Pelvic fracture is a complex fracture,unstable pelvic fracture needs surgical operation.Early open reduction and internal fixation would be benefit for functional rehabilitation,help to reduce mortality,blood loss and late complications.Surgical approaches include iliac-groin approach and Kocher Langenbeck approach.There are many iatrogenic injuries of surgery,including vessels,nerves and viscerals injuries.Once the injuries happened the consequences are very serious.So,preventing these iatrogenic injuries is crucial.Only if we are familiar with surgical approach and research the clinical anatomy much more,we could reduce the occurrence of iatrogenic injury utmostly.

[Objective]To construct arecombinant eukaryotic expression plasmid carrying human BMP-7 gene which was transfected into bone marrow stromal cells(BMSCs) in vitro and expressed.[Method]Clone human BMP-7 cDNA from a Chinese woman placenta was recombinanted with plasmid pcDNA3.1,to construct eukaryotic expression carrier of recombinaut pcDNA3.1-hBMP-7.The BMSCs were isolated from rabbit bone marrow and cultured in vitro.They were divided into three groups: pcDNA3.1-hBMP-7 transduced group;pcDNA3.1 transduced group;untransduced group.The expression of hBMP-7 was detected by RT-PCR,Immuneohistochemistry.ALP,Collogen,Osteocalcin production were detected.[Result]The pcDNA3.1-hBMP-7 transduced BMSCs expressed hBMP-7 at both mRNA and protein levels.ALP activity was detected in pcDNA3.1-hBMP-7 transduced cells from day 2 to day 10,peaking on day 8.Collogen,osteocalcin production were elevated significantly too(P

Objective To observe the effects of dexmedetomidine combined with propofol on the hemodynamics level in elderly patients undergoing gastroscopy.Methods 68 patients undergoing endoscopy from January 2014 to January 2015 in our hospital were selected and randomly divided into observation group and control group, 34 cases in each group.Propofol anesthesia combined with dexmedetomidine was used in the observation group and propofol anesthesia was used in the control group.The RR ( respiratory rate) and HR ( heart rate) of the two groups were observed before the administration (T0), after the administration (T1), when the gastroscope was inserted (T2), after the examination (T3), 5 min after the examination (T4), MAP (mean arterial pressure) and SpO2(pulse oxygen saturation) were measured.The postoperative consciousness, orientation recovery time and surgical tolerance were compared between the two groups.The anesthetic adverse reactions were recorded during the operation.Results The observation group in T1, T2, T3, T4 time point HR were lower than the control group, and the data remained relatively stable level, the difference was statistically significant (P<0.05).There was no significant difference in consciousness recovery time and recovery time of orientation force between observation group and control group.The tolerance of the observation group was higher than that of the control group, the difference was statistically significant (P<0.05).The total adverse reaction rate of the observation group was 32.35% lower than that of the control group 88.24%, the difference was statistically significant ( P <0.05 ) .Conclusion Dexmedetomidine combined with propofol for the elderly patients with painless gastroscopy , analgesic effect is good, and can better maintain hemodynamic fluctuations, reduce propofol anesthesia adverse reactions, does not Affect the patient's awareness and ability to restore the direction.

Objective To evaluate clinical the effects and significance of the occurence and development of varies intervention on control of acute lung injury(ALI)in clinical practice.Methods Sixty-nine ALI patients were randomly divided into three groups:traditional ventilation therapy group(n=17),low dose ulinastatin intervention with traditional ventilation therapy group(n=24)and high dose ulinastatin intervention in lung protective ventilation therapy group(n=28).We compared the changes of pneumodynamics,arterial blood gas and hemodynamics among these groups.Resident time in ICU,time course of mechanical ventilation and mortality of these groups were also compared.Results Large dose ulinastatin intervention in lung protective ventilation therapy group had further improved influence on pneumodynamics,arterial blood gas and puhnonary oxygenation than other groups(P＜0.05)and no mechanical ventilation induced lung injury was found in the group.There were no obvious differences in pneumodynamics,arterial blood gas and pulmonary oxygenation between the other two groups(P＞0.05).Lung injuries induced by mechanical ventilation were all observed in these two groups.There were no obvious differences in hemodynamics among the three groups(P＞0.05).Conclusions Large dose ulinastatin intervention in lung protective ventilation can improve pneumodynamics,arterial blood gas and pulmonary oxygenation of ALI patients.It could decrease the incidence of ventilator induced lung injury(VILI).The treatment should been applied prospectively in clinical practice.

Objective To investigate the relationship between estrogen replacement therapy and female patients with Alzheimer's risk. Methods We searched the PubMed, Springer, CBM, CNKI, VIP database for studies on the es-trogen replacement therapy and women with Alzheimer's disease, retrieval time from database to 2012 December. We evaluated the methodological quality of the included studies, used RevMan 5.0 software to analyze the extracted data. Results We found seven case-control studies which included 1392 patients and 2719 controls. The meta analysis re-sults show that the proportion of estrogen replacement therapy in AD group is significantly lower than that of the con-trol group, the difference has statistically significant [OR=0.68, 95%CI(0.50,0.90), P=0.01]. Conclusions estrogen re-placement therapy has effects on female patients with Alzheimer's disease, and is a protective factor.

Objective To evaluate the significance to detect the Ryanodine receptor (RyR) antibody in the sera of myasthenia gravis (MG) patients.Methods Sarcoplasmic reticulum abound with RyR was extracted by centrifugation,and levels of antibodies in 66 MG patients with thymoma (MGT),98 non-thymoma MG (NTMG) patients,50 non-myasthenia gravis (NMG) patients and 123 normal persons were examined by ELISA-RyR method.Results RyR antibody positive rate of MGT was the highest among MGT,NTMG and NMG groups ( P 0.05).Ages,clinical scores and levels of acetycholine receptor antibodies of patients with RyR antibody positive sera were higher than those with RyR antibody negative sera ( P

Objective To observe the clinical, neuropathogical, neurophysiological characteristics of Charcot-Marie-Tooth disease, type 1A (CMT1A) which was similar to chronic inflammatory demyelinating polyradiculoneuropathy(CIDP).Methods The clinical data, neuroelectrophysiological changes and pathological features of sural nerve biopsy were taken from 2 CMT1A patients who were proven to be 17p12 duplication with CIDP features, and analyzed comprehensively. Results Two CMT1A cases with classical chronic course showed both subacute course and clinical manifestations similar to CIDP, however, the changes of neuroelectrophysiology and pathological characteristics of the nerve biopsy in 2 cases were different from CIDP in some way. We confirmed the chronic inflammatory demyelinating type of the CMT1A patients whom the immunotherapy was effective on.Conclusion The classical CMT1A 17p12 duplication patients who obtained immunotherapy effects might resemble CIDP both in clinical course and manifestation.

Objective It has been shown that partial liquid ventilation (PLV) with perfluorocarbon (PFC) can reduce intrapulmonary aggregation of neutrophils (PMNs) and macrophages and their cytokine release during acute lung injury (ALI) . The purpose of this study was to investigate the effect of PFC on activation of nuclear factor-kappa B (NF-?B) in neutrophils induced by lipopolysacchride (LPS) .Methods PMNs were isolated from peripheral blood obtained from 36 healthy volunteers and incubated in RPM 1640 cell culture medium yielding a concentration of 1?108/ hole. The PMNs were randomly divided into two groups : (Ⅰ) LPS group in which PMNs were incubated with LPS 10?g?ml-1(n = 18) and (Ⅱ) PFC group in which 5 min after stimulation of PMNs with the same concentration of LPS (10?g?ml-1 ) , PFC was added to the cell suspension with the final concentration of PFC / cell culture medium (vol / vol) of 0.3 (n=18 ). After incubation with LPS for 3 h (T1), 8h (T2) and 24 h (T3), the cell suspensions were centrifuged. The supernatants were analyzed for TNF-? concentration and gray value of activated NF-?B was measured in the nuclear of neutrophils. Results The concentration of TNF-a and gray value of NF-?B in PFC group were significantly lower than those in LPS group at all time points ( P

Objective To investigate the efficacy of patient-controlled epidural analgesia(PCEA)with ropivacaine plus fentanyl for postoperative analgesia after suprapubic prostatectomy(SPP).Methods Thirty-six ASAⅡorⅢpatients aged 62-78 yrs weighing 52-84 kg undergoing SPP were randomly divided into 3 groups with 12 patients in each group:groupⅠreceived PCEA with 0.12% ropivacaine and fentanyl 1?g?ml~(-1);groupⅡreceived PCEA with 2% ropivacaine and fentanyl 1?g?ml~(-1) and groupⅢreceived patient-controlled intravenous analgesia(PCIA)with morphine 0.2 mg?ml~(-1).Postoperative pain was assessed using VAS(0=no pain,10= worst pain).The degree of motor blockade(modified Bromage scale)was evaluated at 6,24,48 and 72 h after operation(T_(1-4)).Bladder spasm episodes were recorded.Side effects including nausea,vomiting and pruritus and the total number of RBC in rinse solution were also recorded.Results(1)Bromage score(0=no motor block,3 =inability to flex ankle joint)was significantly higher in groupⅠandⅡthan in groupⅢat T1(6 h after op.), but significantly lower in groupⅠandⅢthan in groupⅡat T_(2-4)(24-72 h after operation).(2)VAS score(0= no pain,10=worst pain)was not significantly different among the 3 groups without bladder spasm but significantly higher in groupⅢthan in other 2 groups during episodes of bladder spasm.(3)The number of bladder spasm episodes was not significantly different among the 3 groups within 6h after operation,but was significant larger in groupⅢthan in the other two groups during 6-72 h after operation.During 6-24 h after operation more bladder spasm attacks occurred in groupⅠthan in groupⅡ.(4)The incidence of side effects was significantly lower and the total number of RBC in rinse solution was significantly smaller in groupⅠandⅡthan in groupⅢConclusion PCEA with 0.12% or 2% ropivacaine plus fentanyl can effectively reduce the number of bladder spasm attack and postoperative bladder bleeding.Different concentrations of ropivacaine should be used for PCEA during different postoperative periods.

3 cases with esophageal fistula following anterior cervical fixation were reported. The diagnosis, treatment, nursing and prevention were summarized with literature.