Donation after cardiac death (DCD) means organ harvest and donation cannot be carried on until the requirement of death criteria using cardiopulmonary arrest is reached.Great success has been achieved since DCD was promoted widely in China.However,some problems were encountered during the implementation of DCD and there also exists many ethical controversies.The ethical principles of informed consent and no harm mentioned inDonation after Cardiac Death Work Instructions of China should be strictly adhered to,while justice,fairness and openness must be ensured in organ allocation.Appropriate compensation should be given to DCD donor and his family,and the utilization of DCD should be further improved.All of these ethical principles will help to promote the healthy development of organ donation and transplantation in China.

The clinical manifestation and laboratory features of juvenile hyaline fibromatosis(JHF)are reposed in a 5-year-old girl.Clinical symptoms began at 1 year of age,which was characterized by multiple cutaneous nodules and gingival hyperplasia with normal intelligence.Histopathologic examination of a skin biopsy specimen showed that the epidermis was normal,the nodules were composed of spindle-shaped fibroblasts embedded in homogeneous,non-fibrous,eosinophilic substance,and normal tissue was disrupted.Moreover,the fibroblasts showed transparent cytoplasm arranged in an obscure bundle-like pattern.No cell atypia or necrosis was observed.PCR amplification and sequencing of the capillary morphogenesis gene-2(CMG2)revealed a homozygous splicing mutation(IVS 14+1G→T)in the patient,while both of her parents were hetemzygous for the mutation.JHF is inherited in this family in an autosomal recessive manner.

Objective To study the relationship between the ultrastructural changes of corneal matrix collagen fibrils diameter and the postmortem interval.Methods Twenty-eight rabbits were killed by the method of air embolism and the samples of cornea were separately cut down in 0,6,12,18,24,48 and 72h after death.The ultrastructure of the collagen diameter was observed by transmission electro microscopy(TEM)and the 4 parameters of area(Y1),perimeter(Y2),average-diameter(Y3)and mean-diameter(Y4)were measured by a computer image technique and analyzed by Excel 2000 and SPSS 10.0 software.Results The 4 parameters of Y1,Y2,Y3 and Y4 were respectively increased from 1 131?53nm to 1 628?26nm,from 132.8?23nm to167.5nm,from 38nm to 45nm and from 37.71?6nm to 44.89?5nm within 72 hours after the death.Conclusion The corneal matrix collagen diameter increase regularly with the postmortem interval in 72h after death,and the parameters of Y1,Y2,Y3 and Y4 could be used as a new reference mark for timing the postmortem interval after death.

Objective To investigate the application of structured triglyceride (STG) in malignant obstructive jaundice (MOJ) patients after pancreaticoduodenectomy.Methods The records of 21 MOJ patients received pancreaticoduodenectomy in our hospital were retrospectively analyzed.The patients received parenteral nutrition on the first postoperative day, of whom 7 were given STG (STG group) and 14 were given medium and long chain triglyceride (MCT/LCT group).The changes of liver function, lipid profile, albumin, and postoperative complications were compared between the two groups.Results The triglyceride levels in the STG group on the 3rd and 7th postoperative days were significantly lower than those in the MCT/LCT group [3rd day:(1.85 ±0.90) mmol/L vs.(2.18 ±1.41) mmol/L;7th day: (1.62 ±0.78) mmol/L vs.(2.46± 1.62) mmol/L;both P =0.042];the level of high-density lipoprotein on the 7th postoperative day was significantly higher than that in the MCT/LCT group [(0.67 ±0.64) mmol/L vs.(0.45 ±0.15) mmol/L, P =0.046].The albumin in the STG group returned to normal on the 3rd postoperative day, which was significantly higher than that in the MCT/LCT group [(35.50 ±2.91) g/L vs.(30.66 ±5.08) g/L, P =0.048].There were no significant differences in terms of liver function, length of hospital stay, wound healing, systemic inflammatory response syndrome, and infection between the two groups.Conclusions Parenteral nutrition with structured triglyceride after pancreaticoduodenectomy in MOJ patients is tolerable and safe.STG has less influence on lipid metabolism than MCT/LCT does, and can increase albumin level rapidly.

Objective To observe the short-,mid-and long-term surgical complications of complex acetabular fractures treated by the Kocher-Langenbeck (K-L) approach combined with digastric trochanteric flip osteotomy (DTFO).Methods We reviewed the 40 cases of complex acetabular fracture that were treated at our department from December 2009 through December 2013.They were 34 men and 6 women,from 17 to 73 years of age (average,47.6 years).Of them,19 were treated by K-L approach combined with DTFO,including 17 males and 2 females,with a mean age of 44.7 ± 11.7 years.The other 21 controls were treated simply through the K-L approach,including 17 males and 4 females,with a mean age of 42.8 ± 14.4 years.The 2 groups were compared in terms of intraoperative results,postoperative outcomes and surgical complications like infection,sciatic nerve injury,heterotopic ossification,femoral avascular necrosis,and post-traumatic arthritis.Results The 40 cases were followed up for an average of 29.7 months (range,from 18 to 59 months).The operation time for the DTFO group (248.2 ± 123.2 min) was significantly shorter than that for the control group (276.1 ±50.6 min),the satisfactory reduction rate for the DTFO group (100.0％) was significantly higher than that for the control group (90.5％),the hip intorsion (19.7° ± 3.5°),hip extorsion (26.1° ±4.3°),and hip abduction (40.5° ±4.7°) at one year postoperation in the DTFO group were significantly superior to those in the control group (14.3°± 6.0°,21.0°± 7.2°,31.9°± 10.8°,respectively),and the hospital stay for the for the DTFO group (19.0 ±7.1 d) was significantly longer than that for the control group (13.6 ±4.9 d) (P ＜ 0.05).The intraoperative bleeding and transfusion for the DTFO group were insignificantly greater than those for the control group (P ＞ 0.05).Infection or iatrogenic sciatic nerve injury occurred in none of the patients.There were no significant differences between the 2 groups in terms of positive Trendelenburg test,hip function,heterotopic ossification,femoral avascular necrosis,or post-traumatic arthritis at the last follow-ups(P＞ 0.05).Conclusions In the surgical treatment of complex acetabular fractures,especially those involving the acetabular dome area and the femoral head,K-L approach combined with DTFO can obtain larger surgical exposure field,good fracture reduction and functional recovery,without obviously increasing surgical complications.This technique only slightly increases intraoperative bleeding and transfusion,and results in longer hospital stay.

Objective Treatment remnant electrode infection of permanent cardiac pace makers Methods Remnant electrodes were wrapped in silicone adhesive and covered with skin Results In 16 patients of permanent pace makers with infections of remnant electrodes, by using the method of wrapped and covered electrodes, infection did not occur in the observation of 3 to 24 months Conclusion It is an effective method to treat the infection caused by remnant electrodes of pace makers by means of silicone adhesive wrapping and covering electrodes

Objective To review the results of limb lengthening over an intramedullary nail in management of femoral defect and length discrepancy.Methods Femoral lengthening over an antegrade intramedullary nail was applied to treat length discrepancy of 4 to 7 cm for three cases,and femoral defects of 8 and 11 cm respectively for two cases from January 2001 to December 2003.The nail and an external fixator(Ilizarov external fixator for bone defect and Orthofix limb-reconstruction system for discrepancy)were applied concomitantly at the time of femoral osteotomy.After a mean fixation time of 16.2 days(13 to 24 days),gradual distraction began at a rate of 0.25 millimeter four times a day.When the managed femur reached the expected length,the nail was locked and the fixator was removed in patients with length discrepancy.The procedure was not finished in patients with bone defects until bony consolidation was partially seen.Results All the patients were followed up for a mean time of 36.4 months(range,22 to 47 months).The mean gain in length was 7.2 cm(range,4 to 10 cm)with good consoli- dation,the mean duration of external fixation was 5 months(range,3 to 8 months),and the mean external fixation index was 0.75 month per centimeter(range,0.57 to 1.00 month per centimeter).Neither axial deviation nor re-fracture occurred.At the last follow-up,the mean range of movement of knee was 107?(80?to 135?).Con- clusions In management of defect and length discrepancy of limbs,lengthening over an intramedullary nail has the advantages of short duration of external fixation,good protection against refracture,and earlier rehabilitation of knee joint,as well as disadvantages of long operation time,massive intraoperative bleeding,high cost and much post- operative scarring.

48 hours.The expressions of leukocyte common antigen(LCA) and intercellular adhesion molecule-1(ICAM-1) in the brain tissues collected during the surgery were detected by immunohistochemistry staining method.Results LCA and ICAM-1 immunopositive cells and microvessels were verified in all 29 cases of ICH groups,and the expressions were more than control group(all P48 hours group were higher than that in 6～24 h group(both P48 hours group.Conclusions Acute inflammatory reaction occurs in acute period of ICH.Expression of ICAM-1 reinforces gradually during early 48 hours since the onset of ICH.

BACKGROUND: The anterior thoracolumbar internal fixation devices can be divided into two main categories: the stick system such as kaneda,and the plate system such as Z-plate. Both categories have satisfactory biomechanical properties, but the devices of these types are all imported and so expensive that they exceed the affordability of domestic patients:Based on various anterior throacolumbar internal fixation devices and the spinal characteristics of the Chinese people, the author designed a new brand of anterior thoracolumbar internal fixation device for Chinese people:New Ti-plate (NTP).OBJECTIVE: Biomechanical properties of three anterior thoracolumbar internal fixation devices were compared in an attempt to provide a scientific and theoretical basis for clinical applications.DESIGN: A sampling investigation.SETTING: The Department of Orthopaedics of the Second Affiliated Hospital of Soochow University and Department of Radiology of Nantong Hongqiao Hospital.PARTICIPANTS: This study was carried out at the Biomechanical Engineering Research Institute of Shanghai University between May and August 2003. Fifteen fresh spinal samples from the healthy adults (T12-S1) were used in this study.METHODS: Fifteen spinal (T12-S1) specimens were obtained from fresh bodies to induce injuries to anterior and middle columns, which were fixed with Dunn Ⅲ, NTP and Z-plate respectively to compare the strength, rigidity, and the stability of the spine.MAIN OUTCOME MEASURES: Changes of load-straining and loaddisplacement of the three groups of specimens under the conditions of axial decompression, anteflection, post-extention, and lateral flexion.RESULTS: Fifteen fresh adult spinal specimens were involved in this study and all entered the stage of result analysis. Under the maximal load of 500 N,the average straining for Z-plate, NTP and Dunn Ⅲ was 410 uε,430 uε, 477 uε respectively. The average longitude displacement for the above three devices was 2.23 mm, 2.38 mm and 2.85 mm respectively.The thoracolumbar fracture was fixed with three anterior internal fixation devices and it was proved that Z-plate and NTP fixations were better than fixation with Dunn Ⅲ in respect of spinal strength, rigidity and stability (P ＜ 0.05), but the difference between Z-plate and NTP had no statistical significance (P ＞ 0.05).CONCLUSION: NTP and Z-plate devices are conformed to the spinal biomechanical principles and were capable of reconstructing spinal biomechanical stability effectively, and it is a preferable anterior spinal internal fixation device.

OBJECTIVETo sum up the experience in diagnosis and treatment of Fournier's gangrene and find an optimal evaluation tool for its prognosis by comparing currently used prognostic scoring systems.

METHODSWe retrospectively analyzed 16 cases of Fournier's gangrene diagnosed and surgically treated in our hospital between 2004 and 2012. Using Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI), Age-Adjusted Charlson Comorbidity Index (ACCI), and Surgical Apgar Score (sAPGAR) , we obtained the prognostic scores of the patients and made comparisons among different scoring systems.

RESULTSFGSI, UFGSI, ACCI, and sAPGAR were all clinically used scoring systems. Statistically significant differences were found in the scores of ACCI and UFGSI but not in those of FGSI and sAPGAR between the death and survival groups, with the maximum area under the ROC curve and minimum standard error for the ACCI score.

CONCLUSIONBoth ACCI and UFGSI are useful for evaluating the prognosis of Fournier's gangrene. However, ACCI is even better for its higher sensitivity and specificity and easier clinical collection.

Age Factors ; Aged ; Fournier Gangrene ; diagnosis ; mortality ; surgery ; Humans ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index