BACKGROUND:It is controversial to treat sacroiliac joint fracture.Some scholars advocated expectant treatment,and some others advocated surgery therapy.Pelvic stability was responsible for the scheme selection.Sacroiliac joint fracture-dislocation destroys pelvic stability,which easily induces instability and bone nonunion,resulting in sacroiliac joint pain,unequal size of lower limbs,sitting pain and dysfunction.Thus,prognosis of mental implant is significantly better than expectant treatment in treatment of unstable pelvic fracture.OBJECTIVE:To summarize the treatment of unstable pelvic fractures and their clinical application using various internal and external fixation of metal implants.METHODS:The computer-based research was done in Pubmed database (http://www.ncbi.nlm.nih.gov/PubMed) and Wanfang database (http://www.wanfangdata.com.cn) for articles published from January 1991 to December 2009 with the key words of "Pelvic fractures,instability,surgical treatment" by the first author.A total of 115 articles were retrieved,and those concerning characteristics and clinical application of implants in the treatment of unstable pelvic fracture.Articles addressing old and repetitive contents were excluded.Literatures of the same fields published in recent years or in authorized journals were selected.Finally,30 articles were included.RESULTS AND CONCLUSION:Sacroiliac joint fracture-dislocation is a severe,high-energy trauma,has been paid great attention in the therapy,particularly in unstable sacroiliac joint fracture-dislocation.A stable type of fracture and dislocation of the sacroiliac joint received a conservative treatment of unstable sacroiliac joint fracture-dislocation appropriate line of external fixation,internal fixation for reconstruction of pelvic stability and internal fixation treatment varied,but the therapeutic effect of internal fixation needs to be improved.What are bio-mechanical characteristics of various internal fixation methods,and how the timing of weight-bearing activities following various internal fixations require further basic and clinical studies.An unstable sacroiliac joint fracture-dislocation fixation has many ways,including the anterior and posterior fixed-fixed.Minim ally invasive therapy such as posterior CT guided sacroiliac joint lag screw is the developmental trend.

Objective To explore the effect and mechanism of intrathecal injecting κ-opioid receptor agonist U50, 488H on the rats with myocardial ischemia/reperfusion injury.Methods 50 Sprague–Dawley rats were randomly divided into five groups (n=10): sham group (Sham), ischemia/reperfusion group (IR), high-dose intravenous injection group (IV1), low-dose intravenous injection group (IV2), and intrathecal injection group (IT).In sham group the rats were followed by the modeling step without ligation of the left coronary and no drug injection by intravenous or intrathecal; in IR group the rats were underwent 30 minutes of myocardial ischemia followed by 120 minutes of reperfusion, and were not treated with any drug.All the rats in IV1, IV2 and IT groups were intravenous injected with U50, 488H at 1 hour before they were underwent myocardial ischemia/reperfusion as in IR group.IV1 and IV2 groups were intravenous injected with U50, 488H respectively at the dose of 0.1 mg/kg and 0.01 mg/kg, while the IT group was intrathecal injected with U50, 488H at the dose of 0.01mg/kg.All the rats from 5 groups were observed with cardiac ultrasound, myocardial sirius staining, serum CGRP and ET level.Results Compared to IR group(EF%=35.4 ±1.1,FS% =21.1 ±1.1), the rats in IT group (EF%=49.1 ±1.2,FS%=27.1 ±1.0) and IV1 group (EF%=46.3 ±2.2,FS%=26.6 ±0.6) showed better myocardial contraction (P<0.05) and reduced myocardial fibrosis (P<0.05).IT group and IV1 group also showed reduced ET but increased CGRP in the serum (P<0.05).There were no difference between IV2 group and IR group in both observation.Conclusion Pretreatment with intrathecal injection of opium κ-receptor stimulant U50, 488H not only protected the myocardial function from myocardial ischemia/reperfusion injury, but also repressed myocardial fibrosis.The protection may result from modulation of CGRP and ET.

Objective To explore the clinical effect of posterior indirect reduction and internal fixation and laminectomy in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.Methods Eighty patients with thoracolumbar vertebrae burst fracture and spinal cord injury treated in our hospital from March 2014 to March 2015 were selected as the objects,and they were divided into reset group and laminectomy group with forty cases in each group according to surgical method.All the patients were followed up for 1 year,the lumbar function of two groups at 1 week and 1 year after operation were observed respectively,and the pain degree was observed in 1month,3 months and 6 months after operation.The amount of bleeding,operation time,hospitalization time and fracture healing time were observed.Neurological function was assessed by classification criteria of the American Spinal Cord Injury Association(ASIA),and incidence of complications was figured in the two groups.Results The anterior heights of the injured vertebra were higher than those before the operation,and the Cobb's angles were lower than those before the operation,the differences were significant(P ＜ 0.05);while there was no significant differences in the anterior heights of the injured vertebra between the two groups at 1 week and 1 year after operation(P ＞ 0.05).VAS scores of the two groups after 1 month,3 months and 6 months decreased significantly when compared with the preoperative scores(P ＜ 0.05),and VAS scores of each time in the reset group were significantly lower than those in the laminectomy group(P ＜ 0.05).The amount of bleeding,operation time,hospitalization time and fracture healing time in the reset group were less than those in the laminectomy group (P ＜ 0.05).The neurological function recovery of the two groups were significantly improved when compared with that before the operation(P ＜0.05).There was no significant difference in recovery of neurological function between the two groups(P ＞ 0.05).The complication rate was 7.50％ in the reset group,lower than 12.50％ of the laminectomy group,the difference was significant (P ＜ 0.05).Conclusion Posterior indirect reduction and internal fixation of lamina both have a certain effect in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.But posterior indirect reduction has less complications and less amount of bleeding,which is beneficial to postoperative recovery.

Objective To study the treatment of the chronic calcaneus osteomyelitis combined with skin ulcers or defects of the posterior heel following internal fixation for calcaneal fractures.Methods From February 1999 to June 2005,17 cases of calcaneus osteomyelitis combined with skin ulcers or defects following internal fix- ation for their calcaneal fractures were treated with elimination of infection focuses and dead spaces,tissue trans- plants and continuous irrigation.Skin flaps or myocutaneous flaps were used to repair heel ulcers or defects and to fill the dead spaces.Drainage and irrigation tubes were placed into the flap covered areas to carry out the continuous irrigation.Results All the cases were followed up for 3 to 36 months(mean,25 months).All the grafts survived without recurrence of calcaneus osteomyelitis.Their posterior heels regained fair appearance.Thirteen cases obtained fine sensory recovery and friction tolerance and could walk with weight-bearing.Conclusion Calcaneus os- teomyelitis can be cured by simply and effectively tissue transplants and continuous irrigation,which can provide adequate anti-infection and improve blood circulation.

Objective To study T lymphocyte subsets and expression of costimulatory molecule CD154 on T-cells in peripheral blood from patients with ankylosing spondylitis and their changes after treated with Enbrel. Methods Sixty-six patients with AS(39 active and 27 inactive, 35 axial and peripheral joint involvement and 31 axial involvement only), 30 patients with rheumatoid arthritis(RA), 30 healthy volunteers were analyzed. The expression of CD154 on CD3+ T cell as well as T-cells subsets were evaluated using flow cytometry respectively. The changes of the expression of costimulatory molecule CD154 in 39 active AS patients(Enbrel treatment or placebo treatment) were observed in a randomized, double-blind, placebothan that of healthy volunteers, and CD154 expression on CD3+ T cells in peripheral blood in AS patients was on CD3+ T cells in the peripheral blood of active AS or AS patients with peripheral joint involvement were significantly higher than those in inactive or axial involvement only AS patients(P＜0.05), and CD154 on CD3+ placebo, in AS patients group, there was significant reduction in CD154 expression on CD3+ T cells in Enbrel group at week 6(P＜0.05), there was no significant difference between Enbrel group and healthy volunteers at week 6(P＞0.05). Conclusion T lymphocyte subsets are significantly abnormal and CD154 is overexpressed on T-cells in peripheral blood of patients with AS. A six-week course of treatment with Enbrel in active AS can induce a down-regulation of the expression of CD154 on T cells.

Objective This retrospective study is designed to analyze the cardiovascular events of CTO to provide new information on secondary prevention of CHD in patients after hospital discharge. Methods 272 patients with definite diagnosis of CTO were enrolled in this study. Patients were divided into two groups according to whether suffering from cardiovascular events, with 167 patients in group A who had not suffered from the cardiovascular events and 105 patients in group B who had suffered from the cardiovascular events. We com-pared the clinical data, severity of coronary artery lesion, treatment in two groups. Results Between two groups, there was statistic signifi-cance in LDL -C, EF, Gensini scots, the number of coronary artery lesion, the number of chronic total coronary occlusion and PCI success. Logistic regression analysis revealed that Gensini scots was the independent factors for prognosis of CTO. Conclusion Gensini scors was the independent factor for prognosis of CTO.

Objective To investigate the distribution of HLA-B27 subtypes in ankylosing spondylitis(AS) patients of Chinese Han population by using the updated HLA-B27 typing data. Methods One hundred AS subjects were randomly selected from spondyloarthritis patients data bank of the third affiliated hospital of Sun Yat-sen university. All subjects were independent individuals, and the duplicated samples in the same family were excluded. Salt fraction method was used to prepare genome DNA. Luminex liquid array combining PCR-SSOP was used to perform the low resolution HLA-B genotyping. PCR-SSP was applied to perform the high resolution HLA-B27 typing for HLA-B27 positive subjects. Results Ninety-eight independent AS patients were recruited randomily, of which, 93 were HLA-B27 positive, with positive rate 94.9%, and covered 96% patients with family history of AS. Three subtypes were detected in this population including B * 2704 (n=76, 81.7%), B * 2705 (n=12, 12.9%) and B * 2715 (n=5, 5.4%). Compared with the two reports about HLA-B27 subtype distribution in healthy HLA-B27 positive Han population there was no significant difference between AS patients and healthy controls. But no B * 2715 case was found in those two reports of healthy population. Three reports (including 1 report in Chinese) could found about B * 2715 subtype, but all positive cases were oriental people. Furthermore, all B * 2715 positive patients were AS patients. Conclusion B * 2704 is the predominant subtype ,in AS patients of Chinese Han population, and followed by B * 2705. We found five cases with positive B * 2715, a considerable rare allele. This may suggest association between B * 2715 and AS.

BACKGROUND: The understanding about characteristics and variation trends of cerebral vascular hemodynamic indexes in high-risk stroke population,in prior and post-stroke period patients as well as in normal people,particularly the cerebral vascular hemodynamic index(CVHD) prior to stroke can improve diagnosis efficiency of stroke and increase sensitivity and specificity of stroke diagnosis.OBJECTIVE: To study the features of CVHD in acute stoke,in order to provide evidences for early evaluation and rehabilitation intervention.DESIGN: Case analysis and observational study based on patients.SETTING: A neurological department in a general hospital of military area command of Chinese PLA and a prevention and cure institute of cerebrovascular diseases.PARTICIPANTS: Totally 55 (male 38,female 17) inpatients in the Neurological Department of Fuzhou General Hospital of Chinese PLA from June to December 2001 were enrolled in the study.METHODS: CVHD was measured during the first week after onset and the data were analyzed.MAIN OUTCOME MEASURES: The CVHD,blood pressure and cerebral vascular hemodynamic parameters.RESULTS: The CVHD of each patient is below 75,median 32.5. The mean velocity,blood flow,maximum velocity,minimum velocity and difference between diastolic and critical pressures were lower than corresponding ones of healthy men in seventies( P ＜ 0.01 ). And the pulse wave velocity,peripheral resistance,specific impedance and critical pressure increased( P ＜ 0. 01).CONCLUSION: During the first week after stroke,the CVHD decreases and many hemodynamic parameters alters significantly. Examination of CVHD can reveal cerebral circulation insufficiency or predict an attack of cerebral stroke.

Objective To investigate the efficacy of the indocyanine green (ICG) clearance test (ICGR15) combined with the model for end-stage liver disease (MELD) for assessing the short-term prognosis of patients with liver failure.Methods Eighty patients with liver failure were analyzed retrospectively.ICGR15 and relevant clinical data within 24 hours of diagnosis were analyzed.Meanwhile,the MELD score and King's College Hospital (KCH) were evaluated.All findings were tested for correlation with 3-month mortality.Quantitative data were analyzed with analysis of variance and Student's t-test.Count data were analyzed with chi-square test.Correlation analysis was performed with Pearson's coefficient test.Results Among 80 patients with liver failure,39 patients survived and 41 died.The mortality rate of all patients was 51.2％.The serum total bilirubin,creainine concentrations,ICGR15,MELD scores and patient number in accordance with KCH criteria of surviving patients were (288.0±109.1) μmol/L,(63.3±24.4) μmol/L,(48.1±10.2)％,20.6±4.4,and 6 cases,respectively,which were lower than those in dead patients [(340.7 ± 108.2) μmol/L,(98.8 ± 59.1) μmol/L,(60.2 ± 10.6) ％,26.9 ± 7.1 and 19 cases,respectively] (P =0.033,P＝ 0.001,P＝ 0.000,P＝ 0.000 and P =0.003,respectively).There was no significant difference of ICGR15 among four types of liver failure.A positive correlation was observed between ICGR15 and MELD score (r=0.289,P=0.009).The ICGR15-MELD model was created by subjecting ICGR15 and MELD scores to Logistic regression analysis.The following ICGR15-MELD model,Logit (P) =0.105 × ICGR15 + 0.178 × MELD score-9.734,was constructed by Logistic regression analysis.The area under the receiver operating characteristic (ROC) curve was 0.860 and the cut offpoint of 0.3 had sensitivity of 85.40％ and specificity of 74.40％.The area under the curve of the ICGR15-MELD model was significantly higher than those of ICGR15 (0.791),MELD score (0.770) and KCH criteria (0.655).Conclusions ICGR15 and MELD scores perform better than the KCH criteria in predicting the prognosis of liver failure.The ICGR15-MELD model is superior to ICGR15,MELD score,and KCH in predicting the short term prognosis of patients with liver failure.

Objective To investigate integrated status of community inpatients with type 2 diabetes mellitus.Methods 240 cases of type 2 diabetic patients in the Zhangjiagang Aoyang Hospital were included in the study from May 1,2007 to Dec 31,2008.A uniform questionnaire was applicated.Gender,disease duration,age,academic qualifications,occupation,education,height,weight,waist circumference,hip,relevant medical history and so on were collected.Results The onset age of inpatients with type 2 diabetes was (48.91 ± 12.38),onset age of male was(46.32 ±12.08),which was significantly lower than female (52.42 ± 11.97) (P ＜ 0.01).The onset age female and male proportion also had significant differences,age onset of male was in advance.The average body mass index was (24 ±3.47)kg/m2,most of the inpatients were workers and farmers,the level of education was primary and secondary.Multiple regression analysis hints,risk factor of onset age is the family history of diabetes,the history of hypertension,male,low academic qualifications.Percentage of newly diagnosed patients was 28.3％,about one-third in patients were with the metabolic syndrome,hyperlipidemia,high blood pressure,fatty liver.Conclusions Education level of the inpatients was lowe in the community,so strengthening diabetes education was required.The persons in the commuities who were male,or with the family history of diabetes,with high blood pressure history were of the communities require for early screening of diabetes mellitus,so the occurrence and development of diabetes woule be controlled.