Complications are always likely to occur in the treatment of fractures. Once fracture-related complications occur,their management will be difficuh,resulting in a long handling process that increases physical and financial pain on the patients.Fea- turing“management of fracture-related complications”,this issue intends to draw attention from orthopaedists to the challenging task of prophylaxis and treatment of such problems in clinic.Not only non-union,malunion,heterotopic ossification,bone necrosis but also such systemic complications as deep vain thrombosis,soft tissue infection and necrosis are discussed.They involve long tubular bones,pelvic,proximal femur,tibial plateau and calcaneum.Authors introduce their experience from their clinical practice which can benefit readers a lot.It is well known that an effective prevention is the best treatment.In treatment of fractures,principles must be strictly followed and preventive measures taken throughout the whole process.Once a complication has been detected,therapy should be individualized 1o gain the best outcome.

Objective To compare the functional and radiographic outcomes of modified dual plating and less invasive stabilization system(LISS)in treatment of patients with complex tibial plateau fractures.Methods From November 2003 to November 2004,84 patients with complex tibial plateau fracture were treated with modified dual plating or LISS fixation.Their functional and radiographic outcomes were reviewed to compare the differences in bone union time,full weight-bearing time,knee joint's HSS(The Hospital for Special Surgery)scores,complications, tibia plateau angle(TPA)and posterior slope angle(PA).Results The 84 cases had complete follow-up records and a mean tollow-up of 16.2 months(range,12 to 23 months).Nine complications occurred in the modified dual plating group.The mean full weight-bearing time and radiographic bone union time were 16.8 and 15.1 weeks respectively for this group which had a mean HSS score of 87.4 points.Six complications were found in the LISS group.The mean full weight-bearing time and radiographic bone union time were 14.1 and 13.8 weeks respectively for this group which had a mean HSS score of 89.6 points.There were no significant differences between the two groups in changes of TPA and PA.Conclusion LISS can provide as good fixation as modified dual plating can for most complex tibial plateau fractures,but additional medial plate fixation may be necessary for some special cases.

Fracture Fixation ; methods ; Humans ; Radius Fractures ; surgery

Objective To compare the biomechanical effect of three fixation instruments for SchatzkerⅥtibial plateau fractures.Methods Twenty four fresh knee specimens were made into models of SchatzkerⅥtibial plateau fractures.The specimens were divided randomly into three groups.Group A were fixed with a lateral periar- ticular plate and a posteromedial antiskid plate,and group B with a lateral periarticutar plate and an anteromedial lim- ited contact dynamic compression plate(LC-DCP),and group C with a lateral periarticular plate and a medical exter- nal fixator.Each model was tested for its biomechanical performance in resisting compression,bending and rotation. Results The performance of group B was higher than group A in anti-compression,anti-bending and anti-rotation, and group C was the poorest,there was no significant difference between group A and group B,and there was signifi- cant difference between group B and group C.Conclusion The biomechanical performance of group B was good. The method might have clinical applications in the treatment of SchatzkerⅥtibial plateau fractures.

OBJECTIVETo explore the distribution of qnr gene and broad spectrum p-lactamase (ESBLs) gene in gram-negative bacteria which were isolated from our hospital patients.

METHODSqnr gene in nonrepetitive 129 isolates of Escherichia coli, 10 isolates of Enterobacter cloacac and 29 isolates of K. pneunoniae were detected by polymerase chain reaction (PCR). For qnr gene positive strains, int I, SHV-1, TEM-1, CTX-M, OXA-I , OXA-II , OXA-III, DHA and EBC genes were examined. Plasmid conjugatable test was applied to examine whether qnr gene was located in conjugate plasmid and ERIC-PCR was carried out for DNA homologous analysis. ESBLs detection (according to phenotypic confirmatory test based on National Committee for Clinical Laboratory Standards criteria) and susceptibility test to 16 antibiotics were also performed.

RESULTSqnr gene was found in 6 clinical isolates including 5 strain of E. coli and one strain of E. cloacac, but qnr gene was undetectable in K. pneunoniae isolates. The 6 clinical isolates were suspectible to imipenem but resistance to some other drugs while only 2 isolates of E. coli were susceptible to quinolone. Among the 6 qnr gene-positive strains, all of them belonged to I type integron-positive isolates, 4 isolates of them were TEM-1 producing strains,with only one isolate was OXA-III gene producing strain, and 2 isolates of them were EBC producing strains. Most of them were with 2 ESBLs gene if not more. qnr gene was on transferable plasmids which could be disseminated by clone.

CONCLUSIONIn Wuhan city, the prevalence of qnr was confirmed. qnr gene were found with some ESBLs gene in the same strains, and qnr gene in suspect strains. The transmission of qnr gene producing strains could be mediated by transferable plasmids or clone, forcing us to make intensive investigation and take effective control measures.

Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; genetics ; DNA, Bacterial ; genetics ; Drug Resistance, Bacterial ; genetics ; Enterobacter cloacae ; drug effects ; genetics ; isolation & purification ; Escherichia coli ; drug effects ; genetics ; isolation & purification ; Escherichia coli Proteins ; genetics ; Genes, Bacterial ; Humans ; Imipenem ; pharmacology ; Klebsiella pneumoniae ; drug effects ; genetics ; isolation & purification ; Microbial Sensitivity Tests ; Plasmids ; genetics ; Quinolones ; pharmacology ; Sequence Analysis, DNA ; beta-Lactamases ; genetics

OBJECTIVETo detect central obesity and related adverse cardiovascular disease risk factors by waist-to-height ratio (WHR) among normal weight adults in Chongqing area.

METHODSA total of 20 000 participants aged 18 - 59 from one hour economic cycle of Chongqing area were selected by group sampling method. We measured the height, waist circumference (WC), body weight, blood pressure, blood lipid and blood sugar. Body Mass Index (BMI) and WHR were computed. We analyzed the differences of the correlated indexes between non-central obesity group (WHR < 0.5) and central obesity group (WHR ≥ 0.5) of those had normal weight (18.5 ≤ BMI (kg/m(2)) < 24). And we used logistic regression method to analyze the relation between central obesity and related adverse cardiovascular risk factors.

RESULTSAmong 11 612 normal weight subjects, 1801 (15.51%) participants were normal weight central obesity. Of non-central obesity group and central obesity group, the levels of waist WC were (73.71 ± 5.91) and (84.47 ± 4.58) cm (F = 328.74, P < 0.01); diastolic blood pressure levels were (72.85 ± 10.30) and (78.22 ± 11.90) mm Hg (1 mm Hg = 0.133 kPa, F = 23.62, P < 0.01); triglyceride levels were (1.22 ± 0.95), (1.97 ± 1.91) mmol/L (F = 114.70, P < 0.01); total cholesterol levels were (4.66 ± 0.84) and (5.04 ± 0.92) mmol/L (F = 13.10, P < 0.01); high density lipoprotein levels were (1.41 ± 0.31), (1.25 ± 0.29) mmol/L (F = 29.44, P < 0.01); low density lipoprotein levels were (2.65 ± 0.74) and (3.03 ± 0.77) mmol/L (F = 9.98, P < 0.01); glycemia levels were (4.94 ± 0.82) and (5.25 ± 1.37) mmol/L (F = 47.21, P < 0.01). The results of the logistic regression analysis showed the central obesity normal weight group was 1.28 (1.02 - 1.60), 1.49 (1.20 - 1.84), 2.24 (1.92 - 2.60), 1.77 (1.53 - 2.05), 1.58 (1.15 - 2.16) and 1.31 (1.06 - 1.63) times more likely than the normal group to have significantly elevated levels of systolic blood pressure, diastolic blood pressure, triglyceride, high density lipoprotein, low density lipoprotein and blood glucose.

CONCLUSIONWHR can effectively reflect the normal weight central obesity and the risk factors of cardiovascular disease;the adverse cardiovascular disease risk was high among normal weight central obesity adults.

Adolescent ; Adult ; Body Height ; Body Mass Index ; Body Weight ; Cardiovascular Diseases ; epidemiology ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Obesity ; Obesity, Abdominal ; epidemiology ; Risk Factors ; Waist Circumference ; Young Adult

Adult ; Fractures, Bone ; complications ; Hemorrhage ; therapy ; Hemostatic Techniques ; Humans ; Male ; Pelvic Bones ; injuries

This study was purposed to characterize the effect of carboxylic acid metabolite (SR26334) of clopidogrel bisulfate deprived of antiplatelet efficacy on the spectrum of gene expression in the cultured human umbilical vein endothelial cell (HUVEC) line (EA.hy926), and to explore the potential molecule mechanism of SR26334 impact on HUVEC. By using a Affymetrix HU133 plus 2.0 oligonucleotide microarray, the alteration of gene expression spectrum induced by SR26334 in HUVEC was detected, the real-time PCR was used to confirm the results of selected differentially expressing genes. The results indicated that total 235 including 176 up-regulated and 59 down-regulated genes were obtained with change more than 1.5-fold after SR26334 (10 µmol/L) acted on HUVEC for 48 h. SR26334 affected the expression levels of genes involved regulation of transcription, transcription, positive regulation of transcription from RNA polymerase II promoter, cell cycle, cell division, protein amino acid dephosphorylation in HUVEC. It is concluded that carboxylic acid metabolite SR26334 of clopidogrel bisulfate modulates function of endothelial cells through different pathway at gene level.
Cell Line ; Human Umbilical Vein Endothelial Cells ; cytology ; drug effects ; Humans ; Ticlopidine ; analogs & derivatives ; pharmacology ; Transcriptome ; drug effects

This study was purposed to investigate the effect of clopidogrel on gene expression profile of cultured human umbilical vein endothelial cell (HUVEC) line (EA.hy926), and explore its potential molecule mechanism. A Affymetrix U133 plus 2.0 oligonucleotide microarray was applied to detect the alteration of gene expression profile induced by clopidogrel in HUVEC. Real time RT-PCR was used to verify the result of selected differentially expressing genes. The results showed that total 508 genes (including 139 up-regulated and 369 down-regulated genes) were obtained with differential expression more than 1.5-fold after clopidogrel (10 µmol/L) acted on HUVEC for 48 h. Clopidogrel affected the expression levels of genes involved protein binding, transcription factor activity, zinc ion binding, regulation of DNA-dependent transcription, transcription, RNA splicing and so on. It is concluded that the clopidogrel modulate function of endothelial cells by regulating sets of genes through different pathway.
Cell Line ; Human Umbilical Vein Endothelial Cells ; drug effects ; metabolism ; Humans ; Oligonucleotide Array Sequence Analysis ; RNA, Messenger ; genetics ; Ticlopidine ; analogs & derivatives ; pharmacology ; Transcription, Genetic ; Transcriptome

OBJECTIVETo evaluate the effect of irbesartan on the proliferation, apoptosis, and VEGF mRNA expression of human umbilical vein cell line EA.hy926 in vitro.

METHODSThe human umbilical vein cell line EA.hyY926 were treated with various concentrations of irbesartan for 24 h. The cell proliferation after the treatment was detected by CCK8 assay, flow cytometry and FITC Annexin V/PI kit were used to detect changes in the cell apoptosis. RT-PCR was used to evaluate the expression of VEGF mRNA.

RESULTSThere were no changes in cell shape with various concentration of irbesartan. CCK-8 assay showed a greater rate of the cell proliferation in irbesartan group than that in control group with a dose-independent manner after 24 h treatment. After incubation with irbesartan, cell proliferation rate was significant (P < 0.05). FCM analysis showed no significantly changes in the cell apoptosis. Irbesartan increased the proliferation of EA.hy926 cells. At concentration of 1 x 10(-4), 1 x 10(-5), 1 x 10(-6) mol/L, VEGF mRNA expression enhanced either (P < 0.05).

CONCLUSIONIrbesartan could promote the proliferation and up-regulated VEGFmRNA expression in EA.hy926 cell line. This result suggested that in addition to antihypertensive effect, angiotensin receptor antagonist might be a novel therapeutic approach to chronic ischemic heart disease as heart failure.

Apoptosis ; drug effects ; Biphenyl Compounds ; pharmacology ; Cell Line ; Cell Proliferation ; drug effects ; Humans ; RNA, Messenger ; genetics ; Tetrazoles ; pharmacology ; Umbilical Veins ; cytology ; metabolism ; Vascular Endothelial Growth Factor A ; metabolism