ObjectiveTo explore the efficacy of posterior approach in treatment of crescent pelvic fracture.MethodsBetween April 2007 and January 2010, 12 patients with crescent pelvic fracture were treated via posterior approach at our department. They were 8 men and 4 women, aged from 21 to 55 years (average, 31.3 years). Six left and 6 right sides were affected. The fractures were caused by a traffic accident in 8 cases, high falling in 3 cases and heavy weight crushing in one. By Tile classification, there were 8 cases of type B2. 1 and 4 cases of B2.2. The time from injury to operation was 3 to 9 days, with an average of 6. 2 days. They were treated with open reduction and internal fixation via the posterior approach. Operation time,intraoperative blood loss, postoperative loss of pelvic ring reduction, fracture healing time and Hannover pelvic outcome scoring were documented.ResultsThe average operation time was 172.5 ± 34. 1 minutes(from 120 to 240 minutes) . The average blood loss was 412.5 ±- 128.1 mL(from 250 to 700 mL) . The average reduction gained was 11.7 ±4. 6 mm(from 6 to 21 mm). Ten patients obtained an average follow-up of 16. 3 months (from 12 to 20 months). The X-ray films showed bony healing in all patients after an average of 3. 1 ± 0. 3 months(from 3 to 4 months). There was no postoperative loss of pelvic ring reduction or implant failure.By the Hannover scoring system, 7 patients were rated as excellent and 3 as good in clinic symptoms, and complete social reintegration was obtained in 8 cases and incomplete one in 2 cases.ConclusionOperation via posterior approach is a good choice for treatment of crescent pelvic fracture.

OBJECTIVE: To summarize the current situation and progress of treating transverse acetabular fractures using different types of internal fixations. DATA SOURCES: The databases including PubMed were retrieved using key words of "acetabular/acetabulum, fracture, plate/plates, screw/screws, cable" both in English and Chinese. DATA SELECTION: The basic research, clinical research, review articles, as well as case reports concerning operation opportunity, and internal fixation methods were included. And repeated papers or articles with incomplete data were excluded. MAIN OUTCOME MEASURES: Totally 35 papers were selected, including 3 review articles, 8 basic research and 24 clinical research. RESULTS: Open reduction and internal fixation has been a preferred treatment for transverse acetabular fractures. The goals of treatment are anatomical reconstruction of articular surfaces and rigid internal fixation of the fragments of the fracture, so that to get early active motion. Reconstruction plate was characterized by great strength, good toughness, stable fixation, as well as excellent histocompatibility, which has accepted as standard internal fixation materials. However, the application of newly developed system, such as locking plate, absorbable screws, shape memory alloy staple, and acetabular memory internal fixation system, has received a better clinical results. CONCLUSIONS: There are plenty of internal fixations can be used in treating transverse acetabular fractures, and the reconstruction plate is the most accepted one. Actually, the internal fixations should be combined together to obtain a good result if necessary.

From January 2006 to December 2007,44 cases of humeral shaft fractures were admitted to Department of Orthopaedics,Sixth People's Hospital of Shanghai Jiao Tong University,including 29 males and 15 females,with an average age of 40.7 years old(ranging 19-89 years).Of them,13 cases of fracture involved upper segment,24 involved middle segment and 7 lower segment.All fractures were close fractures.According to AO/ASIF classification,there were 5 cases of type A1,11 of A2,6 of A3,6 of B1,12 of B2,and 4 of B3.All patients were treated by expendable intramedullary nailing system.Time of operation,hospitalization and healing,blood loss,intra-or postoperative complications and range of shoulder and elbow motion were recorded and analyzed statistically.X-ray was shot to observe the union of fractures.The expendable intramedullary nailing was successfully performed in all patients for 86 minutes(ranging 30-150 minutes).The blood loss ranged from 30 to 200 mL with a mean of 70 mL.Except primary injury-caused radial paralysis,no iatrogenic radial paralysis occurred.All 44 patients were follow-up with an average of 18 months.Of them,41 patients had fracture union,and 3 nonunion.The average healing time was 15.8 weeks.There were 15 patients complained of pain in the shoulder joint,which did not affect daily life.According to UCLA shoulder scoring system,an excellent result was found in 18 patients,good in 23 patients,and fair in 3 patients with an excellent/good rate of 93.2%.All the patients had the excellent results according to Mayo elbow performance score system.No infection,iatrogenic fracture,limb shortening,nail breakage,fat embolism syndrome or peripheral nerve injury was found.The expandable nail offers the advantages of little blood loss,reduced operation time and exposure to radiation.However,nail antegrade insertion may lead to shoulder pain,and it should be paid more attention for cases of rotational instability in inferior segment of the humerus.

Congenital bile duct cysts, which is a kind of malformation of bile duct, will lead to the inflammation in the bile duct system for a long time. Therefore, patients with cholelithiasis and cyst canceration have a risk. Surgical operation is the only treatment option for the congenital bile duct cysts patients. Resection of the cysts and complete " biliary-pancreatic duct shunt" are the key points of the standardized treatment of congenital bile duct cysts. The non-standard surgical treatment will bring the postoperative complications such as the stricture of choledochojejunostomy, the remnant cysts and even the canceration of cysts, which will seriously affect the quality of life and threaten the health of patients. Based on the retrospective study of congenital bile duct cysts patients in Eastern Hepatobiliary Hospital, the author proposed a new classification system according to the pathological and anatomical characteristics of congenital bile duct cysts. The congenital bile duct cysts can be divided into three regions and five types, i. e. localized type and diffuse type of extrahepatic bile duct cysts of hilar, trunk and terminal type; central type; and intrahepatic bile duct cysts of limited and diffuse type. It is our hope that this typing system will accurately guide the design and implementation of surgical treatment plans for congenital bile duct cysts and reduce the risk of long-term postoperative complications for patients.

BACKGROUND:Genetic factors, environment, chronic infection, and autoimmune disorders are considered to be involved in the pathogenesis of ankylosing spondylitis. Genetic factors play an important role in the pathogenesis of the disease. Ethnic and regional diversity of differentialy expressed genes has become research hotspot because of family aggregation and ethnic diversity of ankylosing spondylitis.
OBJECTIVE:To screen differentialy expressed genes in Xinjiang Uygur and Han patients with ankylosing spondylitis by microarray screening and compare differences in gene expressions.
METHODS: Uygur and Han patients with active ankylosing spondylitis in department of rheumatology of our hospital were randomly colected with five patients for each. In addition, three healthy volunteers were selected as controls. RNA from peripheral blood was extracted and used for microarray hybridization after probe preparation to screen differentialy expressed genes in ankylosing spondylitis samples and the microarray results were verified by semi-quantitative RT-PCR analysis.
RESULTS AND CONCLUSION: Twenty differentialy expressed miRNAs were screened in Uygur and Han patients with active ankylosing spondylitis (P < 0.05). From relationship analysis of target genes and miRNAs, 15 target genes corresponding to the 79 miRNAs involved in human leucocyte antigens and interleukins which linked to human immunity system were found. These findings suggest that differentialy expressed genes can be screened from Uygur and Han patients with ankylosing spondylitis.

Objective To investigate the risk factors for postoperative liver failure of patients with hepatocellular carcinoma (HCC) and bile duct tumor thrombus through a risk evaluation model.Methods The clinical data of 107 patients with HCC and bile duct tumor thrombus who received hepatic resection at the Eastern Hepatobiliary Surgery Hospital from March 2002 to February 2011 were retrospectively analyzed.All patients were divided into the non-liver failure group (98 patients) and liver failure group (9 patients).Risk factors associated with liver failure were analyzed and a risk evaluation model was established.All data were analyzed using the bivariate regression model,and factors with significance were further analyzed using the multivariate regression model.Results Of the 107 patients,105 received hepatic resection + choledochotomy + thrombectomy and 2 received hepatic resection + extrahepatic bile duct resection + cholangiojejunostomy.The operation time was 2.0-5.5 hours,and the intraoperative blood loss was 200-3500 ml.In the non-liver failure group,5 patients had pleural and peritoneal effusion,3 had biliary bleeding,2 had incisional infection,1 had biliary infection,1 had bile leakage,1 had stress-induced ulcer of upper digestive tract and 1 had thoracic epidural hematoma.The bleeding of the patients with thoracic epidural hematoma was stopped after thoracic spinal decompression,but subsequent paraplegia occurred.In the liver failure group,2 patients died of postoperative acute liver failure,and 7 patients died of postoperative subacute liver failure (death caused by tumor recurrence or medicine was excluded).The results of univariate analysis showed that preoperative total bilirubin,albumin,pre-albumin,albumin/globulin ratio,distribution of tumor thrombus,operative blood loss and ratio of postoperative residual liver volume to the total liver volume were correlated with the postoperative liver failure in patients with HCC and bile duct tumor thrombus (OR =3.017,0.191,0.248,2.681,9.048,4.759,13.714,P ＜ 0.05).The results of multivariate analysis showed that preoperative total bilirubin ＞ 256.5 μmol/L,albumin/globulin ratio ≤ 1.3 and postoperative residual liver volume ＜ 50％ were the independent risk factors of postoperative liver failure (OR =5.537,11.107,172.450,P ＜ 0.05).The risk evaluation model was Z =1.77 × preoperative total bilirubin + 2.408 × preoperative albumin/globulin ratio + 5.150 × ratio of postoperative residual liver volume to the total liver volume-17.288.The risk of postoperative liver failure increased as the increase of Z value.The risk of postoperative liver failure ＞ 50％ when the Z value ＞ 0.Conclusions Preoperative total bilirubin ＞ 256.5μmol/L,albumin/globulin ratio ≤ 1.3 and postoperative residual liver volume ＜ 50％ were the independent risk factors of postoperative liver failure.Risk evaluation model is helpful in screening the risk factors so as to decrease the incidence of postoperative liver failure.

Objective To study the effects of the antiarrhythmic drugs of propafenone, amiodarone and dilthiazem on c-type Kv1. 4 channels in Xenopus laevis oocytes with two-electrode voltage-clamp technique. Methods Defolliculated oocytes ( stage Ⅴ - Ⅵ) had transcribed cRNAs of ferret Kv1. 4△N channels injected. The oocytes were continuously perfused with control solution or propafenone, amiodarone and dilthiazem under monitoring of software of Clampfit v 9. 0. Results All of the three drugs blocked ferret Kv1. 4△N channel in voltage-, frequency- and concentration-dependent manners. The values of IC50 (50%inhibiting concentration ) of propafenone, amiodarone and dilthiazem were ( 103.4± 2. 2 ) μ mol/L,(501.22 +5.9) μmol/L and (353.62 +9.9) μmol/L, respectively. The currents under the actions of propafenone , amiodarone and dilthiazem were decreased to 41%, 32% and 21% of control group, respectively. Propafenone (100μ mol/L), Amiodarone (500μmol/L), dilthiazem (350μmol/L) inhibited currents to (54. 6 + 1.9 ) %, ( 46. 3 + 3.5 ) %, ( 52. 8 ± 2. 8 ) % of control group in voltage-dependent blockage. Conclusions The results suggested that all the three drugs blocked the kv1. 4△N channel in the open state. The three drugs block the kv1. 4△N channel maybe had the similiar effects in some respects, but each had its unique characteristics.

Objeetive To analyze traffic accidents involving pedestrians in Chongqing from 2000 to 2006 so as to understand injury characteristics of the pedestrians. MethodsThe data of pedestrian road traffic crashes and injuries in three districts including one district in downtown,one in suburb and one in county of Chongqing from 2000 to 2006 were collected from road traffic crash and road traffic injury database to analyze severity of crashes,casualties,action and location of pedestrians in crashes. Results The road crashes led to 7 934 pedestrian injuries (24.74％) and 867 pedestrian deaths (49.46％).Intensity of the pedestrian road crashes in rural areas was higher than that in downtowns and suburbs.Of all pedestrian casualties,57.91％ were due to illegally crossing the driveway,and 15.43％ of the casualties were on the crosswalk.Most of the casualties occurred on the main roads,the third class highways and second main roads in Chongqing.But serious crashes occurred on the first and second class highways and substandard highways,which led to average 3.17,4.13 and 5.42 deaths,respectively.Pedestrians accounting for 52.46％ of the total severe injuries were more than the proportion among the minor to moderate injuries.Head injuries were the most common for the pedestrians and chest injuries were also usual among the severe injuries. Conclusions The intensity of pedestrian road crashes is higher than that of other crashes,especially in rural areas.It should be noticed that the main injuries of the pedestrians are head injuries,which is mainly resulted from illegally crossing driveway.It is worth noticing that a rather high proportion of pedestrians are impaired on the crosswalks,indicating that we should pay more attention to protect right of the pedestrians on the crosswalks during transportation law enforcement and safety education in the future.

Objective To establish a road traffic crash (RTC) & traffic injury (RTI) database database with scientific and reasonable structure. Methods ( 1 ) A set of scientific and standard RTC&RTI survey form was made and a software for collection of data on RTC&RTI developed. (2) The general data on RTI&RTI of China was obtained from traffic management departments of China and the data of some districts in Chongqing from 2000 to 2006 were obtained. All the data were input into the database for analysis. Results A TRC&RTI database software V1. 0 was developed based on the survey form. The input items included data about the areas where the accidents occurred, the general situation of the specific accident, the road conditions, the accident causes and responsibilities, the vehicle and the injury to persons. We obtained the RTC and RTI data of China during past 13 years and collected data on 33 987 cases of RTC and 52369 RTI of four districts in Chongqing. The RTC&RTI database was established. Conclusions The database has involved detailed data of general road crashes and injury as well as individual crash, which provides a good support for further study of RTC and RTI.

Objective:To study the effect of microsurgery for parasellar menningiomas and to analyze the impact factors of recurrence. Methods:Clinical and follow-up data in a consecutive series of 134 patients with parasellar meningiomas were retrospectively analyzed. Results:A total of 109 patients (81.3%) had radical removal (Simpson grade I and II), and 116 patients were followed up for an average period of 81.6 months. The mean quality of life score (KPS) was 91.9, 90 patients regained full daily activity and 16 patients were able to take care of themselves. Oculomotor paralysis occurred in 7 patients, epilepsy in 8, and another 9 patients suffered hemispheral paralysis. Tumor recurred atfer the radical removal in 12 out of the 96 follow-up patients (12.5%). Tumor progressed atfer subtotal removal in 12 out of the 20 follow-up patients (60%). Tumor with cavernous sinus (CS) invasion had significantly higher risk of recurrence campared with non-CS invasion (P=0.043). The recurrence rate increased with the pathological grade (P<0.01). Conclusion:Patients with parasellar meningiomas undergoing microsurgical resection may have a good long-term function outcome. For most patients, total removal by microsurgery is the ifrst choice. Careful follow-up is needed if tumor invaded the CS and radiosurgery is proposed for WHO grade 1 and 2.