Objective: To clarify the pathologic change of the motor neuron on spinal cord ischemia reperfusion injury delayed paraplegia. Methods: The infrarenal aorta of White New Zealand rabbits (n=24) was occluded for 26 minutes using two bulldog clamps. Rabbits were killed after 8, 24, 72, or 168 hours (n = 6 per group), respectively. The clamps was placed but never clamped in sham-operated rabbits (n = 24). The lumbar segment of the spinal cord (L5 to L7) was used for morphological studies, including hematoxylin and eosin staining, the expression of bcl-2 and bax proteins in spinal cord was detected with immunohistochemistry. The apoptotic neurons in spinal cord were measured with terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end-labeling of DNA fragments (TUNEL) staining. Results: Delayed paraplegia occurred in all rabbits of ischemia reperfusion group at 16-24 hours, but not in sham groups. Motor neurons were selectively lost at 7 days after transient ischemia. After ischemia, the positive expression of bcl-2 protein were in the sham controls but decreased significantly as compared with that of the IR group (P<0.01), especially in 72 hours reperfusion. The positive expression of bax protein were also in the sham controls, but increased in the IR group, especially in 72 hours reperfusion; In addition, TUNEL study demonstrated that no cells were positively labeled until 24 hours after ischemia, but nuclei of some motor neurons were positively labeled at peak after ischemia reperfusion at 72 hours. Conclusion: Spinal cord ischemia in rabbits induces morphological and biochemical changes suggestive of apoptosis. These data raise the possibility that apoptosis contributes to neuronal cell death after spinal cord ischemia reperfusion.

Objective To clarify the pathologic change of the motor neuron on spinal cord ischemia reperfusion injury delayed paraplegia. Methods The infrarenal aorta of White New Zealand rabbits (n=24) was occluded for 26 minutes using two bulldog clamps. Rabbits were killed after 8, 24, 72, or 168 hours (n=6 per group), respectively. The clamps was placed but never clamped in sham-operated rabbits (n=24). The lumbar segment of the spinal cord (L5 to L7) was used for morphological studies, including hematoxylin and eosin staining, the expression of bcl-2 and bax proteins in spinal cord was detected with immunohistochemistry. The apoptotic neurons in spinal cord were measured with terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end-labeling of DNA fragments (TUNEL) staining. Results Delayed paraplegia occurred in all rabbits of ischemia reperfusion group at 16-24 hours, but not in sham groups. Motor neurons were selectively lost at 7 days after transient ischemia. After ischemia, the positive expression of bcl-2 protein were in the sham controls but decreased significantly as compared with that of the IR group (P＜0.01), especially in 72 hours reperfusion. The positive expression of bax protein were also in the sham controls, but increased in the IR group, especially in 72 hours reperfusion; In addition, TUNEL study demonstrated that no cells were positively labeled until 24 hours after ischemia, but nuclei of some motor neurons were positively labeled at peak after ischemia reperfusion at 72 hours. Conclusion Spinal cord ischemia in rabbits induces morphological and biochemical changes suggestive of apoptosis. These data raise the possibility that apoptosis contributes to neuronal cell death after spinal cord ischemia reperfusion.

ObjectiveRecurrent rupture of Achilles tendon is a severe complication after primary repair.The optimal treatment remains controversial.This study was in aiming to explore the risk factors of recurrent ruptures of Achilles tendon,to evaluate the indication,outcome and complications of reconstructing Achilles tendon recurrent ruptures by V-Y advancement flap and Flexor Hallucis Longus tendon (FHL) transfer.MethodsWe retrospectively studied 16 cases who underwent reconstruction of Achilles tendon recurrent ruptures from Mar,2006 to Jan,2010.Among them there were 12 males and 4 females with the mean age of 50.9 years(35-72 years).The period of time between recurrent rupture and primary operation was 6-49 weeks(ave.21.8 weeks).The follow-up interval was 6-52 months (ave.27.5 months).During operatin,4 cases with a rupture gap less than 4 cm had received V-Y advancement flap and 12 cases with a rupture gap more than 4 cm had received FHL transfer.At the time of follow-up,all patients were assessed with the American Orthopaedic Foot and Ankle Society(AOFAS) Ankle-Hindfoot Scale and Leppilahti Achilles Tendon Repair score.ResultsThe average AOFAS score had increased from 70.2±8.5 preoperatively to 92.4±6.1postoperatvely.Leppilahti Achilles Tendon Repair score had increased from 74.8±6.2 preoperatively to 91.7±4.8 postoperatvely.MRI of Achilles tendon showed even signal without signs of tear.ConclusionV-Y advancement flap could repair a rupture gap within 4 cm,FHL transfer is suitable for rupture gap over 4 cm in reconstruction of Achilles tendon recurrent ruptures.

ObjectiveTo evaluate effect of periarticular osteotomy in the treatment of asymmetrical ankle arthritis.MethodsSixty-five patients with asymmetrical ankle arthritis were treated with periarticular osteotomy between February 2005 and May 2011,including 43 females and 22 males,aged from 35 to 74 years (mean,55.5 years).According to the Takakura classification of ankle arthritis,there were 29 patients in grade 2,32 in grade 3 and 4 in grade 4.Supramalleolar tibial osteotomy were performed in 20 patients,supramalleolar tibial and fibular osteotomy in 12,supramalleolar osteotomy combined with calcaneal osteotomy in 30 patients,and supramalleolar tibial and fibular osteotomy combined with calcaneal osteotomy in 3patients.Forty three patients underwent ligament reconstruction procedures.Based on radiographs,the tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were compared before and after operation.AOFAS-AH score was used to evaluate the function of the ankle.ResultsFifty-nine patients were followed up for an average of 35.7 months (range,7 to 94 months).Bone healing was observed in all patients,and the average healing time was 7 to 8 weeks.The average AOFAS-AH score was improved from 49.7 points preoperatively to 78.6 points 12 months postoperatively.Tbe average TAS and TLS was improved from 86.1° and 70.0° preoperatively to 93.9° and 81.5° 6 months postoperatively,respectively.Delayed wound healing occurred in 5 patients,which was resovled after nursing care.Forty-two patients felt excellent about results,15 felt good and 2 fell fair.ConclusionPerarticular osteotomy is a sound method in the treatment of asymmetrical ankle arthritis,based on chosing proper patients.The procedure can decrease the contact pressures on the degenerated cartilage and prolong the life span of the ankle.

Objective To discuss the pathomechanism of medial ankle instability after medial ligament injury. Methods The study involved 15 patients including eight males and seven females, at average age of 40 years (range 22-58 years). There were two patients with acute ankle sprain, three with chronic ankle injury, three with congenital pes planus, five with posterior tibial tendon dysfunction, one with pronation external rotation ankle fracture and one with old avulsion medial malleolus. All patients were treated surgically with deltoid ligament repair, when eight patients further received calcaneal lengthing osteotomy, five received medial cuneiform close wedge osteotomy and one received medial shift calcaneal osteotomy. All patients were followed up for 7-56 months. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale was used for pre- and post-operative evaluation of the function. All data were analyzed using t test. Results The clinical data of one patient was excluded from the statistical analysis because AOFAS ankle-hindfoot scale could not be applied for evaluating the acute ankle fracture. The AOFAS ankle-hindfoot scale was 42.4 + 10.6 before surgery and 89.8 +6.2 at the final followup for 14 patients (P＜0.05). Conclusions Deltoid ligament is an important anatomical structure.More attention should be paid to its repair under following aonditions: ( 1 ) the injury of the deltoid ligament involves tibiospring and tibionavicular ligament; (2) patients have congenital pes planus and posterior tibial tendon dysfunction; (3) patients present with ankle fractures and have history of repeated ankle sprain.

Objective To evaluate the effect of clinical pharmacists on cases consultation by retrospective analysis.Methods Seven hundred and thirty-one consultation cases from January 2011 to December 2014 were systematically reviewed, and the clinical department, question classification, organ system of infection, consultation purpose, recommendation variety to infection problems, acception percentage, infection problem outcome were recorded.Furthermore, the typical cases were analysed.Results The number of consultations and clinical departments increased by years, formulating anti-infective therapeutic regimen, determining duration of therapy and drug dosage were the main purposes of consultation.The proportion of infection problems was 86.0%, adoption rate of recommendations was 83.6%, the clinical efficacy rate was 84.3% among them.The proportion of non-infectious problems was 14.0%, adoption rate of recommendations was 100.0%.Conclusion Clinical pharmacists' professional skills are respected by doctors.Anti-infection problem is a breakthrough point for deeply developing the work of clinical pharmacists.

Objective To observe the efficacy, safety and feasibility of the four kinds of anticoagulation method in hemodialysis patients with high risk of hemorrhage. Methods 128 patients with high risk of hemorrhage who had undergone hemodialysis were randomly divided into four groups. In group A, 68patients were resorted with 30% regional sodium citrate anticoagulation(RCA). In group B, 60 patients were treated with local heparin anticoagulation. In group C, 64 patients were treated with low molecular weight heparin (LMWH). In group D, 66 patients received no heparinization hemodialysis. The changes of bleeding, clotting function, adverse effect and nursing strategies were studied. Results All patients of group A completed regular hemodialysis with satisfactory indices, 6 cases with bleeding and primary bleeding aggravated in group B, 8 cases with bleeding and primary bleeding aggravated in group C, 8 cases occurred grade three coagulation and finished dialysis in group D. 3 cases in group A and 2 cases in group B occurred adverse reaction, but no adverse reaction was seen in group C and D. Conclusions RCA is safe,effective and can be easily handled in regular hemodialysis. It is an ideal dialysate for hemodialysis in patients with high risk of hemorrhage.

Objective To investigate the symptoms, signs and distribution of focus in acute insular infarct syndrome, as well as the effects on cardiovascular system. Methods The clinical manifestations of 20 patients with first-event acute insular infarct syndrome were analyzed retrospectively. Results All the patients revealed the intellectual deterioration, aphasia, hemiparalysis, sensory disorder and vestibular-like symptoms. The temporal lobes were mostly involved (65%). Electrocardiogram showed ST segment depressed mostly. The supraventricular premature beats were the most frequence finding by Holter monitoring in left insular infarction except atrial fibrillation, and their heart rate variability indicated that the standard deviation of normal-to-normal intervals (SDNN) decreased, but root mean square successive difference (RMSSD) increased. Conclusion The insular infarct syndrome can be charactered as a group of symptoms of intellectual deterioration, aphasia, hemiparalysis, sensory disorder and vestibular-like symptom. Left insular infarct could be complicated with arrhythmia, which increases the risk of adverse cardiac outcome. The characteristics of arteries to Sylvian angle may be associated with the syndrome.

Objective:To investigate the preventive effects of Pueraria on presbycusis in rats. Method:Thirty-two 24-26 month old Wistar rats were randomly divided into four groups, and were treated with different dosages of Pueraria (1,2,4,0 g·kg~(-1)·d~(-1)) seperately for 4 weeks. Auditory brainstem response (ABR) was used to de-tect the change of hearing threshold of rats. Hemorheological items of rats were checked in each group. Result: Compared with control group,the hearing threshold and hemorheological items of rats was significantly improved after treated with Pueraria(P<0. 05). In addition, 2 g/(kg·d) was found to be the best dosage of Pueraria for rats, which can achieve ideal effect with minimum side effect. Conclusion:Pueraria could improve tiny circulation, has good preventive effect on presbycusis of rats.

Objective To evaluate the curative effect and related factors of the treatment for the osteochondral lesion of talus (OLT) by the osteochondral autografts harvested from medial femoral condyle of the ipsilateral knee.Methods The data of 15 OLT patients was retrospectively analyzed who received the operation during July 2009 to November 2012.There were 8 males,and 7 females,with an average age of 49.6±17.2 years (range,19-73 years).International Knee Documentation Committee (IKDC) and Lysholm score were used to evaluate the knee function preoperatively and postoperatively respectively.The ankle functions and pain were assessed according to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind-foot score and visual analogue scale (VAS) preoperatively and postoperatively respectively.Correlations between age or follow-up duration and all the score increments were further analyzed by Spearman rank correlation test.Results Twelve patients complete the follow up,with an average duration of 21.8±10.4 months.The average IKDC,Lysholm,AOFAS,and VAS were 90.91±6.44,95.33±8.00,63.58±18.50,and 7.25±1.54 respectively before operation,and 85.63±11.89,90.75±11.83,90.33±4.98,2.17±1.19 respectively after operation.Correlation coefficients of age between AOFAS,Lysholm,and IKDC score increments were -0.74,-0.63,and-0.76,respectively.There were 4 cases which received excellent effect (33％),5 cases (42％) good and 3 (25％) fair.Conclusion The ankle joint function of patients with OLT recovered well by treated with osteochondral autografts harvested from medial femoral condyle of the ipsilateral knee operation.A correlation was found between patients' age and postoperative functional recovery of ankle and knee joint.