Objective To explore early prognostic value of quantitative detection of paraquat (PQ) plasma concentration and urine sodium dithionite assay for prognosis in patients with acute PQ poisoning. Methods A prospective study was conducted. The patients with acute PQ poisoning admitted to Department of Emergency of First Hospital of China Medical University from August 2013 to December 2015 were enrolled. At admission, blood samples and urine samples were collected. The PQ plasma concentration was determined by high-performance liquid chromatography (HPLC), and the PQ urine concentration was determined by sodium dithionite, meanwhile the biochemical parameters were determined to carry out sequential organ failure assessment (SOFA) score. According to the prognosis of 90-day follow-up, the patients were divided into survival group and death group. Logistic regression analysis was used to analyze the relationship between the prognosis and the indexes, and the receiver operating characteristic curve (ROC) was drawn to evaluate the prognosis. Results There were 148 patients with acute PQ poisoning, with 43 alive and 105 dead, and the 90-day mortality rate was 70.9%. The ingestion volume (mL: 22.69±18.57 vs. 9.91±4.61), plasma concentration of PQ (mg/L: 2.28±1.52 vs. 0.91±0.38) and positive rate of urine sodium dithionite (87.6% vs. 14.0%) in death group were significantly higher than those of survived group (all P < 0.01), but no significant differences in gender, age, poisoning time, gastric lavage time between the two groups were found. Significant differences in white blood cell count [WBC (×109/L): 13.45±6.12 vs. 23.03±7.67] and blood lactate [Lac (mmol/L): 1.50±0.45 vs. 8.10±4.51] between survival group and death group were found (both P < 0.01), while no significant difference in SOFA score was found (0.98±0.72 vs. 1.34±1.29, P > 0.05). It was shown by logistic regression analysis that the key factors affecting the prognosis of patients with PQ poisoning were urine sodium dithionite assay [odds ratio (OR) = 8.731, 95% confidence interval (95%CI) = 2.828-26.954, P = 0.000], PQ plasma concentration (OR = 2.082, 95%CI = 1.204-3.603, P = 0.009) and ingestion volume (OR = 1.175, 95%CI = 1.048-1.318, P = 0.006) respectively. It was shown by ROC curve that the area under ROC curve (AUC) of plasma PQ concentration, urine sodium dithionite assay, poisoning dose and SOFA score for predicting the prognosis in patients with acute PQ poisoning was 0.866, 0.857, 0.826, and 0.631 respectively (all P < 0.05). The sensitivity of urine sodium dithionite assay for predicting the prognosis was 87.6%, and the specificity was 83.7%. Conclusions Early plasma PQ concentrations can objectively reflect the body absorbed toxicant doses and actual situation after poisoning, and help to judge the early evaluation of prognosis. The accuracy of urine sodium dithionite assay in judging the prognosis of PQ poisoning is high. Because of its simplicity and availability, it was easier to be performed in the primary hospital.

0.05).But,the count of lymphocyte in treatment group was higher than that in control group(P

Heterotopic ossification is a pathologic bone formation,and can lead to joint dysfunction.There are several related factors for heterotopic ossification,such as surgery and wound,cytokine,genetic factor and perioperative drugs,while the definite pathogenesis is still unclear.Mature heterotopic ossified bone shows similar images as normal bones,and dynamic histomorphologic measurements suggest contrast to normal bone,heterotopic ossified bone exhibits higher metabolic activity.Risk factors for heterotopic ossification include severe central nerve injury,long-term coma,limb spasticity,limb braking and increase of serum alkaline phosphatase.Related factors for heterotopic ossification at molecular level are important in future studies to provide support for the prevention and therapy in heterotopic ossification following trauma or surgery.

Fractures of the femoral head (FFH) are mainly seen in young adults,and the majority mechanism is due to dashboard injury in crushing vehicles.FFH can be present with or without posterior dislocation of the hip joint.Except for periarticular pain and hip dysfunction,the typical signs include flexion,adduction and internal rotation of the hip and shortening of involved limb.CT and MRI get their popularity as diagnostic methods for FFH.An emergency open reduction should be indicated in the scenario of failed closed reduction in FFH with posterior dislocation,of FFH with femoral neck fractures,of unmatched head and acetabulum following closed reduction and of deteriorating sciatic nerve damage.Pipkin as well as Brumback classification is still the most popularly used methods,which have great significance for establishment of surgical strategy and prediction of prognosis.More and more clinical evidences show conservative care of FFH should only be indicated for non-displaced fractures or displacement less than 2 mm.These cases must meet the following criteria simultaneously,including stable hip joint,concentric head and acetabulum,no free fractured fragments in the joint space and no labrum entrapment.Operative care is naturally the treatment of choice.Surgical approaches for FFH are hot topics in recent years.In previous control studies to compare Kocher-Langenbeck (K-L) and Smith-Peterson (S-P) approach,it is revealed less operative time,less blood loss and better operative field you can get in S-P approach,however,the incidence of ectopic ossification is higher.Ganz approach,which is characterized by osteotomy of great trochanter,hip capsulotomy and surgical dislocation of the hip,is a novel pattern for operative care of FFH.Ganz approach can show the entire femoral head,while can not damage medial femoral circumflex artery (MFCA) and induce iatrogenic osteonecrosis of the femoral head (ONFH).Various screws are the main implants for the fixation of fractured femoral head.Osteoarthritis and ONFH are two principal complications following FFH,which not only closely associate with severity and mechanism of primary injury,but also correlate with reduction quality and iatrogenic factors.Artificial hip joint replacement is a rational choice for extremely comminuted femoral head and these FFH in the elderly.

Objective To investigate the combination appr oach used to treat the complex acetab ular fractures.Methods Form January 1998to August 2001,31c ases of acetabular fractures were tr eated through combination of Kocher-Langenbeck a nd ilioinguinal approaches.26case s of them resulted from traffic injur ies,and 5from fall injuries.The average interval from injure to operation wa s 17.6days.The average blood loss wa s1890ml.The average operative duration was 252minutes.According to the classification of Letournel and Jud et,associated fracture types accounte d for 27cases,and simple type 4cases.They were fixed by the reconstructi ve plates and /or plates +lag screws.Results The average follow-up was 20.2month s.According to criteria of Matta,of the 20cases who underwent a natomic reduction,10were satisfac tory while 1unsatisfactory.21case s had excellent and good clinic results,8fair,2poor.Conclusion Because of the advantages of excelle nt ex-posure,convenient reduction,rigid fixation and lower heterotopic ossification,the combination approach is good to treat the complex acetabular fractu res involved the two columns.[

Objective To discuss the surgical treatment of delayed acetabular fractures and factors that affect the clinical outcomes. Methods From February 2001 to July 2005, 37 cases of delayed acetabular fractures were surgically treated. There were 22 males and 15 females, with an average age of 36.8 years (17 to 58). 10 cases were simple fractures and 27 complicated ones. The interval between injury and surgery averaged 44.8 days (21 to 399 days). 6 cases were treated through Kocher- Langenbeck approach, 1 ilio- inguinal approach, 2 extended ilio- inguinal approach, and 28 combined approaches. The mean operation time was 226 min (120 to 490 min). The average blood loss was 1 798 mL. Results The mean follow- up period was 18.9 months (6 to 56 months). Evaluation was conducted with Matta' s reduction criteria and modified D’ Aubigne and Postel clinical scoring. Reduction was anatomical in 31 cases, unsatisfactory in 4 and poor in 2. Clinical outcomes were rated as excellent in 21, good in 9, fair in 5 and poor in 2. There was 1 case of femoral head necrosis. Heterotopic ossification developed in 11 cases. In addition, transient paralysis of the sciatic nerve happened in 4 patients. Conclusions In principle, combined or extended ilio- inguinal approach should be reserved for the delayed acetabular fractures with the exception of simple fractures of posterior wall or/and posterior column, anterior wall and anterior column which can be managed by a single approach. The occurrence of arthritis correlates with the severity of the fracture. No direct relation has been found in this series between femoral head necrosis and femoral head dislocation before operation. Severity of fracture, interval between injury and surgery, and skills of orthopedists determine the clinical outcome, operation duration, and perioperative blood loss.

Objective To investigate the reliability of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in assessing the severity of acute respiratory distress syndrome (ARDS) in critically ill patients.Methods Forty-six patients with ARDS,who were admitted in our emergency intensive care unit,aged 18-72 yr,weighing 46-72 kg,of Acute Physiology and Chronic Health Evaluation Ⅱ score 11-25,were divided into 3 groups:PaO2/FiO2 ≤ 100 mmHg severe group (n =16);100 mmHg ＜PaO2/FiO2 ≤ 200 mmHg moderate group (n =14);200 mmHg ＜PaO2/FiO2 ≤ 300 mmHg mild group (n=16).Before treatment,and at 24 and 72 h after diagnosis of ARDS,PVPI,EVLWI,cardiac index (CI),and intrathoracic blood volume index (ITBVI) were measured,and blood gas analysis was performed.PaO2/FiO2 was calculated.The 28 day fatality after admission to hospital was recorded.Person correlation of PVPI and EVLWI with PaO2/FiO2,ITBVI and CI was analyzed.Results The PVPI,EVLWI and fatality rate were significantly higher at each time point in moderate group and severe group than in mild group,and in severe group than in moderate group (P＜0.05).The correlation coefficient between PVPI and PaO2/FiO2 was 0.778,and between EVLWI and PaO2/FiO2 was-0.437 (P＜0.05).There was no correlation between CI and ITBVI (P＞0.05).The correlation coefficient between EVLWI and PaO2/FiO2 was-0.448,and between EVLWI and ITBVI was 0.347 (P＜0.05).There was no significant difference between the correlation coefficient between PVPI and PaO2/FiO2 and the correlation coefficient between EVLWI and PaO2/FiO2 (P＜0.05).Conclusion PVPI and EVLWI both can assess the severity of ARDS in critically ill patients,showing a consistent reliability.

Objective To optimize human acellular dermal matrix(ADM) and evaluate its biological characters. Methods Human skin was treated with hypertonic saline followed by NaOH maceration(group A), hypertonic saline followed by sodium dodecyl sulfate (SDS) detergent(group B) or Dispase Ⅱ followed by Triton X-100(group C), the resulting ADM were sectioned, and then were stained by special immunohistochemistry method. The cytotoxicity of them were evaluated by methyl thiazolyl tetrazolium (MTT) colorimetry and then cell compatibility was analyzed by cell culture;The optimized ADM resulted was choosen for use. Fibrablasts(FBs)were transfected with adenovirus vector encoding green fluorescent protein gene(Ad-GFP)and the growth of them on the optimized ADM was observed by fluorescent microscopy. Results Collagen and elastic fibers can still be observed in three kinds of ADM. The cells in dermis can be disintegrated both in group A and C, but not in group B. The cytotoxicity scores of the ADM prepared in group A and B were grade 0 or grade 1, while that of group C was more than grade 1.The ADM prepared by NaCl-NaOH maceration had good biocompatibility. There was statistical difference in adhering number of NIH3T3 cells in group A and B. NIH3T3 cells grew well in group A and the resulted ADM was optimized. FBs transfected with Ad-GFP grew well in the optimized ADM. Conclusion The ADM prepared by NaCl-NaOH maceration was a good tissue engineering biomaterial with a little cytotoxicity and rich in resouce.

Objective To discuss factors influencing the heterotopic ossifications (HO) after treatment of bi-column acetabular fractures. Methods One hundred and ninety-three cases of bi-column acetabular fractures were followed up, including 147 males and 46 females with an average age of 34. 4 years. Thirty-one cases were associated with craniocerebral trauma. The interval between injury and surgery was less than 1 week in 15 cases, 1 to 2 weeks in 121 cases, 2 to 3 weeks in 34 cases, and over 3 weeks in 23 cases. Factors that might have influenced HO, including surgical method, associated injury, and interval between injury and surgery, were analyzed retrospectively. Results All the cases were followed up for an average of 44. 2 (14 to 84) months. The mean operation time was 238 (150 to 330) minutes, and the average blood loss was 1453 (450 to 4400) mL. The incidence rate of HO was 39. 9% (77 in 193 cases), including 39 cases of degree one, 23 cases of degree two, and 15 cases of degree three. Of the 77 cases associated with HO, 14 had craniocerebral trauma and 63 did not (χ~2 = 0. 019, P = 0. 891) . HO was found in 2 cases that had been operated on in less than 1 week, 38 cases in 1 to 2 weeks, 21 cases in 2 to 3 weeks, and 16 cases in over 3 weeks. The Spearman correlation analysis between HO degree and clinical result showed no correlation ( R = 0. 041, P =0. 722). Only 15 cases (7. 8% ) were associated with HO after the debridement of the necrotic gluteus minimus. Conclusions HO after surgery for bi-column acetabular fractures may not be correlated with craniocerebral trauma, but highly correlated with the interval between injury and surgery. Debridement of necrotic gluteus minimus and other muscles can reduce the incidence of HO.

Objective To report the clinical results of the treatment of subtrochanteric fractures of the femur with reconstruction intramedullary nails. Methods 51 cases of femoral subtrochanteric fractures were treated with reconstruction intramedullary nails in our department in the period from January 1997 to June 2003. Among them 9 cases belonged to Russell Taylor type ⅠA, 26 ⅠB, 2 ⅡA, and 14 ⅡB. 34 patients sustained high energy injury, and 17 low energy one. 17 cases had some complicated injuries. 5 cases were open fractures. Results The mean follow up of 18.5 (3 36) months revealed that fractures healed in all the 51 cases. The clinical healing time of the fracture averaged 13.5 (8 26) weeks after surgery. The functional evaluation was done by Sanders traumatic hip rating scale. The good and excellent rate was 94.11%(48/51). Three elderly patients experienced hip pain after surgery. There were no infection,varus deformity and implant breakage. Conclusion The Russell Taylor reconstruction intramedullary nail can be used to treat all kinds of femoral subtrochanteric factures with good results, high union rate and rare complications.