESULTS: Twelve compounds were obtained,and nine of them were identified as atractylenolide Ⅰ,Ⅱ,Ⅲ,biatractylenolide,levistolid A,pachymic acid,ferulic acid,?-sitosterol and ?-daucosterol,of which only atractylenolide Ⅲ can improve the cell viability significantly. CONCLUSION: Atractylenolide Ⅲ may be one of the active compounds of FBD in curing vascular dementia.

Objective To establish the reconstructive ladder for the leg without sufficient recipient vessels by case analysis and literature review.Methods From January,2009 to January,2015,772 cases were treated in our center using free flap for leg coverage and 129 cases were found intra-operatively to have insufficient recipient vessels.There were 113 males and 16 females,and the age ranged from 4 to 71 years,averaging 36.5 years.The wounds were post-traumatic (n=108) and non post-traumatic (n=21).The management methods included elongating incision (n=25),vessel transfer(n=22),Flow-through anastomosis(n=17),end-to-side anastomosis (n=13),useing neighboring vessels (n=1S),anastomosis distal to the injured zone (n=14),cross-leg free flap (n=7),and abandoning free flap transfer(n=13).Results Except for the cases of abandoning surgery (n=13,10.1％),there were 86 cases whose flap healed totally (66.7％),9 cases total lost(7.0％),and 11 cases marginal loss (8.5％).It established a reconstructive ladder for this special situation according to the principle of difficulty level.Conclusion The insufficient recipient vessels of the leg were had multi-causes which should be taken account generally before surgery.The optimal protocol for each case should be chosen from the reconstructive ladder based on the technical difficulty level.

Objective To investigate the changes of pulsatile tinnitus on HRCT and MRI CE 3D-SPGR image.Methods CT and MRI images of 1 5 pulsatile tinnitus patients were retrospective analysis.All 1 5 patients underwent temporal bone HRCT and MRI CE 3D-SPGR scan.Abnormal changes on CT and MRI image,which caused the pulsatile tinnitus,were compared.Results In 1 5 patients,9 sides (8 cases)showed abnormal sigmoid sinuses including 4 sides of sigmoid sinuses diverticulum,5 sides sigmoid sinu-ses uncovering,8 sides dominant sigmoid sinuses.The high jugular bulb was showed in 10 sides (8 cases),the thick emissaria mas-toidea in 5 sides (4 cases),bilateral semicircular canal dehiscence in one case,glomus tympanicum tumor in one case and the cochle-ar nerve was constricted by small vessel in one case.Conclusion Cranial base vessel abnormity can be visualized more precisely on MRI CE 3D-SPGR image than that on HRCT.On the contrary,the detection of temporal bone abnormalities is superior on HRCT.

ObjectiveTo explore the possible molecular mechanisms of β-elemene combined with cisplatin and heat therapy for killing A549 cell line.MethodsThe protein expressions of Stat3,p21 Waf1/Cip1 and Survivin were detected with Western blot after treatment with β-elemene of different concentrations combined cisplatin and heat therapy.ResultsThe protein expressions of Stat3,and pStat3 and p21Waf1/Cip1 in A549 cell line were enhanced with increasing concentrations,and there was significant difference in the expressions between high and low concentration,but Survivin protein had no change at 37°C.After adding 4 μg/mL cisplatin,the expressions of p21Waf1/ Cip1,Survivin,Stats and pStat3 were reduced at β-elemene of high concentration.At 42°C,there was no significant difference in expression of Stat3 protein at 60 μg/mL elemene,but the expressions of pStat3,p21Waf1/Cip1 and Survivin proteins had sharply declined.When using 15 μg/mL elemene combined with 4 μg/mL cisplatin,the protein expressions of Star3 and pStat3 increased,and Survivin expression decreased.ConclusionsAt temperature of 37°C,β-elemene of high concentration may inhibit growth of A549 cells by higher expression of p21Waf1/Cip1 protein,and mainly by inhibiting expressions of Stat3 and pStat3 and Survivin after combined with cisplatin.At temperature of 42°C,β- elemene of highconcentrationmaypromoteapoptosispossiblythroughinhibition ofStat3 phosphorylation and expression of Survivin protein.β-elemene of low concentration combined with cisplatin leads to synergy killing effect by reducing expression of Survivin protein.

Objective To investigate the effects of continuous invasive mechanical ventilation combined with BAL on COPD patients with respiratory failure. Methods Sixty COPD patients with respiratory failure were divided into BAL and control group randomly. Control group were treated with sputum suction tube to aspire sputum and BAL group treated with BAL. The changes in the indicators were observed. Results The SpO2, airway peak inspiratory pressure and blood gas analysis were improved significantly compared with the control group (P < 0.01). The number of peripheral blood leucocytes and the level of CRP in BAL group were lower than those in control group at the seventh day (P < 0.01). The duration of invasive mechanical ventilation and hospital stay in BAL group was shorter than that in control group (P < 0.01) and there was no severe complication in both groups. Conclusion BALwith continuous mechanical ventilation support are safe and effective and shorten hospitalization time and improve the prognosis of COPD patients with respiratory failure.

Objective To observe the percentage of Th17 cells in peripheral blood mononuclear cells (PBMCs) and the serum level of interleukin-17 (IL-17) in children with Henoch-Sch?nlein purpura (HSP). Methods A total of 30 HSP children and 20 healthy children were selected. The percentage of Th17 cells in PBMCs was measured by lfow cytometry analysis and the serum level of IL-17 was measured by ELISA method. The results were compared between HSP children and healthy children. Results The percentage of Th17 cells in PBMCs in HSP and healthy children was (2.14 ± 0.90)%and (0.84 ± 0.41)%, respec-tively, and the difference was signiifcant between two groups (P<0.05). The serum levels of IL-17 in HSP and healthy children were (38.36 ± 13.44) pg/ml and (10.59 ± 4.17) pg/ml, respectively, and the difference was also signiifcant (P<0.05). Conclusions The percentage of Th17 cells in PBMCs was obviously increased in HSP children. It is suggested that Th17 cells may play a role in the pathology of HSP.

Objective To analyze risk factors for soft-tissue defects after surgery on leg trauma,to discuss methods for prevention of soft-tissue defects and its treatment.Methods A retrospective analysis was conducted on 217 cases of soft-tissue defects with bone exposure and / or internal fixation exposure after surgery on leg trauma from January,1999 to December,2012.Soft-tissue defects with various flaps were used in 201 cases,including neurocutaneous flap(89 cases),random flap(21 cases),free flap(75 cases),cross-leg flap(16 cases),and by skin grafting in 16 cases.For the 117 internal plate-fixated fractures,96 removed the plate and 21 cases did not remove the plate.For the 13 intramedullary nail fixations,4 cases of intramedullary nails were removed,9 cases were not removed.For the 56 cases of external fixation of the fractures,39 patients had unadjusted external fixation,17 cases re-adjusted external fixations.Results Of the 217 cases of soft-tissue defect after surgery on legs,201 cases were conducted flap surgery.The flap was completely necrosis in one case,and partial distal necrosis were in 14 cases,of which 6 cases healed after changing the dressing,5 underwent debridement and skin grafting,3 cases underwent flap surgery again.In cases of fracture patients,177 cases healed within 1 year,delayed union 23 cases,nonunion eight cases.Nonunion healing after bone grafting and re-fixation surgery.In 9 cases of uncontrollable osteomyelitis,6 patients underwent bone removal and bone transport surgery,3 patients underwent amputation.Conclusion Soft-tissue defects after surgery on leg trauma is a serious complication whose prevalence is associated,in a certain degree,with incorrect surgical time and methods.It is crucial for early repair of soft-tissue defects by using various kinds of proper flaps whenever soft-tissue complication occurs.In patients with early stage internal fixation,flap surgery without internal fixation removing is feasible if little soft-tissue defect,little exposed internal fixation and mild infection,otherwise it is necessary to remove internal fixation and re-fix by external fixation before flap surgery.