Objective To evaluate the clinical outcome of external bracket fixation in the treat- ment of complex tibia diaphysis fracture involving intra-articular fractures.Methods Forty-two cases of complex tibia diaphysis fracture with proximal and distal intra-articular fractures treated surgically in our hospital from January 1999 to January 2004 were analyzed.The complex tibia diaphysis fractures were categorized according to the AO classification as type C2 (multiple segments fracture) and type C3 (ir- regular fracture),proximal and distal intra-articular fractures in 23 and 19 cases,respectively.Definite operation was done within one week.Twenty-two cases were treated with simple external fixator,and 20 cases treated with screws and external fixator.Results All the 42 cases were followed-up regularly. According to AO evaluation of the knee and ankle joint movement,83% (35/42 cases) of the cases gained satisfactory functional outcome,14% (6/42 cases) had quite satisfactory results and 2% (1/42 case) had unsatisfactory functional outcome.Conclusion External bracket fixation can obtain outcome of relative length of the tibia and fibula,tube structure reconstruction,smoothness of the articular surface and the parallel and symmetric relation of knees and ankles for complex tibia diaphysis fracture with proxi- mal and distal intra-articular fracture.The arthritis resulting in pain in movement and restriction of func- tion is considered to be the most important factor affecting the joint function.Early functional exercise is important for best recovery of knee and ankle function.

OBJECTIVETo compare clinical outcomes between two suturing methods using non absorbable materials through drilling the bone and suturing anchors for the treatment of complete rupture of the deltoid ligament.

METHODSFrom January 2009 to January 2013, 58 hospitalized patients with ankle fracture combined with complete rupture of the deltoid ligament were treated with suturing using non absorbable materials through drilling the bone or suturing anchors. There were 29 patients who received suturing treatments using non absorbable materials through drilling the bone (Group A), including 18 males and 11 females, with an average age of (39.76 +/- 11.81) years old. According to the Lauge-Hansen classification, 12 patients had supination external rotation (SER) injuries with IV degree, 5 patients had pronation external rotation (PER) injuries with III degree, 10 patients had PER injuries with IV degrss, and 2 patients had pronation abduction injuries with III degree. There were 29 patients who received treatments with suturing using anchors (Group B), including 14 males and 15 females, with an average age of (41.79 +/- 13.28) years old. According to the Lauge-Hansen classification,9 patients had SER injuries with IV degree, 6 patients had PER injuries with III degree,13 patients had PER injuries with IV degree, and 1 patient had pronation abduction injuries with III degree. All the patients were treated with open reduction and internal fixation, as well as reconstruction of deltoid ligaments to restore the stability of the medial ankle structures. The clinical examination, imaging evaluation, American society for ankle surgery (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the clinical results after operation, and the results of the two groups were compared and analyzed statistically.

RESULTSThe follow-up duration of the 58 patients ranged from 23 to 40 months,with an average of 27.3 months. All the patients had fracture union, and the mean healing time was 12.3 weeks (ranged, 10 to 17 weeks). There were no incision complications and ankle instability. There were no significant differences between two groups in AOFAS (P=0.666) and the VAS (P=0.905).

CONCLUSIONTreatments of complete rupture of the deltiod ligaments with the two suturing methods get similar good clinical effects, but the suturing using non absorbable materials through drilling the bone has several advantages such as reducing the financial burden of patients, saving social medical resources and avoiding the shortcoming in difficult removal of anchor suture.

Adolescent ; Adult ; Ankle Fractures ; surgery ; Ankle Injuries ; surgery ; Ankle Joint ; surgery ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; Humans ; Lateral Ligament, Ankle ; injuries ; surgery ; Male ; Middle Aged ; Young Adult

This study was purposed to compare the significance of multiplex short tandem repeat polymerase chain reaction (STR-PCR) and fluorescent in situ hybridization (FISH) for monitoring chimerism after sex-mismatched allogeneic hematopoietic stem cell transplantation (allo-HSCT). The chimerism of bone marrow or peripheral blood cells from 38 patients was analyzed by STR-PCR and FISH on days 14, 28 and at 3 months after allo-HSCT. The results indicated that on day 14, the complete chimerism (CC) was detected in 14 of 30 cases by STR-PCR and in 8 of 30 cases by FISH (p > 0.05). On day 28, the CC was detected in 26 of 31 cases by STR-PCR and in 15 of 31 cases by FISH (p < 0.01). At 3 months, the CC was observed in 22 of 24 cases by STR-PCR and 17 of 24 cases by FISH (p > 0.05). 14 cases were found to have a graft rejection or relapse among 28 cases which were continuously monitored more than 3 months post the transplants. Donor cell decrease in 9 of 14 cases was proved by FISH alone. It is concluded that FISH is more sensitive than STR-PCR in early monitoring chimerism status of post-transplant and in predicting graft rejection or disease relapse.
Adolescent ; Adult ; Child ; Female ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; In Situ Hybridization, Fluorescence ; methods ; Male ; Microsatellite Repeats ; Middle Aged ; Polymerase Chain Reaction ; methods ; Transplantation Chimera ; Transplantation, Homologous ; Young Adult

Animals ; Cells, Cultured ; Connective Tissue Growth Factor ; Hepatocytes ; cytology ; metabolism ; Immediate-Early Proteins ; biosynthesis ; genetics ; Intercellular Signaling Peptides and Proteins ; biosynthesis ; genetics ; Male ; Plasmids ; genetics ; RNA Interference ; RNA, Small Interfering ; genetics ; Rats ; Transfection

STUDY DESIGN: Retrospective case analysis. PURPOSE: We retrospectively evaluated the clinical and radiological outcomes of posterior sublaminar wiring (PSLW) and/or transarticular screw fixation (TASF) for reducible atlantoaxial instability (AAI) secondary to os odontoideum. OVERVIEW OF LITERATURE: Limited information is available about the surgical outcomes of symptomatic os odontoideum with AAI. METHODS: We examined 23 patients (12 women and 11 men) with os odontoideum and reducible AAI. The average age of the patients at the time of the operation was 44.2 years. The average follow-up duration was 4.5 years. Thirteen patients with anterior AAI underwent PSLW alone, while 10 patients with combined (anterior+posterior) AAI underwent PSLW and TASF. An autogenous iliac bone graft was used for all patients. Nine patients complained of neck or suboccipital pain, and 14 complained of myelopathy. RESULTS: Angulational instability (preoperative 18.7°±8.9° vs. postoperative 2.1°±4.6°, p<0.001), translational instability (16.3±4.9 mm vs. 1.8±2.2 mm, p<0.001), and segmental angle of the C1–C2 joint (23.7°±7.2° vs. 28.4°±3.8°, p<0.05) showed significant improvement postoperatively. Neck Visual Analog Scale score (6.2±2.4 vs. 2.5±1.8, p<0.05) and the modified Japanese Orthopedic Association (9.1±3.1 vs. 13.2±2.6, p<0.05) score also improved, with a recovery rate of 51.8%. Among the three patients who developed nonunion and/or wire breakage, one underwent revision surgery with repeat PSLW and was finally able to achieve fusion. The final fusion rate was 91.3%. CONCLUSIONS: PSLW and/or TASF provided satisfactory clinical and radiological outcomes in reducible AAI secondary to os odontoideum without significant neurological complications. Our results suggest that PSLW and/or TASF can be considered a viable surgical option over segmental fixation in highly selected cases of os odontoideum with reducible AAI.
Asian Continental Ancestry Group ; Female ; Follow-Up Studies ; Humans ; Joints ; Neck ; Orthopedics ; Retrospective Studies ; Spinal Cord Diseases ; Transplants ; Visual Analog Scale

Objective To analyze the clinical practice ofmicrosurgical operation in intracranial ruptured aneurysms of anterior circulation via lateral supraorbital approach and pterional approach.Methods A retrospective analysis was performed on the clinical data of 74 patients with intracranial ruptured aneurysms of anterior circulation,admitted to our hospital from June 2011 to December 2011;38 patients were assigned to neurosurgical treatment via lateral supraorbital approach,while the other 36 were performed neurosurgical treatment via pterional approach.Statistical analysis was performed on the clinical data.Results In the patients performed neurosurgical treatment via lateral supraorbital approach,the average operation time was (142±32) min,average length of incision was (9.2± 1.5) cm,and the mean hospital stay was (11.9±4.3) d.Two months after discharge,33 got recovery and 5 had light disability; no severe disability or PVS was observed.No significant difference was noted in good recovery rate and clipping success rate between the two group patients (P＞0.05),but significant differences were observed in the operation time,length of incisions,and mean hospital stay between the two group patients (P＜0.05).Conclusion Neurosurgical treatment via lateral supraorbital approach is a safe and mini-invasive method for intracranial ruptured aneurysms of anterior circulation,which is more suitable for extensive promotion.

OBJECTIVETo investigate the capacity of commercial HIV enzyme immunoassay (EIA) diagnostic kits to detect antibodies against different genotypes of HIV.

METHODSHIV RNA was detected with RT-PCR from samples positive for HIV antibody. The purified PCR products were sequenced directly and the genotypes of HIV from samples were analyzed. The samples for each genotype of HIV were diluted and the diluted samples were detected with different HIV EIA diagnostic kits.

RESULTSAll 20 samples positive for HIV antibody were also positive for HIV RNA; 9 of 20 isolates were genotype B, 9 of them were genotype C or CRF BC, 2 of them were CRF AE. The sensitivity of different HIV EIA diagnostic kits to detect antibodies against different genotypes of HIV was not significantly different.

CONCLUSIONThe capacity of commercial HIV diagnostic kits to detect antibodies against different HIV genotypes may not be significantly different.

Enzyme-Linked Immunosorbent Assay ; Genotype ; HIV ; genetics ; HIV Antibodies ; blood ; Humans ; RNA, Viral ; blood ; Reagent Kits, Diagnostic ; Reverse Transcriptase Polymerase Chain Reaction ; Sensitivity and Specificity

BACKGROUND: The purpose of this study is to assess the risk of hemorrhage from coexisting unsecured, unruptured aneurysms during hypervolemic hypertensive therapy after treatment for ruptured aneurysms in patients with multiple intracranial aneurysms. METHODS: From 1995 to 2004, the authors treated 1052 patients of ruptured and unruptured aneurysms, in which 201 patients had multiple aneurysms. Of the 201 patients, 45 patients had unsecured, unruptured aneurysms after the initial treatment of ruptured aneurysms. We performed retrospective analysis for these 45 patients' data including the characteristics of unsecured, unruptured aneurysms at risk, hemodynamic parameters and duration of hypervolemic hypertensive therapy. RESULTS: The total number of aneurysms for the 45 patients was 103, where 53 aneurysms were secured at the acute period of post-subarachnoid hemorrhage. Twenty nine out of 45 patients with unsecured, unruptured aneurysms after treatment of ruptured aneurysms had been managed with hypervolemic hypertensive therapy for symptomatic cerebral vasospasm. These 29 patients harbored 30 aneurysms. In 29 patients with hypervolemic hypertensive therapy, the mean systolic blood pressure was 181.4+/-20.7 mm Hg, the mean central venous pressure 12.5+/-2.2 mm Hg, and the mean duration of hypervolemic hypertensive therapy was 10.2+/-5.1 days. There was no hemorrhage from the 50 unsecured, unruptured aneurysms in all 45 patients with or without hypervolemic hypertensive therapy. CONCLUSION: It is presumed that the advantage of hypervolemic hypertensive therapy in the patients with symptomatic vasospasm after surgery of ruptured aneurysms endorses its use, even in the presence of unsecured, unruptured aneurysms in patients with multiple aneurysms.
Aneurysm* ; Aneurysm, Ruptured ; Blood Pressure ; Central Venous Pressure ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm* ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

This study was purposed to investigate the clinical significance of the amount and activated status of T cell subsets, B cells, NK cells in peripheral blood from patients with myelodysplastic syndrome (MDS). The proportion of T cells, B cells, NK cells in peripheral blood from 30 patients with MDS and their surface activation markers of CD28, CD45RA, CD45RO, CD69, HLA-DR were analyzed by flow cytometry. Twenty-two patients were in the low risk group (RA + RAS) while eight patients were in the high risk group (RAEB + RAEBT). The result showed that the amounts of T cells (CD3+ cells) in peripheral blood from patients with MDS were lower than those in control group. The amounts of naive CD4+ cells (CD4+ CD45RA+ cells) in MDS patients were lower than those in control. The expression rates of early activation marker (CD69) and late activation marker (HLA-DR) on CD3+ cells in MDS patients were significantly higher than those in control. The abnormalities of the immunologically competent cells were mainly observed in the low risk group (RA + RAS), and were characterized by the high expression rates of CD69+ and HLA-DR+ on CD3+ cells, the decrease of B cell amounts. The amount abnormalities of T cell subsets were mainly observed in high risk group (RAEB + RAEBT), and were characterized by the decrease of CD3+ cells and CD3+ CD4+ CD8- cells (Th cells) amounts without high expression of the CD69 and HLA-DR, the decrease of NK cells amounts. It is concluded that there are the abnormalities of T cell subsets and function in the patients with MDS and may change with disease progression, so the measurement of amount and activated status of T cell subsets in peripheral blood from MDS patients can have predictive role for diagnosis of disease progression and guide of therapy.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antigens, CD ; immunology ; Antigens, Differentiation, T-Lymphocyte ; immunology ; B-Lymphocytes ; immunology ; CD3 Complex ; immunology ; Female ; HLA-DR Antigens ; immunology ; Humans ; Killer Cells, Natural ; immunology ; Lectins, C-Type ; Lymphocyte Activation ; immunology ; Male ; Middle Aged ; Myelodysplastic Syndromes ; immunology ; T-Lymphocyte Subsets ; immunology

This study preliminarily investigated the mechanism by which chloroquine (CQ) relieves acute lung injury (ALI) complicated in acute hemorrhagic necrotizing pancreatitis (AHNP). Sixty male Wistar rats were randomized into sham-operated group (group A, n=10), AHNP group (group B, n=10), L-arginine-treated group (group C, n=10), L-N-nitro-L-arginine methyl ester (NAME)-treated group (group D, n=10), CQ-treated group (group E, n=10) and CQ+L-NAME-treated group (group F, n=10). TLR4 expression was measured by using real time-PCR and Western blotting respectively. The results showed that, in the group B, the expression of TLR4 and the levels of TNF-α and IL-6 in the lungs were significantly increased, and the nitric oxide (NO) concentration was reduced, as compared with those in the group A (P<0.05 or P<0.01). Lung injury was aggravated with the increased expression of TLR4. When the inhibitor and stimulator of TLR4, namely L-Arg and L-NAME, were added respectively, lung injury was correspondingly relieved or aggravated (P<0.05 or P<0.01). In the group E, TLR4 expression was substantially lower and NO concentration higher than those in the group B (P<0.05 or P<0.01). However, in the group F, NO concentration was markedly decreased, and the inhibitory effect of CQ on TLR4 expression and the relief of lung injury were weakened when compared with those in the group E (P<0.05 or P<0.01). It was concluded that TLR4 may play an important role in the pathogenesis and development of ALI complicated in AHNP. CQ could relieve ALI by decreasing the TLR4 expression and increasing the NO release.
Acute Lung Injury ; drug therapy ; immunology ; pathology ; Animals ; Chloroquine ; therapeutic use ; Cytokines ; immunology ; Male ; Pancreatitis, Acute Necrotizing ; complications ; pathology ; Rats ; Rats, Wistar ; Toll-Like Receptor 4 ; immunology ; Treatment Outcome